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Journal of social hygiene (Volume 28) online

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responsibility, not one for the armed forces. There is little likelihood
of Boston's being declared off-limits for servicemen under <he May
Act. Infected servicemen, except those who escape detection, are
treated by their medical officers until rendered non-infectious before
they can again visit civilian communities. The armed services have no
authority over the civilian population.

It is the community, therefore, which must find and treat its
infected citizens and keep its women and girls from conduct leading
to promiscuity, prostitution and disease.

The media for girls who want to meet servicemen include grills
and bars, Boston Common, the Esplanade, streets or parks and the


foci of genitoinf actions include hotels, girls' apartments, rooming
houses, automobiles, including taxis, roadside cabins, houses of pros-
titution. Should the emphasis in any preventive or remedial program
be on these places or on the girls who frequent them? The survey
committee believes each approach is important and neither should be

From the dearth of houses of prostitution in Boston, from the
record of police arrests, from the relative freedom of the Boston popu-
lation from syphilis, and from the description of the case-handling of
girls on probation and parole and in reformatories, the conclusion is
inescapable that competent work by police, court, health, reformatory
and voluntary agencies is being done with successful results, so far as
concerns individual girls with genitoinfections or whose sex offenses
land them in the toils of the law.

The police are not too successful in finding girls named as contacts
by infected servicemen nor do they use properly trained policewomen
in vice work. However, they do enforce the laws against sex offenses
with vigor.

There is a lack of temporary shelter for girls arrested on sex
charges, particularly those girls with genitoinfections. But in most
respects, court, probation and parole officials are making use of facili-
ties available and are handling girl cases with sympathy and under-
standing and with the end in view of rehabilitation and restoration to

As for the girl who is not yet a sex offender, but whose conduct is
leading her toward that end, no concerted action is being taken.
Such a girl or her family may be known to case work or group work
agencies. If so, her history may be on record and might be of use as a
basis for a preventive program.

Whether or not a girl has a case history in a social agency, it is
likely that one or another agency could be of help in guiding her to
more healthful use of her leisure time. Such assistance is of par-
ticular importance if, as reformatory records show, girl sex offenders
are generally maladjusted personalities who have never had normal
opportunities for self-expression and have never been able to find
happy childhood or adolescent relations within their neighborhood or
school groups.

Who will find these girls and bring them to the attention of social
agencies ? Since the girls congregate in grills and bars and on Boston
Common, the chain must start in those places. The only person who
can approach the girl in such a place, win her confidence and induce
her voluntary cooperation, or, in cases of recalcitrance, take her into
custody, is a policewoman trained in social work procedures.

The general policy that should guide a community in meeting the
girl problem is summarized by Miss Katharine F. Leiiroot, Chief,
Children's Bureau, U. S. Department of Labor, in an address at the
Regional Conference on Social Hygiene, Cincinnati, February 4, 1942 :


"Social Protection in its broadest sense begins with the strengthening and
emotional security of the home; with effective health service and medical care,
including measures for safeguarding both physical and mental health; with
opportunities afforded children and young people for an education which serves
immediate needs, is attuned to the whole growth cycle, is directed toward the
objectives of a free society; and with opportunities for play, for wholesome
companionship and leisure-time influences."

Granting that the foregoing is a generalized and long-range pro-
gram, and realizing that low standards of living for families and
individuals constitute the most important single obstacle in social
protection, the survey committee believes that some of these objectives
can be translated into immediate action in Boston by the concerted
effort of agencies already established.

If policewomen trained in social work were employed to visit the
places where girls and servicemen meet, they would discover many
girls whose conduct does not stamp them as sex offenders in the
criminal sense, yet who are definitely on the road leading to prostitu-
tion and promiscuity. These are girls whose home surroundings are
unattractive or devoid of any stimulating, healthful activity, and who
go, night after night, to these public places because of the atmosphere
of excitement and gaiety found there.

If the facilities of voluntary and public agencies were found ade-
quate and available and cooperation were established, policewomen
could, after preliminary case investigation, turn over such girls to
one or another of these agencies. Health follow-up workers could also
refer girls to such agencies for general rehabilitation.

While it is true that many agencies with available facilities are in
existence in Boston, there is no central office of direction or coordina-
tion now set up in the community to enlist their services in the specific
problem of social protection. The Boston Committee on Social Pro-
tective Measures, under the Public Safety organization, is composed of
voluntary workers whose duties are principally policy-making and no
one of whom can, at present, give full-time attention to an operating
program. It is believed that the extensive scope of the problem
requires the full-time professional services of at least one person to
work with the various agencies involved.

