• syphilis
• neisseria gonorrhoea
• public health
• medical history

After asking 80 experts 22 296 questions over 64 days and distilling the findings into 758 pages and 30 appendices, the Royal Commission on Venereal Diseases (1916) provided an exhaustive insight into the grip that syphilis and gonorrhoea had on UK society.1 Recruiting healthy young men for the many conflicts of the early 20th century had highlighted the poor state of the nation’s health but, as WWI dragged on, high morbidity due to syphilis and gonorrhoea became a significant operational issue for the military. The government accepted the Royal Commission’s conclusion that only state intervention could effectively address the problem and passed the Venereal Diseases Act in 1917. Confidential diagnosis, treatment and management, including partner notification, was to be offered to patients within specialist clinics, a novel, publicly funded healthcare initiative implemented by Local Authorities (LA). Unfortunately, the judgemental atmosphere that pervaded British society in 1917 meant that blame, stigma and intolerance clouded implementation. Some LAs gave little support and accommodated the ‘Special Clinics’ in basements, attics or out buildings away from mainstream of hospital services. Others engaged skilled staff and excellent facilities: Liverpool’s purpose built Seamen’s Dispensary opened in 1924 on Paradise Street at the margins of the docks and served local residents and sailors from around the world until 19912.

The burden of disease detected from 1918 to 1924 was almost as high as the speed of the reduction in cases that was expected to be achieved. In 1920, with a budget of £470000 (equivalent to £22.2 million in 2017), 1.48 million attendances were handled.3 New cases of syphilis and gonorrhoea peaked at 42 805 and 40 284, respectively, in 1920. Demand for clinical services was huge and the specialty needed to evolve quickly in the face of practical challenges. Although clinical methods have changed discussions at meetings of the Medical Society for the Study of Venereal Disease (founded 1922) and in the British Journal of Venereal Disease concerning the accuracy and utility of diagnostic tests, therapeutic effectiveness, testing coverage among clinic attenders and at-risk populations, partner notification methods, clinical practice and funding resonate with the 21st century service. However, it is the emphasis of the Commission’s recommendations around public engagement that are strikingly progressive. Initial concerns that the public would not wish to be seen entering services proved largely unfounded as confidence grew. Services quickly realised that public presence, engagement and education to prevent reinfection were as important to disease control as prompt, skilled, non-judgemental treatment. It was this recognition that a profound change in attitudes towards sexual health would be needed for control to be effective that marks out the early years of the service and laid the foundation for the century of development and innovation that followed.