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Presidential Address: Quarantining Women: Venereal Disease Rapid Treatment Centers in World War II America John Parascandola
Bulletin of the History of Medicine, Volume 83, Number 3, Fall 2009, pp. 431-459 (Article) Published by The Johns Hopkins University Press DOI: 10.1353/bhm.0.0267
For additional information about this article http://muse.jhu.edu/journals/bhm/summary/v083/83.3.parascandola.html
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Presidential Address
Quarantining Women: Venereal Disease Rapid Treatment Centers in World War II America john parascandola
Summary: Concern about the infection of servicemen and essential war workers with venereal disease led the U.S. Public Health Service, with the cooperation of state and local health officials, to set up a national program of venereal disease quarantine hospitals during World War II. Although some of the hospitals eventually accepted men, the initial purpose of these facilities was to detain and treat venereally affected prostitutes and “promiscuous women” who were considered a threat to the war effort. Using quarantine powers, officials forcibly detained venereally infected women and treated them for their disease. The hospitals were generally known as “rapid treatment centers” because of the methods employed to treat venereal disease. Health officials were especially concerned that prostitutes (and other women of “loose morals”) would not comply with the traditional lengthy and arduous treatment for syphilis, which involved weekly injections of arsenical drugs for a year or more and unpleasant side effects. Therefore, the newly established quarantine hospitals used recently developed rapid treatment methods based on the administration of multiple injections or intravenous drips of arsenicals over a period of days. Although some objections were raised against these policies, which obviously discriminated against women, on the whole the rapid treatment centers were accepted as a necessary measure in the defense of national security. Some of the issues raised by these centers are still relevant to public health policy today. Keywords: venereal disease, syphilis, quarantine, World War II, Public Health Service
In the April 1943 issue of Collier’s Magazine, journalist J. D. Ratcliff opened his article, “The War Against Syphilis,” with the following words: “Down in western Louisiana there is an institution known as the Leesville Quar-
This article is a revised version of the presidential address delivered at the eighty-first annual meeting of the American Association for the History of Medicine, Rochester, New York, 11 April 2008.
431 Bull. Hist. Med., 2009, 83 : 431–459
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antine Hospital. It is a camp for women of easy virtue. All inmates have venereal disease and will be cured before they are released.”1 Ratcliff went on to add that military and civilian leaders had recognized that dealing with venereal disease in “women without morals” by fining them $10 and putting them in jail for ten days was not doing anything to curb the spread of the infection. As Ratcliff noted, “It was like fining a typhoid carrier and telling her to go and carry no more typhoid.”2 Most likely he had in mind the famous case of “Typhoid Mary” (Mary Mallon), the Irish-American cook who was a healthy carrier of the disease in earlytwentieth-century America and was held in quarantine for years by New York public health officials. In fact, in 1940, the Journal of Social Hygiene had compared “Typhoid Mary” with “Spirochete Annie.”3 In 1939, the army had selected the area near Leesville to set up a training facility, Camp Polk. The arrival of the soldiers was followed, not surprisingly, by the arrival of a number of prostitutes. Besides the prostitutes, other women, so-called “camp followers,” also swarmed into the region. Ratcliff estimated, on an unknown basis, that probably no more than 5 percent of the women who were picked up were professional prostitutes. The rest, he said, were young girls “caught up by the excitement of war” who had left home seeking adventure. Such amateurs, he argued, were more dangerous than professionals, because they had less knowledge about how to care for themselves (presumably he meant how to protect themselves against venereal disease). Although he indicated that the women could come from the “whole scale” of social backgrounds, his gender, race, and class biases were obvious. At the top, he noted, were college women who had had “a moral smash-up.” At the bottom were “14-year old Negro girls from share-cropper homes, with no particular desire in life beyond owning a pair of yellow rayon slacks and a pair of spike-heeled shoes.”4 This contempt is also reflected in his general comment about the camp followers who came to Leesville: “Girls who had been raised in one-room swamp cabins—and for whom sex held no sweet mysteries—moved to town. Here was their chance to get the fancy raiment in mail-order catalogues.”5 1. J. D. Ratcliff, “The War Against Syphilis,” Collier’s Magazine, 10 April 1943, pp. 14 –15, 72, quotation on p. 14. 2. Ibid., p. 14. 3. Ray H. Everett, “Program Emphasis for Preparedness Conditions,” J. Soc. Hyg., 1940, 26 : 366. On Typhoid Mary, see Judith Walzer Leavitt, Typhoid Mary: Captive to the Public’s Health (Boston: Beacon Press, 1996). 4. Ratcliff, “War Against Syphilis” (n. 1), p. 72. 5. Ibid., p. 15.
Venereal Disease Rapid Treatment Centers 433 The police and the local jail were ill equipped to deal with this situation. Then Dr. George M. Leiby, head of the venereal disease control work for the Louisiana State Board of Health, stepped in. Leiby decided that what was needed was a hospital for treating the women rather than a larger jail. With the aid of $75,000 from the Federal Security Agency, the host agency for the U.S. Public Health Service (PHS), Leiby turned a deserted barracks into a 120-bed hospital. Leiby assembled a staff, which was supplemented by a doctor sent by the PHS and by three state troopers. He was able to use state legislation that permitted the isolation of people with communicable diseases as a basis for detaining the women.6 Ratcliff described how the process worked: When Army doctors discover a soldier has a venereal disease, he is questioned at length. Lists of his contacts are made, and the girls are rounded up for a check. If blood tests show they have syphilis or if there is evidence of gonorrhea, they are taken to the hospital immediately. The health men of the parish (county) pick up diseased girls in their routine examination of food handlers. State police meet incoming busses. Unescorted girls who get off are questioned. If they are coming to meet husbands who are in the Army, or if they have other legitimate business, the troopers assist them. But if they give unsatisfactory answers, they are politely informed that they must undergo examination.7
Historian Marilyn Hegarty, who has examined a study of the Leesville facility, reported that “suspect women” could be arrested on a variety of charges, such as vagrancy and loitering, or even “on suspicion.” One married woman was picked up when she stopped to eat lunch alone on her way home from her job as a waitress. She was charged with vagrancy and pressured to commit herself voluntarily to the quarantine hospital. However, she tested negative for venereal disease.8 Her occupation probably contributed to her detention, as waitressing was listed in a report by a PHS employee as one example of the types of work that “may be conducive to making contacts which are likely to lead to extra-marital sexual experience.”9
6. Ibid., pp. 14 –15. 7. Ibid., pp. 15, 72. 8. Marilyn E. Hegarty, Victory Girls, Khaki-Wackies, and Patriotutes: The Regulation of Female Sexuality During World War II (New York: New York University Press, 2008), pp. 138–41. 9. James B. Hamlin, Counseling in Rapid Treatment Centers in Relation to the Community and the Individual Patient (Bethesda, Md.: Public Health Service, 1944), p. 6 (copy at National Library of Medicine).
