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Pox Americana

Microbes and Morals: The Strange Story of Venereal Disease

by Theodor Rosebury M.D.
Viking, 361 pp., $7.95

Dr. Rosebury’s readable and enlightening account of the history and present extremely active status of venereal disease is interesting for reasons that far transcend his subject. The subject itself is, of course, of general interest. Syphilophobia is a classic form of obsessional anxiety, frequently encountered and described in the psychiatric literature. Presumably, on grounds of symmetry, syphilophilia must also exist among persons of more exotic taste. There is, moreover, a special satisfaction to be gained from reflecting on venereal disease during the Yuletide season, when fantasies of domestic bliss are apt to get out of hand, driving the suicide rate up sharply throughout Christendom.

Venereal disease and the family have a common origin; and while, if authorities like R. D. Laing are to be believed, the latter is a far more potent source of misery, madness, and human waste than the former, VD may still constitute the more serious problem. The family, though still highly pathogenic, is said to be losing its power and may be dying out. Venereal disease is more prevalent than ever. “The United States figures for 1968 and 1969, which became available early in 1970, showed gonorrhea at the top of the list of reportable infectious diseases; and it began to be spoken of in terms of ‘epidemic proportions’ and even as ‘out of control,’ ” Dr. Rosebury reports.

The increase in VD is, of course, the principal reason for this book. With gonorrhea this increase has been going on long enough to be far beyond any chance of error or excuse; and as the same thing seems to be happening with syphilis, the danger signals are getting too loud and insistent to be ignored.

Urgent importance does not, however, ensure that readers will pay attention. Even if the Gravel-voiced Papers had been published under the title Everything You Always Wanted to Know About America’s Role in Indochina (But Were Afraid to Ask), their sales might not have been much greater. But Dr. Rosebury’s book, though written with impeccable taste, may well enjoy the success it deserves and requires if it is to dispel public apathy about a serious and growing threat that could be controlled with a little hygienic care.

Microbes and Morals resumes the tradition of masterful treatment of medical problems in books for the general reader that seems to have lapsed since the days of Paul De Kruif and Hans Zinsser. This lapse corresponds to the concurrent decline in the status of the doctor and scientist as popular heroes: no serious writer today is likely to produce a new version of Arrowsmith. Recent popular writing about medicine has emphasized the politics and economics rather than the scientific triumphs of the profession, and has taken a relatively dim view of doctors’ dilemmas. Books like Berton Roueché’s The Incurable Wound are a partial exception and attest to the public’s continued interest in reading about diseases; but they also, I think, partake of this anti-heroic trend. Roueché’s hard-working public health bureaucrats bear the same relation to Koch and Ehrlich of De Kruif’s medical sagas as John Le Carré’s minor intelligence agents, who take all the risks for none of the glory, do to the Scarlet Pimpernel.

Meanwhile the old myths do not die but, like Treponema pallidum itself, become quiescent until time for Stage Two; nor do the institutions that gave rise to those myths readily or rapidly lose their power. Anti-imperialist, revolutionary rhetoric may be moving and convincing; but Frantz Fanon, faced with the serious business of dying, had finally no better place to do it than Washington, D.C., in a hospital named for Walter Reed, the United States Army surgeon who, by identifying the mosquito that carries yellow fever, made the Panama Canal and Theodore Roosevelt possible. Even that is probably less wretched than waiting around in a dusty Bolivian village schoolroom for the CIA to make a house call.

Dr. Rosebury, God bless, is no stranger to the Realpolitik uses of medical science. The dust jacket of Microbes and Morals identifies him as Chief of the Airborne Infection Project at Fort Detrick during World War II, and as the author of a book on biological warfare called Peace or Pestilence, presumably favoring the first. These aspects of his credentials are relevant to an understanding of the peculiar merits of Microbes and Morals—and not just ironically. They contribute to the author’s attitude toward the organisms of disease and hence to the way he views disease generally. And—though we must all surely have learned this by now, from many more striking examples—they explain the sunny, liberal emphasis which, in spite of its grim and frankly discussed content, informs the tone of the book throughout.

The reiterated and central message of Microbes and Morals is plain enough, and though applicable to the problem of venereal disease is certainly not restricted to it. That message is simply this: moralizing interferes with the efficient solution of the problems of medical science and with the full and effective use of the information about those problems that we already have. Sometimes moralizing does interfere, but at Fort Detrick they try not to let it.

Dr. Rosebury’s attitude toward microbes helps to make his book convincing. He does not, as De Kruif did, portray them as the enemy whose conquest provides the stuff of heroic legend. Instead, he writes about them as a high-ranking corporate executive might write about the machinations of a rival firm and its personnel: without affection, certainly, but with a keen appreciation of their resourcefulness and special abilities to exploit unusual opportunities, matched by an equally keen interest in the weaknesses that may make it possible for men to control them. Underlying his attitude is the respect vouchsafed a worthy adversary whom one could easily imagine serving, under other circumstances, as an ally.

