Victorian London - Disease - Venereal disease

    A few stubborn figures may perhaps assist the candid reader towards, at least, a partial removal of impressions he may have received, in common with a large portion of the public, as to the causes of mortality among prostitutes.
   
Some years ago, in 1851, the Registrar-General, Major Graham, with his usual politeness and at considerable trouble, extracted for me the number of deaths ascribable to venereal diseases which occurred in the Metropolis during the years 1846-48, and again in the year 1868. I am further indebted to him and Dr Farr for the additional tables, and from them I have compiled the following:

    The first thing that strikes the reader here is the paucity of fatal cases. Notwithstanding the frequency of the complaint in the Metropolis, . . . only 127 deaths are noted during 156 weeks, out of a population amounting to more than 3,000,000, or on the average less than one a week.
   
The above table, I think, disposes of the hypothesis that any large number of females, whether prostitutes or not, die annually of syphilis. It exhibits only 73 women to 54 men; and this proportion is more striking when we consider that the female population of London is to the male as 120 to 100, or six to five.
   
In order to corroborate my assertions made some years ago, that syphilis was not a fatal disease, I again applied, in May 1857, to Major Graham, and he kindly forwarded me the annexed table, which is curious as showing how large a proportion of the female mortality from syphilis falls upon infants and children under five years of age.

    In a letter, dated 1868, with which Dr Farr has favoured me, that gentleman says: ' It is probable that at least a portion of the increase in the number of cases of syphilis is due to improved and more accurate registration.'
   
Let persons who have been through the syphilitic wards of hospitals call to mind the stamp of women to be seen there. The fact of a girl's seduction generally warrants her possession of youth, health, good looks, and a well-proportioned frame - qualifications usually incompatible with a feeble constitution. She, at least, meets the world with power of resistance beyond the average of women in her station. Notwithstanding all her excesses (and legion is their name) the prostitute passes through the furnace of a dissipated career less worse from wear than her male associates; and when she withdraws from it - as withdraw she will in a few years, for old prostitutes are rarely met with - she is seldom found with her nose sunk in, her palate gone, or nodes upon her shins.
   
Nay, more, experience teaches that frequently the most violent and fatal cases among women take their rise during the period of comparative innocence, before their adoption of prostitution, and their consequent acquirement of worldly knowledge. I grieve to say that there are systematic seducers so unutterably base as not only to pollute the mind of modest girls, but simultaneously to steep their bodies in most lamentable corruption. Their want of knowledge and ingenuous sense of shame induce, in cases such as these, aggravation of suffering from which the experienced prostitute is comparatively exempt.
   
So rare is death from uncomplicated syphilis, that many a surgeon has never witnessed a single instance; and those attached to hospitals where venereal diseases are specially treated have so few opportunities of witnessing post-mortems of persons who have succumbed to them, that it becomes interesting to inquire how they produced death. This is answered by the return from the Registrar-General. In the first place, erysipelas may attack the sores of all patients entering a hospital, and a certain number of syphilitic patients, as of other classes, die from this cause. Syphilis, therefore, acted but a secondary part in producing the fatal termination of the 17 cases of erysipelas in the above table.
   
  ... Syphilis is most frequently fatal when it has reached the tertiary form, in the neglected cases of which we observe its greatest ravages. Patients are destroyed by the deposit of bone, which, pressing on the brain, produces paralysis, convulsions, and other nervous phenomena. In other cases caries of bones takes place, and exhaustion causes death. Occasionally the cartilages of the larynx fall in, and the patient dies asphyxiated. Lastly, the hopeless and intense form of tertiary syphilis, known as syphilitic cachexia, sometimes comes on, and gradually leads to a fatal termination, as in the following instance.
   
I was called to see a young girl who was stated to be very ill, at King Street, Islington. I found my poor dispensary patient living in an attic, in one of the small streets off the Lower Road, attended by her mother, without fire or furniture, almost without clothing. She lay, doubled up in the corner of this bare room, on an old mattress stuffed with shavings, with no bed-linen but a thin patched quilt and a few rags. She was covered with rupia, and attenuated to the last degree, though bearing marks of having been a very pretty girl.
   
