Permeable Walls: Historical Perspectives on Hospital and
Asylum Visiting (The Welcome Series in the History of
Medicine)
Visit the link below to download the full version of this book:
https://cheaptodownload.com/product/permeable-walls-historical-perspectives-on-h
ospital-and-asylum-visiting-the-welcome-series-in-the-history-of-medicine-full-p
df-download/
THE WELLCOME SERIES
IN THE HISTORY OF MEDICINE
Forthcoming Titles:
The Imperial Laboratory:
Experimental Physiology and Clinical Medicine
in Post-Crimean Russia
Galina Kichigina
The Stepchildren of Science:
Psychical Research and Parapsychology in Germany, c.1870–1939
Heather Wolffram
The Wellcome Series in the History of Medicine series editors are
M. Neve, V. Nutton, R. Cooter and E.C. Spary.
Please send all queries regarding the series to Michael Laycock,
The Wellcome Trust Centre for the History of Medicine at UCL,
183 Euston Road, London NW1 2BE, UK.
PERMEABLE WALLS
HISTORICAL PERSPECTIVES
ON HOSPITAL AND ASYLUM VISITING
Edited by
Graham Mooney and Jonathan Reinarz
Amsterdam – New York, NY 2009
First published in 2009
by Editions Rodopi B.V., Amsterdam – New York, NY 2009.
Editions Rodopi B.V. © 2009
Design and Typesetting by Michael Laycock,
The Wellcome Trust Centre for the History of Medicine at UCL.
Printed and bound in The Netherlands by Editions Rodopi B.V.,
Amsterdam – New York, NY 2009.
Index by Merrall-Ross International Ltd.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from The Wellcome Trust Centre for the History of Medicine at UCL.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 978-90-420-2599-8
E-Book ISBN 978-90-420-2632-2
‘Permeable Walls:
Historical Perspectives on Hospital and Asylum Visiting’ –
Amsterdam – New York, NY:
Rodopi. – ill.
(Clio Medica 86 / ISSN 0045-7183;
The Wellcome Series in the History of Medicine)
Front cover:
Comical scenes of grand ladies visiting hospital patients with gifts of
cigarettes and cakes. Coloured lithograph after Louise Catherine Ibels, 1916.
Courtesy of the Wellcome Library, London.
