1 William Acton and Medical Discourse in Mid-Nineteenth Century Britain Submitted by Madeleine Prudence Morgan to the University of Exeter as a thesis for the degree of Doctor of Philosophy in History, April 2011 This thesis is available for Library use on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. I certify that all material in this thesis which is not my own work has been identified and that no material has previously been submitted and approved for the award of a degree by this or any other University. ......................................................................................... 2 Abstract This thesis presents the life and work of the physician William Acton from his education and medical training in Paris up to the introduction of the Contagious Diseases Acts. This thesis aims to re-visit Acton‟s two works on sexual function and sexual behaviour Prostitution, Considered in Its Moral, Social and Sanitary Aspects, in London and Other Large Cities. With Proposals for Mitigation and Prevention of Its Attendant Evils and The Functions and Disorders of the Reproductive Organs in Childhood, Youth, Adult Age and Advanced Life Considered in Their Physiological, Social and Moral Relations in order to understand Acton‟s intellectual development up to the middle of his career. The overarching theme of Acton‟s work identifies the necessity of regulation on a public and private level of sexual dysfunction. Acton‟s studies of prostitution and of sexual dysfunction in the male both conclude that the effective treatment of diseases such as syphilis and spermatorrhoea was not the intervention of medical curatives, but the regulation of the body. This thesis explores the development of Acton‟s writing, from medical treatises on diseases to social scientific works on the causes and consequences of diseases and his appreciation of and interaction with contemporary ideas on nature and hereditary predisposition. This work highlights the similarities of his approach to the treatment of prostitution and sexual dysfunction and explores the need for a revision of Acton‟s contribution to nineteenth century debates on sexuality. 3 Contents Abstract 2 List of Contents 3 List of Figures 4 Acknowledgements 5 Introduction 6 Chapter One 26 Acton Revisited Chapter Two 60 Acton on Prostitution Chapter Three 113 The Necessity of Regulation Chapter Four 162 Regulation of Personal Behaviour Chapter Five 209 Regulation of the Child Conclusion 239 Bibliography 245 4 List of Figures Page Fig. 1 TABLE INDICATING THE PROFESSIONS 84 EXERCISED BY THE FATHERS OF THE PROSTITUTES OF PARIS WHO WERE BORN THERE Fig. 2 NUMBER OF UNREGISTERED 92 PROSTITUTES ARRESTED AND FOUND DISEASES IN PARIS DURING TEN YEARS. Fig. 3 POLICE ESTIMATES OF KNOWN 129 PROSTITUTES: LONDON V ENGLAND & WALES Fig. 4 DEATHS FROM SYPHILIS OF FEMALES 131 AT DIFFERENT AGES IN ENGLAND AND WALES, AND IN LONDON, IN THE YEARS 1855, 1866 AND 1867 Fig. 5 TABLE SHOWING THE NUMBER OF 133 PATIENTS TREATED BY MR. CALLENDER, ASSISTANT SURGEON TO ST BARTHOLOMEW’S HOSPITAL ON JULY 21, 1869. Fig. 6 DR. HOLLAND’S QUESTIONNAIRE ON 134 THE PROVISION OF VENEREAL BEDS IN BRITAIN AND IRELAND. Fig. 7 PATIENTS TREATED FOR VENEREAL 137 DISEASE, ST BARTHOLOMEW HOSPITAL, FOR 1868 Fig. 8 CASES ADMITTED INTO HOSPITAL IN 145 SEVEN YEARS AND A QUARTER IN THE UK, 1838-1845. Fig. 9 ARMY MEDICAL REPORT SHOWING THE 146 NUMBER OF CASES OF VENEREAL DISEASE FOR THE YEARS 1860-66.1 Fig. 10 AVERAGE RATIO OF VENEREAL DISEASE 148 IN THE ARMY COMPARING LEVELS IN 1859 WITH THE AVERAGE BETWEEN 1837 – 1846 Fig. 11 TABLE SHOWING COMPARATIVE 150 PREVALENCE OF VENEREAL DISEASE ON THE DIFFERENT STATIONS IN 1864 AND 1865, PER 1000 MEN 5 Acknowledgements First and foremost I must offer my sincerest gratitude to my supervisors Dr. Kate Fisher and Professor Mark Jackson who have supported, encouraged and guided me throughout my thesis. Furthermore I am indebted to my former colleagues at the Centre for Medical History, University of Exeter for their help. In particular thanks are owed to Dr. Sarah Toulalan, Claire Keyte, Mary Carter and Dr. Alison Haggett. The completion of the thesis would not have been possible without the financial support of the Centre for Medical History, The Wellcome Trust and the British Federation of Women Graduates who funded my research trips. Thanks are also due to the staff of the British Library, The Wellcome Trust Library, London and the Bodleian Library, Oxford. Thanks also my friends for their fabulous support and encouragement, for there are too many to mention everyone, but special thanks are owed to Lucy Clarke, Roger Clegg, Jamie Hall, Alison Carrol, Leanne Fennel and Victoria Crockett. I am forever indebted to my parents and my grandmother for their endless patience, encouragement and support. Finally thanks must go to Stephen Mossman, without whose constant support and love, I would have been unable to complete the thesis. 