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Journal of social hygiene (Volume 28) online

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their accomplishment.

(A.G. 726.1 (12-4-41).)

By order of the Secretary of War:

Official: G. C. MARSHALL,

E. S. ADAMS, Chief of Staff.

Major General,

The Adjutant General.

The files of the War Department show many other pertinent
orders, circulars, and communications sent to "The Com-
manding Generals, All Armies, Army Corps, Air Force
Combat Command, Departments, and Corps Areas ; the Chief
of the Armored Force, and the Chief of the Army Air Forces.
The Commanding Officers of Exempted Stations, ' ' with copies
furnished the Secretary of War, the Under-secretary of War,
the Chief of Staff, G.H.Q., the Chiefs of Arms, Services, and
Bureaus, and the Divisions of the War Department General
Staff. For example, on October 10, 1941, the following was
transmitted by Major General E. S. Adams, The Adjutant
General :

1. It has been evident that in some cases local commanders have not taken
advantage of the provisions of War Department Circular No. 170,3 August 16,
1941, subject: "Prohibition of prostitution within reasonable distance of mili-
tary establishments." Commanders are enjoined to make appropriate use of
the procedure as prescribed by this circular with view to removing conditions
harmful to the efficiency, health and welfare of military personnel.

2. Members of the Inspector General's Department will, during their official
visits make particular inquiry at stations where a high venereal rate exists in
order to determine whether or not the provisions of this circular are being

This is indicative of the efforts being made to tighten up
procedures between the headquarters staff and corps areas.
Simultaneously, facilities for combating the venereal diseases
by education, medical inspection, diagnosis, and treatment are
being expanded, and correlated with the social protection
program and public health services of the government. The
policy is to emphasize and utilize in every possible way the

s See text p. 57.


cooperation of other agencies, official and voluntary, national,
state and community, to the one great end of a healthy,
contented army, fit to fight, and fit for successful family life
and good citizenship in their home towns when the fighting
is over. 4

These cooperative activities are vitally important to the
success of this program, in that they involve Army relations
with civilian groups, and that they focus on one of the most
difficult and persistent anti-social problems with which man-
kind has to deal the commercialized prostitution racket.
Here is the most serious source of venereal disease spread,
and here, if the number of infections continues to rise, will be
found the reason for loss of all the hard-won gains of past
years. Here is a threat to Army morale, as well, and a
treacherous undertow dragging at the strength of American
family life. Here must the Army build a firm bulwark, and
in the building use all the help it can get.

The Army's program for soldier efficiency, health and
welfare is under the direction of the Personnel Division ' ' G-l ' '
of the General Staff, reporting directly to the Chief of Staff.

Administrative units responsible for carrying out these
activities are

The Medical Department
The Morale Branch
The Corps of Chaplains
The Provost Marshal General

Now, as the Nation is being placed on a definite war footing
these activities may be summarized as follows :


Few health and welfare campaigns have a background of effort
covering one hundred and sixty-five years, and there are none which

* Cooperation of the soldier and his family is sought even before he enters the
Army ranks. A booklet recently issued by the War Department, You and the
Army, written especially to help "in making the change from civil to military
life" and outlining what the army expects and what the army offers is sent to
each selectee about a week before he enters service, with the suggestion "after
you have read the booklet, let the members of your family read it so that they,
too, may secure a clearer picture of the new and stimulating experience that is
soon to be yours." A section of the text dealing with health is shown fac-simile
on inside of picture spread opposite page 16.


have presented such difficult problems as have been faced by the
War Department in its long battle against the venereal diseases.
Since 1778, when General George Washington said to his army

"Let Vice and immorality of every kind be discouraged
as much as possible in your regiment. . . . Particular care
is to be taken to prevent a number of women from
following. ..."

syphilis and gonorrhea have been recognized as chief causes of
disability and lost time among the armed forces, and have been
combated with increased effect, as scientific knowledge and adminis-
trative experience have grown. 5

Such direct and sustained attack is bound to get results. Carefully
compiled Army statistics show venereal disease rates slanting steadily
downward from a Civil War peak of 215 infected soldiers out of
every thousand, to less than thirty per thousand at the beginning
of 1940. Even now, with both openly organized and guerilla forces
of commercialized prostitution skilfully attempting the exploitation
of soldiers from forts and camps in every part of the country, Army
rates for syphilis have not risen appreciably (6.59 per thousand men
in 1939, 7.3 in 1940, and 5.7 in 1941). And infections from
gonorrhea show 20 per thousand men in 1939, 30 in 1940 and 31
in 1941. 6 These figures are most promising in comparison with the
alarming sky-rocket upshoot which has so often dismayed Army
officials and civilians alike in most of the emergency manpower
mobilization of past years.

