‘A Night with Venus’ in Late Georgian Dublin

Introduction

The old saying ‘A night with Venus, a lifetime with Mercury’ reflected the fact that until early in the twentieth century, Mercury was the standard treatment for Syphilis. Its use had a long history and was widely deployed in Dublin in the 1830s.

Syphilis

Gonorrhoea had long been prevalent in Europe, but European expansion, resulting in the ‘Columbian Exchange’, may have produced a highly unequal trade-off in which Columbus helped import Syphilis from the Americas.¹ In return, the Americas acquired Smallpox and Measles. Syphilis erupted in 1693-4 during a war between France and Spain, which was fought in Italy. After the French celebrated their victory at Naples in the traditional debauched fashion, and their army disbanded, a terrible epidemic ensued across Europe: genital sores heralded a generalised rash which proceeded to ulceration and revolting bone-destroying abscesses, affecting the nose, lips and genitals, and often proved fatal. There is another theory that the disease is more ancient, but the Columbian Exchange origin remains the frontrunner.²

Its name evolved too: initially it was the ‘disease of Naples’, then ‘The French Pox’, and so on, with countries usually naming the disease after other countries. It also became known as ‘The Great Pox’, in contrast to Smallpox. The name Syphilis derives from Fracastoro who, in a poem, tells of a mythical shepherd named ‘Syphilus’ who kept the flocks of King Alcithous.²

Syphilis in Late Georgian Dublin

In the eighteenth century, Dublin was the second city of the British Empire. Economic expansion resulted, as did population growth, but “was coloured by riches for a few and poverty for the many”.³ The 1798 Rebellion culminated in the Act of Union in 1801 when 100 Irish MPs took their seats at Westminster. This was followed by recession while the population burgeoned. Morton quotes Curwen who made a tour some years after the Act of Union was passed: “Poverty, disease and wretchedness exist in every town but in Dublin the misery is indescribable”, adding, “Typhus, long endemic, sprouted into epidemics”.

Attempts to live off the land were frustrated by the high rents being exacted by absentee landlords. By 1815 the economic plight was dire and by 1821 the population density of Ireland was the highest in Europe.³

Despite Francis Bacon’s maxim that, ‘Prosperity doth best discover vice, but adversity doth best discover virtue’,⁴ the incidence of Syphilis in Dublin was high with “an enormous number of cases”.³

Abraham Colles (1773-1843 - see Figure 1), the pre-eminent Surgeon of his day, was famous for his fracture, ligament and fascia, and his Law.⁵ The latter stated that when a child with congenital Syphilis was breastfed by a wetnurse, which was common at the time, the wetnurse would develop a chancre (ulcer) on her breast, but the child was:⁶

…never known to infect its own mother, even though she suckle it while it has venereal ulcers of the lips and tongue.

Figure 1:

Abraham Colles (1773-1843) as a young man (Courtesy of RCSI).

The only trouble was that another Dublin-based doctor, William Wallace (1791-1837 - see Figure 2), who wrote extensively on the disease, had already described the Law,³ as was pointed out by a Dr Shaw-Mackenzie in a Lancet paper in 1899.⁷ This is by no means the only example of a misattributed eponym: for example, Cheyne-Stokes breathing had originally been described by Hippocrates.⁸

Figure 2:

William Wallace (1791-1837) (Courtesy of RCSI).

The Treatment of Syphilis in Late Georgian Dublin

Although no new treatments were introduced in Dublin over the period, significant advances were made in refining the dosage of the existing ones. Fracastoro had introduced Mercury as a treatment in 1530,² and he coined the term gumma (resin L) for the scabs that form later in the course of the disease. Mercury treatment had awful side effects such as neuropathies, kidney failure, severe mouth ulcers and loss of teeth, and countless patients died of mercurial poisoning rather than the disease itself. The treatment would typically go on for years, so gave rise to the saying quoted in the Introduction. It was taken by mouth, applied to the skin and even vapourised.⁹

Colles was born in Kilkenny in 1773, entered Trinity College Dublin in 1790, and then undertook apprenticeships in Dublin.¹⁰ He subsequently qualified MD in Edinburgh in 1797, and later worked with Astley Cooper in London, before returning to Dublin. Colles believed that the best results of Mercury treatment were obtained at low doses. His great contribution was to carefully delineate the dose of Mercury so that its efficacy was maintained while the minimum side effects resulted.¹¹ Since Mercury was a sialagogue, he achieved this by carefully adjusting the dose so that the minimum quantity of saliva was produced while the benefits were preserved.

