History of Medicine

VENEREAL DISEASE AND COMPULSION

     In the spring of 1916 the Mexican revolutionary Pancho Villa raided the town of Columbus, New Mexico, setting off a small war with the U.S. After General Pershing chased him back to Mexico numerous American troops remained encamped on the Mexican border. Saloons and brothels appeared almost instantly and the venereal disease rate among the troops soared, reaching close to 30%. As rumors of the “debauched” scene drifted out, Secretary of War Baker dispatched Raymond Fosdick, a

Raymond Fosdick (Wikicommons)

Progressive and social reformer, to investigate, and he confirmed the news. Baker ordered stricter discipline, which helped, somewhat.

     The very next year the U.S. military began preparing for war in Europe. The War Department formed the Commission on Training Camp Activities (CTCA), headed by Fosdick, to help keep STIs out of the military training camps. The goal was to create a wide perimeter around the camps, devoid of bars and brothels, encourage sporting and recreational facilities, and provide education about STIs with graphic lectures, pamphlets, and movies.

     But male-female contacts flourished anyway and the VD rate remained high. As a stopgap measure “chemical prophylaxis” was provided for recruits recently exposed: first urinate, then wash the genitals, follow with a mercury bichloride rinse, then an injection of protargol (a silver-albumin compound) into the urethra to be held for five minutes, then expelled. It seemed to be effective for gonorrhea prevention.

     Meanwhile, another group, the Committee on Protective Work for Girls (CPWG), headed by the social worker Maude Miner, was formed to patrol around bases, befriend nearby women, and try and talk them out of meeting recruits. This also had little impact, persuading the CTCA to turn to more repressive measures, initiating a dark chapter in public health history. Detention became the watchword.

     Subdivisions of the CTCA worked with Law Enforcement personnel. They approached young women found near training camps and, if suspicious, hauled them off for an examination for venereal disease. If any was found they were incarcerated for treatment. For syphilis this meant several weeks.

     State governments, fearful of losing lucrative military camps, cooperated in the effort by passing laws for the arrest of women “reasonably suspected” of having VD. In many cases there was no habeas corpus, bail, or legal recourse for arrested women. By March 1918, 32 states had passed such laws. Rockefeller money went into the CTCA. President Wilson allocated $250,000 for establishing “detention homes” where the women were held and treated (to keep them out of prisons), and states provided others. Congress passed the Chamberlain-Kahn bill authorizing one million dollars for the same purpose, though the money went for maintenance of existing ones. The homes were often pretty shabby. Many of the detainees were given IQ tests, part of the nascent eugenics movement seeking to sterilize mental defectives. Over 18,000 women were incarcerated in federally funded institutions, some of whom did not have VD. The total number incarcerated is estimated at 30,000 or more.

     A recent book describes the ordeal of Nina McCall, an 18-year-old woman in St. Louis, Michigan, thought to have been fraternizing with soldiers at a nearby base. Confronted with a choice of being quarantined in her house with a sign outside saying she had venereal disease or entering a treatment facility, she opted for the latter. She was treated for gonorrhea and syphilis

August von Wassermann

in a “detention hospital” – a former contagious disease hospital. Once inside she could not leave until treatment was complete, about 2 ½ months in her case.

     A cacophony of public opinions on venereal disease provided a backdrop. Many still saw it as a moral issue, preaching education and abstention. Others advocated legally regulated prostitution near camps, with regular inspection of women by doctors to weed out those with disease (This was done in Nashville and Memphis during the Civil War). Many, especially women’s groups, complained, rightly but in vain, that detaining women and suppressing prostitution implied that men had little responsibility for passing on infections. If women were to be arrested, why not

Poster for film on Paul Ehrlich played by
Edward G Robinson (Wikipedia)

men? In the military soldiers were seldom disciplined even though acquiring VD was a punishable offence. Strangely, condoms were seldom emphasized, partly because they were seen as an inducement for “loose behavior” and partly to avoid antagonizing the Catholic Church.

     Medically, progress had been made with VD. In the first decade of the twentieth century the spirochete causing syphilis was

Fritz Schaudinn (Wikipedia)

discovered by Schaudinn and Hoffmann, and August von Wasserman developed his serologic test for syphilis. In the next decade Paul Ehrlich’s lab discovered compound 606 (Salvarsan), then Neosalvarsan, both arsenicals, usually used with mercury, for treatment of syphilis. Side effects of arsenicals were significant and dose regimens unstandardized. Many underwent treatment for months. Urethral silver

remained the treatment for gonorrhea.

     After WWI most of the detention activities ceased as training camps dissolved and funding evaporated. Important too was a public reaction against detentions and the compromise of civil rights. Raymond Fosdick eventually became president of the Rockefeller Foundation. The US Public Health Service, filling the postwar void, assumed a greater role in STI prevention and education.

SOURCES:

Stern, Scott. The Trials of Nina McCall. 2018; Beacon Press.

Brandt, Allan. No Magic Bullet: A social History of Venereal Disease in the United States since 1980. 1985; Oxford Univ Press.

Parascandola, John. Sex, Sin, and Science: A history of Syphilis in America. 2008; Praeger Press.

Sartin, J S, Perry, H O. “From Mercury to Malaria to Penicillin: The History of the Treatment of Syphilis at the Mayo Clinic-1916-1955”. J Amer Acad Dermatology 1995; 32:255-61.

Kampmeier, R H. “Venereal Disease in the United States Army: 1775-1900”. Sexually Transmitted Dis 1982; 9(2): 100-03.

Kampmeier, R H. “The Continuous Treatment of Early Syphilis by Arsphenamine and Heavy Metals”. Sexually Transm Dis 1981; 8: 224-6.

Brown, MT and Fee, E. “Raymond D. Fosdick (1883-1972): Ardent Advocate of Internationalism” Am J Public Health. 2012; 102(7): 1285.