The “Reservoir” Metaphor in Anti-Venereal-Disease Campaigns in Mid-Twentieth-Century North America

ABSTRACT

Focusing on British Columbia during the mid-twentieth century, this article illuminates how North American medical, public-health, and law-enforcement professionals used the “reservoir” metaphor in efforts to control venereal disease (VD). It traces the transition from a pre-Second-World-War paradigm of VD eradication – what I call an epidemio-logic – focused on the single reservoir of female sex workers, to one concerned with several groups, including the White “male homosexual.” The article also demonstrates how conceptualizing VD control in terms of human reservoirs led to analogical reasoning, improvements and setbacks to disease-control efforts, shifting understandings of infection risks, and changes to the built urban environment.

KEYWORDS:

• British Columbia
• homosexuality
• metaphor
• prostitution
• sexually transmitted infections (STIs)
• venereal disease (VD)

In January 1937, Dr S. C. Peterson, the first director of British Columbia’s newly created Division of Venereal Disease Control, addressed a luncheon meeting of provincial health and welfare workers at the upscale Hotel Vancouver. Dr Peterson outlined the scale of the Canadian province’s syphilis problem, likened it to tuberculosis – “largely a disease of the poor” – and referred to its human reservoirs. He also described plans to establish an extensive centralized bureaucracy that would compile records from clinics, police, social workers, and private physicians to develop “reliable statistics” on the local incidence of sexually transmitted infections (STIs). The city’s Province newspaper summarized the physician’s presentation the following day (Social disease 1937), including his comments about reservoirs: “Problems of tuberculosis control are practically identical with those of venereal control. The reservoir of reinfection in tuberculosis is the Indian. In venereal disease it is the prostitute.”¹

Peterson’s remarks begin to show how medical professionals conceptualized, discussed, and managed STIs – or in the language of the period, venereal disease (VD) – in early to mid-twentieth-century North America. The emphatic certainty with which public-health workers like Peterson labeled certain groups as reservoirs raises several questions that are the focus of this article: how was this knowledge created? By whom? What practices and traditions underpinned it, in what communities, and through what networks? How did the designation of VD reservoir evolve over time to accommodate newly recognized “sources” of infection? I am also interested in exploring how the very flexible reservoir metaphor functioned over this period – what meanings did it acquire, what did the term enable its users to accomplish, and what did it obscure? To answer these questions, I will draw on close readings and analyses of a wide range of sources, including public-health textbooks and annual reports, congressional hearings, newspaper and medical journal articles, images, and archival records relating to VD investigation spanning from the 1910s to the 1960s.

This article will demonstrate that medical, public-health, and law-enforcement professionals actively mobilized the fluid power of the reservoir metaphor during the twentieth century’s middle decades. Rising, falling, swelling, and often at risk of flooding – even bursting – the metaphor held considerable rhetorical and image-making power for political and educational outreach activities. Efforts to tackle and drain this vast and dangerous volume of infection included “decreas[ing],” “reducing,” and “drying up” its pathogenic flows. Almost immediately, the reservoir acquired misogynistic overtones, with an anti-feminine rhetoric conceptualizing the vagina and, later, the rectum of “the male homosexual” as hidden infected pools demanding discovery and cleansing.

Thinking historically about how diseases were conceptualized in terms of reservoirs is important for several reasons. First and foremost, metaphors – and their part-for-whole relatives, metonyms – wield power and meaning beyond their stated definitions, in ways that are often more readily understood through ethnographic or historical analyses. In their classic study, Metaphors We Live By (1980), cognitive linguists Lakoff and Johnson theorize that these habits of speech “structure not just our language but our thoughts, attitudes, and actions” (39). As such, metaphors offer generative sites for analysis. Medical anthropologists have shown how, by likening one thing to another, metaphors draw on social and bodily experience to make abstract ideas of illness more concrete (Kirmayer 1992), and to prepare the ground for a course of action (Van der Geest and Whyte 1989) which can affect the individual body-self, the social body, or the body politic (Scheper-Hughes and Lock 1987). Given their power to shape both perceptions and material reality, metaphors need to be deployed with significant care – an ethical argument raised by scholars studying subjects as wide-ranging as illness (Sontag 1990), contagion (Davis 2002; Mitchell 2012), and consumption in relation to climate change (Wilk 2016).

Second, use of reservoir terminology can obscure structural factors affecting a status quo that appears to be “natural.” An authoritative dictionary of epidemiological terms (International Epidemiological Association 2008:267) defines a “reservoir of infection” as “[t]he natural habitat of the infectious agent,” and, more specifically, “[a]ny person, animal, arthropod, plant, soil, or substance, or a combination of these, in which an infectious agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such a manner that it can be transmitted to a susceptible host.”² These definitions, which seek to establish the “normal” or “natural habitat” of a pathogen, raise several questions, particularly regarding their application to humans. How and why might a particular person or group of people be identified as a “natural” reservoir? When might this be problematic (for example, by serving to dehumanize minoritized groups by comparing them to animals)? And what circumstances and broader factors might the term reservoir conceal?

