University of Portsmouth's History Blog

The morality of state intervention in sexually-transmitted disease

Is it appropriate for governments to restrict personal liberty in an effort to control disease? This issue has come very much to the fore in the wake of the current worldwide Coronavirus epidemic.  In this post, Darcy Mckinlay, a second year history student, writes about nineteenth-century arguments against forcible methods of controlling venereal diseases.

Punch Cartoon, 1857

During the nineteenth century there was an increase in state intervention, marking a transformation from a previous ‘non-interference’ government approach.[1]  In 1864, the first of three Contagious Diseases Acts was passed, permitting the compulsory medical inspection and detention of prostitutes with venereal diseases.[2]  This law was specifically aimed at working-women in military-based towns because the government feared that the spread of sexually transmitted diseases was weakening the armed forces.[3] But the Contagious Diseases Acts were controversial, forming part of a wider debate surrounding state intervention.  Historians Jim Jose and Kcasey McLoughlin argue that contemporaries opposed the Acts because they violated freedom.[4]  Lisa Shapiro

Saunders, on the other hand, suggests that there was support for the extension, regarding increasing public safety.[5] This piece considers the 1870 report self-published by John Simon, the first Medical Officer of Health for London, arguing against the extension of the Contagious Diseases Act to the general public.  Simon’s duty in public health did not alter his view that compulsory sexual examinations were immoral.[6]  Ultimately, the repeal of the Contagious Diseases Acts in 1886 showed that this forcible method was unsuccessful.

A fashionably-dressed German prostitute, 1880.

A German prostitute, 1880.

Sir John Simon, 1881, Wellcome Library V0027166

Sir John Simon, 1881, Wellcome Library V0027166

Simon introduces the aim of the report, writing that it intends to determine “whether it is expedient to have … a systematic sanitary superintendence of prostitutes” in Britain.[7]  The word “superintendence” is significant, suggesting that prostitutes will have no agency under state management. The Contagious Diseases Acts allowed police officers to bring prostitutes before a magistrate who could order a medical examination.[8]  If the woman was found to be carrying a venereal disease, she was detained in hospital until clear and if she refused, the Acts permitted her imprisonment.[9]  Maria Luddy states that the Contagious Diseases Acts introduced a wider debate surrounding the role of the state in attempting to “control the behaviour and morality” of society.[10]  Jose and McLoughlin agree that this intervention was controversial among contemporaries.  The philosopher John Stuart Mill, for example, publicly opposed the Acts, arguing that they took away “the security of personal liberty”.[11]  In his report Simon acknowledges that this surveillance system was originally put in place to protect the army and navy.  Judith Walkowitz argues that the initial support for the Acts was based on their status as “national defence legislation”.[12]  However, regarding the proposal for “the extension … to the civil population”, Simon questions whether the state’s previous laissez-faire approach should be “abandoned”.[13]  As Saunders highlights, some contemporaries supported this public extension; for example, Dr Elizabeth Garrett Anderson believed that further state intrusion would protect family members of those infected with venereal diseases.[14]  This suggests that contemporaries approved of state intervention as a new and growing concept.  However, Margaret Hamilton argues that there was sufficient opposition to this, for example, Josephine Butler believed that the Acts were “unconstitutional because they violated the basic liberties of English women”.[15]  This highlights that a complex debate surrounding public health state intervention existed in the latter half of the nineteenth century.

The pioneering female doctor Elizabeth Garrett Anderson contributed to the debate over state intervention in sexually-transmitted disease. Wellcome Library 12778i,

Simon explains that the state referred to prostitutes as “dangerous members of society”, who should be “prevented from communicating [disease] to others”.[16]  Luddy argues that this perspective helped to facilitate a “double standard of sexual morality”.[17]  Pamela Cox agrees that class and gender impacted the treatment of venereal diseases, as women were subject to more coercive sexual governance than men.[18] Fundamentally, the report explains that the extension of the Contagious Diseases Act to the general population would result in common prostitutes across Britain being subject “to a compulsory medical examination, and to compulsory detention”.[19]  The repetition of “compulsory” again emphasises the lack of freedom prostitutes had under this forcible legislation.  Simon argues that the network of examination and treatment is “not likely to be met by voluntary contributions”.[20]  However Catherine Lee provides evidence from Kent to demonstrate that compliance to the Contagious Diseases Acts was in fact high, for example, in Canterbury in 1871, only two prostitutes were prosecuted for non-compliance.[21]  Lee suggests that poor women complied with the Contagious Diseases Acts to access free medical care.[22]  Some prostitutes used medical inspections to capitalise profit, through advertising “disease-free status”.[23]  However, Simon argued that tax payers would find it “immoral” to pay for the medical expenses of a prostitute so that she is “clean for hire”.[24]  This demonstrates a wider debate about the funding of state intervention.  Overall, the debate surrounding the extension of the Acts was based on both moral and economic factors.

Social reformer Josephine Butler also took part in the debate.

