Vice, VD and prostitution

1. Medicine, Disease and Society in Britain, 1750 - 1950 Vice, VD and prostitution Lecture 15

2. Lecture themes • Links with previous lectures: • Treatment approaches between regulars and quacks. The development of a modern ‘cure’ and how this was implemented • Issues of Morality and Blame – innocent and not so innocent victims. Working classes causing the degeneration of the nation etc • Ideas about sexuality, biological urges and gender roles • Example of how disease progress is dependent on biological and socio-cultural values and responses • Part of national degeneration fear

3. State Involvement • Pre 1864- no state control • 1864-1886- state regulation • 1886-1913- little involvement • 1913- onwards- more involvement

4. The opening-up of the Americas 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

5. Syphilis raged from the late fifteenth century. Known as ‘le mal de Naples’ ‘French pox’

6. James Boswell - 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

7. 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’.

9. Contagious Diseases Act 1864 • 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.

11. Opposition to Act • Ladies’ 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

12. Effective treatment-salvarsan • 1905 - disease causing parasite identified- treponmema pallidum. • 1906 – Wasserman developed a blood test to use for screening. • Paul Erlich tested effectiveness of arsenical compounds against the parasite. Salvarsan was Number 606. • Within three years claimed to have effectively treated 10,000 syphilitics.

13. Salvarsan : ‘the magic 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 with no danger of side effects. 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.

14. Royal Commission 1913 & Venereal 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.

15. First World War and VD • Defence of the Realm Act 1914 – powers to stop soliciting to soldiers • Further Act of 1918, targeted those with venereal disease, allowing for compulsory treatment if caught

16. Treatment centres - A 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’

17. Post 2 World War More focus on prevention Continued free treatment

18. 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 – heighted by WW1 Conclusion