The port

1Hermoupolis is the capital town of the island of Syros and of the Cycladic group of islands as well (figure 1).

Fig. 1

2The port city was created during the anomalous circumstances of the Greek War of Independence against the Ottoman Empire (1821-1828), when Greek refugees from the city of Izmir, Asia Minor, as well as from the islands of Chios, Psara, Kasos found refuge on the island of Syros. The population of Syros at the time was mainly Roman Catholic and for this reason the island was protected by French and Austrian warships. Within few years the settlement at Hermoupolis grew rapidly from having merely 150 people in 1821 to 13,805 in 1828. Thus, a town, which in the beginning seemed temporary, soon became permanent. The first Greek Orthodox church was established in 1824, the first school in 1825, the Municipal Hospital in 1826 and the largest lazaretto of the Greek state in 1841¹.

3The demographic and economic development of the city of Hermoupolis was due to the following factors: (i) the French and Austrian protection. (ii) The geographical position of the island at the crossroads of commerce in the Aegean between main ports of the Black Sea (Odessa, Tangarog), the eastern Mediterranean, (Izmir, Istanbul), the north Africa (Alexandria) and the western Mediterranean (Trieste, Livorno, Marseille). (iii) The merchants from Chios, who had sufficient funds and wide experience in commerce, because of their inclusion in the pre-revolutionary commercial networks, (iv) and finally, the refugees from Psara, a traditional maritime center, who contributed in the development of shipping².

4Of course, not only was Hermoupolis’ wealth based on the commercial activities of its port and the shipyards, but also on manufacturing industries, which included, among other things, tanning, soap-making, distilleries, blacksmiths, flour mills, hats³. Hermoupolis’ prosperity soon attracted Greeks from many regions who sought work and other opportunities for upward social mobility.

5As we can see in table 1, in the following decades Hermoupolis’ population rose to 20,000, thus making it the second largest city in the newly founded Greek kingdom, which gained its independence in 1830, and was by far the most important port of Greece in mid-nineteenth century. The residents of Ano Syros and the shifting population of the port should be added to the residents of Hermoupolis.

6The last quarter of the nineteenth century is the time when a convergence of factors led to the decline of the city. In summary, these factors were: (i) the use of steam, mostly from the 1870s, which is generalized and reduces the time and the cost of shipping and thus decreases the transit role of Hermoupolis. (ii) The decline of two major industries, tanning and shipbuilding, as a result of the reduction of trade and shipping. (iii) The development of Piraeus after the 1870s, to which the opening of the Corinth Canal in 1893 contributes and (iv) finally, the economic growth of the new Balkan countries and the increased competition they brought about⁴.

7However, Hermoupolis sustained the functions of a large city until the 1930s, despite the fact that it wasn’t the most important port of the country⁵.

The sources

8The main source of this paper is the original manuscript patients’ logbooks of the municipal hospital “Helpis”. The municipal hospital was established in 1826 and was divided in two sections in 1868. The A section, which was the surgical, and the B section, which was the pathological. Each clinic had its own patients’ logbook. Patients with venereal diseases were hospitalized in both clinics. Eight books related to the nineteenth century have been located, covering the following years: July 1834‑1858, 1869‑1883 and 1886‑1900. However, for the period 1869-1900 we have the patients’ logbooks of both sections only for the years 1881-1883. Moreover for the year 1878 the logbooks do not note any patient generally.

9The following information is provided for each patient: (i) serial number, (ii) full name, (iii) age, (iv) profession, (v) marital status, (vi) origin, (vii) residence, (viii) dormitory and bed number, (ix) disease, (x) date of entry and exit from the hospital, (xi) number of days which the patient remained in the hospital, (xii) comments (figure 2).

Fig. 2

10Moreover, the Minutes of the City Council of Hermoupolis for the period 1840-1900, the draft registers of death certificates of the Municipality of Hermoupolis of the years 1848-1853, 1876-1879, 1892-1898 and the local Press from 1834 to 1900 are utilized. The official registers of death certificates of the Municipality of Hermoupolis do not record regularly the cause of death for the period 1859-1900.

