There is need for continuing research pointing toward artificially induced immunity to syphilis, toward the improvement of diagnostic tests and laboratory procedures, and toward more effective public education.

There is need in some areas for selective mass testing surveys to reduce the reservoir of syphilis.

Replies from State and city health officers to the questionnaire indicate that some needs are being met in some areas. No State indicated freedom from problems. Most of them accent two major deficiencies: shortage of staff and shortage of funds to recruit, train, and support staff.

The objective of present and future venereal-disease control programs should be to meet these needs as quickly and efficiently as possible.

5. TO WHAT EXTENT IS VENEREAL-DISEASE CONTROL A FEDERAL RESPONSIBILITY NOW AND IN THE FUTURE?

Venereal-disease control is a Federal responsibility to the extent that control activities protect Federal interests and extend beyond State jurisdiction. Military facilities of all sorts, atomic-energy plants, defense-production centers-in fact, any areas where concentrations of population are collected around essentially Federal operations are primarily Federal responsibilities. Prevention of the spread of venereal disease in interstate traffic and its importation across national boundaries is again primarily a Federal responsibility because it is beyond the jurisdiction of any single State.

It is of course precisely in these areas of Federal responsibility that many of the present venereal-disease hazards lie. The spread of venereal disease from State to State by migrant laborers and others, the introduction of venereal disease from outside the country, the investigation and treatment of contacts to the military and to defense-production workers-these are all problems involving Federal responsibility and interests.

Venereal-disease control has been and must continue to be a partnership affair. Federal, State, and local governments, as well as voluntary agencies, have legitimate interests and certain clear responsibilities. The areas of interests and responsibilities have often been defined. What is needed is a long-range plan of activity with the extent and nature of participation agreed to by all the responsible parties.

All three of the organizations sponsoring this statement are firmly convinced that so long as there is uncontrolled venereal disease anywhere in the United States, the Federal Government must be an active partner in its control. The Federal Government must provide, in addition to technical assistance, grants for case finding and the implementation of investigative staffs, especially as this case finding and investigation lead across State boundaries. The Federal Government must continue to collect, analyze, and distribute comparative venereal-disease intelligence data by State and locality and for the country as a whole. It must, through its various official agencies, lend assistance in education, in research, in the standardization of serologic procedures, and in whatever other ways these agencies are peculiarly fitted to assist.

On the basis of reports from the States with their evidence of increasing venereal disease, we assume that a national choice must be made between the alternatives of a continued and increasing problem or resumption of augmented case-finding activities. The American Social Hygiene Association, American Venereal Disease Association, and Association of State and Territorial Health Officers therefore join in urging the Federal Government to:

1. Make a detailed survey of venereal-disease control needs to determine how they can best be met to insure a continuous fall in local venereal disease rate such as has occurred for the Nation as a whole in the past decade.

2. Carefully evaluate the significance of present rising rates to determine (a) the extent to which they may represent a need for emergency action on the part of the Federal Government in order to prevent the serious spread of veneraldisease infection, and (b) the extent to which skilled personnel lost to the control effort over the past 2 years must eventually be replaced.

3. Continue to provide grants and technical assistance for case finding and such other epidemiologic services as are required to prevent the spread of infection. 4. Provide funds to cover recruitment, training, and operation of investigators to serve under State jurisdiction in and around military, defense, and other areas of Federal responsibility.

5. Provide $5 million for venereal-disease control in fiscal 1956 to meet the need expressed by 37 States for additional funds and to support necessary emergency activity to check alarming increases in venereal-disease rates which now threaten to wipe out previous gains.

ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS,

J. W. R. NORTON, President.

FRANKLIN D. YNLER, M. D., Secretary.

AMERICAN VENEREAL DISEASE ASSOCIATION,

WM. L. FLEMING, President.

JOHN C. HUME, Secretary.

AMERICAN SOCIAL HYGIENE ASSOCIATION,

PHILIP R. MATHER, President.

