Sites of Reformation and Healing
The significance of lock hospitals cannot be divorced from the function they fulfilled in the clusters oflarger complexes that included workhouses, rescue homes and asylums. In these integrative structures, as in the various instances of self-profiling, lock hospital authorities underscored the reformative and curative character of the institutions. This tendency to fashion lock hospitals as providing moral and physical healing, was evidently also fuelled by the necessity to raise funds for their upkeep.48 Lowndes demonstrates that most non-governmental institutions were based on voluntary schemes and needed external support for survival, which brought with itself a number of problems:
Lock Hospitals can never be open to the inspection of the public, nor can they ever be the object of public entertainments, annual dinners, concerts, or bazaars. Their claims cannot be especially pleaded from pulpit or platform. Their work must be begun and carried on silently and unnoticed, save by the very few. (1882: 1-2)
The estimated sum of 800 pounds necessary to furnish one permanent place for the sick, was neither small nor easily obtainable as transpires from a number of unused beds (Lowndes 1882: 5-6). Not even such renowned benefactors as Prince Albert could manage to help solve the financial problems.49 It is, therefore, not surprising that regularly published pamphlets addressed at (potential) benefactors and dinners organized for them abounded with the rhetorics of spiritual healing and Samaritan charity:
On the painful character of the disease, under which the applicants for admission to the Hospital labor, it is needless to comment [...]. This Department [... ] will give the Charity a wider sphere of usefulness; it will help to arrest in the earliest stages the progress and the consequence of disease, and, by a free and gratuitous tender of advice and medicines, will place within the reach of all the several benefits attaching to the Hospital Department of the Institution.50
Thirty years later, R. W. Coe of the Bristol Lock Hospital continued to use the same rhetoric in support of his work.51 The hospital bill issued under Kinnaird and Coote, combined calls for funds with persuasive visual rhetoric. On the bill, the juxtaposition of the number of beds in the hospital with the total sum of those that can be occupied precedes a short, suggestive description of the institution’s singularity (“the only one of the kind in the Metropolis”) and its dire financial situation (“NO INVESTMENTS, NO ENDOWNMENT, and NO GOVERNMENT SUPPORT”) (Kinnaird and Coote 1892: 17). The emphasis, however, quickly shifts to the asylum to communicate its success rate: “The Asylum is a ‘Rescue Home’ for those patients who wish to give up their former mode of life. MORE THAN ONE-FOURTH of all who pass through the Hospital are thus rescued” (17). The bill focuses on the importance of lock hospitals as institutions integral to the system of health provision ( “Many cases are sent to it from the London General Hospitals, and from all parts of the country”) (17). Its significance for the metropolis and the whole country is further connected to the ‘Rescue Home’, whereby the lock becomes vital to reformative work. The accompanying print of the hospital buildings supports its claim to being a site of salubriousness. With the rhythmically repetitive parallel floors and towers, the hospital’s architecture bespeaks confinement, regulation and order.
The financial insecurity of lock hospitals indicates the extent to which the institutions occupied an ambiguous position on the margins of visibility. In order to ensure their future, they had to become visible. However, this visibility was from the start problematic on account of the nature of their preoccupations and the type of patients they admitted. They had to tailor their mission and reshape their own public appearance to be regarded as worthy of charity funds. It goes without saying that the discrepancy between lock hospitals as conceived by their founders and as perceived by society was particularly acute: their perceived and conceived spaces diverged.
Lock hospital architecture and facilities seldom exhibited the level of orderliness called for in the century of hospital reform. Often situated in old, refurbished buildings, with little funds and even less public appreciation, lock hospitals were far from meeting the sanitary standards Florence Nightingale or George Godwin (editor of the Builder) campaigned for.52 Growing pressures of urbanization, changes in medical procedures and technologies and legislative improvements of sanitary conditions had influence on hospital architecture (J. Taylor 1997: 15). Effective sanitation and drainage, adequate (natural and artificial) ventilation and efficient architectural planning became the major criteria underlying the establishment of new medical premises. Purpose-built, specialist hospitals, novel ward schemes, with the pavilion as the architectural pinnacle of progress, and a shift from small-scale hospitals to large-scale building complexes were some of the characteristic new developments. The quality of the new sites (with preference given to rural, suburban, healthy areas), their building materials and interior decoration became hotly discussed subjects (J. Taylor 1997: 26).
