Transience, Class and Gender in Interwar Sexual Health Policy: The Case of the Liverpool VD Scheme

Transience, Class and Gender in Interwar Sexual Health Policy: The Case of the Liverpool VD Scheme Abstract Focusing on the implementation of the Liverpool VD Scheme, this article reasserts the importance of morality to interwar medical understandings about the spread of venereal disease. Despite claiming to offer impartial, practical solutions to the spread of venereal disease, the Liverpool VD Scheme, created in 1916, reflected and promoted the notion that the transient lifestyles of many of the working class presented physical and moral threats to the city. This article therefore counters suggestions that the interwar control of venereal disease was shaped by practicalities rather than moralities. Evidence is provided for the persistence of a medico-moralising that continued to place working-class sexual practices at the heart of discussions about the spread of venereal disease. However, presumptions about men’s biological need for sex combined with the local importance of the port, meaning that working-class seamen with VD were judged less harshly than working-class women with the same infections. morality, prostitution, public health, seamen, Liverpool Introduction In late 1915, John Glynn, Chairman of the Liverpool Branch of the White Cross League and advocate of Christian prayer and abstinence, suggested that ‘Many [men] have told me they were under the impression that self-abuse and fornication did them good. … Then we remind them of the enormous number of fresh cases of disease every week’.1 As a social purity organisation that credited men with a greater sense of sexual agency than women, the White Cross League called upon men to take responsibility for maintaining Britain’s sexual morality.2 On the surface, Glynn’s sentiment appears to signal a break with Victorian attitudes towards venereal disease, which saw women (prostitutes in particular) targeted for treatment and blame.3 During the early twentieth century there was increasing attention paid to the male role in the spread of venereal disease. Lesley Hall suggests that, by the start of the twentieth century, an increasing amount of disapprobation was directed towards unfaithful men who were said to be putting the health of their innocent families at risk by bringing infection into the marital bed.4 Moreover, once Britain had returned to peace following the First World War, there was further diminution in the cultural appetite for excusing men’s role in the spread of infection, but such excuses did not go away. More recent research by Leanne McCormick suggests that women were still disproportionately blamed for venereal disease, especially once concerns about male promiscuity began to lose some of their urgency after the First World War.5 This questioning of the gendering of attitudes towards venereal diseases (VD) is a corollary of a broader debate about the extent to which moral judgement still featured in interwar VD policies. I want to argue here that a regional understanding of the issue is key, since in order to assess overlaps between policy and morality we need to consider how VD Schemes were implemented in response to local pressures and prejudices. Regional approaches to the study of public health and venereal disease before the First World War have examined the punitive elements of the treatments offered, particularly where prostitutes were concerned.6 There is also an emerging body of work on venereal disease after the First World War, with studies by Roger Davidson, Gayle Davis and Susan Lemar focusing on Scotland and McCormick’s work on Northern Ireland.7 The work of Philip Howell on the Irish Free State and Pamela Cox on the limits of English voluntarism expands definitions of regulation beyond notions of legal compulsion.8 As Cox notes, however, ‘coercion work within English VD measures’ has been ‘less well documented’ than in areas like Scotland.9 Variations within England must also be considered. Francesca Moore’s recent article on interwar Rochdale highlights the importance of examining English attitudes towards venereal disease.10 However, as this article will show, there are significant differences between the attitudes of doctors in Liverpool and those in Rochdale, despite the relative proximity of these two locations. Moore suggests that Rochdale’s doctors paid little notice to ‘the gendered difference’ in infection rates or sexual behaviours.11 The same cannot be said for Liverpool. Although men were no longer at war, seafaring in particular still connoted difficult, necessary, men’s work. The arguments put forward here suggest that while working-class male sexuality was still perceived as potentially excessive, in a port city like Liverpool, the importance of seafaring as an occupation meant that excuses about men’s need for sexual release still underpinned local attitudes towards venereal disease. At the same time, local discussions about rates of infection among seamen intersected with uncertainty about whether the problem should best be tackled as a moral or medical issue. Although the Liverpool VD Scheme presented itself as a morally neutral programme of treatment, moral pressure was still exerted upon patients. Once again, this points to a contrast with the existing literature. Susan Lemar has used the case of interwar Edinburgh to argue against the idea that compulsion and the moral control of the sex lives of the working class, especially working-class women, were significant parts of that city’s public health approaches to VD prevention.12 She takes issue with the ‘themes of victimisation and patriarchal control of women’s bodies’ which have characterised feminist histories of the late-nineteenth and early-twentieth centuries.13 Lemar also seeks to counter the emphasis that Roger Davidson places upon social control and morality in his assessment of the campaign to institute compulsory notification of venereal diseases in Edinburgh.14 For Lemar, the debate about compulsory treatment in interwar Edinburgh was shaped less by morality and more by practical concerns about the efficacy of treatment, the spectre of the Contagious Diseases Acts and the cost of treating people who then prematurely stopped attending clinics.15 On the surface, it appears that Liverpool followed Lemar’s reading of the situation in Edinburgh. As this article will show, Liverpool’s Medical Officers of Health favoured mandatory treatments; they were concerned about the numbers of people who abandoned treatment; and their clinics claimed to be free from punitive proselytising. Indeed, there was an apparent shift during the latter part of the First World War towards developing pragmatic venereal disease policies which purported to have overcome the weight of earlier moral discourses in favour of focusing on practical intervention. Moreover, despite the city’s large Irish-Catholic population, religious issues do not appear to have interfered with uptake at Liverpool’s VD clinics.16 Nevertheless, I want to question the progressive, moral impartiality of the Liverpool approach and argue that the picture in Liverpool actually supports Davidson’s account of the situation in Edinburgh and Leanne McCormick’s research on Northern Ireland.17 The supposedly practical VD policies implemented in Liverpool were inflected with moral concerns and prejudicial attitudes about which communities to target for treatment. In 1916, the Royal Commission on Venereal Disease recommended that local authorities tackle the spread of venereal disease by making free treatment by experts readily available, investing in facilities for diagnosis and by raising public awareness about the dangers of infection and the treatment services on offer.18 As a result of the report, and in the same year, Liverpool established the Liverpool VD Scheme, creating five new free treatment centres in the city.19 These clinics were based at the Royal Infirmary, the Royal Southern Hospital, the David Lewis Northern Hospital, the Stanley Hospital and, until 1921, the Cancer and Skin Hospital. During the first half of the twentieth century, Liverpool’s City Council oversaw the city’s Health Committee, which was responsible for the management of (among other things) environmental health, port health services and venereal diseases.20 Under this Committee, the city’s Medical Officers of Health were in charge of various medical officers with different specialisms, ranging from a Senior Port Medical Officer (who examined ships and inspected foodstuffs) to a VD Officer, who oversaw the treatment clinics.21 This article situates local doctors’ work on the Liverpool VD Scheme within the wider context of health discussions among employers of seamen and the relatively few instances that the local press dared to report on venereal disease.22 It should be noted that local newspaper articles on venereal disease tended to focus on statements made by public officials such as the Medical Officers and local councillors, while the records of the Steamship Owners’ Association will be used to show that there was no overall agreement about what should be done to reduce rates of venereal disease among seamen.23 Discussions continued to be cautious and stymied by the weight of the stigmatism that surrounded these diseases. Consequently, even in a city like Liverpool, which took a proactive approach to the treatment of VD (as signified by the swift creation of the VD Scheme in 1916), older moral discourses continued to frame medical narratives. The increasing emphasis placed by public health workers on scientific developments was not mutually exclusive, either at the broad cultural level or at the level of regionally-specific practical policy, with the continuation of medico-moralising about venereal disease.24 Lesley Hall’s work has usefully charted the policies and practicalities of treating VD on board ships and she explains the economic motivations of ship-owners for getting involved in debates about VD.25 However, the wider ramifications of this involvement for class and gender relations remains unexplored. This article argues that, in Liverpool, reliance upon shipping meant that, despite the promiscuous reputation of seamen, it was women who were still disproportionately blamed for the spread of venereal infections. To this end, the Liverpool case study offered here shows that medico-moral discourses had an impact that reached far beyond the work of either doctors or moral campaigners. While stereotypes about promiscuous seamen persisted, the reputation of this type of work combined with persisting ideas about men’s biological urges to afford them a degree of insulation from moral condemnation that was not afforded to working-class women. Morality: From War to Peace With the swift creation of the Liverpool VD Scheme following the Royal Commission on Venereal Disease, it was clear that Liverpool took the problem of venereal disease seriously. In fact, even before the report was published Liverpool was widely recognised as a ‘pioneer’ city in its approach to venereal disease, having undertaken educational work and offered lectures ‘to men and women on this subject’.26 Towards the end of the First World War, the number of out-patients of both sexes in Liverpool being treated for venereal disease grew steadily. Running both evening and day clinics at the site, and with costs paid by the Liverpool Corporation, treatment rates at the Liverpool Royal Infirmary grew at the end of the war. Between 1918 and 1919 treatment rates for new patients at the clinic more than doubled, going from 1,819 patients to 3,770.27 The Medical Officers’ Annual Reports to the Port Authority afforded those in this role an opportunity to report on their successes in dealing with various threats to public health in the city. They contained statistical information, but they also included statements from the Medical Officers which give indications as to their understandings of the physical and indeed moral threats to the city. Reflecting in his 1932 Report on Liverpool’s experiences of dealing with venereal disease during the First World War, Dr Frazer, Liverpool’s then Medical Officer of Health, drew parallels between seamen’s relationships with female prostitutes and wider questions about a decline in wartime moral standards. He declared that the ‘prevalence of venereal diseases’ was a subject with a ‘close association with seafaring life’, before adding that ‘Public opinion towards the end of the War was exercised on the … change in moral habits of the people, and it was expected that a considerable increase in the number of cases of venereal disease would occur’.28 Even before the war, the development of the Wasserman syphilis test in 1906 and the use of Salvarsan as a treatment from 1910 placed the issue of venereal disease firmly on the national agenda in the early years of the twentieth century.29 Medical professionals applied their new-found knowledge to debates about changing sexual practices and whether or not advances in treatment might actually undermine public morals. The case for aligning moral and practical provisions was made explicit where the potential for venereal disease amongst pregnant women could do harm to fetuses. In 1917, Dr Mary Scharlieb had praised Liverpool’s ‘Dr. MacAlister, Dr. Hope, the Medical Officer of Health, and other professional men and women’ in the city for their ‘wise’ efforts to tackle venereal disease among pregnant women.30 The medical problems experienced by children born to mothers with venereal disease served to reinforce perceptions amongst doctors that some patients with venereal infections, such as these children, were innocent, whilst others were guilty. This notion that some patients bore moral culpability for infections within the local community meant that considerable responsibility for the transmission of venereal disease was still placed disproportionately on those perceived to be immoral, namely the working class and working-class women especially. Much of the wartime concern about a supposed decline in morality focused on women.31 When the government controversially introduced the Defence of the Realm Act Regulation 40D, which criminalised women with venereal diseases who had sex with soldiers, it was used disproportionately to police prostitutes.32 By contrast, servicemen received considerably less disapprobation for their role in the spread of venereal disease and the supposed downfall of British moral standards. An ideology of masculinity, pervasive within the military, rooted men’s physical health in sexual expression, leading to concern about the effects of soldiers’ long-term separation from their wives upon morale and physical well-being. Cowman notes that British soldiers stationed in France made frequent trips into local towns for the purpose of indulging in the ‘corporeal realities’ of eating, drinking, shopping and sexual pleasure, resulting in a boom in prostitution in French towns during the war.33 Similarly, Clare Makepeace argues that the British military subscribed to gendered ideologies of prostitution, with servicemen’s visits to brothels justified by the widespread belief that sex was necessary to the physical and mental health of soldiers. So ingrained was this thinking that the army reversed its policy of informing the next of kin when soldiers were being treated for venereal disease following the introduction of conscription in 1916, when the number of married men serving went up significantly.34 An examination of the medical culture surrounding Liverpool’s seamen indicates that this degree of understanding afforded to unfaithful and promiscuous soldiers had peace time ramifications for men working at sea. That is to say that the attitudes described by Cowman and Makepeace were not specific to either soldiering or to the war itself. Seamen’s sexual escapades in Liverpool were framed as an escape from the difficult conditions of life on-board ship. In 1921 Liverpool’s Medical Officer explained that, along with afflictions caused by the ‘peculiar stresses of the work’ and exposure to various tropical diseases like malaria and beriberi (a potentially serious vitamin B1 deficiency), seamen were ‘peculiarly liable’ to diseases ‘attending the vices to which sailors in foreign ports are particularly liable to be attracted. Alcoholism and venereal disease’.35 Excess and sexual indulgence by working-class men were therefore made more palatable to the Port Authority when they were explained as consequences of, if not antidotes to, hard work. Even where discussion about preventing the spread of venereal disease did turn towards critically examining men’s sexual behaviour, this assumption that sexual release was necessary to men’s physical health was still part of the debate, leading to criticism from some quarters. Alison Neilans, assistant secretary to the Association for Moral and Social Hygiene, wrote to the British Medical Journal in 1916. As a campaigner for the abolition of the solicitation laws and an advocate for moral work with prostitutes, Neilans argued: The thing which makes all moral and social reform work so intensely difficult, which produces both the prostitute and her partner, is that great body of public opinion which tacitly upholds the double standard of morals, and when it sees the results of its doctrines murmurs meaningless platitudes about ‘human nature’.36 Neilans therefore challenged the long-standing assumption that prostitution was a social inevitability brought about by the need for men to find a controlled release for their sexual urges. By voicing this opinion in a letter to the British Medical Journal, Neilans did not attempt to disassociate prostitution from debates about venereal disease. Indeed, she attempted to appropriate the interests of public health in order to further her own organisation’s approach to prostitution. Specifically, she wanted to tackle the double standard of gender morality that worked against prostitute women, whilst seemingly offering their male clients a degree of absolution. Nevertheless, Neilans’ acknowledgement of and attempt to invert the moral discourses that surrounded the spread of venereal disease were at odds with cultural anxiety about rates of wartime infection and the need to scapegoat particular patients. In 1916 the Report of the Royal Commission on Venereal Diseases estimated that 10 per cent of urban Britons had syphilis, and it proposed even higher levels of gonorrhoea.37 The following year, in an article on the Royal Commission, it was hoped that more women would seek treatment for venereal disease, as previously there had been no ‘provision … for separating the really guilty from the totally innocent, the prostitute debauched by long years of life on the streets, from the respectable married woman infected by her husband’.38 References to the guilty prostitute indicate that the Report had not resulted