Purity and Hygiene: Women, Prostitution, and the "American Plan," 1900-1930 (review)

David Pivar examines the transition from the social purity movement to the social hygiene movement. Nineteenth-century social purity movements, led by feminists and religious idealists, located the problems of venereal diseases and prostitution in excessive male sexuality and the sexual double standard. Activists, who hoped to change sexual behaviors and create a more ideal world, regarded the prostitute with sympathy and as a sister. (As others have shown, of course, the sisterhood offered by middle-class reformers to downtrodden women could be extremely controlling.) As corporate reformers and physicians became interested in reform, they narrowed the focus to disease and hygiene rather than social transformation. With the shift in emphasis to hygiene in the Progressive Era, Pivar argues, "prostitutes, formerly the object of sympathy, became pariahs charged with spreading syphilis into the nation's bloodstream" (p. xv). This new way of seeing female sex workers—as disease vectors—contributed to newly oppressive policies.

Purity and Hygiene has several strengths that add to our understanding of the responses to venereal disease and prostitution in the Progressive Era. First, Pivar connects turn-of-the-century U.S. feminists who opposed the regulation of prostitution to international struggles in Britain, India, and China over the British system of regulation (in which the British military mandated the "inspection" and treatment of prostitutes and certified them to be disease free, thereby protecting the pleasures and health of male soldiers). Indeed, American activists had gone to India and China themselves to investigate. Drawing upon Josephine Butler's analysis, they attacked the sexual double standard, the coercion involved in medical regulation, and the establishment of regulation systems in the U.S. empire and American cities. Second, Pivar shows the internal struggles among women and religious activists in the social purity movement, the military, and medicine. Finally, he shows the consequences for working-class women when the new medical-military "American Plan" was put into practice during World War I.

I have long wanted to know more about the military's removal of suspected prostitutes from areas around military training camps during World War I. The federal government's encouragement of the mass detention of women for quarantine and medical treatment in order to prevent the spread of venereal disease to soldiers is a significant example of the use of police powers on behalf of public health, and one that receives insufficient historiographic notice. Police picked up tens of thousands of women, and more than 15,000 were incarcerated without due process in new federally funded institutions, forcibly examined gynecologically, and held by local boards of health—many for a year or more—until they were declared free of disease. Pivar's chapter on World War I indicates the vulnerability of stigmatized female sex workers to mistreatment in the name of protecting the nation during war.

Pivar's style leans toward detail without a strongly theoretical analysis. For instance, he takes newspaper exposés of prostitution and child-selling at face value, without analyzing the newspapers as producers of stories and fantasies and disagreement (as shown by Judith Walkowitz in her analysis of prostitution and sex scandals in Britain, in City of Dreadful Delight: Narratives of Sexual Danger in Late-Victorian London, 1992). Yet Purity and Hygiene nonetheless offers insights and a wealth of valuable material for those interested in pursuing more cultural projects on the histories of sexuality, prostitution, venereal disease, and health in the Progressive Era. The abuses of the civil liberties of women, Pivar argues, grew out of the fading of the nineteenth-century movements and the rise to power of business interests (Rockefeller) and medical professionals who focused narrowly on the examination, control, and treatment of prostitutes in order to solve the problems of VD. Syphilis was no longer understood in social terms. Pivar forcefully underlines that the path taken in the United States, which blamed prostitutes for VD, was...