Spaces of Isolation and Invisibility
Lock hospitals were only one material manifestation of the Victorian management of venereal diseases. What Kevin Siena (2004) regards as typical of eighteenth-century centres of venereal disease administration continued to hold true in the nineteenth century. A varied medical market comprised of private orthodox and fringe practitioners was available to anybody with sufficient financial means. In his 1882 overview Lock Hospitals and Lock Wards in General Hospitals, Frederic Walter Lowndes, surgeon at the Liverpool Lock Hospital, categorized nineteenth-century facilities of syphilis management into voluntary and governmental lock hospitals, lock wards in general hospitals and workhouse infirmaries. These institutions continued to admit patients on the basis of such criteria as gender, disease stage, parish allegiance and financial possibilities. Apart from these facilities, which targeted the urban poor, the middle and the working classes, there were also institutions for the wealthy middle and upper classes, who enjoyed the privileges of private consultations and European sanatoria. Like in the eighteenth century, in the Victorian era, “medical discretion [also] came with a price tag and was not available to everyone” (Siena 2004: 257). Throughout the centuries, socio-economic considerations continued to shape the landscape of syphilis prevention and treatment.
Admission strategies were changing with time. In the course of the eighteenth century, venereal patients were denied admission to general hospitals. If existent, venereal wards, for instance at Guy’s, St Bartholomew’s and London Hospital, provided separate facilities by introducing specific cost and space arrangements that helped them maintain a distance between clean and ‘foul’ patients (Siena 2004: 220-3). The emergent locks, which, according to Siena, appeared as a response to demographic changes instituted by growing migration to urban centres, while initially admitting patients gratuitously, soon modified their policy in view of the changing geopolitical developments. Increasingly, venereal patients were regarded as the responsibility of their respective parishes, with exceptions made for those who had to travel considerable distances to the lock. High fees, varying according to gender and the type of patient care (in- and out-patients), served as a deterrent and further restricted access to the facilities (Siena 2004: 231-3). In the nineteenth century, voluntary lock hospitals continued to rely on donations, appeal dinners and supplementary income from the Chapel or the adjacent laundry (D. I. Williams 1995: 58, 110). In the mid-century, the system of admissions began to change from a strongly centralized arrangement in which the Governor recommended future patients to a system in which parishes and surgeons nominated the candidates (68). Under the CD Acts, the government paid for a number of beds in voluntary hospitals and supported financially the newly established garrison facilities. Financial insecurity and limited capacities continued to be the main practical reasons for the segregation of the admitted patients (Siena 2004: 242-5) as were gender and class-based isolationist policies, which were often based on various moral considerations (for example, in the London Lock; see D. I. Williams 1995: 68).
Local arrangements in the provision of syphilis patients differed considerably, as can be seen in Bristowe and Holmes’s Report on the Hospitals of the United Kingdom (1864). St Bartholomew’s and Guy’s hospitals, which freely admitted male and female patients, segregated them into distinct wards. The London Hospital admitted only female syphilitics, and only those with letters of recommendation, and also treated them in separate wards. At King’s College Hospital, they were accommodated in general wards. At the Royal Free Hospital, on the other hand, women patients were restricted to separate wards while men mingled with other patients in general wards (Bristowe and Holmes 1864: 474). The commissioners themselves did not recommend regular admission of syphilis patients to general wards for fear of wasting the “funds of the charity,” though they agreed that severe cases should be treated (474). Judged oflittle interest to medical study, these patients could be “ as well, or better, studied in the outpatient room” (474). While Bristowe and Holmes suggested separating larger groups of prostitutes in female wards, they did not regard individual patients pursuing the profession as particularly dangerous to the morality of other patients. Should their presence be assessed as injurious to others, they were to be admitted to general rather than to female wards. Bristowe and Holmes saw no practical reason in separating male patients. In fact, they did not consider the establishment of separate wards as urgent or necessary (1864: 475). Although not to the extent which would become characteristic of the late nineteenth century, these recommendations reflected existing social differences and disadvantaged women.33
Twenty years later, Lowndes promoted the separation of venereal cases as advantageous to health provision and as a matter of moral stringency:
For obvious reasons such wards must be kept distinctly separate. There must be not only separate wards, but separate closets; special male and female nurses, whose duties must be limited to these wards; and complete isolation from the other patients. These can only be satisfactorily obtained in a separate building. (1882b: 24)
