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

“Infertility,” writes Simon Szreter in his introduction to The Hidden Affliction, “is now a high-profile contemporary public policy issue around the world.” And yet, he argues, “there has been remarkably little systemic and comparative historiography addressing the infertility aspects of historical STIs [sexually transmitted infections]” (p. 3). This ambitious volume, examining the origins, dissemination, and impact of syphilis, gonorrhea, and Chlamydia, begins in the ancient world and ends in the first half of the twentieth century. With its broad sweep and compelling individual chapters, this volume is informed by a range of multidisciplinary perspectives, as historians are joined by researchers from archaeology, biology, classics, demography, geography, and medicine.

Each of the chapters covers a specific issue important to understanding the historical impact of STIs on fertility. For example, when and where did each of these diseases—venereal syphilis, gonorrhea, and chlamydia—appear in human history? In chapter 1, Rebecca Flemming explains that gonorrhea as we know it was most likely not present in the ancient Mediterranean world. As subsequent chapters covering later periods demonstrate, however, considerable debate continues to exist about when STIs did make their appearance. As Szreter notes, “It currently remains unclear whether either venereal syphilis or gonorrhea in fact afflicted any human populations in the world before the 1490s and differences of opinion on this are expressed by different contributors to this volume” (p. 27). Chlamydia, in contrast, was not identified as a clinical entity until centuries later, in the 1970s. It is possible, however, according to this volume, that it has been infecting humans for millennia.

Geographically, the individual chapters stretch from the ancient Mediterranean to modern Europe and the Global South. Chapters on Australia, Melanesia, and East Africa detail the impact of STIs in their populations. In chapter 9, for example, historian Janet McCalman and demographer Rebecca Kippen use population data and medical casebooks to explore in detail the experiences of four distinct groups of marginalized women in Australia: four generations of a single family, convict women transported from England to Tasmania, Aboriginal women in Victoria, and women admitted to a charity hospital in Melbourne. The chapter includes searing stories of the lives of women suffering from a range of painful and sometimes fatal medical conditions, including birth injuries and pelvic inflammatory disease. These women endured lifelong poverty, were marginalized by their “delinquency,” or, in the case of Aboriginal people, were profoundly afflicted in multiple ways. “We need to know more about who, where, and why men and women became sick from sex and what it did to their lives,” the authors write (p. 279). In the end, McCalman and Kippen concluded, although they were unable to determine the precise role that sexually transmitted diseases played in these women’s pain and illness, “What we can say is that pelvic inflammatory disease and birth injuries inflicted great suffering on women and must have had a significant impact on fertility over the life course” (p. 297).

In part 4, the book’s final section, the focus shifts to modern Europe and the role played by STIs in the late nineteenth and early twentieth-century fertility decline occurring in Germany, France, and Britain. The chapter on Germany begins with the story of Emil Noeggerath, a well-known expert in the treatment of infertility, who coined the diagnostic term “latent gonorrhea.” Born and educated in Bonn, Germany, Noeggerath later trained in Vienna, Prague, and Paris before immigrating to the United States in 1857. He was the first physician to argue that men who had apparently been “cured” of gonorrhea were responsible for a significant proportion of infertile marriages. Either the disease had made them sterile, he declared, or they had infected their wives, who then developed pelvic inflammatory disease, which caused blockage of their fallopian tubes. As Christina Benninghaus explains, Noeggerath’s ideas gained significant traction in Germany, where physicians...