8

Stage-Managing a in the Eighteenth Century: Visitation at the

Kevin Siena

London’s Lock Hospital, established in 1747 to treat venereal diseases, depended heavily on charity. Its administrators tried valiantly to project a positive image of the hospital in spite of the pervading moral assumptions about its and doubts about whether they deserved charity. Policies governing visitation were bound up in the hospital’s attempts to police itself and promote its cause to benefactors. Visitation policies served numerous ends, including policing patients, introducing moral reform, monitoring the staff, and obscuring the reality of the wards from public view, ensuring that prospective donors only saw what administrators wanted them to see.

London’s Lock Hospital was unique. Founded in 1747, it was the first English hospital devoted exclusively to the care of venereal disease. The royal of St Bartholomew’s and St Thomas’s also provided treatment for the scourge often called the ‘Secret Malady’ or the ‘Foul Disease.1 But the Lock was the only hospital in England to make its sole purpose caring for victims of the ‘wages of sin’ – another cliché from the period. This unique mission meant that the Lock had to tread cautiously. Many were the critics who argued that the hospital encouraged sin by allowing the justly punished to escape their plague. As a result, hospital authorities were acutely aware of the need to handle certain policies carefully. Rules governing visitation were among the most important of those policies. At the Lock, the issue of visitation concerned much more than merely whether to allow patients’ friends and relatives to enter the hospital. That question was important, but in addition to this meaning of the term, visitation at the Lock Hospital also demonstrates how older notions of the concept continued well into the Enlightenment. As it had throughout the mediaeval and early modern period, visitation also constituted, on the one hand, an important form of institutional surveillance and, on the other, a strategy for moral reformation. One can only fully understand visitation at 175

Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Kevin Siena the Lock if one appreciates the influence of these older legacies of the term. Moreover, policies governing all three forms of visitation were bound up in the hospital’s vital and carefully managed public relations campaign.2 The Enlightenment is now characterised as witnessing the birth of the all- important public sphere, or the rise of what some simply choose to term ‘public opinion’.3 As public opinion became increasingly influential in most every endeavour – whether in politics, culture or the economy – so too did it take on new importance for hospitals. Public opinion was essential to the survival of the Lock Hospital, and, we will see, visitation policies were essential to public opinion. Finally, visitation policies can also provide a gauge of the direction of the institution itself, for after 1780, the charity intensified its efforts to reform patients, and visitation policies changed dramatically. The Lock Hospital emerged from the voluntary charity movement in eighteenth-century England. That movement witnessed a flurry of charitable activity driven by private initiative. Unlike parish institutions such as workhouses, funded by the state through the Poor Law, or the Royal hospitals like St Bartholomew’s, St Thomas’s or Christ’s, which had been endowed by the crown and had ties to the city government, voluntary charities were funded exclusively by private donation. Groups of urban mercantile élites applied the principle of the joint stock company, whereby many investors could join together in a charitable endeavour. Most benefactors were unlike Thomas Guy, the London bookseller so fabulously wealthy he could launch the hospital that still bears his name largely from his own fortune. Unable to give such enormous lump sums, most contributors to eighteenth-century voluntary charities ‘subscribed’ a set amount each year. Through collective organisation and steady contribution, members of the urban middle class could finally take some pleasure in the rewarding act of conspicuous contribution, something which – as the term noblesse oblige suggests – was traditionally a luxury of the landed nobility.4 Hospitals were among the most important examples of this new charitable form.5 By the time the Lock opened its doors in the late 1740s, London could already boast of such institutions as the Westminster Infirmary, the Middlesex Infirmary, the London Hospital and St George’s Hospital.6 The voluntary charity model was particularly popular, not just because it offered an opportunity for giving to a new class, but because of particular advantages the voluntary charity structure seemed to provide. For one thing, these polite and commercial people wanted good value for money. One of the most attractive features of the voluntary hospital was that participation in the administration of the institution accompanied subscription. Donors who gave the annual subscription fee – five guineas at the Lock – became governors of the hospital with all the rights and privileges 176

Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Stage-Managing a Hospital in the Eighteenth Century therein. Subscribers thus had the chance to involve themselves in the actual running of the house. Not only could they attend and vote at all meetings, but benefactors could see first-hand that their money was put to good use. The voluntary hospital model thus promised efficient and transparent operation, something about which London merchants were particularly keen.7 Voluntary charities also provided important networking opportunities, as membership brought with it the chance to mingle with other urban élites, including the titled nobles who frequently leant their names to such endeavours as chancellors – usually along with generous donations. Importantly, a policy altogether novel saw governors acquire the power to nominate patients. This may have been the voluntary hospital’s particular genius, for aspiring patients could only access care through a personal appeal to a governor, who held the proverbial keys to the institution in the form of the crucial nomination letter. Roy Porter made a convincing case that this admissions policy appealed to prospective benefactors because it guaranteed donors the chance to restrict their benevolence to ‘worthy objects of charity’.8 The attitude that indiscriminate charity bred sloth and immorality was intensifying.9 Handpicking the recipients of care guaranteed subscribers that the inmates of their hospitals truly deserved it. This practice allowed donors to puff themselves as good Christians while subtly turning their institutions towards the end of social discipline. The immoral and the unworthy could find their relief in the workhouse while the honest poor would be saved from such a fate, rewarded for their good character in one of these new infirmaries. This link between morality and charitable worthiness spelled bad news for syphilitics. London’s voluntary hospitals routinely banned them. The Westminster Infirmary provides the clearest, though hardly the only, example. Its language could not be more obvious:

That no person having the venereal disease shall be admitted into this Infirmary. That if any person having the venereal disease and not discovering the same shall obtain Admission under pretence of some other distemper such person upon discovery afterwards made thereof shall be immediately discharged without cure.10 However, it seems likely that the omnipresence of the disease among the London poor11 pressured some governors to try to amend the policy in 1738. Those suggesting that the hospital start admitting syphilitics met intense opposition. Emphasising that the charity was intended only for ‘honest, Sober, [and] Industrious poor Sick persons’ angry governors argued that 177

