Medicine: Great Pox

(See front cover)

A new president and an old disease awaited the American Public Health Association in New Orleans this week when that ancient and honorable organization convened for its 65th annual meeting. The new president is Dr. Thomas Parran Jr., Surgeon General of the U. S. Public Health Service. The old disease is syphilis. The conjunction of these two was of large medical importance because Surgeon General Parran is now well launched on a nationwide campaign to bring this venereal disease out into the open and under control. Today, though exact figures are lamentably lacking, it is expertly estimated that one U. S. citizen out of ten is afflicted with syphilis.

This affliction of mankind runs back into the mists of antiquity. Some scholars believe that the ancient Jews knew about syphilis and that this disease and its peculiar transmission were referred to in the Second Commandment: For I the Lord Thy God ama jealous God, visiting the sins of the fathers upon the children unto the third and fourth generation of them that hate me. The Greeks, in a dim, foggy way, described ailments contracted by unclean intercourse. The Romans were among the first to develop a sense of shame in connection with venereal diseases and said as little about them as possible.*As the Dark Ages settled down on Europe, syphilis was lumped with leprosy and other skin troubles, was given no special recognition. In 1493 a great plague of syphilis spread out of Naples, apparently carried there by Spanish troopers. Up to that time the disease had no specific name, was thereafter referred to as the Great Pox. In 1530 Girolamo Fracastoro, an Italian, produced a Latin poem entitled Syphilis sive Morbus Gallicus. Its hero, a shepherd named Syphilus was smitten with the Great Pox. Thus did this ancient disease finally get a literary name.

The modern history of syphilis began in 1905 when Zoologist Fritz Schaudinn of Germany discovered the specific cause of infection. One year later August von Wassermann of Germany devised his Famed blood test for diagnosing the disease. In 1910 Biochemist Paul Ehrlich, once more of Germany, after 605 laboratory experiments, finally hit upon a positive ure for syphilis. Popularly called 606 or Salvarsan, this Ehrlich remedy wastechnically a compound of arsenic known as arsphenamine. With the cause & cure well in hand, world medicine was fully equipped to move forcefully against one of the worst scourges of the human race.

But the human race was not yet ready to admit that it was being scourged by syphilis. Because the disease was generally contracted in the course of sexual misconduct, an enormous social taboo had developed. Victims suffered in silence or ignorance while Society took the moral view that they had simply got what was coming to them. To break down this taboo in the U. S. and tackle syphilis scientifically rather than morally is the high and burning purpose in the official life of Surgeon General Parran.

As head of the Public Health Service, as president of the American Public Health Association, Dr. Parran is in an advantageous position to press his crusade. His predecessors in and out of Federal office had virtually eliminated smallpox, yellow fever and cholera from the U. S. by the turn of the Century. Typhoid fever had been brought under epidemiological control by 1910. Diphtheria had ceased to be a major communicable disease by 1920*. Beginning in 1904 public health officials and charitarans turned their attention to tuberculosis. In 31 years they have brought the death rate down from 200 per 100,000 population to 55. Syphilis thus remains the last nationwide plague to be brought under control by regimented medicine.

Last week Surgeon General Parran was crusading here, there &everywhere, against the taboo and the disease that lay behind it. In St. Paul he told the Inter-State Postgraduate Medical Assembly: “Although the death rate from heart disease and cancer is increasing, fatalities from communicable and preventable maladies are decreasing steadily. Considerable progress has been made in the war against influenza, and in the reduction of deaths from pneumonia through the use of serum. The next battle of the medical profession is against syphilis. The nation’s Press aided mightily in stamping out tuberculosis, and I am happy to observe that newspapers are beginning to take an active part in the battle against syphilis.”

Speeding on, he stopped in Washington only long enough to greet his family, pick up memoranda on the disbursements of the $8,000,000 allotted him under the Social Securities Act, to get a conspectus of the nation’s health. Then on to New Orleans went he, to be installed as president of the American Public Health Association and to put Syphilis at the top of its agenda.

Dr. Parran believes “that if all conditions due to syphilis were reported as such, it would be found the leading cause of deaths in the U. S.” This destructive disease last year “attacked and disabled more than half a million persons. There is more of it than measles, twice as much as tuberculosis, a hundred times as much as infantile paralysis. It is responsible for 10% of all insanity. 18% of all diseases of the heart and blood vessels, for many of the stillbirths and deaths of babies in the first weeks of life. . . . Syphilis has always seemed to me the mad dog of the communicable diseases and needs as swift action to control it.”

Last year Dr. Parran, while still New York State’s Health Commissioner, journeyed to Sweden, Norway and Denmark to learn how health officials of those nations had succeeded in making this disease as rare as typhoid fever, smallpox, typhus, cholera, yellow fever. He also surveyed England to learn why England now has only 20,000 new cases of syphilis a year whereas in 1920 it had 40,000 new cases yearly. In all those countries Dr. Parran found that every case of syphilis must be reported to health authorities. In the Scandinavian countries “all persons infected with syphilis have a right to demand free treatment, but equally are obliged to submit to treatment.” In England free treatment is available to all.

