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Compulsion, Voluntarism, and Venereal Disease: Governing Sexual Health in England after the Contagious Diseases Acts

Published online by Cambridge University Press:  21 December 2012


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Copyright © North American Conference of British Studies 2007

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1 The term “sexually transmitted disease” has now replaced “venereal disease.” “Venereal disease” was used from the eighteenth to the late twentieth centuries to refer mainly to syphilis and gonorrhea.

2 Towne, Arthur W., “Compulsory versus Voluntary Methods of Venereal Disease Control in Scandinavia, Holland and Great Britain,” American Journal of Syphilis, Gonorrhea, and Venereal Diseases 23, no. 3 (1939): 27Google Scholar.

3 Davidson, Roger and Hall, Lesley, “Introduction,” in Sex, Sin and Suffering: Venereal Disease and European Society since 1870, ed. Davidson, Roger and Hall, Lesley (London, 2001), 1–14Google Scholar; Lesley Hall, “Venereal Diseases and Society in Britain, from the Contagious Diseases Acts to the National Health Service,” in ibid., 120–36, and Sex, Gender and Social Change in Britain since 1800 (London, 2000)Google Scholar; David Evans, “Sexually Transmitted Disease Policy in the English National Health Service, 1948–2000: Continuity and Social Change,” in Davidson and Hall, Sex, Sin and Suffering, 237–52, and Tackling the Hideous Scourge—the Creation of the Venereal-Disease Treatment Centers in Early 20th-Century Britain,” Social History of Medicine 5, no. 3 (1992): 413–33CrossRefGoogle Scholar.

4 Evans, “Sexually Transmitted Disease Policy,” 240.

5 Davidson, Roger, Dangerous Liaisons: A Social History of Venereal Disease in Twentieth-Century Scotland (Amsterdam, 2000)Google ScholarPubMed.

6 Levine, Philippa, Prostitution, Race and Politics: Policing Venereal Disease in the British Empire (New York, 2003)Google Scholar.

7 Baldwin, Peter, Contagion and the State in Europe, 1830–1930 (Cambridge, 1999), 487–96CrossRefGoogle Scholar.

8 Cox, Pamela, Gender, Justice and Welfare: Bad Girls in Britain, 1900–1950 (Basingstoke, UK, 2003)Google Scholar, and “Girls in Trouble: Defining Female Delinquency, Britain, 1900–1950,” in Secret Gardens, Satanic Mills: Placing Girls in European History, 1750–1960, ed. Maynes, Mary Jo, Soland, Birgitte, and Benninghaus, Christina (Bloomington, IN, 2005), 192205Google Scholar, and “Girls, Deficiency and Delinquency,” in From Idiocy to Deficiency: Historical Perspectives on People with Learning Disabilities, ed. Wright, David and Digby, Anne (London, 1996), 184206CrossRefGoogle Scholar.

9 See Dean, Mitchell, Governmentality: Power and Rule in Modern Society (London, 1999)Google Scholar, for an outline of how these concepts are identified and examined by theorists of governmentality.

10 The term “mixed economy of welfare” generally refers to the interplay among the state, the voluntary sector, the private sector, and the family in shaping provision of and demand for welfare services. See Lewis, Jane, “Voluntary and Informal Welfare,” in British Social Welfare in the Twentieth Century, ed. Page, Robert M. and Silburn, Richard (London, 1999), 249CrossRefGoogle Scholar; Lewis, Jane, The Voluntary Sector, the State and Social Work in Britain: The Charity Organisation Society/Family Welfare Association since 1869 (Aldershot, UK, 1995)Google Scholar; Mooney, Gerry, “‘Remoralizing’ the Poor? Gender, Class and Philanthropy in Victorian Britain,” in Forming Nation, Framing Welfare, ed. Lewis, Gail (London, 1998), 51Google Scholar.

11 Scott, J., “The Management of Venereal Disease in New South Wales, 1871 to 1916,” Venereology—the Interdisciplinary International Journal of Sexual Health 14, no. 2 (2001): 6979Google Scholar.

12 Valverde, Mariana, “Targeted Governance and the Problem of Desire,” in Risk and Morality, ed. Ericson, Richard V. and Doyle, Aaron (Toronto, 2003), 438–58Google Scholar. The drug she discusses here is naltrexone. See also Valverde, Mariana, Diseases of the Will: Alcohol and the Dilemmas of Freedom (Cambridge, 1998)Google Scholar.