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‘persons infected with the Venereal Disease do generally bring it upon themselves by their own lewd and vicious Habits.’ Moreover, the hospital had a limited amount of spaces, so admitting the poxed would mean having to exclude others more deserving of care.12 No fewer than thirty-seven of the hospital’s subscribers signed an open letter, published as a pamphlet, opposing the motion and calling the admission of venereal patents ‘a Subversion of the Charity, or a Misapplication of the Money given in trust for the Poor.’ The society had consistently rejected such patients ‘for the very reason of Being Venereal’.13 The London Hospital would fight the same fight a decade later.14 In both cases, proponents who suggested extending care to venereal patients backed down when they saw the reality of what such a policy might mean for their institution’s public image and hence its fundraising campaigns. These pressures likely drove the same policies of exclusion at St George’s Hospital and the Middlesex Infirmary as well.15 A tangible result of these policies was a dire need for hospital beds for syphilitics by the middle of the eighteenth century. William Bromfeild, a surgeon at St George’s Hospital with a highly lucrative private practice built on a significant noble clientele, moved to address the crisis by organising a new voluntary hospital in 1747, this one devoted entirely to these frequently neglected patients.16 However, the new Lock Hospital found the crowded world of London charity extremely competitive. It managed to soldier on, but as Donna Andrew has noted, it competed quite poorly for subscribers.17 Londoners of means had no dearth of charities from which to choose. Foundlings, orphans, impoverished mothers – benefactors contributed much more eagerly to the institutions bestowing care upon these recipients than to the hospital treating the repugnant ‘foul disease’.18 It was hard not to view an institution like the Foundling Hospital or the Lying-In Hospital as simply more worthy than the Lock Hospital. Thus, the Lock faced an uphill battle in the world of eighteenth-century charity. It had to work hard for every pound and penny it dug out of the pockets of the well-heeled. For this reason, I contend, the hospital had to be particularly vigilant of its operation, its patients, its staff and, especially, its public image, and that this coloured visitation policies in a number of ways. Visitation as institutional self-policing For starters, it was imperative for the Lock, as it was for all voluntary hospitals, to avoid any accusations of mismanagement. One strategy was to constitute a committee of ‘house visitors’ charged with visiting the wards to oversee operations and report problems to the administrative board. This policy assumed a definition of visitation in its essentially mediaeval and early modern sense; in the tradition of ecclesiastical visitation, it referred to an act of authoritative inspection.19 In this way, the concept of visitation in the 178

Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Stage-Managing a Hospital in the Eighteenth Century eighteenth century still carried with it a strong sense of surveillance. Such committees remained common at voluntary hospitals. For example, the ‘house visitors’ committee at the London Hospital kept a separate report book to document abuses,20 as in 1754, when the surgical apprentice Thomas Dunckly was dismissed for ‘endeavouring to commit indecencys with One of the Women Patients’.21 These house visitors policed both the employees and the patients,22 and while they were not members of the medical staff, they even weighed in on medical issues, as in 1759, when they reported that several patients seemed well enough to be discharged to make room for new patients. On this occasion, the visitors were also vigilant to prevent abuse of the charity by the unworthy, in this case unemployed women trying to use the hospital for food and shelter rather than medical care:

And as your Committee have great reason to believe that Several Persons received into this Hospital come here for a Maintenance (particularly Several Women out of place) we are of opinion that such Visitation once in three weeks or a Month would be of a great use to the Publick, therefore have desired the above said Three gentlemen to make another Visitation, and Report to your Committee how they find the State of the Patients, by which means we hope to get the House clear of such improper People, and Consequently Room be made for those who are real Objects of the Charity.23 The London Hospital was hardly unique; the records of Guy’s, St Bartholomew’s and St Thomas’s Hospitals all demonstrate regular inspection–visitations by governors.24 The Lock Hospital employed visitation in this manner roughly from its inception. The earliest list of hospital rules (1754) stipulated regular visitation by a committee of house visitors. Two governors sitting on the Weekly Committee (overseeing admissions and other day-to-day business) formed a subcommittee for visitation, charged with weekly inspection of the wards. As at the London Hospital, this was as much an inspection of the staff as of the patients. The Lock’s inspection also seems to have been quite thorough. At the time of visitation the house visitors cleared the wards of all staff in order to question the patients candidly about the quality of their care. Likewise, the house visitors were instructed to question the nurses about the patients, the matron about the nurses, the surgeons about their apprentices, and so on.25 The Lock’s administration was compelled to do this because it was not infrequent that its board of management received angry communiqués from governors complaining about the treatment their nominated patients had received. Letters like that of John Major, in November 1759, threatened to suspend subscription ‘on account of some ill

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Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Kevin Siena treatment’ that his recommendations met with at the hospital.26 The personal interest in patients that the voluntary model afforded governors like Major meant that stories from the wards could easily make their way to benefactors’ ears. It was to prevent just such complaints that the hospital utilised visitation. Problems addressed by the house visitors ranged greatly. Food figured prominently. On several occasions patients complained about the quality of their meals.27 In 1760, the matron and cook were both fired when provisions were found to be ‘so extremely bad they were not fit to be given to a Christian.’28 While in June 1789, porter John Oram narrowly escaped the same fate when the weekly visitors discovered that he had emptied his chamber pot into the patients’ gruel.29 If this were not bad enough, visitation also revealed instances when the staff took advantage of the female patients. Years before soiling the oatmeal, Oram tried to use his position to gape at women’s bodies. Telling incoming women that it was his job to conduct physical examinations – which, of course it was not – Oram:

[E]xamined them… as to their wounds, & if they had any discharge upon them &c. that he took up the cloths of some of them, & actually examined them, that he attempted it in others, but was resisted.30 With a somewhat precarious moral reputation already, the Lock could hardly afford such practices to go unpunished, especially since patients might easily report such abuse when they returned thanks to their nominating governor after discharge, which policy required them to do.31

Controlling the doorway The policy of weekly visitation, then, was aimed at keeping good order in the house and thereby maintaining a good public reputation. But this was difficult to do. In part, harmony on the wards was difficult to keep because of the visitors who came into the hospital from the outside. Policy regarding this second form of visitation also points at an attempt to keep stern order. The hospital’s walls were indeed permeable, so governors strove to manage the flow of people in both directions. Patients’ movements outside the house, and visitors’ movements into the house, were strictly policed. Visitors coming to the house were clearly viewed as problematic. House rules instructed the porter ‘that he shall not suffer any stranger to come into the house without giving notice to the matron,’ who would vet them before admission.32 Moreover, nurses were charged with clear instructions to limit strictly the amount of time visitors who gained access could stay. Even family members could only visit sick relatives for a few minutes. Nurses were ordered to let visitors stay a mere ‘20 minutes or half an hour at most’.33 It

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Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Stage-Managing a Hospital in the Eighteenth Century is clear that governors policed visitation in part because visitors were constantly smuggling alcohol into the house. Governors were adamant ‘that no presume to send for victuals or drink of any sort into the Hospital’ and complained that visitors represented a means ‘whereby liquors & Provisions were brought in, contrary to the Rules & orders of this Hospital.’34 Surgeons, by contrast, seemed more concerned that visitors might retard patients’ treatments by bringing them the wrong kinds of food. In 1764, the surgeon complained that the matron and porter were doing a poor job of guarding the door, because a woman had been observed entering the wards to sell tarts and cakes to the patients ‘which greatly hurt them’.35 Perhaps due to the aforementioned concern for appearances of respectability, the governors seemed especially concerned with policing entry to the female wards. Women who contracted the pox were already viewed as morally loose, and the need to quarantine them seems to have been intense. One of the first motions passed while the hospital was still under design emphasised this concern; the Board unanimously agreed:

