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Sin versus Science: Venereal Disease in Twentieth-Century Baltimore
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Sin versus Science: Venereal Disease in Twentieth-Century Baltimore

Elizabeth Fee

Ways of perceiving and understanding disease are historically constructed. Our social, political, religious, and moral conceptions influence our perceptions of disease, just as do different scientific and medical theories. Indeed, these different elements often cannot be easily separated, as scientists and physicians bring their own cultural ideas to bear in the construction of scientific theories. Because these cultural ideas may be widely shared, their presence within medical and scientific theory may not be readily apparent. Often, such cultural conceptions are more obvious when reviewing medical and scientific theories of the past than they are in contemporary medical practice.[1]

Just as cultural conceptions of disease may be embodied in the framing of scientific theories, so these theories also influence popular perceptions of disease. At times, such scientific theories may reinforce, or contradict, other cultural conceptions; for example, religious and moral ideas, or racial stereotypes. The aspects of disease that we call "social" and "biological" are parts of a single social reality in which disease is produced, experienced, and reproduced, and in which the cultural meanings of the experience are defined, acted upon, and struggled over. The germ theory of disease tends to remove disease from its social context and to define disease as a biological phenomenon best studied in the laboratory. But a more complete understanding of disease must deal with its social as well as its biological aspects, with its cultural meanings as well as its statistical incidence.

In the case of the venereal diseases, it is clear that our attitudes em-


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body a fundamental cultural ambivalence: Are venereal diseases to be studied and treated from a purely biomedical point of view—as the result of infection by a microorganism—or as social, moral, or spiritual afflictions?[2] As the name implies, venereal diseases are inevitably associated with sexuality, and therefore our perceptions of these diseases tend to be entangled with our ideas about the social meanings and moral evaluations of sexual behaviors. In the case of syphilis, a major killer in the first half of the twentieth century, health officials could decide that the true "cause" of syphilis was the microorganism Treponema pallidum , or they could define the "underlying cause" as "promiscuous sexual behavior." Each claim focuses on a different part of social reality, and each carries different messages of responsibility and blame. Each is part of a different language in which the disease may be described and defined. The first suggests the primacy of the clinic for treating disease; the second, the primacy of moral exhortation.

The parallel between syphilis and AIDS lends a special relevance to the study of that earlier epidemic. Both diseases, in laboratory terms, are caused by a microorganism—in the case of AIDS, by the HIV retrovirus. Both diseases can be transmitted by sexual contact; both can also be transmitted nonsexually. The social perception of each disease has been heavily influenced by the possibility of sexual transmission and the attendant notions of responsibility, guilt, and blame. In each case, those suffering from the disease have often been regarded as both the cause and embodiment of the disease, and have been feared and blamed by others who define themselves as more virtuous.

Until the advent of AIDS, syphilis was the most feared of the venereal diseases. Syphilis can be transmitted by body fluids during sexual contact, and by blood transfusions during the early stages of infection. It can be contracted by health workers after clinical examination of infectious lesions, and can occasionally be transmitted by contact with contaminated articles. It can be passed from mother to fetus during pregnancy.

Syphilis has an incubation period of several weeks. Initial infection is marked by a primary lesion on the skin or mucous membranes at the site of infection. This may then be followed by a latency period of several weeks or several years. The secondary stage of syphilis is marked by secondary lesions on the skin and mucous membranes. Syphilis is most communicable during the primary and secondary stages and the latent period. There is no natural immunity to syphilis; approximately 10 percent of exposures result in infection. Late syphilis, five to twenty years


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after initial infection, is marked by disabling lesions of the skin, viscera, cardiovascular system, and central nervous system, and may cause death.

Nonvenereal syphilis is spread by the same spirochete, Treponema pallidum , and is a common childhood disease in some Asian and African countries characterized by poor socioeconomic conditions and primitive sanitary arrangements. It is spread by direct contact with infectious skin lesions and by poor sanitation. The terms "venereal" and "nonvenereal" syphilis are, of course, problematic, because "venereal" syphilis may sometimes be transmitted by nonsexual contacts, but the term "venereal syphilis" does remind us of the inextricable identification of syphilis with sexual behavior in Western societies.

Throughout the twentieth century struggles have been waged over the meaning and definition of the venereal diseases. At times these diseases have been blanketed in silence, as though they belonged to a "private" realm not open to public discussion. Wars, however, have tended to make venereal diseases visible. The need to mobilize a large and healthy armed force brings venereal disease out of the private sphere and into the center of public policy discussions, highlighting the struggle over the proper definition and treatment of disease. During World War I, for example, the American Social Hygiene Association consistently equated venereal disease with immorality, vice, and prostitution.[3] Its members thus tried to close down brothels and taverns, to arrest prostitutes, and to advocate continence and sexual abstinence for the soldiers. The Commission on Training Camp Activities tried to suppress vice and liquor, and also to organize "good, clean fun": sports events, theatrical entertainments, and educational programs.[4] Meanwhile, the army quietly issued prophylactic kits to the soldiers and made early treatment after possible exposure compulsory. Any soldier who failed to get treatment could face court martial and imprisonment for "neglect of duty." These different approaches illustrate alternative conceptions of disease: the first viewing infection as the consequence of "vice," the second as a medical problem requiring prevention and treatment.

When dealing with major disease problems, we often try to find some social group to blame for the infection. During World War I, educational materials clearly presented the fighting men as the innocent victims of disease; prostitutes were the guilty spreaders of infection, implicitly working for the enemy against patriotic American soldiers.[5] In many communities prostitutes were the focus, and often the victims and scapegoats, of the new attention to venereal infections. Prostitutes—the women responsible for the defilement of the heroic American soldier—


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would be regularly rounded up, arrested, and jailed in the campaign against vice.

The end of World War I brought a waning of interest in venereal disease and a return to "normal life," freed of the restrictions and regulations of military necessity. The once-energetic public discussion of venereal disease fell silent. Prostitutes and their customers were again permitted to operate without much official harassment; health departments quietly collected statistics on venereal disease but avoided publicity on the subject.[6]

Here we will examine the subsequent history of venereal disease, and especially syphilis, by focusing on a major industrial city, Baltimore, where a struggle between the moral and biomedical views of disease was played out in the context of city politics in the 1930s and 1940s. Although syphilis is no longer such a significant public health problem, this account should be useful in helping us reflect on the contemporary problem of AIDS. The politics and policies surrounding AIDS are characterized by a remarkably similar set of tensions between the moral and biomedical conceptions of disease.

Treatment for Venereal Disease: The Public Health Clinics

In Baltimore, in the 1920s, a great social silence surrounded the problem of syphilis. The negative social stigma associated with venereal diseases caused extensive underreporting. Physicians endeavored to save patients and their families from possible embarrassment by attributing syphilis deaths to other causes. A tacit social conspiracy of silence resulted: Patients did not talk about their diseases, physicians did not report them, the health department did not publicize them, and the newspapers never mentioned them. The diseases were thus largely invisible. Many hospitals and physicians refused to treat patients with venereal diseases; physicians who specialized in these diseases could make a great deal of money from private patients.[7] Many patients, however, could not afford private medical care.

