HEALTH SCIENCES STANDARD HX641 50380 iC201 .Un38 Report of the United RECAP mm^mtt»^^tmmmm ■ ■ ■ ■ ■ j w i i ■ Columbia llnitjer^itp Hibrar? ^ Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/reportofunitedsOOunit REPORT OF THE UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD FOR THE FISCAL YEAR ENDING JUNE 30 1920 WASHINGTON GOVERNMENT PRINTING OFFICE 1920 7\ C x^l 5 L UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. Members. David F. Houston, ^ Secretary of the Treasury. Newton D. Baker, Secretary of War. JosEPHus Daniels, Secretary of the Navy. Col. P. M. ASHBUEN, ^ Medical Corps, United States Army. Lieut. Commander J. R. Phelps, Medical Corijs, United States Navy, Asst. Surg. Gen. C. C. Piekce, United States Puhlic Health Service. Officers. Josephus Daniels, Chairman of the Board, Secretary of the Navy. Executive Committee. Asst. Surg. Gen. C. C. Pierce, U. S. P. H. S,, Chairman. Col. P. M. AsHBURN, ^ M. C, U. S. A. Lieut. Commander J. R. Phelps, M. C, U. S. N. Executive Secretary. T. A. Storey, M. D., Ph. D. 1 Hon. David F. Houston succeeded Hon. Carter Glass Feb. 2, 1920, who succeeded Hon. William G. McAdoo Dec. 16, 1918. The Secretary has been represented throughout this period by Hon. J. H. Moyle, Assistant Secretary. " Col. P. M. Ashburn succeeded Lieut. Col. William F. Snow Oct. 3, 1919. During Col. Snow's absence in Europe he was represented by Maj. Wilbur A. Sawyer and Col. F. F. Russell, Dee. 20, 1919 to June 4, 1920. Col. Weston P. Chamberlain will succeed Col. P. M. Ashburn July 6, 1920. TABLE OP^ CONTENTS. Page. Lettei- of submittal 9 Part I. Genenil discussion of tlie work of the Unit-^J Stater. Intcrdepuilinental Social Hygiene Board for the year enclec! Jtiiie 30, 1920 11 A. Discussion of year's work 11 B. Summary of accomplishment^: . 21 1. Appropriation for the care of civilian persons, etc 21 2. Appropriation for allotment to States for the prevention, treatment, and control of venereal diseasss 23 * H. Appropri.ition for the puipose of discovering more effective medical mensnres in tlie prevention and treatment of venereal diseases 23 4. Appropriation for the purpose of discovering and developing more effective educational measures in the prevention of venereal diseases and for the puriiose of soqiologic and psychologic research related thereto 24 Paet II. Report on the activities of the several divisions under the United States InteiTlepartmental Social Hygiene Board . 26 A. Charts of appropi'iations, functions and personnel 26 B, Eeport on the division of relations with States 42 1. Report on protective social measures 42 fl. Appropriation .and congressional authorization 42 &. Social-measures program' of the United States Inter- departmental Social Hygiene Board for the protec- tion of soldiers and sailors from venereal disease 42 c. Tabulation showing program of assignment of bureaus of protective social measures on June 30, 1920 47 (1) States to which bureaus of protective social measures have been assigned 47 (2) States in which assignment is in process 47 (3) States in which plans for bureaus have not yet been perfected 47 (4) States in which because of their present lim- ited naval and nrilitary population no attempt has been made to establish bureaus_ 47 a. Tabulation by States showing location of Army and Navy complements, known localities from which ve- nereal infections have been received by soldiers and the distribution of agents of the board for the appli- cation of protective social measures as of June 20, 1920 4g 8 4 CONTENTS. Page. Report on the activities of the several divisions under tlie United States Interdepartmental Social Hygiene Board — Continued. B. Report on the division of relations with States — Continued. 1. Report on protective social measures^Continued. e. Report of case work with women and girls by the field service 77 Table 1. — Number of cases, fiscal year 1919-20__ 77 Table 2.— Color of new cases, fiscal year 1919-20- 77 Table 3. — Men involved in new cases, fiscal year 1919-20 77 Table 4.- — Sex relations of new cases, January to June, 1920 77 Table 5. — Source of complaint of new cases, fis- ^ . cal year 1919-20 . 78 Table 6. — Reason for complaining of new cases, fiscal year 1919-20 79 Table 7. — Disposition of new cases, fiscal year 1919-20 ^ 80 Table 8. — Disposition of continued and reopened eases, fiscal year 1919-20 81 Table 9.— Total disposition, fiscal year 1919-20— 82 Table 10.— Special data, fiscal year 1919-20 83 f. Red-light districts and their relationship to the Army and Navy 84 g. Case histories: Examples of cases that come under the influence of the protective social measures field service of the board 84 7i. Geographic distribution of the sources of infection of 10,000 soldiers reporting to the Surgeon General of the Army 90 i. Analysis of the nine consolidated reports of individual venereal disease reports, Nos. 1 to 10,000, submitted in compliance with Surgeon General's Office Cir- cular Letter No. 293, between September 10, 1919, and September 13, 1920 91 j. Records for 13 years of venereal diseases in the Army_ 92 7c. Venereal diseases in the Army for the fiscal year ending June 30, 1920 94 I. Venereal diseases in the Navy for the fiscal year ending June 30, 1920 94 m. Reports received from field representatives 94 n. Reports of supervisors and field agents (men) 94 o. Reports of confidential agents (men and women) 95 p. Record of law enforcement stimulated by evidence submitted to law-enforcing agencies through repre- sentatives of the board 95 q. Committees formed 95 r. Tabulation showing red-light districts which were closed through the assistance of the board's field representatives, giving the number of houses and inmates thereof 95 -s. Tabulation of certain observations made by protective social agents of the board in their search for the foci of venereal disease from November 1, 1919 to June 30. 1920 ,„. . 96 CONTENTS. Pace. Report on the activities of the several divisions under tlie United States Interdepartmental Social Hygiene Board — Continued. B. Report on the division of relations with States — Continued. 1. Report on protective social measures — Continued. t. Tabulations show^ing red-light districts discovered by the board's agents which remained open on June 30, 1920 97 2. Program for assistance of States in maintaining civilian persons whose detention, isolation, quarantine, or commit- ment to institutions has been foimd necessary for the pro- tection of the military and naval forces of the United States against venereal diseases 97 a. General regulations governing appropriations from the United States Interdepartmental Social Hygiene Board for assistance of institutions in the mainte- nance of venereally infected patients 97 b. Summary 98 3. Report on medical measures 99 a. Regulations and administration 99 &. Statement summarizing the program made this year by the Division of Venereal Diseases of the United States Public Health Service in cooperation with the United States Interdepartmental Social Hygiene Board, applying the program promulgated by the Secretary of the Treasury and supported by the Federal allotments to States through the United States Interdepartmental Social Hygiene Board, for the prevention, treatment, and control of venereal diseases through State departments of health 100 (1) Medical measures 100 (a) Reporting 100 (&) Treatment 101 (c) Clinics 102 (2) Law enforcement 104 (3) Educational 105 (4) Conclusion 105 C. Report on the Division of Scientific Research 106 1. Classification and description of the scientific researches that are being assisted by the United States Interdepart- mental Social Hygiene Board 106 a. Chancroids 106 6. Gonorrhea 107 c. Syphilis 115 2. Data on scieiitific research fund 128 a. Table 128 b. Summary . 128 D. Report on the Division of Educational Research and Develop- ment 128 1. Principles and regulations . 128 2. Applications for assistance from the educational research and development fund : Number, purpose, and disposition. 130 3. Allotments: Number, amount, purpose, distribution, and relevant facts 132 4. Administrative relations between the board and cooperating d( pardnents of hygiene 136 b CONTENTS. Report on the activities of the several divisions under the United States Interdepartmental Social Hygiene Board — Continued. D. Report on the Division of Educational Research and Develop- ment — Continued. 5. Administration of the educational research and develop- ment fund 138 6. Progress in effective organization of. departments of hygiene 139 7. Extent to v^rhick the program, of instruction and training in hygiene has been put into effect 141 8. Progress in developing better educational methods 146 9. Indirect infliience through departments of hygiene 149 10. Researches: Sociological and psychological 1,51 E. Report on the business office 154 1. J'inancial summary, fiscal year ended June 30, 1920 155 2. Detail of expenditures from appropriation (a) 1.55 [" Interdepartmental Social Hygiene Board, 1920," $100,000.] 3. Detail of expenditures from appropriation (h) 1.56 ["Aid to States, etc.," $784,000.] 4. Statement of payments to detention houses, etc 1.56 5. Detail of expenditures from appropriation (c) 1,56 ["Payments to States," $1,087,831.42.] 6. Detail of expenditures from appropriation (cl) 1,57 [" Payments to universities, etc., for research in educa- tional measures," $439,030.] 7. Detail of expenditures from appropriation (e) 1.58 ["Payments to universities, etc., research venereal dis- eases," $103,430.] Part III. Extracts covering activities for the year ending .June 30, 1919, taken from' the manual for the various agents of the United States Interde- partmental Social Hygiene Board 1.59 A. Introduction 1.59 1. Background and purposes of law creating the boards 1.59 2. Summary of the work of the board for the period ending June 30, 1919 161 B. Period of organization 165 1. Period of interpretation 166 2. Proposed amendments and their fate 168 3. Period of incomplete administrative organization 168 C. Activities 170 1. Civilian quarantine and isolation fund 170 a. Program for assistance of States in building re- formatories 170 b. Program for assistance of States in maintaining vene- real disease patients 173 c. Program of protective social ureasures — Service of women agents 174 d. Program of protective social measures — Service of men agents I'J^S 2. Scientific research fund 182 3. Educational research and development fund 185 4. United States Public Health Service venereal disease fuud__ 189 (-•ONTKNTS. i l'AX{T IV. Page. Appendices 193 Special appendix : Cost of venereal disease — Estimates of costs of venereal diseases in — 1. The United States Array 193 2. The State of Massachusetts (selected group) 194 3. The St. Louis-Southwestern Railway lines 195 4. England 196 Appendix A 197 1. Federal law under which the Interdepartmental Social Hy- giene Board operates : An act making appropriations for the support of the Army for the fiscal year ending June 30, 1919_ 197 2. Amendments to law 199 a. Reappropriations for the year ending June 30, l&^iO : An act making appropriations for sundry civil ex- penses of the Government for the fiscal year ending June 30, 1920, and for other purposes 199 b. Extensions of duties and powers and appropriations for the fiscal year ending June 30, 1921: Section of the sundry civil act for fiscal year ending June -30, 1921__ 199 Appendix B 201 1. Regulations for assistance of institutions in the maintenance of venereally infected patients 201 2. Form of request for maintenance of venereally infected patients 201 Appendix C 203 1. Functions of the protective social measures staff 203 2. Form of proposal for governmental assistance in the organiza- tion of bureaus of protective social measures in State de- partments of health 211 Appendix D . 214 Rules and regulations governing expenditures of the State allot- ments from the Chamberlain-Kahn funds 214 1. Appropriations 214 2. Regulations 215 3. Allotments, percentage, population 218 4. Population of continental United States, census of 1910 218 5. Unexpended balances, 1919-20 218 6. Board's regulations regarding payment of balances 219 7. State certificates 219 8. Joint State and Federal budgets 220 9. Sample joint State and Federal budget 220 10. Revised joint State and Federal budget 221 11. The 50-50 plan 221 12. Payment 222 13. Uniform accounting 222 14. Voucher form 222 15. Clinics 224 16. Obtaining signatures to vouchers 224 17. Books, periodicals, and automobiles 225 18. Classification of expenditures 225 8 CONTENTS. Appendices — Continued. Page Appendix D — Continued. Rules and regulations governing expenditures of tlie State allot- ments from the Chamberlain-Katm funds — Continued. 19. Quarterly statement of budget balances 226 20. Disposition of vouchers 226 21. Monthly reports 227 22. Summary recorded on monthly reports 227 23. State laws 227 24. Conclusion 228 Appendix E 229 1. Regulations governing the scientific research fund 229 2. Application form for assistance in scientific research 230 Appendix F 232 1. Regulations governing the educational research and develop- ment fund 232 2. Application form for assistance in the establishment or en- largement of departments of hygiene in normal schools, col- leges, and universities 239 Appendix G- 245 1. Regulations governing payments to State universities for the establishment of divisions of educational hygiene in State departments of education 245 2. Form letter of agreement with State universities to assign administrative personnel to State departments of public education 245 Appendix H 248 Publications on hand June 30, 1920 . 248 1. General and miscellaneous 248 2. Protective social and medical measures 248 3. Educational research and development 248 4. Scientific researches 249 LETTER OF SUBMITTAL. \ United States Interdepartmental Social Hygiene Board, Washington, D. C, October 14, 1920. Gentlemen : In accordance with the act of July 1, 1902, I have the honor to submit herewith for transmittal to Congress the Annual Report of' the Interdepartmental Social Hygiene Board for the fiscal year- ending June 30, 1920. Respectfully, T. A. Storey, Executive Secretary Interdepartmental Social Hygiene Board. To the United States Interdepartmental Social Hygiene Board.. 9 ♦* ANNUAL REPORT OF THE INTERDEPARTMENTAL SOCIAL HYGIENE BOARD, 1920. Paet I. General Discussion of the Work of the United Slates Inlerdepaitmental Social Hygiene Board for the Year Ending June 30, 1920. DISCUSSION OF YEAR'S WORK. The startling frequenej' and universal distribution of the venereal diseases, the type and habits of their human carriers, the useless waste of human vigor, human productivity, and human life which they inflict upon the people of the nation, and the proven possibility •of their practical control, are powerful national arguments that wholly and completely justify the program of the United States Government for the assistance of its constituent State governments in the control and eradication of these diseases. We find that during the fiscal year ending June 30, 1920, there were 14,000 cases of venereal disease reported in the Army, 21,000 cases reported in the Navy, and 326,000 cases (men, women, and children) reported to State boards of health from the civilian population. The probabilities are that the total number of these cases in the civilian population of the continental TTnited States during this period was very considerably in excess of the number reported to State commis- sioners of health. Kather conservative estimates made by the Ameri- can Social Hygiene Association place this number in the civilian population at 1,106,000 men and 420,000 women. ^ And we know from observations m.ade in all parts of the world covering a great number of years that these diseases are commonly associated with crime, Avith shame, and with wrecked lives and ruined homes, with misery, pain, and unhappiness. These facts give tragic emphasis to the national importance of the 1,500,000 cases estimated for the civilian population of this past year. The financial, social, and biologic damages from these diseases must be enormous. 1 While these figures are not stiitistlcally accurate, they are believed to be approxi- mately correct. 11 12 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. An estimated wage loss of more than $69,000,000 a year, an estimated minimum cost to the Government of $15,000,000 in the Army, for the calendar year 1919, a contribution of more babies made blind and more men and women made sterile by gonorrhea than by any other cause, and a record of more cases of insanity from syphilis than from any other one cause, are a few of the items in the economic, social, and biologic bookkeeping of syphilis, gonorrhea, and chancroid that -would lead to a staggering ledger account if such items could be posted. We know the causes of these diseases and we know their carriers. We know that each of the three venereal diseases— syphilis, gonor- rhea, and chancroid — is caused by a specific organism (a germ) and that this organism in each case is the cause of no other disease. We know that the human is the only animal that under ordinary circum- stances is infected with these diseases. We know that every case i& the result of a transfer of living germs from a person infected to -another person who is not, and we know that the transmission of these diseases is in the vast majority of cases associated with sexual inter- course between diseased and undiseased persons. The common and most effective disseminator of gonorrhea, syphi- lis, and chancroid is the prostitute. But the man and the woman of loose morals and promiscuous sex habits are factors of almost equal! importance in the spread of these diseases.^ If there were any ques- tion on these facts, it v/ould be settled by reference to Col. Ashburn's Studies on Venereal Diseases in the Army, or by reference to our own analysis of 15,000 cases of delinquent women and girls. These dis- ease carriers are commonly persons who are not attached perma- nently to one locality. They travel from place to place. Therefore the woman that gives herself promiscuously and the loose man that brings disaster to the innocent— often his own wife and babies — are national liabilities. Consequently the control of prostitution is a joint problem involving a community. State, and national obligation. The enormous number of citizens involved, the huge financial^ economic, and social losses sustained, the irreparable damage done to man power and woman power and to the infant and child life of the Nation, and the fact that not a community, not a village, and not a city in the Nation escapes are additional records that establish the protective, preventive, and remedial hygiene of these diseases as joint • obligations of the State and the Nation. Our scientific knowledge of the living causes, the human carriers, and the method of dissemination of these diseases places us in posi- tion to lay out plans for their successful treatment, prevention, con- trol, and possible eradication. 1 There are now 10 States with legislation that defines prostitution as an act of the male as well as of the female. REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 13 The following report furnished by the Surgeon General of the Army emphasizes the several very important factors that must l^e included in a successful program for the control of these diseases and brings clearly into view some of the educational, informational, economic, social, and medical difficulties involved, and gives a vivid picture of legal and institutional inadequacies and limitations that must be surmounted : .[Extract from a report of a sanitary inspection of Camp E ■ made by Col. H , Medical Corps, June 5-6, 1920.] G. Statistics of sickness : ******* Tile venereal i-ate at this post is excessive. Men who conti-acc venei'eal dis- ease are usually infected by AA-onien or girls who v\'ork in the mills, and 50 per tent of the men are said to pay nothing to these women for their association. The present city ordinance, city of C , authorizes the health officer to segregate those who have venereal disease, and C has appropriated •$41,000 to build a detention hospital for these people. An active venereal clinic is maintained by the healtli officer. More than 200 active venereal cases are now being treated at this clinic, one full-time doctor and one nurse being employed. All the girls and women who come to this clinic are sent by Miss W , field agent, Interdepartmental Social Hygiene Board. If they do not appear, when she tells them to do so, they are arrested, fined, and then placed in the so-called stockade which is used temporarily as a deten- tion hospital. As a rule, she gets her information concerning the girls from medical officers at the camp who interrogate soldiers and secure the names of the individuals who infected them. Miss W stated to the inspector that the information thus secured from soldiers had always been accurate, and she had always been able to get the female in question under treatment, or else have her placed in the stockade. The stockade in which these Avomen at present are detained, if they do not appear daily for treatment as directed, is not an attractive place, and Miss W states that she has little dif- ficulty in getting them under treatment for the reason that they fear the stock- ade. Six women were in the stockade on the date of inspection. When the detention home is built that is now authorized space will be available to accom- modate 50 women. In the absence of adequate detention space infected Avomen may go home and report daily for treatment. "If they fail to report daily they are arrested and placed in the stockade. This stockade is merely the city jail, but the infected women have freedom of the back yard, Avhich constitutes the stockade. When these girls are cured an effort is made to remove them from their old environment, 68 having been sent out by Miss W , who has secured positions for them at other points, with the hope that the change might prove of benefit. Most of the girls handled by Miss W are from 13 to 17. A great many are infected at an early age. Miss W now has one family of four children, all infected with gonorrhea. The oldest child is 14 and the youngest 7. She is also working upon another family of three children, a boy 14, a girl 9, and a brother 7, all of whom have gonorrhea, and the mother and father are also infected. In this case a 16-year old prostitute was living in the house with the family. The father contracted gonorrhea from this youthful prostitute, as did also the 14-year old boy and the 7-year old child, all through direct sexual intercourse. The 9-year old girl contracted it in a manner not known. In another instance the whole family has syphilis. In another family, 14 REPORT U, S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. a girl 13 and a boy 9 have gonorrhea, and when the father was informed of their condition, he replied, " Of course they have venereal disease." A good many of the professional prostitutes are said by Miss W to be 13 years old, and she knows of one case in a little girl of 11. This latter child is now at the juvenile court and an endeavor is being made to place her in some suitable institution. Miss W sent off a child aged 12 on the day of inspection who was a professional. She w;is placed in the G ■ Training School for Girls. Miss W states that this is the worst place in this State. If it isn't, the morals of are not to be commended. The commanding. officer of Camp B , the camp surgeon, the morale officer, the prison, officer, and all city authorities are lending every aid to Miss W — in, this work. The United States Interdepartmental Social H3'giene Board iS; now completing an analysis of carefully compiled case histories of- 15,000 delinquent girls and women whose lives are more or less t^^'pi- fied in the communication quoted above from Col. H ■ — . These 15,000 cases demonstrate with a tragic emphasis the importance, of education, information, protection, and medical and social treat- ment in the control of these diseases. They disclose sex discrimina- tion and utterly inadequate penal, detention house, and reformatory provisions. These analyses associated with the experiences and con-, elusions of other individuals and agencies concerned with the con- trol and eradication of these communicable diseases, and added to. the lessons learned under the stress of the Great War, have led to the formulation of a much more nearly complete program for the. protection of the individual, the home, and the community. Briefly, the control of gonorrhea, syphilis, and chancroid depends upon the effective operation of a composite program of hygiene, considered in its broadest sense. Each factor in this program is. essential to the success of the program as a whole. The main fac- tors in the hygiene of the venereal diseases are : (1) The educational hygiene of infancy, childhood, and youth. Moral, mental, and physical education of the young human, giving him the character basis on which he will form safe judgments and develop wise conduct. (2) The informational hygiene of childhood, youth, and maturity, supplying scientific facts and rational deductions for those occa- sions upon which the individual is called upon to exercise safe- guarding judgments and select wise plans of conduct for the acquisi-., tion, conservation, and improvement of health. (3) The protective hygiene of the venereal diseases developed through the health habits of the individual, the hygienic regulations . of his home (protective group hygiene), and the hygienic laws and ordinances of the community in which he lives (protective inter-, group hygiene). REPOin U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 15 (4) The preventive hygiene of the venereal diseases applied to all individuals with gonorrhea, syphilis, or chancroid in a communicable state, making it impossible for such disease carriers to transmit their disease to others. (5) The remedial hygiene of these diseases providing for their rapid and effective cure. (6) The reconstructive hygiene of venereal disease carriers (the- prostitute) bringing to them the ability to support themselves in health and comfort without having to resort to prostitution for a " livelihood." The i^rogram of the United States Interdepartmental Social Hygiene Board, as laid out and made possible by Congress this year, provides for each of the main factors in the hygiene of these diseases: described above. In the two years ending June 30, 1920, the United States Govern- ment has invested $537,900 in the program of educational hygiene in colleges, universities, and other suitable institutions. This sum was more than matched by the institutions to which these appropriations were made, so that it may be estimated safely that in these two years the total joint institutional and Federal appropriation for educa- tional hygiene amounted to $1,500,000. As described in more detail in Part II of this report, the depart- ments of hygiene that have been established or enlarged with the help of the Interdepartmental Social Hygiene Board in 39 normal schools, colleges, and universities will reach each year 35,000 or 40,000 3^oung men and young women who will carry the influence of their instruction into their homes in future years as parents, into schools, colleges, and universities as teachers, and into communities of the country as influential citizens. It is obvious that these invest- ments of the Government placed in stable, well-organized, and well- established educational institutions become instrumental in the de- velopment of programs of education that will endure as long as those institutions last. Even now, in spite of the short period of time in which these investments have been made, there is convincing evidence that the experienced educational intelligence of the institutions con- cerned is being focused uniformly upon an improvement in their instruction and upon measures whereby that instruction shall in- fluence all of the students that pass through their courses. These same appropriations from the educational fund for the establishment or enlargement of departments of hygiene in normal schools, colleges, and universities are instrumental in securing a very important distribution of informational hygiene, emphasizing pro- portionately the hygiene of the venereal diseases. As stated in a subsequent chapter of this report, great care is exercised to discourage 16 KEPOKT U. S. INTERDEPAETMENTAIi SOCIAL HYGIENE BOAKD. the overemphasis or the disproportionate emphasis of these diseases in their regular curriculum. Scientific research for the acquisition of reliable and trustworthy- information concerning the hygiene of gonorrhea, syphilis, and chancroid is the purpose for which the board has made appropria- tions during the last two years amounting to $200,000 from the scien- tific research fund and $62,100 from the educational research and development fund for specific medical, educational, sociologic, and psychologic investigation of important problems in this field. In- formational hygiene sought through these researches is described in more detail in the second division of this report. It may be said in passing that this research program carried on with the help of the Government in the medical schools and universities of America has called into service a fairly large group of the best-trained men and women in America, and gives promise of results that will repay the Government and the people of the United States many times over the amount invested. ^ The profits upon these investigations will be reckoned in terms of better informed, and therefore a better protected citizenship ; a reduced cost of treatment and more rapid €ure for these diseases; and a general reduction in the economic, social, and biologic damage hitherto sustained by the men, women, and children of America because of the present expensive, difficult, and tedious treatment involved. The appropriation administered by the board " for the assistance of the States in the care of civilian persons * * * for the pro- tection of the military and naval forces of the United States against venereal diseases " has been applied in the States for the develop- ment and operation of social measures protecting soldiers, sailors, and civilians from , exposure to the venereal diseases. These protec- tive measures involve the closure of red-light districts, houses of prostitution and houses in which prostitution is carried on. This program of protective hygiene against the venereal diseases pro- tects the individual and the community against the programs and machineries of prostitution as carried on in the low-class dance hall, the house of assignation and the place of public amusement in which plans are systematically made for prostitution. Under this fund the agents of the board assigned to work under the direction of State commissioners of health, and who are assigned to the work where local conditions are bad, are often brought into advisory and coun- seling relationship Avhich enables them to assist in the formulation of laws, ordinances, and regulations for the protection of the home and the community against prostitution and its ramified program. The appropriation made by Congress from which allotments are made to fetates for the prevention, treatment, and control of venereal diseases through their respective departments of health, has made REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 17 possible the establishment of divisions of venereal diseases in those States and has led to the enactment of laws, ordinances, and regula- tions under the advice and assistance of the United States Public Health Service, whereby the preventive hygiene and the remedial hygiene of gonorrhea, syphilis, and chancroid have been given a powerful and growing support in each of those States. The legisla- tive enactments, the ordinances, and the regulations that have been established have been directed in large measure toward the control of the individual carrier of those diseases so that he will be prevented from transmitting his diseases to others. The venereal disease clinics established under this appropriation have applied remedial measures to an enormous number of men and women who come to them for treatment. During this last year 126,000 individuals were treated in these clinics. The reconstructive hygiene of the venereal diseases has been sup- ported this last year in part by the appropriation of the board that is concerned with the care of civilian persons, as described above, and in part by the appropriation which has been allotted to States for the prevention, treatment, and control of venereal diseases. From the first of these two appropriations over $100,000 was paid out this last year for the assistance of detention houses and reformatories to which were committed women with venereal disease who were thought to be a menace to the Army and to the Navy. The purpose laid down in each one of these appropriations from the board was concerned with influencing these unfortunate persons, through medi- cal and social treatment, to return to a physical and social status which would enable them to resume a normal and safe relationship in community life. This assistance was given to 16 of these insti- tutions. The second appropriation noted above, the allotment to States for the prevention, treatment, and control of venereal diseases, has led each State commissioner of health, who is cooperating with the Gov- ernment under his allotment, to lay plans for the rehabilitation of the prostitute, or for her long-time commitment to institutional life, for the protection of the citizens of his State and of the Nation from further infection. It is wholly safe to assume that the pressing need for a program of reconstructive hygiene in the interest of the pros- titute will lead to the ultimate establishment in every State of pro- visions for the long-time commitment or for the ultimate restoration of the delinquent woman or girl to useful community life. It is obvious from this rapid summary of the work of the board that the four appropriations made by Congress in the interest of social hygiene are being administered by the board in conformity with a well organized plan which covers the entire field of the hygiene 15610—20 '-2 18 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. of these diseases. It is evident, however, that the control and the eradication of these diseases will not be accomplished for a great many years to come. The achievements of the past year in each of these several activities are most encouraging and justify most com- pletely the financial investment and the thought and the energy put into them, but the progress made up to date is very small compared with the progress that must be made before we have a control over gonorrhea, syphilis, and chancroid that will be comparable with the control that has been developed through other agencies, assisted by the Government, in relation to such diseases as yellow fever, cholera, malaria, typhoid fever, smallpox, hookworm, and bubonic plague. The control of the venereal diseases is very much more difficult be- cause of their relationship to elemental emotions fundamental to the continuity of human life. With a continuation of governmental assistance, and with an increasingly larger self-support from the States, a satisfactory control of these diseases should be ultimately secured. '^n reviewing the work of the board for this past year it is im- possible to arrive at a satisfactory estimate of progress made without taking into consideration the short period of time in which the board has been operative, and particularly the unavoidable delays that retarded the initiation of nearly all of the activities which the board was finally called upon to support. While it is true that on June 30, 1920, the United States Inter- departmental Social Hygiene Board completed the second year of its legal existence, it is also true that for various reasons stated else- where 2 this second year of legal existence has been hardly more than the first year of its real activity in any of the several divisions of work authorized and required by Congress. The more complete organization of the administrative office of the board was necessarily delayed until July 1, 1919. Prior to that date this administrative organization was unavoidably incomplete because of inadvertencies in the act creating the board and outlining its obligations. The major activities of the board were correspondingly delayed. The administration of the field service concerned with protective social measures was turned over to the board on April 1, 1919. Ap- propriations for scientific research for the discovery of more effec- tive medical measures in the prevention and treatment of venereal diseases were made to only three universities before June, 1919. Eleven more institutions were added during that month. It is evi- dent that the research activities made possible by these grants could not have been actually under way prior to June, 1919, and probably a Manual for the Various Agents of the United States Interdepartmental Social Hygiene Board. (See Part III.) REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 19 not before September of that year, when the college and university year began. Appropriations from the educational fund were de- layed in like manner. No payments were made to colleges, univer- sities, or other suitable institutions or organizations " for the pur- pose of discovering and developing more effective educational meas- ures in the prevention of venereal diseases for the purpose of socio- logical and psychological research related thereto " until the first year of the board was practically gone. None of these educational investments of the Government became active or could have become active before September, 1919, well into the second year of the board. The allotments to the States for the prevention, treatment, and control of the venereal diseases were paid over to the States as fast as they qualified after SejDtember, 1918. This one fund was, in the nature of things, more easily invested in accord with the direction of Congress than were any of the others. However, it must be noted that the board was unable to develop satisfactorily a disbursing and accounting system for this fund until a resource for administrative purposes had been made available by Congress in July, 1919. From these facts it is clearly evident that the fiscal year ending June 30, 1920, to which j^ear this report is directed, was really the first year in which productive activity was possible in connection with any of the various governmental investments made through the board, save, to a limited degree, the investment allotted to the States for the use of their respective boards or departments of health in the prevention, treatment, and control of venereal diseases "in accordance with the rules and regulations prescribed by the Secretary of the Treasury." This year, then, has been a year of organization, of investment, and of improvement. Comparing June 30, 1920, with June 30, 1919, we find that the governmental investments in scientific researches under the board have increased from 26 researches in 14 institutions to 36 researches in 22 institutions, and that all of these research investments were at work during this year and that they give prom- ise of profit. The investments made by the board for the Government from the educational research and development fund have increased from investment made last year assisting 28 normal schools, colleges, and universities to establish or enlarge their departments of hygiene, for the purpose of emphasizing proportionately the hygiene of venereal diseases in the instruction of their young men and young women students, to 39 normal schools, colleges, and universities under agree- ment with the board to emphasize the hygiene of these diseases with appropriate and due proportion and with proper tact and per- sistency. The appropriations made from this fund last year reached some 28,000 young men and women during the present academic 20 REPORT U. S. INTERDEPAETMENTAL, SOCIAL HYGIENE BOARD. year. The appropriations made from this fund this year will in- crease this number to about 40,000 during the coming academic year 1920-21. Last year one appropriation was made from this fund for psychological research in accordance with the provisions of our act. This research is practically complete at the end of the fiscal year 1920. (See p. 151.) This year appropriations have been made for 16 psychological, sociological, and educational researches. Of these, 3 have been completed within the year (see p. 153). The other 13, because of necessity of protracted research or because allot- ments were made late, will be carried over into the coming academic year. The protective social measures program of the board last year reached 65 cities. This year 15 State departments of health have taken over the direction of workers assigned them by the board and 8 others are ready to do so as soon as competent personnel is avail- able through the Federal civil service. In all, the board has located under this same appropriation 149 workers in 51 cities. This same fund supplied resource last year amounting to $66,160.98 for the maintenance of venereal disease carriers in 17 reformatories, deten- tion homes, and hospitals. This year $106,199.46 has been paid out to 16 such institutions, assisting in the provision of 96,842 days' treatment as compared with 64,462 days' treatment last year. Last year 46 States adopted the rules and regulations issued by the United States Treasury and by the United States Interdepart- mental Social Hygiene Board for participation in the allotment to States for the use of their boards or departments of health in the prevention, treatment, and control of venereal diseases. This year 46 States adopted these rules and regulations and, in addition, satis- fied the governmental requirement that they match each dollar re- ceived from the Government with $1 appropriated or otherwise set aside by the State.