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The Myth of Exceptionalism: The History of Venereal Disease Reporting in the Twentieth Century

Published online by Cambridge University Press:  01 January 2021

Amy L. Fairchild ,
James Colgrove  and
Ronald Bayer
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Extract

As therapeutic advances in the treatment of AIDS began to emerge in the late 1980s and public health began to have more to offer than just the threat, or the perceived threat, of quarantine or partner notification, fissures began to appear in the alliance against named HIV reporting that had emerged a few years earlier. In 1989, New York City’s Health Commissioner stated that the prospects of early clinical intervention warranted “a shift toward a disease-control approach to HIV infection along the lines of classic tuberculosis practices,” including the “reporting of seropositives.”

Although his proposal met with fierce and effective resistance, it is now clear that his call represented part of a national trend. The CDC continued to press for cases of HIV to he reported by name to health departments, an effort that assumed the dimensions of a campaign. It was supported by a growing number of public health officials.

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Article
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Journal of Law, Medicine & Ethics , Volume 31 , Issue 4 , Winter 2003 , pp. 624 - 637
Copyright
Copyright © American Society of Law, Medicine and Ethics 2003

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References

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The goal of the program was to eradicate syphilis by 1972, leaving a structure in place for the subsequent eradication of gonorrhea. Parts I and II, Venereal Disease Branch Chief’s Statement, Control of Venereal Diseases, December 1963, p. 2, Part I, p. 4, Part II. RG 442, Box 108374, Folder: Program Planning Conference (December 1963), NARA, Atlanta Georgia. See also letter from Bauer, Theodore J., Assistant Surgeon General, to Surgeon and Chief, Bureau of State Services, Re: Task Force Report on Syphilis Control in the United States, January 12, 1962. RG 442, Box 105232, Folder: “Task Force Report on Syphilis Control in the United States,” NARA, Atlanta, Georgia; E-mail communication from Russell Havlak, March 20, 2003. For a critique of the eradication effort, see Aidan Cockburn, T., Assistant Commissioner of Health, Director Division, of Research, Ohio, “Comments on the Proposal to Eradicate Syphilis from the USA,” transcript of proposed article, February 1963. RG 442, VD Manuscript Files, Box 70A470, Folder, “Cockburn, Aiden T.” NARA, Atlanta, Georgia.Google Scholar
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One source indicates that in 1967 27 states required lab reporting. Public Advisory Committee on Venereal Disease Control: A Follow-Up Report of The Surgeon General’s Task Force on Syphilis Control, Atlanta, Georgia, June 16–17, 1966 (US Department of Health, Education, and Welfare, Public Health Service, 1967):7. RG 90, Box 334068, Folder: “Public Advisory Committee on VD Control,” NARA, Atlanta, Georgia. Another, however, suggests that 33 states and 80 locales had mandatory lab-based reporting as early as 1965. The American Public Health Association, The American Social Health Association, The American Venereal Disease Association, The Association of State and Territorial Health Officers, with the cooperation of the American Medical Association, “Today's VD Problem,” February 1966, p. 33. RG 442, Box 318288, File: “VD Program Informational Materials,” NARA, Atlanta, Georgia. See also letter from Donaldson, Alan W., Scientist Director, to Chief, CDC Washington Office, BSS (CH), and Deputy Chief, Communicable Disease Center, Re: Proposal for State Legislation, March 25, 1964. RG 442, Box 108379, Folder: “Legal 1964, Proposed Legislation,” NARA, Atlanta Georgia, which indicates that as of 1964 the following areas required lab-based reporting: Chicago, Connecticut, California, the District of Columbia, Florida, Illinois, Kentucky, Michigan, Missouri, Nebraska, New Jersey, Nevada, New York State, New York City, Oregon, Pennsylvania, Puerto Rico, Tennessee, Utah, and Ohio (regulations only in Ohio).Google Scholar
Health departments, however, were not able to follow-up on all of the lab-based reports, and in 1966 designated some 31 percent of cases as not requiring follow-up. Health departments did not follow up on weakly reactive specimens, specimens among the elderly, and specimens from health department clinics. US Department of Health, Education and Welfare, Public Health Service, Report of the Venereal Disease Branch Fiscal Year 1966 (CDC:Atlanta, Georgia, 1966):9–10. RG 90, Box 334069, Folder: “VD Branch Report, FY 1966,” NARA, Atlanta Georgia. Thus, by 1967, despite a 24 percent increase in physician reporting from 1954 to 1965 and an increase in the percentage of patients contacted and interviewed by health officials (81.8 percent in 1963 and 89.6 percent in 1965), the PHS cut back on visits to private physicians in the face of continuing personnel shortages creating by failure of funding to keep pace with activities. Public Advisory Committee on Venereal Disease Control: A Follow-Up Report of The Surgeon General’s Task Force on Syphilis Control, Atlanta, Georgia, June 16–17, 1966 (US Department of Health, Education, and Welfare, Public Health Service, 1967):1–2, 5–6. RG 90, Box 334068, Folder: “Public Advisory Committee on VD Control,” NARA, Atlanta, Georgia. Instead, the Surgeon General’s Task Force on Syphilis Control recommended intensified contact tracing efforts in all high incidence areas, dubbing the program “Operation Pursuit.” Public Advisory Committee on Venereal Disease Control: A Follow-Up Report of The Surgeon General’s Task Force on Syphilis Control, Atlanta, Georgia, June 16–17, 1966 (US Department of Health, Education, and Welfare, Public Health Service, 1967):1–2, Box 334068, Folder: “Public Advisory Committee on VD Control,” NARA, Atlanta, Georgia.Google Scholar
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The California code required laboratory-based reporting not only for syphilis and gonorrhea, but also diphtheria, tuberculosis, and typhoid. The prohibitions against patient contact until a report had been made applied to all conditions. Memorandum from Chief, Venereal Diseases Branch, Public Health Service, Center for Disease Control and Prevention, to Assistant Chief, Communicable Disease Center, February 27, 1964 and attached California Administrative Code. RG 442, Box 108379, Folder: “Legal 1964, Proposed Legislation,” NARA, Atlanta, Georgia.Google Scholar
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E-mail from Russell Havlak, March 25, 2003.Google Scholar
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