in a decisive move away from the moral judgement of people with venereal disease. Assertions in the same article that there had been an ‘almost revolutionary’ change in attitudes towards people with venereal disease and a move away from the ‘prudery’ and ‘secrecy’ of treatment reflected the hope of the Report rather than the reality.39 Liverpool’s Dr Frazer suggested in 1932 that the perceived danger that venereal disease posed to ‘the innocent and guilty alike’ had been a fundamental consideration in the Royal Commission’s report and the passing of Public Health (Venereal Diseases) Regulations in 1916.40 Here, Dr Frazer seemed to argue that moral reflection upon the behaviours that might precipitate infection offered little of practical value in the battle to contain a public health danger as pervasive as venereal disease. He attempted, also, to give a sense of his own moral impartiality in not distinguishing between the treatment of the ‘innocent’ or the ‘guilty’. Yet these awkward references to innocence and guilt indicate that Liverpool’s Medical Officer of Health did continue to hold on to and make moral judgements about the ways venereal disease could be contracted. Dr Frazer was not anomalous amongst the medical community in this regard. Immediately after the war, concern that promiscuity was increasing caused some doctors to argue that a reassertion of moral values was necessary if the threat of venereal disease was to be halted. In 1919 the Manchester Guardian reported soberly on debates at the conference of the Royal Sanitary Institute in Newcastle.41 At this event, York physician Dr Edmund M. Smith argued that ‘there was a large body of opinion amongst medical men of standing and amongst the general public denying the assumption that sexual continence was impracticable’.42 For Dr Smith, efforts to make sex safer through, for example, ‘supplying prophylactic outfits’ could do little other than ‘act as an incentive to immorality’. However, appeals to such a broad consensus of moral opinion were immediately undercut by a proclamation at the same event by Sir Archibald Reid that ‘the teaching of sexual morality to children was neglected, and the moral lessons sometimes given to adults were futile’.43 According to Reid’s position, ‘present social conventions’ meant that it was ‘not possible to teach morality or to prevent morality, but it was easy to prevent disease’.44 Other doctors believed that a combined middle-ground was the best approach. Dr Douglas White, from London, urged the medical profession to ‘adhere to the principle that public health and public morals ran along parallel lines’.45 In large part, the debate in which these doctors engaged in 1919 reflected the extent to which the First World War was thought to have had a profound effect upon the sex lives of the British people, with the effect that practical policies could not be extricated from moral concern. Seafaring and Venereal Disease By 1921, the VD treatment centres that were established in Liverpool under the VD Scheme were being described by Dr William Edward Hope, Liverpool’s Medical Officer of Health between 1894 and 1924, as ‘very serviceable and popular’, with the patients’ euphemistically-termed ‘special ailment[s]’ dealt with carefully and sensitively.46 In his 1921 report to the Port Sanitary Authority of Liverpool, Hope noted ‘patients are not singled out or made conspicuous’.47 But the creation of these treatment centres did not necessarily create distance between medical treatments and moral discourses about the prevalence of venereal disease. In the 1960s Elisabeth Rees, a Consultant Venereologist in Liverpool, recalled working with a senior doctor in the 1940s who ‘used the tail of his white coat to turn the knob of the door’ due, according to Rees, to his presumption that his patients were part of a promiscuous and degraded working class.48 This perception of the class and morality of patients was rooted in the procedures and presumptions of the Liverpool VD Scheme from the start. Although working from within a voluntary system of treatment, doctors and the local authority in Liverpool actually favoured mandatory treatment, whereby patients suffering from venereal disease could be made to attend the clinics until cured. The local authority felt that the issue would be better dealt with if local Health Authorities were given powers ‘to compel the patient to seek a doctor’s advice and to follow it should he be found to suffer from the disease’.49 Although the Ministry of Health rejected repeated calls during the 1920s from doctors in cities like Edinburgh and Liverpool to use the law to penalise those with VD who did not maintain their treatment, at local level, the fields of medicine and public health governance had not necessarily moved far beyond the thinking behind the Victorian Contagious Diseases Acts or the Defence of the Realm Act Regulation 40D. Moreover, the acquiescence of the Ministry of Health was not a necessary pre-requisite to the implementation of coercive policies at local level.50 Although the local VD schemes that emerged from the war have been regarded a success in terms of promoting greater uptake of treatment, this treatment cannot be said to have been entirely voluntary.51 In the absence of mandatory treatment, local doctors found other ways to put pressure upon patients. Doctors stressed to patients the need to undergo ‘steady and continuous’ treatment by sending out ‘appropriate[ly] worded letter-cards’ asking patients who stopped attending to come back to the clinic.52 Pressure did not just emanate from the medical field either. In 1926, the Medical Officer of Health commended one shipping company which had instituted a system requiring ‘any man known to have suffered from venereal disease to submit a certificate of health from the medical officer of the dispensary before accepting him for sea service’.53 At this time, employers could certainly take an interest in the sex lives of their working-class employees. Anna Lundberg notes that, in Sweden, there was a long history of repressive control, whereby employers reported cases of venereal disease to the state, while treatment regimes there were mandatory.54 Similarly, Michael Tuck argues that in the British colony of Uganda, early twentieth-century approaches to venereal disease were heavily punitive, with doctors writing to patients’ landlords and employers to prevent them discontinuing treatment.55 Despite a less repressive approach being adopted in Britain, there was still opportunity for employers to be involved in this non-mandatory system. Practices and discourses relating to employment intersected with approaches to venereal disease, not just in the sense that employers could be co-opted into coercive policies of treatment but also in the sense that employment could influence perceptions of venereal disease. The notion of the promiscuous seaman, whose indiscretions were considered to be biologically rooted, was a case in point. During the mid-twentieth century, it was not usual for those in charge of shipping to work alongside doctors, the Ministry of Health and social work agencies to intervene in the sexual health of seamen. The National Council for Combating Venereal Disease (NCCVD, known from 1925 as the British Social Hygiene Council) reached out to maritime employers and trade unions during the 1920s in a bid to ‘reduce the incidence of diseases among the sea-faring population’.56 Similarly the Ministry of Health worked with the NCCVD, to whom they gave funding, and ship-owners’ associations to address ‘the prevention and treatment of venereal diseases amongst Merchant Seamen’.57 The Liverpool Steamship Owners’ Association sent Dr Graeme Robertson, of the White Star Line, to attend a conference between the Ministry, employers and the NCCVD at the Ministry of Health on 3 November 1920.58 A number of points were agreed upon at the meeting. It was noted that seamen should be treated on board ships ‘free of charge’ and that ‘All seagoing Surgeons’ should ‘take a course in modern venereal treatment’.59 Ship-owners were to help facilitate this medical ‘instruction’ by taking advice from ‘the State’ on what training centres were available and passing this on to surgeons. In addition, it was also agreed that ships’ masters ‘be approached re qualifying in elementary diagnostics and treatment of venereal disease’.60 Although it was suggested at the conference that the state should cover the cost of supplying ships’ surgeons with equipment and drugs, this expense was later given over to shipping owners. The Merchant Shipping Act 1923 stated that shipping owners had to cover the cost of medical expenses for the treatment of seamen suffering from venereal disease.61 As Hall argues, money was therefore a motivating factor for employers taking an interest in venereal disease.62 The Liverpool Steamship Owners’ Association continued to take an interest in venereal disease and to communicate with welfare agencies throughout the interwar years. They maintained their links with the NCCVD, later as the British Social Hygiene Council (BSHC). In 1935, the Association accepted an invitation from the BSHC to send a representative to sit on a committee that they were in the process of establishing in support of ‘Seaman’s Welfare’. Alongside maritime employment representatives, the committee was also supported by Liverpool’s Medical Officer and by charitable organisations.63 By the time of the Second World War the Shipping Federation and the National Maritime Board called upon the Ministry of Health to make it compulsory for ships to carry sheaths and ointments (although they were not successful in this campaign), and many ships offered these things anyway.64 The interest that ship-owners took in the issue of venereal disease reflected the fact that it was an issue within the seafaring community. Paying particular attention to the dangers of the port as a workplace, the statistics of Liverpool’s Medical Officers of Health catalogued the gender and occupations of those suffering from venereal disease, and identified seamen as an especially infected group during the interwar years. For example, out of 1,754 men registered for treatment at the Royal Infirmary in 1921, 703 were described as ‘Seafaring people’.65 Well over half of all male patients in 1921 were described as ‘discharged soldiers and sailors’. The overrepresentation of male sufferers, particularly in these groups, stood in stark contrast to the total 199 women registered for treatment. Of these, housewives were by far the greatest in number, at 121.66 Instances of suspected venereal disease in Liverpool and public health officials’ reliance upon male transience as an indicator of susceptibility to infection appears to be mirrored by experiences in other parts of the north west. In 1934 Salford saw a total of 1,971 suspected cases of VD across its services while Liverpool saw 4,739 new cases, not a great discrepancy when the relative population sizes of these areas are considered.67 Just as in Liverpool, doctors in Salford located the problem of venereal disease amongst the transient working class, with ‘drivers of vehicles and … “lorry girls”’ highlighted as being particularly susceptible to ‘the dangers of neurosyphilis’.68 The mention of ‘lorry girls’ was tied directly to the issue of prostitution, with these hitch-hiking girls associated with delinquency, promiscuity and amateur prostitution.69 Professional prostitution was also a concern for doctors at the VD clinic in Salford, who expressed unease in 1935 about ‘the danger of prostitutes who live in flats, control of whom is difficult’.70 However, while it was clear that seamen and other transient members of the working class did represent a significant proportion of those being treated for venereal disease in Liverpool, the Medical Officers’ statistics also reflect the degree to which the local authorities, the state and moralists strove to target venereal disease amongst these transient groups. The Port Authority in Liverpool was so concerned with venereal disease in seamen that it needlessly prioritised the issue, to the detriment of other, more pressing threats to the health of men working on-board ships, such as those associated with unsanitary living conditions, poor ventilation and tropical diseases.71 Sally Sheard’s work has carefully mapped trends in public health provision for seamen in Liverpool and, while an analysis of class and gender falls outside the remit of her paper, she has located this disproportionate attention paid to venereal diseases, over and above other issues affecting the health of seamen, within the context of a shift which saw ‘the personal’ emphasised in place of ‘the environmental’ in matters of public health.72 Rather than focusing upon the environmental causes of ill-health, increasing attention was devoted to the patient’s role in maintaining their own physical well-being. This reiteration of the personal and the importance of behaviour enabled late nineteenth-century discourses about the failures of working-class morality to continue to be articulated through interwar venereal disease policies that were supposed to be more practical and objective. Alongside seamen, other groups of working-class men were identified as key audiences in local interwar education programmes. Efforts to warn ‘the general public and those likely to come into contact with Venereal Disease’ saw the Merseyside Borough’s VD Education Committee send doctors to give lectures at a local prison, Seamen’s Institutes and at ‘various industrial concerns’, indicating that the education of working-class men was regarded as one of the quickest ways to combat further infection.73 The Seamen’s Dispensary, opened in 1924, offered its services to a broad spectrum of working-class men, including international seamen. Although 85 per cent of patients at the clinic were seamen, it was noted that ‘the hours prove convenient for those following such occupations as motor drivers, barmen, and certain shopkeepers’.74 Other groups of transient men who attracted attention were foreign seamen and travellers. Legislation was in place to mitigate the supposed risk that these new arrivals might pose in terms of bringing disease into the city. Under the Aliens Act 1919, immigrants faced a medical examination by Assistant Port Officers in order to ensure that they could not ‘present a danger to the public health of the country’ or ‘become a charge on public funds by reason of their existing or probable future incapacity to support themselves and their dependents’.75 Although these examinations were unlikely to find evidence of venereal disease (it was acknowledged that the examinations lacked rigour and that immigrants with various ailments were likely to slip through the net), the persistence with these unreliable inspections nevertheless reflected the concern that transient communities posed public health issues in Liverpool and the wider area. Despite accepting the public health limits of this initiative, Liverpool’s Port Authority supported these examinations, with the Medical Officer of Health arguing that ‘the cost of administration per alien rejected’ needed to be off-set against ‘the moral and physical harm’ that ‘aliens suffering from mental or physical disease’ could ‘do in this country’.76 It should be noted, however, that where venereal disease was concerned, the evidence does not support the idea that the movement of non-Britons through the port was a particular problem. Only a small minority of those infected were described by Liverpool’s Medical Officer of Health as ‘not natives of the British Isles’.77 For example, in 1921, 8.5 per cent of seamen who visited the Royal Infirmary for venereal disease treatment were ‘not natives of the British Isles’ (the majority of these, just 21, came from the USA and Canada, while a further 20 came from the ‘Colonies’).78 In 1925 just 4 per cent of the seamen who visited the Royal Infirmary for treatment were ‘not natives’, although the greatest number of these, just six, were listed only vaguely as ‘other nationalities’.79 Despite the small numbers of foreign seafarers who presented in Liverpool with venereal diseases, the Port Authority was concerned about the likelihood of these men becoming free from VD; their transient lifestyles made it difficult for them to undergo the regular and sustained treatment necessary in curing cases of venereal disease. This concern was alleviated somewhat in November 1924 when the Ministry of Health issued a memorandum ratifying an international agreement that ‘merchant seamen without nationality’ would be able to receive treatment for venereal disease at ‘each of the chief sea and river ports of the countries concerned’.80 Medical cards were issued to seamen, allowing them to present information about the conditions from which they had suffered and the treatments they had received at other ports.81 In theory, this meant that the mobility of seamen no longer posed such a barrier to the full continuation of a course of treatment, since treatment did not have to be confined to one clinic, one city or even one country. Yet overcoming the prohibitive factors of taboo and patient embarrassment proved difficult while local medical workers and even employers continued to stigmatise the problem. Shame and Taboo Assessing quite what the working-class made of the targeted interest that some medical practitioners showed in their sexual health is difficult. Despite the attention devoted to the issue by local authorities, doctors and employers, sexual health was not a topic that people were necessarily comfortable to talk or write about, leaving gaps in the archive. Nevertheless, oral histories do give us a glimpse into the mindset and sexual education of the working class. Kate Fisher and Simon Szreter’s extensive oral histories suggest that sexual ignorance was common during the interwar years.82 Those who did manage to receive some form of sex education typically encountered this at boys’ camps or in the military.83 With sex still being such a taboo subject in public discourse, it appears that what education there was tended to be aimed at boys and men. Even in these cases, though, oral histories still point to high levels of ignorance and shame. Speaking in 1978 at age 62, Ernie Roberts, a tackler in a textile factory from Barnoldswick in Lancashire, recalled the inadequate sex education he received at school: ‘But sex education at school? It were tadpoles, that’s all it were. Get some frogs eggs, put ’em into a bottle and watch ’em develop. Aye, tadpoles!’84 When, as a teenager in the early 1930s, Ernie feared that he had caught infections after some of his early sexual encounters, he was too embarrassed to ask his friends for advice (‘VD? Oh deary me, if you’d got VD you’d be sent to Siberia!’).85 A visit to the Liverpool Anatomy Museum at the age of 18 served only to compound Ernie’s confusion and fears about venereal disease. Although cloaked with the veneers of education and medicine, anatomy museums functioned as places of entertainment.86 It ‘didn’t cost much’ for Ernie to get into Liverpool’s Anatomy Museum but what he saw inside left him ‘shocked’ rather than informed: ‘There were some specimens in bottles, you know, and models. Oh it were bloody awful.’87 Significantly, even Ernie’s own local doctor seemed ill-equipped to deal with the issue. When Ernie ‘got a sore dick’ after ‘frigging about’ with a girl when he was sixteen, the local doctor took one look at him and diagnosed syphilis. Terrified and unhappy about his diagnosis, Ernie went to Burnley VD Clinic where a more experienced doctor declared that there was ‘nothing wrong’ with him. That the first doctor whom Ernie saw was so quick to assume that he had syphilis after only a cursory examination raises the possibility that Ernie’s working-class background had influenced the doctor’s misdiagnosis. In response to the misdiagnosis, the doctor at the VD clinic gave Ernie a letter to take back to his local doctor, who promptly ‘screwed it up into a little ball and threw it in the corner’ and ‘as much as said to me “Get out!”’