'Searching for Mary, Glasgow': Contact tracing for sexually transmitted diseases in twentieth-century Scotland

Social History of Medicine

Volumn 9, Issue 2, 1996, Pages 195-214

  Davidson, Roger ^a  

^a UNIVERSITY OF EDINBURGH   (United Kingdom)

Author keywords

Contact tracing; Policy making; Public health; Scotland; Sexually transmitted diseases; Twentieth century; Venereal disease; Venereology

Indexed keywords

ARTICLE; DISEASE TRANSMISSION; EPIDEMIOLOGY; HEALTH CARE POLICY; HISTORY; HUMAN; PUBLIC HEALTH; SEXUALLY TRANSMITTED DISEASE; UNITED KINGDOM;

DISEASE TRANSMISSION; EPIDEMIOLOGIC METHODS; GREAT BRITAIN; HEALTH POLICY; HISTORY, 20TH CENTURY; HUMANS; PUBLIC HEALTH; SEXUALLY TRANSMITTED DISEASES;

EID: 0030208799     PISSN: 0951631X     EISSN: None     Source Type: Journal    
DOI: 10.1093/shm/9.2.195     Document Type: Article

References (118)

1. See for example, D. Evans, 'Tackling the "Hideous Scourge": The Creation of the Venereal Disease Treatment Centres in Early Twentieth-Century Britain', Social History of Medicine, 5 (1992), 413-33. In twentieth-century Britain, the term 'venereal disease' ('VD') has been commonly used to describe those diseases arising from infection transmitted during sexual intercourse. In Public Health Regulations, VD has been narrowly defined as syphilis, gonorrhoea and soft chancre. However, from the 1970s, the term 'sexually transmitted diseases' ('STDs') was increasingly substituted in recognition of the wide range of other infections spread by means of sexual contact.
2. See for example, B.A. Towers, 'Health Education Policy 1916-26: Venereal Disease and the Prophylaxis Dilemma', Medical History, 24 (1980), 70-87;
3. R. Davenport-Hines, Sex Death and Punishment: Attitudes to Sex and Sexuality in Britain since the Renaissance (London, 1990), ch. vii.
4. See for example, R. Davidson, '"A Scourge to be Firmly Gripped": The Campaign for VD Controls in Interwar Scotland', Social History of Medicine, 6 (1993), 213-35;
5. R. Davidson, 'Fighting "The Deadly Scourge": The Impact of World War II on Civilian VD Policy in Scotland', Scottish Historical Review, 75 (1996), in press.
6. See especially, D. Armstrong, Political Anatomy of the Body: Medical Knowledge in Britain in the Twentieth Century (Cambridge, 1983), pp. 7-18.
7. Annual Report of MOH for Dundee (1937), p. 119; Interview, retired venereologist, July 1994.
8. For an account of contact-tracing procedures for TB in interwar Britain, see F.B. Smith, The Retreat of Tuberculosis 1850-1950 (London, 1988), pp. 67-74.
9. L. Bland, '"Cleansing the Portals of Life": the Venereal Disease Campaign in the Early Twentieth Century', in M. Langan and B. Schwarz (eds.) Crises in the British State 1880-1930 (London, 1985), pp. 203-4;
10. Joint Select Committee on Criminal Law Amendment Bills, (P.P. 1918 (142) III), pp. 116-25, minutes of evidence of Scottish Office.
11. On interwar VD debate in Scotland, see R. Davidson, 'A Scourge to be Firmly Gripped', 213-35;
12. R. Davidson, 'Venereal Disease, Sexual Morality and the State in Interwar Scodand', Journal of the History of Sexuality, 5 (1994), 267-93.
13. Annual Report of MOH for Dundee (1936), p. 109.
14. S.R.O. HH 65/121/81; HH65/122/39, discussion papers on D.O.R.A. Regulation 33B,1942; Report of E[dinburgh] P[ublic] H[ealth] D[epartment] (1943), p. 24.
15. Leading clinicians at Edinburgh Royal Infirmary were strongly in favour of more aggressive contact tracing in dealing with infectious diseases. Sir Robert Philip, Professor of Tuberculosis, urged that dispensary staffs 'should be a mobile force, ready to hunt down the enemy in a systematic search for all cases in their area'. British Medical Journal, 2 July 1932, p. 3.
