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
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
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
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,
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.