In the late 18th century, one in five Londoners contracted syphilis by their mid-30s, according to a fascinating (if you enjoy reading about the history of medicine, as I do) paper published online this week in the journal Economic History Review.
Using data painstakingly collected from the archived admission records of London’s hospitals and workhouse infirmaries, the paper’s authors — historians Simon Szreter of Cambridge University in the U.K. and Kevin Seina of Trent University in Canada — estimate that 2,807 Londoners were being treated annually for syphilis in the “foul” (venereal disease) wards of those facilities in the 1770s.
That’s twice as many people as were being treated for syphilis in the much smaller English city of Chester during that period and about 25 times more than as were being treated in rural areas of England and Wales.
Based on those 2,807 cases, Szreter and Seina estimate (conservatively) that 20 percent of Londoners during the Georgian era could expect to have at least one bout of syphilis by their 35th birthday.
Yet syphilis was just part of the considerable venereal disease problem in 18th-century London. “A far greater number would have contracted gonorrhea or chlamydia than contracted syphilis in this period,” the historians point out.
No one who has read the surviving diaries of James Boswell (1740-1795), the biographer of the great English writer and wit Samuel Johnson, will be surprised by the findings in this paper. In his diaries, Boswell recounts no less than 19 episodes of venereal disease between 1760 (when he was 20) and 1786.
“Our findings suggest that Boswell’s London fully deserves its historical reputation,” says Szreter in a released statement. “The city had an astonishingly high incidence of STIs at that time. It no longer seems unreasonable to suggest that a majority of those living in London while young adults in this period contracted an STI at some point in their lives.”
“In an age before prophylaxis or effective treatments, here was a fast-growing city with a continuous influx of young adults, many struggling financially,” he adds. “Georgian London was extremely vulnerable to epidemic STI infections rates on this scale.”
Georgians called syphilis “the pox,” while gonorrhea was known as “the clap.” Both tended to be lumped together as a single disease: “venereal distemper.” The first effective treatment for syphilis was not discovered until 1910, so Georgians who developed the disease had no real hope of recovery, although they didn’t know that at the time, as Szreter and Siena explain:
On experiencing initial signs of discomfort, such as a rash or pain in urination, most hoped it was just ‘the clap’ and would have begun by self-medicating for many weeks with various pills and potions — there was certainly a large market for these.
However, a substantial proportion would find that this failed to alleviate symptoms, which worsened, because the delayed secondary stage of syphilitic infection, when it arrives, typically produces debilitating pain and fevers lasting weeks and even months, which could not be ignored. Although they cursed their luck for getting the pox, most contemporaries believed that there was available to them a reliable, permanent cure. This was to submit to the rigours of mercury salivation treatment.
The idea behind the mercury treatment was to get the patient to excessively salivate, which was thought to help get rid of the impurities causing the disease. The initial administration of the mercury often occurred in a hospital, where patients typically stayed for a minimum of five weeks. Mercury, however, is a poison, so the treatment led to severe side effects, including painful mouth ulcers, loss of teeth, kidney failure and often death.
Despite doing more harm than healing, mercury treatments were administered for weeks, months and years, a factor reflected in a well-known Georgian saying: “A night with Venus, and a lifetime with mercury.”
Most affected: the young and impoverished
As Szreter and Seina emphasize, the incidence of syphilis and other STIs in 18th-century London was particularly high among “young, impoverished, mostly unmarried women, either using commercial sex to support themselves financially or in situations that rendered them vulnerable to sexual predation and assault like domestic service.”
Indeed, Boswell’s STIs were the result of frequent encounters with London’s sex workers.
It’s not surprising, therefore, that financially established men like Boswell also had a high incidence of STIs. The other group of men with a high incident rate were young, unmarried laborers who had migrated to London from other areas of Britain and who lived on the margins of the city’s economy.
Both men and women who could not afford treatments could usually get them for free at London’s specialist hospitals and infirmaries, Szreter and Siena point out.
This look at syphilis in the 18th century has ramifications beyond simple historical curiosity.
“Syphilis and other STIs can have a very significant effect on morbidity and mortality and also on fertility,” says Szreter. “So infection rates represent a serious gap in our historical knowledge, with significant implications for health, for demography and therefore for economic history.”
“Understanding infection rates is also a crucial way to access one of the most private, and therefore historically hidden, of human activities, sexual practices and behaviours,” he adds.
FMI: You can read the paper in full on Economic History Review’s website. If you have a general interest in London during the Georgian era, I recommend the recently published book “The Club: Johnson, Boswell, and the Friends Who Shaped an Age” by Leo Damrosch.