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the Selective Service Board. The health officers were informed of the program.
A detailed brochure on the diagnosis and treatment of gonorrhea in the male
was prepared and sent to all physicians. This was so well received it was
deemed advisable to prepare a similar brochure on the diagnosis and treatment
of the disease in the female. To further the cooperation of the physicians in the
program, sulfathiazole was made available free of charge for the treatment of
rejected selectees.

On August 1, 1940, the premarital legislation for venereal disease control
became effective. Though it placed a great burden on the laboratory and the
clerical staff of the venereal disease division which handles the reports, a great
deal of good has been accomplished. It has been of positive value in the improve-
ment achieved in the performance of serodiagnostic tests as shown in the evalua-



346 JOURNAL OF SOCIAL HYGIENE

tion studies described above. It has been of educational value and given many
individuals the assurance that they and their marital partners are free of syphilis.
In cases of individuals found infected before marrying, both parties have been
informed of the fact and instructed concerning the importance of treatment to
themselves and their future offspring. This point is particularly important for
females in the child-bearing age group, for without such information many of
those who were infected would bear congenitally maimed and crippled children.

Eighty-three per cent, of the total examinations were made on individuals
under 30 years of age the group to whom this knowledge is most important.
Moreover, since it is generally accepted that 50 per cent of all new cases of
syphilis occur in the age group 21 to 30, the examinations of these individuals
is particularly valuable in efforts to control the disease. Without this legislation,
many of the 1,357 individuals found infected in this age group would never have
been aware of their infection and, therefore, would not be under treatment.
It is of interest, too, to note that the infection rate among females of child-
bearing age is approximately the same as the rate determined for that group in
previous prevalence studies made in Virginia.

In cooperation with the Bureau of Industrial Hygiene and Laboratories,
surveys were made of the knitting and woolen mills of Orange County and of
certain industries in Albemarle. Each of these surveys was preceded by educa-
tional programs, utilizing talking motion pictures, printed bulletins, posters, and
talks in an attempt to achieve voluntary cooperation of the employees. As a
result of this work, each of these industries now requires serologic examinations
as a prerequisite to employment.

At the end of the year, there were 108 clinics holding 184 weekly sessions in
the State. During the year, 11 new clinics were added and 10 dropped because
they did not meet the minimal requirements or because the venereal disease
problem in the area they served had decreased to the point where it was not
considered administratively worthwhile to continue them. Ninety-one of these
clinics are located in cities and counties with full-time health service, serving 70
per cent of the population of the State, and 17 in counties without health service,
serving 30 per cent of the population. There is need of more clinics where there
are no health departments, but it is felt that without proper case finding and
follow-up work, the clinics will continue to have poor attendance.

Considerable attention was given to the improvement of treatment and diagnos-
tic standards in the clinics through field visits and consultations. Three
hundred and fourteen physicians served as clinicians during the past year.
Through the State Department of Health clinic subsidy plan, honoraria were
granted to these physicians in the amount of $36,037.

Free drugs were distributed to clinics and physicians of the State for the
treatment of cases of syphilis in the amount of $46,292.60, a total of 775,483
doses which would render adequate treatment to approximately 18,800 individuals.

Through field visits of the Division's personnel and the advisory nurses of the
Bureau of Public Health Nursing, as well as through informative reprints, the
current aspects of case-holding and case-finding were emphasized. Particular
emphasis was placed on the follow-up of early infectious cases and their sex
contacts in an effort to conserve time and to minimize unproductive field visits.
This program was not limited to clinics, but included the investigation and
follow-up of cases for private physicians. Improvement was made in contact
investigation and in case-holding by using the persuasive approach and the
education of the patient rather than legal measures.

A system has been designed for the field investigation of cases reported through
the marriage examination law and the Selective Service program. Letters are
sent to individuals infected with syphilis or gonorrhea and to suspect cases of
syphilis, requesting them to report for examination. When they do, they are
examined in a clinic or referred to their family physician. In the event that
they do not respond to the letters, a field visit is made, and if this fails to
accomplish the desired results, legal steps are taken.



