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Pre-employment examinations are required in all instances and the
physical standards for acceptance are prescribed by the Commission.
If the candidate presents obvious clinical signs of syphilis or gonor-
rhea he is rejected, but a blood test of applicants for syphilis is not
stipulated. The adoption of the syphilis control program advocated
by the U. S. Public Health Service and the American Social Hygiene
Association would require the concurrence of the Civil Service
Commission.



86 JOUKNAL, OF SOCIAL HYGIENE

Retirement Provisions. All employees are eligible for retirement
for total physical incapacity after completion of five years' service,
the retirement compensation being dependent on length of service.
This refers to non-industrial causes. The Commission has complete
jurisdiction over retirement matters. It should be emphasized that
an employee completely incapacitated by the late effects of syphilis
would be eligible for retirement after sufficient length of service.

(b) The United States Employees Compensation Commission.

This is the independent agency set up directly under the President
for the administration of all laws relating to compensation of Federal
Employees for industrial accidents and illnesses. The syphilis control
program would be of pertinent interest to the TL S. Employees Com-
pensation Commission in that the accident rate would tend to be
reduced and compensation costs lowered accordingly.

(c) The Shore Establishments Division of the Navy Department.
The industrial Shore Establishments of the Navy are under the juris-
diction of the Assistant Secretary of the Navy, the direct administra-
tion being vested in the above Division of the Navy Department.
Directives as to policy affecting all stations emanate from him.

(d) The Administration of the Navy Yards.

The Navy Yards or naval construction centers are commanded by
a naval officer of the rank of rear admiral. There are two Depart-
ments, i.e., (1) industrial and (2) military. The Medical Division of
the Yard is an independent unit, the head of which reports directly
to the Commandant.

Both the Army and the Navy have recently recognized the growing
importance of industrial hygiene by the organization of industrial
hygiene units staffed by technically trained medical personnel in the
Medical Division of their industrial establishments. This is impor-
tant in relation to venereal disease control in that any program to
this end would fall under the cognizance of these units. The prob-
lem of such control would in all probability be simpler for govern-
ment industries than industry in general for the reason that they
are served by full-time medical officers of the Army or Navy who are
familiar with the principles as applied to the military forces which are
fundamentally similar to those required for industry.

VENEREAL DISEASE PROTECTION OF THE GOVERNMENT DEFENSE WORKER
AS COMPARED WITH ARMY AND NAVY PERSONNEL

As Dr. Walter Clarke has recently pointed out, the defense indus-
trial worker is in a distinctly inferior status in regard to the preven-
tion and medical care of venereal diseases as compared with Army and
Navy personnel. Thus the following features are officially provided
for enlisted men: recreation and other morale-sustaining activities,
educational measures, medical inspection to reveal cases of venereal
disease, facilities for diagnosis and treatment, prophylaxis facilities
and public interest and concern as to welfare measures. On the other
hand, no such provisions are made at present for government defense
workers.



PROTECTING WORKERS FROM VENEREAL DISEASES 87

We, therefore, see that the social hygiene problems of industry
are more difficult and quite as urgent as those of the armed forces
in view of the present demands upon the National Defense Program.
These problems, moreover, are complicated by the large congregations
of population in areas far distant from their homes in the vicinity
of expanding war industries with bad housing conditions.

PLANS FOR THE CONTROL OF VENEREAL DISEASES IN INDUSTRY

At this point may I invite attention to one of the most important
advances achieved in the administrative control of venereal disease.
The naval and military services have long been aware that one of
the main lines of attack in a control program is upon infection in
the civilian population, especially in areas where the Army and Navy
or National Industrial Defense employees are concentrated. To this
end, early in the present National Emergency, the Secretary of War
and the Secretary of the Navy asked for cooperation from the Surgeon
General of the Public Health Service in developing the most suitable
facilities possible for the control of venereal diseases among civilians.
The basic consideration was to formulate a common working plan so
that in the event of mobilization a mechanism would be available to
install at once the most effective type of control program. Although
the principles of venereal disease control were already well determined,
still the delineation of responsibility had not been definitely established
among the Army and Navy and civilian units, the Health Depart-
ments, Public Health Service and police and welfare organizations.

