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June 30, 1940 * was studied with relation to other pertinent
factors ; but it was recognized that variations in accuracy of
reporting might make such comparisons of doubtful validity.
When data regarding the prevalence of syphilis among the
first million selectees and volunteer service men, as revealed
by the Wassermann test, April-November 1941 2 became
available, Dr. Winslow suggested that a comparison of the
two sets of figures might prove of significance. (See Table I.)

In order to obtain a reported syphilis case rate per thou-
sand for the states under consideration, the population bases
used by the United States Public Health Service in estimating
the combined syphilis and gonorrhea rate per thousand
inhabitants by states for 1939-1940 were then computed and
compared with the rate of positive Wassermann tests in the
draft examination of 1941. (See Table I.)

Coordinate plotting of the reported case incidence of
syphilis for the whole population against the Wassermann
results for young men of draft age by states (Figure 1)
revealed a surprising and encouraging degree of correlation.
When Yule's association coefficient was computed on the
basis of a fourfold analysis using the mean as the point of
dichotomy, the association proved to be + 0.98 .02.

1 Federal Security Agency, U.S.P.H.S. Annual Eeport of the Surgeon-General
for the Tear 1940, Washington, Government Printing Office, 1941. p. 146,
Table I.

2 Vonderlehr, E. A. and L. J. Usilton. Syphilis Among Selectees and Volun-
teers. JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 117:16, October 18,
1941. p. 1350, Table I.

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106 JOURNAL OF SOCIAL HYGIENE

From observation of the simple coordinate plotting of the
rates alone (Figure 1), it is demonstrated that the relation-
ship between the number of cases of syphilis per thousand
inhabitants by states June 30, 1939-July 1, 1940 and the num-
ber of positive Wassermann tests as revealed during the exam-
ination of the first million selectees and volunteers, April-
November, 1941, is direct and positive. The absolute figures
cannot of course be compared, since the draft examinations
obviously reveal many cases which would not be reported
and since these examinations covered an age period of high
syphilis incidence. The fact that laboratory tests made on a
group unselected except for age and sex correspond so closely
with routine reporting does, however, suggest that such
reporting is relatively uniform and that it yields informa-
tion as to relative prevalence in various states which is
highly significant.

The deviations from this general correlation are also of
interest. In Figure 1 the names of those states which do not
fall close to the line of correlation are specifically indicated.
Six states show rates of case reporting lower than would be
expected from the Wassermann results. The deviation in
Maine, Maryland, South Carolina and Tennessee is slight;
in Arkansas and Georgia, it is more considerable; and in
Louisiana, very great. (The Louisiana reported rate is only
one-third of the expected rate.)

For six other states, the reported incidence is higher than
would be anticipated from the Wassermann results; in Cali-
fornia, Illinois, Nevada and New York, the excess is slight;
in Delaware and Mississippi, it is great. (The Mississippi
rate is nearly double the expected figure.)

Although no offhand explanation can be offered for the
deviations indicated, one important factor to be considered
is the completeness and consistence in reporting in the several
states. In those states where the rate of reported cases of
syphilis is low compared to the Wassermann results, report-
ing may perhaps be poor ; while in those states in which the
rate of reported cases of syphilis is high, compared with the



SYPHILIS REPORTING AND WASSERMANN FINDINGS BY STATES 107

FIGURE 1.

Coordinate Plotting of Annual Rates of Reported Cases of Syphilis (per 1000)
toy States, July 1, 1939 - June 30, 1940 and Rate of Positive Wassermann
Tests Among Selectees and Volunteers (per 1000) by States
April, 1941 - November, 1941




3 4 o 6 7 8 9 B U. K B H B IB T7 B 5
Reported Cases of Syphilis per 1000 Inhabitants, by States, 1939 - 1940
SOURCE: 'Table 'I.

Wassermann results, machinery for case-finding and report-
ing may be unusually efficient. Or, on the other hand, there
may have been significant differences in the draft examination
procedures in different states.

