Book Review: Sex, sin, and science: a history of syphilis in America.

For medical historians, the concept that a disease has a biography within a social, cultural and political frame that varies from culture to culture and over time is an analytic given. However, for students and the public new to this kind of thinking, even in the face of the HIV/AIDS pandemic, there is still the sense of wonderment that comes from realizing that not just seemingly scientific information shapes the naming, aetiology, and treatment of diseases. In the hope of furthering this understanding, the former US Public Health Service (PHS) historian John Parascandola has written a short book about the scourge of the sexually transmitted, and once terrifying, disease of syphilis. His focus on blame, sexuality, the loss of civil liberties, and silences about sex shape this synthetic disease biography. The book begins with a re-examination of the debates over the disease’s first appearance in Naples in 1495 and the questions on whether the affliction was taken to the New World by Columbus’s men, or transported back by them as unacknowledged plunder that wrecked biological havoc. The author weighs the recent evidence on the DNA and transformations of Treponema pallidum, the spirochete that causes syphilis, which may help us to settle finally this old argument. Explanations for why women, and in particular prostitutes, were blamed as the source of the disease are familiar, but Parascandola relates this tale with an eye to summarizing other historians and providing some new evidence of the efforts to protect the “innocent”. He discusses carefully the belief that the disease was hereditary, rather than congenital, and how long it took (after the Second World War) for this idea to be disproved. Parascandola traces syphilis as it spread through the various populations in colonial America into the twentieth century. As an historian of pharmacy, he is particularly sensitive to the various drugs and cures that were purported to have an effect on syphilis, and he covers this aspect of the history with great care. Specialists concerned with the disease will, in particular, appreciate the way he explores the history of differing treatment regimens of both the seemingly scientific and quack cures. Parascandola’s emphasis on the link between medical inspection and regulation of prostitution serves as a reminder of the extent to which the power seized by public health officials has always been underlined by the threat of infectious, and particularly sexually transmitted, disease. His analysis of how the concept of the “innocent victim” became part of public discourse is thoughtful and thorough, although those who know the extensive literature on the social hygiene movements and the efforts to police working-class women’s sexuality will find this recognizable ground. Parascandola draws upon his earlier work on the role of the government and media in the effort to control syphilis. Making use of the primary materials, he provides more detailed insight into the rise of the PHS’s Venereal Disease Division and the continued struggles it and the American Social Hygiene Association had between the wars to gain support for their efforts. The reproduction of posters and propaganda about syphilis drive home his points visually. Parascandola has done an excellent job of relying upon the secondary literature in the areas of the history where he has not spent time in the archives. He concludes by bringing the story up to the AIDS era, focusing on what was never learned. The result is a readable disease biography that will provide new insights for those who do know the literature on the history of syphilis. It will introduce those who are unfamiliar with the disease to its historical lineage and still unanswered questions.