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

Venereal Disease, Hospitals, and the Urban Poor is a historical view of the treatment of venereal disease in early modern London, spanning the 17th through 19th centuries. The author seeks to understand how the English social welfare system responded to the considerable problem of sexually transmitted diseases among its poorest urban residents. Siena provides a broad variety of perspectives, including demographic and institutional analysis from official records, along with the lived experience of dealing with the disease as reported in diaries and letters. Both cross-sectional and longitudinal perspectives are used to provide a good comprehensive coverage of the subject. A diagnosis of venereal disease during this period could include a range of conditions such as urinary tract infections, gonorrhea, and syphilis. Treatment consisted primarily of mercury, which caused intense salivation and other, toxic side effects. This was consistent with the contemporary medical paradigm of disease as an imbalance of humors. Alternative therapies were available to those who could afford them, but nothing is known to have been effective before the age of antibiotics. The author emphasizes throughout that the delivery and availability of services differed greatly between classes and especially genders, essentially constituting a two-tiered system. Personal privacy and shame played central roles for patients. It was difficult if not impossible to hide the condition from peers, employers, or neighbors. In addition to any visible, dermatological effects of disease, the treatment itself required weeks of isolation and mercury-induced salivation in a “foul ward.” A certain amount of privacy and discretion was available, but only at a price. Some physicians would keep late hours, provide treatment by mail, or provide a female practitioner for examinations. For the poor, the only choice was to submit to the public shame of visible examination and interrogation, which led many to delay or avoid treatment. The stigmatizing nature of these diseases was disproportionately hard on the poor and, as the author notes, just having the disease could impoverish its victim. The admissions process for the public hospitals varied somewhat over the period, but typically required the patient first to obtain a nomination from the local parish official or hospital administrator. Once eligible, patients had to gather periodically so that a committee could choose which patients received the limited number of beds in the wards. Patients or their sponsors had to post a bond for burial expenses should the patient die during treatment (an early form of life insurance). In addition, for most of the period the patients who were assigned to foul wards were charged higher fees than “clean” patients.