A survey is necessary to determine what public or voluntary agen-
cies in Boston either have available facilities that can be utilized in a
social protection program, or would be able to expand their facilities
to provide necessary services. It was beyond the scope of the survey
committee to make such a determination. Merely asking various
agencies whether they have such facilities would not serve the purpose
since many might consider themselves unable to take on greater loads
at this time and so reply in the negative. It is important for some
competent person or group familiar with all agencies to make such an
analysis independently.

At the present time there is no place where a girl infected with
syphilis or gonorrhea can be isolated until rendered non-infectious,


unless she is a court case and only then if she is sent to a penal or
reformatory institution. Thus the fact that a girl is infected virtually
compels law enforcement agencies to treat her as a person deserving
more stringent penal treatment than a non-infected girl. This is
deleterious sociologically as it classes a girl who might be rehabili-
tated as in a definite criminal status and throws her among hardened
offenders who may influence her and thus defeat efforts at rehabilita-
tion. A ward in a hospital, not part of a penal institution, to which
girls with genitoinfections may go voluntarily or to which they may
be sent under probationary or parole status during their infectious
stages, might solve this problem.

At the present time no action is being taken against grills and bars
known to be foci of infection. Infected servicemen name as contacts
girls and women they meet there, even though actual exposure occurs
elsewhere. Since the bars and grills most frequented by servicemen
and girls are notorious among Army and Navy men and among girls
as places where they can encounter members of the opposite sex, such
places are in fact the clearing houses for the contacts that spread
disease. Once their notoriety as meeting places is established, a vicious
circle begins. More and more servicemen and girls resort to these
places and more and more infections result.

The police and licensing officials maintain they cannot take punitive
action against such places because nothing illegal occurs there. It is
not clear why evidence that a place is a focus of infection for diseases
dangerous to the public health should not weigh heavily with the
Licensing Board's determination of whether its license should be
suspended or denied.

There is the possibility that the Health Department might be able to
take action on this evidence under Chapter 111, Sections 122 et seq.,
of the General Laws, or the public prosecuting authorities under
Chapter 139, Sections 4 et seq., of the General Laws, both relating to
abatement of nuisances, if the Attorney-General rendered an opinion
that it was legal to do so.


Because of inadequacies in present facilities for dealing with the
girl problem in many phases, the survey committee makes the fol-
lowing recommendations :

1. The Boston Police Department should be asked to consider the
advisability of rotating the policemen detailed for extra duty at eating
and drinking places.

2. The Boston Police Department should be granted funds sufficient
to employ, and should employ, such number of policewomen adequately
trained in social work, as will provide proper policing of the public
places where servicemen and girls meet.

3. The Boston Council of Social Agencies should determine what
public and voluntary agencies now have facilities, or could expand to


provide facilities, to meet the demands of a comprehensive social
protection program, particularly in the provision of temporary
shelters for girls, group activities, employment opportunities, voca-
tional guidance, leisure-time activities, family welfare, and the like.

4. A full-time worker should be employed whose duties would be to
work with the Boston Council of Social Agencies, the Boston Com-
mittee on Social Protective Measures and the public agencies, so as to
coordinate the facilities of Boston agencies in a social protection
program and with sufficient authority under the Public Safety
organization to carry out whatever unified, continuous procedures are
determined advisable by the Boston Committee on Social Protective
Measures, at least for the duration of the war.*

5. The Boston Health Department and the State Division of Geni-
toinfectious Diseases should be requested to explore the possibility of
establishing an isolation ward in a non-penal institution to which
girls with genitoinf ections or suspected of having same, may go volun-
tarily or may be sent on court order, during the infectious stages of
their diseases.

6. The Attorney-General of Massachusetts should be asked by the
Massachusetts Department of Public Health to render an opinion as to
whether the provisions of Chapter 111, Sections 122 et seq., and/or
Chapter 139, Sections 4 et seq., of the General Laws of Massachusetts,
both relating to nuisances, apply to public places notorious as places
where men and women can encounter members of the opposite sex,
and where meetings of men and women are frequent and continually
result in infections of syphilis and gonorrhea even though no actual
exposures occur on the premises.


Any complacency engendered by Boston's relative freedom from
syphilis, compared with other cities, should be counteracted by the
knowledge that there is still an appreciable reservoir of infection in
the city as evidenced by the fact that 1,600 syphilis cases among the
general population came to the attention of clinics, institutions and
physicians in 1941. Gonorrhea cases and rates for Boston show a
decline for the 12-year period, but bear a steady ratio of 10 times
the number of early syphilis cases.

This ratio for the entire population of Boston is interesting to com-
pare with the consistent relationship between gonorrhea and early
syphilis cases among Army men in Massachusetts. Gonorrhea cases
were found to be 14.5 times as frequent on the average, as are early
syphilis cases in these particular groups of males, most of them in
their early twenties.