[T]hat no Man be admitted on any Pretence whatsoever into the woman’s ward in this Hospital, except Governors & Officers of the House, or Persons introduced by a Governor or Officer.36 This concern was as much about men from outside the hospital as from within it. Nurses of the female wards were repeatedly instructed ‘never [to] permit the Men Patients to enter their [ie. female] wards on any pretence whatever.’37 Such anxiety was common in eighteenth-century hospitals like St Thomas’s, where male and female patients could not ‘talk suspiciously’ nor enter each other’s wards.38 Evidence suggests that control of visitors to the women’s wards, even by women, was taken so seriously that it could lead to conflict. In the autumn of 1794, the porter refused visiting privileges to a woman who applied to see a female patient in the Lock. The reason she was denied is not known, but she clearly went away angry. She brought charges against the hospital porter, for whose legal defence the hospital had to pay. On 4 November 1794, the minutes record:

[T]hat Jn. Oram the Porter be paid six Guineas on account of the Expence he was at in defending a prosecution brot. agt. him by a Woman for opposing her going up into the Womans Ward contrary to the Rules of the house.39 As this incident suggests, the anxiety surrounding the female wards did not merely stem from worries that the women might be abused by men. Most women who arrived at the Lock Hospital were assumed to have been prostitutes, or at the very least, women who had been debauched by the low

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Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Kevin Siena company they kept. Governors thus frequently viewed their friends and acquaintances as denizens of London’s seedy underbelly and found visits from them extremely worrisome. The minutes of 2 May 1765 recorded the kernel of their concern:

This court receiving information that Bawds & disorderly persons had found means to get into the Women’s Patients Ward and endeavor’d to Decoy or prevail upon sevl. of the Women Patients who were nearly Cur’d to return to their former evil courses.40 What use was their hospital if the women they cured could be lured back into a life of sin? Such visitors had to be banned. Fanny Finley was just such a character. Finley ran a brothel in Fleet Market. One of the women she employed was Ann Hook. Ann was still a teenager when she contracted the pox and was treated for the disease in the Lock in 1764. When she was about to be discharged the governors questioned her about her circumstances; they must have been moved by Ann’s story because they recorded it in great detail. With a tale so typical Ann could have stepped from the plates of Hogarth’s Harlot’s Progress. Ann told the board how she had come to London hoping for work as a domestic servant, but she was unable to secure a job. Unemployed, she took her first step down a slippery slope when she befriended a woman who gave her ‘great Quantities of Liquor’ and when she was ‘quite insensible’ put her to bed with a man who slept with her and infected her. Soon deserted by these new ‘friends’, Ann was convinced by some street walkers to apply to the bawd, Fanny Finley. Finley agreed to provide her with room and board for fifteen shillings a week, which Ann was expected to earn ‘by Walking the Streets & bringing Men & bad Company to her House, whom she us’d to sell Liquor to & extort money from.’ This she did until her disease worsened. Finley agreed to arrange to get Ann a governor’s nomination for the Lock on the condition that she promise to return to the bawdy house when discharged. The governors must have been infuriated to learn that Finley coached her to lie, telling her to enter the house under the pseudonym Ann Lamb, to claim to be younger than she was, and to tell the admissions committee that she had been infected through a rape by a stranger, all of which Ann related when she was first admitted. But Finley’s gall went even further; she regularly visited Ann in the hospital, pretending to be her mother. She habitually came to see Ann with gifts of tea and sugar ‘in order to keep her in the mind to return to her.’ Ann pleaded with the Board to help her. She shuddered to think of returning to Finley, but she was penniless, homeless and unemployed. Upon hearing Ann’s story the Board resolved to enquire into prosecuting Finley for keeping a bawdy house. In the meantime they agreed

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Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Stage-Managing a Hospital in the Eighteenth Century to keep Ann out of the reach of Finley and her cohort, allowing her to stay in the house and emphasising to the staff ‘that [neither] the said Fanny Finley nor any person from her be suffer’d to come into the House, or speak with the said Ann Lamb [sic].’41 Given its clientele, it was imperative for the Lock to monitor who came into the hospital. But they also had to control who left. Early house rules ordered patients ‘not [to] stir out of their respective Wards’ while in the house. Employees were warned never to send patients out of the house on errands.42 The matron was instructed to keep the door locked, especially at night, and the porter was ordered to keep all patients from leaving the premises.43 Exceptions were made for patients given specific written permission by the board to leave, as well as for patients in need of fresh air who were allowed to walk in St James’ or Green Parks. However, such exceptions were to be limited. It is immediately discernable that this drive to corral patients linked up with the hospital’s aforementioned public relations campaign. When emphasising why patients should not be seen on the streets – patients who, it should be remembered were suffering from rather odious symptoms – the governors exclaimed that the policy of quarantine was intended ‘to prevent offence’.44 This admission strikes at a vital truth concerning a venereal disease hospital. It was, to most polite eighteenth-century eyes, disgusting. Try as they might to keep the house , governors knew deep down that their hospital was not for the faint of heart. Its patients suffered from one of the most repellent diseases then known, their bodies riddled by open sores. Some lost their noses when the cartilage deteriorated, and the main treatment – mercurial salivation, in which patients were given large doses of mercury and kept warm as they sweat and spit copious amounts – was painful for those enduring it and shocking for those witnessing it.45 Indeed, the control of visitation had as much to do with keeping the reality of these wards out of public view as with maintaining order among patients’ working-class visitors. Governors demonstrated considerable anxiety about members of polite society glimpsing the inside of their hospital for fear that potential benefactors, if they saw the wards first hand, might be turned off the idea of giving. So it was that the porter was given strict instructions never to allow fashionable visitors onto the wards. This policy had to be handled delicately, however. While he might easily exclude some people out-of-hand, as in the case of the aforementioned woman who sued when she was barred from the wards, the lowly porter could hardly bar a gentleman who wished to see the house. In these cases, he was carefully instructed to steer them. He was to guide them away from the wards full of rank, ulcerated patients, and into the one respectable room in the building, the board room. The porter had to be constantly on the lookout: 183

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Figure 8.1

The Lock Hospital, Hyde Park Corner, Westminster

Engraving, drawn by Thomas Hosmer Shepherd and engraved by W. Wallis. Source: Wellcome Library, London.

