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cases among its employes during the six weeks' educational campaign, under-
wrote the cost and arranged to continue the educational and medical service.
One employe who could ill afford it had paid $800 for "quack" treatment.

One large steel company found 30 cases per 1000 men in its various plants.

Several large corporations translated this approved government material into
other languages for the benefit of foreign speaking employes and engaged
doctors and nurses to operate clinics.

Another company reprinted at its own expense 30,000 copies of an approved
government pamphlet and provided a medical service.

Many large industrial conventions gave the subject a place on their programs.

Thousands of men called to war were unfit to fight or man ships because of
venereal diseases. The government found it necessary and worth while
to utilize a large personnel of the Army, Navy and Public Health Service
to cure these men and prevent other infections.



INDUSTRY'S OPPORTUNITY 77

With the Outline of Plan went also an Industrial Questionnaire
which, after getting the number of employes, ascertained whether
there was a company physician, plant nurse, or an industrial medical
service of any kind. This questionnaire also disclosed whether there
was a social or welfare program in the plant and obtained answers to
certain direct questions as to whether the plant would cooperate with
the State Board of Health and in other ways. These questionnaires
in that day, came back by the thousands, and since 1918 there have
been marked advances in social consciousness among employers so
that even better results might be anticipated today.

Because of government regulations where the employer was buying
the material he used at his own cost it was necessary for him to send
his order to the American Social Hygiene Association and all other
communications to the U. S. Public Health Service. It was surprising
how many employers did this, indicating the serious interest they
had in what was being done. They ordered pamphlets at the rate
of $3 per 100 and framed placards at a cost of 50 cents each, and
unframed placards at a cost of 5 cents each.

The pamphlet which for men was entitled The Facts About
Venereal Diseases carried the imprint of the Public Health Service
and the American Social Hygiene Association, and in many instances
also the imprint of the firm making the distribution. This pamphlet
listed the clinics then established in all the states, numbering several
hundred and they were printed in small type. The factual informa-
tion in the pamphlet remains today, I believe, acceptable for ordinary
use and with little modification would meet the needs of today.
It was a handy pamphlet that could go for 1 cent postage unsealed
or be carried in the pocket easily.

If we Should, by a program of action, assume this community or
any other will face its problem in this respect again, it should be
relatively easy to introduce a program of education and treatment
into industry, using the formula that was so effective in the last war.
Certainly our experience of the past provides the lamp by which
our feet might be guided in the future.

By way of conclusion I would point out that the field of social
hygiene goes far beyond the mere cure of the venereal diseases and
the intent of the late Dr. Brown's will did likewise. Social hygiene
educational work, while helping in the cure and control of the venereal
diseases, if well done in industry and elsewhere, will contribute hand-
somely to the popularity of right living, which is fundamental in the
control and cure of all diseases and at the base of effective medical
work in any field.



PROTECTING WORKERS FROM VENEREAL
DISEASES

I. IN CIVILIAN DEFENSE INDUSTRIES *

JAMES G. TOWNSEND, M.D.
Chief, Division of Industrial Hygiene, National Institute of Health

The health of the American worker has achieved new
public significance these past 12 months. Not only do industry,
labor, government, medicine, and public health realize this,
but citizens also in every walk of life look with growing
interest and concern toward industrial health.

The urgency of industrial production for our National
Defense Program is indeed the highlight of today's news. The
struggle in which we and other nations find ourselves involved
is, indisputably, an economic struggle. Our nation has been
called upon to produce the most the best and the fastest.

The answer we give to this challenge depends very heavily
upon the health of industrial workers. An ample labor supply
is not enough. Government and industry alike have recog-
nized the need for trained workmen by the establishment of
programs for vocational training. But again, trained workers
are not enough. America needs healthy workers, physically
and mentally capable of sustaining production at a high level.

