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Journal of social hygiene (Volume 28) online

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in 1939 a vital pact evidenced the teamwork that already had been
initiated in the defense program among the various groups primarily
concerned in venereal disease control as a public health procedure.
The published statement covering this pact read as follows :

An Agreement by the War and Navy Departments, the Federal

Security Agency, and State Health Departments on Measures for

the Control of the Venereal Diseases in Areas Where Armed

Forces or National Defense Employees are Concentrated 1

It is recognized that the following services should be developed by
State and local health and police authorities in cooperation with the
Medical Corps of the United States Army, the Bureau of Medicine
and Surgery of the United States Navy, the United States Public
Health Service, and interested voluntary organizations :

1. Early diagnosis and adequate treatment by the Army and the
Navy of enlisted personnel infected with the venereal diseases.

2. Early diagnosis and treatment of the civilian population by the
local health department.

3. When authentic information can be obtained as to the probable
source of venereal disease infection of military or naval personnel, 2
the facts will be reported by medical officers of the Army or Navy to
the State or local health authorities as may be required. If additional

1 Adopted by the Conference of State and Territorial Health Officers, May 7-13,
1940.

2 Familial contacts with naval patients will not be reported.



32 JOURNAL OF SOCIAL HYGIENE

authentic information is available as to extramarital contacts with
diseased military or naval personnel during the communicable stage,
this should also be reported.

4. All contacts of enlisted men with infected civilians to be reported
to the medical officers in charge of the Army and Navy by the local
or State health authorities.

5. Recalcitrant infected persons with communicable syphilis or
gonorrhea to be forcibly isolated during the period of communica-
bility ; in civilian populations, it is the duty of the local health author-
ities to obtain the assistance of the local police authorities in enforcing
such isolation.

6. Decrease as far as possible the opportunities for contacts with
infected persons. The local police department is responsible for the
repression of commercialized and clandestine prostitution. The local
health departments, the State Health Department, the Public Health
Service, the Army, and the Navy will cooperate with the local police
authorities in repressing prostitution.

7. An aggressive program of education both among enlisted per-
sonnel and the civilian population regarding the dangers of the
venereal diseases, the methods for preventing these infections, and
the steps which should be taken if a person suspects that he is infected.

8. The local police and health authorities, the State Department of
Health, the Public Health Service, the Army, and the Navy desire
the assistance of representatives of the American Social Hygiene Asso-
ciation or affiliated social hygiene societies or other voluntary welfare
organizations or groups in developing and stimulating public support
for the above measures.



Augmenting the formal program outlined above, physicians in
private practice, as well as in clinics and hospitals, have increased
their alertness and are cooperating more intensively in diagnostic
and treatment efforts. Blood tests as diagnostic aids are becoming
routine in many circumstances rather than being used solely in cases
where syphilis is suspected. The voluntary services of thousands of
private physicians have been needed in the examinations of draftees,
and draft boards throughout the nation have depended on these
medical associates for progress in their task of selection.

Syphilis and gonorrhea statistics gathered in examinations of selec-
tees have supplemented the extensive data already compiled in this
field by the United States Public Health Service and the States, and
have indicated certain areas where more intensive work is needed.
The Venereal Disease Control Act of May 24, 1938, requires that
allotments be made to the states on the basis of (a) population,
(b) extent of the venereal disease problem, and (c) financial need.
Adequate administration of this Act requires constant examination
and study of reports and corroborative data from the states, in order
that Federal funds may be put to maximum use for the benefit of the



CONTRASTS .




Early treatment by a
good doctor Is the key-
stone of today's Federal-
State-local venereal disease
control plan.



The cynical quackery of
unscrupulous practitioners,
and the sale of home rem-
edies still flourish and will
flourish until the facts
strike home to all.




These photos are from the Public Health Service's new film, KNOW FOR SURE, which itself
is illustrative of modern methods of education for prevention and adequate, early treatment.
This film, telling for men the story of syphilis and the facts about prevention of venereal
disease, is available to health authorities, and authorized professional groups. Full informa-
tion is available from the Public Health Service, Washington, D. C.