© Editions Rodopi B.V., Amsterdam – New York, NY 2009
Printed in The Netherlands
All titles in the Clio Medica series (from 1999 onwards) are available to
download from the IngentaConnect website: http://www.ingentaconnect.co.uk
Contents
List of Figures 1
List of Tables 3
Acknowledgements 5
1 Hospital and Asylum Visiting in Historical Perspective:
Themes and Issues
Graham Mooney and Jonathan Reinarz 7
2 Receiving the Rich, Rejecting the Poor:
Towards a History of Hospital Visiting in
Nineteenth-Century Provincial England
Jonathan Reinarz 31
3 ‘Family-Centred Care’ in American Hospitals
in Late-Qing China
Michelle Renshaw 55
4 Care, Nurturance and Morality:
The Role of Visitors and
the Victorian London Children’s Hospital
Andrea Tanner 81
5 Pariahs or Partners?
Welcome and Unwelcome Visitors in the
Jenny Lind Hospital for Sick Children, Norwich, 1900–50
Bruce Lindsay 111
6 Visiting Children with Cancer:
The Parental Experience of the Children’s
Hospital of Pittsburgh, 1995–2005
Robin L. Rohrer 131
7 Infection and Citizenship:
(Not) Visiting Isolation Hospitals in Mid-Victorian Britain
Graham Mooney 147
8 Stage-Managing a Hospital in the Eighteenth Century:
Visitation at the London Lock Hospital
Kevin Siena 175
9 ‘The Keeper Must Himself be Kept’:
Visitation and the Lunatic Asylum in England, 1750–1850
Leonard Smith 199
10 ‘A Disgrace to a Civilised Community’:
Colonial Psychiatry and the Visit of Edward Mapother
to South Asia, 1937–8
James H. Mills and Sanjeev Jain 223
11 ‘In View of the Knowledge to be Acquired’:
Public Visits to New York’s Asylums in the Nineteenth Century
Janet Miron 243
12 ‘Amusements are Provided’:
Asylum Entertainment and Recreation
in Australia and New Zealand c.1860–c.1945
Dolly MacKinnon 267
13 Challenging Institutional Hegemony:
Family Visitors to Hospitals for the Insane in
Australia and New Zealand, 1880s–1910s
Catharine Coleborne 289
Notes on Contributors 309
Index 313
List of Figures
2.1 The Duchess of York at the Woodlands 46
2.2 The Prince of Wales at the Woodlands 47
3.1 A Family Witnesses an Orchidectomy 68
4.1 Adrian Hope, HSC Secretary,
Escorts Lady Visitors Around the HSC 96
4.2 The Prince and Princess of Wales’s Visit to the HSC,
22 March 1902 97
8.1 The Lock Hospital, Hyde Park Corner, Westminster 184
12.1 Collingwood Lunatic Asylum Ball, Victoria, Australia, 1868 271
12.2 Mr Tucker’s Bay View Private Asylum,
New South Wales, Australia, 1869 277
1
List of Tables
4.1 Distinguishable Male Visitors to the Hospital for Sick Children,
London, 1856–60 to 1876–9 85
7.1 Isolation Hospital Admissions by Age,
Sanitary Authorities in England and Wales, c.1881 156
7.2 Admissions, Deaths and Visitors to Dangerously Ill Patients,
London MAB Hospitals, 1878–81 162
3
Acknowledgements
The idea for an edited collection on hospital and asylum visiting emerged
from two conference sessions. The first, ‘Institutional Visiting’, took place in
2004 at the Annual Conference of the Social Science History Association
(SSHA) in Chicago. The second was ‘Children in Hospital’ at the 2006
Annual Conference of the American Association for the History of
Medicine, Halifax, Canada. We are grateful to the organisers of both
conferences for placing these sessions on the respective programmes. We
have accrued a number of other debts along the way, and it is our pleasure
to acknowledge them. Barbra Mann Wall (School of Nursing, University of
Pennsylvania) served as chair and commentator at the SSHA conference in
Chicago. Her comments and interest in the presentations were very
encouraging to us. Judith Young (Margaret M. Allemang Centre for the
History of Nursing, Toronto) provided Jonathan Reinarz with a tremendous
amount of information and advice. Professors Anne Hardy and Roger
Cooter extended an invitation to Jonathan Reinarz to present a version of
Chapter 2 at The Wellcome Trust Centre for the History of Medicine at
UCL. Carolyn Strange alerted us to other researchers working on
institutional visiting and Marta Hanson pointed us to the contemporary
significance of visiting for equity and rights. The reader for Clio Medica: The
Wellcome Series in the History of Medicine provided helpful comments, while
Mike Laycock and Esther Roth have steered the project skilfully to
completion. Finally, our contributors have been a delight to edit and we
thank them for their patience, promptness and enthusiasm.
Graham Mooney and Jonathan Reinarz
5
1
Hospital and Asylum Visiting
in Historical Perspective:
Themes and Issues
Graham Mooney and Jonathan Reinarz
Compared to doctors, patients and institutions, visitors are an under-
studied constituency in medical history. The collection of essays in this
book situates the historical practice of hospital and asylum visiting in
broad social, cultural and geographical perspectives. This introduction
loosely categorises visitors into four groups: patient visitors, including
family and friends; public visitors, such as entertainers, tourists and the
clergy, who have no direct formal ties with the institution or the patients;
house visitors involved with the management and government of the
hospital; and official visitors, who have inspectorial responsibilities.
Discussion of the wider historical significance of visiting draws attention
to issues such as urban governance, philanthropy, the public sphere, civil
society and citizenship.
