Graham Mooney, Jonathan Reinarz, eds. Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting. Amsterdam: Rodopi, 2009. 352 pp. EUR 70.00 (cloth), ISBN 978-90-420-2599-8.

Reviewed by Ian Miller (University of Manchester)
Published on H-Disability (January, 2010)
Commissioned by Iain C. Hutchison (University of Glasgow)

Historicizing Hospital and Asylum Visiting

Graham Mooney and Jonathan Reinarz’s Permeable Walls is the first collection entirely devoted to the history of visiting patients in the hospital and asylum setting, neatly deflecting attention away from a more traditional focus within the history of medicine upon the experiences of patients and doctors within the institutional setting. This is an important contribution to the historiography, given that visiting patients, relatives, and friends in medical institutions is a universal practice worldwide, and that people tend to visit the hospital as a visitor more frequently than they do as a patient. Consideration is therefore given to an experience that is not so much part of the institution, but one that is periodically and momentarily drawn into its ambit. Throughout the collection, visitors are presented as an understudied constituency in medical history, and their experiences are explored in broad social, cultural, and geographical perspectives. It is shown, for instance, that discussion of the wider significance of visiting in fact draws attention to issues such as urban governance, philanthropy, the public sphere, civil society, and citizenship. This is all achieved via discussion of the different types of visitors: patient visitors, public visitors, house visitors, and official visitors. 

Permeable Walls covers the period between the eighteenth and twentieth centuries, and incorporates case studies from around the globe. Whilst the authors agree that hospitals and asylums are remarkably penetrable places, policies towards visitors are shown to have varied dramatically, according to to the type of institution or the wider sociocultural context of attitudes towards the ill. Ultimately, these studies reveal much about the changing relationship between different communities and healthcare institutions. For instance, the first Chinese missionary hospitals adopted a policy of near open access, contrasting sharply with policies of outright exclusion in British isolation hospitals during the Victorian era.

Permeable Walls also presents a view of visiting that extends far beyond the familial, aiming to deepen understandings of who visitors were, what visiting involved, and how the practice evolved historically. It concerns relatives and friends, administrators, managers, philanthropists, lay care-givers, priests and ministers, entertainers, and tourists. Each visitor is shown as holding different roles, so that, for instance, family visitors offer emotional and practical support for the institutionalized, providing an intimate link to a familiar world that is beyond reach. 

The first section of the collection deals principally with hospital visiting. Jonathan Reinarz’s opening article provides an overview of hospital visiting in the nineteenth and early twentieth centuries. He focuses on Birmingham, and reveals that visiting was dependent upon issues related to shifting conceptions of infection, gender, and class. Michelle Renshaw skillfully links debate over family-centered care in America with discussion of the role of family visitors in missionary hospitals in China, within which we hear of families being present at surgical operations and the importance placed upon the provision of food by relatives, a tradition continued as a result of the centrality of dietetics to traditional Chinese medicine. 

One of the strongest chapters presented here is Graham Mooney’s contribution on the subject of infection in mid-Victorian isolation hospitals, a piece which firmly locates hospital visiting within a far wider cultural context of citizenship. Shifting attention away from diseased patients, he discusses the interaction between individual liberty and governance with visitation policy. Kevin Siena, meanwhile, reveals how London’s Lock Hospital depended so heavily upon charity that its administrators attempted valiantly to project a positive image of the hospital in the face of cultural and moral assumptions about the syphilis patient’s right to charity. Policies governing visitation here are shown to have served numerous ends at different times, including policing patients, introducing moral reform, and obscuring the realities of the ward from public views in order to ensure that prospective donors only saw what administrators wished them to see.

There then follows discussion of children’s hospitals, and the unique role that visitors played within these in comparison to other institutions. Hence, we find Andrea Tanner analyzing the role of visitors in the Victorian London Children’s Hospital, revealing the declining role of the mother as visitor as nurses gained an increasing nurturing role, and the institution’s ability to bolster its reputation through official visits. 

The latter part of the edited collection deals with visitors entering the asylum setting. James H Mill and Sanjeev Jain provide a fascinatingly informative account of Edward Mapother’s visits to India and Ceylon in the early twentieth century, considering visiting from the viewpoint of an expert visitor. Meanwhile American asylum tourism is provocatively analyzed by Janet Miron, who suggests that asylums were deeply embedded within the social and cultural landscape of the time, and that visiting can be used as a platform from which to analyze the history of popular public attitudes towards the mentally ill.

Overall, Permeable Walls offers a fascinating insight into a new area of medical history. Furthermore, these histories appear to be particularly relevant today at a time when service providers seek ways to involve patients’ representatives in healthcare decision making, to control hospital superbugs, and to make the hospital environment accessible yet simultaneously safe and secure. Restricted visiting has reemerged once more, making many of the themes explored in this collection relevant as well as emotive.

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Citation: Ian Miller. Review of Mooney, Graham; Reinarz, Jonathan, eds., Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting. H-Disability, H-Net Reviews. January, 2010.
URL: http://www.h-net.org/reviews/showrev.php?id=26216

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