Infants were not the only targets of public concern: across Europe, governments set up schemes to tackle a range of diseases among the adult population. In the late nineteenth century, the pattern of disease was changing. Overall, life expectancy increased as the number of deaths from epidemic diseases such as cholera, typhus and typhoid fever declined. Instead, chronic illnesses – heart diseases, tuberculosis (TB) and cancer – emerged as significant causes of death. A new form of medicine emerged called ‘social medicine’. Whereas infectious diseases had been brought under control by cleaning up the environment and isolating patients, social medicine dealt with disease through social interventions, improving housing, diet and working conditions by educating people to live in ways that would improve their health and stop the spread of disease. In the case of TB, this meant isolating patients in their own homes. TB patients were taught to sleep separately from other family members, not to share plates and cutlery, and to spend as much time as possible in the open air (Smith, 1988). People were taught about the dangers of cancer, were encouraged to watch for early symptoms and to follow a healthy lifestyle, taking exercise in the opening air, avoiding alcohol and tobacco, and eating ‘natural’ foods (Proctor, 1999).
Governments put a lot of effort into tackling venereal diseases (VD). Although it is hard to arrive at accurate statistics of the levels of infection, it was clear that the incidence of VD was increasing. Over 24,000 cases were reported in Sweden in 1918, compared with just 3,681 in 1900 (Davidson and Hall, 2001, p. 30). Some estimates suggested that 10 per cent or more of the population were infected. Both syphilis and gonorrhoea had serious consequences: untreated syphilis could end in insanity and death while babies born to women suffering from gonorrhoea could be left blind. As well as a threat to individuals, VD was singled out as a danger to society (see Figure 5). It was ‘one of the greatest public evils – a chief cause of premature death, of untold suffering, of racial degeneration, of blindness, of deafness, of ugliness, of everything that is hateful’ (The Times, 1913, p. 6). VD was linked with ‘modern’ lifestyles and moral decline. In the postwar period, a loosening of moral codes, a loss of influence among the churches, which could no longer regulate behaviour, and greater sexual freedom for women were all blamed for a rise in rates of VD.
Broadly speaking, there were two possible approaches. The first, supported by churches and social purity campaigners, argued that VD could be controlled by changing moral standards and patterns of behaviour. Young people should abstain from sex until marriage, and then remain faithful to their partners. Alternatively, a more pragmatic approach suggested that such high moral standards were unattainable: sex outside marriage was a fact of life and it was the responsibility of the state to ensure that the results of this behaviour should not be life-threatening by offering free VD treatment. By 1918, medical practitioners had a good understanding of both diseases. The bacteria responsible for syphilis and gonorrhoea had been identified in 1902 and from 1910 there was an effective treatment for syphilis – Salvarsan, one of the first ‘magic bullet’ drugs, which targeted the infective agent. It still had unpleasant side effects and required long periods of treatment.
European states adopted a variety of strategies to deal with VD. A number of countries, including Spain and Italy, maintained nineteenth-century policies that targeted only prostitutes, who were required to submit to regular medical inspections, and were compelled to undergo medical treatment if found to have VD. Other states extended such policies to the whole population. In Germany and Sweden, the authorities had to be notified of any cases of VD and sufferers were compelled to undergo treatment. Anyone who failed to complete the treatment, or continued to be sexually active while infected, could be sent to prison for up to three years. In practice, it was very difficult to prove such cases and such regulations functioned as a deterrent (Davidson and Hall, 2001, pp. 39–40). An alternative strategy, adopted in Britain through legislation in 1916, was aimed at encouraging sufferers to come forward for treatment. There was no mandatory notification of VD cases, and free, confidential treatment was offered through local authority clinics. By 1919, over a million patients were seen by the clinics and deaths from syphilis declined. While British VD policy was pragmatic in the sense that it accepted a certain level of sexual freedom, it still had a moral dimension, which can be seen in approaches to dealing with different social groups.