In Copenhagen a sight in the main square made Dr. Parran pause with admiration, for “along with advertisements of department stores, model houses, parks and other attractions of the city was posted the list of names, places and hours of all venereal disease clinics.” In Scandinavia Dr. Parran also found that practically every case of syphilis was traced to the individual from whom it was contracted. In the U. S. only New York State tries to make a systematic search for the original source of infection. With his $8,000,000 Social Security fund, Dr. Parran is trying to make other states imitate New York and Scandinavia.

New York City’s Health Commissioner John Levi Rice, who does more than any other municipal health officer to support the Parran campaign, last week revealed another new method in the U. S. fight against venereal disease. The 827 municipal clinics throughout the U. S. where venereals may receive free or cheap treatment, get only a fraction of the victims. Of the rest, some do not know that they are infected, while the rest shamefacedly sneak to quacks, urologists, and skin specialists. Henceforth the 14,000 doctors of New York City are to function as “shock troops” in the war against syphilis. They may send patients to any one of the Health Department’s 14 diagnostic centres, get back without charge confidential Wassermann reports. Such patients will get free antisyphilitic drugs and nursing service from the city, where needed. Special medical investigators will track down sources of infection, put them under treatment. When money is available, great physicians cooperating in the public war will receive some pay for their generous services.

Commented Dr. Rice, who estimates that 5% of New York City’s population is suffering with syphilis: “We hope to cut down the spread of the disease. We may do something towards its elimination here later, but it will remain for the next generation really to make a dent here.”

Dr. Rice, Dr. Parran and every other responsible social hygienist in the country admit that they cannot strike their enemy dead unless they first demolish the social custom which forbids public discussion of venereal diseases. Nowhere is this taboo more rigidly enforced than on the screen or in radio. Cinema producers are well aware that any reference to the subject, regardless of good motives or public purpose, will only make trouble for themselves. Columbia Broadcasting will not permit the word “syphilis” to go out over the air from its stations. National Broad casting this year gingerly permitted Dr. Parran and two other authorities to mention the word in broadcasts. On the other hand the Press has made a notable response to Dr. Parran’s campaign to get syphilis out into the open.

The ice of journalistic reticence was first broken in 1929 when the St. Louis Post-Dispatch specifically mentioned syphilis in a report of a St. Louis meeting of the Na tional Society for the Prevention of Blind ness. Last year breaks in the taboo began appearing far & wide. The Chicago Tribune published three full-page articles on syphilis in its Sunday editions. In New York, the News (circulation 1,629,000), put on a campaign to publicize syphilis with news stories, editorials, cartoons, has sold 16,054 reprints at 5¢ each. The more conservative New York Herald Tribune and New York Times began putting the word “syphilis”into their headlines. By last week some 125 newspapers of some 100 communities had mentioned “venereal disease” or “syphilis” Though the Associated Press and United Press occasionally mention this plague in their dispatches, they report that local editors generally blue-pencil it. Symbolic of the Press’s hesitancy to take up the Parran crusade in full is the fact that in most states a person described in print as syphilitic can successfully sue for libel.

Last July Surgeon General Parran wrote a lengthy article called “Stamp Out Syphilis” which appeared simultaneously in The Reader’s Digest and Survey Graphic. Last week the editors of The Reader’s Digest bragged: “Discussion [of this article] in conversation everywhere and in the Press of the nation has brought the whole subject into the open for the first time. To date more than 1,500 organizations and individuals have ordered 276,021 reprints of the article for distribution.”

For this war against a hidden enemy Dr. Parran has had long training. He joined the Public Health Service in 1917 when he was 25 and two years out of Georgetown University School of Medicine. By 1925 he was chief of the Service’s division of venereal diseases. Largely because he was an expert in that field he became Health Commissioner of New York State in 1930 upon nomination of his great, good friend and backer Governor Franklin Delano Roosevelt. Largely for the same reason he became Surgeon General last spring, upon nomination of President Roosevelt. A Roman Catholic Marylander whose family has grown tobacco there since 1655. he has a strong craving for the gentleman farmer’s life of herds, droves, flocks and bevies, of hunting, fishing and camping. His family estate lies close to Washington. But today he has little time for those avocations, or lor his family of four young sons. Wrote he last summer in his Reader’s Digest trumpet call: ”If the eradication of syphilis were to be my one official duty during the next 20 years I should attempt it very confidently with a budget substantially less than that which has been expended during the past 20 years for a single animal disease— bovine tuberculosis. Syphilis can be fought somewhat more cheaply. Tuberculous cows must be destroyed and paid for in full, regardless of the financial status of the owner. The human beings now suffering with syphilis, certainly the new infectious cases, usually can be cured and restored to normal life.”

*Wrote Aurelius Cornelius Celsus in the 1st Century: “With us Romans these terms . . . are certainly filthy and are never employed by anyone who has a proper regard for modesty in language.”

*Last week in New York City occurred the first death from diphtheria in seven weeks.