Sickness of all kinds occupational accidents and diseases, non-
industrial illness and injuries has done more to slow up production,
to retard our defense effort than labor disturbances or bottle necks.
In 1940, about 7 million days were lost from work because of strikes ;
and in the same year, some 350 million days were lost because of dis-
ability. Sickness is, truly, the most powerful and subtlest of saboteurs.

To the public health worker, and especially to the industrial
hygienist, this is an old story. For more than twenty years, the
United States Public Health Service has charted the course of occu-
pational disability. Year in and year out, our records tell essentially

* Presented at the Round-table on Venereal Disease and Defense Workers.
Sponsored by the American Social Hygiene Association, Atlantic City, New Jersey,
October 12-13, 1941.

78



PROTECTING WORKERS FROM VENEREAL DISEASES 79

the same story. Sickness and accidents among our wage earners in
industry cost the nation ten billions of dollars annually.

The problems of industrial hygiene, then, are not new ones. Old
problems, against which but slow progress has been made, are intensi-
fied by our emergency needs.

Another factor has stimulated fresh attention to industrial health.
During the past twenty-five years, great advances have been made in
scientific knowledge. Chemical, engineering, and clinical research
have taught us how to find and to eliminate specific occupational
hazards. Medical progress, in general, has taught us how to deal
with non-industrial diseases and injuries more effectively than in the
past. But we have not effectively applied the knowledge which would
prevent large amounts of the industrial disability which annually
sabotages defense production.

True, continued research is needed and is being carried forward;
new substances and new conditions, born of rapid changes in manu-
facturing methods, are being investigated. Nevertheless, the modern
industrial hygiene program has for its objective the reduction of dis-
ability and the promotion of health through more effective application
of existing knowledge and existing services.

For the purpose of our discussion it is important that you and I
clearly understand that objective. May I repeat? It is to reduce
disability and promote health among industrial workers through the
more effective application of existing knowledge and services.

Among industrial workers the major causes of disability and ill
health are not the illnesses and injuries incurred on the job. Occupa-
tional diseases and accidents account for approximately ten per cent
of the total time lost from work as a result of disability. The great
volume the 90 per cent of industrial disability results from the
common diseases and accidents of which you and I, as well as the
industrial worker, may be the victims.

The venereal diseases which we are here to discuss are among the
causes of general illness that afflict the worker. But as important
causes of disability, syphilis and gonorrhea do not appear in our
records, I think we can readily understand this. The worker newly
infected with these diseases is not " disabled" in the sense that his
illness keeps him off the job. He may not recognize his condition ; or,
he may recognize it and go along without treatment. If he seeks
medical aid he often goes to doctors who are not connected with the
plant in which he is employed. Even if he is under treatment, he
can remain so without losing much time from work.

If we come to consider the end-results of venereal disease in terms
of disability due to syphilitic heart disease, gonorrheal arthritis,
paresis, and other late manifestations, the available data leave us very
much in the dark. Diseases of the heart, arthritis, rheumatism, nerv-
ous and mental diseases are important causes of disability in industry.
But who is to tell us what proportion of these all-too-common ailments



80 JOURNAL OF SOCIAL HYGIENE

are due to venereal infection? Experience indicates that the pro-
portion of chronic diseases attributable to venereal infection in indus-
try is about the same as that in the general population.

The data on venereal infection in the industrial population are
meager. No studies have been made of gonorrhea in industry so
far as I know. And no systematic study of syphilitic infection in
industry has been made. Reports of routine blood-testing for
syphilis among industrial groups over the past five years run the
gamut of infection rates from less than half of one per cent to ten
per cent or more of the employees infected. Therefore, it is impossible
to make out a case for an unusually high or low prevalence of syphilis
among the industrial population.

Again, experience has been much the same as that of serologic sur-
veys in general population groups. Considerations of age, sex,
economic and social status yes, and even geographic region must
condition our determination of the prevalence of syphilitic infection
among industrial groups. In fact, one might well say that the preva-
lence rate of syphilis is high among industrial workers in those
communities and States where the rate is high in the general popu-
lation. "Where venereal disease has been attacked vigorously,"
Surgeon General Parran said, "it has receded."

