Venereal Disease, Hospitals, and the Urban Poor: London's "Foul Wards," 1600-1800 (review)

This social history of venereal disease in early modern London is a welcome addition to a field that has produced rich intellectual histories of venereal disease but few social histories. Social historians have concentrated on the nineteenth and twentieth centuries, leaving many unanswered questions about how widespread the "pox" was, and who its principal victims were, in the early modern period. By mining early modern hospital and asylum records, Kevin Siena is able to disprove the hypothesis that few, usually only the rich, suffered from the pox: on the contrary, it afflicted approximately 20 percent of hospital patients during the seventeenth century. Because the disease was so widespread, virtually every charitable institution was forced to deal with its consequences, including London's infamous workhouses.

Siena is adept at handling the complex methodological and theoretical issues that face historians of medicine. In early modern London, the pox was a single disease that initiated with a "clap"—a burning sensation when urinating, or a discharge from the genitals—and, if left untreated, progressed to a pox, when the disease's poison passed into the rest of the body. By interweaving patients' and physicians' descriptions of the pox, Siena is able to both explain the particular, historical understanding of this disease and convey the suffering that patients endured. To argue that the pox was a culturally constructed category is not to deny the historical existence of disease.

Suffering, shame, and the consequent desire for privacy dominated patients' experience of the pox. Medical privacy was, however, an expensive commodity, available only from private physicians. The rich could shield themselves from stigma, while the poor exposed their reputations when seeking care at one of the royal hospitals. Despite the shame associated with the pox, hospitals accepted these patients: both St. Bartholomew's and St. Thomas's hospitals accepted pox patients from at least 1549 and 1556, respectively (the dates of the oldest surviving records). A pox diagnosis was, in fact, one of the primary reasons for seeking hospital care during the early modern period. Although medical care was available, stigma took its toll in other ways: pox patients had their diagnosis disclosed publicly in their home parishes; they had to stay in "foul" wards isolated from the "clean wards"; and, after the 1666 Great Fire of London imposed widespread financial hardships on institutions, pox patients had to pay higher fees than other patients. Men were more likely to gain admission to the foul wards than women, because men were less likely to face disapproval and were more able to pay hospital fees.

Because hospitals were unaffordable, other charitable institutions found pox patients on their doorsteps. Unable to work due to illness, patients fell into destitution. Many sought relief in London's workhouses, originally designed as moral and social reformatories to eradicate the perceived idleness and apathy of the poor. As Siena effectively shows, the fundamental engine of poverty was not idleness, but disease, especially (but not only) the pox. Disproportionately female, workhouse residents faced a difficult, regimented life—but the workhouse was often their only option, since at least it offered medical care and shelter.

By examining the network of charitable institutions engaged in care of the sick, Siena provides a more complete picture of early modern medical care and offers a fresh perspective on certain institutions' roles. London's eighteenth-century Lock Hospital, for example, filled a niche created by changing migration patterns: rural migrants who were ineligible for public hospital admission could turn to this new private hospital. For historians of early modern Europe and specialists in medical history alike, Siena has provided a perceptive, carefully researched monograph.