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''HEALTH is THE STATE'S FOUNDATION ..." 33

entire nation. Selective service reports have aided by showing up
the strengths and weaknesses of certain sections of the country as
compared with others. The reports indicate, for instance, that more
intensive work must be carried on in those states having large Negro
populations, if this section of the nation's people is to be able to
render its full share of military and industrial service now, and gain a
reasonable share of peacetime benefits when peace is achieved.

Recognizing the need because of war's imminence, for stepping-up
venereal disease control work in defense areas the Surgeon General
set aside from the total $6,200,000 appropriated by Congress for the
1941 fiscal year's program, $458,600 "to provide additional funds
required for intensifying the program in areas in which the armed
forces are located." It may be noted, also, that "approximately
$1.00 out of every $4.00 available for venereal disease control from
Federal sources was budgeted for venereal disease control in national
defense areas."

Again because of national defense exigencies, expenditures have
been recently directed largely to the "service functions" i.e. diag-
nosis and treatment. This means that less, in proportion, has been
available for use in the vital long-range essentials case-finding,
case-holding, education, and social protection. Expenditures for
laboratory and treatment services were increased by two-thirds and
one-half, respectively during 1941, while the increased allocations
for case-finding and case-holding were only 15 per cent.

Before mobilization took place under the Selective Service System,
the Public Health Service conferred with that agency and the State
Health Authorities, for the purpose of developing a cooperative pro-
gram which would provide for the discovery of venereal diseases
among those who are being inducted into the armed forces. The
resulting agreement made possible the examination of a large repre-
sentative portion of the man power of this country and thus a more
exact determination of the prevalence of the venereal diseases. To
the extent that it proved possible to carry this out, it also provided
an opportunity to bring under treatment a larger number of men
infected with syphilis and gonorrhea than had ever before been
treated in the United States.

Blood tests for syphilis are included as a routine part of physical
examinations which are given by local draft boards. The Surgeon
General addressed a letter to all State health officers pointing out
that medical regulations of the Selective Service System include this
provision and urging full cooperation by State and local authorities.

Blood specimens are taken by the examining physician of the local
board and forwarded to the State laboratory or other laboratory
designated by State Selective Service headquarters. The State
health departments are requested to perform the test and to furnish
the necessary containers and report forms for the blood specimens.



34 JOURNAL OF SOCIAL HYGIENE

This expansion in the number of persons upon whom blood tests
for syphilis are being made has resulted in State health officers being
faced with the challenge of providing increased clinical diagnosis and
treatment and epidemiological services to insure adequate care for
all infected individuals and the thorough investigation of all contacts
of such infected persons.

Progress in the control of syphilis will be greatly accelerated within
the next few years if adequate funds are made available to provide
epidemiological, diagnostic, and treatment facilities for the care of
those persons found to have an infection through routine physical
examinations, including blood testing, under the Selective Service
and premarital and prenatal legislation. Present facilities are insuffi-
cient to follow up and place under treatment more than 25 per cent
of the persons showing evidence of syphilis or gonorrhea through
these mass testing programs.

Liaison officers have been detailed by the Surgeon General to the
nine corps area headquarters offices of the Army and the Department
of Puerto Rico to help develop the health program in national
defense areas. A considerable portion of the liaison officers' activities
is devoted to venereal disease control problems. In addition, four
United States Public Health Service officers are devoting full time
and twelve officers at least half time in the field to aid in the solution
of problems arising out of concentration of military forces and
workers in defense industries.

Prostitution has created a problem in the control of the venereal
diseases in practically all defense areas. The Public Health Service
has aided the American Social Hygiene Association in its studies to
determine actual prostitution conditions in such areas. Information
obtained through these studies has helped in planning the needs for
more adequate venereal disease control measures.

In cooperation with the Work Projects Administration, plans were
developed for the operation of a nation-wide program of research and
demonstration in venereal disease control methods and record systems.
The purpose of this certified national defense project is to provide a
program of assistance to regular venereal disease control activities in
defense areas. Special emphasis will be placed on the follow-up and
treatment of the exposed contacts of military and industrial personnel.