16. S.R.O. HH 65/117/65, W.A. Home (Senior Deputy MOH, Glasgow), 'Incidence of Venereal Diseases in Glasgow', 3 December 1943.
17. Due to the threat of assault, male nurses were in fact rarely used for contact tracing. (Communication from retired consultant venereologist, 21 June 1995).
18. S.R.O. HH65/116/85, D[epartment] of H[ealth] for S[cotland] to MOH Kirkwall, 18 Nov. 1939.
19. New cases of early infectious syphilis at Scottish treatment centres increased by c 22 per cent between 1939 and 1940 with a further increase of 116 per cent recorded in 1941. See S.R.O. HH65/126/78.
20. E.P.H.D. Annual Report (1940), p. 19.
21. S.R.O. HH65/126/7, S[cottish] C[ommittee] of the BSHC, Memorandum on the Incidence of VD in Scotland, 15 May 1941; minutes of meeting of DHS with SCBSHC delegation, 26 May 1941. Established as a semi-official sex education body during the First World War in response to crisis perceptions of promiscuity and VD, the Council had expanded its aims to include the eugenic and moral objectives of social hygiene. As in England, the Council had played a vital part in interwar Scotland in raising public awareness of the incidence and effects of venereal infection and in networking the voluntary and governmental agencies dealing with the disease. However, whereas its work south of the border had focused on educational issues and moral propaganda, with a lasting commitment to a voluntarist strategy, the Scottish Committee had adopted a compulsionist stance and given priority to co-ordinating a campaign for controls such as compulsory notification.
22. S.R.O. HH 65/126/33 , Memorandum on 'Proposed Venereal Disease Regulations', by W. Dalrymple-Champneys, 23 January 1942.
23. For a detailed account of the social politics surrounding VD policy in this period, see R. Davidson, 'Fighting the Deadly Scourge'.
24. S.R.O. HH 65/119/11, Statutory Rules and Orders, 1942 No.2277.
25. For parallel developments in North America and Australasia, see A. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (Oxford, 1985), Ch.V;
26. R.R. Pierson, 'The Double Bind of the Double Standard: VD Control and the CWAC in World War II, Canadian Historical Review, LXII (1981), 31-58;
27. P.J. Reming, ' "Shadow over New Zealand" : The Response to Venereal Disease in New Zealand, 1910-45. Ph.D dissertation, Massey University (1989);
28. M. Sturma, 'Public Health and Sexual Morality: Venereal Disease in World War II Australia', Signs, 13 (1988) 725-40;
29. K. Saunders and H. Taylor, 'The Impact of Total War upon Policing: The Queensland Experience' in M. Finnane (ed.). Policing in Australia : Historical Perspectives (Sydney, 1987), 143-69.
30. See, L. Bland, '"Guardians of the Race" or "Vampires upon the Nation's Health"?: Female Sexuality and its Regulation in Early Twentieth-Century Britain', in E. Whitelegg et al., The Changing Experience of Women (London, 1982), 375-88;
31. L. Bland and F. Mort, 'Look out for the Good Time Girl: Dangerous Sexualities as a Threat to National Health', in Formations of Nation and People (London, 1984), 131-51.
32. See for example, J.M. Mackintosh, (CMO to the DHS 1937-41) 'Venereal Diseases', Health and Empire, XVI, (December1941), p. 264.
33. S.R.O. HH65/126/17,18,33, Rough drafts of VD Regulation, June 1941-January 1942.
34. S.R.O. HH65/126/33; Fawcett Library, 3/AMS/46, Minutes of Association for Moral and Social Hygiene Executive Committee, 12 March 1942.
35. For a detailed account of this campaign, see Davidson, 'Fighting the Deadly Scourge'.
36. Founded in 1915 out of the merger of the Ladies' National Association and the British Abolitionist Association, the AMSH had spearheaded the campaign against DORA 40D during the First World War. Thereafter, the Association had co-ordinated much of interwar feminist resistance in Scotland to local authority proposals for the compulsory notification and treatment of VD. See, Davidson, 'A Scourge to be Firmly Gripped', 229-33.
