Survey Associates.

Survey midmonthly : journal of social work (Volume 74) online

. (page 14 of 109)
Online LibrarySurvey AssociatesSurvey midmonthly : journal of social work (Volume 74) → online text (page 14 of 109)
Font size
QR-code for this ebook

A the social worker in the syphilis clinic of a large
hospital with an established reputation for its
treatment of syphilis and for its graduate teaching
in syphilology, I find myself in a particularly fortunate
position to observe what may be called the "backwash" of
the present campaign to eradicate syphilis. Of course, we,
who long have been hushed by the conventions of a society
which preferred not to think about syphilis, welcome the
change that is making it possible to bring this problem
to public notice. But we ask ourselves, "What is this
'syphilis consciousness" doing to the lay public whose curi-
ous and often morbid interest is being aroused by the many
revealing articles about the disease now being published?"

The campaign seems to be mobilizing public opinion in
two camps. It is teaching a small but well-informed part
of the public to consider syphilis along with diabetes,
tuberculosis, and other diseases asking practically and
realistically what can be done about it. Fortunately this
group is increasingly able to see syphilis without its moral
connotations and to recognize it for what it is a disease
sapping the life blood of individuals and lessening the vigor
of the whole race. When these aroused individuals learn
more about syphilis, they find that as a germ disease it is
no respecter of persons, although, as with so many other
things, it is better concealed among the economically
secure. But whoever has it those society calls "respect-
able" or those branded "bad" this intelligent group does
not level criticism but concerns itself with what will help
the afflicted individuals. Members of the group seek to
familiarize themselves with scientific facts about the nature
of the disease, its means of transmission, and its treatment.
In so doing they are denied the perverted pleasure of con-
templating it as "a filthy disease which no decent person
could have." It is not this small group about which I am
concerned. It respects the best medical opinion of the time
and it is learning to face the fact of syphilis without
grimacing, blushing, or shutting its eyes.

My concern is for that hysterical part of the lay public
which, while devouring the more graphic of the current
articles on syphilis, fails to go a step further and examine
the facts of the disease and its transmission. These are the
people who, because of their real ignorance of the nature
of the disease and their usual attitude of condemnation
toward those infected, build up false impressions which
threaten to counteract the many desirable results of bring-
ing syphilis to public attention.

Let us look at some of these individuals. Mrs. Jones
hears that her maid, a well-trained and efficient domestic,
is taking "shots" at a clinic. Through indirect questions
and underhanded methods of spying she gathers that Susie
is receiving anti-syphilitic treatment. With frantic con-
cern, she angrily and righteously dismisses Susie, burns
all the objects the maid has handled and worries lest she
and Mr. Jones and their two small children, whom Susie
has cared for since they were babies, could have con-
tracted this "terrible disease." Susie, thrown out of a job

and having no resources except her wages, has to turn
to "the relief."

Had Mrs. Jones consulted a reliable syphilologist she
could have been assured that so long as Susie had no open
lesions on her body and remained under regular treatment,
there was no sound medical reason why she should not
be employed as a domestic. She could have learned that
Susie could not possibly harm her family through caring
for their clothing, preparing their food, or washing their
dishes; and much frustration could have been avoided.
The syphilologist might have explained to her that the
spirochete (germ) of syphilis, because of the very special
conditions under which it must live, is seldom, if ever,
transmitted through the usual contacts of daily life.
Further he might have explained how the powerful drugs
used in the treatment of syphilis help render the germ
impotent to others even in sexual contacts. The syphilol-
ogist could have assured Mrs. Jones that it was wholly
unnecessary to dismiss Susie, and Susie, herself, could have
been spared the demoralization of a lay-off.

True, to secure that opinion Mrs. Jones would have
needed to consult a specialist on syphilis, a man who had
worked with it in the laboratory, the clinic, and in private
practice, a man whose efforts had kept him abreast of and
enabled him to contribute to the increasing knowledge of
the disease over the past few years.

