William W. Sanger

FRANCE.—SYPHILIS.

First recorded Appearance in Europe.—Description by Fracastor.—Conduct of the Faculty.—First Hospitals in Paris.—Shocking Condition of the Sick.—New Syphilitic Hospital.—Plan of Treatment.—Establishment of the SalpÉtriÈre.—BicÊtre.—Capuchins.—Hospital du Midi.—Reforms there.—Visiting Physicians.—Dispensary.—Statistics of Disease.—Progress and Condition of Disease.

It properly belongs to this chapter to allude to the rise and progress of the diseases termed syphilitic.

Whether they were of ancient date—whether the “shameful diseases” which have been mentioned in the chapter devoted to prostitution at Rome were the same as the modern syphilis—may be decided by the reader. It will suffice here to say that, throughout the Middle Ages, a species of disease, termed sometimes leprosy, sometimes pudendagra, appears to have prevailed in France as in other European countries, and to have chosen for its chief seat the organs of generation. It was not, however, till the close of the fifteenth century that public attention began to be generally directed to the subject of sexual disease.

We shall briefly enumerate the earliest notices of its appearance. When Charles VIII. entered Naples in 1495, he found the city suffering from a plague (syphilis) to which the prejudice of the natives gave the name of “French malady.” Italy, said the writers of the day, was attacked simultaneously by the French army and this new disease.[198] Most of the Italian writers accuse the French of its introduction. Benevenis, however, says they got it from the Spaniards, and Guicciardini candidly admits that his countrymen were the real propagators of the malady. German physicians likewise traced its origin to Naples, and placed it about the year 1493,[199] ascribing it to an untoward planetary conjunction. The disease appeared at Barcelona in 1493, and in other parts of Spain in the following year.[200] But sixty years before, in 1430, public regulations had been made in London to prevent the admission of persons attacked with a disease very similar to syphilis into houses of prostitution, and requiring the police to keep constant watch over such as should show symptoms of this infirmitas nefanda.[201] The first authentic allusion to the disease in France is the ordinance of the Parliament of Paris, dated 1497, ordering all persons attacked by the “large pox” to vacate the city within twenty-four hours, and not to return till they were cured; providing a sort of hospital for those who can not move; and appointing agents to bestow four sols parisis on the exiles to pay for their journey.[202] This ordinance alludes to the disease having been prevalent for two years.

It may therefore be taken for granted that, whether syphilitic diseases had existed before or not, they prevailed to a very alarming extent throughout Europe at the close of the fifteenth century.

To prevent misconception, it may be as well to give the diagnostic signs of the “French malady” as furnished by Fracastor: “The patients were in low spirits, and broken down; their faces were pale. Most of them had chancres upon the organs of generation. These chancres were obstinate; when cured in one place they reappeared in another, and the work was never ended. Pustules with a hard surface appeared upon the skin, generally on the head first. On first appearing they were small, but gradually increased to the size of an acorn, which they resembled in shape. In some cases they were dry, in others humid; some were livid, others white and pale, others again hard and reddish. They burst after a few days, and discharged an incredible quantity of vile fetid humor. When they began to suppurate they became true phagedÆnic ulcers, consuming both flesh and bone. When they attacked the upper part of the body they gave rise to malign fluxions, which gnawed away the palate, or the windpipe, or the throat, or the tonsils. Some patients lost their lips, others the nose, others the eyes, others the whole organs of generation. Many were troubled with moist tumors on the limbs, which grew as large as eggs or small loaves. When they burst, a white and mucilaginous liquor exuded from them. They were usually found on the legs and arms. Some were ulcerated, others again remained callous to the last. And, as if this was not enough, the patients suffered terrible pains, especially at night, not only in the articulations, but in the limbs and nerves. Some sufferers, however, had pustules without pains, others pains without pustules; but, in most cases, both occurred together. The patients were languid, had no appetite, desired to remain constantly in bed. The face and legs swelled. Some had a slight fever, but this was rare; others had severe headaches for which no remedy could be found.”[203]

At first, it seems, the faculty, strangely misapprehending its duties, refused to treat patients assailed by this new plague. As at Rome, they were left to the tender mercies of quacks, barbers, and old women. About the beginning of the sixteenth century, however, the extent of the mischief provoked sympathy from the physicians, and one or two treatises appeared on the subject. Sudorifics seem to have been the chief agent employed. Large use was made of holy wood (the wood of the lignum-vitÆ-tree), which was imported from America for the purpose. It was doses of holy wood, in decoction, which are said to have saved the life of the great Erasmus.

