Admittedly not Victorian but it highlights the false narrative of progress – ‘The easy girlfriend’, poster, England, 1943-1944 (Wellcome Images)
Cases of syphilis have hit their highest level since 1949 after being nearly eliminated. The rise of dating apps such as Tinder and Grindr have been implemented in the rise which has echoes of our Victorian forbearers who often considered syphilis and other venereal diseases as a suitable punishment for the moral crime of ‘promiscuity’. In a time without antibiotics the treatment for syphilis was intensive moral reform coupled with mercury – if you were a women you were likely to be admitted to a Lock Hospital where you would receive religious instruction and often, heavy metal poisoning. If moral shaming was ineffective in the nineteenth century then it certainly is not effective now. We may be far past the days of mercury treatments but without effective testing and public awareness syphilis can be an insidious beast, sometimes remaining symptomless for decades by which time the damage has been done.
The first symptom of syphilis is generally a singular chancre which is most often painless and easily missed or dismissed as an ulcer if they appear in the mouth. Syphilis is often termed ‘the great imitator’ as symptoms can look like numerous other diseases. After the initial infection syphilis progresses into the secondary stage where the sufferer may experience a widespread skin rash and flu symptoms. If untreated, a third stage of the disease can manifest itself after as long as twenty years without symptoms.
How many of us would even consider syphilis as a possibility?
The majority of syphilitic patients seeking treatment in the nineteenth century would be well in the grips of the disease. Those who could afford it would be treated privately in their home and it was the lower classes that could be confined to institutions that did not treat them kindly. Men were more likely to be admitted to general hospitals but women were for the most part turned away due to their ‘depravity’ or required to provide a character reference. Poorer women were admitted to Lock Hospitals, named after the earlier leprosy hospitals – ‘fallen’ women with VD were very much the social lepers of the day.
The Glasgow Lock Hospital admitted over 32,000 patients from its establishment in 1805 until 1900. The hospital’s exterior was wholly unremarkable, resembling a tenement far more than the grand architecture of most Victorian hospitals.
The Glasgow Lock Hospital (Glasgow City Archives)
The Deaf and Dumb Institute, Glasgow (Wellcome Library)
This was a testament to its stigma as it was hidden away on Rottenrow in the East End of the city. The Lock Hospital was a complex institution which isolated patients, subjecting them to intense religious instruction as well as medical treatment, before referring them for further reform in a Magdalene Home. It was not until 1910 did the hospital consider dispensary treatment, as this impeded on the moral aspect of the regime. Until then you were very much confined to the institution with the Matron reflecting in 1914 that it had the atmosphere ‘of a prison (with its ward doors all locked), instead of a hospital’.
It was officially denied but patients were subject to a compulsory examination using the speculum which could be so painful that younger patients were given chloroform in order to endure it. Hospital officials were so quick to deny the use of a compulsory examination as they attempted to distance themselves from the strategies of the Contagious Diseases Acts in use in certain port and garrison towns in England. Yet, in practise the treatment in Glasgow, once considered a good candidate for the CD acts, was hardly voluntary but punitive in character.
In terms of medical treatment, mercury was the order of the day and its overzealous use could result in poisoning which was often worse than the disease itself. By the early twentieth century the chemotherapeutic agent Salvarsan was in widespread use in the treatment of early syphilis. It was expected to replace mercury but it was standard practice to use both treatments until the mid 1920s. For those suffering with neurosyphilis they could be infected with malaria which effectively induced a seriously high fever to burn out the disease.
Bottle of Salvarsan treatment for syphilis, 1909-1914, London (Wellcome Images)
The moral agenda still underpinned medical treatments with patients being instructed to abstain from alcohol, dancing and even masturbation. Penicillin was introduced for the treatment of syphilis in 1943 and was found to be highly effective but public health campaigns upheld the view that the disease was an erosion of family life. The rhetorical shift from the nineteenth century moved from that of the ‘prostitute’ to ‘risky behaviour’ continued to demonise female sexuality.
Treatment was only effective once health campaigners moved away from moral culpability as a strategy and instead focused on awareness, prevention and accessible care.
The social response to syphilis in Britain was characterised by moral anxiety with the fear of ‘promiscuity’ impacting on its medical treatment. We must not let the moralisation of sex inform our current strategies in dealing with this sexual health crisis. Data from Health Protection Scotland showed that in 2015 cases of infectious syphilis were almost double that of 2014 with 96% being men and the vast majority men who have sex with men. There are stark parallels between the moral responsibility projected onto Victorian women and the ‘risky lifestyles’ discourses informing much of the response today which veers dangerously close to blame. Narrating the rise of syphilis with the rise of Tinder and Grindr does exactly this. Policy makers must address the challenge of reaching those most at risk without fostering stigma.
A public awareness campaign that does not rely moral shaming and implementing effective and confidential testing is what will combat this sexual health crisis. Early stage syphilis is easily treatable with a short course of antibiotics but increasing stigma will do nothing to encourage people to go to a clinic. As a disease it is certainly not confined to the history books and we must take seriously the lessons that its history has taught us.
 Roger Davidson, Dangerous liaisons: A social history of venereal disease in twentieth-century Scotland (2000)
 A. Patterson, Statistics of Glasgow Lock Hospital since its foundation in 1805 : with remarks on the Contagious Diseases Acts, and on syphilis (1882)