Guy Browning’s droll advice on ‘How to… Visit a Hospital’ in The
Guardian’s Weekend 2 April 2005 edition satirises some of the experiences
historicised in this book.1 Browning warns today’s potential hospital visitor
that the ‘smart, middle-aged woman in a uniform… dishing out words of
comfort’ is the cleaner, while the ‘young girl in casual clothing visiting the
old man in the next bed’ is, in fact, the senior consultant; on gifts of food,
visitors should be aware ‘that people who don’t like fruit at home are unlikely
to have developed a taste for it in hospital’; and in the realm of infection
prevention, Get Well Soon cards are to be avoided as they have been
identified as major carriers of the hospital ‘superbug’ MRSA. Of course,
Browning’s spoof would carry little comedic weight if his audience could not
instantly recognise and understand the basis of his lampoon in the first place.
The same applies to the work of the Cornish poet, Charles Causley, who
addressed the subject of institutional visiting three decades earlier in his
7
Graham Mooney and Jonathan Reinarz
poem ‘Ten Types of Hospital Visitor’.2 Causley, like Browning, banks on the
vast majority of his readers having visited a friend or a relative in a hospital.
We would further wager that probably most people’s experience with a
health institution, historically, is as much as a visitor as it is a patient.
The collection of essays in this book is intended to situate the historical
practice of hospital and asylum visiting in broad social, cultural and
geographical perspectives. From them we learn that the scope of visiting
extends far beyond the familial context. It is hoped that these essays will
deepen our sketchy understanding about who visitors were, what visiting
involved and how the practice has evolved from the mid-eighteenth century
to the present day. In a variety of national contexts, visiting in its widest
sense emerges as an intricate set of disputed arrangements and interactions.
Scrutiny of visiting promises, at least partially, to deflect attention away from
patients and doctors, and from the glorification or demonisation of the
institutions themselves. Rather, consideration is given over to a constituency
that is not so much part of the institution as periodically and momentarily
drawn into its ambit. Historical studies of visitors and visiting promise to tell
us much about the changing relationship between institutions and the
communities they serve, particularly at a time when it is becoming more
common to find visitors themselves as the topic of academic research.3
Who were visitors and what did they do? The answers to these questions
are, in fact, complex and encourage us to categorise types of visitor in order
better to understand them. As we shall see, visiting involved the comings and
goings not only of relatives and friends, but also of administrators, managers,
philanthropists, lay care-givers, priests and ministers, entertainers, and
tourists. For the purposes of simplicity, in this introduction we consider four
categories of visitor that form the basis of the studies in this book. First,
family and friends or ‘patient visitors’. Second, ‘public visitors’, under which
are classed members of the public not associated with the direct
administration of the hospital or with familial ties to the patients. Such
visitors might include entertainers, tourists or members of the clergy. We
identify a third group as ‘house visitors’, individuals who were usually
involved in the formal management and government of the hospital by way
of a donation or subscription. Such individuals commonly performed, for
want of a more historically appropriate term, quality control tasks.
Historians have already argued that these visitors took an active interest in
patients who entered the institution on their subscription ticket.4 The final
category is that of ‘official visitors’ who were usually, but by no means
always, salaried inspectors of the state, and were responsible for monitoring
and reporting on the performance of, and conditions inside, institutions.
Often, though again not always, run by local and central governments, such
inspections were, of course, carried out on behalf of the wider community.
8
Hospital and Asylum Visiting in Historical Perspective
They were, and indeed continue to be,5 normally a feature of institutions
funded by taxation, though that is not to say private voluntary institutions
escaped the roving eyes of surveillance at times.
Though below we consider each of these categories of visitor separately,
it is important to recognise that their roles and functions often overlapped.
Sources of emotional support could come from a priest as well as a family
member; monitoring was undertaken by both house visitors and official
visitors and, it must be said, by family and friends acting in the patient’s
interest.
Patient visitors
Patient visitors, namely family and friends, offer emotional and practical
support for the institutionalised, and provide an intimate link to a familiar
world that is temporarily, or even permanently, beyond reach. Given the
significance of visiting for today’s experience of health care, it is perhaps
surprising how little has been revealed about the historical evolution of this
seemingly universal practice. Case studies of general and specialist hospitals
in this volume, and a scattering of references elsewhere in the literature,
illustrate the complexity of the institution–patient visitor relationship. At
various points in time and across a wide range of hospitals, visiting by
relatives and friends has been prohibited, discouraged, policed, or positively
welcomed.
