Class distinction and moral policing

Resolved that a distinction be made in the sort of meals served up for the Superior & Inferior Patients ... with respect to the food of the Inferior Patients it be such as is suitable to their habits of life ...

Warneford Committee of Management 1828

No Female, except the Mother, Wife, Daughter or Sister, shall visit any Male Patient; and no Male, except the Father, Husband, Son or Brother, shall visit a Female Patient, except by special permission

Radcliffe Infirmary by-laws 1898

The social attitudes of the past can make an interesting study, and the history of hospitals is no exception. Mixed wards are still a comparatively new phenomenon but in previous centuries whole hospitals, especially psychiatric hospitals, were designed to keep the sexes apart at all times. Both the Warneford and Littlemore Hospitals were built in such a way as to ensure that male and female patients never met, and the nurses and attendants were always of the same sex as their patients. Even in 1950 the Matron of the Watlington Hospital was not prepared to employ a male domestic assistant without the express permission of the House Committee, even though the appointments were entirely in her hands.

The Warneford took very great care: Samuel Warneford is reported as saying 'a wall is not enough to separate the sexes - there should be two walls and an interval of ground between'. When a proposal for changing the use of part of the garden was put forward in 1834 the Rev. Vaughan Thomas, of the Committee of Management, recorded his dismay that now the men would 'have access to the walls of the Women's airing court, and that the men instead of being kept away from the females, and at the greatest possible distance, are brought close to the females, with nothing but a low wall between them'. Elsewhere he records that the low wall in question was in some parts 'not more than 6 feet 6 inches high, and easily to be scaled'.

Warneford Hospital plan 1820s

When the chapel was built at the Warneford mixed services took place and the Annual Report for 1850 says that 'the United attendance of the male and female patients ... has not been attended with any of the consequences which were once apprehended'. This was hardly surprising, as the men and women entered by different doors and did not even see each other as there was a screen down the centre of the chapel. Segregation remained strict for many years. It was not until 1925 that a female (qualified) nurse took over the male side of the hospital as Matron; the unqualified head male attendant was pensioned off. Even as late as 1944 a report states that 'the sexes were judiciously mixed' as an experiment at the Christmas dinner.

A report on the Littlemore Hospital in 1874 records that 'a weekly entertainment, usually a ball, is given as a means of amusement for both sexes', but it is most unlikely that such entertainments were mixed. In 1862 the Chaplain was holding separate reading classes, on Sundays for the men and Sundays, Tuesdays and Fridays for the women.

At the Radcliffe Infirmary the wards in the attics were reserved for male patients only. However, in February 1840 the female wards were overcrowded and in consequence women were sent up to the attic wards. They were not put with the men, but they were in adjoining rooms and Vaughan Thomas was horrified (he was a governor of the Radcliffe as well as being on the Warneford Committee). There was nothing to prevent the mixing of men and women at dinner time, for there was only one nurse to a ward and when she went for a meal the patients were unattended. In the evenings the patients were allowed out to the airing courts for exercise and, unlike those of the Warneford, the courts were not segregated. In 1838 a governor was disturbed to find that male and female patients 'are allowed to go into the same Court at the same time', the contact forbidden to them indoors taking place 'in the evening in the airing court and perhaps after dark - this is an Irregularity'.

The morals of the patients were a consideration in the rules of the Radcliffe: they were to attend prayers, were not to swear or play dice or cards and were to behave decently. Concern for the virtuous provoked several comments in the Visitors' Book:

I think it very improper to place a Procuress and a Prostitute upon the Beds of the Lichfield Ward which as I am informed was done on the last admission day - ought the feelings of the virtuous to be outraged in this manner? never were ministerial prudence and pastoral authority better exercised than in excluding their Prostitute Friends who came to visit them.
Venereal Disease is expressly mentioned as a reason for excluding a Patient ... The effect of allowing females to stay under such disease is to act unjustly by all the virtuous females in the Ward ... It is moreover unchristian, as an offense against the Christian admonition "evil communications corrupt good manners" .

Radcliffe Infirmary rules 1770

The Radcliffe Infirmary also took great care to protect its nurses; for example the 1898 by-laws lay down that the Porter was to attend the male patients in the bath rooms. In 1871 a new arrangement was made for emptying the bed pans in the accident ward. The Committee of Management objected to the proposals on the grounds that 'however virtuous a Nurse might be it was not right that her feelings of delicacy should be pained by the possibility of her having to empty a bedpan in the sink with the chance of there being at the same time a man seated in the water closet so near it, or of her meeting one buttoning up his trousers on leaving the place'. John Briscoe, Honorary Surgeon, pointed out that the arrangements in another, new, ward 'will still more pain the Nurse's feelings of delicacy for while emptying a bed pan, she will have the chance of there being a man in the place for the urinal on her left hand and one in each of the water closets on her right'.

Although it is undoubtedly curious to find concern for the nurses' delicate feelings whilst they were engaged in the indelicate occupation of emptying bedpans, it is a surprise to find such feelings mentioned at all. Dr. Palmer, house surgeon 1870-1874, described the nurses as 'kind, intelligent, simple women of the superior servant class, without any pretension to being ladies'. The rules of the Brackley Cottage Hospital, founded in 1876, stated that when the nurse visited a house she was to be treated as an upper servant. Such considerations of class were usual. When the Warneford Hospital was opened in 1826 it was intended to cater for the middle class of society, but even this class was divided. The fees for patients were on a sliding scale according to the capacity to pay, and the hospital was arranged on both female and male sides for patients of the superior, second and third classes. The bedrooms, dining rooms and airing courts were all divided: for example the airing courts for the superior class were at the front next to the gardens, those for the second class at the side and those for the third class at the back near the kitchen yard. In 1834 it seems that even the corridors were not to be communal, for the following recommendation appears in the Visitors' Book: 'Considering the importance of keeping the classes of patients .. [apart from] .. each other, though they be of the same sex, especially the gentlemen from those of the lower class, it is advised to change the door way into the Bath Room so as to make it accessible to the parlour patients without entering the poor mens' gallery'.

It is possible that all this sounds very Victorian and very English, so it is interesting to find a twentieth century American equivalent. Marjorie Peto, who was Chief Nurse of the U.S. Army's 2nd General Hospital at the Churchill Hospital 1942-1944, records that when the nurses finally returned to America the army delivered a last lecture. 'After having travelled on land and sea with men, bivouaced with them, nursed and cared for them when they were wounded, watched them die and after having worked with them for three and a half years' the subject of the lecture was 'How to Behave in America. With emphasis on deportment with the opposite sex.' It seems that some things never change.

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