.88 Although the contents of the letter remained a mystery to Ernie, the gulf between the two doctors speaks to the degree to which venereal disease could be a controversial and marginalised issue even within the medical community. This marginalisation of the issue and the degree of embarrassment felt by patients less brave than Ernie presented a problem for VD clinics. During the interwar years, venereal disease doctors in Liverpool were especially concerned about the number of patients who prematurely discontinued their treatments, with almost 50 per cent of patients in 1921 stopping treatment before being free of the infection.89 Negatively situating the problem within the context of the clinics having been ‘established at very considerable cost’, the Medical Officer wrote that ‘patients may come and go as they please, or not come at all’.90 At the same time, embarrassment about receiving treatment and the inconvenience of having to repeatedly attend clinics no doubt deterred many from completing their courses and encouraged those with infections to declare themselves prematurely cured. Liverpool’s Medical Officer of Health, Dr Hope, proposed, somewhat ironically given his desire to see the law used to manage venereal disease, that the ‘real bar to much of the work of treatment and eradication of these diseases is because they are not respectable by reason of the moral stigma attached to having acquired them’.91 Moreover, doctors’ efforts to enlighten the public about the steps that they could take to maintain their sexual health sometimes overlapped with more punitive and foreboding approaches to education. Purity organisations such as the Alliance of Honour also embarked upon education programmes, but when they did so they entered into a difficult negotiation with Medical Officers and local authorities.92 There was no easy route to take for the moralist who wanted to talk about this taboo subject. On the one hand, the dissemination of information might lead to greater promiscuity as people became more adept at maintaining their sexual health. On the other hand, it was proposed that knowledge about VD could be used to shock and scare people out of promiscuous relationships. When the Alliance of Honour hosted a lecture and film screening by Liverpool’s Medical Officer of Health in 1924, they hoped to see footage that would bring home to the local population the facts of venereal disease and the potentially sensationalist outcomes of promiscuous indulgence. However, R. A. Black, a member of the Alliance from the Bootle area, wrote to the Walton and North Liverpool Times to complain that ‘the film shown was not in accordance with the printed objects of the society’.93 According to his letter in this local paper, the film focused upon ‘the comparative process of reproduction of species in a superficial way’, which Black feared did not offer ‘any solution to sex immorality and disease’ and may in fact ‘only excite the latent morbid curiosity of young people’.94 Walton and Bootle were working-class areas close to the docks, and as such Black wanted to see these communities targeted with propaganda of a more ominous tone.95 Black argued that a film which showed ‘the ravages of the disease both by inoculation and the hereditary ill-effects’ would have had ‘a more restraining control’. Unimpressed by the approach of the Medical Officer of Health, Black urged: Continuous instruction classes and lectures partly undertaken by the laity on the lines of temperance and ambulance classes, under the supervision of the medical profession, would forewarn young people of the wrath to come, and teach them that nature never forgives or forgets.96 Black wanted to see the audience overloaded with information that would shock and appal them to such an extent that they would be compelled into abstinence. As such, Black was a supporter of the idea that information should be used to instil ‘Fear of contagious disease’.97 By contrast, the medical community in Merseyside tended to avoid discussing the problem of venereal disease in such overtly condemnatory terms. In trying to open up a public discourse about venereal disease, local doctors had to manage moral concerns about whether improvements in treatment provision were exacerbating the problem by generating more promiscuity and they continued to battle against public embarrassment. When Dr R. W. McKenna gave a lecture at Bootle Town Hall later in November 1924 on behalf of the Merseyside Borough V.D. Education Committee, Councillor Harry Pennington, Chairman of the Health Committee, lamented that there were ‘so few people in the hall’ and said the event should have had ‘more publicity given to it’.98 The lack of publicity given to Dr McKenna’s lecture is entirely in keeping with the lack of attention given over to the issue of venereal disease within the Liverpool press. There are few references to local VD talks, with the likes of the aforementioned Medical Officer’s screening for the Alliance of Honour and Dr McKenna’s lecture featuring rarely and after these events had already taken place. Moreover, Dr McKenna’s lecture does not appear to have been an event to which the working class or seamen were especially invited to attend. Dr McKenna complained that the problem of venereal disease was ‘too often treated with levity’.99 In a bid to counter this, Dr McKenna promoted a pragmatic explanation of why the issue mattered. He noted that in 1923, twenty and a half million weeks had been lost by English workingmen through various forms of ‘preventable ill-health’.100 Dr McKenna argued that poverty and poor housing facilitated the spread of many of these diseases, but he did not neglect to tie these economic and practical concerns to the supposed immorality of the working-class when referring to the spread of venereal diseases: ‘Bad houses are not the only breeding places of disease, but are also the breeding places of crime and immorality’, he argued. Yet Dr McKenna did not want to see the medical profession have a monopoly over educational programmes. Indeed, he explained that, as the issue had ‘a moral aspect’, young people needed to be ‘warned … by the school master, the clergyman, and above all, the parent’.101 Just as moralists struggled to decide how much information about VD it was safe to promote to the general public, so the local medical community were limited in the publicity they gave to the issue by concerns about the propriety of the topic. Moreover, the way doctors negotiated the need to educate the public indicates that some members of the working class were considered very specifically and carefully, especially in the case of seamen. Following the previously mentioned November 1920 conference between the Ministry of Health, the NCCVD and employers’ groups like the Liverpool Steamship Owners’ Association, one doctor was critical of the presumed links between seafaring and venereal disease. After the conference, Dr Broad agreed with the White Star Line that ‘cases on the voyage are very few so far as [that company] is concerned’.102 Yet Dr Broad appears not to have been motivated by either the costs to employers when it came to VD or by concern about medical resources being unnecessarily diverted towards an over-estimated problem. Instead, his concern was with the image of seafaring men. At the same time as the doctor supported the belief that the ‘supply of preventatives’ on ships would ‘encourage the continuance of the trouble’, Dr Broad argued that ‘placards’ alerting men to treatment facilities ‘would be a libel on the men of the Mercantile Marine’.103 This complicates notions of interwar masculine culpability. For Dr Broad, who appears to have worked with the White Star Line, there was, no doubt, pressure to be cautious about associations between seafaring and VD for fear of besmirching the company. However, Dr Broad also held the somewhat contradictory position of believing that the increased availability of preventatives would encourage seamen to have more promiscuous sex whilst at the same time suggesting that the image of the libidinous seafarer was libellous. ‘Guilty’ Women Given how taboo the subject of venereal disease was, and given concerns about the respectability of seafaring and shipping companies, it was still easier to place the blame for transmission upon a figure whose respectability and legitimacy were already discredited, the promiscuous woman. If the men of the port were considered promiscuous and morally dubious, then the working-class women that they associated with were even further stigmatised as the supposed originators of the venereal diseases carried by seamen. Local doctors held foreign women up for criticism via allusions to prostitution and promiscuity. In 1928, Liverpool’s Medical Officer of Health at that time, Dr Mussen, argued: ‘of the various places in the world where infection is prevalent, West Africa and South America … are the most usual places from which infection reaches Liverpool’.104 Dr Mussen drew upon statistics compiled by his colleague, Dr Ross, a physician at the Seamen’s Dispensary in Liverpool. Ross suggested that out of 446 men who claimed they had caught their infections in South America, 445 stated that they were infected by a prostitute.105 Of the 129 men who said they had been infected in West Africa, 128 said that the woman had been a prostitute. Criticism was not reserved for foreign women, however. Ross’s own figures suggest that infection often occurred much closer to home. A total of 594 men said that they had become infected in Europe (585 of these by prostitutes) and the greatest number, 1,589, were infected in Great Britain (1,119 infections having apparently been contracted after sex with prostitutes).106 The blame and judgement that was apportioned to prostitutes grew from the continued prevalence of the belief that immoral women bore particular responsibility for the spread of these diseases. For example, in 1926 Dr Chambers wrote an article in the British Journal of Venereal Diseases outlining the roles that both amateur and professional prostitution played the spread of venereal disease, with little mention or thought given to the role of the male customer in this transaction.107 Moreover, working-class women in general often drew the concerns of local moralists, fearful about the propensity of young women travelling through Liverpool in search of employment to succumb to the temptations of vice and promiscuous adventure.108 This local context is key to understanding why, in a port city like Liverpool, gendered concerns about transience were articulated through the issue of venereal disease. Unlike in a mill town like Rochdale, where, Moore argues, doctors tended to focus on sending letters out to male patients who defaulted on treatment, doctors in Liverpool openly targeted women as both the source of infection and the group most susceptible to pressure to take up and maintain a course of treatment.109 In 1931 Dr Ross suggested that ‘married women … present a held where earnest endeavour on the part of the health authorities would bear much fruit’ [sic].110 This was apparently due to women attending treatment more regularly than their husbands, as well as women being ‘more amenable to reason if visited by a social worker in the event of her ceasing to attend’.111 In fact women were targeted for visits in ways that men were not. In 1921 it was reported that ‘in the case of women, special visits have been made by a member of the Female Staff of the Health Department who has been specifically detailed for this work as a portion of her daily duties’.112 For Dr Ross, clearing infection in women was the key to preventing the spread of venereal disease. He suggested that whenever he encountered male patients who claimed to have been infected by their wives or girlfriends, ‘I make it my business to influence the woman through the man’.113 Though Ross did not elaborate on his methods, it appears that Dr Ross was concerned with the attitudes and behaviours of local women. Dr Ross primarily placed the blame for infection upon the shoulders of prostitutes, but he saw working-class women in general as potential transmitters of venereal disease. He believed it would ‘be a great benefit to women patients’ if an all-day clinic could be established as ‘the usual hours for female clinics do not conduce to the regular attendance of housewives, maid-servants, barmaids, shop assistants and so on’.114 As with the men of the port, the presumption was that treatment should be targeted very deliberately and methodically at the working class. Yet, where women were concerned, Ross showed more scepticism about their work and morality, noting that the existing clinic times were at least suited to the ‘idle classes and … girls working in offices or factories’.115 Rather than being considered to be at the mercy of biological urges, women with venereal disease were presumed to be feckless ‘girls’. Moreover, Ross remained confident in his assessment of the moral culpability of women in the spread of venereal disease throughout the interwar years and beyond. As late as 1944, he referred to Liverpool’s problems with venereal disease as ‘the evil in a large port’ and claimed that ‘the prostitute is the vehicle of infection to the stranger within our gates, but the amateur and wife are stated to be the main sources of infection for the townsman’.116 In other words, male foreigners to the city (highly likely to be seamen) were thought to have been infected by prostitutes, whilst local men were believed to be picking up infections from their wives and promiscuous girlfriends. In both cases, the blame was placed upon the shoulders of a working-class woman. So, even where faithful wives of seamen found themselves suffering from venereal disease, the presumption would still have been that the infection had originated from another woman, likely the amateur prostitute her husband had had sex with at some point before or during their marriage. In this way, Liverpool’s efforts to deal with venereal disease reflect the extent to which gendered and class-based moral judgements continued to inflect public health initiatives aimed at improving the sexual health of the city. The idea that women were ultimately more responsible than men for the spread of venereal disease indicates that there are considerable continuities between interwar public health policies and those of the late nineteenth century. The Contagious Diseases Acts were suspended in 1883 and repealed in full in 1886.117 Nevertheless, the medicalised discourse of the prostitute that they relied upon informed approaches to prostitution and public health well into the twentieth century, with the effect that medical debates about venereal disease fed directly into discourses which aimed to restrict female sexuality on moral grounds. In 1921 G. Archdall Reid, a doctor with a firm interest in public health, wrote a letter to the British Medical Journal addressing increases in the number of cases of gonorrhoea and syphilis since the First World War. Despite suggesting that three out of four soldiers acquired their infections from ‘ordinary women’ Reid nonetheless believed such women to be ‘less diseased than prostitutes’.118 With this statement Reid placed culpability for the spread of venereal disease upon the shoulders of supposedly immoral women. These discursive distinctions between good and bad women, as well as between women and men, clouded public health approaches to seafaring in port towns. Although ‘drunken’ and impoverished seamen were considered conduits for all kinds of diseases, from tropical infections to venereal disease, the women who consorted with seamen were nonetheless considered to be the originators of venereal infection and were ‘denigrated’ more so than the seafarers.119 Where promiscuity by men was explained away in references to biology and the stresses of particular forms of manual labour, working-class women’s sexual desires were afforded no such understanding. During the 1920s the Port Sanitary Authority regularly distributed a notice to seamen containing advice on how to preserve their health. Along with instructions not to ‘drink water from polluted or doubtful sources’ and to avoid ‘prolonged exposure’ to sun and high temperatures, the notice warned seamen that ‘Serious lifelong illness may be contracted by sexual intercourse with loose women’.120 The moral disapprobation of the licentious woman far out-did that aimed at her male consorts, and so doctors promulgated a sexual health discourse that situated the promiscuous woman, and the prostitute in particular, at the centre of the city’s problems with venereal disease. Moreover, these attitudes were in evidence among other official, non-medical institutions within the city. In 1928, the Stipendiary Magistrate of Liverpool, Stuart Deacon, was called to London to give evidence to the Street Offences Committee, which had been set up to investigate and review the laws used to police prostitution. Deacon supported the criminalisation of prostitutes because he believed that they were responsible for spreading venereal disease through the city.121 He argued: ‘I do think the diseased woman is as much a danger to the community as a contagious animal’ and he proposed that women with VD who solicited should be dealt with via legal measures.122 Deacon was not specific about the form that any legal controls might take or how any potential problems policing this issue might be overcome. His response appears to have been a gut reaction to a line of questioning that revealed his own prejudicial and dehumanising view of the prostitute as a social danger. This type of emotive, moralising in support of the