Based on several conferences, a statement of policy was drawn
up outlining the services to be developed by state and local health and
police authorities in conjunction with the Medical Corps of the
Army and Navy, the Public Health Service and interested voluntary
organizations, notably the American Social Hygiene Association. Lim-
itation of space prevents the outlining of the details of this agreement.

Two other important events have occurred which relate to the con-
trol of the venereal diseases since the beginning of the National
Defense Program. The first of these was the mobilization under the
Selective Service System, which made possible through the examination
of a large representative portion of the manpower of the country a
much more exact determination of the prevalence of syphilis in young
personnel of the industrial age group; also presenting an oppor-
tunity to bring a larger number of persons infected with syphilis and
gonorrhea under treatment than ever before in the United States.
The second related to the instructions by Congress that the facilities
for the control of venereal diseases, developed as a civilian health
program in the preceding years, be intensified and adapted to the new
requirements created by the present mass movement of large popu-
lation groups.

The agreement cited above on measures for the control of venereal
diseases in areas where military forces or national defense employees
are concentrated recognized that control in military areas and in
industrial areas are simply different phases of the same problem.



88 JOURNAL OF SOCIAL HYGIENE

However, as already stated, government industry has not yet given
serious thought to a constructive policy in dealing with these diseases.

A SYPHILIS-CONTROL PROGRAM FOR GOVERNMENT INDUSTRY

The basic principles of an anti-syphilis campaign for industry in
general have been formulated by the United States Public Health
Service. As already mentioned, a considerable number of the civilian
defense industries have adopted a program of syphilis control gen-
erally patterned in its main features to this formula. The methods
employed will, of course, vary according to the local situation and
availability of diagnostic and treatment facilities.

A proposed program of syphilis control for government industry
will now be outlined under the following captions :

(a) Administrative Approval.

The program will require the authorization of the U. S. Civil
Service Commission and Naval Management for its full operation.
It is, therefore, imperative that these agencies understand the plan
and objectives of attack and are in agreement as to its basic principles.
This is essential if effective executive backing is to be obtained.

(b) Educational.

(1) Management: The education of executives is sometimes neces-
sary, many thinking that all luetic personnel are infectious and there-
fore to be avoided ; also with regard to the fact that such personnel, if
free from symptoms, are not bad industrial risks or will not prove
expensive in costs for medical care or early retirement for disability,
provided that adequate treatment is administered. On the other hand,
it should be pointed out that the real industrial risk is engendered
by the failure to diagnose syphilis by serological test prior to employ-
ment, thereby accepting an unknown fraction of employees with
this infection.

A pertinent illustration follows : At one of the largest Navy Yards
approximately 27,000 pre-employment physical examinations were
conducted from January 1, 1939 to June 30, 1941, i.e., a two and one-
half year period. One instance only of syphilis was reported, this
being an advanced disabling case of neurosyphilis. Based on the
recent prevalence of the disease in general industry, determined by
epidemiological studies, the expectancy of infections missed during this
period was of the order of 1080 cases. Under a syphilis control pro-
gram, provision would have been set up for the treatment of this
group with virtual elimination of the element of industrial risk.

(2) Labor: An educational program to be developed which will
teach employees the facts about venereal diseases, such as the mechan-
ism of infection and the methods of prevention and treatment; the
hazards of untreated or improperly treated syphilis being stressed.
The most effective single method of demonstration is the sound motion
picture followed by a question period for the audience. The films of
the American Social Hygiene Association such as In Defense of the
Nation and With These Weapons are invaluable for this purpose.



PROTECTING WORKERS FROM VENEREAL DISEASES 89

Sound education of the lay public is essential if the maximum coopera-
tion is to be assured. Venereal prophylaxis, both chemical and
mechanical, should be a part of the instructional schedule.

