Medicine, morality, and political culture Legislation on venereal disease in five Northern European countries, c. 1870 – c. 1995
nordic academic press
Nordic Academic Press P.O. Box 1206 SE-221 05 Lund Sweden www.nordicacademicpress.com
© Nordic Academic Press and Ida Blom 2012 Typesetting: Karin Österlund Jacket design: Design för Livet Jacket image: ‘Albertine in the police physician’s waiting-room’ (1885–1887) by Christian Krohg. Photo: National Museum of Art, Oslo, Norway. Printed by ScandBook, Falun 2012 ISBN 978-91-85509-73-7
Contents Preface Introduction
part i different solutions in scandinavia 1. The European background
2. A ‘Scandinavian Sonderweg ’ ?
3. From coercion to voluntary expedients?
Sweden and Denmark in the long nineteenth century Changing municipal by-laws in Norway, 1888–1910
part ii a ‘scandinavian sonderweg’ 4. Separating prostitution from disease?
5. Norway – the long road to national legislation
The Danish law of 1947
6. National variations, international differences
part iii abolishing special legislation on venereal disease 7. From syphilis to HIV/AIDS
8. Path dependence or reform capability Five Northern European countries, 1947–1994
About the author
Introduction How to contain infectious disease? The answers to this question have varied down the ages. For centuries, disease was seen as God’s punishment for sinful behaviour, and it was thought that Christian morals would offer the greatest protection. When cholera pandemics swept the world in the nineteenth century, quarantine was thought best in stopping contagion. Medical disputes over whether this or sanitary measures would be most effective raged for decades, but in the meantime isolating the sick became central to the attempted control of diseases such as leprosy and tuberculosis. Among these infectious diseases was venereal disease. Unlike plagues and cholera, VD did not attack large groups of people simultaneously. Neither did it result in sudden and pronounced suffering, nor in rapid death. It proved difficult to prevent the spread of both syphilis and a more common disease, gonorrhoea. Although both were contagious, they were also endemic; isolation was powerless against them. Add to this the fact that syphilis was especially hard to diagnose. If not cured, VD had very serious consequences, but effective cures proved elusive. For centuries, mercury treatment was among the most important re medies the medical profession could offer, which explains the old saying, ‘A night with Venus, a lifetime with Mercury’. If for some a night with Venus was an exciting event, a life with mercury was certainly not a pleasant experience. Mercury treatment was expensive and prolonged, and had serious side-effects.1 The alternative was to avoid nights with Venus altogether. Thus from the beginning sexual morality was intimately intertwined with medicine. Medicine may be defined both as attempts to prevent disease, such as quarantine and isolation, and as ‘the art of restoring health’, hence the mercury treatment. Morality refers to ‘a particular system of morals’,2 and may be said to concern both sexual morality and what may be termed the morality of citizenship. Sexual morality was strongly gendered throughout the nineteenth century and for at least the first half
medicine, moralit y, and political culture of the twentieth century. Female sexuality was seen as dormant until marriage and important mainly in terms of procreation; prostitutes were thought of as deviant females on the hunt for easy money. Respectable men were expected to show self-restraint in sexual matters; however, many thought of male sexuality as a strong urge that had to be met in order to prevent damage to men’s mental and physical health.3 Given that age at marriage was high, this might make it difficult for many men to avoid extramarital sex. Consequently, men were seen as especially in need of protection against VD. One response to this was stricter medical checks on prostitutes. However, expectations as to the proper behaviour of a good citizen gradually changed. Widely accepted sexual norms were slowly transformed as the Victorian world of gender differences gave way to more liberal attitudes. During the last decades of the twentieth century, increasing acceptance of homosexuality brought heteronormativity into question. This change also left its mark on approaches to VD. The term ‘morality of citizenship’ refers to the principle that all citizens should have the same duties and the same rights. Where contagious diseases are concerned, the responsible citizen is duty-bound to behave in a manner that protects society as such from contagion. Similarly, rights would denote the right to free treatment, regardless of personal economic resources. Thus the morality of citizenship brings us to the concept of the welfare state. The period from the late nineteenth to the late twentieth centuries saw the gradual construction of various types of welfare state. In a number of ways, legislation was adopted to assist specific sections of national populations with certain social and health problems. A socialdemocratic welfare state dominated in the Nordic countries, while a conservative welfare state developed in Germany and a liberal welfare state evolved in Britain. I shall investigate how the two concepts – medicine and morality – came together in legislation on venereal disease. The focus will be on the three Scandinavian countries, Sweden, Norway, and Denmark, but their legislation will be compared to German and British legislation of the same period in order to consider how the three different political cultures differed or converged in the question of VD. A few examples of how legislation was implemented will be presented, but this is not the main theme of the book.
