The London Lock Hospital in the Nineteenth Century

← viii | ix → Illustrations

Picture of Anne Sewell, 4th September 1850, Portrait by J. Holt, Patients’ Records, the Library, Royal College of Surgeons of England, MS0022/6/6.

Picture of William Bentley, 23rd April 1850, Portrait by J. Holt, Patients’ Records, the Library, Royal College of Surgeons of England, MS0022/6/6.

Picture of the child of Mary Ann Agnes, 2nd May 1850, Portrait by J. Holt, Patients’ Records, the Library, Royal College of Surgeons of England, MS0022/6/6.

Front Cover Appeal for 6,000 pounds to complete the Asylum for Female Penitents, Cuttings Album, the Library, Royal College of Surgeons of England, MS0022/11.

Front Cover Report 1839, Cuttings Album, the Library, Royal College of Surgeons of England, MS0022/11.← ix | x →

← x | xi → Acknowledgements

This monograph is the result of many years of hard work on the issue of fallen women and prostitution in the nineteenth century in England and on the archives of the London Lock Hospital and Asylum which are kept in the Library of the Royal College of Surgeons of England, in Lincoln’s Inn Fields, London.

My deepest gratitude goes first to my dear friend and colleague, Professor Logie Barrow from Bremen University, Germany, who is an academic with a solid career and academic prestige in the history of the working classes and the history of medicine in the United Kingdom. Without his support and advice this monograph would have never seen the light. I also want to express my gratitude to the librarians and archivists at the Library of the Royal College of Surgeons of England because they have always been helpful and supportive in the difficult process of taking notes from archival materials and locating manuscripts for my research. My special thanks go as well to my research leader and friend, Professor Pilar Cuder, and my colleague and friend, Dr. Beatriz Domínguez, both from the University of Huelva in Spain, for their constant encouragement and for believing in me as an academic; also, I wish to show my gratitude to my dear colleague, Dr. Blanca Krauel, from the University of Málaga, for being my friend and counselor through hard times of professional and personal challenges. I am also indebted to Professor Cora Kaplan from Queen Mary University of London, and Dr. Paulina Palmer, retired from Warwick University, who have always encouraged me in my academic projects and given me their friendship and advice. Finally, I would like to put in words my gratitude to my family, and especially to my parents and my children, who are my inspiration in life. To all of them I dedicate this work.← xi | xii →

← xii | 1 → CHAPTER 1

Introduction: The London Lock Hospital and Asylum and Specialist Hospitals in the Nineteenth Century

Although several publications have focused partially or as a whole on the London Lock Hospital and Asylum archives, which can be found at the Library, Royal College of Surgeons of England in London, none of them has taken into consideration the role of these two institutions in the rescue and cure of fallen women in the nineteenth century.

David Innes Williams in his 1995 book, The London Lock: A Charitable Hospital, 1746–1952, writes a careful history of the Hospital from its foundation in 1746 to its closure in 1952, analysing different periods in relation to aspects such as the treatment of venereal disease, medical theory and practice, the patients, the staff, the governors, finance, the Chapel and chaplains, the buildings and the situation of the Hospital and Asylum at the different stages of their existence. Williams’ work constitutes a comprehensive volume essential for the scholar who wishes to have a general encompassing approach to the history of the hospital. A narrower aim is achieved in the case of the book published by Kevin Siena in 2004 entitled Venereal Disease, Hospitals and the Urban Poor: London’s Foul Wards 1600–1800, which devotes two chapters to the London Lock. Throughout his work, Siena analyses the role of Royal Hospitals and Poor Law Infirmaries in the cure of venereal disease in the destitute poor as well as the creation of lock hospitals which came to complete the offer of medical institutions for “foul” patients in London. However, his endeavours to come to terms with the social and hospital treatment of the pox are centred on the history of the eighteenth century. The same happens with two other contributions that deal with the institution: Donna Andrew’s chapter on the London Lock Hospital and the Lying-in Charity for Married Women ← 1 | 2 → included in the 1994 book by Jonathan Barry and Colin Jones Medicine and Charity before the Welfare State; and Linda Merions’ 1997 edition The Secret Malady: Venereal Disease in Eighteenth Century Britain and France, where she writes a chapter where she explores the Lock Asylum for Women in the eighteenth century.

Other scholars have also focused their attention on different reform institutions and hospitals in the nineteenth century. One of them is Judith Walkowitz’s Prostitution and Victorian Society: Women, Class and the State (1980), which touches on the Royal Albert and the Royal Portsmouth, which had lock wards for women in Southampton and Portsmouth respectively; another is Frances Finnegan, whose Poverty and Prostitution: A Study of Victorian Prostitutes in York (1979) talks about rescue and reform at the York Penitentiary. This Penitentiary had many similarities with the London Lock regarding the running of the institution, its propaganda to obtain funding and its aims at reforming and teaching prostitutes and fallen women; her later Do Penance or Perish: A Study of Magdalene Asylums in Ireland (2001) analyses the characteristics of these places of confinement in Ireland which were dominated by the Catholic approach to rescue work; and Linda Mahood’s The Magdalenes: Prostitution in the Nineteenth Century (1990) deals with the Glasgow Lock Hospital and Asylum in several chapters as a an example of a Scottish institution for the reform and cure of Victorian prostitutes.