(c) Blood Tests.

(1) Pre-employment and Re-employment Blood Tests : Routine blood
tests for syphilis to be made on all applicants for employment or
re-employment, and this to include executive and clerical, as well as
mechanical, personnel. The objective, of course, is to secure medical
control of all lueties and to exclude cases in the infectious and late
disabling stages. Compliance with the blood test will be a require-
ment for acceptance.

(2) Periodic Blood Tests: While it would be highly desirable to
obtain the serology of all employees of the plant who would volunteer
for the purpose, it is proposed at present that only such groups be
taken as are now regularly examined, such as workers in hazardous
trades or men in key positions for safety control, such as cranemen,
locomotive engineers, chauffeurs, etc.

(d) Disposition.

(1) Cases Positive With No Other Signs: These cases to be accepted
for employment on condition that they will accept adequate treatment.
Those refusing should be referred to the local health department.
Those accepted will be referred to their private physician or to public
clinics if indigent.

(2) Cases Presenting Symptoms: To be excluded from employment
if in the early infectious stage, with the proviso of reconsideration
when rendered non-infectious by treatment; to be permanently
excluded if in late disabling stages.

(3) Cases Found On Periodic Examination Of Employees: To be
retained in employment even though in infectious stage in the event
of compliance with treatment requirements ; cases presenting evidence
of late disabling stages to be retained, if feasible, by transfer to other
types of activity not involving possible occupational hazard. In other
words, discrimination must be strictly avoided. The leaders of both
the American Federation of Labor and the Committee on Industrial
Organization have given wholehearted support to the national
syphilis program but are disinclined to advise active cooperation of
members unless protection against discrimination is assured.

(4) Follow-up Procedures: This is regarded as the most difficult
aspect of the control program. Patients under treatment should be
required to report to the medical officer of the plant at definite
intervals for a blood test and with a statement from their physician
or clinic as to the precise amount of treatment over the period stipu-
lated. Patients should be vigorously warned as to the danger incurred
in lapses of treatment.

(e) Records.

One of the difficulties of the present Civil Service plan is that the
medical record is not made confidential and is available to any govern-



90 JOURNAL OF SOCIAL HYGIENE

ment officer. If a syphilis control program is introduced this would
be a pernicious system, inasmuch as executives who might be preju-
diced because of the existence of syphilis would deliberately discrimi-
nate against otherwise competent applicants. The confidential
character of this information should be protected without question.
If impracticable to file physical examination records in the Medical
Department, the diagnostic laboratory findings could be recorded on
a separate form, this confidential record being kept in a suitable card
index file in the Medical Department.

(f ) Repression of Prostitution.

It is recognized that the vigorous measures of public health and
medical control of syphilis and gonorrhea must be paralleled by
equally effective social and legal measures for the repression of
prostitution. These fields of activity must be carefully coordinated
with general health, recreation and related defense activities inside
and outside of government defense industries.

A tremendous step forward in this field was accomplished by the
passage by Congress of the May Act; made effective in July, 1941,
making prostitution a Federal offense in the vicinity of Army and
Navy establishments. This authorized the Secretaries of War and
Navy, and the Federal Security Administrator to take such action
as they consider necessary to execute the provisions of the Act.
Other departments, particularly the Department of Justice, are
required to cooperate.

May I emphasize the enormous value of the contribution which the
American Social Hygiene Association has made and is continuing in
the field of cooperation with legal and protective measures? I am
authorized to say that the field studies of the Association in areas
adjacent to government defense industries have shown definite recent
improvement.

(g) Gonorrhea-Control Program.

The gonorrhea-control program would follow the same general lines
as have been outlined in the foregoing plan. No data are available as
to the industrial prevalence of this infection but the records of the
Army and Navy reveal that it is three to four times as frequent as
syphilis.

