Epidemiology of syphilis and STIs
From venereal peril to HIV
Call for contributions to a thematic issue of Annales de démographie historique.
In order to instigate public health measures, a disease must be visible to scientists, health care providers, public authorities and society. From the middle of the 19th century, three types of evidence have been used to prove the reality of a disease at the individual and collective levels: clinical sciences, which reason by case; laboratory sciences, which analyse human biological samples; and medical statistics, which rely on serial population data analysis. In the cases of the major scourges of the first half of the 20th century (i.e. the so-called ‘social’ diseases: tuberculosis, alcoholism, syphilis), the use of numbers became a key element in the construction of proof of their existence, their inclusion on political agendas and their management by the nascent public health system.
Public and political action related to public health relies on numbers: firstly, general mortality statistics, and secondly, mortality statistics by disease, which can be established according to sex, age or social class, but also according to profession, housing conditions or nutritional condition. During the inter-war period, the regime of evidence by numbers was transformed: the previous mortality statistics gave way to medical statistics, basis of the test-trace-treat triptych. After the Second World War, advances in mathematisation and the probabilistic approach further transformed pathological accounting, which became a specific science contributing to the foundation of modern population and probability epidemiology.
For a disease with transient symptoms - which is conducive to non-detection and lack of treatment - the reliance on numbers, albeit essential to proving its spread, raises the question of which medical statistics count, of what is officially reported and according to what calibration. Laboratory tests, the only valid option for calculating the number of cases, are nevertheless hampered by their own technological limitations and by the production of false positives and negatives. On what fraction of the population and on what scale can the calculation be generalised? For what representativeness (soldiers, nurses, schoolchildren, other “risk groups”)? On the basis of mandatory reporting or not?
From the middle of the 20th century onwards, the numbers produced tend to indicate that infectious diseases are on the decline in most regions of the world, in some cases to the point of justifying the demobilisation of health services and the suspension or cessation of epidemiological surveillance built up over decades. The story of the genesis and development of epidemiology in the 20th century is historically established. Nevertheless, at a time of calculating Covid-19 cases and of state rivalry over its management, it is useful to return to a history of calculating practices; by asking what is counted, on what basis it is counted, and how it is counted. To this end, the exemplary case of syphilis will serve as a concrete framework for understanding epidemiology over the course of a long 20th century.
A socially shameful and clinically complex disease, syphilis presents an interesting historical case study. The more marginalized and underground the disease is, the more important it is to use digital representations to show the importance of the health threat and its dynamics over time. Charts, graphs and maps are all ways of seeing proof of a disease and its treatment: quantification is inevitably accompanied by the mediation of numbers in public space. Health propaganda in the first half of the 20th century, like public health information and communication later on, arranged and scripted numbers that were supposed to speak for themselves.
This issue aims to explore the history of STI epidemiology over the course of a long 20th century, from the time of the ‘venereal peril’, embodied by syphilis, to the AIDS/HIV years. It will question issues relating to the production, representation and use of numbers concerning these diseases in Europe and the rest of the world.
Call for contributions
In order to prepare this special issue of Annales de démographie historique, we welcome all proposals for articles that could shed light on the history of STI epidemiology since the end of the 19th century. While part of the issue will be devoted to case studies in Europe, papers relating to other geographical areas are also welcome. Proposals should focus on one of the following areas:
(1) Counting the disease and the dead. How are morbidity and mortality statistics produced? Who are the actors and institutions involved in their calculation? What tools do they use? By bringing together different case studies, we aim to shed light on the evolution of practices surrounding the production of statistical data on STIs since the late 19th century. As Western, Central and Southern Europe are covered by pre-selected articles, we will give priority to proposals from other geographical areas: Africa, Asia, Near East, America, Eastern and Southern Europe, Oceania, etc.
(2) Counting tests and bacteria, analysing strains. Counting the number of victims of a disease depends on scientific and technical knowledge that is capable - or deemed capable - of identifying it. The history of STI screening tests, in particular for syphilis, shows the decisive influence of these devices in the production of epidemiological data since the development of the Wassermann test in 1906. The identification of different strains of an infectious agent, however, opens a more detailed understanding of epidemiological dynamics in space and time. We wish to consider all the scientific and social facts related to these issues. Proposals on the history of testing and cartography approaches related to STIs will therefore be particularly appreciated.
(3) Numbers that speak / that we give voice to. Numbers and statistics are at the root of the data which render public health discourses and mechanisms legitimate. By what means are they disclosed to health professionals, public officials or the population? In what form? How are they put into a narrative to convey the past, present or future evolution of an infectious threat? We will give preference to studies on the history of antivenereal propaganda or to studies that take a new look at the use of epidemiological data in the prevention of STIs.
Papers should not exceed 60,000 characters and may be written in French or English. A first draft of the papers will be presented at a workshop in September 2023. The aim of this meeting will be to reinforce the coherence of the issue and to offer a first critical round of feedback on the papers before the official submission in December 2023. Information and submission of proposals to Guillaume Linte (University of Geneva; . )
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Bergouignan, Christophe, “Le VIH-SIDA en France métropolitaine : des générations inégalement touches”, Populations vulnérables, vol. 2, 2016, p. 69-115.
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Engelmann, Lukas, Mapping AIDS. Visual Histories of an Enduring Epidemic, Cambridge, Cambridge University Press, 2018.
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Mazumdar, Pauline M. H., “‘In the Silence of the Laboratory’: The League of Nations Standardizes Syphilis Tests”, Social History of Medicine, vol. 16, n° 3, dec. 2003, p. 437‑459.
Porter, Theodore M., Trust in Numbers: The Pursuit of Objectivity in Science and Public Life, Princeton, Princeton University Press, 1995.
Rosental, Paul-André, L’intelligence démographique : sciences et politiques des populations en France, 1930-1960, Paris, Odile Jacob, 2003.
Setel, Philip, Lewis, Milton James & Lyons, Maryinez (eds.), Histories of Sexually Transmitted Diseases and HIV/AIDS in Sub-Saharan Africa, Westport, Greenwood Press, 1999.
Van denBelt, Henk, Spirochaetes, Serology and Salvarsan: Ludwig Fleck and the Construction of Medical Knowledge about Syphilis, Wageninge, Netherlands: Ponsen & Looijen 1997.
- Deadline for proposals: 31 January 2023
- Response to proposal authors: 15 February 2023
- Workshop (with first draft): September 2023
- Submission of full texts: 31 December 2023
- Peer-review and final versions: January-June 2024
- Publication: in one of the issues 2025 of the Annales de démographie historique
Guillaume Linte, Université de Génève