The topic of Victorian social reform on the part of the middle class and of private and public institutions for the cure and restitution of deviant women can also be found in the work of other scholars in a more general way. This is the case of social history writers such as Louise A. Jackson, focusing on social reform with fallen girls in her 2000 Child Sexual Abuse in Victorian England, and Paula Bartley, who writes about reform institutions in general, dealing with fallen women in Prostitution: Prevention and Reform in England, 1860–1914, also published in 2000.

This book aims throughout its chapters to analyse the London Lock Hospital and Asylum archives for the study of aspects concerning the cure of venereal disease in the nineteenth century and the treatment and reform of fallen women. Issues of gender and female sexuality will become the centre of debate together with the policing and regulation of deviancy ← 2 | 3 → in the working classes, and particularly in women. For that, a brief history of the reform movement and the spread of specialist hospitals in England together with a history of the Hospital and Asylum will be included in order to establish the background for the treatment of venereal disease as far as prostitutes and fallen women are concerned. Similarly, the application of middle-class standards of behaviour and respectability will be studied in the light of Hospital regulations in the nineteenth century, and also in the functioning of the Asylum as an institution with the purpose of reforming female penitents and restoring them back to society as decent working-class women. After that, the impact of the application of the Contagious Diseases Acts in the running of this charity following the Reports and Accounts of those years will be the object of my concern. After that, focus will shift to the impact of the application of the Contagious Diseases Acts in the running of this charity via the Reports and Accounts around the time of those Acts. Finally, the changes brought about by the end of the century with their emphasis on child prostitution, white slavery and new perspectives on rescue work and purity, and the extension of the work of the Lock to other elements in the charity movement will round off my efforts to portray a critical image of the moral and medical activities carried out in the Hospital and Asylum to help those individuals suffering from extreme poverty and from the “most dreadful disease”.

Specialist hospitals and voluntary hospitals began to proliferate in the eighteenth century. At the same time, modern medicine was born – at least if we follow what Foucault describes as “the birth of the clinic” with its associated expert (“clinical”) gaze – and helped generate the new concept of hospital medicine.1

The case of British specialisation was especially slow and difficult in comparison with France and the rest of the continent, because it faced strong hostility. In the eighteenth century, there were bonesetters, dentists, oculists and specialists in venereal disease who were considered as quacks and worked outside the regular profession which was dominated ← 3 | 4 → by physicians and surgeons. Similarly, in the late eighteenth and early nineteenth centuries, specialist surgeons began to appear, becoming ophthalmic surgeons, surgeon-dentists and orthopaedic surgeons; however, the most popular field of specialisation was midwifery.2

The British medical profession was first divided into three groups: physicians, surgeons and apothecaries. The 1815 Apothecaries Act stipulated that licenciates of the Society of Apothecaries attend various lectures and pass its examinations; they also had to spend six months in a hospital, dispensary or infirmary to finish their training. At the beginning, surgeons had a lower social status than physicians and were allowed to treat patients externally but not internally; physicians thus constituted the elite of medical practice. Getting the education and training to become a doctor was very expensive, and medical men usually came from the upper classes. Scottish Universities like Edinburgh, Glasgow, St. Andrews and Aberdeen all had medical schools, so the majority of doctors graduated from them. At the beginning of the nineteenth century, most medical teaching was obtained from private schools and only three London Hospitals had medical schools: St. Bartholomew’s, the United Hospitals (St. Thomas’s and Guy’s) and the London; similarly, the early 19^th century saw the founding in London of two university colleges, King’s and University, where medical teaching was carried on. But doctors also needed the training in hospitals to get qualified, and those who got their teaching from provincial medical schools in hospitals could sit this university’s examinations. Oxford and Cambridge students could get their training and research in the London hospitals, but then they were examined by their universities.³