In the aftermath of World War I, the city health department began quietly to treat venereal diseases in its public clinics. The first such clinic, which opened in 1922, had thirteen thousand patient visits in its first year of operation. The clinic population grew so fast that the city soon opened a second clinic, and then a third. These patients, brought to the public clinics through poverty, were recorded in health depart-


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ment files as venereal disease cases. Like all the diseases of the poor, they attracted little public attention. Syphilis among the wealthy was covered with the silence of discretion; syphilis among the poor was covered with a silence of public disinterest.

The venereal disease problem in Baltimore was, however, turned into news by a survey conducted by the U.S. Public Health Service in 1931.[8] The Public Health Service described syphilis as a major problem in Baltimore, and defined it as a problem of the black population. The "colored" rate was especially high at 22/1000 for males and 10/1000 for females; this contrasted with a reported white rate of 4/1000 for males and 1.3/1000 for females. Of course, whites were more likely to be seeing private physicians and were therefore less likely to have their disease reported to the health department. Syphilis, which had originally been perceived as a disease of vice and prostitution, was thus redefined as a black disease.

The treatment of syphilis might well have been considered a punishment for sin. The recommended treatment required sixty or more weekly clinic visits, with painful injections in alternating courses of arsenicals and heavy metals. The minimum effective treatment required forty weekly visits. To the distress of health officials, many patients drifted away from the clinics as soon as their symptoms had been relieved; only half the white patients and a third of the black patients stayed to receive the minimum necessary treatment.[9] Fewer black patients continued in treatment because many of the white physicians and nurses were said to have an unsympathetic attitude to black patients. In 1932 the health department employed black physicians and nurses, hoping to increase the rate of successful treatments:

Indeed, after several years of experience along these lines, it can safely be concluded that the best results are obtained by encouraging the colored race to take care of its own people. . . . The success of these clinics is unquestionably due to the fact that colored physicians have a more sympathetic approach and a better understanding of the psychology of the Negro race.[10]

As the depression deepened, patients who previously would have been able to pay were increasingly forced to depend on the free public clinics. In 1932 the public clinics were becoming more crowded than ever before, now with more than 84,000 annual visits. The city health department, already burdened with tight budgets and increasing health problems of every kind, complained that the hospitals in town were dumping poor patients on the city clinics.[11] The city health department wanted to


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distribute the then current chemotherapy—neoarsphenamine, sulpharsphenamine, and salvarsan—free of charge to physicians and hospitals for the treatment of indigent patients; but with cuts in their own budgets, they could do little beyond helplessly watching while the clinic population continued to grow.

In 1933 the problem of overcrowding became so acute that the city health department was faced with a real crisis. The department decided to concentrate on patients at the infectious stage of syphilis. They discontinued treatment to any patients who had already received four courses of arsphenamine—that is, patients who had received sufficient drugs to render them noninfectious to others, even though they had not themselves been cured.[12] The reason for the change in policy was reduced health department funding; its justification, that health departments should primarily be concerned with rates of infection, and not with individual cures.

The new operating rules instituted in 1933 effectively changed the character of the health department clinics. Previously, the clinics had been operated as treatment facilities for patients who could not afford the fees of private physicians; however crowded, however inadequate the medical attention, they had at least intended to cure their patients. Now the clinics no longer pretended to cure but simply to render people noninfectious. For the poor, it became impossible to receive full treatment. The unemployed could not afford the expensive series of weekly treatments given by private physicians, but they could not get jobs if they tested positively for infection.

Venereal Disease and Racism

In the 1930s, as today, health statistics were gathered by race but not by income. The statistics on venereal diseases confirmed the definition of syphilis as predominantly a black or "colored" problem. It is difficult to know the extent to which these statistics reflected a bias in reporting, as blacks were more likely to attend the public health clinics where cases of syphilis were reported for health department records. The bias in reporting presumably emphasized and exaggerated racial differences in rates of infection, and fed the belief that syphilis was a "colored" disease. In fact, almost all infectious diseases were far more prevalent among blacks than whites, reflecting the effects of poverty, poor housing, and overcrowding. The distribution of syphilis, for example, was virtually identical with the distribution of tuberculosis, and both were


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heavily concentrated in the slums and ghettos. Ferdinand Reinhard, the head of the bureau of venereal diseases, blamed both diseases on economic conditions, noting that the black population "suffered severely under the depression . . . actually existing near the bread line."[13] Reinhard deplored the poor quality of public clinic facilities and expressed the forlorn hope that "at some future time, when the social conscience of the community becomes more highly developed, something may be done to rectify these conditions."[14]

Although Reinhard described the venereal disease problem among blacks as an effect of economics and social conditions, most whites saw venereal disease as a question of sexual immorality. Blacks were popularly perceived as highly sexual, uninhibited, and promiscuous. The historian James Jones, writing about the "notoriously syphilis-soaked race," has graphically described the sexual perceptions and attitudes underlying syphilis programs in the southern states. Briefly stated, white doctors saw blacks as "diseased, debilitated and debauched," the victims of their own uncontrolled or uncontrollable sexual instincts and impulses.[15] Baltimore, lying on the border between north and south, was little different: If, as nobody doubted, venereal diseases were more prevalent among blacks, this fact was seen as both consequence and evidence of their promiscuity, sexual indulgence, and immorality.

Because the problem was perceived as one of sexual behavior, it seemed appropriate for the city health department to begin an energetic public education project, aimed at changing sexual attitudes—by persuasion or by fear. In 1934, for example, a new program of "sex hygiene" was directed at the black population. Talks were given at the Colored Vocational School and the Frederick Douglass High School; exhibits were held for Negro Health Week and for the National Association of Teachers in Colored Schools. Nearly fourteen thousand pamphlets on venereal diseases were distributed. A "social hygiene motion picture" with the discouraging title, Damaged Lives , played in twenty-three theaters, thus reaching more than 65,000 people, one-tenth of Baltimore's adult population.[16]

The main aim of this health propaganda was to stress the dangers of sexual promiscuity, but it also emphasized the need for early detection and treatment of disease. Apparently unaware that the public clinics no longer offered full treatment to their patients, the famous and controversial Baltimore journalist H. L. Mencken thundered in local newspaper columns that "we must either teach and advocate the use of prophylactic measures [condoms] or force patients to take adequate treatment un-


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til they are cured."[17] Although the first suggestion was perfectly sensible as a method of prevention, it flew in the face of public morality as seeming to encourage "sexual irregularity"—only Mencken seemed to have the courage to publicly advocate such an approach. Pamphlets distributed by the national Social Hygiene Association and the city health department continued to urge chastity before marriage and sexual fidelity within marriage as the only solution to syphilis.

In 1935 syphilis was by far the most prevalent communicable disease in the city, with 5,754 reported cases; the next most prevalent disease was chickenpox—not a disease considered of much importance—with 3,816 reported cases.[18] The same year, the staff of the bureau of venereal diseases gave twenty-one public talks on syphilis, published five articles in the local press, produced a radio talk for Negro Health Week, and distributed sixteen thousand pamphlets. The facilities for actually treating syphilis were still completely inadequate.

