Sex, Sin, and Science: A History of Syphilis in America (review)

John Parascandola’s Sex, Sin, and Science is a contribution to the series Healing Society: Disease, Medicine, and History, of which the author himself is a series editor. The series aims to issue books that will appeal to both general and specialist audience. Sex, Sin, and Science takes in a broad sweep of time, beginning with the origins of syphilis in colonial America and continuing right up to the present day. The author has conducted a significant amount of research, especially in the administrative records of public health organizations and bureaucracies of the first half of the twentieth century. But this book is primarily a work of synthesis, drawing together the large historical literature devoted to the history of syphilis and venereal disease in the United States.

The basic story is a familiar one. In the United States, as elsewhere, syphilis emerged as a major public health concern in the late-nineteenth and early-twentieth centuries. Government responses, however, remained sporadic until the First World War, when the federal government initiated a major public health campaign intended to protect U.S. fighting forces from the depredations of the dread disease. A lull ensued in the interwar years until another war intervened and the federal government again ratcheted up its involvement in the control of venereal disease. In the postwar period, the advent of a new wonder drug, penicillin, gave rise to the hope that syphilis might be eradicated, but declining government funding, overestimation of the impact of the drug, and possibly some combination of changes in sexual behaviors and the emergence of new strains of the cause of syphilis, the spirochete, dashed all such hopes. While rates of infection have clearly declined substantially over the last fifty years, a “magic bullet” to rid us of the disease once and for all has not materialized and rates of infection have once again begun to climb. Parascandola cites a recent British study, suggesting that many of the “ups and downs” of the disease are due to its “natural cycle” (148). By this account we can anticipate rates of infection to continue to rise for at least several more years before eventually declining again.

Parascandola emphasizes the diverse ways that attitudes toward sex, race, and, especially, gender double standards have shaped public health policies. Especially during the two world wars, “women were made to bear the brunt of the blame for the spread of venereal disease” (122). Such an observation is hardly novel but it bears repeating. Those unfamiliar with the subject will likely be surprised at the draconian measures taken against women during the most aggressive public health campaigns. During World War II, for instance, women merely suspected of “promiscuity” and testing positive for syphilis could be forcibly locked up in “nonpenal” institutions and required to submit to a treatment regimen for up to ten weeks.

One of the central themes of the book is the tension between the protection of individual rights and the protection of public health. The book documents something of a pendulum effect with the world wars representing an extreme in the willingness of public authorities to subordinate individual rights to what they perceived as the public good. It nevertheless remains the perspective of the various advocates and agencies responsible for government-sponsored attempts to control the disease that underwrites Parascandola’s narrative. Somewhat curiously the author says virtually nothing about the question of doctor–patient confidentiality and doctors’ own divided allegiances (a topic recently addressed in Amy L. Fairchild, Ronald Bayer, James Colgrove, Searching Eyes: Privacy, the State and Disease Surveillance in America [Berkeley: University of California Press; New York: Milbank Memorial Fund, 2007] 58–80). More notable is the absence of any significant treatment of the “private” side of the story: either the experiences and perceptions of those who suffered from syphilis, thought they suffered from syphilis, or feared they might suffer from syphilis; or the diverse ways that syphilis was managed within...