37. See especially, S.R.O. HH65/116/105-7; HH65/117/31; HH65/119/38, Representations of women's organizations to the DHS on VD Regulations 1942-43.
38. S.R.O. HH 65/126/53, Minute by I.N.Sutherland, 30 July 1942.
39. See for example, Minutes of Scottish Branch of the Medical Society for the Study of Venereal Diseases, 22 February 1939. I am indebted to the Executive Committee of the Branch for permission to use their archives.
40. S.R.O. HH 65/126/18, notes of meeting in CMO's room, 3 July 1941. The identification of controls with German totalitarianism was a common inhibition in official circles in the early years of the war. See, Davenport-Hines, Sex, Death and Punishment, p. 270.
41. S.R.O., HH 65/126/43, Minute on 'Proposed VD Regulation', 5 March 1942; HH 58/66, Minute on Legal Advice.
42. Annual Report of D[epartment] of H[ealth] for S[cotland] (1947), (P.P. 1947-8 (Cmd.7453) XII), p. 74.
43. Report of M.O.H. for Aberdeen (1940-45), p. 38;
44. Annual Report of M.O.H. for Dundee (1947), p. 127.
45. Report of D.H.S. (July 1945-December 1946), (P.P.1946-7 (Cmd.7188) XII), p. 34. Data for 1943 and 1946 reveal a similar gender distribution of proceedings: See S.R.O. HH 65/120/81, HH65/121/82.
46. For comparative data relating to England and Wales, see Hansard (HC) 396, Cols.1529-30, 4 February 1944;
47. Ministry of Health Summary Report to 31 March 1947 (P.P. 1947-8 (Cmd.7441) XII), p. 47.
48. Annual Report of M.O.H. for Dundee (1947), p.128;
49. Annual Reports of M.O.H. for Glasgow (1944), p. 52;
50. Annual Reports of M.O.H. for Glasgow (1945), p. 78;
51. Annual Reports of M.O.H. for Glasgow (1946), p. 81;
52. Annual Reports of M.O.H. for Glasgow (1947), p. 110.
53. See e.g. Annual Report of M.O.H. for Glasgow (1947), p. 109;
54. Paisley Daily Express, 9 May 1944;
55. Scotsman, 9 May 1944.
56. S.R.O. HH 65/120, National Vigilance Association of Scotland to DHS, 1 April 1943. Perversely, even when women were imprisoned under Regulation 33B, they rarely received proper medical treatment for their infections. See P.R.O. M.H.55/1366, Venereal Disease: Treatment in Prisons.
57. During the period 1942-47, some 25 per cent of contacts attending VD clinics in Edinburgh under Regulation 33B were found to be uninfected with gonorrhoea or syphilis. E.P.H.D. Annual Report (1947), p. 90. The Secretary of State was authorized, where appropriate, to refer any case brought under DORA 33B that was found to be free of venereal infection to the Procurator Fiscal for possible proceedings by the Crown against the informants.
58. S.R.O. HH 65/120/87, Ministry of Health Circular 2896, 28 Dec. 1943.
59. Report of Medical Advisory Committee (Scotland) on Venereal Diseases, (P.P. 1943-44 (Cmd. 6518) IV), p.14; S.R.O. HH 58/66, minute by G.A. Birse, (DHS Solicitor) 31 January 1944. In the view of medico-legal experts, such fears were by no means unfounded.
60. See especially, Dame Louise McIlroy, 'Medico-Legal Problems in the Treatment of Venereal Diseases', Medico-Legal and Criminological Review, 12 (1944), pp. 7-22.
61. See E.P.H.D. Annual Reports (1943), p. 24;
62. E.P.H.D. Annual Reports (1944), pp. 27-8;
63. E.P.H.D. Annual Reports (1945), p. 37;
64. E.P.H.D. Annual Reports (1946), p. 100;
65. E.P.H.D. Annual Reports (1947), p. 90.
66. Annual Report of M.O.H. for Dundee (1947), p. 128. It should be stressed that in view of the problem of 'false positives' and the variability in the quality of diagnosis and testing within the Scottish VD services, such figures are highly speculative.
