Sexually Transmitted Diseases in Historical Context

An examination of the first decades of the twentieth century—a time of intense concern and interest in sexually transmitted diseases not unlike those today—may demonstrate how this process has worked. Indeed, the first two decades of the twentieth century witnessed a general hysteria about venereal infections. The historical analogues are striking; they relate to public health, science, and, especially, social and cultural values.

This period, often referred to as the Progressive era, combined two powerful strains in American social thought: the search for new technical, scientific answers to social problems, and the search for a set of unified moral ideals. The problem of sexually transmitted diseases (STDs) appealed to both sets of interests. The campaign against these infections—the "social hygiene" movement—was predicated on a series of major scientific breakthroughs. The specific organism that causes gonorrhea, the gonococcus bacterium, and the causative agent for syphilis, the spirochete, were identified. By the end of the first decade of the twentieth century diagnostic exams had been established.^[2] In 1910 German Nobel laureate Paul Ehrlich discovered the first major chemotherapy effective against the spirochete—salvasan. Science thus had the effect of reframing the way in which these diseases were seen.

The enormous social, cultural, and economic costs of venereal disease were revealed when doctors defined what they called "venereal insontium," or venereal disease of the innocent. In the early twentieth century physicians traced the tragic repercussions of syphilis within the family. Perhaps the best-known example of venereal insontium is ophthalmia neonatorum, gonorrheal blindness of the newborn, and as late as 1910 as many as 25 percent of all the blind in the United States had lost their sight in this way, despite the earlier discovery that silver nitrate solution could prevent infection. Soon many states began to require the use of this prophylactic treatment by law.^[3]

But doctors stressed the impact of venereal disease on women even

more than on children. In 1906 the American Medical Association (AMA) held a symposium on "The Duty of the Profession to Womanhood." As one physician at the conference explained:

These vipers of venery which are called clap and pox, lurking as they often do, under the floral tributes of the honeymoon, may so inhibit conception or blight its products that motherhood becomes either an utter impossibility or a veritable curse. The ban placed by venereal disease on fetal life outrivals the criminal interference with the products of conception as a cause of race suicide.^[4]

Family tragedy was a frequent cultural theme in these years. In 1913 a hit Broadway play by French playwright Eugene Brieux, Damaged Goods , told the story of young George Dupont, who, although warned by his physician not to marry because he has syphilis, disregards this advice only to spread the infection to his wife and, later, to their child. This story was told and retold, revealing deep cultural values about science, social responsibility, and the limited ability of medicine to cure the moral ailments of humankind.^[5]

But physicians expressed concerns that went beyond the confines of the family; they also examined the wider social repercussions of sexually transmitted diseases. The turn of the century witnessed the most intensive periods of immigration to the United States in its entire history; more than 650,000 immigrants came to these shores each year between 1885 and 1910. Many doctors and social critics suggested that these individuals were bringing venereal disease into the country. As Howard Kelly, a leading gynecologist at the Johns Hopkins School of Medicine, explained: "The tide [of venereal disease] has been raising [sic] owing to the inpouring of a large foreign population with lower ideals." Kelly elaborated, warning: "Think of these countless currents flowing daily from the houses of the poorest into those of the richest, and forming a sort of civic circulatory system expressive of the body politic, a circulation which continually tends to equalize the distribution of morality and disease."^[6]

Examinations at ports of entry failed to reveal a high incidence of disease; nevertheless, nativists called for the restriction of immigration. How were these immigrants thought to be spreading sexually transmitted diseases to native, middle-class, Anglo-Saxon Americans? First, it was suggested that immigrants constituted the great bulk of the prostitutes inhabiting American cities; virtually every major American metropolis of the early twentieth century had clearly defined red-light dis-

tricts where prostitution flourished. These women, it was suggested, were typically foreign-born.^[7]

But even more important, physicians asserted that syphilis and gonorrhea could be transmitted in any number of ways. Doctors catalogued the various modes of transmission: Pens, pencils, toothbrushes, towels and bedding, and medical procedures were all identified as potential means of communication.^[8] As one woman explained in an anonymous essay in 1912:

At first it was unbelievable. I knew of the disease only through newspaper advertisements [for patent medicines]. I had understood that it was the result of sin and that it originated and was contracted only in the underworld of the city. I felt sure that my friend was mistaken in diagnosis when he exclaimed, "Another tragedy of the common drinking cup!" I eagerly met his remark with the assurance that I did not use public drinking cups, that I had used my own cup for years. He led me to review my summer. After recalling a number of times when my thirst had forced me to go to the public fountain, I came at last to realize that what he had told me was true.^[9]

The doctor, of course, had diagnosed syphilis. One indication of how seriously these casual modes of transmission were taken is the fact that the U.S. Navy removed doorknobs from its battleships during World War I, claiming they had been a source of infection for many of its sailors (a breathtaking act of denial). We now know, of course, that syphilis and gonorrhea typically are not contracted in these ways. This poses a difficult historical problem: Why did physicians believe they could be?