Peterson’s remarks clearly illustrate how easily the violent disruptions of a settler colonialist system could hide behind the term reservoir. Vancouver was a new city, built on the unceded traditional territories of the Musqueam, Squamish, and Tsleil-Waututh First Nations, and populated mostly with White English, Scottish, and Canadian settlers, with important concentrations of Chinese, Japanese, and Black residents alongside Indigenous people (Provincial Officer of Health 1931; Masuda et al. 2019). If the newspaper’s summary of Peterson’s speech was accurate, his passing reference to “Indian” people as a reservoir for tuberculosis reinfection glosses the numerous dislocations White-supremacist policies enacted against Indigenous people. These included interfering with their ability to subsist from the land, mandatory relocation to less desirable reserves, substandard housing, and forced residential schooling, policies which have more recently been labeled “cultural genocide” and which had a devastating impact in terms of tuberculosis infection (Truth and Reconciliation Commission of Canada 2015:1). Thus, the seemingly “natural” location of disease in a particular ethnic group under the purportedly neutral label of reservoir can hide much historical violence, injustice, and social dislocation.

Turning to VD, we find the groups designated as “natural reservoirs” varied by location, local demographics, and history. For example, across the United States, incomplete data and assumption-inflected interpretations (Jones 1993:16–19; Reverby 2009:13–28) led many to believe that African Americans were, in the words of one physician (Lucke 1916:395), “a notoriously syphilis-soaked race.” In British Columbia during the period under investigation, historical records paint a more nuanced, regionally specific picture. The province’s first attempt at drawing population-level infection estimates based on reported cases suggested that higher per capita rates of infection existed among Black, Indigenous, and Asian residents. However, these three groups together contributed just over one tenth of the total reported number of new infections of syphilis and gonorrhea. By contrast, more than two thirds of the overall number of new infections were attributed to “European” and “British Races.” Consequently, provincial authorities generally approached VD as a problem primarily affecting White, younger working-class people (Division of Venereal Disease Control 1939), albeit one initially inflected with racist fears about male Chinese residents having sex with White working-class women (Freund 1995).

Third, while present-day discussions often focus on animal reservoirs deemed at risk of generating “spillover” epidemics in humans (Kelly, Keck, and Lynteris 2019:5–6), some early-twentieth-century experts viewed humans themselves as the most significant category of disease reservoir. For instance, while acknowledging the role of “lower animals,” the influential public-health practitioner Milton J. Rosenau (1913:313–314) stated that since “man” was “the great source and reservoir of human infections,” he was his own “greatest foe in this regard.” This understanding, Rosenau emphasized, was the fruit of recent developments in sanitary medicine over the past decade, which mobilized “all the forces of sociology to that of preventive medicine.” However, he immediately warned of the limits of this knowledge:

We ruthlessly wage war against insects or against infected food or water. In other words, we can arbitrarily control our environment to a very great extent, but the control of man himself requires the consent of the governed. Thus it is easier to stamp out yellow fever than to control typhoid fever. It is easier to suppress malaria than tuberculosis, rabies than influenza, trichinosis than measles.

Rosenau (1913:50) singled out syphilis among the venereal diseases as “a good illustration” of this limitation, in contrast to his confident assertions regarding environmental management. Thus, human reservoirs were distinctly important, both in terms of their overall large numbers, and for their troublesome resistance to straightforward control measures.

Finally, while other historians of sexually transmitted infections (for example, Castejón-Bolea 2001;Davidson 2001; Hall 2001) have highlighted the distinctive reservoir metaphor for scrutiny, there have been no genealogical analyses of the phrase in this context. Such an investigation helps illuminate the influences of tropical and sanitary medicine, hinted at by other historians (Brandt 1988; Fedunkiw 2003), on attempts to address the urgent issue of VD. Rosenau (1913:49) described venereal infections as “the greatest of modern plagues, and their prophylaxis the most pressing problem of preventive medicine that confronts us at the present day.” Emphasizing the appeal of tropical and sanitary medicine’s approaches for social hygienists in the 1910s helps to make sense of the frequent analogies to malaria and yellow fever that later permeated anti-prostitution discussions during the Second World War.

During the twentieth century the reservoir metaphor traveled widely through North America, Europe, Africa, and beyond, part of diverse medical and moral efforts to regulate, abolish, or otherwise contain prostitution and control VD (Crowhurst, Dewey, and Izugbara 2021:24–56). Several factors warrant a close look at British Columbia, the focus of this article’s empirical research, over a broad period, from the reinvigoration of the province’s VD-control program in 1936 to the partial decriminalization of homosexual contact in Canada in 1969. First, VD-control efforts in Canada, funded since 1919 through transferred federal authorizations (Cassel 1987:145–75), were a provincial responsibility. Second, the province’s influential anti-prostitution drive of the 1930s and 1940s drew praise and attention across the country and the Anglo-American world, resulting in a corresponding richness in archival sources for analysis. And third, doctors in this province published the country’s first major study linking male homosexuality to VD transmission (Kaney and Hunt 1951), contributing to a broader shift in views about which groups constituted the main source of sexually transmitted infections.