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Quarantining Prostitutes and “Promiscuous” Women At the time at which the Leesville facility was opened, the PHS was already in the midst of planning a national program of quarantine hospitals with the cooperation of state health officials. By the end of 1943, over twenty of these facilities were in operation, and the numbers continued to increase over the following year. Most of the hospitals were established near military training facilities or important war industry cities. Although some of these treatment centers eventually accepted a variety of venereally infected patients, including men and even children, the initial impetus for the development of this national network of hospitals was concern about the infection of servicemen and men involved in essential war industries by prostitutes and other women who were deemed a threat to the health of these men.10 The initial focus was clearly on prostitutes. These quarantine hospitals were generally referred to as rapid treatment centers, for reasons that will become evident shortly. The first “Rapid Treatment Centers” entry in the index of the PHS journal Venereal Disease Information in 1943 read as follows: “Rapid treatment centers See Prostitutes, rapid treatment of.”11 Correspondence of the period also makes clear the initial purpose of the centers. In one letter of October 1942, for example, Raymond Vonderlehr, chief of the PHS Venereal Disease Division, specifically referred to these facilities as “detention centers to provide treatment for prostitutes infected with a venereal disease.”12 In another place, he referred to them as “Rapid Treatment Centers for women with venereal disease.”13 In another example, in a 1943 letter about a proposed rapid treatment center for the state of Washington, PHS Surgeon General Thomas Parran (Figure 1) referred to the program as one whose purpose was “to provide
10. R. A. Vonderlehr to K. E. Miller, 15 October 1942, National Archives and Records Administration, College Park, Md., Public Health Service Records (hereafter PHS Records), Record Group 90 (hereafter RG 90), General Classified Records (hereafter GCR) II, 1936– 44, District 8, 0425, box 179; Vonderlehr to R. C. Williams, 30 October 1942, PHS Records, RG 90, GCR II, District 1, 0425, box 152; “U.S. Public Health Service Outlines Policies and Responsibilities Toward Rapid Treatment Centers,” J. Soc. Hyg., 1943, 29 : 239–40; Odin W. Anderson, Syphilis and Society—Problems of Control in the United States, 1912–1964 (Chicago: Center for Health Administration Studies, Health Information Foundation, 1965), pp. 19–20; Donna Pearce, “Rapid Treatment Centers for Venereal Disease Control,” Am. J. Nurs., 1943, 43 : 658–60. 11. Vener. Dis. Inf., 1943, 24 : 386. 12. Vonderlehr to Miller (n. 10). 13. Vonderlehr to Lawrence Kolb, 2 October 1942, PHS Records, RG 90, GCR IX, 0425, box 531.
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Figure 1. Thomas Parran, surgeon general of the Public Health Service (1936–48), waged a vigorous campaign against venereal disease. Source: Centers for Disease Control and Prevention.
medical care for prostitutes and other promiscuous females who have a venereal disease.”14 The idea of quarantining prostitutes was not a novel one in the 1940s. In fact, the practice dated back almost to the time at which syphilis first emerged as a problem in the late fifteenth century. This previously unknown disease, which frequently appeared first in the “private parts” of the victim, made its first significant appearance in Naples in 1495, near the beginning of a series of “Italian Wars” that engulfed Europe for about a half-century. Controversy over whether the disease had been brought to Europe from the Americas as a result of the voyages of Columbus has 14. Thomas Parran to Warren G. Magnuson, 3 March 1943, PHS Records, RG 90, GCR IX, 0425, box 531.
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continued to the present day. It was agreed fairly soon after the appearance of the disease, however, that it could be transmitted through sexual contact. As early as 1497, there were medical writers warning men against having sex with women who were infected with syphilis lest they themselves contract the disease.15 The association of syphilis with sex was not gender neutral, since women received the major portion of the blame for the disease and its spread. In 1497, for example, the Italian physician Gaspar Torrella argued that men suffered more from the pox than did women because they had a hotter complexion. In addition, he argued, the uterus encouraged the corruption of vapors in infected women, and hence contributed to the spread of the disease. Men should therefore avoid having sex with infected women. However, according to Torrella, if an infected man had sexual relations with a woman who was infection free, she was not likely to contract the disease because the cold, dry, and dense nature of the uterus meant that it did not suffer damage easily. Women would become infected only after repeated sexual contact with infected men.16 Historian Mary Spongberg has pointed out that after syphilis appeared, women (especially promiscuous women) were generally regarded as the source of the disease in the popular mind and that most medical authorities did not seem to oppose this view. It was believed by many that women could be exempt from the disease and yet pass it on to men and that the symptoms of the disease were often hidden in women who did suffer from syphilis. Spongberg added: “The idea that men acquired venereal disease from women is taken for granted throughout the medical literature on the subject. Men are consistently represented as the victims of disease, women as its source.”17 Prostitutes and promiscuous women were especially targeted as sources of syphilis. Already in 1497, even before the venereal nature of syphilis was firmly established in the medical community, the town council of Aberdeen, Scotland, in an effort to combat the disease, ordered all “loose women” to desist from “the sins of venery” or they would be branded with a hot iron and banished from the town.18 The practice of placing a 15. Claude Quétel, History of Syphilis, trans. Judith Braddock and Brian Pike (Baltimore: Johns Hopkins University Press, 1990), pp. 22–23; Jon Arrizabalaga, John Henderson, and Roger French, The Great Pox: The French Disease in Renaissance Europe (New Haven, Conn.: Yale University Press, 1997), pp. 129–31. 16. Arrizabalaga, Henderson, and French, Great Pox (n. 15), p. 123. 17. Mary Spongberg, Feminizing Venereal Disease: The Body of the Prostitute in NineteenthCentury Medical Discourse (New York: New York University Press, 1997), pp. 1–6, quotation on p. 3. 18. Ibid., p. 1.
Venereal Disease Rapid Treatment Centers 437 major share of the blame for the spread of venereal disease on women, especially those whose morals were considered suspect, continued right up through the twentieth century. The concept of quarantining prostitutes with venereal disease while they underwent treatment for their condition was first voiced in the early days of syphilis. Torrella called at the end of the fifteenth century for the inspection of prostitutes and the forced detention of those who were infected until they had fully recovered.19 Although this demand was not implemented at the time, the practice of isolating women with venereal disease was later adopted in various locales. In the sixteenth century, for example, the Italian city-state of Venice developed institutions for the confinement of certain types of women in part as a response to the spread of syphilis. Although it is true that both men and women were frequently treated in special hospitals established for syphilitics in Italy (and elsewhere as well), it was only “fallen women” who were encouraged to repent and to enter a convent designed for repentant prostitutes. These facilities were generally placed on islands to insure their physical remoteness and to “quarantine” the women for the protection of Venetian society.20 The regulatory systems for prostitution that were established beginning in the late eighteenth century frequently incorporated some type of quarantine measure. Under the French system, for example, prostitutes who were examined and found to have a venereal disease were required to undergo a course of treatment at a prison hospital. The 1864 British law that established a system of regulated prostitution in naval ports and garrison towns gave magistrates the authority to order the detention of a diseased woman for up to three months.21 In Italy, prostitutes could also be required to undergo treatment if infected. A decree in 1862 established hospitals that had the characteristics of prisons for the treatment of prostitutes with venereal disease. Infected prostitutes in Paris were also frequently confined to a hospital that was much like a prison.22 Spongberg has argued that in the nineteenth century, venereal disease came to be more and more associated with prostitutes (and, by extension, with women of “loose morals”). Although it was believed by doctors that any woman, even a virgin, could transmit venereal disease, the prostitute 19. Quétel, History of Syphilis (n. 15), p. 66; Arrizabalaga, Henderson, and French, Great Pox (n. 15), p. 129. 20. Laura J. McGough, “Quarantining Beauty: The French Disease in Early Modern Venice,” in Sins of the Flesh: Responding to Sexual Desire in Early Modern Europe, ed. Kevin Siena (Toronto: Center for Reformation and Renaissance Studies, 2005), pp. 211–37. 21. Spongberg, Feminizing Venereal Disease (n. 17), pp. 36–37, 63. 22. Quétel, History of Syphilis (n. 15), pp. 214 –15.
