The Persistence of the Serpent

It is not exactly a historical secret that sex is here to stay. But it is only in relatively recent times in this country that sexual behavior has been so openly described, depicted, and debated in the public forum. It has also become a fit subject for scholarly research; and these new studies are downright painful when they involve life-and-death matters like sexually transmitted disease, or STD, the abbreviation of current choice. When I was in my twenties, the term in use was VD—venereal disease—more euphemistic and not quite so terrifying, since the killer AIDS had yet to stalk its victims. Syphilis and gonorrhea were treatable —although if neglected, they could do extremely unpleasant things to your mind and body, as the United States Army kept reminding me and my buddies almost obsessively during World War II.

I am reminded of this topic by the arrival of a brochure noting that 1994 marks the eightieth birthday of the American Social Hygiene Association (now the American Sexual Health Association). I supplemented its information with Allan Brandt’s No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880 (Oxford University Press, 1985). The tale they tell is important.

One of the peak years for the progressive spirit in America was 1914, and I was not surprised to learn that among ASHA’s founders were many distinguished progressives from business, social work, law, education, and medicine. Participating were Jane Addams, John D. Rockefeller, Jr., David Starr Jordan, chancellor of Stanford, and Charles W. Eliot, president emeritus of Harvard, Henry James, Jr., the nephew of the novelist, Dr. Thomas Hepburn, the father of the actress, and Dr. William F. Snow (ASHA’s first executive director and the grandfather of the editor of this magazine).

The problem that brought them together was the ravaging effect of venereal disease on “individuals, families and communities.” Unknown numbers of men picked up infections from houses of prostitution, which were then an open and flourishing industry, and many of them brought syphilis and gonorrhea home to their unsuspecting wives, with disastrous medical results, including sterility in some cases and infection of their unborn children in others. Counterattack on these tragedies could take two forms: either the suppression of the “vice” that fed VD or vigorous programs of prophylaxis, prevention, and treatment. Most progressives in 1914 supported both, and few medical men then would have taken the stand of a Massachusetts physician who wanted simply to treat syphilis like any communicable disease, “leaving the academic discussion of its moral and social aspect to others.”

Yet both the medical and moral approaches required breaking powerful taboos against even mentioning the subject in polite society. Solutions required enlightenment, and that was where progressives came into the picture, for it was their conviction that scientific research and publicity would conquer any hindrance to human advancement. “No evil ever flourished long in the world’s history,” said one, “after the limelight of knowledge had uncovered it.” And so ASHA set out on a combined track: to encourage research and treatment (including chemotherapy with a brand-new drug, Neosalvarsan, an arsenic compound so effective that it was called a magic bullet) and to fight prostitution and “immoral” behavior by warning of VD’s dire consequences.

What happened thereafter is an intriguing study in the interplay of the two strategies. ASHA’s publicizing efforts got an early boost when the United States became involved in the war, which made it a patriotic duty to fight diseases that kept men off the firing line. The War Department initiated in 1917-18 the practical programs that reduced VD rates in France and that remained part of military life thereafter. Meanwhile, ASHA and allied organizations worked on other fronts, helping provide “wholesome” recreation for “the boys” and telling the home front, too, that VD was “the Invisible Enemy . . . the epitome of all that is unclean, malignant and menacing.” A film, Fit to Fight , was produced, about some doughboys who fell to temptation and languished in hospitals while others kept clean for the girls back home and went on to manly triumphs. By 1919 VD seemed decidedly out of the closet, and an ASHA spokesman happily predicted that the soldiers “marching home” would “know more of the scientific and practical facts of sex hygiene than any similar group of men in the world” and pass on to their children “wholesome and sane information regarding healthful living.”

Alas, it was not to be. The Roaring Twenties brought well-advertised increases in overt sexual activities but the twenties of Republican “normalcy” also brought cuts in funding for public health activities, and between the two developments VD rates rose anew. A censorious reaction blamed it all on the “revolution” in morals and manners, and anti-VD programs languished in the face of attitudes like that of the lawmaker who attacked the idea of a division of syphilis control in his state’s health department because he hated its name. “I say this word is not decent,” he argued, “and should not be spread among . . . the youths.”

A defining moment in the retreat from openness came in 1934, when the New York State commissioner of public health, Dr. Thomas Parran, was told that he could not use the word syphilis in a radio address—and promptly refused to go on the air. But then the tide turned once more. The family breakups, vagrancy, and general poverty of the Depression years increased the number of VD infections and forced a public response in the New Deal, if only on the ground that war on economic stagnation required healthy workers. Parran himself was named U.S. Surgeon General, and ASHA continued its research, legal, and educational work, supporting such activities as community and industry drives to identify and treat gonorrhea and syphilis carriers, plus state legislation mandating blood tests before obtaining a marriage license. In 1938 Congress passed a Venereal Disease Control Act that provided federal assistance to states in carrying out anti-VD programs.

Conversion to ASHA’s viewpoint was not unanimous—Roman Catholic officials, for instance, objected to the advocacy of condoms (actually avoided by ASHA); but despite pockets of resistance, government involvement in VD control continued to grow and ballooned after 1941 in the huge new campaigns to subdue vice and VD in the name of the war effort.

The 1940s brought a breakthrough when penicillin seemed to hold out the prospect of ending VD altogether—a prospect not cheering to some physicians like Dr. John Stokes, who worried that if science eliminated those diseases “without commensurate attention to the development of . . . self-control,” it might be “bringing mankind to its fall instead of fulfillment.” These precise sentiments had been voiced some thirty years earlier by one medical man who thought that if we could “eradicate the [venereal] diseases, we would . . . in one short generation, fall wholly under the domination of the animal passions.”

Conservatives, however, had no need to fear the elimination of what we shall henceforth call STDs. By the 1960s and 1970s, after the Kinsey Report and the Pill had wrought yet another sexual revolution, new or resurgent forms of them were appearing—genital herpes, chlamydia, chancroid, human papillomavirus (HPV), or genital warts—stoutly resistant to existing antibiotics. By then ASHA, rechristened in 1960, had moved toward a more “holistic” approach consistent with the switch from “social hygiene” to “social health.” It was investing more energy in collaboration with government programs to attack disorders broadly associated with STDs: drug use, promiscuity, teen-age pregnancy. But in light of the alarming increase in new infections, ASHA undertook to co-sponsor increased medical research, while it continued its tradition of spreading public information via the media as well as through a device undreamed of in 1914—the confidential STD information hot line founded in 1979, which fielded nearly two hundred thousand calls a year. Then came HIV (human immunodeficiency virus) and AIDS. An AIDS twenty-four-hour hot line was set up in 1986; it now answers about 1.5 million calls a year.

The AIDS epidemic itself defies a closing generalization, though the attentive reader will find that many of today’s arguments about dealing with it (medically, morally, or in any other fashion) echo controversial positions struck throughout the years of ASHA’s existence. The organization’s birthday history, however, concludes with the game statement that its mission remains unchanged: “to bring the message about STDs home to Americans for as long as it takes, until the problem is solved [author’s italics].

There speaks the progressive voice, to which I listen as a historian with mixed pleasure and sadness. I cherish the survival of the spirit that insists that all problems have some reasonable solution. Without it, societies can become paralyzed by cynicism or gloom. But idealists who read history carefully can’t deny that human emotions and instincts too often override reason—especially in contested areas like sex. Periods of “repression” and “liberation” may alternate, but STDs and debate over their proper treatment will go on a long time, keeping step with ASHA’s hopeful endeavors.