13 Bland, Lucy, Banishing the Beast: English Feminism and Sexual Morality, 1885–1914 (London, 1995)Google Scholar, and “‘Cleansing the Portals of Life’: The Venereal Disease Campaign in the Early Twentieth Century,” in Crises in the British State, 1880–1930, ed. Langan, Mary and Schwarz, Bill (London, 1985), 192–208Google Scholar; Davidson, Dangerous Liaisons; Mort, Frank, Dangerous Sexualities: Medico-Moral Politics in England since 1830, 2nd ed. (London, 2000)Google Scholar.

14 The acts covered eighteen areas by the late 1860s and twenty-two in the 1880s.

15 On the workings of the CD Acts and the repeal campaign, see Walkowitz, Judith, Prostitution and Victorian Society: Women and the State (Cambridge, 1980)CrossRefGoogle Scholar; Hall, Sex, Gender and Social Change; Baldwin, Contagion and the State, chap. 5. On imperial legislation, see Levine, Prostitution, Race and Politics.

16 In 1860, the infection rate among soldiers was estimated at 309 per thousand. This did fall to 201 in 1870 and to 139 in 1875, although the fact that, between 1873 and 1879, soldiers who reported their condition while undergoing treatment forfeited their pay led to much underreporting as evidenced by the rise in the infection rate to 245 per thousand in 1880. After 1900 (and long after the repeal of the CD Acts), rates fell more dramatically, to ninety in 1905 and fifty in 1913. See SirCantlie, Neil, A History of the Army Medical Department, vol. 2 (London, 1974), 374Google Scholar; Inter-departmental Committee on Infectious Diseases in Connection with Demobilisation, Command Paper no. 322, “Note by the Chairman (the Hon Waldorf Astor, MP) to the Minister of Health on Prophylaxis against Venereal Disease” (London, 1919), 6, table D.

17 The National Archives (TNA): Public Record Office (PRO), WO32.11403, 14 June 1918, Letter from the secretary of the Association of Moral and Social Hygiene to the under-secretary of state for war.

18 During 1942, an estimated seventy thousand new civilian cases presented at venereal clinics, though some doctors believed that new cases numbered nearer one hundred and fifty thousand—a figure similar to cases recorded in the late 1920s. See, e.g., Dr. Edith Summerskill MP, Hansard, Parliamentary Debates, Commons, vol. 385, 15 December 1942 (1942–43), “Emergency Powers (Defence), Venereal Disease (Compulsory Treatment),” 1807.

19 On the workings of Regulation 33B, see Hall, “Venereal Diseases and Society.” See also Hall, Lesley, “‘War Always Brings It On’: War, STDs, the Military and the Civilian Population in Britain, 1850–1950,” in Medicine and Modern Warfare, ed. Cooter, Roger, Harrison, Mark, and Sturdy, Steve (Amsterdam, 2000), 205–33Google Scholar, and ‘The Reserved Occupation’? Prostitution in the Second World War,” Women's History Magazine 41 (2002): 49Google Scholar.

20 Hansard, Parliamentary Debates, Commons, vol. 385, 15 December 1942 (1942–43), 1807–88.

21 On contact tracing, see Wilson, H., “History of Sexual Health Advising,” in The Manual for Sexual Health Advisers, ed. Society of Sexual Health Advisers (London, 2004), 188–93, 192Google Scholar; Davidson, Dangerous Liaisons. On the development of postwar sexual health policy, see Berridge, Virginia and Strong, Philip, eds., AIDS and Contemporary History (Cambridge, 19932002)CrossRefGoogle Scholar; and Berridge, Virginia, AIDS in the UK: The Making of Policy, 1981–1994 (Oxford, 1996)CrossRefGoogle Scholar.

22 The Lancet 1 (1944): 167, cited in Hall, “Venereal Diseases and Society,” n. 67.

23 Scharlieb, Mary, Venereal Diseases in Children and Adolescents: Their Recognition and Prevention (London, 1920), 5Google Scholar. Other advances were made in relation to gonorrhea; in 1906, Müller and Oppenheim discovered an effective laboratory test for it.

24 Rose, Nikolas, Powers of Freedom: Reframing Political Thought (Cambridge, 1999), 41CrossRefGoogle Scholar.

25 Ellis, Kathryn, “Welfare and Bodily Order: Theorizing Transitions in Corporeal Discourse,” in Social Policy and the Body: Transitions in Corporeal Discourse, ed. Ellis, Kathryn and Dean, Hartley (Basingstoke, UK, 2000), 122CrossRefGoogle Scholar.

