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A study of advances in the control of syphilis

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A STUDY OF ADVANCES
IN THE CONTROL OF SYPHILIS
A T h esis
P re se n te d to
th e F a c u lty of th e School o f E d u c a tio n
U n i v e r s i t y o f S o u th e r n C a l i f o r n i a
In P a r t i a l F u lfillm e n t
o f t h e R e q u ir e m e n ts f o r t h e D egree
M a s te r o f S c ie n c e i n E d u c a t i o n
by
R oss L a v i o l e t t e
F e b r u a r y 1941
UMI Number: EP54060
All rights reserved
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UMI EP54060
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789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, Ml 48106- 1346
Th is thesis, w ri tt en under the direction of the
Chairman of the candidatefs Gui dan ce C o m m i t t e e
and a p p r o v e d by all me m be rs of the C o m m it te e ,
has been pr es e nt e d to and ac ce pte d by the F ac u lty
of the Sc h o o l of E duc a tio n in pa rt ia l fu lfillment
of the requirements f o r the degree of M a s t e r of
Science in Education.
Date
j.1941
D ean
Guidance C om m ittee
Win. R, LaPorte
Chairman
Wm. G-. Campbell
Lloyd E. Webster
TABLE OF CONTENTS
CHAPTER
I.
II.
PACE
INTRODUCTION.................................................................................
1
The p u r p o s e o f t h e I n v e s t i g a t i o n . • ........................
2
I m p o rta n c e o f t h e p r o b le m ................................................
3
Method o f p r o c e d u r e ..............................................................
7
R e l a t e d i n v e s t i g a t i o n ........................ . ............................
8
O r g a n i z a t i o n o f r e m a i n i n g c h a p t e r s ........................
10
HISTORY. . . ...................................................
S o u rc e o f s y p h i l i s
............................
13
E a rly s y p h ilis
...........................................
16
.............................
17
T h e o r i e s o f t h e o r i g i n o f s y p h i l i s ........................
17
I n f l u e n c e o f th e d i s e a s e ..........................................
19
E a r l y c u r e s f o r t h e d i s e a s e ...........................................
20
R e s e a r c h i n t h e f i e l d .................................
22
The nam ing o f th e d i s e a s e .
S y p h i l i s i n t h e U n ite d S t a t e s .
III.
12
...................
25
S y p h i l i s an d t h e N e g r o ....................................................
27
E a r ly a t te m p ts t o c o n t r o l th e d i s e a s e .
. . . .
28
War tim e e f f o r t s t o c o n t r o l s y p h i l i s . . . . .
29
War tim e c o n t r o l s s h o r t - l i v e d ......................................
32
THE PROPOSED PROGRAM OF THE FEDERAL
GOVERNMENT, PRESENT AND FUTURE PLANS . . . . .
34
F i n a n c i a l a i d o f f e r e d t o t h e s t a t e s ........................
35
iii
CHAPTER
PAGE
B ases o f a l l o c a t i o n o f fu n d s . . . . . . . . .
56
A lig n m e n t o f s t a t e and l o c a l c l i n i c s
. . . . .
37
C l i n i c s m ust a d m it v e n e r e a l p a t i e n t s
. . . . .
38
.............................
39
E lim in a tio n of q uackery. . . •
IV.
CONTROL OF SYPHILIS IN CALIFORNIA.......................
Funds a v a i l a b l e t o C a l i f o r n i a .
. • • • • • • •
...................
B u re a u o f V e n e r e a l D is e a s e
D u t i e s o f mem bers.
. .
............................................................
43
43
45
45
Use o f f u n d s ............................................................................
47
Growth o f c l i n i c a l a c t i v i t i e s .
.............................
48
S t a t e a i d s t o p r i v a t e p h y s i c i a n s .............................
49
P la n s f o r th e f u tu r e a s s e t f o r t h by th e
Com m ittee on V e n e r e a l D i s e a s e C o n t r o l . . .
V.
52
THE INCIDENCE AND CONTROL OF STPHILIS IN
LOCAL COMMUNITIES...................................................................
53
Los A n g e le s .
53
.
...................................................................
San D ie g o
San F r a n c i s c o .
• • . • • • • • • •
M o n te re y C o u n ty
C a m a r il lo S t a t e H o s p i t a l
• • • •
65
........................
67
• • • • •
69
. . .
74
P a t t o n S t a t e H o s p i t a l .........................................................
75
M endocino S t a t e H o s p i t a l • • • • • • • • • • •
75
Agnew S t a t e H o s p i t a l ................................
76
Napa S t a t e H o s p i t a l
76
. . . • • • •
iv
CHAPTER
PAGE
N orw alk S t a t e H o s p i t a l .....................................
V I.
. . ♦
SUMMARY AND CONCLUSIONS...................................................
.
76
78
Summary.....................................
78.
C o n c l u s i o n s .................................................................................
81
BIBLIOGRAPHY................................. .............................................................
86
L IS T OF TABLES
TABLE
PAGE
I.
Los
A n g e le s C i t y - C e n t r a l Men’ s C l i n i c
II.
L os
A n g e le s C i t y - C e n t r a l and B ran c h C l i n i c s
III.
Los A n g e le s C i t y -
. . . *
.
. .
T.
Los
A n g e le s C i t y - Women’ s W a tts C l i n i c C a s e s
VI*
Los
A n g e le s C i t y - S o c i a l S e r v i c e R e p o r t
(ViIomen)...................................................
V III.
57
Los A n g e le s C i t y - Women’ s C e n t r a l C l i n i c
C a s e s . .................................................
V II.
56
S o c i a l S e r v i c e R e p o r t (Men)
A l l C l i n i c s ...................................................................... . . .
IT .
55
.
59
62
64
San D iego C i t y - V e n e r e a l D is e a s e C l i n i c . . . .
66
M ig h t C l i n i c s .............................................................................
68
CHAPTER I
INTRODUCTION
S y p h i l i s i s a com m unicable d i s e a s e !
I t i s s im ila r to
o th e r d is e a s e s o f t h i s n a t u r e — sm a ll pox, d i p h t h e r i a , ty p h o id ,
and th e common c o l d — i n t h i s r e s p e c t , t h a t i t h a s no r e g a r d
f o r c la s s d i s t i n c t i o n , r e l i g i o n , m o ra ls, o r f i n a n c i a l s ta n d in g .
I t i s n o t p e c u l i a r t o an y one r e g i o n o r l o c a l i t y .
i s man.
I ts host
I t i s o n l y w i t h t h e g r e a t e s t o f c a r e t h a t i t can be
t r a n s m i t t e d t o a n i m a l s , su c h a s t h e c h im p a n z e e , by t h e i n o c ­
u l a t i o n o f the' human v i r u s .
The c o m p le x i ty o f th e m odern c i v i l i z a t i o n i n w h ich
man l i v e s d o e s n o t p e r m i t one c o u n t r y t o be e n t i r e l y in d e p e n d ­
e n t o f o t h e r c o u n t r i e s any more t h a n i t a l l o w s one man t o be
e n t i r e l y in d e p e n d e n t o f a l l h i s f e l l o w men.
He m u s t, p e r ­
f o r c e , c o n t a c t many d i f f e r e n t p e o p le o f a l l c l a s s e s t h r o u g h o u t
t h e c o u r s e of a y e a r .
I t I s th ro u g h th e s e v a r io u s c o n t a c t s ,
some c a s u a l , o t h e r s i n t i m a t e , t h a t he i s s u b j e c t e d t o t h e
v a r i o u s fo rm s o f com m unicable d i s e a s e .
I t is th ro u g h th e se
c o n t a c t s t h a t d i s e a s e s p a s s fro m one c l a s s t o a n o t h e r .
An o b v io u s i l l u s t r a t i o n o f t h e s p r e a d o f d i s e a s e i s
t h e s p r e a d o f th e common c o l d .
VJho was r e s p o n s i b l e f o r th e
f i r s t c o l d we do n o t know, n o r i s i t t o o i m p o r t a n t .
The
i m p o r t a n t f a c t i s t h a t no o n e , r i c h o r p o o r , c a r e f u l o r
c a re le ss,
i s a b s o l u t e l y immune.
So i t i s w i t h s y p h i l i s .
2
S y p h i l i s i s a v e n e r e a l d i s e a s e a n d c a n be s p r e a d by c o n t a c t
w i t h a p e r s o n vrho h a s b e e n i n n o c e n t l y i n f e c t e d .
l e s s t o a c c u s e one a n o t h e r o f o r i g i n a t i n g i t .
I t is use­
The p la g u e i s
h e r e and t h e r e s p o n s i b i l i t y f o r i t s c o n t r o l i s one common to
a l l men.
I.
THE PURPOSE OF THE INVESTIGATION
The p u rp o s e o f t h e i n v e s t i g a t i o n w i l l be t o make a
s u r v e y o f th e v a r i o u s p ro g ra m s o f f e r e d by th e F e d e r a l G o vern ­
ment and by th e S t a t e o f C a l i f o r n i a i n a n a t t e m p t t o c o n t r o l
th e d i s e a s e , s y p h i l i s .
fo llo w in g :
E m p h asis w i l l be p l a c e d upon t h e
(1) p r e v a l e n c e o f t h e d i s e a s e ;
p r o p o s e d b y th e F e d e r a l G overnm ent;
(2) t h e p ro g ra m
(3) t h e f i n a n c i a l a i d
t h a t th e F e d e r a l Government o f f e r s th e v a r i o u s s t a t e s i n a n
a t t e m p t t o make t h e i r p ro g ra m s e f f e c t i v e ;
(4) t h e p ro g ra m
w h ich t h e S t a t e o f C a l i f o r n i a i s f o l l o v / i n g ;
(5) how t h i s
p ro g ra m c o i n c i d e s w i t h t h e p ro g ra m o f th e F e d e r a l G overnm ent;
(6) how t h e S t a t e o f C a l i f o r n i a f i n a n c e s i t ’ s p ro g ra m ;
t h e p ro g ra m i s a d m i n i s t e r e d ;
o b ta in e d ;
(7) how
(8) r e s u l t s t h a t th e S t a t e h a s
(9) how t h e c i t i e s and d i s t r i c t s have f i t t e d
in to
th e g e n e ra l p ro g ram s.
The w r i t e r w i l l n o t a t t e m p t a d i s c u s s i o n o f t h e c a u s e
o f th e d i s e a s e , n o r t h e e f f e c t , o t h e r t h a n i s n e c e s s a r y t o
g iv e a c l e a r u n d e r s t a n d i n g o f th e m a t e r i a l p r e s e n t e d .
3
II*
IMPORTANCE OF THE PROBLEM
S y p h i l i s i s a n a t i o n a l p r o b le m !
I t has ta k e n p re c e ­
d en c e o v e r a l l t h e d r e a d e d com m unicable d i s e a s e s , i n c l u d i n g
t u b e r c u l o s i s , s c a r l e t f e v e r , d i p h t h e r i a , e tc*
P a u l D eK ru if
s t a t e s t h a t , "T h ere a r e 1 ,0 0 0 ,0 0 0 new c a s e s o f s y p h i l i s e a c h
*1
y e a r i n t h e U n ite d S t a t e s . ttJ* I f t h i s f i g u r e i s c o r r e c t , t h e r e
a r e 2 ,7 3 9 new c a s e s a d a y , 114 c a s e s an h o u r , an d 1*7 new
c a s e s p er second.
A more c o n s e r v a t i v e e s t i m a t e i s g i v e n by
D r. F i s h b e i n , who s a y s , "T h ere a r e p r o b a b l y 6 8 1 ,0 0 0 new
c a s e s o f s y p h i l i s i n t h e U n i t e d S t a t e s e a c h y e a r . "2
H ow ever,
he h a s t e n s t o s a y , "M oreover i t i s shown t h a t s t a t i s t i c s a r e
n o t r e a l l y r e l i a b l e b ecause o f th e ta b o o s a g a i n s t th e d i s e a s e ,
a n d i t s h id d e n c h a r a c t e r .
S y p h i l i s t h r e a t e n s t o become t h e " G r e a t A m erican
D ise a se ."
D r. P a r r a n , U. S . S u rg e o n G e n e r a l , r e f e r s t o i t
as:
A p la g u e t h a t d o e s a h u n d re d t i m e s a s much damage a s
t h e d r e a d e d i n f a n t i l e p a r a l y s i s ; a p la g u e t h a t i s w re e k ­
in g homes an d f i l l i n g i n s t i t u t i o n s a l l o v e r th e l a n d
w i t h i t s i n s a n e , b l i n d , f e e b l e - m i n d e d o r -unemployable
v ic tim s—th a t is s y p h ilis .*
^ P a u l D e K r u if, " E n l i s t i n g Women A g a i n s t Sham e," K en.
1 : 2 9 , A p r i l 7 , 1 9 38 .
^ M o r ris F i s h b e i n . S y p h i l i s
McKay and Company, 1 9 3 7 ; , p . 2 7 .
(P h ila d e lp h ia :
D avid
^ L o c. c i t .
^Thomas P a r r a n , "Why Don’t We Stamp Out S y p h i l i s ? "
R e a d e rs D i g e s t . 2 9 : 6 5 , J u l y , 1 936.
4
S y p h i l i s d o e s n o t l i m i t i t s a c t i v i t y t o th e c e n t r a l
n e r v o u s s y s te m , n o r t o an y o t h e r r e g i o n o f th e b o d y .
One
o f th e w o r l d ’ s m o st fam ous p h y s i c i a n s , S i r W i llia m O s i e r ,
c a l l e d s y p h i l i s t h e " G r e a t I m i t a t o r " ; he m a i n t a i n e d t h a t i f
a p h y s i c i a n u n d e r s t o o d s y p h i l i s i n i t s many r a m i f i c a t i o n s ,
he w ould s u r e l y u n d e r s t a n d c l i n i c a l m e d i c i n e .
T h erefo re,
one i s n o t s u r p r i s e d t o l e a r n t h a t s y p h i l i s i s r e s p o n s i b l e
f o r v a r i o u s a i l m e n t s and d e a t h s .
To i l l u s t r a t e
th is s ta te ­
m e n t, D r. P a r r a n s a y s :
Of t h e 1 6 0 ,0 0 0 A m eric an s w i t h c a r d i o v a s c u l a r s y p h i l i s
4 0 ,0 0 0 d ie e a c h y e a r . A d e a t h r a t e o f one i n f o u r .
Of
t h e 2 ,5 4 0 ,0 0 0 A m e ric a n s w i t h o t h e r t y p e s o f h e a r t d i s e a s e
2 7 3 ,3 0 0 d ie e a c h y e a r . A d e a t h r a t e o f one i n e i g h t and
a h a lf.
I t can be s t a t e d c o n s e r v a t i v e l y t h a t 10 t o 12
p e r c e n t o f a l l d e a t h s fro m h e a r t d i s e a s e a r e due t o
c a r d i o v a s c u l a r s y p h i l i s , th o u g h i t p r o b a b l y o n l y a c c o u n t s
f o r 6 .5 p e r c e n t o f t o t a l r e c o g n i z e d c a s e s .
We have a s s e m b le d i n f o r m a t i o n a l s o on th e p r o p o r t i o n
o f p a t i e n t s w i t h l a t e n t an d l a t e s y p h i l i s who have c a r d ­
i o v a s c u l a r s y p h i l i s show ing t h a t among 1 7 ,6 0 6 p a t i e n t s ,
2 ,0 9 4 o r 12 p e r c e n t s u f f e r e d fro m t h i s c o m p l i c a t i o n . 5
I t s h o u ld be p o i n t e d o u t t h a t t h e r e a r e tw ic e a s many
new c a s e s o f s y p h i l i s a s o f s c a r l e t f e v e r .
T h irte e n tim e s
a s many c a s e s o f s y p h i l i s a r e r e p o r t e d a s o f d i p h t h e r i a ,
t w e n t y - e i g h t t i m e s a s many a s o f t y p h o i d , and one an d one
h a l f t i m e s a s many a s o f t u b e r c u l o s i s . ^
Y et m ost o f t h e
s y p h ilis c a se s .a re not re p o rte d .
^Thomas P a r r a n , Shadow on t h e Land (New Y ork:
an d H i t c h c o c k , 1 9 3 7 ) , p p . 6 0 - 6 1 .
6F i s h b e i n , o p . p i t . . p . 60.
R e y n al
5
D r. F i s h b e i n s a y s , ” I n t h e U n ite d S t a t e s i t
is best
t o e s t i m a t e t h a t 6 0 ,0 0 0 b a b i e s a r e b o r n e a c h y e a r w i t h c o n ­
g e n ita l s y p h il is .”7
The m ain b u l k o f th e d i s e a s e seems t o be d i s t r i b u t e d
among t h e u n d e r p r i v i l e g e d p e o p l e .
U n d o u b te d ly th e s o c i o ­
l o g i c a l f a c t o r s su c h a s h o u s i n g , s a n i t a r y c o n d i t i o n s , and
lo c a lity -a re
in p a r t r e s p o n s ib le f o r t h i s tr e n d in th e
d i s t r i b u t i o n o f th e d i s e a s e .
T h en , t o o , t h e p o o r man h a s
b e e n u n a b le t o s e c u r e c o n s i d e r a t e an d c o n t i n u o u s t r e a t m e n t
b e c a u s e o f h i s l a c k o f a d e q u a te f i n a n c e s and e d u c a t i o n .
A n o th e r f a c t o r w h ich w ould t e n d to f o r c e th e m ain b u l k
o f th e d i s t r i b u t i o n on t h i s end o f t h e s c a l e i s t h a t t h e w ork
t h a t h a s b e e n done i n t h e f i e l d o f r e s e a r c h h a s b e e n done e s ­
s e n t i a l l y on t h i s c l a s s l e v e l , b e c a u s e t h e s e p a t i e n t s c a n
n o t a f f o r d t o pay f o r t h e s e r v i c e s o f a p r i v a t e p h y s i c i a n .
The p a t i e n t w i l l o r d i n a r i l y g iv e a l l i n f o r m a t i o n d e ­
s i r e d by th e c l i n i c .
I f he s h o u ld r e f u s e t o g iv e t h e i n f o r ­
m a tio n t h e a u t h o r i t i e s w ould n o t h e s i t a t e t o ta k e f u l l a d ­
v a n t a g e o f t h e la w .
The p h y s i c i a n i n c h a rg e o f t h e c l i n i c
w ould be l e s s i n c l i n e d t o be u n e t h i c a l an d r e p o r t t h e
p a t i e n t as a n y th in g b u t a s y p h i l i t i c .
On t h e o t h e r h a n d ,
t h e p r i v a t e p h y s i c i a n m ig h t c o m p l e t e l y s h r o u d t h e c a s e w i t h
m y s t e r y and c l a s s i f y h i s p a t i e n t a s a c a r d i a c c a s e , o r a
7F i s h b e i n , l o c . c i t .
6
g a l l "bladder c a s e , d e p e n d in g p o s s i b l y upon t h e " s t a t u s ” o f
th e in d iv id u a l.
T h e r e f o r e , one c a n n o t be to o c e r t a i n t h a t
" n i c e p e o p l e " do n o t have s y p h i l i s .
N e v e rth e le s s , w ith a
know ledge a s t o t h e m o st l i k e l y d i s t r i b u t i o n o f t h e d i s e a s e ,
o u r p ro b le m s h o u ld be somewhat s i m p l i f i e d . .
th e p ro b le m o f d i s t r i b u t i o n ,
In c o n s id e rin g
i t i s w e l l t o b e a r i n mind t h a t
s y p h i l i s was unknown t o th e A f r i c a n N e g ro ; i t was a " g i f t "
t o him fro m t h e w h ite man.
D r. P a r r a n s a y s :
We know w here s y p h i l i s i s .
One h a l f o f t h e i n f e c ­
t i o n s o c c u r i n t h e age gro u p BO t o 30. L ik e t u b e r c u l o s i s ,
i t s t r i k e s a t t h e m ost v i g o r o u s and p r o d u c t i v e a g e , t h a t
o f th e wage e a r n e r , th e young p r o f e s s i o n a l man o r woman.
T h ere i s more o f i t among men, a t t h e r a t e o f 6 f o r e v e r y
4 women i n f e c t e d . T h ere i s s i x t i m e s a s much among
N eg ro s a s among w h i t e s . The c i t i e s show f o u r t i m e s a s
many i n f e c t i o n s a s th e r u r a l a r e a s .
Random s a m p le s have shown t h e r e l i e f r o l l s a r e l o a d e d
w i t h s y p h i l i s i n a l l s t a g e s . M cD aniel r e p o r t e d a n i n t e r ­
e s t i n g s t u d y w h ic h s o u g h t t o d e t e r m i n e t h e p r e v a l e n c e o f
t h e d i s e a s e among t h e unem ployed o f F u l t o n C o u n ty , G e o r g ia ,
an d t o compare t h e a b i l i t y t o e a r n a l i v i n g o f t h e s y p h i ­
l i t i c an d t h e n o n - s y p h i l i t i c .
Of t h e 6 ,9 1 1 r e l i e f a p p l i c a n t s , 1 ,3 1 1 o r 1 8 .9 p e r c e n t
w ere fo u n d t o h av e s y p h i l i s and t w o - t h i r d s o f t h e s e w ere
b e tw e e n BO an d 39 y e a r s o f a g e . Of th e N e g r o s , 34 p e r
c e n t a v e r a g i n g b o t h s e x e s w ere i n f e c t e d ; and 7 p e r c e n t
o f t h e w h i t e s , b o th s e x e s . T a k in g a l l fo rm s o f th e d i s e a s e
r e p r e s e n t e d i n t h e g r o u p , b o t h e a r l y and l a t e , i t was
fo u n d t h a t 40 p e r c e n t o f th e s y p h i l i t i c s were u n a b le t o
do a f u l l d a y f s w o rk . U n le s s t r e a t m e n t i s made a v a i l a b l e
f o r them t h e y may c o n s t i t u t e a c o n t i n u i n g l o a d upon home
r e l i e f . Among th o s e n o t i n f e c t e d many o t h e r d i s e a s e s
w ere f o u n d , a s was t o be e x p e c t e d , a c u t e and c h r o n i c .
A l l o f them t o g e t h e r , h o w ev er— t u b e r c u l o s i s , c a n c e r , r h e u ­
m a tis m , h e a r t d i s e a s e , p e l l a g r a , an d d o z e n s o f o t h e r s —
a c c o u n te d f o r o n l y BO p e r c e n t b e i n g u n a b le t o do a f u l l
d a y ’ s w o rk .8
8P a r r a n , Shadow on t h e L a n d , o p . c i t . , p p . 6 3 - 6 4 .
7
M a t e r i a l p e r t a i n i n g t o s u c h f a o t s c o u ld be p r e s e n t e d
alm o st i n d e f i n i t e l y .
Yet t h e y a l l p o i n t i n t h e same d i r e c ­
t i o n , t h a t s y p h i l i s i s more p r e v a l e n t t h a n a n y o t h e r communi­
c a b l e d i s e a s e , e x c e p t g o n o r r h e a an d t h e common c o l d .
c a n be no d o u b t t h a t , u n t r e a t e d ,
i t d o e s more damage t h a n a n y
o t h e r d i s e a s e t o t h e g r e a t e s t number o f i n d i v i d u a l s .
ta tiv e ly ,
T h ere
Q u a n ti­
in a l l o f i t s fo rm s, i t p ro b a b ly la y s a h e a v ie r
b u r d e n t h a n a n y o t h e r d i s e a s e upon th e com m unity.
Illi
METHOD OF PROCEDURE
V a r io u s m etho ds w ere u s e d i n g a t h e r i n g m a t e r i a l w hich
w ould be o f v a l u e i n m aking a s u r v e y o f t h e a d v a n c e s an d
p ro g ra m s u s e d i n t h e c o n t r o l o f s y p h i l i s .
Some o f t h e more
r e c e n t s c i e n t i f i c b o o k s w r i t t e n on th e s u b j e c t o f s y p h i l i s
were r e a d ; m a g a z in e s su c h a s , A m erican J o u r n a l o f P u b l i c
H e a l t h , H e a l t h News. R e s e a r c h Q u a r t e r l y . A m erican J o u r n a l o f
M e d i c i n e . an d t r a d e j o u r n a l s su c h a s , T h e r a p e u t i c N o t e s . The
L a b o r a t o r y . D r u g g i s t C i r c u l a r . B i o l o g i c a l B r i e f s , an d T i l e an d
T i l l . w ere c o n s u l t e d .
Many g o v e r n m e n ta l do cu m ents w ere o b ­
t a i n e d fro m t h e U. S . P u b l i c H e a l t h S e r v i c e , The S t a t e o f
C a l i f o r n i a , v a rio u s c i t i e s in th e S ta te o f C a l i f o r n i a and
sev eral ru ra l d is t r ic ts .
The i n v e s t i g a t o r was f o r t u n a t e
o b t a i n i n g p e r s o n a l i n t e r v i e w s w i t h v a r i o u s members o f t h e
Los A n g e le s B oard o f H e a l t h , an d a l s o w i t h t h e members o f
th e C a l i f o r n i a S t a t e B oard o f H e a l t h .
in
8
P erson al l e t t e r s
t o th e f o llo w in g :
i n q u e s t i o n n a i r e fo rm were w r i t t e n
H e a lth O f f ic e r s of th e c i t i e s o f E u re k a,
F r e s n o , K in g C i t y , Long B e a c h , Los A n g e le s , San F r a n c i s c o ,
S a c r a m e n to , S t o c k t o n , and San D ie g o , and t o t h e C ounty De­
p a r t m e n t f o r N o rw a lk , B e l l , and Downey; t o th e s e v e n S t a t e
I n s a n e I n s t i t u t i o n s i n C a l i f o r n i a ; t o t h e D e p a rtm e n t of
I n s t i t u t i o n s , S t a t e o f C a l i f o r n i a ; t o t h e D e p a rtm e n t o f
P u b l i c H e a l t h o f t h e S t a t e o f C a l i f o r n i a ; and t o D r, Thomas
P a r r a n , S u rg e o n G e n e r a l .
See C h a p te r V f o r th e q u e s t i o n s
a s k e d an d th e r e p l i e s r e c e i v e d .
In a d d i t i o n t o t h e s e , th e w r i t e r a l s o v i s i t e d s e v e r a l
c l i n i c s and in te rv ie w e d p r i v a t e d o c t o r s .
IV.
RELATED INVESTIGATIONS
S in c e t h e d i s c o v e r y o f a s p e c i f i c c u r e f o r t h e d i s e a s e
s y p h i l i s , n a m e ly , a rs p h e n a m in e a n d t h e h e a v y m e t a l s , m e rc u ry
a n d b is m u t h , much h a s b e e n w r i t t e n on th e s u b j e c t , s y p h i l i s .
The m a j o r i t y o f w r i t e r s have b e e n c o n c e r n e d s o l e l y
w i t h t h e c a u se o f th e d i s e a s e , th e c u r e s f o r t h e d i s e a s e ,
an d t h e e f f e c t o f th e d i s e a s e .
Most o f t h e w r i t e r s have
a tte m p te d to a c q u a in t th e in d iv i d u a l w ith th e g e n e ra l c h a ra c ­
t e r i s t i c s o f t h e d i s e a s e , and t o p o i n t o u t t h e n e c e s s i t y o f
e a rly tre a tm e n t.
V ery l i t t l e
h a s b e e n w r i t t e n on s y p h i l i s i n C a l i f o r n i a
r e g a r d i n g t h e number o f c a s e s an d t h e i r d i s t r i b u t i o n , o r on
9
t h e p ro g ra m w h ich t h e S t a t e o f C a l i f o r n i a f o l l o w s i n a t t e m p t ­
i n g t o c o n t r o l th e d i s e a s e .
H ow ever, a few s t u d i e s h ave b e e n
m ade.