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became the obvious symbol of sexual excess and the easiest target for regulation. As Spongberg noted, it was impossible to police all women, and “virtuous” women would have been outraged at the idea that they were diseased. Blame was thus increasingly shifted specifically toward prostitutes. Spongberg wrote, “Prostitutes were seen as both physically and morally responsible for the spread of venereal disease. They were seen not merely as agents of transmission but as inherently diseased, if not the disease itself.”23 Except for a few isolated experiments, the United States never developed a system of regulated prostitution. As several historians have pointed out, however, steps to incarcerate prostitutes were taken in the United States during World War I. Political and social leaders were concerned about the threat of prostitutes and so-called “camp girls” spreading venereal disease to military men in training camps. With the encouragement of federal authorities, thirty-two states passed laws requiring compulsory examination of prostitutes for venereal disease. A Virginia ordinance, for example, authorized health officers to examine vagrants, prostitutes, “persons not of good fame,” and others who might reasonably be suspected of having syphilis or gonorrhea. No one arrested under this law could be released on bail until examined and found to be free of venereal disease. The federal Department of Justice supported the compulsory examination of arrested women, and courts tended to uphold quarantine rulings. In addition to prostitutes, women charged with vagrancy or guilty of other behavior that might cause an official to “reasonably suspect” them of being infected were also sometimes detained and tested for venereal disease.24 David Pivar has summarized the situation as follows: “Enforcement officers arrested women suspected of prostitution and health boards conducted hearings. Writs of habeas corpus could be suspended. Women could be subjected to compulsory, inconclusive and painful physical examinations. If diseased, suspects could be sent to detention centers under indeterminate sentencing. According to the law, they would be treated for diseases and given vocational training.”25
23. Spongberg, Feminizing Venereal Disease (n. 17), p. 6. 24. Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880, expanded ed. (Oxford: Oxford University Press, 1985), p. 85; Linda Sharon Janke, “Prisoners of War: Sexuality, Venereal Disease, and Women’s Incarceration During World War I” (Ph.D. dissertation, Binghamton University, State University of New York, 2006), pp. 299–319. 25. David J. Pivar, Purity and Hygiene: Women, Prostitution, and the “American Plan,” 1900– 1930 (Westport, Conn.: Greenwood Press, 2002), p. 211.
Venereal Disease Rapid Treatment Centers 439 During World War II, prostitutes were once again targeted in the fight against venereal disease. On the eve of America’s entry into the war, Parran and Vonderlehr wrote in their book, Plain Words About Venereal Disease: If commercialized prostitution were eliminated, the attack rate [from venereal disease] would decline far more quickly than is possible through treatment of disease victims, no matter how prompt and efficient that treatment might be. Now, however, commercial prostitution looms large in the picture. As several million young men have mobilized in our camps and defense industries, the prostitute army has mobilized too. While no one would venture to speak authoritatively, it is our present estimate that prostitution of all types is causing 75 percent of the infections.26
Note that although they claimed that “no one would venture to speak authoritatively” on the subject, the authors proceeded to give their estimate of the huge proportion of venereal disease infections that could be traced to prostitution. Given the positions they held in the federal health bureaucracy, their views were likely to have been considered authoritative despite their disclaimer. The figure of 75 percent was an estimate restricted to infections among men in the military and defense industries, where, presumably, the “prostitute army” in the vicinity of the camps and factories was in a better position to infect more men. In the general population, Parran estimated that prostitution was responsible for 25 percent of all venereal infections.27 It is not clear in either case how these estimates were obtained and how accurate they were, as statistics on venereal disease were notoriously unreliable at the time. The preparation for war had greatly increased concerns about venereal disease and prostitution, as is typical in wartime. Parran, who earlier in his career had directed PHS’s Venereal Disease Division, inaugurated a vigorous campaign against venereal disease upon assuming the position of surgeon general in 1936, and this campaign was intensified after war broke out in Europe. Many of the venereal disease posters, leaflets, and films produced by the PHS and other organizations were aimed at men, particularly those in the armed forces and the defense industries, and many of them warned the men against having sex with prostitutes or women of “easy virtue.”28 (See Figures 2 and 3.) 26. Thomas Parran and R. A. Vonderlehr, Plain Words About Venereal Disease (New York: Reynal and Hitchcock, 1941), p. 96. 27. Ibid., p. 95. 28. On the PHS venereal disease campaign of World War II, see Brandt, No Magic Bullet (n. 24) and John Parascandola, “Syphilis at the Cinema: Medicine and Morals in VD Films
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Figure 2. A World War II poster warning American servicemen about the dangers of prostitutes as carriers of venereal disease. Source: Centers for Disease Control and Prevention.
Believing that local law enforcement agencies had failed to stop the increase in prostitution around military camps, Congress passed the May Act, which took effect in July 1941. This law made vice activities near military installations a federal offense and was modeled on similar legislation passed during World War I. At first, there was little effort made to enforce the May Act, and Parran publicly criticized the military for not taking sufficient action to protect servicemen against venereal disease, an act for which he was reprimanded by his boss, the head of the Federal Security Agency. After Pearl Harbor, however, the time for internal bickering was over, and the campaign to repress prostitution was intensified.29 of the U.S. Public Health Service in World War II,” in Medicine’s Moving Pictures: Medicine, Health, and Bodies in American Film and Television, ed. Leslie J. Reagan, Nancy Tomes, and Paula A. Treichler (Rochester, N.Y.: University of Rochester Press, 2007), pp. 71–92. 29. Brandt, No Magic Bullet (n. 24), pp. 162–63.
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Figure 3. Prostitutes and “promiscuous” women were often portrayed as a threat to the war effort, as in this World War II American poster titled “Juke Joint Sniper.” Source: National Library of Medicine.
Rapid Treatment The creation of the rapid treatment centers was a part of this increased effort to control venereal disease, especially with respect to prostitutes and other women who were considered to be a threat to the war effort. At this point, it is necessary to explain what was meant by the term “rapid treatment.” The first effective drug for the treatment of syphilis was Salvarsan, an organic arsenic compound introduced in the early twentieth century by the German scientist Paul Ehrlich. By the time of World War II, arsenical drugs, sometimes combined with the use of bismuth compounds, were still the treatment of choice for the disease. Although scientists in Britain and America were actively investigating penicillin, evidence for the effective-
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ness of this drug against gonorrhea and syphilis was not published until 1943, and penicillin was in short supply until near the end of the war.30 The arsenicals were complicated to administer and could have toxic side effects. In addition, treatment was prolonged. A standard course of therapy might involve a patient visiting his or her doctor weekly for a year or more to receive injections of the drugs. Side effects of the drugs were often unpleasant. Patient compliance with this regimen was sometimes a problem, and public health officials were doubtful that the average prostitute would stick with the therapy for the duration. By the early 1940s, however, so-called rapid treatment methods requiring a few days to several weeks, in which the drugs were administered by intravenous drip or in multiple injections, had been developed. This intense treatment had to be carefully monitored and involved an increased risk of reactions. The intravenous drip method required hospitalization of the patient. Gonorrhea could be more easily treated orally with the then relatively new sulfa drugs, but careful compliance with the dosage regimen was still required for these remedies to be completely effective.31 The PHS saw a need for special hospital facilities to provide rapid treatment for venereal disease to prostitutes and other women who they believed could not be trusted to follow the traditional long treatment regimen for syphilis (and perhaps even the simpler treatment for gonorrhea) if treated by a private physician or at an outpatient clinic. Because of the nature of the treatment, these facilities were generally referred to as rapid treatment centers (RTCs). One PHS officer, in an article about the RTCs, wrote of the “immature teen-age girls who have left their farm homes or their little towns” in search of defense jobs or following childhood sweethearts. To him, it was obvious that throwing together young, immature girls with men living away from home could have only one result, “sexual delinquency.” The war situation had led to “increased numbers of young girls who brazenly parade from one honky-tonk to another and who end up tragically infected in our offices or clinics.” Although admitting that the boyfriends of these girls were also delinquents, it is clear that his emphasis was on controlling the sexuality of the young women and in 30. On Salvarsan, see John Parascandola, “The Theoretical Basis of Paul Ehrlich’s Chemotherapy,” J. Hist. Med. Allied Sci., 1981, 36 : 19–43. On the use of penicillin against syphilis, see Parascandola, “John Mahoney and the Introduction of Penicillin to Treat Syphilis,” Pharm. Hist., 2001, 43 : 3–13. 31. R. H. Kampmeier, “Syphilis Therapy: An Historical Perspective,” J. Am. Vener. Dis. Assoc., 1976, 3 : 99–108; Louis Chargin and William Leifer, “Massive-Dose Arsenotherapy of Early Syphilis by Intravenous ‘Drip Method,’” A.M.A. Arch. Derm., 1956, 73 : 482–84; Harold Thomas Hyman, “Massive Arsenotherapy in Early Therapy by the Continuous Intravenous Drip Method,” Arch. Derm. Syphilol., 1940, 42 : 253–61.