As head of the bureau of venereal diseases, Ferdinand Reinhard continued to argue that venereal disease patients needed adequate treatment. Syphilis deaths were now running at between 110 and 150 per year. Reinhard complained: "Any other group of diseases scattered throughout the community to this extent would be considered to have taken on epidemic proportions and would be cause for alarm on the part of health authorities."[19] Perhaps despairing of the efficacy of moral arguments, Reinhard began to stress the economic costs of the refusal to treat syphilis. At least 12 percent of the patients refused treatment would probably end their days in insane asylums; 10 percent more would be charges on the public purse because of cardiovascular complications—conservatively estimated at a direct charge to the city of $180,000 annually, without counting the economic costs of lost individual and family earnings, or of medical treatment prior to complete physical or mental collapse.[20]

Reinhard continued for several years to struggle against the partial treatment plan and to advocate extended clinic facilities, sufficient for all syphilis patients, and staffed with black physicians, nurses, and social workers. It seemed, at the time, to be a one-man campaign. Most physicians approved of the fact that the health department was not offering treatment, the proper domain of fee-for-service medicine. Particularly during the depression years, when many physicians found it difficult to make a living on patient fees, the medical profession was antagonistic to efforts by public health officers to offer free treatments to any patients, whatever their illness.


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Syphilis Becomes Everyone's Disease: The National Campaign

In 1936 Reinhard's "one-man campaign" against syphilis in Baltimore suddenly became part of a major national effort. Thomas Parran, surgeon general of the U.S. Public Health Service, now lent the full weight of his energy and authority to a campaign against venereal diseases. A forceful and dynamic man, Parran decided to break through the wall of silence and make the public confront the scope and magnitude of the problem. He thus redefined syphilis as a disease that struck "innocent" victims: the educated, respectable, white population. Although his books, Shadow on the Land and Plain Words about Venereal Disease are best remembered in public health circles, Parran's short popular article, "Why Don't We Stamp Out Syphilis?" published in Survey Graphic and the Reader 's Digest in 1936, reached a much larger popular audience.[21] In this article, Parran called syphilis "the great American Disease" and declared: "We might virtually stamp out this disease were we not hampered by the widespread belief that nice people don't talk about syphilis, that nice people don't have syphilis, and that nice people shouldn't do anything about those who do have syphilis."[22] Parran's point was that nice people did have syphilis, and he never tired of pointing out that respectable physicians, innocent children, and heads of industry were among those infected.[23] If people could only free their minds of "the medieval concept that syphilis is the just reward of sin," he said, they could "deal with it as we would any other highly communicable disease, dangerous to the individual and burdensome to the public at large."[24]

In order to separate syphilis from its well-worn associations with sin, black immorality, vice, and prostitution, Parran peppered his talks and articles with a series of little anecdotes such as the following: "Remember that a kiss may carry the germ. In an eastern state recently one of our health officers traced 17 cases of syphilis to a party at which kissing games were played."[25]

Parran declared that half the victims of syphilis were "innocently infected": "Many cases come from such casual contacts as the use of a recently soiled drinking cup, a pipe or cigarette, in receiving services from diseased nursemaids, barber or beauty shop operators, etc., and in giving services such as those of a dentist, doctor, or nurse to a diseased person."[26] Syphilis was just another contagious disease, although a highly threatening and dangerous one. The point was to find syphilis cases and


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to treat them; the state should be obliged to provide treatment, said Parran, and the patient should be obliged to endure it. Syphilis would be the next great plague to go—as soon as the public broke with the old-fashioned and prescientific notion that syphilis was "the wages of sin." From a financial point of view, the state and the individual would profit from early identification and treatment before the disease had a chance to produce "human wrecks, the incompetents, the criminals."

In Baltimore, Huntington Williams, the young commissioner of health, took up the campaign as articulated by Parran. He termed syphilis "the greatest unmet problem of public health" but declared that "medical science has all the weapons it needs to defeat this tiny but ferocious enemy, once the defenses thrown up by society itself are beaten down."[27]

Beginning in 1936 the new syphilis campaign began to have an impact on the local press. The Baltimore Health News , a popular health magazine published by the city, began the process with two issues devoted to syphilis. The American Public Health Association broadcast a radio message on syphilis from its annual meeting in New Orleans; the Baltimore health department reprinted Parran's Reader 's Digest article and showed a "talking-slide film" entitled "For All Our Sakes" to large and apparently enthusiastic audiences; the local press and radio stations picked up the campaign.[28]

But while the city health department was consolidating the new biomedical approach to syphilis, it was suddenly challenged with a new moral crusade against vice and prostitution—led by none other than the redoubtable J. Edgar Hoover and the FBI.

Medical Treatment or Crusade against Vice?

"Captives Taken in Weekend Drive against City's White Slave Traffic" declared the headlines of the Baltimore Sun on May 17, 1937. The newspaper reported:

Striking at Baltimore's white slave traffic, thirty-five Federal agents, commanded by J. Edgar Hoover, chief of the Federal Bureau of Investigation, Department of Justice, swept down on ten alleged haunts of vice here late Saturday night and early yesterday morning, taking forty-seven persons into custody. . . . Mr. Hoover said the crusade will continue "until Baltimore is completely cleaned up."[29]


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The raids generated great excitement and controversy in Baltimore, magnified when local prostitutes implicated a number of high-level police officers and at least one state senator in Baltimore's "white slave trade." [ 30] The local newspapers delighted in the revelations of an organized racket, reporting on Baltimore as a now-famous center of vice and iniquity. As a result of a succession of titillating revelations, the Baltimore police force was discredited and Hoover was admired for his resolute action.

State Senator Raymond E. Kennedy seized the political opportunity and accused the city health department and the police department of implicitly condoning vice. He demanded that all prostitutes being treated in city clinics be immediately incarcerated. Meanwhile, a grand jury investigation of Baltimore's "haunts of vice" had been organized, and Parran was called to appear as a witness. On his arrival in Baltimore, however, Parran pulled a public relations coup for the health department. He managed to turn the public fervor away from prostitution, and toward a medical program for venereal disease control. He announced a state survey of venereal diseases, suggested that Baltimore follow the successful Swedish model of disease control, including the provision of free drugs, and he declared to enthusiastic mass meetings that Maryland would take the lead in the fight against "social diseases."[31]

Public interest in Parran's speeches was so great that when city budget officials refused a health department request for an extra $21,000 to combat syphilis, their action was publicly denounced as "incredible." Even Senator Raymond Kennedy now joined in the popular demand for adequate medical services, and Mayor Howard Jackson was forced to agree to an increased health department budget. As Kennedy declared: "There has been more discussion of syphilis in the last ninety days than in the twenty years before."[32]

In 1938, when the American Society for Social Hygiene complained that prostitution still flourished in Baltimore, the local press had lost interest in exposés of vice, and no local politician emerged to carry a crusade. When "National Social Hygiene Day" was announced for February 2, 1938, Commissioner Williams decided to celebrate it in Baltimore, but changed its name to "Syphilis Control Day." Obviously, the change in name was significant: Not only did the new name recognize the word "syphilis" as acceptable public discourse, it also associated Baltimore's program with the biomedical approach to disease, and distanced it from the traditional focus of the social hygienists on vice, pros-


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titution, and morality.[33] Thanks to citywide publicity and political pressure on Mayor Jackson, Williams was able greatly to expand his budget and open the Druid Hill Health Center for black patients in west Baltimore—the first time that adequate public health facilities had been available in that area of the city.[34]

