treatment which was provided in the hospitals
attached to cantonments (permanent military
stations). There were no specialist venereolo-
gists in India before 1910, but there was an
army adviser who laid down treatment sched-
ules, and special wards were provided for “dif-
ficult cases” in military hospitals in Britain.
Because of the time taken to travel from India,
these diYcult cases were predominantly men
with postgonococcal urethral strictures and
late syphilis; acute complications of STDs
were treated locally. There had been lock hos-
pitals in India since 1805, but these were
intended for the treatment of infected prosti-
tutes and for those who were the victims of
venereal insontium, syphilis among the inno-
cent; they were not patronised by the military.
After the first world war special centres for the
treatment of STDs in the armed forces were
opened throughout India, staVed by service
medical oYcers who had received special
training in venereology. There was a
consultant venereologist in Delhi, and four
expert advisers in venereology attached to
large centres, who performed clinical as well as
administrative work.
6
In the oYcial statistics venereal diseases were
classified as syphilis, gonorrhoea, and soft
chancre (now called chancroid); some units
added “extras” like bubo, genital abscess,
phimosis, and so on. The commonest diagnosis
was gonorrhoea, followed by chancre, then
syphilis. For unexplained reasons syphilis was
relatively more common, and gonorrhoea less
common, in the Indian army than in the British
army in India. Until well into the present cen-
tury diagnosis in India was clinical. In the case
of male gonorrhoea this did not matter much,
but a clinical diagnosis of gonorrhoea in
women is a shaky proposition. Although the
gonococcus had been discovered in 1879, the
examination of stained smears did not come
into general use until the turn of the century.
Harrison
7
recorded his examining cervical
smears from prostitutes in India in 1903, but
he had been trained as a bacteriologist. It was
too much to expect station medical oYcers to
undertake this then. Culture of Neisseria gonor-
rhoeae as a diagnostic aid was little used in
Europe at this time, and not at all in India.
Dark ground microscopy and the Wassermann
reaction were available after 1906, but techni-
cal problems and poor microscopes delayed
their use in the army.
Eventually, when proper training of vener-
eologists began in around 1910, microscopy
and serology came into general use throughout
the Empire. Before this, many cases of early
syphilis were either diagnosed as chancroid or
missed altogether. To settle the diagnosis,
atypical cases were sometimes left untreated to
see whether or not they developed secondary
syphilis.
6
This unsatisfactory practice was also
sometimes used in Britain. The diagnosis of
chancroid was, as so often before and since,
often dubious; many men with this diagnosis
actually had syphilis, herpes, phagedaena, or
other kinds of ulceration. Non-gonococcal ure-
thritis was common, but was not recorded in
oYcial statistics.
Treatment of STDs in India followed the
methods used in England. Since the 18th cen-
tury gonorrhoea had been treated with urethral
lavage. In India, various urethral antiseptics
were used; in the early days astringents such as
alum or zinc sulphate were favoured, but these
were replaced by silver nitrate or organic silver
salts. Some of these were intensely irritating,
and no doubt caused many cases of epididymi-
tis and urethral stricture. At the end of the cen-
tury, Janet’s method of urethral irrigation with
large amounts of dilute antiseptic solutions was
adopted in Europe and, soon after, in India.
The antiseptic was a matter of choice. A senior
colleague told Harrison
7
that “it did not matter
what lotions one used, as long as one did not
forget the water”; in the end, potassium
permanganate was most often used. The appa-
ratus for the irrigation varied between units
and some had a distinctly homemade look.
Nevertheless, lavage was thought to be eVec-
tive, and it stayed in use until the advent of sul-
phonamides in the late 1930s, and penicillin in
1944.
The mainstay of the treatment of syphilis in
the 19th century was mercury. In India,
mercurial preparations had been in use for
years for the treatment of many non-venereal
complaints, and its side eVects were well
known. In the case of syphilis, the army
authorities did not like oral treatment with
mercury compounds because of gastrointesti-
nal side eVects and the diYculty of securing
compliance. Inunctions were ruled out as too
labour intensive and in the end, a course of
injections of mercuric chloride or calomel was
recommended, although they were painful. In
1903 the expert adviser to the army at the time
proposed repeated injections of “mercurial
cream”, also known as “grey oil”, a suspension
of metallic mercury in oil and fat which had
been devised by Lange in Vienna in 1887. This
was alleged to be less painful and it remained in
use until the advent of organic arsenicals after
1910. Courses of treatment were supposed to
last for two years, but there were administrative
problems in maintaining these in men who
were from time to time posted to other stations,
or indeed sent home. Unless “destructive”
lesions were present soldiers under treatment
could, after the first few injections, perform
ordinary duties, but they were not allowed to
take part in active service. The results of even a
course of mercury treatment considered to be
optimal were disheartening. Harrison noted
that 83% of a group of 371 soldiers had clinical
relapses—some actually occurred during the
course of treatment. Furthermore, in some sta-
tions men with syphilis did not receive the rec-
ommended course of treatment, but only a few
doses of oral mercuric chloride. There can be
no doubt that in the army in India many men
with syphilis were seriously undertreated. As a
result, destructive lesions due to late syphilis
were not uncommon, particularly aVecting the
face, mouth, and nasopharynx. Such patients
were often seen in the syphilis wards of the
military hospital at Netley, in Hampshire—
wards which were known as “the inferno”. In
an oYcial report Lord Onslow described the
Sexually transmitted diseases and the Raj 21