This respect, and this alone, is enough to solve at the outset the most obvious literary problem confronting the author of such a book. It enables him to be completely candid and graphic about both the ravages of and the social response to venereal disease without ever becoming either melodramatic or prurient. Had Adlai Stevenson lived to become, through some prank of fate, chief defense counsel for Ralph Ginzburg, he might have written a book about it with just such a tone.

Since, as pathogenic microbes go, those that cause venereal disease behave unusually, they provide Dr. Rosebury with some fascinating material. These microbes are so delicate, and their requirements so specialized, that they cannot survive for more than a few seconds outside the bodies of their hosts. This fragility, which ought to make them more vulnerable to scientific control—as it does to simple hygiene—instead protects them. One reason that vaccines cannot be developed against them, for example, is that they cannot be kept alive in vitro successfully enough to permit extensive study or, especially, the breeding of attenuated strains with limited toxicity, as Jenner did with smallpox virus. Gonococcus, which causes gonorrhea, can be grown in culture, but tends to lose toxicity rapidly.

This extreme specificity in choice of substrate also makes it possible for us to view venereal infections with the social scorn and ridicule that depend on the virtual certainty that infection could only have resulted from sexual contact. You might contract VD from the proverbial toilet seat, if you happened to have a toilet that was kept at an invariant temperature of 98.6°F. and flushed with lukewarm blood plasma; but this is a luxury beyond the resources of all but the most decadent.

This is not, of course, to imply that the organisms of venereal disease subsist solely in the genitalia. Obviously, if this were true, syphilis would not even be regarded as serious since it would not, in that case, be able to ravage the body and destroy the nervous system. But among the modestly clothed and reserved specimens of Homo sapiens septentrionalis, sexual intimacy—and childbirth—afford virtually the only occasion for the protracted contact with body fluids required for transmission of venereal disease.

Among tropical peoples who live under primitive conditions without much of anything in the way of clothing or sanitation, three other diseases occur that are not classed as venereal, though they are caused by organisms identical with Treponema pallidum—they cannot be distinguished even under the electron microscope. All three—bejel (nonvenereal syphilis), yaws, and pinta—induce positive serological tests like the Wasserman indistinguishable from tests for syphilis. In each, infection usually starts in childhood (though, unlike syphilis, it can hardly be congenital, since the disease is past its actively contagious stage by adulthood). Bejel is about as serious as syphilis in its secondary stages, but does not develop into the ravages of tertiary syphilis. Yaws produces painful and disfiguring sores over the surface of the body. Pinta results in scaly white patches on the skin which are, of course, especially disfiguring to dark-skinned persons.

None of these is pleasant; but none is as destructive as venereal syphilis. This dread disease seems to have attained the dimensions of a scourge partly because the clothing and reticence of the civilized defer infection until adulthood. Where the treponematoses are endemic in childhood, the population appears to develop a kind of tolerance, though far from a true immunity, which limits the damage they do. In this respect, at least, syphilis is to be regarded as a plague of civilization, unknown among primitive people until introduced among them by voyagers from more prosperous centers of enterprise.

This statement contradicts, of course, one of the most widely held myths about syphilis: that it was introduced into Europe by Columbus’s sailors on their return from America, where it had been endemic. Much of Microbes and Morals is devoted to a painstaking examination of the evidence for this dubious and ethnocentric proposition, which Rosebury convincingly dismisses. There is, in fact, overwhelming evidence from the Bible that syphilis was well-known among the ancient Hebrews. Shakespeare provides a wealth of scornful but highly specific references to what can only have been this disease, and while these are not, of course, pre-Columbian, it is clear that he is referring to a familiar, though lethal, nuisance rather than to some new horror that had burst upon England unheralded within the century.

The problem is compounded by certain confusing similarities in the symptoms of syphilis and those of leprosy or bubonic plague, which were of course ancient Eurasian scourges. Any disease that, like syphilis, produces symptoms not by its own toxic effects but by gradual destruction of successive organ systems will, of necessity, be easily confused with infections specific to each of those organ systems and difficult to identify except by recently perfected serological tests.

But the problem, as Rosebury emphasizes, is not just technical in character. Venereal disease has been consistently misunderstood because it arouses loathing and moral revulsion. Everyone wants to think that it is something other than what it is or—if that becomes impossible—that it was brought in by foreigners. One of the few amusing things about syphilis has been the consistent tendency for people to name it after some other, preferably detested, country: most often, outside France, as “the French disease”; Shakespeare rings changes on this epithet frequently. This, of course, is only one aspect of the moralistic approach to VD against which Dr. Rosebury pits the force of his argument.

Both gonorrhea and syphilis are on the rise now: the dislocations of war increase their spread; strains of the gonococcus that resist antibiotics have come to require enormously increased doses for control, and something similar seems to be happening with respect to the use of penicillin against Treponema pallidum, though the evidence is less clear here. Meanwhile, sexual hygiene remains as effective in preventing infection as ever—that is, about 100 percent effective if practiced thoroughly during and immediately after possible exposure—and early diagnosis likewise increases the probability of cure before serious damage, and arrests the further spread of infection.