UNFORTUNATELY she might not have secured this
opinion from a family doctor who had not kept up with
recent advances in the field. He might even have shared her
fear at discovering her maid had a venereal disease. It is
not an uncommon experience to hear a general practi-
tioner recommend the lay-off of a person under treatment
for syphilis. One well-respected physician in an official
position was found to be recommending the dismissal of
laborers with syphilis, arguing that it was "dangerous for
non-syphilitics to use the syphilitics' shovels and picks."
Of course this ruling was reversed when the opinion of
recognized syphilologists was brought to the attention of
the proper authorities. But if the family doctor is often
confused about what to do with the syphilitic employe,
it is small wonder that the ordinary layman is stumped
when someone he employs or who serves him is found to
have syphilis.

Equally unwise attitudes often mark the handling of
this problem by industrial and commercial employers. For
example the XYZ Candy Company inspired by the pres-
ent interest in syphilis had Wassermann tests made on all
its employes. Mr. Bee, a middle-aged man employed in the
wrapping room, was found, along with several other
employes, to have syphilis. From the case history, the
syphilologist believes that this man has been infected for
over twenty years. Mr. Bee had experienced no ill effects
from the disease although he recollects some symptom in
his early life which marked the primary stages of the dis-
ease. These early manifestations passed and, lacking other



symptoms, he seemed not to have realized he had syphilis
until the personnel manager of his company gave him the
results of the test, then dismissed him from the position
he had held for sixteen years. The personnel manager,
believing that Mr. Bee is a menace to public health, rea-
sons that he is doing his duty to the public which buys
XYZ candy. The personnel manager may not know that in
the opinion of the venereal disease division of the United
States Public Health Service, composed of and advised
by some of the greatest syphilologists of the day, Mr. Bee
might safely have been retained on the job after being ad-
vised to start treatment at once.

In viewing Mr. Bee's dismissal it is important not to
lose sight of the psychological and economic effects on the
man himself. Laid off in spite of his sincere efforts to ad-
here to the clinic recommendations, he assumed a "don't
care" attitude and abandoned the treatment so vital to
his health and well-being. Even had he been interested in
continuing treatment in spite of his lay-off, he would have
been unable to do so with his source of income cut off;
and this, notwithstanding the fact that the number of free
clinics is increasing, for without work even carfare to
clinics becomes a prohibitive expense. Economically, then,
Mr. Bee became a burden on the taxpaying public, which
must support him, his wife and their five children since he
has been added to the "relief rolls." Likewise treatment
has been made more difficult, both from the standpoint of
cost and the social disgrace involved. When, in addition,
it is remembered that Mr. Bee may become finally a help-
less invalid if he does not have the necessary treatment,
it becomes clear that this dismissal may prove a very costly

FOR the guidance of anyone who hesitates to consult a
specialist regarding an employe with syphilis, or who
lives in a community where there are no syphilologists, I
offer several general statements on the infectiousness of an
individual having syphilis:

1. A syphilitic may be infectious as a domestic, food
handler, or child's nurse only in the primary or secondary
stage of the disease, when a chancre or rash is present.
While this infectious stage ordinarily occurs shortly after
syphilis is contracted, it may also recur during the first
few years of the disease if treatment has not been given.
A syphilitic doing work in which he does not handle the
food or personal effects of others is employable even dur-
ing the infectious period, provided he remains under

2. In the infectious period there may be such acute dis-
comfort (headache, sore throat, and general malaise) that
the sufferer of his own volition will stop work and seek
medical attention.

3. When under treatment which consists of weekly in-
jections of a drug specially selected to arrest infectious-
ness, the "open sores" of syphilis rapidly disappear. Cur-
rent experience with large numbers of patients in the clinic
with which I am connected has shown that one injection
each week for four weeks is adequate to curb infectious-
ness, except in very unusual cases. After the initial four
treatments it is customary to allow the individual to return
to work. He is urged to remain under regular weekly
treatment for a minimum of eighteen months. Persons
found to have latent or non-infectious syphilis are not
asked to stop work even temporarily. Treatment is ad-
vised to prevent a possible but rare lapse into infectious-

ness, and to prevent organic damage in the syphilitic

4. Here is the safe rule to follow in deciding whether
to employ or to continue to employ an individual with
syphilis: "Is he under regular weekly treatment?" Any
physician or social worker connected with a syphilis clinic
would be willing to state whether treatment is being
regularly administered in a specific case and whether the
patient is employable. An employer in my experience, who
kept a syphilitic maid on the advice of the clinic, gets in
touch with the clinic at intervals to learn whether treat-
ment is regularly received.