In this article’s first section I consider the meanings of reservoir as they evolved in the first half of the twentieth century in relation to VD. As Lynteris (2019:13) suggests, “the notion of the reservoir had a long history in epidemiological reasoning” – a past in need of greater elucidation. Then, with recurring attention to the British Columbian experience, the article’s following three sections trace the transition from a pre-Second-World-War paradigm of VD eradication focused on the single major reservoir of female sex workers, to a new paradigm concerned with several sources of infection, including “the male homosexual,” a seemingly new actor to contemporaries. This transition demonstrated how well the reservoir metaphor had supported a dominant epidemio-logic, by which I mean a reinforcing set of knowledge, practices, and assumptions that guided medical and public-health practitioners in their efforts to locate and treat VD cases. Improvements in treatment, case finding, and contact tracing, motivated in part by an explicitly stated desire to “decrease” the reservoir, allowed public-health workers to identify homosexuality and the male homosexual’s body more frequently as a source and reservoir for VD. Throughout, I highlight how attempts to understand VD control in relation to human reservoirs were characterized by analogical reasoning, improvements and setbacks to disease-control efforts, shifting understandings of infection risks, and even changes to Vancouver’s built environment.

The evolution of the “reservoir” metaphor, 1910s-1940s

VD had long been tightly linked with prostitution, a commercial activity almost universally understood by European and American observers as offered by female practitioners to male clients (Baldwin 1999:362). However, “reservoir” – a word that frequently appeared in North American and British social hygiene parlance from the 1920s onwards – made its distinctive debut in relation to sex work during the First World War, through explicit analogy to tropical medicine’s successes.

Earlier European studies drew on different – though still vivid – metaphors when linking the dangers of VD to prostitution. For example, the French sanitarian Alexandre-Jean-Baptiste Parent-Duchâtelet (1836:7), in his extensive study of prostitution in Paris, borrowed from his previous investigations of sewers to refer to prostitution as “a filthier cesspool than the rest.” A Spanish expert (Roselló y Olivé:54; translated by Castejón-Bolea 2001:63) declared in an 1883 public address that “All or most agree on the fact that the real germ and breeding ground of syphilis rest on prostitution.”³ Likewise, influential American studies of prostitution produced by the Rockefeller-funded Bureau of Social Hygiene, George J. Kneeland’s Commercialized Prostitution in New York City, written with Katharine Bement Davis, and Abraham Flexner’s Prostitution in Europe, emphasized, as perhaps “the greatest cost” of sex work (Kneeland with Davis 1913:134), “the long score chargeable to venereal disease” (Flexner 1914:37). The term reservoir is notably absent from all these works.

Similarly, Charles Chapin’s influential public-health text, The Sources and Modes of Infection (1910), does not use the phrase in relation to VD. When he employs the word in passages other than explicit references to contaminated water sources, for example when considering if “lower animals” might harbor the protozoan that causes sleeping sickness, “reservoir” appears in quotation marks, suggesting its recent importation into English-language public-health discourse (87). By contrast, Milton J. Rosenau’s Preventive Medicine and Hygiene (1913) helped popularize the term and see its broader application for human infections. Reservoir began to serve as a synonym for disease prevalence – a combined pool of infectious cases, including the newly discovered “healthy carriers,” whose sub-clinical disease experiences helped to explain “hidden” links in chains of transmission.

By 1918, public-health authorities were attributing to William F. Snow explicit analogies that likened efforts to control VD and prostitution to those undertaken in response to yellow fever and malaria. Snow was a prominent social hygienist, general secretary of the American Social Hygiene Society, and head of the Venereal Disease Section of the Surgeon General’s Office. “Prostitution constantly replenishes the great reservoir of venereal infection,” noted one official (Kelley 1918:208), “or, in the vivid phrase of Major W. F. Snow, prostitution is to venereal disease what the anopheles breeding swamp is to malaria.”⁴ North American social hygienists, law-enforcement officers, and military authorities readily adopted and repeated this language as they attempted to tackle VD rates over the next five decades. An explicit focus on the value of tackling reservoirs for other diseases led to the porous linkage of VD, reservoirs, and swamps in much anti-prostitution discourse. As Snow wrote in 1920 with a colleague (Snow and Storey 1920:5),

In malaria, we have long advocated the elimination of swamps and the protection of the uninfected portion of the population from the bites of malaria-carrying mosquitoes; but in venereal diseases, we not only withhold from the health officer information of known foci of infection, but encourage him to state that he has no interest in the elimination of red-light districts and other recognized centers for spreading these diseases.

Similarly, Snow and Storey asserted that scientific management had “accomplished dramatic and spectacular results” in tackling malaria and yellow fever “by the use of screens and of sanitary procedures for draining swamps and oiling water, thus closing off the feeding places and destroying the breeding places of the mosquitoes that carry these diseases.” They highlighted ongoing “plans for devising analogous social and legal ‘screens’ [… to] keep the human carriers of syphilis and gonorrhea away from their victims and eliminate the conditions which breed them.” (7)

Snow’s comparison was elaborated by Howard Woolston (1921:194) in his investigation of American prostitution before the advent of the First World War:

The prostitute has sometimes been compared to the mosquito, which carries the germs of yellow fever and malaria. It would perhaps be more accurate to regard her as a pool, in which the germs of disease breed, and from which they are carried by her numerous visitors. We have seen that the ratio of diseased men to women is as eight or nine to one. Any system, therefore, which attempts to eradicate venereal infection must also control the spread of these diseases by men.

