Many welfare historians, myself included, have tended to assume that after teething difficulties in the first decade or two of the New Poor Law, medical provision for the poorest in Britain improved. The General Medical Order of 1842, passed in the context of medical scandals and with pressure from the medical profession, was the first time the state recognised its responsibility for providing medical care, and although there were problems with its implementation, over time these were thought to have been attended to and ironed out. Growth in the number of workhouse hospitals in the second half of the nineteenth century saw the arrival of specialist workhouse hospital wards with specialist treatments and even medical experimentation, which seemingly added to this picture of progress. But Price shows that this was far from the case. In his carefully written and skilfully argued monograph, Price illustrates how better care was not an inevitable feature of the New Poor Law and at particular times medical care worsened, especially during the ‘Crusade Against Outdoor Relief’ between the 1870s and 1890s.

While the standard of care was not consistent throughout the nineteenth century, the anger of medical professionals was. Their pay and working conditions, as Price analyses, were also problematic. He demonstrates how historians’ views that salaries improved by the late nineteenth century are incorrect: the majority of medical officers saw no increase in their salary during their employment. Medical officers continued to expose medical neglect and abuses, as they had before 1842, in order to illustrate the problems of the system, not their own incompetence. A key group which pressurised the central welfare authorities for the reform of poor law medical policies was the Poor Law Medical Officers’ Association. It was formed in 1868 from metropolitan and provincial medical associations by Joseph Rogers, a medical officer himself, elected as the chairman of the Association. Instead of being the effective pressure group they strived to be, however, Price shows that Rogers ended up creating a ‘quasi-defence union’ which was unable to muster national support for the overhaul in policy it sought.

Price manages to weave together social, economic, cultural and political perspectives, providing us with a rich picture of the medical treatment and medical profession in the nineteenth century. In a sophisticated opening chapter, Price also intricately pieces together the complex socio-legal context of medical negligence. Histories of the New Poor Law tend to omit details on the savage maltreatment of the poorest within and beyond the workhouse, how medical officers caused harm, and also brought these abuses to the knowledge of other poor law staff and the central welfare authorities. I especially welcome the attention Price pays to the Assistant Commissioners, known as ‘Inspectors’ after 1847, who, at times, effectively communicated to London the problems encountered by the medical officers and their patients in the localities. Indeed, the approach Price takes lends itself to a more holistic and democratic understanding of medical relief provision under the New Poor Law, in which patients’ experiences are as important as the administrators’. Price's work is in dialogue with much of the literature on this subject, but especially with Ruth Hodgkinson's seminal volume The Origins of the National Health Service (1967) and Anne Digby's monographs on the medical profession published in the 1990s, each of which have remained largely unchallenged until now.

Price's book is an important intervention in welfare, poor law and medical history. I would recommend it to scholars working in these fields and also more generally to those interested in nineteenth-century British history and the history of British social policy. Indeed, it throws more doubt on long held assumptions about the so called ‘age of improvement’. There is much to learn in this book about state power, the impact of popular discourses about poverty, and how pressure groups of the time tried, and sometimes failed, to forge new social policies to help the vulnerable in society.