This is a point which deserves further study ; on the whole,
however, the draft findings provide distinct encouragement
in regard to the use of case-reporting as a measure of the
relative incidence of syphilis in various areas.



EDITORIAL

HEALTH BUILDS MANPOWER

The national labor force, according to latest official
figures,* numbers something over fifty-two million workers
close to forty per cent of the country's total population
manpower needed now as never before for production and
success in arms to insure victory in the War.

If manpower is to function most effectively, body and brain
must be steady and strong and capable of maximum endur-
ance. How much is efficiency cut down by failure in these
respects? How much of delay in production and all that
depends on production is due to health shortage? And how
much of health shortage among workers is due to the ' ' under-
cover diseases" syphilis and gonorrhea?

Neither manpower nor those who hire manpower can
answer these questions fully yet. More accurate and en-
couraging answers are constantly being worked out through
the painstaking efforts of medical, public health and social
welfare experts such as those who contribute to this number
of the JOURNAL, with the cooperation, as shown also in this
issue, of many employers and the workers themselves. More
plants are including examinations for syphilis and gonorrhea
in pre-employment and routine health check-ups. More
employers are coming to understand that employees having
either of these diseases may still be valuable workers, pro-
viding they are not physically incapacitated or in an infec-
tious state, and remain under treatment ; that the thing to do
with infected applicants for jobs is to help them get under
medical care, then hire them, rather than turn them back into
the community unemployed and perhaps a danger to them-
selves and to others.

But we are still a long way from seeing these beneficial
practices universally observed in the fields of industry, or

* Fifty-two million six hundred thousand in February, according to Victory,
the weekly Bulletin of the Office of Emergency Management. About one million
are women workers.

108



EDITOKIAL 109

from demonstrating fully what it would mean in terms of
manpower and womanpower if they were observed. Medical
officers in Army and Navy, where comprehensive and effective
programs for prevention and control of venereal diseases are
in regular and long-continued practice, still report more time
lost among soldiers and sailors from these diseases than from
any other cause. State health departments found that
45,000 four and a half per cent of the first million draft
selectees for the new army had syphilis, and from this
the United States Public Health Service concludes that one
person out of every 42 in the general population now has
this disease. An unknown number suffer from gonorrhea,
though its power is rapidly being limited by use of the
sulphonamide drugs.

Whatever the ratios and percentages, the facts are clear :
Industry loses time and money through syphiUs and gonorrhea.
Now more than ever such losses must be prevented wherever possible.

Government, community, employer and employee, medical profes-
sion, public health officials and all concerned must cooperate in an
all-out effort to find these diseases among workers, get them treated
and cured without delay.

A health official recently said: "In time of peace, industrial
hygiene is a tool. In time of war, we must make it a weapon."

Let "manpower through health" be the battle-cry on the
industrial front, for the duration, and after.



THE PROGRAM IN ACTION IN THE STATES AND
COMMUNITIES

As previously announced, the April and May issues of the JOURNAL
OF SOCIAL HYGIENE will be given over to an account of war-time
social hygiene activities in the states and communities. This will be
Number VII in the series on Social Hygiene and National Defense,
which began in November, 1940. Planned especially for information
and reference for all who are working in this field, this forthcoming
double number will list social hygiene societies and other organiza-
tions, national, state and community, which are cooperating in the
social hygiene program, and will give brief resumes of important
recent social hygiene activities in each state. With additional useful
material, the April-May numbers will be reprinted as The Social
Hygiene Tear Book for 1942. Price $1.00 postpaid.



INDUSTRIAL NOTES

The West Coast Dr. Storey has spent the fall and early winter on
field work in California, Oregon, and Washington. He has visited
all the important highly industrialized towns and seaport areas
where he has been able to bring about increased cooperation between
industrial medical departments and public health authorities. He
has also found great interest among leaders of defense industries,
as well as among their welfare departments, in the problems of
venereal disease and the best methods for meeting them.

