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can infect chimpanzees with the virulent treponemes which cause syphilis in humans. The disease in chimpanzees parallels the course in the human, and this year we have been able to infect the chimp with the treponeme which causes rabbit syphilis, and to the best of our knowledge this has never been done before.

PERCENT CHANGE IN REPORTED CASES OF PRIMARY AND SECONDARY SYPHILIS
FY 1965 COMPARED TO FY 1956

[graphic]

LEGEND:

1-159 Percent Increase

Decrease

Mr. FLOOD. What is the incubation period?
Dr. BROWN. In the human 10 to 90 days.

Mr. FLOOD. In the chimp?

Dr. BROWN. Essentially the same. A lesion appears in 14 to 20 days after inoculation.

We are asking and proposing in this budget that we establish a treponemal bank. We propose to collect treponemes of all varieties from throughout the world to inoculate the chimpanezee with, hopefully infecting him, and afterward challenge the chimpanzee with the virulent treponema which causes syphilis in humans and watch the response and hope we will gain some lead from this to develop a

vaccine.

RECOMMENDATION OF AMERICAN SOCIAL HEALTH ASSOCIATION

Mr. FOGARTY. You know about the American Social Health Association?

Dr. BROWN. Yes, sir.

Mr. FOGARTY. They recommend in a letter to us an appropriation of $15,500,000 instead of $10 million.

Dr. BROWN. Yes, sir.

Mr. FOGARTY. Are you acquainted with their recommendations? Dr. BROWN. I did receive a copy of their recommendations. Mr. FOGARTY. What do you think about it? I am going to put the letter and the recommendations in the record.

(The letter and recommendations follow:)

Hon. ROBERT M. MOYER,

AMERICAN SOCIAL HEALTH ASSOCIATION,

New York, N.Y., February 9, 1966.

Staff Assistant, Subcommittee on Labor-HEW of the House Appropriations Committee, Washington, D.C.

DEAR MR. MOYER: We are enclosing page proofs of the recommendations from "Today's VD Control Problem, 1966." This is a joint statement by the American Public Health Association, the American Social Health Association, American Venereal Disease Association, and the Association of State and Territorial Health Officers, prepared this year with the cooperation of the American Medical Association.

These recommendations have been recently endorsed by the above organizations. They concern larger appropriations than those of past years. Yet we urge you to consider them, because reported venereal infections continue to rise in spite of present efforts to curb them and turn the trend downward.

The complete documentation of these recommendations will be mailed to you later this month when the whole joint statement is completed by the printer. Sincerely,

RECOMMENDATIONS

PHILIP R. MATHER,
Board Chairman.

Further expansion and intensification of the venereal disease control program is required to halt the continuing rise in incidence of both infectious syphilis and gonorrhea and to achieve progressive reduction in incidence until these diseases are finally eliminated. Increased effort by governmental, professional, and voluntary organizations in research and education is required to support this program.

Therefore, we the undersigned, recommend:

I. That the Congress appropriate $15,500,000 for fiscal year 1967 for the initiation of a strengthened venereal disease control program designed to reduce the incidence of infectious syphilis and gonorrhea in the United States by one-half in the next 5 years;

That the estimates of the cost of such a program submitted by State and city health officers which are contained in this joint statement be considered by the administration and the congressional Committees on Appropriations in determining the Federal appropriation for 1967;

And that the recommended appropriation of $15,500,000 be allocated as follows: Eleven million five hundred thousand dollars for maintenance of the venereal disease control program at its present level:

Two million five hundred thousand dollars for pilot studies in the control of syphilis and gonorrhea in selected areas-at least one-half million of this amount should be allocated to studies in control of gonorrhea;

One million five hundred thousand dollars for expansion of research, professional training, and public education-one-half million of this allocation should be earmarked for medical training of professional personnel.