67. Strathclyde Regional Archive, Minutes of Corporation of Glasgow, Sub-Committee on Clinical Services, 4 June 1943.
68. See especially Fawcett Library, 3/AMS/310, Pt.2, Papers of Association for Moral and Social Hygiene, NVA for Scotland to AMSH, 12 September 1944. Dr A.R. Miller of Glasgow's Public Health Department described the difficulties of tracing 'a person defined as "Mary, Glasgow". . . [e]ven if particulars were given of public houses or other haunts visited . . . and even if she was alleged to have blonde hair . . . [and] even with the help of police investigators.' (S.R.O. HH 65/121/84, minute by Dr. I.N. Sutherland, 12 May 1947). For developments in England, see especially H.M. Johns, 'The Social Aspect of the Venereal Diseases- 3. Contact Tracing', British Journal of Venereal Diseases, XXI (1945), pp. 17-21; Fawcett Library, AMSH Papers, 3/AMS/310 Pt 2, Enquiry into the Operation of Defence Regulation 33B, December 1945.
69. E.P.H.D. Annual Reports (1945), p. 37;
70. E.P.H.D. Annual Reports (1946), p. 100.
71. See e.g. Annual Reports of M.O.H. for Aberdeen (1940-45), p. 38;
72. Annual Reports of M.O.H. for Dundee (1947), p. 21;
73. S.R.O. HH 65/117/65, Memo on 'Incidence of Venereal Diseases in Glasgow', W.A. Home, 3 December 1943.
74. For a positive verdict on the indirect effects of DORA 33B in Scotland, see also, History of the Second World War;
75. A.S. MacNalty (ed.) The Civilian Health and Medical Services: Vol. 2, (London, 1955), p. 271.
76. S.R.O. HH 65/121/80, H.K. Ainsworth (Min. of H.) to R. Howat (DHS), 10 April 1947; S.R.O. HH58/66/2, Ministry of Health Circular, 5/48, 5 Jan. 1948, 'Venereal Diseases: Expiry of Defence Regulation 33B. Suggested Method of Continuing to Trace Sources of Infection'.
77. S.R.O. HH65/121/84, note by Dr. I.N. Sutherland, 12 May 1947; minutes by I.N. Sutherland, 29 April, 12 May, 20 May 1947; Annual Report of M.O.H. for Dundee (1947), p. 129.
78. S.R.O. HH 65/121/85, R. Howat to H.K. Ainsworth, 21 May 1947.
79. E.P.H.D. Annual Report (1947), p. 90.
80. S.R.O. HH 65/121/84, 85.
81. S.R.O. HH 58/66/ 1-8, Minutes and papers on possible circular on contact tracing, 1948.
82. S.R.O. HH58/66, Minutes and correspondence on contact tracing 1948-62.
83. E.P.H.D. Annual Reports, (1948-60);
84. see especially E.P.H.D. Annual Reports, (1948), p. 95;
85. E.P.H.D. Annual Reports, (1952), p. 141;
86. E.P.H.D. Annual Reports, (1953), p. 108;
87. E.P.H.D. Annual Reports, (1958), p. 197;
88. E.P.H.D. Annual Reports, (1960), p. 144.
89. Although compulsory examination was strictly unlawful, in practice, all girls committed to borstals and remand homes were routinely examined for sexually transmitted diseases, often without their personal consent. See E.P.H.D. Annual Report (1964), p. 99.
90. See Annual Reports of M.O.H. for Glasgow (1948-60); Communication from former Regional Consultant on Venereology, 14 May 1993.
91. Ministry of Health, Circular 6/59, Prevention of Venereal Disease, 27 April 1959.
92. S.R.O. HH 58/66, Minutes and correspondence on the prevention of Venereal Disease, items 11-30.
93. See ibid., items, 33-44; D.H.S. Circular 64/1960, 2 Sept. 1960, Venereal Disease in Scotland. Increase in Incidence of Gonorrhoea.
94. S.R.O. HH 104/35/21a, note by SHHD, May 1963. I am greatly indebted to the The Scottish Office Home and Health Department for permission to consult files in the Scottish Record Office relating to VD/STD policy during the period 1964-80.
95. S.R.O. HH 104/35/37, minute by Dr I.M. Macgregor, 14 July 1964.
96. S.R.O. HH 104/35/75, Report of Working Party, October 1965.
97. National Health Service (Venereal Diseases) Regulations, 1968, S.I. 1968 No. 1624. Ministry of Health, National Health Service: Control of Venereal Disease HM(68)84, November 1968.