suggestion that the spread of venereal disease should be dealt with in law chimed with the efforts of Liverpool’s Medical Officers of Health to try to get the government to give them powers to legally compel patients to continue treatment. That the government rejected these proposals should not necessarily be interpreted as a sign that compulsion was now seen as an outdated mode of dealing with threats to public sexual health. Conclusion Liverpool’s VD Scheme circumvented the attitude of the Ministry of Health as doctors put pressure upon working-class communities to receive and continue treatment. Not only was morality still key, it intersected with gendered ideas about travel and employment. Understanding this intersection is crucial to understanding why different sections of the working class were targeted for treatment in different ways. Associations between doctors and maritime employers meant that, even within a non-mandatory system, venereal disease could be seen as an obstacle to work. Population transience was tied to concerns about bad habits among those who travelled in and out of the city for work. Liverpool’s Medical Officers of Health made considerable provisions for the diagnosis and treatment of venereal disease during and after the First World War. One of the chief concerns of the city’s Medical Officers of Health was to ensure that that Liverpool’s port did not act as a conduit for infectious diseases to make their way into the general population. As a result, British and foreign seamen were regarded as potentially threatening to the health of the local population, moving as they did between life in foreign ports, on-board ships and back among the local community. It was also assumed that the working-class, male seafarer dislocated from traditional family structures was more likely to engage in promiscuous sex. Nevertheless, the targeting of these men for education about the dangers of venereal disease and efforts to make treatment a condition of employment, while no doubt coercive, were underpinned by a gendered discourse about men’s biological need for sex that ultimately placed the greater portion of the ‘blame’ for venereal disease upon the shoulders of working-class women. Moreover, late nineteenth-century gender ideals were still influencing discussions about working-class women’s role in the spread of infection, with real implications in terms of public health policy. These women in Liverpool were subjected to visits and pressure from medical staff that their male sexual partners were not. This emphasis on working-class women’s culpability also added to the continued criminalisation and ostracising of women prostitutes, with the Liverpool VD Scheme lending legitimacy to the marginalisation of these women on public health grounds. Footnotes 1 John Glynn, ‘The Prostitution Problem. Has the Best Been Done to Solve it?’ in Straight Talk, October/December 1915, 12. Liverpool Record Office, M364LWD/7/5. 2 The White Cross League grew from the White Cross Army, formed in 1883 by Ellice Hopkins and the Bishop of Durham. The White Cross League focused its attentions on improving the sexual morality of working-class men. For more on this organisation see Paula Bartley, Prostitution: Prevention and Reform in England, 1860–1914 (London: Routledge, 2000), 156. 3 See, for example, Bartley, Prostitution; Linda Mahood, The Magdalenes: Prostitution in the Nineteenth Century (London: Routledge, 1990); Anne Summers, ‘“The Constitution Violated”: The Female Body and the Female Subject in the Campaigns of Josephine Butler’, History Workshop Journal, 1999, 48, 1–15; Judith Walkowitz, City of Dreadful Delight: Narratives of Sexual Danger in Late-Victorian London (Chicago: University of Chicago Press, 1992) and Prostitution and Victorian Society: Women, Class, and the State (Cambridge: Cambridge University Press, 1980). 4 Lesley Hall, ‘Venereal Diseases and Society in Britain, from the Contagious Diseases Acts to the National Health Service’, in Roger Davidson and Lesley Hall, eds, Sex, Sin and Suffering: Venereal Disease and European Society since 1870 (London: Routledge, 2001), 120–36, 123. See also Ann Sumner Holmes, ‘The Double Standard in the English Divorce Laws, 1857–1923’, Law & Social Inquiry, 1995, 20, 601–20. 5 Leanne McCormick, Regulating Sexuality: Women in Twentieth-Century Northern Ireland (Manchester: Manchester University Press, 2009), ch. 4. 6 Judith R. Walkowitz and Daniel J. Walkowitz, ‘“We are Not Beasts of the Field”: Prostitution and the Poor in Plymouth and Southampton under the Contagious Diseases Acts’, Feminist Studies, 1973, 1, 73–106; T. J. Wyke, ‘The Manchester and Salford Lock Hospital, 1818–1917’, Medical History, 1975, 19, 73–86. 7 See Roger Davidson, Dangerous Liaisons: A Social History of Venereal Disease in Twentieth Century Scotland (Amsterdam: Rodopi, 2000); Roger Davidson, ‘Venereal Disease, Sexual Morality, and Public Health in Interwar Scotland’ and ‘“Searching for Mary Glasgow”: Contact Tracing for Sexually Transmitted Diseases in Twentieth-Century Scotland’, Social History of Medicine, 1996, 9, 195–214; Gayle Davis, ‘The Cruel Madness of Love’: Sex, Syphilis and Psychiatry in Scotland, 1880–1930 (New York: Rodopi, 2008); Susan Lemar, ‘“The Liberty to Spread Disaster”: Campaigning for Compulsion in the Control of Venereal Diseases in Edinburgh in the 1920s’, Social History of Medicine, 2006, 19, 73–86; McCormick, Regulating Sexuality. 8 Pamela Cox, ‘Compulsion, Voluntarism, and Venereal Disease: Governing Sexual Health in England after the Contagious Diseases Acts’, Journal of British Studies, 2007, 46, 91–115; Philip Howell, ‘Venereal Disease and the Politics of Prostitution in the Irish Free State’, Irish Historical Studies, 2003, 33, 320–41. 9 Cox, ‘Compulsion, Voluntarism and Venereal Disease’, 99. 10 Francesca Patricia Moore, ‘“A Mistaken Policy of Secretiveness”: Venereal Disease and Changing Heterosexual Morality in Lancashire, UK, 1920–1935’, Historical Geography, 2015, 43, 37–56. 11 Ibid., 41. 12 Lemar, ‘The Liberty to Spread Disaster’. 13 For example, Lucy Bland, ‘Cleansing the Portals of Life: The Venereal Disease Campaign in the Early Twentieth Century’, in Mary Langan and Bill Schwarz, eds, Crises in the British State: 1880–1930 (London: Hutchinson, 1985), 192–208; Frank Mort, Dangerous Sexualities: Medico-Moral Politics in England Since 1830 (London: Routledge, 2000); Walkowitz, Prostitution and Victorian Society. 14 See Davidson, ‘Venereal Disease, Sexual Morality, and Public Health in Interwar Scotland’. 15 Lemar, ‘The Liberty to Spread Disaster’, 82. 16 For more on the Catholic attitudes towards sexual health see Caitriona Beaumont, ‘Moral Dilemmas and Women’s Rights: The Attitude of the Mother’s Union and Catholic Women’s League to Divorce, Birth Control and Abortion in England, 1928–1939’, Women’s History Review, 2007, 16, 463–85. 17 Davidson, ‘Venereal Disease, Sexual Morality, and Public Health in Interwar Scotland’; McCormick, Regulating Sexuality. 18 Annual Report of the Medical Officer of Health to the Port Authority, 1923, 24–5. Liverpool Record Office (LRO), HEA 4/1/1/1. 19 Annual Report of the Medical Officer of Health to the Port Sanitary, 1921, 21. LRO, 352 HEA 4/1/1/1. 20 ‘A Century of Progress, 1847–1947’, Public Health Pamphlet, Liverpool City Council. LRO, H352/4HEA. 21 Ibid. 22 Kate Fisher and Simon Szreter argue that, prior to the 1940s, the national press considered discussion of venereal disease to be ‘beyond the pale’. See Kate Fisher and Simon Szreter, Sex Before the Sexual Revolution: Intimate Life in England 1918–1963 (Cambridge: Cambridge University Press, 2010), 69. 23 Steamship Owners’ Association Minute Books, Maritime Archives, National Museums Liverpool (NML), D/SS/1/17–65. 24 Cf. Lemar, ‘The Liberty to Spread Disaster’, 76. 25 Lesley Hall, ‘What Shall We Do with the Poxy Sailor?’ Journal for Maritime Research, 2004, 6, 113–44. 26 A. Maude Royden, ‘Report of the Royal Commission on Venereal Diseases’, International Journal of Ethics, 1917, 27, 171–88 [original emphasis]. 27 Annual Report of the Liverpool Royal Infirmary, 1919, 11. LRO, H362/113 ROY. 28 Annual Report of the Medical Officer of Health to the Port Authority, 1932, 40. LRO, HEA 4/1/1/2. 29 S. M. Tomkins, ‘Palmitate or Permanganate: The Venereal Prophylaxis Debate in Britain, 1919–1926’, Medical History, 37, 382–98, 384. 30 The Observer, 1 July 1917, 11. 31 See Philippa Levine, ‘“Walking the Streets in a Way No Decent Woman Should”: Women Police in World War I’, The Journal of Modern History, 1994, 66, 34–78; Alex Rock, ‘The “khaki fever” Moral Panic: Women’s Patrols and the Policing of Cinemas in London, 1913–19’, Early Popular Visual Culture, 2014, 12, 57–72; Angela Woollacott, ‘“Khaki fever” and its Control: Gender, Class, Age and Sexual Morality on the British Homefront in the First World War’, Journal of Contemporary History, 1994, 29, 325–47. 32 Julia Laite, Common Prostitutes and Ordinary Citizens: Commercial Sex in London, 1885–1960 (Basingstoke: Palgrave Macmillan, 2011), 122. 33 Krista Cowman, ‘Touring Behind the Lines: British Soldiers in French Towns and Cities during the Great War’, Urban History, 2014, 41, 105–23, 112–13. 34 Clare Makepeace, ‘Male Heterosexuality and Prostitution during the Great War,’ Cultural and Social History, 2012, 9, 65–83, 70. 35 Annual Report of the Medical Officer of Health, 1921, 86. 36 Alison Neilans, letter to the British Medical Journal, published 10 June 1916. 37 Tomkins, ‘Palmitate or Permanganate’, 383. 38 Maude Royden, ‘Report of the Royal Commission on Venereal Diseases’, 182. 39 Ibid., 171. 40 Annual Report of the Medical Officer of Health, 1932, 40. 41 ‘Public Morals and the Public Health: the Danger of Divided Councils’ in The Manchester Guardian, 31 July 1919, 12. 42 Ibid. 43 Ibid. 44 Ibid. 45 Ibid. 46 Annual Report of the Medical Officer of Health, 1921, 21. 47 Ibid. 48 Elisabeth Rees, MD, ‘Failure to Control the Venereal Diseases’, British Medical Journal, 1964, 2, 47–9. 49 Annual Report of the Medical Officer of Health, 1921, 26. 50 Becky Taylor, John Stewart and Martin Powell have questioned the extent to which the Ministry of Health, ‘far removed from the daily reality of policy formation and implementation’, actually wielded influence at the local level. See Becky Taylor, John Stewart and Martin Powell, ‘Central and Local Government and the Provision of Municipal Medicine, 1919–39’, The English Historical Review, 2007, 122, 397–426, 417. 51 Hall, ‘Venereal Diseases and Society in Britain’, 128. 52 Annual Report of the Medical Officer of Health, 1921, 22. 53 Annual Report of the Medical Officer of Health to the Port Sanitary Authority of Liverpool, 1926, 29. LRO, 352 HEA 4/1/1/1. 54 An update in Swedish law in 1918 meant that people who suspected they were infected had to report to a doctor, while local authorities were required to provide free medical care. See Anna Lundberg, ‘Passing the “Black Judgement”: Swedish social policy on venereal disease in the early twentieth century’, in R. Davidson and L. Hall, eds, Sex, Sin and Suffering: Venereal Disease and European Society since 1870 (London: Routledge, 2001), 29–43. 55 Michael Tuck, ‘Venereal Disease, Sexuality and Society in Uganda’, R. Davidson and L. Hall, eds, Sex, Sin and Suffering: Venereal Disease and European Society since 1870 (London: Routledge, 2001), 191–204. 56 Letter from B. Vivian, Organising Secretary of the National Council for Combatting Venereal Disease, to the Liverpool Steamship Owners’ Association. 18 May 1920. Liverpool Steamship Owners’ Association Minutes, Part 2, Vol. 25, 1920–1921, Reel 33. NML, D/SS/1/17–65. 57 Letter from F. Slator (Ministry of Health) to Liverpool Steamship Owners’ Association. 22 October 1920. Liverpool Steamship Owners’ Association Minutes, Part 2, Vol. 25, 1920–1921, Reel 33. NML, D/SS/1/17–65. Hall notes that the Ministry of Health gave funding to the NCCVD (later the British Social Hygiene Council) until 1929, when, under the Local Government Act, responsibility for this funding was passed to local authorities with mixed results. See Hall, ‘Venereal Diseases and Society’, 127–9. 58 Liverpool Steamship Owners’ Association General Meeting Minutes, 23 November 1920. Liverpool Steamship Owners’ Association Minutes, Part 2, Vol. 25, 1920–1921- Reel 33. NML, D/SS/1/17–65. 59 ‘Proceedings of “Venereal Disease” Conference. Held in London on November 3rd. 1920’. Liverpool Steamship Owners’ Association Minutes, Part 2, Vol. 25, 1920–1921- Reel 33. NML, D/SS/1/17–65. 60 Ibid. 61 Roger Davidson, Dangerous Liaisons, 74, footnote 88. 62 Hall, ‘What Shall We Do with the Poxy Sailor?’ 63 Liverpool Steamship Owners’ Association Minutes, Part 2, Vols 44–45, 1933–1935, Reel 54. NML, D/SS/1/17–65. 64 Tim Carter, Merchant Seamen’s Health, 1860–1960: Medicine, Technology, Shipowners and the State in Britain (Woodbridge, 2014), 146. 65 Annual Report of the Medical Officer of Health, 1921, 24. 66 Ibid. 67 For Salford, see ‘Annual Report of the City and Royal Borough of Edinburgh VD Scheme; Annual Report on the VD Scheme of the City of Salford’, British Journal of Venereal Diseases, October 1935, 11, 269; for Liverpool, see Annual Report of the Medical Officer of Health to the Port Sanitary Authority of Liverpool, 1934, 29. LRO, 352 HEA 4/1/1/2. For information on the population sizes of these areas see John Belchem, Merseypride: Essays in Liverpool Exceptionalism (Liverpool: Liverpool University Press, 2000), 4 and Andrew Davies, Leisure, Gender and Poverty: Working-class Culture in Salford and Manchester, 1900–1939 (Buckingham: Open University Press, 1992), 8. 68 British Journal of Venereal Diseases, October 1935, 11, 271. 69 Julia Laite, ‘Immoral Traffic: Mobility, Health, Labor, and the “Lorry Girl” in Mid-Twentieth-Century Britain’, Journal of British Studies, 2013, 52, 693–721. 70 ‘Annual Reports—Salford, Edinburgh, and New South Wales’, Journal of British Studies, October 1937, 13, 278. 71 Sheard, ‘Mixed Motives: Improving the Health of Seamen in Liverpool, 1875–1939’, in Laurinda Abreu, ed., European Health and Social Welfare Policies (Blansko: Compostela Group of Universities, 2004), 322. 72 Ibid. 73 Annual Report of the Medical Officer of Health to the Port Sanitary Authority of Liverpool, 1925, 29. LRO, 352 HEA 4/1/1/1. 74 Annual Report by the Medical Officer of Health, 1926, 28. 75 Annual Report of the Medical Officer of Health to the Port Authority, 1922, 81–2. LRO, HEA 4/1/1/1. 76 Ibid. 77 Annual Report of the Medical Officer of Health, 1921, 24. 78 Ibid. 79 Annual Report of the Medical Officer of Health, 1925, 26. 80 Ibid., 28–9. 81 Sheard, ‘Mixed Motives’, 328. 82 Kate Fisher and Simon Szreter, Sex Before the Sexual Revolution, 74–7. 83 Ibid., 77. 84 Ernie Roberts, Oral History Recording, 20 July 1978. North West Sound Archive, 78/AC/1/2/3/4. 85 Ibid. 86 A. W. Bates, ‘“Indecent and Demoralising Representations”: Public Anatomy Museums in mid-Victorian England’, Medical History, 2008, 52, 1–22. 87 Ernie Roberts, Oral History Recording. 88 Ibid. Since Ernie does not appear to have gone on to suffer from any of the complications of untreated syphilis, it seems reasonable to assume that the first diagnosis was incorrect and that the assessment of the doctor at the VD clinic was accurate, rather than this just being the diagnosis that Ernie chose to believe. Moreover, since the first doctor appears to have refused to discuss the issue with Ernie any further upon reading the letter from the VD clinic, it seems that the first doctor accepted (albeit ungraciously) the second diagnosis. 89 Annual Report of the Medical Officer of Health, 1921, 22. 90 Ibid. 91 Annual Report of the Medical Officer of Health, 1921, 26. 92 See Roger Davidson and Gayle Davies on the Alliance of Honour’s provision of sex education in schools during the postwar years. Roger Davidson and Gayle Davis, The Sexual State: Sexuality and Scottish Governance 1950–80 (Edinburgh: Edinburgh University Press, 2012), 191. 93 Letter by R. A. Black, The Walton and North Liverpool Times, 21 March 1924, 2. 94 Ibid. 95 The Medical Officers do not appear to have kept records of the content of their lectures to seamen, though it seems likely that the Medical Officer used similar content to that described in this letter. 96 Letter by R. A. Black, The Walton and North Liverpool Times, 21 March 1924, 2. 97 Ibid. 98 ‘How Disease is Spread’, The Walton Times, 28 November 1924, 2. Patients in Bootle were treated for venereal disease at Bootle Borough Hospital. See ‘Bootle’s Health’, The Walton and North Liverpool Times, 9 May 1924, 2. 99 ‘How Disease is Spread’, The Walton Times, 28 November 1924, 2. 100 Ibid. 101 Ibid. 102 Dr Broad appears to have worked with the White Star Line. ‘Extract from Memorandum’, 23 November 1920. Liverpool Steamship Owners’ Association Minutes, Vol. 25, 1920–1921, Reel 33. NML, D/SS/1/17–65. 103 Ibid. 104 Annual Report of the Medical Officer of Health to the Port Authority, 1928, 34. LRO, HEA 4/1/1/1. 105 Ibid. 106 Ibid. 107 W. Metcalf Chambers, ‘Prostitution in Relation to Venereal Diseases’, British Journal of Venereal Diseases, January 1926, 2, 68–75. 108 Samantha Caslin, ‘“One Can Only Guess What Might Have Happened If the Worker had not Intervened in Time”: the Liverpool Vigilance Association, Moral Vulnerability and Irish Girls in early- to Mid-twentieth-century Liverpool’, Women’s History Review, 2016, 25, 254–73. 109 For more on the targeting of male patients in Rochdale see Moore ‘A Mistaken Policy of Secretiveness’, 43–4. 110 A. O. Ross, ‘Venereal Diseases and the General Community’, Public Health, 1931, 44, 353. 111 Ibid. 112 Annual Report of the Medical Officer of Health, 1921, 22. 113 Ross, ‘Venereal Diseases and the General Community’, 353. 114 Ibid. 115 Ibid. 116 A. O. Fergusson Ross, ‘Venereal Diseases in a Large Port,’ Public Health, 1944, 57, 135. 117 See Summers, ‘The Constitution Violated’. 118 G. Archdall Reid, letter to the British Medical Journal, published 22 January 1921. 119 Carter, Merchant Seamen’s Health, 68–71. 120 Annual Report of the Medical Officer of Health to the Port Sanitary Authority, 1930, 37. LRO, HEA 4/1/1/2. 121 For more on Deacon’s evidence to the Street Offences Committee see Samantha Caslin, ‘Flappers, Amateurs and Professionals: The Spectrum of Promiscuity in 1920s Britain’, in Kate Hardy, Sarah Kingston and Teela Sanders, eds, New Sociologies of Sex Work (Farnham: Ashgate, 2010), 11–22. 122 Street Offences Committee Minutes of Evidence, Mr Stuart Deacon, 14 January 1928, 17. National Archives, HO45/12663. Acknowledgements I would like to thank Dr Andrew Davies and Professor Sally Sheard for their comments on drafts of this text, as well as the very helpful anonymous peer reviewers. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Social History of Medicine Oxford University Press

Transience, Class and Gender in Interwar Sexual Health Policy: The Case of the Liverpool VD Scheme