II. That physicians in private practice, who treat the majority of persons infected with primary and secondary syphilis and gonorrhea, follow the leadership of their professional organizations, the American Medical Association, American Osteopathic Association, and National Medical Association, by becoming active participants in the national campaign against the venereal diseases.

III. That a followup study to the national study of venereal disease incidence be made on the reporting of venereal disease cases by private physicians, and that the study be so designed as to identify factors which would improve such reporting.

IV. That where adequate legislation does not now exist, State and city legislative bodies be urged to enact laws requiring that all laboratories-public, pri

vate, hospital, and blood bank-report all positive laboatory findings relating to syphilis by name to the health department having jurisdiction.

V. That in order to prevent the spread of syphilis through chains of infection, epidemiologic (preventive) treatment be given to all adequately identified sex contacts exposed to infectious syphilis who are clinically and serologically negative upon initial examination.

VI. That since statistics prove that 40 percent of all infectious syphilis cases in the United States in fiscal 1965 were brought to treatment as a result of epidemiologic investigation, health departments, and physicians in private practice jointly accept responsibility for carrying out complete epidemiology on all reported cases of early syphilis.

VII. That the Surgeon General appoint a committee of experts to examine and find ways of removing the roadblocks to the allocation of adequate Federal funds for a major expansion of research in the immunology of syphilis and in the diagnosis and treatment of gonorrhea in women.

VIII. That the Joint Commission on Hospital Accreditation again reconsider as an accrediting factor the reinstatement of serologic tests for syphilis on all routine hospital admissions.

IX. That national, State, and local civic and professional groups continue to press for more informational and educational programs about the venereal diseases, particularly for young people; and that they continue to urge the inclusion of venereal disease education courses in the school curriculum.

X. That military and civilian health officials at the national level review the military aspects of venereal disease control, with particular emphasis on the communication of epidemiologic information between military and civilian health departments.

XI. That full recognition be given to the fact that the recrudescence of the venereal diseases is a worldwide problem requiring active international cooperation; and to this end that official and voluntary health organizations in the United States extend full cooperation of the World Health Organization, United Nations Children's Fund, the International Union Against the Venereal Diseases and the Treponematoses, and other international organizations working in the cause of venereal disease control.

EVALUATION OF RECOMMENDATIONS

Mr. FOGARTY. What do you think about it? It is a pretty good outfit, is it not?

Dr. BROWN. Yes, sir.

Mr. FOGARTY. It is a joint statement by the American Social Health Association, American Venereal Disease Association, and the Association of State and Territorial Health Officers prepared this year with the cooperation of the AMA.

Dr. BROWN. Yes, sir.

Mr. FOGARTY. I thought these recommendations ought to be looked at pretty carefully. What do you think about them?

Dr. BROWN. I notice they divided these recommendations—

Mr. FOGARTY. What do you think about the $15.5 million compared to your $10 million plus?

Dr. BROWN. From the information that I have gathered from the American Health Association, they have based this on a questionnaire which was sent to all States and many of the big city health departments. The $11.5 million they are suggesting is to maintain the VD program at its present level and is based upon answers to a questionnaire. The States feel they need additional moneys to employ additional personnel to bring them up to the level which they feel is necessary to maintain the present level of VD control. The $2.5 million they are suggesting is for pilot studies in the control of syphilis and gonorrhea. They go on to say at least half a million dollars of this

should be allocated to studies in the control of gonorrhea. The remaining recommended $2 million is based on intensifying syphilis epidemiology in all of the States. We have promoted such a syphilis casefinding program in a limited number of areas and it appears that by placing emphasis on this part of the program more cases will be found more rapidly, thus preventing further spread.

Mr. FOGARTY. What do you think about these recommendations? Are you for them or against them?

Dr. BROWN. I think that the money could be well spent, leading more quickly to reducing the incidence and closer to eradication. Mr. FOGARTY. That is the answer right there.

Mr. Shriver?

Mr. SHRIVER. I have no questions.

Mr. FOGARTY. Mr. Denton.