* Carrying out this recommendation, on June 15, 1942, the Budget Committee
of the Greater Boston Community Fund earmarked $8,000 per annum for the
purpose of employing a full-time worker and sufficient other staff to coordinate
the activities of all agencies concerned with the Social Protection problems in
Boston. On July 2, 1942, it was announced that a social worker had been
appointed to the position of executive secretary for the Committee.


Servicemen report their infections to the medical authorities for
diagnosis and treatment or are discovered to be infected during
periodic physical inspections by their medical officers. There may
have been additional servicemen infected who failed to report their
infections and whose infections were not discovered during physical
inspections, among these groups. Nevertheless, the chance of an
infected serviceman 's escaping detection is lower than that of a person
in the civilian population and there is a greater measure of control
over the diagnosis, treatment and reporting of syphilis and gonorrhea
among servicemen than among civilians.

Hence the proportion of gonorrhea cases to syphilis cases found
among servicemen (14.5 times in the Army group mentioned) can be
accepted as reasonably indicative of the relative incidence of the two
diseases in the group measured.

In the general civilian population, however, the situation is dif-
ferent. Few cases of gonorrhea come to light through general physical
examinations. Diagnosis of gonorrhea in women is admittedly more
difficult than in men. Women are far less likely than men to dis-
cover symptoms that would suggest to them the presence of infection.
Lay persons are apt to attach less importance to gonorrhea than to
syphilis and so fail to seek diagnosis or treatment. Self-medication
with sulfonamides will eliminate clinical and laboratory manifesta-
tions of gonorrhea, whereas self-medication for syphilis is highly
unlikely to be attempted. Sulfonamide drugs are sold in drugstores
to anyone who seeks them; chemicals for treating syphilis are not
commonly known or sold over the counter. Private physicians are
frequently unaware that state regulations require them to report
gonorrhea cases as well as syphilis.

For all these reasons the number of gonorrhea cases reported to the
State Division is believed to bear a much lower proportion to total
cases than do reported syphilis cases bear to total syphilis cases.

It is probable, therefore, that the gonorrhea cases reported for
Boston by no means express the total gonorrhea! infections actually in
existence during the years covered. Since clinics and institutions
are in the habit of reporting all their gonorrhea cases, it is in cases
treated by private physicians that the greatest likelihood of incom-
plete reporting is present.

The remarkably few cases of syphilis traceable to Boston among
servicemen and the declining early syphilis rate in Boston for recent
years, lead to the conclusion that the concentration of servicemen in
Massachusetts apparently has not increased the incidence of syphilis
among the civilian population of Boston during 1941.

As previously stated, the figures on gonorrhea do not permit any
conclusions as to the effect the presence of servicemen had on the
gonorrhea rates for the Boston civilian population. During the
13-month period ending December 31, 1941, 180 servicemen who con-
tracted gonorrhea reported that their infections came from Boston


contacts. This was 10 times the number of syphilis patients (18)
reporting Boston contacts, which is the same ratio as between gonor-
rhea and early syphilis in the Boston general population for recent
years. Boston is clearly a focus of infection for syphilis and
gonorrhea among servicemen, and the number of infections traceable
to Boston is increasing.

From a tabulation it can be seen that Boston places named by
infected men as either the situs of meeting the women or girls who
infected them, or the scene of actual exposure, were 26 per cent of
total places named and 60 per cent of total places in Massachusetts.
Boston is therefore the chief focus of infection in Massachusetts for
servicemen stationed in the state or visiting it on ships. This dictates
that the Massachusetts genitoinfectious disease control program must
have its major emphasis in Boston, particularly in relation to Army
men from Fort Devens and the Boston Harbor forts and to men in
the sea services.

The Massachusetts system in which nurse epidemiologists interview
infected servicemen is unique in the United States, so far as is known.
It sets in motion an immediate epidemiological train and so brings
persons named as contacts to diagnosis and treatment in a far shorter
time than would be possible if reports from service establishments,
which take longer to route, were used as a basis for follow-up.

The nurse who, herself, must follow many contacts, is in a position
to obtain exactly the information she needs and can evaluate better
the accuracy of it by the personality of the man interviewed. The
system also provides controlled data for statistical analysis as the
State Division's own workers gather it as well as compile it.

Tabulation of interviews with infected servicemen indicate nurse
follow-up of contacts is far more successful than police follow-up.
This is not entirely due to the greater efficiency of the nurses. The
cases they follow are likely to be better identified than those furnished
the police. The type of sexually promiscuous woman or girl referred
to the police is apt to be elusive and resistant to follow-up. Neverthe-
less, the relatively poor results of police follow-up raise the question of
whether all follow-up might be done by the nurse epidemiologist.
Such a system might be more beneficial sociologically, and the possi-
bility is that the percentage of failure would not be any higher and
might be lower, than at present under police follow-up.

