Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting (review)

The editors of this volume on visits to medical institutions are to be commended for compiling a rich collection on what they rightly say is "an under-studied constituency in medical history" (p. 7). Based on two sessions at North American conferences, the book consists of an introduction and twelve case study chapters, which range chronologically from the eighteenth to the late twentieth century and include contributions from the United States, India and Ceylon, China, Australia, and New Zealand as well as Britain. The chapters are organized according to type of institution, beginning with general hospitals and moving on to specialist children's hospitals, isolation hospitals, lock hospitals, and mental asylums.

In their introduction, the editors attempt to impose order on this diversity by identifying four types of visitor (patient, public, house, and official) and drawing on Foucault's concept of governmentality and Habermas's notion of a bourgeois civil society to distil themes like "governance," "norms of conduct," and "citizen formation" (p. 23). These strategies are not entirely successful. The ubiquity of house visitors means that discussion of their role becomes repetitive. On other occasions, visiting itself has too low a profile, most notably in the near-contemporary account of how parents experienced childhood cancer at a Pittsburgh hospital. However, contributions like the exploration of public visits to New York's nineteenth-century asylums exemplify the historiographical sophistication to which the editors aspire. As the author concludes, "Although segregation manifests in both spatial and psychological ways and the walls of the asylum were never erased, isolation was never complete nor was it even an objective embraced unilaterally by either asylum officials or the public" (p. 260).

Other chapters confirm the porous nature of institutional seclusion. At asylums in Australia and New Zealand between 1860 and 1945, balls and sporting events were designed to attract visitors from the local community. Moreover, in the American mission hospitals of China, established from the mid-1830s, families and friends were welcomed not just for entertainment but as "companions, advocates, intermediaries or nurses" (p. 65). Elsewhere, however, visitors were viewed as in need of reformation, with mid-Victorian isolation hospitals instructing them on how to limit the spread of infection. But more often outsiders were agents for reform. At the eighteenth-century London Lock Hospital, clerical visitation was thus applied to the rehabilitation of venereal patients, while at the Great Ormond Street Children's Hospital—also in London—women, though excluded from the management board, were "welcomed on the wards as agents of maternal socialization, bringing the breath of the well-ordered and comfortable Christian home to the working-class patients" (p. 91).

Women's professional as opposed to philanthropic ambitions were pursued at the early-twentieth-century Jenny Lind Hospital in Norwich where, by barring relatives, nurses sought to demonstrate that "the skills required to care for the sick hospitalised child were beyond those held by the untrained parent" (p. 123). Professionalized inspection of English lunatic asylums had been achieved between 1750 and 1850 as the Commissioners in Lunacy—intent upon regulating the private sector and encouraging higher standards in the voluntary and public sectors—"translated the ideals of visitation into reality" (p. 215). In the British Empire, however, the expert witness dispatched to bring about improvements had limited powers. Therefore, when in 1937 the medical superintendent of the Maudsley Hospital in London visited mental hospitals in India and Ceylon, his recommendations were only selectively acted on by local bureaucrats and politicians.

Permeable Walls shows that hospital and asylum visiting raises key issues for historians: family and community, class and gender, professionalization, social control, the state, and imperialism. It is a pity that its engagement with them is uneven.