Evidence from the early voluntary hospitals in England and its colonies
suggests that by providing food, clean clothes and linen for relatives, visitors
sometimes offset the institution’s operational costs. But such visitors were
little more than tolerated. Like English hospitals, those in late nineteenth-
century America tended to be rule-bound institutions where visitors were
discouraged outside prescribed visiting hours. In the context of American
hospitalisation, Charles Rosenberg has noted how visiting regulations were
part and parcel of creating a highly ordered community that encompassed
patients and staff as well as outsiders. Violations of visiting rules were
frowned upon: the overriding concern of hospital authorities in this context
was the potential hygienic and moral contamination brought into the
ordered hospital environment.6 Of course, the maintenance of a moral
quarantine predates the late nineteenth century, as Kevin Siena’s study of the
London Lock Hospital in this volume illustrates. Not unlike the
contemporaneous penitentiary movement, the Lock Hospital kept watch
over those wanting to visit patients. Such control was connected to the moral
reform of the patients, especially those women who, it was feared, might
return to a life soliciting sin once they had achieved respite from their
ailment and then discharged. The hospital had a system of total quarantine
in place by the end of the eighteenth century and visits were forbidden.
9
Graham Mooney and Jonathan Reinarz
Sequestration sought to purge the Lock’s women both spiritually and
physically.
As Jonathan Reinarz demonstrates in this volume, though the visits of
patients’ families were often restricted in the early nineteenth century, they
continued to be ‘a necessary evil’ at all hospitals, especially those with least
funding, given the goods and services they provided. Wealthier institutions,
such as London’s Great Ormond Street Hospital for Sick Children, could
afford to dispense with such concerns and reduce patient visiting to just a
couple of hours each week. Bruce Lindsay shows in his chapter that the
Jenny Lind Hospital for Sick Children, a small charitable institution in
Norwich, England, initially seized the opportunity of family visits to educate
parents in hygiene and childcare in the late 1890s. The Jenny Lind’s
acceptance of visitors in this way, however brief the episode, provides a
significant counter-balance to the overwhelming portrayal of children’s
hospitals that they more-or-less universally excluded visitors up to the 1950s.
However, using evidence from microbiology and psychology, the Jenny Lind
followed the example of Great Ormond Street and began to curtail family
visits so that, by the 1920s, children’s parents were largely prevented from
entering the hospital. Patients’ visitors at most institutions were increasingly
identified by name and address, issued with passes, and their periods of
access similarly regulated. Occasionally, their discussions with patients were
observed, especially when involving vulnerable groups, such as women and
children. In most cases, visiting days were clearly advertised in publicity
material and sometimes adjusted to suit patients’ families.
But why did this shift to greater restriction occur? It seems apparent that
it was the result of a gradual increase in medical control over all aspects of
the institutional experience. In many children’s hospitals, visits from parents
came to be regarded as traumatic for their offspring, and disruptive of the
daily routines that were determined for them by medical staff.7 Patient
visitors were possibly the victims of professional nursing turf wars.8 Bruce
Lindsay argues that the exclusion of parents, and especially mothers, would
have enhanced the status of Registered Sick Children’s Nurses in the eyes of
general nurses, who regarded children’s nursing as somewhat inferior.
More widely, it was not uncommon for fears to be articulated about the
biological exchange of infection between the hospital and the wider
community, and the possible moral contagion introduced by ‘undesirable’
visitors, especially ‘strangers’.9 Debate about cross-infection within general
hospitals, which characterised these places as ‘gateways to death’, raged for
much of the nineteenth century.10 Concern mainly was with the admission
of infectious patients and not with the role of visitors in transmitting
infection. But as the infected were increasingly catered for in specialist
isolation hospitals towards the end of the nineteenth century, Graham
10
Hospital and Asylum Visiting in Historical Perspective
Mooney detects that families and friends of patients – the overwhelming
majority of patients being children – were identified as potential exporters of
infectious disease from the hospital to the local neighbourhood. As a result,
strategies were adopted to discourage visiting, if not ban it outright. When
visiting was permitted, visitors were often given guidelines for the most
appropriate behaviour to reduce the possibility of infection. This
demonising of visitors as biological fetchers-and-carriers undoubtedly played
into the policies of infection prevention at general and children’s hospitals in
the early twentieth century. Yet any discussion about using the restriction of
visiting to non-infectious disease hospitals as a tool of infection control by
the medical staff is thrown into dispute – if not revealed as grossly
hypocritical – when class distinctions are considered. In the case of Toronto’s
Hospital for Sick Children, semi-private (paying) parents in the 1920s were
granted daily access to their children, whereas patients receiving care on the
public’s dollar were restricted to one hour per week.11 Similarly, visitors to
adults residing in the public wards of other Canadian hospitals were
invariably subjected to shorter visiting hours when compared with those to
the private wards.12
One may also point to the American mission hospitals in China as a
point of departure from the visiting regimes of Western general hospitals.