The most recent and dramatic proof of this statement lies in reports
of the prevalence of syphilis among young men examined by Selective
Service Boards. The syphilis rate among the first million men exam-
ined varies from 5.8 per 1,000 for white men in a northern State to
170.1 per 1,000 in a southern State. In the northern State the con-
trol of venereal disease has been prosecuted vigorously ; in the south-
ern State, these services are poorly developed.

"What I am trying to demonstrate is that venereal disease is a
public health problem, and not an industrial problem any more than
it is a white collar problem or a business class problem.

The control of venereal disease among industrial workers likewise
is not the responsibility of industry, per se. It is, rather, a part of the
total public health program which must be brought to bear upon the
health of the worker not as an employee of a particular company,
but as a citizen entitled to the services provided by his community.

Recent efforts to stimulate industry to "do something" about
venereal disease among employees have produced small results, much
confusion, and some unnecessary hardship. It should be remembered
that even in normal times, less than one-seventh of the industrial
workers in the United States have the full-time services of a physician
employed by the company. In a very few instances, industrial com-
panies with well-established medical services have initiated programs
for the detection and treatment of syphilitic infection among em-
ployees. On the other hand, the great majority of companies with
or without medical services have done nothing. A few have initiated
or cooperated in serologic surveys, and in many instances the blood-
testing campaign has resulted in nothing more than the enunciation
of a personnel policy for dealing with workmen found infected.



PROTECTING WORKERS FROM VENEREAL DISEASES 81

To date, no such policy, satisfactory to all concerned, has been
enunciated. And even where policy has been proposed, there has
been nothing like uniform adoption by the companies who have spon-
sored serologic surveys.

The objective of the serologic survey, or of the routine physical
examination and blood-testing of employees, is to get more persons
with early gonorrhea or syphilis under treatment. This should be
clearly understood by employers and employees alike, as well as by
interested citizens desiring to stimulate action for the protection of
workers from venereal disease.

Despite remarkable advances, during the past three years, in the
detection of syphilitic infection and bringing infected persons under
treatment, Selective Service examinations in 22 States, Hawaii, and
the District of Columbia, revealed that only 25 or 30 per cent of
infected candidates were under treatment. The bulk of these regis-
trants had syphilis of recent origin. If this percentage could be
increased to 75 if three-fourths of our cases of early syphilis were
under treatment syphilis could be eliminated as a public health
problem in a few years.

The demands of national defense are likely to affect the problem
of venereal disease in industry. Younger, less experienced men, more
girls and women, and more older workmen may be expected to line
the benches of defense industry in increasing numbers. Moreover,
considerable migration of workers to new employers, even to new
communities, has already taken place, and is likely to increase enorm-
ously in the next few months. The recruitment of new workers and
the rapid migration in the industrial population are important rea-
sons for all of us to hold fast to the good old public health principle
control of communicable disease is a responsibility of the community
health service.

The establishment of blood-testing or even blood-testing and
treatment programs in a few industrial companies will not answer
the purpose of protecting defense workers from venereal disease.
Nevertheless, the presence in any community of an increasing indus-
trial population offers both an opportunity and a challenge to com-
munity leaders.

The Federal-State cooperative programs for the control of venereal
disease and for the promotion of industrial hygiene make available
to every community in the nation services which can be directly
applied to the protection of the industrial population. The indus-
trial hygiene and venereal disease divisions of State health depart-
ments are in a strategic position to bring the venereal disease control
program into the defense industries if sympathetic State health officers
support the program.

