Vice, VD and prostitutionVice, VD and prostitution

Lecture 16

Medicine, Disease and Society in Britain, 1750 - 1950

Lecture themesLecture themesLinks with previous lectures:

◦ Treatment approaches of regulars and ‘quacks’ (sexual quackery). The development of a modern ‘cure’ and how this was implemented

◦ Issues of morality and blame – innocent and not so innocent victims. Working classes related to the degeneration of the nation, etc

◦ Ideas about sexuality and gender roles

Example of how disease relates to socio-cultural values and responses

Part of fears of national degeneration and related to war, military service

The opening-up of the Americas (1492) and the fusing of Old and New Worlds gave rise to an explosion in the rate and scale of disease exchange.

Europeans introduced many diseases to America with severe consequences for native populations, e.g. smallpox.

It is thought that Syphilis travelled to Europe

A medical illustration attributed to Albrecht Dürer A medical illustration attributed to Albrecht Dürer (1496) depicting a person with syphilis. Here, the (1496) depicting a person with syphilis. Here, the disease is believed to have astrological causes.disease is believed to have astrological causes.

Portrait of Gerard de Lairesse by Rembrandt van Portrait of Gerard de Lairesse by Rembrandt van Rijn, ca. 1665–67, oil on canvas. De Lairesse, Rijn, ca. 1665–67, oil on canvas. De Lairesse, himself a painter and art theorist, suffered from himself a painter and art theorist, suffered from congenital syphilis that severely deformed his face congenital syphilis that severely deformed his face and eventually blinded him.and eventually blinded him.

Syphilis raged from the late fifteenth century.

Known as ‘le mal de Naples’

‘French pox’

morbus gallicus

James Boswell James Boswell - diary records episodes- diary records episodes

‘I rose very disconsolate, having rested very ill by the poisonous infection raging in my veins and anxiety and vexation boiling in my breast... I have just got a gleet (discharge) by irritating the parts too much with excessive venery. And yet these dammed twinges, that scalding heat, and that deep-tinged loathsome matter are the strongest proofs of an infection... I thought of applying to a quack who would cure me quickly and cheaply. But then the horror of being imperfectly cured and having the distemper thrown in my blood terrified me exceedingly. I therefore pursued my resolution of last night to go to my friend Douglas, whom I knew to be skilful and careful; although I knew it should cost me more, yet to get sound health was a matter of great importance, and I might save on other articles’.

January 1763

William Hickey - memoirs (1810) William Hickey - memoirs (1810)

‘During the last 2 years, I had never been entirely free from venereal taints, sometimes extremely ill and constantly using that powerful medicine mercury; not did I ever give myself fair play - in the worst of the disorder, if I could move at all, frequenting my nocturnal haunts, sitting up whole nights committing every degree of folly and excess. Mr Hayes, the surgeon who attended me, frequently remonstrated, observing that death and destruction must inevitably be the consequence of the life I led, and never shall I forget a speech he once made me. I had, as was often the case, by inattention, late hour and intoxication, whilst using mercury, thrown myself into a salivation; my head suddenly swelled to an enormous size; my tongue and mouth became so inflamed I could take no other nourishment than liquids; in which forlorn state he found me; when, instead of the pity and condolence I expected, he, in a great rage, swore he had a strong inclination to leave me to die as I richly deserved’.

Lock Hospital, Hyde Park Corner, Lock Hospital, Hyde Park Corner, London, mid-nineteenth centuryLondon, mid-nineteenth century

Contagious Diseases Act Contagious Diseases Act 18641864

Required prostitutes to be medically examined

Forcible treatment in a Lock Hospital for 3-6 months if found to be infected.

1864 - applied to garrison towns. In 1866 and 1869 the Acts were extended to include other districts.

New departure - compulsory treatment, state intervention.

‘‘Syphilis’, by Richard Cooper, Syphilis’, by Richard Cooper, 19101910

Opposition to ActOpposition to ActLadies’ National Association, Civil liberties,

medical men◦ Blamed prostitutes not men◦ Double standards for men and women◦ Implied different biology-men ‘biological necessity’;

women were either ‘pure’ or ‘depraved’◦ Officially condoned ‘vice’

Royal Commission 1873

1886 – Repealed Contagious Disease Acts

Effective treatment-Effective treatment-salvarsansalvarsan

1905 - disease causing bacteria identified - treponmema pallidum.

1906 – Wasserman developed a blood test to use for screening.

Paul Erlich tested effectiveness of arsenical compounds against the bacteria. Salvarsan was Number 606.

Within three years claimed to have effectively treated 10,000 syphilitics.

Salvarsan : ‘the magic Salvarsan : ‘the magic bullet’bullet’Ehrlich's best known magic bullet was

arsphenamine (Salvarsan, or compound 606), the first effective treatment for syphilis. At a meeting in 1910, Ehrlich and his colleagues announced the remarkable effects of their treatment of syphilis with this magic bullet.

A magic bullet is a perfect drug to cure a disease. The term magic bullet was first used in this sense by the German physician and scientist Paul Ehrlich who received the Nobel Prize in Physiology or Medicine in 1908.

Initially, Ehrlich invoked the notion of a magic bullet in characterizing antibodies. He then reused the concept of a magic bullet to apply to a chemical that binds to and specifically kills microbes or tumor cells.

Royal Commission 1913 & Royal Commission 1913 & Venereal Diseases Act 1916Venereal Diseases Act 1916

Free, optional diagnosis and treatment in Local Authority run clinics & salvarsan supplied free to GPs.

Protected patient’s anonymity

Health education - based on moral behaviour

Recommended be added to the medical curriculum

Banned advertising of quack remedies.

First World War and VDFirst World War and VDDefence of the Realm Act 1914 –

powers to stop soliciting soldiers, clamp down on prostitution

Venereal Disease Act 1916 – free clinics

National Council for Combatting Venereal Disease

Further Act of 1918, targeted those with venereal disease, allowing for compulsory treatment if caught suffering from disease

Treatment centres - A Treatment centres - A successful experiment?successful experiment?

1917 - 113 centres treating 29,000 patients

1920 - 190 centres treating 105,185 patients

Treated more men than women

Some patients did not complete treatment (1920- c. 40%)

Supported by GPs as ‘national emergency’

Anti-venereal disease campaingn Anti-venereal disease campaingn amongst allied troops in Italy, amongst allied troops in Italy, 1943-441943-44

ConclusionConclusion• The effective treatment of disease depends not

only on the development of effective treatments but also on how they are made available. Education, counselling and clinical services, as well as cultural attitudes all play an important part

• Gender roles in sexuality – ‘fallen’ women (prostitutes) to blame

• Links with public health movement – Contagious

Diseases Acts 1860s, Royal Commission 1913, VD Act 1916

• Concerns over national efficiency – heightened by WW1