CONCLUSIONS

The venereal diseases are of pressing industrial and public health
importance. The United States Public Health Service and the Amer-
ican Social Hygiene Association are ready to cooperate with govern-
ment industry in control programs. Every effort is being made by the
Public Health Service to strengthen state and local health departments
in industrial defense areas. Certain corporations in private defense
industry are giving serious attention to the problem. In view of
these facts, it is believed that Federal Government Industry should
now take the initiative in venereal disease control.

ADDENDA

The views and opinions expressed in this paper are those of the author and
are not to be construed as reflecting the policies of the Navy Department.



COMBATING SYPHILIS AMONG CINCINNATI
INDUSTRIAL WORKERS

W. H. BICHAKDSON

Chairman, Cincinnati Industrial Committee for the Control of Syphilis
V ice-President, Gardner-Eichardson Company

There was an article in the Readers' Digest, July issue,
1936, entitled, Why Don't We Stamp Out Syphilis? The
author of that article was Surgeon General Thomas Parran,
whom we had hoped to have with us today as one of our
honored guests. It made a deep impression on me. Here,
exposed in dramatic clarity for the uninformed public, were
facts about a highly prevalent disease, syphilis, that to a very
large degree is curable, but which, if neglected, holds dire
and devastating results for the persons so afflicted. Or as
Dr. Parran put it (I quote )

"A plague that disables half a million Americans a year;
a plague that does a hundred times as much damage as the
dreaded infantile paralysis ; a plague that is wrecking lives,
shattering homes and filling institutions all over the land with
its insane, blind, feeble-minded, or unemployable victims
that is syphilis. It bids fair to become the great American
disease. And yet we might virtually stamp out this disease
were we not hampered by the widespread belief that nice
people don't talk about syphilis, that nice people don't have
syphilis, and that nice people shouldn't do anything about
those who do have syphilis."

I became even more impressed when I applied the possibilities of
these facts and averages to the members of our own organization.
After consulting with our local doctor and our industrial nurse, we
decided to have Wassermann tests made at our Lockland Plant where
there are about 800 employees. This was in October, 1936.

The big problem, it seemed to me, was how to sell the idea to the
men and women in our factory. We obtained 1,000 copies of
Dr. Parran 's article, which we distributed among our employees at
several group meetings, with the result, that on a strictly voluntary
basis, about 98 per cent of the members of our organization were
blood-tested. It was understood, in advance, that the results of the
blood-tests would be strictly confidential and that any positive find-
ings would be disclosed only to the doctor and nurse, and that in no

91



92 JOURNAL, OP SOCIAL HYGIENE

way would a positive finding affect anyone's job. This promise
was kept.

The results of these tests at our Lockland Plant were better than
average. It is interesting to note that some who had the disease were
not aware of it. All who were found to be infected took treatment;
about one-half going to their own physicians, and about one-half to
clinics. Incidentally, quite a number of our organization expressed
to me their appreciation of this interest in their welfare. This was
very gratifying to me because it proved that we had needlessly
worried about their willingness to cooperate.

About two years later, May, 1938, I was requested by Dr. William
S. Keller, President of the Cincinnati Social Hygiene Society, to
undertake to organize Cincinnati industries to do what we in the
Gardner-Richardson Company, had accomplished. We formed a
committee known as "The Industrial Committee for the Control of
Syphilis," made up of representatives from industries of greater
Cincinnati.

We were very fortunate in the selection of our committee. We were
also very fortunate that from the start we had the services of Mrs.
Eleanor Holmes, who had been deeply interested in our program
from its inception. We had the approval of the Cincinnati Board
of Health, The Academy of Medicine, and the Cincinnati Social
Hygiene Society.

Our first consideration was to obtain funds sufficient for carrying
on. By letter and by solicitation by Mrs. Holmes, we raised approxi-
mately $4,000. Arrangements were made with several of the blood-
testing laboratories to make tests on the basis of 50 cents each, in
quantities of twenty or more, as we felt it was essential that the
cost of the Wassermanns should be kept as low as possible.

