A test before marriage

April 01, 2013
by Brendon Nafziger, DOTmed News Associate Editor
Several years ago, my wife and I applied for a marriage license at the County Clerk’s Office in lower Manhattan. The place had recently been remodeled, in part, in an effort to turn New York into a destination city for quickie weddings, much like Las Vegas. There were now computer kiosks you could use to fill out the application forms. There was even supposedly (though I never saw it) a device you could plug your iPod into. It would then broadcast your favorite song at that magical moment when a curt city functionary monotonically pronounced you man and wife.

To Manhattanites of a generation or two ago, all of this – aside from the monotone city functionary – would be quite new. Equally surprising, perhaps, would be what was missing. Unlike potential newlyweds for much of the 20th century, my wife and I did not need to go through a public ritual once required of all to-be-married couples in the state of New York: a blood test.

On April 12, 1938, when the Breitbart- Desmond bill was signed into law, New York State wasn’t the first to require serological testing for would be spouses. Its neighbor, Connecticut, had started a similar program three years previously. But it was a big step in a nation that had just begun a public conversation about a formerly hushed-over danger, a menace that was poisoning the young and weakening the human race: syphilis.

The British writer D.H. Lawrence blamed the pox, which likely originated in the New World, for being the source of the Puritan horror of sex. Thanks to the disease, intercourse was something that could kill you, or even corrupt your unborn babies. Whatever its subtle effects on culture, the latter was key – the premarital testing regimen was started mainly to prevent mothers from catching the disease and having children born with congenital syphilis, a once somewhat common cause of deformity and disability. “Too many people regarded syphilis as an unmentionable moral scourge rather than as a threat to the public health,” the St. John’s Legal Review said around the time New York’s law was passed.

The change wasn’t just social. It was technological, too. The Wassermann blood test, developed in 1906, meant doctors had a reasonable objective marker with which to diagnose the disease, and no longer had to rely on dubious clinical signs. Also in 1910, Nobel Prize winner Paul Ehrlich’s lab developed Salvarsan, an arsenic-based drug that was more effective, and safer, than the mercury products originally used to treat syphilis. Salvarsan still had terrible side effects – including apparently liver damage – and didn’t work on later-stage syphilis, but it was widely used until finally eclipsed by penicillin in the 1940s.

The hope was big. Dr. Thomas Parran, a U.S. surgeon general who led the public health campaign against venereal disease, told students at Skidmore College in the summer of 1938: “It should be possible by national effort such as now is underway to make syphilis a rare disease in this generation.”

Alas, the pre-marriage tests were something of a bust. During the first year of testing in New York City, only 1.34 percent of grooms and brides tested positive for syphilis, although officials believed at least 10 percent of its citizens were afflicted. Why was the catch so low? It’s possible the original estimates were inflated, according to No Magic Bullet: A Social History of Venereal Disease in the United States by Alan M. Brandt, a history professor at Harvard University. Couples also probably evaded the tests by getting hitched in neighboring states without the law. Before New York passed a law of its own and after Connecticut passed its in 1935, neighboring New York counties saw their weekend marriage rates spike 55 percent, according to Brandt.

More successful was legislation, passed in New York in the same year, that required pregnant women to have their blood tested for syphilis. A similar prenatal testing regimen in California lowered the syphilis infant mortality rate from 6.50 per 1,000 in 1938 to 0.15 per 1,000 in 1945, Brandt said, helping to protect babies from syphilis before the widespread adoption of antibiotics.

By the 1980s, most states realized the money spent on the tests wasn’t worth it, and they were striking their premarital blood test laws from t he books. New York finally repealed its test law in 1985.