The city health department now tackled the problem of syphilis in industry. At the time, industrial workers were being fired (or never hired in the first place) if they were found to have positive blood tests for syphilis. Employers fired infected workers on the grounds that they were more likely to be involved in industrial accidents and would thus increase the costs of workmen's compensation and insurance premiums. The health department started to provide free laboratory blood tests for industrial workers; they kept the test results confidential and referred those infected for appropriate treatment. The health department followed individual workers to make sure they were receiving treatment but—at least in theory—no worker who accepted treatment could be fired. The fact that no guarantee of confidentiality was made for workers refusing treatment meant that syphilis treatment was essentially made compulsory for industrial workers participating in the plan.[35]

Baltimore's industrial employers were gradually persuaded of the plan's value; by 1940 eight industries with eighty-five hundred workers were participating. Some industries, however, still insisted on their right to fire infected workers—and many of the physicians to whom workers were referred had little idea how to treat syphilis. Despite these problems, the "Baltimore Plan" for industry was said to be relatively successful in treating syphilis while protecting workers' jobs.[36]

The Impact of War

In the late 1930s there was considerable optimism that the campaign against the venereal diseases was beginning to show results. The more open public health attitude toward syphilis as a problem of disease rather than of morality seemed to be successful. The industrial screening plan was convincing reluctant employers, the city was supporting the health department with larger budget appropriations, and the new Druid Hill Health Center was treating patients.[37] The numbers of reported cases of syphilis were decreasing each year despite increased screening efforts and probably more effective reporting mechanisms. In 1938, 8,236 new cases were reported; in 1939, 7,509; and in 1940, only 6,213. Spot surveys of selected populations, such as that of the


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black Dunbar High School in 1939, suggested that syphilis was indeed declining and was less prevalent than the more pessimistic reports had suspected. These records of syphilis incidence and prevalence may have been quite unreliable from an epidemiological point of view, but this was the first time that syphilis rates had even seemed to be declining, and it was a natural conclusion that health department efforts were finally showing demonstrable results.

Amid such optimism, however, came the prospect of war and, with it, the fear that war mobilization and an influx of sixty thousand soldiers would upset all previous gains.[38] By 1941, with the institution of selective service examinations, reported venereal disease rates had already started to climb. In Baltimore in that year, 1.7 percent of the white enlistees had positive blood tests for syphilis, as had 24 percent of the black recruits.[39] Mirroring the racial separations of civil society, black and white troops were segregated, and even black and white blood donations continued to be segregated throughout the war.

Baltimore City now had the dubious distinction of having the second-highest syphilis rate in the country, second only to Washington, D.C. Of 6,081 Baltimore draftees examined, 616 had tested positively for syphilis. Baltimore's rate was therefore 101.3 cases per 1,000 men examined, more than twice the national rate.[40] In an effort to justify these statistics, the city health department blamed the situation on the nonwhite population: The relatively high proportion of blacks to whites "explained" why Baltimore had the second-highest venereal disease rate among the country's largest cities (the same way it "explained" the city's soaring tuberculosis rate).[41]

Such justifications were hardly sufficient for a country at war. With the war mobilization had come renewed national attention to protecting the health and fighting efficiency of the soldiers. As during World War I, the first concern was with the control or suppression of prostitution in the vicinity of army camps, and with "social hygiene" rather than treatment programs. The May Act passed by Congress made prostitution in the vicinity of military camps a federal offense.

In Baltimore, as in several other cities, the FBI called a conference of local law enforcement agencies to discuss the problem of prostitution.[42] Almost immediately, wrangling and mutual accusations broke out between the military officials and different local authorities involved. Major General Milton Reckord of the U.S. Army accused the police department of having failed to control prostitution or the liquor trade.[43] Police Captain Joseph Itzel, in turn, accused the military officials, the


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liquor board, and the courts of hampering the police in their fight against prostitution and venereal diseases: The military officials had refused to ban the nightclubs and taverns believed to be sources of venereal infections; the liquor board had not revoked their licenses; and the courts had either dismissed charges of prostitution or levied such trivial fines as to be completely ineffective.[44] As if there were not problems enough, Itzel also charged that Baltimore congressmen were protecting some of the establishments that his police officers had tried to close.

Perhaps mindful of J. Edgar Hoover's attack on the police department in 1935, the Baltimore police seemed determined to prove their dedication in the battle against prostitution. By early 1943 they claimed to have closed most of Baltimore's brothels and to have driven prostitutes from the streets.[45] Police Commissioner Stanton demanded statewide legislation to allow police officers to arrest prostitutes, force them to submit to medical examination, and, if infected, to take medical treatment.[46]

Jumping into the controversy, Dr. Nels A. Nelson, head of the state venereal-disease-control program, declared that arrests of prostitutes and compulsory medical examinations were completely ineffective: Only a few prostitutes could be arrested at any one time, and as soon as they were treated and released, they would immediately return to the streets to become reinfected and to continue to spread the infection. The only real control of venereal disease, concluded Nelson, depended on the complete "repression of sexual promiscuity." Nelson advocated closing all houses of prostitution, jailing all those who derived profit from prostitution and all "confirmed prostitutes," institutional rehabilitation of "girls who are simply on the wrong road," employment of policewomen to take charge of "girls who seem headed for trouble" and closing all dance halls, taverns, and nightclubs to unescorted women.[47] Nelson also accused physicians of failing to cooperate with the effort and of not wanting to be associated with venereal diseases.[48]

Alarmed by the growing conflict between local health and law enforcement agencies, the Maryland State Senate now set up a vice inquiry, and invited Nelson and Robert H. Riley, the state director of health, for a "full and frank" discussion behind closed doors.[49] At this meeting Police Commissioner Stanton repeated his demand for the compulsory examination and treatment of prostitutes, while the state and city health departments reiterated their opposition to the Stanton plan, which would, in their view, only be a way for the police to harass prostitutes.[50] Meanwhile, the city health commissioner stated that reported


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cases of syphilis were rapidly increasing. Between 1940 and 1942 new cases of syphilis had almost doubled, from 6,213 to 11,293. In 1942 selective service records showed that almost 3 percent of the white draftees and more than 32 percent of the black soldiers had syphilis.[51] Thousands of worker hours were also being lost in the war industries from hospitalization of workers with venereal diseases.

In an effort to develop some kind of cooperative effort between the feuding agencies, the city organized the Baltimore Venereal Disease Council in December 1942. The council members represented the Medical and Chirurgical Faculty of Maryland, the Baltimore Retail Druggists Association, the Venereal Disease Control Office of the Third Service Command, the Baltimore Criminal Justice Commission, the Board of Liquor License Commissioners, the Emergency Medical Services for Maryland, the Johns Hopkins University, the Maryland State Health Department, the State Supreme Court, the police commissioner of Baltimore, the Maryland Medical Association, and the city health department.[52] Three committees were created: the Committee on Rehabilitation; the Committee on Legislation; and the Committee on Medicine, Public Health, and Pharmacy. The rehabilitation committee offered a social, rather than moral, analysis of prostitution: "Prostitution exists because of the urge for sexual gratification in numerous males, on the one hand, and the inadequacies of conventional social arrangements to meet these demands." For women, prostitution was bound up with "inadequate income, bad housing, insufficient diet, lack of recreation and other facets of total life," although a small number were thought to enter prostitution because of "an overwhelming craving for sex stimulation."[53] The committee carefully divided all prostitutes into three main types and thirteen subtypes, ranging from "bats, or superannuated prostitutes rendered unattractive by drink and drugs and by the least particular of bums and homeless men," to "potential prostitutes who are willing to accept money for sex relations which, however, may also be on a volunteer or free basis."[54] The committee recommended that older "hardened" prostitutes be jailed, that "mental cases" be institutionalized, and that "young and potential" prostitutes be offered rehabilitation services, care, and assistance.

