No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880 (Oxford Paperbacks) by Allan M. Brandt

Author:Allan M. Brandt
Language: eng
Format: epub
Published: 2008-06-15T07:20:00+00:00

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According to the American Social Hygiene Association, the disruption in traditional family roles created by the Great Depression generated criminal and juvenile delinquency, immorality, and higher rates of venereal disease. Men searching for work, as well as women leaving home to assist in the support of their families, implied neglected children, social chaos and increased disease, in the opinion of the Association. Moreover, the Association speculated that, as men lost jobs and women sought to support their families, prostitution would increase during the depression." Syphilis and gonorrhea were seen as the consequences of social instability and decay, the manifestations of an essential failtire of traditional social controls. Again, the propensity to view these infections as symptoms rather than diseases became clear. Any disturbance to the familial status quo, in this view, could lead to higher rates of infection.

In one way, without question, the economic crisis did lead to greater prevalence of infection: fewer individuals could afford the required treatment. The depression greatly increased the numbers of individuals seeking free care for venereal disease; demand at public health clinics rose by at least 20 percent between 1929 and 1933. According to estimates of the New York State Division of Social Hygiene, fully onehalf of all newly infected cases now sought treatment at public expense. Health economists Leon Bromberg and Michael M. Davis argued that eighty percent of the population could not afford the cost of adequate care for syphilis from private physicians. Treatment for an uncomplicated case of syphilis required repeated visits to a physician for injections of arsenical compounds alternated with injections of bismuth to reduce the chance of toxic reaction. Sometimes this necessitated weekly appointments for more than a year. The cost of such treatment with a private physician in the early 1930s averaged between $305 to $380, but could range as high as $1000.`' Even public clinics often charged as much as $80 for a curative level of therapy. These costs were often multiplied by the fact that typicall more than one member of a family needed treatment if an infection was diagnosed.

The expense of treatment often caused infected individuals to forgo a complete regimen, risking relapse and continued contagion. According to one study, more than 80 percent of all syphilis patients failed to complete the arduous therapeutic course. As Dr. Albert Keidel, a venereal expert at Johns Hopkins, explained: "1 believe that one of the chief reasons for failure to continue is the high costs of medical care, and that the element of costs prevents not only the proper treatment of many patients, but even the recognition of the syphilitic condition." Tragically, some doctors refused to continue treatment when patients failed to pay their bills. "It is indefensible," declared Keidel, "to treat the patient until his funds arc exhausted and then drop him." Some physicians argued that failure to act responsibly in the conduct of venereal cases would lead to state controls on the profession, if not to socialized medicine. "'T'he medical profession must at this time

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