She had never left her mother's roof for twenty-four hours; but had nevertheless been seduced, diseased, and deserted - sad and frequent story - and, as long as she was able, had in secret attended at a hospital. Her mother had never left her, and - so naive had she remained in this city of licentiousness - was apparently unaware of the nature of her child's disorder. Never applying to the parish, she had obtained a bare subsistence by her needle, until her ministering office had shut out even this precarious support. She had parted with her every property, till, indeed, no warmth could be obtained except by creeping close together under their miserable counterpane.
   
At once, seeing the nature of the case, and the impossibility of my being of material service to this poor creature, I spoke of the hospital, but neither mother nor daughter would hear of it: they had never been separated, and never would be. Persuasion was in vain. Assistance was procured; still the debility increased, and I was absolutely obliged to threaten the interference of the parish officers. At last the patient consented to be carried to the hospital, but at such a stage of the complaint this could only be effected with the greatest difficulty. She was, however, admitted into St Bartholomew's, and the comforts which that noble institution so liberally furnishes to its sick, at first caused her to rally, but an immense abscess formed in her thigh, and she sank in a short time under syphilitic cachexia.
   
Who could have seen that hapless, unoffending victim to her woman's trust and man's barbarity, hurried to an early grave, without asking himself could such a one have been marked out for example and for punishment by a discerning Providence, as some would tell us?
   
.... [Despite] the public and popular notion that by deaths in hospitals we rid ourselves of the immoral female population, . . . not a single female died from syphilis [at St Bartholomew's Hospital in 1868], although some of the worst cases are admitted to the wards, and the most accurate accounts are kept.
   
Syphilis is the fate neither of the bulk, nor of an important fraction, of prostitutes. . . . To meet the hypothesis that, if such is not the fact, they may at least fall victims to suicide, intemperance, or complaints incidental to an irregular course of life, I have made special inquiries among the medical attendants of hospitals, penitentiaries, as well as well-informed private practitioners, and certain parish authorities. Their replies seem to corroborate my impressions that the combined operation of all these agencies, in addition to venereal complaints, is inadequate to extirpate, as alleged, a generation of prostitutes every few years, and that no other class of females is so free from general disease as this is. I find that in 1867, 83 females committed suicide; 7 of these were under 20 years of age; 76 were aged 20 and upwards. There was no reason to believe that even one-half were prostitutes.* ( It has been supposed that many prostitutes become insane. We find little evidence corroborative of this opinion.... It is a question whether grief, anxiety, and broken hours may not have a greater share in dethroning the reason than sensuality.) ...
   
The records of our civil courts have recently proved how hard it is to kill a person of fine constitution, supplied designedly with unlimited liquor and relays of pot companions; and we know again, that by the thorough prostitutes the sexual act is generally performed with the least possible exertion, and that her visitor is not uncommonly himself debauched and, for the time being, impotent....
   
If we compare the prostitute at thirty-five with her sister, who perhaps is the married mother of a family, or has been a toiling slave for years in the over-heated laboratories of fashion, we shall seldom find that the constitutional ravages often thought to be necessary consequences of prostitution exceed those attributable to the cares of a family and the heart-wearing struggles of virtuous labour ....

DISEASES THE RESULT OF PROSTITUTION

    I have now to consider one or two of the most ordinary consequences of promiscuous intercourse. In passing through (as she generally does, whether rising or falling in the scale) this phase of her career, the prostitute almost inevitably contracts some form of the contagious.., diseases, which in medicine we term ' venereal'. How these are passed from sex to sex and back again, ad infinitum, it were superfluous here to illustrate. I have treated at length elsewhere, under the head of specific disease, of the laws which govern these complaints, and of the influences which favour their diffusion, and the reader will, I dare say, gladly dispense with the introduction of those topics here. I propose, however, in the following pages, to offer some idea of their importance, as being the first and foremost of the effects of prostitution coming under the notice of the surgeon. ...
   