The “obvious reasons” incontestably reference moral considerations as Lowndes calls for the isolation of venereal patients not only in architectural terms but also through the employment ofspecial attendants. The evocation of “separate closets” highlights his strong conviction of the general contagiousness of the patients, whose belongings and/or alimentary provisions could be harmful to other inhabitants of the premises. Lowndes regularly supports his propositions with the help offavourable opinions, such as these of R. W. Coe of Bristol Lock Hospital, who regards separation as a way of placing the patients “in healthful moral condition” (qtd. in Lowndes 1882b: 18). The female Hospital and Asylum at Westbourne Green, Harrow Road and the Male Hospital and Out-Patient Department at 91 Dean Street, Soho, aimed to both “relieve disease” but also to “restore destitute fallen women” from all over Britain.34 One ward was devoted to those women who were sent by the War Office, while a separate ward was prepared for
“‘married’ women who suffer through no ‘fault of their own’.”35 An inspector reported:
One Ward is kept for those of the worst description of character; another for those sent to the Hospital through the different Unions, and a third for those who have expressed a desire to go to the Rescue Home in connection with the Hospital or to some other such Institution. [... ] Those patients who wished to go into the Rescue Home are kept by themselves for a period of 2 or 3 months as probationers; they perform such work as scrubbing and sewing, and help generally in the work of the Home, but are not allowed to mix with those who have passed their probationary period and who are accupied [sic] in laundry work.36
It transpires from this report that separation was a mechanism serving the maintenance of order, which itself relied on the reification of social differences and women’s submissiveness to hegemonic power incarnated by the hospital staff.37
The isolationist debate aside, local planning schemes, legal circumstances and topographical practicalities had an incontestable influence on the geographical placement and visibility of the hospitals. The midnineteenth century saw the relocation of various facilities, and with them the lock, as an effect of larger, albeit always pragmatically dictated, changes in urban design. Gary A. Boyd, for instance, traces the highly “peripatetic” character of the Dublin Lock Hospital (later the Westmoreland Lock Hospital), whose changing locations evince no noticeable pattern (2006: 146-7). The 1747 voluntary Lock Hospital in London, established in Grosvenor Place, also had to move from Hyde Park Corner in 1842 because the lease on the premises was expiring and it was made clear that its presence was not altogether desirable in the more and more fashionable neighbourhood. New hospital buildings - the hospital itself, an asylum and a chapel - were erected in Westbourne Green, Paddington (Harrow Road). The choice of Westbourne Green for the new site, David Innes Williams speculates, was motivated by the “potential for a new congregation” that would ensure funds to the adjacent chapel, and hence also to the hospital, rather than by “the catchment area for clinical practice” (1995: 63). Soon, however, it became clear that with the growing number of syphilis cases, overcrowding and cumbersome distance for the city patients, a branch of the hospital would have to be opened in close vicinity to the high centres of urban density. A house in 91 Dean Street, near Soho Square, was chosen and refurbished as a city site of the hospital in 1862. These city premises, built at the end of the seventeenth century, could hardly be distinguished from other buildings in the area which, vacated by its previous fashionable owners, now formed a district full of hospitals (D. I. Williams 1995: 73).
In the colonial context, the visibility of the hospitals and their isolation were equally, if not more, complicated and likewise dependent on local specificities. Lock hospitals have been shown to be an integral part of the geopolitics of prostitution regulation. Accordingly, the “political geographies” that governed the brothel landscape were also characteristic of the management of lock hospitals (Levine 2003: 313). Their geographical distribution was often premised on the principle of complex visibility: while brothels were placed in the vicinity of cantonments, and thus exuded a degree of legalized visibility, lock hospitals, as “shameful establishments, often remain[ed] hidden from public view” (Levine 2003: 314). At Cannanore, the hospital was deemed too close to the main road as it provided an unobstructed view of the inmates to the curious gazes of the passers-by. During the early twentieth century similar practices continued, with, for instance, Dorre and Bernier Islands becoming the geographically distinct spaces of isolation for Aboriginal syphilis patients, which shows that both “practical and moral considerations” underscored the choice of setting for lock hospitals: “[a]rchitecture, space, and living arrangements took on a moral cast” (Levine 2003: 314). Customarily situated near “lunatic or leper asylums, or jails,” lock hospitals were required to render the inmates invisible while remaining clearly demarcated and easily controllable sites (314).
