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Permeable Walls: Historical perspectives on hospital and asylum visiting

July 22, 2010

By Diana E Manuel

While the subtitle alone could have sufficed for this attractively produced work, the short main title emphasises the fact that hospital walls could, did and still do act as barriers controlling the range of visitors entering them.

The institutions under scrutiny include general hospitals, isolation hospitals and those specialising in mental disorders, children’s conditions and venereal diseases. Their diverse locations are mainly in English-speaking former colonies and the timespan the two centuries from 1750. This long period offers the possibility of indicating some of the major changes in for instance the rule-bound management practices and fundraising, the therapies available, the nature and quality of staff handling the patients, and the hospitals’ relations with their surrounding communities. In her essay on New York asylums in the 19th century Janet Miron suggests that these hospitals were deeply embedded with the social and cultural landscape of the time.

The editors, in addition to their valuable joint introductory chapter, each contribute a further significant chapter. Graham Mooney writes on isolation hospitals and Jonathan Reinarz on hospital visiting in 19th-century provincial England. The chapters as a whole deal eloquently with the underlying relationships, highly complex and sometimes controversial, between the hospitals and their visitors, especially parents in the case of sick children.

The visitors to the hospitals included family members (generally not children), and other members of the public such as entertainers and members of religious groups, although in some hospitals nuns could be part of the hospital staff. Other visitors were salaried officials such as inspectors, whose responsibilities were to monitor and report on the performance of and conditions within the different institutions. The inspectors were often steered away from ‘unfavourable’ or potentially sensitive aspects of the hospitals. Most welcome of all the visitors were those – especially philanthropists – who made financial contributions.

There were perpetual efforts by the hospitals to deflect attention away from the doctors. But the authors pay some attention to the professionalisation of medicine, including reference to the status of regular physicians compared with that of the so-called ‘mad doctors’. The famous illustration of the ‘Twelfth Night Entertainment’ in Hanwell Lunatic Asylum, to the west of London, which appeared in the Illustrated London News in 1848 is included. There is, however, no mention of the physician John Conolly, who, having earlier served as the Resident Physician to Hanwell, resigned his professorship in the University of London (University College London) because medical students were not allowed to visit patients in lunatic asylums. Nor is there mention of his contemporary Marshall Hall, who was widely consulted in his central London practice for nervous disorders and who was involved in establishing the specialist hospital for nervous disorders in Queen Square in Bloomsbury. Hall also made fortnightly visits out to Moorcroft Asylum in Uxbridge, west London, where one of his patients composed a birthday poem to him.

Mooney G, Reinarz J (eds). Permeable Walls: Historical perspectives on hospital and asylum visiting. Amsterdam/New York, NY: Rodopi; 2009.

Dr Diana E Manuel is Honorary Senior Research Fellow at the Wellcome Trust Centre for the History of Medicine at UCL.

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