Until I pointed out the data, some twelve years ago, neither the profession nor the public recognized the fact that one-half the outpatients at our leading public hospitals came there in consequence of being affected with venereal diseases. The . . . statistical tables which I published are now admitted to have brought about the change in legislation which I shall have hereafter to chronicle....
   
It would appear . . . that two-thirds of the male applicants for relief at [the Royal Free Hospital] have recourse to it on account of venereal affections; and it would seem probable that this has been going on for twenty-six years at the least. .
   
Surgeons to the Royal Free . . . agree that the proportion of venereal diseases is very large, and that even the physicians see among their cases a large proportion of syphilitic complaints, affecting not only the external but the internal parts of the body....
   
I am disposed to attribute some share in the diminished virulence of venereal complaints to the opening of this and other perfectly free institutions, together with a slight increase of cleanliness among the poor - though by no means proportional, as yet, to the increase of water supply - the institution of public baths, and the greater cheapness of soap and clothing...
    It appears... from [the] statistics that about one in three soldiers suffers from some venereal complaint.... In the French Army.., at present only 97 per 1,000 men come into hospital for these venereal affections, showing that these complaints are 2˝ times more common in England than in France, not one in ten suffering abroad, instead of one in three as in England. . . . Let us hope that the measures I recommended twelve years ago, and now on the point of being carried out in our garrison towns, may render the English soldier as free from such complaints as his Continental confreres. ...
   
I understand that a mild mercurial treatment is usually pursued in the army, for hard sores especially. Some surgeons give no mercury; but this depends upon the discretion of the individual....
   
It is cheering . . . to observe that the absolute deaths in the last decennial period upon an aggregate of 254,597 men numbered only 17; and happily, also, we now rarely meet with those losses of the palate, nose, or portions of the cranium which our museums show must formerly have been frequent. ... .
   
[In 1865, in the navy], 4,313 cases of syphilis were under treatment, of which 130 were invalided. .. .. . Venereal diseases .. .. . are more common among soldiers than among sailors, owing, probably, to the more limited opportunities of becoming infected which the profession of the latter exposes them to ...
    In the merchant service, one in every three patients who applies to the hospital suffers from venereal disease.
    As far, then, as we may judge. . . venereal diseases are still very common among large bodies of otherwise healthy males engaged in the public service. At the same time, scurvy and hospital gangrene have nearly disappeared from the reports. The returns do not enable us to arrive at any accurate conclusion how far they incapacitate their victims from duty. Dr Wilson, who must be supposed to be a competent judge, inasmuch as he has compiled the returns, told me in 1857 that on an average each man so affected [was] incapacitated
from doing duty for a month. In the army, his stay in hospital has been averaged at six weeks. In the return furnished by Mr Busk, the average stay in hospital is stated to be twenty-two days; this is similar to that in the army; and during five years the expense of venereal patients was £4,165.
   
I doubt whether venereal complaints, although evidently more severe formerly, were ever more common than at present, or whether, since syphilis was first treated in hospitals, the large proportion. . . (namely two out of three out-patients at the Free Hospital, nearly one in two at St Bartholomew's, one out of every three at the Dreadnought, one out of four in the army, one out of seven in the navy) at any former period suffered from venereal disease. And yet many believe that the disease is declining. That such is not the case, if number be any criterion, must be admitted by all who weigh well the statistics, and compare them with the statements met with in nearly all the books that have treated of syphilis. .
   
If my inferences are correct, that venereal diseases, though decreasing in virulence, are numerically as prevalent as ever, where single men are massed together, is it not time to consider, whether in the present advanced state of civilization, some methodical steps should not be taken still further to mitigate and, as nearly as may be, eradicate the evil, more especially as we have so successfully operated against many others of ' the thousand natural shocks that flesh is heir to'?
   