At the present time, 34 State industrial hygiene units and mobile
units of the Public Health Service are operating with increased
personnel in defense areas. Their programs involve the determination
and control of occupational hazards and the promotion of health



82 JOUBNAL, OF SOCIAL HYGIENE

and sanitation in defense industries. Their knowledge of defense
production in the State and community, their understanding of
plant procedure and operations, and their close relationship with
industry and labor make the industrial hygiene units the logical
agents to open the way for venereal disease control activities by
State and local health agencies among defense workers.

In the past two months alone these units have surveyed more
than 800 plants in defense areas. Much valuable time and effort
can be saved by integrating State or community venereal disease
services with the plant surveys. Moreover, as liaison between indus-
trial medical services and the health department, the industrial
hygiene unit can be expected to stimulate attention to venereal diseases
in companies having medical facilities.

The detection and treatment of syphilis and gonorrhea are not
the entire story of protecting the gainfully employed adult from
venereal disease. Programs of education among both employers and
employees are needed, not only to make control measures effective
but also to guard against future infection.

The rapid concentration of new population in defense areas has, as
we all know, created many serious problems of housing, sanitation,
and recreation. The worker in a strange community is fair game
for the agents of unwholesome recreation. He has more money in his
pocket than the soldier, and for this reason is an especially attrac-
tive prospect for the procurer and the prostitute. All of us know
too well how this factor increases the peril of venereal infection.

Much has been done to expand the facilities for wholesome recrea-
tion for the armed forces in communities adjacent to military camps.
To what extent these facilities are also available to the defense worker,
I do not know. Clubs and play centers have been provided by some
plants for their employees. Certainly no program such as the United
Service Organizations has been developed for workers. We all know
that the provisions of the Army and Navy for recreation and other
morale-building facilities in the camps are not enough. It is in
community life that the soldier and the worker alike spend their
leisure time not in their work places. No efforts for the protection
of industrial workers from venereal disease can be considered complete
without planning for wholesome community recreation.

The coordination of public health and industrial hygiene services
for the detection and treatment of venereal disease among defense
workers and the promotion of wholesome leisure-time activities
together challenge community leadership. Labor, industry, the medi-
cal profession, civic organizations, and public health services all should
be enlisted in the community attack on these subtle saboteurs of
national defense effort.



II. IN GOVERNMENT DEFENSE INDUSTRIES

CAPTAIN ERNEST W. BEOWN (MC)
Bureau of Medicine and Surgery, United States Navy

In approaching the topic of the protection of workers in
government industry I may find it difficult not to repeat
certain principles which have been set forth in Dr. Townsend's
important paper. I must, therefore, request your indulgence
in this respect and endeavor to emphasize such minor differ-
ences as do exist between the two groups in the mechanism
involved. The term government defense industries in the
present discussion will refer specifically to those activities
under the direct administrative control of the Army and
the Navy.

The past four or five years has seen a tremendous and
widespread increase in the interest in venereal diseases,
largely as a result of popular education in the subject and the
leadership of Surgeon General Parran of the U.S.P.H.S.
This interest has been reflected in every walk of life and it
was to be expected that industry in general would be aroused
to the problems of the worker with these infections.

In fact the importance of syphilis in industry was rec-
ognized in certain isolated instances long before there was
any thought of the present aggressive and open campaign
against this disease. After the World War demonstration of
the effectiveness of venereal disease prevention, interest in
syphilis control centered chiefly in the railroads. This is
readily understandable as the life of a railroad is its reputa-
tion for safety; and safety reflects not only mechanical
development but also human alertness, precision and power.

However, with relatively few exceptions the question of
venereal disease control in industry has been neglected until
within the last few years, an outstanding exception being the
control program of the DuPont Corporation under the leader-
ship of Gehrmann and initiated in 1934. But the attention of
employers is now beginning to be focussed upon the relation
that venereal diseases bear to lowered industrial efficiency

83



84 JOURNAL OF SOCIAL HYGIENE

and hidden costs. Some of the largest industries are now
carrying on programs of syphilis control, notably the DuPont
Corporation as just mentioned, the Caterpillar Tractor
Works, the Aluminum Company of America, The General
Electric Company, The Koppers Coal Company and New
River Coal Company. The recent studies of the industrial
prevalence of syphilis in Buffalo, Cincinnati and New York
City are also of outstanding importance. The seriousness
and costliness of syphilis as a health risk is, therefore, becom-
ing a growing concern in industry.

