The Wages of Sin
Sex and Disease, Past and Present
PETER LEWIS ALLEN
University of Chicago Press, Chicago, 2000, 202 pp, $25 hardcover
ISBN 0-22-601460-6

Morality and medicine—the linkage is complex but significant. Earlier this year, U.S. Surgeon General David Satcher released a report that some Americans viewed as controversial, partly because of its conclusions about sex education. While public health advocates praised the surgeon general for emphasizing prophylaxis as well as sexual abstinence in sex education, leaders of the religious right accused Satcher of sanctioning “immoral” behavior, by which they meant premarital sex and “nontraditional” relationships (i.e., homosexuality).

Why would some sectors of the American public oppose public health measures that are proven to prevent disease? In The Wages of Sin: Sex and Disease, Past and Present, Peter Lewis Allen suggests that the animosity toward certain forms of disease prevention has roots extending into the Middle Ages. There is a long tradition in the West of viewing disease as God’s punishment for sin, Allen writes, especially sexual sin. Current sentiments about deadly diseases such as AIDS (and the means to prevent them) derive from earlier religious attitudes toward maladies like syphilis, leprosy, and bubonic plague. Allen traces the history of the religious response to disease and illustrates how religious attitudes influenced the medical treatment and public perception of sick people.

The medieval medical establishment and the Church first came into conflict over a “disease” that is no longer recognized: lovesickness. What physicians called lovesickness was a type of depression believed to be caused by unrequited love, or in the terminology of the day, an excess of “black bile”. The cure that doctors prescribed for lovesickness and its attendant physical and emotional ills was sexual intercourse. Such a prescription was anathema to the Catholic hierarchy, and at the Fourth Lateran Council of 1215, the Church prohibited medical treatment by “sinful means”.

The debate over lovesickness and its cure highlighted the “sharp cultural divide” between those whose primary concern was the body (i.e., physicians) and those who considered physical health important only if it served the spirit (i.e., religious leaders and institutions). The conflict once initiated was not soon to abate. The medieval Church also encouraged the belief that the scourge of leprosy was God’s punishment for human sin. Lepers were commonly denied treatment unless they “confessed”, and the Church even enacted “ceremonies of separation”, which characterized suffering lepers as the living dead and expelled them from communities.

The Catholic Church was not alone in connecting sin, sex, and disease. The 16th-century rise of Protestantism, especially Calvinism,increased public intolerance toward the ill. Victims of syphilis were condemned as targets of God’s wrath and were ignored by many medical and charitable institutions. Religious artists often depicted Jesus striking down the unjust, raining murderous arrows down from heaven upon syphilitics and those who suffered from bubonic plague. It was during this early modern period that the notion of “guilty” and “innocent” victims of disease arose, a distinction that would reappear during the AIDS crisis of the 1980s.

The final two chapters of Allen’s book deal with masturbation and AIDS. The author demonstrates that in the 19th century, masturbation was understood to be sinful and physically debilitating. This perspective was primarily religious, but physicians adopted it as well, owing to the pervasive influence of religion on the medical community.

moregoodreading

And the Band Played On: Politics, People and the AIDS Epidemic By Randy Shilts St. Martin’s Press, 2000 (reprint edition) Morality and Health Allan M. Brandt and Paul Rozin, Eds. Routledge, 1997 Chicago’s War on Syphilis, 1937–1940: The Times, The Trib, and the Clap Doctor By Suzanne Poirer University of Illinois Press, 1995 Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History By Sheila M. Rothman Johns Hopkins University Press, 1995

Religious influence on public health issues did not disappear in the 20th century, as the battle against AIDS demonstrates. Many conservative Christians believe that AIDS is God’s judgment against homosexuals,and because such religious attitudes held sway in the Reagan administration, federal and state agencies were unable to give complete information about disease prevention to the public, and funding for vaccine research and drug treatment was delayed.History seems to repeat itself: As former Surgeon General C. Everett Koop was criticized in the 1980s for his report on AIDS and its emphasis on prophylaxis, David Satcher is the contemporary target of abuse. Wages provides an excellent history of the sex–sin–disease nexus in Western culture, and it is a timely text for a society that all too often moralizes about public health issues instead of addressing them with sound medical science.