The patients

11According to tables 2a-b, 21,575 patients were hospitalized in the nineteenth century in the municipal hospital of Hermoupolis, but the disease had been recorded for the 16,901 of them. The patients with venereal diseases were 1,222 and they represent the 5.66% of the total of patients and the 7.23% of patients for whom the disease is known⁶.

12Comparing the above percentages with data from others hospitals in the same periods, we notice that they range in relatively similar levels. More specifically, at the municipal hospital of Nafplio 28 out of the 653 hospitalized patients (4.29%) suffered from venereal diseases in the period 1837-1846, while in the military hospital of Athens 231 out of 3,219 patients (7.18%) suffered in 1855⁷.

13In tables 3-4 and figure 3 we can see the distribution of patients with venereal diseases in comparison to the total number of patients for each year in the municipal hospital. In the first period, we can assume that the municipal hospital, as a new medical place of isolation and treatment, does not attract patients of weak socio-economic classes, to whom it is addressed. Gradually, the trust towards the hospital was improved, which is reflected in the number of patients hospitalized each year. Furthermore, a report drawn up by the Hospital’s Brotherhood in 1901 indicates that 500 to 900 patients were hospitalized per year, a size that indicates a relative increase comparatively to the number of patients in the early years of the municipal hospital⁸.

14But if the number of patients was increased in the following decades, why was the number of patients with venereal diseases reduced, especially in the last two decades of the nineteenth century?

15The City Council of Hermoupolis decides to forbid the male patients with venereal diseases from being hospitalized in the municipal hospital in 1892. This decision may have prevented the hospitalization of a number of men, although the available data does not seem to be applied with absolute rigor and does not justify the corresponding reduction of women (table 4). In addition, there has not been significant development in the treatment of venereal diseases to justify a reduction in the number of hospitalized patients⁹.

Fig. 3

16The most important factor for the reduction is that the disease in patients’ logbooks was not recorded regularly in the last quarter of the nineteenth century. This was a common practice that was particularly intense in the years 1879-1896, when the disease had been recorded for just 1,266 out of the 5,545 patients (22.83%). Thus, even if they were hospitalized, the precise number of patients with venereal diseases is unknown.

17Table 5 shows the dominance of men in the cases with venereal diseases, almost 72% (877 patients). However, the dominance of men in the patients’ logbooks of the municipal hospital is general and venereal diseases are not an exception. For example, during the period 1834-1850, 88,4% of patients are male and just the 11,3% are female¹⁰.

18It should be noted that the 1,222 cases of patients with venereal diseases do not correspond to the same number of people since some of them were hospitalized more than once. So the 1,222 cases correspond to 765 men and 236 women. From these, 88 men and 48 women were hospitalized more than once. Studying the cases of patients and not the patients as individuals has been chosen. Otherwise, we would miss a considerable part of the complexity and magnitude of the phenomenon. Besides, if we exclude the place of origin, all other data (age, place of residence, occupation, marital status, disease) are volatile over time.

19As far as the cases of male patients (table 6), syphilis is the most frequent disease, (412 patients or 46.98%), followed by gonorrhea (283 patients or 32.26%) and “French disease” (102 patients or 11.63%). On the contrary, the main disease for female patients is gonorrhea (161 patients or 47.2%), followed by syphilis (125 patients or 36.6%).

20The significant percentage of “French disease” in the record books is due to the fact that it was almost exclusively used for venereal diseases from 1834 to 1841. It is indicative that 104 out of 123 patients for the period 1834-1841 belong to the “French disease¹¹”.

21As regards the dominance of the designation of “French disease” over the other national denominations in Greece and in particular in Hermoupolis in the nineteenth century, may be related to the fact that the first Greek aphrodisiology of Ioannis Nikolidis in 1794 uses the phrase “French passion” to describe syphilis.