CONRAD VAN GURUZ, Executive Director

APPENDIX II (a).—Problems of venereal disease control-Results of questionnaire,

48 States

I. (a) Is your appropriation for VD control for the current fiscal year
adequate to permit an effective and progressive control program?
(b) If you have any areas in your State where adequate VD control
coverage is not now provided, are any of them a potential or
actual hazard leading to the transmission of VD into other parts
of your State and/or to other States?..

(c) Have you had any recent evidence of local epidemics of early
infectious syphilis pointing to the possibility of the resurgence
of the disease?...

II. Has your State been able to compensate for the current fiscal year
with State and local funds for the loss in Federal VD funds?__.
III. (a) 1. Is your State at present experiencing any rise in the attack rate
of syphilis?.

2. Of gonorrhea?.

3. Of other venereal diseases?.

(b) Is your present VD case-finding program adequate to insure a
continued fall in rates such as has occurred for the Nation as a
whole in the past decade?..

IV. Are your diagnostic and treatment facilities adequate to the need?.
V. (a) Do you have in your State any high prevalence areas which should
be surveyed with selective mass blood-testing or other case-
finding procedures?___

(b) Do you have any such high prevalence areas within urban areas
with lower average rates?..

VI. (a) Are adequate provisions made in your State for the complete and
careful interview of infected military and defense-plant per-
sonnel, and for the investigation, on a statewide basis, of con-
tacts named by them?...

(b) Do military installations and defense plants within your State contribute to any appreciable extent to your VD program?_ (c) What percent of the total VD contacts originating within your State are reported by military installations within the State? 2. (d) What percent of contacts reported to your State from sources outside the State are contacts to military personnel? 3 VII. (a) Have you experienced any recent seasonal, other temporary or permanent influx of migratory workers from high prevalence areas who may act to introduce venereal disease into your State? (b) Does the transmission of VD through migrant laborers contribute any appreciable portion of your DV control problem?_

1 More recent Health Department reports add 4 States for syphilis rise, 15 States for gonorrhea rise.

2 Under 10 percent, 12 States; 10 to 49 percent, 22 States; 50 percent and over, 4 States.

• Under 10 percent, 8 States; 10 to 49 percent, 14 States; 50 percent and over, 17 States.

APPENDIX II (b).-Problems of venereal disease control-Results of questionnaire, 44 cities, including Washington, D. C.

I. (a) Is your appropriation for VD control for the current fiscal year adequate to permit an effective and progressive control program? (b) If you have any areas in your city where adequate VD control coverage is not now provided, are any of them a potential or actual hazard leading to the transmission of VD into other parts of your city and/or to surrounding areas?_

(c) Have you had any recent evidence of local epidemics of early in-
fectious syphilis pointing to the possibility of the resurgence of
the disease?..

II. Has your city been able to compensate for the current fiscal year with
State and local funds for the loss in Federal VD funds?...

III. (a) 1. Is your city at present experiencing any rise in the attack rate of

2

syphilis?

2. of gonorrhea?_

3. of other venereal diseases?_

(b) Is your present VD case-finding program adequate to ensure a con-
tinued fall in rates such as has occurred for the Nation as a whole
in the past decade?

IV. Are your diagnostic and treatment facilities adequate to the need?.
V. Do you have in your city any high prevalence areas which should be
surveyed with selective mass blood-testing or other case-finding
procedures?..
VI. (a) Are adequate provisions made in your city for the complete and
careful interview of infected military and defense plant per-
sonnel, and for the investigation, on a statewide basis, of con-
tacts named by them?__

(b) Do military installations and defense plants in or near your city
contribute to any appreciable extent to your VD problem?....
(c) What percent of the total VD contacts originating within your
city are reported by military installations within the State?1_
(d) What percent of contacts reported to your city from sources out-
side the State are contacts to military personnel??.
VII. (a) Have you experienced any recent seasonal, other temporary, or
permanent influx of migratory workers from high prevalence
areas who may act to introduce venereal disease into your city?..
(b) Does the transmission of VD through migrant laborers contribute
any appreciable portion of your VD-control problem?...

1 Under 10 percent, 18 cities; 10 to 49 percent, 18 cities.

2 Under 10 percent, 14 cities; 10 to 49 percent, 7 cities; 50 percent and over, 9 cities.