Woolston’s comments highlight the frustration of campaigners who lamented controls that often solely focused on female prostitutes and not on their male clients. And yet comparisons like his, which made the link between the sex worker and a dangerous germ-breeding pool even more explicit, significantly undermined the expressed goal of redirecting attention to men. To this tropical-medicine-inflected discourse, British venereologists added in the 1920s and 1930s the tradition of employing reservoir to refer to specific cavities where infection might gather. This could include, for example, the accumulation of pus behind newborns’ eyelids in gonorrhea ophthalmia (Hudson 1925:290), or the seminal vesicle as “the reservoir of infection” in male chronic gonorrhea cases (Harnett 1930:140).

Thus, by the 1930s, writers in the Anglo-American sphere were using the phrase in three different, but interconnected ways: as a flexible metaphor for general population disease prevalence, often directly analogizing from physical water reservoirs; to refer to specific groups within a population in which consistently high disease levels posed a more general threat; and to refer to individual human sources, or parts of their bodies, where the infectious agent accumulated. Thus, a White physician based in New Orleans (Sullivan 1933:439) could observe the high rates of syphilis infection among African Americans and claim the need for self-protective public-health intervention, since “the syphilitic Negro population is a great reservoir of disease capable of extension to whole communities if unchecked.” This assertion, which included tales that Black nurse maids were infecting White children, was vigorously resisted by some. One African American physician (Bousfield 1937:346) declared that “the Negro resents the implication that his race was the reservoir of syphilis in this country.”

Experts regularly noted that there were no non-human reservoirs for the causative Treponema pallidum (Parran 1936) and gonococci microorganisms (Guthe and Hume 1948). Rather, Parran explained, infection “appears in a multitude of sporadic epidemics, through single infections by personal contact from victim to victim.” The lack of intermediate non-human hosts for syphilis, Parran commented, was unlike “mosquito-borne malaria or louse-borne typhus, and there is no reservoir of infection aside from man himself.” Given this human focus, users in the 1930s, 1940s, and 1950s began to lean into reservoir as metaphor as a way of conceptualizing the prevalence of syphilis and gonorrhea, the two chief VDs of concern during this period.

The logic was often implicit, although occasionally some writers offered elaboration. One article from the American Social Hygiene Association (1954) explained that “[t]he reservoir level rises as the cases of undiagnosed and untreated early syphilis accumulate. It falls as cases are found and treated,” with each infected individual brought to treatment “reducing” (Parran 1946), “decreas[ing]” (Kaney and Hunt 1951), or, in the words of one military official (Carter 1945:10) testifying on the value of contact tracing, “drying up the reservoir of infection.” Conversely, cuts in funding for public-health case-finding work, and the “constant threat” posed by “the highly promiscuous,” caused the reservoir to “swell” (Joint statement 1954:335–36), or in worst-case scenarios to “overflow” (American Social Hygiene Association 1954). The head of the US Public Health Service’s Venereal Disease Branch (Shafer 1953) praised case-finding and public-education efforts, “which dry up the streams of new syphilis that feed the reservoir” (193). He likened public-health activities to Dutch efforts to hold back the sea: “we have worked hard to erect a workable system of dikes behind which we have been able to restrain and slowly reduce a vast reservoir of infection. But,” he continued, invoking the devastating floods that struck the Netherlands that year, “like the deep ocean currents venereal disease in the human body and in society is often hidden and frequently undetected” (197). Constant vigilance – and funding – was required.

The reservoir metaphor offered a flexible phrase which, alongside other VD imagery like “cesspools” and “icebergs” (for example, Smith 1937; Parran 1946), suggested accumulating fluid matter subject to stasis, pooling, and flow. The word lent itself to images of rising and falling volume, which could be harnessed and managed, to fluid sources that could be contaminated and poisoned, and, via linkages to the water reservoirs and sewers of growing metropolises, suggested vast and hidden cross-city networks – “the foul web of community venereal disease.” Wrote one public-health official (Williams 1943:250), “The patient with a recent venereal infection has touched that hidden network somewhere; that is why he is ill … .” Older images of cesspools, breeding grounds, and localized foci of infection were also overlaid onto the notion of enclosed cavities, literally imagined as stagnant pools of infection. The reservoir metaphor could be scaled up to refer to whole populations or specifically affected groups within them, and scaled down to the bodies, or even body parts, of individual carriers who were infected. Much like an underground spring subject to hydrostatic pressure, ignoring a venereal reservoir would not deter the geologic-like forces acting upon it. Writing of commercialized prostitution in a widely circulated Reader’s Digest article, the US Public Health Service’s Surgeon General Thomas Parran (1936:4–5) conceded that it affected “only 25% of the problem. But,” he warned, “even granted that syphilis were a reservoir of disease in the one lowest social class of the population, scientists insist that such disease always filters through to higher strata of society.”

