The V.D. epidemic; The V.D. detectives

The following program was produced by a group w o the Westinghouse Broadcasting Company and is distributed to educational stations by the national educational radio network. Say what you. Want. This is a doctor working with a patient and a regular. Basis he said. This time it's really you know say that they have a safe place and years ago perhaps a few perhaps as many as 30 years ago that men contracted syphilis. His symptoms may have been imperceptible. They may have been ignored at any rate with no treatment. The symptoms and signs went away and the man lived a normal life until he became the victim of late syphilis. The organisms which hid in his body all those years might have blinded him crippled him or killed him. Instead he became one of the syphilitic insane with that strange and dreadful speech pattern that

sometimes is manifest in such cases. Ivan the Terrible. Al Capone both were victims of syphilitic insanity but it is no respecter of persons I'm told at least one United States congressman and one state governor were struck by a while in office the results in both cases disastrous. The ironic tragedy is the syphilis and gonorrhea can be cured simply and quickly. If it is found the job of finding VD cases of being epidemiologists of creasing diseases being what might be called a VD detectives is in the hands of only a few hundred men around the country. Here is one such. He works in San Francisco. My name is James and I'm a city epidemiologist and just exactly what does that job involve. When a patient is diagnosed with the now disease that then we attempt to interview this individual male or female and

ascertain in so far as possible. 100 percent of his sexual contacts during the infection risk area. And once we ascertain its information then we go out into the field and invited people into the clinic for their treatment and perhaps interview also dedicated is perhaps a much overworked word. But I can think of no other in connection with the men I met who were literally working seven days of each week night and day trying to track down VD victims why their job is important will be the subject of this one of a series of reports on the venereal disease presented not to be sensational but to warn you that you're living in the midst of a nationwide. Indeed I worldwide epidemic these reports are being presented by a group w Westinghouse Broadcasting Company in cooperation with the Columbia University School of Public Health and administrative medicine and with the American Social Health Association. Your reporter Walter McGraw.

Let's face it you got syphilis by having intercourse with somebody and chances are pretty good you might have passed it on to somebody else so we're not only interested in determining the source of your infection but also we're interested in the fact that you might have spread the disease and this isn't a pretty thing to think about is that is typical of what you just antibiotic use go let's toss a lot of it has this interview or is totally unmarried went on in a big city Clint you had sexual relations with. What is his last name the last person that you've had relations with. What is his last name. I have to mention his name. If there's a marital situation involved here if you're having intercourse with a married man believe me you're not posing an unusual situation or difficult situation as far as we're concerned. Surely. We deal with situations like this day in and day out. This is what we're getting paid for. We're very discreet in the manner in which we handle these matters. And I can guarantee you one thing that your name will never be mentioned. And we take great pride in this.

So surely you and I have a responsibility right now to talk about these people. Now who is that last person that you've had relations with. She later admitted to three contacts one a married man if she was telling the whole truth then she must have caught syphilis from one of these he might still be infectious. He could be infecting other people conceivably Shirleys other two contacts could have been infected through her. They too might be infectious and might be spreading the disease to others. This situation fits the definition of the word epidemic. And when the interviewer finished his talk with Shirley he had a single assignment to stop an epidemic. It's often said that people are reluctant to go for BD treatment because they don't want to talk about their sex contacts. But Dr. Irwin Braff director of the Bureau of disease control of the San Francisco Department of Public Health has long had to live with the answer to that.

Understandably people are reluctant to discuss their sexual activity. Of course there are the brackets that want to talk about the large numbers of their conquests but in general people would prefer not to discuss it it's a dirty subject to them and they with this you know they just get the treatment go to the doctor's office the more comfortable they are. But it isn't really serving their best interests. First of all the chances of VD in a community are going to be greater if the number of people capable of spreading it to them again is the same. It was a fewer people in the community with the less chance there is of you know picking it up in the future. I'm quite sure most of the people that are sexually active and picked up the idea in the first place going to go right back. And it's to their advantage to reduce it. It's simply a matter of convincing them that the various agencies involved in this are only interested from that point of fear that the information that they get is not going to be used for any other point of view. It's not going to be punitive. It's not

available to outside agencies on fishing expeditions to find out if so-and-so is a good moral risk or not a good man. Risk all our records are confidential. There are no exceptions and incidentally I'm thinking particularly now of people arrested on a morals charge by law these people are examined for VD when they're in jail. And I think this is a very worthwhile thing because if you look at the figures we find approximately 15 to 20 percent of these people are in fact infected to an aerial disease. So it's a good case for finding these people are taken care of where there otherwise may not have been taken care of. But apparently the courts hadn't been interested in the medical report of prisoners and I think in general courts do have access to medical records of prisoners in terms of. Other health problems not related to VD are not related to anything

confidential and so this is sort of part of the health record and I think people didn't realize the implications but it became quite evident that all things being equal a gal that was arrested on a prostitution charge who had a CD at the time of the examination was more likely to get a maximum sentence from certain judges as compared to the same gal same situation who didn't have a day and I think this is very unfortunate. And so the information was not made available to the court. No one has ever questioned our position. This is our responsibility and I think we fulfill it. An example of this I suppose relates to treating teenage VD. We examine diagnose and treat minors without parental consent and it's estimated that in 1965 more kids Americans 19 and under became afflicted with infectious VD