Government industry, however, has not as yet committed
itself to definite action in an attack on the problem, although
its industrial force is relatively of enormous magnitude and
still rapidly mounting. Thus the industrial civil personnel
in the Shore Establishments of the Navy was approximately
227,000 on July 1, 1941, an increase of 90 per cent over that
of the corresponding duty in 1940. This included eleven Navy
Yards, or ship-construction plants, with an industrial popu-
lation ranging from around 7,000 to 20,000 each, the total
number of Navy Yards and other stations reaching 232. It
may also be of interest to mention that 49 private shipbuilding
corporations are under Navy contract, that is, are devoting
100 per cent of their effort to Naval construction with a
total of approximately 83,000 employees.

The total industrial population under the control of the
Army was nearly 266,000 on July 1, 1941. The combined
civil personnel carried by both Army and Navy was approxi-
mately 493,000 or nearly half a million persons.

EXPECTANCY OF PREVALENCE OF SYPHILIS IN GOVERNMENT

DEFENSE WORKERS

The prevalence of syphilis in government defense workers has not
been examined but the expectancy can be estimated on the basis of the
prevalence found in the young men recently called for selective service
and from recent epidemiological studies in industrial groups. This
is conservatively estimated as roughly 20,000 cases of syphilis.

URGENT REASONS FOR A SYPHILIS CONTROL PROGRAM IN

GOVERNMENT INDUSTRY

The development of safety and industrial hygiene programs in
Navy Yards has brought new knowledge to lay personnel and the
realization of accompanying benefits through reduced absenteeism



PROTECTING WORKERS FROM VENEREAL DISEASES 85

and labor turnover and increased efficiency and production. It is
believed, however, that Government management has not given suffi-
cient attention to the liabilities involved in the industrial menace of
syphilis. The disease not only leads to time losses, but if untreated,
may be hidden many years and attack the cardiovascular and central
nervous system, with crippling effects leading to industrial losses,
interruptions in production through labor replacement, damage to
equipment and worker's compensation to others injured in accidents
caused by syphilitic workers.

Attention is invited in this connection to the industrial studies of
Osborn, Traenkle and Dolce in Buffalo ; finding a relatively high pre-
valence of early syphilis in employees of age groups 18 to 30 ; a high
rate of latent syphilis, cardiovascular and neurosyphilis from 30 to
40; and after 40 a high rate of late cardiovascular and neurosyphilis.
"Workers subjected to severe physical strain were found to be more
than twice as liable to develop late cardiovascular syphilis as those
employees engaged in mild physical effort.

The importance of syphilis as a government industrial, as well as a
public health, problem has been enormously intensified by the rapid
government industrial expansion in the National Defense Program.
Now, with government defense industry doubling and redoubling
production, it is time for both management and labor to unite in a
fight against the sabotage of this venereal disease.

Men engaged in government defense industry are as important to
National Defense as men in uniform. It will be recalled that in the
first World War five men in defense industries were estimated as
required to maintain one man on the fighting line. Under wartime
conditions today the ratio is near 15 to one. Accent, therefore, hardly
needs to be placed on the fact that the control of venereal diseases
promises to be another safeguard for increased industrial output.



I turn now to certain administrative aspects of the problem in
government industry. All industrial establishments of the Army and
Navy are provided with a full-time medical service as an integral
part of the organization. The industrial physicians and surgeons
are commissioned medical officers of the military service.

(a) The Civil Service Commission.

All civil employees are appointed by the Civil Service Commission.



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