Negotiating Exclusion in Early Modern England, 1550–1800 by Naomi Pullin Kathryn Woods

Author:Naomi Pullin, Kathryn Woods [Naomi Pullin, Kathryn Woods]
Language: eng
Format: epub
ISBN: 9781000359121
Barnesnoble:
Publisher: Taylor & Francis
Published: 2021-03-08T00:00:00+00:00

Discharge

In comparison to admittance, described in detail by historians such as Risse, the history of patient discharge has received limited historical attention. The reasons for this are unclear, but it is likely because the structures, processes, and practices of patient discharge are more nebulous than admission and tend to be more deeply intertwined with individual patient treatment and case histories. Indeed, at least in relation to the Westminster Infirmary, practices of patient discharge tended to be reactive to individual cases rather than planned processes, meaning that they are less well documented in formal institutional records. The standard evidence of discharge we have from the surviving records is a few lines stating the name of the patient and when they were discharged, whether or not they had been cured, or if they had died. In a few more exceptional cases, there is evidence of potentially controversial reasons why a patient was discharged without a cure.

Practices of discharge are worth studying because they are highly revealing of institutional cultures, shifting pressures within and outside institutions, and because of their symbiotic relationship with rules of admittance. In terms of the Westminster Infirmary in the period considered, practices of discharge reveal how the ‘rules’ were negotiated between various hospital stakeholders. They also indicate some of the methods used to maintain social order in the hospital, and ways in which the hospital responded to challenges caused by London’s social problems. There was also a close relationship between instances of patient discharge and structures of admission. For example, after dealing with particular cases of unruly behaviour, it was common practice for the hospital to pass new rules of admission to prevent similar instances arising in the future. This approach to the development of admission rules was significant because it increasingly made the hospital a more exclusive space.

Numerous factors could lead patients to be discharged from the Westminster Infirmary after admission. The most common cause of patient discharge, it is important to note, was cure. For example, in a public account of 1734, it was reported that in the period December 1719 to March 1734, 228 patients had left the hospital ‘cured’, in comparison to 10 discharged for irregularity, and 24 discharged incurable.70 To be discharged, patients had to have their leave of the hospital agreed by the physicians and trustees. Successful cure of patients was something that the hospital celebrated as evidence of its social value and impact, and to encourage ongoing and increased support for the institution. This explains why the hospital regularly published figures on the numbers of successfully treated patients. After 1721 it was also ordered that ‘everyone discharged cured from this infirmary be enjoined by the chairman to give publick thanks in their parish churches’.71 This was a further means of promoting the charity and publicising its good deeds across London, England, and beyond. In addition, this practice served to reaffirm the hierarchical distinctions between the givers and receivers of charity. Records of who had, and who had not, given thanks to

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