Governmental lock hospitals, established under the CD Acts, were built in the vicinity of army quarters, often marking the threshold between the civic and the military sites. Kildare Lock Hospital was positioned along the High Road, between the Camp and the town.38 In Aldershot, the facilities were situated on the opposite side of the town entrance.39 Very often, governmental complexes were criticized for their disadvantageous planning. In her testimony delivered for the “Report of Royal Commission upon the Administration and Operation of the Contagious Diseases Acts” (1871), for instance, a matron to the Colchester lock hospital, Miss Brown, was content to report that the hospital was “not in an objectionable part of the town” but bemoaned the fact that its windows overviewed the field where soldiers “exercised their horses, and the officers had a cricketing ground” (645). In her testimony, the positioning of the hospital within the cityscape was as important as its distance from the military quarters. Here, the Colchester Lock Hospital is conceived of not only as a space of separation but also as a site of confinement and unremitting supervision, whose permeability could be endangered by any type of porosity, be it escape or an exchange of glances.
The lock hospital as a type of heterotopia was an obviously policed space. Its role as a site of confinement and heightened supervision has been documented in detail. Boyd has shown that the plan of the Dublin Lock Hospital was based on a close surveillance and policing of the circulation of bodies within its walls (2006: 144-93). Likewise, most of the governmental hospitals were planned to improve this supervision. The plan of the Chatham Lock Hospital, for instance, shows the extent to which confinement and isolation were ensured. The entrance of the hospital was highly policed as it faced the hospital tower adjacent, on the right side, to the superintendent’s and police quarters and to the surgery and the examination room on the other. Access to any of the wards was monitored by a nurse and a special segregation ward was supplemented at the end of the hospital corridor in case separate space was needed for particularly problematic cases. Such segregation wards were usually positioned deep within the hospital grounds, at a considerable distance from the entrance.
Similar arrangements can be seen in the governmental Lock Hospital in Colchester, where the segregation ward is the remotest building of the complex.40 Here, the regular ward is situated between the separation ward and the surgery/police quarters. These administrative buildings mark the entrance to the whole complex. As in Colchester, it was the police officer and the surgeon (medical superintendent) who guarded the space. They decided who could enter and leave it. Here again, within the confines of the conceived hospital space, as instantiated by the architectural plans, the power of the government, the military and the medical establishment were combined. In Aldershot (Fig. 5.2), the insularity of the individual spaces of the complex was further ensured by landscape planning. The surgeon’s quarters, almost parallel to the main ward, on the far left side of the complex, were separated from it by a garden, whose trees also provided shelter and a degree of privacy. The plan shows the extent to which landscape and architectural planning offered an aesthetically pleasing site of confinement and internal segregation.
The prison-like character of colonial lock hospitals has been noted (Levine 2003: 73-4). Abolitionists often used what they perceived as flawed hospital planning as arguments to highlight the inadequacy of the facilities and to lament the lack of dignity these facilities granted to
Fig. 5.2 Lock Hospital in Aldershot, Aldershot Lock Hospital, General Plan. 1871. National Archives, London women. In their report, Kate Bushnell and Dr Elizabeth Andrew repeatedly emphasized the architectural internment of prostitutes in Indian lock hospitals. In Lucknow, they reported, the women’s department was doubly enclosed, its windows were barred and the traffic was regulated by the watchman, whose lodge was located at the entrance (1899: 44). Inside the lock, native patients, such as respectable women who contracted the disease from their husbands, were separated from the garrison women, while the menstruating patients were lodged in another ward so as not to spread contagion (43). In Umbala, the hospital was enclosed by a “high brick wall” and a “heavy spiked gate” (44). In Meerut, although the facilities resembled “an Englishman’s bungalow,” they were surrounded by a wall high at the back and low at the front and were positioned opposite the headquarters of the native police (45). As Bushnell and Andrew’s list of cantonment buildings - surrounded by walls and monitored by watchmen, guarded by “furious dogs” (48) and labyrinthine passages - includes facilities in Mean Meir, Peshwar, Pawal Pindi, Bareilly and Sitapur, it is not surprising that the report evokes a powerful image of Indian lock hospitals as sites of particularly stringent confinement. Even the rectification of the presented information41 does not correct the impression that Bushnell and Andrew used their descriptions of the chak- las and the hospitals as a means of supporting their argument as to the dire state of affairs in India even after the repeal of the Acts.