26 Report of the Royal Commission on Venereal Disease (London, 1916), 1011Google Scholar.

27 Evans, “Tackling the Hideous Scourge,” 431.

28 Hall, “Venereal Diseases and Society,” 128. For discussion of Scottish rates, see Davidson, Dangerous Liaisons, 157–76.

29 The 1889 Infectious Disease (Notification) Act aimed to reduce the spread of conditions such as smallpox, cholera, scarlet fever, diphtheria, and typhoid through a series of compulsory measures. These included notification, removal of the patient to the hospital for treatment (or their thorough isolation at home), and the disinfection of houses, bedding, and personal property. See Mooney, Graham, “Public Health versus Private Practice: The Contested Development of Compulsory Infectious Disease Notification in Late Nineteenth-Century Britain,” Bulletin of the History of Medicine 73 (1999): 238–67CrossRefGoogle ScholarPubMed.

30 For these and more general examples of opposing views, see Dr.White, Douglas, “The Case against Notification of Venereal Diseases,” in The Venereal Clinic, ed. Clarkson, Ernest R. T. (London, 1922), 387–91Google Scholar; and Towne, “Compulsory versus Voluntary Methods.”

31 Baldwin, Contagion and the State, 475, 487. According to Baldwin, “the only limitation[s]” to that “perfect freedom” (with the exception of provisional wartime measures) “were potential nuptial consequences: that marriages could be nullified if one partner was ill, that women infected by their husbands could (eventually) sue for divorce and maintenance” (487).

32 Davidson, Dangerous Liaisons, 325, 10–11.

33 The 1914 Public Health (ophthalmia neonatorum) Regulations introduced this measure.

34 Evans, “Tackling the Hideous Scourge,” 433.

35 The name “lock” has uncertain origins. Some historians claim that it derives from the old French word “loque,” meaning a cloth dressing applied to a sore, especially and notably sores caused by diseases such as leprosy. Certainly, the leper houses and colonies of earlier eras where patients were often treated and confined were more than a model for lock hospitals. “Lock” could also in practice be understood in the more literal sense of “locked in,” or detained.

36 For example, the 1881 census returns for the Bristol and Colchester lock hospitals list thirteen and fifteen female patients, respectively, aged between fifteen and twenty-six. See Bristol census, 1881, St. Michael parish, Lock Hospital, Lower Old Park Hill, Bristol Record Office; Colchester census, 1881, St. Giles parish, Lock Hospital, Park Lane [sic, should read Port Lane], Essex Record Office, Colchester branch.

37 Manchester Medical Library, 4/25/1/23, The Report of the Manchester and Salford Lock Hospital (n.p., 1916), 5. Soon after the publication of this report, the hospital became a designated VD clinic, changing its name to St. Luke’s. It is not clear when its inpatient admissions patterns changed. See also Wyke, T., “The Manchester and Salford Lock Hospital, 1818–1917,” Medical History 19 (1975): 7386CrossRefGoogle Scholar.

38 For reference to the Bristol institution, see Mrs.Pendlebury, M., The Ratepayer and the Lockward (London, 1918Google Scholar; reprinted from The Nineteenth Century [September 1918]). On Glasgow, see Davidson, Dangerous Liaisons, 96; and Mahood, Linda, The Magdalenes: Prostitution in the Nineteenth Century (London, 1990)Google Scholar, and Policing Gender, Class and Family, Britain, 1800–1940 (London, 1995)Google Scholar.

39 See Williams, David, The London Lock: A Charitable Hospital for Venereal Disease, 1746–1952 (London, 1995)Google Scholar, for a rare account of the workings of the London Lock after the repeal of the CD Acts. For its earlier history, see Andrew, Donna, “Two Medical Charities in Eighteenth-Century London: The Lock Hospital and the Lying-In Charity for Married Women,” in Medicine and Charity before the Welfare State, ed. Barry, Jonathan and Jones, Colin (London, 1991), 82–97Google Scholar; Merians, Linda E., “The London Lock Hospital and the Lock Asylum for Women,” in The Secret Malady: Venereal Disease in Eighteenth-Century Britain and France, ed. Merians, Linda E. (Lexington, KY, 1996), 128–45Google Scholar.

40 Williams, The London Lock, 96, 114, 120–21. Admissions had fallen to 340 in 1912.

41 Scharlieb, Venereal Diseases in Children, 17. Scharlieb discusses the findings of Dr. R. W. Johnstone, commissioned by the Local Government Board to investigate poor law lock wards. See R. W. Johnstone, Report on Venereal Diseases, Command Paper no. 7029 (London, 1913).

