The Hospitals 1800–1948. Brian Abel-Smith. Heinemann. 50s.
The taint of pauperism, some cold, Christian charity, ‘the social conscience and the frustrated energies of the Victorian spinster’ allied to medical research and an eye to the main chance: this book is a goldmine for the student of motives in the welfare services.
There is such a plethora of facts from which to choose and so many starting points for discussion, that choice is necessarily arbitrary; for the conflicts and arguments which preoccupied the 19th century are still fought, their casualties crowd the halls of the Labour Exchanges and the guichets of the National Assistance Board. How far has the Left undermined the conservative bastion to ensure that the able-bodied may at least enjoy the bitter privileges of the destitute, without an involuntary decline down the slopes of penury?
‘All medical relief should be granted with intent to deter so that it may act as “an incentive to provident habit”.’ This was medicine imprisoned in the Poor Law Bastille. ‘It was equally important that. . . “the stamp of pauperism is plainly marked upon all relief given . . . the words ‘Dispensary’ and ‘Infirmary’ should never be used in forms, advertisements and addresses without the prefix ‘Pauper’ or ‘Poor Law’ or ‘Workhouse’, which should appear as far as possible in every document supplied by the Guardians to those relieved by them”.’ (Page 89).
The labyrinthine development of the hospitals, the extraordinary hierarchical dominance of the voluntary teaching hospitals and the armadilloid reactions of the medical ‘guilds’ to social change are extensively discussed. There is a quaint, forthright declaration of the use of poor, non-paying patients as guinea pigs in Cottage Hospitals for the treatment of the rich. ‘The lessons he (the surgeon) learns day by day in these hospitals are, in time of need, of value in the ancestral hall.’ (Page 103.)
Finally, the story of the disastrous concessions to the powerful Royal Colleges, settled over a meal at Prunier’s in St. James. This may lay the belief that Bevan would have been tougher with ‘big business’ than Dalton. Bevan played upon an old quarrel in the profession to wean its leaders from their nominal loyalty to the rank and file. The price was the concession of administrative control to an anarchic association. The right to part time payment for ill defined and unregulated sessions, private practice, the uncontrolled expenditure of public money on ‘merit awards’ for doctors recommended by Moran and two others. The highroad to a ‘unique socialist achievement’ arranged with some gentlemanly horse-trading in clubland.
This book is essential reading for those who wish to understand how the Health Service has developed in the way it has.