The combined rate for all venereal diseases for December, 1941,
was approximately 39 per thousand men. But, of course, says the
Army, thirty-nine soldiers incapacitated by syphilis or gonorrhea
are thirty-nine men who could be safe from infection, among each
thousand of the million and a half men on active duty, if all known
measures were fully applied by military and civil authorities and
by the men and women concerned.

America needs full fighting strength as never before in our
history, and efforts are being redoubled today, not only to prevent
further increase in infections, but to keep the declining rates
moving towards zero.

s In his Annual Report to the Secretary of War for the year 1940, Surgeon
General James C. Magee said: "Loss of time from a military point of view is
of vital importance to the Army. Every commander of troops must know how
many men he can expect to have available for duty at any given time, and this
number is almost entirely controlled by disease and injuries. . . . Gonorrhea as
usual is still the leader in loss of time. ..." (Syphilis was ninth among causes
of non-effectiveness.)

e Estimates based on incomplete data for first ten months.



1695 1900 1909 1910

919 1920

Chart from Office of the Surgeon General, U. S. Army


Army records of venereal diseases begin with 1819, when 115 men per thousand
were recorded as infected, and exhibit sharp peaks whenever a national emergency
has occurred, until World War I, when a full program of monthly physical
inspection, compulsory prophylactic treatment immediately following exposure,
forfeiture of pay in case of infection, and responsibility of both line and medical
officers was put into effect. This plan resulted in "less venereal disease among
American troops than in any other Army in the War." Even in France, where
the environmental conditions and difficulties of prophylaxis, inspection and treat-
ment were greatly increased, General Pershing and his chief medical officer
Major General Ireland, and their officers were able to keep the infections down
to a point which justified the appellation, "the cleanest Army in the world."
Nevertheless our soldiers suffered more casualties from syphilis and gonorrhea
than from wounds in battle, and lost over seven million days' time by reason of
these diseases during the war period of nineteen months. The Army venereal
disease rate for all personnel in 1917 was 107 infected men per thousand strength;
and in 1918, 90 per thousand. In 1919 it was 61 per thousand.

The office of the Surgeon General of the Army is organized in
twelve divisions, with appropriate sub-divisions. 7 Several of these
sub-divisions have important relations to social hygiene activities,
and the sub-division for venereal disease control, under the Preventive
Medicine Division, is also concerned with sex education and venereal
prophylaxis in the Army, and cooperation with the public health
services and other civilian control agencies in eliminating foci of
infection in the civil population. The standardized forms of therapy
for early syphilis, and the well-prepared syphilitic registers assure
the necessary continuity of treatment; and the newer therapy for
gonorrhea is giving promise of equally valuable procedures for
control of this disease.

i Administrative, finance and supply, preventive medicine, military personnel,
planning and training, professional service, statistical, army medical library,
dental, veterinary, nursing and hospitalization. Boards and units are constituted
from time to time for the performance of special duties.


The Army program as it relates to venereal disease control includes :

Education Nursing

Case-finding Disciplinary measures

Treatment (both preventive measures Participation of medical officers in

and specific therapy) other phases of the War Depart-

Reporting of alleged sources ment's social hygiene program

The activities under these headings may be outlined briefly as follows :


Commanding officers of all grades are responsible for promoting
education in sex hygiene among military personnel. At least twice
yearly the commanding officer of each basic unit is required to
arrange and personally supervise suitable instruction in sex hygiene
and the prevention and control of venereal diseases for all enlisted
men of his command. The instruction period is conducted informally,
questions and discussion by the men being encouraged. A medical
officer and a chaplain are required to take part. The medical officer
discusses the nature and gravity of the venereal diseases, the
importance of early discovery and treatment, and the means of
avoiding them; the chaplain takes up the moral aspects; and the
commander presents the broader social aspects of the diseases and
their harmful influence on military efficiency. 8

Case- finding :

Evidences of venereal diseases found on physical examination for
induction into service is cause for rejection (or for deferment until
cured in the case of draft examinees). Regulations require that
once each month the medical officer make a general physical inspection
of all enlisted men of the command, including a careful investigation
for the detection of communicable diseases. The commanding officer
may, if conditions warrant, order once each month an additional
special venereal inspection. Individuals found with disease are
immediately placed under treatment.

