The following extract from the book "Syphilis and the Army" by Dr G. Thibierge, Surgeon to the Saint-Louis
Hospital in France, and edited by C. F. Marshall, M.D., F.R.C.S., was published in 1918 by the University of London
Press, Ltd. The extract describes the origins of syphilitic infection in the French army; syphilis, for all practical
purposes, is only spread by sexual intercourse and the majority of cases were acquired from professional sex workers.
However there was a significant number of women infected who were not prostitutes, reflecting the relaxation of
sexual mores during wartime. The origins of venereal infection here described would also apply to the other Allied
armies on the Western Front.
The reference to syphilis acquired from 'pederastic acts' in Table 1 is difficult to understand as children would
have been unlikely to have been present in the army nor in a military hospital; these words may have been a synonym
for homosexuality. The reference to 'simple chancre' in the same table is also curious as a chancre is a cutaneous
manifestation of syphilis.
Dr M. Geoffrey Miller, Editor
ON THE ORIGIN OF SYPHILITIC CONTAGION IN THE ARMY
As may be supposed, the origins of syphilitic contagion in the Army are multiple.
It is frequently difficult to determine them. All patients do not lend themselves to investigation with equal readiness : some have contracted syphilis under circumstances which they do not care to divulge; others refuse, from a spirit of chivalry, to denounce the woman who accorded them a favour, whether gratuitous or paid for; some, on account of drunkenness. are unable to give either place, time of meeting, profession, or colour of the hair of their temporary partner; while others, again, have had so many and such frequent adventures with different women that they are unable to blame one more than another.
Despite the difficulties of the inquiry, a certain number of soldiers have replied to the questions with apparent veracity, and medical men have been able to obtain information of sufficient accuracy.
Some of these inquiries have been published, and they contain a sufficient number of names to be of value, especially those of Jolivet and Carle.
Take first Jolivet's inquiry, [Jolivet, " Origin of the Contamination of 100 Venereal Patients treated in the Army Zone ", Annales de dermatologic, May 1916, p. 126]. which contains a list of the first 100 venereal patients treated in an infectious hospital in the army zone, and the information he was able to obtain as to the manner of their contamination.
Table 1
Carle [Carle., " Three Months' Work in the Dermatological and Venereological Sections of an Army Ambulance. Statistical and Critical study" Archives de Médecine et de Pharmacie militaires, June 1916, p. 865., and Carle, " Prophylaxis of Venereal Diseases in the Army. Measures taken. Measures to be undertaken." Report at the Meeting of the Heads of the Venereological Centres, July 13th, 1916. Annales des maladies vénériennes. September 1916, p. 536.] has obtained statistics giving the mode of contamination of 291 men observed in the venereological centre of an army.
These two statistics are particularly interesting, because they both of them treat of contaminations incurred as much in the army zone as in the interior; thus allowing comparison of the mode of syphilitic dissemination in two entirely different centres.
The following statistics, prepared by Madame Govaerts with scrupulous accuracy, record 165 syphilitic men observed in my clinic in the St. Louis Hospital, from February 15th to August 15th, 1916, and in these cases it was possible to trace the origin of contamination.
The statistics refer to both military and civil patients; I thought it better to combine them in the same table, in order to show that, in the interior, the majority of syphilitic contaminations are due to prostitution, amongst the civil as well as amongst the military population.
Table 2
It is interesting to determine the source of syphilitic
contagion separately in the different military classes: soldiers at the front, those in the depots and sedentary
services, and men mobilised in munition works.
Men at the front may be contaminated either in the Army or the interior; statistics show that they become affected
much more frequently in the interior than in the army zone.
Table 3
Jolivet, whose inquiry yielded 100 cases of venereal disease, observed in an infectious hospital near the front, gives the following table:
Table 4
Carle, out of 291 men under observation in the venereological
centre of the Army in Figure 2, takes 178, i.e. 61%, as having been contaminated in the interior. In a series of
238 cases, more recently observed, he counts 170 contaminations coming from the interior, i.e. 71%.
In adding together the totals of these three statistics, out of 629 cases of venereal disease, 524 contagions are
from the interior, i.e. 73.6%.
Men on leave have various opportunities of contracting venereal disease: from the moment of quitting their unit
they pass through towns in the military zone where syphilis is rampant, and stop at railway and transport junctions,
often in Paris, where the station approaches are seething with women of all kinds. Jolivet, out of 100 patients,
cites no less than 6 cases (2 syphilis, 4 gonorrhoea) contracted from women near railway stations by men passing
through the towns. I have heard authoritatively that men have even been contaminated in the train taking them on
leave by women who walk the trains and succeed in escaping observation.
At the place of destination there are various sources of contagion: barmaids, waitresses, laundresses, and work-girls
give themselves up to clandestine prostitution ; there is also the mistress who, abandoned on mobilisation, has
since taken one or more lovers. Men who have been mobilised longest sometimes incriminate their wives: medical
men at the front cannot verify the accuracy of the statements of their patients, and, despite the number who assert
that their wives have contaminated them (16 in Jolivet's statistics, 11 in Carle's), may be sceptical. Facts observed
in the interior, of women infected in the absence of their husbands, and dreading to infect them when on furlough,
leave no doubt as to the reality and relatively large number of these contagions. Indeed, it has occasionally been
possible to examine the husband when on subsequent leave, and make an accurate inquiry into the evolution of the
two infections with syphilis. I myself have seen more than forty absolutely authentic cases.
