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1 Introduction in the First Quarter of the 20 Century in Australia And Introduction In the first quarter of the 20 th century in Australia and elsewhere there was a strong perception that venereal diseases were spreading in epidemic proportions, and ricocheting across class and gender boundaries: that they constituted a ‘red plague.’ 1 This opinion was fueled by wartime anxieties related to productivity and defence and led to a fear that venereal diseases were spreading virulently through populations, stripping the new Australian nation of its health and vitality. Such views prompted impassioned debates throughout the period about the most appropriate methods for monitoring, treating and preventing venereal diseases. At their most fundamental, these debates centred on the relationship between the government of self, the government of others, and the government of the state, and the modes of rule considered necessary to maintain the health of populations. I argue that in New South Wales (NSW) from Federation in 1901, through the first three decades of the 20 th century, there was a perceptible shift in modes of rule that related to the management of venereal diseases. At the beginning of the 20 th century, a medico-penal and coercive approach was central to the management of venereal diseases, and so-called ‘case-hardened’ prostitutes, in brothels, were believed to be the most dangerous transmitters of transmission. By 1925, persuasion and ‘responsibilisation’ were becoming important modes for the management of venereal diseases, and young people, in a range of settings including homes and workplaces, were assessed as being a venereal risk. 2 At its core, then, this thesis is concerned with examining these shifting modes of rule. This study focuses in detail on specific records and institutions in NSW between 1901 and c. 1925. It examines medical records from Sydney’s Royal Prince Alfred (RPA) Hospital Venereal Wards and Outpatient Clinique, weekly statistical returns on the prevalence of syphilis and gonorrhoea submitted to the New South Wales (NSW) 1 Black, G., The Red Plague Crusade , Sydney, 1916. 2 Responsibilisation is a term used to describe the various ways in which governments develop legislation and policies aimed at inculcating a culture of self-discipline or surveillance of the self, by the self. In the context of the management of venereal diseases, this meant that citizens were encouraged to monitor their own venereal health, seek authorized treatment and agree to surveillance and notification procedures. See Scott, J., ‘The Management of Venereal Diseases in New South Wales, 1871 to 1916’, Venereology, 2001:14: pp. 69-81 1 Department of Public Health by both Sydney and RPA Hospitals, the publications of various charitable and non-government organisations involved in the prevention of venereal diseases, and medical texts and journals which described aetiological, pharmacological and medico-political developments in the management of venereal diseases. Framing this period were three important political and legislative changes which I closely examine: the NSW Prisoners Detention Act 1909, the NSW Select Committee on the Prevalence of Venereal Diseases 1915 and the NSW Venereal Diseases Act 1918. I place these legislative interventions in broader national and international contexts, and argue that developments in the management of venereal diseases in NSW were at times incongruent. On the basis of this core of data and this framework of legislation I analyse three of the most fundamental aspects of the management of venereal diseases: treatment, epidemiology and prevention. There are compelling medico-cultural, microbiological, biopolitical and social reasons to study venereal diseases in NSW between 1901 and 1925. In the late 19 th century, the organism responsible for gonorrhoea was identified. 3 In the first decade of the twentieth century, the organism that caused syphilis was isolated. 4 These discoveries allowed for ongoing investigations into the nature and sequelae of these infections, and the development of therapeutic responses. In 1909 a procedure for diagnosing syphilis was patented by Gustav Wasserman: the Wasserman reaction. In 1910, Paul Ehrlich and his assistants marketed a preparation called ‘606,’ or ‘Salvarsan,’ as a 3 In 1879, Albert Ludwig Sigesmund Neisser (1855–1916) discovered the organism gonococcus nesseria , responsible for gonorrhoea. Neisser’s discovery occurred in the wake of rapid developments in the field of bacteriology, and was made possible by utilising Koch’s smear tests for bacteria, and the new Zeiss microscope, based on the condensor and oil immersion system. In 1892, based on his own design, he established a dermatological clinic in Leipzig. He worked for a time with Ehrlich on the syphilis microorganism, but in 1910 he was publicly censured for a series of syphilis experiments with children, in which they were inoculated with syphilitic serum (See Ligon, B. L., ‘Albert Ludwig Sigesmund Neisser: The Discoverer of the Cause of Gonorrhoea,’ Seminar Pediatric Infectious Diseases , 2005: 16: 4: pp. 336–41). 