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

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-

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.