O liv e N. G ib so n s a i d i n 1935:
A s t u d y o f d i s o r g a n i z a t i o n i n th e e l e m e n t a r y s c h o o l s
r e s u l t i n g fro m s y p h i l i s l e a d s u s t o b e l i e v e t h a t s y p h i l i s
i n t h e c h i l d i s t h e f o r e r u n n e r o f many e v i l s . E x a c t
s t a t i s t i c s of i t s p re v a le n c e a re n o t o b ta in a b le , bu t i t
i s e s t i m a t e d t h a t b e tw e e n one an d f i v e p e r c e n t o f a l l
school c h ild re n are i n f e c te d .9
A s u r v e y c o n d u c te d i n 1939 by Jo h n Few Simmons r e v e a l s
th a t:
✓
M e d ic a l p r a c t i t i o n e r s and g e n e r a l t e c h n i c i a n s a l l
seem t o a g r e e t h a t th e K lin e t e s t i n a l l i t s p h a s e s o f
p r e p a r a t i o n an d p e r f o rm a n c e r e q u i r e s a h i g h l y s k i l l e d
an d t h o r o u g h l y e x p e r i e n c e d t e c h n i c i a n , and t h e f a c t
r e n d e r s t h e t e s t n o t a s d e s i r a b l e a s th e L o u g h l i n t e s t ,
w h ic h c a n be p e r f o r m e d b y a s e m i - s k i l l e d t e c h n i c i a n an d
s t i l l m a i n t a i n a h ig h d e g r e e o f c o r r e l a t i o n w i t h r e s u l t s
o b t a i n e d fro m seru m t e s t e d s i m u l t a n e o u s l y b y a n y o t h e r
m e th o d .19
K im brough, C o w g il l, a n d Bowerman made a s t u d y i n
1938 on r u r a l s y p h i l i s :
The s p r e a d o f th e d i s e a s e may be c o n s i d e r e d a s h a v i n g
fo u r phases:
(1) i n i t i a l c a s e an d h i s i n f e c t i o n o f t h r e e
p r o s t i t u t e s ; (2) t h e s p r e a d c o n t a c t s o f th e t h r e e p r o s t i ­
t u t e s ; (3) t h e p a s s a g e o f th e d i s e a s e fro m t h o s e i n f e c t e d
by p r o s t i t u t e s , or o th e r s , p r i n c i p a l l y fa m ily c o n ta c ts ;
(4) u l t i m a t e b r i n g i n g u n d e r c o n t r o l o f a l l c a s e s w i t h
90 1 iv e N. G ib so n , " D i s o r g a n i z a t i o n i n t h e E le m e n ta r y
S c h o o ls R e s u l t i n g fro m S y p h i l i s , ” ( u n p u b lis h e d d i s s e r t a t i o n ,
The U n i v e r s i t y o f S o u th e r n C a l i f o r n i a , Los A n g e le s , 1 9 3 5 ) .
19 Jo h n Few Simmons, "A S u rv e y an d C om parison o f t h e
L o u g h l i n and K lin e R ap id S e r o d i a g n o s t i c T e s t s f o r S y p h i l i s , "
( u n p u b l i s h e d d i s s e r t a t i o n , The U n i v e r s i t y o f S o u t h e r n
C a l i f o r n i a , 1939).
10
c l o s e o f th e e p i s o d e and c e s s a t i o n o f s p r e a d o f d i s e a s e .
( T h is b r i e f h i s t o r y i l l u s t r a t e s t h e s t e p s n e c e s s a r y i n
t h e c o n t r o l o f t h e d i s e a s e i n r u r a l c o m m u n itie s .)
C o n c lu sio n s:
(1) c a r e l e s s i g n o r a n t t r a n s i e n t , when
i n f e c t e d , s h o u ld be r i g i d l y c o n t r o l l e d ; (2) g e n e r a l
p r a c t i t i o n e r s i m p o r t a n t i n a t t a c k on s y p h i l i s ; (3) i n ­
f e c t e d p e r s o n w i l l g e n e r a l l y s u p p l y names o f c o n t a c t s ; i f
t r e a t e d w ith c o n s id e r a tio n , th e y w i l l u s u a lly c o n tin u e
t r e a t m e n t ; (4) i n f e c t i o u s r e l a p s e o c c u r s e v e n a f t e r
tw e n t y t r e a t m e n t s ; i t i s n o t b e l i e v e d t h a t t h e y were new
i n f e c t i o n s ; (5) i f m ain s o u r c e i s b r o u g h t u n d e r t r e a t ­
m e n t, e p id e m ic comes t o a c l o s e ; (6) a l l c a s e s s h o u ld be
s t u d i e d fro m s t a n d p o i n t o f s o u r c e . 11
D r. P a u l 1 . H a n z l i k , o f th e S t a n f o r d U n i v e r s i t y
M e d ic a l s c h o o l , r e c e n t l y made a s t u d y t o d e v e lo p a s o l u b l e
b is m u th p r e p a r a t i o n i n t e n d e d f o r b o t h o r a l a n d i n t r a m u s c u l a r
a d m i n i s t r a t i o n in th e tr e a tm e n t o f s y p h i l i s :
T h i s o r a l rem edy c a n n o t be e x p e c t e d t o r e p l a c e com­
p l e t e l y t h e c a r e f u l l y s u p e r v i s e d u se o f o t h e r e s t a b l i s h e d
t h e r a p e u t i c a g e n t s . I t i s t o be e m p h a siz e d t h a t , w h ile
a n o r a l b is m u th p r e p a r a t i o n may i n some s i t u a t i o n s be
s u b s t i t u t e d i n w hole o r i n p a r t f o r a b is m u th p r e p a r a ­
t i o n a d m i n i s t e r e d i n t r a m u s c u l a r l y , i t c o u ld n e v e r s e r v e
a s an a d e q u a te s u b s t i t u t e f o r a l t e r n a t e c o u r s e s o f &rs e n i c a l s and b is m u th co m p ou nd s.12
Y.
ORGANIZATION OF REMAINING CHAPTERS
C h a p te r I I w i l l p r e s e n t a b r i e f h i s t o r y o f th e d i s e a s e ,
sy p h ilis.
11R. D. K im brough, D. M. C o w g il l, and E . P . Bowerman,
" R u r a l S y p h i l i s , a L o c a l i z e d O u tb r e a k ," A m erican J o u r n a l o f
P u b l i c H e a l t h , XXVIII ( J u n e , 1 9 3 8 ) .
12P a u l J . H a n z l i k , " S o b is m in o l Mass i n O ra l T r e a tm e n t
o f S y p h i l i s , " D r u g g i s t C i r c u l a r . LXXXIY, No. 1 ( J a n u a r y , 1 9 4 0 ) .
11
C h a p te r I I I w i l l be c o n c e r n e d w i t h th e p ro g ra m - t h a t
th e F e d e r a l Government h a s p r o p o s e d t o th e s e v e r a l s t a t e s .
The f o l l o ? / i n g p o i n t s w i l l be c o n s i d e r e d :
th e p r o p o s e d p r o ­
gram , f i n a n c i a l a r r a n g e m e n t s , and a d m i n i s t r a t i o n .
C h a p te r IV w i l l p r e s e n t m a t e r i a l d e a l i n g w i t h t h e
a t t e m p t t h a t t h e S t a t e o f C a l i f o r n i a h a s made t o c o n t r o l
th e d i s e a s e , s y p h i l i s .
The p o i n t s t o be c o n s i d e r e d a r e :
t h e p l a n o f t h e S t a t e p ro g ra m , i t s f i n a n c i n g , a d m i n i s t r a t i o n ,
and f u t u r e p l a n s .
The p ro g ra m s o f some o f th e c i t i e s w i l l
a l s o be d i s c u s s e d .
C h a p te r V w i l l d e a l w i t h th e q u e s t i o n n a i r e s s e n t o u t
d u r i n g t h e c o u r s e o f t h i s s t u d y an d t h e r e s p o n s e s r e c e i v e d .
C h a p te r VI w i l l g iv e t h e summary and c o n c l u s i o n s *
CHAPTER I I
HISTORY
No a t t e m p t w i l l be made t o p r e s e n t a c o m p le te h i s t o r y
of s y p h ilis .
How ever, en ou gh w i l l be p r e s e n t e d t o c o n v in c e
t h e r e a d e r t h a t th e d i s e a s e i s q u i t e a s much a n A m erican i n ­
h e rita n c e as i t i s a h e rita g e of a fo re ig n c o u n try .
T h is
s t a t e m e n t m ig h t a p p e a r t o be a m in o r p o i n t t o t h e c a s u a l
read er.
N e v e r t h e l e s s , t h i s a t t i t u d e a s su m e s d e f i n i t e s i g n i ­
f i c a n c e i f one c o n s i d e r s t h e p o l i t i c a l u n r e s t o f o u r d a y .
T here a r e , u n d o u b t e d l y many who b e l i e v e t h a t t h e
U n ite d S t a t e s w ould be f r e e fro m s y p h i l i s i f a l l a l i e n s were
d e p o rte d .
T h is c a n be i l l u s t r a t e d b y r e f e r r i n g t o a m e e tin g
o f D r. P a r r a n w i t h a c e r t a i n Mr. B l a n k .
The c o n v e r s a t i o n
t u r n e d t o t h e t o p i c o f s y p h i l i s an d Mr. B la n k p r o c e e d e d t o
t a k e D r. P a r r a n t o t a s k , p o l i t e l y , b u t v e h e m e n tly , f o r " s t i r ­
r i n g up a f u s s a b o u t so u n p l e a s a n t a s u b j e c t a s s y p h i l i s . "
T h ere may be a good d e a l o f i t , a s you s a y , b u t t a k e
my word y o u ’ l l f i n d t h e s e f i l t h y E u ro p e a n s b r o u g h t i t
o v e r , a l o n g w i t h communism. Now, my g r e a t - g r e a t g r a n d ­
f a t h e r f o u g h t on t h e C o n s t i t u t i o n ; a b l e - b o d i e d seam an,
d i e d o f h i s wounds a f t e r t h e b a t t l e w i t h C u e r r i e r e . L in e
comes r i g h t on down. C le a n A m erican s t o c k . Why s h o u ld
my w ife and d a u g h t e r hav e t o l i s t e n t o n a u s e a t i n g d e t a i l s
a b o u t t h i s h o r r i b l e d i s e a s e and why s h o u ld I s h e l l o u t
good t a x money t o t a k e c a r e o f t h e r e p r o b a t e s who have
it?
S h ip them b a c k t o E u rop e w here t h e y b e l o n g . I
-^Thomas P a r r a n , Shadow on t h e Land (New Y ork:
an d H i t c h c o c k , 1937) , p p . 7 3 - 7 4 .
Reynal
13
A few d a y s a f t e r t h i s m e e t i n g , D r. P a r r a n was b ro w s in g
th r o u g h some m a t e r i a l an d h a p p e n e d t o come a c r o s s t h e s h i p f s
M e d ic a l Log on th e ’’U. S . F r i g a t e C o n s t i t u t i o n . ”
The l o g
c o v e r e d more t h a n a y e a r p r o c e e d i n g t h e h i s t o r i c f i g h t a g a i n s t
t h e " G u e r r i e r e ” i n th e y e a r 1 8 1 2 .
D r. P a r r a n s a y s :
Y et one o f t h e names on t h e " C o n s t i t u t i o n ' s ” s h i p ' s
r e c o r d was t h a t o f th e g r e a t - g r e a t g r a n d f a t h e r B la n k ,
who h a d r e q u i r e d t r e a t m e n t f o r a p a r t i c u l a r l y w ic k e d
u l c e r ! A l l t h a t I c o u l d s a y t o Mr. B la n k i f he w ere t o
b r i n g up t h e s u b j e c t a g a i n i s t h a t h i s g r e a t g r a n d f a t h e r
was l u c k y t o have b e e n s i r e d b e f o r e th e h e r o o f t h e '
" C o n s titu tio n ” c o n tra c te d h is in f e c tio n , and, c ru e l
th o u g h i t may seem , t h a t t h e g r e a t - g r e a t g r a n d f a t h e r
d i e d o f h i s w o unds— t h e wounds o f a s y p h i l i t i c h e a l
b a d ly --b e fo re in f e c tin g h is fa m ily .^
Most d i s e a s e s app ear, s l o w l y i n m e d i c a l l i t e r a t u r e ,
b u t n o t so s y p h i l i s !
The h i s t o r y o f s y p h i l i s , s a y s P u s s e y , i s u n iq u e among
th e g r e a t d i s e a s e s i n t h a t i t d o e s n o t g r a d u a l l y em erge
i n t o t h e r e c o r d s o f m e d ic in e a s i t s c h a r a c t e r becom es
r e c o g n i z e d , b u t a p p e a r s on t h e s t a g e o f h i s t o r y w i t h a
d ra m a tic suddenness in k ee p in g w ith th e t r a g i c r e p u t a t i o n
i t h a s made, a s a g r e a t p la g u e sw e e p in g w i t h i n a few
y e a r s o v e r t h e known w o r l d . *
S o u rc e o f s y p h i l i s .
I t i s b e l i e v e d b y many m e d ic a l
h i s t o r i a n s t h a t s y p h i l i s was f i r s t i n t r o d u c e d i n t o E u ro p e by
members o f C olum bus1 c r e w .
I t i s b e lie v e d th a t th e y c o n tra c te d
th e d i s e a s e fro m th e W est I n d i e s women.
T here a r e t h o s e who
b e l i e v e t h a t Columbus h i m s e l f s u f f e r e d fro m th e d i s e a s e .
Kemble p o i n t s . o u t t h a t i n t h e e a r l y m on th s o f 14 9 4 , d u r i n g
p
P arran , lo c . c i t .
«%. A. P u s s e y , The H i s t o r y an d E p id e r m i o lo g y o f S yphilis
(S p rin g fie ld :
C. C. Thomas, 1 9 3 3 ) , p . 39.
14
h i s s e c o n d voyage t o t h e new w o r l d , "he b eg a n t o have a t t a c k s
o f f e v e r ; p o s s i b l y t h i s was th e f i b r i l s e c o n d a r y s t a g e o f
s y p h i l i s , ”^
D u rin g h i s se c o n d c r o s s i n g he was s u p p o s e d t o have
d e v e lo p e d a s e v e r e c a s e o f t h e g o u t . '
The' i n f l a m a t i o n was
n o t c o n f i n e d t o one o r tw o j o i n t s , b u t r a m i f i e d th r o u g h o u t
th e b o d y .
I t i s a l s o c h a r g e d t h a t he b e g a n t o show s i g n s o f
m e n t a l d i s o r d e r , and t h a t he came t o r e g a r d h i m s e l f a s t h e
"A m bassador o f G o d .”
T hese symptoms c o u l d h a r d l y be t h e
r e s u l t of th e g o u t.
I f Columbus d i d d i s p l a y th e above sym ptom s, B o b a d i l l a ,
t h e n ew ly a p p o i n t e d G o v erno r o f th e I s l a n d s , was j u s t i f i e d
i n s e n d i n g him b a c k t o S p a in i n c h a i n s .
Columbus was a s i c k man when he made h i s t h i r d t r i p .
He r e t u r n e d t o S p a in i n 1 5 0 4 , so i l l t h a t he had t o be c a r ­
r i e d a s h o r e , h i s w hole bod y was r e p o r t e d to h ave b e e n d r o p ­
s i c a l fro m t h e c h e s t downward, a c o n d i t i o n w h ic h i s s i m i l a r
t o an i n j u r y o f t h e v a l v e s o f t h e h e a r t , h i s lim b s p a r a l y z e d ,
and h i s b r a i n a f f e c t e d .
sy p h ilis.
T hese a r e a l l symptoms o f l a t e
Columbus d i e d on May 2 0 , 1 5 0 6 .
The h i s t o r i a n s g iv e f u r t h e r s u p p o r t t o t h e i r t h e o r y
b y p o i n t i n g o u t t h a t p r i o r t o th e y e a r 1493 t h e r e w ere no
books o r a r t i c l e s w r i t t e n about th e d is e a s e .
The d i s e a s e
was o b s e r v e d among t h e S p a n is h t r o o p s s e n t b y F e r d in a n d and
K em ble, I d o l s and I n v a l i d s (New Y ork:
D oran an d Company, I n c . , 1 9 3 6 ) , p . 4 3 .
D o ub leday
I s a b e l t o h e l p A lp h on so I I o f N a p le s a g a i n s t t h e i n v a d i n g
arm y o f C h a r l e s V I I I o f F r a n c e .
t o c l a i m t h e th r o n e o f N a p l e s .
C h a r l e s V I I I was a t t e m p t i n g
He h ad em ployed a n arm y o f
a p p r o x i m a t e l y 5 0 ,0 0 0 m e rc e n a r y a d v e n t u r e r s .
t h i s army w a s, u n d o u b t e d l y , F r e n c h .
The m a j o r i t y o f
How ever, t h e r e w ere
G erm ans, S w is s , A u s t r i a n s , E n g l i s h and I t a l i a n s among them .
T h is arm y e n t e r e d N a p le s on F e b r u a r y 23, 1 4 95 , a f t e r t h e
f l i g h t o f th e S p a n i a r d s .
C h a r l e s ’ arm y, s u p p o s e d l y , fo u n d
t h e c i t y a l r e a d y p e r m e a te d w i t h s y p h i l i s .
The t h e o r y i s
t h a t t h e d i s e a s e s p r e a d r a p i d l y among t h e i n v a d e r s .
In th e
m i d s t o f t h e p e s t i l e n c e C h a r l e s r e c e i v e d word t h a t he was t o
be a t t a c k e d by a c o a l i t i o n o f I t a l i a n s .
He a n d h i s army
r e t r e a t e d t o F ra n c e and a t t h i s p o i n t th e arm y was d i s c h a r g e d .
They p r o c e e d e d t o c a r r y t h e d i s e a s e w i t h them t o t h e f a r c o r ­
n e r s o f W e s te rn E u r o p e .
T h ere w ere r e p o r t s o f t h e d i s e a s e
i n Germany and S w i t z e r l a n d th e same y e a r .
D r. P a r r a n s a y s ,
We know t h a t i n 1496 th e d i s e a s e a p p e a r e d i n P a r i s
w here t h e number o f v i c t i m s grew so g r e a t t h a t p a r l i a ­
m ent p a s s e d a d e c r e e t h a t a s y p h i l i t i c s h o u ld n o t l e a v e
h i s home u n t i l c o m p l e t e l y c u r e d ; t h a t t h e h o m e le s s p o o r
s h o u ld be c o n s ig n e d t o th e b o ro u g h o f S t . G erm ain o u t ­
s i d e t h e w a l l s o f P a r i s ; a n d t h a t th e i n f e c t e d f o r e i g n e r s
s h o u ld be f o r c e d t o le a v e t h e c i t y w i t h i n t w e n t y - f o u r
h o u rs .5
I t i s b e l i e v e d t h a t Vasco de Gama an d h i s crew c a r r i e d
s y p h i l i s a r o u n d th e Cape o f Good H ope.
An o u t b r e a k r e p o r t e d
i n I n d i a i n 1498 h a d s p r e a d e a s t w a r d t o C hina b y 1 50 5 .
^ P a r r a n , oj>. c i t . , p . 34 .
16
E a rly s y p h i l i s .
T hese e a r l y v i c t i m s s u f f e r e d " h o r r o r s "
¥?hich a r e a l m o s t unknown t o d a y .
T h e i r symptoms w ere q u i t e
d e f i n i t e h e a d - a o h e s , t e r r i b l e s o r e s , bone u l c e r s , h i g h f e v e r
and p a i n s i n t h e b o n e s .
th e s e c o n d a r y s t a g e s .
D e a th was more o r l e s s common d u r i n g
T h is s ta g e to d a y i s r a t h e r m ild ,
w h ic h , i n c i d e n t a l l y , h a s i n c r e a s e d t h e d a n g e r o f t h i s s t a g e
of sy p h ilis.
The v i o l e n c e o f t h e e a r l y ty p e o f s y p h i l i s
m ig h t be a t t r i b u t e d t o t h e l a c k o f a b u i l t up im m u n ity , o r
t h e v i r u l e n c e m ig h t have b e e n e x c e p t i o n a l .
I t i s an e s t a b ­
l i s h e d f a c t t h a t "new" d i s e a s e s do w ork h a v o c .
T h is i s b o r n
o u t by r e v i e w i n g t h e e f f e c t o f t u b e r c u l o s i s on t h e N eg ro s
and E sk im o s , o r t h e e f f e c t o f m e a s le s on t h e S o u th Sea
I s l a n d e r s , when t h e s e d i s e a s e s w ere f i r s t c o n t r a c t e d by
th e se g ro u p s.
The d i s e a s e was v e r y c o n t a g i o u s .
I t s p r e a d th r o u g h
v e n e r e a l c o n t a c t , an d t h r o u g h t h e o r d i n a r y p r o c e s s o f l i v i n g .
The s c i e n t i f i c w o r ld o f t h e day was q u i t e u n p r e p a r e d t o be
o f any r e a l a s s i s t a n c e .
I t t u r n e d w i t h hope to w a r d H ip p o ­
c r a t e s , and t o G a le n ic p h i l o s o p h y .
s ta r s fo r h e lp .
They e v e n lo o k e d t o th e
S i g e r is t says t h a t
in th e o p in io n o f th e a s t r o l o g e r s th e c o n ju n c tio n o f
p l a n e t s S a t u r n and J u p i t e r i n t h e Z o d ia c o f S c o r p io on
November 2 5 , 1 4 9 4 , was c o n s i d e r e d o f g r e a t im p o rta n c e
as i n d ic a t in g th e approach o f a s e x u a l p la g u e .b
^H. e . S i g e r i s t , S o c i a l i z e d M e d ic in e i n t h e S o v i e t
U nion (New Y ork: W. W. N o r t o n , 1 9 3 7 ) , P • 3 6 .
17
The nam ing o f th e d i s e a s e .
d i d n o t have a s p e c i f i c name.
co u n try .
To b e g i n w i t h , s y p h i l i s
E ac h c o u n t r y blam ed some o t h e r
H ow ever, i t became g e n e r a l l y known a s t h e " F re n c h
s i c k n e s s , " w h ich name i t r e t a i n e d f o r a lm o s t a c e n t u r y .
The
name, s y p h i l i s was a c q u i r e d when a n I t a l i a n p h y s i c i a n , F r a c a s t o r , who i n 1530 w ro te a poem a b o u t i t ,
C h a r a c t e r i n t h e poem t h e name S y p h i l i s .
gave t h e l e a d i n g
He was s t r i c k e n
w i t h t h e d i s e a s e b e c a u se o f a n i n s u l t t o A p o l l o .
The poem
was v e r y s u c c e s s f u l and S y p h i l i s became known t o a l m o s t
every o n e.
" I t was a c c e p t a b l e , " s a y s Abraham o f t h e name,
" b e c a u s e i t was a new w o rd , c a s t i n g no a s p e r s i o n s upon a n y
n a tio n ." 7
T h e o r i e s o f th e o r i g i n o f s y p h i l i s .
The t h e o r y t h a t
t h e d i s e a s e o r i g i n a t e d i n A m erica g a i n s f u r t h e r s u p p o r t fro m
th e f i n d i n g s o f th e p a l e o p a t h o l o g i s t s , who o f f e r a s e v i d e n c e
t h e s k u l l s and lo n g b o n es o f t h e I n d i a n s , t a k e n fro m b u r i a l
s i t e s o f t h e p re - C o lu m b ia n p e r i o d .
s u p p o s e d l y , q u i t e n u m e ro u s.
T hese f i n d i n g s a r e
T hey h ave b e e n t a k e n fro m
vd.del y s e p a r a t e d a r e a s , New M ex ico , T e n n e s s e e , P e r u , an d
A rg e n tin a .
I n t h e E a s t e r n H em isp h ere r e l a t i v e l y few b o n e s
have b e e n fo u n d t h a t g iv e t h e s l i g h t e s t i n d i c a t i o n t h a t t h e y
m ig h t have b een s y p h i l i t i c .
E l l i o t t S m ith h a s ex a m in e d
a p p r o x i m a t e l y 3 0 ,0 0 0 b o d i e s o f a n c i e n t E g y p t i a n s an d N u b ia n s ,
7J . J . Abraham, I n t r o d u c t i o n t o F r a c a s t o r on S y p h i l i s
(London: Wm. Hinemann, 1 9 3 5 } , p . 3 7 .
18
w h ic h r e p r e s e n t e d p r a c t i c a l l y e v e r y p e r i o d o f E g y p t i a n h i s ­
t o r y f o r t h e p a s t 60 c e n t u r i e s , a l s o e v e r y p a r t o f t h a t
co u n try .
Mr. S m ith s a y s t h a t ,
" i t ca n be s t a t e d c o n f i d e n t l y
t h a t no t r a c e w h a te v e r s u g g e s t i n g s y p h i l i t i c
i n j u r y t o bone
o r t e e t h was r e v e a l e d i n E g y p t b e f o r e m odern t i m e s ." ®
O t h e r s , n am ely S u d h o f f i n E u rop e an d Holcomb i n A m e ric a ,
b e lie v e th a t i t is q u ite
im p ro b a b le t h a t Columbus * c re w c o u ld
have s p r e a d t h e d i s e a s e so r a p i d l y .
The a lm o s t u n i v e r s a l
r e p o r t o f th e d i s e a s e t h e y a t t r i b u t e t o a n e x tre m e e p i d e m i c ,
an d t o t h e c o n f u s e d t e r m i n o l o g y w h ic h e x i s t e d a t t h e t i m e ,
i n r e g a r d t o t h e v a r i o u s p e s t s , p e s t i l e n c e s an d c o n t a g i o n s .
Some s i g n i f i c a n c e i s a t t a c h e d t o t h e f a c t t h a t 1 9 ,0 0 0
l e p e r s w ere t u r n e d l o o s e b y t h e O rd e r o f S t . L a z a r u s .
I t is
b e l i e v e d t h a t t h e y w ere r e s p o n s i b l e f o r a n a l l e g e d o u t b r e a k
of s y p h ilis.
I t i s a l s o b e l i e v e d t h a t t h e 1 5 t h c e n t u r y was
a n i d e a l tim e f o r t h e s p r e a d o f a l l d i s e a s e s , i n c l u d i n g
s y p h i l i s , because o f th e a rm ie s t h a t d r i f t e d o v e r E u ro p e,
an d t h e v e rm in o u s l i v i n g c o n d i t i o n s .
The i n t i m a t i o n d u r i n g t h e s i x t e e n t h c e n t u r y t h a t t h e
d i s e a s e o r i g i n a t e d i n t h e new w o rld i s a s c r i b e d t o a commer­
c i a l m o t i v e .-
A d e f i n i t e e f f o r t was made t o s e l l q u a n t i t i e s
o f " h o l y w ood," o f t h e W est I n d i e s , a s a c u r e f o r s y p h i l i s .
The t h e o r y was t h a t t h e " d i v i n e p r o v i d e n c e " m e r c i f u l l y
® P a rra n ,
0£
. c i t . . p . 37.
19
p r o v i d e d t h e a n t i d o t e f o r a d i s e a s e so i n f l i c t e d , a t t h e
p l a c e w here t h e d i s e a s e ’ o r i g i n a t e d .
D r• P a rra n s a y s :
I t i s p o s s i b l e t h a t f a r b ac k i n t h e dim p a s t b e f o r e
t h e tim e o f r e c o r d e d h i s t o r y , a sa v a g e w ad in g i n a
s t r e a m i n t h e t r o p i c s , t h r o u g h some s c r a t c h o r b r e a k i n
h i s s k i n , p r o v i d e d a p l a c e f o r th e f i r s t w i g g l i n g a n ­
c e s t o r o f th e s p i r o c h e t e . 9
The above i s p o s s i b l y a s good a s a n y t h e o r y a s t o t h e
o r i g i n o f th e s p i r o c h e t e .
T here i s u n d o u b te d ly a n a d a p t i v e
e v o l u t i o n o f germ l i f e a s t h e r e seems t o be i n human l i f e .
I t w ou ld be r a t h e r d i f f i c u l t t o d e te r m in e t h e a d a p t i v e s t a g e s
th r o u g h w h ic h t h e s p i r o c h e t e h a s p a s s e d .
H ow ever, i t
is
known t h a t t h e s p i r o c h e t e h a s u n d e rg o n e a s e l e c t i v e a d a p t a ­
t i o n c h o o s in g mueousmembranes o f t h e g e n i t a l s w here i t h a s
th riv e d .
I n flu e n c e of th e d i s e a s e .
S y p h ilis has a f f e c te d
n a t i o n s i n more ?/ays t h a n t h e d i r e c t s u f f e r i n g i t b r i n g s
its e lf.
F o r e x a m p le , t h e f i r s t w if e o f K ing H enry V I I I , o f
E n g la n d , C a t h e r i n e o f A ra g o n , b o r e him f o u r c h i l d r e n , a l l
s t i l l - b o r n o r d y in g so o n a f t e r b i r t h , b e f o r e t h e b i r t h o f
h e r s i n g l e l i v i n g c h i l d , a g i r l , who was t o r u l e a s " b lo o d y
M a ry .”
I t seems q u i t e p o s s i b l e t h a t t h i s c h i l d was b o rn a
sy p h ilitic .
She i s d e s c r i b e d a s b e i n g p r e m a t u r e l y o l d an d
s c a r r e d , h e r h a i r was t h i n , g i v i n g t h e a p p e a r a n c e o f b e i n g
9I b i d . , p . 4 0 .
20
m o t h - e a t e n , h e r head was s q u a re w i t h a p r o t r u d i n g f o r e h e a d ,
h e r s i g h t was e x t r e m e l y h a d , a c o n d i t i o n p o s s i b l y due t o
in te rs titia l k e ra titis .
H er su d d e n d e a t h a t t h e age o f f o r t y
was s u p p o s e d ly due t o a s y p h i l i t i c a n e u ry s m .
H en ry F i l l ’ s
d i s a p p o i n t m e n t w i t h t h e i n a b i l i t y o f h i s w if e t o p r e s e n t him
w ith a son p o s s i b ly le d to h i s in s i s te n c e of th e l e g a l i t y o f
h i s s e c o n d m a r r i a g e , w h ic h p r e c i p i t a t e d t h e b r e a k w i t h t h e
Roman C a t h o l i c C h u rc h , an d a l l i t s r e p e r c u s s i o n s i n E n g l i s h
h isto ry .
