How 19th century "harlot wards" scrutinized women's bodies in the name of public health
Sex work is often referred to as the world’s oldest profession, but rarely as the world’s most scrutinized profession. Yet throughout history, few groups of people have been more intently watched—or had their bodies more closely inspected—than sex workers. The motivations behind this near-obsession have shifted over centuries, but they don’t stray too far from the idea that sex work is either an inherently immoral act or a public health hazard—or sometimes both. At the highest legislative levels, this has resulted in the development of countless regulatory systems that combine moral, legal, and medical concepts in grand attempts to regulate the lives and labor of sex workers.
In the early 19th century, Europe was a hotbed of such experiments. As more people flocked to live in urban centers, European states struggled with the question of how to regulate sex work, by then a highly visible form of women’s labor. Although it was considered immoral and contrary to good customs, sex work served the useful purpose of, as one Portuguese scholar writes, “meeting the affective and sexual needs of men.” The concept of sex work was intrinsically connected to the concept of masculinity: If one was viewed as a necessary evil, it was only because the other was seen as an indomitable, uncontrollable force that demanded constant attention.
It was this tension that gave rise to regulationism, first in France, then all over Europe. Under regulationism, sex work was tolerated (but never, ever endorsed) as long as it complied with a narrow set of regulations imposed by the state. As an obvious consequence, sex workers who could not or would not comply with the endless regulations continued to be treated as criminals. If such a system is recognizable, it’s because many of its tenets remain in place to this day under the updated name of “neo-regulationism” in European countries, such as Germany and the Netherlands.
Portugal was an early adopter of regulationism. In 1838, the government’s top authority for matters of health and hygiene issued the “Regulamento Policial e Sanitário para Obviar os Males Causados à Moral e à Saúde pela Prostituição Pública” (Police and Health Regulations to Prevent the Evils Caused to Moral and Health by Public Prostitution), a set of laws that technically allowed sex workers to do their job while subjecting them to endless legal and medical scrutiny. While the text was ostensibly directed at the women engaged in sex work, in the sense that it defined strict rules of engagement for their everyday lives, it spared no concern for their health or safety. That concern was directed at clients, the presumably respectable men whose moral standing and reputation authorities deemed worth protecting at all costs.
“The concept of sex work was intrinsically connected to the concept of masculinity: If one was viewed as a necessary evil, it was only because the other was seen as an indomitable, uncontrollable force that demanded constant attention.”
Local authorities were expected to build on the basic principles of the “Regulamento” to create their own guidelines, and many did over the following decades. One of the strictest sets of adaptations, the “Regulamento Policial das Meretrizes e Casas Toleradas da Cidade de Lisboa” (Police Regulation of Harlots and Tolerated Houses of the City of Lisbon), was issued in Lisbon in 1858. Its stated goal was to “subject the harlots to rigorous inspections” in order to “prevent and guard against the evils that result to moral, health, and public safety, from the remarkable debauchery in which this wretched class finds itself.”
A revised version of the Lisbon police regulation, published in 1865, was uncompromising in its definition of “harlots” (“all women who habitually and as a way of life indulge in prostitution”) and relentless in its direction of their daily lives. First, all such women had to be registered in a special police book that formalized their status as meretrizes toleradas (tolerated harlots). As members of a vilified professional class, meretrizes couldn’t rent a house without permission from the police. They couldn’t live near temples, schools, or public gardens; they couldn’t live with their own children or socialize with any child over the age of three. They couldn’t leave the city for more than five days without notifying the local police.The meretrizes lived in a state of permanent probation—even the tiniest slip-up could result in a fine or jail time.
And then there were the sanitary inspections. Meretrizes were required to undergo a full-body examination, including a gynecological evaluation every eight days. They could either receive a walk-in examination wherever a doctor happened to be holding visits or request to be seen at home, but were given little choice beyond that. If found to carry any kind of contagious disease (including, but not limited to, the dreaded syphilis infection), they were immediately referred—if not directly escorted—to the nearest hospital for treatment.
In 1860s Lisbon, these referrals were bona fide medical incarcerations, most of which took place at the now-defunct Hospital do Desterro. Although Desterro was a general hospital, it was best known for its skin and venereal disease wards. Two of these, named after St. Mary Magdalene and St. Mary of Egypt, were dedicated to the inpatient care of meretrizes. It was by treating sex workers in isolation, in the style of lock hospitals, that the state tried to contain the spread of syphilis and other sexually transmitted diseases, all the while taking inventory of the women whose bodies were considered threats to public health.
Desterro wasn’t a popular place. Its clientele was thought of as morally bankrupt, and the conditions in which they were kept were befitting of this perceived lack of value. Thomaz de Mello Breyner, a renowned doctor in the wards, once described the food served to the patients as “filthy water with a layer of fat on the surface.” Hygiene was so poor that the entire hospital was nearly closed down by a dedicated commission in the 1870s; the plan was to transfer the entire operation to a newer building, but it never came to fruition. Understaffed and underfunded, the hospital resisted every plan for reform.