Nels Nelson of the state Health Department had abandoned the fight against prostitution. He was busily distributing free drugs for the control of syphilis to private physicians; the city had wanted such a program but had been unable to afford it. Nelson publicly declared the city venereal disease clinics "little more than drug pumping stations in dirty,


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unattractive quarters."[55] He told the press he was tired of hearing the V.D. rate discussed as though it were only a black problem: "Negroes are plagued by venereal diseases because of their economic and social position. . . . They have had the benefits of only two or three generations of Western civilization."[56]

The army was also under attack for failing to organize an effective V.D. program.[57] Its programs and policies were plagued by contradictions; publicly it advocated chastity while privately providing prophylactics for the men. Those in charge of the army's venereal disease program were caught between those advocating the suppression of prostitution and sexual continence for the soldiers, and many army officers who felt that "any man who won't f———, won't fight."[58] The army finally adopted a pragmatic approach and simply attempted to reduce the sources of infection. The pragmatic approach lacked the fervor of a purity crusade, but tried to steer some middle course between laissez-faire attitudes and moral absolutism.

In Baltimore the new acting directors of the city's venereal disease program, Ralph Sikes and Alexander Novey, shared this pragmatic view. Noting that syphilis cases were continuing their sharp increase during the war, they philosophically began their annual report for 1943 by remarking that "the close association between Mars and Venus has existed since historians first recorded human annals."[59] Under their leadership, the bureau concentrated on rendering patients noninfectious as rapidly as possible; health officers cooperated with the armed services in distributing prophylactic kits throughout the city—in police stations, firehouses, transportation terminals, hospitals, and clinics.[60] The V.D. control officers had thus implicitly accepted the idea that this was a campaign against disease, not a campaign for sexual morality; they concentrated on a fairly mechanical, albeit effective, approach to prevention, while leaving the struggle around prostitution to social hygiene reformers, the police, and the courts.

Sex Education During the War

During the war the city health department and a research group at the Johns Hopkins School of Hygiene and Public Health undertook a daring task—to teach "sex hygiene" in the public schools. They gave talks to groups of high school students (separated by sex), showed plaster models of the male and female reproductive systems, and gave simple explanations of "menstruation, conception, pregnancy, nocturnal emis-


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sions and masturbation, but omitting intercourse and childbirth."[61] The project organizers found that "the boys frequently asked for further information about masturbation, and often about prophylaxis which had purposely been omitted from the talk."[62]

The talk presented to the students offers an interesting glimpse of sex education in 1944 and of a project regarded with much interest, and some nervousness, by the city health department. Sex was introduced with military metaphors; sex, the students were told, was like "the fast, tricky fighter planes of the Army"—very difficult to handle. "Sex is just as difficult a problem to handle as any airplane . . . . It is no wonder then that there are so many crashes in the field of sex. When a plane crashes, a person may not walk away from such an accident, or if he does he may carry injury that will last his lifetime. Similar results occur from crashes in the field of sex."[63]

Having been assured that sex was both exciting and dangerous, students were then given a brief description of male reproductive physiology, ending with a caution against masturbation. Masturbation was not dangerous, students were told, merely unnecessary and possibly habit-forming: "It is true that having formed the habit a person may devote too much time and thought to that sort of thing which will hurt the other things in life, such as studies, athletics, and normal friendships."[64] A brief description of the female reproductive system was followed by a discussion of morals and ethics, warning of the need for judgment, but avoiding any definite conclusion: "Since this problem differs for each one, because of different religions, different stages of financial independence and varied ethical standards, we cannot answer anyone's special problem here."[65] Students were urged to discuss their questions with parents and teachers and to read a social hygiene pamphlet entitled "Growing Up in the World Today."[66]

The third part of the presentation, on venereal diseases, emphasized the dangers of sex. Intimacy brought the germs of syphilis—sexual intercourse was the most threatening, but even kisses could carry disease. Early treatment could help before much damage was done, but the best strategy was to avoid any possible contact with these sexual germs: "They can be caught only from an infected person and therefore, we should avoid intimate contact with an infected person. But we cannot tell by looking at a person whether he or she is infected or not; the answer is to avoid intimate contact with all persons except in marriage. This is the only sure way of avoiding these diseases."[67]

At least for these high school students, the link between sexual mo-


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rality and venereal disease was clear—sexual intimacy led to syphilis and was therefore to be avoided except in marriage (why marital sex should be "safe" was never explained, nor was congenital syphilis ever mentioned).

After the War: The New Penicillin Therapy

By the end of World War II the problem of syphilis was beginning to recede, both in public consciousness and in terms of statistical measures. Part of this was the normal relaxation in the immediate aftermath of war, the return to home and family, the desire for stability, and a reluctance to confront social and sexual problems or to dwell on their existence. Even more important, however, was the success of the new drug, penicillin: At last, it appeared that venereal diseases could be quickly and effectively treated. It seemed to be only a matter of time before the venereal diseases would finally be eliminated with the aid of modern medicine's "miracle cures."

By 1940 the new "miracle drug" penicillin had been discovered and purified. In 1943 it was used for the first time to treat syphilis but was not yet generally available; supplies were still strictly rationed.[68] Soon it would completely transform the old methods of treating venereal diseases. Penicillin treatments for syphilis were given over a period of eight days; because supplies of the drug were then very limited, only cases judged to be highly infectious were sent for "an eight-day cure, or what is for the present considered to be a cure." [69] On December 31, 1944, the Baltimore City Hospitals opened the first rapid treatment center for treating syphilis with penicillin. From all initial reports, the new experimental treatment was remarkably effective.

On June 20, 1945, Mayor Theodore R. McKeldin approved a new city ordinance, making treatment for venereal diseases compulsory for the first time. Those suspected of having syphilis or gonorrhea were required to take penicillin therapy at the Rapid Treatment Center.[70] Those refusing treatment could be isolated in the venereal disease division of the Baltimore City Hospitals; members of the Church of Christ Scientist, who could not be forced to take treatment, could still be quarantined. This new ordinance was much stricter than previous health regulations but was passed with little controversy. The new penicillin therapy was, apparently, safe and effective, requiring, at most, a few days' treatment. Legislators who might have hesitated in requiring a prolonged or


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possibly dangerous therapy—such as the older treatment with arsenic and heavy metals—had few qualms about mandating the new penicillin treatment.