Truth demands the acknowledgment that the individual affections both in England and on the Continent, are less severe in the present day. In but few cases do the symptoms run high, or is the patient permanently crippled by the disease. I myself can testify to enormous changes in this respect during the last twenty years. The frightful cases, attended with the loss of the nose, palate, etc., which formerly were really not uncommon, are now very rare either in hospitals or in private practice. The weekly average of deaths from syphilis in London, within the last ten years, varies from 1.6 to 4.3. Phagedaena, or the . black lion of Portugal', was formerly to be met with weekly in our hospitals. It is now an exceptional case. Sir Astley Cooper states, that in the St Giles's Workhouse at one time and in one room there were seven of these terrible cases, of which five were fatal. I need not say that, thanks to the improved treatment, and the many channels of relief available to the poor, these wholesale calamities are put a stop to, although an isolated case... may every now and then result in a fatal termination....
   
I cannot pretend to offer an opinion as to the general increase or decrease of these complaints in private practice. There is in our profession very little interchange of notes and statistics, and no organized correspondence with any body or society, and I fancy no medical man could draw a sound deduction as to the greater or less prevalence of any particular disease from the state of his own practice. He who should believe and say disease was extravagantly rife in London because he individually happened to be much in vogue, would deliver himself of as notable a fallacy, I apprehend, as another who should declare it was totally extinct, because from being out of repute, out of date, out of the stream, or for some other of the thousand reasons which sway the British public, he never happened to see a patient at all.
   
Each one, however, may without difficulty contribute a little information to the common stock by analysing the mass of cases which are presented to him. I shall give here one or two opinions, resulting from my own experience, which may, perhaps, be hereafter of value to others.... 
   
In the first place - the venereal affections now seen in private practice are slight. Patients come to the medical man early. The mauvaise honte, which formerly acted to their prejudice, is passing away, and the necessity for immediate treatment generally admitted. To this cause I attribute to a great extent the mildness of the disease, and the rapidity of cure in the majority of cases. No doubt can exist that improved treatment and a more correct diagnosis are operating in the same direction; science has been assisted by the almost complete abstinence of the upper classes generally from intoxication, though not from liquor, and the liberal ablutions now so much and so beneficially in fashion.
   
The loss of the virile organ is, nowadays, a thing almost unheard of in private practice. A surgeon might practise in London for many years without gaining any experience of the affection of the bones of the nose which causes that organ to fall in. It is true that we occasionally meet with an obstinate case of this affection in highly strumous patients, but even these, under appropriate treatment, escape the sad deformity, and ultimately recover. I have, every now and then, cases of tertiary symptoms, which return again and again, and offer most rebellious instances of the virulence of the disease amongst the weak and debilitated; but still death from syphilis is almost unheard of in private practice. I did see one some time ago. It came on gradually from a want of rallying power in the system, and a few tubercles were found in the lungs. It is to be regretted that in the present day the indurated sore is not more rare, attended as it is with many sad sequelae. Secondary symptoms are not severe, but, although slight, they linger on for months, now better, now worse, until the powers of the system, if well supported, get the better of the affections of the tongue or the eruption on the skin. Rarely, now, are the deeper structures affected, and patients generally, if not very injudiciously treated, completely recover within a reasonable time.
   
The results of private practice bear out the statistics from the public institutions, that gonorrhoea is the most frequent of the venereal affections. It no longer, however, takes the formidable shapes of bygone times, although it is often to the full as tiresome from assuming the chronic form.
   
I am often obliged to remind nervous patients who complain of tardy cures, that though they have to thank advancing science for such mild results as now form the penalty of their frailty, they must not expect a day when the complaint is to be divested of all pain or annoyance. Neither the disease nor our treatment are in general so much to be blamed for the worst phases which the former even now occasionally assumes, as the naturally bad constitution of the sufferer or the perverse industry he has applied to the debilitation of a sound one. He has oftentimes his own neglect to thank for doubled and trebled suffering - often his own folly in bringing to us only the reversion of a case complicated, and perhaps aggravated, by one or other of the villainous quacksalvers who are still permitted to flaunt their nostrums in the public face, to gull, to swindle, and to kill.