Treatment :

a. Preventive: Standard preventive treatment in the Army is
chemical prophylaxis in the form of washing, injection of a silver
salt and an inunction of calomel ointment administered by a trained
enlisted man of the Medical Department. Regulations require that
a sufficient number of facilities (prophylactic stations) for the
administration of this treatment be established at suitable places
in each military command, and the commanding officer is authorized
to establish such stations when needed in adjacent civilian com-
munities. In addition, as a first-aid personal procedure, regulations
require that post exchanges make available for purchase material
for individual prophylaxis. For such purpose, current scientific
opinion approves the rubber sheath in conjunction with a water-

s Motion pictures and educational pamphlets are also used, including the new
training film Sex Hygiene, prepared in Hollywood under the auspices of the
War Department, and a specially written pamphlet Sex Hygiene and Venereal
Disease, which is given to each recruit.


soluble lubricant, followed by the use of soap and water cleansing.
All persons who expose themselves to venereal infection are instructed
regardless of the use of individual prophylactic material, to report
at once to the nearest military prophylactic station.

b. Specific: Management of the venereal diseases conforms to the
best current methods. Infectious cases are usually hospitalized, but
may be held in "working quarantine" or restricted to the limits
of the post, as the surgeon may recommend. All precautions are
taken against the possibility of further spread of the infection.
Every case is promptly subjected to treatment.

The most effective drugs available are administered until the
individual is cured or separated from the service. In the latter event,
he is advised of the necessity of continuing treatment, and the
pertinent information is sent to the health department of the com-
munity to which he is returned to insure, insofar as it is possible,
that he, his family, and the public -will be protected.

Nursing :

As in civilian hospitals and outpatient services and clinics, so
in the Army medical establishment, the nurse corps provides valuable
assistance in relation to diagnosis, treatment, clinical and public
health follow-up and epidemiology of venereal disease control.

Disciplinary Measures :

Penalties for contracting venereal diseases have been specified by
Congress and are applied by the War Department on the basis that
the soldier should not be permitted to render himself unfit for
service by activities not connected with military duties. In recent
years these penalties have been progressively lightened, at present
consisting only of

a. Court martial at the discretion of the commanding officer for failure to
report the existence of the disease;

b. Loss of pay during the period of incapacity;

c. Extension of the term of enlistment to make up time lost on account of
the disease.

In action, this program is carried out under the immediate direction
of commanding officers of the various units, under the general
supervision of the commanding generals of the Corps Areas and
Departments. The assigned medical staff, 9 the morale officers and

9 In order to meet the new conditions created by the war, a plan similar to
that developed during World War I has been reactivated. This plan provides
for the assignment of a specially trained ' ' venereal disease control officer ' ' to
be assistant to the surgeon of each division, each corps area and department,
each army headquarters, to General Headquarters, and to each camp of 20,000
or more troops. This officer, in performing designated duties of directing a
comprehensive program aimed at reducing the noneffectiveness resulting from
venereal disease, will also be responsible for development of cooperative relations
with civilian agencies, and the recommendation of such administrative measures
as may seem desirable.


chaplains function under these officers, receiving professional guidance
and instructions from their respective Department Chiefs of Service.
With more than twenty thousand company commanders responsible
for two million men at the present time, differences of emphasis,
limitation of action and some confusion naturally occur in carrying
out policies and orders. Similar deductions, however, may be drawn
from most of the weekly reports on venereal disease infections filed
by the post medical officers. By and large, wherever civilian com-
munities visited by the men are actively informing the public about
the dangers of syphilis and gonorrhea, providing wholesome recrea-
tion for young people, and repressing prostitution, the Army rates
for these diseases are low. Wherever communities fail to maintain
essentials of wholesome environment, either for their own young people
or the soldiers who spend their off hours there, the venereal disease
rates are high. This is true regardless of the arm of the service
concerned or the location, as the inquiries of the Inspector General
and the other Chiefs of Arms and Services repeatedly have shown.
For example, in a recent inquiry covering all Corps Areas, the
following factors forcing venereal disease rates upward and account-
ing for a large proportion of syphilis and gonorrhea in the Army
were repeatedly mentioned in the reports of the post medical officers. 10

Infections occurring in civilian life between the time of first examina-
tion and time of actual entrance into army service;

Infections occurring while away from post on long furlough (usually
in home community) ;

Infections occurring while on week-end leaves in large cities, sometimes
100 or more miles distant from post.n

As previously mentioned, Army officers are under order from the
Secretary of War to encourage and cooperate in every way possible
with civilian authorities in repressing prostitution as a reservoir
of venereal infection and as a hazard to the future family life of the
nation. All Army officers can and should advocate this policy of
the Government and offer every possible assistance in applying it;
but unless martial law is established they cannot do this alone, except
to the limited extent of barring their own soldiers from entering
known houses of prostitution, or refusing any leaves to visit the local
community. As has often been said, venereal diseases are not
acquired "in camp, on ship, or at the shop bench." It is up to the
communities where off-duty hours are spent to meet this challenge.