Middle West Miss McGrath recently returned from a field trip to
industrial centers in Michigan, Illinois, Indiana and Kentucky. Her
trip was particularly concerned with finding out to what extent
women have been absorbed by defense industries. In some of the
small towns where the government ordnance plants are located,
several thousand women are working, either loading explosive
powder into bags (bag loading plants), or putting the powder into
shells (shell loading plants). In both cases these plants, employ-
ing a majority of women, are usually located near the powder
manufacturing plant. These latter employ only men.

Only the modern car makes possible the plants' geographical
location. They are purposely far from any city, and the workers
live from twenty to fifty miles away, commuting by automobile.
In all but one of these ordnance plants the medical examinations
were excellent, including Wassermanns. All plants visited stated
that they accepted persons infected with syphilis for employment
and then required them to get treatment. Some of the companies
which had not accepted positive reactors in their home plants found
that the labor shortage made this necessary in new establishments.

In several cases company management explained that it had no
facilities for doing educational work regarding venereal disease and
suggested that the employees' labor union was willing to bring
information to its members. On following up this idea it developed
that the local unions owned a motion picture projector, a large hall,
and were delighted with the idea of a health meeting. The educa-
tional committee organized the program, inviting one of the town
doctors to speak, advertising the evening among its members, and
distributing literature.

This experience suggests that much more might be done through
cooperation with the trade unions to bring information about
venereal disease to the public. As one labor leader said, when asked
why he had never worked out such a scheme before in cooperation
with his local health department, " I have sat in this chair five years,
and no one has ever come to see me about our members' health ! "

110



INDUSTRIAL NOTES 111

Questionnaire Findings Tabulations on the questionnaire sent to
industry concerning venereal disease control procedures have been
completed and the results may be seen on pp. 97-102. The returns
cover more than two hundred companies, with one million workers,
in forty-three states, and represent nearly every industry. Inevita-
bly it was the largest companies that were approached and that
answered. The small ones, those with less than five hundred workers
in which over half of our workers are employed, only rarely have
medical departments. So the group to which we wrote was origi-
nally selected, as to whether or not they had an accepted medical
department. Approximately one thousand companies in the United
States are rated by the American College of Surgeons as having
approved medical departments. Twenty-two per cent of these
replied to our letter.

It was interesting to find that nearly seventy-five per cent of the
companies answered the " attitude " question favorably. That ques-
tion read : " Does your company seek to discover all cases of syphilis
among its employees, and does it require that they be treated as a
condition of continued employment ? " To this 151 replied " yes "
and 57 "no."

Several groups over the country have been carrying on interest-
ing educational programs for industrial workers.

The Social Hygiene Council of Toledo, Ohio for several years
has been engaged in an effort to bring information about venereal
disease to men and women workers. In the past they have invited
physicians from the Toledo Academy of Medicine to lecture to
various factory and labor groups. This year they plan to approach
persons in industry in charge of health and ask permission to place
literature in racks and put up educational posters. The Toledo
group has met with better success since it had its printing done in
a union shop which affixed the union label. Previously they had
been criticized by labor groups for having work done in a non-union
shop. Speaking of stamps, this Social Hygiene Council has had
a rubber stamp made with which to put their name and address on
every piece of literature distributed. This is an excellent advertis-
ing stunt at a few cents expense.

Portland and Salem, Oregon A successful program has been pro-
jected and carried out in Portland, Oregon by Mrs. George Moore-
head, Director, Health Education of the County Department of
Health. This department began simply with the idea of placing
in the hands of as many people as possible accurate information on
venereal disease, and started with the labor unions in Portland since
it was felt that through these groups large numbers of people
could be reached.

To quote from Mrs. Moorehead's letter:

"Labor gave us excellent support on tuberculosis legislation. We worked out
with them a program for health education on tuberculosis followed by tuberculin



112 JOURNAL OF SOCIAL, HYGIENE

testing of unions in Salem. After this series we followed with motion pictures and
discussion of syphilis and set up a blood testing clinic. These programs were
presented at regular union meetings. I felt that this point is the key of successful
meetings with unions. Cut your program to one-half hour with the understanding
that if you go beyond this length, it will be because of their questions. Frankly
speaking some meetings have lasted one and one-half hours to two hours but our
actual part was completed within the stated one-half hour.