William Acton, Prostitution, considered in its Moral, Social, and Sanitary Aspects 2nd edition 1870

LOCK HOSPITAL

    If we turn to London, a city of 3,000,000 souls, we find but ONE institution specially devoted to the treatment of venereal diseases the LOCK HOSPITAL, formerly of Southwark, afterwards of Grosvenor Place, now of Westbourne Green and Dean Street, Soho, the existence of which for more than a century was one continued struggle Formerly, both male and female patients were received at Westbourne Green; now females only are taken in there, the male patients having been transferred to the branch establishment in Dean Street Soho, which contains 30 beds, though the funds of the institution only admit of 15 being occupied at present. Out-patients, both male and female, are attended to at Dean Street, and apply in large numbers. In 1868, 5,052 males and 800 females were treated there as out-patients. In connexion with the Female Hospital at Westbourne, is the Asylum, containing an average of about 6o inmates, but cap able of receiving 80, for the reformation of patients who have been cured in the hospital.
    A new wing, called the Prince of Wales's Wing, has been recently added to the female division of this hospital. The cost of the erection for building alone was £9,800, and when swelled by the sums expended on foundations, gas stoves, baths, fittings, furniture, and everything required for habitation, amounted to £12,000. It contains 75 beds, which would make the cost £160 per bed. But this would be an unfair estimate, because the new part contains all the kitchens, store-rooms, and other offices required for 150 patients, together with all the residents' rooms. The parts of the old building previously devoted to these purposes have now been either converted into wards, or given up to the use of the asylum. In 1867, 169 ordinary patients were admitted, with an average stay in hospital of 50 days each. The daily average, therefore, of ordinary patients present throughout the year was 23.15 ....

GUY'S HOSPITAL

    ... Out of 700 beds the hospital devotes 28 to male venereal cases, and 30 to female. During the year i868, there were treated in the hospital 422 cases of syphilis. Of these 123 males and 124 females were cured; 69 males were relieved and 87 females; 8 males left unrelieved, and ~ females; i male died, and i female, and the cause of the deaths was sloughing of the vulva, and laryingeal disease.
    ... The proportion of venereal out-patients seen at this hospital are about 43 per cent.

ST BARTHOLOMEW S HOSPITAL

    Having been educated at this hospital, I may be pardoned for rejoicing at the noble prominence my Alma Mater has been enabled to assume in alleviating the miseries of humanity. This present work of mine may probably be traceable to the unequalled opportunities this noble institution afforded me of seeing venereal affections in the commencement of my studies, and it still continues to devote more wards to the treatment of venereal cases than does any other general hospital.
    I have already stated . . . that this institution contains 75 beds, given up to venereal cases. There are 25 devoted to males and 50 to females, 597 cases were treated in the hospital for syphilis and other specific complaints in the year 1868, and, as we have seen, . . . more than half the out-patients are sufferers from venereal affections.
    ... I regret to say that the indecent system of exposing females before the whole class of students is still pursued, and that the employment of the speculum is the exception, not the rule. It is with regret I mention the shortcomings of my Alma Mater. Before another edition of this book appears, I trust I may be able to chronicle that every woman entering the venereal wards is examined with the speculum; that the examinations are made in a separate ward or behind a screen raised at the farther extremity, and thus separated from the gaze of her fellow-sufferers; and that only a few pupils are allowed to be present at a time.

...