Venereal Disease Rapid Treatment Centers 443 making sure that they complied with the treatment regimen. Note the tone of the following quotation from this article and the number of times that the word “control” is used: all of us have had some bitter experiences with these girls. Time and again medical personnel would give these young girls sulfathiazole pills to cure them of gonorrhea and they would go home, take five or six, become a bit nauseated and throw the rest in the wastebasket. It would be a week or two weeks before this failure to take treatment would be discovered and in the meantime the girl was continuing her promiscuous activity . . . We all began to realize we needed a greater element of control over these girls. We needed to remove them from the community and control them so that they could not continue their promiscuous activity. We needed to control them so that we could be absolutely sure that they received every bit of the treatment that they so badly needed.32
As Marilyn Hegarty has emphasized, in Victory Girls, Khaki-Wackies, and Patriotutes: The Regulation of Female Sexuality During World War II, the sexually alluring female was seen as a “morale builder” for the troops but also as sexually dangerous and as a carrier of venereal disease. Sometimes the two views were conflated, as in the term “patriotute,” coined by a PHS physician, a blend of “patriot” and “prostitute.” Hegarty’s book provides a perceptive account of the dual discourse on female sexual mobilization, where women were both needed and feared by the state for support of and participation in wartime services.33 In the pre-penicillin era, the most common forms of treatment for syphilis in an RTC involved the administration of an arsenical drug along with bismuth by a slow intravenous drip over a period of eight days or multiple injections of the drugs over a period of twenty-five days. For patients who were considered to be poor risks (for health reasons) for the more rapid treatment, the multiple injections could be extended over six weeks. Sometimes the arsenical treatment was supplemented by fever treatment, which involved inducing fever in the patient by typhoid vaccine or a heat cabinet. In late cases of syphilis involving paresis, malaria-induced fever was sometimes employed. Even when penicillin became available to the centers, it was often combined with arsenicals and bismuth at first. Gonorrhea, as noted above, was generally treated by sulfa drugs before the advent of penicillin.34
32. William G. Hollister, “The Rapid Treatment Center: A New Weapon in Venereal Disease Control,” Miss. Doct., 1944, 21 : 316–19, quotation on p. 316 (italics added). 33. Hegarty, Victory Girls (n. 8), especially pp. 1–5. 34. Pearce, “Rapid Treatment Centers” (n. 10), p. 658; Venereal Disease Division to Medical Officers in Charge, Rapid Treatment Centers, 31 August 1944, PHS Records, RG 90, GCR II, 0425, box 149; “Facilities for the Rapid Treatment of Syphilis,” J. Vener. Dis. Inf., 1946, 27 : 186–87.
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Toxic side effects of the chemicals, especially the arsenicals, were a constant concern in these expedited treatment procedures. Parran warned in one letter, for example, that toxic side effects to arsenicals would occur in the RTCs, adding that “some serious toxic reactions will be obtained with any intensive procedure.”35 Dr. Udo Wile, professor of dermatology and syphilology at the University of Michigan, was appointed as a consultant in the PHS to coordinate the treatment program in the RTCs. Wile provided training in the application of the intensive treatment methods for syphilis to the medical officers in charge of the RTCs.36 Nurses who worked in these hospitals also received training in these methods; they, in particular, were told to be on constant alert for any signs of chemical toxicity in the patients. Staff members were warned that sometimes patients who did not wish to lie in bed daily for six to eight hours of the intravenous drip would open the pinchcocks on the intravenous line to speed up the flow of the drug, which could lead to a severe toxic reaction.37 Although there is no evidence to suggest that there were large numbers of fatal reactions to treatment in the RTCs, one 1946 PHS document reported a mortality rate of one per three hundred patients for all centers. Of course, these fatalities were not necessarily all due to the treatment. Another study involving about 4,300 patients reported 3.2 fatal encephalopathic reactions per one thousand courses of treatment in the case of intensive arsenic therapy.38
RTC Facilities and Operation The passage in 1941 of two laws known as the Lanham Acts, named after their sponsor in the House of Representatives (Fritz Lanham of Texas),
35. Parran to Herman Bundesen, 12 April 1943, PHS Records, RG 90, GCR II, 0425, box 149. 36. Pearce, “Rapid Treatment Centers” (n. 10), p. 659; Vonderlehr to R. C. Williams, 5 November 1942, PHS Records, RG 90, GCR II, 0425, box 149. In 1916, Wile had been involved in a controversy over the ethics of his research involving brain punctures on patients with neurosyphilis. See Susan E. Lederer, Subjected to Science: Human Experimentation in America Before the Second World War (Baltimore: Johns Hopkins University Press, 1995), pp. 95–100. 37. Carl C. Kuehn, “Administrative Problems in Rapid Treatment Centers” (M.P.H. thesis equivalent, University of Michigan, 1947), University of Michigan Library, Ann Arbor, Mich.; Pearce, “Rapid Treatment Centers” (n. 10), pp. 659–60. 38. Interview with Dr. Rodriguez, Rapid Treatment Center Program, Midwestern Medical Center, St. Louis, 1 June 1946, three-page typescript, Elizabeth G. Pritchard Papers, MS C187, National Library of Medicine, Bethesda, Md., VD Control, RTC, District 7; “United States Public Health Service Evaluation of Massive Arsenotherapy for Syphilis: Cooperating Clinics of New York and Midwestern Groups,” Vener. Dis. Inf., 1944, 25 : 323–31.
Venereal Disease Rapid Treatment Centers 445 provided a mechanism that would fund the establishment of the RTCs envisioned by public health officials. These acts allowed the use of federal funds to construct, maintain, and operate defense housing and community facilities in war areas. The money was provided through the Federal Works Agency, and the appropriate war agencies had to certify that the facilities supported were directly related to defense needs. If the projects involved health or sanitation, then they also had to be cleared through the PHS. Lanham Act funds were made available to state and local governments to construct and operate RTCs for quarantining and treating venereally infected women in areas near military camps and defense industries. Funds for the actual medical care of the patients were provided by the PHS under the Venereal Disease Control Act of 1938. The PHS preferred that these centers be operated at state and local levels but would directly operate centers where these governments were unable or unwilling to do so. In addition, the PHS provided consulting services, as well as some staff, such as physicians and nurses, on request (Figure 4). The PHS, in conjunction with the other federal agencies involved with Lanham Act funds, also issued a guide for the operation of the RTCs in January 1943.39 The first of the RTCs began operation in the latter part of 1942, and by 30 June 1944, there were fifty-eight centers in thirty-eight states and three territories.40 According to the PHS, “the prostitute and the promiscuous girl” were the two greatest sources of venereal disease among the armed forces and war workers, and the RTCs were designed to “quarantine, treat, and aid in redistricting these girls.” The PHS considered the establishment of these centers to be an “outstanding achievement.”41 The fifty-eight centers had a total bed capacity of 6,100, and in 1944 the average length of stay for a patient was twenty-two days. One indication of the number of patients treated in these facilities is the 74,946 cases of infectious or potentially infectious syphilis that were admitted into the RTCs in 1945. The cost per patient day varied widely, ranging from about $2.00 to $10.50 per day. The PHS emphasized that rapid treatment ren39. Vonderlehr to Kolb (n. 13); Ralph C. Williams, The United States Public Health Service, 1798–1950 (Washington, D.C.: Commissioned Officers Association of the United States Public Health Service, 1951), pp. 643–46; Rapid Treatment Centers: A Guide Designed for Use in Connection with Lanham Act Projects and Other Locally Operated Centers (Washington, D.C.: United States Public Health Service, 29 January 1943), copy in Pritchard Papers (n. 38). 40. United States Public Health Service, Annual Report of the United States Public Health Service (Washington, D.C.: 1944), p. 85. 41. United States Public Health Service, Annual Report of the United States Public Health Service (Washington, D.C.: 1942–43), p. 148.