In the context of these public debates, lock hospitals continued to exist on the margins of visibility. Bristowe and Holmes ostensibly neglect the subject in their parliamentary report:
there is no medical objection to the establishment of Lock hospitals, if they should be thought desirable; but as there is also little medical necessity for such foundations, as they are at present constituted, to hold a few of the patients of a large city, we have not thought it needful to go into the question of their construction and management. (1864: 478)
Lock hospitals appear to have equally been of little significance to architects. In his monumental four-volume work on British hospitals and asylums, Burdett casts a cursory glance at such facilities. His description of the London Lock Hospital is indicative of the conception and workings of its infrastructure:
The building consists of a long straight block, with central corridor and two wings, one at each end, and the chapel projecting out in the centre. On the ground floor, the east wing contains the main entrance and resident officer’s and matron’s rooms. The central portion contains secretary’s offices, ladies’ committee-room, kitchen offices, dispensary, patients’ waiting-room, vestry and anteroom to chapel. The west wing contains the asylum, dining-room, laundry, washhouse and mangling-room. On the first floor the east wing and the greater part of the central portion is devoted to sick wards and nurses’ rooms. There is no disconnection between the wards and the closets, and there is a room in close proximity to the wards called the “foul linen-room” - a most objectionable feature. A small portion of the central part is devoted to the asylum probationers’ work-room and asylum clothes-room, and the east wing contains the asylum dormitories. At one end of the latter a water- closet is placed in the corner, opening directly into the dormitory. (Burdett 1893: iv, 308)
The London Lock, like many other such facilities, lacked proper sanitary amenities. Lewis Vulliamy, the architect of the Westbourne Green premises, for instance, was, as David I. Williams notes, more interested in the outline of the chapel than in the layout of the wards, which resembled, in their crudeness, those of the adjacent workhouse (1995: 65). The provisional character of most of the facilities obviously made the implementation of the latest sanitary trends difficult.
Contemporary commentators bemoaned the state of sanitation in lock hospitals and lock wards. In his appeals for funding, Lowndes paints a bleak picture of the newly erected facility in Manchester (1874), which, seven years into its existence, remains unfinished, with unpainted wards as synecdoches of this artefact of neglect (1882b: 12-14). Bristowe and Holmes regard the wards as dirty and disorderly, due to the habits of their inhabitants and little hospital supervision:
Phagedaena is, we believe, slightly more common in such wards than in those of the general hospital, but then the patients are for the most part of dirty habits and broken down constitution. The less interesting nature of the cases, and the remote position of the wards, [... ], we believe, tend to render the visits to this part of the hospital less frequent, and therefore to check the supervision which they so much require; hence such wards usually appear less cleanly and less well ventilated than the rest of the hospital. These two objections appear to us to be supported by facts, but we do not urge them as of any decisive weight. (1864: 475)
The wards take the appearance of a disorderly, suffering body. Like its patients, the constitution of the hospital is broken. In his history of the
London Lock Hospital, Williams makes a similar comparison as he holds the out-patients of the Dean Street Male Hospital responsible for its worn- down condition: the patients “put an intolerable strain on the old house” (1995: 112). Converted from a mid-seventeenth century residential building, the hospital did not approximate the new standards.53 The male branch of the hospital was badly ventilated, especially the upper floor, with its very low ceilings. The windows of the ground floor had to be locked in order “to prevent alcoholic drinks being passed up from the streets the Hospital having in its read a large number of very low class swelling houses.”54 In the “Report of Royal Commission upon the Administration and Operation of the Contagious Diseases Acts,” the refurbished facilities in Aldershot, described as “a long galvanized iron hut, lined with wood, having windows on each side,” allegedly performed the new duties very well (1871: 41). Burdett mentions in his elephantine volume that the Madras Lock Hospital is in fact “a bungalow utilised as a hospital” with a central hall and with four wards on each floor (1893: vol. iv, 222). Commenting on the facilities in the Colchester Lock Hospital, its matron, Miss Brown bemoans its spartan arrangements, and complains that there was no chapel in the complex and that, for lack of separate facilities, women had to eat in the same rooms where they slept, which was a frequent cause of disorder (1871: 645). Indeed, the plans of the wards (Fig. 5.3) show the bare purposefulness of the rooms and their austerity. With the scullery and nurse’s chambers on one side and with sanitary facilities on the other, the regular ward was a corridor-like, long room with windows and cupboards on both sides. In the segregation ward, the beds were placed in close vicinity to one another; the room itself was separated from the single-bed separation ward by the nurse office and sanitary facilities.