^ The divisions of venereal diseases established in each of these 46 States and supported by State funds and by gov- ernmental funds allotted through the Interdepartmental Social Hy- giene Board, and carrying on their activities in conformity with regulations laid down by the Secretary of the Treasury, have reported to the Division of Venereal Diseases of the United States Public Health Service a tremendous growth in activities this year compared with the same activities last year." Last year the office of the board (central administrative office) was concerned almost wholly with disbursements from the one fund carrying allotments to State departments of health, and with a *Tlie Division of Venereal Diseases of the United States Public Health Service covers the details of this program in the States In its annual report. * See p. 99 for a summary of work carried on under th.is joint fund for the fiscal year ending June 30, 1920. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 21 limited correspondence with the universities, colleges, and other suitable institutions or organizations qualified for scientific research. Latterly, that is, after April, 1919, the central office was assigned certain administrative personnel from another governmental depart- ment to direct the " law enforcement section " in the field. This sec- tion would otherwise have been without direction. This year the central office has been called upon for a steadily increasing service in connection with the five funds under its administrative and execu- tive supervision. This service necessarily covered not only the safe- guarded investment of more than $2,000,000 in accordance with pro- visions and requirements of Congress and the United States Interde- partmental Social Hygiene Board, but it Avas called upon also to cover the inspection and investigation of investments made in the preceding year amounting to over $1,500,000. Moreover, the financial, legal, scientific, administrative, medical, hygienic, informational, edu- cational, social, moral, and basic human factors involved in the pro- gram of the board, as laid out hj Congress, call for a very high type and a varied type of special personal service in the central office. The success of this difficult and complicated program depends upon the quality of the personal service which puts that program into operation. SUMMARY or ACCOMPLISHMENTS. In conclusion, the most important accomplishments of the board during the year ending June 30, 1920, may be summarized concisely as follows : 1. Appropriation for the care of civilian persons, etc. — (a) The protective social measures program developed under this appropriation has been carried on by a field force which in June, 1920, numbered 149 employees. The demand of the States for this service is such that the board has at this time more than 50 unfilled positions. This field personnel has been assigned to work directly under State commissioners of health in 15 States. In the other States in which there are military and naval units of importance agents have been assigned to cities and regions in which it has been found important to protect soldiers, sailors, and the civilian popula- tion from the carriers of venereal disease. As a result of this service, 18 red-light districts have been investigated and closed in neighborhoods more or less remote from military and naval estab- lishments, and no red-light district has been maintained during this year in the near neighborhood of military or naval posts. In closing these 18 segregated districts in its search for the foci of venereal dis- ease, the service of the board assisted in the closing of the 214 houses in which 703 women were found engaged in prostitution ; 719 houses of prostitution were closed outside of red-light districts; programs 22 REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. of prostitution were suppressed in 646 places other than in houses of prostitution ; 55 regions were placed " out of bounds " by military and naval authorities; 10,129 men were arrested because of their relationship with prostitution; 260 citizens' committees or organiza- tions were formed or stimulated to action in favor of protective social measures and law enforcement; and 17,000 prostitutes were observed in relation to their activities in a search for evidence as to the existence of prostitution or its programs. Furthermore, this field service has carefully investigated this last year 7,351 new cases of delinquent women and girls who were thought to be a menace to soldiers and sailors, and who certainly were a menace to the civilian population. With these new cases the total number of individual women and girls given especial attention by this service reached 25,459 for the period subsequent to January 1, 1919. It is impossible to estimate with any precision the gain in the campaign against the venereal diseases achieved by closing 933 houses of prostitution or by abolishing 18 red-light districts or by keeping- other such districts closed. It is obvious, however, that such accom- plishments must result in a very large diminution of exposures to gonorrhea, syphilis, and chancroid, and consequently to a very large reduction in the occurrence of such infections. Furthermore, it is obvious that the 7,351 delinquent women and girls brought under the special influence of the agents of this board must have been deterred, for a period of time at least, from the continuation of their delinquenc}''. The same influence must have been exercised to some extent at least upon the 17,000 prostitutes observed by the field service and the 10,000 men arrested. Some of these men and women, how many we do not know, were permanently led away from prostitu- tion. One can not estimate accurately the effect of this influence of our field service. For instance, a report on prostitution in New York City some years ago indicated that the prostitute in New York at that time associated on the average with 10 men or boys in each period of 24 hours. One can not guess at the number of such associations that have been prevented through our influence upon these houses, these men, and these women. (b) During this year $106,299.46 was distributed from this fund to 16 reformatories, training schools, detention hospitals, and vene- real disease quarantine hospitals in which were confined women and girls with venereal diseases, who were thought to be a menace to sol- diers and sailors. With this appropriation the board was enabled to give assistance in the maintenance and subsistence of these inmates which can be reckoned best perhaps in terms of the total number of days which such " treatment " covered. Our records indicate that the actual number of days' " treatment " given by these institutions REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 23 during this period of time was 96,842. In other words, the appro- priation of the board would have maintained one inmate for 96,842 days. Here, again, it is not possible to estimate the value of this assistance with any accuracy. The fact that each inmate was prevented from exposing soldiers, sailors, and civilians during the period of time for which she was confined in the institution makes it clearly evident that this assistance from the Government was at least tem- porarily effective in the protection of men in the Army and in the Navy and men and women in the civilian population of the United States from these disease carriers. It is, perhaps, unjustifiable to assume that these inmates all averaged 10 exposures a day while they were engaged in prostitution, nevertheless the fact that such an average has been ascribed to that profession would give a great deal of weight to the importance of these 96,842 days of " treatment." 2. Appropriation for allotment to States for the prevention, treat- ment, and control of venereal diseases — Under this appropriation 46 States huxe adopted programs of prevention, treatment, and control of venereal diseases as promul- gated by the Secretary of the Treasury. During this year 326,000 cases of venereal diseases were reported to the State commissioners of health and 126,000 cases were treated in clinics operated under this program laid out by the Secretary of the Treasury and sup- ported by the allotment paid out by the Interdepartmental Social Hygiene Board. Informational programs have, been carried out in each of these 46 States carrying facts to the public through lectures, posters, pamphlets, moving-picture films, lantern slides, and other graphic media. It is probably true that the main facts connected with the hygiene of the venereal diseases are better known to the American public to-day than ever before because of this informa- tional program that has been carried by the Division of Venereal Diseases of the Public Health Service and by the departments of health of 46 of our States. Furthermore, through this appropriation legislation regulations and ordinances for the protection of the public and for the prevention of these diseases have been adopted to greater or lesser extent in each of these 46 States during these last two years. While it is not possible to evaluate the importance of this phase of our program with any exactness, it is evident that these measures are exerting an enormous influence for the cure of venereal diseases and for their medical prevention and control. 3. Appropriation for the purpose of discovering more effective medical measures in the prevention and treatment of venereal diseases — 24 REPORT U. S, INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. On June 30, 1920, there were 35 researches being carried on m^ 22 of the best American medical schools and universities in a scientific search for better methods in the prevention and treatment of the venereal diseases: The results from these research activities will not appear until sufficient time has elapsed for careful, thorough, and painstaking investigation. The possibilities of profitable return from these investments of the Government are most promising. Information of value to the individual, to the home, and to the com- munity will, in all probability, be secured through some, at least, of these investigations. A single one of them may very easily reduce the time and the cost of treatment to an extent that would represent a saving of millions of dollars in wages because of time saved, and a saving of millions of dollars in cost of treatment because of im- proved methods of treatment, or because of cheaper medication. When one realizes that during this last year the problem of treat- ment alone involved over 14,000 cases in the Army, over 21,000 cases in the Navy, and possibly more than 1,500,000 cases in the civilian population, he can not escape the conviction that there is every reason to expect that one or more of these scientific researches will result in a tremendous gain to the Government and to the people of the United States through cheaper medication, or through more effective methods of administration or through new and more effective drugs. 4. Appropriation for the purpose of discovering and developing more effective educational measures in the prevention of venereal diseases, and for the purpose of sociologic and psychologic research related thereto — Since this appropriation became actually available in January, 1919, approximately $520,000 has been paid to normal schools, col- leges, and universities for the establishment and enlargement therein of departments of hygiene for the purpose of emphasizing normally and logically, and with due proportion, the hygiene of the venereal diseases. These payments have been made to 39 normal schools, colleges, and universities, and the programs which have been made possible thereby have reached approximately 28,000 young men and women this year and will reach 35,000 or 40,000 young men and young women the coming academic year. Here, again, it is impos- sible to make any exact estimate of the returns that may be expected from these educational investments. It is inevitable, however, that with the best educational intelligence of the country devoted to the problem our future citizenship will be scientifically and practically informed concerning these diseases and their causes, their carriers, their damages, and their preventions. It is already clear that we may expect a very much larger number of educational institutions to adopt this departmental organization, and that an increasingly large REPORT U. S. INTERDEPARTMENTAL SOCIAL. HYGIENE BOARD. 25 number of our future citizens will develop habits of personal health control and habits of home protection, and measures for community protection that will enormously reduce prostitution and venereal disease. The most important division of activity' assigned to the Inter- departmental Social Hygiene Board by the United States Govern- ment is probably represented in this educational program. Ulti- mately education and the information which it carries will have a very much larger influence upon the prevention of these diseases and upon the control of the economic and social and educational condi- tions that lead to their prevalence than will any other influence that has been brought to bear for the control or eradication of these diseases. Pakt II. Report on the Activities of the Several Divisions Under the United States Interdepartmental Social Hygiene Board. A. Charts of appropriations, functions, and personnel. B. Reports on the Division of Relations with States. (a) Report on the protective social measures program. (5) Assistance in the maintenance of venereally infected inmates of reformatories, etc. (c) Report on Medical measures — Cooperation of the Di- vision of Venereal Diseases of the United States Public Health Service, State boards or departments of health, and the Interdepartmental Social Hygiene Board. C. Report on the Division of Scientific Research. D. Report on the Division of Educational Research. E. Report on the Business Office. Charts of Appropriations, Functions, and Personnel, Compiled IN Satisfaction of Congressional Action. Chart 1. Funds and Their Purposes. Chart 2. Administrative Fund, Purposes and Personnel. Chart 3. "Aid to States " Fund, Purposes and Personnel. Chart 4. " Payment to States " Fund, Purposes and Personnel. Chart 5. Educational Research and Development Fund, Purposes and Personnel. Chart 6. Scientific Research Fund, Purposes and Personnel. Chart 7. General Organization. Chart 8. Executive Office. Chart 9. Personnel Section. Chart 10. Business Office. Chart 11. Division of Records, Information and Planning. Chart 12. Division of Relations with States (Protective Medical Measures). Chart 13. Division of Relations with States (Protective Social Measures). Chart 14. Division of Educational Research and Development, Chart 15. Division of Scientific Research. 27 SCIENTIFIC RESEARCH FUND— The sum of $103,430, which shall be paid to such universities, col- leges or other institu- tions qualified for scientific research for more effective medical measures in the pre- vention and treatment of venereal diseases. '3 g O oJ 05 -^ rt o o O P-JS PI '^ a> 3 rd ?i 0) £ f-i g o 03 0) O .2 ^ S 73 O rd I I g « - l^ .i; -^ ?c > TJ 17 nd H H of $784,- e purpose le various 'S d 0) »-( ro ^ d" en <^ d 'o w 1 The sum 6.84 for th assisting t .d 1 m I'i .^1 T3 2^J t3 d d . , O ;- O I" -^ W S 03 0.2 J:; a> o -g 'd 2 ci; d d -Js o3 1^ ^ '^l £ t3 d 00 CO d rQ 0) d T3 8J fB- A fl5 rd a (11 r the ectiv in t a> d n r^ E > d -(J p,,d •+1 'BQ -tJ d <» "^ fN tn >H o3 ,d H i-i b4 Q '^ -s ^ m M ti rd =« c5 00 CQ +3 > y 9 > H H CO 03 •« J2 O-P o racy y ^ 0) ■ rt O Q) Ph d o y ^§ ^ '-^ be O) d d '-' C 3 O Pi 01 01 bo ,d d ^ O Vl o <» 3 f^ S 9 2 h.' ^-5 p.^ m:3P^ (28) ADMINISTRATIVE FUND $100,000 for personal services, books of refer- ence, periodicals, printing, binding, traveling, and other necessary expenses of the Board in adminis- tering the provisions of the Federal Lav?. EXECUTIVE OFFICE, BUSINESS OFFICE, HEADQUARTERS DIVISIONS- (a) Division of Relations with States. (b) Division of Educational Research. (c) Division of Scientific Research. (d) Division of Records, Information, and Planning. (e) Personnel Section. FUNCTIONS Administration of five activities for which Congress has made appropriations — 1. Scientific Research. 2. Educational Research and Development. 3. Payments to State Departments of Health for medical treatment, prevention, and control of venereal diseases. 4. Aid to States in caring for civilian carriers of venereal diseases: (a) Protective social measures. (6) Detention, isolation, quarantine, commitment, rehabilitation of infected. 5. Central office or headquarters administration. PERSONNEL jjo. Executive Secretary 1 Superintendent of Field Service — Educational research and development 1 Supervising assistant and inspector 4 Accountant and disbursing ofiicer 1 Secretary to executive secretary 1 Statistician 2 Clerk 7 Bookkeeper 1 Stenographer .11 Typist 7 File Clerk '. , 3 Coding statistical clerk 1 Key-punch operator 1 Telephone operator 1 Messenger 2 Draftsman (part time) 1 Total personnel 45 UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Cliart of ADMINISTRATIVE FUND, PURPOSES, AND PEBSONNKL &-3O-20 (29) PAYMENT-TO-STATES FUND The sum of $1,087,831.42 to be paid to States for use of their respective boards of health in the treatment, prevention, and control of venereal diseases. DIVISION OF RELATIONS WITH STATES,— PROTECTIVE MEDICAL MEASURES, —COOPERATING WITH STATE DEPARTMENTS OF HEALTH, AND WITH THE DIVISION OF VENEREAL DISEASES, UNITED STATES PUBLIC HEALTH SERVICE. FUNCTIONS (OF THE BOARD) 1. To inquire into the legislative action of the various States in order to ascertain what States have made appropriations qualifying them under the conditions laid down by Congress for participation in the fund set aside by Congress for allotment to States for the treatment, prevention, and control of venereal diseases, 2. To inquire into the use made by the States of the moneys allotted to them in order to learn if that use has been in conformity with the rules and regulations established by the Government. 3. To disburse moneys in accordance with the provisions of this appropriation and to carry on a safe and satisfactory monthly accounting of those moneys. PERSONNEL This work is directed by the Executive Secretary. Other necessary services are distributed among the following: 1. Personnel Section — Stenographic and clerical. 2. Business Office — Disbursing, auditing, paying, accoimting. , 3. Division of Records, Information, and Planning — Records, information, services (mimeograph, addressograph, etc.), supplies. UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Cnart of PAYMENT-TO-STATES FUND 6-30-20 (30) AID-TO-STATES FUND The sum of $784,376.84 for the purpose of assist- ing the various States in caring for civilian persons whose detention, isolation, quarantine, or commit- ment to institutions may be found necessary for the protection of the military and naval forces of the United States against venereal diseases. DIVISION OF RELATIONS WITH STATES FUNCTIONS Unraer this Fund, the protective social service of the Board is concerned with— 1. Search for foci of venereal disease that may be a menace to soldiers, sailors, and civilians. 2. Identification or discovery of individuals who are carriers of venereal disease and who may be a menace to soldiers or sailors. 3. Inquiry into the reasons and conditions that have led these individuals to become carriers of venereal disease. 4. The preparation of systematic, accurate reports covering the activities of the pro- tective social agents of the Board. 5. The presentation of these reports to law-enforcing agencies through proper chan- nels (that is, through the United States Interdepartmental Social Hygiene Board, or through the State Department of Health, or directly, as may be deter- mined by previous arrangement with the individual agent of the Board). 6. Follow-up investigations covering — (a) The use made of evidence submitted to law-enforcing agencies. The enforcement of laws relating to the prevention of venereal disease. {b) The marshaling of cooperative community forces for the enforcement of laws for the "care of civilian persons whose detention, isolation, quarantine, or commitment to institutions may be found necessary for the protection of the military and naval forces of the United States against venereal disease." (c) The conduct of individuals subsequent to their medical or social treatment for the prevention of venereal disease and the eradication of prostitution. (d) The care of persons while they are quarantined, isolated, or committed to institutions as a measure for the protection of the armed military and naval forces of the United States. PERSONNEL— Employed Under Administrative Fund Chief of Division— Executive Secretary 1 I Executive assistant (woman) 1 Executive assistant (man) 1 | Stenographers 2 FIELD PERSONNEL— Employed Under Aid-to-States Fund Supervising assistants and inspectors . . 9 Supervisor of confidential agents 1 Field agents 59 Confidential protective social agents.. 10 Assistant field agents 2 Assistant special agents 29 Stenographers 34 Stenographers (part time) 6 Total 150 Unfilled Positions. Supervising assistants and inspectors. . 6 Confidential protective social agents. . . 5 Field agents .-SO Assistant field agents Assistant special agents : . . 46 Stenographers _36 Total 123 UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Chart of AID-TO-STATES FUND ^.30-20 (31) EDUCATIONAL RESEARCH AND DEVELOPMENT FUND The sum of $439,030 to be paid to such uni- versities, colleges, and other institutions or organiza- tions for the purpose of discovering more effective educational measures in the prevention of venereal diseases and for the purpose of sociological and psychological research related thereto. DIVISION EDUCATIONAL RESEARCH AND DEVELOPMENT FUNCTIONS 1. Select colleges, universities, and other suitable institutions or organizations in which to discover, develop, and demonstrate more effective educational measures for the prevention of venereal diseases. 2. Select colleges, universities, and other suitable institutions or organizations for sociolog- ical and psychological research for better methods of education and demonstration in the prevention of venereal diseases. 3. Sift and judge educational, sociological, and psychological researches proposed. 4. Apply the rules and regulations of the Board as required by law. 5. Determine proper sums to be expended for educational development, improved educa- tional methods, and for sociological and psychological research in the various institu- tions assisted by the Board. 6. Approve budgets and authorize revisions, 7. Follow up and check these investments of the Government in order to ascertain their usefulness. 8. Organize and publish reports from educational institutions and other organizations to which funds are allotted by the Board. PERSONNEL Division Staff — Chief of Division, Executive Secretary. Superintendent of Field Service Stenographer Note. — General Services furnished this Division by — Executive Office. Business Office. Division of Records, Information, and Planning. Personnel Section. UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Cnart of EDTJCATIONAL RESEARCH AND DEVELOPMENT FUND 6-30-20 (32) SCIENTIFIC RESEARCH FUND The sum of $103,430, which shall be paid to such universities, colleges, or other institutions qualified for scientific research for more effective medical measures in the prevention and treatment of venereal diseases. DIVISION OF SCIENTIFIC RESEARCH FUNCTIONS 1. Select colleges, universities, and other suitable institutions for scientific research. 2. Sift and judge researches proposed for discovering a^nd developing more effective medical measures in the prevention and treatment of venereal diseases. 3. Apply the rules and regulations of the Board as required by law. 4. Determine proper sums to be expended for approved researches. 5. Approve budgets and authorize re^dsions. 6. Follow up disbursements from the scientific fund to determine the value of the research work done. 7. Prepare reports, technical data, memoranda, and bulletins. PERSONNEL A. Division Staff— Chief of Division, Executive Secretary. Supervising assistant Stenographer Note. — General services furnished by — Executive Ofiice. Business Office. Division of Records, Information, and Planning. Personnel Section. UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Chart of SCIENTIFIC RESEARCH FUND 6-30-20 15610—20 3 (33) w o CO H o > bO B 3 •a » .2^ So 73 l-l m ft 1-1 !tl!(j T3 «J t! en m a •«>2 •s^ Pi 5 « 9 ■O be § tS « (rt s-s u Scq ft sars O'^ CO 5fl 3 03 U] g K 2 a 3 W ti « OS CO CO (34) CONGRESS INTERDEPARTMENTAL SOCIAL HYGIENE BOARD EXECUTIVE COMMITTEE EXECUTIVE OFFICE FUNCTIONS Executive Secretary — 1. Authorized and responsible agent of the Board, operating all of its policies and applying all of its judgments and directing and coordinating all of the several divisions under the Board: (a) Division of Relations with States. (6) Division of Scientific Researches. (c) Division of Educational Research and Development. (d) Division of Records, Information, and Planning. (e) Business Office. (/) Executive Office. Secretary to Executive Secretary — 1. As senior private secretary: Relieves the executive secretary of office details: conserves his time by super- vising work of his immediate office, by examining letters and documents, and by taking independent action in disposing of all matters which do not require his personal attention; when required, represents him as his personal agent; collects and interprets information as a basis for executive action. 2. As Chief Clerk: Supervises personnel section, general files, telephone exchange. PERSONNEL Executive Secretaiy 1 Secretary to the Executive Secretary : 1 Stenographers 2 PERSONNEL SECTION GENERAL FILES TELEPHONE EXCHANGE UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE HOARD Chart of EXECUTIVE OFFICE f>-30-20 * (:i5) EXECUTIVE SECRETARY SECRETARY TO EXECUTIVE SECRETARY PERSONNEL SECTION FUNCTIONS All central office relations with Civil Service Commission. All relations with Reclassification Commission. Records of attendance, assignments, sick leave, vacations, head- quarters personnel. Assignment of stenographic, clerical, accounting, technical, and other personal services to headquarters divisions. PERSONNEL Personnel Clerk. 1 UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Cliart of PERSONNEL SECTION 6-30-20 (36) EXECUTIVE SECRETARY BUSINESS OFFICE FUNCTIONS 1. Disbursing. 2. Purchasing. 3. 'Auditing. 4. Paying. 5. Accounting. In connection with five appropriations, totahng $2,514,668.26, for all Divisions of Board, Headquarters, and Field. PERSONNEL Accountant and Disbursing Officer 1 Bookkeepers 3 Clerks ^ 3 Typist . 1 Typist (unfilled) 1 File Clerk 1 UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD CHart of BUSINESS OFFICE, FUNCTIONS, AND PERSONNEIj 6-30-20 (37) EXECUTIVE SECRETARY DIVISION OF RECORDS, INFORMATION, AND PLANNING FUNCTIONS 1. Records — (a) Gathering. (b) Classifying. (c) Analyzing. 2. Information — (a) Preparation. (b) Distribution. 1. To Congress and other Government authorities. 2. To active personnel. 3. To the public. 3. Assisting Executive Secretary with special informa- tion as required in connection with the planning and development of programs. 4. Supplies. "" 5. General services — (a) Messengers. In connection with activities of all Divisions of the Board, Headquarters, and Keld. (6) Mimeograph and mimeoscope. (c) Addressograph. For all Headquarters Divisions. PERSONNEL Chief of Division — Executive Secretary. Supervising assistant 1 Statistician 1 Assistant statistician (unfilled) 1 Stenographers 2 Coding statistical clerk (unfilled) 1 Key^punch operator Chief of Services and Supplies Stock clerk Mimeograph operator Messengers (2 unfilled) UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Chart of DIVISION OP RECORDS, INFORMATION, AND PLANNING 6-30-20 (38) EXECUTIVE SECRETARY CHIEF OF DIVISION OF RELATIONS WITH STATES (The functions of this section are satisfied through the cooper- ation of the Division of Venereal Diseases of the United States Public Health Service, the State Departments of Health, and the Interdepartmental Social Hygiene Board.) FUNCTIONS (OF THE BOARD) 1. Ascertain States legally qualified for Federal allotment. 2. Inquire into use made of allotments. 3. Disbursements and accounts. PERSONNEL This work is directed by the Executive Secretary. Other necessary services are distributed among the following: 1. Personnel Section — Stenographic and clerical. 2. Business Office — -Disbrn'sing, auditing, paying, ac- . counting. 3. Division op Records, Information, and Planning — Records, information services (mimeograph, addresso- graph, etc.), supplies. PROTECTIVE SOCIAL MEASURES (See following chart) STATE DEPARTMENTS OF HEALTH RECEIVING FINANCIAL AID FOR PROTECTIVE MEDICAL MEASURES Cooperation with State Boards or Departments of Health by the United States Public Hoalth Service, Division of Venereal Diseases. (INITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Ciiart of DIVISION OF REI^ATIONS WITH STATES 6-30-20 (39) EXECUTIVE SECRETARY CHIEF OF DIVISION OF RELATIONS WITH STATES PROTECTIVE MEDICAL MEASURES (See preceding chart) PROTECTIVE SOCIAL MEASURES FUNCTIONS 1. Selection, instruction, assignment of qualified personnel. 2. Establishment and maintenance of Bureaus of Protective Social Measures in the States. 3. Direction of Protective Social Measures Agents and programs in the States. Maintenance of relations with the Army, Navy, Department of Justice, Internal Revenue, Public Health Service, State Departments of Health, local law enforcing agencies, and national civilian agencies. 4. Chief of Division, Executive Secretary. Executive Assistants 2 PERSONNEL Case Supervisor 1 Report Examiner (unfilied). . 1 Stenographers 2 FIELD STAFF IN MILI- TARY AND NAVAL AREAS REPORTING DIRECT TO BOARD. FUNCTIONS Discovery of local machin- ery and methods of pros- titution. Discovery of venereal dis- ease carriers. Inquiry into causes. Reports on results. Inspection and advice on — Use made of information. Enforcement of laws. Marshaling of community forces. Legal, medical, hygienic, social and reconstructive treatment of infected persons. Conduct of infected per- sons. PERSONNEL On duty Un- filled Total 82 G 28 20 10 20 85 5 18 32 5 2.5 Supv. Assts... Field Agts.... Assts Conf. Agts Stenos CONFIDENTIAL PRO- TECTIVE SOCIAL AGENTS. FUNCTIONS Secure definite information on— Existence of prostitu- tion. Houses of prostitution. Houses in vt^hich pros- titution is carried on. Programs of prostitu- tion. Report to Headquarters or as specially directed. PERSONNEL 1 Supervisor of Confidential Agents. 10 Confidential Agents in , Field. o Confidential Agents (un- filled). STATE HEALTH OFFICERS DIRECTING ASSIGNED PERSONNEL UNDER AGREEMENT WITH BOARD. FIELD STAFF ON ASSIGN- MENT TO STATE BU- REAUS OF PROTECTIVE SOCIAL MEASURES. FUNCTIONS Discovery of local machinery and methods of prostitution. Discovery of venereal disease carriers. Inquiry into causes. Reports on results. Inspection and advice on — Use made of information. Enforcement of laws. Marshaling of commujiity forces. Legal, medical, hygienic, so- cial , and reconstructive treat- ment of infected persons. Conduct of infected persons. PERSONNEL Total Supv. Assts. Field Agents Assts Stenos On duty Un- filled 38 1 12 14 11 UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Cnart or DIVISION OF RETjATIONS WITH STATES 6-30-20 (JO) DIVISION OF EDUCATIONAL RESEARCH AND DEVELOPMENT FUNCTIONS 1. Select colleges, universities, institutions, other organizations with adequate technical equipment, personnel, experience in educational research. 2. Select colleges,' universities, institutions, other organizations with adequate technical equipment, personnel, experience in sociological and psychological research. 3. Sift, judge, and estimate value of educational, sociological, and psychological researches proposed. 4. Apply rules and regulations of the Board as required by law. 5. Determine sums to be expended on approved researches. 6. Approve budgets and authorize revisions. 7. Follow up disbui'sements and determine value of research work done. 8. Prepare reports, technical data, memoranda, and bulletins. PERSONNEL Division Staff — Chief of Division, Executive Secretary. Superintendent of Field Service '. 1 Stenographer 1 Note. — General Services furnished this Division by — Executive Office. Business Office. Division of Records, Information, and Planning. Personnel Section. UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Chart of DIVISION OF EDUCATIONAiL RESEARCH AND DEVEIjOPMENT 6-30-20 (41 EXECUTIVE SECRETARY DIVISION OF SCIENTIFIC RESEARCH FUNCTIONS 1. Select colleges, univeraities, other institutions with adequate technical equipment, personnel, experience in research. 2. Sift, judge, and estimate value of researches proposed. 3. Apply rules and regulations of Board as required by law. 4. Determine sums to be expended on approved researches. 5. Approve budgets and authorize revisions. 6. Follow up disbursements and determine value of research work done. 7. Prepare reports, technical data, memoranda, and bulletins. PERSONNEL A. Division Staff — Chief of Division, Executive Secretary. Supervising Assistant » Stenographer ^ Note. — General services furnished this division by — Executive office. Business office. ♦ Division of Records, Information, and Planning. Personnel Section. UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD Chart of DIVISION OF SCIENTIFIC RESEARCH 6-30-20 (42) REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 43 REPORT ON THE DIVISION OF RELATIONS WITH STATES. Report on Protective Social Measltres. appropkiation and congressional authorization. Sbo. 2. That the Secretary oi' War and the Secretary of the Navy areliereby authorized and directed to adopt measures for the pui-pose of as.sisting the various States in caring for civilian persons whose detention, isolation, quaran- tine, or commitment to institutions may be found necessary for the protection of the military and naval forces of Ihe United States against venereal diseases. Sec. 3. * * * Sec. 4. * * * • Sec. 5. That there is h('rel)y appropriated ont of miy money in the Treasury, not otherwise appropriated, the sum of $1,000,00(J to he expended under the joint direction of the Secretary of War and the Secretary of the Navy to carry out the provisions of section 2 of this chapter: ProrifJerl, That the appropriation herein made shall not hr- do^enred exclusive. I)nt shall lie in addition to other appropriations of a n;ore general cliai'acter which are applicable to the same or similar purposes. (Chap. XV, Army appropriations bill, .Tuly 9, 1018.) Under the provisions of this appropriation the Secretary of War and the Secretar^^ of the Navy, both of Avhom are members of the Interdepartmental Social Hygiene Board, authorized that board to develop tAvo general lines of activity during the year ending June 30, 1920. The first plan of activity is concerned with the develop- ment and operation of a program of protective social measures which shall assist the States in caring for the civilian persons referred to in the paragraph below. The second of these activities is concerned with assistance of re- formatories, detention houses, and A-enereal disease hospitals, in the maintenance, subsistence, and treatment of civilian persons, whose detention, isolation, quarantine, or commitment to such institutions has been found necessary for the protection of soldiers and sailors from A^enereal diseases. SociAi. Measures Program or the United States Interdepart- mental SociAl Hygiene Boarb for the Protection of Soldiers AND SaHjOrs from Venereal Diseases. 1. The protective social measures program of the board is a pro- gram of search, investigation, formulation of reJDorts, and presenta- tion of facts for the construction and operation of programs of protective social measures and for the effective enforcement of laws relating thereto, by duly constituted authorities for the protection of the armed military and naval forces of the United States against venereal disease.^ 1 Parsuant to sees. 2 and 5, Chap. XV, Army appropriations l>ill of July 9, 1918. 44 REPOET U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 2. An agent of the board, however, ma}? act directly as a law- enforcement officer, in case he has been authoritatiA^ely designated as such by a State health officer or some other governmental agent competent to make such designation, such authorization having been approved by the board. In such an event the State health officer or other authorired agent making this designation of law enforcing authority must assume responsibility for the law enforcing acts of the agent so designated. The Interdepartmental Social Hygiene Board will not be responsible for the law enforcing acts of agents to whom such powers have been delegated by local officers of the law. The board proposes to use every reasonable measure at its disposal to influence law enforcing and related agencies to meet their obliga- tions relative to the prevention of venereal diseases and the conse- quent protection of the armed military and naval forces of the XTnited States.^ 3. The protective social agents of the board, where assigned to service in a State department of health, will receive their directions from, and be responsible to, the chief health officer in the State de- partment of health to which they are assigned. In such an event the chief State health officer will be responsible for the wise and careful direction of those agents in conformity v/ith his agreement Avith the Indepartmental Social Hygiene Board. 4. The protective social agents of the board, where assigned to service in States, cities, or regions in which State departments of health have not agreed to be responsible for the program proposed by the board, will be under the immediate direction of the board. 5. The protective social service of the board Avill be concerned with the following : (1) Search for foci of venereal disease that may be a menace to soldiers or sailors. (2) Identification or discovery of individuals who are carriers of venereal disease and who ma}' be a menace to soldiers or sailors. (3) Inquiry into the reasons and conditions that have led these individuals to become carriers of venereal disease. (4) The preparation of systematic, accurate reports covering the activities of the protective social agents of the board. (5) The presentation of these reports to law enforcing agencies through proper channels (that is, through the United States Interdepartmental Social Hygiene Board, or through the State department of health, or directly, as may be deter- mined by previous arrangement with the individual agent of the board) . 1 Pursuant to sees. 2 and 5, Chap. XV, Army appropriations bill of July 9, 1918. REPORT U. S. JNTERJJEPARTMENTAL SOCIAL HYGIENE BOARD. 45 (6) FolloAv-up investi-(6), abo\f, include — (a) A search for information as to the use made of facts submitted to law enforcing agencies and for evi- dence as to the enforcing of antivenereal disease laws. This information may be secured by direct investigation by the a^ent of the board, or from other reliable sources. (6) The preparation, information, or organization of co- operative community forces that may assist the local or State authorities in the enforcement of laws for the " care of civilian persons whose detention, isolation, quarantine, or commitment to institu- tions may be found necessary for the protection of the military and naval forces of the United States against venereal disease." This " team w^ork " may be secured through such measures as the following : (1) Alliances with already established commu- nity organizations of power and influence, such as the chamber of commerce, the Ro- tary Club, Parent-Teachers Association, Mothers' Club, social hygiene societies, the churches, etc. (2) Organization of special associations for law enforcement. (c) An inquiry into the conduct of individuals subsequent to their medical or social treatment for the preven- tion of venereal diseases and the eradication of prostitution involves a program of helpful, unirri- tating personal inquiry and follow-up contact with the individuals concerned. (d) The inquiry of the agent of the board concerning the care of persons while they are quarantined, isolated, or committed to institutions for the protection of the armed military and naval forces of the United States. This inquiry involves a critical and helpful inspection or examination of jails, detention homes and hospitals, clinics, reformatories, etc., first, as to the existence of these institutions ; second, as to the provisions for treatment (medical and social), instruction in hygiene, programs of recreation, and training and preparation for productive economic life after release from confinement. 