While this was taking place, Mrs. Holmes was selling our program
to industry. First to the management, then to the plant physician
or superintendent, and later on, both Mrs. Holmes and Dr. Carl
Wilzbach, at the request of the management, met employees of a
company in groups and explained to them the importance of blood-
testing and the benefits from treatment.

We printed explanatory pamphlets which were distributed among
employees. For these services we made a charge of 10 cents per capita.
That is to say, we asked each company to give us 10 cents for each
employee and in most instances I believe that our requests were met.
If, however, we were unable to obtain the service charge, the work
was started without cost to the firm. Many of the companies have
continued to make the same yearly contribution to our committee,
so that with these funds, augmented by gifts from individuals, we
have been able to carry on our program for over three years.

We greatly appreciate the fact that during the year 1939 we were
fortunate in having the financial assistance of the United States
Public Health Service, through the State and local Health Depart-
ments. The program has been continued under the direction of the
Cincinnati Commissioner of Health, Dr. Wilzbach, augmented by the



COMBATING SYPHILIS AMONG INDUSTBIAL WORKERS 93

services of public health nurses, follow-up workers, public medical
clinics, and laboratory services.

I am informed by Dr. Wilzbach that

110 firms employing 27,703 workers have completed

blood-testing.

35 firms employing 43,300 workers are in process of

blood-testing.

34 firms employing 52,955 workers have agreed to, but

have not as yet started blood-testing.

Of the 45,955 persons tested of which we have records,

1,799 or 3.9 per cent had Syphilis.

I am also told that approximately two-thirds of these patients are
being treated by private physicians and one-third in public clinics.

Mrs. Holmes also tells me that to date

434 education lectures have been given to 53,483 persons.
161,570 pamphlets and 472 posters have been distributed.

But even more important, the discussion of syphilis as a public
health menace has now been brought out into the open. The Cin-
cinnati newspapers have given our Committee full cooperation and
our crusade much appreciated publicity.

Now what about the future?

We are at war we have no longer merely a defense program we
must win. This much is certain, the products of industry are essen-
tial and without them we cannot win. Therefore, it is more impor-
tant now than ever, that industrial workers be sound of body and
free from mental worry in order to stand the strain of longer work
hours and a speeded up production.

One of the obstacles that must be faced is the fact that all
industry is now being classed as either essential or non-essential.
Non-essential industries may cease to operate. All manufacturing
plants are confronted with changes in product, raw materials, loss of
men to Armed Forces, and to the defense industries.

An ever-increasing number of Government reports and new regula-
tions, priorities, etcetera, require more and more of the management's
time and attention. It seems to me, therefore, that the managers of
industry at the present time may be slow to take on our program.
In spite of this, there must be no lapse.

Our efforts more than ever should be concentrated on the so-called
defense plants which are now adding to their personnel. Blood-
testing should be a part of the physical examination that is usually
required of each applicant for a job. Anyone afflicted should be
employed on a temporary basis until a cure is effected.

I know that any company will be repaid many times in a reduction
of hours of lost time from work, because of accidents or sickness, and
that an increase in the "good will" of employees, which is so essential
to a company's success, can be gained.

The publicity given regional conferences like this one here in
Cincinnati is bound to help our industrial program.



COOPERATION OF INDUSTRY WITH THE DETROIT

HEALTH DEPARTMENT IN VENEREAL

DISEASE CONTROL

CLEMENT SCOTT, M.D., DR.P.H.
Associate Physician, Social Hygiene Division, Detroit Department of Health

A program featuring the cooperation of the Social Hygiene Divi-
sion of the Health Department and industrial establishments in
Detroit was planned primarily to assist in tracing patients who were
delinquent in their treatment for a venereal disease, and in locating
persons reported as contacts to known cases of venereal infection.

The finding of both of these types of persons is often very difficult.
The delinquent case may not be located because he gives a false
address on admission, or has moved since that time, or simply because
the working hours of the department inspector coincide with the
working hours of the person sought. The locating of persons named
as contacts often must be attempted on very meager information.



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