22A total of 570 cases of male patients with syphilis and 170 cases of female patients were documented if one adds the cases with syphilis, syphilis and another disease, “French disease” and “venereal disease”. There are two more cases with syphilis, but unfortunately the first page with the main information (full name, age, occupation, marital status, origin and residence) is missing and for that reason they will not be counted from now on.

23The vast majority of men (table 7) were single (480 patients or 84,21%), while the married (75 patients or and 13.16%) and the widowed (10 patients or 1.75%) were far fewer¹². Certainly, the large percentage of single patients is due to and interacting with the age of the male patients (table 8), as 57% were 21-30 years old (325 patients) and by adding the group of 16-20 years old (58 patients or 10.18%), the young men 16-30 years old patients surpass 67% (383 patients). Combining the data of the two analytical categories of marital status and age, it is concluded that more than half of syphilitic men were single 21-30 years old (300 or 52,63%)¹³.

24Regarding the occupations 102 have been recorded (table 9). The variety of occupations indicates the developing character of the city. Policemen (139 patients or 24.39%) and seamen (122 patients or 21.40%) are dominant, followed by domestic servants (31 patients or 5.44%) and soldiers (29 patients or 5.09%).

25Only 6.32% of the patients were from Hermoupolis/Syros, while most of them came from other municipalities, primarily the neighboring islands of Cyclades. However, 39.30% of male patients declared the city of Hermoupolis as place of residence, which means that some patients moved to the city. Of course, a lot were from other countries, like England, France, Ottoman Empire, usually seamen. One was from Marseille. He had been hospitalized in 1838, he was 42 years-old, single and seaman. We don’t know how many days he spent in the hospital but the diagnosis was “French disease”.

26From the 570 male patients with syphilis the duration of hospitalization for 427 of them is known. The average time spent in the hospital was 28 days in the period 1834-1858, which was reduced to 26 days in the period 1869-1900.

27Finally, only 7 out of 506 patients as individuals died from syphilis, which means a mortality rate of 1.38%.

28Similarly to the group of men, most of the women (table 10) were single (95 patients or 55.89%), followed by the married (39 patients or 22.94%) and the widows (22 patients or 12.94%). Of particular interest is the designation of “polygamy” attributed to only ten prostitutes at the end of 1858. The term does not appear again during the nineteenth century. Besides, the patients’ record books for the next ten years (1859-1868) have not been saved in order to examine if they had continued to use the term. It states, however, the doctor’s belief about prostitutes.

29As table 11 shows, the majority of women were 16-25 years old (94 patients or 55.29%), which rises to 69% if the group of 25-30 years old is added (118 patients or 69.41%). Combining again the data of marital status and age it is noticed that most of the women patients were single 16-25 years old (69 or 40.59%)¹⁴.

30The variety of occupations for the group of women appeared to be fairly limited (table 12). Only six different jobs had been declared. The dominance of prostitutes (91 patients or 53.53%) was due to their occupational pathology, which lies in the workplace conditions, the terms of their job and the disadvantaged position in the network of prostitution¹⁵. All of these factors rendered the group of female prostitutes vulnerable¹⁶. Meanwhile, the second most frequent occupation was domestic servants (22 patients or 12.94%)¹⁷.

31Similarly to the group of men, only 4.71% of women patients were from Hermoupolis, while 32.94% declared the city of Hermoupolis as a place of residence, which means that a part of them relocated to the island.

32Finally, the duration of hospitalization for female patients changed dramatically during the nineteenth century. The hospital stay for the period 1834-1858 was 45 days while in the period 1869-1900 was reduced to 23 days, almost the half. The mortality rate of women was 3.10% as 4 out of 129 individual patients died due to syphilis.

33It is important to mention that this is the minimum number of patients with venereal diseases which can be documented in Hermoupolis. Only those who wanted to visit, be examined and hospitalized in the municipal hospital had been recorded in the patients’ logbooks. It is unknown if record books for the outpatients were kept, since none has been found so far. However, it seems that record books for the outpatients were not kept since there is no precise data in any medical statistical report of the municipal hospital’s doctors published in the local Press.