Bushnell and Andrew also recounted a number of practices which supported the coercive character of these spaces. On the one hand, they narrated the fate of one of the inmates kept in the hospital by the supervising surgeon to provide sexual services to his brother-in-law. On the other hand, they also noted their astonishment at many women’s declarations as to their voluntary residence in the hospitals, despite the legal and financial enforcement thereof (Bushnell and Andrew 1899: 49-53). Bushnell and Andrew’s report focuses on the inhumanity of the Acts and their repercussions, which involved physical coercion and psychological oppression of the women, who were forced to recognize compulsory confinement as a voluntary state.
Confinement was obviously only one practice within an array of regulatory actions directed at lock hospital patients.42 Alexander Patterson, surgeon to the Glasgow Free Lock Hospital, listed a series of rules by which the patients had to abide, which ranged from proper social behaviour to regulated meal and bed times to personal hygiene and arrangement of their own spaces. Indecency in speech and deed (consumption of alcohol, swearing and disobedience) would be punished as a way of inculcating desirable behaviour in the inmates. These rules, which the patients had to sign on admission, also included guidelines regarding their mobility and the possibilities of exchange with the ‘outside world’. The inmates were forbidden to leave the premises of the hospital unless regularly discharged. They were also not allowed to accept any alimentary or book provisions (Patterson 1882: 8). Inappropriate literature, like correspondence, was regarded as a major source of potential disturbance and often became subject to censure. Reflected in the guidelines of most lock hospitals for women was the desire to promote the ideal of middle- class womanhood (Levine 2003: 255).
While the submissiveness of lock hospital patients has frequently been documented, there was also resistance against these institutions.43 Especially after the implementation of the CD Acts, the late nineteenth century saw a number of resistance strategies, ranging from regular escapes and refusal of examination to riots and petitions. The asylum was only as good an investment as the quality of behaviour exhibited by its patients. Even though she could not ascertain the actual state of affairs at Harrow Road, Elizabeth Blackwell was quick to point out that, from her experience, overcrowded lock hospitals led to “outrageous disorder” among “able-bodied” but nonetheless “idle” women who could not even be curbed by the chaplain’s influence and who seemed to harbour a desire “ to escape from a virtual imprisonment. ” 44 Mr Arthur Maddison, from the Female Mission to the Fallen in London, confirmed the grim state of affairs, acknowledging that some cases of insubordination made it necessary to call for the police.45 No doubt hoping to leverage such accusations, banker and philanthropist Arthur Kinnaird, who was involved in the work of the London Lock Hospital, appended annual reports to the letters he sent out in which he asked for donations.46 Nonetheless, the colonial and home landscape abounded in cases of official complaint on the part of the lock hospital patients. Women at Alipore lock hospital wrote to the Indian government in 1875 to complain about their treatment (Levine 2003: 222). Various establishments in India would levy money fines and impose imprisonment on those leaving before discharge; in such circumstances women would petition cantonment magistrates, hoping for a release (Bushnell and Andrew 1899: 49-51). In Madras in the 1870s, poor women, as they used lock hospitals to survive, subverted “these institutions into [... ] asylums of relief” (Hodges 2005: 379). At the Royal Albert Hospital, a number of women petitioned for release and went to court to argue their cause (Walkowitz 1980: 228-9). Elizabeth Cotzibitch rioted against the correspondence rule by breaking glass (224-5).
The metaphorical significance of this last act of resistance was similar to the glass-breaking rampages by unionists and, later, suffragettes who insisted on being heard.47 The “somatic immediacy” of this form of expression, Isobel Armstrong argues, not only challenged the perspective from which the rioters (their bodies, material and social stance) were to be seen but also evidenced, in the clamour of breaking glass, their uniqueness and “refusal of anonymity” (2008: 67). While “an act of social despair” (69), glass-breaking was also an act of (re)claiming one’s identity. In the colonial and home context, lock hospitals, as they served as arenas for the promotion and production of middle-class womanhood, also often became stages for the performance of resistance and a training site for civic visibility.