The cases of Susie and of Mr. Bee are only two ex-
amples of unfortunate public response to the current
publicity being given to syphilis. Along with them we find
different shades and degrees of hysteria the teacher who
shuns a congenital syphilitic child as something unclean;
the social worker who suspects that every individual with
facial lesions is syphilitic; the man in the street who
talks of syphilis, emphasizing its disgrace and condemning
as worthless all who have it all of these are facing the
problem emotionally and neurotically. The program for
syphilis control carefully thought out and admirably
planned under the leadership of the United States Public
Health Service will avail little in the end if ignorant and
emotional "syphilis consciousness" causes the lay-off of
people who could safely remain in their jobs, and drives
those people infected to psychological breakdown and the
evasion of treatment because of the stigma attached to them
by an uninformed and moralistic public.

But how can the public be taught to face syphilis with-
out panic?

A first step in banishing fear would be to bring before
the medical profession, especially the general practitioner,
the present thinking of the specialists on the disease, so
that the questions brought to the family doctor may be in-
telligently answered. This would seem to be the job of
the profession itself, through its teaching in medical schools
and its many professional associations, the chief purpose
of which is to keep members abreast of new developments
in disease and treatment. The younger and more open-
minded men of the profession are without a doubt aware
of the lack of up-to-date information among their own
group. It is to be hoped that they will find ways to stim-
ulate the thinking of their more conservative associates.

WITH the leading of the medical profession, social
workers, public health nurses, teachers and others
can help the public work out its solution through intelli-
gent publicity, directing attention away from the morbid
and sensational aspects of the disease to constructive phases
of this public health problem. The job of this group will be
to explode some of the popular misconceptions about the
transmission of syphilis and to challenge every person
reached to take stock of his prejudices and his unreasoned

The educational campaign against syphilis has attained
its first objective. It has focused the public's attention on
an age-old problem, it has expanded existing facilities and
provided new ones for diagnosis and treatment, and it has
helped to put under care many infected persons. To insure
the continued success of the program, a second objective,
seemingly ignored up to the present time, must be attained.
The public itself must recognize the irrationality of many
of its fears of syphilis. It must stop "being afraid."




"Speaking of Interpretation . . ."


MISS Bailey felt like a dog when at long last
she was summoned into the office of the director
of public welfare. To be sure she had come on
the tick of her appointment and had been waiting for half
an hour. But so too had come and waited her six or
eight fellow sufferers, most of whom had had a longer
vigil than she. For half an hour she had watched their
growing impatience, had listened to their irritated com-
ments, and observed the take-it-or-leave-it manner of the
girl at the desk. It wasn't time lost, Miss Bailey assured
herself, for she had come here to inquire about methods
of interpretation, and if this wasn't interpretation, what

u:i> it?

Miss Bailey frankly eavesdropped on the conversation
around her. These were not complaining clients but sub-
stantial citizens each here on legitimate business which,
as the waiting time lengthened, turned into a personal
grievance. "What in the world," she queried herself, "can
that woman be doing in there that is more important
than seeing these people of her community ? They're pool-
ing their grievances while they wait. She may, in her own
good time, satisfy each individual, but pools aren't so
simple, they have a way of persisting and spreading."

Aware of the outraged, not to say dirty, looks that had
followed her into the director's office Miss Bailey was
apologetic others had been waiting longer probably
their business was more urgent. . . .

