The Hidden Affliction: Sexually Transmitted Infections and Infertility in History ed. by Simon Szreter (review)

The Hidden Affliction is an interdisciplinary collection that explores the history of sexually transmitted infections (particularly gonorrhea and syphilis); most of its articles also link these diseases to issues of demographics and infertility. The collection is impressive in disciplinary and chronological scope, including work by historians, demographers, archaeobiologists, and virologists. It is divided into four sections—pre-modern sexually transmitted infections (sti), scientific approaches, and demography in the "Global South" and modern Europe. Although each of the articles stands alone, the overall editorial structure makes this collection into a cohesive unit that is worth reading as a whole book. Szerter's introduction provides valuable insights about the topic and the importance of interdisciplinary work in the history of medicine more broadly. He argues that in order to obtain valuable knowledge about the ways in which venereal diseases led to historical infertility, we need not only to familiarize ourselves with the cultural and medico-social sources but also to "know as much as we can from today's biological, evolutionary, and epidemiological sciences . . . . It is crucial not to restrict ourselves only to texts from the past but to embrace all available forms of relevant evidence" (12).

Many of the chapters follow this logic, for example, by combining textual history with insights from ancient dna studies or epidemiology. Historians of medicine who want to familiarize themselves with scientific methodologies will find the second section particularly valuable. It offers a series of readable chapters about the virology and bioarchaeology of STis that serves as a useful introduction to these fields, although they may be too basic for experts. The fourth section, which includes Szerter's own work, demonstrates the value of interdisciplinary scholarship most strongly. It examines attitudes to stis and declining fertility in Western Europe at the turn of the twentieth century. Each of the three contributions focuses on a different country (Germany, France, and Britain) and uses a different research methodology. The result is a thought-provoking examination of the subtle differences between medical views in these countries, as well as of the kind of historical knowledge gained from different scholarly approaches.

Given the innovative nature of most of the work in this collection, it was jarring to find within it two chapters that make uncritical use of early twentieth-century anthropological descriptions of Pacific Islanders. These texts are not used as primary sources describing bygone attitudes but as acceptable descriptions of indigenous cultures to be cited by contemporary scholars. Tim Bayliss-Smith and Roy F. R. Scragg both argue that the demographic decline in some Pacific Island societies after colonial encounters was caused by the spread of gonorrhea, which can cause infertility in women while being otherwise asymptomatic. Their argument itself may be sound, but it is obscured by references to "Aphrodisian" and "Non-Aphrodisian" indigenous cultures, and descriptions of the "ritual promiscuity" and "sexual generosity" of indigenous women (206—209), or their reputation for "customary promiscuous behavior" (240). Substantial anthropological scholarship in the past several decades has criticized such descriptions of Pacific Island cultures, demonstrating that it obscures the true nature of colonial encounters.¹

Moreover, the other essays in the "Global South" section of this collection argue that colonial medical authorities tended to overdiagnose STIs among indigenous populations due to false perceptions of promiscuity. The absence of a more critical engagement with these antiquated anthropological views is thus an unfortunate blemish on a collection that otherwise makes an important contribution to the history of medicine.