Michelle Renshaw’s chapter reveals how it was not uncommon for family
members, friends and servants to live with the patient in American-run
hospitals. Renshaw identifies a number of reasons to account for this: a lack
of resources to employ staff; Chinese cultural norms concerning the
inappropriateness of women nursing men; customary familial involvement
in caring for the sick; and the fact that missionaries were prepared to make
concessions to these norms and customs so that Chinese patients would
agree to come into hospital to undergo unfamiliar procedures and perhaps
even receive a dose of religious instruction.
Visitors in the missionary hospitals assumed responsibilities of both
nursing and nutrition. So integrated were visitors in hospital life that this
may even have helped reduce the rates of cross-infection in missionary
hospitals, something not recognised in British hospitals until well into the
twentieth century. Renshaw argues persuasively that the centrality of
dietetics in Chinese medical practice ultimately served to do the hospital
patient both physical and psychological good: foods would be selected and
prepared by family members according to their knowledge of dietetics and
the patient’s symptoms; patients presumably believed that the food would
help restore their health and complemented any medical treatment; and,
they would feel cared for and valued.13
It would seem that in the mid-twentieth century hospital, visiting in the
West came to be encouraged again for the psychological benefits it conferred
11
Graham Mooney and Jonathan Reinarz
on the patient. The work of numerous psychologists began to draw attention
to the damage caused by ‘hospitalisation trauma’.14 Initially resisted by health
professionals, further research was disseminated widely, stimulating both
government reform and much public debate. Now associated with the
Tavistock Clinic, founded in 1920, and the work of James Robertson and
John Bowlby, the recognition of ‘separation anxiety’, initially disputed
within the medical community, helped unlock hospital doors once again and
liberalise visiting hours. By the 1940s, new perspectives from developmental
psychology and changing societal views on childcare were influencing the
return to centrality for the family of the sick child. Additional work in this
area will presumably develop the uneven and regional pace of change at
specific institutions.
There has been relatively little new research on visiting hospitals in the
intervening half century or so. Robin Rohrer’s chapter brings us up to date
with a survey of parental involvement with the diagnostic and treatment
regimes at the Children’s Hospital of Pittsburgh from 1995 to 2005. Besides
shifting to a contemporary American context, the chapter examines the
families’ involvement in many aspects of patient care. Contact with medical
and psychosocial staff and relationships with family visitors of other
hospitalised children with cancer are explored. Issues of psychosocial
support, treatment decision roles and the emotional care of the children are
at the heart of Rohrer’s study. The degree of family participation is
reminiscent of, if not identical to, that of the American missionary hospitals
in China.
Rohrer alerts us to the sense of psychological isolation that characterises
institutional settings, noting that frequent and often unpredictable hospital
admissions and treatment side-effects including hair and limb loss
undeniably contribute to the feeling of seclusion. Rohrer’s study provides a
crucial departure for this volume in that she assesses not only how the
expectations of family visitors in the realm of psychosocial support from
hospital staff match up to reality, but also what it is that the child’s treatment
team expects or requires from family visitors. Consequently, the families of
young cancer patients are very much engaged in the formation of new
communities. In considering the benefits and drawbacks in-patient family
members have on the experience of cancer treatment for the child and
his/her quality of life, Rohrer’s findings depict a sea change in the views of
healthcare professionals that one hopes will bring lasting benefits to patients.