The nurse epidemiologists also are highly successful in obtaining
useful information from men interviewed. While in 38 per cent of
the total contact cases the information elicited was insufficient to
permit reference of the contacts, in many, perhaps most, instances
this was not the fault of the nurses. Infected men are sometimes
drunk at the time of exposure, or do not learn the last name of the
girl, or later forget it, or have no idea of the actual address of the
place they met or where exposure occurred.



The following recommendations under Title III are made :

1. Private physicians in Boston should be acquainted with the
urgent necessity, particularly as a wartime duty, of accurate, imme-
diate and complete reporting to the State Division of Genitoinfectious
Diseases of all cases of gonorrhea and syphilis among their patients.

2. The sale of sulfonamide drugs in drugstores should be prohibited
by law except through a physician's prescription. Druggists in
Boston should be urged to agree not to diagnose genitoinfectious
diseases and to refer customers who suspect they have genitoinfections
to physicians, clinics or hospitals.

A clean community environment can be obtained by carrying out a practical
program to include fundamental measures like the following:

1. Educate our children and young people for sane and wholesome sex living.

2. Tell the public the facts about commercialized prostitution.

3. Strengthen laws relating to prostitution, and provide sufficient well-trained
law-enforcement personnel and the proper facilities for handling this complex
social problem.

4. Organize local voluntary committees to back up official law enforcement.

5. Provide adequate and wholesome opportunity for ' ' good times in good
company" for all young people.

When responsible citizens make sincere and alert effort to defend their com-
munity against commercialized vice in this way, success must prevail and the
" business" of prostitution itself admit failure.


in We Need Not Tolerate Prostitution



Chairman, Executive Committee of the American Social Hygiene Association

The need for all concerned to have a clear conception of
the relations of police and health officers to the problems of
prostitution and venereal diseases leads to the republication
of the following statement. The points originally set down
regarding the division of responsibility between the two
official departments represent views expressed during a dis-
cussion of the problem at a regional conference on social
hygiene held in Louisville, Kentucky, in 1927. Since that
meeting, this statement has been widely circulated and dis-
cussed, and these relationships are generally accepted in
principle by health and police authorities. As indicated, the
consensus has been that while the functions of the legal and
of the health divisions of government administration in rela-
tion to the problems of prostitution and of the venereal dis-
eases must be carefully specified, mutual understanding and
close cooperation should exist among all the respective law
and health agencies concerned both official and voluntary
if their efforts are to be effective.

Functions of the Police Department, Functions of the Health Department,
Courts, Probation Service, and Custodial Medical Officers, Social Service Bureaus,
Institutions Quarantine and Other Health and Medi-

cal Agencies

1. The Police Department should receive 1. The Health Department should re-
information regarding complaints of ceive information regarding persons
commercialized prostitution on desig- known or believed by physicians or
nated premises, or of solicitation on other responsible authorities, to be
the streets, and related activities. infected with syphilis or gonorrhea.

2. In accordance with law the Police 2. In accordance with health laws and
Department should investigate to de- regulations, the Health Department
termine whether arrest is necessary, should make inquiry to confirm the
or whether cooperation with other report and determine whether the
official and voluntary agencies may infected persons are dangerous to
be effective under the conditions other individuals or the community,




Functions of the Police Department,
Courts, Probation Service, and Custodial

3. Offenders arrested should be taken
before the court, charged with vio-
lating specific laws and ordinances
against prostitution and be given a
fair and prompt trial.

4. After conviction they should be :

(a) Placed on probation

(b) Sent to a correctional institution

(c) Or otherwise dealt with in the

best interests of themselves and
the community.

5. After completion of sentence they
should be released from custodial
control of the police, courts, and
other law enforcement agencies con-

6. Throughout these procedures, from
the hour of arrest, the individual
should be provided by the law enforc-
ing agencies with proper supervision,
health and medical care, and protec-
tion against undesirable contacts with
other persons awaiting trial or already
convicted. Prior to release at any
time subsequent to arrest, all persons
charged with practicing prostitution
or known to be infected with syphilis
or gonorrhea should be reported to
the health officer for such quarantine
or health supervision by the Health
Department as may be deemed neces-
sary in the best interests of the in-
dividual and the public after release.

Functions of the Health Department,
Medical Officers, Social Service Bureaus,
Quarantine and Other Health and Medi-
cal Agencies

3. The degree and character of super-
vision required to protect the public
health, will be based on the facts in
each case.

4. According to this decision the per-
sons found to be infected will be:

(a) Aided to secure treatment and

supervision when necessary of
the medical social service.

Online LibraryAmerican Social Hygiene AssociationJournal of social hygiene (Volume 28) → online text (page 54 of 71)