In approaching full participation in the Second World War, the
Medical Department has had the advantage of experience with rapid
growth and adjustment of emergency conditions and civilian relations
in all the states during 1917-20; and in the past two years, through
the correlated activities outlined in the "Agreement by the War
and Navy Departments, the Federal Security Agency, and State health

10 See illustrative text p. 49 et seq.

11 Another factor affecting the general Army rates for syphilis and gonorrhea
is the higher rate for these infections among Negro troops stationed in certain


departments 011 measures for the control of the venereal diseases in
areas where armed forces or national defense employees are concen-
trated. " 12 In this latter connection, the Adjutant General's Office
issued a memorandum to Commanding Generals of all Corps Areas
and departments reciting the provisions of the agreement, calling
particular attention to the valuable cooperation rendered by the
United States Public Health Service and the state health services
in safeguarding the health of military personnel by suitable measures
of extra-military sanitation, and directing that this agreement be
brought to the attention of and adhered to by all officers in the Army.

The efforts of all concerned with carrying out this agreement showed
that in both military and civilian phases of the program more
extensive education work, increased personnel, and more effective
correlation were necessary. It also became evident that it would
be helpful to have re-enactment of Section 13 of the old draft act of
1917, which made prostitution a Federal offense as well as a violation
of existing state and local laws and regulations, whenever the
Secretary of War designated an area for its application in relation
to military establishments. Accordingly, early in 1941, this pro-
vision, slightly modified, was sponsored by the American Social
Hygiene Association with the cooperation of numerous other volun-
tary groups, including the American Legion, the General Federation
of Women's Clubs and church organizations, was introduced before
the Congress by Chairman Andrew J. May of the House Military
Affairs Committee; was duly passed by both Houses, and signed
by the President July 11, 1941. 13 The Act was implemented on the
part of the Army by issuance of Circular 170, August 16, 1941. 14

Early in 1940, in order to secure greater correlation of activities,
the Army requested the United States Public Health Service to
supplement its established cooperation with state and local civilian
agencies by assigning to each of the nine Corps Areas of the Army
and the Puerto Rican Department an experienced liaison officer to
be stationed at headquarters. These officers have served as repre-
sentatives of the Surgeon General of the Public Health Service in
promoting the broad program of extra-military health and sanitation
including venereal disease control. They function from the military
side under direction of the corps area surgeons, and opportunity is
thus provided for close contact and cooperation between the Army,
the regional and state health officers, and the local officials. Similarly,
the War Department has recognized the civilian voluntary leadership
and participation of the American Social Hygiene Association, with
whose national and affiliated groups throughout the country the Army
maintained such mutually helpful relations throughout the First
World War.

The Subcommittee on Venereal Diseases of the National Research
Council has contributed greatly to the cause of venereal disease

12 See page 31 for details of this Agreement adopted by the Conference of
State and Territorial Health Officers May 7-13, 1940.

13 See page 61 for text.

14 See page 57 for text.


control through its recommendations in regard to the medical manage-
ment of these diseases in the armed forces and its investigations of
civilian venereal disease control programs.

Through continuous interchange of information and frequent con-
ference, both in Washington and in the Corps Areas, understanding
and united action is being built up which is calculated to bring about
important results, both for the military and the civilian populations. 15


In his final report at the close of the World War, Raymond B.
Fosdick, Chairman of the War and Navy Departments Commissions
on Training Camp Activities, recommended that the Commissions'
program be taken over by the Army and Navy. Both Departments
adopted Mr. Fosdick 's suggestions, and the result, in the Army, is
the Morale Branch, today greatly expanded, of which Brigadier
General Frederick H. Osborn is Chief.

To keep the soldier glad he joined up, sure that the United States
Army is the best army in the world, and his own regiment, company,
or platoon, the finest military organization of the kind, is the job
of the Morale Branch. "Morale," said an Army officer recently,
"is nothing you can buy with base-ball bats, or band instruments,
or special privileges. Morale is something you build, together, by
hard work, competent instruction, discipline and many other means,
chief among which is a feeling of solidarity and confidence among
the men that the company officers are out to do the best they can
for their command."

General Osborn and his staff go about this building job with a
combination of tools, all driving towards the objective of keeping
the soldier busy and contented in his spare time in camp. The Morale
Branch Army Exchange Division supervises the operation of the
post exchanges where the soldier buys postcards and chocolate bars,
and the Morale Branch Editorial Division encourages the publication
of the numerous and often extremely lively camp newspapers edited
by the enlisted men, and runs the radio and pictorial section, which
has turned up some remarkable soldier talent in posters, cartoons,
and broadcasting programs; the Morale Branch Services Division
conducts the Army library service. The Welfare and Recreation
Division is responsible for a wide-flung program of advisory service,
education for self -improvement, athletics and entertainment.

The Morale Branch, like the rest of the War Department, uses
the help of other agencies to the full. On the official side, its work

IB Similar cooperative relations exist between the Association and the United
States Navy Department and the Federal Security Agency, including the Division
of Social Protection and the U. S. Public Health Service. In these connections,

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