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Figure 4. A nurse attending patients in a World War II venereal disease rapid treatment center. Source: National Library of Medicine.
dered a highly communicable disease noninfectious in a quick, safe, and efficient manner. In addition, the percentage of patients who completed the course of treatment was much higher in the RTCs than it was in traditional outpatient clinics. Figures for July–December 1944, for example, showed that 92 percent of patients completed treatment in the inpatient RTCs compared with 30 percent under ordinary outpatient care.42 When the program began, officials had to quickly locate buildings that could be converted into quarantine facilities to house the infected women who were detained. A number of the centers were established in former work camps used by the Civilian Conservation Corps (CCC), the Depression-era agency created by the federal government to provide 42. Annual Report, 1944 (n. 40), p. 48; J. R. Heller, Jr., “State and Territorial Health Officers Consider the Problem of Venereal Disease Control,” J. Vener. Dis. Inf., 1945, 26 : 168–75; “Report of the Committee on Venereal Disease Control to the State and Territorial Health Officers’ Association, April, 1946,” J. Vener. Dis. Inf., 1946, 27 : 147–51; “Special Reports,” J. Vener. Dis. Inf., 1946, 27 : 215.
Venereal Disease Rapid Treatment Centers 447 employment for jobless young men. Other buildings that were used for the centers included former cigar factories and gymnasiums, remodeled small hotels, and sanatoria. Some general hospitals also converted a section into an RTC or built an addition to house one. Not surprisingly, communities sometimes objected to the establishment of an RTC in their midst, as, for example, when Rush Springs, Oklahoma, successfully blocked plans for such a facility in town.43 The PHS guide to the operation of RTCs pointed out that since the patients would not be bedridden for most of their stay, considerably less space would be needed than in a regular hospital. The centers would need only the equipment required for the diagnosis and treatment of venereal disease (and some equipment for emergency medical care). The RTCs would also require the standard household equipment used for ward care in a general hospital.44 The RTCs did require space for other activities, however, such as recreation and vocational training. The PHS believed that adequate opportunities for “wholesome recreation,” for example, would “aid materially in creating a cooperative attitude and in keeping the patient physically fit.” Games, craft classes, and informal dramatic activities were among the types of programs recommended for patients. The PHS guide also suggested that whenever possible, patients be chosen to provide the leadership needed in the recreational activities, emphasizing that those chosen for this purpose should have a “pleasant manner, ability to cooperate, and the capacity for ready adaptation to changing situations.” The guide also recommended making use of community resources for assistance in providing entertainment, books, game equipment, and radios to the centers.45 Patients were also sometimes given some type of venereal disease education while in the center.46 Another goal of many of the RTCs, at least in the period before penicillin was introduced, was to provide the patients with at least some minimal vocational training. The purpose was to encourage the women to find
43. Wilson T. Snowder, “Latest Information about the CCC Camps for Infected Prostitutes,” Vener. Dis. Inf., 1943, 24 : 102; Pearce, “Rapid Treatment Centers” (n. 10), p. 658; “U.S. Public Health Service Outlines Policies” (n. 10), pp. 239–40; Vonderlehr to R. C. Williams, 30 October, 1942, PHS Records, RG 90, GCR II, District 1, 0425, box 152; Monthly Activity Report, United States Public Health Service, District No. 7, Kansas City, Mo., September 1944, PHS Records, RG 90, GCR II, District 7, 1850, box 176. 44. Rapid Treatment Centers (n. 39), pp. 3–4. 45. Ibid., p. 8. 46. Manfred Wilmer to C. L. Williams, 18 March 1944, PHS Records, RG 90, GCR II, District 4, 1850, box 169; Kuehn, “Administrative Problems” (n. 37).
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gainful employment when they were released from the hospital, instead of going back to prostitution if that had been their means of support. As one PHS physician wrote in 1943: “The object of the program is to direct these girls, after they are physically fit, to war industries in order to raise their economic status so as to eliminate their turning to prostitution to supplement their low incomes.”47 Surgeon General Parran himself was quoted in a newspaper as saying that prostitutes could be a source of womanpower that was badly needed in war industries. The RTC in Indianapolis, for example, developed a friendly relationship with one of the defense plants and persuaded the plant to hire a number of its discharged patients.48 Vonderlehr, who headed the PHS Division of Venereal Diseases, also recognized that the rehabilitation side of the work was an important justification for the quarantine hospitals, especially as there were “important social and economic reasons why an attempt should be made to salvage this woman power in war time.”49 The training that was provided was often in jobs that were traditionally considered to be “women’s work,” such as sewing and cooking. Because of the previously mentioned need for workers in war industries, however, some centers provided training in fields such as welding. The women were also often responsible for some of the work involved in the operation of the center, such as cooking, sewing, cleaning, and waiting on tables, work that was also often considered to be training. In some centers, such as the one in Lebanon, Pennsylvania, it appears that these tasks provided the only type of vocational training available. The PHS guide for the centers advocated paying the patients for such work, but it is not clear whether this was done as a general practice.50 As penicillin became more available, treatment regimes were considerably shortened, and patients were released earlier, making it more difficult to provide any vocational training. Rehabilitation, of course, was never the primary purpose of the RTCs, whose main function was to curb the
47. Rachlin to Vonderlehr, 19 April 1943, PHS Records, GCR IX, 0425, “1943.” 48. “Parran Urges Industrial Use of Prostitutes,” newspaper clipping, Birmingham, Ala., 23 October 1942, Venereal Disease as a Military Problem Scrapbooks, 1941–1946, MSC 481, National Library of Medicine, Bethesda, Md. 49. Vonderlehr to Doctor Draper, 18 December 1942, RG 90, GCR IX, 0425, “1942.” 50. Rachlin to Vonderlehr, 19 April 1943, PHS Records, GCR IX, 0425, “1943;” Parran to Magnuson (n. 14); Rapid Treatment Centers (n. 39), p. 7; Florence M. Long, “Lebanon County Looks After Its Girls: A Pennsylvania Community Combats Delinquency and VD,” J. Soc. Hyg., 1945, 31 : 284 –89; Francis J. Weber to W. T. Harrison, 18 October 1944, PHS Records, GCR II, District 5, 1850, box 172; “New Treatments Increase Rapid Treatment Center Capacity,” J. Soc. Hyg., 1945, 31 : 239–40.
Venereal Disease Rapid Treatment Centers 449 spread of venereal disease, especially among the military and war workers. Even before penicillin, RTCs generally had only a few weeks in which to provide any kind of vocational training. Once the antibiotic became widely available, the time spent by patients in RTCs was generally a matter of days. One PHS physician noted in late 1944 that the accelerated treatment with penicillin would mean that “the function of RTCs will of necessity be purely medical since the curtailed but active treatment schedule (injections every three hours around the clock) will leave no time for other activities.” He went on to add that since the length of stay in an RTC would now be so short, “it would not be possible nor desirable to attempt anything in the way of social redirection while patients are in the Centers.”51 The reduction in length of stay in the RTCs affected not only the time available for vocational training but also the time that could be devoted to psychological counseling of the patients. For the PHS also made psychiatric and counseling services available to the centers, since, in the words of the PHS guide, “many of the patients are likely to have emotional and adjustment difficulties.”52 One PHS doctor stated that it was a “known fact” that many of the “girls” were not employable because of mental deficiency or emotional disturbance.53 A treatise on counseling in the RTCs by a PHS occupational specialist pointed out, however, that the centers had neither the time nor the expertise to provide comprehensive social service counseling (especially after the advent of penicillin). The main objective of the PHS was to ensure that none of the patients were “turned loose without defense against the social problem that may in part have been responsible for the original infection.” The PHS had to rely extensively on resources in the community to provide the additional assistance required to “render the patient capable of participating fully in the normal life of today.”54 A social worker in the Baltimore RTC noted in 1945 that she had only nine days to provide case work service to patients, which allowed her to conduct only two or three interviews with each patient.55 The largely middle-class professionals who worked with the patients in the RTCs often could not understand or accept sexual mores that dif51. Weber to Harrison, 18 October 1944, PHS Records, RG 90, GCR II, District 5, 1852, box 172. 52. Rapid Treatment Centers (n. 39), p. 5. 53. Rachlin to Vonderlehr (n. 50). 54. Hamlin, Counseling in Rapid Treatment Centers (n. 9), p. 3. 55. Rose A. Moss, “A Valid Focus for Case Work Service in a Rapid Treatment Center,” in A Case Work Approach to Sex Delinquents, ed. Rosa Wessel (Philadelphia: Pennsylvania School of Social Work, 1947), p. 35.