EFFORTS TO IMPROVE REPORTING

Mr. DENTON. What steps are you taking to secure better cooperation from the doctors in reporting cases? That seems to be your big problem.

Dr. BROWN. As a following to each case reported to the health departments, sir, someone from that health department visits the practicing physician, offers the services of the health department

Mr. DENTON. That is not what I mean. I understood you said the difficulty was that doctors were not reporting the cases as well as you had hoped they would. What have you done to improve that situation? That seems to be the root of this problem.

Dr. BROWN. Last fall the American Medical Association conducted a seminar on venereal disease in Chicago. We, along with the American Social Health Association, worked with the American Medical Association. This was done to stimulate physicians to do better reporting and to understand what the problem is.

Mr. DENTON. That is the American Medical Association?

Dr. BROWN. Yes, sir. We are directing educational efforts toward the practicing physician as well as the intern, the resident, and the medical student, so that they will know more about the disease and understand their responsibilities to public health when they go into private practice.

EFFECTIVENESS OF PENICILLIN FOR ERADICATION

Mr. DENTON. When I was on one of the islands a couple years ago, they told me they had some disease down there in these mandated islands and to eliminate it they inocculated everybody with penicillin. As a byproduct they abolished venereal disease in the island. Do you know anything about that or is this a practical way to abolish venereal disease?

Dr. BROWN. I don't think that would be a very practical way in this country. However, if everybody in 1 single day did get adequate therapy for syphilis, whether they had it or not, the disease could be eradicated. It would be a tremendous expense and it would be almost impossible to do.

Mr. DENTON. Just an isolated place like that it is all right?

Dr. BROWN. Yes, sir.

Mr. DENTON. I think that is all.

Mr. FOGARTY. Thank you, Doctor. Anything else you want to say? Dr. BROWN. No, sir.

NEED FOR ELAN IN CONTROL PROGRAM

Mr. FLOOD. I again find this problem: There is no doubt of your awareness of the problem. There is no doubt of your awareness that certain steps should be taken to meet the problem. But on this side of the table once again I get the very clear impression of lack of urgency. I get the very clear impression that this will be a workmanlike job in the best bureaucratic tradition of analyzing and approaching a problem and attempting to solve it.

This, of course, in the kind of shop you are handling is not enough. That is commendable and acceptable in most areas of government, and I certainly am not going to change it. That goes on like Tennyson's brook, forever.

That is built in. But in the veneral disease branch of the Communicable Disease Center of the Public Health Service, this calls for special troops. This calls for a green beret.

You are not just another infantryman. These are special forces. I don't feel the elan, espirt or urgency. I do not feel any gung-ho special forces attitude here. What do you feel?

Dr. BROWN. Sir, I intended to express before this committee that there is a sense of urgency on my part. I have always, and the staff has always, felt that a single reported case of syphilis is a medical emergency and we impart this feeling to State health department officials and their staffs.

I feel that within the past few years we have been able to change their attitude and that they do consider it now more of an emergency than they did years ago.

Mr. FLOOD. It was common knowledge during the last several years, and for a combination of reasons, that VD was flaring up again all over the place. The age groups were pretty clearly identified and to some extent the areas. A great deal of publicity has been given to it.

I would think the yellow flag would have been up on your masthead on this one and there would have been a frontal attack on this thing. Instead of that we have a continuing increase in both syphilis and gonorrhea. What about that? Why were you not on the barricades leading a charge about this several years ago?

Dr. BROWN. We have been.

Mr. FOGARTY. That one shot does the job still, does it not?

Dr. BROWN. Yes, sir. In the majority of cases of syphilis and gonorrhea, it does.

RESISTANCE TO PENICILLIN

We have been noticing an increase in resistance to penicillin by the gonococci, and we have been evaluating other antibiotics.

Mr. FLOOD. Why didn't you know that would happen? This was clear for the other infections for a long time. In some within a sur

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