After the passage of the law of 1497, a house in the Faubourg St. Germain was appropriated to the reception of the victims of syphilis; but there is no reason to believe that any attempt was made to treat them there. They were left to die, or to quack themselves. Eighteen years after, in 1505, the house in question being too small for the numbers of the sick, and it being clearly shown that syphilis was not contagious except by sexual intercourse or positive peculiar contact with the person afflicted, a new decree of Parliament appropriated funds for the construction of “a hospital for persons attacked by the large pox (les grands vÉrolÉs),” and directed that they should be properly cared for.[204] This decree was never carried into effect. Thirty years afterward the condition of the sick was far worse than it had ever been, they being left to die in the streets. A new decree, in 1535, appointed commissioners to choose a locality for a hospital; and, notwithstanding some opposition from the religious authorities, they performed their task. A small hospital was appropriated to syphilitic patients, and persons suffering from itch, epilepsy, and St. Vitus’s dance. It was soon filled, and several patients were thrust into the same bed. Owing to mismanagement on the part of the directors, it was short of linen, lint, and medicine. The Parliament interfered, but without success; and, in despair, the unfortunate sufferers contrived to effect an entrance into the hospital general, the Hotel Dieu. They were soon admitted on the same terms as other sufferers; but, as the establishment was far too small to accommodate all who sought refuge there, they were thrust four and five together into the same bed, and persons with syphilitic diseases lay by the side of men in contagious fevers, and others with broken legs and arms.

The Parliament interfered a second time. The municipal officers of Paris were assembled, and called upon to provide a hospital for venereal cases; but for many years the strenuous opposition of the Hotel Dieu neutralized all the efforts that were made. It was not till 1614 that the project of the Parliament was realized, and a syphilitic hospital actually opened.

Up to this time, that is to say, for a period of a century and a quarter, persons attacked by venereal disease were left to the care of Providence. Males could, with some exertion, occasionally obtain admission to the Hotel Dieu, where they often contracted new diseases without getting rid of the old; but of females, not a word had yet been spoken. No one in that hundred and twenty-five years had ever raised a voice to plead on behalf of the prostitutes; it never seems to have occurred, even to the Parliament which had so much sympathy for the pauvres vÉrolÉs, that the women likewise deserved pity and attention.

We possess no information with regard to the treatment used in this new hospital. It is certain, however, that, in obedience to the law of its foundation, patients were soundly whipped when they entered and when they left it, by way of punishing them for having contracted the disease. In 1675 the managers of the hospital declared that this practice deterred many sick persons from coming forward and confessing their condition; but it prevailed, apparently, for a quarter of a century afterward.

About the middle of the seventeenth century, under the reign of Louis XIV., a hospital prison, named the SalpÉtriÈre, was established for the reception of prostitutes; but, by a strange inconsistency, in 1658 it was closed to women suffering from syphilis (femmes gatÉes), and physicians were directed to examine all women “who showed symptoms of syphilis on the face.” A few years’ experience showed the fallacy of this system. Diseased women were confined in the place; should they not be treated there? The physicians thought they should, and accordingly, though in violation of the rules of the establishment, a small room was appropriated to this class of patients. It appears that at this time a prostitute found some difficulty in obtaining admission to the SalpÉtriÈre; it being not unusual for unfortunate creatures to have themselves arrested for vagabondage, and to submit voluntarily to the whipping which the ethics of the day required in the case of females as well as males, in order to obtain medical treatment. It will be seen that our New York system can not claim the merit of originality. Prostitutes, in fact, flocked to the SalpÉtriÈre in such numbers that the room furnished by the connivance of the authorities was soon far too small to accommodate them. The hospital managers declared to the royal government that medical treatment was out of the question in so crowded an apartment, and that a putrid fever might be expected if better accommodations were not provided. In reply, the government placed at their disposal a ward in the hospital of BicÊtre.

This was in 1691. For nearly a hundred years afterward the severe cases of venereal disease were sent to BicÊtre, the milder ones kept at SalpÉtriÈre. Both establishments were a disgrace to humanity. The patients were cheated of the food allowed them, and supplied with cheap broth and cheese in its stead. No baths, and but few medicines were at their command. Their ward was filthy, close, and in ruin. Patients were often obliged to wait so long for medical attendance that their maladies became incurable. The air in which they lived was pestiferous, and no one could visit the hospital without being shocked at its aspect.[205] Medical men who saw the place expressed amazement that so many persons should exist in so small a room. Eight women slept in a bed, and in the room appropriated to those whose turn for treatment had not come, the patients slept by gangs, one half sleeping from 8 P.M. to 1 A.M., and the remainder from 1 A.M. to 7 A.M. The floor was covered with dirt and filth, and the windows were nailed down, for fear of their being broken if opened. There was but little linen, and that was in rags, and abominably dirty. One hundred persons only were treated at a time, fifty men and fifty women. A new batch was admitted to treatment every two months, and, as the hospital always contained from three to four hundred sufferers, some cases remained six or eight months without any treatment whatever. Many died before they reached the hands of the doctors. The diet was the same for all. Those who had not been admitted to treatment were supplied with coarse bread, cheese, rancid butter, and (very seldom) a little meat. The surgeons of BicÊtre usually made fortunes in a short time.[206]

If any thing farther were needed to characterize the hospital of BicÊtre in the eighteenth century, it would be the rules in virtue of which no diseased person could claim admission until a complete year had elapsed from the time of their first application, and every diseased person was turned out, whether ill or well, after six weeks’ treatment. It was stated to M. Parent-Duchatelet that the average mortality was one hundred women and sixty men per annum.[207]

In 1787, Dr. Cullerier was appointed surgeon in charge of syphilitic cases at BicÊtre. He commenced his administration by denouncing the state of things he found there, and it is mainly from the memoires he addressed to the government that the preceding facts have been obtained. His representations seem to have met with but little success. In 1789, however, the bulk of the prisoners at BicÊtre were set free, and he immediately availed himself of the increased room to accommodate his patients.