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fered from their own, at least in women. A PHS physician who conducted a study of some three hundred women in an RTC in St. Louis claimed that a considerable number of them admitted to being indiscriminate in their choice of male companions. Though they were promiscuous, the doctor noted, they resented any inference that they were prostitutes. In his view, their low ethical standards must stem from either “a lack of moral consciousness” (i.e., amoral behavior) or an aggressive response of the individual, expressed through sexual delinquency, toward the community.56 The sexual behavior of so-called promiscuous women was repeatedly explained by health and social workers as being caused by such factors as a broken home, hypersexuality, mental deficiency, or mental illness.57
Admissions to RTCs Although some patients voluntarily admitted themselves to an RTC for treatment, admittance to these centers was frequently not on a completely voluntary basis, and all patients were not necessarily free to leave of their own accord. Many were confined to the centers under state laws involving the control of communicable diseases; in other words, they were considered to be quarantined. The PHS guide to the operation of the centers commented as follows on the admission and release of patients: At the discretion of the State Health Officer, admission to Rapid Treatment Centers may be on a voluntary or involuntary basis. In either case persons suspected of having, known to have had, or who have been under observation for a venereal disease may be committed. Involuntary admissions should result principally from commitments under quarantine laws . . . Release of patients admitted involuntarily should be at the discretion of the State Health Officer or his deputy.58
Essentially, all states had laws that allowed the quarantine of persons with certain infectious diseases. Although the PHS had been given authority during the war to quarantine persons who traveled between states or who might infect military forces or war workers, Surgeon General Parran indicated that he preferred not to invoke federal quarantine laws, since 56. H. L. Rachlin, “A Sociologic Analysis of 304 Female Patients Admitted to the Midwestern Medical Center, St. Louis, Mo.,” Vener. Dis. Inf., 1943, 24 : 265–71, quotation on p. 270. 57. Ibid.; Mary Louise Webb, “Delinquency in the Making: Patterns in the Development of Girl Sex Delinquency in the City of Seattle with Recommendations for a Community Preventive Program,” J. Soc. Hyg., 1943, 29 : 502–10; Hamlin, Counseling in Rapid Treatment Centers (n. 9). 58. Rapid Treatment Centers (n. 39), p. 3.
Venereal Disease Rapid Treatment Centers 451 ample authority resided within the states to deal with the problem. Police and health officials often used the powers at their command to detain venereally infected women. Frequently, as noted previously in the case of the Leesville RTC, women were detained not just for prostitution but for what officials considered to be “suspect behavior.” For example, women could be detained on charges of vagrancy in an area near a military facility and forced to undergo examination for venereal disease.59 The City Health Department of Richmond, Virginia, “acting on what it considers to be reliable information,” could order a person suspected of having a venereal disease to report for examination and treatment.60 In Louisville, Kentucky, all persons “apprehended under suspicious circumstances” could be brought to the city hospital for examination.61 As Hegarty has commented, “it is difficult to determine just what made a woman suspicious beyond her sex/gender, although suspicion was intensified by race, ethnicity, and class distinctions.”62 In Lebanon County, Pennsylvania, case workers visited taverns, dance halls, hotels, and other venues to acquaint themselves “with the type and class of people who frequent these places.” They tried to “get a line on all questionable and suspicious persons.” When a woman was identified as a problem, a case worker would try to persuade her to voluntarily undergo an examination. However, if they had “definite information that the girl was spreading infection and was promiscuous at all,” then they held her in quarantine. If she tested positive for a venereal disease and it was believed that she could not be trusted, she was sent to a quarantine hospital.63 When local health officers or other officials expressed legal concerns about quarantining persons with venereal disease, the PHS made efforts to clarify the authority for such action. One PHS physician, for example, reported that he had made considerable progress in clearing up a “misunderstanding” on the part of a Peoria health officer who was hesitant about using quarantine authority. Apparently in this case the legal advisor to the 59. Thomas Parran, “Address of Welcome and Statement of General Purpose of Conference,” in Postwar Venereal Disease Control, Supplement 20 to J. Vener. Dis. Inf., 1945, pp. 3–7 (esp. p. 6); Bascom Johnson, George Gould, and Roy E. Dickerson, Digest of State and Federal Laws Dealing with Prostitution and Other Sex Offenses (New York: American Social Hygiene Association, 1942), pp. 446–51; Hegarty, Victory Girls (n. 8), pp. 135–42; A. B. Price to C. L. Williams, 7 February 1942, PHS Records, RG 90, GCR II, District 4 –5, 1850, box 171. 60. “Discuss Plans for Venereal Control Here,” News Leader (Richmond, Va.), newspaper clipping, Venereal Disease as a Military Problem Scrapbooks (n. 48), box 2. 61. “Annual Report, U.S. Public Health Service, District No. 3, Fiscal Year 1943,” p. 6, PHS Records, RG 90, GCR II, District 3, 1850, box 165. 62. Hegarty, Victory Girls (n. 8), p. 142. 63. Long, “Lebanon County” (n. 50), pp. 284 –85.
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local health board had raised the admittedly remote possibility of board members being sued by individuals who had been quarantined against their will. The PHS pointed out examples of various other Illinois cities that were isolating persons with venereal disease under state regulations as well as citing legal documents upholding quarantine authority. Some health officials also expressed concern about actually arresting a person just because he or she had or was suspected of having a venereal disease, since it was not a crime to have a contagious disease.64 Federal and state officials were aware of the potential legal problems occasioned by their policies and practices. One particular area of concern was the widespread use of “suspicious persons” charges. The evidence used to justify detention and arrest was often based on hearsay, and some law enforcement agencies regularly arrested prostitutes without warrants. Sometimes the women or their families hired lawyers to try to get the women released from quarantine under a writ of habeas corpus (through which a person can seek relief from unlawful detention). Although occasionally successful, more often the courts upheld health authorities. Among the arguments used in support of quarantine were the right of the government to reasonably regulate liberty in the public interest and the wartime authority of the government to protect the troops.65 As Marilyn Hegarty has commented, “Despite these legal concerns, challenges to wartime policies were minimal. The text of legal briefs provides some insights into the lack of visible support for women’s civil liberties by traditional supporters of civil rights.”66 One especially sensitive issue was the question of forcing treatment on the patients. It was one thing to quarantine an individual, but it was a more serious matter to actually compel the person to undergo treatment. This was especially true in the case of the rapid treatment of syphilis with arsenical drugs. Vonderlehr pointed out, for example, that although every state had laws to permit the forced isolation of “uncooperative and recalcitrant” individuals with venereal disease, it would be unconstitutional to force them to take treatment for syphilis “since it was necessary to perform a ‘surgical’ operation under the law” to administer it.67 The intravenous 64. A. J. Aselmeyer to F. V. Meriwether, 13 November 1943, PHS Records, RG 90, GCR II, District 3, 1850, box 165; Aselmeyer to Meriwether, 30 January 1943, PHS Records, RG 90, GCR II, District 3, 1850, box 165. 65. Hegarty, Victory Girls (n. 8), pp. 20–21; Interview with Dr. Hesbacher, 19 April 1946, Pritchard Papers (n. 38), Venereal Disease Control, District 5; Aselmeyer to Meriwether, 13 November 1943 (n. 64). 66. Hegarty, Victory Girls (n. 8), p. 21. 67. Vonderlehr to the Surgeon General, 17 June 1943, PHS Records, RG 90, GCR IX, 0425, box 531.