34Furthermore, the patients could be examined by the municipal doctors, who were obliged to visit the poor patients in their home and examine them free of charge. The municipal doctors used to keep records, but they have not been found yet. In addition, there were several doctors used to examine the needy with no charge, usually two days a week, in the context of their charitable activity.

35Finally, another group of patients, the size of which is impossible to calculate, preferred folk medicine. Besides, during the nineteenth century, the controversy between the “scientists” physicians and the “empirical” therapists was intense¹⁸.

36The hypothesis that patients with venereal diseases resort to empirical doctors and folk practices of medicine it can be proved in the “Draft death registers books” of the Municipality of Hermoupolis. At the Municipal Archives of Hermoupolis there are four logbooks for the years 1848‑1853, 1876‑1879, 1892‑1895 and 1895‑1898.

37As table 13 shows, during the second half of the nineteenth century, 11 deaths were caused by venereal diseases: ten due to syphilis and one due to “French disease”. Little do we know about the two women. The one who died from “French disease” in 1851 was a 32 year-old housewife from Kasos. The second, who died at the age of 70 in 1897, was a widow housewife.

38With regard to male deaths, two were infants, one was a 3-year-old kid and the rest six were between 35 and 70 years old (35, 36, 42, 55, 60, 70). The two younger men were single, the oldest widow and the other three married, while two were merchants, one stoker, one seaman, one worker and one idle. Finally, three of them came from Hermoupolis, one from Kasos, one from Psara and one from Spetses.

39The most important thing, however, is that none of them had ever been hospitalized in the municipal hospital of Hermoupolis, while the same is observed for parents of infants who died due to hereditary syphilis.

40Moreover, five deaths from syphilis have been identified in the local Press¹⁹. Only the names of the two cases are known and again none of them had ever been hospitalized in the municipal hospital.

41Finally, one last group of patients who may have suffered from syphilis is the patients who were “detained” in the municipal hospital by the police. According to the “Directive on public girls and homes of tolerance” (1834) of the Ministry of the Interior, among other ordinances aimed to control and surveillance the prostitution, it stipulates a police officer with a doctor (sanitary police) to examine the prostitutes once a week. If the doctor finds that someone is suffering from venereal disease then he must detain her for treatment in the municipal hospital. This ordinance was maintained in the law about “venereal disease spyrokolo” in 1848 and in the guidelines of the Ministry of the Interior “about common women” and “about the houses of debauchery” in 1856.

42Twenty-two cases of “detained” patients were recorded in the patients’ logbooks of the municipal hospital, during the years 1856-1857 and 1869-1876, corresponding to one man and 20 women. However, the disease had not been noted and so it cannot be proven if they had been “detained” due to venereal disease. It is sure that the man did not belong in this case as the ordinances referred only to women.

43According to table 14, 13 out of 20 (65%) were single 16-25 years old, quite similar to the female patients with venereal diseases. However, the vast majority were domestic servants (9 patients or 45%) followed by housewives (5 patients or 25%) and prostitutes (3 patients or 15%), while for the rest 3 the occupation is unknown. None of them had origins from Hermoupolis or Syros as they had come mainly from the neighboring islands of Cyclades.

44It can be assumed that probably the three prostitutes recorded in 1875 had been noticed by the sanitary police to suffer from venereal disease. Besides, two of them had been hospitalized before with gonorrhea, which increases the chance of verifying this case.

45For the rest of the cases, the reason why they were detained to the municipal hospital by the sanitary police remains unknown. If any of them had been found in a brothel during an examination of the sanitary police, she would have been recorded as a prostitute. They may have been arrested by the police, became ill and been transferred to the municipal hospital. Besides in similar cases of hospitalized patients from city’s institutions, like poorhouse and orphanages, the disease is also not mentioned.

The City Council

46Having formed a general overview of the characteristics of the patients with syphilis, the extent to which the local society considered syphilis and generally the venereal diseases as a threat is going to be examined.