48 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. III. The success and the efficiency of this program, as applied through cooperation with State health departments, depend upon the vigor- ous expert support of the chief health officer in each State. To drain a red-light district and destro}?" thereby a breeding place of S3^philis and gonorrhea is' as logical as it is to drain a swamp and destroy thereby a breeding place of malaria and yellow fever. The obligations and responsibilities of the health officer are equally clear in both of these tj^^pes of aggressive intergroup hygiene. On the one hand, he must secure the service of the sanitary engineer. On the other, he must make use of the social protective agent — the worker, the court, the police. Tabulation Showing Pkogkam of Assignment of Bureaus of Pro- tective Social Measures, On June 30, 1920. STATES to which BUREAUS OF PROTECTIVE SOCLiL MEASURES HAVE BEEN ASSIGNED. 1. Arkansas. 2. Florida. 3. Georgia. i. Kansas. 5. Louisiana. 6. Marylam]. 7. Missouri. 8. New Hampshire. 9. New Jersey. 10. North Carolina. 11. Pennsylvania. 12. Tennessee. 13. Texas. 14. Virginia. 15. Washington. STATES IN WHICH ASSIGNMENT IS IN PROCESS. 1, Ohio. 2, South Carolina. 3, Arizona. 4. Colorado. 5. New Mexico. 6. Mississippi. T. Utah. 8. Iowa. STATES IN WHICH PLANS FOR BUREAUS HAVE NOT YET BEEN PERFECTED. 1. California. 2. Illinois. 3. Kentucky. 4. Massachusetts. 5. New York. 6. Oklahoma. 7. Rhode Island. 8. Wisconsin. 9. Nebraska. 10. Michigan. 11. Alabama. 12. Connecticut. 13. District of Co- lumbia. STATES IN WHICH BECAUSE OF THEIR PRESENT LIMITED NAVAL AND MILI- TARY POPULATION NO ATTEMPT HAS BEEN MADE TO ESTABLISH BUREAUS. 1. Idaho. 2. Maine. 3. Minnesota. 4. Montana. 5. Nevada. 6. North Dakota. 7. Oregon. 8. South Dakota. 9. Vermont. 10. West Virginia. 11. Wyoming, 12. Delaware. REPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 49 si Ob Ji 00 gi>J ,c « ^ -I .g-o 2 c3 .a .2 as 3 CD S «T' ,rt „&>.a-aas«^5a ad 5 iSa-ss.^ssod'-fl-s eao°2g ■go !>>g iS> ■ar-i d o fl ^ ai(N 2re-2^flo §a aa- •g a^ g § § S_g^' flS cl >=.2 OCO CO-^ UD --2D a.^„- c3 OS — 9eM -T- ..=^ a> L^ »- ^ na » .2 0^ -in O o C3 CI. t. .52 p ~ CD ^H 02 lO CD ."^ 3 o o ■§2 o !4 03 t> ■d o C3 p, o D c8 ^ cc i-3 15610—20- 50 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD, ■a CO IS « ^^ ^^ o cc On CI ^ ^^ o Q c3 '-' i-f rv-t-s O) '^ QJ O TT .fh 03 CD g w MO ffl o 05CCC^i-li-tC0C^C^-^ '^ a ?^ ^ ,^ S &i h'^ K s g ro 00 ^ C^ r« Cn ts P ^ c Std 0*M s P-&0 CH REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 51 H 2c S " ^ III! « rt . s S^ cy S >-d S3 « g S'3 ♦HO ^^ -" ^ci ^i ^ ri .^ „-tc: o gj 2 -■ O o, fee O (D o o* >- C3 CS O i^SPfi^^ C3 »3K-^i ^ g § s ^ i g^ i Sli-gli II g « g § g fl r'^= ■ rr' ^ - T'^'^'^^,--N/-\rtrr»^n?^^ 03 03 ro C3 CZ C3r/} C3 < SMMi--l,=^<5rtOOOPHPHpHpH3;cncc!fficQ0Qa!0Q!: "oj.fl Is X g O 03 l--^CO^H(MOOOCOr - ~ -■« c ® H « S 5 CO S-^a 03 O" 5oS§|g2gc3mQ£0(£^c3^?^ i^-l g §"§ s- s^ i'g|.> ll g g g s s g s-e §3 I rt 1-1 rH lO rt M 1^ - M M fl 2 5,.2 3 o CS p p p 3 o C a S s$ 3 C5 OO r* O »0 l>- 1—1 OO I— I CO CO yo-a ga ?* o o p-..£; CJ " >. n ^|£- •S fl G ' "35 03 csa i-< .-I CC1(M p p fl t,-j n o o £ Sa^ &"S £ 2; o?L^ O u o f ro-^ ra 5 a M 03 ^« «;? 2^ S.*-',:^ fl "£ n fl-m'S ° ° ° ft§ .2 r.s|||a'-s "Sw S fl fl fl g-s >:|:ii:i.s.s <;pcc«t^-S fl.fl c3 cd c^ ^ ^ O P P,^ ■- o CO " 6 w) ^:§ ait W • r-1 ° a'P Su fl+r cot: o p Sh *. ?fl C 03 fl bc m p Pm 52 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. ^ o 5? C3 > b .^ Sf.a 3 ,„ a) p, a> j s « a S ^i '^•g .o'^ >» ^ dSd.g 6 O m g cb OV? o2 a,-te » S IE . ft.y a oj M +j ft 9 1 +^ o iS .H p M-5 fl ft-M -9001 .2 ^ t« ^ oj g fc^ :^ CD r^ CO--- • n o ^ K, 3 a M ,-1 ,-1 tN T-< r l^„ o,l|o I I I— i 1— I I I>- I lJ ^ a> 49 gp O -H ai 3 rt 03 el 00 (N •* t> M o '-' CO d ;w : 1 fl M icQ ; t) fl '"3 • .■o ° 0-3 M -2 « ; ■ftO ; stia, tion Was ice). ks ( o o3 „> p3 g ca ^'2 S S fc ; <> 2S 2o bin j "§3 • iSS 5M»o|'^_gM ^ ? -B c3 [j_^ t- ,2 -^ i^ REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 53 59 .3-2 h;3 ^="3 WS tX-*- t- .—- t- CL r^ 0^ y:H T3 ^ T' Vj m S i-T n > --3 a; a ■tt o o 1^ 43 m Hi •Si g 03^^ t.," aP-i PI'S 03 Ol as 3 § C m~ o PI P -li-l«i-IOOi-l ;C ^-g ?? =? o r:: -^ 'a^=ji3'S3c8St:ssao3=3oadc3.-SocaiioT:c3o3Si>>a!S ^<<<<^<^<^pqMmfqooo3PfiOWH!^f^OOOOah:if^H:iSS Tl<0 O (M t^ rt f* 03 :0 ^^ CO CO Po'c^r r-T i-T I " ^•3 P= 8 .. , a> B c o *•> Q^ c3 ^ ^ ^O; o ^ O 'O I1 "S > s> ^ o3 03 S?""^ .^^^ «^OSc3H"Ca' o«<^w 54 REPORT U. S. IlSrTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. S PI »- CI So. t^ 1^ ^, '^ sc^ s > s cc ?? p; W, fin Si.^ § P-^ Sr, S~ ^ < '^ -V! cs s B Sm , CQ s ^ !^ ^■-S Js 9o c3 t> f^ lag »o§^a-2>„« ■2 *^ S m 5:! " O 2 -^OvH fe_ S^ '^^ tn -S ??2 o ^ O cj rt w •"''-" c3 w ^ , ; Oi2.t : tiC4^ ;:^ PiVji a o ■go >>g"^ M rt o_i H r-t [>, fl fc&oM — Z.a'Z £f So 00 ^ 0^ CQ _g ,— ( x'-s S ■""''^ © "^ m '^ .2-|2|5go o ^p,' - m r- fl o S"E S-- s^fi-S tB-S " 03 ® ^ i? ^- » =3 • • 2 rt d m o o P Ph f^ CO t> i> '-li-(10,-l50'*'-'Ni-l^ <^^ I 0OC<5^'-l'-<'-'-*S'~" m5 3-r c3 a)il oT3 • e8 ft ■3 03^ Sd ^So3S''='>o3-^ s§o-g^^ag^> -^■r 03 03 03 CD .d-d t^^ ^ ^ 1 •1-s a ■3 a; a a fl o< T) a fl .s CO Tt^ CO coo th coco cq CO O 1) o=3 d' . £ a=3 f^-StdSa^ d g+i'^ a "d d o dry 03S-C -d '"'iS S Sfl O OpHoaccM REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 55 CO M g O g 3 ® a a t^ w CO en M . -rHOSi-Hr-Hi-HWtHr» cc sn .a s i> t> m A t« w cS > dS'S.S o o w g cfl o^ o2 ° ^ S (D fe H o 2 t>,fl"" o : m'+3 S Pi+3.H o i ss' 3 fl „- s:^?; |sl , o>. ;bxp^ dnJftoH.o^^-S'-'S ^O ° 2 goo 2 c !^ §3 a§ gfi bS^«^ S '^V, S n t>.-2. O 3 »3 g iS CD S o » o^^^tso ^^-g E^. u >,f SSo°2£ .S J o c] « ?< _, _ Srcuo P O fl S »IM b m PI g « pi ft Tja iOi-iC<)cn r ^CCC000C^(^3^HrHT-^( i; ^ ^ ir! . ft d 's «■ s a 03 o ri a» . - aj o dJ t>i 5 ^ o ri o g „■ "g S ri .-„ a. t* fc- Q M M"^ ■*■ a^- ea+3 Ob fifi o fl o p. & cj ca 03 T» 03 KEPORT U. S, INTEEDEPARTMENTAL SOCIAL HYGIENE BOARD. 57 W|i< w:s:sag;a;g , - - -- :Z,CJ S "3 ; M I • o ■ ) K -S 5 M73 «®SSx!c3ri>:flS llitlisiii-s i^-ti ill! Ill II ■^^ t^ CO CO (M -»-' O 2 O O -1^ O o ** •58 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. S rt ^4^ CO 1-1 ^ O 05 Co 1^ -IS § 5>5 e 2 53 ^1 C3 i> 2 ■ffl 1 2 rt li s^ flS'S.S isi S.a-aasg^flft Id =»^ fe fl-P f* !> £ 3 o rt t. •■y o5.H^a:p3ft-^.So b O (S a g'B °2~P o <^ g P PI a oc^ ■d S-iH o a ft-g d m r„ '*^ '-' * £; V en ^ 5Pd ■ a q -2 ffl o S en II ^ 0 to P aj nv^a AC'S O t3 ft 03 .f^ i rt -C 03 O - 60 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. s S 5i O e o^ ccCQ U3 11 ^ rj 03 § £ © tsSt;.y;-^3i2o3(co d rt o °2 » ■go t-.g'^ M d°'tfS'->= •S rd o fl « ?i -d fc; &oM^ ^l*Sg . d o d ^ «eq !*:d ®X!'"rH o « ^ fe-aS S d CO CO(M(Nr-(i-(.-H(MlOC^O;r-=3o:3P^gS^ X3 (E ■a "5 d 5ga.g®&g| ^ ^-1 ^2 S t^or^c^i-t 00 CD CO 01 oocctMoo^H CO 00 Tj* 00 d "D m^z; g >• Ss;; ® « a '^'^ d d csm" MM *.g 2 'a- g,-9 S do ^> M d ® > " " d D s ® ca<^f:Hj2;K HEPORT U. S. INTERDEPARTMENTAL, SOCIAL. HYGIENE BOARD. 61 .■^ d Sm 3 J, o) » o b J => P.-3 .g - •X^ 03 o H(MCqr-j< I ■^ HIA 05 t^ i-l S _ ..g 5 d.2 2 c3 s ^pSmI? IS ID ■ .g ■■" p o o ^ fH c ;r* o .-HO >-H g « 03 5 •c 5! "5 '^ iH G2 REPORT U. S. IITTERDEPARTMENTAL SOCIAL HYGIENE BOARD. fe ^ Co >*( •^1 v^ o to ^ §'^ r< HO OS'S * is is:^. <» >2lM P o C S aj(M P m ,„ "^ " «^ > >"S.£m ?p'5y : .Ore) 3 • § » § • t- Kc3(Scaaiyoe3o3a>OOc345'd Q..CI p.S cS el Q el ° KEPORT U. S. INTERDEPARTMENTAL SOCIAL. HYGIENE BOARD. 63. ort .HCC'-H.-Hr-lTfrt.-lOOr ^ (N CC tH ^ lO i-i T-t i-H 00 1-1 C^ CC -^ i-t C<» ^ r-H W (N T-l M CO :<^- O ■ V)- >2 c S « £ oi o o a; c- P- aj K (Tj c3 a> I fl S w, S m O o tz; a ^ ^ 3 .2 o •-' is 5; q o t. o H S ^- gcT3 pqM mo^cM ^ §5 5^ ^ '64 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. "'^ ^ • S PI ■w O 50 I =» 00 1^ 'OS 03 w f=H 03 c« o o SB • 03 C •'-I ^ 111 O 03 MvH .Z. mQ O Sr^ 03 iS o3_ RTS c3 ^" tft *-■ m r/i r/) E MpR M C^ W s">.bftd I S*- d ft SW ■y o 5.3 p M+j d ftis in b a> 2 03 a-s p o 03 ea 03 11) o i3 > S o c ^ S 1 K'^r, O -^H ^+J 5 s Ci S S^ ?i, A, (^ ■u §> e. '^ '^ o s» o cs kq ^ O,^ di-l >, S -^ ® . > S ?, -S ^ "S IS k o £ S d d § d N p° . rt ■' 3 d ^ >? d ^ ;ts;= •C ? o-OjS 03 d g d d ft fts'fl ?^-s > osx;; a ^ S S a S p-sg d £oi;P- .,-, O '^ 03Xh O ^1 §11 «lll il5|llil^^«^si., w:;3ocot^'3gsai.rto3o33.i S^ o Si o o ^ a> > g a +j c3 ?; o O 03 REPORT U. S. INTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. 65 5f cc Sf '^' Sim fti,'-Q <3 TJ c/-:t3 t3 -rt ^^ " o o -^ o -7" -2 2 _,~i3 o u — . O O -*_> -si£a2^s^c r:; « <« C3 S oSr^--< 03 4J CD (H 1. a f^ 2 6/ tJ fl CO rest, stcn ogra elm 1 043 , f^^ JO B.-^r^^ aj fl — . OT3 ^ .2fiHi: 2< ,00 -w. f?3 Ofa ■2 6=3 ioo.g|, ^ ^"-- -^o ^(So3-( I §lk -i^. ., !^ n S gii o o o C T3feS iid i3-.t3 i; £; = S o- S := S 53 S^S as eoOi-H en a 0-2 .= 03 '3 1;' 3 CO .^5 . CSi CD CC iO 05 CO S M t^ CO C^ CO iH C^ ^ lO t-^ ^ -OSIOCOQOC^COOJCO t-^ 1^ CO C^ 00 iH C-i s: o <-^ '*n =2i S K ?i T^ •-^ « ^ It. or, s "-J <» s~ ■« :» CO =^ "*1 u ;^ ■^ o^ .« 5^ •Si f^ ga'S.S o i 2 § 05 o-s o2 ■^ H ^ O.^^ cu 0) qi 0) T* r^ ^ '^ o^ ♦^ iX r-rt T^ _j /-^ "^ 03 03 m tao >, p,-S g 0) S -w F5 ft S* -w ojs.y p ic43 p ft+3.a o fl b a-s 1^' • w'^'O .0 mti^n gflPn i^^fG^o^^ iiifj|iggti2§liiMiiiiiiilit 3 fc fto<»^ ri o c a aijq o 3n § S 03- o^ oarages ■ 2 3 ^ ^^iisgi ^ ^ il f .iii^t^i fill 2 ^p §1 »-H 03 1-H O >0 Cq l> ■* i-tcnr-icoio CSV- a< rt o © C6 o 5^2 &■ i3 S m E^^ > "^ REPORT U. S. INTERDEPARTMENTAL, SOCIAL. HYGIENE BOARD. 67 ii •5 M I^S — Si "U 03 " M .2 Sf i^ tJ — -^ fl« H Sf&a *-' sea § -o o £ ; c o o « « o S 8^ 3 illllliHI .3^^ o TtHrHi-C^^^CCi-lr-trHTtKNOOCllO '"' : PI on o •a « :? § -o „ fl cS t> p o fs rh _- '=' at; CO p> ,P" •-' 3 p^ g n o dPH p Eld 3.t3 68 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 'S 11 Si 53 ,03 os o;i; 33 g fe ®-s ^ P d S ft-e a> 5^ CD ^ OT M t>> p,.^ g flj tn +^ p! a n fd +; O ^.3 p M+3 P ft-M.3 o q m o .2 S "^o= 3 ■g o >:> S ""1,3^ ;! fl t^ £fSd fl O PI a OKM ~i Ml OJ j;? te o> r/^ ^ at CQ _j;^ I— I ^^ °M g*^ O--^ IS b -oa el o 2— a ^■g.g £ si §1 il|s| fe fe-g fl| &3^^;S^ REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 69 o ° ° t. t" ■ a § ft" 3 ^- » s I^S o -.tl c &a ■ o DO fl jSSS o ^ oj 3 t<' --1 ® 03 oS,J3 ^1^ i-li-IC-HT-lr-l-*C^W.-li-li-IOCi-l(NT-l i-ii-dMiHi-iosi-H o T-no-*i-nr: 03 § fl OfiS teg's b 2 ■* lis 3'3 H o S ftTSTH 03 03 oj 3 03 » otS Q 3 <; Qi CO OJ CO "^; 1^ S e i?; a. Si, S5 -J o ^ •>* cs S e cq •S « o I- o J3 R o '>'> ti-i'^-B ° i; i § -' S; »-« »-• SS o o d _: c3 t-i o g2 o^ MO g a.S.2s 3 £ S C<5T-imU5t-^i-l(Mi-lC^.-(,-Hi-H r CC 1-H i-H r-< O XI Mf Iii^s^ii^ gild's fe > 3 t^ o g O d 03 O ;-( I-< r-( .^^ O OOO o aJ i o:=! OM ' S fe c« § d "■" ' > Sf a> is 2 t; |»-SgE3t5 'd o 03 m 03 S c3 (O S So S >?' 03 ? te t ^^ ^ .2.2 B S .g tS Ql? COt^ (MO >0 Cq CD CO CC ^ S^K 03 03 ;^ bio ^ 03 fl CD l>.-S ISO •2 ^.g.g >^-; ■oS' 03 a Ol 72 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 'W >« ?>T3 f~ a s d fe CO 15 CO ■^; i^ •^^ S 'Z' o e m:) >i <» ^ "5^ V-S K o 1 1^ ^ o s o &- ■^^ i= s 3 o ^ •2 oo 'e >» w -« ^ ? Si e 0) o m r:^ w TD ^ rtl rn O m U u > > CS J5 OJ ss -H > aj 0) oj OJT cC ft— ,„ fl t>^o o o o j5 1; ^ +-> 03 a> o ■^' n fl h -{^ ^ t- s'^q 03 > u^ H b '1' C So °2 £ O 03 K„?i H O 03 ^.^l ■rf 03 S C' -" - fe 3 £ y rt rt o a ^ a>c^ -' te- ^S— H 2 -*^ [> O Id 4J Oi H b fl, 1^ S O^T-J Cii -5 03 , 'o 05 m 03 =3 (o-fc! 3tg c3 p M g' ■S qn cs tj -1^ el 05 m W o 'm -^ m w Cl rtQ ■sss,o§« OfiW i;D C^ '^ CO OS t>- o--i d'3 ,M o o,?3 o"P<„ CO o ^o o-^ >>2 o o 05M p SPh ^o — a M fr C3 " P M05 o.S''- wo .rOp '^0"„ g'or'g Q> ®r-T-i vj X q |^« 03 pjO ^og OPfi REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOAED. 73 flo^B^g.g ^g M dl 73 S3 q pi^Hf C^i-f00t-i-C^i-HC0COCDrHCCO'^-O'^C0^HCv:)rHi— (CJi-HCCO^'-tcrji-Hi-HT— (.— lic».'7(NC'J'- g O O 03 O 03 02 b d-d ■^ ° o ~ -SSqO Soi&.s-aog= SOg :So<<: 5 e 12 S > yr-ii! ; •'3 03 c^ 03 _g =?§ f^ CtCf-l 03 £N- o ^ c "^.1 ioa.g o 3 s S OS'S 2 ; Pi pi pi OT CB 03 Eh Eh 3 S fig tfffl o a _ [^ o ^ OP 74 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. -.a ►OQ « o fC- V o^ K O > fe ta -!; n > 05 O-j- OS 5 * fe oi-;^ S eg oj , ^TT -T r^^: < -H C<» ^ l> CO T-l i-H 1-H 00 t-t OS <»co CSO :CC0C0'<*00Oi:0C0OO00i000 r-HCO O0(Mi— !.-( ^- T-^t-Ht^ '"S* coco ^ CO '«*< 1-H lO (N CD 00 CD (N O O CO i-H tj< (NIC i-H CO r-H 1-H Oi ?-l CO CO CD .-I TTi lO ^ CO t^ '^ O r^ (M CD lO Ol •<*< O 00 CO Tt*o tN Ci cot-- (N OSC40THOi^-l>lOcO iOi-Hi-H i-HO I>CO rH 05 CO lO O ' COOO (M 1-ICO i-H -^ CO -sO -^ '*COCO COiO^C^i-HCOt^C^ CO cq »-H ooi-i oo CO w CO CO CO CN --I OS COi-H lO Cq CS OO (M w OO iC 00 CO CO-O - i-H CM CO CO'-hO rHO (M COOO ''^JH t^ CD 00 Tti O IN 00 Cq »0 O CSJ CO CO-rJH ■-.:i f>H o 00 H CO liJ 13 00 8 r/) J-^ M o ■K, o Q 4-^ ^ •?? ^ Si. W § § n ^ w s H o M ^ § ■M ? M 1 O CO i? » H I-; P9 (/J •^ < O H f^ o H ,« O di ■Ph f^ fl fig M a OOlOtOOO MlCniMOOiH (NrHIMOOS c5i-(COi-l (Ncq'^otN oooo>o(Moo-*eo« W)(NCO"^tH t-h O -"S^ iH T-tt» i05i-HC0O 05 "^ -^ O t>" lO lO CO »0 T-(C0H CO (N(M5-*IM (NiO-^IM .-ItN J-H 1-HOCOt^-^ CO >c >>'J sa »sga5&S3-Sdap--S; REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD/ 81 M 5S a Q 15610- O Oi -H CC C^ CO I- »o T-< (■ 1 oi r^ c-i 'C CD O i-l T-t 1-H r-4 CO CO CO 1-t CO CO Oi CO CO (M CM CO 1-* O Tt^ t CO -^ IM • • rH GiO CD »-H --H CO ' '(N r^ r-l ■^ 1-icq CO CTi -t^ CO O 1-- "^ co-^(M-fc-)(NO(N-y: X CO O-^iCOCO-^'-^-t^Ol CO oo - 00 1-H ^ l>- CO t^i-H CS CO C<) «:: -^ 00 '^ CO lO CO CO (N lO CO CO >0 t— CD o coo -^ r^ r-l ^ IC CC c: -** t- CO CO CO-^ O ''f -^ CO X 1— I cc o CO CO CD M 0> CO iO.-Hl>-(Mt--cOiOOb- Cir--^aiCXDO0(NCSC^i-Hi-C'*CCOOiOOOr-*CO lOCOOlt^QO CO r^ CN 'rt^ Oi r-i t -t^ -7^ ;i^ ^^ p e p « s! =1 « !>.0 >> S ^ » o S+J 03 o -^ r^ q5 "2 o = rt a i.Sp 3.3' 20 PL,>>fioSMoc'iifebto-c;©s§-oS 00 IS S ® o O (-> o 3 ^ .-dfl 3cS qEh^ 82 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. •73 o o <3 w !2i s w •^ S s o ^ H-. o a «i^ H H .2 (S: i « w 00 < & u ^ n tR 0 OS CO i-H iHCO rH TfCO -* i-< I-H t- N il 1-1 ■* 05 rt i-l(N lOOi-l c^«3i-ies CO ■^ (NCC O O (>) i-H COIM COi-H OOOWCOC^COOIOO 1— I -^J^ I-H '^ lO -* CO CD CD 00 t^ CO O i-( 05 (N 05 1*1 COCD -wj^wHOi COCO^CO'* (N CO t^CO t^ 40 I-H cor^ oo TlKMUtlOOt^ I-H 1—1 OS CD CO t^ lO 00 00 1-1 OS IC ■<}* t^ 0> 00 CO t^ •* CS lO 1-1 i-lr-C«0 CO CO CO coos ir^ 1*1 iO (N 1*1 ITS CO C^ CO OS CD -^ Cq CD 00 CO lO O ^ t^ OS l> 1** --I »i5 CO 00 t^ CO iraoi(MDoosoiraoiMi-iio- th ii:) i-( 1-t 1*1 1-1 00 03 C3 13 J P 6JC.2 03 slip gS5 ■So fl g4:jS ; ^^^ :gas|&° 2 o a « 03 =« "S ,1,- " =5^5 S P.S 2 o o iHtSOfiO 23 a s 03 O 5o ,£3 » 2^ cS-O d 9° el:- Pi-:; 03 g? c« > ^ o £ REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 83 a> pi PI o »0 CO CO rH Tt^ CO (© O CC t^ CO CS CD O I 05 00 CO (N i-< CO CO CO CO cD^t--f— liOCOO •^ »C CT> C^ ^H N N »C C< M IlO ^- "* CO CO '^£2^3!*^ -riOOOi— (tOC^rt'^-^'^O O 01 (N Cl CO ^ '-0 00 ii^r-ooo-t* CS CO CO »0 O <-( OS Oi OS -^ Q CO CO CM Tji -Tf -^ -^ i-H IXI i-H lO -^ OSi-HCO OS CO lO 00 ■-»< >OI-- t^ t^ 00 »Oi-HI>COO cOr-( r^o CO cot^ cs ir^ o t- o ^ (N ^ C^ C-lC^CMiO-^MOOF-C'ti .-(T-i03iOt>. Cj C0£:J'^00rHCO-^-*COCO'-<(NOs-*t- •-H CO lO .-H CO "^ j-^ CCOOCOO • CO CO i-H coio • r^ 000 1-H 10 • 00 -^ 00 i-H CM •t-hcOOO i-h • fH 00 Tt< CO IC r-t OS 00 00 I-H Tt< tH »H 00 »0 OS ^ S'^SSiS^^OSCMCO (--OcOOsCSiOi— lOlCCCMOt'-OiOCM S SJS'^^'^SSSS^Si r-c2t-oooo6ocDoocM^t^Scom *Q CO 10 CM CM CO CM i-H »0 --l CO CO lO t-h t- i-H 1— ( OS >— ( O dO-^.9 Md 43 o ^ : : :>>§^ .'i_. o^ &H 3 SI £Sg.s5Ss.aSfe?&°^ PH>>oofcWofc^£^Sr fl.2 o Q^ ^ r3 O •as il op J3 03 X) pt 1-2 2.9 as ^ o > tS'O 5 tern i^S O a OS" ?-22 84 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. "-4J o M 2 SB CO I CO 1—1 ^ II O CO CO CO cq (Ni-I '^O C-< OiCO »o p oc^ 21 CS i-t rH t^ CO ^ O lO CO I t^ 05t " COC>^ COtN CO i-H ' CO C^ rH »0 '00 UO»-H • COM • (M CO ' t- 1-H CO • Tf^ (M • lO-^CD COiOGOO lO CO ■^ CO *o C<) a a S ^ cs , §11 aa 73 i) C3 ^"3 ? CI ■ S 5r:.3 : 3 o o a a 3 3 -flizioiz; 55 15 S^ H i. ••( ' 4 9 ' # # 1 '(' ?i» * » » ■ si -. 1 ^« ' ^ ' .^ i; ^ , _,'i ' «■ ®'^ % - t. X -- - t t , # # 1 ^ ^ # ^ ; .,-^ ,l -- = , - t ft 1 s ; r --"•'- - - .. t» , - ■ J ^'^ 41 '' 1 ' '' ' ' 13 J 1 f "■ /'/; - ,''; •' P ^/ / • / 1 85-1 i&^ REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 85 Eed-Light Districts and Their Relationship to the Army and Navy. The protective social-measures program of the board is a program of search, investigation, formulation of reports, and presentation of facts for the construction and operation of programs of pro- tective social measures and for the effective enforcement of laws relating thereto by duly constituted authorities for the protection of the armed military and naval forces of the United States against venereal disease. The board, through its field representatives, has been active in assisting the dul}^ constituted authorities to close red-light districts in the vicinity of military and naval stations. That this program has been effective is demonstrated by the three maps reproduced on the opposite and two following pages. A com- parison of the location of known red-light districts with the location of military and naval establishments, together with the complements thereof presented in another section of this report, will show that in five cases only is there a red-light district within 50 miles of an Army or Navy station with a complement of more than 30 men. These known exceptions are as follows : Red-light district. Name of station. Nmnlier of men. Distance apart. Des Moines, Iowa Harrisburg, Pa . . . Paterson, N. J Savannah, Ga Tacoma, Wash . . . Camp Dodge General Hospital No 31, Carlisle. Navy yard, Brooklyn Fort Screven Camp Lewis, American Lake 2,694 381 3,576 235 1,925 Miles. Case Histories. Examples of cases that come under the influence of the protective social measures field service of the board: INDEX. 1. Edna; venereal disease; food handler (sailors). 2. Mabel; venereal disease; community (soldier). 8. Mae; venereal disease (soldier). 4. Bertha; venereal disease; feeble-minded (sailors). 5. Lena; protective (soldiers). 6. Sophie; protective (sailors). 7. Belle; venereal disease; feeble-minded (sailors). 8. Margaret ; closed dance hall, venereal disease. 9. Esther ; closed dance hall. 10. Helen; venereal disease; feeble-minded (civilian). 11. Rae ; venereal disease ; drugs (civilian). 12. Mildred ; protective (sailors). 13. Katherine; male venereal disease (civilian). 14. Hattie; male venereal disease; food handler (soldier). 86 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. Examples of types of service rendered by women agents of the board, taken from individual case records, are cited below, showing in various cases the character of constructive work done with the girl, with the family, with the community, and, so far as is possible under existing conditions, with the man involved in the case. Edna. — This girl, aged 18, lived in a furnished " light housekeeping " room with her mother, a deserted wife, and both were employed packing chocolates in a nationally known wholesale grocery plant. The girl frequently disappeared from home to associate with sailors on Staten Island, remaining away several weeks at a time, and after one of these absences she returned infected with •syphilis. The mother, through her ignorance and poverty, attempted to effect a cure by means of patent medicines, permitting the girl to remain at her work wrapping chocolates in the meantime. When found by agent the girl was in an advanced stage of infection, a serious menace to her associates and to the food she was handling. Agent had her admitted immediately to the city hospital, and her mother was directed to the clinic for examination. The case was reported to the president of the grocery company, who evinced great interest, and directed that routine examinations be made hereafter on all ■employees coming in contact with food. Mabel.— In this case, a bright, responsive girl of 16 was brought up in an orphanage, and adopted by an ultra-conservative fanatical type of elderly woman, incapable of any degree of understanding of her charge. The girl's favorite form of recreation was taking long walks by herself after the dinner hour, a practice permitted by the otherwise cautious guardian. A chance acquaintance with a discharged soldier developed into a nightly rendezvous, and an unlighted park afforded the opportunity. Agent's attention was brought to the case when the girl, infected with gonor- rhea, was brought into court by the guardian, who demanded that she be sent to a reformatory. The agent's recommendations, however, were accepted by the judge, and the girl, only slightly infected, was placed under treatment until entirely cured ; she was then sent to the home of a sympathetic young woman in a small town, to work as mother's helper. Our last reports show that the girl has remained almost a year in this position and that she is happy and contented. The matter of the unlighted parks was taken up with the mayor and the park commissioners, which resulted in provision for additional lighting and policing. Mae. — We have in this case a type of hardened prostitute, infected, a con- tinuous source of danger to the community. A soldier sent to the venereal disease hospital named the girl as the source of his infection, and agent took immediate steps to have the girl apprehended and examined. A careful study of condi- tions did not disclose evidence that would warrant agent in giving her a " chance " on probation, and upon agent's recommendation, she was sentenced to the State reformatory, where treatment and training will be given, covering a period of years. Bertha. — This girl presents a type of feeble-mindedness that is frequently the victim of exploitation. At 22 she possessed a mental age of 8. Her school record showed that she was permitted to stay in the third grade until she was 17. A few attempts at various occupations followed, but she was not kept longer than a day or two in each position. Then she commenced to run away from home. The last time her father, a respectable clerk, found her, she was living in a room over a stable with an Italian chauffeur who brought sailors EEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 87 to lier every night. The Italian collected the money from the sailors. The girl was arrested on her father's complaint and sentenced to 90 days in the county jail. Agent became interested in the case and secured mental and physical exami- nations, which disclosed her hopeless state of feeble-mindedness and a four plus Wassermann reaction. The girl was removed to the State institution for the feeble-minded, where she will be safely kept from the reach of the exploiter, and, as a protection to the community. Lena. — This is the case of an attractive little 17-year-old girl, living alone and working in questionable restaurants near a large camp. The military police requested her detention for examination, as she was continuously seen in the company of soldiers. Examination showed the girl to be free from infection, but it brought her to the attention of agent. She told agent that her family was scattered and indifferent and that no one ever took any interest in her. A soldier had promised to marry her, but had left her after persuading her to have immoral relations with him, and she was discouraged and ready to embark on a life of prostitution. Agent was able to gain this girl's confidence. She went to live in a home agent selected for her, worked steadily and attended church at agent's sugges- tion, helped and encouraged by her sympathy and friendship. In the rehabilitation of tliis girl, agent was not only helping an individual but she was saving the camp and community from the inestimable cost of an additional prostitute. Sophie. — A parallel case is found in this bright little Polish girl of 17, whose questionable conduct with sailors caused the chief of police to refer her to agent. Agent found an intelligent, responsive girl with marked traits of leadership. The Polish home she came from did not fulfill all of her American- acquired ideals, and her work in a Polish restaurant did not absorb an appre- ciable amount of her youthful energy. She " hung around " other restaurants talking to sailors. Agent found that the girl had committed no wrong, but that she was in serious danger if she were to be left to her own resources. She responded readily to agent's suggestion to join a girl's club, and when it was found that the Neighborhood Settlement House afforded no club to which she was eligible, at agent's suggestion the girl organized her own friends and brought them into the settlement. Our last report shows that her club had more than doubled its membership. In cases like these the keen sympathy and understanding of trained workers effect what rigid police methods fail to touch. Belle. — This is the instance of a girl of respectable parentage who got beyond the control of her family. She became infected with chronic gonorrhea, and while detained in the city hospital she freely discussed her fondness for sailors and her plans to don a uniform and board a ship. Agent had the girl placed under mental observation, which proved her to be feeble-minded, and she was committed to a State institution, where she will be safely kept away from danger to herself and to the community. Margaret. — This is the case of a 21-year-old girl, having a high-school edu- cation and possessed of some natural attainments. The girl was a stenog- rapher, but later became an " instructor " in a closed dance hall at the alluring salary of $45 a week. The temptations to which girls are exposed in the closed dance halls proved too much for her, and she was arrested when she was found in a compromising position with two soldiers in a park. 88 REPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. Esther. — This girl was brought up on a ranch, and the agent found her in tlie city deserting domestic service for tlie glamour of the closed dance hall. An intoxicated sailor afforded an opportunity for grand larceny, and her arrest followed. Probably one of the most serious problems our agents encounter in rehabilita- tion work is trying to compete in honest work with the salaries, fascination, and excitement of the closed dance halls; and the fact that many of the so-called instructors eventually come under the agent's notice and care is evi- dence of their vicious influence on the community. It is fortunate that this type of dance hall is confined to a few cities. In many cases the women and girls who come under our agents^ observation have not been involved with sailors or soldiers, but they have been directly involved with civilians. By the very nature of their offenses and their condition they are a potential menace to the armed forces in their vicinity, and it is an important part of our agents' duties to afford such civilian offenders as careful and inter- ested attention as the girls who have been in direct contact with Liniformed men. Agents are frequently called into conference on community matters affecting problems of delinquency, and their advice is sought by all organizations having a girl problem. A num- ber of communities have been exceedingly cooperative and anxious to avail themselves of the cooperation of our workers. The following cases present types of civilian and community prob- lems handled by agents : Helen. — In this case the girl, a foundling, spent 18 years of her life in a church institution under the strict surveillance of the instructors. When she was placed out in a housework position and upon her own resources there was a marked change in her conduct. No responsibility could be placed in her ; her work grew steadily poorer ; and she was not able to retain a position. After a year or two of failures she was taken from housework and placed in a factory, where she was able to do simple operating. Life in furnished rooms brought with it the usual loneliness, and seeking for pleasure the girl became involved with the worst type of Greek candy-store keepers. Agent found her too ill to work, in the secondary stage of syphilis, but still attempting to ply her trade at night. The girl was admitted to the city hos- pital for treatment and placed under mental observation. She was committed to the State institution for the feeble-minded to remain during her child- bearing years. Rae. — This is the case of a girl of 23, brought up in a good home and graduated from high school. An unfortunate marriage with a dissipated man who infected her with syphilis resulted in a separation. Following the separa- tion, invalidism from an accident was the direct cause of an excessive use of drugs, and agent came into the case after the girl had been brought Into court for violation of the State drug law. Agent persuaded the girl to undergo treatment for drug addiction, which she consented to do, and the case is closed with the girl returned from the hospital, living with her sister, and entering upon a course in the local business college. Mildred. — Tliis is the instance of a girl of 17, of youthful spirits and energy, living alone with a very strict father. She had been returned by the Trav'elers' Aid Society after an attempt to change her lot by running away, and on one occa- sion her father had had her arrested for attending a dance. They lived in con- REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 89 staiit discord, due to the man's strict discipline of her, and the girl's struggle for self-expression. When agent caiue into the case the father was making an effort to have tlie girl committed to a reformatorj'. Agent was successful in a plan to permit the girl to attend community dances, entertain her sailor friends in her home, and to interest her father in her friends. Whenever the hiws permit, agents make every effort to have the male offender accorded the treatment meted out to the woman offend- ers. Communities providing facilities for physical examinations are steadily increasing, and the man is also prosecuted if sufficient evi- dence can be secured. The following illustrate cases in which man offenders have been dealt with by agents of the board: KatJierine. — In this case a girl of the hardened prostitute type lived in the United States but worked each day in the " cribs " attached to the barrooms in a Mexican town across the border. The barkeeper who secured the post for her paid her daily license and collected her earnings, and then, because they were constantly crossing and recrossing the border, as a precautionary measure, he married her. When agent came into the case she found the girl a drug addict and infected with syphilis, and she was placed in the city hospital. The man was not permitted to escape, however, and a charge of violation of the Mann Act has been brought against him for his activities prior to mar- riage to the woman. At the last report he was awaiting trial in the county jail. Hattie. — In this case a 17-year-old girl lived with her father in a small town near an arsenal. The neighbors complained about tlie number of soldiers and other men going in and out of their house and the district attorney had the girl brought before him. She told a sordid story of immorality and incest dat- ing back too early for her to remember when it all began. Her father liad done no work for years and lived on her illicit earnings. The girl had an older sister who had left her husband to live with a Negro consort, and the girl also admitted relations with her brother-in-law and with the Negro. A Greek restaurant was named as a place regularly visited by the women. Further investigation in- volved an 11-year-old daughter of the married sister, who had also been ex- ploited by the degenerate members of this family. It is almost unnecessary to add that every one of the persons who figured in this case were actively infected with venereal disease. Sentences in reformatories were given the two women, while the father of the girls, the son-in-law and husband, and the Negro consort received sentences of 15 years each in State prison on charges of rape and incest. The restaurant keeper was ordered examined and found to be in an active stage of syphilis, and his restaurant was closed by the district attorney and the man ordered to take treatment. The work of agents of the board is not confined to work with in- dividuals. While it is important to have appeals from the pulpit and from women's organizations and civic associations when the need is felt for new machinery in the community, it is infinitely more forceful to present an appeal based on actual experience. When a worker can show by real histories the necessity for making provision for meeting the problems and can speak from actual experience of unsatisfactory conditions in the community, the force of the appeal is going to be felt. 90 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. In a recent investigation of histories of a number of unmarried mothers in an eastern city an appreciable number of the girls named a city park as the place where they had practiced immorality. Agent's investigation brought forth the facts that the park was in an isolated part of the city, and that it was poorly lighted and in- sufficiently policed, facts that were obviously known to an indifferent community. When, however, she was able to state the number of girls bearing illegitimate children on account of opportunities pro- vided in that park, and the girls and their babies, could be produced, it was not difficult to arouse the community to concerted action to remedy the evil with a power and force that unlimited agitation against an unlighted park fer se never could have brought forth. An agent having the actual disposition of a number of feeble- minded girls, with no facilities for giving them the custodial care, without which neither they nor the community can be safe, can make the most direct appeal for an institution for the feeble-minded. Through intensive case-work methods all of the facts of a delin- quent girl's history are brought out, and a pretty fair estimate of community weaknesses can be observed in the summary of the records. In a southern city it was found that a great number of young girls brought into court on various charges of delinquency had been employed in candy factories. The agent made a study of the connection between that sort of employment and the offense, and her investigation showed that the low wages prevailing in the candy trades forced the unskilled worker to supplement her earnings by acts of prostitution. Her findings were that employment in candy factories in that community would be classified as one of the dan- gerous trades for young women, at least until compensation had been adjusted to permit of a living wage. Evidence of the social " weak spots " in a community are repeat- edly forced upon the attention of agents of the board. They know from carefully compiled case records of delinquent girls just how vicious an influence is the average soft-drink parlor and the shoe- shining parlor conducted by Greeks; the public taxi, with its pro- curing chauffeur ; the unsupervised dance hall and the indecent bur- lesque show. They are able to present these cases with telling force in a campaign to exterminate the sources of prostitution. By carefully compiled studies of court sentences showing the dis- position of women's cases the pressure of public opinion has been brought to bear by agents on the importance of provision for mental and physical examinations of offenders, of facilities for custodial care of the mentally unsound, and of training and education for those competent to profit by it, and they have helped to expose the utter futility of the fining system — a system licensing and tolerating prostitution, not tending to eliminate or control it. 1 " t t /, ■ ' ' • ♦ _» j^ S ii "S S _■ '■>. "^^* ife* ft ' > - ^ i 2 1 vi^^^ . fel ! ! : / : I • » • , "" .^«:^./ .• *v.f^ * *-^ ■ • • a » ■ ' * .« ■ . ♦ .*» ♦ i " ^^ *• V ■^'■^■;■■■ i" ■ • ,- . ■'; • '■■ ■ •#^ • 1* ■■.-:■■;.■,..■ ♦^ ■ ^ : "■ ,' -' • ■ ■' • ' *: . ■ » ■ * " «r\ ■ft • • * f :. • * ' > • * • ', ♦ • ;. % > • * "W^ * ' , •* ■ * ■ Si e n en Q- ^ LU III (X. a < n iX. Ill - II) Q LU o < o >. li. O op O 3 LU rr u < ir -) UJ o X CO 1- U. Q- O tu O o 1- 91 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 91 Monthly text reports received in Washington show the far-reaching influence of agents in the community and the wide variety of com- munity problems they are called upon to meet. On the prevention of delinquency side an agent in a New England city recently made a survey of recreational opportunities for girls, showing the lack of such opportunities for girls between tlSe ages of 18 and 25. Carefully selected data of this sort forms the basis of a campaign for additional recreational facilities. In the hope of securing publicity in prison conditions and intelli- gent interest in the management of public institutions in a Middle West city a study was made of conditions in three municipal houses of detention, and the report was presented to the police committee of a civic organization. An agent in the Southwest instituted a school for women confined in a venereal disease ward of the city hospital. The work was started primarily for the education of the women, but it has stimu- lated an interest in something besides the continuous recital of their experiences to each other. The moral effect upon the women, making them feel — as it has — that their welfare was being considered, and that they were not merely consigned to isolation and forgotten, has been pronounced. The foregoing is typical of the varied activities of the field agents, but results are necessarily intangible and can not be set forth in figures. Geographic distHhution of the sources of infection of lOfiOO sol- diers reporting to the Surgeon General of the Army. {See map opposite; also Tdble^ p. Ji-8.) This distribution demonstrates the fact that every State is in- volved, even in the consideration of this relatively small number of in- fections, and that prostitution and venereal disease are matters of compelling national importance as well as serious local concern.^ This demonstration would be strikingly emphasized if there could be added to it the geographical distribution of the sources of infec- tion of 21,000 sailors reported to the Surgeon General of the Navy, a very large proportion of which was contracted in the United States. This demonstration is concerned with the distribution of sources of infections of soldiers. It is obvious that the protection of the civilian population is a matter of very considerably greater im- portance, a fact which is established beyond question by the reporting of 326,000 cases of infection to the State commissioners of health this last year and by the estimate that there were over 1,500,000 cases of gonorrhea, syphilis, and chancroid in the civil population of con- tinental United States during this period. 1 The numbers of cases reported as infected in different cities are largely dependent upon tlie presence of bodies of troops in the vicinity, and therefore can not be taken as necessarily indicating the respective vice conditions in the communities. 92 EEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD» OQ 5; <=5 o <^ 1^ 5-0 -^a S •1^ •9 p^ ■G ft §3 « ft t I COO O O CO -lO W3.-HCC^-CCO^ t^ i-i-ut-h O (N « (N i-( tC C-J t-H CO T-H CO o; Tj-oio ; o cc -.o; CO C^ (N CO o «o ^ ^ ..-HCO^' OC i-H T-H tH )-l CO CO r- o uti CO t^ o CO -H^0 . ■ .?QiO . 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J o 9-3 S?g ° s '^ 9 ^ ^ M Pi CD 2 » rf-e-ti-l °^SPPPPggS°° SSooo'oo'oocgS pjqoa'aja^cDii^ajiDp^jq « n a a I § a a 3 a^S eie^^;!z;;2;i2;?^^;25^EH 15610—20- [BJOi cicoccootoiNco-tt--T-o ■msuoosjAi »0 ir. f-t CO »0 t^ O IN 00 It to COi-IC-l 00 •■enngji^ ?s8jv^ "^■*OO»£3T**10»O00WOI- ■ctH c^i o c I CO i^ cj: oi c:^ CO * •■'^ »H CO CO CM ■^uonija^ •q^m •SBX9X •98SS3TrU8J, •Bm[OJeo qinog ■pn^isi epoqy: •BraBAi^snngj •uoSaio ■'BraOTIB[3[0 «-H Cl IN IN Oi I l-^ t^ CO c^ r^ ^-lNc0 0r. t^CiOCOO >H CO IN -* O CO -II CO ^ 1-1 • CD ■ o t^c; CO c • ^ 'CO CO CM c t^ -t CO CO t^ a; u:> r^ cr. 1 _ - T-ii>icoiocoi-iccc^ioiNr^o I C5 i-l e3: T-l INCOTt^-ihCOOOiOINOOt^f— IIN i-li— Ii-ICOINt-i OOI ffiC0i-ITfl-*rtO-. CM r-1,-11-1,-1 ,-1 OiC •oiqo (iO^COOOO(NCOdlNCMOri-l 1-1 INOOUD-tCiOCM^H-:}! •Bnnoj'BO m-iON CTSCCTflO-c^CMCDCTOCr^lCIN r-IINTtlf^'^'iiJHt^lNCMClOOO •i[JOj^ AS.8J^ r^i-it^t-ocoococnr^oct^ CM'^lO^b'COCMOCOCOOaO i-t CM CM r-l r^ T-l •OOpcaH j119^ t>r^ccioc-■ rt rt -ii oi •eirqsdmGH -siSN •^9SJ8£ JAdf^ •jmossiH iOlOi— l-^CO 'ICODICIC'IO COlO»OT-!»OCMCOt--COt^OOOO CM CO i-< CO 1-1 »0 CO CO O CO ^co-;^0500lLCo:■coo»oco ci CO »^- CO o -f -.ai 00 oo c^ H O cs ' go.s.g il-S'llgflc! CD g ;^ R C I^ s~ '^'co'w'm ' S3 O OJ CD pj +J -Ui +J 2j3 ftqS g g O o O O C3 o'o O S a 3j3fc^tHiHfc-.t-.i-.tH(^;:J5 Pi a OCI cifiS sa ea aas^^^ oo3f33id335doo 98 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. Tabulations showing red light districts discovered by the board's agents which remained open on June 30, 1920. City. Albany, Ga Bangor, Me Bath, Me Beaumont, Tex . . . . Biloxi, Miss Brownwood, Tex. . . Cairo, 111 Carson City, Nev.i.. Corpus Chfisti, Tex. Cumberland, Md. . . Des Moines, Iowa... Dodge, Kans Erie, Pa Florence, S. C Gallup, N. Mex Galveston, Tex Goldsboro, N. C Hagerstown, Md Harrisburg, Pa , Jackson, Miss Jactsonville, Fla Keokuk, Iowa Kinston, N. C Lebanon, Pa Mason City, Iowa Number of houses. 