or program, as dictated by the shifting nature of the venereal disease problem. Without adequate resources, however, this shifting is mere firefighting — necessary under the circumstances, but unable to eliminate permanently the conflagration potential throughout the country. Education and prevention In the years 1946 through 1952, funds were made available to States and communities for "education" efforts in venereal disease control. The net result was the development of a highly effective public appeal designed to support the casefinding effort. Materials were prepared for use by press and radio, in clinics and health agencies, and to some extent in the schools. Young people in those years had been exposed also to the military venereal disease education program. In the last decade, however, a generation of young people has come along almost completely ignorant of venereal disease. The Task Force is aware of their needs and has reviewed educational efforts directed to them. Although funds have been limited primarily to finding and treating cases of syphilis, attempts have been made to explore the education possibilities. Some of these efforts have been: (1) a program in Ohio to demonstrate the possibility of incorporating venereal disease educational materials into the school curriculum; (2) support for a film produced by the Kansas State Health Department for use with school-age children to convey knowledge and understanding of syphilis; (3) sociological study of the teenage clinic population in New York City to determine some of the characteristics of the venereal disease-prone youth; (4) a pilot program in Philadelphia to ascertain the rehabilitation potential of teenagers admitted to the clinic; and (5) pilot studies in teenage sex behavior to help understand the teenager and his relationship to the world he lives in. Recent increases (since 1956) among people under 20 (Figure 9) indicate to Members of the Task Force that the success of these education efforts at prevention has not been striking: (1) Reported early infectious syphilis among the 15-19-year age group rose from 1,093 cases in 1956 to 2,577 cases in 1960, an increase of 136 percent. For the same period, and among the same age group, the number of reported gonorrhea cases rose from 44,264 to 53,649 — an increase of 21 percent. (2) In 1960, 61,265 cases of infectious venereal disease (early infectious syphilis and gonorrhea) were reported among persons under 20 years of age. This represents 22 percent of the infectious cases in all age groups. (3) Considering the under-reporting of gonorrhea particularly, the Task Force is convinced that there may be more than 200,000 cases of infectious venereal disease occurring among teenagers every year. (4) The infectious syphilis age-specific rate reported among teenagers in the 15-19-year age group has increased from 10 per 100,000 population in 1956 to over 19 per 100,000 population in 1960. (5) More cases of infectious venereal disease occur at age 18 among females than at any other year of age. (6) Teenage venereal disease is associated with sexual promiscuity, illegitimacy, and juvenile delinquency. More than 50 percent of all reported infectious venereal disease in the United States occurs among teenagers and young adults under 25 years of age. In 1956 the infectious syphilis rate among the 15-19-year age group was 10.1 per 100,000 population; in 1960, it was 19.4 per 100,000, an increase of 92 percent. That less is being done today in venereal disease education than was during the war suggests some of the reasons for the apathy and ignorance which surround the venereal diseases. The Task Force feels that continuing progress towards the elimination of syphilis demands a major intensification of effort in the area of venereal disease education. DISCUSSION AND CONCLUSIONS The Task Force notes, and is impressed by, the very real progress made by States, communities, and the Federal Government in the control of syphilis in the past 20 years (Figure 11). It acknowledges the difficulties inherent in the epidemiologic control of syphilis because of its involvement in depth with morals, sex, prostitution, and delinquency. It recognizes also the startling progress that has been made in epidemiologic method and in diagnosis and treatment. It is not surprised that in the early 1950's, the Venereal Disease program lost support and status in the face of the remarkable promise of penicillin and the widespread publicity it received. MORTALITY DUE TO SYPHILIS AND FIRST ADMISSIONS TO MENTAL INSTITUTIONS DUE TO SYPHILIS RATE PER 100,000 POPULATION — UNITED STATES, 1949-1959 The Task Force believes there has been for some time a true increase in the occurrence of syphilis. The basis for this position rests in the following facts: Reported increases in the United States are general. The American Social Health Association reported in March 1961 that 33 States and 63 major cities reported increases in primary and secondary syphilis; whereas, only nine States and 12 major cities reported decreases. In many of the health departments that reported rising rates, there has been no substantial change, either in method of control or in intensity of the control effort. Although it is conceded that the rising rates depend on other factors than rate of occurrence, health officers in 24 States indicated their belief that an actual increase in the occurrence of syphilis is a major factor in the rising rates. Forty-eight cities agreed. Other factors mentioned by States and cities included more complete reporting and improved casefinding. 81716 62 (Part 1) - 36 In addition, there is the constant importation of syphilis from abroad. Data at hand in the American Social Health Association indicate that during 1960, Americans with syphilis, when interviewed for sex contacts, named individuals in 52 foreign countries. These facts, along with data indicating a higher rate of illegitimacy and a more casual attitude toward sex, particularly among young people in the United States, incline the Task Force to believe that rising rates of reported syphilis represent, among other things, increased rates of occurrence. CASES OF PRIMARY AND SECONDARY SYPHILIS REPORTED TO THE PUBLIC HEALTH SERVICE AND PERCENT CHANGE FROM PRECEDING QUARTER CASES OF PRIMARY AND SECONDARY SYPHILIS REPORTED TO THE PUBLIC HEALTH SERVICE JULY 1, 1958 THROUGH SEPTEMBER 30, 1961, UNITED STATES BY QUARTER |