4 Hideyo Noguchi (1876–1928) and Simon Flexner (1863–1946) discovered the bacteria that was the cause of syphilis, Treponema pallidum , confirming the earlier discovery made by F. R. Schaudinn (1871–1906) and E. Hoffman in 1905 (See Kampmeier R. H., ‘The Demonstration of Spirochetes in Syphilis Lesions by F Schaudinn and E Hoffman,’ Sexually Transmitted Diseases , 1979: 6:1: pp. 25– 27). In his ongoing work on syphilis, Noguchi was able to modify the Wasserman test, the purpose of which was the detection of syphilis, as well as to prove that general paralysis of the insane and tabes dorsalis were the late stages of syphilis, as Fournier had argued. Noguchi also discovered that syphilis had delayed effects on the nervous system that did not become apparent until 10 to 20 years after the original infection. Hall remarks that ‘the sense of the pervasiveness and insidiousness of syphilis was only confirmed and extended when the guilty micro-organism was finally identified’ (Hall, L., ‘‘‘The Great Scourge’: Syphilis as a Medical Problem and Moral Metaphor, 1880–1916,’ Courtauld Institute Symposium , May 1998 – URL http://homepages.primex.co.uk/~lesleyah/webdoc3.htm). 2 treatment for syphilis. 5 As a result of these changes and other advances in the field of microbiology, and because of the interest of both the Commonwealth of Australia, and the NSW Department of Public Health, there were significant debates about treatment options for venereal diseases. Treatment debates focused on the relative merits of inpatient and outpatient services, and the values of public and private treatments vis-à-vis indigent and well-to-do patients. There was also a lengthy and inflammatory debate about how best to prevent venereal infections, whilst not inadvertently arousing sexual desire. Advocates in these debates argued from ‘purity,’ ‘hygiene’ and ‘sex-education’ perspectives. Considerable argument about the most appropriate legislative responses to the management of venereal diseases occurred, and correspondents in medical journals argued for and against notification and compulsory or voluntary treatment. With the support of the Commonwealth, venereal diseases legislation was passed in most states in Australia between c. 1901 and 1925. In NSW, the Venereal Diseases Act passed in 1918, and subsequent Regulations were gazetted in November 1919. This followed the Prisoners Detention Act 1909 and the aforementioned Select Committee on the Prevalence of Venereal Diseases of 1915. In this period, as well, the Great War was being waged, necessitating a global movement of soldiers and the consequent globalisation of venereal infections. 6 This broad set of medico-cultural shifts meant that new terminologies were needed to understand and describe the impact of venereal diseases. Ways of naming, defining and understanding syphilis and the broader category of venereal diseases changed over the course of the 19 th and into the 20 th century. In the mid 19th century, particularly in France, three theories related to venereal diseases were prominent: the orthodox theory of the unity of gonorrhoea and syphilis; the Broussais theory which denied the existence of such a disease; and the Ricord theory which made a distinction 5 By 1926, Ehrlich had been immortalised, along with other significant scientists who investigated germs and related theories, in Microbe Hunters (Orlando, 1926) by Paul de Kruif. De Kruif wrote an entertaining and hagiographic account of important early virologists, microbiologists and immunologists like Koch, Pasteur, Metchnikoff, Ros, Grassi and Ehrlich. Ehrlich was possibly apocryphally described as saying that ‘we must learn to shoot microbes with magic bullets’. 6 Most broad-ranging histories of venereal diseases take it as axiomatic that the prevalence of venereal diseases increases during, and as a result of, war. See Brandt, A., No Magic Bullet: A Social History of Venereal Diseases in US since 1880 , Oxford, 1985; Oriel, J. D., The Scars of Venus: a History of Venereology, London, 1994; Cassel, J., The Secret Plague: Venereal Disease in Canada, 1838–1939 , Toronto, 1987. It should be noted that the perception that venereal diseases increased during, and as a result of war, is also true: there were, and are, many interests to be served in inflaming the perception of a ‘red plague.’ 3 between gonorrhoea and syphilis. Dracobly argues that such theoretical arguments were closely linked to therapeutic developments. 7 Remnants of these theoretical debates
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