CONTAGIOUS DISEASES ACT

However much it may be the duty of the State to leave for settlement to the individual conscience all questions of morals and religion, it can hardly be seriously contended that it is right to abandon to the care of the improvident and profligate the restraining of contagious maladies, yet this, except in a few military and naval stations, is virtually the case in England. A woman who knows herself to be diseased, is free to invite all corners to the enjoyment of her person, and to spread among them deadly contagion. The total of venereal beds is, as we have seen, in St Bartholomew's, 75; in Guy's, 58; in Middlesex, 20; in the Royal Free, 26; in the Lock, exclusive of those required by Government, 30. Thus, although the population of London numbers over 3,000,000, there are only 155 beds given up to females labouring under venereal affections, if we deduct the 120 beds at the Lock Hospital devoted to the Government patients sent there from Woolwich, Aldershot, and other garrison towns.
    These figures speak for themselves, and when we remember the deadly character of the disease with which we have to contend, the strong temptations that lead to its contraction, and the vast numbers who yield to that temptation, and compare them with the means at our disposal for supplying an antidote to the poison, we may well marvel at the indifference of society and the supineness of Government. But if we can ill excuse the laws, which afford no protection to those who, after all, are comparatively free agents, what shall we say of them, if we find them placing thousands of men every year in the utmost jeopardy, compelling them almost, for the convenience of the State, to have recourse to the prostitution by which they are surrounded, and yet providing for them no means of safety or adequate relief? It is hardly credible that, until a few years ago, this was the case in England. At length in 1864 the injury inflicted by this apathy on our soldiers and sailors, and the loss sustained by the public purse, seem to have touched the conscience or the cupidity of the legislature, and in that year an Act was passed, ... having for its object the remedy of the evils to which the army and navy are exposed its provisions, however, proved totally inadequate to meet the requirements of the case, and it was followed in 1866 by a more comprehensive measure, . . . commonly called the Contagious Diseases Act.
    This Act now extends its operation to Canterbury, Dover, Graves end, Maidstone, Southampton, Winchester, Portsmouth, Plymouth and Devonport, Woolwich, Chatham, Sheerness, Aldershot, Windsor, Colchester, Shorncliffe, the Curragh, Cork, and Queenstown By the 15th and 16th sections, a justice of the peace, on information being laid before him that a woman, living in any place to which the Act extends, is a common prostitute, and on oath before him substantiating such information, may, if he thinks fit, order that the woman be subject to a periodical medical examination by the visiting surgeon appointed under the provisions of the Act, for any period not exceeding one year, for the purpose of ascertaining at each such examination whether she is affected with a contagious disease; and thereupon she shall be subject to such a periodical medical examination, and the order shall be a sufficient warrant for the visiting surgeon to conduct such examination accordingly. And by the 17th section any woman, in any place to which the Act applies, may, by a submission signed by her, in the presence of, and attested by the superintendent of police, subject herself to a periodical examination under this Act for any period not exceeding one year. Any woman found on examination to be diseased, may either go herself, or will be apprehended and sent, to some hospital certified for the reception and detention of Government patients. The reception of a woman in a certified hospital by the managers or persons having the management or control thereof shall be deemed to be an undertaking by them to provide for her care, treatment, lodging, clothing and food during her detention in hospital. This period of detention is limited to three months, or, on the certificate prescribed by the Act that further detention is necessary, to a further period of six months, making nine months in the whole. If a woman considers herself detained in hospital too long, she may apply to a justice for an order of discharge.
    Prostitutes refusing to conform to the provisions of this Act are liable to be punished by imprisonment, and anyone permitting a woman who to his knowledge is suffering from a contagious disease, to use his house for the purpose of prostitution shall, in addition to the other consequences to which he may be liable for keeping a disorderly house, be liable to six months imprisonment with or without hard labour. The appointment of the necessary surgeons, inspectors of hospitals, and other officers, is intrusted to the Admiralty and War Offices, by whom also hospitals may be provided and certified for use, and all expenses incurred in the execution of the Act must be defrayed. The carrying out of the Act in the minor details is of course intrusted to the police.
    It is also provided that adequate provision must be made by the several hospitals for the moral and religious instruction of the women detained in them under this Act. We have already seen that a considerable number of beds have been secured at the Lock Hospital for the use of Government patients. The most admirable arrangements have been adopted at this institution for the examination and treatment of the patients committed to its care, and as the possibility of carrying out an act having for its object the diminution of disease forms an important element in considering the advisability of further extending its sphere of usefulness, I shall offer no apology for relating pretty fully the method pursued in this institution.