Rohrer’s chapter provides an important counterpoint for much of the
evidence presented in this volume and elsewhere on the long-standing
resistance of medical staff to patient visitors. In addition to reiterating the
encouragement of visiting at the Jenny Lind in its early years and the
example of the American mission hospitals in China, we want to conclude
12
Hospital and Asylum Visiting in Historical Perspective
this section with four more observations that complicate this issue, at least
over the long run of history. The first is the importance of visiting to
therapeutic regimes at asylums, as argued by Catharine Coleborne in her
study of visitors in New South Wales, Victoria, Queensland and New
Zealand in the nineteenth century. Coleborne’s analysis of a rich array of
source materials makes the point that, in private at least, the asylum medical
staff recognised the psychological benefits that patient visiting accrued. Even
before admission, asylum authorities involved relatives and friends,
requesting and compiling family histories and acquiring advice about
incoming patients.15 Second, as Coleborne’s chapter also indicates,
occasionally patients exercised their right not to be visited. This is probably
less of an issue for children than for adults, and perhaps more relevant for
mental than for physical illness. But whatever the circumstances, we should
be sensitive to the possibility that for some patients, isolation, seclusion and
solitude were what they themselves recognised as being appropriate for their
stability and recovery above and beyond the ‘intense resentment against their
families for having committed them to an asylum’.16 Third, this volume gives
prominence to the important roles played by families and friends of patients
during periods of institutionalisation. Nevertheless, Reinarz extends our
understanding even further to include visitors to medical, nursing and
ancillary staff, many of whom lived on hospital premises well into the
twentieth century. Finally, we have been unable to say anything at all about
the identity, motivations and views of relatives or friends who did not
attempt or wish to visit the sick or infirm in hospital.
Public visitors
The visiting of medical institutions by members of the wider public is a
long-standing tradition. One of the main purposes of allowing members of
the public inside the walls of the institution was to court potential financial
donors and we consider these in the section below on house visitors. But
public visitors, in fact, played a remarkably diverse set of roles, from religious
and moral rejuvenation of the patient, through the provision of
entertainment, to institutional tourism, if not voyeurism. In the case of
military hospitals, unfortunately not addressed in this volume, well-timed
visits, often by celebrities, were certainly important historically in boosting
morale during the least successful episodes of military campaigns.17
Traditionally, nineteenth-century asylums for the insane have been
portrayed as institutions that existed on the social and physical margins of
society. The characterisation of mental asylums as isolated and segregated
from the local community has been dismantled gradually.18 Various chapters
in this volume continue this process of revision. Somewhat ironically, by
placing the experiences of asylums and other healthcare institutions side by
13
Graham Mooney and Jonathan Reinarz
side, the former appear to have been comparatively open to interaction with
those who did not have a direct interest in their operation.
Sometimes the physical fabric of the institution was the focus of
attention. In the late eighteenth century, for example, visitors came to peruse
the paintings that adorned the walls at London’s Foundling Hospital,
arguably England’s first art gallery.19 As with the first voluntary hospitals, the
opening of a new hospital or asylum in subsequent decades remained cause
for a mass invasion. Tens of thousands of people trooped through the new
isolation hospitals in Oldham, Nottingham and Edinburgh for their
openings in the 1870s, 1890s and 1900s respectively, though well before the
patients themselves were admitted. Indeed, Graham Mooney notes that
visiting restrictions meant that such an occasion might have been the only
opportunity for the community to view the inside of the local isolation
hospital, paid for by their own taxes. Hospital administrators, on the other
hand, regarded such visits as ideal fundraising opportunities, some having
even contemplated the introduction of admission charges.20 In any case, the
opening of a new institution, ward or wing was an important event in the
annals of a town or city, and many considered themselves fortunate to be
granted a royal visit to commemorate the occasion. While the closely
supervised nature of royal visits is evident, it is worth noting that practically
all forms of visits were subject to a greater or lesser degree of stage-
management by the hospital authorities.
