What began as a local effort to reduce prostitution around military bases quickly expanded. Federal agents divided the nation into ten districts within which paid supervisors and field representatives were “to investigate the presence of alcohol, prostitution, and general female promiscuity in a given area.” Should investigators discover women they considered likely to have an STI, they had the legal authority to examine them, quarantine them indefinitely, and subject them to medical treatments that were thought to be a “magic bullet” but were known to be extremely painful and carry terrible side effects. At the time, Stern writes, “no effective treatment existed for syphilis or gonorrhea.” This practice “went on for decades”—well after the supposed need to protect soldiers in both World War I and World War II passed—and incredibly, “the age listed for a first ‘offense’ or ‘delinquency’ was often as low as seven.”
Reformers with their sights on eradicating prostitution were the ones originally most keen to promote the work of the American Plan, but in time numerous other governmental agencies were equally eager to underwrite the effort after it lost federal funding in 1922. By 1918 the plan was operating in forty-one states, in no small part because legislators across the country had been handed a preworded “model law” regarding how best to control STIs. Among other things, this law stipulated that the spread of venereal diseases was “to be declared unlawful,” that such infections must be “reported by name, not merely number,” and that those deemed infected must be quarantined because “their habits are a menace to others.” These people were prohibited from seeking “private treatment” (from, say, a drugstore) and were also prohibited from asking any other authority to issue them “certificates of freedom from venereal diseases.” These model laws remained in place, largely unchanged, in every state, establishing a legal precedent for detaining and quarantining citizens during any outbreak of disease—most recently Ebola and the Zika virus.
Although it is obvious from these drastic guidelines that the political and legal architects of the American Plan had little regard for civil liberties, what it actually meant to endure the effects of the plan was murky even to Stern until he came across the case of Nina McCall, who died in 1957. He was struck by her story in part because she did not come from a major American city known for “immoral” or “seedy” living, such as San Francisco or Chicago. Nina lived in a small town in central Michigan, a sign of how deeply into the nation the American Plan reached. Most importantly, she decided to sue those who subjected her to confinement and treatment, leaving behind a paper trail of her testimony. “In all these ways,” Stern writes, “Nina made for an ideal protagonist.”