LOCK HOSPITAL

I was anxious to see the working of the existing Government Lock Hospital, and Mr J. Lane kindly allowed me to accompany him, and explained everything on my visit in October, 1868.
    The patients (female) are lodged in a new wing; the wards are lofty, and kept scrupulously clean. Each inmate has a separate bed, provided with three blankets, and a hair mattress, an extra blanket being given in winter. Each patient has two pannikins, a half-pint and a pint tin can, with a pewter spoon and a steel knife and fork; and a little box in which she may keep her things is placed near her bed. The patients are not allowed to go into other wards, but there is an open court in which they take exercise, and they have a sort of hospital dress in place of their own clothes, which are left under the care of the matron. At the head of the bed hangs a towel.
    In a little room at the end of the ward water is laid on, and copper basins are hung by a chain to the wall; these basins are kept for the women to wash their faces. This arrangement is specially made to prevent any possible contagion. Fixed to the floor is a bidet, across which the female sits. There is here an admirable device for facilitating the cleansing of the private parts; by... means [of] a brass syringe, with a long pewter ball, and holding, say six ounces, she injects the lotion, and the waste fluid runs away on opening a plug fixed in the bottom of the bidet. The only improvement I could suggest was that each patient be furnished with two small napkins to dry the organs after injection. The patient always uses an injection before presenting herself to the surgeon, in order that the organs may be in a proper condition for examination, and I must say the cleanliness shown does great credit to the nurses who manage the wards.
    The inspections are conducted in the following manner. The women are introduced one at a time from the wards by one nurse into a special room, containing a properly-raised bed, with feet, similar to the one in use on the Continent. The patient ascends the steps placed by the side of the bed, lays down, places her feet in the slippers arranged for the purpose, and the house surgeon separates the labia to see if there are any sores. If no suspicion of these exists, and if the female is suffering from discharge, the speculum is at once employed. In this institution several sizes are used, and they are silvered and covered with india-rubber. The head nurse after each examination washes the speculum in a solution of permanganate of potash, then wipes it carefully, oils it ready for the next examination, so that the surgeon loses no time, and the examinations are conducted with great rapidity. In the course of one hour and three quarters I assisted in the thorough examination of 58 women with the speculum.
    In this institution the house surgeon examines the women; the surgeon superintending and prescribing the remedies.
    Mr J. Lane, in a recent paper, has so well described the method of treatment adopted by him, that I shall give an account of it in his own words:

    Since the admission of patients into this hospital, under the Contagious Diseases Act, from Woolwich and other military districts, the treatment of uterine and vaginal discharges has constituted a large part of its practice. In fact, in 1867, as many as 58 per cent, and in 1868, 65 per cent of the class of patients alluded to, were placed under treatment for this form of disease alone, uncomplicated by any symptom of a syphilitic character, either primary or secondary. These patients are, for the most part, strong, healthy girls, aged from 17 to 25, well fed, and in good condition. Their disease appears to be entirely local, both in its origin and character. It arises, as I believe, in the great majority of cases, simply from the continual irritation and excitement of the generative organs consequent upon their mode of life, though it may be caused, no doubt, occasionally by direct contagion from urethral discharges in the male. The secretion, when they first come under observation, is of an obviously purulent or muco-purulent character, and evidence of its contagiousness is afforded by the fact (as I am informed) that nearly all of them have been accused of communicating disease before being subjected to examination. It is remarkable how little pain or inconvenience is suffered by these patients; usually they make no complaint whatever, and many of them are unaware that anything whatever is the matter with them, although, when examined with the speculum, a profuse discharge, derived chiefly from the uterus, is found lodged in the upper part of the vagina. Associated with this, especially in the more chronic cases, abrasions of the epithelium excoriations, or superficial ulcerations on the vaginal portion of the cervix uteri are very frequently seen. Anything approaching to an inflammatory condition, to which the terms acute gonorrhoea or vaginitis might be applied, is uncommon, and when met with, it is usually in young girls, as yet unseasoned to a life of prostitution. Incidental complications, of a painful character, such as labial abscess, or inflammatory bubo, are occasionally seen, but are not of frequent occurrence.
    
