Bulletin of the History of Medicine

In a multiauthor collection of essays, Andrew Cunningham and Ole Grell expand our knowledge of institutions of welfare and poor relief in the early modern period to often-neglected locales on the rim of the North Sea and the Baltic Sea. During the sixteenth century, the dominance of large northern ports from Antwerp to Danzig as the entrepôts of trade and commerce and as magnets for rural populations was unquestioned. By the end of seventeenth century, most had been incorporated into national economies, but in the intervening century and a half, they participated and set trends in the North European shift to early modern poor law and charity care. That this shift was in good part driven by the dynamics of Protestant reform is the central thesis of this book.

Reform occurred at many levels, some comparable to developments in the rest of Europe; in the social domain of health care and poor relief, however, it was driven by the basic economic imperative, to borrow Grell’s metaphor, of the disempowerment of the Catholic Church and its vast human and financial resources as omnipresent providers of care and relief. All the locales under [End Page 314] discussion did indeed convert to the various Protestant denominations during the first part of the sixteenth century, and, with the exception of Antwerp, they remained Protestant or Protestant enclaves—Danzig and the Baltic cities of Reval and Riga coming most readily to mind.

An overview of these cities’ welfare, medical care, and poor-relief arrangements thus makes an important contribution to the growing literature on both Catholic and Protestant Europe, and to the development of a comparative framework within which to assess differences and similarities. While the current volume is still too disjointed in its individual contributions and the emphasis of its various contributors to permit a fully integrated perspective, it offers a wealth of detail on little-known rural areas in Scotland, Finland, and Sweden, and on the multicultural Hanseatic towns that shaped much of the Northern European commercial economy before the ascendancy of the Atlantic ports.

As Ole Grell notes in his important essay on the components of the Protestant imperative, in most studies health care has received less attention than have demographic and economic trends, which have been considered the major determinants of poor relief. He argues, and argues well, that research has been shaped by these perspectives to the neglect of the religious factor, which has tended to be considered rhetorical icing or superstructure. In an age that “was profoundly dominated and shaped by faith” (p. 45), it would indeed have been strange if religion, private and public, had not permeated both discourse and the practical mechanisms of funding, staffing, benefits, and control. His argument that Protestant administrators were as possessed of the reforming and even utopian spirit of the times as humanists on either side of the religious divide certainly is supported in these essays. Students of the history of welfare, of indoor and outdoor relief, and of the division between deserving and idle poor will find that much of the religious argument was carried over and accepted in the modern discourse on these topics.

This said, the content and provision of medical care still remain less well represented in this volume than one might wish. They are prominent mainly in the discussions on the late seventeenth and the eighteenth centuries—such as that by Robert Jütte, who describes the northwest German Hanseatic triangle of Lübeck, Hamburg, and Bremen; and by Paul Slack, who provides a brilliant tour de force of English social welfare reforms since Thomas More and Cardinal Wolsey. Barring further work in the field along the lines suggested by the editors in their introductory essay, we will not know if this relative neglect is due to disciplinary preferences, or to a genuine lack of patient-care data in the municipal and institutional settings that left any records. Beyond the categorical hospitals for the infectious diseases of the period and the mentally ill, most care was provided at home, often with the help of outdoor relief; it would be interesting to know, however, whether local infirmaries like those described for rural Sweden and Finland by E. I. Kouri in fact existed much beyond the planning stage and were prevalent elsewhere.

A lack of data or of access to archives also may account for some of the omissions. While Amsterdam and other cities of the Dutch Republic became [End Page 315] famous for their efficient institutions of confinement for different population groups, from rasphuis to orphanage, Jonathan Israel’s argument for the pervasiveness of the Dutch model is not really reflected in the essays on Denmark and Germany. By contrast, the absence of studies of the centers of early Calvinist reform—Strasbourg, Geneva, and Lausanne—leaves an empty spot in our understanding, in view of the omnipresence of their reformers in most of the discourse of the period. The archives of Reval and Riga probably were not fully used or usable when this volume was being planned, and thus the fate of German Lutheran welfare under Swedish and subsequent Russian dominion cannot be assessed. Institutional private philanthropy is not a major focus in most essays, although the issue of public versus private funding of poor relief and health care is obvious throughout and in all geographic settings.

Overall, this is a valuable and timely volume that should prove equally useful as a reference for further research and in the still all-too-rare courses on the history of public health. Although the editors do not stress this point, the roots of modern welfare and its discourse lie in large part in this period of often draconian welfare reform.