According to Coakley:¹¹

Large pewter mugs were kept in Dr Steevens’ Hospital for the patients to spit into, and the dose of mercury was adjusted depending on the number of mugs filled during the day.

Another treatment for secondary Syphilis was Potassium Iodide.¹² Its dosage was refined by Dr William Wallace, who was born in Downpatrick in 1791. He undertook apprenticeships in Dublin, obtaining his Diploma in 1813. Like Colles, he afterwards spent time with Astley Cooper in London. In 1818, at his own expense, he opened the Dublin Infirmary for diseases of the Skin, at 20 Moore Street, which accepted male patients with venereal disease. He was “probably the first true dermatologist in Dublin”.¹³

Between 1819 and his death in 1837, Wallace published no less than five books, three being revised for a second edition, and nearly thirty papers;³ his Treatise on the Venereal Disease and its Varieties appeared in 1833.¹⁴ In 1835-6, he published a series of 142 patients taking Potassium Iodide in the Lancet.¹⁵ Iodine as a treatment had been introduced by Martini of Lubeck in 1821.¹⁶ Wallace showed by experimenting on dogs that Potassium Iodide was better tolerated than Iodine, which was converted to Hydroiodic Acid and irritated the gastric mucosa.¹⁵ He controlled the dosage by testing the urine for Iodine, which was liberated by the addition of dilute solutions of Sulphuric Acid and Chlorine; starch was then used as an indicator. The Iodide was given until the urine when tested became as black as ink.¹⁷

The Contagious Nature of Syphilis

In experiments, which Cameron described as ‘indefensible’, Wallace was first to show that secondary Syphilis was contagious. He published his series of three male patients, whom he had inoculated with infected material, in the Lancet in 1837.¹⁸ He claimed that he had cured all three by administering Mercury. The only snag was that none of the subjects had been told the nature of the experiment, although the results were of considerable scientific value.

Wallace’s approach followed that of the great Scottish anatomist John Hunter, who in 1767, set out to prove that Gonorrhoea and Syphilis were the same disease. With greater ethical probity than Wallace, however, Hunter infected himself with the former and developed Gonorrhoea. Sure enough, within ten days, he also developed Syphilis.

The unfortunate Hunter’s source of Gonorrhoea was also infected with Syphilis.¹⁹

Wallace’s experiment was to be echoed almost a century later, only on a vastly greater scale, when the ‘Tuskagee Study of Untreated Syphilis in the Negro Male’ at Alabama, in America’s ‘Deep South’, ran from 1932-72.²⁰ It involved 399 men with Syphilis and 201 without. The men were told that they were being treated for ‘bad blood’, but the shocking aspect was that they were not offered Penicillin when it became available in the 1940s. By the Study’s end, many deaths had occurred and many family members had been infected. It became a powerful symbol of racism in Medicine, leading to a Presidential apology in 1997.²¹ Strangely, as part of his study of human dermatology, with foretastes of the Tuskagee Study, Wallace kept a person of African ethnicity in his house so that he could make observations on his skin!¹² He was to apply the results to the treatment of skin naevi.

In the Oslo Study of the natural history of Syphilis,²² which ran from 1891 to 1910, Boeck also withheld treatment from approximately 2,000 patients with primary and secondary Syphilis. Although it was forerunner of Tuskagee, and on a far greater scale, the treatment withheld was nowhere near as effective as Penicillin, and there was no racial dimension. The study demonstrated that hospitalisation reduced community spread, but unlike the approach adopted in the WLH (see Figure 3 below), patients of both sexes were included.

Figure 3:

The Westmoreland Lock Hospital (Courtesy of Archiseek).

In 1838 Philippe Ricord had indubitably established² that Syphilis and Gonorrhoea were separate diseases, something which Hunter could have claimed, had he been aware of it. Ricord differentiated Syphilis’ three stages, and he adopted Wallace’s regime of Potassium Iodide which soon became used throughout Europe³.

