CRS Knowledge Box

Prostitution and Public Health Before Germ Theory: exploring Sanskrit sources

Today, the regulation of s*x work is a complex enterprise involving legalisation (or criminalisation), licencing, anti-trafficking, public order and city zoning, immigration, online platform monitoring and, last but not least, public health. With respect to health, regulations are shaped by modern biomedical understandings of STIs, testing, the use of condoms, and HIV prevention programmes, among many other aspects.
This remains a challenging area of public intervention, which elicits strong emotions and interrogates people’s deep-seated beliefs about morality and propriety.
Given this premise, it is fascinating to imagine how regulating the “oldest profession in the world” would have looked like in the distant past, before modern States and their complex legal canons, public healthcare systems, and biomedical concepts such as viruses and bacteria.
Before turning to Asia, let me offer a few remarks on European history. A pioneering book by Carole Rawcliffe (Urban Bodies, 2013) dedicated a chapter to exploring how s*x work was regulated in late medieval England, approximately 600 years ago. It tells of how city officials attempted to protect the “God-fearing folk” from the devilish snares of desire and decadence, confining brothels to certain areas of town and forcing pr******tes to wear caps of certain shapes and colours, all while extracting taxes and administering fines. From a health perspective, the predominant medical system of the day was framed around Galenic humoral theory, maintaining that excess and imbalances were likely to result in disease. S*x was particularly linked to fears about contracting leprosy, partly because of preliminary observations about skin conditions being transmitted through in*******se, and partly because fear of such terrible punishment worked as an effective deterrent. Males were thought particularly susceptible to contracting the disease if a pr******te had slept with infected patrons. By around 1500 CE, some fairly developed medical works were describing conditions that overlap significantly with modern STIs and suggested various hygienic protocols before and after in*******se.
Medieval England offers a plethora of sources that allow historians of medicine and communal health to study this subject. However, not all regions of the world have preserved such detailed archives. In the case of South Asia, surviving manuscripts allow at least some glimpses into this complex socio-medical and religious world. Perhaps the first document to clearly align s*xually transmitted diseases and public health is a 16th Century Sanskrit medical treatise called Bhāvaprakāśa. It describes phiraṅgaroga, the “disease of the Franks” (note the etymological connection with the Thai term farangs), i.e. syphilis. The text connected its spread directly to s*xual activity. The further back in time we extend our inquiry, finding such “modern sounding” treatments becomes increasingly difficult.
To give but one example, today we tend to take the notion of “contagion” as a fact of life. It may surprise the reader that Ayurvedic medical classics contain but a few passing references to this notion. Much like in medieval England, most diseases were interpreted in terms of lack of balance among humours, environmental degradation (miasma) or divine punishment (in this case negative karma, spirits or black magic). The medical classic Suśrutasaṃhitā does however suggest that skin contact and close cohabitation were implicated in the potential “carryover” of certain conditions. In his short lists, Suśruta uses one Sanskrit term that can be interpreted as “in*******se”, thus allowing for the idea that s*xual partners affected each others’ health. Other classics such as Carakasaṃhitā and Mādhavanidhāna include chapters on conditions that partly overlap with biomedical understandings of STIs, notably the notion of upadaṃśa, which involves blisters and warts on the ge****ls. Overall, the aetiological framework focuses on maintaining humoral balance and avoiding excesses and - despite general advice towards choosing healthy partners - the notion of contagion plays a negligible role.
For considerations of a social nature, one can turn to a unique Sanskrit manual of pragmatic kingship from the Gupta period, the Arthaśāstra, which includes a section on the “Superintendent of Courtesans”. The Superintendent is instructed on how to tax and fine s*x workers in a range of situations. One passage is striking, for it states that they may refuse service to a client who is clearly unhealthy, without incurring a fine. While no details or medical explanations are given, this measure could clearly function as a form of preventative health regulation.
Erotic literature in Sanskrit contains detailed descriptions of the different typologies of s*x workers and stories across Buddhist texts outline the careers of various courtesans who arose to prominent positions in society. However, very little is typically said about health concerns. An informative text in this regard is the famous Kāmasūtra, which dvises to choose healthy partners and lists which characteristics make female or male partners eligible. Thus, those suffering from kuṣṭha, a notion which partially overlaps with that of leprosy, were not deemed eligible. Of course, modern biomedicine informs us that the condition is mostly transmitted through coughing and sneezing, not in*******se per se. Also, the text excludes women who “smell bad”, with a medieval commentator specifying “in their secret parts”. Most STDs that include foul smelling also involve other, far more concerning signs. The commentator thus seems mostly interested in what is “pleasant” and conducive to arousal, rather than actual pathology.
In its “Chapter on Courtesans”, the Kāmasūtra warns against a condition involving worm infestation. The commentator this time clarifies: “[having] worms in the faeces is a condition generally called ‘faeces-flies’, in which worms appear in the opening from which faeces are excreted; when semen infected with the disease through contact with the faeces enters a woman, she gets a fever” (Doniger/Kakar trans.). This fascinating and yet obscure passage likely constitutes an early attempt at outlining the s*xual transmission of a disease. While the notion of “worms” may sound tantalisingly similar to that of microorganisms, germs and bacteria, obviously no such concepts can apply here. Rather, the term may refer to parasites, helminths and perhaps certain types of fungi. Note, however, that Sanskrit medical texts allow for the notion that some such creatures were invisible to the naked eye.
This brief overview hopefully gives a taste of the considerable hermeneutical challenges involved in studying the regulation of s*x in the premodern world, and particularly of prostitution. However, despite considerable differences in aetiology and world-views, the notions of legal and economic regulations, as well as basic health and safety measures for both providers and clients are clearly hinted at in Sanskrit sources. I hope to contribute to this field of research with my next publication for CRS!

Bibliography
Kauṭilya. (2013). King, governance, and law in ancient India: Kauṭilya's Arthaśāstra (P. Olivelle, Trans.). Oxford University Press.

Vātsyāyana. (2002). Ka*****ra (W. Doniger & S. Kakar, Trans.). Oxford University Press.

Rawcliffe, C. (2013). Urban bodies: Communal health in late medieval English towns and cities. Boydell Press.

Wujastyk, D[ominik]. (Trans. & Ed.). (2003). The roots of Ayurveda: Selections from Sanskrit medical writings (Rev. ed.). Penguin Books.

Wujastyk, D[agmar]. (2014). The disease of the others: Phiraṅgaroga and its treatment in the Bhāvaprakāśa. History of Science in South Asia, 2, 39–61.