Book Review

Chicago's War on Syphilis, 1937–1940: The Times, the Trib, and the clap doctor

N Engl J Med 1995; 333:1718December 21, 1995

Article

Chicago's War on Syphilis, 1937–1940: The Times, the Trib, and the clap doctor
By Suzanne Poirier. 271 pp. Champaign, Ill., University of Illinois Press, 1995. $42.50. ISBN: 0-252-02147-9

In 1938, Surgeon General Thomas Parran reported on the status of the campaign against syphilis: “The hampering, ostrich-like attitude toward these diseases is gradually being overcome. When they are brought out into the open, freed from the medieval concept of condign punishment for moral transgressions, and dealt with as are any other highly communicable diseases, the way is open to eradicate them just as we have stamped out other dangerous infections.” The United States has always had a difficult time dealing with sexually transmitted diseases, and this book provides an interesting account of one of our more enlightened moments — the syphilis-control efforts in Chicago from 1937 to 1940. The Parran campaign against syphilis was fought on many fronts, but the efforts in Chicago are perhaps the best example of civic involvement and community awareness. The Chicago Tribune mounted an active public-education crusade, the Chicago Health Department sent over a million informational brochures to citizens, and industry encouraged employees to participate in mass serologic screening. Rather than provide a strictly epidemiologic or dryly historical account, the author interprets the events of the campaign within the context of prevailing social mores, local and national politics, and the strong personalities of the state and local public health officers.

The most interesting aspect of the book is the exploration of the major political and social issues that colored the campaign. Sadly, little has changed, and many of these issues still impair a rational approach to efforts to control sexually transmitted diseases and AIDS today: vocal proponents of “moral prophylaxis” (just say no); the reluctance of public figures to recommend practical methods of protection (e.g., condoms); issues of privacy and the implications of diagnosis for employment and insurance; the concentration of sexually transmitted diseases in minority groups; jealousies between local, state, and national public health officials; and the use of fear, rather than fact, as a method of effecting behavioral change. The reader can readily see parallels between the 1937 approach to syphilis and the current approach to AIDS, and these lessons are explored directly in the epilogue. One of the book's strengths is its ability to identify the interwoven and sometimes competing agendas of public health officials, the medical community, politicians, police officers, and private citizens that directly affect the approach to controlling sexually transmitted diseases. The book is extremely well documented with footnotes and a detailed index.

It has several shortcomings as well. First, it contains a number of factual errors. A few examples: the etiologic agent of syphilis, Treponema pallidum, is misspelled; the Wassermann reaction, a test for lipoidal antibodies, is said to “detect the presence of T. pallidum”; gonorrhea is said to be increasing in incidence today (reported cases have decreased steadily since 1978); and Metchnikoff is credited with identifying the spirochete of syphilis (it was Schaudinn and Hoffmann). Although these errors are not central to the focus of the book, they are very distracting and made this reader wonder whether there were other errors that I could not identify.

Second, there is a lack of data concerning the efficacy of the syphilis campaign. I found it very dissatisfying to spend so much time reading about the campaign and not to be told whether it had been effective. A few relevant data are scattered throughout the book, but the numbers are often contradictory or incomplete. Third, the book is fairly redundant; pertinent information and a message could have been conveyed in half the number of pages.

In reviewing this book, it is perhaps appropriate to discuss its utility and relevance for a variety of readers. As a scientist who has spent 20 years studying syphilis, I was initially very enthusiastic about reading it. Unfortunately, as can be seen from the criticisms above, I was distracted and dissatisfied by the factual errors and lack of hard data. An epidemiologist or clinician would be similarly frustrated. On the other hand, a social scientist or medical historian might find the discussions of the editorial stance of the local newspapers, the impact of World War II, and the use of New Deal dollars for public health fascinating. With a bit more attention to scientific detail, the book would have satisfied a wider audience.

Sheila Lukehart, Ph.D.
University of Washington, Seattle, WA 98195