Female sex workers as the chief “reservoir of venereal disease,” 1930s-1940s

In British Columbia, Donald Williams, a determined and well-connected young physician, took up the directorship of the Division of Venereal Disease Control in early 1938, just as the North American crusade against VD, energized by Thomas Parran’s efforts in the role of Surgeon General, kicked into high gear (Brandt 1987:122–160; Freund 1995). Williams immediately marshaled his agency’s ever-improving statistical data into a battering ram against what he called “the problem of illegally-operating, disease-dispensing commercialized prostitution” (Division of Venereal Disease Control 1941:6). At public meetings he quoted passages from Rosenau’s now classic textbook, declaring VD “the greatest of modern plagues” (Council urged 1939). Williams repeatedly portrayed the activities of the (generally White) female prostitute, in annual reports and newspaper interviews, as the major focus of concern – the chief, dangerous “reservoir of venereal disease.”

At its simplest, Williams noted in a report on the Division’s activities in Vancouver (1943:256), “the basic principle behind all action was that of making it as difficult as possible for apparently healthy men to meet potentially infected women.” The report’s illustration of “the facilitation process” (Figure 1) drives this point home unambiguously. The “Facilitator,” a large sack of money in the shape of a White man wearing a jauntily worn fedora hat, extends his arms wide to bring together a susceptible healthy person and a suspected infected person. These are, respectively, a clean-cut young White man in a suit standing apprehensively in place, and a White woman wearing a knee-length dress and high heels, eagerly walking toward the man with arms extended forwards, her poisonous midsection a white skull on her otherwise black clothes. While this woman is racialized as White, contemporaries also portrayed the province’s sex workers as foreign to British Columbia, with Williams quoted by one newspaper as stating “there were French girls from the east and girls of many nationalities” (Council urged 1939). Popular parlance further amplified the image’s links to tropical medicine, with public-health workers referring to facilitators profiting from prostitution as “parasites” (Council Urged 1939) and unaccompanied women at drinking establishments as “bar flies” (Hendricks and Winebrenner 1944:127).

Figure 1. The facilitation process (Williams 1943:251).

The pragmatic focus on the facilitation process also allowed reformers to evade criticism that they were unfairly targeting vulnerable women. Williams would acknowledge that although commercialized prostitution could never be eradicated (Dr Williams asks 1941), “We can limit it […] and such action is really directed at the third parties involved – the procurers, landlords, etc.” He expanded his list of facilitators in the Division’s annual report for 1942 (Division of Venereal Disease Control 1944:8): “pimps, madames, bar-tenders, hotel clerks, and bell-boys, dance-hall proprietors, waiters, taxi-drivers, land-lords, and many men and women engaged in various types of minor crime.”

Even with this broad surveillance net, however, individual sex workers drew targeted and emotive attention. “She is a menace to civil and military health and is a potential danger to the efficient war effort,” Williams wrote (Police threaten 1941) regarding a woman who described herself as a “sporting girl” and who was subject to police surveillance. Elsewhere he lamented that:

Several of these individuals are old offenders, some of them previous patients of the clinic who have lapsed from treatment or acquired further infections. They are notoriously “birds of passage” and it is a difficult matter even to make contact with them. When contact has been made they often promise faithfully to report but fail to do so and when another search for them is made they have flown. […] Through all this time, however, the woman’s activities as a perambulating source of venereal disease infection never ceases, it is hardly exaggerating to say, for an hour. If one visualizes each new infection thus unchecked progressing through the population in proportion nearer geometrical than arithmetical, it is difficult to overstate the seriousness of the situation. (Division of Venereal Disease Control 1944:14)

Under Williams’s determined leadership, the Division agitated public opinion against commercialized prostitution, pressured the police to target facilitation, and implemented improvements to case-finding efforts. These actions led to further reductions in the number of individuals appearing at Vancouver’s free clinic who identified prostitution as the source of their infections. Attempts to target this VD “reservoir” evidently brought results. But they also obscured other possible contributors to VD prevalence. Williams noted in his 1940 annual report (Division of Venereal Disease Control 1941:16) that “[w]here uncontrolled commercialized prostitution flourished in a community a few diseased inmates of bawdy houses were able to infect a large number of male patrons. Thus the ratio of new gonorrheal infection in the community may reveal many infected males to each infected female even with total reporting and complete detection of all infections.” In imagining such a panoptically drained reservoir - one with “total reporting and complete detection” – his logic held that female sex workers might “to a considerable degree account for the common and wide experience of many health centers that gonorrhea reported in the male is more frequent than gonorrhea in the female.” In other words, the epidemio-logic of a single major reservoir encouraged Williams and his colleagues to improve their tactics to drain it completely, and to believe that any residuum simply required further improvements to their methods, and not, rather, to consider other possible tributaries. In the article’s final section I detail this epidemio-logic failure – by which I mean a breakdown in epidemiological reasoning – whereby the limitations of the female prostitute reservoir became more apparent over the following two decades.