The ordinance was, however, rarely invoked. Most patients were eager to go to the Rapid Treatment Center when diagnosed. In 1946 nearly two thousand people with infectious syphilis received treatment: Most were reported as completely cured. (Before penicillin, only an estimated 25 percent of patients completed the lengthy treatments considered necessary for a full cure.)[71] In 1947 the Baltimore Sun reviewed the city's experience with the new ordinance: "On the basis of this experience [over the last 16 months], it is clear that the protection of the public against persons carrying the disease and refusing to be treated more than outweighs the sacrifice of individual rights by so small a number. . . . Under the circumstances, the enactment of a permanent ordinance seems fully justified."[72]

In 1947 the State Health Department announced that "for the first time in history any resident of Maryland who contracts syphilis can obtain treatment resulting in prompt and almost certain cure."[73] For the first time, there were sufficient supplies of penicillin to treat everyone—not just the veterans, not just the infectious cases, but every patient with syphilis or gonorrhea. By 1948 gonorrhea could be cured with a single injection, and syphilis with a short series of treatments.

Conclusion: The End of the Struggle?

The biomedical approach to venereal diseases had been stunningly successful. Diseases that only ten years before had been described as the most serious of all the infectious diseases had now been tamed by chemotherapy with a simple, safe, and effective cure. Diseases that twenty years previously had been guilty secrets, virtually unmentionable in the press and quietly ignored by health departments, now became glorious examples of the triumph of modern medicine in overcoming ancient plagues. The ideological struggle between those who had seen the fight against venereal disease as a battle for sexual morality and those who had seen it as simply another form of bacteriological warfare was over. The social hygiene reformers had to concede defeat to the public health officers, epidemiologists, and laboratory researchers. Or did they?

In 1947 the Maryland State Department of Health, announcing the


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success of the rapid treatment program, concluded its press bulletin with the warning: "To decrease the number of repeat patients and prevent venereal diseases it will be necessary to reduce sexual promiscuity. If fear of disease is a less powerful restraining factor the problem must be attacked more strongly through moral training and suppression of prostitution."[74] Baltimore's health department sounded even more pessimistic: "It may be stated that so far there is little or no evidence that the apparently miraculous one and eight day cures of gonorrhea and infectious syphilis (respectively) with penicillin have accomplished much toward the control of these diseases. . . . Certainly this new therapy has done nothing to correct the promiscuous sexual behavior which is the ultimate cause of the spread of venereal disease."[75]

In 1948 Thomas B. Turner, the prominent bacteriologist at Johns Hopkins, gave a talk to the American Social Hygiene Association entitled, "Penicillin: Help or Hindrance?" His title alone expressed a curious ambivalence about the new "miracle drug." As head of the Hopkins research group on syphilis, Turner was in a better position than most to understand the extraordinary difference the new chemotherapy had made to patients. He catalogued the successes of penicillin "on the credit side of the ledger" but cautioned that nobody should be "dazzled by the apparent potentialities of this fine new drug." On "the debit side of the ledger" was the loss of fear as a deterrent to exposure and the possibility of multiple reinfections; Turner assured his audience that the real concern of venereal disease prevention programs was "the moral, spiritual and economic health of a community" and urged them to "strengthen those forces in the community which help to preserve not only our physical well being, but our spiritual health as well."[76]

Official admiration for the new chemotherapy was thus linked to warnings that the "real" causes of disease were unsolved. Even those most committed to the bacteriological view of disease seemed uneasy about the decoupling of venereal disease from sin and promiscuity: How would sexual morality be controlled if not by the fear of disease? Would "rampant promiscuity" defeat the best efforts of medical treatment?

A brief review of health statistics in the years since the discovery of penicillin suggests that syphilis has, in the main, been effectively controlled. New cases of syphilis are reported each year, and doubtless others are unreported, but the rates are relatively low. In 1986 a total of 373 cases of primary, secondary, and early latent cases were reported in Baltimore; in 1987, a total of 364 cases. Although these cases are of continuing concern to health department officials, at least from the per-


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spective of the 1930s and 1940s, the miracle of control really has occurred. Gonorrhea, however, is another story. Gonorrhea continues to be the most frequently reported infectious disease in the United States, in Maryland, and in Baltimore City; as press reports like to say, in numbers of cases, it is second only to the common cold.[77] But gonorrhea, too, is declining. In 1980 there were eighteen thousand cases in Baltimore, in 1986, sixteen thousand cases, and in 1987, thirteen thousand cases. In 1986, Baltimore ranked second in numbers of cases of gonorrhea among cities with populations of more than 200,000.

Although gonorrhea is of epidemic proportions, it creates little popular concern. A remarkable effort in 1976 to form a coalition in Baltimore against venereal disease—composed of the Boy Scouts, the National Organization for Women, the League of Women Voters, the Benevolent Order of Elks, and the Baltimore Gay Alliance—was unable to fire public interest.[78] Parents were more concerned about drug use than sex; those infected, or potentially infected, knew the cure was simple, available, and cheap. As Turner had noted, the vital element of fear was missing: Gonorrhea was perceived as an uncomplicated infection, easily treated and readily cured.

As we have since discovered, the fear, and the underlying attitudes toward sexuality, were only lying dormant. The recent public concern, horror, and fear of AIDS have reignited the older social hygiene movement, albeit in a new form. Attitudes once expressed toward the black population as sexually promiscuous, sexually threatening, and a reservoir of disease have now been, in revived form, turned against the gay male population. AIDS is popularly seen as caused by gay promiscuity and, even more broadly, as a punishment for unconventional or unapproved sexual behavior, rather than simply as the result of infection by a microorganism. Just as in the case of syphilis, AIDS is often perceived as the "wages of sin" or, as Jerry Falwell says: "A man reaps what he sows. If he sows seed in the field of his lower nature, he will reap from it a harvest of corruption." Again, the argument pits a new generation of biomedical researchers—eager, in the main, to dissociate a medical problem from a moral crusade—against a new generation of moral reformers, eager to use the new AIDS threat to reform sexual behavior.

The "moral" and "scientific" attitudes toward venereal disease are not, of course, completely separate. As we have seen in the ambivalent responses to the success of penicillin therapy, even the most dedicated scientists tend to share the social and sexual values of their culture—in this case, expressing some regret or misgiving, lest effective and safe


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chemotherapy act as an encouragement to disapproved sexual activity by removing the fear of disease. Moral reformers know that scientific successes, especially in the form of new "miracle drugs," will weaken, but not destroy, their case. If a new "miracle drug" is discovered to be effective against AIDS, it will weaken, but certainly not destroy, their social, moral, and cultural objections to homosexuality.

Both the biomedical and moral perspectives or attitudes toward venereal disease select out specific aspects of a complex social reality. As the history of public health demonstrates, venereal diseases—as all other diseases—occur in a social context within which disease is perceived, experienced, and reproduced. One realm comprises both "biological" and "social" aspects of disease. We may separate out one or the other for purposes of analysis, but any complete understanding of a disease problem must involve both as interrelated parts of a single social reality.

Social and cultural ideas or ideologies provide a variety of ways in which diseases can be perceived and interpreted. The germ theory provides an explanation of disease that largely, but not completely, isolates it from this social context, robbing it of some of its social (in this case, moral) meaning. But the purely "scientific" interpretation is never wholly victorious, for social and cultural meanings of disease reassert themselves in the interstices of science and prove their power whenever the biomedical sciences fail to completely cure or solve the problem. Only when a disease condition is completely abolished do social and cultural meanings cease to be relevant to the experience and perception of human illness.

Notes

Another version of this paper appeared in the Journal of the History of Medicine and Allied Sciences 43 (1988): 141-164.

