Systematising the diagnosis and treatment of venereal diseases among civilians during the First World War

In 1913 the Royal Commission on Venereal Diseases was established to inquire into the prevalence of venereal diseases among the civilian population and to recommend more effective systems of prevention and treatment. In 1916, after 64 sitting days during which 85 expert medical witnesses were asked 22,296 questions and their testimony transcribed into 758 pages of minutes, the Royal Commission finally brought down a comprehensive series of 35 recommendations.

The Royal Commission’s unprecedented series of recommendations was based upon the principal of universal and freely-available healthcare, while rejecting traditional calls for notification and regulation. They were directly responding to long-standing concerns over the training of medical students, the competency of the average general practitioner, the accessibility and effectiveness of treatment, and the role of various professional groups in the diagnosis, treatment, and prevention of venereal diseases. These recommendations constituted the first systematised state intervention in the prevention and treatment of venereal diseases among civilians since the repeal of the Contagious Diseases Acts in 1886. Medical technologies such as the diagnostic Wassermann reaction and the German-manufactured drug, salvarsan (and its British-made wartime substitutes), became available on an unprecedented scale through the establishment of a national network of clinics specifically designed for the treatment of venereal diseases among the civilian population of Britain.

The affordability and availability of these new diagnostic and therapeutic technologies was crucial to the efficient working of the new clinics. The Commissioners therefore recommended that, subject to proper safeguards, local health authorities be empowered to supply salvarsan (an otherwise costly drug) gratuitously to medical practitioners. They also recommended that the Wassermann reaction be made readily available to test the blood serum of any patient suspected of having syphilis. In the years before the First World War much of the clinical work being done with salvarsan had been experimental as clinicians sought the safest concentrations and best methods of administration. Likewise, the performance of the Wassermann reaction had been expensive, experimental, and confined to a small number of institutions. The new centralised system of treatment clinics enabled greater numbers of general practitioners, unskilled in the administration of salvarsan or the employment of the Wassermann reaction, to obtain these new therapeutic and diagnostic facilities for their patients.

By the time the Royal Commission brought down its recommendations in 1916 it had become apparent that, if venereal diseases were to be successfully combatted, practitioners and health officials could not confine their attention to the sexual practices and sexual health of soldiers and prostitutes. The regulatory measures imposed under the Defence of the Realm Act (DORA) 13a and 40d may have prohibited women convicted of soliciting from being in the vicinity of military camps, and may have prohibited any woman, prostitute or otherwise, having intercourse with servicemen if infected with venereal diseases. However, as Julia Laite has most recently demonstrated, DORA had little tangible influence upon a public health bureaucracy and medical profession that, by the First World War, had set itself on a path towards a much less interventionist and regulatory system of treatment and disease prevention. Indeed, the Royal Commission’s recommendations demonstrated a discernable shift towards a gender-neutral system of treatment and disease management. It was a system based upon the principal that venereal diseases could not be effectively controlled unless infected persons were diagnosed early and received adequate and immediate treatment.

If this new non-interventionist system of diagnosis and treatment was to work, then confidentiality was essential. Infected persons seeking care through the new clinics not only needed confidence in the efficaciousness of new treatments. They also needed to feel that their treatment would remain confidential, and not subject of the type of notification and regulation that had been enforced under the Contagious Diseases Acts. Under these circumstances, the Royal Commission could do little else but recommend in 1916 that ‘no system of notification of venereal diseases should be put into force at the present time’.[1] This recommendation demonstrated concern for the fact that many patients, keenly aware of the stigma surrounding venereal diseases and desirous to be done with treatment as soon as possible, were slipping through the cracks of an ill-equipped healthcare system. The Commissioners were placed in a difficult situation. They were having to make recommendations for the improvement of a system of care that was still underpinned by moral prejudices. At the same time, they needed to remain sensitive to the strong liberal and feminist opposition towards any return to the regulationism of the Contagious Diseases Acts.

The network of clinics established in the wake of the Royal Commission not only reflected wider shifts in the ideology of healthcare and in medico-moral attitudes towards venereal diseases and sexual health. As the first universally and freely-available healthcare system in the United Kingdom these clinics would also have profound implications for the trajectory of healthcare throughout the twentieth century, providing important ideological and structural foundations for what would become the National Health Service in 1948.

Anne Hanley has recently submitted a PhD in medical history to the University of Cambridge. Her doctoral research addressed the developing clinical practices, knowledge claims, and professional debates that were instrumental in building up knowledge of venereal diseases in England during the late-nineteenth and early-twentieth centuries. She is now taking this research forward into the First and Second World Wars, examining important legislative changes and technological developments, and their effects upon healthcare provisions. Her blog and more about her research can be found here.