Even as this well-publicized campaign against female prostitution gathered steam, recognition of changing sexual mores – particularly the collapse of separate gendered spheres, increased use of contraception, and a rise in premarital sex – unsettled the assumptions upon which it was based (D’Emilio and Freedman 2012:222–274). One study (Kulchar and Ninnis 1938:584) located the sources of syphilis infection for over 1,100 patients attending a California clinic between 1925 to 1936. The authors noted that “[t]he role of prostitution, long regarded as the most important factor in the dissemination of the disease, may be altered considerably by changes in moral standards. With these changes,” they continued, drawing on the phrasing of John Stokes, a leading syphilologist, “the prostitute reservoir may be dwarfed in importance by, ‘the girl friend, the flapper, the industrially emancipated woman, and the recurrently companionate wife.’” One provincial resident (McLean 1939) wrote a letter to the Vancouver Sun quoting statistics from this study, noting that of 909 male patients, “39.8% acquired their syphilis from prostitutes, 51.1% from clandestine contacts, 4.7% from marital relations, and 4.4% from homosexual contacts.” Based on these percentages, he concluded, “it seems that the professional prostitute is on the way out. She cannot compete with scab competitors.”

Nevertheless, Dr Williams’s confident, progressivist crusade against organized prostitution in Vancouver made waves. After the provincial director discussed his agency’s work with a member of Thomas Parran’s staff in November 1941, the Surgeon General requested that Williams write an article for Venereal Disease Information (Williams 1943), suggesting that “his epidemiologic methods of meeting the prostitution problem will stimulate” American VD-control efforts “very materially” (Parran 1941). As Canada mobilized for the Second World War, Williams was soon appointed to lead the Canadian Armed Forces’ coordinated VD strategy in Ottawa (Dr D. H. Williams 1943). Following his lead (Williams 1944:547), the Chief Constables’ Association of Canada adopted a resolution declaring that “since it has been proven that commercialized prostitution is the greatest reservoir of venereal disease, this Association urges that vigorous action be continued against prostitution in all its aspects.” News of Williams’s efforts traveled across North America via military, law-enforcement, and public-health networks, through conference presentations, journal and newspaper articles, and digested research publications.

Spacializing the reservoir: swamps and spot maps

Prostitution and the War (Broughton 1943), written by a former worker of Washington’s Federal Security Agency, was one such digest. It went through several printings between February 1942 and April 1943, in a pamphlet series from the Public Affairs Committee which sold over four million copies. This text, which mentioned Williams’s successful drive in Vancouver, reasoned analogously from tropical and sanitary medicine to urban VD control:

When any disease attacks, a wise community is not satisfied merely to find and treat cases. Sources must be found, causes eradicated. Malarial swamps must be drained. Water supplies must be filtered and purified. Housing, recreation, sanitary services must be extended. In the same way communities must get down to fundamentals in tackling the threat of venereal disease (5).

The text displays repeated tension between the logic of environmental control and vector eradication, and the impracticalities of dealing with human reservoirs in the same manner. “Swamps and malaria mosquitoes are impersonal,” Broughton (1943) notes at one point, “they can be ruthlessly eradicated. Human beings can’t.” (6) And later: “The carrier of syphilis or gonorrhea is not an impersonal mosquito or an even more impersonal swamp or river. It is a man or a woman. The carriers of venereal disease cannot, therefore, be “wiped out.” (12) And still later: “Human beings can’t be dumped down the sewer like gallons of bootleg booze.” (22)

In contrast to these expressed frustrations regarding the challenges posed by human reservoirs, an accompanying diagram (Figure 2), produced by a prominent American-based pictorial statistics organization, adopted a more confident view. The image quite literally depicts a surging torrent of potential prostitutes being carefully managed and dried to a trickle through redirection, repression, and detention. This was done to prevent the flood of women from intersecting with the vulnerable male “potential customers,” whose own reservoir of exuberant sexual energies are being channeled into a dam of “satisfactory living” and “constructive recreation.”

Figure 2. How to Check Prostitution (Broughton 1943:23).

A contemporary manual guiding law-enforcement officers on how to deal with prostitution employed similar miasmatic and water-based language:

Police have learned the value of a spot map in determining the hazardous traffic points. A similar map is being used by some departments in determining the city’s principal hazardous spots insofar as venereal disease and vice are concerned. Every reported contact point and every known place of operation out of which grew an infection, should be indicated […].

As a public health officer seeks out the source of a health hazard, such as bad water, swamp land, inadequacy of sewage-[disposal] systems, so the law enforcement officer will find the venereal disease swampland by his spot map. (National Advisory Police Committee 1943:21)

The analogy was further extended:

Visualize, if you will, 20 to 40 men bathing in the same tub of water in one evening. Not a nice thought, but common sense tells us that various diseases might develop to these bathers. The same comparison may be drawn between a prostitute and her patrons of a single evening.” (10)

Figure 3, a black-and-white newspaper photograph of A. John Nelson, one of Williams’s successors as Director of British Columbia’s Division of Venereal Disease Control, shows that the spot map technique remained in use into the 1950s. Nelson, sporting glasses, suit and tie, and a wedding ring, is depicted standing before a large-scale wall-mounted street map of Vancouver, marked with, the newspaper caption noted, the “worst areas of venereal disease contagion.” The physician’s hand rests on an impoverished area of the downtown east side known then by the name of “Skid Road.” Echoing the efforts of earlier campaigners like William F. Snow who fought to overcome resistance to tracking venereal infections, the spot-mapping method reinscribed place, via the facilitation process, as a key piece of epidemiological information. Guided by the map, Nelson and his team could discipline problem institutions named as places of encounter and contact by pressuring their industry bodies or threatening the loss of their liquor licenses. As an example of the cat-and-mouse pursuits in these cynegetics (Lynteris 2019:14) of epidemiology and law enforcement, the image caption also warns of a corresponding shift in vice networks’ tactics. By switching to using telephone lines to operate call-girl services, these networks thwarted investigators’ ability to pinpoint and regulate places of assignation and sexual contact, thereby threatening to weaken this control measure.

