Syphilis - Then and Now

created by Dialogue

(idea) by Dialogue (6.4 y) (print) ? (I like it!) 2 C!s Tue Oct 03 2000 at 22:58:24

This is an original work by me written in November of 1999. Reproduction in whole or part of this work without express authorization is a violation of the copyright I hold. So ask first, punk.

In humanity's war against disease, there have been few adversaries like syphilis. The bacterium T. Pallidum (so named because of the fact that it is almost transparent under a normal microscope) has been with our species since before the 10th century. Known as "The Great Imitator" because of its ability to have a variety of symptoms, syphilis can range from a mild annoyance for the infected to a life threatening illness. In its earliest stage syphilis is very easily transmitted, however, and thus plays a subtle, but detectable role in history. There have been portrayals of syphilis epidemics since before the Islamic invasion of Jerusalem (1009 C.E.). More recently, however, city, state, and federal governments have made some attempts at containing the spread of the disease. The most well known initiative of this kind was in the city of Chicago, Illinois, in the late 1930's. The Chicago Syphilis Control Program was the most ambitious attempt to contain disease of its time. T. Pallidum has survived into the 1990's, however, and is still a danger to sexually active individuals.

Avenues for analysis of this phenomenon are twofold. First, an examination of the Chicago Syphilis Control Program. This program, part of a nation-wide effort in the years 1937-40, was the "flagship" of the United States' "War on Syphilis". Much like the "War on Drugs" of today, it met with varied degrees of success and failure. It did provide much information about syphilis demographics, and allowed health officials a chance to inform an otherwise prudish population about a sexually transmitted disease. Second, a brief look concerning syphilis today. Surprisingly, methods that were used with success in the 1930's have since been reversed, creating a possibly unstable situation that has yet to play itself out. Through this process we can gain a perspective on what has worked in the past, and what may work in the future.

The hunt for syphilis in the late 30's was best summarized by Herman Bundesen, commissioner of the Chicago board of health. "Drag the snake out of the bushes, and beat it's head off in public." (Poirier, pg. 1, 1995) This was the mindset of the Chicago Syphilis Control Program. The "snake hunters" faced the disease on three fronts: publicity, legislation, and law.

The Chicago Syphilis Control Program was to be the rising star in the medical world in the late 1930's. In January, 1937, the mayor of Chicago himself (Edward J. Kelly) started off the campaign with a public appearance, stating that the meeting would go down in history as an important day for the entire nation. Health Commissioner Bundesen followed with dramatic words: "A campaign of education, of pitiless publicity, will break down the conspiracy of silence and the public will respond as soon as the facts are known." ( Poirer, pg. 14) The campaign of education and publicity began in the most widely read newspaper in Chicago, the Chicago Tribune. " All Chicagoans Urged to Take Syphilis Tests" (Poirier, pg. 21, 1995) This headline was one of over 65 syphilis related headlines that would grace newsstands before the "War on Syphilis" was officially over. The Chicago Board of Health mailed a survey to over a million households, asking if individuals would be willing to undergo syphilis testing. The open manner in which the topic was addressed was rare for the late 30's, but got results. "Of the million ballots mailed, 99,000 were returned. 'Yes' ballots numbered 93,931, as opposed to 5,202 'No' votes." (Poirier, pg. 24, 1995) In this way it was determined that over 261, 425 individuals would be willing to undergo the test. This provided the opportunity for the Chicago Board of Health to attempt to gather accurate case numbers for syphilis. This opportunity would soon be reinforced by legislation from the Illinois congress.

The second front which the Syphilis Control Program would have against its sworn foe would be legislative. The first shot was fired on July 1st, 1937. On that day the Saltiel Marriage Laws went into effect. The first stated that "couples married in Illinois {must} certify their health by laboratory examination within fifteen days of their application for a marriage license." (Poirier, pg. 52, 1995) Infected individuals could not gain a marriage license until they could show proof they were receiving treatment. In addition, all marriage licenses after the 1st of July were only valid for thirty days, meaning that newlyweds continuously had to keep applying for a marriage license. This, in effect, meant that the state already had one whole demographic in its pocket as far as syphilis tracking was concerned, even before the start of city-wide syphilis testing. In addition, it ensured the health of newborns, undoubtedly a common catalyst to the youth of the 30's wedding. The second law, actually passed by a legislator named Graham, stated that couples applying for a marriage license had to undergo a three day waiting period before receiving the license. This attempted to forgo so-called "gin weddings", in which a couple would become inebriated and decide on the spur of the moment to be wed. Though there was considerable "dodging" of the law through exoduses to Indiana courthouses in the early months of the laws, Indiana soon passed laws prohibiting justices from issuing licenses to out of state couples. Both of these laws reduced the risks for contracting syphilis in a particular demographic, married couples, but the most common vector for the disease in Chicago at that time, prostitutes, was still largely unmonitored. This issue would be addressed through the legal code by the end of the year.