That if any Persons of Fashion Distinction or Quality shall desire to see the house he do immediately shew him into the board room & acquaint the Matron therewith that she may attend them.46 The governors had select forums for communicating with propertied Englishmen. They were happy to have such men and women read their carefully worded fundraising pamphlets or attend one of the many fundraising sermons.47 But unfettered access to the wards was something else entirely. This is why we see so many instances of tension surrounding the issues of windows and doors. Not only were the Lock Hospital’s walls permeable, at times they were transparent. Traditionally, hospitals for odious patients had been purposefully situated on the outskirts of towns, hence the location of most leper houses. Indeed, because the earliest hospitals to deal with

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Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Stage-Managing a Hospital in the Eighteenth Century syphilitics in England were transformed leper houses, these unpleasant operations tended to fall far from the city centre, in neighbourhoods like Southwark, which already had a dubious reputation.48 The Lock Hospital broke with this tradition. Hardly in the seedy boondocks, it was in Hyde Park. As a result the well-to-do walked by the hospital every day. As a gauge of its neighbourhood, consider that in 1761 the hospital’s neighbour, Lord Grosvenor, sent his attorneys to meet with the Lock’s board of govenors, challenging the institution’s right to install windows that faced his property, lest the sight of patients become visible to his estate.49 Indeed, Thomas Sheperd’s sketch of the hospital that survives from the early nineteenth century nicely illustrates how the respectable strolled by the hospital daily (Figure 8.1). The proximity of the hospital to polite Londoners meant that it had to do everything it could to create the illusion of respectability. For example, the hospital was greatly concerned about its street-front façade. It did its best to keep the walkway in front of the hospital as respectable as possible. Unfortunately, in eighteenth-century London, rife with homelessness and unemployment, this was difficult to do. Evidence that the well-to-do indeed frequented the neighbourhood is the fact that beggars consistently set up shop right outside the hospital’s door.50 Twice, the governors contacted the magistrates in attempts to clear their doorway of them. In 1764, and again in 1766, the hospital complained about:

[T]he Numbers of Vagrants and other idle persons that assembled themselves near this hospital at the time of Divine Service, and that Mr Upton had been so kind as to order the Beadles of the Parish to attend and apprehend them, by which means the Avenues leading to the Hospital were much cleared of those Nuisances.51 Governors must have been acutely aware that prospective benefactors might easily mistake these beggars for patients, which would have reflected terribly on the charity. As that passage illustrates, hospital authorities were especially concerned that such beggars harassed the respectable citizens who supported the hospital by renting pews in its chapel. Built in 1761, the chapel quickly became singularly important to the charity. Because its subscription income was so low, the hospital took a chance on the evangelical preacher Martin Madan, who proposed that the charity build a chapel that he would lead, providing all the income from pew rentals and hymnal sales to the hospital. Madan emerged as one of the leading evangelical preachers in London, attracting a large and wealthy following, and it was not long before the chapel income outstretched the donations of all the governors’ subscriptions combined, making it immediately the lifeblood of the charity itself.52

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Chapel-goers were undoubtedly the most important guests the institution ever received, visiting the hospital grounds each and every Sunday. We can therefore understand why the administration was so upset by the ‘poor persons infesting the avenues of the Chapel [who] begg Alms of the people as they pass.’ It was not just that paupers accosted hospital supporters on their way to chapel, when refused, panhandlers frequently ‘behav[ed] ill to them, using very indecent Language’.53 Beggars were bad enough. But it was even more important to manage the circumstances under which these visitors saw actual patients. The hospital’s founder and surgeon, William Bromfeild, was livid in July 1764 when he discovered that one of the hospital’s main doors had been left open. For one thing, it was a security breach that might allow in undesirables such as Fanny Finley. However, the real problem was that it opened the world of the ‘foul wards’ to public view. The surgeon expressed shock when he arrived at the hospital to find patients, possibly just hoping for a bit of fresh air in muggy July, actually standing in the doorway. Bromfeild made plain the nature of the problem, emphasising how such public exposure of the nasty reality of the hospital’s wards might damage the fiscal health of the hospital.

But besides many other inconveniencies that might arise therefrom, he apprehended the Patients standing at the Door and exposing themselves to publick view was so Disagreeable a sight that it might Prejudice Ladys and gentlemen (who frequently pass by there) in their good opinion of the Hospital, and the Charity might Loose Considerably thereby.54 The Board called in the entire staff and issued a stern lecture about the rules governing the locking of the door. Windows were almost as big a problem as doors. In 1772, the house received complaints that the patients leaned out of opened windows and spat upon pedestrians’ heads as they passed. Predictably, the windows were ordered locked; while in July 1783, the house received repeated complaints that male patients looked out the windows, and ‘behave[d] indecently in sight of People, passing & repassing the Road’. In this instance, even a locked window was too transparent; the house ordered that the window be covered to block sight.55 Such concerns clearly increased in frequency in the period after the establishment of the chapel, when Madan’s all-important flock began visiting the hospital grounds on Sundays. After which, it became imperative to keep the hospital tightly locked.56

Visitation and moral reform It is telling that the immediate response to breaches in the visual quarantine of patients was to sweep them out of view by locking doors or covering

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Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Stage-Managing a Hospital in the Eighteenth Century windows. It betrays that the hospital’s attempts to keep the patients orderly met with only limited success. It simultaneously raises the issue of patients’ moral reform, bringing us to the third role played by visitation at the Lock Hospital. As in the case of visitation as a form of surveillance, this view of visitation also suggests the continued currency of mediaeval and early modern usages of the term – namely, clerical visitation.57 The Lock’s clientele were a dubious bunch. The charity thus saw itself as charged with a mission not only to tend to their bodies, but to tend to their souls as well, and clerical visitation played a central and revealing role in this project. However, this moral mission was one that was rather lacking during the hospital’s first few decades. From its inception, the Lock’s minister was supposed to visit the patients on the wards in the name of effecting in them a lasting reformation. Such visitation had long been common practice in London hospitals. St Thomas’s Book of Government (1556) stipulated the importance of clerical visitation, and the records of Bart’s and St Thomas’s each show the practice upheld throughout the seventeenth and eighteenth centuries.58 However, it became clear during a conflict over the issue in 1780 that this had not happened at the Lock for decades – to the shame and damage of the hospital, some argued, in a highly public and vitriolic debate.59 Once Madan’s chapel had been built, the hospital chaplain turned his attention to his wealthy flock and stopped visiting patients on the wards. In a telling admission, Madan confessed that he lacked the stomach to face the reality of the wards. In the preface to a short prayer book that he edited to act as the patients’ ‘private visitor in my stead’, Madan exclaimed:

The cure of your disorder is of such a nature as it renders it often impossible for me to converse with you in private, and a stay of any long continuance in the wards, tho’ the House where you are is so neatly and carefully kept, is what I have attempted, but cannot bear.60 During a heated debate on the issue in 1780, the governors were forced to acknowledge that neither Madan, nor his replacement Charles de Coetlogan, visited the wards at all, admitting that visiting the patients ‘became so exceedingly offensive, that so long ago as 1760 Mr Madan found it impracticable,’ and that from that point forward clerical visitation had been discontinued altogether.61 This was about to change. The 1780s witnessed a significant transformation in the makeup of the Lock’s governing board. Madan’s chapel linked the Lock to London’s evangelical community, influential members of which increasingly joined the ranks of its governors in the 1760s and 1770s. More than just subscribing and nominating patients, evangelicals took an active role in administration and they steered the institution on a course of much more