Nordic political culture It is generally assumed that Nordic social policies during the nineteenth century and especially the twentieth century largely followed the same pattern. Researchers have proposed a special Nordic model of the welfare state and family policies.4 Long democratic traditions and a balance between local and central authorities have been seen as legitimating a strong state and a large public sector. National legislation has promoted welfare policies that rest on the principles of equality, universality, and public funding. Indeed, the cultural construction of the concept of ‘Norden’ – the Nordic countries of Denmark, Sweden, Norway, Finland, and Iceland – has been analysed by Nordic historians in order to understand the traditions that left them comparatively peaceful and democratic nations.5 This view is strengthened when gender is added to the mix. Gender relations in the Nordic countries follow a common pattern that differs substantially from those seen in Britain and on the Continent.6 Finally, a largely homogenous Nordic population has found a shared understanding of Christianity in the shape of Lutheranism. Dialogue and compromise, not confrontation and revolution, have been seen as characterising the Nordic countries, in contrast to other parts of Europe. For a short period in 1918, a civil war made Finland the exception to this rule. Social scientists have discussed the fundamental characteristics of the welfare states.7 They have found that regardless of how they are characterised, the Nordic countries clearly belong to the same welfare regime, quite distinct from the welfare states constructed in Germany and Britain. The Danish social scientist Gøsta Esping Andersen started the debate by distinguishing between three different kinds of welfare state.8 He saw the social-democratic welfare state as typical of the Nordic countries. Huber and Stephens agreed with Esping-Andersen, while Walter Korpi and Joakim Palme had minor reservations about placing Denmark in the same group as the other Nordic countries. However, all these researchers agreed that Britain belonged among what they termed the liberal welfare states – states that offer a basic safety net – and that Germany should be placed with the group that Esping-Anderson called conservative welfare states. Korpi and Palme saw Germany as belonging to a group of corporative welfare states, while Huber and Stephens labelled Germany a Christian Democratic welfare state.9 Whatever the criteria for grouping welfare states, the
medicine, moralit y, and political culture Nordic welfare states have shown a remarkably common pattern, distinguishing them from both Germany and Britain. This makes it interesting to study the degree to which such similarities and differences may be also observed in legislation on VD. The political cultures characterising the German and British welfare states will be discussed in Chapters 6 and 8, where Scandinavian legislation is placed in a wider perspective. The idea of a Nordic model of welfare springing from a common political culture is strengthened by the largely parallel chronology of welfare policies.10 The late nineteenth and early twentieth centuries have been characterised as the period of ‘the social-assistance state’. Poor-law provision was supplemented by the activities of charitable organisations, and some municipalities embarked on social policies later to be adopted by national authorities.11 The inter-war period was characterised by a gradual weakening of the various conservative and liberal parties. The parallel growth of social-democratic parties was more controversial in Norway than in the other two Scandinavian countries, yet even so the 1930s saw broad political compromise pave the way for a number of new national welfare initiatives across the whole of Scandinavia.12 The ‘golden age of welfare’ constituted the third period, stretching from the 1950s to the 1970s. The principles of universalism and public funding were applied to a number of social policies. Class divides dwindled, and second-wave feminism and the student movement challenged long-accepted norms of behaviour.13 A fourth and final stage covered the last decades of the twentieth century and was characterised by a growth in the pursuit of individualism and by opposition to state intervention. As Anne-Lise Seip has put it, the welfare state showed signs of developing into a welfare market.14 Despite all these commonalities, historians have recently questioned the idea that there was one welfare-state regime common to all the Nordic countries. Detailed research on how the central elements of the welfare state were constructed in the five Nordic countries found that they all followed very specific paths and to some degree chose different solutions to similar problems. The concept of a Nordic model of welfare is now being characterised as ‘a model with five exceptions’.15 A gender perspective confirms this pattern. Though the Nordic gender order continues to differ from that of Germany and Britain, in some respects it also varies among the Nordic countries.16 Further, it has
