In general, I disapprove of modern permissiveness in writing about sexual matters, but I realize that, even twenty years ago, this book could probably not have been published. Nobody could call it pleasant reading but, in my opinion, it should be required reading, especially for young people. A wall slogan in one clinic announces: “VD strikes one person every two minutes.” It is the duty of everyone to be as well informed about venereal disease as possible. At present, ignorance and misconceptions are all too common.

The book consists of 327 vignettes of daily life in a VD clinic. Dr. Yanovsky, in addition to being a medical man, is a distinguished novelist and a member of the Russian Orthodox Church. In consequence he is interested in his patients as human beings. In many cases, he found that personal questions were resented, but he discovered how to get round that.

…if I hold a pen in my hand and look at the chart, I can ask the most impertinent questions and always get a reply. That is considered objective, scientific, and of possible use in the treatment.

But before considering the patients, let us listen to what he tells us about the clinics themselves—staff, organization, shortcomings, etc. As one might expect, though there is plenty of money for medicines, there is very little for anything else. The toilets are usually filthy, the water fountains don’t work, the elevators are often out of order, and there is not enough space for the doctors to park their cars. But the most exasperating feature is the organizational setup.

The best pages of Kafka, Beckett, and Ionesco hardly equal the absurdity of NYC arrangements…. Out of the twelve or thirteen steps through which the poor VD customer is forced to move, one half of the total…require him to go back to the waiting-room, sit down, and wait again…. This danse macabre adds at least one hour to the patient’s waiting time, besides being absurd and humiliating….

If, furthermore, one keeps in mind that our clerks take about fifteen to twenty minutes to admit a patient, and that when they have finally written out his papers, they do not rush to bring them to the doctor but accumulate three or four charts at a time, since, as they put it, “they are not messengers,” then the absurdity of the patient-flow arrangement becomes obvious. Sometimes there are several doctors standing around, waiting for a chart to be filled out in order to do some work. The shortage is less of doctors than of intelligent, literate clerks.

Then there is one group of workers at the clinics about whom Dr. Yanovsky has serious misgivings, namely the VD “detectives,” of whom there are more than a hundred in New York City. Their job is to detect and follow up all syphilitics and their contacts and, lately, gonorrhea contacts as well.

This means that now

…all the sexual contacts of a man during the last two weeks before his visit—and with our customers that usually means several women or men—all those named and identified by the unfortunate lover, must be reached by the investigators. The women are called up at their homes or jobs, visited or written to, and finally (through motivation or fright) brought into the clinic. Here, regardless of the result of the medical examination, they are classified G 90 and given 4,800,000 units of penicillin—unless they claim to be allergic to it. One can imagine what family conflicts and even tragedies are created by this interference in the private lives and the bedrooms of people. Notice that those who can afford to consult a private physician escape all the official reports and investigations and are never asked for their contacts.

Thus, unexpectedly, a most progressive, liberal-minded institution, the Health Department, works at transforming our society into a police state. Personally, if I had to choose between freedom, privacy, and gonorrhea on one side and no freedom, no privacy, and no gonorrhea on the other, I would opt for the first alternative.

It is obvious, from reading this book, that there is another matter of organization which could be improved. There are certain noninfectious complaints, urethritis in men and trichomoniasis in women, the symptoms of which resemble VD. Naturally, sufferers come to the VD clinic, only to be told that they cannot be dealt with there and must go to a hospital. Surely, it would save time and trouble for everyone if there could be a department for them in the same building.

One of the great problems in diagnosing VD for certain is that extraneous factors, such as antibiotics, malaria, vaccination injections, heroin, etc., can give a positive reaction when the patient is tested. I have had personal experience of this. One year I had just returned from Austria and went for a general medical checkup. The Wassermann test gave a doubtful positive! Luckily my physician was a personal friend so that, when I told him it was impossible, he believed me. “There is,” he said, “a more reliable test.” (I think it must be what Dr. Yanovsky calls the FTA test.) “It will cost you twenty-five dollars, but we’ll send a blood sample to Albany.” Sure enough, I was OK. I then asked myself if anything unusual had happened lately. Yes, just as I was leaving the house in Austria, I was stung by a bee. I asked my friend if he thought that been venom could have possibly affected the Wassermann. He thought it might have. I don’t suppose any test is 100 percent foolproof but, when one thinks of the emotional complications that might arise from even a suspicion of infection, surely the authorities should use only the most foolproof test they know of.