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Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Kevin Siena intensive soul-saving. They made regular clerical visitation their number one priority. Unfortunately, finding a chaplain who was willing to take on this task proved difficult. Two ministers attempted it initially but they both quickly gave up. One cited his ‘fearful apprehensions’ of completing ‘so disagreeable business’. The other submitted a lengthy letter detailing his failed attempts to visit the patients. It is notable that he considered the effort ‘in vain’, not because he couldn’t stomach it – although he does use terms like ‘offensive’ to describe the experience – but because the patients resisted his efforts, hiding beneath their sheets and doing everything they could to ‘evade [his] attention’.62 De Coetlogan eventually found a minister named Twycross willing to take on the job. Even though he visited the patients less frequently than the board had hoped, just twice a week, the hospital still made the point to emphasise the new development in its fundraising literature. The text of the hospital’s Annual Account had remained virtually unchanged for more than three decades, but the charity now added a new paragraph broadcasting their visitation policy.63 The admission that the hospital had not witnessed clerical visitation for decades was a public relations and fundraising disaster. Donors expected their hospital to make an effort to reform these wayward patients, so the charity swiftly moved to perform damage control. But the new policy was hardly mere stage-managing to placate donors. From the 1780s onwards, the hospital developed several policies to increase its efforts to reform patients and enhance the charity’s moral respectability, and frequently these efforts focused on stricter visitation policies. Indeed, two different forms of visitation quickly intersected. Anxious to gauge the impact of renewed clerical visitation on patients’ reformation, the board ordered the inspecting house visitors to look into the success of clerical visitation in their weekly reports. In addition to looking out for abuses or complaints by patients or staff, the administration now ‘recommended to the weekly Visitors to enquire particularly into the good Effects of the constant visitation of the Patients in their Wards, by the Chaplain or his Assistants’ and to include in their reports ‘such signs of Penitence & Reformation in the patients occasioned thereby’.64 The board also called in Reverend Twycross to give his own report of his success. Twycross was less than sanguine, but he gave some cause for optimism, stating that his labours were ‘not entirely in vain’ and that there was at least some hope of penitence and reformation in several of the female patients. Governors again instructed the weekly visitors to keep an eye out for progress on this front.65 Despite a rather lukewarm report of success, the administration penned a report to donors in which they crowed about the terrific effects of their new visitation policies, stating that ‘they have the greatest reason to believe’ that through

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Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Stage-Managing a Hospital in the Eighteenth Century clerical visitation many patients had been ‘brought to a proper sense of their former evil courses, and from that time become useful members of Society.’66 This momentum picked up steam. By 1785, the hospital succeeded in finding a minister who was much more enthusiastic about the idea of salvation in the foul wards. Reverend Thomas Scott applied to become the new assistant chaplain, the main task of which was visiting the wards. In his interview he proclaimed ‘that he would feel a peculiar satisfaction in visiting the unhappy Patients in the House’. The committee enthusiastically supported him for the job, exclaiming – probably with some measure of relief – ‘that the patients will be again visited with Zeal & Attention’.67 Within six months, the administration patted Scott, and itself, on the back for the clear transformation clerical visitation seemed to be having on the patients. The ‘zeal, piety and unremitted attention with which the patients were now visited’ must account for the ‘visible reformation’ they all agreed was taking place. Patients were said to be much more ‘orderly and tractable’, thanks to the ‘warnings and exhortations’ Scott meted out daily, transforming patients’ stay in the hospital from a largely medical experience to a sombre period of reflection.68 Patients’ physical pain and the torments of mercury now merely underscored a more ominous punishment that Scott assured them lay ahead if they failed to heed his warnings to change their lives. However, strangers on the wards endangered this new mission. In 1787, Scott complained that visitors entering the house threatened to undermine his efforts to reform patients. The liberty of visitation had been very much abused, he claimed, because ‘very improper persons who come for the worst purposes’ frequently gained admission to the wards. Because of them ‘the grand object of reformation, is thereby much prevented, & many bad consequences, both to the Charity and to the Patients themselves, are thereby occasioned.’ The board heeded his warning and dramatically limited access to the wards. Now visitation was restricted to merely one day a week, Mondays and then for just a window of two and a half hours. Moreover, the hospital made visitation procedures more stringent. Members of the public could not enter the wards unless they applied to visit a specific patient and ‘give a satisfactory account of their Business with such patient.’ Other dramatic new policies followed. Visitors and patients could no longer speak privately. Now all conversation had to take place with a nurse present. Moreover, visitors were prohibited from conversing with any but the patient they applied to meet. Further still, all parcels coming into the house for patients were to be inspected by the matron or nurse and only delivered if thought proper. Finally, the new policies were to be posted in large signs ‘in such places, where all who come may read them’.69 Reformation was possible, it seemed, but it required strict cloistering. 189

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Scott and the evangelicals were not done here. However, as they moved forward with even more intense reforming passion it became apparent that they were far more concerned with the reformation of the hospital’s women than its men. Warnings to enforce the new visitation policies tended to emphasise the need for vigilance in the female wards. Women, they feared, were forever vulnerable to the influence of ‘improper conversation [passing] between the female Patients & Visitors’, something about which Scott repeatedly complained, reminding nurses not to allow any private conversation on visiting day.70 This anxiety had long been present in the hospital, as the story of Ann Hook and Fanny Finley showed earlier. However, it was now renewed and intensified. In fact, Scott and the Evangelicals soon proclaimed that the job of reforming loose and debauched women was too difficult to accomplish under the current conditions in the hospital. Yet the task was too important to accept failure; thus Scott proposed his boldest suggestion yet. In 1787, he convinced the Board of Governors to establish an entirely separate institution to save the hospital’s women, the Lock Asylum for the Reception of Fallen Women.71 The Lock Asylum would incarcerate women who had been treated in the hospital and keep them for additional reformation. Their regimen of mercury would now be followed by one of prayer and work.72 The asylum was in keeping with the evangelicals’ well-documented views on gender.73 Above all, women needed to be protected from the public sphere, which only promised to corrupt and ruin them, as it had these women. Their faith in the power of domesticity was such that they believed even these women might be saved if safely returned to their proper place in a household, perhaps as a wife and mother, but failing that, at least as a servant in a gentleman’s home. The asylum also demonstrates the influence of another powerful force in the late Enlightenment, the movement to use institutions to improve human beings. The Lock Asylum was, in many ways, simply another example of the penitentiary movement at work.74 As its etymology suggests, such penitentiaries emerged from homes for penitents, most notably the fallen women’s asylums of sixteenth-century Italy – which often also grew out of VD hospitals.75 London had recently witnessed its own first outlets of this movement in the Magdalen Hospital for prostitutes of 1758 and more recently the Misericordia Hospital of 1780.76 Scott clearly fashioned the Lock Asylum on these institutions. Moreover, it is clear that one of the signature elements of the penitentiary model at the Magdalen and Misericordia was the intense control of visitation. Penitent women had to be quarantined from the outside world as much as possible. Their reform hinged on an internal reformation, in which women must come to loath themselves, to detest how they had lived and, finally, to reject their former lifestyle completely. This, penitentiary proponents emphasised, 190

Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Stage-Managing a Hospital in the Eighteenth Century could only be effected through long periods of intense personal reflection, reflection which could only take place in solitude. In addition to the intense regimens of prayer and work (which, of course, had their own redemptive power) women at the Magdalen and Misericordia were cut off from society in an attempt to cut them off from their former selves. For example, the staff at the Misericordia were forbidden to carry messages into or out of the house unless vetted by the board, and visitors were similarly policed.77 Women in these institutions were even restricted in their discussions with other inmates. Women were threatened with discharge if they dare ‘mention a word relating to [their former] vicious ways of life’.78 Miles Ogborn’s study of the Magdalen similarly emphasises the cloistering that was central to its reforming mission. Women had to be cut off from their former acquaintances for a prolonged period if there was to be any hope that they would turn over a new leaf.79 This was the model Scott proposed to the Lock administration in 1787. Women in the Lock Asylum were to receive religious instruction every morning and daily clerical visitation became routine. The chaplain restricted all reading material to officially vetted religious books. The solitude was intense. Inmates were not permitted to speak, even to one another, save in the presence of the matron. They were confined to the premises.80 Laxity on this last issue was immediately condemned; one of the asylum’s first inmates, Ann Nunn, was permitted to leave the asylum to visit her sick mother. However, Ann’s symptoms soon returned. Rather than attribute this to the failure to cure the disease the first time – the disease was notoriously difficult to treat and such return of symptoms was common – the board assumed the worst: namely, that ‘during her absence (which was only for one Afternoon) [she] had behaved in such a manner as again to be infected with the Venereal Disease. It is resolved that the said Ann Nunn be expelled.’81 Such day-passes quickly became extremely rare. As at the Magdalen, all parcels and letters at the asylum were inspected, whether coming in or leaving the house.82 Above all, the women had to be isolated from their previous friends. Policies forbid not just visits but even letters from women’s former acquaintances. The asylum’s Annual Account emphasised the importance of quarantine. More than anything, reformation hinged on preventing these women from contacting friends; they must be ‘preserved from ever seeing or conversing with their former abandoned companions’.83 The Lock’s new mission of social engineering required a far more intense quarantine than ever before. However, that quarantine was, to a great extent, an institutionalised double standard. While men in the Lock Hospital now certainly received more frequent visits from the chaplain than did male patients of previous decades, their regimen differed dramatically from their female counterparts, who not only underwent physical treatment on the 191

Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Kevin Siena wards, but were then transferred to an altogether separate institution for much more intense moral therapy. This two-tiered regime betrays the stark gender anxiety that would drive policies on venereal disease well into the nineteenth century.84 Conclusion People visited the Lock Hospital for a multitude of reasons in the eighteenth century, and thus visitation came to mean many things. Policy and practice often hinged more on who a visitor was than anything else. Working-class associates of patients hoping to visit a friend in the hospital met with a vastly different welcoming than did prospective donors or wealthy chapel attendees. Moreover, the hospital’s visitation policies convey that older conceptions of visitation still mattered. Clerical visitation formed a vital tool in the struggle to reclaim patients from sin; indeed, the underlying goal of human perfectibility that drove late-Enlightenment institutionalisation hinged on it. Visitation simultaneously represented a crucial form of self- policing, as authorities took turns ‘visiting’ their own hospital in the name of assuring donors – and prospective donors – that their charity was well run and provided good value for money. Understanding visitation at the Lock means understanding how it meant so much more than merely the establishment of hours when the wards were open. Successful visitation policies formed key components in the Lock Hospital’s survival strategy during its first few decades. They worked to enhance the Lock’s reputation by keeping undesirables out, maintaining order, ensuring quality of care, guarding against institutional abuses, keeping patients out of polite company’s sight, and turning the charity towards a more reputable mission of attacking the pox at its true source – not merely the physical cause of disease, but the deeper moral failings that middle-class Londoners were sure were responsible for this awful scourge.

Notes 1. On the care provided by these hospitals see Chapters Two and Three in K. Siena, Venereal Disease, Hospitals, and the Urban Poor: London’s ‘Foul Wards’ 1600–1800 (Rochester: University of Rochester Press, 2004). 2. The use of the term ‘stage-managing’ in this article’s title warrants reference to Erving Goffman’s use of theatrical principles to analyse self-presentation: E. Goffman, The Presentation of Self in Everyday Life (Garden City: Anchor, 1959). 3. The concept, of course, stems from J. Habermas, Structural Transformation of the Public Sphere: An Inquiry into a Category of Bourgeois Society, T. Burger (trans.), (Cambridge: MIT Press, 1991); For useful introductions to the period emphasising Habermas’ core insight see D. Outram, The 192

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Enlightenment (Cambridge: Cambridge University Press, 1995), and J. van Horn Melton, The Rise of the Public in Enlightenment Europe. (Cambridge: Cambridge University Press, 2001). For application of Habermas’s idea to medicine see S. Sturdy (ed.) Health and the Public Sphere in Britain, 1600–2000 (London: Routledge, 2002). 4. The standard work on the voluntary charity movement remains D.T. Andrew, Philanthropy and Police: London Charity in the Eighteenth Century (Princeton: Princeton University Press, 1989). 5. On voluntary hospitals see R. Porter, ‘The Gift Relation: Philanthropy and Provincial Hospitals in Eighteenth-Century England’, in L. Granshaw and R. Porter (eds), The Hospital in History (London: Routledge, 1989), 149–78; A. Borsay ‘“Persons of Honour and Reputation”: The Voluntary Hospital in the Age of Corruption’, Medical History, 35 (1991), 281–94, and ‘“Cash and Conscience”: Financing the General Hospital at Bath, c.1738–1750’, Social History of Medicine, 4 (1991), 207–29; A. Wilson, ‘Conflict, Consensus and Charity: Politics and the Provincial Voluntary Hospitals in the Eighteenth Century’, English Historical Review, 111, 442 (1996), 599–619. 6. Institutional histories include A.E. Clark-Kennedy, London Pride: The Story of a Voluntary Hospital (London: Hutchinson Benham, 1979), and T. Gould and D. Uttley, A Short History of St George’s Hospital (London: Atlantic Highlands, 1997). 7. Andrew, op. cit. (note 4), 29. 8. Porter, op. cit. (note 5), 164–6. 9. For an overview that explores this drift of attitudes towards the poor, see R. Jütte, Poverty and Deviance in Early Modern Europe (Cambridge: Cambridge University Press, 1994). This sentiment found its most important institutional manifestation in the workhouse movement, which increasingly replaced the parish dole with a bed in a workhouse as a key form of poor relief. On the workhouse movement, see T. Hitchcock, ‘The English Workhouse: A Study in Institutional Poor Relief in Selected Counties, 1696–1750’, (unpublished PhD dissertation, Oxford University, 1985), and idem, ‘Paupers and Preachers: The SPCK and the Parochial Workhouse Movement’, in L. Davison et al. (eds), Stilling the Grumbling Hive: The Response to Social and Economic Problems in England, 1689–1750 (New York: St Martin’s Press, 1992), 145–66. 10. ‘Resolutions and Orders of the Westminster Hospital’, London Metropolitan Archives (hereafter LMA) H2/WH/A1/64, 119. 11. Consider that well over twenty per cent of patients in London’s royal hospitals entered their VD wards throughout the seventeenth and eighteenth centuries. Siena, op. cit. (note 1), 70–2 and 110–11. Randolph Trumbach’s research similarly suggests extremely high rates of infection: R. Trumbach, Sex and the Gender Revolution, Volume I: Heterosexuality and the Third Gender 193