42 Pendlebury, The Ratepayer and the Lockward, 5. Other references in this piece suggest that the lockward described was in Bristol.

43 Royal College of Surgeons Archives (RCSA), London, London Lock Hospital, Board of Management Report, 1926.

44 Clarkson, The Venereal Clinic, 400–401, lists thirteen London facilities. Dorothy Manchée (Social Service in the Clinic [London, 1943]) lists many more facilities in her appendix.

45 See Cox, Gender, Justice and Welfare, chap. 3, for a longer discussion of the work of the twentieth-century rescue sector.

47 Ibid., 64–65. London Metropolitan Archive, LCC/CH/D/12/10, VD and vulvo-vaginitis in remand homes and approved schools, 1935–45. From the 1850s, girls committed to custody could be sent to particular kinds of “certified schools” depending on their age and the nature of their “offence.” These were run by charities and monitored by the Home Office. Some only admitted girls who had sexual knowledge or experience, while others excluded them.

48 The observation about “sentences” was made by a woman who taught at one of these schools, Rowley Hall, in Staffordshire, from 1945–50, in an interview with me in 1994. The interview was conducted in confidentiality, and the name of the interviewee has been withheld by mutual agreement.

49 Valverde, Diseases of the Will. See Cox, Gender, Justice and Welfare, 64, for evidence of such examinations in the juvenile justice system.

50 TNA: PRO, MH79/274, London Lock Hospital, “Report of the Committee of Inquiry” (1928–29), 3.

51 TNA: PRO, HO45/19977, Appointment of a Lady Doctor at Holloway and Aylesbury, 1917–18. See also Blythe, Beverley, “The Borstal System for Girls, 1908–1948” (MA thesis, University of Essex, 1998), 10, 53Google Scholar.

52 RCSA, London, London Lock Hospital, Board of Management Report, 1926, 7.

53 Tredgold, A. F., Mental Deficiency in Relation to Venereal Disease (London, 1918), 17Google Scholar.

54 Ibid., 11.

55 Unsworth, Clive, The Politics of Mental Health Legislation (Oxford, 1987), 288, 323–25Google Scholar.

56 Crookshank, F. G., “The Medico-Legal Relations of Venereal Disease,” in Harrison, L. W., The Diagnosis and Treatment of Venereal Disease in General Practice, 4th ed. (Oxford, 1931), 452506Google Scholar. See also H. S. Q. Henriques, “Legislation and the Practitioner,” in Clarkson, The Venereal Clinic, 410–15.

57 White, “The Case against Notification,” 388. White could be referring to debates as to a doctor's obligation to reveal information gained during medical consultations, for example, as part of divorce proceedings.

58 Cox, Gender, Justice and Welfare, chap. 4.

59 RCSA, London, London Lock Hospital, Board of Management's Report, 1927, 10.

60 Davidson, Dangerous Liaisons, 110–14.

61 Clarkson, The Venereal Clinic, 381.

62 RCSA, London, London Lock Hospital, Board of Management's Report, 1927, 10.

63 Manchée, Social Service in the Clinic, 32–33.

64 Ibid., 34.

65 Clarkson, The Venereal Clinic, 402.

66 Manchée, Social Service in the Clinic, 52.

67 Ibid., 42–43.

68 Ibid., 43–44.

69 Ibid., 53. Manchée says such cases were admitted to a special unit at Queen Mary's Hospital in Carshalton, which offered education along with treatment. The fact that local authorities from outside London paid maintenance fees to that hospital clearly suggests that this was a formal arrangement and one that stretched beyond the capital. See Jackson, Louise, Child Sexual Abuse in Victorian England (London, 2000)Google Scholar, for discussion of broader responses to sexual abuse.

70 Manchée, Social Service in the Clinic, 53. Other child cases were sent, according to the earlier 1938 edition of this text, to St. John's Hospital in Battersea (later moved to Carshalton) and St. Margaret's Hospital in Kentish Town.

71 See TNA: PRO, MH55/193, Congenital Syphilis, Dr. J. P. Candler, “The Problem of Congenital Syphilis and of the Control and Treatment of Maternal Syphilis” (1932), for a review of early twentieth-century studies.

72 Scharlieb, Venereal Diseases in Children, 6.

73 TNA: PRO, MH55/177, Congenital Syphilis, Discontinuance of attendance of children and pregnant women at clinics.

74 Manchée, Social Service in the Clinic, 53.

75 Towne, “Compulsory versus Voluntary Methods,” 17.

76 Manchée, Social Service in the Clinic, 50–51.

77 RCSA, London, London Lock Hospital, Annual Reports, 1926 and 1934.

78 Levine, Prostitution, Race and Politics, 277–78. See also Hall, Sex, Gender and Social Change, for a discussion of men and VD.