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© The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
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Abstract

Abstract Focusing on the implementation of the Liverpool VD Scheme, this article reasserts the importance of morality to interwar medical understandings about the spread of venereal disease. Despite claiming to offer impartial, practical solutions to the spread of venereal disease, the Liverpool VD Scheme, created in 1916, reflected and promoted the notion that the transient lifestyles of many of the working class presented physical and moral threats to the city. This article therefore counters suggestions that the interwar control of venereal disease was shaped by practicalities rather than moralities. Evidence is provided for the persistence of a medico-moralising that continued to place working-class sexual practices at the heart of discussions about the spread of venereal disease. However, presumptions about men’s biological need for sex combined with the local importance of the port, meaning that working-class seamen with VD were judged less harshly than working-class women with the same infections. morality, prostitution, public health, seamen, Liverpool Introduction In late 1915, John Glynn, Chairman of the Liverpool Branch of the White Cross League and advocate of Christian prayer and abstinence, suggested that ‘Many [men] have told me they were under the impression that self-abuse and fornication did them good. … Then we remind them of the enormous number of fresh cases of disease every week’.1 As a social purity organisation that credited men with a greater sense of sexual agency than women, the White Cross League called upon men to take responsibility for maintaining Britain’s sexual morality.2 On the surface, Glynn’s sentiment appears to signal a break with Victorian attitudes towards venereal disease, which saw women (prostitutes in particular) targeted for treatment and blame.3 During the early twentieth century there was increasing attention paid to the male role in the spread of venereal disease. Lesley Hall suggests that, by the start of the twentieth century, an increasing amount of disapprobation was directed towards unfaithful men who were said to be putting the health of their innocent families at risk by bringing infection into the marital bed.4 Moreover, once Britain had returned to peace following the First World War, there was further diminution in the cultural appetite for excusing men’s role in the spread of infection, but such excuses did not go away. More recent research by Leanne McCormick suggests that women were still disproportionately blamed for venereal disease, especially once concerns about male promiscuity began to lose some of their urgency after the First World War.5 This questioning of the gendering of attitudes towards venereal diseases (VD) is a corollary of a broader debate about the extent to which moral judgement still featured in interwar VD policies. I want to argue here that a regional understanding of the issue is key, since in order to assess overlaps between policy and morality we need to consider how VD Schemes were implemented in response to local pressures and prejudices. Regional approaches to the study of public health and venereal disease before the First World War have examined the punitive elements of the treatments offered, particularly where prostitutes were concerned.6 There is also an emerging body of work on venereal disease after the First World War, with studies by Roger Davidson, Gayle Davis and Susan Lemar focusing on Scotland and McCormick’s work on Northern Ireland.7 The work of Philip Howell on the Irish Free State and Pamela Cox on the limits of English voluntarism expands definitions of regulation beyond notions of legal compulsion.8 As Cox notes, however, ‘coercion work within English VD measures’ has been ‘less well documented’ than in areas like Scotland.9 Variations within England must also be considered. Francesca Moore’s recent article on interwar Rochdale highlights the importance of examining English attitudes towards venereal disease.10 However, as this article will show, there are significant differences between the attitudes of doctors in Liverpool and those in Rochdale, despite the relative proximity of these two locations. Moore suggests that Rochdale’s doctors paid little notice to ‘the gendered difference’ in infection rates or sexual behaviours.11 The same cannot be said for Liverpool. Although men were no longer at war, seafaring in particular still connoted difficult, necessary, men’s work. The arguments put forward here suggest that while working-class male sexuality was still perceived as potentially excessive, in a port city like Liverpool, the importance of seafaring as an occupation meant that excuses about men’s need for sexual release still underpinned local attitudes towards venereal disease. At the same time, local discussions about rates of infection among seamen intersected with uncertainty about whether the problem should best be tackled as a moral or medical issue. Although the Liverpool VD Scheme presented itself as a morally neutral programme of treatment, moral pressure was still exerted upon patients. Once again, this points to a contrast with the existing literature. Susan Lemar has used the case of interwar Edinburgh to argue against the idea that compulsion and the moral control of the sex lives of the working class, especially working-class women, were significant parts of that city’s public health approaches to VD prevention.12 She takes issue with the ‘themes of victimisation and patriarchal control of women’s bodies’ which have characterised feminist histories of the late-nineteenth and early-twentieth centuries.13 Lemar also seeks to counter the emphasis that Roger Davidson places upon social control and morality in his assessment of the campaign to institute compulsory notification of venereal diseases in Edinburgh.14 For Lemar, the debate about compulsory treatment in interwar Edinburgh was shaped less by morality and more by practical concerns about the efficacy of treatment, the spectre of the Contagious Diseases Acts and the cost of treating people who then prematurely stopped attending clinics.15 On the surface, it appears that Liverpool followed Lemar’s reading of the situation in Edinburgh. As this article will show, Liverpool’s Medical Officers of Health favoured mandatory treatments; they were concerned about the numbers of people who abandoned treatment; and their clinics claimed to be free from punitive proselytising. Indeed, there was an apparent shift during the latter part of the First World War towards developing pragmatic venereal disease policies which purported to have overcome the weight of earlier moral discourses in favour of focusing on practical intervention. Moreover, despite the city’s large Irish-Catholic population, religious issues do not appear to have interfered with uptake at Liverpool’s VD clinics.16 Nevertheless, I want to question the progressive, moral impartiality of the Liverpool approach and argue that the picture in Liverpool actually supports Davidson’s account of the situation in Edinburgh and Leanne McCormick’s research on Northern Ireland.17 The supposedly practical VD policies implemented in Liverpool were inflected with moral concerns and prejudicial attitudes about which communities to target for treatment. In 1916, the Royal Commission on Venereal Disease recommended that local authorities tackle the spread of venereal disease by making free treatment by experts readily available, investing in facilities for diagnosis and by raising public awareness about the dangers of infection and the treatment services on offer.18 As a result of the report, and in the same year, Liverpool established the Liverpool VD Scheme, creating five new free treatment centres in the city.19 These clinics were based at the Royal Infirmary, the Royal Southern Hospital, the David Lewis Northern Hospital, the Stanley Hospital and, until 1921, the Cancer and Skin Hospital. During the first half of the twentieth century, Liverpool’s City Council oversaw the city’s Health Committee, which was responsible for the management of (among other things) environmental health, port health services and venereal diseases.20 Under this Committee, the city’s Medical Officers of Health were in charge of various medical officers with different specialisms, ranging from a Senior Port Medical Officer (who examined ships and inspected foodstuffs) to a VD Officer, who oversaw the treatment clinics.21 This article situates local doctors’ work on the Liverpool VD Scheme within the wider context of health discussions among employers of seamen and the relatively few instances that the local press dared to report on venereal disease.22 It should be noted that local newspaper articles on venereal disease tended to focus on statements made by public officials such as the Medical Officers and local councillors, while the records of the Steamship Owners’ Association will be used to show that there was no overall agreement about what should be done to reduce rates of venereal disease among seamen.23 Discussions continued to be cautious and stymied by the weight of the stigmatism that surrounded these diseases. Consequently, even in a city like Liverpool, which took a proactive approach to the treatment of VD (as signified by the swift creation of the VD Scheme in 1916), older moral discourses continued to frame medical narratives. The increasing emphasis placed by public health workers on scientific developments was not mutually exclusive, either at the broad cultural level or at the level of regionally-specific practical policy, with the continuation of medico-moralising about venereal disease.24 Lesley Hall’s work has usefully charted the policies and practicalities of treating VD on board ships and she explains the economic motivations of ship-owners for getting involved in debates about VD.25 However, the wider ramifications of this involvement for class and gender relations remains unexplored. This article argues that, in Liverpool, reliance upon shipping meant that, despite the promiscuous reputation of seamen, it was women who were still disproportionately blamed for the spread of venereal infections. To this end, the Liverpool case study offered here shows that medico-moral discourses had an impact that reached far beyond the work of either doctors or moral campaigners. While stereotypes about promiscuous seamen persisted, the reputation of this type of work combined with persisting ideas about men’s biological urges to afford them a degree of insulation from moral condemnation that was not afforded to working-class women. Morality: From War to Peace With the swift creation of the Liverpool VD Scheme following the Royal Commission on Venereal Disease, it was clear that Liverpool took the problem of venereal disease seriously. In fact, even before the report was published Liverpool was widely recognised as a ‘pioneer’ city in its approach to venereal disease, having undertaken educational work and offered lectures ‘to men and women on this subject’.26 Towards the end of the First World War, the number of out-patients of both sexes in Liverpool being treated for venereal disease grew steadily. Running both evening and day clinics at the site, and with costs paid by the Liverpool Corporation, treatment rates at the Liverpool Royal Infirmary grew at the end of the war. Between 1918 and 1919 treatment rates for new patients at the clinic more than doubled, going from 1,819 patients to 3,770.27 The Medical Officers’ Annual Reports to the Port Authority afforded those in this role an opportunity to report on their successes in dealing with various threats to public health in the city. They contained statistical information, but they also included statements from the Medical Officers which give indications as to their understandings of the physical and indeed moral threats to the city. Reflecting in his 1932 Report on Liverpool’s experiences of dealing with venereal disease during the First World War, Dr Frazer, Liverpool’s then Medical Officer of Health, drew parallels between seamen’s relationships with female prostitutes and wider questions about a decline in wartime moral standards. He declared that the ‘prevalence of venereal diseases’ was a subject with a ‘close association with seafaring life’, before adding that ‘Public opinion towards the end of the War was exercised on the … change in moral habits of the people, and it was expected that a considerable increase in the number of cases of venereal disease would occur’.28 Even before the war, the development of the Wasserman syphilis test in 1906 and the use of Salvarsan as a treatment from 1910 placed the issue of venereal disease firmly on the national agenda in the early years of the twentieth century.29 Medical professionals applied their new-found knowledge to debates about changing sexual practices and whether or not advances in treatment might actually undermine public morals. The case for aligning moral and practical provisions was made explicit where the potential for venereal disease amongst pregnant women could do harm to fetuses. In 1917, Dr Mary Scharlieb had praised Liverpool’s ‘Dr. MacAlister, Dr. Hope, the Medical Officer of Health, and other professional men and women’ in the city for their ‘wise’ efforts to tackle venereal disease among pregnant women.30 The medical problems experienced by children born to mothers with venereal disease served to reinforce perceptions amongst doctors that some patients with venereal infections, such as these children, were innocent, whilst others were guilty. This notion that some patients bore moral culpability for infections within the local community meant that considerable responsibility for the transmission of venereal disease was still placed disproportionately on those perceived to be immoral, namely the working class and working-class women especially. Much of the wartime concern about a supposed decline in morality focused on women.31 When the government controversially introduced the Defence of the Realm Act Regulation 40D, which criminalised women with venereal diseases who had sex with soldiers, it was used disproportionately to police prostitutes.32 By contrast, servicemen received considerably less disapprobation for their role in the spread of venereal disease and the supposed downfall of British moral standards. An ideology of masculinity, pervasive within the military, rooted men’s physical health in sexual expression, leading to concern about the effects of soldiers’ long-term separation from their wives upon morale and physical well-being. Cowman notes that British soldiers stationed in France made frequent trips into local towns for the purpose of indulging in the ‘corporeal realities’ of eating, drinking, shopping and sexual pleasure, resulting in a boom in prostitution in French towns during the war.33 Similarly, Clare Makepeace argues that the British military subscribed to gendered ideologies of prostitution, with servicemen’s visits to brothels justified by the widespread belief that sex was necessary to the physical and mental health of soldiers. So ingrained was this thinking that the army reversed its policy of informing the next of kin when soldiers were being treated for venereal disease following the introduction of conscription in 1916, when the number of married men serving went up significantly.34 An examination of the medical culture surrounding Liverpool’s seamen indicates that this degree of understanding afforded to unfaithful and promiscuous soldiers had peace time ramifications for men working at sea. That is to say that the attitudes described by Cowman and Makepeace were not specific to either soldiering or to the war itself. Seamen’s sexual escapades in Liverpool were framed as an escape from the difficult conditions of life on-board ship. In 1921 Liverpool’s Medical Officer explained that, along with afflictions caused by the ‘peculiar stresses of the work’ and exposure to various tropical diseases like malaria and beriberi (a potentially serious vitamin B1 deficiency), seamen were ‘peculiarly liable’ to diseases ‘attending the vices to which sailors in foreign ports are particularly liable to be attracted. Alcoholism and venereal disease’.35 Excess and sexual indulgence by working-class men were therefore made more palatable to the Port Authority when they were explained as consequences of, if not antidotes to, hard work. Even where discussion about preventing the spread of venereal disease did turn towards critically examining men’s sexual behaviour, this assumption that sexual release was necessary to men’s physical health was still part of the debate, leading to criticism from some quarters. Alison Neilans, assistant secretary to the Association for Moral and Social Hygiene, wrote to the British Medical Journal in 1916. As a campaigner for the abolition of the solicitation laws and an advocate for moral work with prostitutes, Neilans argued: The thing which makes all moral and social reform work so intensely difficult, which produces both the prostitute and her partner, is that great body of public opinion which tacitly upholds the double standard of morals, and when it sees the results of its doctrines murmurs meaningless platitudes about ‘human nature’.36 Neilans therefore challenged the long-standing assumption that prostitution was a social inevitability brought about by the need for men to find a controlled release for their sexual urges. By voicing this opinion in a letter to the British Medical Journal, Neilans did not attempt to disassociate prostitution from debates about venereal disease. Indeed, she attempted to appropriate the interests of public health in order to further her own organisation’s approach to prostitution. Specifically, she wanted to tackle the double standard of gender morality that worked against prostitute women, whilst seemingly offering their male clients a degree of absolution. Nevertheless, Neilans’ acknowledgement of and attempt to invert the moral discourses that surrounded the spread of venereal disease were at odds with cultural anxiety about rates of wartime infection and the need to scapegoat particular patients. In 1916 the Report of the Royal Commission on Venereal Diseases estimated that 10 per cent of urban Britons had syphilis, and it proposed even higher levels of gonorrhoea.37 The following year, in an article on the Royal Commission, it was hoped that more women would seek treatment for venereal disease, as previously there had been no ‘provision … for separating the really guilty from the totally innocent, the prostitute debauched by long years of life on the streets, from the respectable married woman infected by her husband’.38 References to the guilty prostitute indicate that the Report had not resulted in a decisive move away