Simon held the view that “venereal diseases are … infections which a man contracts at his own option”.[25]  It was not the responsibility of the state to intervene and treat them, “the true policy of government is to regard the prevention of venereal disease as a matter of exclusively private concern”.[26]  Walkowitz argues that despite the Acts, “many officials continued to believe that sexual promiscuity among civilians rightly constituted a private medical risk for the parties concerned”.[27]  Additionally, the phrase caveat emptor [let the buyer beware], used by Simon in his report, suggests that customers of a prostitute should check the quality of ‘goods’ before purchase.[28]  Saunders highlights the economic difference between men and women, as buyers and sellers in this sexual exchange.[29]  Simon acknowledges that innocent wives can be infected with venereal diseases which cheating “husbands … have earned”, but remains clear on his view that the state should not intervene to protect dependents.[30]  Saunders highlights how Dr Garrett Anderson disagreed, instead promoting the compulsory treatment of prostitutes to “end the suffering of innocents”.[31]  However, this report was published in 1870, before the repeal of the Contagious Diseases Acts in 1886, and it does not explain the exact reasons for the repeal or whether compulsory state intervention had worked.  Nonetheless, Walkowitz states that Simon’s report “ended any immediate prospects for the extension of the Acts to civilian areas in Britain”.[32]  Simon’s respectability as a health officer contributed to the argument opposing the extension of the Contagious Diseases Acts.

Group portrait of medical staff at St Thomas's hospital, London, with Sir John Simon on the right, Wellcome Library no. 569770i

Medical staff at St Thomas’s hospital, London, with Sir John Simon on the left, Wellcome Library no. 569770i

In conclusion, Simon argued against the extension of the 1866 Contagious Diseases Act to the general population.  Government intervention reflected a sexual double standard, with women being subject to immoral control.[33]  Yet there was support for the extension from contemporaries who wanted further protection from venereal diseases.[34] These arguments formed as part of a wider, more complex debate on state intervention.  Overall, the delay of this extension and the repeal of the Acts shows that forced sexual governance in Britain during the nineteenth century was unsuccessful.


[1] Peter W. Bartrip, “State Intervention in Mid-Nineteenth Century Britain: Fact or Fiction?”, Journal of British Studies Vol 23, No. 1 (1983): 63.

[2] Maria Luddy, “Women and the Contagious Diseases Acts 1864-1886”, History Ireland Vol. 1, No. 1 (1993): 32.

[3] Ibid.

[4] Jim Jose and Kcasey McLoughlin, “John Stuart Mill and the Contagious Diseases Acts: Whose Law? Whose Liberty? Whose Greater Good?”, Law and History Review Vol. 34, No. 2 (2016): 250-251.

[5] Lisa Shapiro Saunders, “‘Equal Laws Based upon an Equal Standard’: the Garrett Sisters, the Contagious Diseases Acts and the Sexual Politics of Victorian and Edwardian Feminism Revisited”, Women’s History Review Vol. 24, Issue. 3 (2015): 397.

[6] A. N, “The Life Work of Sir John Simon”, The Journal of Hygiene Vol. 5, No. 1 (1905): 1-6.

[7] John Simon, ‘Report on the Contagious Diseases Act (showing the expense, impolicy and general inutility of its proposed extension) to the civil population’ (1870).

[8] Margaret Hamilton, “Opposition to the Contagious Diseases Acts, 1864-1886”, Albion Vol. 10, No. 1 (1978): 14.

[9] Ibid.

[10] Luddy, “Women and the Contagious Diseases Acts 1864-1886”: 34.

[11] Jose and McLoughlin, “John Stuart Mill and the Contagious Diseases Acts: Whose Law? Whose Liberty? Whose Greater Good?”: 250-251.

[12] Judith Walkowitz, Prostitution and Victorian Society: Women, Class and the State (Cambridge: Cambridge University Press, 1980), 73.

[13] Simon, ‘Report’

[14] Saunders, “‘Equal Laws”: 396.

[15] Hamilton, “Opposition to the Contagious Diseases Acts”: 16.

[16] Simon, ‘Report’.

[17] Luddy, “Women and the Contagious Diseases Acts 1864-1886”: 32.

[18] Pamela Cox, “Compulsion, Voluntarism and Venereal Disease: Governing Sexual Health in England after the Contagious Diseases Acts”, Journal of British Studies Vol. 46, Issue 1 (2007): 111-113.

[19] Simon, ‘Report’.

[20] Ibid.

[21] Catherine Lee, “Prostitution and Victorian Society Revisited: the Contagious Diseases Acts in Kent”, Women’s History Review Vol. 21, Issue. 2 (2012): 301-309.

[22] Ibid: 312.

[23] Lee, “Prostitution”: 312.

[24] Simon, ‘Report’.

[25] Simon, ‘Report’.

[26] Ibid.

[27] Walkowitz, Prostitution, 72.

[28] Simon, ‘Report’.

[29] Saunders, “‘Equal Laws”: 398.

[30] Simon, ‘Report’.

[31] Saunders, “‘Equal Laws”: 396.

[32] Walkowitz, Prostitution, 86.

[33] Luddy, “Women and the Contagious Diseases Acts 1864-1886”: 32.

[34] Saunders, “‘Equal Laws”: 397.



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