7 5 37 15 4 11 13 40 5 16 3 9 9 41 Number of inmates. City. Number of houses. Memphis, Tenn Muscatine, Iowa Nashville, Tenn Natchez, Miss Old Forge, Pa Ottumwa, Iowa Paterson, N.J Pensacola, Fla Peoria, 111 Port Arthur, Tex Raleigh, N. C Reno, Nev.i Savannah, Ga Scranton, Pa , Sioux City, Iowa , Springfield, 111 Tacoma, Wash , Tampa, Fla Tonopah, Nev.i Troy, N. Y Vicitsburg, Miss Wilson, N. C West Palm Beach, Fla. Total Number. of inm.ates. 10 8 45 27 13 37 12 18 18 15 10 40 15 42 95 38 15 1,016 1 Information secured by correspondence. Number of houses and inmates unknown. Program for Assistance of States in Maintainijstg Civilian Per- sons Whose Detention, Isolation, Quarantine, or Commitment TO Institutions Has Been Found Necessary for the Protection OF THE Military and Naval Forces of the United States Against Venereal Disease. In continuation of the policy adopted last year the Secretary of War and the Secretary of the Navy authorized the Interdepartmental Social Hygiene Board this year to give further assistance to the States in the maintenance, subsistence, and treatment of civilian per- sons with venereal disease who were a menace to soldiers or sailors. In July, 1919, the boai'd adopted the following regulations relative to this type of assistance: GENEEAL REGULATIONS GO\'ERNING APPEOPRIATIONS FROM THE UNITED STATES INTER- DEPARTMENTAL SOCIAL HYGIENE BOARD FOR ASSISTANCE OF INSTITUTIONS IN THE MAINTENANCE OF VENEREALLY INFECTED PATIENTS. The Interdepartmental Social Hygiene Board at a meeting held on July 22 decided " that in general, no further appropriations will be made for the assistance of institutions in the maintenance of venereally infected patients under the provisions of sections 2 and 5 of the Chamberlain-Kahn bill unless satisfactory assurance is secured (a) that the institution concerned is a perma- nent establishment, (&) that it cares for persons infected with venereal dis- ease who, if free, would be a menace to soldiers and sailors, (c) that a temporary emergency exists making financial help from the board an imperative necessity, (d) that the board of health of the State in which the institution making application is located urgently recommends that the board give the tempo- KEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 99 rary financial assistance requested, (e) that tlie allowance for per capita cost per diem for maintenance will not exceed the actual cost (maximum $1.50) of such maintenance, and that maintenance will not include rent, insurance overhead, or other items of maintenance that do not vary with the number of patients cared for each day by the institution, and (/) that the institution concerned provides a wise policy of medical treatment, hygienic instruction, vocational education, recreation, and social rehabilitation for its inmates." Between June 30, 1919, and July 1, 1920, the board, acting under this authority, gave assistance for these purposes to the following institutions and for the following amounts : 1. State Training School for Girls, Birmingham, Ala .$1,000.00 2. Ward L, San Francisco Hospital, San Francisco, Calif 8, 007. 00 3. Jefferson County Institutions, Louisville, Ky 3, 993. 25 4. Mercy Hospital, venereal disease detention ward, Baltimore, Md_ 100. 00 5. State Department of Health Hospital No. 1, Baltimore, Md 2, 134. 11 6. Fairmount Hospital, Kalamazoo, Mich 11, 077. 27 7. Female Detention Ward, St. Louis City Hospital, St. Louis, Mo- 1, 233. 84 8. Florence Crittenton League, New York, N. Y 349. 50 9. State Home and Industrial School for Girls and Women, Samar- cand, N. C 48, 929. 43 10. Akron Welfare Home for Women, Akron, Ohio 1, 860. 73 11. Cincinnati General Hospital, Cincinnati, Ohio 5,934.00 12. Anna Finstrom Detention Hospital, Columbia, S. C 3, 739. 50 13. Shelby Hospital, Memphis, Tenn 4, 658. 37 14. Chattanooga Venereal Quarantine Hospital, Chattanooga, Tenn_ 7, 200. 00 15. Texas Girls' Training School, Gainesville, Tex 4, 136. 99 16. City Hospital and City Home, Norfolk, Va 1, 945. 47 Total paid 106, 299. 46 STJMMABY. Average number of venereally infected persons in above institutions monthly during period in which assistance was given 11, 493 Actual total number of days maintenance, treatment and subsistence given by above institutions 96, 842 Average per capita cost per day $1. 11 Assistance of this type will no longer be permitted after July 1, 1920, in pursuance with a provision attached by Congress to this appropriation last June. This provision reads as follows : Provided, That no part of these sums shall be expended in assisting reforma- tories, detention homes, hospitals, or other similar institutions in the mainte- nance of venereally infected persons. An investigation has been authorized by the Interdepartmental Social Hygiene Board for the purpose of evaluating the investment made by the Government during the war through the Commission on Training Camp Activities for the construction, repair, and equipment of such institutions as these. This investigation will further evaluate investments that were made last year and this year for the assistance 100 REPORT U. S. INTERDEPAETME^TTAL, SOCIAL. HYGIENE BOARD. of such institutions in the maintenance of venereally infected inmates. It is expected that these investigations will secure material for a re- port this coming year. (See Appendix for regulations and applica- tion form in connection with this appropriation. ) Eeport on Medical Measures. COOPEKATION OF DIVISION OF VENEREAL DISEASES, UNITED STATES PUBLIC HEALTH SERVICE, STATE BOARDS OR DEPARTMENTS OF HEALTH, AND THE INTERDEPART- MENTAL SOCIAL HYGIENE BOARD. Sec. 6. * * * the sum of $1,000,000 whicli shall be paid to the States for the use of their respective boards or departments of health in the prevention, control, and treatment of venereal diseases, this sum to be allotted to each State in accordance with the rules and regulations prescribed by the Secretary of the Treasury in the proportion which its population bears to the population of the continental United States, exclusive of Alaska and the Canal Zone, according to the last preceding United States Census, and such allotment to be so con- ditioned that for each dollar paid to any State the State shall specifically ap- propriate or otherwise set aside an equal amount for the prevention, control, and treatment of venereal diseases, except for the fiscal year ending June 30, 1919, for which the allotment is not conditioned upon the appropriation or set- ting aside of money by the State: Provided, That any State may obtain any part of its allotment for any fiscal year subsequent to June 30, 1919, by spe- cifically appropriating or otherwise setting aside an amount equal to such part of its allotment for the prevention, treatment, and control of venereal diseases. (Extract from Chapter XV, Army appropriation bill of July 9, 1918.) The regulations governing the use of the allotments provided the States by this appropriation from the Grovernment are promulgated by the Secretary of the Treasury in conformity with the provisions of this act. The disbursements, auditing, and accounting for these funds are activities that are carried on by the United States Inter- departmental Social Hygiene Board. The Division of Venereal Diseases of the Public Health Service has been authorized and directed by the Secretary of the Treasury, pur- suant to the authority vested in him by this act, to carry out the pro- gram which he has prescribed. The duties of the Division of Ve- nereal Diseases, as specified by Congress — shall be in accordance with rules and regulations prescribed by the Secretary of the Treasury (1) to study and investigate the cause, treatment, and pre- vention of venereal diseases; (2) to cooperate with the State boards or de- partments of health for the prevention and control of such diseases within the States; (3) to control and prevent the spread of these diseases in interstate traffic: Provided, That nothing in this chapter shall be construed as limiting the functions and activities of other departments or bureaus in the prevention, control, and treatment of venereal diseases and in the expenditure of moneys therefor. It is obvious, therefore, that for the year ending June 30, 1920, this governmental fund for allotment to States for the prevention, treatment, and control of venereal diseases involved in its application REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 101 in the States the adoption and operation of rules and regulations laid down by the Secretary of the Treasury and a regular system of disbursements and accounting in conformity with rules issued by the Interdepartmental Social Hygiene Board. A statement of these rules governing disbursements and account- ing are appended in this report. It is sufficient here to call attention to the fact that every effort has been made in constructing these regu- lations to safeguard the Government and the States so that these financial transactions may not at any time be subject to discrediting criticism. Statement Summarizing the Progress Made This Year by the Division of Venereal Diseases or the United States Public Healtpi Service in Cooperation With the States and With the United States Interdepartmental Social Hygiene Board, Ap- plying THE Program Promulgated by the Secretary or the Treasury and Supported by the Federal Allotments to States, Through the United States Interdepartmental Social Hy- giene Board for the Prevention, Treatment, and Control of Venereal Diseases Through State Departments of Health.^ medical measures. (A) REPORTING. Since the creation of the Division of Veneral Diseases a determined effort has been made to secure the reporting of cases of venereal dis- ease to the State health officers and thence to the Public Health Serv- ice. It was felt that the first step toward the cure of these diseases was knowledge of the extent and distribution of infections. There- fore, one of the conditions under which each State received its por- tion of the Chamberlain-Kahn funds was the existence of a report- ing law. For two years now, monthly reports from all States par- ticipating in the fund have been received and these figures are avail- able. It is not claimed that the figures show the extent of venereal dis- ease in the United States, because all persons infected with such a disease do not go to a physician for treatment, and because all physi- cians have not yet been brought to a realization of the importance of reporting. It is believed, however, that as people are gradually edu- cated to realize that they must receive treatment from a physician, and as physicians are brought to realize more definitely their respon- sibility in the matter of reporting, the data collected will have real statistical value. What figures do show definitely, however, is that progress has been made in this direction during the past two years, 1 Quoted from address of Asst. Surg. Gen. C. C. Pierce, Division of Venereal Disease, United States Public Health Service, before the Academy of Medicine, New York City, Oct. 7, 1920. 102 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. and that these figures may be expected in time to give a true picture of conditions. In 1919 there were reported to the State boards of health 131,193 cases of gonorrhea ; 100,466 cases of syphilis ; 7,843 cases of chancroid and others ; or a total of 239,502 cases of venereal disease. In 1920 there were reported to the State boards of health, 172,387 cases of gonorrhea; 142,869 cases of syphilis; 10,861 cases of chancroid and others ; or a total of 326,117 cases of venereal disease. The total in- crease during the past year therefore has been 88,615 cases or 36 per cent. The relative increase of the cases of gonorrhea reported was 31 per cent and of syphilis 42 per cent. As gonorrhea is generally estimated as from two to four times as prevalent as syphilis a rough check can thus be kept on the finality of reporting figures. Not until the number of cases of gonorrhea reported at least doubles those of syphilis, can the reports be relied on as showing even approximately the true incidence of venereal dis- ease in the United States. (B) TREATMENT. After securing the reporting of cases of venereal disease the next step in limiting venereal infection is necessarily making available proper treatment to all those who are infected. This is a simple enough matter for the men and women in com- fortable circumstance, who, as a matter of course, consult reliable physicians and secure adequate treatment. There are, however, a great number of people receiving moderate wages for whom a pro- longed course of expensive treatment is prohibitive in price. These people are only too prone when they feel improved after a couple of treatments to decide that in view of the expense incurred and the benefit already received further treatments are unnecessary. They therefore form a body of insufficiently treated patients who sooner or later develop a recurrence of disease. Then there are also, of course, the ignorant and indigent people who are unable to pay anything whatever for treatment, and who therefore either treat themselves with some patent medicine or go without treatment and who in either case are potent sources of infection. The establishment of clinics where reliable treatment can be ob- tained at small cost or free of charge for those unable to pay was believed to be the way in which to cope with this difficulty. The es- tablishment of such clinics throughout the United States has there- fore been promoted. In 1919 there were 237 clinics operating under the joint auspices of State boards of health and the United States Public Health Service, and 167 regularly reported their activities. Of the total number of clinics, 145 were established during the year REPORT V. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 103 1919. In 1920 there were 427 clinics operating under State boards of health and the United States Public Health Service, and 383 clinics regularly reported their activities; 190 of these clinics were estab- lished in 1920. It can be stated therefore that there was practically a 100 per cent increase in clinic facilities throughout the United States during the past year. There was also a 100 per cent increase in clinics reporting. Clinic reports show that twice as many patients received treatment in 1920 as in 1919. In 1920, 126,131 patients were admitted against 69,092 admitted in 1919, an increase as stated of over 100 per cent. Further than this the figures show that the treatment received by patients becomes progressively more efficient, for while 6,922 patients were discharged as noninfectious in 1919, 34,215 were discharged as noninfectious in 1920. Or, in other words, only one patient out of every ten was discharged as noninfectious in 1919, while one patient out of ever three or four was discharged as noninfectious in 1920. Moreover, as would be expected from the above, while the number of patients was doubled, the numberof treatments was tripled. In 1919, 8 treatments were given for each person admitted, while in 1920, 12.5 treatments were given for each patient, showing again greater efficiency in treatment. Nearly three times as many Wassermann tests were made in 1920 as in 1919 (63,929, as against 175,872 in 1920), and nearly twice as many microscopic examinations for the gonococcus (89,419 as against 155,275 in 1920), showing the laboratory facilities were being utilized more and more by physicians as well as in the clinics themselves. State boards of health report 328,382 doses of arsphenamine dis- tributed to physicians, hospitals, and clinics during 1920. Com- pared with last year's report, 118,055, this is an increase of 210,327 or 186 per cent. Other medical activities have been included in this campaign in order to secure the cooperation of physicians and dentists and a special course for graduate nurses given at Columbia University in order to fit them for venereal- disease-control work. (C) CLINICS. The corner stone of the medical side of the work has, however, been the clinics. A survey of cities with a population of 15,000 or over made possible a comprehensive study by representatives of the United States Public Health Service of 359 clinics. The study covered the methods of operation, and it is hoped that the result will be improved clinic efficiency. Clinics were rated under the following heads, a mere list of which will give some idea of the scope of the survey: Location, equipment, 104 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. sterilization, histories, records of treatment, use of distilled water, personnel, salaries, treatment, clinic days and hours, daily average attendance, laboratory facilities, fees charged, method of building up clinic, average monthly cost of operation, per capita cost of treatment. An ideal public-health venereal-disease clinic must have a con- venient location, preferably in some public building where attend- ance will not be conspicuous. There must be facilities for diagnosis and for competent treatment for both gonorrhea and syphilis. The staff must be adequate for the clinic needs and for the necessary follow-up work. There must be day and evening hours, so that those employed can receive treatment, and there must be sufficient attend- ance to result in a reasonable per capita cost of treatment. Treatment must be free to those unable to pay. I'he type of treatment given is, of course, all important in deter- mining clinic efficiency. The survey showed that in 325 clinics, or 90 per cent, the treatment for gonorrhea was efficient and that in 337 clinics, or 93 per cent, the treatment for syphilis was efficient. Three hundred clinics, or 85,5 per cent, had equipment which was considered entirely adequate. Accurate diagnosis being essentially of prime importance, careful observations were made with regard to facilities for diagnosis. It was found that dark field examinations could be carried out in 226 clinics (62.9 per cent) ; Wasserman tests could be made in 166 clinics (46.2 per cent) ; microscopic examinations for the gonococcus could be made in 202 clinics (56.2 per cent). Out of 342 clinics reporting on hours, 198 or 57 per cent, had even- ing hours. Out of the 309 clinics reporting on attendance 175, or 56 per cent, had an average daily attendance of between 10 and 100 patients per day, and 10 of these clinics averaged over 100 patients per day. The per capita cost of treatment is an excellent way in which to judge the efficiency of a clinic from the standpoint of public health. In 50 clinics this averaged 50 cents or under, in 79 clinics it was 50 cents to $1, in 37 clinics it was $1 to $1,50, and in 20 clinics it was $1.60 to $2. The per capita cost of treatment was therefore under $2 in 80 per cent of the clinics. Now that one clinic survey has been completed and analyses have been made of the data on hand, an effort is being made through the representatives of the United States Public Health Service to stimu- late the minority of clinics where satisfactory treatment is not given in order that they may bring up their standard of efficiency to com- pare favorably with the other clinics. In the course of a few months when there has been time for reorganization, a second survey will be REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 105 made and the clinics will again be rated, credit for their improved technique, etc., being given. In this way it is hoped that the clinics may be brought to conform to a high standard of efficiency, so that any man or woman in the United States who is infected with venereal disease may go to a free clinic and be absolutely sure in every case of obtaining the treatment for the disease that is considered most effective by the best medical authorities of the country. (D) LAW ENFORCEMENT. Although it will be impossible to go as fully into the legal and educational sides of the program as has been done on the medical side, still some consideration of these important phases should be attempted if only to give a well-rounded conception of the scope of the entire work that is under way. The first care of the legal section was, of course, to see that as many" States as possible secured their portion of the Chamberlain-Kahn fund. During the second year it was necessary for the State to appropriate an equal amount in order to do so. In both '1919 and 1920 47 States qualified. Further work of the legal division consists in fostering the passage of State laws and city ordinances having for their aim the control of venereal disease and in urging the enforcement of laws which have been so passed. No less than 40 States in 1919 passed legisla- tion aimed at venereal disease control; in 1920, 13 States did like- wise. In 1919 there were 222 city ordinances of this character passed and in 1920 there were 102. Gradually, of course, when the necessary legislative background has been secured, the work of this section will become more and more that of urging the strict enforce- ment of such legislation. The character of the legislation adopted by the States is varied. Model laws and ordinances that have been found serviceable have been drawn up and have been available to State and cities, many of these have taken advantage of the forms and have modeled legisla- tion by them. Such laws and ordinances include those prohibiting the use of taxicabs, dance halls, lodging houses, hotels, etc., for the purpose of prostitution. Others necessitate compulsory medical ex- amination and treatment for those arrested for sex offenses, and still others prohibit the sale and advertising of quack venereal dis- ease remedies and nostrums. The legal section has as its aim largely to aid the various States in the suppression of commercialized prosti- tution as this is undoubtedh?^ the most important focus for spreading . venereal disease. 106 KEPORT U. S. Il^TERDEPARTMENTAL. SOCIAL HYGIENE BOARD. (E) EDUCATIONAL. The aim of the educational section is to disseminate sex instruc- tion among the public and to bring before the people the knowledge of the dangers of venereal disease and the importance of prompt and efficient treatment. Educational activities have included publication of a number of pamphlets on various phases of sex education and hygiene, and ad- vice to those infected with venereal disease. In 1919 more than 14,000,000 pamphlets were distributed in response to requests ; in 1920 more than 8,000,000. The explanation of the decrease in num- ber is that such activities are being shared more and more with the State boards of health as they are willing to take over the printing and distribution of literature. Framed placards giving advice to persons infected with venereal diseases have been placed in railway cars and stations and other public places, and have been influential in inducing many persons to consult a reliable physician or to go to a clinic. Physicians and educators of the Public Health Service have given many educational lectures before societies and clubs which request their services. In 1919 there were more than 8,000 such lectures given; in 1920 there were 12,000, the average attendance being be- tween 130 and 200 persons. Health exhibits and lantern-slide showings are other features of this phase of work. More than 2,000 of these showings were given in 1919, and more than 11,000 in 1920, the average attendance being between 200 and 250. Over 1,000 educational motion-picture show- ings were given in 1919 and over 2,000 in 1920. (D CONCLUSION. It is believed that through educational work of the type described the ignorance of the public on the subject of venereal disease is gradually being dispelled. People are waking up to the dangers and consequences of venereal disease and to the vital importance of receiving treatment when infected. At the same time various States and cities are ridding themselves of commercialized prostitution, through realization of the danger caused by it to the health of the community. Along with this lessened infection and greater knowl- edge comes the all-important work of the venereal-disease clinics, which now cover the county in a network whose function it is to sift out those infected with venereal diseases who can not afford treat- ment and treat them so that they may no longer be a source of danger to the community. In these three ways progress has been made in limiting venereal infections in the past two years, but such progress since it is built REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 107 on the solid foundation of an educated public must of necessity be gradual. Elimination of venereal disease by any lightning-stroke policy is clearly impossible. One can only work steadily and sanely toward the goal in view. REPORT ON THE DIVISION OF SCIENTIFIC RESEARCH. Scientific researches supported by the board for the discovery of more effective medical measures in the prevention and treatment of venereal diseases have been extended and developed this year. The progress made in 1918-19 is described in Part III of this report, on pages 182-184. At the present time there are 35 researches being conducted, of which 2 are investigations regarding chancroids, 14 are studies regarding gonococcus infection, and 20 are researches in relation to syphilis. These are described in detail under the three headings mentioned. Six preliminary reports of scientific investigations aided by the board have been published and are also described in the following pages. Classification and Description of the Scientific Eesearches THAT ARE BeING ASSISTED BY THE UnITED StATES INTERDEPART- MENTAL Social Hygiene Board. chancroids. 1. "Manufacture and investigation of a series of penetrating or- ganic dyes in the treatment of chancroids," under the direction of Dr. Hugh H. Young and Dr. E. O. Swartz, laboratory of the Brady Uro- logical Institute, Johns Hopkins Medical School. The purpose of this research, as the title indicates, is to secure a drug that possesses the necessary penetrating power to reach the bacilli of Ducrey which are deeplj?- buried in the tissues surrounding the chancroidal ulcer. The drugs used at present have been ineffective because of their lack of penetrability. By the use of organic dyes, developed by Dr. White at the Brady Institute, to which antiseptic groups have been chemically bound, Dr. Young and Dr. Swartz have been able to secure nonirritating drugs of low toxicity and deep pene- tration, and of much greater sterilizing value than others pre- viously in use. Mercurochrome 220, one of the new drugs that has been manufactured in the laboratory of the Brady Urological Insti- tute, has been used in the treatment of chancroids, in the form of ointments and solutions. Clinical reports show that this drug, used as an ointment, is very successful, and a great improvement on other applications used. These investigations are being continued. Appro- priation for this research was made in May, 1919, and renewed in March, 1920. 108 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 2. " Study of the etiology of chancroids with especial reference to bacteriology, diagnosis and serum reactions," by Dr. Oscar Teague, in the department of bacteriology of the College of Physicians and Surgeons, Columbia University. Although much work has been done on the Ducrey bacillus, there is still a considerable amount of uncertainty as to the etiology of chancroid lesions, and practically nothing is known concerning the more intimate bacteriology of these organisms, and the immunological and detailed transmission of these organisms. Investigations that have been carried on in the Columbia School of Medicine, department of bacteriology, show that it is possible to find the Ducrey bacilli in almost all the chan- croid lesions examined. Cultural methods have been found in this laboratory which are believed to make it possible to secure bacterio- logical diagnosis of chancroids and of the chancroidal character of mixed lesions within about 24- hours. It is proposed to continue this investigation on a large scale. Appropriation for this research was made in March, 1920. GONORRHEA. 1. "An investigation into more effective treatment in acute and chronic gonorrhea," under the direction of Dr. E. L. Eigdon, chief genito-urinary clinic, and Dr. A. S. Spaldin^g, professor of gyne- cology, Leland Stanford Junior University Medical School. These investigators are devising ways and means of keeping very close supervision over a large number of patients suffering from acute and chronic gonorrhea who visit their clinics, and are investigating sys- tematically the newer methods of treatment that have been pro- posed for these diseases. The efficiency of this treatment is to be checked up by carefully controlled bacteriological examinations. An effort will be made to improve, if possible, the methods that are found to be most efficacious. It is highly important that improved methods for treating gonorrhea be found, because many individuals having the disease fail to continue their treatment sufficiently long- to be entirely cured. The appropriation for this research was made in April, 1919. 2. " Experimental study of various methods of venereal prophy- laxis with the object of developing simpler technic, and more ef- ficient and less expensive drugs," under the direction of Dr. Hugh H. Young, assisted by Dr. William Jacks, of the Brady Urological Institute, Johns Hopkins Medical School. The venereal prophylaxis in present use in the Armj^ depends upon drugs and apparatus avail- able only in especially equipped stations, and is tedious in adminis- tration. The purpose of this research is to procure a preventive for the Army more easily applicable and less expensive. Experimental REPORT U. S. INTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. 109 animals infected with syphilis and gonorrhea have jjeen used as the basis for this research. Tests have been made on the gonococciis with mercurials developed in this laboratory, with soaps, with mixtures of acid reaction fatal to gonococci, and with various mixtures usually prepared as a paste with starch, or gum acacia and glycerine. Studies on the effect of these substances are jusc beginning on the spirochaeta. It is hoped that it will be possible to secure a drug for the early treatment of the venereal diseases that will be effective in a single application, and colorless, odorless, nonirritating, water-soluble, and fatal to both gonococcus and spirochaeta in a very short time. The results already obtained are considered promising in a high de- gree. Appropriation for this research was made in May, 1919, and renewed in March, 1920. 3. "Development of new synthetic drugs for the treatment of gonorrhea," under the direction of Dr. Hugh H. Young, professor of urology, and Dr. E. C. White, experimental chemist to the Brady Urological Institute, Johns Hopkins Medical School, assisted by Dr. E. O. Swartz and R. W. Hale, jr. The drugs in present use in the treatment of acute gonorrhea have been, in the main, ineffective. This investigation is for the purpose of synthesizing drugs which will possess qualities superior to those drugs in present use, and testing their comparative antiseptic values experimentally and clini- cally. A considerable number of new and original organic chemical compounds consisting of mercury and dibromfluorescein, a substance closely related to eosin, have been synthesized and tested clinically as well as in the laboratory. The most successful of these com- pounds to date is mercurochrome 220, a new antiseptic, which has been found to be more potent and at the same time less toxic and irritating than other chemicals now in use. Drs. Young, White, and Swartz in synthesizing this new compound seem to have been successful in loading the penetrating power of a dye with the germ- killing power of mercury in a nonirritating form. Aimed at a disease almost as prevalent as measles and as serious as gonorrhea, mercurochrome does not lack a wide field. There seems to be the promise of large possibilities in the early clinical findings. The compound is now on the market and available for the use of physi- cians. Its use, which is now being rapidly taken up throughout the United States, has resulted in the cure of hundreds of cases of severe infection which had hitherto resisted all efforts to cure. A full report of this research is to be found in the Journal of the American Medical Association, November 15, 1919, volume 73. The investiga- tion is being continued, and recent reports indicate that additional advance has been made in the perfection of this drug. Scientific processes whose discovery has been aided by the United States Interdepartmental Social Hygiene Board are not patentable. The 110 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. appropriation for this research was made in May, 1919, and renewed in March, 1920. 4. " Investigations relative to the development of an internal uri- nary antiseptic," under the direction of Dr. Edwin G. Davis, director of the pathological laboratory, University of Nebraska College of Medicine. In previous studies carried out by Dr. Davis, it has been possible to establish a definite relationship between the chemical struc- ture and renal excretion of drugs, and to predict with reasonable ac- curacy which drugs would be likely to be excreted. It has further been possible to so modify these compounds chemically as to pro- duce an antiseptic compound excreted by the kidney. A number of compounds shown worthy of further investigation have been selected and are at present being tested, using urine as a culture medium. It has been shown that many compounds which are antiseptic in ordinary culture media lose this property in urine, and that tremendous variation in antiseptic strength is caused by variations in the hydrogen ion concentration of the urine. Of these compounds, one has been discovered which given intravenously to rabbits renders the urine an unsuitable culture medium for the staphylococcus. These investigations will be followed up clinically if results justify. The tremendous importance of research along the lines suggested here should be Yerj apparent. The present method of treating infection of the urinary tract is limited largely to irri- gation of the urethra and the bladder and it can not well be given until the acute stage of the disease has passed. The discovery of an internal urinary antiseptic will not only increase the effectiveness of genito urinary medication, but it will also make it possible to begin treatment more promptly. The appropriation for this research was made in June, 1919. 5. " Investigation of the value of certain anilin dyes in the treat- ment of gonorrhea," under the direction of Dr. E. G. Davis, director of the pathological laboratorj^^. University of Nebraska College of Medicine. This investigation includes a preliminary investigation of the antiseptic properties of a large number of anilin dyes on ordinary media against the colon bacillus and staphylococcus, the determina- tion of the antiseptic strength on special media against the gonococcus of a limited number of dyes selected by preliminary tests, determina- tion by animal experimentation of the toxicity and diffusibility of these dyes which may be found to inhibit the gonococcus in vitro in high dilution, and the clinical trial of any dyes which may be found to be gonococcidal, nontoxic, nonirritating and diffusible. Out of 185 dyes tested out, 20 which gave promise of value have been se- lected for further investigation. Suitable media for growing the gonococcus are being prepared. A laboratory and clinical investi-- gation of acriflavine in the treatment of gonorrhea has also been KEPOBT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. HI carried on in connection with this research. A report of this investi- gation is contained in an article prepared bj^ Dr. Davis entitled " Further observations on acriflavine in gonorrhea " printed in the Nebraska State Medical Journal for January, 1920, Volume V, No. 1, page 19. Acriflavine possesses a powerful antiseptic action, and this action is retained in the presence of urine. It is nontoxic, nonirritating, and diffusible. No extravagant claims are made for the efficiency of acriflavine in the treatment of gonorrhea, although the statement seems fully justified that distinctly better results are secured with acriflavine than with the organic silver preparations in common use. Appropriation for this research was made in June, 1919. 6. "A study of the permeability of bacterial membranes, particu- larly the organisms of venereal disease," under the direction of Dr. W. P. Larson, chief of the department of bacteriology and immunol- ogy, and Dr. J. M. McClendon, associate professor of physiology, Uni- versity of Minnesota Medical School. Investigations already under- taken in the laboratories of the Minnesota Medical School go to show that the destruction or disruption of bacteria under the influence of various chemicals, immune serums, etc., depends upon the electro- conductivity and surface tension of these bacteria. The action of such agents upon these organisms is believed to be due to changes pro- duced in the bacterial membranes. The problem proposed contem- plates a study of these conditions as affecting the permeability of bacterial membranes with a view to throwing light upon the phe- nomenon of immunity resulting from certain types of infection. It is the intention of the investigators to trace the processes in im- munochemistry by the electroconductivity method first in organisms that are easily cultivated and later in the organisms that are respon- sible for gonorrhea and syphilis. This investigation of the funda- mental or immunochemical phenomena involved in these two dis- eases should result in increasing our knowledge concerning the mechanism of the reactions that take place .in the body. Knowledge of this nature is necessary in order to combat these diseases more effectively. The appropriation for this research was made in June, 1919, and renewed in April, 1920. 1. " Studies in the bacteriology of the gonococcus — its growth pe- culiarities, classification, immunizing properties, and its mode of infecting experimental animals," under the direction of Dr. E. A. Kinsella, director of the department of experimental medicine, St. Louis University College of Medicine, assisted by Dr. G. O. Brown and Miss Natalie Arnstein. The methods employed in the research have to do with the cultivation of the gonococcus by suitable media, an'd the classification of the strains of gonococci obtained from acute cases of infection. Progress has been fairly satisfactory and it has 112 REPORT U. S. INTERDEPARTMENTAL SOCIAL. HYGIENE BOARD. been possible to devise a medium which is very satisfactory for cul- tivating large amounts of gonococci. Serum agar has been employed successfully for isolating gonococci from human sources. Certain grades in oxygen and carbon dioxide tension have not been found necessary. Animals have been successfully immunized to gonorrheal infection, by intravenous inoculation, and agglutination reactions, positive in dilutions of 1-5,000, have been easily obtained. The success of the work during the past year makes it seem reasonable to hope that some means for shortening the days of the acute infec- tion may be discovered. The appropriation for this research was made in June, 1919, and renewed in April, 1920. 8. " Investigation of phenol-alcohol derivatives in relation to their antiseptic and chemotherapeutic actions on the gonococcus and the spirochaeta," under the direction of Dr. A. D. Hirschf elder, chief of the department of pharmacology, with the collaboration of Merrill C. Hart and F. J. Kucera, University of Minnesota Medical School. Previous to this research, the phenol-alcohol group had been very little studied, although there is reason to believe that the substances combine a definite antiseptic power with a low toxicity, and that higher derivatives can be synthesized in which these characteristics can be greatly enhanced. The starting point for this research was the synthesis of saligenin. An improved method for synthesizing saligenin has been perfected, and some work has been done with the syntheses of nitro-saligenin and mercury-saligenin compounds. These compounds have been investigated chemically and have also been tested biologically. The investigations include tests for the purpose of demonstrating the antiseptic and chemotherapeutic value of these compounds. In the sodium salt of mercury-saligenin. Dr. Hirschfelder has synthesized a compound that possesses about the same antiseptic powers as the bichloride of mercury. It has been found free from irritating properties in the concentration required for antiseptic purposes. It has the further advantage of not being a dye. Preliminary tests of its value in the treatment of gonorrheal urethritis are promising. Studies upon other members of the phenyl carbinol series are under way. A tremendous number of different types of these compounds can be synthesized, some of which seem bound to possess valuable powers. It is hoped that the synthesis of some of the simpler members of the series will indicate the direction in which the best results can be accomplished. The appropriation for this research was made in June, 1919, and renewed in April, 1920. 9. " A serological study of the gonococcus group," under the direc- tion of Dr. John C. Torrey, director of the department of hygiene, assisted by George T. Buckell and Luther Conklin, Cornell Uni- versity Medical College, New York City. The primary object of this study is to determine whether the gonococcus group can be divided REPORT U. S. INTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. 