Venereal Disease Rapid Treatment Centers 453 drip method could more clearly be construed as involving a surgical procedure, but officials (perhaps erring on the safe side) considered even the multiple injection technique to involve a surgical operation. As one newspaper reported, the consent of the patient was required for syphilis treatment, “which requires what legally amounts to a series of surgical operations in the injections.”68 The newspaper went on to note, however, that “usually there is little difficulty in obtaining the co-operation of women sent to such hospitals.”69 Since the patient could be detained indefinitely while infected, it is easy to see why she would agree to treatment so that she could be released. One PHS report indicated that frequently, a threat of court action was used to induce uncooperative patients to undergo treatment.70 Various officials expressed the hope that over time, the majority of admissions to RTCs would become voluntary, and one physician argued that even patients who had been involuntarily committed to an RTC should be encouraged to fill out an application of admission to dispel any sense of compulsion.71
Hospitals, Not Prisons The PHS was clearly sensitive to public perceptions of the RTCs. Officials took pains to stress that these centers were hospitals, similar to other types of quarantine hospitals, and not prisons. On one occasion, Vonderlehr complained to a colleague about a center that was surrounded by high fences with locked gates and used barbed wire charged with electricity. In addition, the facility contained many women who had criminal charges pending against them. Vonderlehr worried that these features gave the center “the characteristic of a penal institution, rather than a medical center with a rehabilitation program.”72 In a published article, he argued that “There is no penal restraint involved in a women’s treatment; no stigma is attached to the individual. She will be cared for as if in a hospital. In addi-
68. Carter Brooke Jones, “Venereal Infections Fall in Armed Services as Health Officials Press Remedial Program,” Washington Star, January 1943, Venereal Disease as a Military Problem Scrapbooks (n. 48), box 1. 69. Ibid. 70. “Annual Report, U.S. Public Health Service, District No. 3, Fiscal Year 1943,” 20-page typescript, PHS Records, GCR II, District 3, 1850, box 165. 71. Hollister, “The Rapid Treatment Center” (n. 32), pp. 317–18; Melford S. Dickerson, “The Rapid Treatment Center Program of Texas,” Vener. Dis. Inf., 1943, 24 : 263–65; Kuehn, “Administrative Problems” (n. 37). 72. Vonderlehr to W. C. Williams, 26 June 1943, PHS Records, RG 90, GCR IX, 0425, box 531.
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tion, much thought is given to adequate rehabilitation measures which will make her a better citizen and place her in a useful job.”73 Vonderlehr was surely being somewhat disingenuous in claiming that there was no “penal restraint” involved in the RTCs and that “no stigma” was attached to the patients. As the centers began to receive more patients who were viewed as women gone astray, rather than professional prostitutes, Vonderlehr became more concerned about the issue of stigma. For example, he was concerned about the publicity given to what he called the “prostitute prison camp aspect” of the quarantine hospitals. He believed that this characterization worked against the effort to rehabilitate the women and branded all of them as prostitutes.74 PHS staff also emphasized that the detention and treatment centers maintained with Lanham Act funds could not be penal institutions, and that any patients incarcerated in them who did not have infectious venereal diseases should be removed. When it was reported to a PHS officer, for example, that women arrested for any reason, whether or not they were venereally infected, were being held at the Phoenix RTC, the officer made it clear to the staff of the center that this practice would have to stop.75 Although newspaper accounts still sometimes referred to the RTCs as women’s prison hospitals, health officials made every effort to combat that image. The physician in charge of the San Antonio facility, for example, changed its name from Jail Clinic to Quarantine Clinic. But even the term “quarantine” projected too negative an image for some public health officers. The word “quarantine” was deleted from the names of two RTCs in Louisiana, for example, because of its “obnoxious connotation,” and the term “medical center” was used instead.76 One physician writing about the administration of the RTCs argued that it should be “considered a privilege to be hospitalized rather than a semi-penal sentence.”77 In 1944, the PHS released a film entitled Venereal Disease Rapid Treatment Center, which portrayed the centers in a positive light and compared them favorably to
73. R. A. Vonderlehr, “No Venereal Disease Tragedies in the World of Tomorrow,” J. Soc. Hyg., 1943, 29 : 201–9, quotation on p. 205. 74. Vonderlehr to Parran, 11 June 1943, PHS Records, GCR IX, 0425, box 531. 75. Charles F. Blankenship to W. T. Harrison, 13 March 1944, PHS Records, GCR II, District 5, 1850, box 172. 76. “Women’s Prison Hospital Plan Gets Approval,” Tampa Morning Tribune, 1 July 1943, Venereal Disease as a Military Problem Scrapbooks (n. 48), box 1; Katherine Dillard, “U.S. Steps In, Slashes Venereal Disease Rate,” San Antonio Light, 3 March 1943, Venereal Disease as a Military Problem Scrapbooks (n. 48), box 1; “Report to the Surgeon General,” 12 October 1944, PHS Records, RG 90, GCR II, District 4, 1850, box 169. 77. Kuehn, “Administrative Problems” (n. 37).
Venereal Disease Rapid Treatment Centers 455 city and rural jails where venereally infected women were often held in detention.78
Racial Tensions African American and white patients were often quarantined in the same RTCs, but when that occurred, they occupied separate quarters. One African American newspaper, the Omaha Guide, optimistically wrote in 1942 that in the venereal disease quarantine hospitals that were being planned at the time, “there will be no differentiation as to the treatments of whites and colored.” The paper added, however, that the facilities “of course, will be segregated as to race.”79 Race relations among patients, or between patients and staff, were not always smooth in the RTCs. Reports from centers in Florida, for example, referred to difficulties and disturbances between whites and blacks. One report even made a point in describing a situation involving white patients to specify that it was not in this case a “white versus colored riot,” although it added that “the negro patients have been reported as being restless.”80 Another report from a Florida RTC described an “uprising” that began as a result of an argument between one of the African American patients and a male carpenter employed at the hospital. When the woman refused to obey an order from the carpenter, he slapped her. After the incident, the black patients, according to the report, “began to assemble and howl.” The patient was admonished for failing to follow a lawful order, but the carpenter was suspended pending an investigation because rough handling of the patients was forbidden. He immediately quit in anger. Further disturbances, however, broke out later in the day, including a battle between black and white patients at the canteen. The report also stated: “The colored patients then paraded the hospital area abusing with utmost profanity the matrons and workers on the area. Assemblies were broken up many times, but race hatred was demonstrated in many ways.” The sheriff was called in and brought police officers with him because he was 78. Venereal Disease Rapid Treatment Center, motion picture (presented by the United States Public Health Service and filmed by United States Department of Agriculture, 1944), copy at National Library of Medicine. For information on this and other PHS venereal disease films of World War II, see Parascandola, “Syphilis at the Cinema” (n. 28). 79. Alvin E. White, “Venereal Disease Control Big Problem to Uncle Sam: Here’s What He’s Doing to Safeguard Soldiers,” Omaha Guide, 26 September 1942, Venereal Disease as a Military Problem Scrapbooks (n. 48), box 1. 80. David C. Elliott to C. L. Williams, “United States Public Health Service Field Trip Report,” 3 July 1943, PHS Records, GCR II, District 3, 1850, box 169.