    An external examination alone is quite insufficient for the discovery of these complaints. Purulent secretions from the vulva or lower part of the vagina are, of course, evident enough; but a profuse uterine discharge may be present, and no trace of it be visible until the speculum is employed. There is, however, a considerable difference in women in this respect; in some, the vagina appears to be equally contractile throughout its whole length, and therefore, any secretion formed in it, or entering it, speedily appears externally; while in others, and these are the majority, its contractility is much less at the upper than at the lower part, and discharges are consequently retained in the former situation.
    When these discharges are of purely local origin, and there is no constitutional fault, their cure may be speedily effected by local applications. The plan commonly pursued at the Lock Hospital is to make the patients use vaginal injections for themselves three or four times daily. The lotions employed are the diluted liquor plumbi subacetatis, or solutions of sulphate of zinc, alum, or tannin, in the proportion of five grains to the ounce of water. The syringes are large enough to hold six ounces of the lotion, and have a pipe long enough to reach the upper part of the vagina readily. Both these points are important, for the syringes commonly used will not contain sufficient fluid to wash out the canal effectually, and the pipe affixed to them will not admit of its reaching the upper part of the vagina at all. When the vaginal mucous membrane is inflamed and tender, the house surgeon, when the speculum is used, which is at least twice a week in all these cases, inserts a strip of lint dipped in the lead-lotion, and this is allowed to remain for three or four hours. If the inflammation be acute, the application of the strip of lint is repeated daily through a small speculum. By these means, discharges proceeding from the vagina may usually be cured in a few days, but the injections should be continued as long as any abnormal uterine secretions are observed, for the latter, if not frequently washed away, will be likely to re-excite disease in the vaginal mucous membrane.* (*James R. Lane, Notes on the Practice of the London Female Lock Hospital', British Medical Journal, 1868, II. 592.)
    The medical officers told me, in reply to my inquiries, that there had been occasional disturbances among the patients. The nurse first tries to stop any outbreak of temper; if unsuccessful, the house surgeon is appealed to, and if he fails, the girl is conveyed to the police station by the hospital porter, who is empowered to act as a police constable in relation to these patients, who are then liable to two months' imprisonment.
    I have little to say about the patients; in appearance they are not generally prepossessing; a few among those whom I saw were young, and looked middle-aged and plain. The primary syphilitic affections were few, but the diseases of the uterus numerous, similar to those I witness in private practice...
    The following is the scale of dietary at the hospital:
    
    ORDINARY
    Breakfast:- 8 oz. Bread; ˝ pint Cocoa.
    Dinner:- Five days - ˝ lb. Meat; ˝ lb. Potatoes.
    Two days:- 1 pint Soup; Soup Meat. 1˝oz. Rice.
    Tea:-  6 oz. Bread;  ˝ pint Tea.
    Supper:-  1  pint Gruel.
    MEAT DIET
    Breakfast:- As above.
    Dinner:- ˝lb.. Meat; . ˝lb. Potatoes, every day.
    Tea:- 6 oz. Bread; ˝ pint Tea.
    Supper:- 1 pint Gruel.
    BEEF TEA AND PUDDING DIET
    Breakfast:- As above, and 1 pint of Milk.
    Dinner:- 1 pint Beef Tea; 2 oz. Rice in a pudding.
    Tea:-. As above.
    Supper:- 1 pint Gruel.
    
    Mutton Chop or Fish, when ordered, instead of Meat Diet or ordinary. Rice occasionally instead of Potatoes. Extras Porter, Wine, Spirits and Milk. 

William Acton, Prostitution, considered in its Moral, Social, and Sanitary Aspects 2nd edition 1870

see also Tempted London - click here