Kevin P. Siena, Venereal Disease, Hospitals and the Urban Poor: London’s “Foul Wards,” 1600-1800 . Rochester, NY: University of Rochester Press, 2004. viii+ 367pp. Bibliography. £55.00/$80.00 hbk.
This is a masterly study, based on meticulous archival research, which transforms our vision of venereal disease provision in early modern London, and provides an illuminating spotlight on many aspects of early modern urban life. The rich and detailed story Siena tells will be of interest to a wide range of historians. There is material here on the history of medicine and health care, of social welfare, of urban life and plebeian culture, on class and gender and changing gender roles, on sexuality in a modernising urban environment, on philanthropy, and even on informal credit arrangements.
Siena thoroughly overturns the widely prevalent belief that the Lock Hospital came into being because of the lack of provision for the poor suffering from the ‘foul disease’ (he is very clear that it is far from easy to determine what this actually meant in any specific instance during the period, but that the symptoms described in numerous cases can frequently be assimilated to those of syphilis). Far from being a new departure, the Lock was a late intervention into a complex network of health care provision, and came into being for extremely specific reasons to do with changes in the city’s demography as a result of increased migration from ever greater distances into the metropolis. It is also now apparent that although it soon came to incorporate an Evangelical agenda of ‘saving’ fallen women, this was a later addition to its endeavours and not part of the originating intentions.
The old royal hospitals of St Bartholomew’s and St Thomas’s are demonstrated to have played a longstanding role in providing care for the venereally-diseased, and Siena analyses the various changes over time in the nature of that provision. He also adduces convincing evidence that several of the hospitals founded as part of the wider eighteenth century movement to create new medical institutions on a philanthropic basis did, in fact, admit ‘foully-diseased’ patients, though not always into the main building (a long tradition of out-wards for a class of patients often suffering noxious symptoms and requiring long-term treatment is very evident). Above all, he reveals the critical importance of Poor Law medical provisions, and the rise of Poor Law infirmaries for inpatient treatment, to the overall pattern of provision for the syphilitic poor during the period under discussion.
Questions of gender and class are shown to have been central as to who obtained what kind of treatment, where and in what circumstances. In an opening discussion of the medical marketplace for venereal disease treatment available to those able to afford it, Siena demonstrates the significance of issues of confidentiality and discretion, which were strongly emphasised in practitioners’ advertisements. He has also discovered the extent to which this marketplace included women (usually members of male practitioners’ families) offering treatment to their own sex that was both discreet and did not violate female modesty. Such an option was not available, he points out, for less well-off women, who were not only obliged to rely for treatment on the male surgeons employed by hospitals or poor law authorities, but in most cases were required to state their case for admission to male ‘gatekeepers’ (such as hospital governors or poor law authorities), usually of superior social status. Siena suggests that evidence for the reluctance of women to undergo these trials may be found in the fact that their cases were often more advanced than those of men when they finally sought inpatient treatment, suggesting that other expedients had been tried before desperation drove them too seek publicly-funded relief. He has also found intriguing evidence for plebeian female networks of financial assistance, with women seeking bonds to cover the costs of their admission to St Thomas’s from other women, and indeed, has uncovered ‘a small industry’ providing temporary credit.
This study provides vivid insights into the lives of the sick poor in early modern London, and into the problems of health and social welfare provision within a growing conurbation with a substantial migrant population. It significantly expands and nuances our hitherto over-simplistic picture of the extent of, and provisions for the treatment of, venereal disease in the metropolis.
Lesley A. Hall
Wellcome Library for the History and Understanding of Medicine, London