Figure 3. Uncredited photograph (Worst Areas of Venereal Disease Contagion 1953). Originally published in The Province, a division of Postmedia Network Inc.

From female sex workers to White male homosexuals, 1950s-1960s

By mid-century, heavy cracks were appearing in the long-held epidemio-logic of female sex workers as the reservoir for most VD, with investigators paying increasing attention to other women and to adolescents (Guthe and Hume 1948). The mass mobilization for the Second World War, while focusing enormous attention on the seemingly intractable issue of female prostitution, also saw a dramatic uprooting and close mixing of large numbers of young men, offering them opportunities for same-sex pleasure away from community restraints, and chances to explore established queer communities in metropolitan areas (McKay 2016). Wartime disruptions led to surging VD rates, which were nevertheless reduced in the postwar period with substantial help from new penicillin therapy.

Meanwhile, new studies from researchers like Josephine Hinrichsen (1944) and Alfred Kinsey and his associates (1948) shed dramatic and controversial light on the sexual activities of American men. For the first time, VD-control workers learned the importance of routinely asking men about same-sex encounters, of examining mouths and rectums for signs of infection, and of anticipating that some male VD patients might have multiple male sexual partners, requiring skilled interviewing to elicit contact details (McKay 2016). As Hinrichsen (1944:484) wrote: “Most of these reservoirs of infection apparently have been overlooked […]. Until diagnosis is more accurate and a much greater number of sources of infection are discovered, it will be impossible to control the venereal diseases.”

In Vancouver, two physicians working for the provincial VD division (Kaney and Hunt 1951:139) made an unexpected discovery while explicitly “endeavour[ing] to decrease the reservoir of early syphilis” in the province’s largest city. “We have been forcibly made aware,” they declared, “of a hitherto unsuspected source of the spread of venereal disease, namely homosexuality.” Noting no reported cases of VD acquired by homosexual contact before 1949, they saw 3 such cases in 1949, and 20 in 1950 (11 with early syphilis, and 9 with gonorrhea). Expressing alarm at these “sufficiently disturbing” figures, the doctors worried about the high proportion of early syphilis cases attributable to homosexuality, and, since their numbers were based on those attending public clinics, about what unknowable number of men might be seeking treatment privately.

The demographic breakdown of the city’s twenty homosexual VD cases in 1950 is noteworthy for two reasons. First, the numbers are significant in terms of the emerging racialization of homosexuality as a White phenomenon (Collins 2004:105–114). VD-control workers played an important role in this process by virtue of their ability to use their specialized knowledge of disease-transmission dynamics to exert pressure on men who presented with VD symptoms to divulge their sexual practices. Except for one Chinese man and another the physicians described as “part Indian,” all the Vancouver cases were White men, ranging in age from two teenagers to one 59-year-old, with most aged 20–29. All the cases, that is, apart from one unmarried White female, the twentieth “homosexual” patient in the series. Her inclusion reminds us that VD transmission between women was occasionally observed but typically considered negligible compared to the much greater number of male cases infected through same-sex contact (for example, Macdonald 1949).

Predictably, the physicians discounted as “dubious rationalizing causes” the explanations offered by the men in their study for the recent apparent increase in same-sex syphilis transmission. These explanations included the ease with which men could associate while avoiding suspicion, their imagined freedom from VD risks that were strongly associated with female partners, the rise “of the male ‘prostitute,’” and increasing rates of narcotic and alcohol use (Kaney and Hunt 1951:139).

Over the next two decades, and up to the 1969 federal legislation that led to a partial decriminalization of sex between adult men, male homosexuality’s contributions to Vancouver’s VD levels were increasingly discussed. Alongside mentions (Myers 1964) of a reservoir of infection amongst “the sexually promiscuous denizens of Skid Road” – a designation that increasingly included Indigenous people – newspaper, public-health (Kennedy 1966:4), and police (Mundie 1966:1–2) reports highlighted how a continued public-health focus on the facilitation process revealed bathhouses named by male homosexual patients to be a new institution of concern. In 1942, during Donald Williams’s watch (Beer parlors 1942), the city had required its beer parlors to install partitions of at least six feet in height to separate sections in each venue for men and unaccompanied women. Their purpose, recalling the “screens” inspired by successes in tropical medicine and endorsed by early-twentieth-century social hygienists like Snow, was to disrupt the potential for illicit encounters between the two sexes. In 1965, city council members voted in favor of a by-law change requiring steam-bath operators to remove privacy doors from cubicles and increase illumination in their premises, this time with the goal of discouraging male patrons from making sexual contact with one another (Mundie 1966:2). If changes to the built environment function as a marker of recognition, then these adaptations signaled the consolidation of a new epidemio-logic, and the perceived role of “the male homosexual” as a human disease reservoir within it.