The causative organism of Syphilis, Treponema pallidum, was not identified until 1906, when an accurate serum test was also introduced by Wassermann,² and the disease remained a huge problem until the introduction of Penicillin in 1943. Similarly, there was no effective treatment for Gonorrhoea until sulfonamides were introduced in the1930s.¹

The Wallace Collection

Wallace encouraged his two young daughters to draw pictures of the structure of the skin and the diseases affecting it. The elder died in her seventeenth year from scarlet fever.¹² He also commissioned several professional artists, including William Burke Kirwan and James Connolly, for a medical atlas that was never published (personal communication). ²³ After Wallace’s death from Typhus in 1837, his widow sold a large portfolio of coloured drawings to the RCSI for £50.³ The RCSI has made the Wallace Collection of 372 images and 13 casebooks available online.²⁴ The site is searchable, and many images depicting advanced syphilitic lesions are not for the fainthearted: for two of the less disturbing images of patients during the 1830s, see Figures 3 & 4.

Figure 4:

Skin Lesions of Secondary Syphilis: Jane Sutherland – possibly ‘the victim of her husband’s profligacy’? (Courtesy of RCSI).

The Westmoreland Lock Hospital (WLH)

The WLH was established in Townsend Street, Dublin in 1792, bearing the name of the then Lord lieutenant, the Earl of Westmoreland.²⁵ At the time of its charter, it was the only Irish hospital dedicated to venereal diseases, especially Syphilis, until 1955, when it closed and was demolished (see Figure 5). The name derives from earlier Lazars, or hospitals for treating Leprosy, which used ‘locks’ (derived from the French ‘loque’, meaning ‘rag’) to cover the leprous lesions.²⁶ It replaced an earlier Lock hospital in south Dublin which was founded in 1755²⁷. It became the largest institution for treating venereal disease in the British Dominions.³

Figure 5:

Skin Lesions of Secondary Syphilis: Rosella Keenan (Courtesy of RCSI).

Abraham Colles was President of the Royal College of Surgeons of Ireland (RCSI) in 1802 and 1830.¹² He became a Governor of WLH in 1802, demonstrating the increasingly close links which grew up between the RCSI and WLH.²⁷ It is worth noting in passing that Frances Ray served as Matron in the WLH from 1835 until 1861. She was the widow and former accomplice of Wilson Ray,²⁵ a surgeon who organised the export trade in cadavers from Dublin in the 1820s. Ray seems to have used the RCSI as ‘a kind of warehouse’,²⁸ so perhaps the RCSI had been more complicit in the trade than it cared to admit?

A Memorial sent to the Earl of Mulgrave,²⁹ the Lord Lieutenant, by the WLH’s Governors on 3^rd February 1838, gave much of the WLH’s early history. It originally had beds for 128 male and female patients, but by 1796 these had swelled to 250. Unfortunately, “several evils” arose, and a Report of 1820 concluded that the failure of the Institution was to be especially attributed:

1^st to the evils consequent on the intercourse between Male and Female patients which had never been guarded against - 2^nd To a deficiency of moral and religious instruction and employment…and 5^th To the abuse of the design of the Institution in the adoption of the erroneous principle of extending it to Male Patients…

Subsequently the WLH only admitted females.

Similar problems must have arisen with the presence of Medical Students, who were all male, in the WLH, because it admitted them until 1820 when they were excluded, and “medical students became the crux of many disputes”.³⁰ The Governors urged the admission of students under restrictions necessary to ensure “propriety and morality”.³¹ They were finally readmitted in 1858,³² as a need to teach Medical Students about the venereal disease in women was recognised, but it was not a success. The antipathy to Medical Students on the premises can be appreciated because:³³

Some twenty-three years ago, Dr. M’Dowell of happy memory, was resident medical officer in the Lock Hospital, and he kept a class of young men in his own room, where he ground them. When leaving after his lecture, they would endeavour to force open the door to one of the wards to get amongst the inmates. And it often took the doctor, two porters, the matron, and nurse to prevent them; this took place when they had no access.

