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