"Don't let that bother you," countered the woman be-
hind the piled-up desk, "if I stopped for everyone who
wants to tell me that this community is different I'd never
get anything done. They're used to waiting. I've got 'em
trained." She laughed heartily, and shuffled a heap of
folders, while Miss Bailey suppressed an inelegant, "Oh

"Now about this business of interpretation," began
the director with a wary glance at the clock. "Of course
it's very very important, and I'd like nothing better than
to hire a smart publicity girl to do it. I have plenty of
ideas for her. See that big fat folder? (Miss Bailey saw
it dusty as well as fat.) That's where I accumulate the
ideas 1 hope some day to do something with. Not that I
don't do everything I can, as I go along. I do quite a lot
of speaking and always give a copy of my paper to the

"I think there's a newspaperman waiting outside now,"
put in Miss Bailey, who had an idea that prompt courteous
treatment of reporters was important.

"I shouldn't be surprised. They're always coming
around. But I've found it much better to give them every-
thing in writing, then if they garble it it's no fault of
mine. If I see the reporters they ask questions I'm not
ready to answer, or want explanations of things they
can't possible understand. Then they write pieces that put
the wrong light on everything. I'm afraid our papers need
a great deal of education."

"Have you ever tried putting all your cards on the
table, getting on a completely frank basis with the news-
papermen ?"

"Oh, you couldn't do that in this town. The newspapers
aren't friendly enough, and they're not looking for im-
portant things, they just want sensations. Now take this
paper I'm giving tonight before the Associated Church
Clubs. It discusses the historical development of social
work, its place in the community, the standards we should
strive for and so on important things that everyone
should know. I'll give it to the press but do you sup-
pose they'll print it? Certainly not. All it will get is a
stingy paragraph on the last page."

Miss Bailey glanced at the formidable manuscript. "You
must have put a lot of time on that."

The director laughed gaily, "Now don't you give me
away but I'll tell you a secret. In a weak moment, a month
or more ago, I promised to make this speech. But I've been
much too busy to get up anything new, so this morning
when I couldn't put it off another minute, I fixed up a
paper I did last year for the woman's club, and that, be-
lieve it or not, was salvaged from one done for the busi-
ness women's association. I recognize the obligation to
interpret our work to these groups, but I can't get up a
new paper every time. This crowd won't recognize it
anyway. Would you like a copy?"

BACK in her room Miss Bailey riffled the sixteen pages
of the speech. She could almost have repeated it word
for word, she had sat through its like so many times. It
was all background and no foreground, with nothing that
geared into the immediate experience and concerns of the
people who were expected to listen to it.

"And it never crosses that woman's mind that they
won't listen," she told herself. "She will mistake passive
endurance for listening just as she mistakes her own
voice throwing for interpretation. And the way she
treated her callers, and blandly assumed that they'd get
used to it! Used to it, my eye! All the smug speeches in
the world will never catch up with the interpretation she
started for herself right then and there."

It was too late to make another call and Miss Bailey sat
on in the gathering twilight and mused on this business
of interpretation, and the glib way people talked about it.

"Do we really know what we mean? Are we clear what
we want to interpret? Is it the institution of social work
or is it a social philosophy? Is it a method if so, whose
a reform, a good cause, or merely the agency that hap-
pened to hire us? If it's a combination of all those things,
and it probably is, it takes a lot of doing and it's no wonder
the dear public is muddled. And what are we interpreting

"Oh yes, Amelia, you know the answer to that one,
know all the ways to say 'widen the base of public under-
standing and support.' But honestly now, would the pri-
vate agencies you used to work for have bothered about
it very much if they hadn't needed money? Did the pub-
lic welfare agencies even know what the word meant until
the last few years when the taxpayers got on their necks?

"And whom are we interpreting to? Whose understand-
ing is it we want? Is it class understanding economic,

1 KBRUARY 1938


intellectual or what have you or mass understanding,
or just the political party to which some of us owe our
jobs? We talk a lot, we social workers, about the public,
but what do we mean? Is the public a great, faceless,
sluggish body, or is it just a lot of people, each as different
from the other as, well, as social workers are different one
from another?