Celebratory openings emphasised the benefits that new configurations of
bricks and mortar – or wood and corrugated iron – would bring to the
patient. The grandeur of institutional buildings, as physical expressions of a
donor’s largesse or the modernity of local government, continued to be a
draw for visitors as tourists beyond the opening ceremonies. By and large,
however, patients tended to be the primary focus of public visiting, as made
famous by excursions into Bethlem in the eighteenth century. So, too, in
Britain’s unreformed gaols, where the insane served as ‘sport to idle
visitants’.21 In her chapter, Janet Miron similarly examines the lay visitors to
psychiatric institutions in the north-eastern United States in the nineteenth
century. While information about asylums could be had from the
contemporary media, a tour in person was also possible. Visitors came from
across the social spectrum and Miron draws upon the records left not only
by the administrators and medical staff but by people who believed that
asylums were a remarkable development in modern society.22
Dolly MacKinnon’s chapter equally demonstrates the permeability of the
asylum’s walls. MacKinnon explores the varieties of official ‘entertainment’
for inmates in Australian and New Zealand asylums between c.1860 and
c.1945. The range of entertainments on offer was impressive, from singing
and dancing, through sports and indoor games, to the provision of
14
Hospital and Asylum Visiting in Historical Perspective
newspapers, magazines, radio and films. Not uncommonly, participation
resulted in the commingling of patients, staff and visitors as either spectators
or participants.
These activities were provided by paid professionals, volunteers and, in
the case of live music, the asylum band. One interesting product of the
interaction with public visitors is that over time their demands prompted the
reconfiguration of institutional space. Wards, dining halls and airing yards
gave way to purpose-built recreation halls and grounds, a testimony of
bricks, mortar and open space to the importance of recreation. The
introduction of silent films in the early twentieth century was followed by
the installation of centralised radio sets in the 1930s. While these media
required censoring, they nevertheless connected the patients to the outside
world and counteracted the effects of institutionalisation. Yet it is equally
plausible to observe that they reduced the necessity of arranging for visiting
entertainers, even if the community continued to be involved with
extravagant annual asylum balls, and cricket and football competitions.
Recreation doubtless served a rehabilitative medical function and, as James
H. Mills and Sanjeev Jain show, they were incorporated into psychiatrist
Edward Mapother’s blue-print for Ceylon’s improved mental health system
in the late 1930s.
Institutions could also be places of religious and moral rehabilitation.
This was no more evident than in London’s Lock Hospital. Salvation could
not be achieved in the absence of contact with the outside world and
visitation was crucial to the hospital’s unique dual medical and moral
mission. Kevin Siena demonstrates how the hospital increasingly emphasised
spiritual visitation, arranging for ministers to attend patients in the hope of
reforming sinners who had caught the nefarious ‘Foul Disease’.
Three broad points can be made in relation to these public visitors, be
they tourists, entertainers or reformers of the soul. The first concerns the
management of the institutional visit. Often resembling choreographed
theatrical performances, the institutional visit has been theoretically
unpacked by the sociologist Erving Goffman.23 The chapters in this volume
tend to confirm Goffman’s observations that hospital and asylum governors
historically had clear motives for trying to control, or stage-manage, the way
in which their institutions were represented to the public. Given the
potential financial implications of many visits, most staff and administrators
engaged techniques that conveyed certain impressions to visitors. Loyal and
disciplined members of an institution’s staff were employed to guide
distinguished guests and sight-seeing parties. As a result, visitors frequently
did not see entire institutions, but only new, clean or prized, state-of-the-art
portions of buildings; occasionally, even patients’ families did not enter
wards, but only purpose-built meeting rooms. Often staff had time to
15
Graham Mooney and Jonathan Reinarz
prepare for visits, in which case they properly rehearsed their parts, members
being schooled as to what to wear, how to curtsey and what to say.24 With
repetition, even the worst-prepared staff developed their own acceptable
visiting routine. Disruptions or ‘inopportune intrusions’ by the least
respectable or ungrateful patients might weaken performances, if not the
exaggerated claims of institutional staff. Whether due to an open door, as
described in Siena’s chapter, or an unexpected visit, unmediated views of
buildings and patients were discouraged at most institutions. Even today, the
‘intrusion’ of family members in the emergency room is a topic of popular
debate.25
Our second point relates to issues of identity. The chapters in this
volume provide indications of how the general public used visiting
encounters to shape the identity of the institutionalised. Their impressions
of patients were recorded in diaries, letters and newspaper reports, even if we
must question how far such testimonies were conditioned by stage
management. What is perhaps less obvious, and only rarely retrievable, is
how visiting shaped the identity of the visitor as well as the patient. Janet
Miron uses the patient newsletter from the Utica Asylum, The Opal, to
gauge inmate reactions to visitors there. But what can be said of the public
visitors themselves? Surely visiting an institution provoked self-reflection at
some level? Did a tourist’s visit to an asylum serve to reaffirm his or her own
normality? Perhaps it provoked a reaction along the lines of ‘there but for the
grace of God go I’, blurring visitors’ notions of what it meant to be mentally
stable?