The subjects of Dr. Yanovsky’s vignettes cover almost every kind of human beings except the chaste and the self-disciplined—married and single heterosexuals, whores, homosexuals, transvestites, lesbians, businessmen who go on Saturday night “sprees,” those who go steady, and those who are promiscuous and indulge in group sex. Patients over sixty are rare and there tend to be more females than males, for many men, it seems, go to a private doctor but send their girl friends to the clinic. A great many have little or no English, which makes communication difficult. When asked, for example, if they are allergic to penicillin, they sometimes think the term means “liking to take.” Then about one fifth of the patients are junkies, so that finding a vein into which to inject penicillin can be a problem, but at least junkies are not afraid, as so many patients are, of a needle.

The most tiresome are the hypochondriacs who, though they have no symptoms, insist on frequent checkups. (“Isn’t that what you’re paid for?”) and complain to the Central Office if the overworked doctor becomes impatient. But it is rare, it seems, for any patient to write to the Central Office to thank the Health Department for the courtesy, kindness, and efficiency of the doctors: they only write when they think they have something to complain about.

Some of the information Dr. Yanovsky conveys has surprised me. Many young males like their girls to bite and scratch them, and come to the clinic with scars and scabs which they fear may be infected. Menstruation no longer seems a protection to a woman.

Lately, a lot of rectal gonorrhea has been showing up in our literature. That’s why the Central Office issued a recommendation to take routinely rectal smears of every woman patient. But we don’t follow these instructions. We simply have too much to do.

Then, though I knew of course that a person under treatment must abstain from sex, liquor, spices, I never knew before that he should also abstain from riding a motor bicycle. Nor had I realized, though I should have guessed, that one consequence of mass tourism in Europe has been a sharp rise in the number of patients after the summer vacation.

As Dr. Yanovsky says, most people know more about their cars than about their bodies, and this ignorance has probably increased, thanks to recent medical research. The public as a whole now believes that science has all the answers, so that it need not worry. If anything goes wrong, wonder drugs can quickly put it right. About possible side effects from penicillin, for example, the average person knows nothing, and, if they occur, he is apt to hold the doctor personally responsible.

Today very few people are “afraid” of VD, though they may fear the pain of a needle. Some men, it seems, can be frightened by being told that VD may render them incapable of begetting children, not because they want to become fathers, but because the thought offends their male egos. Moreover, very few VD patients show any shame or guilt or remorse, or even a sense of personal responsibility for the acts which brought them to the clinic. Many of the young, it seems, regard catching syphilis or gonorrhea as inevitable, like coming down with the flu. Some blame it on alcohol, as if drinking was not an act of human will. Others just say with a grin, “You know how it is.” The true meaning of this expression has been admirably defined by Karl Kraus.

When a man is treated like a beast, he says: after all I’m human. When he behaves like a beast, he says: after all I’m only human.

Some argue that promiscuity provides “multiple experience,” others that “it solves a lot of problems.”


What is to be done? In the atmosphere of VD clinics as they now are, places where medicine is separated from the rest of life, very little.

You can’t moralize with our young patients. You can’t talk to them about Western civilization, the church, or education, for all these are parts of the establishment and responsible for the mess we are in. But they are not down on all religion. They like to hear about Hindu practices. Far Eastern rites, Yoga technique. These have nothing to do with our police or politics….

It is pathetic how these young people, ready to blow up the entire establishment, revere science, which is so important a part of it. Herein lies their greatest contradiction: “Culture, no! Penicillin, sí!

About possible improvements, Dr. Yanovsky has some suggestions to make, though he is under no illusion that they could be adopted overnight.

Why not have music, poetry, discussions on the meaning of life, love, and art while they are waiting for their smears and blood tests? Perhaps even free coffee? Sort of an agape.

To separate medicine from ethics, philosophy, religion, and art is absurd. We must allow a new form of clinic to come into being, like the new theater, school, or church. But it must come spontaneously. It can’t be planned by the Commissioner and his deputies in the Central Office. There must be an openness, a readiness to let it develop, to nurture it wherever it shows itself in the bud.

I have deliberately refrained from quoting dialogues between Dr. Yanovsky and his many patients because I think readers would prefer to read them for themselves. When they have, I am certain that they will come to the same conclusion as his.

They are after something else, and sex is only a substitute, which, apparently, does not satisfy them. It is the job of a teacher, philosopher, or physician to make this clear to every pupil, neighbor, or patient that comes his way.

Every time I stick in my needle I feel: penicillin is not enough!

This Issue

February 22, 1973