98. S.R.O. HH 104/55/55, correspondence relating to Galpern's Bill; Control of Venereal Diseases Bill, (P.P. 1968-69) 1, Bill 40;
99. Hansard [HC], 780, Cols. 944-76, 21 March 1969.
100. S.R.O. HH 104/35/49,75,79; S.R.O. HH 104/55/7,92, papers on Venereal Disease: Incidence and Control 1963-71.
101. E.P.H.D. Annual Report (1962), p.144. Particular attention was paid to identifying the 'inmates' of the more notorious brothels and tracing prostitutes operating in the docks.
102. E.P.H.D. Annual Report Ibid. (1966), p. 133.
103. The changing efficiency of contact tracing could be inferred from the changing ratio of male to female patients with gonorrhoea attending special clinics; from 4.1:1 in 1961 to 1.8:1 in 1971. See Scottish Home and Health Department and Scottish Health Services Council, Report of Joint Sub-Committee on Sexually Transmitted Diseases, (1973), p. 3.
104. Report of Joint Sub-Committee on Sexually Transmitted Diseases, Ibid. pp. 2, 6, 14-15.
105. The following account is based upon S.R.O. H.H.104/36, Correspondence relating to Sexually Transmitted Diseases: Gilloran Report. Information on Services from Health Boards, 1975-80; Minutes and Papers of the Scottish Branch of the Medical Society for the Study of Venereal Diseases.
106. For similar deficiencies in England and Wales, see British Medical Journal, 24 April 1982, p. 1211. It should be stressed that in many areas, such as Dumfries and Galloway, or Argyll and Bute, it would have been economically unviable to attach contact tracers to every clinic. Many of the so-called 'peripheral clinics' had few cases of which only c 10 per cent involved statutory VD that could legally be contact traced. Moreover, even in the absence of an officially designated contact tracer, a great deal of effective tracing was frequently carried out, often informally, by GPs and health visitors in liaison with clinicians in the urban centres. Similarly, in Forth Valley, a very successful tracing programme was initiated 'courtesy of one of the senior prostitutes in the area' who ensured that all the local prostitutes attended a special clinic. (Communication from retired Consultant Venereologist, 15 May 1995). Scottish Returns for 1972-75 reveal that the contacts of 74 per cent of patients with syphilis or gonorrhoea were 'sought' and that 66 per cent of such contacts attended for treatment.
107. See C.B.S. Schofield and N. McNeil, 'Sexually Transmitted Diseases in Scotland 1972-75', Health Bulletin, 35 No.1(1977), p.19.
108. See especially, Papers of the Scottish Branch for the Study of Venereal Diseases, 'Sexually Transmitted Disease: Notes on Facilities in Scotland', 9 April 1984.
109. L.A. Hall, '"The Cinderella of Medicine": Sexually-Transmitted Diseases in Britain in the Nineteenth and Twentieth Centuries', Genitourinary Medicine, 69 (1993), pp. 317-18.
110. R. Lees, 'VD-Some Random Rejections of a Venereologist', British Journal of Venereal Diseases, 26 (1950), p. 157.
111. Communication from retired Consultant Venereologist, 21 June 1995.
112. Armstrong, Political Anatomy of the Body, pp. 10-12.
113. Davidson, 'The Campaign for VD Controls', pp. 213-35 ;
114. Davidson, 'Fighting the "Deadly Scourge"'.
115. See, e.g., S.R.O. HH104/25, VD Legislation: correspondence with Citizenship Groups, Ministerial correspondence and Minutes on Statutory Provisions for Confidentiality of Treatment, 1948-66.
116. S.R.O. HH58/66/93, HH104/55/28, correspondence relating to private member's bills of Richard Marsh, June 1962 and Sir Myer Galpern, February 1968.
117. See especially, Scottish Office, Home and Health Department, HIV and AIDS in Scotland: Prevention the Key. Report of Ministerial Task Force, (1992);
118. Transcript: 'Killing Without a Trace' Focal Point, BBC 1, 15 October 1992.