Sexually transmitted diseases and the Raj.

India was the centrepiece of the British Empire, “the chief jewel in the imperial crown”. After the mutiny of 1857–8 it came under direct British rule, and was a major source of national pride.Queen Victoria had an almost obsessive interest in the subcontinent. Although she never visited India herself, her various homes were full of Indian memorabilia and she employed many Indian servants, some of whom were said to exercise an undue influence on her. In 1876, at her express wish, an act was passed at Westminster which declared her “Empress of India”. A whole department of the British government was devoted to Indian administration, and many people worked there all their lives. The military presence was strong; there were never less than 60 000 soldiers of the British army stationed there, and in addition there was a large Indian Army staVed by British oYcers. Many oYcers in the Royal Medical Corps served in India (fig 1), and other doctors joined the Indian Medical Service and worked in hospitals and academic institutes. In the 19th century India was an unhealthy place in which to live. Malaria, cholera, dysentery, and smallpox were endemic, and there were periodic outbreaks of other infectious diseases. Syphilis reached the subcontinent in the 16th century and soon became widespread. Sexually transmitted diseases (STDs) have always been a problem in armies and by the middle of the century it became clear that the army in India was severely aVected. In many of the principalities the average annual admission of British troops to hospitals for venereal infections, predominantly syphilis and gonorrhoea, was over 200 per 1000; by 1895 this reached over 500 per 1000. In those days treatment was usually prolonged, and the loss of eVective manpower was enormous. The authorities were seriously concerned. One viceroy, writing to the secretary of state for India, acknowledged that “the strength of the British Army in India as a fighting machine has been much impaired by these diseases”. The explanation of the problem seemed obvious at the time. The majority of British soldiers were aged less than 30 years; most were unmarried, and those who were married had left their wives at home. The men were inexperienced, in unfamiliar surroundings, and often underoccupied and bored. Recourse to prostitutes, the source of infection, was inevitable and understandable. Among Indian soldiers the reported incidence of venereal diseases was lower; in 1866, for example, the rates of infection for British and Indian troops were respectively 218 and 54 per 1000. The doctors did their best to explain this diVerence away. It was suggested that native troops concealed their condition or resorted to quacks, or possibly, that they had become partially immune through frequent exposure. Nobody would entertain the idea that Indian soldiers might be less promiscuous than the British. The management of STDs was the responsibility of medical oYcers in the Royal Army Medical Corps. It usually required inpatient