The Colour of Disease: Syphilis and Racism in South Africa, 1880-1950 (review)

It is perhaps a truism to say that infectious disease acts as a giant spotlight on society, illuminating its faultlines, whether of class or race or gender, and revealing its deepest anxieties and fears. In no case is this more evident than in the spread of sexually transmitted disease in a colonial society, as Karen Jochelson shows in her fine account of the history of syphilis in South Africa between 1880 and 1950. These dates are well chosen. Her endpoint—the 1950s—marks the moment at which antibiotics seemed to offer a cure; the 1880s, the moment at which local officials became aware of the accelerated spread of syphilis that—together with occupational lung disease—accompanied South Africa's mining revolution in the last thirty or so years of the nineteenth century.

Official concern was signaled in the Cape Colony by the passage of Contagious Diseases legislation (discussed in chapter 2). In fact, as Jochelson acknowledges briefly, sexually transmitted syphilis was probably introduced into the Cape by the Dutch some two centuries earlier. Given the high rate of sexually transmitted syphilis among Europeans (especially soldiers and sailors) in the seventeenth through the nineteenth centuries, and the high proportion of men among the Dutch and British renegades and raiders, soldiers and settlers, travelers and traders who expanded into the interior in these years, there is scope here for another volume. Wisely, however, she eschews this earlier story and begins instead with the migrant labor system, which propelled hundreds of thousands of young single men to the mines each year, disrupting family relationships and transforming sexual mores. The key characteristic of South Africa's path to industrialization, it "proved a particularly effective way for STDs to spread" (p. 3).

Jochelson is not alone in pointing to migrant labor and the wider socioeconomic and political changes wrought in the last third of the nineteenth century as the source of new diseases and disease patterns in South Africa, when war, dispossession, unregulated industrialization, and rapid urbanization rendered individuals and communities vulnerable. As she notes, by the 1940s a small group of progressive doctors were well aware of the destructive impact of the migrant labor system. Unlike earlier observers, however, she argues that the late nineteenth century saw not one, but two epidemics: in addition to the accelerated spread of sexually transmitted syphilis, there was endemic syphilis, long present in the drier regions of the subcontinent, but now greatly spread by the overcrowding in unhygienic conditions that characterized new mining towns. This dual pathology, she believes, accounts in part for the puzzling features of the disease, which doctors grossly exaggerated and attributed to the racial characteristics of its bearers and their hypersexuality. The argument is compelling, although, as Jochelson shows, by the interwar years, venereal syphilis was by far the commonest form encountered by physicians, especially in the mining areas and along South Africa's southeastern seaboard.

Unraveling this conflation is important in illustrating another major component of Jochelson's account: the way in which the disease was framed by medical practitioners who shared in and helped shape the racial stereotypes and popular anxieties of their age. Using rich municipal and state records, and a variety of published primary sources including pamphlets, educational material, and film, she analyzes the changing moral prescriptions, medical discourses, and health policies surrounding syphilis, rooted as they were in the social values, political prejudices, and class interests of the time. Importantly, she does this for both blacks and poor whites, not only showing the racially discriminatory allocation of health resources (by now a commonplace in the historiography of health care in South Africa—though it never fails to shock) but also, through their juxtaposition, demonstrating the ways...