Winston Churchill and the Spirochaetes

Did you hear the programme about syphilis on Radio 3 on Sunday?  If not, you can catch up on it here – and I’d thoroughly recommend doing so: it was superb.

One bit in particular caught my attention; it had to do with the use of penicillin to treat the illness during World War II.  (It’s from about 38:40 on the iplayer version.)  Astonishingly, in 1942, more men were out of action in North Africa because of syphilis than because of battlefield wounds.  Obviously, penicillin would be of immense help to both groups; but the problem was that there was not enough of the drug to meet both demands.  Giving it to the wounded obviously had some moral gravity… but so did giving it to the syphilitic: after all, they’d be cured and battle-ready very quickly, whereas the wounded might never be battle-ready again.

You can doubtless see why this might be problematic: not only is it basically a resource allocation issue , but it’s one that speaks to fairly deep intuitions about the deserving and undeserving ill (and a hell of an example to use in class to boot – *makes mental note*).  The problem in this instance went all the way to Churchill, who insisted that the penicillin should be used to the best military advantage.  I think we can all see the hint being dropped in that.

So what we have is not just a resource allocation question, but also another question about the proper use of medicine in wartime.  It’s possible that a vital drug might have been diverted away from the needy towards the less needy for military, rather than strictly therapeutic, reasons.  (After all: though syphilis can be life-threatening, it isn’t likely to be life-threatening in the short term, whereas sepsis might be.  A person with syphilis might well be able to return to the battlefield under his own steam eventually: he could be treated later.)  Would this be compatible with the hypocratic ideals of medicine, though?  That is: is military medicine a sui generis form of mediicine, with norms and moral standards that may come into conflict with civilian medicine?

I’m tempted to think that it isn’t, but I know that there are others who disagree: who think that a military medic’s commitments include a duty to maintain the fighting fitness of the forces (and perhaps to priorities friendly casualties over enemies – though that’s a slightly different matter).  And wherever you sit on that question, it might yet turn out that giving penicillin to the syphilitic is just a much more efficient way of using the drug than the alternatives would be; efficiency is a virtue, and often at least a component of justice – and so there could be a fairly compelling argument defending its use to treat VD on those grounds alone.

I’d love to see how today’s press would respond should a similar dilemma ever arise again…

(If I’ve one slight quibble about the programme, it’s to do with all the warnings at the start about how it contains language that may offend.  Really?  Is the kind of person who listens to a radio documentary about syphilis likely to be offended thereby?  (I mean: it’s Radio 3!  The chance of anything on that station being gratuitous is pretty slim…)  If people are offended by things like the word “vulva”, or history in general, should we really take that so seriously?  It seems to me that the offended may be more at fault than the offender.)