Our armed forces have long been aware of the relationship between
civilian and military health. It is fully as important from the stand-
point of national defense to control venereal diseases in the general
population as in the military. Infections among military personnel,
as well as in industrial defense areas, originate in adjacent communi-
ties. Past experience has demonstrated that the venereal disease
attack rate in a given military command or area of industrial defense
concentration reflects the efficiency of the control measure operating
in adjacent communities.



" HEALTH IS THE STATE'S FOUNDATION ..." 35

The large-scale Army maneuvers in 1939 and 1940 presented a
major challenge to public health in the wide application of the estab-
lished venereal disease control program, and the testing of new
measures adapted to modern national defense in the United States.
This was met, in the main, by concentration of trained personnel in
the maneuver areas and by strict adherence to public health principles
m diagnosis, treatment, and epidemiology.

Every effort has been made to strengthen State and local health
departments in military and industrial defense areas. The Public
Health Service has made available the entire resources of its personnel
and facilities to protect the health of the military forces through the
establishment of control measures, and to safeguard and maintain
at a peak of efficiency the industrial agencies on whom such a tre-
mendous responsibility rests today.

The Surgeon General called an emergency meeting of the State
and Territorial Health Officers in September, 1940. The purpose of
this meeting was to consider ways and means of providing a blood
test as a part of the regular physical examination for all candidates
who would be called into military service. This involved some
17,000,000 men between the ages of 21 and 36 years, and provided
unprecedented opportunity for the detection of syphilis and the appli-
cation of public health measures designed for the control of venereal
disease.

The Selective Service System and its Boards undertook to include
blood tests for syphilis, and clinical examinations for both gonorrhea
and syphilis so far as possible as part of all routine physical examina-
tions. The Public Health Service and State departments of health
cooperated by providing laboratory and other services. These activi-
ties resulted in helpful data and in promoting plans for securing
treatment of many infected men among those examined.

Under the Selective Service and Training Act of 1940 registrants
found to be infected with syphilis or gonorrhea are deferred, but
may be called back at any time for reconsideration of their classifica-
tion. With the recent advances in gonorrhea therapy through the
use of the sulfonamides (the so-called "sulfa drugs") and the
increasing efficiency of syphilis treatment, plans for physical rehabili-
tation of men having remediable defects including certain forms of
venereal disease, especially the acute varieties, will be treated prior
to induction. The State and Territorial Health Officers and the
Administrator of the Federal Security Agency have recommended
that persons called for service and found to be infected with uncom-
plicated gonorrhea or urethritis should be inducted into service with-
out delay and promptly treated thereafter. The practicability of
adopting this policy is now under final consideration by the War
Department to supplement the standards already set up for accepting
men who have acquired syphilis but have received adequate treatment
for purposes of military service.



36 JOURNAL OP SOCIAL HYGIENE

The policy of allowing certain portions of the funds allotted to the
States for venereal disease control to be budgeted for training of per-
sonnel has been continued. The Public Health Service has continued
to cooperate with various State and local health departments in
conducting research projects for the study and demonstration of
special aspects of the venereal diseases and their public health control.

Recognizing public information as an essential venereal disease
control measure, the Division constantly develops and makes available
for distribution pamphlets, exhibits, motion pictures, radio transcrip-
tions, and other authoritative informational aids. This is done not
only wth particular and immediate reference to areas of military and
industrial defense concentrations but also with the view to laying a
groundwork for a future long-time program. In this educational
cooperation with state and local health authorities and voluntary
agencies, trained workers aid by field surveys and recommendations,
consultation and advice by correspondence, and guidance in meeting
specific problems where national interests may be immediately con-
cerned. During the past three years more than 4,000,000 pieces of
literature have been distributed, almost 3,500,000 of which were
sold, primarily to state health agencies.

A Venereal Disease Education Evaluation Study was developed
during 1939^10 in cooperation with the American Social Hygiene
Association, and an extensive testing of varied population groups was
carried out at the New York World's Fair and at representative State
and county fairs and other meetings throughout the nation. Likewise,
in cooperation with the national association, a survey of health edu-
cation practices in relation to venereal disease instruction in schools
and universities was carried out in some 30 States, the first of a series
of reports having already been published.