Kemble comments, ” 0 f H e n r y ’ s s i x w i v e s , o n l y Ann o f
C l e v e s , ?/hose m a r r i a g e was n e v e r consum m ated, m ig h t have b e e n
e x p e c t e d t o show a n e g a t i v e Was se n n a n n . tt-L0
F ra n c is I of F ra n c e , a ls o p r e s e n ts an i l l u s t r a t i o n
o f w h at m ig h t h ap p e n i f a c o u n t r y ' s a b s o l u t e r u l e r i s i r ­
rita b le ,
i n c o n s i s t e n t an d s u f f e r s fro m d e l u s i o n s o f g r a n d e u r ,
w h ic h a c c o m p a n ie s one ty p e o f s y p h i l i s .
E a r ly cu re s f o r th e d i s e a s e .
M e rc u ry was i n t r o d u c e d
a s a cure f o r s y p h i l i s w i t h i n a y e a r a f t e r th e ap p earan ce o f
th e d is e a s e .
I t was a ’’s u r e c u r e . ”
I t h ad b e e n u s e d by th e
A ra b s f o r th e c u re o f s c a b i e s w h ic h , u n t i l m e rc u ry was i n t r o ­
d u c e d , had b e e n c o n s i d e r e d i n c u r a b l e .
The s o r e s o f s y p h i l i s
w ere s i m i l a r t o th o s e o f s c a b i e s , t h e r e f o r e , ”ungetum s a r a c e n ic u m ” was t r i e d .
B ecau se t h i s s u b s t a n c e c o n t a i n e d a n i n t h
10Kemble, o p . c i t . . p. 40.
21
p a r t o f m e rc u ry t h e s o r e s h e a l e d u n d e r i t s u s e .
The d a n g e r
t h a t ac c o m p a n ie d t h e c o n t i n u e d u s e o f t h i s m e t a l was unknown.
T hen , a s no?/, t h e r e ?/ere t h o s e ?/ho w ere i n t e r e s t e d o n l y i n
th e r o a d t o • q u ic k w e a l t h an d m e rc u ry was s o l d i n l a r g e a m o u n ts .
I t v/as o n l y n a t u r a l , t h e r e f o r e , t h a t many p e o p l e succumbed
t o th e cu re a s w e ll a s t o th e d is e a s e i t s e l f .
Among t h e
m i l d e r r e s u l t s o f m e rc u ry p o i s o n i n g i s s a l i v a t i o n , ?/hich i n ­
v o l v e s t h e l o s s o f t h e t e e t h , a n d w h ic h was q u i t e a s e r i o u s
m a t t e r a t t h a t t i m e , s i n c e t h e r e w ere no f a l s e t e e t h a v a i l ­
a b l e an d t h e f o o d was h a r d ,
" M e r c u r i l i z a t i o n , " s a y s D r, P a r r a n , f,a t i t s b e s t
a l m o s t a s bad a s t h e d i s e a s e , ?/hen s u p p le m e n te d by b l e e d i n g ,
th e p u r g i n g , an d s w e a t i n g , c o n s t i t u t e s a p i c t u r e o f t h e r a ­
p e u tic s a t i t s e b b tid e o f u s e fu ln e s s ." ^ *
The s u f f e r i n g s w ere so g r e a t , a s a r e s u l t o f t h e o v e r ­
u s e o f m e r c u r y , t h a t o t h e r c u r e s were i n t r o d u c e d .
t h e s e w ere g u a ia c u m , c h i n a r o o t ,
e tc .
Among
sa rsa p a rilla , sa ssafrass,
S w e a tin g came i n t o i t s own, u n d o u b t e d l y a f o r e r u n n e r
o f t h e m odern f e v e r m a c h in e , a n d e n j o y e d a f a i r am ount o f
p o p u la rity .
From 1500 t o 1900 t h e a d v a n c e s i n t h e c o n t r o l
o f s y p h i l i s w ere p r a c t i c a l l y n i l , an d g r e a t names -were fe w .
T h ere was r e a l l y o n l y one s i g n i f i c a n t f i g u r e i n t h e s i x t e e n t h
c e n t u r y , t h a t b e i n g F r a c a s t o r , t h e p o e t p h y s i c i a n , who named
-^ P a rra n ,
ojd .
c i t ..
p. 43.
22
tile d i s e a s e an d s u g g e s t e d m e r c u r y f o r i t s c u r e .
However,
P a r a c e l s u s , who f i r s t s u g g e s t e d t h e h e r e d i t a r y t r a n s m i s s i o n
o f t h e d i s e a s e , an d F e r n e l who made t h e d i s c o v e r y t h a t s y p h i l
i t i c v i r u s c o u l d n o t p a s s t h r o u g h n o rm a l s k i n can s u r e l y he
c o n sid e re d as o u ts ta n d in g .
H e s e a r c h i n th e f i e l d .
The d i s e a s e h ad become so
p r e v a l e n t t h a t many o b s e r v a t i o n s were made an d c a r e f u l d e ­
t a i l e d d e s c r i p t i o n s o f th e d i s e a s e w ere p r e s e n t e d .
N e v e r­
t h e l e s s , t h e u n d e r l y i n g p r i n c i p l e s r e m a in e d v a g u e .
The g r e a t
Jo h n H u n t e r , th e f a t h e r o f E n g l i s h m e d i c i n e , w i l l s e r v e t o
ill u s tr a te th is p o in t.
J t m s he who i n s i s t e d t h a t s y p h i l i s
an d g o n o r r h e a w ere t h e same d i s e a s e .
I n 1767 he a t t e m p t e d
t o p ro v e h i s c o n t e n t i o n b y p e r f o r m i n g a n e x p e r im e n t on him ­
se lf.
He made two p u n c t u r e s i n h i s s k i n , t h e f i r s t he
i n o c u l a t e d w i t h p u s fro m a s y p h i l i t i c c a s e and i n t o th e
s e c o n d he i n t r o d u c e d p u s fro m a su p p o se d c a s e o f g o n o r r h e a ,
b u t w h ic h seems more t h a n l i k e l y now t o have b ee n a m ixed
i n f e c t i o n o f t h e two d i s e a s e s .
d e v e lo p e d .
In each case a chancre
T h is e x p e r i m e n t s e r v e d t o c o n f u s e m e d ic a l m in d s
f o r a n o th e r h a lf c e n tu ry .
P u ssey r e f e r s t o th e ex p e rim en t
a s rTa n i l l u s t r a t i o n o f t h e m i s c h i e f w ro u g h t by e r r o n e o u s
o p i n i o n when b a c k e d by a g r e a t p e r s o n a l i t y . ”12
I t was n o t
u n t i l 1837 t h a t l i g h t was th ro w n on t h e s u b j e c t b y H i c o r d ,
^Pussey, o£. cit.. p. 44.
23
when he d i s p r o v e d t h a t t h e two d i s e a s e s w ere i d e n t i c a l .
I n 1879 N e i s s e r d i s c o v e r e d t h e s p e c i f i c o r g a n is m c a u s i n g
g o n o r r h e a , n am ely t h e g o n o c o c c u s .
I t v/as n o t u n t i l a b o u t one h u n d r e d y e a r s ago t h a t a n y
t r e a t m e n t was a d v a n c e d t h a t had a n y c u r a t i v e v a l u e , t h a t w as
unknown t o F r a c a s t o r ,
in 1530.
W illia m W a lla c e o f D u b lin
i n t r o d u c e d i o d i d e o f p o t a s s i u m i n 1 8 3 4 , w h ic h was v a l u a b l e
i n t h e t r e a t m e n t o f s t u b b o r n s e c o n d a r i e s , and f o r t h e gummy
tu m o rs o f l a t e
sy p h ilis.
I t was n o t u n t i l t h e l a s t q u a r t e r
o f t h i s c e n t u r y t h a t a n e x a c t m ethod f o r t h e a d m i n i s t r a t i o n
o f m e rc u ry was w orked o u t , b y F o u r i e r o f F r a n c e an d H u t c h i n ­
so n o f E n g la n d .
I t h a s s i n c e resu m ed i t s p l a c e a s a s p e c i f i c
f o r s y p h i l i s w ith io d id e o f p o ta ssiu m a s a u s e f u l a u x i l i a r y
t o c l e a r up l a t e l e s i o n s .
I n 1903 M e tc h k in k o f f and Roux l e a r n e d how t o i n f e c t
ap es w ith s y p h i l i s .
Up t o t h i s tim e i t h ad b ee n im p o s s i b l e
t o i n f e c t a n y o f t h e lo w e r a n i m a l s w i t h th e d i s e a s e , so t h a t
i t c o u l d n o t be s t u d i e d e x p e r i m e n t a l l y .
A s h o r t tim e a f t e r
t h i s t h e German Academy o f S c ie n c e a p p o i n t e d two men, E r i e
H offm an, a d e r m a t o l o g i s t , a n d F r i t z S c h a u d in n , a p r o t o z o o l o ­
g i s t , t o a s p e c i a l co m m ittee t o i n v e s t i g a t e t h e c a u se o f
s y p h ilis.
I t was t h e y who d i s c o v e r e d a ” s l e n d e r , v e r y p a l e
c o r k s c r e w - l i k e o b j e c t t h r e a d i n g i t s t w i s t i n g way t h r o u g h an
u n sta in e d p re p a ra tio n of f r e s h s y p h i l i t i c t i s s u e . T h e y
c a lle d i t sp iro c h a e ta p a l lid a .
24
I n 1907 W assermann d e s c r i b e d t h e c o m p l e m e n t - f i x a t i o n
t e s t f o r sy p h ilis*
I t was now p o s s i b l e t o d i s c o v e r o b s c u r e
o r l a t e n t e a s e s o f s y p h i l i s , and t o m e asu re th e p r o g r e s s made
by t r e a tm e n t .
E h r lic h d is c o v e re d s a lv a r s a n in 1910.
The p r e p a r a t i o n
o f a r s e n i c was c a l l e d fl606Tf, b e c a u s e E h r l i c h had p r e v i o u s l y
i n v e s t i g a t e d 605 c h e m ic a l compounds i n h i s s e a r c h f o r a
s p e c i f i c t h a t w o uld k i l l th e v i r u s s y p h i l i s w i t h o u t i n j u r i n g
th e p a t i e n t .
When s a l v a r s a n was f i r s t d i s c o v e r e d , i t was
b e l i e v e d t h a t one i n j e c t i o n w ould be en o u g h t o c u re a p a t i e n t .
H ow ever, c a s e s t h a t w ere s u p p o s e d t o have b ee n c u r e d b e g a n t o
re la p se .
Two i n j e c t i o n s , o r t h r e e , m et iv ith more s u c c e s s .
G r a d u a l l y i t t o o k i t s p l a c e a s th e m ost p o w e r f u l d r u g a t o u r
d i s p o s a l i n th e t r e a t m e n t o f t h i s d i s e a s e , p r o m p tly c l e a r i n g
up e a r l y l e s i o n s an d r e n d e r i n g t h e p a t i e n t n o n - i n f e c t i o u s ,
b u t r e q u i r i n g tw e n t y t o t h i r t y i n j e c t i o n s t o co m p lete t h e
cu re.
L e v a d ite , o f P a r is ,
i n 1922 i n t r o d u c e d m e r c u r y o r
b is m u th a s a s u p p le m e n t t o s a l v a r s a n t o p r e v e n t i n f e c t i o u s
r e l a p s e s a n d p ro m o te a p e rm a n e n t c u r e .
S in c e t h e s e d i s ­
c o v e r i e s , p r o g r e s s fro m t h e s t a n d p o i n t o f m e d ic a l d i s c o v ­
e r i e s has been r a p id .
S ig e r is t says:
When s y p h i l i s f i r s t b u r s t upon E urop e i t ?/as t h o u g h t
o f i n t h e same te r m s a s a n a t i o n a l c a t a s t r o p h e .
One m ig h t
s t r u g g l e f r e e l y t o e s c a p e fro m i t s r e s u l t s a s one m ig h t
25
-
s t r u g g l e t o b u i l d o n e ’ s h o u se a f t e r i t had b e e n d e s t r o y e d
by a h u r r i c a n e . F o r t h e f i r s t tw o c e n t u r i e s t h e g e n e r a l
a t t i t u d e was one o f f e a r and h e l p l e s s n e s s .
I n t h e two
c e n t u r i e s f o l l o w i n g , t h e pendulum i n E u ro p e swung fro m
th e t r a g i c t o th e f r i v o l o u s .
I t became f a s h i o n a b l e t o
ta k e s y p h i l i s l i g h t l y .
The R e s t o r a t i o n c o m ed ie s a r e f u l l
of i t .
V o l t a i r e w r o t e a w i t t y poem on t h e s u b j e c t .
C asanova r e l a t e d s t o r i e s a b o u t i t t h a t seemed e x c r u c i ­
a t i n g l y funny to h i s a u d ie n c e . I t i s s i g n i f i c a n t t h a t
t h e s e a r e t h e y e a r s o f s l i g h t e s t m e d i c a l a d v a n c e s . 13
A t t h e tim e o f t h e s e t t l e m e n t o f A m e ric a , P u r i t a n i s m
came to th e f r o n t .
S y p h i l i s became a d i s g r a c e .
To many i t
was t h e p e r f e c t exam ple o f t h e la w o f c o m p e n s a tio n .
The
d i s c u s s i o n o f t h e d i s e a s e d ro p p e d o u t o f a l l c o n v e r s a t i o n ,
e x c e p t th e t r u l y p r o f e s s io n a l c i r c l e s .
I t ceased to appear
on d e a t h c e r t i f i c a t e s , an d was n o t i n c l u d e d i n r e p o r t s o f
com m unicable d i s e a s e s .
T h is a t t i t u d e h as p r e v a i l e d .
At t h e
p r e s e n t tim e im p o r ta n c e o f c o u n t i n g t h e number o f c a s e s and
r e j j o r t i n g them a s su c h i s j u s t becom ing e v i d e n t .
SYPHILIS IN THE UNITED STATES
A m eric an m e d i c a l l i t e r a t u r e was p r a c t i c a l l y unknown
b e fo re th e R e v o lu tio n .
I n th e e a r l y d a y s i t f e l l t h e l o t o f
t h e c l e r g y t o p r a c t i c e m e d ic in e a s a n e x t r a - c u r r i c u l a r a c t i ­
v ity .
The c le rg y m e n w ere n o t t r a i n e d i n t h e f i e l d o f m e d i­
c in e .
T h ey , t h e r e f o r e , o f n e c e s s i t y h a d t o r e l y upon home
re m e d ie s.
Many o f t h e s e r e m e d ie s o r i g i n a t e d , u n d o u b t e d l y ,
fro m v a r i o u s fo rm s o f s u p e r s t i t i o n .
13Sigerist, aj>. cit.. p. 48.
M e d ic in e , t h e r e f o r e ,
£6
a s p r a c t i c e d by t h i s g ro u p o f i n d i v i d u a l s , was n o t t h e s c i ­
e n c e we u n d e r s t a n d i t t o be t o d a y , b u t r a t h e r a fo rm o f
m y s t i c i s m g o v e r n e d b y th e many s u p e r s t i t i o n s .
T h ere i s l i t t l e
o r no m e n tio n o f t h e d i s e a s e , s y p h i l i s ,
in th e e a r l y l i t e r a t u r e .
I t i s p o s s i b l e t h a t t h e d i s e a s e w as
somewhat o f a r a r i t y due to t h e s e v e r e m o ra l r e s t r a i n t , an d
s e v e r e p u n is h m e n t t h a t was d e a l t o u t when s e x u a l i r r e g u l a r ­
i t i e s w ere d i s c o v e r e d .
The f i r s t r e c o r d o f a n o u t b r e a k o c c u r r e d i n 1646; t h i s
o u t b r e a k I s r e c o r d e d i n t h e d i a r y o f l o h n W in th ro p .
T here f e l l o u t a l s o a lo a th s o m e d i s e a s e i n B o s to n
w h ic h r a i s e d a s c a n d a l up o n t h e to w n an d c o u n t y , t h r o u g h
ju s t cause.
One o f t h e to w n . • . h a v i n g gone c o p p e r i n
a s h i p i n t o . . . a t h i s r e t u r n h i s w i f e was i n f e c t e d w i t h
t h e v e n e r a , w h ic h a p p e a r e d t h u s : b e i n g d e l i v e r e d o f a
c h i l d an d t h e n n o t h i n g t h e n a p p e a r i n g , b u t t h e m id w if e ,
a s k i l l e d woman, f i n d i n g h e r b ab y sound a s a n y o t h e r a f t e r
h e r d e l i v e r y , she had a s o r e b r e a s t , w h ereu po n d i v e r s e
n e i g h b o r s r e s t o r i n g t o h e r , some o f th em drew upon h e r
b r e a s t an d o t h e r s s u f f e r e d t h e i r c h i l d r e n t o draw h e r ,
an d o t h e r s l e t h e r c h i l d draw them (no s u c h d i s e a s e b e i n g
s u s p e c t e d by a n y ) . By o c c a s i o n t h e r e o f a b o u t s i x t e e n
p e r s o n s , men, women, and c h i l d r e n , were i n f e c t e d , w h e re b y
i t came a t l e n g t h t o be d i s c o v e r e d b y su c h i n th e town a s
h ad a n y s k i l l i n p h y s i c an d s u r g e r y , b u t t h e r e was n o t
a n y i n t h e c o u n ty who had b e e n p r a c t i c e d i n t h e c o u r t . - 1-4
I n t h e y e a r 1750 t h e r e a p p e a r e d a book o f m e d i c a l i n ­
s t r u c t i o n s w h ich b o re t h e f o l l o w i n g t i t l e :
Everym an H is Own
D o c to r P l a i n an d E a s y Means f o r P e r s o n s t o Cure T h em selv e s
o f A l l o r Most o f t h e D is te m p e r s I n c i d e n t t o t h i s C lim a te
an d w i t h V ery L i t t l e C h a r g e , t h e M e d ic in e s B e in g C h i e f l y o f
■ ^ P a rra n ,
ojd .
c i t .
, p.
70.
27
t h e G rowth an d P r o d u c t i o n o f T h is C o u n ty *
T h is h o o k g i y e s
a d e s c r i p t i o n o f th e d i s e a s e "Yaws" an d t h e t r e a t m e n t f o r
th e d is e a s e :
The pox may be c u r e d i n e x a c t l y t h e same m a n n er;
and b e c a u s e t h e symptoms a r e t h e same* I t i s p o s s i b l e
t h a t one was g r a f t fro m th e o t h e r (Y aw s)• The p i o u s
S p a n i a r d s c a t c h e d i t fro m t h e i r N egro m i s t r e s s e s i n
t h e W est I n d i e s an d h ad t h e h o n o r o f p r o p a g a t i n g i t
fro m th e n c e t o th e r e s t o f th e w o r l d . I n b o t h c a s e s
c o n f i n e y o u r s e l f a l t o g e t h e r fro m e a t i n g f l e s h , fro m
s t r o n g d r i n k , an d be v e r y c a r e f u l o f c a t c h i n g c o l d . 15
The p r e s c r i p t i o n g e n e r a l l y u s e d seemed t o be t h e
fo llo w in g :
Sumac r o o t , t h e i n n e r b a r k o f p i n e , a n d t h e
b a r k o f S p a n is h Oak, t o be t a k e n i n t e r n a l l y and a l s o a s an
a p p l i c a t i o n f o r th e so re and u l c e r s .
P i l l s p re sc rib e d f o r
I t w ere made o f t u r p e n t i n e an d d e e r dung i n e q u a l q u a n t i t i e s .
S y p h i l i s an d t h e N e g r o .
S c ie n tific in v e stig a tio n
seems t o p ro v e t h a t s y p h i l i s v?ras unknown t o t h e p r i m i t i v e
A fric a n .
H ow ever, i t
soon s p r e a d w i t h g r e a t r a p i d i t y among
t h e s l a v e s im p o r te d i n t o t h i s c o u n t r y .
The t h e o r y t h a t
s y p h i l i s a n d c i v i l i z a t i o n go hand a n d h a n d i s w e l l i l l u s t r a t e d
b y t h e f a t e o f t h e A f r i c a n a n d t h e A m erican I n d i a n .
The r e c o r d s o f t h e Navy s u r g e o n s and t h o s e o f t h e
M arine H o s p i t a l show t h a t t h e r e was a n ab u n d a n ce o f s y p h i l i s
a t an e a r l y d a t e , in th e h i s t o r y o f th e U n ite d S t a t e s .
"When
t h e S t a t e n I s l a n d H o s p i t a l w as o pen ed i n 1 83 1 , t w e n t y - s i x o f
t h e f i r s t . 100 p a t i e n t s w ere s u f f e r i n g fro m s y p h i l i s . ” 16
15I b i d . , p . 7 1 .
16L o c . - c i t .
The
28
m e d i c a l h i s t o r y o f t h e U nion t r o o p s i n t h e C i v i l War p r e s e n t
th e fo llo w in g re c o rd :
A t o t a l o f 7 7 ,3 8 2 c a s e s o f s y p h i l i s *
The a t t a c k r a t e
was 82 p e r th o u s a n d men d u r i n g t h e war p e r i o d . T h is
f i g u r e i s co m p a ra b le t o t h e f i g u r e s o f t h e r e g u l a r army
d u r i n g th e d e c a d e w h ic h p r o c e e d e d t h e W orld W ar, w h ich
was 88 p e r t h o u s a n d men* The r a t e o f t h e c o l o r e d t r o o p s
was o n l y 3 . 8 p e r t h o u s a n d m en.1?
E a r ly a tte m p ts t o c o n t r o l th e d is e a s e *
D r. G r o s s , i n
1 8 7 4 , d e l i v e r e d th e f i r s t a d d r e s s on t h e s u b j e c t o f s y p h i l i s
t o th e A m erican M e d ic a l A s s o c i a t i o n .
He a d v o c a t e d m e d i c a l
i n s p e c t i o n o f p r o s t i t u t e s a s one m eans o f c o n t r o l .
He f u r ­
t h e r a d v o c a te d t h a t t r e a t m e n t s h o u ld be g iv e n t o t h o s e who
w ere i n f e c t e d ,
an d t h a t t h e p u b l i c s h o u ld be e d u c a t e d a s
to
t h e d a n g e r s o f th e d i s e a s e •
Many t o o k i s s u e w i t h D r. G r o s s , e s p e c i a l l y w i t h h i s
id e a o f l i c e n s i n g p r o s t i t u t e s .
o p p o sed t h i s
i d e a was D r. Simms.
E o re m o st among t h o s e who
D r. Simms p r o p o s e d th e
i d e a o f g i v i n g th e B o a rd s o f H e a l t h i n t h e v a r i o u s c i t i e s
th e same power o v e r s y p h i l i s t b a t t h e y had o v e r su c h d i s e a s e s
a s c h o l e r a , s m a l l p o x , a n d y e l lo w f e v e r .
T h i s pow er w o u ld
be t o f i n d th e v i c t i m s , s e n d th em t o h o s p i t a l s f o r t r e a t m e n t ,
a n d p r e v e n t t h e v i c t i m fro m
t h e com m unity.
s p r e a d i n g t h e d i s e a s e th r o u g h
Such a p l a n w ould be j u s t a s so u n d t o d a y
as
i t was i n t h e y e a r 1 8 7 6 .
D r. Ludwig W eiss was c h a ir m a n o f a co m m ittee a p p o i n t e d
b y t h e A m eric an M e d ic a l A s s o c i a t i o n t o i n v e s t i g a t e t h e c o n t r o l
17L o c . c i t .
29
of s y p h ilis .
U n t i l h i s d e a t h i n 1 9 3 0 , he r e t a i n e d h i s b e l i e f
t h a t t h e d o c t o r s an d g o v ern m e n t s h o u ld c o o p e r a t e i n t h e f i g h t
a g a in s t sy p h ilis*
T h is co m m ittee recommended t h a t a N a t i o n a l
C o n g re s s on P r o p h y l a x i s o f V e n e r e a l D i s e a s e s be h e l d u n d e r
th e a u s p i c e s o f th e A m eric an M e d ic a l A s s o c i a t i o n .
H ow ever,
s u c h a t a s k seemed t o o g r e a t , and no a c t i o n was t a k e n .
I n 1908 o f f i c e r s -of t h e P u b l i c H e a l t h S e r v i c e p r e p a r e d
a p a m p h le t f o r m e r c h a n t seamen*
The p a m p h le t was c a r e f u l l y
w o rd ed so a s n o t t o o f f e n d , b u t h e l p t h e seam an.
N ev e rth e le ss
when t h e p a m p h le t w ent t o t h e o f f i c e o f t h e S e c r e t a r y o f th e
T r e a s u r y , George B. C o r t e l y o u , i t m s r e t u r n e d d i s a p p r o v e d ,
w i t h th e fo llo v trin g comment:
"The m a t t e r c o n t a i n e d i n t h i s
B u l l e t i n i s n o t i n k e e p in g w i t h t h e d i g n i t y o f t h i s f i s c a l
d e p a r t m e n t o f t h e government."**-®
Nine s t a t e s r e q u i r e d t h e r e p o r t i n g o f v e n e r e a l c a s e s
b e f o r e t h e U n ite d S t a t e s e n t e r e d t h e w ar i n 1 9 1 7 .
C a lifo rn ia
S t a t e H e a l t h O f f i c e r , D r. W i l l i a m F . Snow, now d i r e c t o r o f
t h e A m erican S o c i a l H y g ien e A s s o c i a t i o n , s t a r t e d r e p o r t i n g
G ases i n 1 9 1 2 , and a t t h a t tim e s t a r t e d a m o d e st e d u c a t i o n a l
cam paign a g a i n s t v e n e r e a l d i s e a s e s .
War tim e e f f o r t s t o c o n t r o l s y p h i l i s .
The b lo c k a d e
o f t h e A l l i e s s h u t German-made S a l v a r s a n o u t o f t h e U n ite d
S t a t e s , p r i c e s s o a r e d t o $ 1 0 0 , o r more a d o s e .
I n 1916
D r. M c L a u g h lin . s e c u r e d a la w a u t h o r i z i n g t h e M a s s a c h u s e t t s
■ ^P arran, o p . c i t . .
p.
79.
30
S t a t e B o ard o f H e a l t h t o m a n u f a c tu r e t h e
t h e German p a t e n t s .
d ru g r e g a r d l e s s o f
I t was n o t lo n g u n t i l i t was d i s c o v e r e d
t h a t th e m a n u f a c t u r e r ’ s f o r m u la was i n c o r r e c t .
H ow ever,
a f t e r a s e r i e s o f t r i a l s s a l v a r s a n was p r o d u c e d .
g i v e n t h e name a r s p h e n a m i n e .
t o t h e c l i n i c s an d d o c t o r s .
I t was
Once a g a i n i t was made a v a i l a b l e
H ow ever, many p h y s i c i a n s f e l t
t h a t t h e d r u g was a d e a d l y p o is o n an d r e f u s e d t o u se i t .
T hen, t o o , t h e r e w ere many who d i d n o t have t e c h n i c a l t r a i n ­
in g t o use t h e d r u g .
I t was s t i l l b e l i e v e d , e v e n b y s p e ­
c i a l i s t s , t h a t t h r e e d o s e s w ere en ou gh t o e f f e c t a c u r e .
W ith t h e e n t r a n c e o f t h e U n ite d S t a t e s i n t o t h e W orld
War, i t was n o t l o n g u n t i l t h e a t t i t u d e to w a r d v e n e r e a l
d i s e a s e s was c h a n g e d .
V e n e r e a l d i s e a s e s have a lw a y s p r o v e n
t o be a p o t e n t f a c t o r in d i s a b l i n g f i g h t i n g men.
S ay s D r.
P arran :
The Red C r o s s , t o i t s e v e r l a s t i n g c r e d i t , s u p p l i e d
f u n d s w i t h w h ic h t h e P u b l i c H e a l t h S e r v i c e s t a r t e d t h e
f i r s t v e n e re a l d ise a se c l i n i c s in tw e n ty -fiv e c i t i e s a d ­
j a c e n t to m i l i t a r y cam ps, o p e r a t i n g them f o r a f u l l y e a r
b e f o r e c o n g r e s s g o t a r o u n d t o d e a l i n g 7 /ith t h i s p ro b le m
on a n a t i o n a l b a s i s .19
I t was so o n fo u n d t h a t d e a l i n g w i t h c i t i e s a d j a c e n t
t o m i l i t a r y camps was n o t e n o u g h .
l a t i o n had t o be d e a l t w i t h .
The e n t i r e c i v i l i a n p o p u ­
I t was l a t e
i n 1917 t h a t t h e
H e a l t h O f f i c e r s o f e a c h S t a t e were e n c o u r a g e d by th e P u b l i c
H e a l t h S e r v i c e t o s t a r t an a c t i v e c o n t r o l p ro g ra m .
