Medicine, Knowledge and Venereal Diseases in England, 1886–1916 by Anne R. Hanley (review)

Sex, sin, and suffering have, over the past thirty-odd years, offered a rich field of study to historians of the long nineteenth century, but one which, as Anne Hanley's book shows, is not yet exhausted. In her book, Medicine, Knowledge and Venereal Diseases in England, 1886–1916, which focuses on medical understandings of syphilis and gonorrhoea, Hanley offers an entirely new and richly enlightening perspective on the problem of venereal disease in Victorian society. The knowledge referenced in the title is that of medical professionals broadly defined—that of doctors, both men and women, and of nurses and midwives—and of the ways in which it was acquired and applied. The years between the repeal of the Contagious Diseases Acts (1864–69) in 1886 and the concluding of the Royal Commission on Venereal Diseases in 1916 were also those in which bacteriology and laboratory-based technologies entered the medical canon, and in which medical education was modernized; postgraduate medical education became available; nursing education was formalized; and the Central Midwives Board was established in 1902 to supervise the training, certification, and conduct of midwives. Although the heroic tradition of medical history was largely abandoned in the 1990s, the more recent historiography of medical and nurse education has nonetheless also tended toward a generally progressive account, emphasizing a growing professionalism through training schools, formal curricula and qualifications, professional societies, associations, and journals. Yet this trajectory is not without its deficiencies, which are exposed with quiet precision in Hanley's analysis. In focusing on the production and transmission of medical knowledge as applied to venereal disease in England, Hanley introduces us to a complex, layered world in which gender, education level, social standing, professional status, professional politics, and individual character all mediated the acquisition of knowledge concerning these diseases and their treatment.

A core problem with venereal diseases was the obscurity and multiplicity of their symptoms, which required a depth of teaching that Victorian medical schools, dedicated to delivering what came to be generally known as the safe general practitioner, were not equipped to provide. The medical curriculum of necessity covered too many subjects for any to be studied in depth, and most newly-qualified practitioners emerged with minimal expertise in the diagnosis and treatment of venereal diseases because further knowledge was expected to come with professional practice. The establishment of postgraduate training schools at the end of the century offered opportunities for specialist training, although these were not open to women. The coming of bacteriology; the identification of the gonococcus and of the spirochæte (Treponema) pallida of syphilis; use of the Wasserman test (1906); and the new drug salvarsan (1909), which was often used in conjunction with the traditional mercury treatment for syphilis, slowly began to improve patient care in the early twentieth century. Public health approaches to the problem (such as the notification of cases), however, were held back by popular opinion, which still took a very moralistic view of these diseases. Opthalmia neonatorum (that is, neonatal conjunctivitis), which has other bacterial causes beside the spirochæte, was the first venereal disease to be made notifiable, in 1914.

Against this background, knowledge acquisition was problematic for many male, and even more so female, practitioners of all kinds, whether doctors, midwives, or nurses. The two latter professions ranked low as claimants to hard medical facts, and their acquisition of knowledge of venereal diseases was qualified by the male medical practitioner view that respectable, unmarried women should not be involved in caring for venereal patients. More broadly, in the competitive, modernizing world of Victorian medicine, venereal patients were a valuable commodity—doctors considered cases of venereal infection as a so-called family event, also involving, as they very often did, spouses and post-infection offspring as well as the mother. There was money to be made from compromised families. Although these infections involved too many bodily structures for venereology to emerge...