The treatment of syphilis through the first half of the twentieth century in England
By Bailey Morris
With a disease as prevalent as syphilis in London, England in the early twentieth century, one of the first thoughts that comes to mind is treatment. The idea of treatment is complex ranging from the different options, to how the public will respond to new and different treatments. Treatment covers a lot more than the simple drugs used to help with the disease. While it would be easy to assume that today, as antibiotics can be used to treat the disease and calm the spread of infection, that was not always the case. Early in the twentieth century, there was a transition for treatment from using mercury to using compound 606, also known as salvarsan. Mercury was used until 1910 when a German scientist named Paul Ehrlich came up with salvarsan, which was commonly referred to as the magic bullet. This was before antibiotics were invented or widely used, and the ideal options for treating an infected person was to dress the wound with salvarsan or receive injections of salvarsan. Once antibiotics came into the picture, a visible switch from the use of compound 606 to using penicillin can be seen in public health records. Salvarsan had good success rates but came with its own limitations. The recipient had to receive numerous injections over an extensive time period, the injections were known to be very painful, and there were commonly toxic side effects.
From a public health and trend standpoint, it is vital to look at the prevalence of salvarsan, antibiotics, and the trends of treatment for syphilis from 1900 – 1960 in Great Britain. First, we will look at the use of and opinions about treatment with salvarsan, followed by an overview of the transition from salvarsan to antibiotics, typically penicillin. Thereafter by a discussion of how the public responded to treatment and the various challenges facing different treatment options and situations.
Looking at salvarsan we can see that introducing this arsenic compound into treatment led to more people seeking treatment for syphilis. The general guideline for a whole course of salvarsan or one of its substitutes was six injections. These injections were cited many times to be quite painful. When salvarsan became available it can be seen in public records that treatment for syphilis exponentially increased. Below are some images that depict salvarsan injections and the kits used to perform them.
In 1928 a world changing discovery was made by Alexander Fleming. He discovered the first antibiotic, penicillin. While its widespread use did not come for a few years, he reinvented how diseases, including syphilis, would be treated. However, there was also a considerable amount of skepticism around the use of penicillin that led to some people still choosing to receive salvarsan as a treatment method. Using penicillin considerably decreased treatment time and quickly made patients not contagious. This was very beneficial from a public health standpoint to decrease the disease from spreading. Due to the initial distrust of penicillin, most practitioners would also give at least one injection of an arsenical compound. Reports do admit that penicillin was able to eliminate the infection in a way that had not been seen before.
Looking at general trends for syphilis and treatment there are a few that stand out. First, syphilis seemed to affect both genders to a similar degree. This can be seen in reports detailing the genders of those who sought treatment. But in that, it is important to ponder that due to various reason, one gender may be more inclined to seek treatment than another. At this time in Great Britain there were many factors that could have affected this, a very significant one being two world wars that the country was involved in. Since syphilis is a sexually transmitted disease a level of embarrassment and secrecy must be considered when considering those who sought treatment. Another trend is that there were many more cases of syphilis and treatments documented in larger cities like London. This raises the question if the disease was more prevalent in larger cities, or if there was just a greater access to treatment. We can see from reports that at the beginning of the 1900s there was a great need for more venereal disease clinics. These diseases were on the rise, but it is still curious to me that there was such a greater number of reported cases in larger cities and makes me question the availability of treatment in more rural areas.
The last trend to look at is the completion of treatment. In rural areas many people would receive initial or partial treatment but would not finish the course. This is concerning due to the serious nature of syphilis. During the earlier years of the 1900s clinics came up with helpful hints to encourage people to finish their rounds of treatment. These included having a one on one discussion with the individual about the seriousness of syphilis, trying to make treatment more available, and printed information to impress the seriousness of syphilis. Due to this and an increasing need of availability, it was mandated that practitioners had to be supplied with salvarsan or one of its substitutes.
To conclude, treatment of syphilis was complex. There were new discoveries of antibiotics, challenging issues of getting the public to take treatment seriously, being able to provide the extent of treatment needed, and the basic complexities that come with all of this occurring in a country that was dealing with war. Through all of this it is fascinating to look at the roles salvarsan and penicillin played, and the slow but obvious transition from the arsenic compound to penicillin.
Frith, John. “Syphilis – Its Early History and Treatment until Penicillin and the Debate on Its Origins.” JMVH. Accessed November 10, 2019.
J. E. Ross, S. M. Tomkins, “The British Reception of Salvarsan,” Journal of the History of Medicine and Allied Sciences, Volume 52, Issue 4, October 1997, Pages 398–423.
Miller, M. G. “Syphilis Treatment During WWI.” Virtual Library. Accessed November 10, 2019.
Szreter, Simon. “Prevalence of Syphilis in England and Wales on the Eve of the Great War: Re-Visiting the Estimates of the Royal Commission on Venereal Diseases 1913–1916.” Social History of Medicine, Volume 27, Issue 3, August 2014, pp. 508–529.