from the moral judgement of people with venereal disease. Assertions in the same article that there had been an ‘almost revolutionary’ change in attitudes towards people with venereal disease and a move away from the ‘prudery’ and ‘secrecy’ of treatment reflected the hope of the Report rather than the reality.39 Liverpool’s Dr Frazer suggested in 1932 that the perceived danger that venereal disease posed to ‘the innocent and guilty alike’ had been a fundamental consideration in the Royal Commission’s report and the passing of Public Health (Venereal Diseases) Regulations in 1916.40 Here, Dr Frazer seemed to argue that moral reflection upon the behaviours that might precipitate infection offered little of practical value in the battle to contain a public health danger as pervasive as venereal disease. He attempted, also, to give a sense of his own moral impartiality in not distinguishing between the treatment of the ‘innocent’ or the ‘guilty’. Yet these awkward references to innocence and guilt indicate that Liverpool’s Medical Officer of Health did continue to hold on to and make moral judgements about the ways venereal disease could be contracted. Dr Frazer was not anomalous amongst the medical community in this regard. Immediately after the war, concern that promiscuity was increasing caused some doctors to argue that a reassertion of moral values was necessary if the threat of venereal disease was to be halted. In 1919 the Manchester Guardian reported soberly on debates at the conference of the Royal Sanitary Institute in Newcastle.41 At this event, York physician Dr Edmund M. Smith argued that ‘there was a large body of opinion amongst medical men of standing and amongst the general public denying the assumption that sexual continence was impracticable’.42 For Dr Smith, efforts to make sex safer through, for example, ‘supplying prophylactic outfits’ could do little other than ‘act as an incentive to immorality’. However, appeals to such a broad consensus of moral opinion were immediately undercut by a proclamation at the same event by Sir Archibald Reid that ‘the teaching of sexual morality to children was neglected, and the moral lessons sometimes given to adults were futile’.43 According to Reid’s position, ‘present social conventions’ meant that it was ‘not possible to teach morality or to prevent morality, but it was easy to prevent disease’.44 Other doctors believed that a combined middle-ground was the best approach. Dr Douglas White, from London, urged the medical profession to ‘adhere to the principle that public health and public morals ran along parallel lines’.45 In large part, the debate in which these doctors engaged in 1919 reflected the extent to which the First World War was thought to have had a profound effect upon the sex lives of the British people, with the effect that practical policies could not be extricated from moral concern. Seafaring and Venereal Disease By 1921, the VD treatment centres that were established in Liverpool under the VD Scheme were being described by Dr William Edward Hope, Liverpool’s Medical Officer of Health between 1894 and 1924, as ‘very serviceable and popular’, with the patients’ euphemistically-termed ‘special ailment[s]’ dealt with carefully and sensitively.46 In his 1921 report to the Port Sanitary Authority of Liverpool, Hope noted ‘patients are not singled out or made conspicuous’.47 But the creation of these treatment centres did not necessarily create distance between medical treatments and moral discourses about the prevalence of venereal disease. In the 1960s Elisabeth Rees, a Consultant Venereologist in Liverpool, recalled working with a senior doctor in the 1940s who ‘used the tail of his white coat to turn the knob of the door’ due, according to Rees, to his presumption that his patients were part of a promiscuous and degraded working class.48 This perception of the class and morality of patients was rooted in the procedures and presumptions of the Liverpool VD Scheme from the start. Although working from within a voluntary system of treatment, doctors and the local authority in Liverpool actually favoured mandatory treatment, whereby patients suffering from venereal disease could be made to attend the clinics until cured. The local authority felt that the issue would be better dealt with if local Health Authorities were given powers ‘to compel the patient to seek a doctor’s advice and to follow it should he be found to suffer from the disease’.49 Although the Ministry of Health rejected repeated calls during the 1920s from doctors in cities like Edinburgh and Liverpool to use the law to penalise those with VD who did not maintain their treatment, at local level, the fields of medicine and public health governance had not necessarily moved far beyond the thinking behind the Victorian Contagious Diseases Acts or the Defence of the Realm Act Regulation 40D. Moreover, the acquiescence of the Ministry of Health was not a necessary pre-requisite to the implementation of coercive policies at local level.50 Although the local VD schemes that emerged from the war have been regarded a success in terms of promoting greater uptake of treatment, this treatment cannot be said to have been entirely voluntary.51 In the absence of mandatory treatment, local doctors found other ways to put pressure upon patients. Doctors stressed to patients the need to undergo ‘steady and continuous’ treatment by sending out ‘appropriate[ly] worded letter-cards’ asking patients who stopped attending to come back to the clinic.52 Pressure did not just emanate from the medical field either. In 1926, the Medical Officer of Health commended one shipping company which had instituted a system requiring ‘any man known to have suffered from venereal disease to submit a certificate of health from the medical officer of the dispensary before accepting him for sea service’.53 At this time, employers could certainly take an interest in the sex lives of their working-class employees. Anna Lundberg notes that, in Sweden, there was a long history of repressive control, whereby employers reported cases of venereal disease to the state, while treatment regimes there were mandatory.54 Similarly, Michael Tuck argues that in the British colony of Uganda, early twentieth-century approaches to venereal disease were heavily punitive, with doctors writing to patients’ landlords and employers to prevent them discontinuing treatment.55 Despite a less repressive approach being adopted in Britain, there was still opportunity for employers to be involved in this non-mandatory system. Practices and discourses relating to employment intersected with approaches to venereal disease, not just in the sense that employers could be co-opted into coercive policies of treatment but also in the sense that employment could influence perceptions of venereal disease. The notion of the promiscuous seaman, whose indiscretions were considered to be biologically rooted, was a case in point. During the mid-twentieth century, it was not usual for those in charge of shipping to work alongside doctors, the Ministry of Health and social work agencies to intervene in the sexual health of seamen. The National Council for Combating Venereal Disease (NCCVD, known from 1925 as the British Social Hygiene Council) reached out to maritime employers and trade unions during the 1920s in a bid to ‘reduce the incidence of diseases among the sea-faring population’.56 Similarly the Ministry of Health worked with the NCCVD, to whom they gave funding, and ship-owners’ associations to address ‘the prevention and treatment of venereal diseases amongst Merchant Seamen’.57 The Liverpool Steamship Owners’ Association sent Dr Graeme Robertson, of the White Star Line, to attend a conference between the Ministry, employers and the NCCVD at the Ministry of Health on 3 November 1920.58 A number of points were agreed upon at the meeting. It was noted that seamen should be treated on board ships ‘free of charge’ and that ‘All seagoing Surgeons’ should ‘take a course in modern venereal treatment’.59 Ship-owners were to help facilitate this medical ‘instruction’ by taking advice from ‘the State’ on what training centres were available and passing this on to surgeons. In addition, it was also agreed that ships’ masters ‘be approached re qualifying in elementary diagnostics and treatment of venereal disease’.60 Although it was suggested at the conference that the state should cover the cost of supplying ships’ surgeons with equipment and drugs, this expense was later given over to shipping owners. The Merchant Shipping Act 1923 stated that shipping owners had to cover the cost of medical expenses for the treatment of seamen suffering from venereal disease.61 As Hall argues, money was therefore a motivating factor for employers taking an interest in venereal disease.62 The Liverpool Steamship Owners’ Association continued to take an interest in venereal disease and to communicate with welfare agencies throughout the interwar years. They maintained their links with the NCCVD, later as the British Social Hygiene Council (BSHC). In 1935, the Association accepted an invitation from the BSHC to send a representative to sit on a committee that they were in the process of establishing in support of ‘Seaman’s Welfare’. Alongside maritime employment representatives, the committee was also supported by Liverpool’s Medical Officer and by charitable organisations.63 By the time of the Second World War the Shipping Federation and the National Maritime Board called upon the Ministry of Health to make it compulsory for ships to carry sheaths and ointments (although they were not successful in this campaign), and many ships offered these things anyway.64 The interest that ship-owners took in the issue of venereal disease reflected the fact that it was an issue within the seafaring community. Paying particular attention to the dangers of the port as a workplace, the statistics of Liverpool’s Medical Officers of Health catalogued the gender and occupations of those suffering from venereal disease, and identified seamen as an especially infected group during the interwar years. For example, out of 1,754 men registered for treatment at the Royal Infirmary in 1921, 703 were described as ‘Seafaring people’.65 Well over half of all male patients in 1921 were described as ‘discharged soldiers and sailors’. The overrepresentation of male sufferers, particularly in these groups, stood in stark contrast to the total 199 women registered for treatment. Of these, housewives were by far the greatest in number, at 121.66 Instances of suspected venereal disease in Liverpool and public health officials’ reliance upon male transience as an indicator of susceptibility to infection appears to be mirrored by experiences in other parts of the north west. In 1934 Salford saw a total of 1,971 suspected cases of VD across its services while Liverpool saw 4,739 new cases, not a great discrepancy when the relative population sizes of these areas are considered.67 Just as in Liverpool, doctors in Salford located the problem of venereal disease amongst the transient working class, with ‘drivers of vehicles and … “lorry girls”’ highlighted as being particularly susceptible to ‘the dangers of neurosyphilis’.68 The mention of ‘lorry girls’ was tied directly to the issue of prostitution, with these hitch-hiking girls associated with delinquency, promiscuity and amateur prostitution.69 Professional prostitution was also a concern for doctors at the VD clinic in Salford, who expressed unease in 1935 about ‘the danger of prostitutes who live in flats, control of whom is difficult’.70 However, while it was clear that seamen and other transient members of the working class did represent a significant proportion of those being treated for venereal disease in Liverpool, the Medical Officers’ statistics also reflect the degree to which the local authorities, the state and moralists strove to target venereal disease amongst these transient groups. The Port Authority in Liverpool was so concerned with venereal disease in seamen that it needlessly prioritised the issue, to the detriment of other, more pressing threats to the health of men working on-board ships, such as those associated with unsanitary living conditions, poor ventilation and tropical diseases.71 Sally Sheard’s work has carefully mapped trends in public health provision for seamen in Liverpool and, while an analysis of class and gender falls outside the remit of her paper, she has located this disproportionate attention paid to venereal diseases, over and above other issues affecting the health of seamen, within the context of a shift which saw ‘the personal’ emphasised in place of ‘the environmental’ in matters of public health.72 Rather than focusing upon the environmental causes of ill-health, increasing attention was devoted to the patient’s role in maintaining their own physical well-being. This reiteration of the personal and the importance of behaviour enabled late nineteenth-century discourses about the failures of working-class morality to continue to be articulated through interwar venereal disease policies that were supposed to be more practical and objective. Alongside seamen, other groups of working-class men were identified as key audiences in local interwar education programmes. Efforts to warn ‘the general public and those likely to come into contact with Venereal Disease’ saw the Merseyside Borough’s VD Education Committee send doctors to give lectures at a local prison, Seamen’s Institutes and at ‘various industrial concerns’, indicating that the education of working-class men was regarded as one of the quickest ways to combat further infection.73 The Seamen’s Dispensary, opened in 1924, offered its services to a broad spectrum of working-class men, including international seamen. Although 85 per cent of patients at the clinic were seamen, it was noted that ‘the hours prove convenient for those following such occupations as motor drivers, barmen, and certain shopkeepers’.74 Other groups of transient men who attracted attention were foreign seamen and travellers. Legislation was in place to mitigate the supposed risk that these new arrivals might pose in terms of bringing disease into the city. Under the Aliens Act 1919, immigrants faced a medical examination by Assistant Port Officers in order to ensure that they could not ‘present a danger to the public health of the country’ or ‘become a charge on public funds by reason of their existing or probable future incapacity to support themselves and their dependents’.75 Although these examinations were unlikely to find evidence of venereal disease (it was acknowledged that the examinations lacked rigour and that immigrants with various ailments were likely to slip through the net), the persistence with these unreliable inspections nevertheless reflected the concern that transient communities posed public health issues in Liverpool and the wider area. Despite accepting the public health limits of this initiative, Liverpool’s Port Authority supported these examinations, with the Medical Officer of Health arguing that ‘the cost of administration per alien rejected’ needed to be off-set against ‘the moral and physical harm’ that ‘aliens suffering from mental or physical disease’ could ‘do in this country’.76 It should be noted, however, that where venereal disease was concerned, the evidence does not support the idea that the movement of non-Britons through the port was a particular problem. Only a small minority of those infected were described by Liverpool’s Medical Officer of Health as ‘not natives of the British Isles’.77 For example, in 1921, 8.5 per cent of seamen who visited the Royal Infirmary for venereal disease treatment were ‘not natives of the British Isles’ (the majority of these, just 21, came from the USA and Canada, while a further 20 came from the ‘Colonies’).78 In 1925 just 4 per cent of the seamen who visited the Royal Infirmary for treatment were ‘not natives’, although the greatest number of these, just six, were listed only vaguely as ‘other nationalities’.79 Despite the small numbers of foreign seafarers who presented in Liverpool with venereal diseases, the Port Authority was concerned about the likelihood of these men becoming free from VD; their transient lifestyles made it difficult for them to undergo the regular and sustained treatment necessary in curing cases of venereal disease. This concern was alleviated somewhat in November 1924 when the Ministry of Health issued a memorandum ratifying an international agreement that ‘merchant seamen without nationality’ would be able to receive treatment for venereal disease at ‘each of the chief sea and river ports of the countries concerned’.80 Medical cards were issued to seamen, allowing them to present information about the conditions from which they had suffered and the treatments they had received at other ports.81 In theory, this meant that the mobility of seamen no longer posed such a barrier to the full continuation of a course of treatment, since treatment did not have to be confined to one clinic, one city or even one country. Yet overcoming the prohibitive factors of taboo and patient embarrassment proved difficult while local medical workers and even employers continued to stigmatise the problem. Shame and Taboo Assessing quite what the working-class made of the targeted interest that some medical practitioners showed in their sexual health is difficult. Despite the attention devoted to the issue by local authorities, doctors and employers, sexual health was not a topic that people were necessarily comfortable to talk or write about, leaving gaps in the archive. Nevertheless, oral histories do give us a glimpse into the mindset and sexual education of the working class. Kate Fisher and Simon Szreter’s extensive oral histories suggest that sexual ignorance was common during the interwar years.82 Those who did manage to receive some form of sex education typically encountered this at boys’ camps or in the military.83 With sex still being such a taboo subject in public discourse, it appears that what education there was tended to be aimed at boys and men. Even in these cases, though, oral histories still point to high levels of ignorance and shame. Speaking in 1978 at age 62, Ernie Roberts, a tackler in a textile factory from Barnoldswick in Lancashire, recalled the inadequate sex education he received at school: ‘But sex education at school? It were tadpoles, that’s all it were. Get some frogs eggs, put ’em into a bottle and watch ’em develop. Aye, tadpoles!’84 When, as a teenager in the early 1930s, Ernie feared that he had caught infections after some of his early sexual encounters, he was too embarrassed to ask his friends for advice (‘VD? Oh deary me, if you’d got VD you’d be sent to Siberia!’).85 A visit to the Liverpool Anatomy Museum at the age of 18 served only to compound Ernie’s confusion and fears about venereal disease. Although cloaked with the veneers of education and medicine, anatomy museums functioned as places of entertainment.86 It ‘didn’t cost much’ for Ernie to get into Liverpool’s Anatomy Museum but what he saw inside left him ‘shocked’ rather than informed: ‘There were some specimens in bottles, you know, and models. Oh it were bloody awful.’87 Significantly, even Ernie’s own local doctor seemed ill-equipped to deal with the issue. When Ernie ‘got a sore dick’ after ‘frigging about’ with a girl when he was sixteen, the local doctor took one look at him and diagnosed syphilis. Terrified and unhappy about his diagnosis, Ernie went to Burnley VD Clinic where a more experienced doctor declared that there was ‘nothing wrong’ with him. That the first doctor whom Ernie saw was so quick to assume that he had syphilis after only a cursory examination raises the possibility that Ernie’s working-class background had influenced the doctor’s misdiagnosis. In response to the misdiagnosis, the doctor at the VD clinic gave Ernie a letter to take back to his local doctor, who promptly ‘screwed it up into a little ball and threw it in the corner’ and ‘as much as said to me “Get out!”’