Patients, Power and the Poor in Eighteenth‐Century Bristol (Book).

This is a model of the local case-study approach to social history. Though grounded in an impressive range and volume of local archives, it is internationally comparative and thoroughly unantiquarian. It could stand as a primer for many of the concerns and questions which have preoccupied social historians of medicine of the early modem period in recent years. Dr Fissell offers a contextually-orientated account of poor relief and medical provision at local level and an exploration of the changing cultural resonance of the body. The long eighteenth century is presented as a period which saw attitudes towards the body changing markedly. Dr Fissell traces an evolution from circumstances in which "everyone [was] their own physician"-where the language of sickness was drawn from a common stock of images and meanings inscribed in the body-to a situation in which the poor had their bodies administered to in ways rooted in elite and savant culture far beyond their ken. The story is one of the rise of scientific medicine clearly, but instrumental in this change too were the hospital and the medical profession. The hospital is viewed as a place in which the bodies of the poor were confined and contained for social rather than medical reasons-social discipline, mercantilistic concern with a healthy, prosperous and industrious population, and the sustenance of reassuring symbolic values and sociability for the social elite. Over the eighteenth century, however, medical functions came increasingly to prevail over the the social ones: from being "a remedy for debauchery, extravagance, cursing, swearing and contempt of authority" (p. 85), the institution becomes a place in which, with a marked disregard for patient sensitivities, the bodies of the poor are handed over to clinically-aware surgeons-a place, as Dr Fissell puts it, where "'medical men sold instruction to other medical men, and patients became teaching aids rather than consumers of medicine" (p. 170). Though much of the story is familiar, it is told with an exceptionally rich savour of local Bristolian detail. It is also worthy of remark that the story is perhaps more familiar to continental than British historians. The social tasks of the Bristol hospital look surprisingly like those of a continental Hopital General, while the trajectory of progressive medicalization recalls Foucault-like "birth of the clinic" arguments. Quite apart from its other merits, this volume should sound a healthy counter-blast against facile acceptance of alleged English exceptionalism. The special quality of …