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in Enlightenment London (Chicago: University of Chicago Press, 1998), 198–201. 12. Westminster Infirmary, Trustees Minutes, LMA, H2/WH/A1/5, 175–7. 13. Some Reasons of a Member of the Committee, &c. of the Trustees of the Infirmary in James Street Westminster, near St James Park, for his dividing against the Admission of Venereal Patients: In a Letter to a Lady (London, 1738), 1–3. 14. Proponents at the London Hospital succeeded in convincing the Board of Governors to open special wards for venereal patients, but these lasted less than a decade. For the bulk of the century the hospital excluded venereal patients. See Siena, op. cit. (note 1), 221–3. 15. Policy at the Middlesex held ‘to guard in future as much as possible against the admission of persons ill of that disease’: M.W. Adler, ‘History of the Development of a Service for the Venereal Diseases’, Journal of the Royal Society of Medicine, 75, 2 (1982), 124; St George’s held the same policy, though evidence suggests that the hospital may have made some exceptions. Gould and Uttley, op. cit. (note 6), 5. 16. On Bromfeild’s career, see D. Innes Williams, The London Lock: A for Venereal Disease 1746–1952 (London: Royal Society of Medicine Press, 1996), 11–15. On the Lock’s establishment, see Williams, idem., 19–24; Andrew, op. cit. (note 4), 69–70; and L. Merians, ‘The London Lock Hospital and Lock Asylum for Women,’ in L. Merians (ed.), The Secret Malady: Venereal Disease in Eighteenth-Century Britain and France (Lexington: University of Kentucky Press, 1996), 129–30. 17. D.T. Andrew, ‘Two Medical Charities in Eighteenth-Century London: The Lock Hospital and the Lying-In Charity for Married Women’, in J. Barry and C. Jones (eds), Medicine and Charity Before the Welfare State (London: Routledge, 1991), 82–97. 18. Bronwyn Coxson’s study of the Middlesex Infirmary similarly points to the competitive charitable atmosphere in Enlightenment London and the importance of a hospital’s – perceived – moral balance sheet; she suggests that the Middlesex’s lying-in service gave it a distinct advantage when fundraising: ‘[I]n the competitive charitable market-place, providing lying-in services was used by the Middlesex to differentiate itself from other voluntary hospitals and to attract benefactors.’ B. Coxson, ‘The Foundation and Evolution of the Middlesex Hospital’s Lying-In Service, 1745–86’, Social History of Medicine, 14 (2001), 29 and 38–40. 19. According to the Oxford English Dictionary (OED): ‘The action, on the part of one in authority, or of a duly qualified or authorised person, of going to a particular place in order to make an inspection and satisfy himself that everything is in order.’

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20. London Hospital, House Visitors Book, 1749–1756, London Hospital Archive (hereafter LH) LH/A/16/1. 21. London Hospital, Report Book 3, LH/A/4/3, 18. 22. For example, the house visitors commonly recommended the discharge of ‘unruly’ patients like Richard Atkinson ejected from the house on 13 March, 1745/6, London Hospital, Report Book 1, LH/A/4/1, 107. 23. London Hospital, Report Book 3, LH/A/4/3, 235–6. 24. Guys Hospital, Court of Committees Minutes, LMA, H9/GY/A3/1/1, 4 April 1726; St Thomas’s Hospital, General Court of Governors Minutes, HI/ST/A1/6, ff.73-5, 223 and 233; St Bartholomew’s Hospital, Governor’s Journal, St Bartholomew’s Hospital Archive (hereafter SBH) HA 1/8, f. 125. 25. Royal College of Surgeons Library (hereafter RCS) Lock Hospital, General Court of Governors Minutes, Book 1, 1. 26. RCS, Lock Hospital, Board of Governors Minutes, Book 2, 3 November 1759, n.p. 27. See for example, RCS, Lock Hospital, Board of Governors Minutes, Book 10, 161. 28. RCS, Lock Hospital, General Court of Governors Minutes, Book 2, 12. 29. RCS, Lock Hospital, Board of Governors Minutes, Book 12, 11 June 1789, n.p. 30. RCS, Lock Hospital Board of Governors Minutes, Book 9, 62 and 64. Original emphasis. 31. RCS, Lock Hospital, Board of Governors Minutes, Book 2A, 6 March, 1662, n.p. 32. RCS, Lock Hospital, General Court of Governors Minutes, Book 1, 142 33. Ibid., 140–1. 34. Ibid., 136–7, and Lock Hospital, Board of Governors Minutes, Book 10, 179. 35. RCS, Lock Hospital, Board of Governors Minutes, Book 3, 176–7. 36. RCS, Lock Hospital, General Court of Governors Minutes, Book 1, 28. 37. RCS, Lock Hospital, Board of Governors Minutes, Book 1, 140–1. 38. LMA, St Thomas’s Hospital, General Court of Governors Minutes, HI/ST/A1/6, ff.73-5. See also LMA, St Thomas’s Hospital Rules, c. 1752, H1/ST/A25. 39. RCS, Lock Hospital, Board of Governors Minutes, Book 14, 4 November 1794, n.p. 40. RCS, Lock Hospital, General Court of Governors Minutes, Book 2, 59. 41. RCS, Lock Hospital, Board of Governors Minutes, Book 3, 140–2. 42. RCS, Lock Hospital, Board of Governors Minutes, Book 10, 239–40. 43. RCS, Lock Hospital, Board of Governors Minutes, Book 3, 138–9 and 142. 44. RCS, Lock Hospital, Board of Governors Minutes, Book 1, 136–7.

