CONTROL IN THE UNITED STATES Efforts to stamp out syphilis and to make progress toward the control of gonococcal infections in the United States differ in certain respects from similar activities in other countries. A con tinuous program of disseminating accurate knowledge among leaders of public opinion promoted by the American Social Hy giene Association and affiliated groups during the past twenty-five years has paralleled the growth of medical and public health ex perience in practical diagnosis, treatment and control measures. To supplement the work of the qualified medical practitioners, there has been built up a sufficient body of trained clinicians, laboratory experts, nurses and medical social workers to make possible the beginning of a nation-wide program for eradication of syphilis.
In December 1936, the Surgeon-General of the United States Public Health Service arranged a notable "Conference on Venereal Disease Control Work." This conference recommended concen tration upon finding all the cases and getting them under treat ment as the immediate objective, with continuance of social hy giene education and promotion of preventive measures as major items of the long range program. Augmented funds of the Public Health Service, the Children's Bureau, and of other governmental bodies, available for distribution as subsidies for improving health work including control of venereal diseases made it possible to stimulate action in many states, cities and counties previously do ing little or no effective work. Within the past two years under the leadership of the Surgeon-General remarkable progress has been made and the public has adopted the slogan "syphilis is the next great plague to go." The so-called fourfold program of medi cal, educational, recreational and legal measures for protecting military and naval forces in war time had demonstrated what could be done by joint action of community and cantonment. It had become clear that further action could be taken.
is need also for X-ray and other special examinations in selected cases, and for the skilled services of experienced syphilologists to arrive at differential diagnoses for which ordinary examinations and laboratory tests will not suffice. In the United States the health authorities and medical profession are urged to extend these services. For example, special efforts are directed toward securing blood examinations of every expectant mother, of both men and women applying for a licence to marry, of students en tering college, and of many persons seeking employment. Exten sive surveys have been made of selected negro, Indian and other population groups and inmates of institutions. Recognizing that every case comes from another case, and may lead to still others, epidemiologic studies are advocated for all sources and con'acts. The purpose of all these examinations is to deterniine who are in fected and to get them under treatment promptly.
The concentration of all available facilities and personnel for competent treatment of early cases is stressed on the ground that thereby the greatest number of infectious individuals can be ren dered permanently non-infectious; and the disease prevented from seriously damaging them before they can be cured. Public opinion supports the health authorities in demanding correlation and adaptation of all the services of private practitioners, voluntary hospitals, clinics, and public institutions to the needs of syphilis patients with due regard to the latter's geographic distribution, opportunities to come for treatment outside of working hours, ability to meet expense, and willingness to follow advice and to continue treatment without interruption. The view is also rapidly gaining ground that the health officer or other proper officials should supplement existing facilities as necessary, and should re quire full co-operation of all infected persons in treatment and protection of others against infection. Legislative acts covering reporting of cases, quarantine when necessary, examinations for evidence of infection before marriage, prophylactic treatment of new born babies' eyes to prevent gonococcal infection and other measures have been adopted by many states.