47The articles published in the local Press during the nineteenth century focus on epidemic and not on endemic diseases. It seems that the cholera epidemic that struck Hermoupolis from June to September 1854 increased the interest for the protection measures from epidemic diseases²⁰. After that there are plenty articles in the local Press with advice for the citizens on how to increase their personal hygiene levels. Syphilis does not seem to be a threat neither to the Minutes of the City Council nor to the local Press. Furthermore, the few times that venereal diseases were mentioned were when prostitution was discussed.

48Throughout the nineteenth century, the Greek state tried to settle the issue of prostitution using various laws. There are three basic acts that regulate prostitution in Greece in the nineteenth century (1834, 1849, 1856).

49The main characteristics of this legislation are: (i) The identification of prostitution with venereal diseases. (ii) The police collaboration with the doctors on the surveillance and control of prostitution. (iii) The recognition of prostitution as a necessary profession. This leads to the legalization of prostitution and, thus, to the attempt of distinguishing legal from illegal prostitution. Of course the legislation seeks for better control, which is accomplished by the inclusion of the prostitutes in brothels or in specific districts²¹.

50This practice is not unique to the Greek state, but goes along with similar European efforts, such as those in France and England, which in the nineteenth century tried to regulate the prostitution. Necessary but dangerous, prostitution should be tolerated but closely controlled. The surveillance aims to prevent any exaggeration²².

51By treating prostitution and prostitutes as a social necessity for a port and identifying the venereal diseases with prostitutes, the interest was not focused on the threat and treatment of the disease, but on the strict control of the prostitutes. And this is why the City Council tried to construct municipal brothel in order to gather the prostitutes and to displace them outside of the city.

52In Hermoupolis, due to the limited space and the continuing expansion of the city, the demands for the displacement of prostitutes were in the limelight quite frequently. The main exponents of the requests were the local newspapers.

53The request for the displacement of prostitutes has already been set by mid-century, in 1853 and the debate continued until 1887. This is the last time the City Council approved a fund for the building. Eventually, the building for the prostitutes has never been built. The reasons which led to the cancelation of the construction of the building remain unknown. Besides, the Municipality of Piraeus, which managed to establish a settlement for prostitutes in October 1876, had set the example²³.

54The prostitutes continued to work on the streets, in hotels, cafes or homes. All the measures failed to fully control and restrict the prostitution. Of course, not only was the failure of restricting prostitution related to the inability of the police but also to the discreet silence of the state. The illegal prostitution was escaping surveillance, recording and regular examination by doctors, because the prostitutes could work periodically in other places, such as hotels, or specific times of the day.

55Finally, it is important to stress that, despite the official identification of prostitution with venereal diseases, the threat of venereal diseases was not used as an argument for the construction of the municipal brothels. This does not mean that there was no interest for the venereal diseases. It means that the identification of prostitution with venereal diseases was so strong that the control of prostitution would lead to controlling the spread of venereal diseases. In the public sphere the threat of the venereal diseases strongly emerged in the Interwar period.

Conclusion

56During the nineteenth century, the venereal diseases were not the only public health problem that Hermoupolis had to face. The epidemic diseases and the control of the lazaretto, the drinking water, the cleanliness of the roads, the municipal cemetery, the sewer system and the slaughterhouse are some of the main issues related to public health which the Municipality tries to solve. Hermoupolis faces the same health problems faced by other European port cities in the nineteenth century and, in one way or another, follows the same health policies.

57The main protection measure against disease is the isolation and exclusion of patients alongside the medicalization of the society. Whatever is considered to be morbid and dangerous must be displaced outside the city boundaries. The lazaretto, the slaughterhouse, the cemetery, the female prostitution and therefore the venereal diseases must be displaced in sites where they cannot be visible.

58At the same time, the municipal hospital is an exception. Although a place of commitment, it operates within the boundaries of the city, due to its transformation into a medical area, into a place of clinical observation and into a place of production and transmission of knowledge; according to Michel Foucault, in a “therapeutic machine”²⁴.