In Search of Sexual Health: Diagnosing and Treating Syphilis in Hot Springs, Arkansas, 1890–1940 by Elliott Bowen

Abstract

Reviewed by: In Search of Sexual Health: Diagnosing and Treating Syphilis in Hot Springs, Arkansas, 1890–1940 by Elliott Bowen Sean Morey Smith In Search of Sexual Health: Diagnosing and Treating Syphilis in Hot Springs, Arkansas, 1890–1940. By Elliott Bowen. (Baltimore: Johns Hopkins University Press, 2020. Pp. xiv, 217. $49.95, ISBN 978-1-4214-3856-6.) In Search of Sexual Health: Diagnosing and Treating Syphilis in Hot Springs, Arkansas, 1890–1940 intervenes in the historiography of both medical tourism and venereal disease (VD) by examining these subjects in one location: Hot Springs, Arkansas. For half a century, more sufferers of syphilis traveled to Hot Springs than to all other treatment destinations in the United States combined. As Elliott Bowen argues, Hot Springs' unique location "played a key role in determining treatment norms, attitudes, and parameters around syphilis" (p. 2). Using sources written by patients and doctors, especially patient letters and case files, allows Bowen to write a bottom-up history of VD and its connection with health tourism. This perspective, Bowen argues, emphasizes the largely unexamined therapeutic aspects of medical tourism and also decenters government action in the history of VD treatment. Most crucially, this therapeutic perspective enables Bowen to demonstrate that the historiographical view of VD treatment as "'sin vs. science'" has overstated the separation between these positions (p. 15). This perspective also showcases the importance of medicine and therapy as located in a specific place. Bowen shows that, starting in the late nineteenth century, syphilis treatments in Hot Springs did not fit neatly into a medicine or morals binary. Though white men were generally the only people able to participate in such medical tourism, they received therapies alongside faith cures and hygienic behavioral regulations. The unique environment at Hot Springs also allowed for particular variations on the nationally accepted treatment for syphilis: mercury rubs. In Hot Springs, the heat of the spring waters allowed physicians to prescribe greater doses of mercury without them being fatal. Doctors continued to stress the importance of the local waters after the development of the first syphilis drug, Salvarsan. From the 1910s, they stressed both that the water cure was a time-tested tradition and that Hot Springs' waters worked best because they contained radium. Bowen also uses patient narratives from Army and Navy Hospital, which opened in Hot Springs in 1887, to demonstrate that syphilis diagnosis changed [End Page 541] less in the early twentieth century than previously believed. He traces greater patient openness in sharing sexual histories after 1910 to a change in policy, rather than a change in morality, and he rejects the common assumption that a "'laboratory revolution'" altered VD diagnosis (p. 77). Specifically, he shows that the Wassermann blood test, used to detect syphilis, was predominantly ordered only after patient histories pointed to a syphilis diagnosis. How physicians used syphilis to reinforce existing forms of racialization is a major theme running throughout In Search of Sexual Health. Bowen demonstrates that white doctors "carve[d] a color line through VD" in order to separate their mostly white clientele from stereotypes of African Americans as a "'syphilis-soaked race'" (pp. 53, 64). Physicians treated syphilis in African Americans solely as a physical disease and argued that African Americans' natural amorality rendered hygienic treatment inapplicable to them. White doctors, meanwhile, positioned their own work in terms of treating a disease caused by urbanism and over-civilization and thereby preventing the destruction of the white race. Race also affected the Depression-era VD efforts of the U.S. Public Health Service (PHS). For instance, the PHS opened Camp Garraday in 1935 solely for white men, a site where they could receive food, shelter, and medical care in an environment isolated from outside prejudice. While women as well as nonwhite men could receive aid, they were not granted the privacy of an isolated camp. Despite Bowen's emphasis on locality, the book perhaps engages less with the South than readers of this journal might expect. Jim Crow is mentioned, and race is an important theme. However, given that racial segregation existed in many forms throughout the country, Bowen could explicitly consider whether it took an especially southern form in Hot Springs...