"We know better, at least most of us know better, than
to talk down to any single living human being, yet aren't
we thinking down when we ask each other what we shall
tell the public? Good grief, as if we weren't telling every-
thing we know and then some! Seems to me our trouble
is that the public wants more and better information than
we have to give it, and we alibi ourselves by means of
speech making and dull little newspaper pieces.

"We think some of us that if we've made a lot of
speeches and collected a fat clipping book we've interpreted
our jobs to the public. I wish we would test our public
utterances a little more severely; be sure that what we
say is fresh and important and attention compelling, or
else keep our mouths shut ! Too many of us, I'm afraid,
make speeches that we wouldn't listen to ourselves. And
a speech that doesn't make people listen and send them out
to think, is worse than no speech at all."

Miss Bailey had a faint realization that she was making
a speech to herself, but with no one to challenge her she
went right on, thoroughly enjoying herself.

"Just now we call it interpretation, this thing we be-
lieve we need, but is what we are doing so different from
what we used to call publicity and believed we needed?
Well, the dear, dead FERA had publicity, miles of it, but
I don't believe that anyone, least of all Mr. Harry Hop-
kins, would claim that it got 100 percent results in terms
of public thinking on social philosophy, programs and
methods. Of course by and large, as Mr. Hopkins would
say, it did do a pretty good job of interpreting the clients.
It did its bit in gaining an acceptance of public responsi-
bility for the economic lame, halt and blind that has con-
tinued and strengthened. But it did not interpret, maybe
it didn't even try, social workers and their methods. It
said to the country something like, 'Papa knows best. Take
'em and like 'em.' And who am I to blame the social
workers if, thrown out in the night as they were, they
didn't make much of a fist of interpreting themselves or
their methods."

'TpHINKING back over her recent trips around the
A country Miss Bailey recalled places where social work-
ers, good ones too, technically speaking, had come and gone
and left behind them no discernible trace in community
life of confidence in progressive methods or in social work-
ers as experts.

On the other hand, she reminded herself, she had fol-
lowed the trail of workers who had gone into pretty
backward communities and left understanding and con-
fidence behind them. To them, it seemed, interpretation
had not been something apart to be done when, as and if
they had time, but a certain quality injected into every
contact, in the way they said what they said, in the very
clothes they wore. It was an ingredient like a chemical
that permeated the whole job. And those were the places,
she recalled, where a social philosophy was taking root
and progressive methods growing into the continuing

To do the technical job well is important, she told

herself, but technical efficiency isn't enough in the present
muddled state of things unless along with it is sensitivity to i
the community setting and to its thinking and experience.
"It isn't enough to use our insight to understand why the
client acts the way he does; we must use it to understand
everybody, especially ourselves." The social workers who
have done things haven't merely followed behind com-
munity thinking but have kept step with it, a pace or two
in advance perhaps, but not too far ahead. "If we get way
out in front we have to spend half our time defending our
position, or else we get a take-it-or-leave-it way with us,
and neither one does us or our jobs any good."

"It hasn't been so very long since old Mr. Public didn't
know a social worker from a dodo. But now, since events
took the bushel off our candle, he thinks he knows all about
us, and the fact that a lot of what he knows about some of
us isn't so about the rest of us is just too bad for all of us.

"TT'S funny when you think of it, that as social workers

A began to see the public not as a solid mass but as
a lot of little publics, groups and individuals, each ap-
proachable in the place where he is, the dear old public
began to see social workers as a mass, as a cohesive unified
body of people, thinking and acting alike, all claiming
special competence. And only social workers know the
degree to which that isn't so, know how unlike each of
us is from another in everything but our good intentions.
But old John Q. Public lumps us all together, jumps
from the one social worker he knows to generalizations
about the whole tribe of us, and, human nature being
what it is, holds against all of us the sins of any of us.

"Now if that's a fair size-up of Mr. Public's attitude
and maybe it isn't doesn't it follow that the concept of

Online LibrarySurvey AssociatesSurvey midmonthly : journal of social work (Volume 74) → online text (page 14 of 109)