"After contacting the state officers of the labor unions, a demonstration
program was arranged for both CIO and AFL Councils in Portland. Representa-
tives of these Councils carried a report back to their individual unions. I made
personal calls on the business agents of the various unions. A letter of confirma-
tion was sent following these calls.

"I made the introduction to the program from the viewpoint of syphilis
as a social problem and quoted costs from a tax viewpoint, number of individuals
in mental hospitals, number of cases reported in City and State and the need for
accurate scientific information in the hands of the public. Dr. Adolph Weinzirl,
former health officer of Portland, felt that in having a woman open the meeting
the highest level would be set for the following discussion. After my introduction,
the film ' With These Weapons' was shown and then Dr Weinzirl spoke very briefly
pointing up what I had said and what had been portrayed in the film. Then he
opened the meeting for discussion and questions."

Missouri Social Hygiene Association This St. Louis society, whose
Executive Secretary is Dr. Harriet S. Cory, has launched an exten-
sive educational program to reduce venereal disease among St. Louis
industrial workers, particularly in defense industries. Dr. Cory
says:

"A letter, a copy of which I am enclosing was sent to 700 executives.
A radio program followed in which Dr. Rogers Deakin, Special Consultant,
U. S. Public Health Service, and I discussed the question. Since then, I have
personally talked to the executive, personnel officer or plant physician (in many
cases all three) of over 80 firms. In spite of the stress of business at this time,
difficulties due to war work in heavy goods industries, labor turn-over in auto
factories and labor trouble in defense plants, we are receiving a remarkable
cooperation. Fully two-thirds of the firms reached are doing one of three things:

(1) using the literature we have recommended for venereal disease education;

(2) already have a blood test as a part of their examination; (3) have expressed
a desire for a conference or a speaker or further information about our program.

"In the course of conversation and conferences, we are making a much needed
survey of what St. Louis industry is doing for the health of its employees.
No data were available when we started our program.

"We have had what I think is the beginning of real cooperation of 'Labor.'
The organization of local AFL unions, called the Central Trades and Labor
Union, has endorsed the program. Its official organ, the St. Louis Union Labor
Advocate, printed an article in its September issue and its editor has promised
to work ' physically and editorially for the program. ' The CIO Regional Director
and the secretary of the St. Louis Industrial Union Council (organization of local
CIO unions) have endorsed it and we feel sure we will have the Council's
endorsement before long.

"We are now working with the Health Departments of both St. Louis City
and St. Louis County and committees of both the St. Louis City and St. Louis
County Medical Societies on a workable plan to present to industry for the
making of a blood test at a reasonable price."



YOUTH NOTES

Prepared by the Youth Service, American Social Hygiene Association



A Story of Real Accomplishment is
the decline of syphilis in the student
body at Fisk University and Meharry
Medical College of Nashville, Tennes-
see. In 1934 a unified Health Service
was begun. Physical and medical ex-
aminations are conducted at the. open-
Year

1934-35
1935-36
1936-37
1937-38
1938-39
1939-40
1940-41
1941-42



Deep in the Heart of Texas is still
Number one on the Hit Parade. That
is our reaction to the report of the
National Youth Administration of
Texas on Social Hygiene Day activi-
ties in that state. A summary of the
report will give you an opportunity
to judge for yourselves, and we feel
confident that your applause will join
ours.

400 discussions with physicians, min-
isters, mayors, school superin-
tendents, nurses, judges, social
workers, etc.
96 talks given

14 National Social Hygiene Day
Proclamations signed by Mayors



Total No.


Total No.


Blood Tests


Positive


395


16


471


21


580


15


658


19


700


22


741


18


702


5


695


4



ing of the school year. Serological
tests are done annually on all students.
Positive Wassennanns are rechecked
and every student with a positive test
is adequately treated before being dis-
charged. The following chart shows
the impressive and encouraging results.

