Reviewed by: Sick, Not Dead: The Health of British Workingmen during the Mortality Decline Graham Mooney (bio) Sick, Not Dead: The Health of British Workingmen during the Mortality Decline, by James C. Riley; pp. xvii + 349. Baltimore and London: Johns Hopkins University Press, 1997, $58.00, £48.00. James Riley cannot be accused of failing to give the reader value for money, since Sick, Not Dead is two books in one. The first part vividly illuminates the ways in which many working-class men and family doctors in Britain in the later-nineteenth century negotiated their at times turbulent relationship. The second part seeks to explain the changing patterns of sickness that these men underwent during a period that has been dominated historiographically by the decline of mortality. Riley’s basic argument in this latter section is that while more adult men lived longer lives as the nineteenth century progressed—that is, in [End Page 341] the aggregate, their level of mortality declined—and the number of sicknesses they experienced was also reduced, these episodes of sickness were more prolonged. In other words, the average amount of sickness time increased. The empirical source of this analysis is the statistics of claims for sickness benefits made by members of the Ancient Order of Foresters (AOF). Before Riley constructs his demographic argument, however, he considers in detail the condition of the medical market in this period through an impressive range of hitherto underused material relating to the activity of Friendly Societies across the country: rulebooks, minutes, committee papers, and local newspapers, to mention but a few. The author’s framework for discussion is built around three main themes, namely the medical, political, and moral economy of the Friendly Societies. The purpose of this part of the book is essentially twofold. First, Riley aims to outline what the Friendly Societies did and who made up their membership. This latter point is especially important, since the assertions regarding sickness patterns that appear later in the book depend upon how representative the AOF was of the male British working population. It is unfortunate that the sources do not allow Riley to bring forward any direct, substantiating evidence on this point, and he relies upon other secondary works to show that the occupational composition of Friendly Societies generally did reflect that of the working class as a whole. Second, an exposition of the ways in which Friendly Societies operated at a number of levels enables the reader fully to understand the origin, nature, and inherent weaknesses of the data Riley uses in the later statistical analyses of morbidity patterns. The sensitive and careful manner in which Riley deals with these themes renders the first part of the book in itself a significant contribution to the history of health care. The sheer scale of their membership—peaking towards the end of the nineteenth century at somewhere around two-thirds of all working men—and their modus operandi makes Friendly Societies perhaps the key agency in molding working-class encounters with sickness and medicine in the Victorian period. Placed in the position of arranging medical contracts with local family doctors, the emergent picture is one in which working people exerted a considerable degree of control over what health care they received and who was to provide it. More often than not, these contracts were secured on very favourable terms. Riley ruminates as to why, in the 1890s, Friendly Societies seemed to recede from this position of strength. He suggests that perhaps general practitioners scaled down the level of service they provided to the Friendly Societies and that working people gradually conceded ground to “specialised and arcane knowledge, especially the knowledge of medicine and actuarial science” (121). Such questions raise important issues not only about the medical market, but also about the perception and acceptance of science in late-Victorian society. The initial analysis of Friendly Society sickness patterns in the second part of the book is equally significant and leads Riley to roll back the boundaries of the debate concerning what has been termed the “cultural inflation of morbidity.” To begin with, Riley reveals that the incidence of new sickness episodes fell between 1872 and 1910. This evidence...