1. For a fascinating analysis of the history of cultural and scientific conceptions of syphilis, see Ludwig Fleck, Genesis and Development of a Scientific Fact (1935; rpt. Chicago: University of Chicago Press, 1979). [BACK]

2. For an excellent recent history of the controversies around venereal diseases in the United States, see Allan M. Brandt, No Magic Bullet : A Social History of Venereal Diseases in the United States since 1880 (New York: Oxford University Press, 1985). [BACK]

3. Scientific and Technical Societies of the United States and Canada , 8th ed. (Washington, D.C.: National Academy of Sciences, 1968), 62. [BACK]

4. Edward H. Beardsley, "Allied against Sin: American and British Responses to Venereal Disease in World War I," Medical History 20 (1976): 194. [BACK]

5. As one widely reprinted article, said to have reached 8 million readers, described "The Enemy at Home": "The name of this invisible enemy is Venereal Disease—and there you have in two words the epitome of all that is unclean, malignant and menacing. . . . Gonorrhoea and syphilis are 'camp followers' where prostitution and alcohol are permitted. They form almost as great an enemy behind the lines as do the Huns in front." "V.D.: The Enemy at Home," cited by William H. Zinsser, "Social Hygiene and the War: Fighting Venereal Diseases a Public Trust,'' Social Hygiene 4 (1918): 519-520. [BACK]

6. In 1920 William Travis Howard, a member of the city health department, complained: "The Baltimore health department has never inaugurated a single administrative measure directed at the control of the venereal diseases . . . . The Baltimore health department has contented itself with receiving such reports as were made and with lending its power, when called upon, to force a few recalcitrant patients to appear at the venereal disease clinic established by the United States Government." William Travis Howard, Public Health Administration and the Natural History of Disease in Baltimore , Maryland , 1797-1920 (Washington, D.C.: Carnegie Institution, 1924), 154-155. [BACK]

7. Baltimore City Health Department Annual Report (Baltimore, 1930). [BACK]

8. Taliaferro Clark and Lida Usilton, "Survey of the Venereal Diseases in the City of Baltimore, Baltimore County, and the Four Contiguous Counties," Venereal Disease Information 12 (Washington, D.C.: U.S. Public Health Service, 20 October 1931), 437-456. [BACK]

9. Ferdinand O. Reinhard, director, Bureau of Vital Statistics, Baltimore, "Delinquent Patients in Venereal Disease Clinics: Result of a Study in Baltimore City Health Department," Journal of the American Medical Association 106 (1936): 1377-1390. [BACK]

10. Baltimore City Health Department Annual Report (Baltimore, 1932), 63.

11. Ibid., 62. [BACK]

10. Baltimore City Health Department Annual Report (Baltimore, 1932), 63.

11. Ibid., 62. [BACK]

12. Baltimore City Health Department Annual Report (Baltimore, 1933), 93.

13. Ibid., 97.

14. Ibid., 99. [BACK]

12. Baltimore City Health Department Annual Report (Baltimore, 1933), 93.

13. Ibid., 97.

14. Ibid., 99. [BACK]

12. Baltimore City Health Department Annual Report (Baltimore, 1933), 93.

13. Ibid., 97.

14. Ibid., 99. [BACK]

15. James H. Jones, Bad Blood : The Tuskegee Syphilis Experiment (New York: Free Press, 1981), 16-29. The Tuskegee experiment was conducted by the U.S. Public Health Service between 1932 and 1972. Four hundred black Alabama sharecroppers and day laborers were followed to determine the effects of untreated syphilis; treatment was deliberately withheld from the subjects of the study, even after effective penicillin therapy became available. [BACK]

16. Baltimore City Health Department Annual Report (Baltimore, 1934), 107. [BACK]

17. "Plague," Baltimore Evening Sun , 13 August 1934. [BACK]

18. Baltimore City Health Department Annual Report (Baltimore, 1935), 115. [BACK]

19. Ferdinand O. Reinhard, "The Venereal Disease Problem in the Colored Population of Baltimore City," American Journal of Syphilis and Neurology 19 (1935): 183-195. [BACK]

20. Ferdinand O. Reinhard, "Late Latent Syphilis—A Problem and a Challenge," Journal of Social Hygiene 22 (1936): 360-363. [BACK]

21. Thomas Parran, Shadow on the Land : Syphilis (New York: Reynal and Hitchcock, 1937); Thomas Parran and R. A. Vonderlehr, Plain Words about Venereal Disease (New York: Reynal and Hitchcock, 1941); also see n. 20. [BACK]

22. Thomas Parran, "Why Don't We Stamp out Syphilis?" rpt. from Reader ' s Digest , July 1936, in Baltimore Health News 13 (August 1936): 3. [BACK]

23. E.g., Parran, Shadow on the Land , 207, 230. [BACK]

24. Thomas Parran, "Why Don't We Stamp out Syphilis?" rpt. Baltimore Health News 13 (August 1936): 8.

25. Ibid., 3. [BACK]

24. Thomas Parran, "Why Don't We Stamp out Syphilis?" rpt. Baltimore Health News 13 (August 1936): 8.

25. Ibid., 3. [BACK]

26. Thomas Parran, "Why Don't We Stamp out Syphilis?" Reader ' s Digest , July 1936, 65-73. [BACK]

27. "Open Attack on Age-Old Curse," Baltimore Sun , 9 August 1936. [BACK]

28. "War on Venereal Disease Impends," Baltimore Sun , 24 December 1936. [BACK]

29. "G-Men's Haul in Vice Raids Totals 47," Baltimore Sun , 17 May 1937. [BACK]

30. "Vice Witness Names Police Lieutenant," Baltimore Sun , 18 May 1937; "Vice Arrests May Total 100; Bierman Named," Baltimore Sunday Sun , 19 May 1937. [BACK]

31. "Starts to Survey Venereal Disease," Baltimore Sun , 29 July 1937; "Venereal Disease Fight Is Planned," Baltimore Sun , 22 August 1937; "Fight Opens Here on Social Disease," Baltimore Sun , 25 August 1937; "Syphilis Control Unit Begins Work," Baltimore Sun , 21 October 1937; ''Over 2,000 Attend Talks on Syphilis," Baltimore Sun , 26 October 1937. [BACK]

32. "Failure to Assist Syphilis Fight Hit," Baltimore Sun , 6 December 1937; "Jackson Pledges Aid in War on Syphilis," Baltimore Sun , 7 December 1937. [BACK]

33. "Attention Called to Syphilis Here," Baltimore Sun , 1 February 1938. [BACK]

34. Baltimore City Health Department Annual Report (Baltimore, 1938), 159, and (Baltimore, 1939), 159.

35. Ibid. (1938), 16; "21 Employers Asked in Drive on Syphilis," Baltimore Sun , 27 March 1938; "Syphilis Control Is Under Way Here," Baltimore Sun , 22 May 1938; W.M.P. "We Join the Anti-Syphilis Crusade," The Kalends (periodical of the Williams and Wilkins Company), June 1938, rpt. Baltimore Health News 15 (July 1938): 53-54; "Syphilis in Industry" (Baltimore City Health Department, n.d.). [BACK]