Similar questions of identity might be posed when the issue of ‘leave’ is
raised. As described by Dolly MacKinnon, patients well on the way to
recovery were granted leave from the asylum for periods of hours, a day or a
weekend to attend dances and films in nearby local towns. Clearly these
recreational outings further dissolved the barriers between the institution
and the community. But, and this is our third point, they also turn the whole
notion of visiting around. No longer is it the outsider coming in to the
asylum, but it is the institutional insider negotiating the outside world. The
patient becomes a visitor to the wider public, preparing for integration into
a new or former community.
House visitors
In this section on house visitors and in the next, on official visitors, we
consider the role of visiting in monitoring the management and operation of
healthcare facilities. Though sharing certain traits, a crucial distinction needs
to be made between two quite separate groups. Official visitors were
independent of the institutions themselves, whereas house visitors tended to
be associated closely with the hospital or asylum administration.
16
Hospital and Asylum Visiting in Historical Perspective
From their establishment, medical institutions frequently deployed
visiting as a promotional tool to generate charitable donations, and it was
not uncommon for lay-visiting to become enmeshed with the administrative
fabric of hospitals and asylums. As such, many of those who eventually
became house visitors began their relationship with the hospital as a public
visitor. Institutions paid a great deal of attention to securing this transition
in status, no more so than with the London Lock Hospital where
administrators were acutely sensitive about the visitors who crossed the
carefully managed threshold of the institution’s doorway. Kevin Siena notes
that hospital governors invested much time and energy drumming up
financial support – an unenviable task given that many potential benefactors
would need to be persuaded that paupers with syphilis were the most
deserving cases for charitable donations. The hospital’s governors were
placed in a delicate position: on the one hand, publicity for the hospital and
its patients had to cast them in the best possible light in order to attract gifts;
on the other, such portrayals risked exposure as less than accurate if visitors
were allowed unfettered access to the wards. As we mentioned above,
hospital administrators carefully stage-managed the circumstances under
which possible donors visited the wards. Acting as administering governors,
donors to the Lock Hospital could monitor how their money was being
spent and regularly visited the wards to inspect the quality of care and
provisions. Their reports also gave disgruntled patients the opportunity to
register complaints and marked an important form of institutional self-
policing.
Both Andrea Tanner and Bruce Lindsay show that children’s hospitals
restricted visits for families and friends of patients on the grounds of
discipline and order, but, at the same time, encouraged open daytime
visiting ‘of a better sort’ to come and see for themselves everyday life on the
wards. Exploring the motives and actions of these so-called ‘disinterested’
visitors helps us to understand the complex web of interactions the hospital
management and staff had with a benevolent public. Enhancing the image
of the hospital in Victorian and Edwardian public opinion, they represented
free publicity, spread the gospel of the institution’s ethos and attracted
donations and additional support.
While a form of house visiting tends to be recognisable in most hospitals
and asylums, there were significant shades of difference between institutions.
Jonathan Reinarz describes how donors and governors in the English
Midlands would visit hospitals in their official capacity to monitor various
aspects of institutional life and propriety, expenditure, and the compliance
of patients and practitioners to house rules. Lady visitors were also a
common presence in the wards of Birmingham’s women’s and children’s
hospitals, as was the case at Great Ormond Street.
17