than caught the traditional childhood disease measles. The VD picture in the United States is both a growing one and a changing one. Again Jim Ashe when I first started working in BD that was indigent and migratory people a farm worker and etc. were saying white collar people in the clinics today now were saying the airline stewardess. We're saying the shop goes the clerks and the secretaries are now coming to us. And we might have. In a given school in a year we might see five teenagers and we treat them in this clinic in that same school. We might treat two teachers. Now it would be reasonable to assume that the teachers would go to private physicians. And why are they coming to us now rather than the private physicians. Well perhaps because we've been in business here for 20 years and the way to spread around that they can get good medical treatment here and it's confidential Confidential is a key word in the life of a VD detective.

As I found out in chatting with Gerry just Salvatore and Tom feeble at a VD clinic in Chicago I asked Jerry about the numbers of contacts they had to deal with in their case finding activities the person might have had two or three hundred different sex partners within a lifetime. And I think our national statistics tell us that on the average the infectious syphilis patient has somewhere in the neighborhood of four contacts within the critical period is it very often that someone comes in with only one color and you can believe them. Very seldom when people are very stubborn about how can we get them to talk. We go through a rather extensive training program interviewing techniques and we have several motivational tools that are available to us when we are talking to patients infected with syphilis. The best motivational tool we have at our disposal is probably to impress upon the patient the severity of selfless. We do this in a number of ways and I think probably the best way that we do it is by

showing the patients colored the pictures of people that have been infected with us not only in the early stages of the disease but in the later stages of disease telling them exactly what can happen to providing the course of syphilis goes all the way through and they aren't treated for it. When I think a lot of people are vitally concerned about how we're going to handle their particular situation and exactly what we do with the information when we do get it and course you can wrap this up in one concise term called confidentiality. And we try to impress upon the patients all our records are confidential at the Health Department. We're not allowed to divulge names or any information. Also we're very discreet in the manner in which we handle the contacts and suspects once we get them because after all we're dealing with a lot of marital situations and we certainly wouldn't want to jeopardize anybody's marital situation or job status or anything like that. What percentage would you say come to a complete dead end.

I think we probably get at least one out of 20 where we can absolutely do nothing one of these to propose a problem where the patient is willing to do everything possible to assist you in locating a contact but they don't have a first or last name. It's all predicated on how much information you get from your patient as to how easy the investigation is going to be and a lot of cases will get very minimal locating information on some of the contacts we might get a first name. A somewhat skimpy physical description and a bar where the individual met the contact by you are successful on these first name minutes. I'd say we are more often than not and I think this is probably due to a lot of dedication on the part of our workers and a lot of perseverance and just a lot of plain elbow grease going out on Saturdays and Sundays. And one of the things that we found profitable is to go into these high incidence areas where we are finding a lot of people in bars those who develop reporter with the people in the bar and

also the bar contacts to facilitate the investigation process in the future. Listen. One job where you have to by duty do drinking not necessarily want to establish report in the various buyers and saloons and cocktail lounge. They know why you come and what your mission is there and they don't expect you to do it because they respect the fact that you are a professional person and you are there on legitimate business. And I drank an awful lot of orange juice and ginger ale. Believe me if you set on a virus as long as I have which is hours on in waiting for a time tag or contacts you can get yourself St.. What if they just refused to come to the clinic. We are in a position in which to offer them a blood test which we can take in the field are people who are specially trained and very competent in taking a blood sample in the field. You mean you can just step into the men's room with a patient and.

Take some blood because this is Ben in men's rooms in kitchens. In parking lots in automobiles in doorways sticking a needle in somebody's arm in a parking lot but I have good identification in case the narcotics people see you. One of our people had made arrangements to go out and blood test an individual. This was about eight o'clock in the evening and he went out to this apartment building and he act on the door and on the whole he walks in and the place is full of people and the next moment the door comes crashing down. They're surrounded by all sorts of plainclothes policemen with guns drawn and point out everyone is up against the wall and they're frisking them and it's a narcotics squad because they had a tip that there was a little party going on or would be in process in this apartment and that accounted for all these additional people being there and this man happened to be there just at the wrong moment and he carried a little black bag with him in which car. If he had it by letting equipment twice they wouldn't believe that he was a member of the

health department drawing blood since he had the syringes that he was a member of the group. So he finds himself in the wagon and he's downtown at the station. Course they made a proper phone calls. But these things happen periodically. Do any of your men get into trouble from angry contacts they have trace Occasionally you may have some irate patients. Be very irritated at the fact that the man come out and talk in the about their sex kind acts and they were very indignant about a sympathy for the fact that they didn't want to admit or have anyone indicate that it was remotely possible for them to contract an infection and courses to intercourse. But this passes an example of this kind of patient is this college girl who was visited by an investigator. I didn't know how long I had been infected so I had on my own initiative done what I could to warn the people I thought might have been affected and so I had a great deal of