113 into a number of more or less distinct types, as has been done with the pneumococcus, and, to a certain extent, with the meningococcus. The first part of the investigation is a serological stud}^ which has not been completed. It has been found that there are strains within the gonococcus group that are distinct serologically, although there is a greater degree of homogeneity than was expected. This is a promis- ing sign. Considerable success has been attained in keeping the dif- ferent strains alive. A valuable plating medium has been disf-ov- ered that favors the development of the gonococcus and inhibits the growth of other types of bacteria. It is hoped that the research will lead to the discovery of a more satisfactory antigen for use in the complement fixation test for gonococcus infections which would prove of especial importance in diagnosing obscure chronic conditions. Such a test will also help determine Avhether a person is cured of gonorrhea. It is not unlikely that vaccine therapy can be made more valuable if a vaccine more representative of the whole group of gonococci can be secured. This investigation will permit the selection of the best cul- tures for the preparation of a stock vaccine, and hence bring this mode of treatment to the highest point of efficiency of which it is capable. The appropriation for this research was made in June, 1919. 10. "An intensive study of methods for the isolation and identifica- tion of the gonococcus with a view to the determination of the homogeneity or heterogeneit}^ of strains and their etiological rela- tionships," under the direction of Dr. George H. Smith, assistant professor of pathology and bacteriology, Yale University Medical School, assisted by Dr. Elliot S. Robinson and Miss Marion E. Snavely. The first step in carrying out the purpose of this research was to find a means of cultivating the gonococcus with a minimal amount of labor and equipment. The investigation has revealed the fact that the power of growth of the gonococcus can be increased and the viability of the organism enhanced by cultivation under specific physical conditions, especially as regards the presence of moisture and the reduction of oxygen tension. Not all culture media advo- cated for the cultivation of the gonococcus meet the requirements regarding luxuriance and viability of growth. Some are particularly well adapted to maintain the viability of the organisms. Others seem particularly well adapted for a luxuriant growth. When grown under the conditions provided by Dr. Smith in the Brady Laboratory of Pathology and Bacteriology, organisms remain viable for at least a month, as compared with two or three days under normal atmos- pheric pressure. It is of the utmost importance that satisfactory cultural methods for the study of the gonococcus (its isolation and identification) be discovered if specific biologic therapy for the in- 15610—20 8 114 EEPOKT U. S. INTERDEPAETMENTAL SOCIAL HYGIENE BOARD. fection with the gonococcus is to be successful. Sufficient progress has been made on this investigation to allow a publication in the near future. The appropriation for this research was made in June, 1919. 11. "An investigation for the establishment, if possible, of a better and more definite standard of cure of gonorrheal infection in the male," under the direction of Dr. L. Hektoem, director of the John McCormick Institute for Infectious Diseases, assisted by Dr. Russell D. Herrold and Ursula S. Herrold. The methods employed in this research are (1) bacteriologic, with the special object of determin- ing the presence or absence of the gonococcus in cases under treatment, and (2) serologic tests for gonorrhea and the results of gonococcus in- fection. Improved methods have been devised and are now being employed in the detailed study of cases of chronic and latent gonococ- cus infection. A simplified plate method for growing the gonococcus under reduced oxygen tension has been worked out (see Journal American Medical Association, 1920, vol. 74, p. 1T16), which is of much value in making cultures of prostate and seminal fluids to de- termine whether a complete cure of gonorrhea has been established. The plate method devised by Dr. Herrold makes it possible to make smears of sufficient magnitude to allow the growth of discrete colonies of organisms. It has been found that the result of fixation tests may serve as an index of the existence of foci of gonococcus infections. An improved method has also been found for testing the agglutina- tion of gonococci which is proving useful in studying the question of strains of gonococci. The improvements in technic that have been developed in connection with this research are of scientific interest, for there can be no doubt that they will help to establish a consid- erably more effective treatment of gonorrhea, because they place in our hands the means for a better control of the results. The appro- priation for this research was made in November, 1919. 12. "A selective medium for the isolation and cultivation of the gonococcus," under the direction of Dr. Henry Albert, professor of pathology and bacteriology. University of Iowa College of Medicine, assisted by Dr. Mary Erickson. The problem here has been to find a culture medimn that will either especially favor the growth of the gonococcus, or inhibit the growth of other bacteria present, or both, so that the gonococcus may be readily discovered in cases of mixed infection. This investigation has required the testing of many cul- ture media, the making of various modifications as regards ingre- dients, reaction, etc., and the doing of experimental work with new media in which various ingredients have been incorporated for the purpose of stimulating the growth of the gonococcus or inhibiting the growth of other organisms. The experiments are very hopeful of a satisfactory solution of the problem under investigation. A cul- ture medium has been found upon which the gonococcus grows readily REPORT U. S. INTERDEPARTMENTAL, SOCIAL, HYGIENE BOARD. 1 1 5 and profusely and which inhibits the growth of certain other organ- isms that may be present in mixed infections. The successful conclu- sion of this research will make it possible to diagnose more accurately obscure chronic gonorrheal infections, and institute specific treatment. Success in isolating the gonococcus from chronic infections will make it possible to prepare autogenous vaccines which are always more effec- tive than the ordinary stock vaccine. The research possesses socio- logic importance because of its promise to furnish a better means for knowing when a case of gonorrhea is free from infection. The ap- propriation for this research was made in February, 1920. 13. " Classification of gonococci and fixation reaction in gonor- rhea," under the direction of Dr. Frederick P. Gay, professor of pathology, University of California, assisted by Dr. Marjorie W, Cook and Mr. Douglas D. Stafford. Gonococci obtained from acute and chronic infections, due to this microorganism, are being studied with a view to establishing whether or not types of the microorganism, exist similar to those described among the pneumococci and strepto- cocci. It is also planned to investigate the reactions of patients in the way of antibody formation of the respective type or types de- termined. The value of this research lies in the possible discovery of more detailed knowledge of the etiology of gonorrheal infections, better methods of serum diagnosis, and possibly of vaccine and serum treatment of these infections. The appropriation for this research was made in March, 1920. 14. " Improvement in methods for determining infection as em- ployed in cultures and complement fixation in subacute and chronic gonorrhea and results of frequent tests in cases under treatment and detention," under the direction of Dr. William H. Park, professor of bacteriology and hygiene. New York University and Bellevue Hos- pital Medical College, assisted by Dr. Noble, Dr. Frankel, and Miss Wilson. The diagnosis of suspected cases of gonorrheal infection in women sent to hospitals by the court presents a problem that is not always readily solved. After determining whether such patients can be detained, it becomes necessary to determine how long they may be detained for treatment. The use of ordinary smears has been found insufficient for diagnosis. Dr. Park proposes to investigate the com- plement fixation test as a means for diagnosing gonorrhea in subacute and chronic cases. He has been able to improve the test in such a wa}^ that it gives reliable evidence for diagnosis in about 85 per cent of the cases. His investigations seem to indicate that the disappear- ance of the positive test is sufficient evidence to certify individuals as free from the danger of giving infection. This- research will result in bringing together clinical, serological, and bacteriological findings in cases of suspected or diagnosed subacute or chronic gonorrhea and shed additional light on the problem of diagnosing suspected cases 116 REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. and determining the period of infection in known cases. An effort will also be made to improve the cultural methods for the gonococcus so that it will be possible to detect small numbers of gonococci in the discharge of subacute cases. The appropriation for this research was made in June, 1920. SYPHILIS. 1. "A research for an improved method of demonstrating the spirochaeta pallida in human^tissues," under the direction of Dr. A. S. Warthin, director of the Pathological Laboratory, College of Medi- cine and Surgery, University of Michigan, assisted by Mr. Allen C. Starry and Miss Ida Wieber. There is nothing more important in the diagnosis of syphilis than the ability to demonstrate quickly and isurely, in sections of tissue, the presence of the organisms of syphilis, inasmuch as the positive diagnosis of syphilis depends upon the demonstration of these organisms. The Levaditi method, which is the chief method used in the demonstration of the spirochaetes of syphilis in tissues, requires 6 to 14 days, is too complicated for the average technician, and its results are capricious, so that this method is not available in ordinary routine diagnostic work. Dr. Warthin's problem has been to obtain an easier and quicker method. His investigation has resulted in the discovery of a greatly improved method of demonstrating the organisms of syphilis in tissue, which takes about 12 hours. The details of this method have been published in the American Journal of Syphilis, January, 1920. Dr. Warthin has recently succeeded in improving the technic of his method so that the demonstration of the treponema pallida can be made in one hour. A report of this newer method is to be published shortly. This re- search has made a valuable contribution to the knowledge of patholo- gists regarding the examination of human tissues for the organisms of syphilis. Hitherto the tissue diagnosis of syphilis has been ineffi- ciently carried out in the diagnostic laboratories because of the diffi- culties attending the older methods employed. These new methods will lead to more frequent, more rapid, and more certain diagnoses of syphilitic infection, thereby making it possible to give a greater per- centage of proper and more effective treatment. The sociological value of the research lies in the fact that diagnosticians will be able to select more accurately the cases needing syphilitic treatment and in this way reduce the number of cases that are potential dangers to other individuals. The appropriation for this research was made in March, 1919. 2. "An investigation into more effective methods of treating sjqDhilis,'"' under the direction of Dr. H. E. Alderson, associate pro- fessor of clinical medicine, and chief of the skin clinic, Leland Stan- ford Junior University Medical School, assisted by H. C. Coe and REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 117 Mrs. R. T, Sheparclson. The problems being investigated in con- nection with this research are (1) tb« value of the provocative Was- sermann, (2) the value of luetin, (3) certain phases of the Wasser- mann reaction, such as the relative delicacy of the antigens used and the value of the ice-box incubation method, and (4) standardization of the treatment of syphilis. Dr. Alderson is endeavoring to stand- ardize the treatment of sjq^hilis and determine just how intensive the treatment can be given without damage to the patient. It is believed that the eradication of the treponema pallida in the early stages of syphilis can best be accomplished by giving intensive treat- ment. This research, in common with the other researches that are being carried on in cooperation with the United States Interdepart- mental Social Hygiene Board, possesses scientific, economic, and sociologic values that must be perfectly obvious to anyone who is informed regarding the far-reaching results of syphilis and gon- orrhea. The appropriation for this research was made in April,. 1919. 3. " The permeability of the meninges to antisyphilitic drugs — an attempt to increase their permeability," under the direction of Dr. H. G. Mehrtens, assistant professor of neurology, Leland Stanford Junior University Medical School, assisted by Dr. William McKay, A. Motzkau, C. A. McArthur, and P. S. Williams. It is hardly neces- sary to emphasize the importance of this research. The amount of suffering and death produced by cerebrospinal syphilis is enormous, and any methods that will improve the treatment of this affliction will necessarily be a great boon to humanity. The problems being investigated by Dr. Mehrtens may be divided into two groups. The first group of investigations deals with intravenous injections of arsphenamine in an attempt to find out how often a single injection of arsphenamine appears in the spinal fluid, the effect of complete- drainage of the spinal fluid following an intravenous injection on the amount of arsenic found in the spinal fluid, and the effect of pre liminary irritation of the meninges on the amount of arsenic pene trating after intravenous injection. The second group of investiga tions deals with the problems related to rectal administration of arsphenamine. Dr. Mehrtens summarizes the results of his investi- gations to date as follows: (1) As 40 per cent of all cases were shown to have membranes permeable to arsphenamine, every case of neurosyphilis should have the benefit of intensive intravenous medi- cation; (2) the experiments would suggest that for the cases re- sistant to ordinary therapy, in order to obtain the maximum con- centration of arsenic in the spinal fluid, the patient's own serum should be injected into the subarachnoid space six hours before the arsphenamine is given intravenously; (3) to be of any practical 118 REPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. use neoarsplienamine should be injected rectally in doses not less than 4 grams; (4) the rectal injection of 4 grams neoarsphenamine (or perhaps even larger amounts) may be the treatment of choice when the veins are not available for intravenous treatment. Both groups of investigations are being continued. The appropriation for this research was made in April, 1919, and renewed in June, 1920. 4. " The manufacture and investigation of a series of new organic compounds in the treatment of syphilis," under the direction of Dr. Hugh H. Young, director of the Brady Urological Institute, in collaboration with Dr. D. M, Davis, both of the department of urol- ogy, Johns Hopkins University and Hospital. Salvarsan is now ad- mitted to have failed in producing radical cures of syphilis, and mercury is again being used to complete the cures. But great diffi- culties still exist in using mercury, owing to the frequency of toxic results, especially on the kidneys. This research aims to produce new mercurial drugs that will be less irritating to the kidneys and therefore tolerated by the system in larger quantity. Some of the results that have been secured point to the possibility of making much progress along this line. The starting point of this investiga- tion was the synthesis of a number of new and original organic chemical compounds, notably a set of mercury bearing phthaleins and azo dyes. The mercurial drugs developed in this laboratory have been shown by various toxicological tests to be much less toxic than ordinary mercurials. Tests show that these compounds are split in the body and that the mercury is slowly excreted. Injury to the kidney is therefore kept at a minimum. Dyes bearing arsenic in ad- dition to mercury have also been produced. The combination of these two metals in the same substance may be expected to lead to interest- ino" results. Promisin^g results have also attended the investigation into the effect of certain of these synthesized mercurial compounds when used intraspinously. The different phases of this research are being investigated energetically, and there seems to be much reason for expecting valuable scientific results. The appropriation for this research was made in May, 1919, and renewed in March, 1920. 5. " A series of studies for the recognition and diagnosis of tre- ponema pallidum in venereal diseases, and the effect of various drugs and materials as germicidal agents against treponema pallidum," under the direction of Dr. Eandle C. Eosenberger, professor of hygiene and bacteriology, Jefferson Medical College of Philadelphia, with the assistance of Dr. John I. Fanz. This research was carried out last summer during the months of June, July, August, and Sep- tember, 1919. A detailed report of the research has been published. Drs. Eosenberger and Fanz introduced the use of color screens in examining preparations for the organisms of syphilis by means of the dark field illumination, which makes it much easier to examine REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 119 secretions because of the fact that the extreme brilliancy of the preparation is overcome and the preparation much softened by sem- oval of actinic rays. Heretofore, attempts to stain the organisms of syphilis in smears of chancre juice have been rather tedious and unsuccessful. By actually forming a dye in the organism, it is brought out distinctly in its morphology, so that anyone acquainted with its peculiarities can not mistake it for any other organism. This method is loiown as the aniline black method of Fanz. A method for the intravitam staining of the treponema pallidum has also been devised as the result of this investigation. The report of this research also contains a description of a novel and new method of cultivating the organism of syphilis in rabbit blood. The impor- tance of this investigation is at once apparent when it is realized that the laboratory diagnosis of syphilis often hangs on the Wasser- mann reaction which can not usually be made with any degree of reliability until the disease has entered the secondary' stage. The investigations of Rosenberger and Fanz are, therefore, important because they make it easier to diagnose cases of syphilis in the first stage when the chancre is the only evidence. Treatment given at this time helps catch the infection in its incipiency and reduces the amount of damage that is bound to result unless the treponema pallidum is killed. Early recognition of the disease is also important because it makes it possible to reduce the contagiousness of the infection and limit it to the individual. The appropriation for this research was made in June, 1919. 6. "An attempt to prepare mercurial and arsenical compounds which have a predilection for the central nervous system, in the hope of finding drugs more useful than any known in the treatment of syphilis of the central nervous system," under the direction of Dr. A. S. Loevenhart, professor of pharmacology and toxicology, Uni- versity of Wisconsin Medical School. Associated with Dr. Loeven- hart in this investigation are Dr. H. C. Bradley, professor of physio- logical chemistry; Dr. P. F. Clark, professor of bacteriology; Dr. W. F. Lorenz, professor of psychiatry; and Dr. W. D. Stovall, director of the State laboratory of hygiene. The problems under investigation include synthetic chemical work, physiologic chemical work, pharmacological and toxicological work, pathological and bacteriological work, and clinical work. A report on the synthesis of arsanilic acid has been published by Messrs. Cheetham and Smith in the Journal of the American Chemical Society, volume 42, page 828. This substance is fundamental to the synthesis of many impor- tant arsenical compounds. The Gutzeit method for the determina- tion of minute quantities of arsenic has been perfected and placed in constant use. This phase of the research is most important. Work on the rate of excretion will probably give an excellent idea as to 120 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. how each drug should be employed therapeutically. Several new compounds have been manufactured, and at least one new arsenical, namely, N-arsenetripiperidonium chloride, has been studied with reference to its toxic powers. Three other new arsenicals are now prepared and are being investigated. A number of the cases of neurosyphilis have been treated with new drugs, and in the main remarkable improvement after a course of treatment has been noted. The cell count of the cerebrospinal fluid fell to within normal, and the gold sol reaction also showed a change toward the normal. The results of this treatment have been far superior to the other treat- ment with salvarsan and neosalvarsan. This research will be con- tinued on a large scale and a great number of cases treated. It may be added that the treatment is very simple and involves no trouble or inconvenience to the patient. Thousands of cases of syphilis which occur in the Army and Navy will doubtless develop paresis or locomotor ataxia and become completely dependent wards of the State or National Government. If this research proves successful, it will be possible to arrest and perhaps cure such cases. Salvarsan and neosalvarsan have been a disappointment for cases of this nature, and there is no efficacious treatment known. The details of this new treatment are being withheld until more opportunity has been given to thoroughly test it out. The appropriation for this research was made in June, 1919, and renewed in June, 1920. 7. "A study of hereditary transmission of syphilis," under the direction of Dr. P. C. Jeans, associate professor of pediatrics, Wash- ington University School of Medicine, St. Louis, Mo. This inves- tigation involves a study of the clinical findings in infants and chil- dren, together with histological examination of placentae, and tes- ticular lesions in latent paternal syphilis. The histological findings will be checked up, whenever possible, with the Wassermann reac- tion on the mother's serum and later a clinical and serological exami- nation of the infant. The cooperation of the Barnes, St. Louis City, St. Louis Maternity, St. Luke's, and Missouri Baptist Sanitarium Hospitals and the Washington University and St. Louis University Dispensaries has been secured. From these institutions placentae and samples of blood from the umbilical cord are collected daily and examined in the laboratory. Through the cooperation of the municipal nurses of the city it has been possible to arrange for " follow up " of such cases as seem advisable. The correlation of this data has not been completed, and it is therefore impossible to draw any conclusions with reference to the problem under consideration. The especial value of this research lies in the fact that there is no reliable method for the early recognition of hereditary syphilis available for routine use. Even if it were possible to demand a Wassermann reaction on every newly born infant, about one-third REPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 121 of the infections would be missed if this alone were depended upon. The examination of blood from the placental end of the cord gives about the same incidence of negative reactions in positive cases. Neither does a positive Wassermann reaction in the mother prove the child to be syphilitic, although it may be valuable evidence. It is a well-recognized fact that the chances of complete cure of syph- ilis, whether hereditary or acquired, steadily diminish as the inter- val between the time of infection and the time of treatment increases. The waste in infant and child life in a large group of syphilitic families is over 60 per cent, as compared with less than 25 per cent in a similar group of nonsyphilitic families of the same social plane. A reliable method for diagnosing the presence of syphilis in the new born should be invaluable, because of the greater opportunity for effecting a cure and also reducing the contagiousness of the case. The appropriation for this research was made in June, 1919. 8. "An investigation of the properties contributing to the toxicity of arsphenamine, neoarsphenamine, and analogous products," under the direction of Dr. Eeid Hunt, professor of pharmacology. Harvard University Medical School, assisted by W. G. Christiansen. This research involves the preparation of arsphenamine by all known methods and some new methods. These products are examined, not only the final product but the products formed during the manufac- ture. The various reagents employed during the manufacture of these compounds are examined to determine at what stage and through the interaction of what reagents the poisonous principles are formed. The problem is one of great difficulty, as is evident from the fact that a number of the leading investigators of Great Britain, France, and Germany have failed to solve it. Very material progress seems to have been made, however, in the research that Dr. Hunt is directing. Many possibilities have been eliminated and the field for further investigation has been narrowed. The value of this research lies in the fact that a successful solution of the problem under investi- gation will result in more effective treatment for syphilis, for it will be possible to give larger doses and at shorter intervals. The course of the disease will be shortened, and what is of even greater im- portance, the period during which an individual can infect others will be shortened. Incidentally the cost of the drug will be lowered. The appropriation for this research was made in June, 1919, and renewed in March, 1920. A paper embodying some of the results obtained is in press (Journal American Chemical Society), and others are in preparation. 9. "A study of the effect of radiant energy upon experimental syphilis in the rabbit," under the direction of Dr. George S. Graham, professor of pathology, and Dr. W. M. Baldwin, professor of anat- omy, Union University Medical School, Albany, assisted by Dr. 122 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. William R. Whitney, director of the research laboratory of the General Electric Co., Schenectady, N. Y. It seems probable that a thorough study of the biological and pathological characters of syphilis induced in lower animals will lead to more effective medical measures in the prevention and treatment of venereal diseases in man. This research involves the subjection of animals to carefully measured X-ray exposures before and after intratesticular inocula- tion with spirochete containing material obtained from rabbits with syphilitic orchitis, Nonrayed animals are used as controls. Dr. Graham reports that he has been successful in producing widespread syphilitic lesions in rabbits which gave typical Wassermann reac- tions in about four weeks. This work has been supplemented by daily examination of the blood (total and differential leucocyte counts), observation of gross lesions and histological study of the inoculated testis at varying periods, and of the various organs after death. The freedom of experimentally infected animals from the intercurrent diseases common to man will make it much easier to study the serology and pathology of the venereal diseases, for the investigator will not have to contend with disease manifestations due to infections other than the particular infection that is being studied. It is also proposed to make a study of the therapeutic effect of certain physical agents on the lesions produced by experimental inoculation with the organism of syphilis, such as the X ray and the ultra-violet rays. The appropriation for this research was made in June, 1919. 10. " Investigation of the chemical and physical properties of the cerebrospinal fluid in the luetic and the nonluetic," under the direc- tion of Dr. L. G. Rowntree, chief of the department of medicine, University of Minnesota Medical School, assisted by Dr. Grete Egerer and Dr. C. E. Nixon. This investigation relates to the fol- lowing problems : (a) The character of the ultra-filtrates from luetic (syphilitic) blood, and (&) the determination of the factors affecting the colloidal gold curve of cerebrospinal fluid and of the ultra- filtrates from luetic blood, and (c) the chemical constituents of blood in luetic and non-luetic individuals. Problem (h) includes the deter- mination of the acid base equilibrium, the globulin content, the salt content, the effects of dilution to the vanishing point of the colloidal gold curve, and the effects of concentration. The object of the first investigation is to ascertain whether or not a reliable method can be developed for obtaining luetic gold chloride curves from the ultra- filtrates of blood which correspond to the colloidal gold curve of the cerebrospinal fluid. It is obvious that success in this particular problem will result in a tremendous addition to the diagnostic methods of recognizing syphilis. The ultra-filtrate apparatus used is a modification of the Bechols pressure apparatus. Problem "(c) involves investigations relative to the sugar, urea, and creatinin con- REPORT V. S. INTERDEPARTMENTAX, SOCIAL HYGIENE BOARD. 123 tent, and enzymatic activity of the cerebrospinal fluid in luetic and non-luetic individuals. The appropriation for this research was made in June, 1919, and renewed in April, 1920. 11. " Studies on the nature of the Wassermann reaction," under the -direction of Dr. Thomas Ordway, dean and associate professor of medicine. Union University Medical School, assisted by Dr. Arthur Knudson, associate professor of biological chemistry; Walter K. Grigg, M. M. Lee, John C. Younie, Jean Tait, and Hazel Ferguson. This research involves a chemical examination of the fat content of the blood, both corpuscles and plasma, in syphilitic bloods having Wassermann reactions of various degrees, and negative control cases, supplemented by certain physico-chemical examinations. The pur- pose of the investigation is to determine whether the Wassermann reaction is a specific, so-called " immunity reaction," or a delicate biological indication which represents measurable chemical changes in the body fluids as a result of syphilitic infection. This work is to be supplemented by studies on the Wassermann reaction in experi- mental animals that have been" inoculated with syphilis. This re- search aims at the explanation of the Wassermann reaction, so that it will be possible to improve the technic and make the reaction more reliable. The appropriation was granted in June, 1919. 12. " The demonstration of the syphilitic nature of unusual lesions encountered at the post-mortem table," under the direction of Dr. M. C. Winternitz, professor of pathology and bacteriology, Yale University Medical School, assisted by Dr. Frank P. McNamara and Miss Alice Thing. This study involves an attempt to demonstrate the specific nature of unusual lesions of syphilis. The gross appear- ance and the histology of lesions are correlated with the bacteriology. Attempts are made to demonstrate the treponema pallidum by the dark-field method, but more especially by the Levaditi method and its various modifications. By demonstrating the syphilitic nature of unusual lesions and unusual clinical manifestations of disease, it will be possible to diagnose more accurately future cases with similar clinical pictures. Such knowledge naturally leads to more prompt and rational treatment, and incidentally (but of great importance) to a shortening of the period of contagiousness of the disease for others. Considerable material has been examined in connection with its clinical history and the syphilitic nature of many of the unusual lesions demonstrated. The appropriation for this research was made in June, 1919. 13. "A study of syphilis in pregnant women and new-born children with special reference to the efficacy of methods of diagnosis and treatment," under the direction of Dr. Bertha M. Meine, director of the research department. Woman's Medical College of Pennsylvania, in collaboration with Dr. Rose Herschler. Married women and chil- 124 REPORT V. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. dren constitute the larger percentage of people who acquire syphilis innocently. The enormity of their number makes it especially im- portant that an investigation be made with reference to the efficacy of methods of treating and diagnosing these cases. Many of these cases go untreated and become a danger to others, unless they are given the benefit of modern laboratory service. Much reliability has been placed on the Wassermann reaction where it could be given. Cases that have not been given this serological test have been diag- nosed on their clinical history, the examination of the placenta, a serological test of the placental blood, or the physical appearance of the child. This research aims to establish the value of these different methods of diagnosis. Furthermore, it is concerned with an investi- gation into the treatment of cases having syphilis. The investiga- tions that have been carried on to date seem to indicate that the ex- amination of the placenta does not give a reliable diagnosis of syphilis ; neither does it appear that the Wassermann reaction on the placental blood is reliable. The value of treating pregnant syphilitic women varies, as might be expected, with the promptness of the treatment. Every case should be given treatment before the eighth month, and as much earlier as possible. Considerable work has also been done on the treatment of new-born children who are syphilitic. The appropriation for this research was made in June, 1919. 14. " The laboratory (biological) investigation of the latent syphilitic as a carrier," under the direction of Dr. M. F. Engman, chief of the department of dermatology, Washington University School of Medicine, St. Louis, Mo., conducted by Dr. F. Eberson, chief of laboratory, assisted by Drs. F. M. Jacob, E. S. Weiss, and H. Gaebe. This research aims to investigate the possibility of the latent syphilitic as a carrier of infection by a study of the infectivity of semen, blood, lymphatic glands, spinal fluid, and nasal washings from authentic cases of latent syphilis. These materials are injected into rabbits' testes to determine the presence of spirocheta pallida. It appears that the blood and other body fluids, excepting semen, are not infectious in latent syphilis, or if so but rarely. In a few instances the inguinal glands have been found to contain active, virulent spirocheta pallida. There are certain parts of the body which act as reservoirs from which the organisms causing syphilis may be dis- charged at intervals. The latent syphilitic may be a carrier and a source of danger in transmitting syphilis to offspring and to a com- munity. In the absence of frank lesions of syphilis, such as the causes in this study proved, the carrier state is of inestimable danger owing to the fact that latency is of much longer duration than all other stages combined, and ignorance on the part of a patient tends inevitably to neglect in treatment. The appropriation for this re- search was made in September, 1919. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 125 15, "All investigation of the family of the syphilitic," under the direction of Dr. H. C. Solomon, Massachusetts State Psychiatric In- stitute. This research involves a studj^ of the social and economic effects of syphilis in special relation to the family. The clinical ma- terial available to the Massachusetts Psychiatric Institute will make it possible to establish a workable plan for studying syphilis of the innocent. Unfortunately, syphilis is a concern to many who have in no way transgressed. Contrary to the usual conception of the word, syphilis as a venereal disease occurs only in a percentage of the cases ; many cases are innocently acquired. The especial value of this re- search lies in the fact that it wnll shed light on the proper method for handling the syj^hilitic family for the treatment of those already in- fected and for the prevention of further spread of the disease. The investigation emphasizes the importance of making examinations of all members of the family where one is infected with syphilis. Unless this is done, many cases of syphilis are missed which later become serious problems to the community. By far the larger part of money spent for the control of the venereal diseases is spent for maintenance of people who have passed the stage in which help is possible. A very small part is spent for the really promising part of the program, i. e., prevention and early treatment. The educational service, as well as the medical and social value of research of this type, is very great for it will give an entirely new idea of the amount of " syj)hilis of the innocent " there is. The appropriation for this research was made in October, 1919. 16. "An investigation of the changes produced in the central nerv- ous system by the treatment of cases of neurosyphilis," under the direction of Dr. H. C. Solomon, Massachusetts State Psychiatric Institute, assisted by Dr. M. H. Hirschfeld, Dr. L. J. Thompson, and Dr. Bernice Bartlett. The value of treatment of cases of neuro- syphilis is a disputed point. This research aims to shed light on the question. An analysis will be made of data secured from the treat- ment of approximately 400 cases of general paresis, all of which have been carefully controlled b}^ serological examinations and carefully charted as to their treatment and condition. This analysis will include the duration of life, the frequency of remissions, the length of remissions, and the serological changes. The data will be com- pared with control groups having received no treatment. . An ex- amination of the brains of cases that have received antisyphilitic treatment is being made to see if the cases that have received treatment show a different type of pathology from those that have been untreated. The clinic of the Massachusetts State Psychiatric Institute is one of the most elaborate of the neurosyphilitic clinics to be found anywhere in the world at the present time. The amount of autopsied material therein is imiqiie and its quality very special 126 REPOKT U. S. INTEKDEPARTMENTAL SOCIAL HYGIENE BOARD. on account of the uniform methods of observation of material, and especially on account of the availability of all the spinal cords as well as the brains and other tissues of the cases. The progress of the study that is being made here indicates that valuable information as to the treatment of various sorts wiU be obtained. The api^ro- priation for this research was made in October, 1919. 17. "A synthesis of organic compounds containing arsenic of pos- sible value in the treatment of syphilis of the central nervous sys- tem," under the direction of Dr. W. Lee Lewis, professor of chem- istry. Northwestern University, assisted by Messrs. C. D, Lowry, Frank H. Bergeim, Harold C. Cheetham, and C. S. Hamilton. The research proposed above is a part of a carefully organized plan whereby the new chemical compounds that may be synthesized through the efforts of Dr. Lewis and his associates will be tested for their therapeutic values in relation to the treatment of syphilis under Dr. A. S. Loevenhart, director of the department of pharmacology and toxicology. University of Wisconsin. Some 12 new arsenicals have been synthesized, being simple derivatives of diphenoxychlo- rasine. Three compounds have been sent to Dr. Loevenhart, of the University of Wisconsin, for tests, and two others are being finished that should be of interest pharmacologically. This work will be extended this fall. Mention might also be made here of the im- proved method which Messrs. Cheetham and Schmidt have discov- ered at the University of Wisconsin for the preparation of pri- mary arsanilic acid, the foundation for all present-day arsenicals used in the treatment of syphilis. The special importance of this improved method lies in the fact that it promises to reduce the cost of the drug and also to decrease the length of time taken in its manu- facture. These two factors are important considerations in the con- trol of the venereal disease group. The appropriation for this research was made in November, 1919. 18. "The preparation of new organic compounds which may have therapeutic value," under the direction of Dr. Roger Adams, pro- fessor of organic chemistrj^. University of Illinois, assisted by Messrs. J. R. Johnson, C. S. Palmer, and J. L. Hall. This research deals with the preparation of new arsenic compounds which are to be tested by Dr. A. S. Loevenhart, director of the department of phar- macology and toxicology. University of Wisconsin, who is collaborat- ing with Dr. Adams. A third phase of this work is being conducted at Northwestern University, where Dr. W. Lee Lewis, professor of chemistry, is investigating the manufacture of new organic com- pounds containing arsenic for a similar purpose. This research com- bines the scientific activities of three universities in the field of KEPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 127 organic chemical compound synthesis, and is being carried out with no little promise of success. The problems being studied by Dr. Adams consist of the investigation of compounds of arsenic which are neutral in character, soluble in water, but not of the salt type. There are three different series which it is hoped may be developed, all of which should have the properties mentioned, and none of which have been investigated up to this time. These new compounds of arsenic should be very stable in solution so that they can be easily sterilized and thus avoid the dangers which are now involved in the use of salvarsan. In addition they may prove useful in the dis- eases of the central nervous system for which purpose salvarsan can not be used. The appropriation for this research was made in Febru- ary, 1920. 