Fitzrovia, 1875. A woman recorded only as A.G. enters hospital and is diagnosed with syphilis.

L0074273 Tab 18, Papulopustular Syphilide, Mracek, 1898

A 24-year-old woman suffering from syphilis.

On 3 November 1875 a 19-year-old girl recorded only as A.G. was admitted to the Central London Sick Asylum in what is now Fitzrovia. As A.G. lay in bed, limbs heavy and eyelids drooping, a throbbing pain seeped down her back. Her entire body was covered with small rose-coloured spots, physical signs that marked her out as both a sufferer of syphilis and a disreputable young woman.

A.G.’s medical notes identify her as a prostitute. About eight weeks before, she may have noticed a small pimple appear. When it grew to the size of a pea, rupturing to form an ulcer, it was the first sign she had contracted a condition the medical establishment claimed to be generated within the bodies of women. Official efforts to contain the disease in the 1800s focused on controlling women – especially women like A.G. These tactics were to have unintended consequences, as they sparked the emergence of the first wave of feminism.

Syphilis was first associated with prostitution and supposed depraved behaviour soon after it appeared in Europe at the end of the 1400s. Originally known as ‘the Pox’, the name syphilis is derived from the title character of a Latin poem of 1530 in which a sinner is punished for betraying the god Jupiter. When it became apparent that it could be transmitted through sexual contact, it was interpreted as divine punishment for promiscuity.

When A.G. started working as a prostitute, ‘fallen women’ were thought to have a high risk of contracting syphilis not – as might be expected – due to their increased chance of being exposed to infection, but because of their inherent immorality. If the disease was a direct result of promiscuous intercourse, prostitutes were nothing less than a festering sore on society. Like plague-infected rats or cholera-swamped sewers, women who made their living selling sex were a problem that had to be monitored and improved.

“[The prostitute] is a woman with half the woman gone, and that half containing all that elevates her nature, leaving her a mere instrument of impurity… a social pest, carrying contamination and foulness to every quarter to which she has access.”
William Acton, Prostitution, Considered in its Moral, Social, and Sanitary Aspects, 1857

V0042209 Journey to eternity; prostitute approaches a man and his son

Syphilis depicted as a skeleton masquerading as a prostitute, 1830

The Contagious Diseases Acts, which were first implemented in England and Ireland a decade before, provided a legal framework for keeping track of prostitutes and isolating those who were infected. Despite the generic title, the Acts were designed specifically to reduce the impact of syphilis and gonorrhoea on men serving in the military. Their reach was limited to a small number of ports or garrison towns, where plain-clothes police officers were empowered to stop any woman they had “good cause” to think might be a prostitute.

These women were then requested to submit to an internal medical examination. The inspection was described as “voluntary”, but police were known to coerce illiterate and underage women into agreeing to it. Later versions of the law made fortnightly inspection compulsory once a woman’s name had been added to an official register. Now identified as apart from – or even something less than – an ordinary woman, if she didn’t comply she could be jailed.

L0031631 A surgeon or gynaecologist examining a woman with a vaginal

A 19th-century drawing of a woman being inspected with a speculum.

“It must be acknowledged, in fact, that by this means alone can we hope to reduce the ever-growing number of cases of syphilis in women whose vice and poverty has set them outside society.”
J-B Venot, Aperçu de statistique médicale et administrative, 1837

Initially, examinations were undertaken using a cold, metal speculum, a device that enables a doctor to open up a woman’s vagina and look inside. The leading syphilis specialist of the era considered the speculum to be an indispensable “instrument of medical control”; prostitutes in France called the device “the government’s penis”, while British campaigners against the Contagious Diseases Acts used the term “instrument of rape”.

“…often they use several. They seem to tear the passage open first with their hands, and examine us, and then they thrust in instruments, and they pull them out and push them in, and they turn and twist them about.”
A woman registered as a prostitute, quoted in The Forcible Introspection, 1870

Gallery: speculums

If found to be infected with syphilis, women were detained in isolation wards or specialist hospitals, effectively quarantining them from the men they were thought to be polluting. From the 1860s onwards, some of these ‘lock hospitals’ also attempted to treat inmates’ moral lapses, hoping to prevent their return to prostitution after release.