STATE AND COMMUNITY SUMMARIES 347

The Division, in cooperation with the Bureau of Bural Health and the Bureau
of Public Health Nursing, held six. regional conferences in which the epidemiology
of syphilis and gonorrhea was thoroughly discussed.

The educational program of the laity was conducted through public addresses,
silent and sound motion pictures, and the distribution of bulletins and folders
concerning syphilis and gonorrhea. The Division continued its policy of rendering
consultation service to private physicians of the State and of releasing timely
and current information on therapeutics and diagnosis. All physicians were
circularized with venereal disease supplements on treatment and diagnostic pro-
cedures in syphilis. They were supplied with a brochure on the new legislation
requiring a serologic examination before marriage, and a list of the approved
laboratories.

The morbidity reporting system was revised to meet the minimal standards
as recommended by the United States Public Health Service and the Cooperative
Clinical Group's committee on nomenclature. Reports from physicians were
requested by name and classified diagnosis. A system of mechanical tabulation
of records was installed in December, 1940. This system became necessary as the
volume of records to be tabulated and filed increased from approximately 20,000
a year to 210,000.

All records used in clinics and local health departments were revised and a
detailed manual with instructions for use and filing was prepared and sent to
all local health departments.



Long-time efforts on the part of the State Department of Health and cooperat-
ing voluntary groups which worked closely with the A.S.H.A. laid the ground
work for the splendid progress of recent years. The Virginia Social Hygiene
Council, now inactive, at one time correlated these activities. The Council of
Social Agencies of Richmond has bolstered social hygiene work in that city, and
a number of the educational institutions regularly give courses on marriage
and family life for both young men and young women students. Social Hygiene
Day is celebrated each year.

Dr. Clarke and Mr. Stenek of the A.S.H.A. staff have visited Richmond during
past months.



WASHINGTON

Population Population rank among states 30

Urban 921,969 A.S.H.A. members in state 73

Rural 814,222

1,736,191

Social Hygiene Societies and Committees

Tacoma: Social Hygiene Committee, Tacoma and Pierce County Public Health
Council: Chairman, Percy Cox, 409 Provident Bldg.

Other Voluntary Agencies

American Legion: Department Adjutant, J. J. Long (acting), 5134 Arcade

Bldg., Seattle.
Kiwanis International:*
Lions International:*
Rotary International:*

* See page 239 for national headquarters.



348 JOURNAL. OP SOCIAL HYGIENE

Washington Congress of Parents and Teachers: President, Mrs. J. S. Stewart,

557 17th Ave., Longview; Social Hygiene Chairman, David W. Gaiser, M.D.,

841 Cliff, Spokane.
Washington Council of Church Women: Secretary, Mrs. W. L. Stone, 20 H.

Street, S.E., Auburn.
Washington Federation of Women's Clubs: Chairman Public Welfare, Mrs.

George Cole, 814 5th Avenue, S.W., Puyallup.
Washington Junior Chamber of Commerce: President, Mearns T. Gates, Box

271j Pomeroy.
Washington State Conference of Social Work: President, George S. Chessum,

Graduate School of Social Work, University of Washington, Seattle.
Washington State Medical Association: President, George W. Cornett, M.D.,

Yakima; Secretary, V. W. Spickard, M.D., 1305 Fourth Avenue, Seattle.
Washington Nurses Association: Executive Secretary, Marian G. Kent, Boom

1110 Textile Tower, Seattle ; Chairman, General Staff Nurses Section, Claribel

Mercier, 4239 Orcas Street, Seattle.

Washington Tuberculosis Association: Executive Secretary, Mrs. B. B. Bu-
chanan, 918 Terminal Sales Bldg., Seattle.
Washington Woman's Christian Temperance Union: (East) President, Mrs.

Euby Lane Colman, N. 2513 Madelia St., Spokane; (West) Headquarters,

5103 Arcade Bldg., Seattle. In charge, Mrs. Louise E. Young; President,

Mrs. Winifred M. Lewis.
United Service Organizations, Region XII: See Oregon.

Official Agencies

National Youth Administration, Region XII: See California.

Social Protection Section, Office of Defense Health and Welfare Services,
Region XII: See California.

U. S. Army, Ninth Corps Area: See Utah.

U. S. Department of Agriculture, Extension Service: State Extension Director,
F. E. Balmer; State Home Demonstration Leader, M. Elmina White, State
College of Washington, Pullman.