resistance to any prying being done. And this young man came around and I at first I said What are you bothering me for I've done everything that is needful and I really don't feel like you have any call to intrude any further. And he handled it very tactfully. If he's typical of the operators they head they have good operators. How did he do. He told me about the U.S. Health Department's determination to crush the disease to wipe it out completely and therefore the determination to try and contact anybody from whom I might have gotten it. And this included somebody overseas as well. And he didn't make me work for the first time. Not only was this quite an epidemic going on but that there was a whole scale governmental effort now to to wipe it out. And it really does it really did reverse my attitude a good deal suddenly I wasn't just somebody who's whose private life was being intruded upon. They weren't they weren't snooping. They were really trying to do something I had to be done. I think that's what reversed my

attitude. This was the first time you were aware that this was an international effort that these conduct tracing went overseas as well as here. Completely. Not only was it the first time I'd been aware that it was an international effort but it was the first time I had been made aware that it was a national effort. Yes the task of contact tracing is a worldwide job. Details on that in just a moment. In Europe recently I had a chance to view the international aspects of the contact tracing. I discovered that American embassies are involved as in London. DR PAUL PETERSEN medical officer in charge of United States Public Health Service American embassy anyone who has been found to have an Ariel disease in the United States and who has been interviewed for a contact. If these contacts are in the British Isles

epidemiological report forms are referred to us by the Communicable Disease Center and Atlanta and would be investigated by the Ministry of Health and in England. What if someone as they conduct in the States and is now here. These would be sent by the Ministry of Health directly to the United States. In England the BD picture is much like that in the States. My name is King and risking. Chief positioned to the top of the venereal diseases at the London Hospital in London. Of course it was always lack of public cooperation in that these diseases are associated with moral judgments people are ashamed they want to conceal the fact they're not willing to have their names brought before anybody and not willing to be interviewed as regards contact if they can avoid it. But we overcome this pretty well. We have people especially trained to do this work. Any

new patient who comes in is of course first seen by the doctor and dealt with and the next thing is you put straight into this welfare worker as we call her duty was her and she who has developed special skills in this matter questions the patient about recent contact. What information he can give about them. This is more fruitful from men than from women. We try with both their names addresses descriptions where they can be found in the restaurant. And she goes straight out in a car and tries to bring the individual in and keeps chasing individual until she or he maybe is brought in. This of course is a technique very highly developed in the United States we we have tackled it here I think in a more modest way but I saw still think it works extremely well if we have the right people doing the job and in Belgium doctor and Inspector people of headless. It's a very important product of the work. It's to create a

context and we have what we called the Money Tree sonny. Nurses and green IT HAS BEEN say that contagious has been done. What about international cooperation. We have also countries we receive. Often a letter from the United States Army in Germany telling us that some of the person and soldier have been contaminated in a place here in Brussels. And this is her girlish as a name issues and looks something like that and we try to find real diseases brought into this country from what countries does it come from is a most dangerous city is clearly Paris and in Paris in the lap of Lucy Lockhart I am director of

research medical says you'll feel and no cell phone in the car. The decision to surface has been going up the last couple of years. Yes not particularly sick leave a similar sound that the class you get who are you must declare that. Doctors don't always declare me in hospital to do any partition and this too was a worldwide problem. Doctors do not report their VD cases. So what is that all our VD statistics must be estimated. But the lack of reliable statistics is a very small part of the problem. According to the American Social Health Association has Conrad been hiding this lack

of cooperation on the part of private physicians is one of the reasons our VD epidemic is growing but the one area in which major improvement is essential if we are to really reduce the number of reported cases and therefore be able to treat them and follow up their contacts in the private physician area. Private physician according to the national instant study made in 1962 or reporting about one out of every nine cases they treated that was in both primary and secondary syphilis and gonorrhea. And if the private physician would report all of the cases that he sees and permit trained public health staff to do the interviewing then you could get out and trace down all contacts and eventually eliminate or eradicate syphilis in generally physicians period to report a routine case. But they are less likely

to be willing to report persons of higher social classes. Teenagers whose parents would be terribly upset about wives or husbands where they feel that the information being passed on to the marriage partner might cause a disruption in married life to a very simple human problem as you can see that the physician who takes great pride in any position of patient relationship didn't want. To run the risk of hurting his patients the American Medical Association has gone on record urging doctors to report 100 percent not just 11 percent of their cases. Dr. Braff wants more than that from doctors that the physician sort of takes this in terms of I got to report the case and you know you're going to have to speak to the health department you know and sell them anything you don't have to. I mean this is certainly not going to help matters any. And I think if the physician.

Encourages the patient and indicates that the physician has confidence in the health department and this sort of thing then I think the chances of getting a successful interview from the patient would be that much better. And the conspiracy of silence on VD in which the doctor is only one of many participants will be the subject of the next of these reports. BD presented not to be sensational but to save lives by a group w Westinghouse Broadcasting Company in cooperation with the Columbia University School of Public Health an administrative medicine and with the American Social Health Association Bill Cale and his executive producer. Your reporter Walter McGraw. This is the national educational radio network.