.88 Although the contents of the letter remained a mystery to Ernie, the gulf between the two doctors speaks to the degree to which venereal disease could be a controversial and marginalised issue even within the medical community. This marginalisation of the issue and the degree of embarrassment felt by patients less brave than Ernie presented a problem for VD clinics. During the interwar years, venereal disease doctors in Liverpool were especially concerned about the number of patients who prematurely discontinued their treatments, with almost 50 per cent of patients in 1921 stopping treatment before being free of the infection.89 Negatively situating the problem within the context of the clinics having been ‘established at very considerable cost’, the Medical Officer wrote that ‘patients may come and go as they please, or not come at all’.90 At the same time, embarrassment about receiving treatment and the inconvenience of having to repeatedly attend clinics no doubt deterred many from completing their courses and encouraged those with infections to declare themselves prematurely cured. Liverpool’s Medical Officer of Health, Dr Hope, proposed, somewhat ironically given his desire to see the law used to manage venereal disease, that the ‘real bar to much of the work of treatment and eradication of these diseases is because they are not respectable by reason of the moral stigma attached to having acquired them’.91 Moreover, doctors’ efforts to enlighten the public about the steps that they could take to maintain their sexual health sometimes overlapped with more punitive and foreboding approaches to education. Purity organisations such as the Alliance of Honour also embarked upon education programmes, but when they did so they entered into a difficult negotiation with Medical Officers and local authorities.92 There was no easy route to take for the moralist who wanted to talk about this taboo subject. On the one hand, the dissemination of information might lead to greater promiscuity as people became more adept at maintaining their sexual health. On the other hand, it was proposed that knowledge about VD could be used to shock and scare people out of promiscuous relationships. When the Alliance of Honour hosted a lecture and film screening by Liverpool’s Medical Officer of Health in 1924, they hoped to see footage that would bring home to the local population the facts of venereal disease and the potentially sensationalist outcomes of promiscuous indulgence. However, R. A. Black, a member of the Alliance from the Bootle area, wrote to the Walton and North Liverpool Times to complain that ‘the film shown was not in accordance with the printed objects of the society’.93 According to his letter in this local paper, the film focused upon ‘the comparative process of reproduction of species in a superficial way’, which Black feared did not offer ‘any solution to sex immorality and disease’ and may in fact ‘only excite the latent morbid curiosity of young people’.94 Walton and Bootle were working-class areas close to the docks, and as such Black wanted to see these communities targeted with propaganda of a more ominous tone.95 Black argued that a film which showed ‘the ravages of the disease both by inoculation and the hereditary ill-effects’ would have had ‘a more restraining control’. Unimpressed by the approach of the Medical Officer of Health, Black urged: Continuous instruction classes and lectures partly undertaken by the laity on the lines of temperance and ambulance classes, under the supervision of the medical profession, would forewarn young people of the wrath to come, and teach them that nature never forgives or forgets.96 Black wanted to see the audience overloaded with information that would shock and appal them to such an extent that they would be compelled into abstinence. As such, Black was a supporter of the idea that information should be used to instil ‘Fear of contagious disease’.97 By contrast, the medical community in Merseyside tended to avoid discussing the problem of venereal disease in such overtly condemnatory terms. In trying to open up a public discourse about venereal disease, local doctors had to manage moral concerns about whether improvements in treatment provision were exacerbating the problem by generating more promiscuity and they continued to battle against public embarrassment. When Dr R. W. McKenna gave a lecture at Bootle Town Hall later in November 1924 on behalf of the Merseyside Borough V.D. Education Committee, Councillor Harry Pennington, Chairman of the Health Committee, lamented that there were ‘so few people in the hall’ and said the event should have had ‘more publicity given to it’.98 The lack of publicity given to Dr McKenna’s lecture is entirely in keeping with the lack of attention given over to the issue of venereal disease within the Liverpool press. There are few references to local VD talks, with the likes of the aforementioned Medical Officer’s screening for the Alliance of Honour and Dr McKenna’s lecture featuring rarely and after these events had already taken place. Moreover, Dr McKenna’s lecture does not appear to have been an event to which the working class or seamen were especially invited to attend. Dr McKenna complained that the problem of venereal disease was ‘too often treated with levity’.99 In a bid to counter this, Dr McKenna promoted a pragmatic explanation of why the issue mattered. He noted that in 1923, twenty and a half million weeks had been lost by English workingmen through various forms of ‘preventable ill-health’.100 Dr McKenna argued that poverty and poor housing facilitated the spread of many of these diseases, but he did not neglect to tie these economic and practical concerns to the supposed immorality of the working-class when referring to the spread of venereal diseases: ‘Bad houses are not the only breeding places of disease, but are also the breeding places of crime and immorality’, he argued. Yet Dr McKenna did not want to see the medical profession have a monopoly over educational programmes. Indeed, he explained that, as the issue had ‘a moral aspect’, young people needed to be ‘warned … by the school master, the clergyman, and above all, the parent’.101 Just as moralists struggled to decide how much information about VD it was safe to promote to the general public, so the local medical community were limited in the publicity they gave to the issue by concerns about the propriety of the topic. Moreover, the way doctors negotiated the need to educate the public indicates that some members of the working class were considered very specifically and carefully, especially in the case of seamen. Following the previously mentioned November 1920 conference between the Ministry of Health, the NCCVD and employers’ groups like the Liverpool Steamship Owners’ Association, one doctor was critical of the presumed links between seafaring and venereal disease. After the conference, Dr Broad agreed with the White Star Line that ‘cases on the voyage are very few so far as [that company] is concerned’.102 Yet Dr Broad appears not to have been motivated by either the costs to employers when it came to VD or by concern about medical resources being unnecessarily diverted towards an over-estimated problem. Instead, his concern was with the image of seafaring men. At the same time as the doctor supported the belief that the ‘supply of preventatives’ on ships would ‘encourage the continuance of the trouble’, Dr Broad argued that ‘placards’ alerting men to treatment facilities ‘would be a libel on the men of the Mercantile Marine’.103 This complicates notions of interwar masculine culpability. For Dr Broad, who appears to have worked with the White Star Line, there was, no doubt, pressure to be cautious about associations between seafaring and VD for fear of besmirching the company. However, Dr Broad also held the somewhat contradictory position of believing that the increased availability of preventatives would encourage seamen to have more promiscuous sex whilst at the same time suggesting that the image of the libidinous seafarer was libellous. ‘Guilty’ Women Given how taboo the subject of venereal disease was, and given concerns about the respectability of seafaring and shipping companies, it was still easier to place the blame for transmission upon a figure whose respectability and legitimacy were already discredited, the promiscuous woman. If the men of the port were considered promiscuous and morally dubious, then the working-class women that they associated with were even further stigmatised as the supposed originators of the venereal diseases carried by seamen. Local doctors held foreign women up for criticism via allusions to prostitution and promiscuity. In 1928, Liverpool’s Medical Officer of Health at that time, Dr Mussen, argued: ‘of the various places in the world where infection is prevalent, West Africa and South America … are the most usual places from which infection reaches Liverpool’.104 Dr Mussen drew upon statistics compiled by his colleague, Dr Ross, a physician at the Seamen’s Dispensary in Liverpool. Ross suggested that out of 446 men who claimed they had caught their infections in South America, 445 stated that they were infected by a prostitute.105 Of the 129 men who said they had been infected in West Africa, 128 said that the woman had been a prostitute. Criticism was not reserved for foreign women, however. Ross’s own figures suggest that infection often occurred much closer to home. A total of 594 men said that they had become infected in Europe (585 of these by prostitutes) and the greatest number, 1,589, were infected in Great Britain (1,119 infections having apparently been contracted after sex with prostitutes).106 The blame and judgement that was apportioned to prostitutes grew from the continued prevalence of the belief that immoral women bore particular responsibility for the spread of these diseases. For example, in 1926 Dr Chambers wrote an article in the British Journal of Venereal Diseases outlining the roles that both amateur and professional prostitution played the spread of venereal disease, with little mention or thought given to the role of the male customer in this transaction.107 Moreover, working-class women in general often drew the concerns of local moralists, fearful about the propensity of young women travelling through Liverpool in search of employment to succumb to the temptations of vice and promiscuous adventure.108 This local context is key to understanding why, in a port city like Liverpool, gendered concerns about transience were articulated through the issue of venereal disease. Unlike in a mill town like Rochdale, where, Moore argues, doctors tended to focus on sending letters out to male patients who defaulted on treatment, doctors in Liverpool openly targeted women as both the source of infection and the group most susceptible to pressure to take up and maintain a course of treatment.109 In 1931 Dr Ross suggested that ‘married women … present a held where earnest endeavour on the part of the health authorities would bear much fruit’ [sic].110 This was apparently due to women attending treatment more regularly than their husbands, as well as women being ‘more amenable to reason if visited by a social worker in the event of her ceasing to attend’.111 In fact women were targeted for visits in ways that men were not. In 1921 it was reported that ‘in the case of women, special visits have been made by a member of the Female Staff of the Health Department who has been specifically detailed for this work as a portion of her daily duties’.112 For Dr Ross, clearing infection in women was the key to preventing the spread of venereal disease. He suggested that whenever he encountered male patients who claimed to have been infected by their wives or girlfriends, ‘I make it my business to influence the woman through the man’.113 Though Ross did not elaborate on his methods, it appears that Dr Ross was concerned with the attitudes and behaviours of local women. Dr Ross primarily placed the blame for infection upon the shoulders of prostitutes, but he saw working-class women in general as potential transmitters of venereal disease. He believed it would ‘be a great benefit to women patients’ if an all-day clinic could be established as ‘the usual hours for female clinics do not conduce to the regular attendance of housewives, maid-servants, barmaids, shop assistants and so on’.114 As with the men of the port, the presumption was that treatment should be targeted very deliberately and methodically at the working class. Yet, where women were concerned, Ross showed more scepticism about their work and morality, noting that the existing clinic times were at least suited to the ‘idle classes and … girls working in offices or factories’.115 Rather than being considered to be at the mercy of biological urges, women with venereal disease were presumed to be feckless ‘girls’. Moreover, Ross remained confident in his assessment of the moral culpability of women in the spread of venereal disease throughout the interwar years and beyond. As late as 1944, he referred to Liverpool’s problems with venereal disease as ‘the evil in a large port’ and claimed that ‘the prostitute is the vehicle of infection to the stranger within our gates, but the amateur and wife are stated to be the main sources of infection for the townsman’.116 In other words, male foreigners to the city (highly likely to be seamen) were thought to have been infected by prostitutes, whilst local men were believed to be picking up infections from their wives and promiscuous girlfriends. In both cases, the blame was placed upon the shoulders of a working-class woman. So, even where faithful wives of seamen found themselves suffering from venereal disease, the presumption would still have been that the infection had originated from another woman, likely the amateur prostitute her husband had had sex with at some point before or during their marriage. In this way, Liverpool’s efforts to deal with venereal disease reflect the extent to which gendered and class-based moral judgements continued to inflect public health initiatives aimed at improving the sexual health of the city. The idea that women were ultimately more responsible than men for the spread of venereal disease indicates that there are considerable continuities between interwar public health policies and those of the late nineteenth century. The Contagious Diseases Acts were suspended in 1883 and repealed in full in 1886.117 Nevertheless, the medicalised discourse of the prostitute that they relied upon informed approaches to prostitution and public health well into the twentieth century, with the effect that medical debates about venereal disease fed directly into discourses which aimed to restrict female sexuality on moral grounds. In 1921 G. Archdall Reid, a doctor with a firm interest in public health, wrote a letter to the British Medical Journal addressing increases in the number of cases of gonorrhoea and syphilis since the First World War. Despite suggesting that three out of four soldiers acquired their infections from ‘ordinary women’ Reid nonetheless believed such women to be ‘less diseased than prostitutes’.118 With this statement Reid placed culpability for the spread of venereal disease upon the shoulders of supposedly immoral women. These discursive distinctions between good and bad women, as well as between women and men, clouded public health approaches to seafaring in port towns. Although ‘drunken’ and impoverished seamen were considered conduits for all kinds of diseases, from tropical infections to venereal disease, the women who consorted with seamen were nonetheless considered to be the originators of venereal infection and were ‘denigrated’ more so than the seafarers.119 Where promiscuity by men was explained away in references to biology and the stresses of particular forms of manual labour, working-class women’s sexual desires were afforded no such understanding. During the 1920s the Port Sanitary Authority regularly distributed a notice to seamen containing advice on how to preserve their health. Along with instructions not to ‘drink water from polluted or doubtful sources’ and to avoid ‘prolonged exposure’ to sun and high temperatures, the notice warned seamen that ‘Serious lifelong illness may be contracted by sexual intercourse with loose women’.120 The moral disapprobation of the licentious woman far out-did that aimed at her male consorts, and so doctors promulgated a sexual health discourse that situated the promiscuous woman, and the prostitute in particular, at the centre of the city’s problems with venereal disease. Moreover, these attitudes were in evidence among other official, non-medical institutions within the city. In 1928, the Stipendiary Magistrate of Liverpool, Stuart Deacon, was called to London to give evidence to the Street Offences Committee, which had been set up to investigate and review the laws used to police prostitution. Deacon supported the criminalisation of prostitutes because he believed that they were responsible for spreading venereal disease through the city.121 He argued: ‘I do think the diseased woman is as much a danger to the community as a contagious animal’ and he proposed that women with VD who solicited should be dealt with via legal measures.122 Deacon was not specific about the form that any legal controls might take or how any potential problems policing this issue might be overcome. His response appears to have been a gut reaction to a line of questioning that revealed his own prejudicial and dehumanising view of the prostitute as a social danger. This type of emotive, moralising in support of the suggestion that the spread of