Two hundred and fifty years ago, London was rife with sexually transmitted infections (STIs). You only have to read about the sexual exploits of James Boswell, the biographer of writer Dr Samuel Johnson, to get a feel for the situation. Between 1760 and 1786, Boswell recorded up to 19 episodes of STIs in his diary, which candidly documented his encounters with prostitutes in London while he was working in the city as a lawyer.
But Boswell was not the only one in Georgian London to experience such diseases. In a first of its kind estimate, based on hospital admission registers, inspection reports, and other sources, researchers suggest that in 1775 at least one in five Londoners in their mid-30s had contracted “the pox” (syphilis) caused by the Treponema pallidum bacterium. Syphilis was one of the most prevalent sexually transmitted diseases of the era.
“Our findings suggest that Boswell's London fully deserves its historical reputation,” study co-author Professor Simon Szreter of the University of Cambridge said in a statement. “The city had an astonishingly high incidence of STIs at that time. It no longer seems unreasonable to suggest that a majority of those living in London while young adults in this period contracted an STI at some point in their lives.”
Many people exhibiting symptoms of syphilis, such as a rash or pain in urination, mistook it for “the clap” (gonorrhea) and tried self-medicating with pills and potions. However, in many cases the pain worsened and after time a different treatment was sought: mercury. Pre-penicillin, mercury salivation treatment was the prescription, and, if it didn’t kill you, would still require a lengthy stay in hospital. The records from such hospitals, including St Thomas’s and Guy's Hospitals (both still in use today), provided the basis for the new estimates, published in Economic History Review.
“In an age before prophylaxis or effective treatments, here was a fast-growing city with a continuous influx of young adults, many struggling financially,” Szreter said. “Georgian London was extremely vulnerable to epidemic STI infection rates on this scale.”
Those who were admitted most for STIs were young, impoverished, mostly unmarried women, who had either turned to commercial sex for financial support or were in situations that left them vulnerable to sexual predation and assault. Other groups in which STIs were also rife, included poor, unmarried in-migrant men, and those men who were more established and wealthy, like James Boswell, who could afford private hospitals and treatment.
In comparison to the rest of England, London was particularly syphilitic – Londoners were 25 times more likely to be treated for syphilis than those in more rural areas. “It isn't very surprising that London's sexual culture differed from that of rural Britain in this period,” Szreter remarked. “But now it's pretty clear that London was in a completely different league to even sizeable provincial cities like Chester.”
Even today, the nation’s capital “consistently” has the highest diagnosis rates for the most common STIs (though its population is three times that of the next largest city in the UK). Yet looking to the past remains an important process in helping to understand how these historically hidden activities impacted broader society.
“Syphilis and other STIs can have a very significant effect on morbidity and mortality and also on fertility. So infection rates represent a serious gap in our historical knowledge, with significant implications for health, for demography and therefore for economic history,” Szreter said. “We hope that our work will help to change this.”