For Their Own Good: The Transformation of English Working-Class Health Culture, 1880-1970.

Hardy, Anne

For Their Own Good: The Transformation of English Working-Class Health Culture, 1880-1970. By Lucinda McCray Beier (Columbus: Ohio Stare University Press, 2008. x plus 409 pp. $64-95).

Industrialisation, urbanisation, public health and the rise of the welfare state are familiar themes in the history of modern Britain. In this study of three towns in the industrial heartland of Lancashire, Lucinda Beier departs from the more usual professional, and administrative, top-down, approach to the topics of health and medicine to examine working class health culture through the lens of oral history, supplemented by reference to medical memories and Medical Officer of Health reports. By this means she traces the transition from a health culture centred on women's inherited domestic knowledge and skills to which self-sufficiency and community support were crucial, through the early twentieth-century's patchy acceptance of 'doctor's medicine', to the clean sweep she argues was achieved by modern biomedicine under the auspices of the National Health Service after 1948.

The centrality of women to this account is plain from the outset: the first chapter is entitled "Every street had its lady." As Beier notes, the traditions of the industrial towns were derived from the rural origins of their immigrants, and the 'wise women' continued to dominate local urban health culture just as they had done in the villages. Such informal health authorities represented a challenge to formal medicine, and from the 1890s onwards local health authorities began developing mechanisms to undercut the handywomen's practice - school medical services, health education, health visitors and mother and baby clinics. The development of these, essentially preventive, services took place against the economic reality of a largely private medical system, although insured workers, generally male, had free access to general practitioner services after 1913. For the rest, the book examines formal health care provision, preventive medicine, sex and family limitation, childcare practices, the role of the media in the construction of twentieth-century health culture, and the cultural transformation wrought by the co-incidence of the coming of the National Health Service and of effective biomedical treatments.

One consistent thread running through Beier's story is the theme of working class respectability. Traditionally expressed through the scrubbed front doorstep, the origins of this central tenet of British urban working class life are gradually revealed to be deeply rooted in notions of belonging, community and the control of that highly dubious human characteristic, sexuality. The community of women in working class localities provided, as Beier demonstrates, the core social and medical support that enabled individual members and families to survive illness, death and disaster. The disrespectable were disallowed such service, pariahs in the community. Loss of respectability was ineradicably associated with sexual activity outside marriage, and the whole fabric of working class community culture was in one sense constructed to prevent any such loss. Children both male and female were kept in ignorance of 'the facts of life', to the extent that pregnancy even within marriage was concealed, unmentionable in the family context. Many young women, even young men, entered marriage unaware of the nature of the contract they had consented to; that was the price the girls paid for marriage and continuing membership of the community. Of course it did not always work out that way: Beier cites two respondents, born in 1919 and 1937, the first of whom had a baby out of wedlock, the second being pregnant before marriage; these cases, however, dare from the interwar and post World War II years, when standards were already changing. Other regional studies have suggested that this culture of sexual obfuscation was a widespread English phenomenon, but the suppression of sexual knowledge in urban communities does suggest that urban working class culture was in some respects reconstructed away from the traditions of rural England, where literary and other evidence indicates that sexual activity outside marriage was often regarded with some resignation as an inevitable and not unacceptable feature of working class life. In this respect, as in others, Beier's exclusive focus on urban communities feels too narrow, and the reader cannot but be aware of the unexplored rural hinterlands within which the cities of Lancaster, Barrow and Preston lay, and from whose peoples and culture their own communities originally derived.

Beier's motivation in undertaking this study was deeply rooted in her own personal experience as a young North American encountering the British way of medicine in the late 1970s. In this respect she came to British - or Lancashire - working class health culture as an anthropologist as much as an historian, and her passionate engagement with the subject is reflected in her constant use of extensive passages of reminiscence culled from the oral history interviews (and indeed, of lengthy passages of comment taken from Medical Officer of Health reports). These often simply repeat or reinforce points made in the text, and can he repetitive, but they do succeed in conveying, as they are meant to do, their subjects' voices. For readers brought up in Lancashire, or like myself with a Lancastrian family background, this material is at once highly evocative and tremendously familiar, and Beier's reading of it offers few surprises. For those to whom early-twentieth century Northern English culture is a foreign country, however, Beier provides a revealing account of traditional stoicism and resource in the face of pain, illness and death, and the ways in which these responses were altered by the coming of the welfare state and of modern biomedicine.

Anne Hardy

Independent Scholar