ABSTRACT
Public protest over the siting of infectious disease hospitals was perhaps nowhere more forcefully and persistently expressed than in Victorian London. While widely understood from the 1870s onward to be a critical institution of professional public health, the isolation hospital was also seen as redistributing and reconstituting some of the most distressing dangers of urban modernity. Most Londoners, in fact, assumed that a ‘fever and smallpox’ hospital would necessarily reproduce and magnify the risk of disease to the neighbourhood in which it was located. It allegedly altered the perceived and lived experience of the unfortunate area in which it was located – and of course jeopardised the value of property and disrupted patterns of capital investment. Informed by these fears, opponents of local hospitals lodged complaints through mass demonstrations and marches, via lawsuits and petitions, and – as articulated elsewhere in this volume – in the press. A tense late-Victorian discourse about hospitals, this chapter argues, challenged conventional medical visions of urban terrain, meaning and practice. As echoed in Rosemary Wall’s chapter, these were grievances toward medicine in which private and public harms were not easily disentangled and where the separation of self-interest and community interests was never completely straightforward. Indeed, shared public complaints were often organised around a complex sense of place. Hospitals were not only manufactories of local complaint but also themselves the sites of complaining. Attention and anxiety in London centred mainly on the activities of the Metropolitan Asylums Board (MAB).1 Established in 1867 as a rates-supported agency to gather together sick paupers from the various metropolitan workhouses, the MAB quickly grew into an extensive network of some of the largest hospitals on earth. During epidemic panics, the infectious sick from all social classes were swept up into hastily built establishments often accommodating over 500 patients. The MAB eventually assumed broader public health responsibilities for London: seeking ever more effective control over outbreaks by isolating known cases as they arose, as opposed to their erratic natural distribution in households, public spaces and general hospitals. Seeking to harmonise this goal of spatial separation
with the principle of geographic proximity, the MAB located isolation hospitals among the population served. In a telling gesture of central planning, a map of London was used to plot an equilateral triangle whose angles fell within three miles of any populated part of the metropolis. The first three hospitals (one opened in 1869 and the next two in 1871) were sited as close as possible to the apexes of this triangle. The next two hospitals (opened in 1877) completed a ring within the city (see Figure 10.1). So, while patients were isolated, the hospitals were not. It was an arrangement that ‘preclude[d] the idea of escaping, even for a short time, from the environment of houses’ – each of which would contain a likely complainant.2