U. S. Navy, Thirteenth District: The Commandant, Headquarters, Seattle;
Venereal Disease Control Officer, Lt. A. N. Johnson (MC).

U. S. Office of Education, Civilian Morale Service: To receive material for
War Information Centers, Glenn H. Jones, State College of Washington, Pull-
man; Ethel Christoffers, University of Washington, Seattle.

U. S. Public Health Service: For Director, District V, see California; for
Liaison Officer, Ninth Army Corps Area, see Utah.

Washington State Defense Council: Executive Director, Irving S. Smith, Eoom
327, 305 Harrison Street, Seattle.

Washington State Department of Education: Superintendent of Public Instruc-
tion, Mrs. Pearl A. Wanamaker, Olympia.

Washington State Department of Social Security: Director, Charles F. Ernst,
Box 1162, Olympia.

Washington State Department of Health: State Director of Health, Donald G.
Evans, M.D., Seattle; Epidemiologist, Control of Syphilis and Gonorrhea,
L. A. Dewey, M.D.

(On leave for Army duty. Acting in his absence is P. A. Surgeon Harold
L. Lawrence, U.S.P.H.S.)

Clinics or Cooperating Clinicians at:

Aberdeen, Bellingham, Bremerton, Centralia (2), Coif ax, Everett, Kelso, Olympia,
Port Angeles, Seattle (3), Spokane, Tacoma, Vancouver, Walla Walla, Wenatchee,
Yakima.

Work Projects Administration: State Director of Community Service Program,
Mrs. Louise S. Taylor, 422 Alaska Bldg., Seattle.

State Department of Health, Seattle. Recent events may be sum-
marized as follows:



STATE AND COMMUNITY SUMMARIES 349

Three additional clinics for the treatment of syphilis and gonorrhea have been
established since 1938 and personnel and equipment have been increased in all
clinics previously in operation. Nine of the seventeen existing clinics are equal
to the local needs. At least two more clinics are needed. The venereal disease
control program in this Department is fairly complete with the exception of a
control program in industry, which is very weak. The program is receiving
adequate appropriations and public support. The chief deficiency felt in the
program is in trained personnel, particularly in the field of Public Health nursing.
Very little cooperation has yet been received from state and local pharmaceutical
societies in the campaign against quackery.

All newspapers and other publications in the State now cooperate fully in
the campaign against venereal disease with the exception of one of the principal
newspapers, which still refuses to mention the diseases by name. Radio stations
throughout the State cooperate fully in the program. A weekly program is
carried on by this Department over KIRO, Seattle. Preliminary arrangements
have been made for the use of car cards carrying venereal disease information
in the Seattle Municipal Transit System.

This Department has cooperated with the Army, United States Public Health
Service and the Division of Social Protection for the most of the past two years
in securing the repression of commercialized prostitution. The active support
of the Seattle Municipal League for Better Government, the Association of
Parents and Teachers, the Associated Women's Club, and various other similar
organizations, has been secured in the campaign for repression. No facilities
are yet available for rehabilitation of women and girls who have been engaged
in prostitution.

A law requiring serological tests on pregnant women was passed by the
Legislature in 1939 and took effect on January 2, 1940.

It is believed that the sex education program in the schools and colleges in
this State is inadequate to the need. Venereal disease and sex education activities
are carried on by the Associated Women's Club and to some extent by the
Lion's Club.

There are numerous extensive industrial plants engaged in the production of
war materials in this State. This Department and local health departments are
carrying on very limited programs in connection with some of these plants
through the distribution of literature and the showing of films. Two industrial
establishments in the State perform serological tests for syphilis on applicants
for employment and refer those found infected to health department clinics.
No comparable attempt is made to discover gonorrhea in employees.

There are also a number of Army and Navy establishments in the State
including installations now under construction. The chief effort connected with
these establishments has been directed toward securing the suppression of com-
mercialized prostitution, decreasing in so far as possible other types of prostitu-
tion. Since August 1, 1941, commercialized prostitution has been suppressed in
22 cities in this State. While suppression has not been complete in these cities,
there has been at least a 90% to 95% reduction. Since suppression went into
effect there has been a very notable decrease in reports of gonorrheal infection
to this Department. In addition, there has been a marked decrease in venereal
disease rates in the Army. At the present time the State Liquor Control Board
is cooperating in eliminating tavern solicitation.