Theories of casual transmission reflected deep cultural fears about disease and sexuality in the early twentieth century. In these approaches to venereal disease, concerns about hygiene, contamination, and contagion were expressed, anxieties that revealed a great deal about the contemporary society and culture. Venereal disease was viewed as a threat to the entire late Victorian social and sexual system, which placed great value on discipline, restraint, and homogeneity. The sexual code of this era held that only marital sex should receive social sanction. But the concerns about venereal disease also reflected a pervasive fear of the urban masses, the growth of the cities, and the changing nature of familial relationships. Finally, the distinction between venereal disease and venereal insontium had the effect of dividing victims; some deserved attention, sympathy, and medical support, others did not, depending on how the infection was obtained. Victims were separated into the innocent and the guilty.

In short, venereal disease became a metaphor for late Victorian anxieties about sexuality, contagion, and social organization. But these metaphors are not simply innocuous linguistic constructions. They have powerful sociopolitical implications, many of which have been remarkably persistent throughout the century.

Concerns about sexually transmitted diseases led to a major public health campaign to stop their spread. In fact, many of the public health approaches we apply today to communicable infections were developed early in this century. Educational programs formed a major component of the campaign, although to speak of education is far too vague. The question, of course, is the precise content of the education offered. During the first decades of the twentieth century, when schools first instituted sex-education programs, their basic goal was to encourage premarital continence by inculcating a fear of sex. Indeed, these programs could more accurately be termed "antisexual education."

The newly acquired ability to diagnose syphilis and gonorrhea led to the development of other important public health interventions. Reporting, screening, testing, and the isolation of carriers were all initiated in the early years of the twentieth century as venereal-disease-control measures, and American cities began to require the reporting of venereal diseases around 1915. Some states used reports to follow contacts and bring individuals in for treatment, and by the 1930s many had come to require premarital and prenatal screening. Some municipalities mandated compulsory screening of food-handlers and barbers, even though it was by then understood that syphilis and gonorrhea could not be spread through casual contact. The rationale offered was that these individuals were at risk for infection anyway and that screening might reveal new cases for treatment.

Perhaps the most dramatic public health intervention devised to combat sexually transmitted diseases was the campaign to close red-light districts. In the first two decades of the twentieth century, vice commissions in almost all American cities had identified prostitutes as a major risk for American health and morals, and decided that the time had come to remove the "sources of infection." Comparing the red-light districts to malaria-producing swamps, they attempted to "drain" them; during World War I more than a hundred red-light districts were closed.

The crackdown on prostitutes constituted the most concerted attack on civil liberties in the name of public health in American history. Not surprisingly, in the atmosphere of crisis engendered by the war, public

health officials employed radical techniques in their battle against venereal disease. State laws held that anyone "reasonably suspected" of harboring a venereal infection could be compulsorily tested, and prostitutes were now subject to quarantine, detention, and internment.^[10] United States Attorney General T. W. Gregory explained: "The constitutional right of the community, in the interest of the public health, to ascertain the existence of infections and communicable diseases in its midst and to isolate and quarantine such cases or take steps necessary to prevent the spread of disease is clear."^[11] In July 1918 Congress allocated more than $1 million for the detention and isolation of venereal carriers. During the war more than thirty thousand prostitutes were incarcerated in institutions supported by the federal government. As one federal official noted:

Conditions required the immediate isolation of as many venereally infected persons acting as spreaders of disease as could be quickly apprehended and quarantined. It was not a measure instituted for the punishment of prostitutes on account of infraction of the civil or moral law, but was strictly a public health measure to prevent the spread of dangerous, communicable diseases.^[12]

Fear of venereal disease during the war had led to substantial inroads against traditional civil liberties. Although many of these interventions were challenged in the courts, most were upheld; the police powers of the state were deemed sufficient to override any constitutional concerns. The program of detention and isolation, it should be noted, had no impact on rates of venereal disease, which increased dramatically during the war. Although this story is not well known, the parallels to the interment of Japanese Americans during World War II are unavoidable.