Thursday 8 October 2015


I tell ya, working in The Institute is The Business! I'll be doing something quite normal, like presenting Cellular Components for my Human physiology course for the third time, and a question will pop up that requires a trip down the rabbit-hole.  To give the theory a more concrete image, I try to find a real disease associated with the sub-cellular organelle under discussion. I've elaborated before on the association of Tay-Sachs disease with lipid processing in the lysosomes. You can't do anything about the disease but you can reduce the incidence by not marrying your cousin especially if you are New Orleans French or New York Jewish. One of the students piped up with "Why are you required to have a pre-marital blood-test in Spain and Lithuania?" two countries where she had lived.  I'm old enough and ugly enough to be unafraid of saying "I don't know" which I always follow with "Let's find out". That's where science begins. In actuality, I deftly turned the question towards something I did know about and asserted that some US states mandated pre-marital blood-testing for syphilis and other STIs.

So here's the skinny.  Pre-marital blood-testing was all the rage 100 years ago to deal with a couple of scourges: syphilis Treponema pallidum and tuberculosis Mycobacterium tuberculosis.  A quite frightening proportion [10-15% of adults] of the population was infected with syphilis and there was no really effective cure that was cost-effective and reasonably free of side-effects.  The assumption was that no sex happened before marriage and that, by flagging the infected before the wedding, you could alert a prospective spouse and/or offer whatever treatment was available. That was difficult given the social stigma associated with syphilis and posed a big ethical dilemma for doctors about disclosure and confidentiality.  Needless to say there was a lot of finger-pointing at black people particularly those who came into domestic contact with white-folks. In 1936, Charles Parran, the US Surgeon General under Roosevelt's New Deal administration, pushed out universal free syphilis tests. Statistics for positive results caused a flap that led to a raft of state legislation, somewhat strangely, for example, requiring food-workers to be syphilis free in Georgia. I suspect that some of the law-makers were confused about what sausage was going where. The roll-out of wide-spread testing and the development of really effective antibiotics in the 1940s and 1950s dropped the rate of syphilis from as high as 20% to a tiny fraction of 1%.

Accordingly, the various states stopped doing the testing. In 1967, California carried out 300,000 blood-tests to identify a mere 35 syphilitics: a 0.012% hit rate that was costing $230,000 per case. $8 million can go a long way under some other item on the state's balance sheet and mandatory testing was stopped shortly thereafter. Other states also made the same cost-benefit analysis and now only two states, Montana and Mississippi (and DC) still retain pre-nup blood testing on the books. Montana requires brides to be tested for Rubella / German measles which is a trifling disease in most people but potentially devastating to a first trimester foetus. MMR vaccination is so wide-spread in The West that finding women who are likely to contract rubella is quite difficult. In any case, you can nowadays get a cert against compliance on religious or other grounds.

South of the borrrder, down Mexico way, pre-marital testing is required in a number of states; most of which will require a RPR test for syphilis and another immun-histochemistry test for HIV before a marriage licence can be issued. Some states do tuberculosis as well.  China requires a number of Big Brother interventions in the course of true love including a stern talking to and a film session. But even they are turning less proscriptive and more advisory.  Catholic Ireland also does Marriage Preparation Courses which are, by report, not without value if you can spare the time. It's not all about making sure the blessed children go to Mass and that you have lots because contraception is verboten; MPCs also talk about finances and budgeting, reconciling differences and dealing with disputes. I can find nothing about what the requirements are in Lithuania.

Where testing is not required there is a still an entrepreneurial market. Raffles Premarital screening in Singapore, for example, "an essential basic test for gentlemen and ladies or couples prior to making plans for a family." Presumably cads, bounders, trollops and the working class are shown the door even if they can muster the S$147 fee [about US$100]. What do you get for your money? Screening for venereal disease [Syphilis, Gonorrhoea, Chlamydia] , rubella, HIV, Hep B. They'll also tell your ABO blood group, whether you're anemic, do an ECG and then have a doctor explain it all to you.  In Irish terms that is phenomenal good value.

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