At the start of the Syphilis Control Program, judges realized they had a unique role to play in the coming sweep of the city for disease. Several times in those beginning months, a judge would fine a prostitute he knew for a fact carried an STD, and then watch helplessly as their boyfriends or pimps would pay the fine and return the girls to the street. They requested, through letters to the Tribune, the ability to place individuals who came before them in court into medical care if they believed that the defendant was carrying a STD. The Tribune reviewed statutes in the Chicago and Illinois jurisdictions, and noted that a 1919 statute allowed "judges to require the examination and treatment for venereal disease of anyone brought before their court whom the judges had reasonable grounds to suspect to be infected with a venereal disease." (Poirier, pg. 72, 1995) The prerogative now in the hands of judges began to be used to test men and women equally when coming before a judge's bench. This then, was yet another demographic that could be easily tested. These filtration systems now in place, Chicago began large scale testing of its population for syphilis.

Responding to the increased demand for tests already in clinics and medical centers throughout the city, the board of health began testing a full month in advance, initiating the testing of Chicago's citizenry on September 1st. In addition to using maternity clinics around the city, as well as a large operation at police headquarters, the Chicago Syphilis Control Program set up easily movable tracking stations throughout Chicago area. Each neighborhood received it's own station, and individuals within an eight block radius were to report to that site for testing. Thanks to the publicity spread by the Tribune, as well as promotional materials distributed by the Chicago Board of Health, turn out was spectacular. By the end of the Syphilis Control Program's run in 1940, more than 19,000 cases of syphilis had been reported, 14,000 of which received or required treatment. (Poirier, pg. 125, 1995) Thus, the United States Health Department succeeded in its quest to "drive the snake from the bushes". It had obtained a considerable database of statistics, and had educated the public as to prevention of the disease.

Attitudes and sexuality, of course, have changed considerably since then. Young adults of the 1990's have been bombarded since childhood about the dangers of unprotected sex. What worked in the 1930's now seems trite and uninformative:

"FILM NARRATOR: Search out the places that infect the city and infect its people, the places with the easy pick-ups. This is where syphilis must be fought. Search out the people too, the people who carry the disease, the people who must be treated. Here we must fight, here in the places that breed syphilis.
MONDELLO: 'Fight Syphilis' was designed to scare the public into being careful. It tells you the disease is contagious and that you can't tell who has it. But in 18 minutes of maps and charts, footage of shoppers shopping and researchers researching, it doesn't tell you how you get syphilis. In fact, that sequence you just heard is the film's most explicit statement on the subject."

(NPR, 1994)

Despite the frank and constant education of the 90's generations about STDs, patterns in current syphilis rates are not easy to discern. Overall, the country has seen an increase in syphilis cases this year. 7,626 cases reported for 1998, compared with 6,370 cases in 1997. (MMWR, Dec 4th, 1998) This is not the case for the entire country, however. In fact, in the "flagship" city of Chicago this year, syphilis rates dropped by more than 25%. (Syphilis Screening Among Women Arrested, 1998) However, the same laws mentioned earlier that were enacted in 1937 have since been repealed, no longer requiring a clean STD bill of health for either pregnant mothers or marrying couples. (Some Find They Wed Bit Too Early, 1989) Thus, the future of syphilis infection in America is somewhat up in the air. Considering the current rates of HIV infection, (51,445 new cases this year alone) it is feasible to estimate that syphilis, like HIV, will continue an upswing in numbers towards the beginning of the next century. (MMWR, Dec. 4th, 1998)

The Syphilis Control Program in Chicago was an enterprise of grand scope, with the dual worthwhile and attainable goals of education and statistical analysis. Modern statistics and attitudes being what they are, perhaps a similar drive should be made surrounding the AIDS virus in an attempt to further educate the population of this country, and obtain accurate statistical information about the epidemic currently facing us in the present. Thus, considering the success of the Chicago program, that enterprise now long past could provide a model of how current health initiatives should be modeled.

Works Cited

Bob Mondello/Noah Adams. (speakers) (1994) Old Films Tried to Educate Public On Venereal Disease. National Public Radio

Centers for Disease Control Home Page, http://www.cdc.gov/

Charles; Enstad, Robert; Fegelman, Andrew; Pearson, Rick.
(September 13th, 1989) Some Find They Wed Bit Too Early. Chicago Tribune, Chicago, IL.

Morbidity and Mortality Weekly Report, Week of December 04, 1998.
Centers for Disease Control.

Poirier, Suzanne. (1995) Chicago's War on Syphilis, 1937-40.
University of Illinois Press, Chicago, IL.

(June 5th, 1998) Syphilis Screening Among Women Arrestees at the Cook County Jail-Chicago.
Vol. 47, Contemporary Women's Issues Database, pp 432-433.

Ross, Linda. (1997) Health Reference Series Volume Twenty Six: Sexually Transmitted Diseases Sourcebook, Chapter 19.
Omnigraphics, Inc, Penobscot Building, Detroit, MI

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