The Memorial continued by asserting that a new regime had effectively stamped out drunkenness in the staff, had improved therapy and outcomes, and from 1821 had established a laundry which catered for the WLH’s needs, and employed 13 former patients, a strategy akin to the Magdalene Institutions “for unfortunate females abandoned by their seducers”.³

The Memorial asserted that thanks to carefully classifying patients, it had been possible to:²⁹

… separate the novice in crime from the hardened offender, and the married woman, who is the victim of her husband’s profligacy, from those where disease has proceeded from choice and personal misconduct.

Indeed, there is some evidence³⁴ that the ‘Domestic Goddess’ Mrs Beeton died of Syphilis - a gift which her husband may have brought to the marriage bed.

One might be forgiven for detecting a strong undercurrent of moralism in all this, particularly in view of the rationale later given for segregating women in a Lock Hospital:³⁵

Two distinct classes of cases come into the Lock Hospital; first, those who have fallen but once, and enter our walls but once; and secondly, the hardened sinners, women who have for years been making a livelihood by prostitution; we try to reform girls of the former class, and if we left the hardened sinners free to roam through the hospital, they would taint these beyond the hope of reclamation.

What precisely underlay all the strong undercurrent of moralism in the Memorial? The Lords of the Treasury had written³⁶ to the Lord Lieutenant querying the need for the complete financial support of a ‘Charitable Institution’, which surely should be supported by charitable subscription. In reply, the Memorial stated:²⁹

- great prejudices exist (however lamentably and unjust) against the support of persons of profligate character, as tending to diminish the funds applicable to other charities, and as holding out an encouragement to vice,…

This was sufficiently convincing to ensure that the costs of the WLH continued to be borne by the State and although, intermittently, financial threats recurred, the WLH survived. As we shall see, the real reason for the WLH Governors’ reluctance to seek truly charitable status was tied to a desire for total secrecy.

In an 1842 Report, the Chairman saw one of the WLH’s main roles as:³⁷

…preventing the extension of a disease of which every infected woman is the centre, and the unhappy instrument of diffusing it around;…

Thanks to the WLH’s strict discipline, after discharge many former patients had a disinclination to return to a “life of infamy”, and “preferred the paths of industry rather than the wages of prostitution”. He went on to justify the full parliamentary support, describing the possibility of any truly charitable support of the WLH as “utterly hopeless”. He added that the WLH was for patients from all over Ireland, so it was unfair to try to raise charitable support locally.

It is not until a Parliamentary Report of 1854 that the true raison d’etre of the WLH was divulged:³¹

The importance of such an institution in a town like Dublin can hardly be over-rated. It appears that in large garrison towns the establishment of a Lock hospital for females is the best mode of preventing venereal disease among the soldiery. On the mere grounds of economy its support by Parliament can be justified, as venereal disease constantly incapacitates and even cause the discharge of the soldier at the very age that he is most serviceable to his country.

Here the question is left moot as to which country is meant, but it certainly is not Ireland. The British Garrison in Dublin around 1850 averaged about 6,000 men, with nearly 9% of them suffering from venereal disease at any one time.³⁸ There were “great objections” to treating female venereal disease patients in general and workhouse hospitals; in Dublin they had been almost totally excluded from the former and “serious evils” had arisen when they were treated in the latter.³¹

According to the Surgeon of Dublin’s military prison, soldiers did not see prostitution “as any immoral act”.³⁹ Indeed, “Prostitution is absolutely necessary” and if it was discouraged in soldiers, their “moral character” would be reduced.⁴⁰ He highlighted the problem of young soldiers being discharged from the army because of venereal disease, “just as they are fit to be sent to the colonies”:⁴¹

A great many are discharged under three years of service, because a soldier discharged under three years of service is entitled to no pension whatever; consequently when he shows this disposition he is got rid of; but then if it is argued that the country is no loser by it, it is wrong, because that man has been kept and trained for three years; it is like buying horses at three years old, and selling them at five, and getting the same price for them.

This statement, made at the time of the Crimean War, makes it abundantly clear how young soldiers were regarded as ‘Cannon Fodder’.

In 1849 Thomas Byrne estimated that around half the females admitted to the WLH were “victims of the British soldiery”.⁴² Moreover, this very soldiery may have been responsible for importing many of the female cases to the WLH from Britain, deserting them when the ‘soldiery’ was posted elsewhere.