If working as a meretriz tolerada was like living on probation, staying in a so-called harlot ward was like serving jail time. Even in a country where their profession was legal, if highly regulated, sex workers were never exempt from persecution. The only difference between time in harlot ward and a jail was the justification of health and safety instead of criminal activity. Augusto Monjardino, a doctor working in the St. Mary of Egypt ward, wrote, “beside the discipline that was intended to be imposed, there was no interest in the life and health of these unfortunates; there was no justice in the choosing of the patients who were to be discharged; there was no affection for these women, considered as separate beings, the scum of society.”
It would take years, if not decades, for physicians like Mello Breyner and Monjardino to start pushing for better, more humane health care for the women kept in the wards. A key attempt began 1897, when Mello Breyner created the first walk-in Consultation of Syphilitic and Venereal Diseases in the city, working out of a cubicle near the hospital entrance. Even more understaffed than the hospital at large, the Consultation was a one-man operation for nearly a year, at which point hospital officials decided to finally assign a head nurse to the unit. When that still wasn’t enough, Mello Breyner put his patients to work, teaching them basic nursing procedures so they could be at once useful in the Consultation and empowered in their everyday lives. Mello Breyner’s clientele was composed of mostly maids, seamstresses, factory workers, artisans, and wet nurses, as well as many meretrizes who took it upon themselves to find treatment before the sanitary police could refer them to the wards.
“Even in a country where their profession was legal, if highly regulated, sex workers were never exempt from persecution.”
Once committed to the harlot wards, it wasn’t particularly easy to leave—or to avoid coming back. Women who were deemed “cured” couldn’t simply walk out; instead, they were escorted back to the police station by an officer who would log their health status into the books. For a meretriz, every interaction with the health-care system meant contact with the police system. And most women had many, many interactions. An analysis of hospital records identified a total of 1,447 women, aged 15 to 36, who were committed to the wards from 1902 to 1906, some of whom were admitted dozens of times in that short four-year period. Their complaints ranged from UTIs to syphilis, the latter of which was of the utmost concern.
Portugal, like most of Europe in the early 20th century, was fighting a battle against syphilis. Medical professionals knew enough about the affliction to understand it was transmitted by sexual contact or from mother to child during pregnancy, but nowhere near enough to treat it. The primary therapy against syphilis hadn’t evolved much since the 16th century. It still relied heavily on mercury, either rubbed into the sores, taken in the form of pills, or injected directly into the urethra. Although mercury minimized the appearance of the disfiguring sores and ulcers associated with the disease, it had no effect on the infection itself. It could give rise to gruesome side effects, such as increased sweating and salivation, tender gums, loss of hair, nails, and teeth, and a panoply of neurological symptoms.
When Salvarsan, an arsenic derivative, was found in 1910 to be effective in treating syphilis, the meretrizes from Desterro were among the first Europeans to use it. In fact, the first person to be treated with Salvarsan in Portugal was an unnamed sex worker in the ward of St. Mary Magdalene, who received her life-changing injection on August 28, 1910.
As treatments for syphilis and other venereal diseases improved, the need for long-term hospital stays began to wane. By 1927, the Directorate-General of Health had created the Central Dispensary of Social Hygiene of Lisbon, a small outpatient health facility that aimed to provide quick and effective treatments against syphilis and other common diseases. As meretrizes began to frequent the Dispensary, the wards began to lose some of their clientele; by 1941, only 5 percent of the patients who visited the Dispensary were being committed to hospital.
Although it represented a new and improved way to combat syphilis, the Dispensary maintained the general mindset of the previous century. Its first director, Alfredo Tovar de Lemos, wrote in 1932, that the unit “seeks the collective good, manages public hygiene, in effect accomplishes this goal by achieving the non-contagiousness of each of the patients, seeking to preserve them from injuries that could infect others.” In the end, the picture remained the same regardless of the arrangement of its parts: an entire health-care system designed specifically for sex workers was only incidentally beneficial to their health, as the end goal was always to protect their clients.
No improvements were on the horizon. By 1944, the Portuguese state, now a Catholic dictatorship, had decided to do away with prostitution altogether. Brothels were closed and police regulations more tightly enforced, until the full-blown prohibition was issued in 1963, accompanied by the destruction of countless documents and records pertaining to the meretrizes toleradas. Desterro continued to treat skin and venereal diseases until 2007, as did various dispensaries until 1978, but their services were no longer open to meretrizes, who were now seen as abject criminals.
Today, sex work is no longer a crime in Portugal, but it’s only just tolerated. While the country decriminalized one-on-one exchanges of money for sex in 1983 and steers clear of persecuting sex workers for the sake of public hygiene, little has been done to improve the relationship between sex workers and law enforcement, or even health-care professionals. Decriminalization, with with its implicit recognition that sex workers are no longer living on the moral and legal margins of society, is but a first step.
Cristina Bastos. Clínica, Arte e Sociedade: A Sífilis no Hospital do Desterro e na Saúde Pública. (Lisboa: Imprensa de Ciências Sociais, 2011.)
Image credit: Example of a lock hospital, institutions for treating sexual transmitted diseases, 1890. (Wikimedia Commons | Public Domain)