A central principle of the Contagious Diseases Acts was the belief that syphilis arose in the bodies of women, especially those of immoral character. Syphilis and other venereal diseases were for many years personified as women who, out to tempt their male victims, should be avoided.

Gallery: twentieth-century depictions of syphilis and other venereal diseases

Yet anyone could see that prostitutes – or even ordinary women – weren’t the only carriers of syphilis. On the same day A.G. arrived at hospital, an educated, married woman in her late 30s was also admitted. Identified by the initials A.P., she struggled to hold a cup of tea, spoke in a “deranged” fashion and endured a persistent ache in her head. Seven years previously she had developed a large coin-shaped sore on her tongue after catching syphilis from her husband.

V0010166 Woman with diseased tongue and broken teeth, 1874.

An out-patient at London’s Royal Free Hospital, 1874.

Women like A.P., who were likely celibate before marriage, could hardly be accused of being a source of disease or of indulging in immoral acts. Yet the possibility that men could act as carriers was largely overlooked. The soldiers that the Contagious Diseases Acts were intended to protect were not monitored in the same way as local women; well-to-do men were not considered a threat, since even the most dissolute philanderer was not expected to infect as many people as a diseased prostitute. However, these established views were questioned when medicine turned its attention towards the issue of congenital, or hereditary, syphilis.

Syphilitic pregnant women had a high chance of miscarriage and A.P. lost several babies after she became infected. Even when a pregnancy reached full term, many ‘innocent’ victims of syphilis died days after birth. Those that survived lived with the stigma of physical deformities, which suggested they might be the product of an immoral liaison. Some also had mental abnormalities that hindered their development. Since some syphilitic babies were born to mothers with no visible symptoms, doctors in the 1800s started to consider whether men could be responsible for transmitting the disease to their children.

Gallery: congenital or hereditary syphilis

The situations of women like A.G. and A.P. led early feminist campaigners to focus on this issue of male responsibility. In 1869 social reformer Harriet Martineau launched the Ladies National Association with the support of Florence Nightingale. The organisation campaigned for the repeal of the Contagious Diseases Acts, which its charismatic secretary Josephine Butler said contravened the constitutional rights of women.

“It is unjust to punish the sex who are the victims of a vice, and leave unpunished the sex who are the main cause, both of the vice and its dreaded consequences.”
The Ladies’ Appeal and Protest, 1870

The Ladies National Association directly challenged mainstream medicine and its subordination of women. Contrary to published medical statistics, it claimed the Acts had failed to control the spread of syphilis and it viewed prostitution not as a public health problem but as the logical result of a society that legitimised men’s sexual privilege.

“It is coming to be more and more a deadly fight on the part of us women for our bodies. If these doctors could be forced to keep their hateful hands off us, there would be an end to laws which protect vice, and to many other evils.”
Josephine Butler, writing in 1872

At the time, the fact that women – and middle-class Christian women at that – spoke publicly on sexual issues caused a sensation. Yet, while they fought for the rights of women like A.G., these early feminists still portrayed women we would now describe as sex workers as unfortunate victims, outcasts that should be “kept apart” from pure, respectable ladies. The campaigners’ ultimate aim was, in reality, two-fold: to nullify a law that applied “to one sex only” and to eradicate the “soul-devouring evil” of prostitution.

L0049215 A well-dressed client inspects the prostitutes at a brothel

Illustration from a French book describing prostitution, 1884.

“The cause of sexual disease is the subjection of women. Therefore to destroy the one we must destroy the other.”
Christabel Pankhurst, ‘A woman’s question’, published in The Suffragette, 1913

The Contagious Diseases Acts were finally repealed ten years after A.G. arrived at the Central London Sick Asylum, but the question of the true cause of syphilis and the fight for women’s rights still raged on almost four decades later. One of the leaders of the suffragette movement, Christabel Pankhurst, believed the “great evil” of sexual disease could only be addressed if women gained greater independence and men observed the same moral standards as virtuous women. Her stance was summed up in the campaign slogan “Votes for Women and Chastity for Men”.

Neither A.G. nor A.P. would live to see the repeal of the Contagious Diseases Acts or gain the right to vote. A.G. died just a week after admission. Her post mortem showed that parts of the membrane around her brain had turned to jelly. Within a few weeks her fellow patient lost the ability to speak. Three months later she died of the same cause as A.G., her education and respectability notwithstanding.

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