SimonSzreter (Ed.) The Hidden Affliction: Sexually Transmitted Infections and Infertility in HistoryRochester, NY: University of Rochester Press, 2019. 450 p. $125.00.

Abstract

Infertility is often treated as an afterthought in contemporary policy discussions around sexual and reproductive health (SRH). In the global North, the number of children couples desire is generally low, treatment for sexually transmitted infections (STIs) is readily available, and there are a range of options offered for those who want children but are unable to have them. In the global South, the discourse is principally focused on the provision of family planning services to prevent unwanted or unplanned births. The physical and emotional toll of suffering from STIs (aside from HIV/AIDS) and possible subsequent infertility is largely overlooked. The edited volume The Hidden Affliction: Sexually Transmitted Infections and Infertility in History makes clear that humans have been subject to the consequences of these infections for centuries, even though the causal connections between them and infertility were not well-understood until the late nineteenth century. This collection of papers presented at a 2015 conference in Cambridge is edited by Simon Szreter, Professor of History and Public Policy, University of Cambridge and Fellow of St. John's College, Cambridge. It is a contribution to the Rochester Studies in Medical History published by the University of Rochester. The evidence collected by a multidisciplinary group of scholars from the fields of history, biology, demography, archeology, and epidemiology is impressive in both its breadth and depth. Densely written and rich with technical detail, the collection will be of most interest to experts. (The number of notes/references in each of the 10 chapters ranges from 69 to 134.) Even for nonexperts, however, the book is striking for its harrowing descriptions of the misery caused by STIs from ancient history to the present day. Part 1 scrutinizes the historical evidence of STIs, a primary focus being their evolutionary ancestry and attempts to date their first appearance in human populations. The answer is sought by examining historical medical and other texts, including the Bible, and by using techniques that employ the study of skeletal evidence and, more recently, DNA samples. Part 2 takes a biomedical look at the history of STIs. Chapter 3 introduces paleopathology—the examination of archeological human remains to understand the origin and evolution of disease—and applies this methodology to the history of syphilis. Chapters 4 and 5 trace the history and the medical and public health responses to chlamydia. Part 3 examines the relationship between STIs and infertility in several parts of the global South. It includes an evaluation of the role of STIs in explaining geographic variation in the severe depopulation that occurred in the late nineteenth century in a number of Pacific Islands. The historical evidence is patched together using the scholarly accounts of anthropologists, ethnographers, and epidemiologists but also relies on the more informal reports of missionaries, sailors, traders, government officials, and physicians. A chapter on twentieth-century East Africa extends the analysis of variations in the role of STIs in the prevalence of infertility, citing the role of mass disease control programs, health education, the pace of advances in diagnosis and treatment, and fears of depopulation. Somewhat surprising, Chapter 9 is the only contribution that explicitly addresses the role of poverty, sexual violence, and social marginalization in the prevalence and treatment of STIs among women (in colonial Australia). Part 4 tackles the question of how infertility, concerns around low birth rates, and their implications for public policy unfolded in modern Europe with separate contributions on Germany, France, and England and Wales. The final chapter is notable for its reanalysis of historical data to provide an empirical estimate of the (substantial, as it turns out) effect of STIs on childlessness in England and Wales in the early twentieth century. Throughout, the collection illuminates the fact that the moral judgments, shame, and secrecy surrounding STIs (described in gruesome and heartbreaking detail in Chapters 2 and 9) have contributed not only to human suffering, but also to the limited and often inaccurate historical record that the authors have tried to overcome in their work on this topic. —A.B.