The reform was so slight, or rather so vast a reform was needed, that the moment the attention of the republican government was drawn to the subject, it removed the syphilitic cases from the hospital of BicÊtre to the hospital of the Capuchins. That establishment was enlarged, and named the Hospital of the South (l’HÔpital du Midi). Gardens and baths were provided; ample wards permitted the classification of diseases; the food was of the best kind, and sufficient in quantity. This immense step was the work of the republican authorities.

It was, however, only the first of a series of reforms. Originally, men and women of all grades were admitted promiscuously. This led to grave inconveniences. The decorum of the hospital was frequently disturbed by the conduct of some of the men with regard to the prostitutes in the adjoining wards. To obviate this, a new hospital was set apart, under the reign of Charles X., for the reception of male patients only. It is the Hospital de Lourcine.

A still more serious trouble arose from the mixture of prostitutes with other women who, from the infidelity of their husbands, hereditary disease, or other causes, found themselves infected with syphilis. For some time complaints had been made on this head, but an accident, which occurred in 1828, compelled the authorities to act. The daughter of a professional nurse, residing in the vicinity of Paris, caught syphilis from a child her mother was nursing, who had inherited the disease. It took the shape of a virulent chancre on the palate, and the girl was sent to the Hospital du Midi for treatment. She found herself thrust among the vilest prostitutes, whose language and sentiments shocked her so terribly that she insisted on leaving the hospital at once. The physician on duty declined to grant her request, whereupon the poor girl contrived to get into the yard, and threw herself into a well. She was drowned, and on an autopsy of her corpse it appeared that she was a virgin. This dreadful incident aroused the public mind. Hitherto the disposal of the prostitutes had been a subject of dispute between the administration of the hospital and that of the city, each wishing to thrust them upon the other. The government now interfered, and special accommodation was provided for prostitutes at the prison of Saint Lazare. The Hospital du Midi was devoted exclusively to such women as were not inscribed on the rolls of the police.

Before these distributions took place, when men and women were indiscriminately received at the Hospital du Midi, the average annual admissions, from 1804 to 1814, were 2700; from 1822 to 1828 it exceeded an average of 3100. Twenty years ago the mortality was said to be less than two per cent.; it was ten per cent. at BicÊtre.

At the Hospital du Midi, diseased persons who do not desire admission to the hospital are treated outside, all the medicines they require being furnished them free of charge.

It would appear, from stray allusions in various old ordinances, that some sort of medical office had been established in the eighteenth century by the government, for the purpose of affording gratuitous advice to prostitutes, and denouncing those who were diseased; but there exists no positive evidence of any such establishment or office. It was not till 1803 that a regulation was made by the prefect of police, requiring all public women to submit to be visited by a physician appointed by him. The plan was a bad one, as the physician was paid by fees which he was authorized to exact; and it was rendered worse in practice by the dishonesty of the man chosen for the office, one Coulon. This individual made money and neglected his duties. The system was altered in 1810, and a dispensary established, with a strong medical staff, who were directed to visit all the prostitutes in Paris. This institution is still in existence; it will be further noticed in the next chapter.

When the dispensary was established, its medical officers were directed to offer to prostitutes the choice of being treated at home or going to the hospital. Almost all chose the former. The physicians then undertook to decide themselves which should go to the hospital and which remain in their houses. The results of their experience, and the policy it compelled them to adopt, are shown in the following table, which was compiled by Parent-Duchatelet:

The system of treating prostitutes at home was, in fact, given up. It was found they could not be compelled to take the medicines given them; and that, though laboring under the most severe disease, they would not abstain from the exercise of their calling.

The tables prepared by the sanitary office, or dispensary, at Paris, afford a clear view of the extent and progress of disease in that city. Of those which are furnished by M. Parent-Duchatelet, we shall take a few of the most striking. The following gives the aggregate disease for a period of twenty years:

Other tables, apparently drawn with care, show that the proportion of disease to prostitutes varies widely in different years. In 1828 it was six per cent., that is to say, six out of every hundred prostitutes were diseased; but in 1832 it was barely three per cent. Four or five per cent. would seem a tolerably fair average.[209]

From another table compiled by the same author we gather that, during a period of eighteen years, January was found the most fatal month for prostitutes; next came August and September; while February, April, May, and July seemed seasons less favorable to disease. M. Duchatelet, however, candidly admits that he can trace the operation of no law here, and inclines to the belief that the variation is wholly due to chance.[210]