19. " Synthesis of new substances of the general type R-HG-0. CO. H' with variations to make new drugs more suited to their use in syphilis and in gonorrhea," under the direction of Dr. Frank C. Whitmore, department of chemistry. Northwestern University, as- sisted by Virgil E. Meharg and Edmund B, Middleton. The syn- thetic chemical work connected with this research will be done by a group of trained organic chemists, all of whom have had consid- erable experience in chemical work with organic mercury compounds. The substances prepared in this laboratory are to be tested, for valu- able pharmacological properties by a staff of expert pharmacologists, physiological chemists, and clinical physicians working under the direction of Dr. A. S. Loevenhart at the University of Wisconsin. Chemical modifications of the substances manufactured under the direction of Dr. Whitmore will be made if the investigations under Dr. Loevenhart seem to indicate such steps to be worth while. The work has not been carried on far enough to make it possible to report more in detail on this investigation. The appropriation for this research was made in February, 1920. Work was started June 15, 1920. 20. "A study of hereditary syphilis with particular reference to the progress of the disease in the individual and the effect of treat- ment," under the direction of Dr. Borden S. Veeder, professor of clinical pediatrics, Washington University School of Medicine, St. Louis. It is proposed to make a clinical-social study of a large num- ber of cases of hereditary syphilis to find out what occurs when syphilis is transmitted from parent to child. No such study has been made as a vs^hole since the development of the Wassermann reaction and other modern phases of syphilis. The exact physical and mental condition of syphilitic children will be determined and compared with a group of non-luetic children of the same social standing and 128 REPOKT U. S. IlS^TERDEPARTMENTAL, SOCIAL HYGIENE BOARD. environment. This study will include the types and nature of physi- cal abnormalities, mental deficiency, results of treatment, death rate in infanc}^ and childhood, etc. The department of pediatrics of the Washington University Medical iSchool possesses an abundance of material for this research. During the last eight years approxi- mately 500 cases of hereditary syphilis have been carefully examined, and to a greater or less degree received treatment. It is proposed to go over this entire material, looking up every case, and examining ever}^ living child in the clinic or home as to its physical and mental condition, including laboratory tests. A research of this type should throw light on the controversy as to whether or not hereditary syphilis is amenable to treatment, and, secondly, as to whether, even if thoroughly treated, hereditary syphilitics do not belong to a per- manently defective class. The appropriation for this research was made in February, 1920. Up to June 30, 1920, preliminary reports have been published of the following: investigations which have been made with the aid of funds granted by the United States Interdepartmental Social Hygiene Board for research in the prevention and treatment of venereal diseases : "A new germicide for use in tlie genito-uriuary tract : Mercurocliroiue 220." A preliminary report of experimental and clinical studies carried on in the James Buchanan Brady Urological Institute, Johns Hopkins Hospital, by Hugh H. Young, M. D., Edwin C. White, Ph. D., and Ernest O. Sv.'artz, M. D., Johns Hopkins University. "A series of studies for the recognition and diagnosis of treponema pallidum in venereal diseases, and the effect of various drugs and materials as germicidal agents against treponema pallidum," conducted by Dr. Randle C. llosenberger and Dr. John I. Fanz, of the John H. McPadden Research Laboratory of the Jefferson Medical College, Philadelphia, Pa. "A more rapid and improved method of demonstrating spirochaetes in tis- sues," by Aldred Scott Warthin, M. D., professor of pathology, and Allen O. Starry, research assistant in pathology, University of Michigan, Ann Arbor. "An improved method for the preparation primary arsanilic acid," by Harold C. Cheetham and John H. Schmidt, of the chemical laboratory of the University of Wisconsin. "A simplified plate method of partial oxygen tension in the cultivation of the g'onococcus," by Russell D. Herrold, M. D., of the John McCormick Institute for Infectious Diseases. " Further observations on acriflavine in gonorrhea," by Edwin G. Davis. M. D., University of Nebraska. REPORT U. S. INTERDEPARTMENTAX, SOCIAL HYGIENE BOARD. 129 Data on scientific resea/rch fund. state and institution. Amount of appro- priation. 1919 1920 Number of re- searches. Scientists in charge. Assisting profes- sors, tech- nicians, social workers, etc. California: Leland Stanford Junior University University of California Connecticut : Yale University Illinois: John McCormick Institute Northwestern University University of Illinois Iowa: State University of Iowa Maryland: Johns Hopkins University Massachusetts: Harvard University Massachusetts State Psychiatric Institute. Michigan: University of Michigan Minnesota: University of Minnesota Missouri: St. Louis University Washington University Nebraska: University of Nebraska New York: Columbia University Cornell University New York University Union University Pennsylvania: Women's Medical College Jefferson Medical College Wisconsin : Universit v of Wisconsin $7, 200 ' '4,' 666 3,875 19,050 7,000 6,000 8,250 3,000 13, 200 5,000 3,000 6,000 3,500 5,320 19, 050 10,000 13, 200 7,440 4,' 380' 1,550 2,500 8,000 9,000 4,000 4,000 4,200 5,400 12,000 4 13 14 Total (13 States, 22 institutions) . Joint 96,570 103,430 200,000 1 Includes research at Jefferson Medical College which was completed in the summer of 1919. Note. — The number of persons engaged in these researches does not include clerks, stenographers, dieners, etc. It represents the trained personnel only. SUMMARY. Board began making appropriations for researches, March, 1919. Number of researches assisted during fiscal year 1919 25 Number of new researches started during fiscal year of 1920 11 Number of old researches assisted during fiscal year of 1920 11 Number of institutions represented in the board's 36 researches 22 Number of States represented 13 Number of scientists in direct charge of investigations 40 Number of trained assistants (professors, technicians, social workers) 98 Cost of researches during fiscal years 1919-20 ?200, 000 Number of researches completed 1 Number of preliminary reports published 6 Number of preliminary reports ready to go to press 6 Number of researches proposed to the board and found unsuitable 44 Number of researches now in progress 35 REPORT ON THE DIVISION OF EDUCATIONAL RESEARCH AND DEVELOPMENT. 1. PRINCIPLES AND REGULATIONS. The report for last year (1918-19) included a statement of the principles by which the Interdepartmental Social Hygiene Board would be governed in the administration of the fund intrusted to it 15610—20 9 130 EEPOET U. S. INTEKDEPAKTMENTAL SOCIAL HYGIENE BOARD. by Congress " for the purpose of discovering and developing more effective educational measures in the prevention of venereal disease^ and for the purpose of sociological and psychological research re- lated thereto." Briefly summarized, these principles are as follows : A program should be formulated that would lead to permanency of educational influence and reach the child in the home and the pupil in the school ; the permanent and self-perpetuating factor is an increasing number of informed, self-respecting and self-reliant persons, who as teach- ers, parents, and community leaders will exert influence in the schools, in the family, and in every educational agency in society; normal schools, colleges, and universities are the sources from which come college professors, school superintendents, school principals, and teachers in elementary and secondary schools, and in general the grad- uates of normal schools, colleges, and universities become citizens of position and influence, who are thus directly or indirectly teachers in the community, in the school, and in the home ; relative permanency of influence therefore will be secured by establishing departments of hygiene in such institutions in the various activities of which " due and appropriate emphasis is given to the venereal diseases," and in which the personnel for each activity included in the program of such departments of hygiene will be selected with special reference to its ability to handle successfully problems in venereal diseases that may be logically considered by the group of students taking part in that activity; such institutions, carefully selected and left free to develop methods and materials most likely to fit the special needs in their respective student bodies, will actually be engaged in carrying out researches for the discovery and development of more effective educational measures in the prevention of venereal diseases. The rules and regulations adopted by the board to govern the fund provided by Congress for educational research and development are in conformity with these principles. The policy therefore was adopted by the board of making allotments to normal schools, col- leges, and universities for the purpose of establishing departments of hygiene in conformity with the general plan of organization out- lined in the rules and regulations. In fulfillment of the authorization to assist colleges, universities, or other suitable institutions " in sociological and psychological re- searches related to better educational measures in the prevention of venereal diseases," the board has adopted the policy of limiting allot- ments from this fund to a very few proposals which promise sub- stantial results. In this report are presented the more important facts in regard to the administration of this fund. The following topics are consid- ered : The number, purpose, and disposition of applications for assist- REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 131 ance from the educational research and development fund ; the num- ber, amounts, purpose, and distribution of allotments from this fund; the administrative relations between the board and cooperat- ing departments of hygiene; provision for administrative functions incident to this fund; progress in organization of departments of hygiene; j^rogress in putting into effect the program of instruction and training; progress in developing better educational methods; indirect influence through departments of hygiene; sociological and psj^chological researches. 2. APPLICATIONS FOR ASSISTANCE FROM THE EDUCATIONAL RESEARCH AND DEVELOPMENT FUND — NUMBER, PURPOSE, AND DISPOSITION. This fund became actually available only after the adoption of the rules and regulations in January, 1919. The report of last year covered only the initial stages in the operation of this fund under these rules. It seems desirable, therefore, at this time to summarize, for the entire period from January, 1919, to June 30, 1920, the im- portant facts in regard to the number, purpose, and disposition of applications for assistance from this fund. (1) During the 18 months the fund has been available applica- tions for assistance have been received from 96 institutions and or- ganizations. Of these, 74 were for the purpose of establishing departments of hygiene in normal schools, colleges, and universities ; 11 were for the purpose of special demonstrations of social-hygiene instruction in summer schools ; 8 were for the purpose of sociological and psychological researches ; ^ 3 were for cooperation of State uni- versities with State departments of education in establishing divisions of educational hygiene in State departments of education. (2) Allotments have been made to 41 of the 74 institutions apply- ing for departments of hygiene ; to 10 of the 11 summer schools ; for 5 of the 8 researches; and for 2 of the 3 State divisions of educational hygiene. (3) Failure of applications to secure allotments has been due to a variety of causes. Of the 33 unfruitful applications for departments of hygiene none were rejected unconditionally. In a large majority of cases, the first application was made with insufficient understand- ing of the implications of the agreements pledged in the application. With full understanding of these implications, some institutions found themselves unable to fulfill the obligations and withdrew their applications; some decided to postpone pressing their applications until a later time ; some were never heard from. Three research ap- 1 Two of these applications covered series of research projects, each one of which might properly be regarded as an independent research. So regarded, the number of research applications would be 20 instead of 8, and the number of allotments would be 17 instead of 5. 132 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. plications failed to mature. In two cases the purpose, scope, and method of the proposed research were not well enough defined to justify an allotment. In the other case the negotiations failed on account of the inability of the institution to assume a part of the finan- cial burden involved. One summer school application was rejected. One application for a State division of educational hygiene is pend- ing. (4) Of the 74 applications for departments of hygiene, 44 were received before January 1, 1920. Twenty-nine of the 44 were ap- proved and allotments were made, to be effective in the academic year 1919-20; one returned the allotment after it was paid. Between January, and June 30, 1920, 30 were received. Of these, 12 were ap- proved and allotments were made to be effective in the academic year 1920-21. In addition to these original applications, there were 28 applications for continuance of assistance ; of these 27 were approved ; approval of one was withheld pending receipt of additional informa- tion. Of the 11 summer school applications 7 were for the summer of 1919 — all approved; and 4 for the summer of 1920' — 3 approved and 1 rejected. Of the 8 researches, 5 were for the year 1919-20 — 2 approved and 3 rejected; and 3 for the year 1920-21 — all approved. The 3 applications for State divisions of educational hygiene were all for the year 1920-21. (5) The preceding facts in regard to applications for assistance from the educational research and development fund are shown in summary as follows: TaMilar summary applications and allotments to June 30, 1920. Total applicatioDs for all objects _ 96 Total number approved and allotments made _ 58 Total number not approved 38 Applications prior to Jan. 1, 1920 56 Allotments effective 1919-20 38 Applications between Jan. 1 and June 30, 1920 ' 40 Allotments effective 1920-21 20 Applications, departments of hygiene 74 Approved 41 Effective in academic year 1919-20 29 Effective in academic year 1920-21 ^ 12 Not approved 38 Applications, summer schools 11 Approved 10 Effective 1919 7 Effective 1920 3 Disapproved 1 1 In addition to these 12 new applications for allotments to be effective in 1920-21, 27 applications for renewals have been granted, making a total of 39 allotments efEective in 1920-21. REPOET U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 133 Applications, researclies 8 Approved 5 Effective 1919-20 2 Effective 1920-21 3 Not approved 3 Applications, State divisions educational hygiene 3 Approved ; 2 Pending 1 All for 1920-21. 3. allotments: number, AMOUNTS, PURPOSE, DISTRIBUTION, AND RELEVANT FACTS. (1) Allotments effective in academic year 1919-20: In the report of last year it was shown that allotments aggregat- ing $166,090 had been made to 24 institutions. Of these 23, aggregat- ing $159,490, were for the purpose of assisting normal schools, col- leges, and universities to establish departments of hygiene in general conformity with the policy and plan set forth in the rules and regula- tions ; one allotment of $6,600 was made for the purpose of carrying on a special psychological research. The activities for which these allotments were made were to be begun and carried on in the academic year 1919-20. One of these institutions, later found itself unable to carry out the agreement and returned its allotment of $5,120 thereby reducing the total from $166,090 to $160,970. Subsequent to June 30, 1919, seven other allotments, aggregating $59,550 were made from the educational reasearch and development fund, to be effective in the academic year 1919-20. Of these, six aggregating $33,550 were for departments of hygiene ; one of $26,000 was for sociological and psychological research. (This allotment covers two series of researches totaling 10 projects. See p. 153.) In addition to these amounts, $1,000 was paid to seven summer schools for special instruction in social hygiene. The total amount, therefore, made available for these several objects in the academic year 1919-20 was $221,520. The distribution is: For departments of hygiene, $187,920; for sociological and psychological researches, $32,600 ; for summer schools, special instruc- tion in social hygiene, $1,000. Of the $187,920 for departments of hygiene, $110,085 was allotted to 12 colleges and universities; $67,885 to 13 normal schools and teachers colleges; $2,550 to one medical school (Woman's Medical College, Philadelphia) , and $7,400 to two institutions for the colored race. The aggregate amount of resource supplied by these 28 insti- tutions in support of departments of hygiene is $252,320.35, or $64,430.35 more than the amount supplied by the Interdepartmental Social Hygiene Board. This figure is too small, as one institution 134 EEPOET U. S. INTERDEPAETMENTAL SOCIAL, HYGIENE BOARD. which supplied an amount for its department of hygiene several times greater than that supplied by the board has failed to report this amount. The ratio of local fund to the fund supplied by the board varies widely; from less than one-sixth the amount furnished by the board to more than four times that amount. It is to be remem- bered that the board supplies funds in payment of ]3ersonal service only. The amounts reported as supplied by the institutions are likewise for personal service. The cost of equipment, supplies, light, heat, janitor service, repairs, replacement, and general administration is not included. The number of students in these 28 institutions that have received instruction and training in hygiene is reported as 28,143 — 12,639 men and 15,504 women. These figures are probably too low, as a number of the colleges and universities reported statistics only of students preparing as teachers, whereas the report of departmental activities shows clearly that the program included large numbers of other students. The following tabular summary shows in detail the important items discussed m the immediately preceding paragraphs : Tabular summary of allotmefits effective for departments of hygiene in 1919-20 and related facts. Number. Resource for departments of hygiene. Number students affected. Type of institution. Interde- partmental Social Hj'giene Board. Institution. Joint. Men. Wom- en. Total. A. Colleges and universities B. Normal schools and teachers' 12 13 1 2 8110,085 67,885 2,550 7,400 Sl.58,311.00 89,099.35 350.00 4. 560. 00 $268,396.00 156,984.35 2,900.00 11,960.00 10,918 1,486 '"'2.35' 5, 502 9,652 85 265 16,420 11,138 85 D Colored 500 ' Total 28 2 7 187,920 32,600 1,000 252,320.35 440,240.35 12,639 15,504 28,143 37 221,520 1 (2) Allotments effective in academic year 1920-21 : Subsequent to January 1, 1920, and prior to June 30, 1920, allot- ments were made from this fund aggregating $384,826, to be effective in the academic year 1920-21. Of this aggregate $344,101 was allotted to 39 normal schools, colleges, and universities for depart- ments of hygiene ; $12,900 to two State universities for cooperation with State departments of education in establishing divisions of educational hygiene ; $5,825 to three summer schools for instruction and demonstration in social hygiene ; and $22,000 for three sociological and psychological researches. REPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 135 Of the $344,101 allotted to educational institutions for depart- ments of hygiene, $239,501 was paid to 27 institutions to assist them in continuing the work in hygiene undertaken under the grant of the current year; and $104,600 was paid to 12 institutions to assist them in establishing departments of hygiene. The institutions thus assisted include 20 colleges and universities, 14 normal schools and teachers' colleges, one medical school (Woman's Medical College of Philadelphia), and 4 normal schools and colleges for the colored race (Fisk University, Hampton, Tuskegee, and Maryland Normal and Industrial School). The aggregate amount of resource fur- nished by the 39 institutions in support of these departments of hygiene is $437,330, or $93,229 more than allotted from the Inter- departmental Social Hygiene Board. The joint aggregate is $781,431. Of these 39 institutions, 18 supply an amount in excess of the amount allotted by the Interdepartmental Social Hygiene Board; 6 supply an equal amount; and 15 less. The number of students who will be affected is estimated by the several institutions on the basis of present enrollment. The total is given as 35,192 — 16,043 men and 19,149 women. These figures are too low, as several of the institutions reported only students prepar- ing as teachers, whereas the program submitted for approval evi- dently included all students enrolled. The actual number will be nearer 40,000 than 35,000. Tabular summary of allotments from educational research and development fund effective academic year 1920-21 and facts related thereto. Number. Resource for departments of hygiene. Number students affected. Type of institution. Interde- partmental Social Hygiene Board. Institution. Joint. Men. Wo- men. Total. A. Colleges and universities: 11 9 $128,125 88,650 8176,176 116,625 S304,301 205,275 7,948 4,954 4,580 3,682 12,528 New allotments 8,636 Total 20 14 1 2 2 216,775 99,926 4,0.50 7,400 15,950 292,801 118, 459 350 5,310 20, 410 509, 576 218,385 4,400 12,710 36,360 12,902 1,779 310 1,052 8,262 9,829 89 280 689 21,164 B. Normal schools and teachers' colleEjes: 11,608 C. Medical schools: Renewal 89 D. Colored: 590 1,741 Total 39 2 3 3 344, 101 12,900 .5,825 29,500 437,330 781,431 16,043 19, 149 35, 192 E. Educational hygiene State departments of education .... 1 1 Total 1 47 392,326 * ^This total includes unexpended balances amounting to .$15,475.50 in the amounts paid to institutions for use in the academic year 1919-20. The actual amount paid to institutions for use in the academic year 1920-21 is $376,850.50. 136 KBPORT U. S. INTERDEPAETMENTAL, SOCIAL HYGIENE BOARD. As indicated above appropriations have been made to four institu- tions for the education of the colored race. It is the policy of the board to extend this aid to other institutions for the colored race in States with large colored population. (3) Allotments for researches 1920-21 : As shown in section 2 of this report, appropriations aggregating $29,500 have been made to three institutions for sociological and psychological researches to be carried on during the fiscal year 1920-21. (a) An allotment of $2,000 has been paid to the Massachusetts State Psychiatric Institute for "An Investigation on the Family of the Syphilitic." This study was begun last year under a grant from the Scientific Research Fund. As the study progressed the prob- lems involved were found to be predominantly sociological rather than medical. The allotment for continuance of the research is made therefore from the educational research and development fund. (h) An allotment of $5,000 has been made to Johns Hopkins Uni- versity " for the purpose of developing a laboratory manual and illustrative material to be used in carrying out the suggestions made in Part II of the outline and syllabus on hygiene issued by the board." (c) Two allotments of $5,000 and $10,000, respectively, have been made to the American Social Hygiene Association. The allotment of $5,000 is " for the formation of a competent committee to investi- gate, evaluate, and report on the educational and informational values of social hygiene literature." The allotment of $10,000 is for the development of three new films, one for use with policemen, one describing the protective social measures program that is being de- veloped by the Interdepartmental Social Hygiene Board, and one to be used in connection with other public health films. A supplementary allotment of $7,500 has been made to complete the researches begun under the allotment for 1919-20 noted on page 130 above and described on pages 153-154 below. (4) Allotments to State universities for cooperation with State departments of education in organizing divisions of hygiene in State departments of education : In conformity with the plans and regulations shown in that part of last year's report dealing with future policies, allotments aggre- gating $12,900 have been made to two State universities for coopera- tion with the State department of education in these States in or- ganizing divisions of educational hygiene within the said department. The States and institutions involved are: Mississippi, the Uni- versity of Mississippi, $6,400; Kentucky, the University of Ken- tucky,' $6,500. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 137 (5) Allotments to summer schools: Ten allotments have been made to summer schools for the inclu- sion of special consideration of social hygiene in their programs. Seven of these were made effective in the summer of 1919. The total of these allotments was $1,000. Of the seven institutions thus assisted, four are now cooperating with the board in maintaining permanent departments of hygiene. For the summer of 1920 three allotments have been made aggregating $5,825. Of this amount $5,000 was allotted to Teachers College, Columbia University, to enable that institution, in cooperation with the Interdepartmental Social Hygiene Board, the United States Public Health Service, the United States Bureau of Education and the American Social Hygiene Association, to put on, during the summer session, a complete pro- gram of social hygiene in its educational relations. The policy of the board with respect to summer schools is to make allotments hereafter only for clearly defined and specialized projects. 4. ADMINISTRATIVE RELATIONS BETWEEN THE BOARD AND COOPERATING DEPARTMENTS OF HYGIENE. The principles by which the Interdepartmental Social Hygiene Board would be guided in its administrative relations with normal schools, colleges, and universities establishing departments of hygiene in cooperation Avith the board was stated in the report for 1918-19 : " In proposing this organization the board has not undertaken to dominate the educational methods or text presentation in any of the educational institutions with which it has come into cooperative relationship. It is assumed that each of these institutions is a high- class educational organization that may be depended upon to select with experienced educational intelligence the methods of instruction that are most likely to fit the special needs of its own particular student body. Each of these institutions may be regarded as being engaged in carrying out a research for the discovery and demonstra- tion of better methods of education in the prevention of diseases." This principle has been scrupulously observed in all the dealings of the board with the 40 institutions that have received allotments or ex- tended their departments of hygiene in conformity with the program proposed by the board. The board is clear and explicit in its convictions that instruction relative to the venereal diseases must be integrated — not submerged — in the composite program of hygiene, " emphasizing with appropriate and due proportion and with proper tact and persistency, the serious importance of the venereal diseases, their causes, carriers, and preven- tion." It is equally clear and explicit in its conviction that to secure 138 REPORT U. S. INTERDEPARTMENTAL SOCIAL H-XGIENE BOARD. largest results an integrated organization of all the hygienic factors and resources of the institution is necessary. To that end it recom- mends an organization that coordinates and integrates in one de- partment or service the teaching of informational hygiene; indi- vidual health examination, consultation and conference ; the physical training activities; the emergency care of students in clinic and infirmary ; the sanitary supervision of the various parts of the insti- tution ; and the development of a hygiene consciousness in the insti- tution as a whole. On the other hand the board recognizes that in many institutions the several elements in this composite program exist more or less independent of each other and severally developed in unequal degree. These institutions vary widely in age, traditions, resources, specific purpose, and equipment. There are normal schools limited to a two-year course and there are universities with four-year undergraduate course and full graduate organization; there are schools exclusively for preparation of elementary teachers and others exclusively for secondary teachers ; there are schools for the cultural education of selected social and intellectual classes and schools voca- tional in purpose and emphasis; there are schools exclusively for men, exclusively for women, and coeducational. Obviously, there- fore, there are wide variations in the adaptation of the program out- lined by the board to local institutional needs. Some have been able to approximate the entire program,, both in content and organization. Others have made only a modest beginning. In its administrative relations with these cooperating institutions it has been the policy of the board to encourage each of them to bring about equal efficiency of all the factors in the departmental pro- gram and to realize as completely and as rapidly as possible the benefits of unified organization. It has not sought to bring about immediate mechanical adoption 61 the plan of organization. In general the attitude of all the institutions has been one of free active cooperation in the development of a great educational enter- prise. The institutions that have been cooperating with the board for the past year, in increasing measure are seeking advice and coun- sel from the board; and the institutions to which new allotments have been made have been careful to secure information and advice in the formulation of their plans of organization. This is without any sacrifice of their autonomy of management or independence of judgment; it is merely in recognition of the fact that the board pre- sents a program that commands respect, and that, therefore, the board should be called upon for the information and counsel that its program justifies the institutions in expecting it to furnish for their guidance. KEPORT U, S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 139 5. ADMINISTRATION OF THE EDUCATIONAL RESEARCH AND DEVELOPMENT FUND. (1) Prior to January, 1920, all of the functions and duties in- volved in administering this fund were performed by the executive secretary. This situation was unsatisfactory for three reasons : The handling of this work required a disproportionate amount of the executive secretary's time and attention ; the vital importance of this part of the board's program, the increasing volume of the work in- volved, and complexity of the problems showed clearly the need of a divisional organization and responsibility; the constantly increas- ing demand for advice and assistance on the part of cooperating in- stitutions and ai)plicants for assistance in planning their organiza- tions and programs emphasized the need of competent field service. To meet these needs, the most urgent of which was the field work, the board through the Civil Service Commission appointed, on Jan- uaiy 1, 1920, a superintendent of field service for the educational re- search and development fund, with the following specifications of duties : The duties of the appointee will be to assist the executive secretary of the board, as follows : (a) Selecting colleges, universities, and other suitable institutions or organi- zations in which to develop and demonstrate more effective educational meas- ures for the prevention of venereal diseases. (5) Selecting colleges, universities, and other suitable institutions or organi- zations for sociological and psychological research for better methods of educa- tion and demonstration in the prevention of venereal diseases. (c) Sifting and judging educational, sociological, and psychological re- searches proposed. (d) Applying the rules and regulations of the board as required by law. (e) Determining proper sums to be expended for educational development, improved educational methods, and for sociological and psychological research In the various institutions assisted by the board. (f) Following up and checking these investments of the Government in order to ascertain their usefulness. (g) Organizing and publishing reports from educational institutions and other organizations to which funds are allotted by the board. Subsequent to this appointment it was decided by the board that hereafter no allotments would be made from this fund for depart- ments of hygiene until the applying institutions should have been inspected and a report made showing that "the institution con- cerned can and will satisfy the terms of their agreement with the board. The executive secretary was further authorized to withhold payment in full or in part to a given institution in case he finds upon investigation that such a course is indicated." This "regulation 140 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOAED. covered both applications for continuance of assistance and new applications. (2) In fulfillment of these duties the superintendent of field service of necessity has spent the major part of his time in the field, inspect- ing normal schools, colleges, and universities. Visits were made to all of the 28 institutions already operating departments of hygiene under allotments received from the board and to 18 institutions from which applications for assistance were under consideration by the board. Inspection of the institutions with departments of hygiene in opera- tion has been determined by the following specific objectives : to ascer- tain the extent to which the agreement to establish departments of hygiene " in general conformity with plans suggested by the board ^^ has been carried out and the difficulties in the way of complete con- formity; to judge of the prospect for permanency of the department of hygiene either with or without continued help from the board, as indicated by the personnel of the department, the attitude of the ad- ministrative affairs, and the financial resources of the institution ; tO' secure evidence of positive achievements as shown in effectiveness or organization, content of courses of instruction and training, in- terest of the students and faculty, and improved facilities; and to- examine the facilities and equipment for formal instruction in hy- giene, for health examinations and for physical-training activities relative to adequacy and appropriateness. Much time was spent in consultation with the departmental staff and with administrative officers. They wanted fuller understanding of the policies and plans of the board and advice in regard to matters of organization " in general conformity with the plans of the board." Similarly the inspection of institution from which new applica- tions were under consideration involved a complete survey of the general equipment and the special facilities of the institutions, the elements of the program already supported, the financial resources, and the attitude and outlook of the administrative officers, of the faculty and of the special group which would be concerned in such a department. Detailed written reports have been made pf all inspec- tions. 6. PROGRESS IN EFFECTI^^ ORGANIZATION OF DEPARTMENTS OF HYGIENE. In section 3 above it was shown that the policy of the board is to encourage cooperating institutions "to bring about equal efficiency of all the factors in the departmental program and to realize as com- pletely and rapidly as possible the benefits of unified organization." The ideal is healthy growth rather than mechanical creation. This section attempts to summarize the conditions of organization existing in the institutions at the time aid was granted and the practical KEPORT U. S. INTERDEPARTMENTAL SOCIAI^ HYGIENE BOARD. 141 results in the direction of better organization secured by one year of such aid. (1) In general, the conditions existing at the time aid was granted for departments of hygiene were of three types. (a) Organization approximating in form and scope that pro- posed by the board. In only one of the 28 institutions assisted (Harvard) was there an existing organization of this type bearing the proposed name " Department of Hygiene." In this case all of the functions specified in the board's plan were included under the existing " Department of Hygiene." These functions were unequally developed and insufficiently supported. In a few institutions the proposed organization was approximated in an existing " department of physical education," e. g., Universitj^ of Utah and Colorado State Teachers College. None of these, however, included all of the func- tions proposed and all of them were inadequately supported. (5) Dual organization. The facilities for instruction and train- ing in hygiene specified in the program of the board were provided, in skeleton at least, in two coordinate departments or services. Ex- amples are University of Pennsylvania, with a department of hygiene and a department of physical education ; Cornell, with a department of physical education and a " Student Health Service ;" Oswego Normal School, with department of physical education and depart- ment of health education. None of the institutions of this type within the existing coordinate departments included completely and adequately all of the functions specified in the organization proposed by the board. (c) Functions more widely distributed. In a number of institu- tions there was little organization of the hygiene factors already existing. The functions provided for in the departmental organiza- tion proposed by the board were performed by three or more distinct and independent departments or services. In the Michigan State Normal College, for example, four departments were involved: Physical educational for examinations, physical training activities and part of instruction in hygiene; natural science for instruction in general and individual hygiene ; the college infirmary for " sick- ness service " and for teaching of " home nursing " course ; a faculty committee in charge of general sanitation and the living conditions of students. The institutions included in this group varied widely as to the completeness with which the functions of the organization proposed by the board were covered by the separate departments and service involved. They varied especially as to the total number of these functions provided for ; the relative emphasis upon the several functions ; and the extent to which unity of purpose and action were realized. In none of them, however, were all of the functions pro- 142 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. vided for ; and in most of them there were marked differences in the adequacy of support given to the different functions. In all of the institutions, however, there was realization of in- adequacy and appreciation of the desirability of unifying the func- tions. 2. In large measure the problem of organization was a problem of financial resources. The resource supplied by the board has en- abled most of these institutions not only to increase the amount of activity, but also take steps toward better organization. There is growing appreciation of the fact that " hygiene " in the board's program of instruction and training is a unity — not merely a collec- tion of activities more or less related. As a corollary there is a growing recognition of the advantages of a unified organization. This is represented by a variety of procedures in the direction of unified organization. A number of institutions have reached the desideratum of a single unified department of hygiene. Some have progressed as far as including all the functions under one directing head with a bifurcated title. Some have created an administrative committee to insure coordination. Some have merely established a cooperative modus vivendi of the departments involved. In the institutions with unified organization there has been increasing effi- ciency through increased personnel. In the institutions with dual or multiple organization there has been increased efficiency through the strengthening of the several functions in the program and the development of coordination. There is no case in which some defi- nite steps have not been taken in the direction of unifying all'the • hygienic factors and resources of the institution. These factors and resources, by virtue of this strengthening and unifying, are more effective agencies for instruction and training in hygiene in general and for instruction relative to the venereal diseases in particular. Perhaps one of the most significant gains is the realization on the part of many of the departmental heads that, as one of them has stated it, " educational hygiene is a big, highly specialized job, which can not b^ done successfully if regarded as a potboiler or as a retreat for the professionally lazy or incompetent." This realization is shared by the administrative heads of institutions in increasing degree. 