34. Baltimore City Health Department Annual Report (Baltimore, 1938), 159, and (Baltimore, 1939), 159.

35. Ibid. (1938), 16; "21 Employers Asked in Drive on Syphilis," Baltimore Sun , 27 March 1938; "Syphilis Control Is Under Way Here," Baltimore Sun , 22 May 1938; W.M.P. "We Join the Anti-Syphilis Crusade," The Kalends (periodical of the Williams and Wilkins Company), June 1938, rpt. Baltimore Health News 15 (July 1938): 53-54; "Syphilis in Industry" (Baltimore City Health Department, n.d.). [BACK]

36. Huntington Williams, "Discussion on the Symposium on Syphilis in Industry," 15 January 1940. Second Annual Conference on Industrial Health, sponsored by the Council on Industrial Health of the American Medical Association, Chicago, 15-16 January 1940; editorial, "Syphilis and Unemployment," Journal of Industrial Hygiene and Toxicology 19 (1937): 189-192; Baltimore Health News 15 (July 1938): 50-57. [BACK]

37. Baltimore City Health Department Annual Report (Baltimore, 1938), 159-163, and (Baltimore, 1939), 159-163.

38. Ibid. (1940), 149-151.

39. Ibid. (1941), 139. [BACK]

37. Baltimore City Health Department Annual Report (Baltimore, 1938), 159-163, and (Baltimore, 1939), 159-163.

38. Ibid. (1940), 149-151.

39. Ibid. (1941), 139. [BACK]

37. Baltimore City Health Department Annual Report (Baltimore, 1938), 159-163, and (Baltimore, 1939), 159-163.

38. Ibid. (1940), 149-151.

39. Ibid. (1941), 139. [BACK]

40. "City Shown Second in Syphilis Survey," Baltimore Sun , 22 October 1941. [BACK]

41. "High Syphilis Rate Laid to Race Ratio," Baltimore Sun , 26 October 1941. [BACK]

42. "FBI and City Agencies Schedule Parley on Vice," Evening Sun , 15 July 1942. [BACK]

43. "Reckord Tells O'Conor of Vice," Baltimore Sun , 17 July 1942. [BACK]

44. "Itzel Charges War on Vice Hampered," Baltimore Sun , 26 January 1943. [BACK]

45. "Says Vice Control Has Improved Here," Baltimore Sun , 27 January 1943. [BACK]

46. "State Law Held Needed in War on Vice," Baltimore Sun , 28 January 1943. [BACK]

47. Nels A. Nelson, "The Repression of Prostitution for Venereal Disease Control," Baltimore Health News 20 (January 1943): 107-108. [BACK]

48. "High Venereal Disease Rate Cited in Maryland," Baltimore Sun , 4 December 1942. [BACK]

49. "Vice Inquiry Transferred to Annapolis," Baltimore Sun , 29 January 1943. [BACK]

50. "Stanton Idea for Examination of Prostitutes Is Denounced," Baltimore Sun , 29 January 1943. [BACK]

51. "Venereal Picture Dark: Dr. Huntington Williams Says No Improvement Is Expected for Some Time," Baltimore Sun , 21 January 1943. [BACK]

52. "Baltimore Disease Council Is Organized," Baltimore Health News 20 (February 1943): 109-110. [BACK]

53. "Three Venereal Disease Council Committee Reports," Baltimore Health News 20 (March 1943): 119-120.

54. Ibid., 118-119. [BACK]

53. "Three Venereal Disease Council Committee Reports," Baltimore Health News 20 (March 1943): 119-120.

54. Ibid., 118-119. [BACK]

55. "Clinics Here under Fire," Baltimore Sun , 30 March 1943. [BACK]

56. "Venereal Disease Rate High in State," Baltimore Sun , 15 June 1943. [BACK]

57. Parran and Vonderlehr, Plain Words about Venereal Disease , esp. 96-120.

58. Ibid., 77. [BACK]

57. Parran and Vonderlehr, Plain Words about Venereal Disease , esp. 96-120.

58. Ibid., 77. [BACK]

59. Baltimore City Health Department Annual Report (Baltimore, 1943), 147.

60. Ibid., 148. [BACK]

59. Baltimore City Health Department Annual Report (Baltimore, 1943), 147.

60. Ibid., 148. [BACK]

61. C. Howe Eller, "A Sex Education Project and Serologic Survey in a Baltimore High School," Baltimore Health News 21 (1944): 81-87.

62. Ibid., 84. [BACK]

61. C. Howe Eller, "A Sex Education Project and Serologic Survey in a Baltimore High School," Baltimore Health News 21 (1944): 81-87.

62. Ibid., 84. [BACK]

63. J. D. Porterfield, Baltimore City Health Department, "A Talk on Sex Hygiene for High School Students," April 1944, Rockefeller Foundation Archives, RG 1.1, ser. 200, 1.

64. Ibid., 4.

65. Ibid., 7. [BACK]

63. J. D. Porterfield, Baltimore City Health Department, "A Talk on Sex Hygiene for High School Students," April 1944, Rockefeller Foundation Archives, RG 1.1, ser. 200, 1.

64. Ibid., 4.

65. Ibid., 7. [BACK]

63. J. D. Porterfield, Baltimore City Health Department, "A Talk on Sex Hygiene for High School Students," April 1944, Rockefeller Foundation Archives, RG 1.1, ser. 200, 1.

64. Ibid., 4.

65. Ibid., 7. [BACK]

66. Emily V. Clapp, Growing Up in the World Today (Boston: Massachusetts Society for Social Hygiene, n.d.).

67. Ibid., 14. [BACK]

66. Emily V. Clapp, Growing Up in the World Today (Boston: Massachusetts Society for Social Hygiene, n.d.).

67. Ibid., 14. [BACK]

68. For the development of penicillin therapy, see Harry F. Dowling, Fighting Infection : Conquests of the Twentieth Century (Cambridge: Harvard University Press, 1977), 125-157. [BACK]

69. Baltimore City Health Department Annual Report (Baltimore, 1945), 29.

70. Ibid., 145-146; "Venereal Law Made Specific," Baltimore Sun , 26 August 1945. [BACK]

69. Baltimore City Health Department Annual Report (Baltimore, 1945), 29.

70. Ibid., 145-146; "Venereal Law Made Specific," Baltimore Sun , 26 August 1945. [BACK]

71. "End of VD—Cure Center Seen as Calamity," Evening Sun , 12 June 1946. [BACK]

72. "A Temporary Power Made Permanent," Baltimore Sun , 9 January 1947. [BACK]

73. "Rapid Treatment: Maryland State Department of Health," Press Bulletin No. 1043, 27 January 1947, Enoch Pratt Public Library of Baltimore, Maryland Room.

74. Ibid. [BACK]

73. "Rapid Treatment: Maryland State Department of Health," Press Bulletin No. 1043, 27 January 1947, Enoch Pratt Public Library of Baltimore, Maryland Room.

74. Ibid. [BACK]

75. Baltimore City Health Department Annual Report (Baltimore, 1946), 28. [BACK]

76. Thomas B. Turner, "Syphilis: Help or Hindrance?" Talk to American Social Hygiene Association, 2 February 1948, Rockefeller Foundation Archives, RG 1.1, ser. 200, 4. [BACK]

77. "Baltimore City STD Fact Sheet" (Baltimore City Health Department, November 1981). [BACK]

78. "City Assembles Coalition to Battle Venereal Disease," Baltimore Sun , 10 June 1976. [BACK]


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