Book Review: The colour of disease: syphilis and racism in South Africa, 1880–1950

This is an impressive study of the incidence of venereal disease (VD) in South Africa during a period of seventy years and official and medical efforts to control it. Drawing upon a wealth of original sources found in municipal, provincial and national archives, Karen Jochelson delineates the construction of racial identity in modern South Africa through medical and scientific discourses. In doing so, she demonstrates that the process of defining disease and disease carriers as medical problems is inherently political, meaning embedded in broader contested processes of political, economic and social change. Therefore her study is valuable to scholars concerned with the analysis of epidemics in South Africa specifically and the history of medicine generally. Jochelson uses a blend of political economy and social constructionism to present a history of the causes and cures for VD, and, more significantly, to restore the disease to its social and historical context. The study links the spread of VD among the majority African population to socio-economic processes such as conquest, land dispossession, poverty, migrancy, urbanization and industrialization, which were devastating to African societies and disrupted their social networks and stable sexual relationships. At the same time it explores the myriad ways that VD and suspected carriers were constructed, demonstrating how concerns about wider social changes were reflected in the perception of potential VD carriers. For example, Africans and “half castes” were viewed as disease spreaders at a time of increasing racial interaction in cities, as were white and black urban women who were rapidly gaining relative economic independence from their patriarchal families. According to Jochelson, fears about both VD and the marginalized segments of society considered responsible for its spread may have reflected “wider fears about social and moral disorder, rather than a real increase in the incidence of disease” (p. 4). The first chapter is especially effective in demonstrating the intimate relationship between massive social changes and socially constructed medical knowledge in the perception and response to VD. In the 1880s there was an epidemic of syphilis among Africans that most doctors assumed was venereal syphilis, which is sexually transmitted. But Jochelson argues that the epidemic at this time was actually endemic syphilis, an indigenous disease related to venereal syphilis but transmitted through unhygienic working and living conditions such as those to which Africans were subjected in urban centres. She explains how predominant scientific racist ideas about African sexuality in combination with the decline of assimilationist ideology shaped the emergence of erroneous medical perceptions of this epidemic. Subsequent chapters trace how assumptions about African sexuality and physiology, and the hardening of segregationist ideology, led to racially differentiated health services for poverty-stricken sufferers of VD during the course of the twentieth century. They also discuss doctors' anxiety about the prevalence of the disease among the mainly Afrikaans-speaking “poor whites” and how it reflected fears about the fragility of white political supremacy. The colour of disease will be greatly appreciated by readers concerned with the practice and politics of medicine in South Africa, not least because the study of the history of disease in that country is still, as the author herself points out, relatively uncharted territory. At the same time, medical historians in other national contexts may find this book frustrating at times, for it is clearly aimed at an audience that has sophisticated knowledge about South Africa. Jochelson's account of the penetration of VD from urban to rural areas, for example, assumes a great deal of familiarity with South Africa's geography—there are no maps—and political history, for place names shift from Afrikaans to English and from pre- and post-Union without explanation. For example, she uses the names Transvaal, the South African Republic and its Afrikaans acronym ZAR, and Gauteng to refer to the same region within the country, names that denote major political developments during the past century and a half. But without maps or chronologies to which to turn for clarification, readers who are unfamiliar with the country's history may find themselves confused. Yet the book's methodological innovation will impress researchers seeking explication of the inseparability of biology and politics in the making of, and response to, epidemic disease. Most notably, the work provides a framework for contextualizing the AIDS pandemic currently ravaging South Africa (indeed much of sub-Saharan Africa) for, as the book's conclusion makes explicit, the contemporary AIDS disaster bears striking similarities to venereal disease in both the material basis of its transmission and the racist response of the white minority.