In continuous publication since 1828, The Spectator is already the oldest English-language magazine in 1916, and even claims the current Prime Minister as a former writer. His replacement, an aristocrat named John St. Loe Strachey, has since doubled circulation and made it the most influential weekly in London as sole owner and editor. Today’s edition reports that after a three-year investigation, the Royal Commission on Venereal Diseases has concluded that perhaps ten percent of Britain’s urban population is infected with syphilis, and an even higher percentage with gonorrhea.
The discovery of the actual causes of these diseases — the spirochoeta pallida and the gonococcus — and the discovery of Wassermann’s test, have done more than a hundred years of practical experience to make diagnosis infallible. The man in the laboratory, with a microscope and a row of test-tubes, miles away from the patient, is, in doubtful cases, the best judge; one might say, in many doubtful cases, the only judge. Moreover, Schaudinn’s discovery of the actual cause of syphilis set Ehrlich to discover a drug which should have a direct selective action on spirochoeta pallida, such as quinine has on plasmodium malariae. That is what salvarsan does. Ehrlich’s researches, as the Commissioners say, “constitute a new epoch in medical science.”
Although true antibiotics remain a future development, there are indeed treatments for venereal diseases in 1916. Prophylactic kits were already available prior to the war, and have even been distributed in military ranks, but they have limited civilian distribution, while the cost of these technologies is too high for many of the civilians who need them most. To reduce the incidence of both diseases, the RCVD suggests public spending on treatment and information — a completely modern, rational, ‘big government’ approach.
“The object must be to bring these means to bear upon every infected person at the earliest possible moment,” the RCVD is quoted. “These measures, if adopted without delay, will go far to remove the grave evils which our investigations have brought to light.”
“None of us can quarrel with this plan,” The Spectator says in response, agreeing that a new infrastructure should systematize the existing laboratories, universities, and health care providers in a centralized detection-and-treatment regime.
It will tend to ensure the protection of women and children; it will save lives; it will improve national health and efficiency; it will even, in the long run, save money. The well-to-do, of course, must pay, according to their means; but we have to provide, now, for those who cannot pay, the advantage of such methods of diagnosis and of treatment as are provided for the Army and the Navy. We have to do this, not only for the sake of the patients, but for the sake of the community, to whom they are dangerous; especially, for the sake of the coming generation. And we have to do it now, before the war is over.
Sexually transmitted disease organisms do not care about our politics, our values, or our shame, much less which uniform a soldier wears. These pathogens thrive on human moral codes which discourage honesty, and by extension, effective treatment. The Commission has acknowledged this behavioral element in calling for society-wide, top-to-bottom public education efforts, yet we can already see those same unhelpful moral codes reasserting themselves within their evidence-based approach.
Such instruction should be based on moral principles and spiritual considerations, and should not be based only on the physical consequences of immoral conduct. In elementary schools detailed instruction in class on sexual matters should not be undertaken. The practice, which has been followed by some head teachers, of having private interviews with pupils before they leave school, or if they show special need for guidance, in order to give moral instruction and to offer warnings against probable temptations, should be general.” This advice is good, all of it. But moral instillation, surely, must be founded on physiological instruction — first, that which is natural, and afterward, that which is spiritual. How many children wait till they are leaving school before they feel the impulse to think or act sexually? Mr. Paton’s evidence on this point should be read with care. But the responsibility for these tragedies of childhood probably rests more on parents than on schoolmasters. One might even surmise that there would be less of impurity among children if no parent told them lies when they ask where a brother or sister comes from. But the parents who habitually delude their children would require a separate Commission. Meanwhile, we have to think of the teaching of those who have got past childhood. Universities, factories and workshops, continuation schools, adult schools, guilds, institutes, and, above all, hospitals, must do what they can to help this teaching.
Worried by a declining birth rate, the urgent necessity of a healthy workforce for making shells and guns, as well as the bloodbath on the Western Front, the report’s author opines that trained presenters ought to show slides of spirochoeta and gonococcus to lecture halls and not hesitate to “add spiritual considerations” to their scientific notes; the “national prosperity” depends on it.
The Commission is not entirely wrong. During the Great War, the British Army experiences at least 400,000 hospital admissions for venereal diseases — roughly five percent of men enlisted in the land force, with some sources suggesting the true number is even higher. Since gonorrhea treatment requires 35-49 days of hospitalization and syphilis up to ten weeks, both microorganisms have a significant impact on what we now call ‘soldier readiness’ and the British military effort.
Prostitution is probably the single largest disease vector for the British Army. Conducting a limited study, one pair of British Army doctors estimated that the brothels along one street in Le Havre had received more than 170,000 visitors during 1915. Most disease transmission does not take place in the famous French maisons tolerées, however, but outside the training camps of England; fully half of all Dominion troops (Canadians, Australians, South Africans, etc) are infected before they arrive in France.
Conventional wisdom of the era holds that men need sex, and that married men need it even more, so the British Army has taken a hands-off approach within the United Kingdom, where the practice is underground. In France, where customs differ, the British Army could put bordellos off-limits, but worries it would offend their hosts. Instead, blue and red lamps segregate officer brothels from enlisted ones.
Of course, the British Army has taken steps to limit the damage wrought by known microorganisms. Salvarsan, an ointment made of mercury and chlorine, and urethral irrigators filled with potassium permanganate, are made available at treatment stations. Condoms also began to appear in the brothels. But the most effective impediment to venereal disease outbreak in the ranks is low pay. British soldiers receive about one-twentieth of a Dominion soldier’s salary, with correspondingly higher infection rates among colonial soldiers. In Egypt, the major way-station for Australian troops on their way to the Western Front, their infection rate is six times higher than British troops stationed in the same country. Between training at Salisbury and their bloody experiences at Ypres last year, the 1st Canadian Division experienced a peak infection rate of 22%.
In large part due to predictable moral panic, British policy never quite resolves the dissonance between clunky rationalism and the spirit of the progressive age to reach some kind of consistent outcome. Beginning with a drive to provide brothels with medical testing and treatment, for example, the Army ends the war with these sanitized locations blacklisted and starts handing out condoms in 1917. Australia takes a harsher tack, suspending the pay of infected men while they are ‘absent without leave’ for treatment and opening special camps for the thousands who contract venereal diseases before ever leaving the nation’s shores.
The worst measures are aimed not at soldiers, but the women who service them. Ever the Victorian prude, Lord Herbert Kitchener anticipated this point in the first months of the conflict when he issued a pamphlet to every troop imploring him to “keep constantly on your guard against any excesses. In this new experience you may find temptations both in wine and women. You must entirely resist both.” Defining women as “temptations” rather than people, the British government takes measures to control disease that end up controlling women instead. Prostitutes are fined, but not the men who visit them. Added to the Defence of the Realm Act, new regulations will criminalize solicitation by afflicted women; put on trial, their names and medical testing results become ruinous public record.
We are used to thinking of the time before the Great War as a sexually-repressed era. In fact, the conflict is deepening pre-existing forms of sexual repression, from censorship to homophobia to misogyny, in ways that haunt Britain and its former imperial domains even now, a century later.