The passing of the 1858 Medical Act represented a crucial step in the history of British medicine. The old system of qualification by apprenticeship was substituted by a formal education based on lectures and written ← 4 | 5 → examinations based on a syllabus together with training in hospital wards and textbooks which would allow medical students to have a knowledge of a range of diseases in order to be able to identify and to treat them. This new legislation did not exclude certain “unqualified practitioners such as homeopaths, herbalists, naturopaths and quacks” but established the Medical Register which was published annually to ensure that all doctors were properly qualified. There were several medical corporations in Britain which included the Royal College of Physicians, the Royal College of Surgeons, the Society of Apothecaries and the Royal Colleges or Faculties in Edinburgh, Glasgow, and Dublin. Both these corporations and universities or hospital medical schools could now examine and certify candidates to practice medicine. With the Act, requirements and qualifications from medical schools were established and a General Medical Council was created to keep the Medical Register and to monitor the ethical and professional behaviour of doctors. Posts for which qualified doctors could apply were those in hospital consultancies, public vaccination, asylums, prisons, the colonies, the Poor Law and the public health service.4

The three categories of doctors were later replaced by General Practitioners and elite Consultants in the second half of the nineteenth century, and this fragmentation was certainly a serious obstacle in the process of specialisation of British medicine. The medical elite in the Royal Colleges saw the latter as a threat. This medical class did not want to lose their situation of power and privilege and, as a consequence, did not want to spread medical and clinical knowledge which was circumscribed to a circle of gentlemanly doctors who were appointed through a system of patronage to purchase hospital posts. The lack of a unified education system with competing hospitals and medical schools was equally a hindrance in the advancement of medical specialisation.⁵

Despite all this, an increasing number of specialist hospitals did appear in the eighteenth century, and this tendency continued growing in the ← 5 | 6 → nineteenth. These hospitals were usually private and catered for those patients who were not accepted in voluntary hospitals, like the mentally deranged, women in labour and those suffering from various types of fever and venereal disease. They were run with the support of philanthropists who could bring them a reputation and a rich private clientele. Many of these hospitals charged a certain amount of money for their services and became very popular among the middle classes as “they were ‘free from the stigma of charity’ which blighted general voluntary hospitals”.6 In the first half of the nineteenth century there were in London 27 specialist hospitals, infirmaries and dispensaries, of which 12 had survived from the eighteenth century, and 22 in the provinces. The Royal Colleges of Physicians and Surgeons did not want to accept specialist doctors among their members and such doctors were largely ignored in the medical press.⁷ As a result, specialisation was taken up by ambitious doctors who had been excluded “for religious, educational or social reasons from posts in general hospitals”,⁸ establishing competing small institutions based on the philanthropic and voluntary model, representing a menace to the general voluntary hospitals as the public responded enthusiastically to this new endeavour. Examples of specialist hospitals established in the nineteenth century were the Eye and Ear Infirmary, later known as “Moorfields” opened in 1805, the Royal Ear Hospital run in Soho from 1816, St. Mark’s Hospital for Fistula and other Rectal Diseases founded in 1835, the Royal Orthopaedic Hospital and the Metropolitan Ear and Throat Hospital both opened in 1838, the Brompton Hospital for lung and heart diseases founded in 1841, the Hospital for Sick Children established in 1850, and the National Hospital for Nervous Diseases set up in 1859.⁹ Thus the natural consequence was that general hospitals began to add specialised departments to their traditional resources between 1855 and 1875, although they systematically appointed ← 6 | 7 → non-specialists to their specific wards, but later in the century it began to be possible to develop a good specialist career in general hospitals. The reasons for the acceptance of this new situation were that Britain had to come to terms with European medicine which was based on clinical research and specialisation; the gradual intervention of the state in the health system; and the attempts at administrative and professional unity made by the advocates of medical reform.10

At the beginning of the eighteenth century, there were two major hospitals in London, St. Bartholomew’s and St. Thomas’s which had been founded by religious orders and were then taken over by the City of London, becoming Royal Hospitals. These hospitals had to admit any patient that required medical assistance, and they used to have “foul” wards or outhouses where the venereally diseased were treated. This period saw the birth of the Voluntary Hospital Movement which endorsed a health system for the poor that relied on charity.¹¹ Hospitals always had difficulty meeting their running costs as far as medical supplies, wages and maintenance of the buildings were concerned. Funding was obtained through a variety of sources which included voluntary subscriptions, church collections, bequests from wills and donations from benefactors, besides diverse charity events like annual fairs, musical festivals, sermons in the chapel, banquets, etc. Annual subscriptions were paid by rich or otherwise conspicuous members of the community, and this pecuniary contribution entitled them to become governors and recommend a certain number of in- or out-patients to the hospital per annum. Subscribers who paid an important sum could become governors for life. In this respect, the roles of the Treasurer and Collector were essential for keeping and increasing the number of annual subscriptions, and with that aim the role of the institutions in the cure and treatment of patients was praised in the propaganda found in Annual Accounts and the local press of the time.¹² Patients were to be treated ← 7 | 8 → free, and Physicians and Surgeons gave their services without receiving any salary; however, working for these charities gave them prestige and status in the community for the good effects of their generosity on these charitable concerns.13 As we shall see, the London Lock Hospital was both a specialist and a voluntary hospital.