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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 8 Stage-Managing a Hospital in the Eighteenth Century: Visitation at the London Lock Hospital 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 patients 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 hospitals 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 Kevin Siena - 9789042026322 Downloaded from Brill.com09/27/2021 04:26:44PM via free access Kevin Siena ‘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.
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