In the army zone, contamination mostly emanates from women whose business brings them in contact with soldiers
restaurant keepers, barmaids, laundresses to whom the men send their washing on returning to quarters; seamstresses,
who mend their clothes, as well as farm-girls met near camp, or in the open country. Often the women are married
(31 out of 113 contaminations in the army zone, according to Carle's statistics), town or country women; these
latter are almost as numerous as professionals, registered or clandestine, free or in houses, mentioned in the
same statistics (35 professionals as against 32 married women).
To sum up, in the army zone, venereal diseases are transmitted more often by women who are not professional prostitutes
than by official or clandestine prostitutes living solely by their bodies. If one could separate the contaminations
occurring in large towns and at the base from those occurring in the army zone, the part played by true prostitution
in the dissemination of syphilis and venereal diseases in the immediate neighbourhood of the front would be very
considerably diminished.
In the Table published by Carle (Figure 2 ) a suggestive comparison may be made of venereal contaminations by professionals,
according to whether these were produced in the army zone or in the interior; in the latter they give 114 contaminations
out of 178, i.e. 64%, and in the army zone 35 out of 113, i.e. 31%, or less than half.
There is, therefore, a danger to soldiers in women who are apparently most innocent, and the importance of this
cannot be exaggerated. I even heard some military surgeons say that every woman in the war zone ought to be watched,
and that no social position should prevent the suspicion of syphilis from being traced to its lair. Proportionally
as the war is prolonged, the opportunities for these women contracting syphilis will be multiplied, with consequent
increase in the dangers run by the troops.
Syphilis is very irregularly distributed in the different bodies of troops, and I could cite such and such a regiment
in which the number of cases of syphilis is at the lowest, although, and perhaps because, medical inspection is
made regularly and carefully. In others, on the contrary, syphilitic morbidity is high. These inequalities, for
the greater part, are due to the sanitary condition of the women with whom the men have intercourse: owing to the
small number of women living near the front zone, it only requires a few of them to become syphilitic for contamination
to multiply with extreme rapidity. Equality amongst the different bodies of troops, in this respect, tends to re-establish
itself by the movements of the men on furlough.
In the base zone, on the other hand, contagion originates especially with professional prostitutes who swarm in
the large towns in search of soldiers quartered in these towns. and with other women brought there by their duties,
or passing through when on furlough. ( L. Spillman "On the Increase of Syphilitic Morbidity among Troops on
Active Service," Comptes rendus de la Société de Médecine de Nancy, December 22nd, 1915,
has noted the increase in the number of prostitutes at Nancy. This has also been reported to me from all the large
towns near the front.)
For some time there has not been one of these large towns in which syphilis has not made an incessant advance;
statistics are wanting as to the sanitary condition of these towns, but the declarations of both civil and military
surgeons, and the afflux of syphilitic women into the hospitals, prove it abundantly. It is in these towns that
the most rigorous supervision of both official and clandestine prostitution should be exercised.
The risks of contamination in the base zone explain why syphilis is extremely frequent amongst men staying there,
or who have easy access; such, for example, as the staffs of aviation camps, motor-drivers, secretaries of the
general staff, amongst whom a high proportion of syphilitic cases have been observed by the medical men.
In the depots and sedentary services, the sources of contamination are similar to those noted with men on leave.
They are, as in times of peace, but in higher degree, prostitutes of all kinds. Statistics of my clinic show that,
out of 31 syphilitic soldiers, 20 had been contaminated by avowed professionals, and 3 others also probably by
professionals. In these 20 contaminations it was always a case of solicitation, especially around the Paris railway-stations
and near the depots. We thus come to a proportion of 64, or perhaps 70% of infections by prostitutes. Comparing,
in the same statistics, the round numbers (civil and military combined) of cases observed (165) with those of the
contaminations emanating from professionals (which extend certainly to 99, and probably to 122), a similar percentage
is reached, which shows that 60[%,] and probably 73%, of the contaminations are due to professionals.
Meetings take place on the public highway, near the Paris railway stations, in military centres, at depots, concerts,
cinemas, etc.
For men mobilised in munition works, the habitual source of syphilitic contagion is also the prostitute, at least
in Paris. In provincial towns, it is more likely to be caught in the workshop: the promiscuity of the sexes entailed
by the necessities of work, and more especially its inspection (women being inspected by foremen) facilitates more
or less durable liaisons, with resultant contaminations. It is noteworthy that a certain number of pre-war prostitutes,
whose clientele had been reduced by mobilisation enrolled themselves amongst munition workers. It has been stated
that, in a large provincial town, the majority of certified prostitutes were engaged in munition work, their wages
increasing the profits, reduced by war, of prostitution, which they continued to practise with their fellowworkmen.
Non-venereal contaminations occur in the Army the proximity of the trenches and camps, the common interchange of
mugs, forks, pipes, etc., are sufficient to explain these. Cuts from the improvised barber's razor, often a poor
one, may also produce syphilitic infection.
As a matter of fact, however, despite inadequate precautions, such contaminations appear to be rare in the Army.