1 9I b i d . . p. 80.
The
31
p ro g ra m was a s f o l l o w s :
R e p o r tin g 'o f o a se s; i n s t r u c t i o n o f
p a t i e n t c o n c e r n i n g th e n e c e s s i t y f o r t r e a t m e n t ;
t i o n o f th e s o u r c e o f i n f e c t i o n ;
in v e stig a ­
q u a ra n tin e of in f e c te d p e r ­
s o n s who, b e c a u s e o f t h e i r h a b i t s , w ere a menace t o o t h e r s ;
m aking t h e s p r e a d i n g o f t h e d i s e a s e a n o f f e n s e a g a i n s t t h e
la w ; r e p r e s s i o n o f p r o s t i t u t i o n ; p r o v i s i o n f o r t r e a t m e n t o f
t h e i n f e c t e d ; f r e e i s s u e o f f,606tt; w i d e - s p r e a d p u b l i c e d u ­
c a t i o n ; and f i n a l l y s e t t i n g up i n e a c h s t a t e o f an a g e n c y
f o r v e n e re a l d ise a se c o n tr o l.
W i t h i n a v e r y s h o r t t i m e , a p ro g ra m on a n a t i o n a l
b a s i s was u n d e r way t o c o n t r o l s y p h i l i s .
was n e c e s s a r y t o h e l p w in t h e w a r .
litic
S uch a m easu re
The wounds o f a s y p h i ­
h e a l b a d l y ; t h e r e f o r e , t h e human m achine h ad t o be
fre e of i t .
On J u l y 9 , 1 9 1 8 , c o n g r e s s p a s s e d a c o m p re h e n siv e la w
e s t a b l i s h i n g a n i n t e r - d e p a r t m e n t a l S o c i a l H yg ien e B o a r d .
A
m i l l i o n d o l l a r s was a p p r o p r i a t e d f o r t h e a i d o f t h e S t a t e s
i n o r g a n i z i n g su c h w o rk; $ 2 0 0 ,0 0 0 f o r t h e a d m i n i s t r a t i o n o f
P u b l i c H e a l t h S e r v i c e , D i v i s i o n o f V e n e r e a l D i s e a s e s ; an d
$ 4 0 0 ,0 0 0 f o r t h e i n t e r d e p a r t m e n t a l S o c i a l H ygiene B o a rd f o r
r e s e a r c h t o d e v e lo p b e t t e r m e d i c a l an d e d u c a t i o n a l m e a s u r e s .
G r a n ts t o th e v a r i o u s S t a t e s w ere c o n t i n g e n t upon c o n f o r m i t y
t o minimum s t a n d a r d s o f e f f i c i e n c y .
T h ere w ere o n l y two
s t a t e s , N evada an d P e n n s y l v a n i a , a n d t h e D i s t r i c t o f Colum­
b i a t h a t d i d n o t a d o p t th e F e d e r a l s t a n d a r d s w i t h i n a y e a r .
32
The N a t i o n a l R e t a i l D r u g g i s t A s s o c i a t i o n was r e q u e s t e d
by t h e P u b l i c H e a l t h S e r v i c e n o t t o p r e s c r i b e t r e a t m e n t , o r
t o recommend p a t e n t m e d ic in e f o r t h o s e who came i n a s k i n g f o r
a d v i c e a b o u t a v e n e r e a l c o n d i t i o n , b u t to r e f e r them t o a
d o c to r o r to a c l i n i c ,
l i g h t y p e r c e n t o f th e d r u g g i s t s , or
2 8 , 2 2 6 , a g r e e d t o comply w i t h th e w i s h e s o f t h e G ov ernm ent.
T hen, t o o , a l l b u t 200 o f t h e 2 0 ,0 0 0 n e w s p a p e rs o f t h e c o u n ­
t r y a g r e e d n o t t o p u b l i s h q u ac k a d v e r t i s i n g , e i t h e r o f
n o s tr u m s o r o f u n q u a l i f i e d p r a c t i t i o n e r s .
The c o u n t r y was sh o w ered w i t h e d u c a t i o n a l p a m p h l e t s .
The t o p i c s y p h i l i s was f o r th e f i r s t tim e d i s c u s s e d a t p u b l i c
l e c t u r e s , an d e x h i b i t s and m o tio n p i c t u r e s vmre shown i n an
e f f o r t to s tim u la te p u b lic i n t e r e s t .
S e c r e t a r y o f t h e T r e a s u r y W. G. McAdoo, who was a l s o
D i r e c t o r G e n e r a l o f R ailvm y s f o r t h e w ar p e r i o d ,
b i l l f o r n a t i o n a l a c t i o n on s y p h i l i s .
d isp la y ,
sponsored a
He made p o s s i b l e t h e
i n P u llm a n w ash ro o m s, i n r a i l w a y s h o p s , i n e v e r y
p la c e t h a t t h i s in flu e n c e co u ld re a c h p o t e n t i a l p a t i e n t s ,
o f s i g n s w h ich w arned o f v e n e r e a l d i s e a s e s a n d u r g e d t r e a t ­
ment •
War tim e c o n t r o l s s h o r t - l i v e d .
I t seem ed c e r t a i n
t h a t t a b o o s w ere s u r e t o d i s a p p e a r , b u t s u c h e n t h u s i a s m w as
t o be s h o r t - l i v e d .
The pendulum swung b a c k o nce a g a i n , an d
we e n t e r e d i n t o t h e " r o a r i n g T w e n t i e s . ”
The w ar was o v e r !
T h e r e f o r e , f u r t h e r t h o u g h t a b o u t s y p h i l i s was n e e d l e s s .
. •
33
A l l a i d t o t h e S t a t e s f o r v e n e r e a l d i s e a s e w ork ¥/as
t e r m i n a t e d i n 1926*
I n many o f t h e S t a t e s t h e p ro g ra m was
j u s t b e g in n in g t o f u n c tio n ; n e v e r t h e le s s , a l l o p e r a tio n s
w ere s t o p p e d .
The w ar was o v e r !
P o s s i b l y t h e one t a n g i b l e t h i n g t h a t we d i d l e a r n fro m
t h e w ar tim e e f f o r t s , was t h a t a n y r e a l l y s u c c e s s f u l w o rk
t h a t i s t o be done i n t h e f i e l d o f v e n e r e a l d i s e a s e c o n t r o l
m u st b e g i n a t t h e b o tto m .
T h e r e f o r e , t h e f u n d a m e n ta l t a s k
in th e c o n t r o l o f s y p h i l i s i s to e d u c a te .
CHAPTER I I I
THE PROPOSED PROGRAM OF THE 'FEDERAL GOVERNMENT
PRESENT AND FUTURE PLANS
I t i s r a t h e r d i f f i c u l t f o r one t o t h i n k o f a S t a t e ,
in d e p e n d e n t and f r e e fro m a l l o f t h e a c t i v i t i e s o f t h e o t h e r
S ta te s,
i n A m e ric a ,
Such a s t a t e d o e s n o t e x i s t .
The r a p i d
p r o g r e s s t h a t h a s b ee n made i n th e f i e l d s o f t r a n s p o r t a t i o n
an d c o m m u n ic atio n h a s made Rhode I s l a n d and C a l i f o r n i a c l o s e
n e ig h b o rs , in r e s p e c t to th e elem en t o f tim e .
For a person
t o f l y fro m Rhode I s l a n d t o C a l i f o r n i a w ould t a k e tw e l v e
ho u rs.
lis ,
I f , p e r c h a n c e , t h i s p e r s o n ?7ere i n f e c t e d w i t h s y p h i ­
in th e i n f e c t i o u s s t a g e , i t i s q u ite p o s s ib le t h a t he
c o u l d s t a r t a n e p id e m ic o f t h e d i s e a s e i n C a l i f o r n i a i n a
r e l a t i v e l y few d a y s .
The P u b l i c H e a l t h S e r v i c e h a s lo n g r e c o g n i z e d t h i s
f a c t an d h a s f o r e s e e n t h a t i f th e d i s e a s e i s t o be c o n t r o l e d
t h e r e m ust o f n e c e s s i t y be c o o p e r a t i o n b e tw e e n t h e v a r i o u s
s t a t e s an d w i t h i n t h e s t a t e
its e lf.
I t has, th e re fo re ,
a t t e m p t e d t o s e t up a m odel p ro g ra m t o pro m o te c o o p e r a t i o n
b e tw e e n th e v a r i o u s s t a t e s and t o g iv e c o n t i n u i t y t o th e
c o n t r o l of th e d is e a s e th ro u g h o u t th e c o u n try .
I t h a s b e e n w i t h i n t h e p a s t t e n y e a r s o n ly t h a t
s c i e n t i f i c o p in io n has c r y s t a l l i z e d in th e f i e l d o f v e n e re a l
d i s e a s e , and o f s y p h i l i s i n p a r t i c u l a r .
The S u rg e o n G e n e r a l
35
b e l i e v e s t h a t t h e tim e h a s come when much p r o g r e s s c a n be
made i f we b u t a p p l y t h e know ledge we now have a c c u r a t e l y
an d c a r e f u l l y .
F in a n c ia l a id o f f e r e d to th e s t a t e s .
The S o c i a l
S e c u r i t y A ct o f t h e F e d e r a l Government a u t h o r i z e d an a p p r o ­
p r i a t i o n t o t a l i n g $ 8 ,0 0 0 ,0 0 0 f o r a l l o c a t i o n t o S t a t e an d
l o c a l h e a lth d e p a rtm e n ts.
I t i s p r o p o s e d t h a t t h i s sum be
u s e d t o a s s i s t i n t h e e s t a b l i s h m e n t and m a in te n a n c e o f more
a d e q u a te p u b l i c h e a l t h s e r v i c e s .
I n an e f f o r t t o p o i n t o u t t h e more s a l i e n t f e a t u r e s
i n a n e f f e c t i v e p ro g ra m o f v e n e r e a l d i s e a s e c o n t r o l , t h e
S u rg e o n G e n e r a l a p p o i n t e d a n a d v i s o r y co m m ittee t o t h e P ub­
l i c H e a l t h S e r v i c e an d c h a r g e d i t w i t h t h i s r e s p o n s i b i l i t y .
The l a r g e number o f S t a t e an d l o c a l h e a l t h d e p a r t ­
m e n ts a n d t h e h e t e r o g e n e o u s c h a r a c t e r o f t h e p o p u l a t i o n i n
t h e a r e a s c o n c e r n e d made i t n e c e s s a r y f o r th e co m m ittee t o
l i m i t th e r e p o r t c h i e f l y t o g e n e r a l r e c o m m e n d a tio n s .
The
f o l l o w i n g i s b a s e d upon t h e c o m m itt e e ’ s r e p o r t t o t h e
S u rg e o n G e n e r a l , S u p plem ent Wo. 1 0 .
V e n e r e a l d i s e a s e c o n t r o l w ork s h o u ld be i n t e g r a t e d
o r p e r f o r m e d i n c l o s e l i a i s o n w i t h t h e com m unicable d i s e a s e
d i v i s i o n o f t h e h e a l t h d e p a r t m e n t , b u t i t s h o u ld be d i r e c t e d
under a se p a ra te d iv is io n or s u b d iv is io n .
A f u l l tim e o f f i c e r s h o u l d be i n c h a rg e o f t h e p ro g ra m .
I n e a c h d i s t r i c t t h e r e s h o u ld be a l o c a l a d v i s o r y
co m m ittee t o t h e h e a l t h d e p a r t m e n t , w h ic h w i l l c o o r d i n a t e
36
th e d is e a s e c o n tr o l a c t i v i t i e s o f th e h e a l t h d e p a rtm e n t, th e
m e d i c a l an d a l l i e d p r o f e s s i o n s , and v o l u n t a r y a g e n c i e s *
The co m m ittee recommended t h a t t h e S t a t e h e a l t h d e ­
p a rtm e n ts,
i n d e t e r m i n i n g t h e a l l o c a t i o n o f f u n d s , s h o u ld
c o n s i d e r t h e p r o p o r t i o n t o be e x p e n d e d f o r v e n e r e a l d i s e a s e
c o n t r o l a s a s e p a r a t e and d i s t i n c t i t e m .
I t was f u r t h e r
recommended t h a t e a c h h e a l t h d e p a r t m e n t w i t h i n th e S t a t e be
g i v e n a n o p p o r t u n i t y t o show i t s p a r t i c u l a r n e e d s .
I f i t i s a p p a r e n t t h a t f u n d s a r e n o t now a v a i l a b l e
f o r . t h e a d m i n i s t r a t i o n o f th e c o m p le te p ro g ra m e i t h e r
b y t h e P u b l i c H e a l t h S e r v i c e o r by S t a t e o r l o c a l h e a l t h
d e p a r t m e n t s , f u r t h e r c o n s i d e r a t i o n s h o u l d be g i v e n t o :
(a) t h e e l e m e n t s o f th e p ro g ra m w h ic h s h o u ld be u n d e r ­
t a k e n a t once w i t h t h e f u n d s i n h a n d ; an d (b) t h e e l e ­
m e n ts w h ic h s h o u ld be g i v e n p r e f e r e n c e a s a d d i t i o n a l
f u n d s become a v a i l a b l e . 1
B ases o f a l l o c a t i o n o f f u n d s .
The p r o p o r t i o n o f
h e a l t h f u n d s t o be a l l o c a t e d t o v e n e r e a l d i s e a s e c o n t r o l
a c t i v i t i e s s h o u ld be d e t e r m i n e d by two c o n s i d e r a t i o n s :
firs t,
t h e p r e s e n t a t i o n o f a w e l l - p l a n n e d S t a t e p ro g ra m t o s e c u r e
f o r t h e p u b l i c a d e q u a te p r o t e c t i o n a g a i n s t t h e s p r e a d o f th e
d i s e a s e b y i n f e c t e d i n d i v i d u a l s , a n d a d e q u a te t r e a t m e n t f o r
th e p a t i e n t ,
i n c l u d i n g s k i l l e d m e d i c a l e a r e and maximum p r i ­
vacy; seco n d , th e r e l a t i v e p re v a le n c e o f th e v e n e re a l d is e a s e
i n r e l a t i o n . t o a l l com m unicable d i s e a s e s i n t h e S t a t e ’ s
1C o n t r o l o f t h e V e n e r e a l D i s e a s e s i n t h e U n i t e d S t a t e s P r e s e n t a n d F u t u r e P l a n s - S u p p lem e n t Mo. 10 tjo V e n e r e a l D is e a s e
I n f o r m a t i o n (W a s h in g to n , D. C .: U n ite d S t a t e s Governm ent P r i n t ­
in g O f f i c e , 1 9 3 9 ) , p . 9 .
37
m o r b i d i t y r a t e s , o r th e r e l a t i o n s h i p o f su c h m o r b i d i t y r a t e s
to s p e c ia l p o l i t i c a l o r g e o g ra p h ic a l u n i t s w ith in th e S ta te *
I n t h e a l l o c a t i o n o f f u n d s on th e f i r s t b a s i s , t h e
co m m ittee recommended t h a t due r e g a r d be h ad f o r t h e
i n t e g r a t i o n and c o o r d i n a t i o n o f t h e l o c a l w i t h t h e S t a t e
a n d N a t i o n a l p ro g ra m s* I n c o n s i d e r i n g t h e se c o n d p o i n t ,
l o c a l m o r b i d i t y s h o u ld be r e i n f o r c e d by s p e c i a l s u r v e y s
c o n d u c te d b y d i s i n t e r e s t e d a g e n c i e s , s u c h a s th e U n i t e d
S t a t e s P u b lic H e a lth S e r v i c e , to d e te rm in e p re v a le n c e in
i n d i v i d u a l a r e a s , and t o b r i n g t o l i g h t s p e c i a l l o c a l
p r o b le m s
The co m m itte e a g r e e d t h a t c l i n i c a l s e r v i c e i n u r b a n
c o m m u n itie s s h o u ld be a v a i l a b l e f o r t h e d i a g n o s i s and e m e r­
g en c y t r e a t m e n t o f an y p a t i e n t who a p p l i e s t o t h e c l i n i c ;
a n y p a t i e n t who i s r e f e r r e d b y a p r i v a t e p h y s i c i a n , e i t h e r
f o r c o n tin u e d tr e a tm e n t o r f o r c o n s u lta t iv e ad v ice and o p in ­
i o n ; and a n y p a t i e n t who i s u n a b l e t o p a y f o r p r i v a t e t r e a t ­
ment •
A lig n m e n t o f S t a t e and l o c a l c l i n i c s *
In th e o r g a n i­
z a t i o n o f t h e v a r i o u s c l i n i c s a n e f f o r t s h o u ld be made by
t h e S t a t e o r l o c a l a u t h o r i t y t o a l i g n i t s p o l i c i e s an d p e r ­
so n n e l w ith th e g e n e ra l a d m in is tr a tiv e o r g a n iz a tio n o f th e
P u b lic H e a lth S e r v ic e ; t h a t i t f u r t h e r in te g r a te l o c a l a c t i ­
v i t i e s w i t h t h e S t a t e and N a t i o n a l p ro g ra m b y c o n f e r e n c e
w i t h c o n s t i t u t e d S t a t e an d F e d e r a l a u t h o r i t i e s .
M e d ic a l
s c h o o l s , l o c a l h o s p i t a l , r e s e a r c h and p h i l a n t h r o p i c a u t h o r i ­
t i e s s h o u ld be g i v e n a v o ic e w i t h t h e l o c a l o r g a n i z e d m e d i c a l
2Ibid.. p. 10.
38
p ro fe ssio n .
T h is p o l i c y p r e - s u p p o s e s f o r t h e d e v e lo p m e n t o f
e a c h l o c a l p ro g ra m a s p e c i a l p r e l i m i n a r y s t u d y an d c o n f e r e n c e
on n e e d s a s w e l l a s m e th o d s t o be e m p lo y ed i n a d a p t i n g t h e
p ro g ra m t o l o c a l c o n d i t i o n s .
I n g e n e r a l , when p o s s i b l e , p o l y c l i n i c s a r e s u p e r i o r
to is o la te d c l i n i c s .
f o r th e p o l y c l i n i c .
I t i s g e n e r a l l y e a s i e r to d raw s u p p o r t
I n s u c h c l i n i c s minimum e f f i c i e n c y
s t a n d a r d s w ould be demanded by t h e H e a l t h D e p a r tm e n t, i n
c o n f o r m i t y w i t h t h e S t a t e and N a t i o n a l p r o g r a m s .
The s u b ­
s i d i z e d h o s p i t a l o r h e a l t h c e n t e r i n w h ic h t h e c l i n i c was
l o c a t e d w ould have f u l l a d m i n i s t r a t i v e r e s p o n s i b i l i t y .
It
would s e l e c t an d m a i n t a i n t h e p e r s o n n e l a s l o n g a s i t
c o o p e r a t e d w i t h t h e S t a t e p ro g ra m .
Such c l i n i c s w ould be
u s e d t o t r a i n p h y s i c i a n s and n u r s e s , a l s o f o l l o w - u p w o r k e r s .
C l i n i c s m u st a d m it v e n e r e a l p a t i e n t s .
The co m m ittee
s u g g e s t e d t h a t , "Where s e v e r a l c l i n i c s a r e in. o p e r a t i o n i n a
g i v e n l o c a l i t y , a p a t i e n t c l e a r i n g h o u se may be i n a u g u r a t e d
t o a v o i d u n n e c e s s a r y and so m e tim es d a n g e ro u s d u p l i c a t i o n o f
trea tm en tN o
c l i n i c s h o u ld be g i v e n S t a t e a i d i f i t r e ­
f u s e s a t an y tim e t o a d m it p a t i e n t s w i t h g o n o r r h e a o r
s y p h ilis to i t s b ed s.
A r e c o r d o f t h e t r e a t m e n t a d m i n i s t e r e d s h o u ld be
g iv e n t o t r a n s i e n t p a t i e n t s t o i n s u r e c o n t i n u i t y o f t r e a t ­
m e n t.
I t i s a l s o recommended t h a t c o o p e r a t i o n be m a i n t a i n e d
3I b i d ., p . 11.
39
b e tw e e n t h e ' p r i v a t e d o c t o r an d t h e c l i n i c when t h e p a t i e n t
r e t u r n s t o th e p r i v a t e d o c t o r f o r t r e a t m e n t .
may d e s i r e t o do t h i s a t g iv e n i n t e r v a l s .
The p a t i e n t
I f th e p r i v a t e
d o c t o r d e v i a t e s fro m t h e s c h e d u l e , an d f a i l s t o c o o p e r a t e ,
t h e p u b l i c h e a l t h m ethod s h o u l d be a d o p t e d .
I f t h e f a c i l i t i e s o f a p a r t i c u l a r l o c a l i t y a r e deemed
u n s a t i s f a c t o r y , t h e l o c a l h e a l t h a u t h o r i t i e s s h o u ld be c o n ­
s u l t e d and an e f f o r t made t o e s t a b l i s h a l l d e f i c i e n c i e s .
The d e f i c i e n c i e s f i r m l y e s t a b l i s h e d , t h e l o c a l d o c t o r s h o u ld
be c o n s u l t e d an d h i s c o o p e r a t i o n s o u g h t , o r a new c l i n i c
e s ta b li s h e d , o r p o s s ib ly a w e l l - s i t u a t e d o ld c l i n i c p o p u la r­
i z e d t h r o u g h p u b l i c i t y b y p h y s i c i a n s and d r u g g i s t s .
E lim in a tio n of quackery.
I t s h o u ld be t h e d u t y o f
t h e l o c a l h e a l t h d e p a r t m e n t , t h e l o c a l m e d ic a l s o c i e t y ,
p h a r m a c e u t i c a l s o c i e t y and o t h e r i n t e r e s t e d p a r t i e s t o
a b o l i s h a ! ll fo rm s o f ’’q u a c k e r y '1 i n p r e s c r i b i n g t r e a t m e n t f o r
v en ereal d ise a se s.
I n r u r a l c o m m u n itie s t h e co m m itte e f e e l s
t h a t a d e q u a te t r e a t m e n t f a c i l i t i e s f o r i n d i g e n t p a t i e n t s may
be a c h i e v e d b y :
(a) s u b v e n t i o n a r y a s s i s t a n c e to p r o p e r l y q u a l i f i e d l o c a l
p h y s i c i a n s ; (b) b y c o u n ty h e a l t h o f f i c e r s t h e m s e l v e s ,
p r o v i d e d t h e s e h e a l t h o f f i c e r s have had p r o p e r t r a i n i n g
i n t h e c l i n i c a l management o f c a s e s ; (c) b y s u b s i d i e s t o
c o u n t i e s o r c o m m u n itie s f o r t h e t r a n s p o r t a t i o n o f su c h
p a t i e n t s t o t h e n e a r e s t c e n t e r a t w h ich a p p r o v e d t r e a t ­
m ent may be o b t a i n e d ; (d) b y t h e e s t a b l i s h m e n t o f s p e c i a l
t r e a t m e n t c e n t e r s i n r u r a l c o m m u n itie s i n w h ic h l a r g e
num bers o f H e g ro e s a r e i n c l u d e d i n th e p o p u l a t i o n a n d i n
w h ic h i t i s d e s i r a b l e b e c a u s e o f u n u s u a l l y h i g h p r e v a l e n c e
t o su p p le m e n t t h e e f f o r t s o f l o c a l p h y s i c i a n s ; a n d
40
(3) p o s s i b l y b y t h e d e v e lo p m e n t o f a t r a v e l i n g h e a l t h
u n i t i n w h ic h t h e n e c e s s a r y m e a s u r e s may be i n s t i t u t e d
f o r t h e p r e v e n t i o n o f th e com m unicable d i s e a s e s , i n c l u d in g tr e a tm e n t o f th e -v en erea l d i s e a s e s . ^
T h e re s h o u ld be a f r e e d i s t r i b u t i o n o f d r u g s w h ich
are a n t i s y p h i l i t i c .
T h e re s h o u ld be one c e n t e r i n a S t a t e w h ic h w ould
p ro v id e f o r s p e c i a l f a c i l i t i e s ,
to ry t e s t s .
s u c h a s X - r a y s , and l a b o r a ­
T hese i n s t i t u t i o n s s h o u ld p r o v i d e f o r h o s p i t a l i ­
z a t i o n o f p a t i e n t s who r e q u i r e
in -p a tie n t care.
The c o s t o f
t r a n s p o r t i n g su c h i n d i g e n t p a t i e n t s fro m r u r a l co m m u n itie s
s h o u l d be b o r n b y t h e S t a t e .
P r i v a c y i s e s s e n t i a l when t h e e x a m i n a t i o n i s made and
t r e a t m e n t g iv e n *
a v o id e d .
Long an d u n n e c e s s a r y w a i t i n g s h o u ld be
I t i s n e c e s s a r y t o have d ay an d n i g h t c l i n i c s , t h e
l a t t e r f o r t h o s e who a r e em ployed th r o u g h o u t t h e d a y .
i s d e s i r a b l e to t r e a t i n f a n t s ,
It
c h i l d r e n an d a d o l e s c e n t s
d u rin g s e p a ra te c l i n i c a l h o u rs .
The minimum d i a g n o s t i c f a c i l i t i e s s h o u ld be t h o s e of
a n y good o u t - p a t i e n t d e p a r t m e n t .
I t i s w e ll e s t a b li s h e d t h a t ,
in th e v a s t m a jo r i ty of
c a s e s , by th e i n s t i t u t i o n o f e f f e c t i v e t r e a t m e n t f o r s y p h i l i s
b e f o r e t h e f i f t h m onth o f p r e g n a n c y , c o n g e n i t a l s y p h i l i s can
be c o n t r o l l e d .
I t i s n e c e s s a r y t h a t e v e r y e x p e c t a n t m o th e r
be e x a m in e d f o r th e d i s e a s e .
4Ibid., p. 12
-
41
The v e n e r e a l d i s e a s e c o n t r o l s e c t i o n o f th e h e a l t h
d e p a r t m e n t s h o u ld em p lo y t h e s e r v i c e s o f one o r more m e d ic a l
f o l l o w - u p w o r k e r s on i t s own s t a f f .
f o l l o w —up w o rk e r i s t w o - f o l d :
The t a s k o f the^ m e d i c a l
(1) t h e e p i d e r m i o l o g i c i n ­
v e s t i g a t i o n o f th e e a r l y i n f e c t i o u s c a s e s ;
(£) t h e f o l l o w -
up o f p a t i e n t s l a p s e d fro m t r e a t m e n t , e s p e c i a l l y t h o s e w ith
in fe c tio u s v en ereal d is e a s e .
T hese tw o f a c t o r s a r e im p o r­
t a n t in th e c o n tr o l o f th e d i s e a s e .
X n t r a - and i n t e r - S t a t e
c o o p e r a t i o n a r e o f p a ra m o u n t im p o r ta n c e i n a l l e p i d e r m i o l o g i c w o rk .
The co m m ittee s t a t e s , "A d eq u a te an d u n i v e r s a l l y a v a i l ­
a b l e l a b o r a t o r y s e r v i c e f o r d a r k - f i e l d e x a m i n a t i o n s and s e r o ­
l o g ic t e s t s i s a f i r s t e s s e n t i a l in th e c o n t r o l o f s y p h i l i s . ”5
The c o m m itte e b e l i e v e s t h a t i t
i s , "sound p u b lic p o lic y fo r
t h e S t a t e t o s e t s t a n d a r d s f o r t h e p e r f o rm a n c e o f su c h t e s t s ,
to c o n tr o l t h e i r a c c u ra c y , t h e i r c o n tin u e d s p e c i f i c i t y , and
t o se e t h a t c o n d i t i o n s a r e m a i n t a i n e d w h ic h a r e e s s e n t i a l
f o r a c c u r a t e t e c h n i c i n s e r o d i a g n o s t i c ? r a r k .tT^
The lu m b a r p u n c t u r e s h o u ld be a p a r t o f th e r o u t i n e
e x a m i n a t i o n , e s p e c i a l l y d u r i n g t h e s e c o n d s i x m o nths o f
tre a tm e n t in e a r l y s y p h i l i s a n d .a t th e s t a r t o f tre a tm e n t
in l a t e s y p h ilis ..
5i b i d . , p . 1 6 .
6I b i d . . p . 1 7 .
42
"The i n f o r m a t i v e an d e d u c a t i o n a l p ro g ra m a g a i n s t t h e
v en e re al d ise a se s is
i n many r e s p e c t s i t s m ost i m p o r t a n t
p h a s e . r,l7
The t r a i n i n g t h a t t h e v a r i o u s m e d i c a l s c h o o l s o f f e r
a s u n d e r - g r a d u a t e a n d p o s t - g r a d u a t e c o u r s e s s h o u ld be, p o s ­
s i b l y , more e f f e c t i v e .
