In 1937, Chicago went to war. Not against Nazi Germany, not against Japan for invading China, not eve n against organized crime, a powerful presence in the city. In 1937, Chicago went to war against syphilis.
I was alerted to this war—and "war" was the term used by journalists and public officials—when I had occasion recently to reread No Magic Bullet, Allan Brandt's history of venereal, or sexually transmitted, diseases. It's a fascinating account of how social and cultural attitudes about sex and class and race stood in the way of effectively combating STDs. Despite scientific knowledge of how to prevent transmission and despite improvements in treatment, the politics of venereal disease made it resistant to elimination.
Many of us who lived through the 1980s know something about the politics of sex and disease. Headlines like "gay cancer" and phrases like "innocent infection" and President Reagan's five-year silence about AIDS taught us that the prevention, treatment, and cure of illness is not simply a matter of science. Instead, disease can call into play all the fears and prejudices of a society. It can lead majorities to scapegoat minorities and to attach the label of guilty to people infected by a virus.
Long before AIDS, syphilis was a disease that called forth fear, shame, and blame. Its symptoms, especially in women, easily escaped detection. Left untreated, it worked its destruction gradually, leading to heart disease, the degeneration of vital organs, and insanity. Syphilis and gonorrhea could be transmitted from mother to fetus, resulting sometimes in still births, sometimes in blindness. Not until the early 20th century was there effective treatment for syphilis, but the regimens were long and discomforting.
However, even after diagnosis and treatment became available and science knew how to prevent transmission, syphilis remained resistant to control. Imagine an age, like the early 20th century, when sexual expression belonged only in marriage, when men commonly patronized prostitutes but a good woman was supposed to be a virgin until her wedding night, and when respectable society just didn't talk about sex. How could syphilis ever be confronted honestly and openly? Even reformers who tried to do something wrote euphemistically about "social diseases" and "social hygiene." Syphilis was a word not fit to print.
The result? A disease that, by the 20th century, was immune to effective attack and hence at epidemic levels. Surveys by the Public Health Service in the 1930s found over two million diagnoses of syphilis and gonorrhea each year, at a time when the population was 40% of what it is today. A large percentage of these were advanced cases. As many as 60,000 babies a year were born with syphilis.
All of this makes Chicago's 1937 declaration of war on syphilis remarkable.
Some encouragement for it came from Washington. This was the era of President Franklin Roosevelt and his New Deal. Change was in the air. Government was doing things it had never done before. Reformers were challenging every kind of tradition and orthodoxy. Such a climate provided the opportunity for Thomas Parran, the new Surgeon General, to target syphilis. Late in 1936, he organized Washington's first national conference on venereal disease. He wrote a book, Shadow on the Land, that detailed the toll in human suffering that syphilis extracted and put public attention on it.
Most cities across America didn't jump on the war-against-syphilis bandwagon. But Chicago did, more so than any other community. Its leading newspaper, the Tribune, made the crusade a top priority. A paper known for its rigid conservatism took up the mission of challenging prudery.
The Tribune's pages shattered "the conspiracy of silence" about venereal diseases. A term like "social hygiene," it editorialized, was "a euphemism which means little." In the first two months of 1937, the Tribune published over 50 pieces on venereal diseases. "Syphilis" appeared regularly in its headlines, including on the front page.
Mayor Edward Kelly launched the war with a major conference in January. He assembled a large blue-ribbon commission for a citywide assault on "these enemies of mankind." Aware of Chicago's reputation for corruption, the president of the city's board of health told the press that "there is no politics in syphilis and gonorrhea. The city administration has nothing political to sell in undertaking this campaign." Another public health official sounded a similar note. "There are no political, religious, racial, national, or other groups to be favored ... The enemy we are going to fight plays no favorites."
The breadth of support that the campaign against syphilis generated was staggering. Episcopal and Presbyterian leaders signed on. Big manufacturers and trade associations promised cooperation; labor unions encouraged members to get tested. Women's clubs and area colleges enlisted. The superintendent of Chicago's schools promised a new curriculum that would include information about venereal diseases and the introduction of health counselors in high schools.
Washington provided funds to help Chicago open more clinics, hire workers to staff them, and acquire lab equipment and supplies. At the end of 1936, Chicago had just two public clinics that provided VD testing. One was at police headquarters and the other at the city jail, neither location particularly inviting. A year later, the city had 35 new locations. It also offered on-site testing at factories and high schools.
The city roused its residents. With free postage and return envelopes provided by the Post Office, it polled a million city households. "In strict confidence and at no expense to you, would you like to be given a blood test for syphilis?," the ballot asked. On August 13, 1,500 young folks marched through the Loop, carrying signs that read "Our Children Must Be Free from Syphilis" and "Friday the 13th Is Unlucky for Syphilis." Marchers went door-to-door delivering ballots to residents of transient hotels and boarding houses in the downtown. That Saturday, as people flocked to the city's beaches and waterfront parks, a plane flew overhead with a banner urging participation in the campaign. "Chicago, Fight Syphilis—Vote Today." The Federal Theater Project put on a production "Spirochete," named for the micro-organism that caused syphilis.
All this effort had an effect. As "ballots" were tabulated, households supported the campaign 15 to 1. Young women were especially eager for free tests. The new city clinics were swamped by people who wanted their blood drawn. By winter 1938, city labs were analyzing over three times as many blood samples as the year before. One telling measure of the campaign's success: in World War II, according to historian Allan Brandt, Chicago's draftees showed "the lowest syphilis rates of all major cities."
But Chicago's war on syphilis didn't vanquish the enemy. With the retrospective wisdom that living through the AIDS pandemic provides, I could see some reasons why. For instance, take the Tribune's rhetoric. "Syphilis is often contracted innocently," the paper editorialized. Well, if so, which infected were the guilty ones, and why would they cooperate? Words like assassin, enemy, evil, and snake were employed to describe syphilis. Who wanted to be associated with labels like these? Whiffs of coercion surfaced. One judge required women and men who came before him on morals charges to be tested. If he believed an infected defendant might not get treatment, he jailed them until they did.
There was also more than a little scapegoating going on. "Syphilis Centers in the Slums," one headline announced. "Cases Centered in Low Rent Areas." It was hard not to read these accounts, from a paper that championed big business, as a form of blaming the poor. After one report claimed that African Americans were eight times more likely to have syphilis, the Chicago Defender editorialized angrily: "In America, the white race makes the statistics."
Reading this material in the last year, I couldn't help but make analogies to the present. An economic crisis. Dynamic, innovative leadership in Washington. A city wanting to make big claims for itself. An HIV infection rate that is still much too high. Technical knowledge about how to prevent transmission and experience with community education models that work. Wouldn't it be great to have federal funds flow to cities, putting people to work as educators against AIDS, with city officials and the press making this a crusade? I could do without the war rhetoric, but as for the rest? A world without AIDS? One can dream ... and organize.
Copyright 2009 John D'Emilio