79 TNA: PRO, WO32/11403, Sir Reginald Brade, War Office, to Mrs May Ogilvie Gordon, president of the National Union of Women Workers, 6 April 1918.

80 TNA: PRO, MEPO 2/7012, Notes relating to Interdepartmental Committee on Venereal Disease, 1943.

81 Levine, Prostitution, Race and Politics, 293.

82 See, e.g., Sir Joseph Lamb MP, Hansard, Parliamentary Debates, Commons, vol. 385, 15 December 1942 (1942–43), 1858; Hall, “War Always Brings It On.”

83 National Council for Combatting Venereal Diseases, The Speakers’ Handbook—Compiled for the Use of Lecturers Representing the NCCVD (London, 1917), 27Google Scholar; “Inter-departmental Committee on Infectious Diseases in Connection with Demobilisation,” appendix, Command Paper no. 322 (London, 1917).

84 National Council for Combatting Venereal Diseases, The Speakers’ Handbook, 20.

85 “Inter-departmental Committee on Infectious Diseases in Connection with Demobilisation,” 11.

86 Hall, Lesley, “What Shall We Do with the Poxy Sailor? Venereal Diseases in the British Mercantile Marine, 1860–1950,” Journal of Maritime Research (October 2004), Scholar; Sally Sheard, “Mixed Motives: Improving the Health of Seamen in Liverpool, 1875–1939” (unpublished manuscript, Department of History, University of Liverpool, 2001), 1–19; Mrs.Neville-Rolfe, C. and Dr.May, Otto, The Mercantile Marine and the Problem of Venereal Disease (London, 1924)Google Scholar.

87 Sheard, “Mixed Motives,” 3.

88 Census of England and Wales, 1881, vol. 2. Area, Houses, Population, BPP, 1883, LXXIX.1, table 6, various pages; Cox, Pamela, “Race, Delinquency and Difference in Twentieth Century Britain,” in Becoming Delinquent: British and European Youth, 1650–1950, ed. Cox, Pamela and Shore, Heather (Aldershot, 2002), 159–77Google Scholar; Tabili, Laura, “Women ‘of a Very Low Type’: Crossing Racial Boundaries in Late Imperial Britain,” in Gender and Class in Modern Europe, ed. Frader, Laura and Rose, Sonya (Ithaca, NY, 1996), 165–90Google Scholar.

89 See Manchée, Social Service in the Clinic, 72, 79, for list of seamen's VD facilities in London.

90 TNA: PRO, MEPO2/2336, Memorandum on “Venereal Disease” from Commissioner's Office to Superintendents, 5 August 1921, and Report, by A. Fielden of A3 Division, 4 July 1921.

91 Williams, The London Lock, 124, 125–27. On the work of the chaplain and missionaries among male patients, see TNA: PRO, MH 79/274, London Lock Hospital, “Report of the Committee of Inquiry,” 1928–29, 5.

92 Houlbrook, Matt, Queer London: Perils and Pleasures in the Sexual Metropolis, 1918–1957 (Chicago, 2005), chap. 7Google Scholar.

93 The cases are discussed in brief in TNA: PRO, MH 79/274, London Lock Hospital, “Report of the Committee of Inquiry,” 1928–29, and in more detail in TNA: PRO, MH 79/275, Lock Hospital Inquiry, 1928, Notes of Evidence.

94 TNA: PRO, MH79/274, London Lock Hospital, “Report of the Committee of Inquiry,” 1928–29, Minority Report, 42. One member of the inquiry team, Mrs. H. J. Tenant, published a minority report in the same document as the majority report.

95 See, e.g., Rose, Powers of Freedom; Dean, Governmentality.

96 Lukes, Steven, Power: A Radical View (1974; 2nd ed., Basingstoke, UK, 2005)CrossRefGoogle Scholar.

97 See Cox, Gender, Justice and Welfare. Board of Control papers show doctors were able to sterilize women if they could prove that the operation was in their medical interests; see, e.g., TNA: PRO, MH51/546.

98 Clarkson, The Venereal Clinic, 402; Manchée, Social Service in the Clinic, appendix; Pendlebury, The Ratepayer and the Lockward, 8.

99 Manchée, Social Service in the Clinic, 62.

100 Cox, Gender, Justice and Welfare, 47.