7. EXTENT TO WHICH THE PROGRAM OF INSTRUCTION AND TRAINING IN HYGIENE HAS BEEN PUT INTO EFFECT. It was not expected by the board in making allotments for the organization and establishment of departments of hygiene that the complete program of activities outlined by the board would be adopted mechanically or could be made effective immediately by executive fiat. The former limitation was anticipated in the agree- EEPOKT U. S. INTEKDEPARTMENTAL SOCIAL HYGIENE BOARD. 143 ment pledged by the institutions accepting aid from the board that the "instruction and training in hj^giene shall conform in general plan and requirements " to the program outlined and suggested by the board. The latter limitation is partly inherent in the project — parts of the program are concerned with consecutive processes ; and is partly a matter of adaptation — adaptation of the proposed pro- gram to existing administrative conditions. In general, satisfactory progress has been made in putting the program into effective operation. The expected variations have oc- curred. The following summary of conditions at the end of the first year are based upon the written reports of progress submitted by the institutions supplemented by inspections of all these insti- tutions : • (1) Instruction in the "principles of hygiene" has been given in all of the cooperating institutions. In nearly all of these this has been a required subject for all first-year students. In quantity and character this instruction has conformed in general plan and require- ments to the suggestions of the board for " general " and " indi- vidual " hygiene. In the few instances where the first-year require- ment has not been made effective the variation is justified either by temporary maladjustment of the general program of studies or by intentional assignment of this requirement to some other year. Group and intergroup hygiene quite naturally have been post- poned in most cases until the second year of operation. In some cases courses in educational hygiene covering specifically the "school hygiene" aspect of group hygiene were already in effect, and of course have been continued. In a very few cases, too, there were existing courses in public-health administration, i. e., intergroup hygiene. In all cases it is proposed next year to incorporate group and intergroup hygiene in the curriculum. (2) Principles of physical training. In more than half of the cooperating institutions instruction in the principles of physical training was included in the program of studies prior to receiving aid from the board. In those institutions offering a curriculum for the preparation of special teachers of physical education the courses on " principles " were of course prescribed for these students. In all other cases these courses were elective. Reports show that all but three of the 28 cooperating institutions offered such courses last jea,v. All of them will offer such courses the coming year. Five of the normal schools and teachers' colleges report that a course in the principles of physical training will be required of all students after this year. The reports from all the institutions indicate extension of this requirement as rapidly as possible for all teachers in training. (3) Health examination. In all the institutions provision has been made for competent health examination of the students. In 23 144 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. institutions all the students were given at least one complete exami- nation. Of these, 11 report 2 complete examinations; the rest indi- cate that reexamination of individuals is made as needed within the year, or that two examinations will be given in subsequent years. Of the five reporting that not all students are examined, two re- port one complete examination of all freshmen and all students in teacher training and two report examination of freshmen only. All of these indicate reexamination of individuals as necessar3^ The other reports " examinations as required." There is difference of opinion as to the optimum frequency of com- plete examinations. The majority opinion favors a minimum of one complete examination each year, with such reexamination of indi- viduals as may be indicated by the complete examination, by subse- quent illness, accident, or suspicious symptoms, by deterioration in studies, and for participation in specialized athletics. A semiannual examination is regarded as desirable but not necessary if examina- tions are made scrupulously as indicated above, and if adequate supervision is exercised. (4) Sanitary. Practically all report sanitary supervision either under control of department or in cooperation with other agencies in the institution. This varies from complete supervision of all the hygienic factors in the institutional environment to rather casual supervision of some of these factors. In general there is evidence of growing appreciation of the unitary character of this function. (5) Conferences and consultations. All of the cooperating insti- tutions report provision of facilities for health conferences and con- sultations in fairly close conformity with the plans recommended by the board. In most cases accommodations, time, and personnel are adequate. In a few instances, especially where this service is an innovation, the technique of procedure is somewhat crude; and in a few instances, more and better space is needed. The reports show that in all such cases the deficiences are appreciated by institutions and that improvements will be made. (6) Physical training. The proposed program for physical train- ing provides that each student shall engage for one hour each day in some form of physical exercise appropriate to the individual and wisely directed ; that this shall include special training and corrective exercises for all students not organically fit for mass exercises ; that the repertory of exercises shall include all appropriate recreational activities and may include approved work activities; and that both intramural and interinstitutional athletics be included under the departmental jurisdiction. This program for physical training has met with appreciative response from all the cooperating institutions, but few of them have been able to put it into full and complete effect. The chief obstacles KBPORT U. S, INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 145 are: Existing schedules that could not be greatly changed without careful readjustment; insufficiency of equipment; insufficiency of personnel, even with the increase made possible by the aid of the board, to take care of all students one hour daily ; military-training requirements ; and, in case of athletics, the existence of long-standing administrative agencies for interinstitutional athletics. Progress, however, has been made in all institutions in overcoming these ob- stacles and toward realization of the program suggested by the board. (a) Practically all of the two-year normal schools have put into effect the qne hour a day requirement for all students or will do so next year. Most of them provide reconstructional facilities. (h) The four-year institutions for the most part have required physical training only in the first two years. The time requirement has varied from two to five hours per week. In a few instances the requirement is prescribed for freshmen only. In three of the uni- versities military training is required of freshmen and sophomores, and physical training is supplementary. The facilities for recon- structional work are reasonably good in most of the institutions. In one institution the almost complete lack of gymnasium facilities is a serious handicap both for general and special work in physical training. (c) In practically all of the institutions where the prescribed physical training is less than suggested by the board, earnest and successful efforts have been made to increase voluntary participation, both by lower classmen, whose prescribed amount is less than one hour daily, and by upper classmen, for whom physical training is wholly optional. Several report a large part of the students as par- ticipating. The percentage varies ; it is estimated as high as 80 per cent in one institution. (d) The need of increased equipment and facilities has been em- phasized in every institution where they are inadequate. Additional equipment has been secured in several institutions. In some cases a new gymnasium has been put at the head of the building program. (e) In the normal schools and teachers' colleges the question of athletic administration cuts no figure. In the colleges and universi- ties, however, the problem is still vital. In all the cooperating col- leges and universities the intramural athletics are under the direction of the physical training service. Several of these report inter- collegiate athletics also as so controlled. In the institutions where the intercollegiate athletics are under other control there is reported progress toward better cooperation between the department of phys- ical training and the athletic administration. One institution (Cor- nell) reports that by " combining with the athletic association on the 15610—20 10 146 REPORT XJ. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. salary of a number of coach-instructors it has been possible to secure a group of very capable instructors. This arrangement tends to bring together all of the physical work, puts it in the hands of men who have been selected on additional grounds than merely that of coaching ability, and at the same time permits of proper regulation and supervision. The same procedure may in time be followed in the major sports." (Y) Kecords and planning. The division of records and planning as provided for in the departmental organization proposed by the board does not imply special personnel or additional expense. The object of this provision is to emphasize the importance ,of keeping careful records of activities, not primarily to be filed, but rather to be studied and used for improvement of procedures ; and the impor- tance of active investigation of problems incident to the activities of the department. The value of this function has been generally recognized by the cooperating institutions. There is wide varia- tion, necessarily, in the extent to which the different institutions have made this division effective. All of them have made provision for recording the medical examinations. The strongest departments report a fairly complete development of this division, including comprehensive records of examinations and consultations and of subsequent data in regard to illness, defects, days lost, academic failures, etc.; complete records of optional recreational activities; records of sanitary inspections ; definite investigations in progress or proposed. The investigations include both technical problems and immediate practical problems, such as better coordination of func- tions, regulation of living conditions of students, results of the in- creased attention to hygiene, especially of the venereal diseases, and numerous others equally practical. The significant thing is that practically every institution reports improvement in its record forms; a large number report that this year, for the first time, they have been able to organize their record material for study and comparison; and again practically all state that this phase of the departmental work will be more effectively developed next year, (8) Special public health lectures. Two-thirds of the cooperating institutions report that special lectures have been secured from out- side the institution. The number of such special lectures varies from three to fifteen. In some cases merely isolated lectures were given ; in other cases, courses of lectures covering in detail some aspect of hygiene. The major part of these special lectures was concerned with the venereal diseases, but other topics received occasional atten- tion. In most cases the special lectures were prepared for by instruc- tion through the regular channels in the topics covered by the lec- tures. The special lecture or lectures served to clinch the instruction. KEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 147 8. PROGRESS IN DEVELOPING BETTER EDUCATIONAL METHODS. Sections 4 and 5, immediately preceding, summarize the progress that has been made in the first year in setting up departments of hygiene and in carrying out the general program for instruction and training in hygiene. In this section a summary is attempted of the progress that has been made in developing effective educational measures in the pro- motion of hygiene in general and of the hygiene of the venereal diseases in particular. Inasmuch as it is explicitly purposed that in- struction in the venereal diseases is to be integrated in the various instructional and training activities of the program of hygiene it is unnecessary, as well as impracticable, to attempt complete isolation in this summary of results. The following conclusions, which are stated in general terms, are based upon the written annual reports supplemented by inspection. They represent the more significant and better defined results. (1) A tremendous impetus has been given to hygiene in the co- operating institutions. This is emphasized in nearly every report. The following typical statements from the Michigan State Normal College and the North Dakota Normal School, respectively, bring this point out very clearly: The very fact that the teaching of hygiene has received Federal aid has increased the interest of the faculty hi the subject and has also heightened its importance in the minds of the teachers and students. Although health work in this institution has always been strong it is not too much to say that during the past year the general interest in the subject has been greatly intensified. Increased time and attention have been given to the teaching of hygiene in the various curricula of the school. This subject has been planned on a sounder basis with a place and standing in our school program. Hygiene is now on our school map, and growing in prestige among both the students and the faculty. (2) Practically all institutions report better health conditions and increasing respect for hygiene as among the specific results. An illustration of this aspect of progress is the following summary of results reported by the New York State Teachers College: The net result of the year's work has been: («) To improve materially the health, both mental and physical, of a goodly number of students; (&) to stimulate an intelligent interest in health knowledge; (c) to convince a large number of them that systematic exercise is a sine qua non of good health; (d) to establish among them, or at least'' to have made beginnings toward the establishment of, an honest, wholesome attitude toward the question of sex and an intelligent appreciation of the venereal-disease problem. The following from the Cornell report emphasizes the ultimate social benefits of the program : The human quality, the educational background, and the social and economic standards of a body of college students are such that we have a right to expect 148 REPORT U, S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. that they will apply for tliemselves and as a service for others the information they have acquired. It is fair to state that the instruction has developed such open-uiindedness on subjects of health and its protection that these students will not easily be led astray by quackery and charlatanism. They have acquired some of the critical sense and curiosity about self -protection which will serve to make them effective in support and advancement of the public health in their communities where they are certain to be among the leaders in industry and the professions. (3) All of the cooperating institutions have given serious atten- tion to the problem of integrating instruction in the venereal diseases in the general program of instruction and training in hygiene. This is shown not only in the formal reports, but also in the frequent requests for information and advice and in the appreciative use made of the " Syllabus on hygiene " published by the board. In general there has been intelligent appreciation of the opportunities offered by the several factors in the composite program of hygiene for introducing instruction in the venereal diseases and for un- obstrusively exerting wholesome influence upon the student. Nearly every report shows, not merely by general statement but by specific examples, that the different factors in the program have been utilized and that the importance of this varied approach is recognized. The following concise statement from the Winona Normal School is typical : To summarize, then, every available opportunity — ^by lecture, by the regular teaching force, in the women's and in the men's activities, at the time of the physical and medical examinations, and in the individual and group conferences — has been utilized in emphasizing the hygiene of the venereal diseases. The New York State Teachers' College submits the following summary of factors employed to emphasize the hygiene of venereal disease : (a) Frequent but logical references to the venereal diseases in course of dis- cussions of disease transmission, heredity, immunity, etc.; (6) formal in- struction in hygiene concerning sex and venereal disease prevention; (c) individual conferences with students on sex problems (at student's request) ; (d) use of Government pamphlets and those from American Social Hygiene Association on venereal diseasb prevention; (e) discussions with advanced students on methods of presenting sex to high-school students; if) use of New York State Board of Health venereal disease prevention exhibit. It is the Consensus of opinion of the directors in the cooperating institutions that the special lectures are valuable only as they are closely coordinated with the regular program of instruction; and further that the lecturers must be of more than ordinary ability. Most of them are planning, therefore, to make the special lectures fit systematically into the regular course and to exercise discrimina- tion in the selection of lecturers. (4) There is practical unanimity of judgment that the most ef- fective and most valuable instruction is that which is given inci- REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 149 dentally in connection with the individual health examination, con- ferences, and consultations. The other opportunities in the informa- tional courses and in connection with the conduct of physical-train- ing activities are not disparaged or ignored. In a number of reports the interrelations of the several factors are clearly shown, as in the following quotation from the Harvard report : The number of health conferences has been greatly increased this j'ear due to the facts : First, the program of required lectures to the entire freshmen class, which has stimulated the desire to seek an opportunity for conferences ; and second, the careful supervision of physical training by competent instructors. These instructors haA'e kept in close touch with the students and have not in- frequently advised them to come voluntarily for health conferences. Of course, conferences are required of all freshmen, but in my opinion, more good is achieved from the voluntarily sought conferences than from the routine re- quired conferences. But the vital importance of the examination-conference oppor- tunity is emphasized in nearly every report. This conviction is clearly set forth in the following excerpts from Cornell and Harvard reports, respectively: The most important work of this department has been the medical examina- tion of and personal conference with each student of the university twice dur- ing the acg.demic year by graduate physicians trained in the best methods of clinical examination and familiar with the dominant value of hygiene and observance of the laws of right living in the prevention of disease and for the acquisition and development of vigor and positive health. It is believed that the privacy and intimacy of the sympathetic discussion and analysis of personal habits and conduct of life afforded to and availed of by the students gives more tangible and permanent results than any other method of approach in this subject. In addition to the detection and removal of physical and functional defects, there has been a very general overhauling and readjustment of the habits and manner of living of many students as a result of these conferences with the medical advisory staff. (Cornell.) Instruction by lecture is not sufficient for the complicated subject of social hygiene. In our experience, the facts as given in the lecture are regarded as having general application but not special application to one's own case. Many physicians preach the gospel of hygiene and then neglect il in every possible manner themselves. Students are apt to take such a theoretical and distant attitude in regard to lecture instruction. The problem must be brought home in a very definite and personal way, and a favorable oDportunitv is; furnished at the time of the physical examination. * * * It is not possible at the time of the physical examination to give detailed and extensive instruction in social hygiene. It is possible, however, to break down the ban-iers of em- barrassment, and, after breaking them down and starting discussion, to make appointment with the student for proper follow-up advice — and that is the active function of such physical examination. (Harvard.) This realization of the supreme importance of the health exami- nation as an instrument for instruction and guidance is a significant step in developing more effective educational measures. 150 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. (5) There is a growing conviction that separate provision must be made for the two sexes in the courses in informational hygiene, especially in individual hygiene. This is clearly expressed in the following statement from the New York State Teachers College: " From our experience * * * all of the advantages are on the side of separate instruction in individual hygiene. In group and intergroup work it is immaterial. The reason for this is not because of embarrassment on the part of either student or instructor, but be- cause there is a distinctly specialized distribution of emphasis re- quired in handling the subject matter for the two sexes." Numerous illustrative examples, not quoted here, show clearly that the difference oi emphasis relates to other aspects of personal hygiene than sex con- siderations. It is uneconomical therefore to attempt to teach indi- vidual hygiene in mixed classes. Most of the directors, when they began this work a year ago, were not clear upon this point. It is a distinct contribution to the " development of more effective educa- tional measures" that a number of the strongest departments of hygiene cooperating with the board have reached this definite conclusion. 9. INDIRECT INFLUENCE THROUGH DEPARTMENTS OF HYGIENE. The direct influence of departments of hygiene is exerted upon the institution of which they are parts ; upon practices, habits, ideals, and attitudes of the individual students ; upon the individual attitudes of the teachers ; upon the collective attitude of faculties and administra- tive officers as expressed in administrative policies ; upon the effective- ness of sanitary regulations and practices within the institutions. These influences are capable of approximate measurement and evalu- ation. Such measurement and evaluation is the function of the Divi- sion of Records and Planning provided for in the departmental or- ganization. The indirect influences are not so readily definable and not so susceptible of demonstration ; they are not the less real and important. There are, however, three ways in which such influence may be exerted (and generally is exerted.) Obviously it is too early to secure much evidence as to these lines of indirect influence. One year is hardly sufficient to generate the radiating force. It is interesting to note, however, that many of our cooperating institutions are very much alive as to this problem. They are preparing not only to make their influence felt in these three ways, but also to follow up and estimate the strength and effectiveness of these lines of influence. (1) Influence by example : One indication of this type of influence is the number of applica- tions and inquiries that come from institutions that have heard di- rectly about the program from cooperating institutions. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 151 Another example of this type of influence is shown in the follow- ing quotation from the Harvard report : A most important feature of the work and one which can not be overempha- sized is the relation of this particular program at Harvard to other communities. Already following the lead of Harvard certain large preparatory schools have adopted a program in hygiene suitable to their peculiar needs. A great deal of time has been spent in explaining this program by various members of the staff to interested groups of people, who include not only doctors in the sense of individuals connected with colleges and secondary schools but also indi- viduals interested in the general problems of health of industries and com- munities. The Harvard program has raised a great deal of interest as an experiment. It has been extremely successful, and consequently the influence of this successful experiment will undoubtedly be far-reaching. (2) Influence through graduates as teachers: Obviously even less evidence of this type of influence could be gathered in one year than of the preceding. There must be a suffi- cient lapse of time so that the records of several succeeding graduat- ing classes may be studied. A number of the cooperating normal schools are including in the program of the division of records and planning definite plans for securing information from their gradu- ates in regard to their accomplishments for hygiene in the schools and communities they serve. These plans contemplate not sensa- tional and sporadic efforts, but systematic efforts to follow up the work of teachers who have had the benefits, during their period of training, of this program of hygiene. (3) Influence through extension divisions : A good many of the cooperating institutions have well organized extension departments. In some of these institutions effective co- operation has been established between the two departments. In general the function of the department of hygiene has been to fur- nish the extension department with material, to aid in securing such material, and to advise as to its use. In a few instances, where ex- tension departments do not exist a beginning has been made toward some extension work by the department of hygiene. Of the former class, the University of Utah is a good illustration. Through its extension division the following classes of organizations were reached by lectures : Boy Scouts, Camp Fire Girls, mutual im- provement societies, relief societies, Sunday schools, parent-teachers' associations. The University of Mississippi illustrates the second class. It has undertaken to organize and distribute carefully se- lected "package libraries" to organizations upon request. If the plan matures, such package libraries will be furnished to school au- thorities, teachers, parent-teachers' organizations, boys' and girls' clubs, health officers, women's clubs, physicians, and newspapers. 152 REPOET U. S. INTEEDEPARTMENTAL. SOCIAL HYGIENE BOAED. 10. researches: sociological and psychological. Under the authority reposed in the board lo allot money from the educational research and development fund to qualified institutions " for the purpose of making sociological and psychological researches " related to "more effective educational measures in the prevention of venereal diseases," two allotments were made for researches to be carried on during the fiscal year 1919-20. The character of these researches and the progress made in carrying them on are sum- marized below. 1. Psychological laboratory, Johns Hopkins University: (1) Under date of June 6, 1919, an allotment of $6,600 was made to the psychological laboratory of the Johns Hopkins University for the " purpose of investigating the informational and educative eifect upon the public of certain motion-picture films used in various campaigns for the control, repression, and elimination of venereal diseases." This investigation was undertaken by Dr. John B. Wat- son, assisted by Dr. K. S. Lashley, under the general supervision of an advisory committee, approved by the Interdepartmental Social Hygiene Board. This committee consisted of Dr. Adolf Meyer, director of the Phipps Psychiatric Clinic, Baltimore, Md. ; Dr. S. I. Franz, psychiatrist. Government Hospital for the Insane, Washing- ton, D. C. ; and Dr. Robert S. Woodworth, professor of psychology, Columbia University, New York. The research was formulated and conducted with the specific object of securing data that would aid materially and reliably in answering four questions relative to the informational and educative effects of the pictures already in use : (a) The amount, kind, and accuracy of information they can give; (&) The emotions they arouse; (c) The transitory and permanent effects they produce in the behavior of those who see them ; (d) The probable social effects of such permanent modifications in behavior as may be made. The method of procedure included: A preliminary study of all films now in use for the purpose of selecting the film best adapted to the objects of the research; thorough analysis of the film selected ("Fit to Win"), with respect to its informational and emotional content and the relative distribution of time and emphasis to the different informational and emotional effects aimed at; showing of the film to many groups of individuals of various economic, social, and educational status, and investigation of the results of such show- ings by questionnaires, personal conferences, observation of audiences, and inquiries as to results in communities after a lapse of some months. KEPOET U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 153 This main line of investigation was supplemented by an elaborate set of questions designed to " obtain, from medical men and women who have had most to do with problems in sex -education and the actual treatment of venereal infections, judgments and opinions as to what it is Avise and safe to present to the public." (2) The status of this investigation up to June 30, inclusive, is reported by Dr. Watson as follows: (a) A fairly elaborate qiiestiouary dealing with sex education, with facts that will as.siist us in evaluating the iilni, "Fit to Win," and with tliose relevant to the construction of future films for venereal-disease propaganda, was sent to all members of the American Psychopathological Association, American Gynecologi- cal Society, and The American Association of Genito-Urinary Surgeons. The re- sponse to this questionary was very generous indeed and so far as I know it is the first serious attempt to gain a consensus of o-pinion of medical men on such problems. This material has been copied in its entirety and copies will be de- posited with the United States Interdepartmental Social Hygiene Board, American Social Hygiene Association, national committee for mental hygiene, Phipps Psychiatric Clinic. Most venereal disease propaganda are the concep- tions and executions of a single individual or at most .a small group of in- dividuals. This body of medical opinion should be consulted by every one engaged in venereal disease insti'uction. The complete document is so long that' a summary, which will represent about 50 printed pages, is being prepared for the journal. Mental Hygiene. (&) The film has been shown to many groups of individuals. We may mention briefly, at Camp Plolabird to 1,000 soldiers ; at Wilmington to a body of Du Pont individuals, including superintendents, assistant superintendents, and personnel workers ; before 500 individuals of the Brooklyn Rapid Transit Co. (the audience in this case was confined solely to motormen, conductors, and car-barn workers) ; before 500 sailors at the Seamen's Institute, New York. In all of these showings, many details bearing upon the present film and all future films were observed. Furthermore, in all of these cases the questionary was filled out by the audience. On the basis of these results it is possible for us to obtain a good idea of the organization of the audience concerning venereal- disease matters before the film was shown, and their increased organiza1;ion due to the showing of the film. The actual film showings and the filling out of the questionary together with our own observations on the effect of the film will represent the bulk of the report we are now preparing. (c) In addition to this work where results can be controlled, we selected two towns in Maryland, Salisbury and Cambridge, for active propaganda work. These towns were circularized, posters were put up, newspaper notices were in- serted, etc., and the films were shown for a whole week to both negi'oes and whites. Previous to our showing the films in these towns we had gained con- fidence of the physicians, druggists, and clergymen. Valuable material is col- lecting as a result of this work. It is collecting, of course, in the form of opinions and judgments gathered by the physicians, druggists, and clergymen from the conversation and actions of the citizens who saw the film. (d) The complete report should be in the hands of the United States Inter- departmental Social Hygiene Board on or about September 1. This will be printed in full, but in what journal is not yet determined. 154 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 2. American Social Hygiene Association : Allotment was made July 25, 1919, to the American Social Hygiene Association for two series of practical investigations. For the prepa- ration of a series of motion-picture films, $15,000 was allotted; and for study and preparation of new literature, $11,000. Progress in these two projects is set forth in the report by the general director of the American Social Hygiene Association, June 30, 1920, as follows : During the past fiscal year the American Social Hygiene Association has been engaged upon a series of enterprises involving educational research in the development of motion-picture films and new literature. (1) Motion-picture films: First, the film for the education of the physicians in the modern diagnosis and treatment of gonorrhea has been completed and after approval by the board is doing excellent service in the field. Second, the lecture film for women has been completed and after approval by the board is being carefully tested out before selected audiences in different parts of the country. Third, the revision of the lecture film for men has been completed and after approval by the board is being circulated with constantly increasing influence throughout the country. Fourth, the film for explaining the general social hygiene program which has come to be popularly spoken of as the American plan, has been completed but has not been presented to the board for final approval because various por- tions of it are not considered by the motion-picture committee of the associa- tion to be best adapted to the purpose. Experiments have been going forward for some months testing this film by showings to audiences in various parts of the country, securing the comments of those present, and then modifying the film along lines indicated by the consensus of the opinions secured. It is expected shortly to have all the debatable points covered and to release this film for public use as soon as the board has approved it. Fifth, the film for use in normal schools in instructing teachers has been practically completed, but has not been presented for final approval of the board, as it is likewise in the process of final testing. Sixth, the film for adolescent boys has not been completed, but the photo- graphic work has been done and the several parts of the film are now being tested out with various audiences in boys' departments of the Young Men's Christian Association, by Scout Clubs, schools, and other groupings of boys. As soon as these field researches are completed the film will be assembled and tested in final form, prior to presentation to the board for formal approval. (2) Literature: Substantial progress has been made in the study of new literature along all the lines agreed upon. First, printed matter for illiterates and persons of limited education and foreign-language material has been worked out in the following manner: (a) A complete "lay-out" of pamphlet material, with illustrations, has been made for work with the colored population, and this material is now being tested out on a large scale in the State of Tennessee, where the associa- tion, in cooperation with the State health authorities and the United States Public Health Service, is still engaged on a demonstration of the best ways and means of reaching the colored population with informational hygiene of the venereal diseases. REPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 155 (&) For special uses the following have been -worked out and printed in Yiddish : Warning against prostitutes 2, 000 Facts about syphilis 2,500 Facts about gonorrhea 2, 500 Child questions and answers 2, 500 These experimental editions have been circulated for observation of results and the observations are now in process of study and tabulation. (c) For simillar purposes, especially in the Southwest, the following have been worked out and printed in Spanish : Warning against prostitutes 2,500 Facts about syphilis 2, 500 Facts about gonorrhea 2, 500 Child questions and answers 2, 500 (d) For use in the north Atlantic States and in many other parts of the coimtry where there are large numbers of Italians the following have been printed : Warning against prostitutes 2, 500 Facts about syphilis 2, 500 Facts about gonorrhea 2, 500 Child questions and answers 2, 500 Second, a series of eight posters has been developed. These have run on the cover of the monthly bulletin for the purpose of obtaining a consensus of opinion concerning the most effective of the series. Of the latter a few are being prepared for use of State boards of health aud educational authorities. A subsequent series of eight additional posters has been prepared and a contest has been conducted, with awards of $10 prizes for the best designs for posters. A special poster has been prepared for the cover page of the pamphlet in English entitled " Child Questions and Answers," of which 5,000 have been printed for distribution among the members of parent-teachers associations, branches of the Congress of Mothers, and other similar organizations. A good many photographs have been taken of poster groups in the process of developing designs ; additional photographic studies of social customs, conven- tions, manner of dress, recreation, entertainment, and living and working con- ditions, bearing directly or indirectly upon the prevention of exposure to venereal disease, have been planned or are being worked out. On behalf of the directors of the association I desire to take this occasion to renew our expression of appreciation of the cooperation of the Interdepart- mental Board in promoting the important developmental work which has been intrusted to this organization. I think it may be stated conservatively that the educational facilities which have been made possible by the board and already released to the public have given evidence of their importance and increasing value in promoting both informational and educational hygiene of venereal disease. ' REPORT ON THE BUSINESS OFFICE. The business division of the board has been given the above desig- nation, and is composed of the purchasing, accounting, auditing, and paying sections. 156 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. The duties placed under this division are necessarily numerous^ but our experience has proven that by thus concentrating within one division and under the supervision of one official all the business affairs of the board it tends to promote both efficiency and economy. The system of accounting and filing is of the most modern and approved type. Each appropriation under the board is given its special ledgers and bookkeepers, and all the ledgers in use are specially printed and ruled loose-leaf books. All the most important books and documents are kept in fireproof combination safes. Expenditures from appropriations for the fiscal year ended June 30, 1920, are shown in detail on the following pages. Financial summary, fiscal year ended June 30, 1920. (a) Appi'opriation " Interclepartmental Social Hygiene Board, 1920 " $100, 000. OO Amount expended 93, 010. 09 Unexpended balance 6, 989. 91 (&) Appropriation "Aid to States in protection of military and naval forces against venereal diseases, 1920 " 784, 000. 00 Amount expended 387, 983. 83 Unexpended balance 396, 066. 