As the eighteenth century dawned, beds in royal hospital foul wards were becoming harder to get. The financial effects of fire and war in the 1690s severely depleted the coffers as the seventeenth century drew to a close. This fiscal pressure forced St. Bartholomew’s to stop paying to support foul patients in the outhouses after 1696. So as the new century began, venereal patients now had to come up with the four pence per day in order to stay in the outhouses, even though the hospital continued to pay to support the hundreds of patients treated each month in the clean wards of the main hospital. This two-tiered fee structure would last in one form or another throughout the century.

Bart’s did resume paying to support some venereal patients in 1703. However, the figures betray a clear shift in policy. In 1703 the governors spent just £93 to support outhouse patients while they spent in excess of £1,900 to feed clean patients. When translated into fiscal terms this means that that the hospital paid to support about 314 clean patients at a time, while they supported on average only about fifteen foul patients throughout the course of the year. In stark contrast to the pattern in the seventeenth century, when venereal patients represented such a significant portion of St. Bartholomew’s charity cases—well over 20 percent in some years—in 1703 they represented less than 5 percent of the patients supported by the governors.

However, it is important to bear in mind that these figures do not represent all the patients treated at the two outhouses, but only those receiving full hospital charity. The hospital now classified foul patients as either needy of charity or capable of paying their own way. The hospital consented to support only those who were “entirely destitute of Mony, or friends, & parish settlements.” So in late 1702 or early 1703 the governors resumed their charitable support for poor foul patients, but for a much more limited group. This renewal shows that the hospital had not entirely abandoned the people struck by the dual dilemmas of poverty and the pox. There remained some commitment to helping impoverished foul patients. However, governors now drastically limited the amount of money devoted to the cause, and began to call on parishes to contribute towards the support of their own venereal paupers.