The d i s s e m i n a t i o n o f i n f o r m a t i o n l i t e r a t u r e
p h y sic ia n s in p riv a te p ra c tic e
to th e
i s e s s e n t i a l , and th e m a te r ia l
u s e d s h o u ld be s e l e c t e d p a r t i c u l a r l y t o a i d th em i n p r a c t i c e
an d s e c u r e t h e i r a c t i v e c o o p e r a t i o n i n t h e p u b l i c h e a l t h
c o n t r o l o f th e v e n e r e a l d i s e a s e s .
7 I b i d . , p . SO .
CHAPTER TV
CONTROL OF SYPHILIS IN CALIFORNIA
C h a p t e r 757 ( C a l i f o r n i a P e n a l Code) was a p p r o v e d b y
t h e G o v ern o r o f C a l i f o r n i a , J u l y 1 , 1 9 3 7 , and became e f f e c ­
t i v e A u g u st 2 7 , 1 9 3 7 .
T h is c h a p t e r c o n c e r n s a n
A ct r e l a t i n g t o t h e c a r e an d c o n t r o l o f v e n e r e a l d i s ­
e a s e s , g r a n t i n g o t h e r and f u r t h e r p o w ers i n r e l a t i o n
t h e r e t o t o th e S t a t e B o a rd o f P u b l i c H e a l t h an d i t s
s u b o rd in a te a g e n c ie s , a u th o r iz in g th e a c c e p ta n c e o f th e
F e d e r a l S o c i a l S e c u r i t y F unds and m ak in g a n a p p r o p r i a ­
tio n th e re fo r.1
I t w i l l be r e c a l l e d t h a t t h e S o c i a l S e c u r i t y A ct was
p a s s e d by t h e U n i t e d S t a t e s C o n g re s s i n 1935 a n d became
o p e r a tiv e in 1936.
C a l i f o r n i a l o s t no tim e i n r e s p o n d i n g
to th e e f f o r t s o f th e P u b lic H e a lth S e r v ic e .
U nder t h e
te r m s o f T i t l e V I o f t h i s A c t, p r o v i s i o n s w ere made f o r t h e
e x p a n sio n o f p u b lic h e a l t h a c t i v i t i e s th ro u g h a llo tm e n ts
t o th e s t a t e s f o r s t a t e a n d l o c a l h e a l t h s e r v i c e s .
Of t h e
e i g h t m i l l i o n d o l l a r s a p p r o p r i a t e d , a p p r o x i m a t e l y one m i l ­
l i o n was s e t a s i d e f o r v e n e r e a l d i s e a s e c o n t r o l p u r p o s e s .
F unds a v a i l a b l e t o C a l i f o r n i a .
An a l l o t m e n t fro m
t h i s fu n d was made t o C a l i f o r n i a i n J a n u a r y , 1 93 7 , an d t h e
B u re a u o f V e n e r e a l d i s e a s e s was e s t a b l i s h e d w i t h i n t h e S t a t e
D e p a rtm e n t o f P u b l i c H e a l t h , F e b r u a r y 1 , 1 9 3 7 .
The i n i t i a l
^-C a l i f o r n i a P e n a l C o d e. C h a p te r 73 7, S e c t i o n s 1 - 1 6 .
44
a l l o t m e n t t o t h e S t a t e o f C a l i f o r n i a was a t t h e r a t e o f
$ 5 0 ,0 0 0 p e r y e a r .
The 1 9 3 6 -3 7 L e g i s l a t u r e o f th e S t a t e o f
C a l i f o r n i a p a s s e d C h a p te r 737 an d a n a p p r o p r i a t i o n o f
$ 1 5 0 ,0 0 0 was g r a n t e d f o r v e n e r e a l d i s e a s e c o n t r o l p u r p o s e s
f o r t h e 1 9 3 7 -3 8 b ie n n iu m .
T h ere was t h u s a v a i l a b l e t o t h e
S t a t e D e p a rtm e n t $ 1 7 5 ,0 0 0 f o r t h e f i s c a l y e a r 1 9 3 7 - 3 8 .
A t th e 1 9 3 7 -3 8 s e s s i o n o f C o n g r e s s , T i t l e VI o f t h e
S o c i a l S e c u r i t y A ct was amended b y t h e a d o p t i o n o f t h e L a F o lle tt-B u lv /in k le B i l l .
T h is b i l l a u t h o r i z e d C o n g r e s s t o
a p p r o p r i a t e t h r e e , f i v e , and s e v e n m i l l i o n d o l l a r s r e s p e c ­
t i v e l y , f o r th e n e x t th r e e f i s c a l y e a rs .
T h re e m i l l i o n
d o l l a r s was a p p r o p r i a t e d f o r t h e 1 9 3 8 -3 9 f i s c a l y e a r .
t h i s a p p r o p r i a t i o n C a l i f o r n i a was a l l o t e d # 1 0 3 ,7 9 1 .
From
A c c o rd ­
i n g t o D r. M e r r i l l , " T h e re i s a p p r o x i m a t e l y # 3 0 0 ,0 0 0 p e r
y e a r b e i n g s p e n t by l o c a l h e a l t h d e p a r t m e n t s a n d c o u n ty
h o s p ita ls f o r v e n e re a l d ise a se c o n tro l." ^
The f u n d s t h a t a r e now a v a i l a b l e a r e a p p r o x i m a t e l y
$ 4 7 5 ,0 0 0 o r a b o u t s e v e n c e n t s p e r c a p i t a .
The P u b l i c H e a l t h
S e rv ic e e s tim a te s t h a t tw e n ty -fiv e c e n ts p e r c a p ita i s
n e c e s s a r y t o p r o v i d e a n a d e q u a t e p ro g ra m .
C o n t r o l m e a s u r e s a r e d i r e c t l y d e p e n d e n t upon f u n d s
a v a ila b le .
I t i s n o t d i f f i c u l t t o s e e t h a t we h ave b a r e l y
s c r a t c h e d t h e s u r f a c e , fro m th e s t a n d p o i n t o f f u n d s a v a i l a b l e .
^M alcolm H. M e r r i l l , M. D ., V e n e r e a l D is e a s e C o n t r o l
i n C a l i f o r n i a (B u reau o f V e n e r e a l D i s e a s e s , S t a t e D ep a rtm en t
o f P u b l i c H e a l t h ) , November 1 5 , 1 9 38 , p . 3 .
45
The D i r e c t o r
of
o f P u b lic H e a lth i s th e E x e c u tiv e O f f ic e r
t h e S t a t e H e a l t h D e p a r tm e n t.
s e v e ra l bureaus are
The c h i e f s o f e a c h o f t h e
made r e s p o n s i b l e t o t h e D i r e c t o r .
The f o l l o w i n g m a t e r i a l i s b a s e d up o n a r e p o r t g i v e n
by D r. M e r r i l l .
The B u re a u o f Y e n e r e a l D i s e a s e .
T h is B u re a u was
e s t a b l i s h e d F e b r u a r y 1 , 1 9 3 7 , w i t h a p e r s o n n e l o f one member.
At t h e p r e s e n t tim e t h e r e a r e f i f t y - t h r e e m em bers, i n c l u d i n g
se v e n te e n p h y s ic ia n s , f o u r te e n p u b lic h e a l t h n u r s e s , s ix
b a c t e r i o l o g i s t s , two l a b o r a t o r y h e l p e r s , a p u b l i c h e a l t h
i n f o r m a t i o n e d i t o r an d a s s i s t a n t , tw o i n v e s t i g a t o r s , s e v e n
s t e n o g r a p h e r s , two c l i n i c o r d e r l i e s and a m a i l i n g c l e r k .
Of
t h e f i f t y - t h r e e e m p lo y e e s , t e n a r e e n g a g e d i n t h e c e n t r a l
a d m in is tr a tio n , seven are a s sig n e d to o th e r b ureaus in th e
S t a t e H e a l t h D e p a r tm e n ts , and t h i r t y - s i x a r e a s s i g n e d t o
l o c a l h e a lth d e p a rtm e n ts.
Put i e s p e r f o r m e d b y members o f p e r s o n n e l .
The S t a t e
h a s b e e n d i v i d e d i n t o two d i s t r i c t s an d a m e d i c a l o f f i c e r
a s s i g n e d t o do t h e f i e l d w ork i n e a c h d i s t r i c t .
o f f i c e o f t h e B u r e a u i s i n San F r a n c i s c o .
The c e n t r a l
The m e d ic a l
o f f i c e r a s s i g n e d t o t h e N o r t h e r n D i s t r i c t w o rk s o u t o f th e
San F r a n c i s c o O f f i c e .
The m e d ic a l o f f i c e r a s s i g n e d t o
S o u th e r n C a l i f o r n i a w o rk s o u t o f t h e L o s A n g e le s o f f i c e .
The c h i e f o f t h e b u r e a u an d t h e s e tw o o f f i c e r s s e r v e
t o d e v e lo p new c l i n i c s and p ro g ra m s i n l o c a l d i s t r i c t s and
46
t o c o o r d i n a t e t h e a c t i v i t i e s th r o u g h o u t th e S t a t e .
In any
l o c a l com munity t h e w o rk i s done t h r o u g h t h e l o c a l h e a l t h
d e p a rtm e n t.
T h ere a r e t h i r t e e n p h y s i c i a n s a s s i g n e d t o th e l o c a l
h e a lth d e p a rtm e n ts.
Twelve n u r s e s a r e a l s o a s s i g n e d t o t h e
l o c a l h e a lth d e p a rtm e n ts.
The p u b l i c i n f o r m a t i o n p ro g ra m i s a d m i n i s t e r e d by a
p u b l i c i n f o r m a t i o n e d i t o r who n o t o n l y d e v e lo p s a c e n t r a l
b u r e a u p ro g ra m b u t c o o p e r a t e s w i t h l o c a l h e a l t h d e p a r t m e n t s
f o r th e s ti m u la tio n of l o c a l la y e d u c a tio n a l a c t i v i t i e s .
I t can be s e e n t h a t th e m a jo r p o r t i o n o f t h e w ork
done t h u s f a r h a s b e e n c e n t r a l i z e d a ro u n d t h e p h y s i c i a n ,
p u b l i c h e a l t h n u r s i n g an d l a b o r a t o r y p e r s o n n e l .
D r. M e r r i l l s a y s , "The o r g a n i z a t i o n f o r c e n t r a l a d ­
m i n i s t r a t i o n i s now a d e q u a t e .
E x p a n s io n i n t h e f u t u r e w i l l
be i n t h e way o f p e r s o n n e l a s s i g n e d t o l o c a l h e a l t h d e p a r t m e n ts."
E v e r y e f f o r t i s b e i n g made t o i n t e g r a t e c l o s e l y
t h e v e n e r e a l d i s e a s e p ro g ra m w i t h t h e a c t i v i t i e s o f t h e
S t a t e H e a l t h D e p a r tm e n t.
has n o t been s e t u p .
An in d e p e n d e n t n u r s i n g d i v i s i o n
The n u r s e s t h a t a r e e n g a g e d i n v e n e r e a l
d is e a s e c o n t r o l a re a p a r t o f th e g e n e ra l s t a t e n u r s in g s e r ­
v ic e .
L ik e w is e , e x p a n sio n o f th e l a b o r a t o r y f a c i l i t i e s con­
s i s t s in th e e x p a n sio n o f th e G en eral S ta te L a b o ra to ry in
^Ib id., p . 6.
47
B e rk e le y .
The r e c o r d i n g o f m o r b i d i t y s t a t i s t i c s i s r e t a i n e d
i n th e o f f i c e o f th e C h ie f M o rb id ity S t a t i s t i c i a n , th u s
a v o i d i n g s e t t i n g up an in d e p e n d e n t s e r v i c e .
Use o f f u n d s .
The f u n d s t h a t a r e r e c e i v e d fro m t h e
P u b l i c H e a l t h S e r v i c e a r e t o be u s e d f o r e x p a n s i o n o n l y o f
a lre a d y e x is tin g lo c a l e x p e n d itu re s.
I t becom es t h e r e s p o n s i ­
b i l i t y o f t h e S t a t e H e a l t h D e p a rtm e n ts t o se e t h a t t h e s t a n ­
d a r d s a s s e t f o r t h by th e S o c i a l S e c u r i t y A ct a r e m a i n t a i n e d .
The S t a t e B u re a u o f V e n e r e a l D i s e a s e , t h e r e f o r e , a c t s
a s th e c e n t r a l a d m in is tr a tiv e agency f o r th e c o n t r o l o f
v e n e re a l d is e a s e s in C a lif o r n ia .
I t h a s th e d o u b le f u n c t i o n
o f c o o p e r a t i n g w i t h th e U. S . P u b l i c H e a l t h S e r v i c e and
c o o r d i n a t i n g t h e C a l i f o r n i a p ro g ra m w i t h t h o s e . o f o t h e r
S ta te s.
H ow ever, t h e u l t i m a t e a d m i n i s t r a t i o n o f t h e p r o ­
gram r e s t s w i t h t h e l o c a l h e a l t h d e p a r t m e n t s .
To b e g i n on a p ro g ra m i t I s n e c e s s a r y t o know how
p r e v a l e n t a d i s e a s e i s , how many c a s e s t h e r e a r e , a n d w here
th e y a re lo c a te d .
The p h y s i c i a n s o f C a l i f o r n i a have b e e n
r e q u i r e d by la w , s i n c e 1 9 1 2 , t o r e p o r t t o t h e H e a l t h D e p a r t ­
m ent a l l c a s e s o f v e n e r e a l d i s e a s e com ing u n d e r t h e i r c a r e .
H ow ever, t h i s la w h a s b e e n " o v e r - l o o k e d ” ; c o n s e q u e n t l y o n l y
a f r a c t i o n o f t h e c a s e s hav e a c t u a l l y been r e p o r t e d .
" O ffic ­
i a l l y , t h e r e h a s n ’t b ee n a e a s e o f s y p h i l i s o r g o n o r r h e a i n
some c o u n t i e s f o r o v e r 20 y e a r s , ” s a y s D r. M e r r i l l . ^
^L oc. c i t .
48
As was p r e v i o u s l y s t a t e d , t h e r e w ere " 1 7 ,0 0 0 c a s e s o f
v e n e r e a l d i s e a s e s r e p o r t e d d u r i n g t h e f i r s t n i n e m onths o f
1936 b e f o r e t h e p r e s e n t p ro g ra m was l a u n c h e d .
D u rin g t h e
same p e r i o d o f 1939 t h e r e w ere r e p o r t e d 3 0 ,4 7 9 c a s e s , an
i n c r e a s e o f 73 p e r c e n t .’” *5
Growth o f c l i n i c a l a c t i v i t y .
D u rin g th e p a s t two
y e a r s t h e r e h a s b e e n m ark ed e x p a n s i o n o f c l i n i c a c t i v i t i e s ,
"When t h e B u re a u was e s t a b l i s h e d ,
77 c l i n i c s an d t r e a t m e n t
c e n t e r s w ere r e p r e s e n t e d i n th e m o n th ly r e p o r t s coming t o
t h e S t a t e D e p a rtm e n t o f H e a l t h ,
T h ere a r e now 110 su c h
c e n te rs re p re se n te d .
D r, M e r r i l l s t a t e s t h a t , "The i n c r e a s e i n t h e number
o f ca se s t r e a t e d a t c l i n i c s has been r a t h e r im p re ssiv e .
3 2 9 ,1 6 5 t r e a t m e n t s f o r s y p h i l i s an d g o n o r r h e a w ere r e p o r t e d
f o r 1 9 3 6 -3 7 f i s c a l y e a r .
T h i s i n c r e a s e d t o 5 4 9 ,5 1 4 f o r
1 9 3 7 - 3 8 , a 66 p e r c e n t i n c r e a s e . "
He s a y s f u r t h e r ,
I f a d e q u a te f a c i l i t i e s a n d p u b l i c i t y a r e g iv e n t o a
c l i n i c i t i s a b l e t o a c c o m p l i s h much. F o r e x a m p le , i n
1 9 3 6 -3 7 f i s c a l y e a r 11 c a s e s o f s y p h i l i s and g o n o r r h e a
w ere a d m i t t e d t o t h e c o u n t y h o s p i t a l c l i n i c i n M o n te re y
C o u n ty . The c l i n i c m s r e o r g a n i z e d , new c e n t e r s e s t a b ­
lis h e d , e tc .
I n 1 9 3 7 - 3 8 , 125 c a s e s w ere a d m i t t e d — a n
i n c r e a s e o f o v e r 1 0 0 0 $ . I n S a n ta B a r b a r a t h e r e was an
i n c r e a s e o f fro m 16 t o 125 c a s e s o r 7 0 8 $ .
In la r g e r
c e n t e r s much t h e same t h i n g h a s h a p p e n e d .
In F resno
t h e t r e a t m e n t s p e r m onth a t th e c o u n ty h o s p i t a l c l i n i c
i n c r e a s e d fro m 376 t o 1155 fro m J a n u a r y , 1937 t o Nov­
e m b e r, 1 9 3 8 , an i n c r e a s e o f 3 0 0 $ . I n S a c ra m e n to Muni­
c i p a l C l i n i c t o t a l c l i n i c v i s i t s i n c r e a s e d fro m 553 t o
2749 i n t h e same p e r i o d — a n i n c r e a s e o f n e a r l y 5 0 0 $ .?
T hese f i g u r e s a r e i n d i c a t i v e o f w h at c a n be a c c o m p lis h e d i f
5L o c . c i t .
6I b i d . . p . 9 .
l a . . p.
io.
49
t h e c l i n i c p ro g ra m i s b u i l t u p .
At t h e p r e s e n t tim e t h e
c l i n i c e x p a n s i o n i n t h e l a r g e r m e t r o p o l i t a n a r e a s , su c h a s
O a k la n d , San F r a n c i s c o , and Los A n g e le s , i s j u s t b e g i n n i n g
to fu n c tio n .
" A p p r o x im a te ly t w o - t h i r d s o f a l l v e n e r e a l c a s e s u n d e r
8
m e d ic a l c a r e a r e t r e a t e d by p r i v a t e p h y s i c i a n s . ”
E very
e f f o r t i s b e i n g made to make t h e t r e a t m e n t o f t h e p r i v a t e
p h y s i c i a n more e f f e c t i v e .
began in 1937.
The d i s t r i b u t i o n o f f r e e d r u g s
I t i s in te n d e d t h a t t h i s s e rv ic e w i l l c a re
f o r t h e t r e a t m e n t o f t h e f r e e an d p a r t - p a y p a t i e n t s .
"Up
t o O c to b e r 1 , 1 9 3 8 , s u f f i c i e n t d r u g s f o r 4 0 8 ,3 6 1 t r e a t m e n t s
h ad b e e n d i s t r i b u t e d . ” 9
S ta te a id s to p r iv a te p h y s ic ia n s .
I n a d d i t i o n t o th e
above s e r v i c e , a n e d u c a t i o n a l p ro g ra m f o r p h y s i c i a n s i s
b ein g c a r r i e d on.
b e in g p ro v id e d .
L i t e r a t u r e and c o n s u l t a t i v e s e r v i c e i s
A t v a r i o u s t i m e s t h e 1 2 ,0 0 0 p h y s i c i a n s o f
t h e S t a t e a r e c i r c u l a r i z e d and v a r i o u s p h a s e s o f th e p ro g ra m
e x p l a i n e d and s p e c i a l b u l l e t i n s on d i a g n o s i s and t r e a t m e n t
o f v e n e re a l d is e a s e s p ro v id e d .
T h ere h a s b e e n a n i n c r e a s e
i n t h e number o f b lo o d sp e c im e n s ex am ined f o r s y p h i l i s e a c h
m onth i n t h e S t a t e L a b o r a t o r y fro m a p p r o x i m a t e l y 3 ,0 0 0 t o
1 0 ,0 0 0 .
P r a c t i c a l l y e v e ry p u b lic h e a lth la b o ra to ry has
8Ibid.. p. 12.
9L o c . c i t .
50
shown t h e same t e n d e n c y to v /a rd i n c r e a s i n g t h e i r number o f
te sts.
The S t a t e l a b o r a t o r y i s now p r e p a r e d t o c h e c k on th e
a c c u ra c y o f t e s t s ru n in l o c a l h e a lth d e p a rtm e n ts.
S ta te w ill,
The
i f n o t i f i e d i n a d v a n c e , r u n s e r o l o g i c a l t e s t s on
la r g e gro u p s o f p e o p le — i n d u s t r i a l , s c h o o l, o r o th e rw is e .
A c c o r d in g t o D r. M e r r i l l , W assermann t e s t s h av e b e e n
made on 1 1 ,6 1 0 men a d m i t t e d t o S t a t e R e l i e f A d m i n i s t r a t i o n
Camps i n S t o c k t o n , S h a rp P a r k a n d P a c o im a .
rtA t o t a l o f
1 ,2 5 0 s y p h i l i t i c s w ere f o u n d , o r 1 0 .7 p e r c e n t o f t h e men
t e s t e d were p o s i t i v e .
Thes e men w ere t r e a t e d by th e
S t a t e D e p a rtm e n t o f P u b l i c H e a l t h .
An a n a l y s i s was made o f t h e f i n d i n g s i n t h e c a s e s o f
438 o f t h e Gamp S t o c k t o n men d i a g n o s e d a s h a v in g s y p h i l i s .
By f a r t h e l a r g e s t n um ber, 8 5 . 3 p e r c e n t , w ere i n t h e l a t e n t
s ta g e s o f th e d is e a s e .
O nly 2 .1 p e r c e n t w ere i n t h e p r i m a r y
a n d s e c o n d a r y s t a g e s w here c u re i s m ost c e r t a i n .
438 men, 212 ( 4 8 .4 $ )
Of t h e
s a i d t h e y h a d no p r e v i o u s know ledge o f
i n f e c t i o n an d 235 (5 3 .4 $ )
s a i d t h e y h ad no p r e v i o u s t r e a t m e n t .
The c o n c l u s i o n s f o r t h e s e f i n d i n g s a r e a s f o l l o w s :
(1) The r a t i o o f t h e p o s i t i v e s i s h i g h e r among S .R .A .
camps t h a n i s e s t i m a t e d f o r t h e p o p u l a t i o n a s a w ho le i n
th is s ta te .
(2) A bout h a l f o f t h e i n f e c t i o n s w ere n o t
s u s p e c t e d b y th e p a t i e n t .
(3) A l a r g e p o r t i o n o f c a s e s
h ad r e c e i v e d l i t t l e o r no p r e v i o u s t r e a t m e n t .
(4) The
econom ic s i t u a t i o n o f t h e p a t i e n t c o u p l e d w i t h l a c k o f
c l i n i c f a c i l i t i e s and r i g i d r e q u i r e m e n t s f o r c l i n i c
10I b i d ... p . 13
51
a d m i s s i o n h ave b e e n t h e m ain f a c t o r s p r e v e n t i n g p a t i e n t s
fro m r e c e i v i n g t r e a t m e n t .
(5) I g n o r a n c e o f t h e n a t u r e
an d symptoms o f v e n e r e a l d i s e a s e s h av e c a u s e d many p e r ­
so n s n o t t o s u s p e c t t h e y w ere i n f e c t e d . H
D r. F i s h b e i n s t a t e s ,
’’F o r e v e r y known c a s e o f s y p h i l i s i t
i s e s t i m a t e d t h e r e i s one c a s e unknown e i t h e r t o h e a l t h
d e p a r t m e n t s o r t h e p a t i e n t s t h e m s e l v e s . 1*-**^
T here h a s b e e n a d e f i n i t e a t t e m p t t o ex p a n d th e p u b l i c
h e a lth n u rsin g s e rv ic e .
T hese n u r s e s a r e c h a r g e d ? / i t h t h e
d u t y o f e p i d e r m i o l o g i c a l an d f o l l o v / - u p w o rk .
t i o n comes fro m some p r e v i o u s i n f e c t i o n .
T hese n u r s e s
a t t e m p t t o s e e k o u t th e s o u r c e o f i n f e c t i o n .
c a s e s l a p s e ffo m t r e a t m e n t .
E very i n f e c ­
T hen , t o o , many
I t t h e n becom es t h e d u t y o f t h e
n u rse t o r e t u r n th e se la p s e d c a se s to tr e a tm e n t.
They s e r v e
b o th th e c l i n i c and th e p r i v a t e p h y s ic ia n .
A lth o u g h t h i s w ork h a s h a r d l y b e g u n , t h e s e n u r s e s
w ere s u c c e s s f u l d u r i n g t h e f o u r m o nths e n d i n g J u n e , 1 9 3 8 ,
i n l o c a t i n g 69 s o u r c e s o f i n f e c t i o n , 411 c o n t a c t s , a n d i n
r e t u r n i n g 1 ,0 8 2 l a p s e d c a s e s t o t r e a t m e n t .
E d u c a t i o n a l l y , th e S t a t e h a s p r i n t e d s e v e n p a m p h le ts
on d i f f e r e n t p h a s e s o f th e c o n t r o l o f v e n e r e a l d i s e a s e s .
A
number o f en a m el s i g n s h ave a l s o b ee n p r i n t e d a n d h ave b e e n
p o s t e d i n w ashroom s o f p u b l i c an d i n d u s t r i a l b u i l d i n g s .
^ I b i d . . p. 13.
l^ M o rris F is h b e in , S y p h ilis (P h ila d e lp h ia :
McKay & Company, 1 9 3 7 ) , p . 7 0 .
D a v id
A
52
c o u r s e o f s t u d y h a s b e e n p r e p a r e d and i s b e i n g u s e d by v a r ­
io u s s tu d y groups th ro u g h o u t th e S t a t e .
T h ere a r e a v a i l a b l e fro m th e S t a t e c o p i e s o f a 16mm,
two r e e l , s i l e n t m o tio n p i c t u r e e n t i t l e d ,
N a t u r e , P r e v e n t i o n .and T r e a t m e n t . f1
ffS y p h i l i s , I t s
A co m m en tato r u s u a l l y
a c c o m p a n ie s t h e f i l m .
S e v e r a l o f t h e p h y s i c i a n s em p lo yed by t h e b u r e a u can
be s c h e d u le d f o r t a l k s b e f o r e i n t e r e s t e d g r o u p s .
A woman
p h y s i c i a n i s a v a i l a b l e f o r l e c t u r e s b e f o r e women’ s g r o u p s .
P l a n s f o r th e f u t u r e a s s e t f o r t h b y t h e Com m ittee
j
on V e n e r e a l D i s e a s e C o n t r o l .
F i r s t - P r o v i d e a d e q u a te
c l i n i c s — t r e a t m e n t m u st be a v a i l a b l e f o r e v e r y p a t i e n t i n
C a lif o r n i a r e g a r d le s s o f h i s p la c e of r e s id e n c e o r h is
a b i l i t y to pay.
S econd - P r o v i d e a d e q u a te l a b o r a t o r y s e r ­
v i c e — t h e num ber o f b lo o d t e s t s r u n m u st be e x p a n d e d m a n y fo ld
i f we a r e t o f i n d t h o s e t h o u s a n d s o f unknown c a s e s .
T h ird
- C o n tin u e t o e x t e n d e v e r y e f f o r t t o a s s i s t p h y s i c i a n s , and
t o draw them i n t o t h e p r o g ra m .
h e a lth se rv ic e
(n u rsin g ).
p u b l i c e d u c a t i o n p r o g ra m .
F o u r t h - E x te n d t h e p u b l i c
F i f t h - D ev e lo p a w e l l - c o o r d i n a t e d
CHAPTER Y
THE INCIDENCE AND CONTROL OF SYPHILIS
IN LOCAL COMMUNITIES
The s u o o e s s o f a n y p ro g ra m w h ic h t h e F e d e r a l G overn ­
ment o r th e s t a t e g o v e rn m e n t m ig h t d e v i s e f o r t h e c o n t r o l o f
s y p h i l i s d ep e n d s upon t h e r e s p o n s e i t r e c e i v e s fro m t h e
l o c a l c o m m u n itie s .
I n a n a t t e m p t t o d e te r m in e how t h e
s e v e r a l l o c a l c o m m u n itie s h ave r e s p o n d e d t o t h e p r o p o s e d
p ro g ra m s o f t h e F e d e r a l and s t a t e g o v e r n m e n ts , many l o c a l
H e a l t h D e p a rtm e n t B u l l e t i n s .w ere r e a d , l o c a l H e a l t h O f f i c e r s
i n t e r v i e w e d , and a q u e s t i o n n a i r e s e n t t o t h o s e i n o u t l y i n g
d istric ts.
The f i n d i n g s a r e s e t f o r t h b e lo w .
Los A n g e l e s .
The f o l l o w i n g i s b a s e d upon a r e p o r t b y
D r. H. M. E l l i o t t , o f t h e Los A n g e le s B o a rd o f H e a l t h .
The
e d u c a t i o n a l ca m p aig n a g a i n s t v e n e r e a l d i s e a s e s h a s shown
r e s u l t s i n t h r e e w ay s; p r i n c i p a l l y :
(1) The g r e a t i n c r e a s e I n t h e number o f c i t i z e n s s e e k ­
i n g i n f o r m a t i o n an d e x a m i n a t i o n . . (2) The i n c r e a s e o f
in d ig e n t o r lo w -b ra ck et p a t i e n t s a ffo rd e d tre a tm e n t.