For the medical and health professions, the monthly scientific
publication, Venereal Disease Information, carries original articles
and research papers in the fields of diagnosis, treatment, and public
health methodology. This well-edited summary of current studies
and practices leads the field of governmental publications with paid
circulations, a distinction in which the Division has just cause
for pride.

The Division's many valuable research projects carried on by
devoted scientists of the Service, with fine cooperation from their
associates on university teaching staffs, in private laboratories, in the
ranks of public health practitioners and in the field of private
practice, steadily aid the progress of public health. Through the
Committee on Serology, diagnostic tests are periodically checked so
that the highest degrees of sensitivity and specificity may be attained
and the work of laboratories may be made more uniform and exact.
A cooperative undertaking with the American Neisserian Medical
Society involves evaluating the effectiveness of the many sulfonamide
compounds in treating gonorrhea, and an appraisal of the relative
efficiency and toxicity of these drugs. Studies by the Cooperative
Clinical Group designed to evaluate the results of treatment of



"HEALTH is THE STATE'S FOUNDATION .



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38



JOURNAL OF SOCIAL HYGIENE



SYPHILIS CONTROL ACTIVITIES REPORTED FOR STATES AND TERRJTORCS

UNDER PROVISIONS OF THE VENEREAL DISEASE CONTROL ACT
1936 1941




OS IO-J-41



"HEALTH is THE STATE'S FOUNDATION ..." 39

syphilis continue to furnish new diagnostic and therapeutic data of
untold value. Further experiments and demonstrations are fostered
at the National Institute of Health; the Venereal Disease Research
Laboratory at Staten Island, New York; and the Venereal Disease
Medical Center, Hot Springs National Park, Arkansas all notably
significant in the whole national program aimed at the reduction, and
eventual elimination, of syphilis and gonococcal infections in the
United States.

When, as is hoped and confidently believed, the "great
pox ' ' syphilis becomes as rare as smallpox in our country, and
the ravages of the gonococcus are reduced to a tiny fraction
of their present extent, a lion's share of the credit logically
must be accorded to the Division of Venereal Diseases.



"The venereal diseases are not problems for solution tomorrow. They
must be dealt with today. We inherited them from yesterday. With that
heritage came the knowledge and experience on which to base united and
vigorous wartime action. Fortunately, today's public leaders understand
what must be done, thanks to the constructive publicity which has been
given the united efforts for venereal disease control of the government
and voluntary agencies with the leadership of Dr. Thomas Parran, U. S.
Public Health Service. Laboratory tests, medical examinations, facilities
and drugs for treatment, tracing of contacts and sources of infection,
reporting of cases and quarantine when necessary, have become recognized
parts of the established public health and medical program for combating
syphilis and gonorrhea. . . . There must be a program of long range pre-
ventive measures. These have to do with environmental and educational
factors. Opportunities for satisfying occupation and recreation, for mar-
riage and having children, good living conditions, community protection
against anti-social exploitation are necessary. Vigorous law enforcement
measures against prostitution are essential. Sexually promiscuous persons
are especially likely to become infected or to be transmitters of syphilis or
gonorrhea, so prophylactic treatment facilities need to be provided under
proper supervision and follow-up precautions. The influence of education
and the teachings of religion also are vitally important. . . . Recently the
New York State Medical Society adopted the following position which
is a forceful restatement of views generally held by leaders of the medical
profession: First: That the control of venereal disease requires elimina-
tion of commercialized prostitution. Second: That medical inspection
of prostitutes is untrustworthy, inefficient, gives a false sense of security,
and fails to prevent the spread of infection. Third: That commercialized
prostitution is unlawful, and that physicians who knowingly examine
prostitutes for the purpose of providing them with medical certificates
to be used in soliciting are participating in an illegal activity and are
violating the principles of professional conduct of the Medical Society
of the State of New York.



Online LibraryAmerican Social Hygiene AssociationJournal of social hygiene (Volume 28) → online text (page 6 of 71)