Conclusion

Medical, public-health, and law-enforcement professionals used the reservoir metaphor in a highly flexible manner in reference to VD in North America and beyond from the 1910s to the 1960s. The term could function metaphorically, to conceptualize an amorphous total disease prevalence. It also worked metonymically to narrowing degrees – social hygienists who admired the successes of tropical and sanitary medicine presented prostitution, the individual “promiscuous” woman, and even a woman’s infected vagina as miasmatic swamps of foul water. From the Second World War onwards, this same narrowing of focus would apply with increasing frequency to male homosexuals, and even more specifically to the “passive homosexual” and his rectum. These two lineages were evident when an influential London venereologist summarized in 1962 (Jefferiss 1962:1752): “The reservoirs of infectious venereal disease appear to be the asymptomatic promiscuous female of low intelligence and the infected passive homosexual, whose symptoms are also often non-existent or very slight.” By the time that the Gilloran Committee on Sexually Transmitted Diseases referred to “passive homosexuals” as “reservoirs of infection” in a 1973 report (Davidson 2001:224), they took part in a by-then well-established tradition of referring to certain humans as reservoirs of VD, though one whose peak had largely passed.

The phrase’s mutability and overlap with “source of infection” helped to justify the patrol and regulation of areas deemed trouble spots – red-light districts, so-called “Skid Roads,” and establishments identified as locations of pick-up and disease acquisition through the facilitation process. On the one hand, it helped to focus disease-control efforts, galvanize support, and suggest improvements to reservoir-draining strategies. On the other, it also obscured less obvious sources and tributaries to disease prevalence, contributing to failures in epidemio-logic which were only more fully understood toward the end of the period under investigation. Applying the reservoir metaphor to humans also exposed a tension which sits at the heart of the challenges of drawing extended comparisons between Homo sapiens and non-human creatures (Saha 2021:1–27). Likening the problem of VD control to that of diseases like malaria and yellow fever invited a confidence drawn from models used to manage pests like mosquitos and problematic environments like swamps. And yet the different status accorded to humans constantly constrained the direct transfer of such strategies.

Any deployment of the term reservoir should be undertaken with caution, especially if used in relation to people, as the historical evidence presented here highlights the significant risk that labeling certain social groups as reservoirs also serves to dehumanize them. Scientific metaphors often hold power and meaning beyond their stated definitions; they must be deployed with historical awareness and care. While the term’s accepted definition appeals to notions of natural circumstances, I have shown that its deployment in relation to VD in North America was dependent on cultural associations, political and educational pragmatism, and evolving public-health and medical knowledge. In particular, it served to identify specific vulnerable groups who authorities believed needed to be traced, controlled, and drained of their pathogenic potential. This research also indicates that a disease reservoir’s exact contours will always remain obscure, limited in part by constraints in surveillance capabilities and in part by contemporary imaginations during a given period. A reservoir of infection, therefore, is at best a highly contingent, historically and geographically limited snapshot of disease distribution. As such the metaphor may carry some explanatory utility, but unless these cautions are heeded, any helpful meaning it may contain is likely to drain away.

Acknowledgments

I’m grateful to the organisers and participants of the Reframing Disease Reservoirs conference, and to Katherine Foxhall, Alexa Hagerty, Matheus Alves Duarte Da Silva, Jules Skotnes-Brown, and the anonymous reviewers for their helpful reading and comments. The University of Cambrige’s Ethics Committee for the School of the Humanities and Social Sciences and the London – City & East Research Ethics Committee [16/LO/0572] reviewed and approved the research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded in whole, or in part, by a Wellcome Trust Medical History and Humanities Fellowship, [Grant number WT098705]. For the purpose of open access, the author has applied a CC BY-NC-ND public copyright licence to any Author Accepted Manuscript version arising from this submission.

Notes on contributors

Richard A. McKay

Richard A. McKay is a College Lecturer and Director of Studies for History and Philosophy of Science at Magdalene College, Cambridge. His research has been published in the Bulletin of the History of Medicine, Nature, and Newsweek. His first book, Patient Zero and the Making of the AIDS Epidemic (University of Chicago Press, 2017) was named a CHOICE Review Outstanding Academic Title and made into the award-winning documentary feature, Killing Patient Zero. Richard also works as a coach for writers, creative thinkers, and active individuals planning their retirement.

Notes

1. Following Crowhurst et al. (2021:6–7), I use both “prostitute” and “sex worker” to capture the breadth of polarized views on prostitution and the people in it, and to convey contemporaneous language.

2. This stable definition remained unchanged from the first edition (International Epidemiological Association 1983:92) to the cited fifth edition.

3. Although Castejón-Bolea (2001:63) invokes the phrase “reservoir” in his historical treatment of Roselló y Olivé’s work, reference to the Spanish physician’s original text, which reads el gérmen y criadero, gives weight to the view that this was not an emic term.

4. See also Johnson and Davis (1919).