(3) The w ide sc o p e o f p e r s i s t e n t s e a r c h f o r s o u r c e s o f
i n f e c t i o n and c o n t a c t . T h i s i n c r e a s e , w h ic h was e v i d e n t
in th e o u tly in g b ran ch es a s w e ll a s in th e c e n t r a l
c l i n i c , was 35 fo o v e r t h e c a s e l o a d f o r t h e p r e v i o u s y e a r . 1
The c e n t r a l c l i n i c .h a s b e e n e q u i p p e d t o g iv e e a r l y s y p h i l i s
p a t i e n t s e v e ry ty p e o f s p e c i a l t y ex a m in a tio n and tr e a tm e n t
1A n n u al R e p o r t o f t h e B o a rd o f H e a l t h C o m m is s io n e r s ,
Los A n g e l e s , C a l i f o r n i a - F i s c a l Y ear 1 9 3 7 - 3 8 , p . 2 2 .
54
n e c e s s a r y f o r c u re *
T h ere h a s b e e n a n a t t e m p t t o c a r r y on
p r o p a g a n d a w o rk , s u c h a s p a m p h l e t s , t a l k s ,
d e m o n stra tio n s,
a n d news a r t i c l a s .
D r. E l l i o t t s t a t e s ,
"W hile t h e r e c o r d s show a n i n ­
c r e a s e i n w ork done ( s e e T a b l e s I, I I , a n d I I I ) , t h e y
n e v e r t h e l e s s show a l a g g i n g i n e f f i c i e n c y , a n d n o t k e e p i n g
p ac e w i t h t h e num bers o f p a t i e n t s ex a m in e d a n d t r e a t e d . " 2
Too s m a l l a p e r s o n n e l i n th e m e d i c a l s o c i a l w ork d i v i s i o n
i s p o ssib ly re sp o n sib le fo r t h i s c o n d itio n .
A few a d d i t i o n ­
a l n u r s e s ?/ould make t h e w o rk e a s i e r and more e f f i c i e n t , and
w ou ld a l l o w t h e s o c i a l s e r v i c e s t a f f t o g iv e u n d i v i d e d a t t e n ­
t i o n t o th e f e r r e t i n g out o f s o u rc e s o f i n f e c t i o n , and
th e re fo re ,
i n t h e b a t t l e a g a i n s t s y p h i l i s , w ould make f o r
g re a te r success.
A n o th e r d e t e r r e n t f a c t o r , one w h ic h i s o f c o n s i d e r a b l e
im p o r ta n c e a t t h e moment, i s t h e bad p h y s i c a l c o n d i t i o n s
o f o u r q u a r t e r s . T hey a r e n o t c a l c u l a t e d t o i n s p i r e
c o n f i d e n c e i n o u r p a t i e n t s n o r t o make t h e b e s t i n m e d i­
c a l s e r v i c e s p o s s i b l e . We t r u s t t h a t t h e new H e a l t h
D e p a rtm e n t B u i l d i n g w i l l i n c l u d e a d e q u a te q u a r t e r s f o r
t h e h o u s i n g o f t h e t h o u s a n d s who e v e r y y e a r s e e k o u r
s e r v i c e an d t h a t o u r o u t l y i n g c l i n i c s may be im p ro v ed t o
keep p ac e vd.th t h e i r r e s p e c t i v e n e e d s . 3
2Ibid., p. 23.
5Ibid. . p. 23.
55
TABLE I
CENTRAL MEN’ S C LIN IC4
LOS ANGELES CITY
EXAMINATIONS
G o n o rrh e a
S y p h ilis.
N e g a tiv e .
.
.
.
.
.
•
.
.
1958
1937
.
.
.
.
1 ,5 5 4
1 ,1 7 6
3 ,6 8 9
READMISSIONS . . .
G o n o rrh e a . . .
S y p h ilis. . . .
394
554
4 ,7 8 7
636
TERMINATED . . . .
348
288
3 ,9 2 4
1 ,1 8 0
PROBABLY CORED . .
G o n o rrh e a . . .
S y p h ilis. . . •
847
333
787
357
248
DEFERRED ....................
370
TRANSFERRED. . . .
G o n o rrh e a . . .
S y p h ilis. • . •
301
£51
169
201
2 ,0 9 0
DELINQUENT . . . .
G o n o rrh e a . . .
S y p h ilis. . . .
1 ,3 2 8
762
1 ,0 8 7
743
TREATMENTS . . . .
A rs p h e n a m in e • •
B ism u th . . . .
G o n o rrh e a . . .
M is c e lla n e o u s .
4T b i d . , p .
1 ,4 8 7
743
2 ,5 5 7
5 9 ,7 7 7
1 1 ,1 5 6
2 6 ,9 7 1
1 8 ,2 2 2
2 6 ,4 8 0
25.
8 ,1 2 6
1 8 ,4 5 0
2 1 ,9 0 2
1 1 ,2 9 9
56
TABLE I I
CENTRAL AND BRANCH* OFFICE CLINICS5
(Women’ s C e n t r a l C l i n i c n o t i n c l u d e d )
1938
LOS ANGELES CITY
1937
i
EXAMINATIONS . . . . . .
G o n o rrh e a ........................
S y p h i l i s .............................
N e g a t i v e . * ...................
1 ,6 5 6
1 ,4 7 7
4 ,9 6 2
5*, 644
670
HEADMISSIONS........................
G onorrhe a • . • • • ♦
S y p h i l i s .............................
396
556
345
325
4 ,2 7 0
TERMINATED.............................
1 ,2 5 8
PROBABLY CURED .....................
G o n o r r h e a ........................
S y p h i l i s .............................
928
394
876
382
DEFERRED..................................
330
TRANSFERRED.............................
G o n o rrh e a ........................
S y p h i l i s .............................
387
302
252
DELINQUENT .............................
G o n o rrh e a . ....................
S y p h i l i s ........................ ....
1 ,1 2 5
941
TREATMENTS.............................
A rs p h e n a m in e ....................
B ism u th .............................
G o n o rrh e a ........................
M is c e lla n e o u s • • . •
1 4 ,4 1 7
3 2 ,9 4 0
1 8 ,9 0 9
2 8 ,2 4 9
24.
97
290
2 ,2 9 5
1 ,3 7 4
921
7 1 ,2 4 4
* I n e l u d i n g men and women a t B ra n c h O f f i c e s .
5 I b id .. . p .
1 ,5 9 1
1 ,0 5 4
2 ,9 9 9
1 1 ,3 1 2
2 2 ,7 6 4
2 2 ,7 4 8
1 4 ,4 2 0
57
TABLE I I I
SOCIAL SERVICE REPORT6
ALL CLINICS*
LOS ANGELES CITY - MEN
1938
1937
981
819
VISITS TO:
C o n t a c t s ...........................................
D e lin q u e n ts.
. ............................. 2 ,5 9 1
2 ,4 0 8
* I n c l u d i n g Men’ s a n d Women’ s C e n t r a l C l i n i c s an d a l l B ran c h
O ffic e C l i n i c s .
+1*
«L- %
!•> /p
«L*>
^
^U/
MEN98 CLINIC
VISITS TO:
C o n tacts . • • • • • • • • •
D e lin q u e n ts.
. . . . . . . .
D e lin q u e n t L e t t e r s • • • • •
6I b i d . , p . 2 4 .
760
448
1 ,8 8 8
2 ,0 3 6
2 ,4 3 8
1 ,5 6 6
58
The summary o f th e w ork o f t h e C e n t r a l Women’ s
V e n e r e a l D is e a s e C l i n i o f o r t h e y e a r shows d e f i n i t e e x p a n ­
sio n in th e a c t i v i t i e s of t h i s d iv is io n .
c a s e s i n th e c u r r e n t f i l e s
The number o f
i s 400 more t h a n a t t h i s tim e
f o r t h e p r e v i o u s y e a r , an i n c r e a s e o f 80 $ ; t h e t o t a l c l i n i c
v i s i t s show an i n c r e a s e o f 1 2 , 6 0 0 , a n i n c r e a s e o f 46 $; new
c a s e s ex am in ed i n c r e a s e d by 1 0 9 0 , a n i n c r e m e n t o f 33 $;
t r e a t m e n t s f o r s y p h i l i s t o t a l e d 8 ,6 6 0 more t h a n t h e p r e v i o u s
y e a r, an in c re a s e o f 56$.
(See T a b l e s IV, V, an d VI)
The Women’ s V e n e r e a l D is e a s e D i v i s i o n h a s e s t a b l i s h e d
a c l i n i c f o r e x a m i n a t i o n an d t r e a t m e n t o f v e n e r e a l d i s e a s e s
o f women an d c h i l d r e n i n t h e W a tts d i s t r i c t .
T h is c l i n i c
h a s b e e n i n o p e r a t i o n f o r one y e a r .
W ith t h e a l l o c a t i o n t o t h e S t a t e o f f u n d s f o r t h e
v e n e r e a l p ro g ra m , i t
i s a n t i c i p a t e d t h a t im p ro v em en ts i n
v e n e re a l d ise a se tre a tm e n t w ill c o n tin u e .
T h is d i v i s i o n
w i l l e n d e a v o r t o c o o p e r a t e w i t h D o c to r P a r r i s h and t h e
E x e c u t i v e S t a f f i n e v o l v i n g a p r o g r e s s i v e p ro g ra m f o r
re n d e rin g e f f i c i e n t s e rv ic e in v e n e re a l d is e a s e c o n tr o l.
F o llo w in g a r e t h e t a b u l a t i o n s f o r th e C e n t r a l Women’ s .
V e n e r e a l D is e a s e C l i n i c , f o r ' L o s A n g e l e s , C a l i f o r n i a :
TABLE 17
WOMEN'S CENTRAL CLINIC7
CASES
LOS ANGELES CITY
'SYPHILIS GONORRHEA BOTH
CHANC.
A c tiv e b ro u g h t fo rw a rd
New d i a g n o s e d ...................
New n o t i n f e c t e d • . .
R e i n s t a t e d .......................
T ra n sfe rre d in . . . .
T o t a l .......................
415
841
110
242
50
58
1
5
691
1
243
72
1
595
180
7
C lo s e d , n o n - i n f e c t i o u s
C lo se d , t o o t h e r c a r e .
C lo s e d , d e l i n q u e n t • •
C lo se d , d ie d . . . . .
C lo se d , non i n f e c t e d *
T o t a l .......................
533
£67
380
3
A c tiv e c a r r i e d fo rw a rd
765
339
110
100
50
20 *
53
5
LAST
BEE . TOTAL YEAR
28
128
21
5
177
4785
931
507
391
1
2447
4277
508
51
18
75
144
974
417
611
3
3097
5102
53
907
549
123
6
46
57
1
5
431
1054
2447
853
604
1279
3097
1028
1
6009
1
2
3
Number o f c l i n i c s h e l d
T o t a l a t t e n d a n c e o f p a t i e n t s (e x a m in a tio n s and v i s i t s )
New p a t i e n t s (e x a m in a tio n s an d l a b o r a t o r y )
7I b i d . . p . 2 6 .
LUPHO.
GRANU.
ING.
498
2 7,080
4 ,3 6 7 3,276
504
TABLE IY (C o n tin u e d )
WOMEN1S CENTRAL CLINIC
TOTAL
CASES
LOS ANGELES CITY
T re a tm e n ts g iv e n :
S y p h i l i s , A rsphenam ine. • . * 6 ,9 0 2
B ism uth ....................... 1 6 ,9 2 2
Sodium T h io s u lp h a te
222
O ther m e d ic a tio n . .
43
LAST YEAR
3,579
11,660
107
82
1 5 ,4 2 8
T o ta l . . . .
G on o rrh ea, T o p i c a l .......................
O th er m e d ic a tio n . .
3,5 9 5
151
3,545
239
T o ta l . . . .
3 ,7 8 4
C h an cro id • • • • • • • • • •
20
Lympho Granuloma I n g u i n a l e .
.
T o t a l t r e a t m e n t s g iv e n . • • .
1 9 ,23 2
o>
o
TABLE IV (C o n tin u e d )
WOMEN'S CENTRAL CLINIC8
CASES
LOS ANGELES CITY
TOTAL
S p e c i a l p h y s i c a l e x a m in a tio n s* ................................ . . .
M is c e lla n e o u s l a b o r a t o r y w ork. . . . .
............................
L a b o r a to r y f i n d i n g s - Wassermanns, p o s i t i v e . •
n e g a tiv e . •
-Kahn & L a u g h lin , p o s i t i v e . •
n e g a tiv e . .
Sm ears, p o s i t i v e .......................
n e g a tiv e ................... •
D a rk -fie ld , p o s itiv e . . . .
n e g a tiv e . . . .
D ucrey, p o s i t i v e .......................
n e g a t i v e .......................
STAGE OF DISEASE - NE?sf DIAGNOSED: S y p h i l i s , p r im a r y . •
ea rly . . •
la te . . •
co n g e n ita l
G onorrhea, a c u t e . . •
c h ro n ic . •
8I b id . . p . 26.
LAST YEAR
215
31
•
• •
•
♦ •
•
•
# •
• •
0 •
• •
1 ,6 4 5
5,626
1 ,6 41
3,711
498
1 8 ,1 5 8
38
88
9
63
13
228
535
65
165
77
1 ,066
4 ,1 2 8
661
1 4 ,6 3 3
13
31
5
14
3
201
306
61
170
105
TABLE V
WOMEN'S WATTS CLINIC9
SYPHILIS
M. F .
CASES
LOS ANGELES CITY
GONORRHEA
M.
F.
1
1
21
29
3
4
1
8
3
7
65
2
2
5
3
14
C lo se d , n o n - i n f e c t i o u s . • • • 2
C lo s e d , t o o t h e r c a r e , ♦
C lo s e d , d e l i n q u e n t . , . • • •
C lo se d , t r a n s f e r r e d o u t . • • «
C lo se d , d i e d .......................
•
C lo s e d , n o t i n f e c t e d • • • • ♦
T o t a l ............................
2
14
6
1
1
2
1
32
A c tiv e b r o u g h t fo rw a rd .
New d ia g n o s e d .......................
New n o t i n f e c t e d . • • •
R e i n s t a t e d ............................
T r a n s f e r r e d i n ...................
T o ta l • • ■ • • • • •
•
•
A c tiv e c a r r i e d fo rw a rd . • •
•
#
8
BOTH
1
1
DEFERRED
M. F.
1
2
1
TOTAL
25
90
15
12
180
2
1
3
5
5
1
1
1
1
1
1
25
13
10
4
1
Tl
1
I
3
143
J5
1
4
1
90
33
57
Number o f c l i n i c s h e l d .
T o t a l a t te n d a n c e o f p a t i e n t s (e x a m in a tio n s and v i s i t s )
New p a t i e n t s (e x a m in a tio n s and l a b o r a t o r y ) .
9Ibid., p. 2V.
co
TABLE V (C o n tin u e d )
WOMEN'S WATTS CLINIC
CASES
LOs"ANGELES CITY________
TOTAL
T re a tm e n ts g iv e n - S y p h i l i s , A rsp hen am in e........................... 165
Bism uth
......................671
Sodium T h io s u lp h a te . . .
O th er m e d i c a t i o n ........................11
T o t a l .................................................847
G onorrhea, T o p i c a l ....................................
98
O ther m e d ic a tio n . • • • • 27
T o ta l
............................................ 125
Lympho Granuloma I n g u i n a l e . . . .
1
T o t a l t r e a t m e n t s g i v e n .......................................
L a b o r a t o r y f i n d i n g s - ?/asserm anns, p o s i t i v e ...........................
n e g a t i v e ..........................................................
Kahn & L a u g h lin , p o s i t i v e ...........................
n e g a t i v e .................................................
Sm ears, p o s i t i v e ....................................................................
n e g a t i v e ........................................................................ .
D uerey, p o s i t i v e . .........................................................................
n e g a t i v e ................................................................. . . .
STAGE OF DISEASE - NEW DIAGNOSED: S y p h i l i s , e a r l y . .
............................
l a t e ...........................
c o n g e n i t a l ............................... . .
G onorrhea, a c u te • • • . . . . . • • • .
c h r o n ic . . . . . .
....................
973
45
166
81
100
11
396
1
3
21
6
3
1
64
TABLE VI
SOCIAL SERVICE REPORT10
■ LOS ANGELES CITY - WOMEN
'
1938
1937
O ffic e
Home........................................................................
C o n su lta tio n s
1 5 ,2 6 9
821
6 ,3 3 2
1 0 ,3 7 4
842
4 ,0 1 7
TOTAL
2 2 ,4 2 2
1 5 ,2 3 3
1 ,9 1 2
555
1 ,8 1 9
491
2 ,2 4 7
2 ,3 1 0
VISITS:
C o n ta c ts
D e l i n q u e n t s ....................................................
218
603
253
471
TOTAL...................................................................
821
724
PLACED IN INSTITUTIONS.......................................
116
95
6 ,8 5 2
4 ,0 8 0
2 ,7 2 3
528
2 ,1 0 7
431
3 ,2 5 1
2 ,5 3 8
INTERVIEWS:
LETTERS:
In fe c tio u s p a tie n ts
O th e r l e t t e r s
(fo rm ).
. . . .
TOTAL
REFERRED BY OTHER AGENCIES
TIME RECORD:
O ffic e
F i e l d ..............................................................
.
TO TA L...................................................................
10 I b l d . . p . 2 8 .
65
San D ie g o .
The f o l l o w i n g i s b a s e d upon a r e p o r t b y
D r . F . C. Svoboda o f t h e San D iego P u b l i c H e a l t h D e p a r tm e n t.
The v e n e r e a l p a t i e n t s r e g i s t e r e d i n th e c l i n i c a v e r a g e d
6 0 6 .0 8 p e r m onth f o r t h e y e a r 1 9 3 7 - 3 8 , a s com pared ¥ /ith
6 0 2 .5 f o r t h e p r e v i o u s y e a r .
The new c a s e s a d m i t t e d d u r i n g
t h e y e a r t o t a l e d 6 7 2 , t h i s f i g u r e c o m p a rin g c l o s e l y w i t h th e
p re v io u s y e a r ’s t o t a l o f 607.
The number o f m i g r a t o r y
p a t i e n t s was r e d u c e d fro m 728 c a s e s t o 596 c a s e s .
(See
T a b le V II)
T r e a tm e n ts g i v e n a t w e e k ly i n t e r v a l s t o t a l e d 1 0 ,1 4 2
n e o s a l v a r s a n a n d 7 ,7 7 8 h e a v y m e t a l t r e a t m e n t s .
T h is i s a
\
w e e k ly a v e r a g e o f 3 4 4 .6 i n j e c t i o n s .
D r. Svoboda s p e a k s o f
two " n o t a b l e " i n c r e a s e s w h ic h o c c u r r e d i n t h e s e r v i c e s o f
th e c l i n i c a s fo llo w s :
B lo o d w i t h d r a w a l s f o r vTasserman t e s t t o t a l e d 3 ,8 8 5
a s com pared w i t h 1 ,4 1 1 i n t h e p r e v i o u s y e a r . T h i s i n ­
c r e a s e o f 2 ,4 7 4 r e s u l t e d l a r g e l y fro m G i v i l S e r v i c e
a s s ig n m e n t t o t h e C l i n i c t o so t e s t a l l c i t y e m p lo y e e s ,
an d fro m r e c h e c k s on f o o d h a n d l e r s .
The o t h e r o u t s t a n d i n g i n c r e a s e o c c u r r e d i n s m a llp o x
v a c c i n a t i o n s , 1 ,5 4 3 b e i n g done t h i s y e a r a s com pared
w i t h 83 l a s t year.-*-^
•^•^Armual R e p o r t o f t h e D e p a rtm e n t o f P u b l i c H e a l t h .
San D ie g o . C a l i f o r n i a - Y ear 1 9 3 6 -1 9 3 7 , p . 2 .
66
TABLE V I I
VENEREAL DISEASE C L IN IC 12
SAN DIEGO CITY
J u l y , 1936 t o J u l y , 1937
T o t a l o a s e s u n d e r t r e a t m e n t , ♦ .....................................................
7272
Old e a s e s r e a d m i t t e d ............................................................................
378
New c a s e s a d m i t t e d
672
...................................................................
P a t i e n t s d isc h a rg e d as n o n - in f e c tio u s ,b u t n o t cured ♦
256
P a t i e n t s ta k in g tr e a tm e n ts e lsew h ere
156
.......................................
D isc o n tin u e d tr e a tm e n ts w ith o u t p e rm is s io n
.
440
Number c a s e s u n d e r t r e a t m e n t a t t h e end o f ..........................
8006
j{«
sjc
TREATMENTS OVER THESE PERIODS
Male - Neo
...................................................................
5203
Male - M e rc u ry , B is m u th , e t c ...............................................................
3672
Male - G o n o rrh e a
1771
.......................................................
F em ale - N e o .............................................................
4939
F em ale - M e rc u ry , B is m u th , e t c ............................................................... 4106
F em ale - G o n o r r h e a ........................
* .............................1401
Number ex am in ed f o r C i t y J a i l ........................... ..............................
D a r k - f i e l d e x a m i n a t i o n s ..................................................................
12I b id . ,
p . 3.
93
9
67
San F r a n c i s c o .
A l e t t e r r e c e i v e d fro m D r, I .
0.
G e i g e r , M. D . , D i r e c t o r o f P u b l i c H e a l t h , C i t y a n d C o u n ty o f
S an F r a n c i s c o , D e p a rtm e n t o f P u b l i c H e a l t h , s t a t e s t h a t
d u r i n g t h e c a l e n d a r y e a r j u s t c l o s e d B ,007 c a s e s o f s y p h i l i s
( a l l t y p e s ) w ere r e p o r t e d t o t h e D e p a r tm e n t.
T h is i s th e h ig h ­
e s t number e v e r r e p o r t e d i n t h e c i t y d u r i n g a n y tw e lv e m o n th s ,
and h a s r e s u l t e d u n d o u b t e d l y fro m t h e i n c r e a s e d p u b l i c i t y
g i v e n t h e s u b j e c t d u r i n g t h e p r e s e n t n a t i o n a l c a m p a ig n .
Mo
f i g u r e s w ere a v a i l a b l e a s t o t h e number o f c a s e s c u r e d .
I n San F r a n c i s c o t r e a t m e n t was a f f o r d e d t o a l l i n f e c t ­
ed p e rs o n s th ro u g h th e f r e e D ia g n o s tic G lin ic o p e ra te d by th e
D e p a rtm e n t o f P u b l i c H e a l t h an d t h e f r e e t r e a t m e n t o f f e r e d
i n t h e c l i n i c s o p e r a t e d a t t h e two U n i v e r s i t y M e d ic a l S c h o o l s .
P a r t- p a y tre a tm e n t i s o f fe re d in seven o th e r c l i n i c s lo c a te d
th ro u g h o u t th e c i t y .
E v e r y e f f o r t i s made by t h e D ep a rtm en t
o f P u b lic H e a lth to b rin g c o n ta c ts and so u rc e s u n d er t r e a t ­
m ent by l e t t e r s , a n d p e r s o n a l v i s i t s o f P u b l i c H e a l t h H u r s e s
o r P o lic e O ffic e rs .
When n e c e s s a r y , s o u r c e s a r e q u a r a n t i n e d
i n j a i l f o r t r e a t m e n t o r h o s p i t a l i z e d i n t h e I s o l a t i o n H os­
p ita l.
T h e re a r e n i n e c l i n i c s s i t u a t e d i n San F r a n c i s c o
c o n v e n i e n t l y l o c a t e d t h r o u g h o u t t h e c i t y , two o f t h e s e
o p e ra tin g n ig h t se ssio n s
( s e e T a b le V I I I ) .
W asserm ann t e s t s
a re g iv e n f r e e o f charge t o a l l th o se r e q u i r i n g su ch s e r v ic e
a t any c l i n i c .
The D e p a rtm e n t o f P u b l i c H e a l t h a l s o o f f e r s
68
TABLE V I I I
N ig h t C l i n i c s
CITIES
'
NIGHT HOURS
B e l l , C a l i f o r n i a .............................................................................
None
Downey, C a l i f o r n i a
None
. . . . ♦ ........................
E u r e k a , C a l i f o r n i a ..................................................
None
F resn o , C a lif o rn ia
..........................................................
None
..............................................................
None
K in g C i t y , C a l i f o r n i a .
Long B e a c h , C a l i f o r n i a .............................
. . . . . . .
Yes
Los A n g e l e s , C a l i f o r n i a ..............................................................
Yes
San F r a n c i s c o , C a l i f o r n i a ........................................... ....
Yes
S a c r a m e n to , C a l i f o r n i a ...............................................................
None
S to c k to n , C a lif o r n ia
................................................
None
San D ie g o , C a l i f o r n i a ...................................................................
None
. . . .
I t i s e s s e n t i a l f o r c l i n i c s to ' have n i g h t h o u r s f o r
t h e w o rk in g p e o p le so t h a t i s u n n e c e s s a r y f o r them t o l o s e
a d a y ’ s w a g e s, a n d be t e m p t e d , i n many c a s e s , t o p o s tp o n e
tre a tm e n t.
C o n tin u o u s t r e a t m e n t i s p a ra m o u n t t o i n s u r e
e f f e c tiv e tre a tm e n t.
69
f r e e W asserm ann t e s t s t o an y c i t i z e n , i r r e s p e c t i v e o f e c o n ­
o m ic s , on a n y W ednesday a t th e c i t y E m ergency H o s p i t a l s *
D u rin g t h e p a s t y e a r ,
some n i n e th o u s a n d c i t i z e n s h av e made
use of t h i s s e rv ic e *
M rs. R o s ly n M i l l e r , s t a t i s t i c i a n , s t a t e s t h a t t h e
p ro g ra m s u g g e s t e d by t h e U n ite d S t a t e s P u b l i c H e a l t h S e r ­
v i c e i s t h e b a s i s o f t h e p ro g ra m fo llo ¥ * e d by t h e C i t y o f
San F r a n c i s c o .
M o n te re y C o u n ty .
One o f t h e m o st c o m p re h e n siv e
r e p o r t s t h a t t h e a u t h o r r e c e i v e d w as fro m t h e M o n te re y C ou nty
H e a l t h D e p a r tm e n t, c o m p ile d b y D r. J o h n C. S h arp a n d Dr*
Dwight M. B i s s e l l .
The f o l l o w i n g m a t e r i a l , w h ich d e a l s
w i t h s y p h i l i s i n t h i s C ounty, i s b a s e d upon t h e w ork o f Dr*
S h a rp a n d D r. B i s s e l l .
I n M o n te re y C o u n ty , a s i n o t h e r p a r t s o f t h e S t a t e ,
th e re
i s a f l u c t u a t i o n i n t h e num ber o f new e a s e s o f s y p h i l i s
re p o rte d .
new c a s e s .
I n 1938 t h e r e w ere 292 an d i n 1939 t h e r e w e re 272
H ow ever, i t w i l l be n o t e d t h a t th e c h a n g e s a r e
s l i g h t a s com p ared t o t h e p r o b le m a s a w h o le .
I n c o o p e r a t i o n w i t h t h e S t a t e o f C a l i f o r n i a , M o n te re y
C o u n ty h a s e s t a b l i s h e d t h r e e v e n e r e a l d i s e a s e c l i n i c s , one
a t t h e C o u n ty H o s p i t a l n e a r S a l i n a s , t r e a t i n g p a t i e n t s t h r e e
t i m e s w e e k ly , a n o t h e r a t t h e M o n te re y C i t y H a l l , t r e a t i n g
w e e k ly , an d a t h i r d one a t t h e C i t y Hal}, i n K ing C i t y , t r e a t ­
i n g w e e k ly .
" A l l o f t h e s e a r e w e l l a t t e n d e d , 11 s a y s D r. S h a r p .
70
The p h y s i c i a n s i n t h i s C o u n ty h av e v o l u n t e e r e d t h e i r s e r v i c e s
and t r e a t m e n t t o p a t i e n t s .
F re e d r u g s a r e p r o v i d e d by t h e
S t a t e D e p a rtm e n t o f H e a l t h t o p r i v a t e p h y s i c i a n s f o r t h e i r
p a t i e n t s xvho a r e u n a b l e t o p a y f o r them 'or- who a r e p a r t - p a y
cases.
At th e i n d i g e n t c l i n i c s , sp o n so red by th e S ta te H e a lth
D e p a r tm e n t, p a t i e n t s a r e t r e a t e d r e g a r d l e s s o f r e s i d e n c e .
N one, h o ?rev er, a r e t r e a t e d who c a n a f f o r d t o p ay a p r i v a t e
p h y sic ia n fo r c a re .
R o u tin e b lo o d t e s t s f o r s y p h i l i s on
a l l c a s e s a d m i t t e d t o t h e h o s p i t a l and c l i n i c have b e e n
done f o r t h e p a s t t h r e e y e a r s by M o n te re y C o u n t y .13
M o n te re y C ounty a t t e m p t s t o conform t o th e la w w h ich
became e f f e c t i v e S e p te m b e r 1 9 , 1 9 3 9 , s t a t i n g t h a t a l l e x p e c ­
t a n t m o th e r s m ust h av e a b l o o d t e s t b e f o r e t h e i r b a b i e s a r e
born.
