A typical case

Having triumphed over technology and finally managed to set up this blog, I found myself contemplating the most suitable subject for my first proper post. In the end, it seemed only appropriate to introduce the subject that has occupied and fascinated me for the last three years: venereally diseased patients and those responsible for their care. One of the best and most enthralling ways to do this, I have found, is through individual case notes.

So …

In June 1910, ten-year-old Dotty was brought to the outpatient department of the Royal Free Hospital suffering from vaginal discharge, ulceration of the vulva and painful micturition. Specimens sent to the pathological laboratory were found to contain gonococci – the causative microorganism of gonorrhoea. Dotty also developed a rash that, according to the attending clinical clerk, resembled secondary syphilis. A serodiagnostic Wassermann reaction later confirmed the presence of spirochætæ. Yet the case notes suggest that, although the clerk suspected the presence of syphilis, they could not confidently make an empirical diagnosis. Dotty had not improved by July so was admitted as an inpatient. Over the next month the clerk compiled detailed notes about her physical symptoms and her treatment. She received injections of mercury into the groin but salvarsan, Paul Ehrlich’s newly developed arsenical-chemotherapeutic drug, does not appear to have been administered. Dotty was discharged in August as ‘relieved’ rather than cured but was not advised to attend as an outpatient for continued treatment.

Despite significant developments in venereological knowledge and laboratory-based technologies, changes at the coalface of clinical practice were slow and complex. Patient case notes are particularly reflective of uncertainties and clinical limitations. I know I’m already preaching to the converted when I say this, but it’s anachronistic to think of these men and women as confused, unenlightened or simply unaware of the scientific ‘truths’ that are now viewed as orthodox. Developments in medical knowledge were not only driven by ‘eureka’ moments but also by the mistakes, dead ends and accidents that characterised the laborious process of research and clinical practice. And the value of these developments was determined by their usefulness in day-to-day clinical practice.

Unearthing records of venereological practice from the dark recesses of hospital archives is a laborious (and often disheartening) process. The anticipation of opening a new box of records easily gives way to feelings of monotony and futility. It becomes sadly apparent that each new box contains little, if any material relevant to my specific field of research. No venereal disease-induced miscarriages. No tabes dorsalis. No ophthalmia neonatorum.

[Sighs. Replaces lid. Returns dusty box to friendly archivist]

But sometimes, just sometimes, some quite remarkable gems are found in those dusty boxes. It is incredibly satisfying to uncover records of venereal disease but these records are often mere vignettes of clinical practices and patient experiences. When presented with collections of schematic and barely legible case notes (often scrawled by ill-equipped or overworked undergraduate clinical clerks and dressers) it is easy to forget that we are reading about real people and their very real suffering.

Dotty’s secondary-stage syphilis might have been the result of a congenital infection but no family history of syphilis could be obtained. She also had gonorrhoea. This suggests that sexual intercourse was a more likely mode of transmission. Was Dotty the victim of a ‘virgin cure’? Was she a child prostitute? The record is unclear. What is clear is that she was a young girl in great distress. Yet her case notes, preoccupied with the results of laboratory tests and the efficacy of treatment, do not record her feelings or speculate upon the social circumstances that led to her infection. Dotty’s case is just one among many that I have come across. They may say little about the lives and subjectivities of the patients themselves but, taken collectively, they do demonstrate the vast array of ideas, practices and debates that characterised the study, diagnosis, and treatment of venereal disease at the turn of the twentieth century.

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Posted in VD

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