The Perceptions of Pregnancy blog, like the Researchers’ Network, aims to reach beyond boundaries and borders, and to facilitate an international and interdisciplinary conversation on pregnancy and its associated bodily and emotional experiences from the medieval to the modern. Today’s post on reproductive complications arising from syphilis and gonorrhoea is contributed by medical historian Anne Hanley.

In 1895 the medical practitioner and eugenicist, Arabella Kenealy, wrote a letter to the editor of the British Medical Journal, recounting a house call made to a heavily pregnant and syphilitic woman. According to Kenealy, the diagnosis was ‘indubitable’. The patient, ‘a wreck of a young woman’, had suffered three miscarriages in rapid succession, followed by the birth of a child who demonstrated clear symptoms of congenital syphilis. She had since suffered another two miscarriages and was again pregnant but hemorrhaging.

After stopping the haemorrhage and preventing a miscarriage, Kenealy was led to ‘a handsome library’ where she began penning her ‘mercurial prescription’. However, she was distracted from her prescribing by a noise in a distant corner. ‘On a low stool with its head supported heavily on long, lean-fingered hands, a child of some four or five years was sitting, watching [her] out of mournful eyes.’ After rising with great difficulty, this sickly child dragged itself across the library towards Kenealy. She went on to recount her horror and overwhelming pity as she ‘looked down on the bulging head and thin hair, the sunken nose, overhung by prominent brows, and the dull, joyless eyes’ of a child blighted by congenital syphilis. So appalled was Kenealy by this child’s suffering that she tore up her prescription, concluding that the mother must be carrying a similarly diseased child that ‘Nature, abhorrent, was striving to cast off’. Drawing upon her eugenic principles, she questioned whether practitioners were right in their attempts to ‘combat Nature in her effort to abort so monstrous a “degenerate”’. Her letter concluded with an appeal to her fellow practitioners. ‘Will somebody advise me’, asked Kenealy, ‘if I did well in this case when I withheld mercury and left Nature to the promptings of her conscience, instead of abetting a crime so great as that of the birth of such a child as laid its dull misshapen head against my knee that morning?’[1]

Although probably based upon a genuine case of venereal antepartum complication and congenital infection, Kenealy’s melodramatic account of wrecked womanhood, infertility, and degeneration also drew heavily upon the literary style of New Woman novelists as well as the intersecting eugenic ideas about hereditary and racial decline.[2] Her letter is the first recorded case of a qualified female doctor diagnosing and treating venereal diseases in England. It illustrates several important turn-of-the-century problems confronted by doctors in their attempts to treat and prevent infertility and congenital infection resulting from venereal diseases. As R.A. Gibbons lamented during a lecture given to postgraduates at the London Medical Graduates’ College and Polyclinic in 1911, sterility inflicted ‘such mental suffering and such misery’ that it behoved general practitioners and specialists alike to devote much attention to its study, diagnosis and treatment.[3] The gonococcus may have been identified in 1879 but bacteriological testing was a difficult process and slow to be widely adopted in general practice.[4] The causative microorganism of syphilis, the spirochæte, was not identified until 1905 and the serodiagnostic Wassermann reaction was not developed until 1906. In 1895 Kenealy, like many of her medical contemporaries, therefore found such cases of reproductive complication to be clinically and ethically challenging.

By the turn of the twentieth century, medical authors were focusing upon the diagnosis and treatability of reproductive complications among women, who, they now believed, were the principal victims of infertility resulting from venereal infection. (Unless a man was also impotent, few doctors were prepared to declare him infertile.[5]) Yet female infertility resulting from venereal diseases was almost as diagnostically challenging. On the one hand, women might be unable to conceive or they might conceive and then miscarry or suffer stillbirths. On the other hand, gonorrhoea and syphilis could produce troubling physiological conditions in children that infected women were able to carry to full term. Children might be born with congenital syphilis (as in the case attended by Kenealy) or with gonorrhoeal ophthalmia neonatorum.[6] Yet others might demonstrate no discernible signs of infection. For example, in 1891 the gynaecologist, George Bantock, criticised Emil Noeggerath and his supporters such as William Japp Sinclair, professor of obstetrics and gynaecology at the University of Manchester, who argued that gonorrhoea caused innumerable cases of sterility among women and men. Bantock challenged Noeggerath’s argument by calling attention to the many newborns who developed ophthalmia neonatorum following the transmission of gonococci from their mothers.[7]

The fact that many infertile women did not demonstrate clear signs of venereal infection and the fact that many were able to carry children, infected or otherwise, to full term meant that the venereal aetiology of infertility remained a subject of medical debate and uncertainty for many decades. A complex collection of competing hypotheses created problems when attempting to understand and anticipate the effects of venereal diseases upon women’s reproductive health. A focus upon congenital infection and upon those complications resulting from venereal diseases during pregnancy meant that infertility was comparatively overlooked. At the turn of the twentieth century the unpredictable affects of venereal diseases upon individual women meant that the aetiology of their reproductive complications was not necessarily diagnosed or even diagnosable.

About the Author

Anne Hanley has recently submitted a PhD in medical history to the University of Cambridge. Her doctoral research addressed the developing clinical practices, knowledge claims, and professional debates that were instrumental in building up knowledge of venereal diseases in England during the late-nineteenth and early-twentieth centuries. She is now taking this research forward into the First World War and the interwar years, examining important shifts in government policy and healthcare provisions. Her previous work on venereal diseases and pregnancy has been published as ‘“Scientific truth into homely language”: The training and practice of midwives in ophthalmia neonatorum, 1895-1914’, Social History of Medicine (2014): 199-220. Her blog and more about her research can be found here.

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[1] Arabella Kenealy, ‘A Question of Conscience’, BMJ (14 September 1895), 682.

[2] See, for example, Sarah Grand, The Heavenly Twins (London: William Heinemann, 1893).; Angelique Richardson, Love and Eugenics in the Late Nineteenth Century: Rational Reproduction and the New Woman (Oxford: Oxford University Press, 2003).

[3] R.A. Gibbons, A lecture on sterility: Its aetiology and treatment. Delivered at the Medical Graduates’ College and Polyclinic on July 21, 1910 (London: J and A Churchill, 1911), 5.

[4] Michael Worboys, ‘Unsexing Gonorrhoea: Bacteriologists, Gynaecologists, and Suffragists in Britain, 1860-1920,’ Social History of Medicine (2004): 41-59.; George Granville Bantock, ‘On the importance of gonorrhoea as a cause of inflammation of the pelvic organs’, BMJ (4 April 1891), 749-51.; George Granville Bantock, ‘The modern doctrine of bacteriology, or the germ theory of disease’, BMJ (8 April 1899), 846-48.

[5] See, for example, Samuel W. Gross, A practical treatise on impotence, sterility, and allied disorders of the male sexual organs (Edinburgh: Young J. Pentland, 1887).; Gibbons, A lecture on sterility.

[6] Elizabeth Lomax, ‘Infantile Syphilis as an Example of Nineteenth Century Belief in the Inheritance of Acquired Characteristics’, Journal of the History of Medicine (1979): 23-39.; Anne Hanley, ‘“Scientific truth into homely language”: The training and practice of midwives in ophthalmia neonatorum, 1895-1914,’ Social History of Medicine (2014): 199-220.

[7] Bantock, ‘On the importance of gonorrhoea as a cause of inflammation of the pelvic organs’, 751.