Tacoma Department of Health. Outstanding activities are as
follows :

In July, 1940, the Tacoma City Clinic and Pierce County Clinic were merged
under one treatment facility known as the Tacoma Public Health Clinic and
administered by the Director of the Tacoma Health Department. In August,
1940, the clinic was moved from crowded quarters in the City Hall to a 10 room
clinic in the Provident Building which is centrally and conveniently located.
New equipment was purchased and the gonorrhea treatment facilities were greatly



350 JOURNAL OF SOCIAL HYGIENE

improved. All of this was made possible through funds from the United States
Public Health Service. In July, 1940, two part-time physicians were appointed,
one a specialist in syphilis, and the other in genito-urinary diseases, with salaries
provided from U.S.P.H.S. funds. Their services are for diagnosis and treatment.
Two full-time public health nurses, also paid by U.S.P.H.S. funds, are on the
staff, as are a full-time clinic nurse and full-time clerk whose salaries are paid
by the city. The ten public health nurses on the city staff have received special
training in epidemiological techniques of venereal diseases and carry the routine
load of the follow-up work. One male Venereal Disease investigator from the
State Department of Health cooperates on difficult cases of follow-up where night
work is required.

The State Department of Health dispenses arsenicals and heavy metal drugs
to private physicians, using the City Health Department as the distributing
agency. It also furnishes sulfathiazole and sulfadiazine to the Tacoma Public
Health Clinic for the treatment of gonorrhea. An additional program of case
finding has been worked out with the military agencies of the area, functioning
through the State Department of Health. All sources and contacts from army
venereal disease cases are reported to the local health department for follow-up.
No formal program with the local pharmaceutical societies is sponsored by the
Tacoma Health Department.

The two daily papers give freely of their space to articles as offered pertinent
to the venereal disease program. At the institution of the suppression of prosti-
tution program they printed articles. Radio Station KVI in Taeoma donates
15 minutes weekly to a health broadcast known as, How's Tour Health f At
timely intervals the venereal disease program is emphasized. During 1941 two
radio talks were given on venereal diseases. Radio Station KMO donates 15
minutes one evening weekly to the Mayor of Tacoma. As he is particularly
interested in the venereal disease program, educational information has been
given by him, particularly, regarding the suppression of prostitution. Fourteen
talks to various groups and the public were given in 1941.

The Tacoma Public Health Council, which is an organization representing vari-
ous civic, social, club and church groups, made a study of commercialized prosti-
tution in Tacoma in 1940 and 1941. Following this the Tacoma Public Health
Council sponsored a program for the suppression of prostitution in Tacoma.
An intensive educational program of radio talks, talks to groups and to the public,
and newspaper articles was instituted. The military agencies also gave full
cooperation and were personally identified with the program for suppression.

On August 1, 1941, the houses of prostitution were closed. A few have opened
spasmodically but only for a short duration. The city police department has
aided in the enforcement of suppression of prostitution. The county sheriff
and staff have also assisted in preventing the opening of the houses in the
rural areas.

In prevention of sex delinquency, the Travelers Aid, the Catholic Charities, and
the U.S.O. have enlarged their staffs and are carrying a full-time program in
caring for the large number of young girls who have come into the area. Many
are soldiers' sweethearts and wives. They assist in providing information for
housing, employment, and in some cases furnish transportation to return the
girls to their homes. The Pierce County Welfare, the Family Welfare, and the
Catholic Charities have assisted girls who were engaged in prostitution in finding
other employment.

In 1940 prenatal examination for syphilis became a law in the State of
Washington. Through the Public Health Council all church and social agencies
actively support effective enforcement.

The public school program includes a course in Home Eelations. Sex informa-
tion is correlated in the curricula of Physical Education for boys and Home
Economics for girls. The College of Puget Sound offers a course, Marriage
and the Home, which deals with courtship, marriage, and moral, social and
economic aspects. A sociology course entitled, The Family, is relative to social
case work. A required course in health education for both sexes deals with social
hygiene, venereal diseases, and personal hygiene.