6 Introduction William Acton (1813-1875) was a famous, perhaps infamous, nineteenth century physician. Acton undertook training at St Bartholomew‟s Hospital London and at the Hôpital du Midi in Paris. His career as a physician was broadly typical of his generation; yet it, and his subsequent publications, have been regarded as far from typical by some. He had a successful career as a surgeon and physician in London, working his way from an appointment as a surgeon at Islington Hospital to a private practice on Harley Street by the end of his career (an end occasioned by his premature and unexpected death). It is not for his medical practice, however, that he is most remembered. Acton gained fame from his publication of several books and numerous articles on venereal disease, sexual function, and prostitution. His works contributed to the emergent genre of writing on sexual behaviour, and were highly regarded by many, though by no means all, of his medical colleagues. His writings demonstrate mid-nineteenth-century fears of the danger which overt sexual behaviour posed to health. His approach to the study of sexuality was one which regarded the scientific study of behaviour and its effects to be more valuable to his reader than the moralistic evangelical polemic of many contemporary writers. Acton was among the first of a new generation of physicians intent on discussing sexual behaviour in writing without the embarrassment and reserve now associated with the term „Victorian‟, and in rejecting – at least formally, if not implicitly – the adoption of a hectoring moral judgement in their published work. 7 Acton‟s writing has been regarded by historians either as typical of the nineteenth-century physician, or as representative of the double standard of mid- nineteenth-century medical attitude towards women and sexuality. The „late‟ Acton, writing in the very specific context of the Contagious Diseases Acts of the mid-1860s, is considered as the totality of the man and his work, and the attitudes expressed at that point are regarded as proof of the patronising attitude of the medical profession as a whole to women and women‟s health. What is largely overlooked is the contribution Acton made in the early stages of his career to the scholarly discourse on sexual behaviour. A more thorough examination of the genesis and gestation of his ideas from his student days to the introduction of the Contagious Diseases Act is required to place Acton‟s writings in the context of this wider discourse. Acton‟s methodology, his use of novel, „modern‟ methods of statistical analysis, and his social-scientific approach can be used to demonstrate that his works were not typical of a reactionary position, but in the context of their age, at the forefront of mid-nineteenth-century discourses of sexuality. Acton‟s oft-quoted line “The majority of women (happily for society) were not very much troubled by sexual feelings of any kind”2 is perhaps his most famous. Utilised by many historians to demonstrate the misogynistic nature of nineteenth-century medical writing, the sentiment is often quoted out of context. This is symptomatic of a general misinterpretation of Acton‟s works and their contribution to the understanding of sexuality in Britain. The innovative nature of Acton‟s writing, and his engagement with modern techniques and theories is often overlooked. Ivan Crozier has suggested that the 2 William Acton, The Functions and Disorders of the Reproductive Organs in Childhood, Youth, Adult Age and Advanced Life Considered in Their Physiological, Social and Moral Relations (London: John Churchill and Sons, 1862), p. 212. 8 works of Acton have generally been misinterpreted; in this light, it is profitable to pursue a recontextualisation of Acton‟s works, in order to fully appreciate and understand his contribution to the specific medical and societal debates which formed the mid- nineteenth-century medical discourse.3 This thesis seeks to recognise the important contribution William Acton made to discourses on sexuality in the mid-to-late nineteenth century. It places Acton as a central figure for the development of new constructions of feminine and masculine behaviour which defined the normative expectations of sexuality. It identifies the influence of emerging French theories on his work in his early career, and also his acceptance of current thinking and his adoption of new ideas throughout his career. It will challenge previous conceptions of Acton as the archetypal Victorian physician, and will place him as a key figure in the development of British constructions of sexuality and behaviour. Acton stood at the forefront of a new generation of physicians, who looked to pathologize sexual behaviour and created a new dialogue that reached not only the medical community, but the wider general public. It is this attempt to make his work accessible to the public that makes Acton unique.