Anne Borsay (ed.), Medicine in Wales, c. 1800–2000: public service or public commodity?, Cardiff, University of Wales Press, 2003, pp. x, 253, £40.00 (hardback 0-7083-1824-X).

Abstract

As Anne Borsay and Dorothy Porter recognize in the introduction to this edited collection, Welsh historiography has been slow to respond to the emergence of the history of medicine. Conversely, most studies of medical history and healthcare devote little space to Wales, except when using it as an example of a depressed area. Although in recent years there has been a significant increase in research into Welsh medical history, with many good studies, Medicine in Wales is a welcome addition to what is still a limited historiography. As the editor makes clear, Medicine in Wales is designed to “illustrate the growing corpus of research-based material” (p. 2) on the social history of medicine and health in Wales. Its content is deliberately diverse. The contributors draw on a range of sources from documentary records to oral testimony to film to examine the relationship between the public and private provision of healthcare since c. 1800. This relationship provides the intellectual context for the volume. Drawing on Jurgen Habermas's notion of the public and private sphere, the contributors raise questions about the utility of this approach by examining issues of class, gender, participation and citizenship, and the role of the state. David Hirst, for example, in his chapter on the school medical service, highlights how the relationship between family and state was unresolved in the service, and how the state remained ambivalent about offering medical care. Steven Thompson in examining the provision offered by medical aid societies shows how they created a forum for participatory democracy that represented a “proletarian” public sphere, one that effectively determined the nature of local medical care and authority. Borsay on the other hand demonstrates how in the treatment of industrial accidents in the 1940s independence suffered when the state intervened. Chapters by Sara Brady on nursing at the King Edward VII Hospital and Susan Pitt on midwifery in post-war Swansea point to how there is no simple equation between gender and the public/private sphere. In questioning the boundaries between the public and private provision of healthcare, the contributors offer a critique that supports the concept of a mixed economy of welfare and a “moving frontier” between private, voluntary and public provision of medical care. However, this is a mixed collection. Aside from Pamela Michael, Thompson and Borsay, many of the contributors pass little comment on Welsh national identity, or look at what Gwyn Williams has referred to as the “Welsh effect”. Indeed, some of the contributors appear to push Wales into the background. For example, in the chapter by Hirst, and in the contribution by Richard Coopey and Owen Roberts on the municipalization of water, the Welsh dimension is subordinate to a metropolitan or English history. David Greaves in his synthesis of debates about inequalities in health and medical care makes little reference to Wales despite the problems the region faced. Given the peculiar economic, social, and political milieu of Wales, this seems a missed opportunity. Despite this criticism, the volume has its strengths. For example, Michael in her telling analysis of suicide in north Wales examines how the Denbigh asylum came to replace the family as a source of care and how suicide was medicalized. Coopey and Roberts add further weight to the need to revise the heroic historiography of state intervention. They demonstrate how local authorities were important in shaping local initiatives and how the nature of satisfactory water remained a contested commodity. Borsay suggests how documentary film could push the boundaries of the public sphere, helping to construct citizenship around stereotypes of masculinity and femininity. Questions are also raised about the nature of rural services and the urban/rural divide that shaped medical provision in Wales. The volume demonstrates that medicine and health in Wales cannot be reduced to a simple equation between public service and private commodity. In raising questions about the public sphere, and in highlighting the rich medical history of Wales, Medicine in Wales suggests that the “Welsh context” offers a vibrant and under-researched field for the study of the history of medicine.