I n t h e t h r e e a n d a h a l f m o nths t h a t t h i s la w h a s b e e n
i n e f f e c t , f i v e c a s e s o f s y p h i l i s have b e e n f o u n d i n 162
b lo o d s a m p le s t e s t e d a t t h e M o n te re y C o u n ty P u b l i c H e a l t h
L a b o ra to ry .
W ith t h e a i d o f t h e la w w h ic h s t a t e s t h a t a l l
p e r s o n s g r a n t e d m a r r i a g e l i c e n s e s m u st f i r s t h ave a b lo o d
te s t,
s i x p e r s o n s w ere f o u n d t o be i n f e c t e d w i t h t h e d i s e a s e
sy p h ilis.
(From S e p te m b e r 1 9 , 1 9 3 9 , t o J a n y a r y 1 , 1940)
D r. S h a rp s a y s , " A lth o u g h f o u r c a s e s o f c o n g e n i t a l
s y p h i l i s w ere f o u n d i n M o n te re y C ounty i n 193 9, m ost o f t h e
new c a s e s r e p o r t e d a c q u i r e d t h e i r s y p h i l i s t h r o u g h c o n t a c t . ” 1^
1 h e a l t h B u l l e t i n . M o n te re y C ou nty H e a l t h D e p a r t m e n t .
S a l i n a s , C a l i f o r n i a . V o l. Y, No. 1 , J a n u a r y 1 9 4 0 , p . 1 .
14 I b i d . . p .
3.
71
I t p r o v e d t o be a d i f f i c u l t t a s k t o o b t a i n a c c u r a t e
m a t e r i a l p e r t a i n i n g ' t o t h e number o f c a s e s o f s y p h i l i s i n
C a l i f o r n i a f o r a n y g i v e n y e a r , o r how many c a s e s w ere c u r e d
f o r t h e same p e r i o d .
The f o l l o w i n g i s a s a m p lin g o f t h e
r e s p o n s e t h e i n v e s t i g a t o r r e c e i v e d fro m t h e q u e s t i o n s s e n t
t o th e v a r io u s c i t i e s .
The l e t t e r s e n t t o th e C i t y H e a l t h O f f i c e r , C i t y o f
S a c r a m e n to , S a c r a m e n to , C a l i f o r n i a , was a n s w e re d b y H e r b e r t
F . T r u e , M. D . , C i t y H e a l t h O f f i c e r ,
i n t h e f o l l o w i n g m a n n e r.
How many c a s e s o f s y p h i l i s o c c u r a n n u a l l y ?
A nswer unknow n• T o t a l c a s e s f o r 1 9 3 6 , 4 2 6 ; 1 9 3 7 , 615;
1 9 3 8 , 1 1 5 1 . The a p p a r e n t i n c r e a s e i s due t o b e t t e r S t a t e
re p o rtin g .
How many c a s e s a r e c u r e d a n n u a l l y ?
Answer unkno\*m. P r i v a t e p h y s i c i a n s do n o t have t o
r e p o r t th e tim e o f r e l e a s e . B e ca u se o f o u r t r a n s i e n t
p o p u l a t i o n many move aw ay.
Vvrh a t i s done t o make t r e a t m e n t p o s s i b l e f o r a l l t h o s e
in f e c te d w ith th e d is e a s e ?
J o i n t C i t y an d S t a t e C l i n i c f o r d i a g n o s i s o f a l l
cases.
Same c l i n i c f o r i n d i g e n t a m b u l a t o r y c a s e s .
Same
c l i n i c f o r a s s ig n m e n t t o p r i v a t e p h y s i c i a n s who w i l l
ta k e p a r t- p a y p a t i e n t s .
What e f f o r t i s made t o g e t c o n t a c t s u n d e r t r e a t m e n t ?
D i s t r i c t n u rs e s fo llo w -u p a l l in fo rm a tio n a s t o th e
c o n t a c t s s u p p l i e d t o them by t h e c l i n i c p h y s i c i a n s and
p r i v a t e p h y s i c i a n s , We a l s o h ave a m ale i n v e s t i g a t o r
t o h an d le o b s tre p e ro u s c a s e s .
How a r e s o u r c e s o f i n f e c t i o n p r e v e n t e d fro m s t a r t i n g
new e p i d e m i c s ?
72
B ro u g h t i n , e x a m in e d , t e s t e d , p u t u n d e r r e g u l a t i o n s ,
i f n o t a c c e p tin g th e r e g u l a t i o n s , q u a ra n tin e *
Does y o u r c o u n ty have a n y la w s p e r t a i n i n g t o t h e
d ise a se s y p h ilis
( o th e r th a n th e S ta te la w s)?
We u s e e n t i r e l y t h e S t a t e la w s r e g a r d i n g th e r e p o r t i n g
an d h a n d l i n g of s y p h i l i s .
Bo?/ many c l i n i c s a r e t h e r e i n t h e C i ty ?
Two— C i t y and C o u n ty .
Are t h e y o v e r-e ro ? /d e d ?
C i t y v e r y much o v e r c r o w d e d . Some m o rn in g s o v e r 300
are t r e a te d .
C o un ty c l i n i c i n t h e o u t l y i n g d i s t r i c t
l a r g e l y h a n d l e s C o u n ty c a s e s a n d i n - h o s p i t a l c a s e s .
Are t h e y c o n v e n i e n t l y l o c a t e d f o r t h e p e o p l e t o g e t
t o them?
Y es.
Are a l l th e c l i n i c s i n t e g r a t e d i n t o a c i t y - w i d e sy ste m ?
I s e e h e r e a p p e a r s a g a i n th e much o v e rw o rk e d word
" i n t e g r a t e d . 11 You c a n u s e y o u r ju d g m e n t by c o n s i d e r i n g
th e p re v io u s an s w e rs .
I s t h e r e a n i g h t c l i n i c f o r men an d women?
No.
Are W asserm ann t e s t s g i v e n t o a l l who may a s k f o r them?
Yes an d No.
In d iv id u a ls re q u e s tin g i n i t i a l t e s t s ,
g i v i n g good r e a s o n s , a r e a c c e p t e d f r e e a t t h e C i t y C l i n i c .
T e s t s d u r in g t h e c o u r s e o f t r e a t m e n t f o l i o ? / t h e p l a c e ­
m ent o f t h e p a t i e n t e i t h e r i n c l i n i c , o r f u l l - p a y s e r ­
v i c e s . L o cal l a b o r a t o r i e s , by ag ree m en t, fo llo w th e s e
same r u l e s .
Croup t e s t i n g o f s c h o o l s , c o m m e rc ia l i n s t i ­
t u t i o n s , e t c . i s n o t d o n e , h o w e v e r, s m a l l g r o u p s w h ich
we s e l e c t fro m t h e H e a l t h D e p a r tm e n t’ s v ie w p o i n t , su c h
a s M ilk H a n d l e r s , a r e t a k e n a t minimum f e e s o f $1 p e r
p e r s o n . T h i s l a s t i s c o m p u ls o r y .
73
T h i s same s e t o f q u e s t i o n s w as s e n t t o a n o t h e r c i t y
an d th e f o l l o w i n g r e s p o n s e was r e c e i v e d :
T h i s o f f i c e d o e s n o t p r e p a r e an a n n u a l r e p o r t f o r
p u b l i c a t i o n . H ow ever, we a r e s e n d in g y ou a summary o f
v i t a l s t a t i s t i c s -which may p o s s i b l y be o f some v a l u e t o
you.
T h e r e was no r e s p o n s e o f an y k i n d r e c e i v e d fro m t h r e e
c i t i e s t o w h ic h t h i s l e t t e r was s e n t .
T h is same s e t o f q u e s t i o n s was s e n t t o t h e D e p a rtm e n t
of P u b lic H e a lth , S ta te of C a lif o r n i a , as a check a g a in s t th e
r e p l i e s r e c e i v e d fro m t h e c i t i e s , a n d b e lo w i s t h e a n s w e r
r e c e i v e d fro m th e S t a t e D e p a r tm e n t, H e le n M a c k le r , M. D.
We have no f i g u r e s a t a l l a s t o how many e a s e s a r e
c u r e d a n n u a l l y . A bout 80 p e r c e n t o f p a t i e n t s l a p s e
fro m t r e a t m e n t and d i s a p p e a r b e f o r e d i s m i s s a l . S in c e
we do n o t have f u n d s f o r c o m p le te f o l l o w - u p c a r e , many
o f them may be a c t u a l l y c u r e d , b u t i t i s i m p o s s i b l e t o
s a y how many. S in c e l|* t o 2 y e a r s t r e a t m e n t a r e n e c e s s a r y
f o r c u r e o n l y 20 p e r c e n t a r e f o l l o w e d t h r o u g h t h i s , we
may s a y t h a t some 10 p e r c e n t o f t h e t o t a l s g iv e n i n
D r. M e r r i l l ’ s s p e e c h a r e a n n u a l l y c u r e d .
One o f th e m a jo r p o l i c i e s h a s b e e n t o p r o v i d e f r e e
d i a g n o s i s a n d f r e e lo w c o s t t r e a t m e n t a v a i l a b l e f o r a l l
p e r s o n s i n f e c t e d . The la w c o v e r s c o n t a c t s e a r c h e s , and
p r o v i s i o n f o r t h e i r q u a r a n t i n e i f fo u n d i n f e c t e d . L o c a l
c o m m u n itie s , h o w e v e r, had n e i t h e r f u n d s f o r s u p e r v i s i o n n o r i n t e r e s t i n p r o v i d i n g a n a d e q u a te p ro g ra m i n m ost
in sta n c e s.
I n r u r a l a r e a s , we h av e p l a n s t h a t a r e b e i n g t e n t a ­
t i v e l y t r i e d o u t . As f a r a s p o s s i b l e , i n d i g e n t s a r e s e n t
t o l o c a l c o u n t y h o s p i t a l s w e e k ly f o r t r e a t m e n t .
I n some
a r e a s w here t h i s i s i m p o s s i b l e , a s m a l l sum i s b e i n g
p a i d p r i v a t e d o c t o r s f o r c a r e o f su c h p a t i e n t s .
T h is
w i l l c o n t i n u e t o be a d i f f i c u l t s i t u a t i o n e v e n i f we ^
have more f u n d s a v a i l a b l e b e c a u s e o f t h e n e e d f o r p r i ­
vacy.
I t w i l l be n o t e d t h a t i n t h e above no m e n tio n was
made o f t h e num ber o f c a s e s o f s y p h i l i s i n C a l i f o r n i a .
74
The f o l l o w i n g i n f o r m a t i o n w as g a t h e r e d fro m t h e s e v e n
S ta te Insane I n s t i t u t i o n s in C a lif o r n i a .
?/ere a s k e d :
T hese q u e s t i o n s
(1) w h at i s t h e p e r c e n t a g e o f s y p h i l i t i c p a t i e n t s
o c c u p y in g b e d s i n t h e h o s p i t a l ?
(2) w h at i s t h e p e r c e n t a g e
o f p a t i e n t s i n t h e h o s p i t a l whose p s y c h o s i s i s c a u s e d by
s y p h ilis?
(3) i s a W asserm ann t e s t g iv e n t o a l l e n t e r i n g
p a tie n ts?
I s a d a r k - f i e l d e x a m i n a t i o n made on a l l d o u b t f u l
cases?
CAMARILLO STATE HOSPITAL. I am s o r r y t h a t we h ave no
a v a i l a b l e d a t a t h a t w i l l p e r m i t u s t o g iv e you t h e e x a c t
f i g u r e s . We have a t t h e p r e s e n t tim e a p p r o x i m a t e l y 2300
p a t i e n t s a n d o u t o f t h a t number we a r e c a r r y i n g on a c t i v e
t r e a t m e n t on a b o u t 100 c a s e s . T h is i s n o t a f a i r r e p r e ­
s e n t a t i o n o f t h e p e r c e n t a g e o f p a t i e n t s who have h a d or
s t i l l have e v i d e n c e o f s y p h i l i t i c i n f e c t i o n b e c a u s e o f
th e f a c t t h a t C a m a rillo h as r e c e iv e d o v e r h a l f o f i t s
p r e s e n t p o p u l a t i o n fro m o t h e r s t a t e h o s p i t a l s i n t h e s t a t e
a n d among t h o s e p a t i e n t s a r e an u n d e t e r m in e d number who
h ave a l r e a d y u n d e rg o n e e x t e n s i v e t r e a t m e n t an d a r e n o t
under tre a tm e n t h e re .
I b e l i e v e a f a i r e s t i m a t e w ould be
10 p e r c e n t o f a l l p a t i e n t s s e n t t o t h e h o s p i t a l a r e
a f f l i c t e d w i t h s y p h i l i s a n d have b e e n c o m m itte d h e r e
b e c a u s e o f t h e e f f e c t t h a t s y p h i l i s h a s h a d upon t h e
c e n t r a l n e r v o u s s y s t e m . A much s m a l l e r p e r c e n t , n o t
more t h a n 5 p e r c e n t a t t h e m o s t, an d p o s s i b l y l e s s t h a n
t h a t a r e a d m i t t e d f o r o t h e r t y p e s o f p s y c h o s i s an d f o u n d
t o have s y p h i L i s t h a t h a s n o t a f f e c t e d t h e c e n t r a l n e r ­
vous sy stem .
do n o t o r d i n a r i l y c o n s i d e r t h a t t h e
p sy c h o sis has been caused by s y p h ilis in such c a s e s ,
alth o u g h th e in f e c tio n o f te n i s a c o n tr ib u tin g cau se.
B lo o d ?/asserm ann t e s t s a r e g i v e n t o a l l p a t i e n t s a d m i t t e d
t o t h e h o s p i t a l . S p i n a l t e s t s a r e done on a l l t h o s e who
show a p o s i t i v e b lo o d W asserm ann b u t i s n o t done r o u t i n e ­
l y on o t h e r p a t i e n t s .
The above i n f o r m a t i o n was g iv e n b y C. R. B e n n e t t , M.
D . , u n d e r t h e d i r e c t i o n o f T h o s . W. H a g e r t y , M. D ., M e d ic a l
D ir e c t o r and S u p e rin te n d e n t o f C a m a rillo S t a t e H o s p i t a l .
75
PATTON STATE HOSPITAL*
A l e t t e r fro m G. M* W e b s t e r ,
M. D*, M e d ic a l S u p e r i n t e n d e n t , s t a t e s t h e f o l l o w i n g i n r e ­
sp o n se t o t h e same q u e s t i o n s .
We h av e no e x a c t s t a t i s t i c s , b u t i n a n s w e r t o y o u r
f i r s t q u e s t i o n ?<rill s a y we b e l i e v e a b o u t t w e n t y - f i v e p e r
c e n t o f t h e in m a te s o f t h e i n s t i t u t i o n h ave s y p h i l i s ,
o r have had s y p h i l i s i n some form*
A l l c a s e s who come i n w i t h s y p h i l i s a r e t r e a t e d a c t i ­
v e l y o v e r a p e r i o d o f fro m one t o two y e a r s .
We w ould s a y nice p e r c e n t o f t h e p a t i e n t s i n t h e
i n s t i t u t i o n have a p s y c h o s i s due to a s y p h i l i t i c i n f e c ­
tio n .
MENDOCINO STATE HOSPITAL.
The f o l l o w i n g i s fro m a
l e t t e r w r i t t e n b y R. A. Cushman, M. D . , M e d ic a l S u p e r i n t e n d e n t .
We have t h e e x a c t d a t a a s o f A p r i l 3 0, 1 9 3 8 , Vsrhich
was t h e l a s t tim e t h a t t h e e x a c t num bers o f t h e v a r i o u s
fo rm s o f m e n t a l i l l n e s s e s w ere worked, o u t .
On t h a t d a t e
t h e t o t a l num ber o f p a t i e n t s was 2 7 97 , b e i n g 1845 m ale
a n d 952 fe m a le p a t i e n t s .
Of t h e same t h e r e w ere a s
fo llo w s:
P s y c h o s is w ith S y p h i l i t i c M e n in g o -E n c e p h a litis . . .
95 m ale - 18 f e m a le
T o t a l .................................. 113 - 4 .0 6 $
P s y c h o s i s w i t h O th e r Forms o f S y p h i l i s o f t h e
C e n t r a l N erv o u s S y stem
46 fe m a le - 17 fe m a le
T o ta l
___ '............. 63 - 2 . 2 $
S in c e t h e f i r s t o f J a n u a r y 1 9 3 8 , t h e r e have b e e n 414
a l c o h o l i c p a t i e n t s a d m i t t e d , t h e s e b e i n g s im p l y i n te m ­
p e ra te c a s e s , and n o t in s a n e .
Of t h e s e 20 w ere f o u n d
’ t o h ave s y s t e m i c s y p h i l i s ............ 4 . 8 $
B lo o d W asserm anns a r e done on a l l p a t i e n t s a d m i t t e d ,
a n d s p i n a l f l u i d e x a m i n a t i o n s on a l l p a t i e n t s a d m i t t e d
as in sa n e .
S p i n a l f u i l d e x a m i n a t i o n s a r e done on t h e
i n t e m p e r a t e e a s e s when i t i s f o u n d n e c e s s a r y , a n d o f
co u rse p ro p e r tr e a tm e n t g iv e n t o a l l s y p h i l i t i c p a t i e n t s .
76
AGNEW STATE HOSPITAL,
The same s e t o f q u e s t i o n s ?*as
s e n t t o Agnew S t a t e H o s p i t a l and t h e f o l l o w i n g r e s p o n s e was
r e ce i ve d :
5$ ) T h ese a n s w e r s w ere m e r e l y p e n c i l n o t a t i o n s on
5io ) t h e i n v e s t i g a t o r ’ s l e t t e r , r e t u r n e d t o h im , u n Y e s ,) s i g n e d .
NAPA STATE HOSPITAL.
A l e t t e r fro m J . M. S c a n l a n d ,
M. D ., M e d ic a l D i r e c t o r a n d S u p e r i n t e n d e n t , o f t h e Napa S t a t e
H o s p ita l g iv e s th e f o llo w in g in f o rm a tio n .
You a r e in f o r m e d t h a t I am u n a b l e t o g i v e you t h e
p e r c e n t a g e o f p a t i e n t s i n t h i s h o s p i t a l whose d i a g n o s i s
i s c a u s e d by s y p h i l i s . Ve do n o t m a i n t a i n s t a t i s t i c a l
reco rd s.
A l l n e w ly a d m i t t e d p a t i e n t s a r e g i v e n a ?^assermann
te s t.
NORWALK STATE HOSPITAL.
Edw in W a y te , M. D . , M e d ic a l
S u p e r i n t e n d e n t , o f t h e N o rw alk S t a t e H o s p i t a l r e s p o n d e d t o
t h e q u e s t i o n s i n t h e f o l l o w i n g m a n n e r.
P e r c e n t a g e o f s y p h i l i t i c p a t i e n t s o c c u p y in g b e d s i n
t h e h o s p i t a l .................. 1 2 .6 5 $
U nder p e r c e n t a g e o f s y p h i l i t i c p a t i e n t s o c c u p y in g b e d s
i n th e h o s p i t a l we have i n c l u d e d a l l t h o s e who h av e
s y p h i l i s , a n d t h i s d o e s n o t n e c e s s a r i l y mean t h a t t h e .
p s y c h o s i s i n e a c h c a s e i s due t o s y p h i l i s . The p e r c e n t a g e
o f p a t i e n t s i n h o s p i t a l whose p s y c h o s i s i s c a u s e d by
s y p h i l i s i s 1 0 .5 7 $ .
A l e t t e r was w r i t t e n t o t h e D e p a rtm e n t o f I n s t i t u t i o n s ,
S t a t e o f C a l i f o r n i a , w i t h t h e hope t h a t a d d i t i o n a l s p e c i f i c
i n f o r m a t i o n c o u l d be o b t a i n e d .
asked:
The f o l l o w i n g q u e s t i o n s w e re
(1) w h at p e r c e n t o f t h e i n d i v i d u a l s i n t h e S t a t e o f
C a lifo rn ia are b lin d as a r e s u l t of s y p h ilis ?
(2) w h at p e r
77
c e n t o f t h e f e e b l e m i n d e d i n th e S t a t e o f C a l i f o r n i a a r e
s y p h ilitic ?
(3) w h a t i s t h e p e r c e n t a g e o f t h e p a t i e n t s i n
t h e v a r i o u s S t a t e I n s a n e I n s t i t u t i o n s whose p s y c h o s i s i s
cau sed by s y p h i l i s ?
To t h e s e q u e s t i o n s , A aron J . R o s a n o f f ,
M. D ., D i r e c t o r o f I n s t i t u t i o n s , S t a t e o f C a l i f o r n i a , r e p l i e d
in p a r t :
T h i s d e p a r t m e n t h a s no d a t a w i t h r e s p e c t t o t h e num­
b e r o f p eo p le in th e S t a t e a f f l i c t e d w ith s y p h i l i s , o r
who a r e b l i n d a s a r e s u l t t h e r e o f .
The p a t i e n t s i n o u r homes f o r t h e f e e b l e m in d e d and
h o s p i t a l s f o r th e i n s a n e a r e n o t c l a s s i f i e d i n a c c o r d ­
an c e w i t h t h e d i s e a s e s w h ich may have b r o u g h t a b o u t t h e i r
m e n ta l c o n d i t i o n , b u t t h e y a r e c l a s s e d i n a c c o r d a n c e
w i t h t h e p a r t i c u l a r m e n ta l d i s e a s e o r g r a d e o f f e e b l e ­
m in d e d n e s s p o s s e s s e d by th e m .
The f a c t s seem t o i n d i c a t e , a f t e r a c a r e f u l s t u d y ,
t h a t i f s y p h i l i s i s t o be c o n t r o l l e d , e m p h a s is m ust f i r s t be
p l a c e d upon r e p o r t i n g t o t h e p r o p e r a u t h o r i t i e s an d p r o ­
v i s i o n f o r a d e q u a t e d i a g n o s i s and t r e a t m e n t .
R e p o rtin g , n e e d le s s to s a y ,
c o n tr o l o f th e d is e a s e .
i s t h e f i r s t s t e p i n th e
I f ¥/e d o n o t know where o r how much
o f t h e d i s e a s e we h a v e , t h e r e
is l i t t l e
t o be done a b o u t i t #
From t h e r e s p o n s e s r e c e i v e d above i t w ould seem t h a t we o f
C a l i f o r n i a do n o t know much a b o u t t h e number o r d i s t r i b u t i o n
of th e d is e a s e s y p h i l i s in our S t a t e .
CHAPTER V I
SUMMARY AND CONCLUSIONS
Summary.
The h i s t o r y o f th e d i s e a s e s y p h i l i s h a s
shown t h a t t h e d i s e a s e c a n n o t be c o n s i d e r e d a s a l o c a l
p r o b le m , n o r i n t h e s t r i c t e s t s e n s e o f th e w o rd , a n a t i o n a l
^ p r o b le m , b u t r a t h e r a s a n i n t e r n a t i o n a l p r o b le m .
The h i s ­
t o r y ’f u r t h e r i n d i c a t e s t h a t i f t h e d i s e a s e i s t o b e c o n t r o l ­
l e d we m ust k ee p a c o n s t a n t v i g i l .
R e s e a r c h h a s g iv e n u s
t h e p r o p e r t o o l s w i t h w h ic h t o f i g h t t h e d i s e a s e .
The c o n t r o l
m e a s u r e s w h ic h w ere u s e d d u r i n g t h e f i r s t W orld War p r o v e d
t o be more s a t i s f a c t o r y t h a n a n y m ethod.w e have, e v e r e m p lo y e d ;
The F e d e r a l G overnm ent i n t h e p a s t d e c a d e h a s made
p r o g r e s s i n p r e s e n t i n g p l a n n e d p ro g ra m s t h a t t h e v a r i o u s
s t a t e s o f th e u n io n c o u ld f o llo w .
The F e d e r a l G overnm ent
h a s a l l o c a t e d money Y/hich t h e v a r i o u s s t a t e s may o b t a i n i f
t h e y m eet t h e r e q u i r e m e n t s a s s e t f o r t h by t h e g o v e r n m e n t.
Some o f t h e s e r e q u i r e m e n t s a r e :
(1) v e n e r e a l d i s e a s e
c o n t r o l s h o u l d be c o n s i d e r e d a s a s e p a r a t e an d d i s t i n c t
ite m ;
(2) c l i n i c s e r v i c e i n u r b a n c o m m u n itie s s h o u ld be
a v a i l a b l e f o r d i a g n o s i s and e m e rg e n c y t r e a t m e n t o f a n y
p a t i e n t who a p p l i e s t o t h e c l i n i c ;
(3) no c l i n i c s h o u l d be
g i v e n s t a t e a i d i f i t r e f u s e s a t a n y tim e t o a d m it p a t i e n t s
w ith go n o rrh ea o r s y p h i l i s to i t s b ed s;
(4) a r e c o r d o f
t r e a t m e n t s h o u ld be g i v e n t o t r a n s i e n t p a t i e n t s t o i n s u r e
c o n tin u ity of tre a tm e n t;
(5) an e f f o r t s h o u l d be made t o
a b o l i s h a l l fo rm s of. q u a c k e r y ;
(6)
i n r u r a l c o m m u n itie s
t r e a t m e n t f a c i l i t i e s may be a c h i e v e d by (a) l o c a l q u a l i f i e d
p h y sic ia n s,
(b) C ou nty H e a l t h O f f i c e r s ,
of p a tie n ts to n e a re st c e n te r,
tre a tm e n t c e n te rs ;
(c) t r a n s p o r t a t i o n
(d) e s t a b l i s h m e n t o f s p e c i a l
(7) a f r e e d i s t r i b u t i o n o f d r u g s ;
(8) one
c e n t e r in th e S t a t e e q u ip p ed w ith s p e c i a l f a c i l i t i e s ,
a s X -ray ;
(9) d a y and n i g h t c l i n i c s ;
p r e g n a n t women;
su c h
(10) e x a m i n a t i o n o f
(11) a n a d e q u a t e number o f f o l l o w - u p w o r k e r s
(IB) l a b o r a t o r y s e r v i c e f o r d a r k - f i e I d e x a m i n a t i o n s an d
s e r o lo g i c a l e x a m in a tio n s;
(13) e d u c a t i o n a l p ro g ra m s*
The f e d e r a l g o v e rn m e n t i s h a n d i c a p p e d i n tw o r e s p e c t s
(1) i t
c a n n o t f o r c e a s t a t e t o c o n fo rm t o t h e p ro g ra m i t
s e t s f o r t h , b u t o n l y a t t e m p t t o e d u c a t e t h e p e o p le o f t h e
co u n try ;
(3) i t l a c k s s u f f i c i e n t f u n d s t o o f f e r t h e v a r i o u s
s ta te s .
The S t a t e o f C a l i f o r n i a ,
i n an a t t e m p t t o a l i g n
i t s e l f w i t h t h e p r o g ra m o f th e F e d e r a l G overnm ent u n d e r t h e
S o c i a l S e c u r i t y A ct o f 1 9 3 6 , e s t a b l i s h e d C h a p te r 737 o f th e
S ta te L e g is la tu re
( P e n a l C o d e ) , an a c t w h ic h e s t a b l i s h e d
a g ra n t fo r v e n e re a l d ise a se c o n tr o l.
To a d m i n i s t e r t h e
p ro g ra m th e s t a t e w as d i v i d e d i n t o two d i s t r i c t s , n o r t h e r n
and s o u th e r n .
d istric t.
Two m e d ic a l o f f i c e r s w ere a s s i g n e d t o e a c h
The C h i e f o f t h e B u re a u a n d t h e s e two o f f i c e r s
d e v e lo p new c l i n i c s an d p ro g ra m s i n l o c a l d i s t r i c t s , a n d
c o o rd in a te th e a c t i v i t i e s th ro u g h o u t th e s t a t e .
80
The f u n d s t h a t a r e r e c e i v e d fro m t h e P u b l i c H e a l t h
S e r v i c e a r e . u s e d f o r s u p p le m e n t in g a l r e a d y - e x i s t i n g l o c a l
e x p e n d itu re s.
The S t a t e B u re a u o f V e n e r e a l D is e a s e a c t s a s
th e c e n t r a l a d m in is tr a tiv e agency f o r th e c o n tr o l o f s y p h i l i s
in C a lif o r n ia .
I t s e r v e s a d o u b le f u n c t i o n :
(1) c o o r d i n a t i o n
o f t h e s t a t e p ro g ra m w i t h t h e U n ite d S t a t e s P u b l i c H e a l t h
S e r v i c e , an d (£) c o o r d i n a t i o n o f t h e C a l i f o r n i a p ro g ra m
w ith th o se o f o th e r s t a t e s .