Per Cent
Positive

4.0
4.4
2.5
2.8
3.1
2.4
.71
.57



36 newspapers gave space for an-
nouncements or news
9 films shown

10 special programs such as plays,

skits, etc.

4,062 NYA youths reached directly
10,810 (estimated) people other than
NYA reached.

We understand that Miss Lila Ruther-
ford, Director of Health Education,
State Board of Vocational Education,
Austin, Texas, is largely responsible
for this fine record. To her and all
of her assistants we send our congratu-
lations.



IN AND OUT OF THE NEWSPAPERS

JOSEPH L. STENEK
Assistant Director in Charge of Publicity, American Social Hygiene Association

A SOCIAL HYGIENE DAT PUBLICITY REPORT

"There could hardly be a more spectacular demonstration of the
fact that there are not two wars than that afforded by the facts
about venereal disease and the present campaign against it. There
is not one war on the fighting front and one war on the home front
which the reactionaries keep saying we can no longer afford to wage.
The social welfare of the community at home is seen directly to bear
on our success with arms abroad. Had reactionary influences in the
Government prevailed and the social services, which have planned
and inaugurated a successful campaign against syphilis and gonor-

113



114



JOURNAL, OF SOCIAL, HYGIENE



rhea, been cut off from public support, more damage would have been
done to our armed forces than a hundred Pearl -Harbors."



With these challenging words and
the headline, SYPHILIS AND GONORRHEA,
Axis PARTNERS, FACE ALL-OUT FIGHT,
Ralph Ingersoll editorially launched the
special Social Hygiene Day edition of
PM (February 4, 1942) which gave
over eight full pages to a summary and
discussion of the war on venereal
diseases. Albert Deutsch and Tom
O'Connor wrote the lead article. All
of us engaged in carrying forward the
fight against venereal disease should
have a copy of the February 4 PM it
is a good bit of interpretive reporting.
If you can't get a copy at home write
to the Association. We'll be glad to
send you one.

Over the country other newspapers
took up the Social Hygiene Day news.
Six regional conferences poured out
news copy as leaders in the venereal
disease fight met to plan the attack
for Victory on the home front. In
October, Howard W. Blakeslee, Asso-
ciated Press, science editor, blasted the
opinion that segregation and routine
inspection is the solution to the pros-
titution problem. In January an As-
sociated Press Feature, headed The
Army Must Be Fit to Fight, carried
this note of Sixth National Social
Hygiene Day to all defense communi-
ties: "Cooperating with military and
civilian authorities is the American
Social Hygiene Association, which is
promoting the Sixth National Social
Hygiene Day on February 4. No com-
munity can afford to pass up this
chance to help eliminate the most
insidious saboteur of all venereal dis-
ease." In New York, Cincinnati, Okla-
homa City, Jacksonville, Boston, and
Portland, regional conference publicity
directors worked with newspapers and
radio stations to make one of the best
Social Hygiene Day publicity programs
in several years. More feature stories
and editorials were placed than in
other years. Picture stories were
especially plentiful. Cartoons and
photo stories in the rotogravure sec-
tions of newspapers were used. C. D.
Batehelor, Pulitzer prize winner and
cartoonist of the New YorTc Daily News
did two cartoons. More radio time
was devoted to social hygiene news
material. Radio plays and talks were
abundant. The United Press Radio
Wire, servicing 550 stations nationally,
carried a full news announcement
about Social Hygiene Day. In the
New England area the Associated



Press Wire Service did a special New
England story. Cal Tinney, talking
over Mutual Network in a two and a
half minute news summary of regional
conference programs and the Esso Re-
porter over National Broadcasting Com-
pany's network, did splendid jobs of
reporting the Social Hygiene Day
programs.

Association mat features covered the
small dailies and weeklies across the
country. A mat feature of a scene
from the shooting of the new film
Health Is a Victory was given large
circulation. Batehelor 's industrial car-
toon was distributed to over 500 news-



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