STATE AND COMMUNITY SUMMARIES 351

A required subject for all students at Pacific Lutheran College is, Health
Essentials, which incorporates social hygiene in broad aspects. A sociology course
in family life offers training in marriage and parenthood from social, economic,
and moral angles. Freshmen are given an orientation course in phases of college
life including lectures on personal hygiene and sex from an individual basis.
Prenatal classes for wives of enlisted men are sponsored by the Public Health
Nursing Association of the Taeoma Health Department. These classes incor-
porate information on marriage, parenthood, and family life.

Pamphlets and other literature on marriage and family relations are distributed
by the U.S.O. under a special project sponsored by the Taeoma Public Health
Council.

One and one-half years ago, Taeoma, a city of approximately 110,000 popula-
tion, was moving along in comparatively normal channels. Taeoma has five
waterways in its harbor in Puget Sound. This coupled with the fact that cheap
electric power is available makes Taeoma a natural industrial center. Most of
the industries have expanded and new ones developed and are engaged in the
production of war materials. At present no agency is carrying informational
or cooperative activities in the social hygiene field with industrial management
or the labor groups. A program is under consideration at present and efforts
are being made to make it a reality in the near future. Some of the industries
are giving blood tests for syphilis as part of the examination for employment,
which is being done on a contract basis with a medical agency in the community.

Within the boundaries of Pierce County in which Taeoma is located are 3 major
military centers having a total of approximately 80,000 men and officers. An
Army-Navy Club, four U.S.O. centers, a Lutheran Service Men's Club, one
Travelers Aid U.S.O., and one Junior Hostess Bureau have been organized to
provide entertainment, wholesome conditions, and assistance for service men and
their families.

The Boy Scouts, Girl Scouts, Camp Fire Girls, incorporate social hygiene in
their programs in the prevention of sex delinquency.

The Children 'e Division of the County Welfare Department functions in placing
children in supervised foster homes to improve social conditions.

Taeoma: Social Hygiene Committee: Health Section of the Taeoma
Community Council. The purpose of this Committee is to work for
ultimate legislation leading to the teaching of social hygiene in the
public schools. A panel discussion before the Taeoma PTA Council
elicited favorable response. Preliminary correspondence with the
health councils of Seattle and Spokane indicated interest that could
be enlisted in cooperative effort. The Federated Women's Clubs
also expressed interest in supporting such legislation.

A Committee on Special Education, to deal with the Suppression of Prostitu-
tion was extremely active during the spring and summer of 1941, meeting almost
weekly. Considerable study, research and activity resulted in the following projects :

A study of prostitution and venereal disease in Taeoma and Pierce County;
also a digest of expert opinion and the experience of other cities throughout the
world in suppressing prostitution. . . . Dr. Donald H. Williams, head of the
V. D. Department of British Columbia, who had successfully organized a pro-
gram of suppression was guest speaker at the spring quarterly meeting of the
Health Council. He made an excellent impression and his talk was publicized. . . .
Subsequently a public mass meeting was arranged at the Jason Lee Junior High
with Dr. Williams as speaker, affording another opportunity for educational
publicity. Press, radio and word of mouth publicity were also used. . . . Pam-
phlets issued by the American Social Hygiene Association were purchased and made
available for distribution. . . . Letters and telegrams to senators and representa-
tives urging passage of the May Bill. . . . Meetings in cooperation with Army,



352 JOUBNAL OP SOCIAL HYGIENE

state, regional, and national health officers. Cooperation in connection with
educational program to help in the enforcement of May Bill provisions.

On the legislative side, also, the Health Council endorsed 8 B No. 12 which
would have provided for premarital physical examinations to determine venereal
infection, but this bill was defeated.



Though the farthest removed from national headquarters, Washington ia a
state with which A.S.H.A. contacts and cooperation are frequent and close.
Staff visits to the cities of Seattle, Tacoma, Spokane and Wenatchee have been
made during the past year by Dr. Snow, Dr. Clarke, Dr. Storey and Miss
Shenehon, who took part in the State Conference of Social Work in 1941. The



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