venereal disease should be dealt with in law chimed with the efforts of Liverpool’s Medical Officers of Health to try to get the government to give them powers to legally compel patients to continue treatment. That the government rejected these proposals should not necessarily be interpreted as a sign that compulsion was now seen as an outdated mode of dealing with threats to public sexual health. Conclusion Liverpool’s VD Scheme circumvented the attitude of the Ministry of Health as doctors put pressure upon working-class communities to receive and continue treatment. Not only was morality still key, it intersected with gendered ideas about travel and employment. Understanding this intersection is crucial to understanding why different sections of the working class were targeted for treatment in different ways. Associations between doctors and maritime employers meant that, even within a non-mandatory system, venereal disease could be seen as an obstacle to work. Population transience was tied to concerns about bad habits among those who travelled in and out of the city for work. Liverpool’s Medical Officers of Health made considerable provisions for the diagnosis and treatment of venereal disease during and after the First World War. One of the chief concerns of the city’s Medical Officers of Health was to ensure that that Liverpool’s port did not act as a conduit for infectious diseases to make their way into the general population. As a result, British and foreign seamen were regarded as potentially threatening to the health of the local population, moving as they did between life in foreign ports, on-board ships and back among the local community. It was also assumed that the working-class, male seafarer dislocated from traditional family structures was more likely to engage in promiscuous sex. Nevertheless, the targeting of these men for education about the dangers of venereal disease and efforts to make treatment a condition of employment, while no doubt coercive, were underpinned by a gendered discourse about men’s biological need for sex that ultimately placed the greater portion of the ‘blame’ for venereal disease upon the shoulders of working-class women. Moreover, late nineteenth-century gender ideals were still influencing discussions about working-class women’s role in the spread of infection, with real implications in terms of public health policy. These women in Liverpool were subjected to visits and pressure from medical staff that their male sexual partners were not. This emphasis on working-class women’s culpability also added to the continued criminalisation and ostracising of women prostitutes, with the Liverpool VD Scheme lending legitimacy to the marginalisation of these women on public health grounds. Footnotes 1 John Glynn, ‘The Prostitution Problem. Has the Best Been Done to Solve it?’ in Straight Talk, October/December 1915, 12. Liverpool Record Office, M364LWD/7/5. 2 The White Cross League grew from the White Cross Army, formed in 1883 by Ellice Hopkins and the Bishop of Durham. The White Cross League focused its attentions on improving the sexual morality of working-class men. For more on this organisation see Paula Bartley, Prostitution: Prevention and Reform in England, 1860–1914 (London: Routledge, 2000), 156. 3 See, for example, Bartley, Prostitution; Linda Mahood, The Magdalenes: Prostitution in the Nineteenth Century (London: Routledge, 1990); Anne Summers, ‘“The Constitution Violated”: The Female Body and the Female Subject in the Campaigns of Josephine Butler’, History Workshop Journal, 1999, 48, 1–15; Judith Walkowitz, City of Dreadful Delight: Narratives of Sexual Danger in Late-Victorian London (Chicago: University of Chicago Press, 1992) and Prostitution and Victorian Society: Women, Class, and the State (Cambridge: Cambridge University Press, 1980). 4 Lesley Hall, ‘Venereal Diseases and Society in Britain, from the Contagious Diseases Acts to the National Health Service’, in Roger Davidson and Lesley Hall, eds, Sex, Sin and Suffering: Venereal Disease and European Society since 1870 (London: Routledge, 2001), 120–36, 123. See also Ann Sumner Holmes, ‘The Double Standard in the English Divorce Laws, 1857–1923’, Law & Social Inquiry, 1995, 20, 601–20. 5 Leanne McCormick, Regulating Sexuality: Women in Twentieth-Century Northern Ireland (Manchester: Manchester University Press, 2009), ch. 4. 6 Judith R. Walkowitz and Daniel J. Walkowitz, ‘“We are Not Beasts of the Field”: Prostitution and the Poor in Plymouth and Southampton under the Contagious Diseases Acts’, Feminist Studies, 1973, 1, 73–106; T. J. Wyke, ‘The Manchester and Salford Lock Hospital, 1818–1917’, Medical History, 1975, 19, 73–86. 7 See Roger Davidson, Dangerous Liaisons: A Social History of Venereal Disease in Twentieth Century Scotland (Amsterdam: Rodopi, 2000); Roger Davidson, ‘Venereal Disease, Sexual Morality, and Public Health in Interwar Scotland’ and ‘“Searching for Mary Glasgow”: Contact Tracing for Sexually Transmitted Diseases in Twentieth-Century Scotland’, Social History of Medicine, 1996, 9, 195–214; Gayle Davis, ‘The Cruel Madness of Love’: Sex, Syphilis and Psychiatry in Scotland, 1880–1930 (New York: Rodopi, 2008); Susan Lemar, ‘“The Liberty to Spread Disaster”: Campaigning for Compulsion in the Control of Venereal Diseases in Edinburgh in the 1920s’, Social History of Medicine, 2006, 19, 73–86; McCormick, Regulating Sexuality. 8 Pamela Cox, ‘Compulsion, Voluntarism, and Venereal Disease: Governing Sexual Health in England after the Contagious Diseases Acts’, Journal of British Studies, 2007, 46, 91–115; Philip Howell, ‘Venereal Disease and the Politics of Prostitution in the Irish Free State’, Irish Historical Studies, 2003, 33, 320–41. 9 Cox, ‘Compulsion, Voluntarism and Venereal Disease’, 99. 10 Francesca Patricia Moore, ‘“A Mistaken Policy of Secretiveness”: Venereal Disease and Changing Heterosexual Morality in Lancashire, UK, 1920–1935’, Historical Geography, 2015, 43, 37–56. 11 Ibid., 41. 12 Lemar, ‘The Liberty to Spread Disaster’. 13 For example, Lucy Bland, ‘Cleansing the Portals of Life: The Venereal Disease Campaign in the Early Twentieth Century’, in Mary Langan and Bill Schwarz, eds, Crises in the British State: 1880–1930 (London: Hutchinson, 1985), 192–208; Frank Mort, Dangerous Sexualities: Medico-Moral Politics in England Since 1830 (London: Routledge, 2000); Walkowitz, Prostitution and Victorian Society. 14 See Davidson, ‘Venereal Disease, Sexual Morality, and Public Health in Interwar Scotland’. 15 Lemar, ‘The Liberty to Spread Disaster’, 82. 16 For more on the Catholic attitudes towards sexual health see Caitriona Beaumont, ‘Moral Dilemmas and Women’s Rights: The Attitude of the Mother’s Union and Catholic Women’s League to Divorce, Birth Control and Abortion in England, 1928–1939’, Women’s History Review, 2007, 16, 463–85. 17 Davidson, ‘Venereal Disease, Sexual Morality, and Public Health in Interwar Scotland’; McCormick, Regulating Sexuality. 18 Annual Report of the Medical Officer of Health to the Port Authority, 1923, 24–5. Liverpool Record Office (LRO), HEA 4/1/1/1. 19 Annual Report of the Medical Officer of Health to the Port Sanitary, 1921, 21. LRO, 352 HEA 4/1/1/1. 20 ‘A Century of Progress, 1847–1947’, Public Health Pamphlet, Liverpool City Council. LRO, H352/4HEA. 21 Ibid. 22 Kate Fisher and Simon Szreter argue that, prior to the 1940s, the national press considered discussion of venereal disease to be ‘beyond the pale’. See Kate Fisher and Simon Szreter, Sex Before the Sexual Revolution: Intimate Life in England 1918–1963 (Cambridge: Cambridge University Press, 2010), 69. 23 Steamship Owners’ Association Minute Books, Maritime Archives, National Museums Liverpool (NML), D/SS/1/17–65. 24 Cf. Lemar, ‘The Liberty to Spread Disaster’, 76. 25 Lesley Hall, ‘What Shall We Do with the Poxy Sailor?’ Journal for Maritime Research, 2004, 6, 113–44. 26 A. Maude Royden, ‘Report of the Royal Commission on Venereal Diseases’, International Journal of Ethics, 1917, 27, 171–88 [original emphasis]. 27 Annual Report of the Liverpool Royal Infirmary, 1919, 11. LRO, H362/113 ROY. 28 Annual Report of the Medical Officer of Health to the Port Authority, 1932, 40. LRO, HEA 4/1/1/2. 29 S. M. Tomkins, ‘Palmitate or Permanganate: The Venereal Prophylaxis Debate in Britain, 1919–1926’, Medical History, 37, 382–98, 384. 30 The Observer, 1 July 1917, 11. 31 See Philippa Levine, ‘“Walking the Streets in a Way No Decent Woman Should”: Women Police in World War I’, The Journal of Modern History, 1994, 66, 34–78; Alex Rock, ‘The “khaki fever” Moral Panic: Women’s Patrols and the Policing of Cinemas in London, 1913–19’, Early Popular Visual Culture, 2014, 12, 57–72; Angela Woollacott, ‘“Khaki fever” and its Control: Gender, Class, Age and Sexual Morality on the British Homefront in the First World War’, Journal of Contemporary History, 1994, 29, 325–47. 32 Julia Laite, Common Prostitutes and Ordinary Citizens: Commercial Sex in London, 1885–1960 (Basingstoke: Palgrave Macmillan, 2011), 122. 33 Krista Cowman, ‘Touring Behind the Lines: British Soldiers in French Towns and Cities during the Great War’, Urban History, 2014, 41, 105–23, 112–13. 34 Clare Makepeace, ‘Male Heterosexuality and Prostitution during the Great War,’ Cultural and Social History, 2012, 9, 65–83, 70. 35 Annual Report of the Medical Officer of Health, 1921, 86. 36 Alison Neilans, letter to the British Medical Journal, published 10 June 1916. 37 Tomkins, ‘Palmitate or Permanganate’, 383. 38 Maude Royden, ‘Report of the Royal Commission on Venereal Diseases’, 182. 39 Ibid., 171. 40 Annual Report of the Medical Officer of Health, 1932, 40. 41 ‘Public Morals and the Public Health: the Danger of Divided Councils’ in The Manchester Guardian, 31 July 1919, 12. 42 Ibid. 43 Ibid. 44 Ibid. 45 Ibid. 46 Annual Report of the Medical Officer of Health, 1921, 21. 47 Ibid. 48 Elisabeth Rees, MD, ‘Failure to Control the Venereal Diseases’, British Medical Journal, 1964, 2, 47–9. 49 Annual Report of the Medical Officer of Health, 1921, 26. 50 Becky Taylor, John Stewart and Martin Powell have questioned the extent to which the Ministry of Health, ‘far removed from the daily reality of policy formation and implementation’, actually wielded influence at the local level. See Becky Taylor, John Stewart and Martin Powell, ‘Central and Local Government and the Provision of Municipal Medicine, 1919–39’, The English Historical Review, 2007, 122, 397–426, 417. 51 Hall, ‘Venereal Diseases and Society in Britain’, 128. 52 Annual Report of the Medical Officer of Health, 1921, 22. 53 Annual Report of the Medical Officer of Health to the Port Sanitary Authority of Liverpool, 1926, 29. LRO, 352 HEA 4/1/1/1. 54 An update in Swedish law in 1918 meant that people who suspected they were infected had to report to a doctor, while local authorities were required to provide free medical care. See Anna Lundberg, ‘Passing the “Black Judgement”: Swedish social policy on venereal disease in the early twentieth century’, in R. Davidson and L. Hall, eds, Sex, Sin and Suffering: Venereal Disease and European Society since 1870 (London: Routledge, 2001), 29–43. 55 Michael Tuck, ‘Venereal Disease, Sexuality and Society in Uganda’, R. Davidson and L. Hall, eds, Sex, Sin and Suffering: Venereal Disease and European Society since 1870 (London: Routledge, 2001), 191–204. 56 Letter from B. Vivian, Organising Secretary of the National Council for Combatting Venereal Disease, to the Liverpool Steamship Owners’ Association. 18 May 1920. Liverpool Steamship Owners’ Association Minutes, Part 2, Vol. 25, 1920–1921, Reel 33. NML, D/SS/1/17–65. 57 Letter from F. Slator (Ministry of Health) to Liverpool Steamship Owners’ Association. 22 October 1920. Liverpool Steamship Owners’ Association Minutes, Part 2, Vol. 25, 1920–1921, Reel 33. NML, D/SS/1/17–65. Hall notes that the Ministry of Health gave funding to the NCCVD (later the British Social Hygiene Council) until 1929, when, under the Local Government Act, responsibility for this funding was passed to local authorities with mixed results. See Hall, ‘Venereal Diseases and Society’, 127–9. 58 Liverpool Steamship Owners’ Association General Meeting Minutes, 23 November 1920. Liverpool Steamship Owners’ Association Minutes, Part 2, Vol. 25, 1920–1921- Reel 33. NML, D/SS/1/17–65. 59 ‘Proceedings of “Venereal Disease” Conference. Held in London on November 3rd. 1920’. Liverpool Steamship Owners’ Association Minutes, Part 2, Vol. 25, 1920–1921- Reel 33. NML, D/SS/1/17–65. 60 Ibid. 61 Roger Davidson, Dangerous Liaisons, 74, footnote 88. 62 Hall, ‘What Shall We Do with the Poxy Sailor?’ 63 Liverpool Steamship Owners’ Association Minutes, Part 2, Vols 44–45, 1933–1935, Reel 54. NML, D/SS/1/17–65. 64 Tim Carter, Merchant Seamen’s Health, 1860–1960: Medicine, Technology, Shipowners and the State in Britain (Woodbridge, 2014), 146. 65 Annual Report of the Medical Officer of Health, 1921, 24. 66 Ibid. 67 For Salford, see ‘Annual Report of the City and Royal Borough of Edinburgh VD Scheme; Annual Report on the VD Scheme of the City of Salford’, British Journal of Venereal Diseases, October 1935, 11, 269; for Liverpool, see Annual Report of the Medical Officer of Health to the Port Sanitary Authority of Liverpool, 1934, 29. LRO, 352 HEA 4/1/1/2. For information on the population sizes of these areas see John Belchem, Merseypride: Essays in Liverpool Exceptionalism (Liverpool: Liverpool University Press, 2000), 4 and Andrew Davies, Leisure, Gender and Poverty: Working-class Culture in Salford and Manchester, 1900–1939 (Buckingham: Open University Press, 1992), 8. 68 British Journal of Venereal Diseases, October 1935, 11, 271. 69 Julia Laite, ‘Immoral Traffic: Mobility, Health, Labor, and the “Lorry Girl” in Mid-Twentieth-Century Britain’, Journal of British Studies, 2013, 52, 693–721. 70 ‘Annual Reports—Salford, Edinburgh, and New South Wales’, Journal of British Studies, October 1937, 13, 278. 71 Sheard, ‘Mixed Motives: Improving the Health of Seamen in Liverpool, 1875–1939’, in Laurinda Abreu, ed., European Health and Social Welfare Policies (Blansko: Compostela Group of Universities, 2004), 322. 72 Ibid. 73 Annual Report of the Medical Officer of Health to the Port Sanitary Authority of Liverpool, 1925, 29. LRO, 352 HEA 4/1/1/1. 74 Annual Report by the Medical Officer of Health, 1926, 28. 75 Annual Report of the Medical Officer of Health to the Port Authority, 1922, 81–2. LRO, HEA 4/1/1/1. 76 Ibid. 77 Annual Report of the Medical Officer of Health, 1921, 24. 78 Ibid. 79 Annual Report of the Medical Officer of Health, 1925, 26. 80 Ibid., 28–9. 81 Sheard, ‘Mixed Motives’, 328. 82 Kate Fisher and Simon Szreter, Sex Before the Sexual Revolution, 74–7. 83 Ibid., 77. 84 Ernie Roberts, Oral History Recording, 20 July 1978. North West Sound Archive, 78/AC/1/2/3/4. 85 Ibid. 86 A. W. Bates, ‘“Indecent and Demoralising Representations”: Public Anatomy Museums in mid-Victorian England’, Medical History, 2008, 52, 1–22. 87 Ernie Roberts, Oral History Recording. 88 Ibid. Since Ernie does not appear to have gone on to suffer from any of the complications of untreated syphilis, it seems reasonable to assume that the first diagnosis was incorrect and that the assessment of the doctor at the VD clinic was accurate, rather than this just being the diagnosis that Ernie chose to believe. Moreover, since the first doctor appears to have refused to discuss the issue with Ernie any further upon reading the letter from the VD clinic, it seems that the first doctor accepted (albeit ungraciously) the second diagnosis. 89 Annual Report of the Medical Officer of Health, 1921, 22. 90 Ibid. 91 Annual Report of the Medical Officer of Health, 1921, 26. 92 See Roger Davidson and Gayle Davies on the Alliance of Honour’s provision of sex education in schools during the postwar years. Roger Davidson and Gayle Davis, The Sexual State: Sexuality and Scottish Governance 1950–80 (Edinburgh: Edinburgh University Press, 2012), 191. 93 Letter by R. A. Black, The Walton and North Liverpool Times, 21 March 1924, 2. 94 Ibid. 95 The Medical Officers do not appear to have kept records of the content of their lectures to seamen, though it seems likely that the Medical Officer used similar content to that described in this letter. 96 Letter by R. A. Black, The Walton and North Liverpool Times, 21 March 1924, 2. 97 Ibid. 98 ‘How Disease is Spread’, The Walton Times, 28 November 1924, 2. Patients in Bootle were treated for venereal disease at Bootle Borough Hospital. See ‘Bootle’s Health’, The Walton and North Liverpool Times, 9 May 1924, 2. 99 ‘How Disease is Spread’, The Walton Times, 28 November 1924, 2. 100 Ibid. 101 Ibid. 102 Dr Broad appears to have worked with the White Star Line. ‘Extract from Memorandum’, 23 November 1920. Liverpool Steamship Owners’ Association Minutes, Vol. 25, 1920–1921, Reel 33. NML, D/SS/1/17–65. 103 Ibid. 104 Annual Report of the Medical Officer of Health to the Port Authority, 1928, 34. LRO, HEA 4/1/1/1. 105 Ibid. 106 Ibid. 107 W. Metcalf Chambers, ‘Prostitution in Relation to Venereal Diseases’, British Journal of Venereal Diseases, January 1926, 2, 68–75. 108 Samantha Caslin, ‘“One Can Only Guess What Might Have Happened If the Worker had not Intervened in Time”: the Liverpool Vigilance Association, Moral Vulnerability and Irish Girls in early- to Mid-twentieth-century Liverpool’, Women’s History Review, 2016, 25, 254–73. 109 For more on the targeting of male patients in Rochdale see Moore ‘A Mistaken Policy of Secretiveness’, 43–4. 110 A. O. Ross, ‘Venereal Diseases and the General Community’, Public Health, 1931, 44, 353. 111 Ibid. 112 Annual Report of the Medical Officer of Health, 1921, 22. 113 Ross, ‘Venereal Diseases and the General Community’, 353. 114 Ibid. 115 Ibid. 116 A. O. Fergusson Ross, ‘Venereal Diseases in a Large Port,’ Public Health, 1944, 57, 135. 117 See Summers, ‘The Constitution Violated’. 118 G. Archdall Reid, letter to the British Medical Journal, published 22 January 1921. 119 Carter, Merchant Seamen’s Health, 68–71. 120 Annual Report of the Medical Officer of Health to the Port Sanitary Authority, 1930, 37. LRO, HEA 4/1/1/2. 121 For more on Deacon’s evidence to the Street Offences Committee see Samantha Caslin, ‘Flappers, Amateurs and Professionals: The Spectrum of Promiscuity in 1920s Britain’, in Kate Hardy, Sarah Kingston and Teela Sanders, eds, New Sociologies of Sex Work (Farnham: Ashgate, 2010), 11–22. 122 Street Offences Committee Minutes of Evidence, Mr Stuart Deacon, 14 January 1928, 17. National Archives, HO45/12663. Acknowledgements I would like to thank Dr Andrew Davies and Professor Sally Sheard for their comments on drafts of this text, as well as the very helpful anonymous peer reviewers. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.

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Social History of MedicineOxford University Press

Published: Sep 23, 2017

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