In Search of Sexual Health: Diagnosing and Treating Syphilis in Hot Springs, Arkansas, 1890–1940 by Elliott Bowen (review)

In 2021, it is not hard to imagine living during an era in which a dreaded disease stalks the planet, inflicting loved ones with baffling symptoms, transmitting with baffling irregularity. For the past two years, our dreaded disease has been COVID-19. Between the 1870s and the availability of penicillin in the 1940s, the nation’s most dreaded disease was syphilis, the diagnosis and treatment of which were further complicated by the shame, secrecy, and euphemism so often attached to sexually transmitted infections. Hot Springs, Arkansas emerged in the 1890s as a “mecca for syphilitics in America” because of its eponymous healing waters and because of its long-standing tolerance for vices, including prostitution, outlawed in most other U.S. cities (p. 1). In fact, Hot Springs attracted more syphilis patients than all other U.S. health resorts combined, making the city an ideal case study for examining the cultural and medical history of syphilis (p. 5). Elliott Bowen’s In Search of Sexual Health: Diagnosing and Treating Syphilis in Hot Springs, Arkansas, 1890–1940 challenges the prevailing “wages of sin” historiography of syphilis treatment, centers patient voices and experiences, and argues for the importance of Hot Springs in the history of American medicine and public health.

Perhaps the most interesting and unique contribution of In Search of Sexual Health consists of the in-depth clinical case files, patient records, and personal letters that Bowen draws on, especially those from the Garland County (AR) Historical Society and the Army and Navy General Hospital at Hot Springs. Patient voices highlight not only the daily indignities and pains they suffered, but also offer glimpses of living with a mysterious chronic illness and of the community they found among fellow travelers in Hot Springs. Bowen includes a few photographs (more would have been welcomed by this reader) and, in general, creates a vivid picture of the atrocities wrought by syphilis both emotionally (several health seekers committed suicide in Hot Springs) and physically, including rotting flesh, and severe ambulatory difficulties.

Bowen argues against previous histories of syphilis which emphasize the wages of sin approach to treating (or not treating) syphilis and finds in Hot Springs more fluid understandings of sin and morality among both physicians and patients. Bowen’s examination of Hot Springs aims to “decenter the state” by focusing on patients, stressing the chronic nature of syphilis, and analyzing how ideas about “sin and shame” shaped medical practice and patient experience. Within the city limits, health seekers availed themselves of myriad treatments at the hands of a variety of specialists, including “dozens of medical offices run by privately practicing venereal specialists, a military hospital whose surgeons treated the nation’s syphilis-stricken soldiers and sailors, and a new VD clinic operated by the United States Public Health Service (PHS)” (p. 2). Correspondingly, Hot Springs physicians had an outsized influence on national discussions and practices regarding syphilis due to their special expertise and access to so many patients.

In Search of Sexual Health is organized chronologically and by type of physician, with chapters on the private physicians, the Army and Navy Hospital, and the Public Health Service (PHS) clinic. Regardless of training or specialty, the vast majority of health care providers and patients in Hot Springs were white men. Bowen pays close attention to the gendered and racial dynamics underscoring syphilis treatments and diagnosis. Hot Springs was racially segregated, drastically limiting the care options available to Black Americans. Not only could African American men and women not visit the same clinics or baths as White Americans, they often performed the most dangerous jobs at White health spas, including rubbing toxic mercury on White patients’ backs. Given this fascinating and unique urban setting, Bowen could have done more—such as provide a map or two—to help readers understand the shifting...