4 Middle-class medicine
It is well known that Englishmen are in the main
opposed to any and every new system with which they are not familiar.
Probably to this influence is due the fact, that, with a few exceptions,
pay wards are as unknown in this country as the pay hospitals
Sir Henry Burdett
This book examines the payment systems operating in British hospitals before the National Health Service (NHS). An overview of the British situation is given, locating the hospitals within both the domestic social and political context, before taking a wider international view. The book sets up the city of Bristol as a case study to explore the operation and meaning of hospital payments on the ground. The foundation of Bristol's historic wealth, and consequent philanthropic dynamism, was trade. The historic prominence of philanthropic associations in Bristol was acknowledged in a Ministry of Health report on the city in the 1930s. The distinctions in payment served to reinforce the differential class relations at the core of philanthropy. The act of payment heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare. The book places the hospitals firmly within the local networks of care, charity and public services, shaped by the economics and politics of a wealthy southern city. It reflects the distinction drawn between and separation of working-class and middle-class patients as a defining characteristic of the system that emerged over the early twentieth century. The rhetorical and political strategies adopted by advocates of private provision were based on the premise that middle-class patients needed to be brought in to a revised notion of the sick poor. The book examines why the voluntary sector and wider mixed economies of healthcare, welfare and public services should be so well developed in Bristol.
The ‘pathology’ of childhood in late nineteenth-century London
primarily led by influential middle-class women, eager to expand beyond the well-defined gender roles of the period, and whose moralising gaze focused on the amelioration of children who were perceived to be helpless and deserving.
The Goschen Minute of 1869, issued by the President of the Poor Law Board, George Goschen, signalled a renewed focus on reducing poor law expenditure and stricter adherence to the principals of the Poor Law Amendment Act (1834). His core demand was for a closer relationship between welfare and
-improvement through phrenological self-knowledge. The Fowlers’ ‘nonintellectualist’ and ‘healthean’
brand of phrenology enabled a populist response to perceptions of ‘epidemic’ health issues and, in particular, to what mainstream medicine considered largely innate and untreatable conditions. It was working-class Victorians who bore the brunt of widespread cultural fears of degeneration and race suicide, while the middleclasses were increasingly diagnosed with the ‘modern’ illnesses of neurasthenia and dyspepsia. The Lamarckism
charity, even as these underwent significant changes over the early twentieth
century. The previous two chapters examined the arrival in the hospital of
patient payments and the almoner, contributory schemes and the middle-class
patient, and how they became commonplace in the interwar years. It is typically
assumed that these changes undermined or even ended philanthropy as the
organising principle of the voluntary hospitals. 1 Yet, as we have already seen
fellow’. 4 Meanwhile, the
surgeon was ‘interested’ in George, who was ‘so obviously middleclass. And he guessed he must have been pretty low’ for his doctor to have
sent him there. As a poor patient of middle-class character, the surgeon knew
‘Anderson would get the same skill – if not the same nursing –
for nothing.’ He explained the medical details ‘to the students who,
recognising Anderson as one of their own class, felt slightly
according to class, race and gender across the nineteenth and twentieth centuries. John Benson, Kay Heath, Patricia Cohen and Steven Mintz have done much to direct scholarly attention to the middle years of life and to expose many of the myths of ageing through adulthood, in both the past and present.
The anthropological and cultural studies of Margaret Lock and Margaret Morganroth Gullette have also challenged beliefs in the biological inevitability of decline through the middle years, highlighting the ways in which
For certain demographics such as white, middle-class women and men, the uptake of relaxation therapies and minor tranquillisers share a combined history of intersecting populations and goals, which helped to co-create their markets.
A Ciba-sponsored medical conference in 1971, ‘Relaxation therapy for psychosomatic disorders’, for example, centred on tranquillisers and the new Ciba anti-anxiety drug Tacitin, which claimed to ‘reduce muscle tension in man’.
were notably coded in traditional values of masculine, Christian self-restraint, forged in the industrial and imperial context of Britain's nineteenth century, and which continued to provide the most prominent – if contested – signs of masculine character in interwar and early post-war Britain.
There were likely epidemiological and cultural explanations for the dominance of gendered advice across the first half of the twentieth century. The invocation of white, male, middle-class
Health as moral economy in the long nineteenth century
, as a progressive industrialist, creatively. The responses of Mellors and of the other main character, the nurse Ivy Bolton, are necessarily more complicated. Being of Tevershall and dependent on it, they have fewer degrees of freedom. Yet each, crossing boundaries of class, encounters the same ambiguities that inspectors experienced. Like the inspectors, gamekeeper Mellors is expert yet servile. His education and experience would allow a middle-class career of local civic leadership, yet as much as possible he has abandoned Tevershall for a life in the woods