introduction been shown that the principles of universality and public funding, which give all citizens the same right to welfare benefits and are seen as centra足l to the Nordic model of welfare, are not without their important exceptions. Welfare provision was primarily aimed at wageearners in state employ, while people in the private sector were given special treatment or were simply not included. This principle was also in many respects disadvantageous for married women, who were dependent on their husbands to provide for them. Thus class and gender gave rise to uneven distributions of welfare benefits.17 As will be shown in the present book, views on sexual morality further complicated the concept of universal rights in welfare systems. Finally, the influence of the social-democratic parties in constructing the welfare state has been questioned, since liberal and even conservative parties have also been actively involved in welfare policies. The means to the desired end was often political compromise or consensus.18 Welfare policies in the Nordic countries display a number of national differences, while a comparison of Nordic welfare policies with those of other nations tends to stress the special nature of Nordic courses of action: the chosen level of analysis seems important in determining the result. Here I shall limit myself to a standard set of Nordic countries: Denmark, Norway, and Sweden, the three countries that make up Scandinavia. Similarities in the political culture of the Scandinavian welfare states make these countries especially interesting when studyin足g not only similarities in political approaches to VD, but also the possibl足e differences. By analysing a variety of Scandinavian legislation, I shall highlight the shifting impact of medicine and morality on the political discourse and point to the parallels, or lack therof, with the main characteristics of the welfare policies. Finally, I shall discuss how and why Scandinavian VD legislation resembled or differed from legis足 lation adopted by two other political cultures the German and British welfare states. My intention is to shed light on what distinguished the Scandinavian policies and where these five Northern European welfare states showed a similar reaction to VD. In a number of articles published in the past eight years I have studied various aspects of this theme.19 In rethinking my earlier research and adding unpublished material, I analyse here how the medicine, morality, and political culture that characterised the growth of welfare states came together in legislation on VD.
medicine, moralit y, and political culture
International comparisons For the historian, international comparisons offer special problems, but also special opportunities. The immediacy of the source material may easily be lost in the more generalised observations of the social science approach. To make up for this, I offer a close reading of parliamentary documents relevant to Danish and Norwegian legislation. A thorough knowledge of how Danish and Norwegian laws were made helps in framing the issues to be addressed when relying on research by other historians, as is the case for Sweden, Germany, and Britain. As the Swedish historian Klas Åmark has pointed out, where social scientists look for the wider pattern, historians want to study complexities and contextualisation.20 The advantage of an international comparison is that comparing general structures may help the historian see the uniqueness of the policies adopted in each country and at the same time the similarities and differences across national boundaries.21 The Northern European countries featured in this study lend themselves to this approach. The political culture of the five Nordic countries is sufficiently similar to make differences interesting, which comes out very clearly when the policies chosen in the individual Scandinavian countries reveal variations in the Nordic model of welfare, and when similar legislation in Germany and the Scandinavian countries so clearly results from different political cultures. Although the British approach to VD legislation throughout the period derived from a political culture that in many respects differed fundamentally from that of the other four countries in question, some similarities across national borders are nevertheless to be found. International comparisons thus help generate a nuanced understanding of the route taken in each country. The final decades of the nineteenth century saw intense discussions on how best to cope with VD. This was a time when political citizenship was reserved for men, sometimes still to the exclusion of poor men. All women were left without suffrage. Yet that did not mean that women had no influence on political decisions. A growing number of voluntary organisations served as mouthpieces for women’s opinions on a number of problems, not least on questions of sexual morality. Gradually, the definition of who should have political citizenship and who was regarded unworthy changed. National suffrage was widened first to include all men and finally all women. The morality of citizenship shifted. The growth of political parties and the increasing impact of parliaments on