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reportedly concerned that “anything could happen with colored women in that frame of mind.”81 This last comment reflects the continuing racial bias and condescension of many whites toward African Americans. For example, a 1947 thesis on administrative problems in RTCs, written by a physician as a requirement for his master of public health degree, is rife with stereotypical negative views of blacks. The document noted that many patients were “uneducated plantation negroes inherently suspicious of everyone in the white race not associated with the plantation.” It went on to state that some of the blacks were believers in voodoo and that superstitions were “deeply rooted into the lives of the southern negro, and reasoning is of no avail.” The author described an incident, which he termed “ludicrous,” in which about fifty black women fled a ward one night after supposedly seeing a ghost. In another section of the dissertation, the author claimed that black patients were in the habit of saying “yes, mam,” whether or not they understood a request. He also expressed the views that the black patients knew syphilis only as “bad blood” and had no understanding of its venereal connection, and that a large number of them had common law spouses (sometimes several). White patients were not singled out for any specific criticisms.82 Hegarty has pointed out that officials of various government agencies, although admitting that factors such as low economic status and inferior educational and health care systems played a role in the higher venereal disease rate of blacks, tended to view African Americans as apathetic concerning venereal disease. White officials generally ignored the long history of efforts to combat venereal disease in African American communities. They also dismissed attempts by black leaders to question the statistics on venereal disease. In addition, according to Hegarty, they commonly accepted the “stereotype of hypersexuality as characteristic of black persons, especially black women.”83 The stereotyping of African Americans (and also women) is also reflected in the previously mentioned 1944 PHS film on the centers. In a segment of the film dealing with recreational activities at the center depicted, which was only for females, white patients are shown putting on a musical show. Black patients, on the other hand, are shown jitterbugging, while the narrator exclaims: “The Negro patients enjoy dancing—
81. F. M. Williams to W. E. Sowder, 20 June 1943, PHS Records, GCR II, District 3, 1850, box 169. 82. Kuehn, “Administrative Problems” (n. 37), section VI. 83. Hegarty, Victory Girls (n. 8), pp. 81–84, quotation on p. 83.
Venereal Disease Rapid Treatment Centers 457 and how!”84 It should be remembered that at this same time the PHS was in the midst of conducting the Tuskegee Syphilis Study that began in 1931.
Conclusion As the war progressed, some of the RTCs began to admit male patients as well, although the population remained overwhelmingly female throughout the conflict. One 1944 study of 146 patients in a Washington, D.C., center, for example, showed that 119 were women and only 27 were men. By 1944, Parran had noted in an article in Look Magazine that men and children were also being admitted to the centers, although the main focus of the article was still on women.85 The RTCs eventually died out in the postwar period, with PHS Surgeon General Leonard Scheele closing the last of them in 1953. The introduction of penicillin, which allowed syphilis and gonorrhea to be treated much more simply, quickly, and safely on an outpatient basis, was one of the important factors in their demise. As Scheele pointed out, with the aid of penicillin, every physician could be a venereal disease control officer, providing ambulatory treatment in his or her office. Cutbacks in funding for venereal disease programs after the war, combined with an effort to have the states rather than the federal government assume responsibility for the expense of venereal disease control, also contributed to the demise of the RTCs.86 Did these centers actually slow the spread of venereal disease in America? It is difficult to assess their effectiveness, but certainly syphilis and gonorrhea continued to be a significant problem among the military and civilian populations in and after World War II. Whatever their effectiveness, we may well ask whether it was worth the price paid in terms of sexual discrimination and forced confinement and treatment of women 84. Venereal Disease Rapid Treatment Center (n. 78). 85. Evelyn Sarris, “A Study of 146 Patients Admitted to a Rapid Treatment Center,” project submitted to National Catholic School of Social Service in partial fulfillment of requirement for diploma in social work, May 1944, Washington, D.C., copy at Catholic University Library; Thomas Parran, “The New War Against Venereal Disease,” reprint from Look Magazine, 1944, Surgeons General and Other Health Administrators Speeches Collection, 1926–1963, MS C 244, National Library of Medicine, Bethesda, Md. 86. Laura J. McGough and H. Hunter Handsfield, “History of Behavioral Interventions in STD Control,” in Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases, ed. S. O. Aral and J. M. Douglas (New York: Springer Science and Business Media, 2007), pp. 3–22 (esp. p. 16); Brandt, No Magic Bullet (n. 24), pp. 174 –78; Anderson, Syphilis and Society (n. 10), pp. 22–33.
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with venereal disease. But in a wartime emergency, in a time when the federal government did not hesitate to incarcerate thousands of Japanese on the West Coast, it is perhaps not surprising that these same officials were also willing to resort to detaining and forcibly treating women who were deemed a threat to the war effort. Although the RTCs have disappeared, some of the questions they raise still remain with us. Questions about quarantining the infected and about singling out particular populations as disease carriers have continued to confront us. Specific groups have continued to be targeted as the “problem” in the transmission of certain diseases. For example, gay men and Haitians were singled out as especially involved in the transmission of AIDS in the early years of the epidemic, and HIV-positive individuals were shunned by many.87 How far should the government go in quarantining the victims of serious infectious diseases? Although no large-scale quarantine of those infected with HIV occurred in the United States, such measures were discussed. A Los Angeles Times poll in 1985 revealed that a slight majority of Americans favored the quarantine of AIDS patients. In the case of other diseases, large-scale quarantine has occurred in recent years. For example, concern about SARS led to mass quarantine measures in China in 2003. In the United States, President George W. Bush, in the midst of worries about avian influenza in 2005, authorized the use of the government’s quarantine powers in the event of an outbreak of pandemic influenza, although it has not yet been deemed necessary to invoke such measures. With the resurgence of tuberculosis, particularly the drug-resistant kind, the issue of quarantining and forcibly treating victims of the disease who are considered to be unreliable in terms of compliance (in this case, largely the homeless, at least in the United States) has resurfaced. Even more recently, the New York Times carried a story in March 2008 about the South African government’s establishment of a prison-like hospital for the quarantine of patients with lethal and drug-resistant strains of tuberculosis.88
87. See, e.g., Elizabeth Fee and Daniel M. Fox, eds., AIDS: The Burdens of History (Berkeley: University of California Press, 1988). 88. “Poll Indicates Majority Favors Quarantine for AIDS Victims,” New York Times, 20 December 1985; Michael D. Lemonick and Alice Park, “The Truth About SARS,” Time, 5 May 2003; “Bush Authorizes Use of Quarantine Powers in Cases of Bird Flu,” New York Times, 2 April 2005; Mireya Navarro, “New York City to Detain Patients Who Fail to Finish TB Treatment,” New York Times, 10 March 1993; Celia W. Duggar, “TB Patients Chafe Under Lockdown in South Africa,” New York Times, 25 March 2008.
Venereal Disease Rapid Treatment Centers 459 Obviously, public health has always involved, and will continue to involve, a balancing act between protecting the rights and civil liberties of the individual and protecting public health. With respect to the RTCs, one woman who worked for the Office of Community War Services during World War II commented to a PHS physician that her work with these centers presented her with a dilemma. On one hand, she believed that personal liberty should not be infringed, but on the other hand, she believed that a more severely regimented system of dealing with the venereal disease problem had distinct advantages. The physician assured her that “all of us who valued our own independence were in a similar situation.”89 Likewise, all of us today are in the situation of having to weigh individual liberty against the public good in deciding what stands to take on various public health issues that confront us. Although the past will not allow us to predict the future, we can hope to at least use the perspective of history to inform our current policy directives, assuming that is, that policy makers are willing to pay attention to history.
John Parascandola received his Ph.D. in the history of science from the University of Wisconsin–Madison in 1968. During his professional career, he has served as professor of history of science and history of pharmacy at the University of Wisconsin–Madison, chief of the History of Medicine Division of the National Library of Medicine, and Public Health Service historian. He currently teaches courses in the history of modern biology and the history of public health at the University of Maryland. He is the author of The Development of American Pharmacology: John J. Abel and the Shaping of a Discipline (1992), which received the George Urdang Medal of the American Institute of the History of Pharmacy in 1994, and of Sex, Sin, and Science: A History of Syphilis in America (2008). Correspondence may be directed to 11503 Patapsco Drive, Rockville, MD, 20852.
89. Erwin C. Drescher to Director, District No. 1, U.S. Public Health Service, 20 March 1944, PHS Records, RG 90, GCR II, District 1, 1850, box 153.