Rosebury, therefore, vigorously dismisses as dangerous puritannical nonsense the sense of shame that keeps people—especially the young—from seeking prophylactic or therapeutic help when they may need it, and the harshness and ridicule to which people who get burned sexually are subjected in our culture, and which make it difficult or impossible for them to look for help when they could use it. The risk of infection is also increasing with the adoption of greater freedom with respect to sex among members of the counterculture and elsewhere. Dr. Rosebury is far from condemning this as licentious—that is just what he does not do—but he does deplore the wicked paradox whereby the sense of freedom that makes people more available sexually to one another vanishes when the possibility of venereal infection arises to be replaced by pious horror.

But this, I think, is where his argument is both most conventionally liberal and weakest. The apparently paradoxical attitude toward sexual experience seems to be more deeply rooted in human character than liberalism is. Ideologically, Rosebury is thoroughly committed to the view most Western bourgeois have come to accept without question: sexual intercourse is normal and should be groovy; like anything else worth doing it involves certain risks and responsibilities; mature people accept these realistically and do what is necessary to anticipate them; disaster overtakes those who refuse to be realistic and they are punished, not because sexual misbehavior is sinful but because being unrealistic and refusing to risk some slight embarrassment to avoid foreseeable trouble is sinful. Having been socialized as a North American bourgeois for fifty years, I believe this myself. But it isn’t the whole truth, by any means.

Liberalism to the contrary notwithstanding, the consensus among most of the peoples of the world, now and in the past, seems to have been: fucking is nasty, and everybody knows it. It is also, of course, for most people a source of great pleasure and satisfaction; though just how much of this pleasure is ideologically determined is hard to tell. Sexologists now dismiss the reports of earlier researches on the quality of sexual experience, which held that a majority of women do not much enjoy sexual intercourse or achieve orgasm during it, as naïve, male chauvinist, and ruined by cultural bias which led the investigators to accept as natural what was in fact a serious disability induced in women by repressive socialization. The healthy woman wants it, naturally, it was claimed; and a multi-million-dollar counseling and propaganda industry has arisen to make sure she realizes this. As for men, chastity remains, as the French proverb says, the rarest of perversions, and few of us indeed would voluntarily announce ourselves as its overt practitioners.

Still, the occasional practice of chastity is soothing, and has its own seductive charms. Whether this view is itself the result of social repression seems to me beside the point; if that repression proves nearly universal it, too, must be accepted as natural and human. As such, it probably represents the equilibrium position to which people-in-culture would tend to return when not under pressure to be more deeply groovy than they otherwise would be. The fact seems to be that people usually have to be taught that they ought to enjoy fucking, as they do drinking or getting stoned. If they aren’t, they are likely to end up muttering, like Fabrice in La Chartreuse de Parme, “Is that all there was to it? Was I really at Waterloo? Where’s the ‘loo anyway?”

This diffidence is not due to a conviction that sexual behavior is evil. Indoctrination with that view, as has frequently been observed, is more than likely to break down into licentious joy since the Puritan must identify and emphasize—and thereby validate—what he would denounce. The obstacle to the eradication of venereal disease that Dr. Rosebury and other social hygienists find so difficult to overcome is not guilt but shame; and the attitude toward sexual encounter that he would encourage is not modern but prelapsarian.

The consequences of the Fall have, however, been widespread, and are difficult to reverse. Is there any society in which people don’t tell dirty stories? Is there any society in which the people who tell them don’t think of them as dirty? Would even the most tiresomely boastful Great Lover sit, or lay, for his portrait in the very act of consummating his passion? Today, to be sure, there are the Plaster Casters who seek to create and preserve a permanent replica in extenso of the sex organs of the celebrities they admire. But their interests are more rhetorical than sexual; they are guilty of synecdoche and occasionally of downright hyperbole; but rarely of lust.

Even to reconstruct the prelapsarian frame of mind is probably beyond us by now. Holy scripture has inspired magnificent paintings of the great events of the Judaeo-Christian tradition including, of course, the expulsion from the Garden of Eden. It is difficult, however, to imagine how artists might have interpreted these events had a more merciful God granted Adam and Eve absolution, or, at least, probation. How would Masaccio have rendered, say, “The Return from a Bosky Dell in the Garden After the Conception of Cain”? What sort of expression would he have placed on Eve’s face? On Adam’s?

We can never know. But for the same reason that we cannot, it would be oversanguine to expect too much of Dr. Rosebury’s moral exhortation that we cease to moralize about the possible consequences of sexual conduct. Of those affected by these consequences, only Treponema pallidum itself can be expected to behave wholly without self-consciousness or apology, conveying through every micron of its bearing that most characteristic of modern attitudes: “Sorry for the inconvenience, Mac; I only work here.”


A Matter of Urgency February 10, 1972

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