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45. On the conspicuous nature of the disease’s symptoms and treatment see Siena, op. cit. (note 1), 18–24. 46. RCS, Lock Hospital, Board of Governors Minutes, Book 1, 142. 47. For the charity’s official fundraising pamphlet, see Account of the Proceedings of the Lock Hospital near Hyde-Park Corner (London, 1749). Examples of fundraising sermons include M. Madan’s, Every Man our Neighbour: A Sermon Preached at the Opening of the Chapel, of the Lock-Hospital near Hyde- Park Corner (London, 1762), and A Sermon Preached at the Parish-Church of St George, Hanover-Square, For the Benefit of the Lock-Hospital (London, 1777). 48. N. Orme and M. Webster, The English Hospital, 1070–1570 (New Haven: Yale University Press, 1995), 41–8; and M.B. Honeybourne, ‘The Leper Hospitals of the London Area’, Transactions of the London and Middlesex Archaeological Society, 21 (1963), 6. On Southwark’s reputation, see J.A. Browner, ‘Wrong Side of the River: London’s Disreputable South Bank in the Sixteenth and Seventeenth century,’ Essays in History, 36 (1994): 34–71. 49. RCS, Lock Hospital, Board of Governors Minutes, Book 2A, 17 October 1761, n.p. 50. On begging strategies see T. Hitchcock, Down and Out in Eighteenth Century London (London: Hambledon and London, 2004). 51. RCS, Lock Hospital, General Court of Governors Minutes, Book 2, 32–5. 52. RCS, Lock Hospital, General Court of Governors Minutes, Book 1, 270–1. On the chapel see Williams op. cit. (note 16), 37–9; Merians, op. cit. (note 16), 136; and Siena, op. cit. (note 1), 187–9. 53. RCS, Lock Hospital, Board of Governors Minutes, Book, 4, 126. On the place of intimidation in begging strategies see Chapter Four, ‘Menaces and Promises’ in Hitchcock, op. cit. (note 50), 75–96. 54. RCS, Lock Hospital, Board of Governors Minutes, Book 3, 176–7. 55. RCS, Lock Hospital, Board of Governors Minutes, Book 11, 10. 56. Yet another example came in 1791 with the renewed order ‘that the Street Door and Hall Door at the foot of the patients stairs be always shut when service is over’ to prevent exposure of the wards to chapel attendees. RCS, Lock Hospital, Select Committee Book, 22 March 1791. 57. The OED’s third definition of the noun ‘visitation’ reads ‘3. a. The action or practice of visiting sick or distressed persons as a work of charity or pastoral duty,’ and ‘3. b. The action of pastoral visiting on the part of a clergyman.’ 58. LMA, St Thomas’s Hospital, The Book of the Government of the Hospital, HI/ST/A24/1; St Thomas’s Hospital, General Court of Governors Minutes, HI/ST/A1/6, ff.73-5; SBH, St Bartholomew’s Hospital, Governors’ Journal, HA 1/5, f. 118; HA 1/8, f. 242, HA 1/10, ff. 65, 98, and 285. 59. Bromfeild first criticised the minister for not visiting the wards as a counter attack to earlier criticism that he had poached hospital medicines for his 196

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private practice. The ensuing feud was quite hostile, splitting the governors into camps. For details see Siena, op. cit. (note 1), 197–200; and Williams, op. cit. (note 16), 43–8. 60. M. Madan, ‘Preface’ to J. Reynolds, Compassionate Address to the Christian World… Revised, Corrected and Published for the Use of the Patients in the Lock-Hospital, near Hyde-Park Corner (London, 1767), iii–iv. 61. An Address to the President, Vice-Presidents, and the other Governors of the Lock Hospital near Hyde Park Corner on Behalf of that Charity (London, 1781), 20–1. 62. RCS, Lock Hospital, Select Committee Book, 11 June 1781, n.p. 63. Ibid., 10 August 1781. This passage remained in the fundraising pamphlet for the rest of the century. See, for example, Account of the Proceedings of the Lock Hospital near Hyde-Park Corner (London, 1789), 5–6. 64. RCS, Lock Hospital, General Court of Governors Minutes, Book 3, 139–40. 65. Ibid., 115. 66. Ibid., 169–70. 67. Ibid., 198. 68. Ibid., 204–5. 69. RCS, Lock Hospital, Board of Governors Minutes, Book 12, 17 May 1787, n.p. 70. RCS, Lock Hospital, General Court of Governors Minutes, Book 3, 334. 71. Ibid., 311–13. 72. On the Lock Asylum see especially Merians, op. cit. (note 16), 136–43. 73. The classic study is L. Davidoff and C. Hall, Family Fortunes: Men and Women of the English Middle Class (Chicago: University of Chicago Press, 1987), 149–92. See also, C. Hall, ‘The Early Formation of Victorian Domestic Ideology,’ in her White, Male, and Middle Class: Explorations in the History of Feminism (New York: Routledge, 1992), 75–93; A. Clark, The Struggle for the Breeches: Gender and the Making of the British Working Class (Berkeley: University of California Press, 1995), 92–118; and R. Shoemaker, Gender in English Society, 1650–1850: The Emergence of Separate Spheres? (London: Longman, 1998), 217–25. 74. Andrew, op. cit. (note 4), 187–94. On the penitentiary movement see especially M. Ignatieff, A Just Measure of Pain: The Penitentiary in the Industrial Revolution, 1750–1850 (London: Macmillan, 1978); and M. Foucault, Discipline and Punish: The Birth of the Prison, A. Sheridan (trans.), (New York: Vintage, 1979). 75. On these institutions in Italy, see S. Cohen, The Evolution of Women’s Asylums Since 1500: From Refuges of Ex-Prostitutes to Shelters for Battered Women (Oxford: Oxford University Press, 1992); and L. McGough, ‘Quarantining Beauty: The French Disease in Early Modern Venice’, in K. Siena (ed.), Sins of the Flesh: Responding to Sexual Disease in Early Modern 197

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Europe (Toronto: Centre for Reformation and Renaissance Studies, 2005), 226–34. 76. What we know about the Misericordia, a venereal disease hospital that seems to have lasted less than a decade, comes mainly from founder Jonas Hanway’s fundraising pamphlet, J. Hanway, An Account of the Misericordia Hospital for the Cure of Indigent Persons, involved in the Miseries Occasioned by Promiscuous Commerce. With Moral and Religious Advice to the Patients (London, 1780). On the Magdalen, see S. Nash, ‘Prostitution and Charity: The Magdalen Hospital – a Case Study’, Journal of Social History, 17 (1984), 617–28; S. Lloyd, ‘“Pleasure’s Golden Bait”: Prostitution, Poverty and the Magdalen Hospital in Eighteenth-Century London’, History Workshop Journal, 41 (1996), 51–72; and Chapter Two ‘The Magdalen Hospital’ in M. Ogborn, Spaces of Modernity: London Geographies, 1680–1780 (New York: Guilford Press, 1998), 39–73. 77. Hanway, op. cit. (note 76), 66, 69 and 77. On similar policies at the Magdalen, see Nash, op. cit. (note 76), 621; and Ogborn, op. cit. (note 76), 60–70. 78. Hanway, op. cit. (note 76), 79. 79. Ogborn, op. cit. (note 76), 66–70. 80. RCS, Lock Asylum Committee Minute Book 1, 10–17; Merians, op. cit. (note 16), 139–40. 81. RCS, Lock Asylum Committee Minute Book 1, 44–5. 82. Ibid., 15–17. 83. An Account of the Institution of the Lock Asylum (London, 1793), 7–8. 84. Siena, op. cit. (note 1), 210–18; on the nineteenth century, see J. Walkowitz, Prostitution and Victorian Society: Women, Class and the State (Cambridge: Cambridge University Press, 1982), 11–148; M. Spongberg, Feminizing Venereal Disease: The Body of the Prostitute in Nineteenth Century Medical Discourse (New York: New York University Press, 1998); P. Baldwin, Contagion and the State in Europe, 1830–1930 (Cambridge: Cambridge University Pres, 1999), 355–523; and R. Davidson and L. Hall (eds), Sex, Sin and Suffering: Venereal Disease and European Society since 1870 (London: Routledge, 2001).

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