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  • Venereal Disease, Hospitals and the Urban Poor: London’s “Foul Wards,” 1600–1800
  • Mary Fissell
Kevin P. Siena. Venereal Disease, Hospitals and the Urban Poor: London’s “Foul Wards,” 1600–1800. Rochester Studies in Medical History. Rochester, University of Rochester Press, 2004. 280 pp. $80.

Kevin Siena has written an insightful book about people who were twice down on their luck in early modern London: poor and poxed. The book opens with a valuable reminder to the post-penicillin world that the so-called foul disease—cognate to what we call syphilis—was a horrifying ailment that brought much shame and suffering to its victims. Nor was treatment much better. "Salivation," or treatment with large quantities of mercury, was so nasty that Siena has found a few examples of individuals who chose suicide instead. Siena reconstructs the choices for the more fortunate who could afford treatment, using advertisements, and it is clear that a substantial proportion of the medical marketplace specialized in the treatment of venereal disease, in part because the demand was great.

This book's real contribution lies in its careful archival work, which enables Siena to reconstruct the options for care for the poor. First, as in so [End Page 223] many other cases, poor people were clever users of the system when they could be—finding ways to get the treatments they deemed necessary by hook or by crook. And "system" it was—Siena shows that the old royal hospitals, St. Bartholomew's and St. Thomas's, took in so many venereal patients that they created whole separate accommodations for them at the edge of the city, away from the more deserving objects (those without venereal disease). Getting a bed in one of these wards was not easy and could be shameful. Patients either had to pay out of their own pockets, which was not usually affordable for the working poor, or they had to persuade their parish to pay for them under the local welfare system (the Old Poor Law). This latter option involved telling one's sad tale to a series of one's betters, publicly admitting to having contracted a very shameful ailment. But confess they did, because there was little other recourse for free treatment. Siena's work offers a useful corrective to our understanding of the city hospitals, which were taking in substantial numbers of paying patients. Our assumption has been that venereal patients were always excluded from English hospitals (with the exception of the purpose-built Lock Hospital) in this period, and that few, if any, patients paid for a bed. He also shows that institutional care was a bigger piece of the health-care system in London than we had thought.

Siena shows how gender as well as class shaped the foul disease. Women had tougher experiences than men, he suggests, both because they had to tell their shameful tale to male authority figures, and because they had fewer economic resources than men—as many as three-quarters of the royal hospitals' poxed patients were female. When the Lock Hospital, built for sufferers of the foul disease, came under the influence of evangelical reformers in the 1780s, it deployed new ideas about women's domesticity and disciplined female patients with new strictness, creating even greater divides between male and female patient experiences.

It is a pleasure to read a book so deeply grounded in archival work; Siena's extensive research offers new perspectives on health care in early modern England. First, he dispels any lingering ideas about the happy, unrepressed, pre-Victorian days of jolly sexuality in which venereal disease was just a minor inconvenience. The foul disease was horrible, dangerous, and shameful. Second, like other scholars, he shows poor patients to be resourceful players in a jerry-built system that met their needs imperfectly at best. As always, ideas about morality and gender shaped health care for the poor, and especially for the poor with venereal diseases.

Mary Fissell
Institute for the History of Medicine, The Johns Hopkins University, Baltimore, Maryland 21205.
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