These unfavourable conditions were often exacerbated by the type of health provision the institutions offered. In the colonial context, Bushnell and Andrew commented on the most basic equipment of many facilities, where a speculum, some syringes and sponges were the only medical instruments they found (1899: 45). David I. Williams emphasizes the backwardness of the London Lock Hospital, with very few medical practitioners who believed in new types of therapy or contributed to the state of current knowledge and who often expressed outdated views concerning the disease (1995: 102-3). By the end of the nineteenth century, two medications were used to treat syphilis: mercury and iodine ofpotassium, with the latter being employed in cases in which mercury treatment brought no visible effects (Hutchinson 1887: 47). According to
Fig. 5.3 Colchester Lock Hospital, detail, 1867. National Archives, London
Hutchinson, iodines were ineffective in early stages of the disease and their success was proportionate to the period elapsed after the appearance of primary symptoms. Inunction - rubbing of a mercury ointment - was the most commonly used method. It was necessary to apply it to different parts of the body in order to avoid eczema: chest, abdomen and thighs were the most convenient of places for this action. Hutchinson recommended an evening routine, improved by the use of a flannel gown and by the avoidance of ablution before sleep and followed by a warm bath in the morning (1887: 57-8). Fumigation baths were another method of administering the cure: a form of mercury known as calomel was heated over a lamp and with watery vapour set on the patient’s skin, after which, wrapped in flannel, the patient was advised to go to sleep (58-9). Hutchinson considered these methods as more effective than oral intake, albeit more difficult to execute. A hypodermic injection of mercury was, according to him, rare in Britain, but was used by Astley Bloxam in the London Lock Hospital for reasons of efficiency and easiness of application. Mercury had to be injected into the muscle over a period of approximately three days to produce adequate salivation (Hutchinson 1887: 59). As far as the administration of iodines is concerned, Hutchinson recommended their small-dosage application in combination (iodines of sodium, potassium and ammonium) (60).55 A number of precautions had to be taken to ensure the proper administration of mercury, which in itself is a poison. The observation of a patient’s kidney functions and the body weight were fundamental in this respect. Proper hygiene, especially the hygiene ofthe mouth, was recommended to prevent the deterioration of the teeth. A healthy diet, outdoor exercise and an avoidance of alcohol and smoking were the major recommendations (Keogh et al. 1907: 124-9). The schemes of treatment varied from a continuous application ofmilder doses ofmercury to intermittent treatments, which started with a high dosage and successively diminished it as the symptoms regressed (136-7). The Pharmacopoeia in Use at the Male and Out-Patient Department of the London Lock Hospital (1887) offered a specification of the dosage and composition ofvarious forms oftreatment.
No doubt, the treatment offered in such facilities was dependent on an array offactors such as the financial situation, the conditions ofthe venue or the available medical and nursing services. While the conceived space of the lock hospitals highlighted their reformative character, their lived space was a much more complicated, symbolically laden site, co-produced by patients, medical and nursing staff, subscribers and the general public on the one hand and the function that the facilities gained in late Victorian society on the other.56 As sites of particular visibility of venereal patients, they were also frequently ignored in larger debates concerning health provision. Of little interest to medical reformers and architects, they were makeshift buildings that often offered basic accommodation and medical services for those suffering from the disease. Despite their conceived hierarchies, these spaces were frequent sites of porosity that, paradoxically, offered a stage for the individual usurpation of civil rights.