In the 1860s, the Surgeon John Morgan was experimenting on two eight-year-old girls with Syphilis⁴³ by inoculating them with material from older patients with the same condition. He hoped to arrive at a cure, but his experiments were just as ethically flawed as those conducted by William Wallace, and the WLH’s Governors ordered him to desist. He also wanted to take serial photographs of his patients, but, once again, his ambitions were reined in by the Governors.⁴⁴

Morgan also published a Report of cases under treatment in the WLH for the half-year ending 31^st December 1868.⁴⁵ For each unmarried woman he records the period over which they had been ‘unvirtuous’, highlighting the moral opprobrium in which unmarried females with venereal disease were held at the time. George Bernard Shaw was later to describe virtue as ‘the Trade Unionism of the married’.⁴⁶ The Report included⁴⁵ a haunting image of a woman with gangrene of the face caused by Mercury therapy (see Figure 6).

Figure 6:

Gangrene of the face caused by Mercury therapy.

Source: Morgan ?1869.

(Courtesy of Wellcome Library).

The Treatment of Females with Venereal Disease in the 19^th Century

Between 1800 and 1940 thousands of women worked as prostitutes in Ireland,⁴⁷ and were looked upon as “carriers of disease and immorality”. The official responses, however, were erratic and often the result of some crisis. The authorities obsessively attempted to classify ‘immoral’ women, and this resulted in the classification of unmarried females with venereal disease as ‘fallen’ and married sufferers as victims of their husbands’ philandering.

The designation of unmarried female patients as ‘fallen’ seems grossly unfair, for, some at least, would have enjoyed steady relationships with their common law husbands, and became infected by them. Moreover, the classification of females with venereal disease into the two groups is reminiscent of the Victorian obsession with differentiating between the ‘Deserving’ and ‘Undeserving’ Poor in the 1834 Poor Law Amendment Act.⁴⁸

Speaking from an Epidemiological perspective, if the ‘immoral’ women represented the disease reservoirs of venereal disease, men represented the vectors (transmitters), just as mosquitos spread Malaria. It has therefore been prudent to limit the spread of the disease by controlling the mosquito population. Thus, the adoption of a wholly female-orientated approach to controlling the disease by incarceration in the WLH was not only grossly unfair to females, but also irrational. In effect, “...it was the body of the prostitute that became identified as the source of venereal disease”.²⁷

The results of the Oslo Study demonstrated²² that community control could be achieved by incarcerating men as well as women. Although the derivation of ‘Lock’ has been given above, another meaning of the word is a pretty accurate description of the punitive practices which were exercised at the WLH. This meant that the inmates were segregated by religion,⁴⁹ their heads were shorn,⁵⁰ they were not allowed to look out the windows,⁵¹ and there was no “yard to walk about in”.⁵²

There is a poignant letter,⁵³ written in 1853, after a shocking incident, “in a house of bad repute” in French-street, which involved the shooting of a young woman and a man’s suicide. The incident coincided with Queen Victoria’s visit to Dublin. There was a letter in Saunders’s News-Letter a few days later under the heading ‘A Refuge for Outcasts’ in which the writer, ‘J. D. S.’, suggested that the refuge should be for men.⁵⁴ A flurry of letters in the same newspaper a few days later were emphatic that the Refuge should cater for women.⁵⁵ One of these, from ‘B’, described the writer’s experiences as a pupil in the WLH (the writer must have been a student before 1820). The writer had been a witness to:⁵⁵

…the mental sufferings which many abandoned females endured while patients in that institution; and I well remember the dreadful imprecations which they used in cursing the libertines by whom they had been seduced. I was induced to go round the wards and ask each individual whether she would, if restored to health, prefer the sanctuary of a penitentiary [a place of penitence] to reverting to a life of sin and shame, and all of them, with one or two exceptions, implored of me to get them into an asylum, as nothing but dire necessity would induce them to lead the lives of inconceivable sorrow and degradation which they had been leading;…

There is no doubt that prostitution was driven above all by poverty, and gainful employment for poor, young women, other than domestic service, was scarce in Victorian times. Hurren starkly illustrates⁵⁶ this by quoting individual histories. These cut through the rhetoric of much of what is popularly accepted. The reality was that once a girl had a baby, and they were abandoned by the biological father, prostitution sometimes represented the only means of supporting the child.⁵⁷ Shockingly, for most of the 19^th century the age of consent for girls was just 13 years. The Criminal Law Amendment Act of 1885 raised it to 16 years.⁵⁸

Some women became “comfortable mistresses,” but others developed serious venereal disease, and if they died, their bodies, being unclaimed by disaffected family members, were sold and ended up on the dissecting table at St Bartholomew’s Hospital.⁵⁷ Such dissections were carried out rapidly as students were wary of acquiring an infectious disease. One nick of the skin with the lancet would suffice, and this was before the days of latex gloves.

