The magnitude of the problems of syphilis and gonorrhoea con trol in the United States may be suggested by the following fig ures, although notification is far from complete. At present the number of cases of syphilis recorded each year approximates 267, 00o and of gonorrhoea 162,00o. Syphilis always stands high in the total number of cases of infectious diseases recorded, being out ranked only by such common diseases as measles and chicken-pox; and gonococcal infections stood seventh in the last Federal report. However, studies as to the prevalence of syphilis and gonorrhoea which have been made in certain cities and States seem to show that a larger proportion of patients suffering from syphilis than of gonococcal infection place themselves under medical care. In addition to private practice and institutional facilities, there are now in the United States approximately 1,000 clinics and dis pensaries, where these diseases are treated gratuitously or for a small part of the cost. But various studies indicate that of the patients under treatment the majority are under the care of pri vate physicians. Thus, in the United States as a whole, private physicians were treating 64% of the cases of syphilis and gon orrhoea. From all available data it is estimated that collectively 5% of all the men, women and children of the United States are infected with syphilis ; and that this figure may rise to one in ten of adults. Gonorrhoea is known to be somewhat more prevalent. But of course these diseases are very unevenly distributed among different groups and population areas.
of the general public in regard to syphilis and gonococcal infections is, like other phases of public health instruction, a duty of the established educational system and official health agencies; but such voluntary organiza tions as the American Social Hygiene Association, and its affili ated societies, co-operate actively in demonstrating to educational, social and religious institutions and associations in the United States the means by which scientific sex instruction and knowl edge of these diseases can be incorporated in the activities of schools, colleges, churches, parent-teacher associations, men's and women's clubs, and numerous other organizations. In general, it is the aim of all these educational measures to promote among the public a sound knowledge of sex problems and to integrate sex education with all forms of instruction which have for their object normal growth and development of youth and their train ing for marriage and family life, the promotion of ethical stand ards as well as a knowledge of the elements of personal hygiene. Specifically, in regard to the venereal diseases, the educational program aims to make it impossible for persons to be infected with syphilis or gonorrhoea through ignorance of the seriousness of these diseases and the means of their spread, and to make the socially sound uses of sex more appealing as a great factor in suc cessful living. The methods and materials used in this educational
work in the United States include lectures, motion pictures, ex hibits and printed matter, and particularly the inclusion of appropriate sex teaching in such subjects as physiology, hygiene, biology, home economics, sociology and psychology, in the schools and colleges.
aim to reduce com mercialized prostitution and other forms of promiscuous conduct by either sex, because such conduct is anti-social and such per sons tend to become carriers and disseminators of venereal dis eases. Furthermore, prostitution leads to exploitation of weak and irresponsible persons of both sexes; and promotes corruption of other individuals and officials. By providing opportunities for the wholesome use of leisure, and through child guidance clinics, vocational adjustment bureaus, visiting teacher associations, vol untary protective agencies and women police, protective measures aim to prevent young people from forming habits and associations which may lead to promiscuity and prostitution. Legal measures have involved the passage and enforcement of laws which penalize the recruitment, the exploitation and the traffic in women or girls for prostitution. They aim to repress the activities of prostitutes and of their male customers. In addition to the passage of neces sary laws, legal measures have included adequate training of the police, men and women. The responsibility for such measures rests upon the law enforcement and correctional officials and institutions of the cities, counties and States, and the Federal Government. In addition, there are numerous voluntary organiza tions.
are many indications of what may reasonably be expected in the future. The U.S. Army and Navy have continued plans of control of the venereal diseases, similar to those of the World War period. The annual admission rates in the Army have dropped from 107 per 1,000 men in 1917 to 27 per i,000 in 1936. In civil life the State of Massachusetts has already produced impressive evidence of declining syphilis prev alence ; and the situation is full of promise in New York and other States. The death rate from syphilis, locomotor ataxia and general paralysis of the insane combined has declined only 32% between the peak in 1917 and 1935 (from 19.8 per i oo,000 to 13.4 per oo,000), despite constantly increasing ability to recog nize syphilis in all its manifestations. The decline, it may be added, is largely due to falling rates for locomotor ataxia and general paralysis of the insane. Figures from the Metropolitan Life Insurance Company show an even more marked downward trend in the death rate from syphilis. The death rate from syphilis of infants under one year of age has decreased about one half during the same period.