The v a r i o u s c i t i e s o f C a l i f o r n i a have f a s h i o n e d t h e i r
p ro g ra m s under t h e g u i d i n g hand o f t h e S t a t e .
The Los
A n g e le s B o a rd o f H e a l t h s t a t e s t h a t t h e r e i s a d e f i n i t e
s h o r t a g e o f f o l l o w - u p w o r k e r s , an d t h e i r w ork i s f u r t h e r
ham p ered b y bad q u a r t e r s . .
The San D iego B oard o f H e a l t h h a s shovm a m ark ed i n ­
crease in c lin ic a tte n d a n c e .
The i n c r e a s e , i t
is b e lie v e d ,
i s due t o c i v i l s e r v i c e r e q u i r e m e n t s f o r t e s t i n g a l l c i t y
e m p lo y e e s .
The S an F r a n c i s c o D e p a rtm e n t o f H e a l t h r e p o r t s t h a t
1939 showed t h e h i g h e s t num ber o f s y p h i l i t i c c a s e s e v e r r e ­
p o r te d (£ 0 0 7 ).
D r. J . C. G e i g e r , D e p a rtm e n t o f P u b l i c
H e a l t h , b e l i e v e s t h a t th e h i g h number i s a r e s u l t o f i n ­
c r e a s e d p u b l i c i t y g i v e n t h e s u b j e c t d u r i n g th e p r e s e n t
n a t i o n a l c a m p a ig n .
I n c o o p e r a t i o n w i t h t h e S t a t e o f C a l i f o r n i a , M o n te re y
C o u n ty h a s e s t a b l i s h e d t h r e e v e n e r e a l d i s e a s e c l i n i c s .
81
P a tie n ts are tr e a te d r e g a r d le s s of re s id e n c e .
The d e p a r t m e n t
f e e l s t h a t i t i s ham p ered i n i t s w ork by l a c k o f f i n a n c i a l
su p p o rt.
C o n e lu sio n s.
I t i s a p p a r e n t fro m t h e r e s p o n s e s r e ­
c e i v e d fro m t h e v a r i o u s q u e s t i o n n a i r e s s e n t o u t t h a t t h e r e
i s a l a c k o f f a c t u a l i n f o r m a t i o n c o n c e r n i n g t h e number o f
s y p h i l i t i c p a t i e n t s in C a li f o r n i a .
T h ere a r e u n d o u b t e d l y
many r e a s o n s f o r t h e l a c k o f s u c h i m p o r t a n t i n f o r m a t i o n .
The f o r e m o s t r e a s o n ,
in th e o p in io n o f th e i n v e s t i g a t o r ,
o u r P u r i t a n a t t i t u d e to w a r d t h e d i s e a s e .
is
In s p i t e o f th e
p u b l i c i t y t h a t s y p h i l i s has re c e iv e d in th e p a s t d ecade,
m ost p e o p l e h e s i t a t e t o d i s c u s s i t o p e n l y .
T h is f a c t co u ld
be i l l u s t r a t e d i n many w ays; h o w e v e r, t h e a t t i t u d e o f t h e
New York S e n a te w i l l p o s s i b l y s u f f i c e .
On M arch 1 6 , 1 9 3 7 , t h e S e n a t e d e f e a t e d a n in n o c u o u s
m e a su re t o c h a n g e , i n t h e D e p a rtm e n t o f H e a l t h , t h e name
o f t h e D i v i s i o n o f S o c i a l H y g ie n e , w h ic h i t i s n o t , t o
t h e D i v i s i o n o f S y p h i l i s C o n t r o l , w h ic h i t i s .
The a t t i ­
t u d e o f some o f t h e members o f t h e S e n a t e i s e x p r e s s e d
by S e n a t o r J o h n McNaobe, o f New York C i t y , who s a i d ,
’ I may be o l d f a s h i o n e d , r e a c t i o n a r y and a B u rb o n , b u t I
s a y t h i s w ord i s n o t d e c e n t an d s h o u ld n o t be s p r e a d o u t
among t h e c h i l d r e n an d y o u t h s . ’
’T h ere i s a l i m i t t o o u r m odern i d e a s , ’ S e n a t o r A.
S p e n c e r F i e l d i s a l l e g e d t o have a g r e e d .
’T h is b i l l
w o u ld o n ly be g i v i n g o u r c h i l d r e n a new w ord t o t a l k
ab o u t.
I t i s n o t d e c e n t o r n e c e s s a r y . . . T h ere i s no
r e a s o n why t h i s w ord s h o u l d become a commonly u s e d
w o rd .
lrj?homas P a r r a n , Shadow on t h e L and (New Y o rk :
an d H i t c h c o c k , 1 9 3 7 ) , p p . 6 3 - 6 4 .
H eynal
82
T h is a t t i t u d e
Y o rk , we know.
i s n o t p e c u l i a r t o t h e p e o p l e o f New
Many p e o p l e c a n n o t s e p a r a t e t h e d i s e a s e
s y p h i l i s fro m t h e i r m o r a l s t a n d a r d s .
D r. J o h n H. S t o k e s ,
n o t e d a s a n a u t h o r i t y on s y p h i l i s , h a s s a i d :
One p o s i t i v e t e s t w i l l u s u a l l y c o n v i c t a l a b o r e r o v e r
h i s own d e n i a l ; two may i n d i c t a r a i l r o a d p r e s i d e n t o r
a b a n k e r ; b u t I have known t h r e e t o be i n s u f f i c i e n t t o
s a t i s f y a c l i n i c i a n o f th e g u i l t o f a m i n i s t e r .
A se c o n d d i f f i c u l t y i n m ak in g a n a c c u r a t e c o u n t o f
t h e d i s e a s e l i e s i n t h e f a c t t h a t many p e o p l e , b e c a u s e o f
t h e n a t u r e o f t h e d i s e a s e , s u f f e r fro m i t w i t h o u t know ing
it.
Many o f t h e s e u n f o r t u n a t e v i c t i m s s h o u ld be d i s c o v e r e d
t h r o u g h t h e u se o f t h e b i l l r e c e n t l y p a s s e d i n C a l i f o r n i a
r e q u i r i n g a l l p e r s o n s t o undergo e x a m in a tio n b e f o r e m a r r ia g e .
A t h i r d d i f f i c u l t y i s p r e s e n t e d b y t h e g ro u p o f p e o p l e
who p r e f e r t o t r u s t home r e m e d ie s b o u g h t fro m a " q u a c k . "
F o u rth , in s p i t e o f th e f a c t t h a t th e p r i v a t e p h y s i­
c i a n s have b e e n r e q u i r e d by la w s i n c e 1912 t o r e p o r t a l l
v e n e r e a l c a s e s , t h e y have n o t b e e n t o o a c c u r a t e w i t h t h e i r
r e p o r t i n g o f t h e v a r i o u s c a s e s t h a t come u n d e r t h e i r t r e a t ­
m ent .
The d i f f i c u l t y i n o b t a i n i n g f a c t u a l m a t e r i a l seems to
i n d i c a t e t h a t m a n y o f t h e p e o p le i n c h a r g e of- th e v a r i o u s
c l i n i c s a r e n o t f a m i l i a r w i t h t h e s y s te m s t h a t t h e i r c l i n i c s
a re u sin g .
They a r e n o t a b l e i n many c a s e s t o d e s c r i b e w h a t
i s a c t u a l l y g o in g o n .
I t seems to t h e w r i t e r ,
th a t i t is
e s s e n t i a l f o r t h e h e a d o f a d e p a r t m e n t o r a c l i n i c t o be
83
a b le t o p r e s e n t a n n u a l r e p o r t s n e c e s s a r y f o r th e c o m p le tio n
of s t a t i s t i c a l re p o rts*
The n e c e s s i t y f o r a d e q u a t e c l i n i c a l e q u ip m e n t f o r
d i a g n o s i s and t r e a t m e n t i s n o t n e a r l y so e v i d e n t a s t h e
n e c e s s ity fo r re p o rtin g of ca ses, but i t is a t le a s t as
im p o rta n t.
Many o f u s do n o t know w h at t h e i n s i d e o f a
c l i n i c l o o k s l i k e , an d f e w e r s t i l l r e a l i z e t h e a d e q u a c y , o r
more o f t e n i n a d e q u a c y , o f t h e f a c i l i t i e s o r e q u ip m e n t*
f a c t t h a t t h e same s y r i n g e
The
i s u s e d many t i m e s a n d th e n e e d l e
p o i n t becom es d u l l m eans n o t h i n g to u s , u n l e s s m i s f o r t u n e
o v e r - t a k e s u s an d we become a p a t i e n t .
Y et p r a c t i c a l l y a l l
c l i n i c r e p o r t s in d ic a te t h a t th e re i s a d e f i n i t e sh o rta g e
o f sp a c e , p e rs o n n e l, and eq u ip m en t.
We c a n n o t hope t o c o n ­
t r o l t h e d i s e a s e s y p h i l i s i f we do n o t s u p p l y t h e v i t a l
n e e d s o f th e c l i n i c , p e r s o n n e l , s p a c e . and e q u i p m e n t .
Too much e m p h a s is c a n n o t be p l a c e d on t h e c o n c e n t r a ­
t i o n o f e f f o r t t h a t s h o u l d be made on t h e f i r s t y e a r o f
sy p h ilitic
i n f e c t i o n s , on th e f i r s t s i x m o n th s , t h e f i r s t
t h r e e m o n th s , i f n o t h i n g b e t t e r ’ ca n be d o n e , f o r e v e r y d a y
o f t r e a t m e n t c o n t i n u i t y m eans l e s s r e l a p s e , l e s s r e s i s t a n t
s e r o lo g y , l e s s v i s c e r a l , l e s s v a s c u l a r , and n e u r o - s y p h i l i s
in th e f u t u r e .
D r. S t o k e s s t a t e s t h a t ,
”I t i s w e ll to
rem em ber t h a t t r e a t m e n t d i s c o n t i n u e d b e tw e e n t h e f i r s t an d
f o u r th i n j e c t i o n s le a d s to s i x t y - f o u r p e r c e n t r e l a p s e ;
t r e a t m e n t p r o l o n g e d fro m f i v e t o n i n e i n j e c t i o n s l e a d s t o >
84
o n ly f o u r te e n p e r c e n t r e l a p s e . T h e
c o o p e ra tiv e c l i n i c a l
g ro u p d i v i d i n g l i n e o f t w e n t y - t w e n t y b e tw e e n much a n d l i t t l e
i s a good s t a n d a r d , f o r tw e n t y i n j e c t i o n s o f e a c h a r s e n i c a l
a n d h e a v y m e t a l have d e f i n i t e l y p r o v e n s u p e r i o r t o a n y t h i n g
e lse .
A t t h e p r e s e n t tim e t h e r e a r e t o o few c l i n i c s .
We
c o u l d p o s s i b l y i n c r e a s e t h e e f f i c a c y o f t h e c l i n i c s t h a t we
now h ave by p r o l o n g i n g t h e h o u r s t h a t t h e y r e m a in o p e n .
C l i n i c s s h o u l d be o pen e a r l y i n th e m o rn in g b e f o r e w o rk in g
h o u r s a n d l a t e a t n i g h t a f t e r w o rk in g h o u r s t o a f f o r d t h e
w o r k in g man am ple o p p o r t u n i t y f o r t r e a t m e n t .
T a b le V I I I
c l e a r l y shows t h a t t h i s i s n o t t h e c a s e i n t h e m a j o r i t y o f
c i t i e s in C a lif o r n ia .
T h e re i s a n e e d f o r a s u r v e y t o d e t e r m i n e t h e m o st
e f f e c t i v e m ethod o f p r e s e n t i n g e d u c a t i o n a l i n f o r m a t i o n
p e r t a i n i n g t o s y p h i l i s t o th e g e n e r a l p u b l i c .
At t h e p r e ­
s e n t tim e t h e r e i s a v a i l a b l e a w e a l t h o f m a t e r i a l , b u t i t
l i e s d o rm an t b e c a u s e o f o u r i n a b i l i t y t o make p r o p e r u se o f
it.
The p ro g ra m s t h a t have b e e n e s t a b l i s h e d f o r t h e co n ­
t r o l o f s y p h i l i s c o u ld be made more e f f e c t i v e b y b e t t e r
f in a n c ia l su p p o rt.
T h i s a t t h e moment, t h o u g h , d o e s n o t
seem p o s s i b l e b e c a u s e i t would mean an i n c r e a s e i n t a x e s ,
an d p e o p l e w o u ld u n d o u b t e d l y l o o k w i t h d i s f a v o r upon more
^ P r o c e e d i n g s o f C o n f e r e n c e on V e n e r e a l D i s e a s e C o n t r o l
Work, p . 3 7 .
85
more t a x e s .
H ow ever, s i n c e t h e w r i t e r s t a r t e d p r e p a r i n g
t h i s t h e s i s , many t h i n g s h av e h a p p e n e d w h ic h w i l l u n d o u b t­
e d l y a f f e c t t h e s y p h i l i s p r o b le m t h r o u g h o u t t h e U n ite d S t a t e s
a n d th e w o r l d i n g e n e r a l .
E u ro p e i s a t War!
The. q u e s t i o n
p a ra m o u n t i n t h e m ind o f m ost A m e ric a n s a t t h e p r e s e n t tim e
i s , W i l l we go t o w ar? an d i f s o , Hot so o n ?
t h a t man be p h y s i c a l l y f i t .
and v a r i e d h a r d s h i p s .
War demands
He m ust be a b l e t o e n d u r e many
I f a man i s wounded i t becom es t h e
p r o b le m o f t h o s e i n c h a r g e o f m e d i c a l o p e r a t i o n s t o r e t u r n
him t o t h e f i e l d a s s o o n a s p o s s i b l e !
P a s t e x p e rien ce h as
t a u g h t u s t h a t t h e wounds o f a s y p h i l i t i c h e a l b a d l y .
fo re,
T h ere­
i t i s e s s e n t i a l t o c u r e , o r a r r e s t th e d i s e a s e s y p h i l i s
a s so o n a s p o s s i b l e .
M e d ic a l s c i e n c e i s now a b l e t o a c c o m p l i s h
t h i s w i t h t h e a i d o f th e h e a v y m e t a l s , b i s m u t h and m e r c u r y ,
and th e a r s e n i c s a l t ” 6 0 6 .”
A n o th e r m e asu re e s s e n t i a l t o t h e a r r e s t o f a n y e p i ­
dem ic i s t h e r e g i m e n t a t i o n o f t h e e n t i r e p o p u l a t i o n .
In
t h e c a s e o f s y p h i l i s t h e p o p u l a t i o n w i l l be r e g i m e n t e d and
p a s s e d t h r o u g h t h e d r a g n e t s o f t h e W asserm ann, K ahn, a n d
d a r k - f i e l d e x a m in a tio n s.
T h i s p r o b le m w i l l b e , co m p a ra ­
t i v e l y s p e a k i n g , s i m p l i f i e d b y t h e d r a f t b i l l , w h ic h m akes
m i l i t a r y t r a i n i n g c o m p u ls o ry f o r some 4 2 ,0 0 0 ,0 0 0 p e o p l e .
B I B L I O G R A P H Y
BIBLIOGRAPHY
A.
BOOKS
A braham , la m e s J o h n s t o n , I n t r o d u c t i o n t o F r a c a s t o r on
S y p h i l i s . London: W i llia m H inem ann, 1 9 3 5 .
H is t o r i c a l l y a v ery in te r e s ti n g book. ■
B e c k e r,. Sam uel W i l l i a m , Ten M i l l i o n A m e ric a n s Have I t .
P h i l a d e l p h i a : L i p p i n c o t t a n d Company, 1 9 3 7 , 220 p p .
A w e l l - w r i t t e n bo ok i n t e n d e d f o r t h e n o n - p r o f e s s i o n a l ,
y e t t e c h n i c a l en o u g h f o r a l l .
W orth r e a d i n g .
B ig lo w , M a u r ic e , S ex E d u c a t i o n . New Y o rk : A m eric an S o c io
l o g i c a l H y g ien e A s s o c i a t i o n , 1 9 3 6 . 285 p p .
A bo o k w o r t h r e a d i n g , b u t n o t to o much c o n c e r n e d w i t h
s y p h ilis.
B l a n t o n , W. B . , M e d ic in e i n Y i r g i n i a i n t h e E i g h t e e n t h
C e n t u r y . Richmond: G a r r n e t t a n d M a s s ie Company, 1931
C o r l e t t , T . , The M e d ic in e Man o f t h e A m eric an I n d i a n an d
h i s C u l t u r a l B ackground. S p r i n g f i e l d :
0 . C. Thomas
an d Company, 1 9 3 5 .
An i n t e r e s t i n g h i s t o r i c a l b a c k g ro u n d o f t h e e a r l y
A m eric an I n d i a n s a n d t h e i r m e d i c i n e .
F is h b e in , M o rris, S y p h i l i s . P h ila d e lp h ia :
a n d Company, 1 9 3 5 . 70 p p .
A s h o r t boo k w r i t t e n f o r t h e la y m a n .
D avid McKay
J o h n s o n , C h a r l e s S . , Shadow o f t h e P l a n t a t i o n . C h ic a g o :
U n i v e r s i t y o f C h ic a g o P r e s s , 1 9 3 4 . 214 p p .
K em ble, J a m e s , I d o l s an d I n v a l i d s .
D oran an d Company, I n c . , 1 9 3 6 .
New Y ork:
D o u b le d a y
Loivy, A l e x a n d e r , and B e n ja m in H arro w , An I n t r o d u c t i o n t o
O rg a n ic C h e m i s t r y . New Y ork: J o h n W ile y an d S o n s ,
1 9 3 2 . 383 p p .
W ritte n f o r s tu d e n ts of c h e m istry .
N ew sholm e, A u th u r , Red M e d i c i n e . New Y ork: D o u b led a y
D oran and Company, I n c . , 1 9 3 3 .
312 p p .
C o n t a i n e d a v e r y s h o r t an d i n s t r u c t i v e c h a p t e r e x p l a i n
in g R u s s i a 's a tte m p t t o c o n t r o l v e n e r e a l d is e a s e .
87
P a r k , W i l l i a m H a l l o c k , an d Anna W e s s e ls W i l l i a m s , P a t h o ­
g e n i c M i c r o o r g a n i s m s . P h i l a d e l p h i a : L ea an d F e b i g e r ,
1 9 3 3 . 829 p p .
A t e c h n i c a l b o o k w r i t t e n f o r t h o s e i n t h e f i e l d o f m e d i­
cin e .
P a r r a n , Thomas, Shadow on t h e L a n d . Hew T o rk : R e y n a l an d
H itc h c o c k , 1937.
301 p p .
An e n l i g h t e n i n g book on s y p h i l i s , an d one w h ic h e v e r y o n e
sh o u ld re a d !
P u s s e y , I f . A . , The H i s t o r y an d E p id e m io lo g y o f S y p h i l i s .
S p rin g fie ld :
G. C. Thom as, 1 9 3 3 .
R o t h e r y , A g n es, Denmark Kingdom o f R e a s o n . Hew Y ork:
V i k i n g P r e s s , 1 9 3 7 . 275 p p .
A g e n e r a l i z a t i o n o f t h e p r o g r e s s o f Denmark i n a l l
f i e l d s , n o t d e a lin g w ith s y p h i l i s a lo n e .
S ch am b erg , J a y F . , T r e a tm e n t o f S y p h i l i s .
D. A p p le t o n Company, 1 9 3 2 .
Hew Y ork:
S i g e r i s t , H e n ry E r n s t , S o c i a l i z e d M e d ic in e i n t h e S o v i e t
U n io n . Hew Y ork: W. W. H o r t o n , 1 9 3 7 . 378 p p .
T h i s b oo k c o v e r s e v e r y p h a se o f m e d ic in e i n R u s s i a .
S e v e r a l v e r y w o r t h w h i le p a g e s on v e n e r e a l d i s e a s e s .
An e x c e l l e n t b o o k .
S o u t h a r d , E . E . , S olo m an, H. I . , H e u r o s y p h i l i s . Modern
D i a g n o s i s a n d T r e a t m e n t . B o s to n : W. M. L e o n a rd
Company, 1 9 2 7 .
A book w r i t t e n more f o r th e p r o f e s s i o n a l man.
S t o k e s , J o h n H . , The T h i r d G r e a t P l a g u e . P h i l a d e l p h i a :
W. B . S a u n d e r s Company, 1 9 1 7 .
T h i s i s one o f t h e o l d e r b o o k s on t h i s s u b j e c t . H ow ever,
much o f th e m a t e r i a l i s a p p l i c a b l e t o d a y . P o s s i b l y
w r i t t e n i n an a t t e m p t t o e d u c a t e t h e la y m a n .
V e d d e r, Edw ard B . , S y p h i l i s and P u b l i c H e a l t h .
L e a an d F e b i g e r , 1 9 1 8 .
B.
P h ila d e lp h ia :
PERIODICAL ARTICLES
A ly e a , D a n i e l , 11S u l f a n i l a m i d e - r e s i s t a n t G o n o r r h e a , ” C u r r e n t
M e d ic a l D i g e s t . F e b r u a r y , 1 9 4 0 .
88
D e K r u if , P a u l , " E n l i s t i n g Women A g a i n s t S h am e," K en . 1 : 2 9 - 3 1 ,
A p r il 7, 1938.
D i n g l e , J . H . , a n d M. 0 . H e in z , "A S u rv e y o f P r e n a t a l S y p h i­
l i s , " The J o u r n a l o f t h e A m eric an M e d ic a l A s s o c i a t i o n ,
1 7 3 1 - 1 7 3 3 , May, 1 9 4 0 .
A te c h n ic a l d isc u ssio n .
"G en eral P r i n c i p l e s in S y p h ilo th e r a p y ," T h e ra p e u tic N o te s .
195-223, J u ly -A u g u s t, 1940.
An a r t i c l e w r i t t e n f o r t h o s e i n t h e f i e l d o f m e d i c i n e .
G iv a n , T. B . , a n d G. V i l l a , " T r i s o d a r s e n i n C o n g e n i t a l
S y p h i l i s , " What *s New, 8 - 9 , M arch, 1 9 4 0 .
One o f t h e n ew e r t r e a t m e n t s f o r s y p h i l i s .
B a n z l i k , P . J . , " S o b i s m i n o l Mass i n O r a l T r e a tm e n t o f
S y p h i l i s , " D ru g g is t C i r c u l a r . 38, J a n u a r y , 1940.
A good a r t i c l e ; a l l s h o u l d he f a m i l i a r w i t h i t s c o n t e n t .
K im brough, R. C . , D. M. C o w g i l l , an d E . P . Bowerman,
" R u r a l S y p h i l i s - A l o c a l i z e d O u t b r e a k ." A m erican
J o u r n a l o f P u b l i c H e a l t h . 2 8 : 7 5 6 - 7 6 2 , J u n e , 1938.'
I n t e r e s t i n g and i n s t r u c t i v e .
K i r k , P . L . , and G. B e n n e t t , " R a p id T e c h n ic f o r S y p h i l i s
T e s t i n g w i t h F i n g e r B l o o d ," Modern M e d i c i n e . 4 9 ,
J a n u a ry , 1940.
" M a d s to n e s ," T i l e and T i l l . 2 5 : 4 1 - 4 3 , M arch , 1 9 3 9 .
Im p o rta n t o n ly w ith r e s p e c t t o g e n e r a l m e d ic a l h i s t o r y .
M c D a n ie l, J . G . , " S y p h i l i t i c a n d N o n s y p h i l i t i c P e r s o n s on
t h e F u l t o n C o u n ty , G e o r g ia , R e l i e f R o l l s , " J o u r n a l
A m eric an M e d ic a l A s s o c i a t i o n . A p r i l 3 , 1 9 3 7 .
P a r r a n , Thomas, "Why D onf t we Stamp Out S y p h i l i s ? " R e a d e r s
D i g e s t . 2 9 :6 5 -7 3 , J u ly , 1936.
A p o p u l a r a r t i c l e , p o s s i b l y one o f D r. P a r r a n f s b e s t .
C.
GOVERNMENT PUBLICATIONS
F ed eral
P r o c e e d i n g s o f C o n fe re n c e on V e n e r e a l D is e a s e C o n t r o l Work,
W a s h in g to n , D. C . , U n i t e d S t a t e s G overnm ent P r i n t i n g
O f f i c e , S u p p le m e n t No. 3 t o V e n e r e a l D is e a s e I n f o r m a t i o n ,
1 9 3 7 . 154 p p .
89
C o n tro l o f th e V e n e re a l D is e a s e s in th e U n ite d S t a t e s —
P r e s e n t a n d F u t u r e P l a n s , Y fo sh in g to n , D. C ., U n i t e d
S t a t e s G overnm ent P r i n t i n g O f f i c e , S u p p le m e n t No. 10
t o V e n e r e a l D is e a s e I n f o r m a t i o n , 1 9 3 9 . 25 p p .
P r o g r e s s i n V e n e r e a l D i s e a s e C o n t r o l i n t h e S t a t e s . Ju n e
5 0 . 1 9 5 8 . W a s h in g to n , D. 0 . , U n i t e d S t a t e s G overnment
P r i n t i n g O f f i c e , V o l. 1 9 , D ecem ber, 1 9 3 8 .
Holcom b, R. C . , " C h r i s t o p h e r Columbus and t h e A m eric an
O r i g i n o f S y p h i l i s , " U. S . N a v a l M e d ic a l B u l l e t i n
Y Jash in g to n , D. C .: U n i t e d S t a t e s P r i n t i n g O f f i c e ,
V o l. 3 2 , No. 4 , 1 9 2 7 . p p . 4 0 1 - 4 5 0 .
S olom on, H a r r y C e a s a r , " S y p h i l i s o f t h e I n n o c e n t , " U n i t e d
S t a t e s I n t e r d e p a r t m e n t a l S o c i a l H y g ien e B o a r d . 1 9 2 2 .
S ta te
C om bating S y p h i l i s . V. D. P a m p h le t No. 1 , S a c r a m e n to :
C a l i f o r n i a S t a t e P r i n t i n g O f f i c e , 1 9 3 8 . 15 p p .
S t a t i s t i c a l R e p o r t of t h e D e p a rtm e n t o f I n s t i t u t i o n s o f t h e
S t a t e o f C a l i f o r n i a . S a c r a m e n to :
C a lifo rn ia S ta te
P r i n t i n g O f f ic e , 1938.
95 p p .
M e r r i l l , M alcolm H . , " V e n e r e a l D is e a s e C o n t r o l i n C a l i f o r n i a , "
B u re a u o f V e n e r e a l D i s e a s e s . S t a t e D e p a rtm e n t o f P u b l i c
H e a l t h . November 1 5 , 1 9 3 8 .
C h a p te r 7 5 7 . C a l i f o r n i a P e n a l C o d e , A p prov ed b y t h e G o v ern o r
J u ly 1, 1937. S ec. 1 to 16.
C ity
A n n u a l R e p o r t o f th e B o a rd o f H e a l t h C o m m issio n e rs. C i t y o f
Los A n g e l e s . C a l i f o r n i a . 1 9 3 8 . 52 p p .
M o n te re y C ounty H e a l t h D e p a rtm e n t R e p o r t , S a l i n a s . C a l i f o r n i a .
V o l . V, N os. 1 , 2 , a n d 3.
A n n u al R e p o r t o f t h e H e a l t h D e p a r tm e n t. C i t y o f S a c r a m e n to .
C a l i f o r n i a , 1938 an d f i r s t s i x m o n th s o f 1 9 3 9 .
A n n u al R e p o r t o f t h e D e p a rtm e n t o f P u b l i c H e a l t h . San D ie g o .
C a l i f o r n i a , 1 9 3 6 -1 9 3 7 .
90
D u b l i n , L u i s I . * "The J o b an d t h e L i f e S p a n ," H a r p e r ^
M o n th ly M a g a z in e , J a n u a r y , 1 9 3 0 . B e p r i n t .
The G r e a t I m i t a t o r , M e t r o p o l i t a n L i f e I n s u a r n c e Company.
New Y o rk , N. Y.
S e r v i c e s a s an i n t r o d u c t i o n t o S i r W i l l i a m O s i e r .
M a c C a rth y , 0 . B. H . , A S u rv e y o f t h e M ex ican H a r d s h i p
G ases A c t i v e i n t h e Los A n g e le s C ou nty D e p a rtm e n t o f
C h a r i tie s '. Los A n g e le s, C a l i f o r n i a .
U. S . C . . S o c i o l o g y .
Ju n e , 1939.
B u s s e l l , A. S . , " S y p h i l i s Case F i n d i n g i n I n d u s t r y , " J o u r n a l
o f t h e A m eric an M e d ic a l A s s o c i a t i o n . CXIV. No. 1 4 . A p r i l .
1940.
S c h ia m , L . C . , An E v a l u a t i o n o f S t a t e w i d e T e a c h e r s R e t i r e ­
m ent S y s te m s . XJ. S . C . , E d u c a t i o n , J u n e , 1 9 3 9 .
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