The treatment of women suspected of having venereal disease became even more draconian with the passing of the first of three Contagious Disease Acts in 1864.⁵⁹ They applied not only to England but also to the garrison camps of the Curragh, Cork and Queenstown (now Cobh) in Ireland, and extended to a five-mile radius of each camp. Women on the street were subjected to arbitrary and compulsory testing.

As usual, the spread of venereal disease was blamed on women, particularly prostitutes. Lamentably, supporters of the Acts argued:⁶⁰

...while men would be degraded if subjected to physical examination, women who satisfied male sexual urges were already so degraded that further indignities scarcely mattered. Protection for males was supposed to be assured by inspection of females.

The Acts ordained that women could be arrested and ordered to be examined at a certified hospital, with a refusal punished by a month in jail. All ‘common prostitutes’ were registered. The soldiers in the camps:⁵⁹

…all seemed to agree to speak of these abandoned women as a kind of dreadful and scandalous necessity, and as beings beyond the pale of human sympathy or help.

Some vigorously defended the Acts,⁵⁹ such as Sir Charles Cameron; others were diametrically opposed to them, especially various women’s groups. The Belfast branch of the Ladies’ National Association saw them as an affront: “to the dignity and independence of every woman in the land”. As ever there was religious split on this island with many denominations opposing the Acts: Catholic priests were an exception as they tended to support them.

The Acts were suspended in 1883 and withdrawn three years later.⁵⁹ Malcolm observed⁶⁰ that the repeal of the Acts in Ireland, while thwarting state public-health regulation, in the long run simply strengthened clerical moral control – as became all too obvious after 1922. Before that watershed, Nationalists had linked prostitution to the British garrison’s presence in Ireland, but after independence, the levels of illegitimacy and venereal disease actually increased.⁶¹

Conclusions

Dublin Medicine’s major contribution to the treatment of Syphilis in the late Georgian period was the downward adjustment of the doses of the Mercury and Potassium Iodide employed, while still maintaining their efficacy.

The vilification and subjugation of females with venereal disease in 19^th century Ireland may have been ‘of its time’ but it seems abhorrent today. The simple fact is that the WLH was being used to maximise the ‘Coercive Control’ of the British garrison by ensuring that venereal disease was reduced in its soldiers.

Researchers have difficulty in establishing women’s history before 1900, as women were largely ‘invisible’ then, being identified by their husbands’ Christian names, and reduced to mere appendages. Things had begun to change in Ireland in the late 1800s with the advent of the Suffrage movement, which held its first public meeting in Dublin in 1870. In 1872, Isabella Tod in Belfast founded⁶² the North of Ireland Suffrage Society, followed by Anna Haslam in Dublin, who in 1876 established⁶³ the Irish Suffrage Society. Ireland’s Suffrage movement flourished in the early years of the last century, becoming increasingly militant. Key figures were the ‘Sheehy-Skeffingtons’. The surname was famously adopted by Hanna Sheehy and Frank Skeffington when they married in 1903.⁶⁴ Like Willliam Wallace, Frank was reared in Downpatrick.⁶⁵ When the 1916 Easter Rebellion was in full swing, ‘Skeffy’ as he was known, went to the GPO to exhort the leaders to stop people looting. He was later arrested and summarily executed.⁶⁶ The efforts of the Suffragettes delivered limited suffrage to England and Ireland in 1918, probably in recognition partly of women’s role in the war effort.⁶⁷ Full parity with men was achieved in Ireland in 1922 when the Irish Free State drew up a constitution which firmly placed women and men as equal citizens (Tiernan), six years ahead of England.⁶⁸