17 (c) Appropriation "Payments to States for the prevention, treat- ment, and control of venereal diseases, 1920 " 1, 087, 831. 42 Amount expended 991, 486. 12 Unexpended balance 96, 345. 30 (d) Appropriation "Payments to universities, etc., for research in educational measures, 1920 " 439, 030. 00 Amount expended 437, 400. 50 Unexpended balance 1, 629. 50 (e) Appropriation "Payments to universities, etc., for research venereal diseases, 1920 " 103, 430. 00 Amount expended 103, 430. 00 Unexpended balance None. For details of expenditures, see reference letter. Detail of expenditures from appropriation (a). [Appropriation : " Interdepartmental Social Hygiene Board, 1920," $100,000.] Salaries of personnel $6^' 437. 71 Office supplies and equipment, envelopes, etc 14, 631. 51 Railroad transportation 3, 192. 00 Traveling, incidental expenses, and per diem allowance 2, 038. 93 Printing and binding 4, 409. 94 Miscellaneous expenses, including telephones, telegraphing, etc 2, 300. 00 Total 93- 010. 09 REPOET U. S. INTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. 157 Detail of expenditures frovi appropriation (&). T Appropriation : "Aid to States in protection of military and naval forces against venereal diseases, 1920," §784,000.] Salaries $204, 268. 57 Railroad transportation 16, 548. 91 Traveling expenses and per diem allowance 35, 638. 82 Office expenses, including rentals of offices, furniture, purchase of stationery, telephone costs, telegraphing, and miscellaneous items_ 24, 345. 57 Maintenance of venereally infected persons in institutions (for details see below) 107, 131. 96 Total 387, 933. 83 ^Statement of payments to detention liouses, etc., for maintenance of venereally infected persons, fiscal year ended June 30, 1920. 1. State Training School for Girls. Birmingham, Ala $1, 000. 00 2. AVard L, San Francisco Hospital, San Francisco, Calif 8, 007. 00 3. Jefferson County Institutions, Louisville, Ky 3, 993. 25 4. Mercy Hospital, V. D. Detention Ward, Baltimore, Md 100. 00 5. State Department of Health Hospital No. 1, Baltimore, Md 2. 134. 11 6. Fairmount Hospital, Kalamazoo, Mich 11, 909. 77 7. Female Detention Ward, St. Louis City Hospital, St. Louis, Mo__ 1, 233. 84 8. Florence Crittenden League, New York, N. Y 349. 50 9. State Home and Industrial School for Girls and Women, Samar- cand, N. C 48,929.43 10. Akron Welfare Home for Women, Akron, Ohio _1 1, 860. 73 11. Cincinnati General Hospital, Cincinnati, Ohio 5. 934. 00 12. Anna Finstrom Detention Hospital, Columbia, S. C 3, 739. .50 13. Shelby Hospital, Memphis, Tenn 4, 658. 37 14. Chattanooga Venereal Quarantine Hospital, Chattanooga, Tenn_ 7, 200. 00 15. Texas Girls' Training School, Gainesville, Tex 4, 136. 99 16. City Hospital and City Home, Norfolk, Va 1, 945. 47 Total paid 107, 131. 96 SUMMARY. Average number of venereally infected persons in above institutions for one month 11, 493 Actual number of days' treatment given by above institutions 96, 842 Average per capita cost per day $1- 11 Detail of expenditures frorn appropriation (c) fiscal year ended June 30, 1920. [Appropriation : " Payments to States for the prevention, treatment, and control of venereal diseases, 1920," $1,087,831.42.] Alabama $25, 288. 99 Arizona 2, 250. 00 Arkansas 17, 118. 74 California 25, 800. 00 Colorado 9, 450. 70 Connecticut 12, 000. 00 Delaware 2, 393. 02 Di.strict of Columbia Florida 8, 90L 84 Georgia 15, 000. 00 Idaho .3, 540. 13 Illinois 06, 692. 24 Indiana $31, 945. 49 Iowa - 15, 000. 00 Kansas 20, 000. 24 Kentucky 27, 084. 58 Louisiana 19, 590. 46 Maine 8, 07L 68 Maryland 14, 651. 96 Ma.ssachusetts 36, 602. 51 Michigan 33, 238. 23 Minnesota 24, 551. 10 Mississippi 21, 2-55. 94 Missouri 31, 969. 03 158 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. Montana $4, 447. 88 Nebraska 12, 962.. 75 Nevada New Hampshire 4, 981. 54 New Jersey 27,586.22 New Mexico New York 107, 794. 18 Nortli Carolina 26, 095. 57 Nortli Daliota 6,274.24 Ohio 25, 000. 00 Oklahoma 19, 600. 53 Oregon 7, 314. 87 Pennsylvania 90, 661. 56 Rhode Island 6, 000. 00 South Carolina $17, 923. 88 South Dakota 5,000.00 Tennessee 25, 841. 29 Texas 45, 600. 00 Utah Vermont Virginia Washington West Virginia. 4, 41^5. 92 4, 210. 19 24, 384. 37 13, 507. 25 12, 900. 00 Wisconsin 25, 000. 00 Wyoming- 1, 587. 00 Total 991, 486. 12 Detail of expenditures from appropriations (d), fiscal year ended June 30, 1920. " Payments to universities, etc., for research in educational measures, 1920," $439,030.] [Appropriation Alabama : University of Alabama, University $9, 500. 00 Tuskegee Normal and Industrial Institute, Tuskegee 9, 950. 00 California : State Normal School, San Diego 75. 00 Colorado : State Teachers' College, Greeley 8, 631. 00 ■Florida : University of Florida, Gainesville 10, 100. 00 Illinois : Northwestern University, Evanston 10, 000. 00 Northern Illinois State Normal School, DeKalb 100. 00 Indiana : Indiana University, Bloomington 7, 440. 00 Teachers' College of Indianapolis, Indianapolis 75. 00 Iowa: State University of Iowa, Iowa City 15, 938. 52 Iowa State College of Agriculture and Mechanic Arts, Ames 10, 000. 00 Kentucky : University of Kentucky, Lexington I 17, 600. 00 Louisiana : State Normal School, Natchitoches 5, 750. 00 Maryland : Maryland State Normal School, Towson 4, 600. 00 Maryland Normal and Industrial School (colored), Bowie 1,960.00 Johns Hopkins University, Baltimore 5. 000. 00 Massachusetts : Harvard University, Cambridge 13, 600. 00 Massachusetts State Psychiatric Institute, Boston 2,000.00 Michigan : Michigan State Normal School, Ypsilanti 6, 200. 00 Minnesota : State Normal School, Winona 5, 300. 00 Mississippi : University of Mississippi, Oxford 20, 575. 00 Missouri : State Teachers' College, Kirkville 11, 920. 00 University of Missouri, Columbia 5, 722. 06 New Mexico : University of New Mexico, Albuquerque 6, 600. 00 Nevada : University of Nevada, Reno 6, 000. 00 New York : State Normal and Training School, Oswego 7.650.00 New York State College for Teachers, Albany 10, 161. 00 Cornell University, Ithaca 37, 065. 00 Teachers' College, Columbia University, New York City 5, 000. 00 College of the City of New York, New York City 375. 00 American Social Hygiene Association, New York City, 14 re- searches 48, 500. 00 EEPOKT V. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 159 North Carolina : North Carolina College for Women, Greensboro $10, 800. 00 North Dakota : State Normal School, Valley City 4, 500. 00 Ohio : University of Cincinnati, Cincinnati 12, 000. 00 Oregon : University of Oregon, Eugene 10, 000. 00 Reed College, Portland 2, 200. 00 Pennsylvania : Women's Medical College of Pennsylvania, Phila- delphia 3, 376. 73 South Carolina : University of South Carolina, Columhia 6, 570. 00 South Dakota : Northern Normal and Industrial School, Aberdeen 11, 433. 00 Tennessee : University of Tennessee, Knoxville 9, 250. 00 Peabody College for Teachers, Nashville 10, 000. 00 Fisk University, Nashville 10, 000. 00 Utah : University of Utah, Salt Lake City 12, 000. 00 Virginia : Hampton Normal and Agricultural Institute, Hampton 6, 000. 00 Washington : State Normal School, Cheney 3, 808. 30 State Normal School, Bellingham 10,300.00 Wisconsin : Milwaukee State Normal School, Milwaukee 11, 774. 89 Total 437, 400. 50 Detail of expenditures from appropriation (e) fiscal year ended June 80, 1920. [Appropriation : " Payments to universities, etc., research venereal diseases, 1920," $103,430.] California : Leland Stanford University Medical School, San Francisco— $885. 00 University of California, Berkeley 3,875.00 Illinois : John McCormick Institute for Infectious Diseases, Chicago 3, 000. 00 Northwestei-n University, Evanston 6, 000. 00 University of Illinois, Urbana 3,500.00 Iowa : University of Iowa, Iowa City _ 5, 320. 00 Maryland : Johns Hopkins University, Baltimore, four researches- 19, 050. 00 Massachusetts : Massachusetts State Psychiatric Institute, Boston 13, 200. 00 Harvard Medical School, Boston 10,000.00 Minnesota : University of Minnesota Medical School, Minneapolis, three researches 9, 000. 00 Missouri : St. Louis University School of Medicine, St. Louis 4, 000. 00 Washington University School of Medicine,- St. Louis 4,000.00 New York : Columbia University College of Physicians, New York 4, 200. 00 New York University and Bellevue Hospital, New York 5, 400. 00 Wisconsin : University of Wisconsin, Madison 12, 000. 00 Total - 103, 430. 00 Pakt III. Ixfracts Covering Activities for the Year Ending June 30, 1919, Taken From the Manual for the Various Agents of the United States Interdepartmental Social Hygiene Board. INTRODUCTION. BACKGROUND AND PURPOSES OF LAW CREATING THE BOARD, The compelling events of the Great War very early focused the at- tention of the world upon the fundamental importance of man power. The remark that the war would be won by the side that could fight for the last 15 minutes was taken at its face value. The conservation of man power came to be a dominating factor in the plans of each of the warring nations. When the United States entered the war the medical service of the Army and the medical service of the Navy were ready with practical plans for the prevention, treatment, and control of malaria, typhoid, typhus, and smallpox, each of which has a military history of greater morbidity and greater mortality than all the weapons of warfare in all the great armies of all history combined. Very recent military history had demonstrated the practical values of scientific hygiene for the prevention, treatment, and control of these diseases in the Army, in the Navy, and in the civilian population upon which armed forces depend in so many ways for safety and support and recruits. The United States made use of this information and in consequence the Medical Corps of the Army, the Medical Corps of the Navy, and the Public Health Service of the Treasury saved an enormous resource in American man power that otherwise would have been needlessly sacrificed to these diseases. But there is a group of other diseases of well-known military, naval, and civilian danger that had not been successfully controlled in previous wars. Gonorrhea, syphilis, and chancroid have been among the determining factors in all the great wars for many cen- turies. Their causes, carriers, injuries, and preventions have been known for a number of years, but up to this great war no thoroughly organized, systematic, and relatively complete program had been de- veloped and applied for the prevention, treatment, and control of these diseases. 160 REPORT U.S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 161 Even before the United States entered the Great War, govern- mental and civilian experts began laying plans for the control of gonorrhea, syphilis, and chancroid. The most powerful of these pre- war stimuli came from the American Social Hygiene Association, a voluntary civilian organization that for a number of years had been gathering scientific information and laying carefully organized plans for the control of the venereal diseases. As a result of these influences, the venereal disease programs of the Army and the Navy were effectively organized soon after the United States entered the war. But no program of protective hygiene can possibly succeed in defending the Army or the Navy from military diseases and espe- cially from the venereal diseases unless that program protects also the civilian population. Knowing that venereal disease is much more common in the civilian population than in the Army or Navy ; know- ing that every soldier or sailor with gonorrhea, syphilis, or chan- croid secured his infection from a civilian source ; knowing that the civilian prostitute, male and female, is in a large measure respon- sible for the dissemination of venereal disease ; and knowing that the prostitute is not a local or regional, but rather a national liability, the well-informed authorities concerned applied to Congress for legis- lative action that would enable the War Department, the Navy De- partment, and the Treasury Department to join together to assist the States to meet their very important obligations and i3omplete the American program for the prevention, treatment, and control of the venereal diseases. The startling facts that led Congress to enact the law which es- tablished the Interdepartmental Social Hygiene Board and the defi- nite purposes for which that legislation was proposed, are stated in the records of a hearing held before a subcommittee of the Senate Committee on Military Affairs on June 18, 1918. The evidence pre- sented at this hearing was furnished by a group of men who are known to be among those most expertly qualified to furnish reliable information on the community, State, and National menace of vene- real diseases. The defensive, protective, and remedial proposals made to and ap- proved by the committee, and supposedly contained in the act as finally submitted, were approved by the House of Representatives and by the Senate, and the act carrying this presentation of the law was signed by the President on July 9, 1918. These proposals may be stated concisely as follows : To assist the various States in caring for civilian persons whose detention, isolation, quarantine, or commitment to institutions may be found necessary for the protection of the military and naval forces 1.5610—20 11 162 REPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. of the United States against venereal diseases during the war and after the war ; To protect the civilian population against venereal diseases during the war and after the war ; To assist States in building reformatories and detention houses for hygienic, social, and economic redemption and restoration of venereal-disease carriers ; To assist States in the cure of persons with venereal diseases ; To assist States in the eradication of venereal diseases ; To assist colleges, universities, and other suitable institutions to carry out scientific research for the discovery of better medical methods for the treatment and prevention of venereal diseases; To assist colleges, universities, and other suitable institutions in the instruction of their students concerning the defensive hygiene of venereal disease. A copy of the act is appended. ( See Appendix A. ) Summary or the Work of the Board for the Period Ending June 30, 1919. The board is made up of the Secretary of the Treasury, the Secre- tary of War, the Secretary of the Navy, and a representative chosen by the Secretary of the Treasury from the United States Public Health Service, a representative chosen by the Secretary of War from the Medical Corps of the United States Army, and a repre- sentative chosen by the Secretary of the Navy from the Medical Corps of the United States Navy. This act of Congress carried with it an appropriation of something over $4,000,000 which was made available for a period of two years. One million dollars of this sum was set aside for payment to States for expenditure through their boards of health for the prevention, treatment, and control of venereal diseases. This appropriation of $1,000,000 was repeated for the year beginning July 1, 1919. A second appropriation of $200,000 was made for the establishment of a division of venereal diseases in the United States Public Health Service. This Division was directed by the law to study and investi- gate the causes, treatment, and prevention of venereal diseases, to cooperate with State boards or departments of health for the pre- vention and control of such diseases within the States ; and to control and prevent the spread of these diseases in interstate traffic. A third appropriation of $1,000,000 was made for the purpose of assisting States in caring for civilian persons whose detention, isolation, quar- antine, or commitment to institutions would protect the armed mili- tary and naval forces of the United States from venereal diseases. A fourth appropriation of $100,000 was made for the present year and REPORT U. S. I2!TTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 168 repeated for the ensuing fiscal year for the purpose of assisting sucli colleges, uniAersities, and other institutions as, in the judgment of the Interdepartmental Social Hygiene Board, are qualified for scieji- tific research to discover more effective medical measures for the treatment and prevention of venereal diseases. And finally the law carried an appropriation of $300,000 for the first fiscal year (1919) and of $300,000 for the second year which " shall be paid to such universities, colleges, or other suitable institutions or organizations as, in the judgment of the Interdepartmental Social Hj^giene Board, are qualified for scientific research for the purpose of discovering and developing, in accordance with the rules and regulations prescribed by the Interdepartmental Social Hygiene Board, more effective edu- cational measures in the prevention of venereal diseases and for the purpose of sociological and psychological research related thereto.'- The work of the board has been very seriously handicapped because of certain inadvertences in the wording of the law which brought the board into existence. Nevertheless a great deal has been accom- plished through the application of these several funds. A tremendous campaign along the lines of information relating to the individual, group, and intergroup hygiene of venereal diseases has been carried on by the Division of Venereal Diseases of the United States Public Health Service and by the commissions on training-camp activities. Practically all of the States in the United States have passed laws or adopted regulations for the control of these diseases in accordance with the recommendations of the. Secretary of the Treasury and the Interdepartmental Social Hygiene Board. All of the States with the exception of three have availed themselves of the appropriation set aside for the use of their boards of health for the prevention, treatment, and control of venereal diseases. Most of these States qualified for the appropriation set aside for them for the second fiscal year on the condition that for each dollar received by a State from the Government under this appropriation the State should set aside a dollar from its own treasury. The appropriation for assisting States in caring for infected civilian persons^ in order to protect soldiers and sailors from venereal diseases, has been spent this year (1919) largely through the law enforcement division of the commissions on training-camp activities. The commissions on train- ing-camp activities have been greatly reduced in personnel, and the law-enforcement division has become, as a result, the field service of the Interdepartmental Social Hygiene Board. This field service has- accomplished a tremendously important piece of work. Among other things, it has taken care of over 30,000 delinquent women and girls who were detained in the neighborhoods of military and naval camps and has either sent them home, placed them on parole, or committed them to institutions for care and treatment. 164 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. The combined program of the Army, the Navy, the Public Health Service, the commissions on training camp activities, and the United States Interdepartmental Social Hygiene Board resulted in a re markable reduction of venereal infection in the Army and in^ the Navy during the war. Just as we succeeded in reducing or eliminat- ing typhoid or typhus fever and other serious diseases when we wisely applied scientific knowledge and when we spent money in suffi- cient amounts, so we have succeeded in reducing enormously the occurrence of venereal infections, now that we have used the avail- able scientific knowledge and have spent money' intelligently for that purpose. No army in the history of the world has enjoyed the freedom from these diseases which the American Army has secured. A number of interesting facts have been brought up in connection with this whole program. In the first place, it seems to be true that in the civilian population, without any systematic control, venereal infections may be ten times as numerous as in the Army and Navy under the systematic and regular control that obtains there. It has been found that a soldier with venereal infection is usually able to do some kind of work after about 10 days in the hospital, and that it is very much better for the soldier that he be given work as soon as it is reasonably possible to do so. It may be said therefore that every case of venereal infection means a loss of at least 10 days on the part of the man concerned. It must not be forgotten, however, that none of them is able to work at full normal capacity so soon, and that some men become incapacitated for life. It would be safe to state that the incapacity resulting from venereal disease persists usually for several weeks and sometimes for life. Between September, 1917, and February 14, 1919, there were over 220,000 cases of venereal disease in the Army, and there were over 60,000 cases in the Navy. Our record, then, was somewhere in the neighborhood of 300,000 cases, causing the Army and Navy to lose a minimum of 3,000,000 days of service. If there had not been an efficient program of venereal disease control, with its educational, in- formational, protective, and preventive elements operating in the camp and outside of the camp, we would have had five times as many cases of venereal disease and we would have lost more than five times that amount of time and human service because of those diseases. The United States Government by spending several million dollars in this campaign and by using the expert service of some of the best- equipped men and women in America has saved a million or more young men from infections that would have incapacitated them all for at least 10 days and some of them for life— infections that would have injured not only them but many others with whom they would come in contact. This investment has been of priceless value to the Government and to the men for whom it was made, and to the home.s REPOKT U. S. mTERDEPARTMENTAL SOCUAL HYGIENE BOARD. 165 and families of those men. It gives us an example of what can be done by intensive ^organization for the control of this particular group of agencies that injure human health. Our fund for the encouragement of scientific research is being distributed to institutions whose representatives come to us with medical problems concerning the prevention and treatment of venereal disease, which these institutions cannot solve without financial help. The board has made some distributions already and is negotiating with a number of institutions relative to other appro- priations. Up to July 1, 1919, appropriations were made to 14 uni- versity laboratories located in 11 States for the purpose of investigat- ing 27 important problems in the prevention and treatment of ve- nereal diseases. At the present time 40 of the most capable and best- known students of scientific medicine in America are engaged in directing and carrying out these researches. With them are asso- ciated a number of younger promising scientific investigators. The Interdepartmental Social Hygiene Board has taken the posi- tion that education for the prevention of, avoidance of, and protec- tion from venereal diseases, and unwise and injurious sex life should not be developed through a special and dramatic emphasis of those subjects, but rather through their normal consideration in their proper and regular relation with the other important divisions and subdivisions of hygiene. Furthermore, the board takes the position that the greatest amount of permanent influence may be achieved if the regular classroom teacher is prepared in general hygiene as thoroughly as she is prepared in English or geography or mathe- matics. With these principles in mind, the board has proposed to assist each State in the United States that will accept this assistj^nce, to establish in one of its normal schools, colleges, or universities that trains teachers, a department of hygiene that will reach every teacher in training in that institution, so that upon graduation the prospective teacher will have had as a part of his or her preparation for life work, training secured in a required, expertly supervised curriculum, including courses and conferences in informational hy- giene and courses and conferences in the applications of hygiene wherein are emphasized with appropriate and due proportion and proper tact and persistency the serious importance of the venereal diseases, their causes, carriers, and prevention, and at the same time, with all the consideration they deserve, emphasis is given to the other important facts, and applications of general, individual, group, and intergroup hygiene. The board is interested not only in this training for teachers but also in such a training for all college and university students. Up to June 30, 1919, the board had made appro- priations for the assistance of normal schools, colleges, and uni- 166 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. versities in the establishment of departments of hyo;iene in 22 edu- cational institutions situated in 18 States. It is wholly obvious that it is only through some such method of approach as this that we will be able to influence our future citizen- ship to protect itself through habits of individual, group, and inter- group hygiene from the venereal diseases, as well as from the great variety of damaging agencies of similar character with which the race has to contend. While it is true that one can, within limits, buy health, and while it is true that the city or the nation that will spend its money can buy protection from the agencies that destroy life and damage health, it is nevertheless equally true that there is a point be- yond which your dollar and the dollars of the Nation can not go for the purchase of vigor, physiological efficienc'^% and enduring life. Be- yond that point the individual must provide his own protection, and he must supply this protection through his habits of living. He must achieve this greater physiological efficiency, this better health, through his own physical education. If the United States Interde- partmental Social Hygiene Board succeeds in demonstrating the practical value of departments of hygiene in training schools for teachers, and in colleges and universities, the Government will have accomplished one of the most important tasks that lies between us and the achievement of more perfect national vitality and of national health. If every parent and every other teacher of children were in possession of safe, general knowledge of the elements of hygiene, the children would profit enormously through their home and school experiences, and we would be supplied ultimately with a very much more complete program of defense against the agencies that destroy the health, the man power, and the woman power of the Nation. PERIOD OF ORGANIZATION. Pursuant to the provisions of the act of July 9, 1918, the board met on August 8, 1918, for the purpose of organizing. The members of the board at that time were : William G. McAdoo, Secretary of the Treasury, represented by Judge J. H. Moyle, Assistant Secretary of the Treasury. Newton D. Baker, Secretary of War. Josephus Daniels, Secretary of the Navy. Lieut. Col. W. F. Snow, Medical Corps United States Army. Lieut. Commander J. E. Phelps, Medical Corps United States Navy. Asst. Surg. Gen. C. C. Pierce, United States Public Health Service. 'Secretary Daniels was elected chairman and Asst. Surg. Gen. Pierce was made temporary' secretary. An executive committee was organized, the membership of which was composed of Lieut. .Col. Snow, Lieut. Commander Phelps, and Asst. Surg. Gen. Pierce. REPORT U. S. INTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. 167 Acting on informal advice secured from the office of the Comp- troller of the Treasury, the board appointed a disbursing agent on September 3, 1918, through regular civil-service channels. After a search for an available man competent to serve as an executive sec- retary, the board made appointment to the position October 12, 1918. The board proceeded immediately to adopt measures for the ac- complishment of the purposes that weve defined in the hearings that preceded the passage of the act. These purposes the board had every reason to believe were the intent of the act resulting from the hear- ing. Communications were developed with competent State authori- ties and public-spirited citizens, for the assistance of the States in ac- cordance with well-known plans of the framers of the act. It very soon became evident that the intent of the framers of the act was not carried in whole by the provisions of the statute and that the law establishing the Interdepartmental Social Hygiene Board contained certain inadvertencies of a very serious character. One by one the delaying influences of these inadvertencies became evident. As a re- sult, the administrative organization and functional activities of the board fell naturally into three periods — a period of delayed organiza- tion pending an authoritative interpretation of the law, a period of incomplete administration because of insufficient financial re- sources, a period of final organization which will consume a large p|irt of the second fiscal year in the life of the board. Period of Interpretation. The period roughlj^ extending from July to December, 1918, may be designated as the " period of delayed administrative organization or interpretation." The delay was due to loss of time, first because of necessary processes in the office of the Comptroller of the Treasury leading up to decisions for the board, and second because of inevitable loss of time in connection with the formulation of an application for an emergency resource with which to maintain the board until con- gressonal amendment could be secured to correct the situation that had developed. The duties of the board, in certain cases, were not by any means clear in the law as passed or in conformity with the supposed in- tention. The original bill as proposed to the Senate committee and as printed in the record of the hearing of June 18, 1918, contained six sections. Subsequently section 5 of the proposed bill was divided into sections 5, 6, and 7. Unfortunately this subdivision was not ac- companied by a revision of section 1, which carried two specific ref- erences to section 5 as it stood in the original bill, references relating to the duties of the board, namely: " (1) To recommend rules and 'regulations for the expenditure of moneys allotted to the States under 168 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. section 5 of this chapter; (2) to select the institutions and organiza- tions and fix the allotments to each institution under said section 5." After the original section 5 to which these references were made had been subdivided into sections 5, 6, and 7, neither one of the two references was concerned with the new section 5. In the bill as it was changed and passed finally, both of the references in section 1 applied to the new section 6. It is obvious that difficulties became at once imminent and, as the law now reads, it would seem that the board has no function in relation to the rules and regulations govern- ing the expenditure of moneys allotted to the States under the new section 6 and only a limited function in the relation to the selection of institutions and allotments under the new section 6. The matter was brought to the attention of the Comptroller of the Treasury, who pointed out: "The terms of the appropriation under section 5 do not provide for allotments to States, institutions, and organizations. Such an appropriation is provided for by section 6 of this act, but the allotments to the States are to be in accordance with rules and regulations prescribed by the Secretary of the Treas- ury and those to organizations, institutions, etc., under the board. The duties of the board and the appropriations are thus not properly designated in connection with the statutory provisions." Again, when the board took up the question of assisting the various States " in caring for civilian persons whose detention, isolation, quarantine, or commitment to institutions may be found necessary for the protection of the military and naval forces of the United States against venereal disease," the board was confronted with another un- expected term. The policy was adopted of aiding the States in con- formity with this provision through assistance granted in the con- struction of reformatories. The Comptroller of the Treasury, how- ever, gave a ruling holding that none of the money appropriated by the act for this purpose could be spent for the construction or repair of any institution. The board could not undertake to build or repair structures not on Government property. Another serious inadvertency was discovered in the 'wording of section 7, which carried an appro- priation of $100,000 intended for use in the administrative organiza- tion of the board. Because of the wording of the clause, however, the board was informed that none of this $100,000 could be used for the employment of personnel or for the organization of a cejitral office. This matter was taken up with the Comptroller of the Treasury, who pointed out that the law as it stood appropriated the sum of $100,000 to be used " for any purpose for which any of the appro- priations made by this chapter are available," and since "none of the appropriations are for the expenses of an organization of ther board " none of the $100,000 could be used for this purpose. REPORT U. S. INTERDEPARTMENTx\L. SOCIAL HYGIENE BOARD. 169 To meet the emergency application was made to the President for assistance from his national security and defense fund, in order that the board might have funds with which to administer its various activities. The application was granted by the President and a total of $20,000 set aside from the national security and defense fund to meet the administrative expenses of the board, one appropriation being made November 8 and the second November 20. During this period of delayed organization, the administrative personnel of. the board consisted of the executive secretary, a dis- bursing and accounting agent, and three stenographers. Two of the stenographers were furnished by an agency other than the board, and the others making up the personnel in the office of the board were without salaries until the emergency fund was made available. Proposed Amendments and Their Fate. After discovering the various inadvertencies in the act creating it, the board made every reasonable effort to secure corrective amend- ments through Congress. A general amendment to the act was drawn up, which it was believed would correct all of the diffi- culties, make the law and the purposes of its framers coincide, and permit the Interdepartmental Social Hygiene Board to carry on to the full the duties placed upon it by Congress. The cor- rections proposed were approved by the various committees to which they were presented in the Sixty-fifth and also the Sixty-sixth Congress. In January, 1919, the amendments were included in the Army appropriation bill, which " died " in the Senate March 4, 1919. In May, 1919, the amendments were introduced by way of the Appropria- tions Committee of the Senate, and were removed with a number of other proposed amendments by the conference committee on the sun- dry civil bill of the Senate and the House, Fortunately, the sundry civil bill as finally enacted in July, 1919, authorized the board to use its resources of $100,000 for administra- tive purposes. It will be seen, however, that this authority came virtually a year after the board was legally established. In the meantime the board was supported by a very inadequate financial administrative resource — a total of $20,000 — with which to admin- ister four appropriations aggregating $2,400,000, and covering a number of complicated administrative activities. Period of Incomplete Administrative Organization. The period of incomplete administrative organization of the Inter- departmental Social Hygiene Board extended from the date of the receipt of financial assistance from the national security and defense 170 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. fund, to the end of the fiscal year ending June 30, 1919. The request for $20,000 from the emergency fund was originally intended to cover the administrative expenses of the board up to March 4, 1919, by which time it was confidently expected that Congress would have enacted corrective amendments making available to the board the appropriation originally intended for administrative purposes. When these amendments were not acted upon by Congress the board adopted the only policy open to it for the remainder of the fiscal year, namely, the restriction of its activities to limitations imposed by the amount of administrative financial resources at its disposal. During this period an administrative organization was developed by the board for the purpose of — 1. Maintaining a satisfactory record of disbursements and accounts in connection with each of the five funds for which the board was responsible in whole or in part. 2. Assisting States in the " care of civilian persons whose detention, isolation, quarantine, or commitment to institutions may be found necessary for the protection of the military and naval forces of the United States against venereal diseases." 3. Selecting by correspondence and expert investigation and mak- ing appropriations to " such universities, colleges, or other suitable institutions as in the judgment of the board are qualified for scientific research for the purpose of discovering, in accordance with the rules and regulations prescribed hj the Interdepartmental Social Hygiene Board, more effective medical measures in the treatment and preven- tion of venereal diseases." 4. Selecting by correspondence and making appropriations to " such colleges, universities, and other suitable institutions or organizations as in the judgment of the Interdepartmental Social Hygiene Board are qualified for scientific research for the purpose of discovering and developing, in accordance with the rules and regulations pre- scribed by the Interdepartmental Social Hygiene Board, more effec- tive educational measures in the prevention of venereal diseases and for the purpose of sociological and psychological research related thereto." 5. Making the most effective use of the limited resource secured from the national security and defense fund for the maintenance of the board during this period of administrative financial difficulty. On April 1, 1919, the War Department assigned to the board the major part of its administrative personnel, which had prior to that date been attached to the commission on training-camp activities, and known as its law-enforcement division. It was at this time that the commission on training-camp activities was very largely demobilized. The field service for some months prior to this time had been per- formed by employees of the board, so that it was wholly logical to REPORT U. S. INTERDEPARTMENTAL SOCIAL. HYGIENE BOARD. 171 transfer the administrative personnel of the law-enforcement divi- sion to the Interdepartmental Social Hygiene Board at this time. Under these conditions the organization of the board during this period was partly made up of personnel receiving compensation from the board and partly of personnel assigned to the Ijoard from the War Department. This central administrative organization was as follows : PJxecutive secretary, Dr. T. A. Storey. Assistant director of the medical research fund, Dr. R. W. Hoffman. Supervising assistant in charge of men in the field service, C. 1^. JViiner. Supervising assistant in charge of women in the field service, Miss Henrietta Additon. Specialist in reformatories, Mrs. Martha P. Falconer. Assistant specialist in reformatories, Dr. Mary B. Harris. Disbursing agent, R. H. Lovett. Clerks and stenographers. ACTIVITIES. 1. Civilian Quarantine and Isolation Fund. Under the provisions of the act creating the Interdepartmental Social Hygiene Board, the Secretary of War and the Secretary of the Navy are authorized and directed to adopt measures to assist the various States " in caring for civilian persons whose detention, iso- lation, quarantine, or commitment to institutions may be found neces- sary for the protection of the military and naval forces of the United States against venereal diseases." The statute set aside $1,000,000 for the purpose of carrying out this provision, which the board called " the civilian quarantine and isolation fund." PROGRAM for ASSISTANCE OF STATES IN BUILDING REFORM AT<1RIES. The Secretary of War and the Secretary of the Xavy adopted the program proposed before the subcommittee of the Senate Committee on Military Affairs at the hearing June 18, 1918, and authorized the interdepartmental Social Hygiene Board, of which the Secretaries are active memljers, to administer this fund in harmony with that program. In conformity with this program an agent of the commission on training-camp activities was sent out into the States for the purpose of assisting the officials and public-spirited citizens to secure financial resources with which to build detention houses and reformatories for women over the age of 18 years and for girls 18 years old and under, and in certain States for colored women and ffirls. 172 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. i he work of establishing throughout the country reformatories for women and girls, detention houses and detention hospitals, and re-_ organizing those which already existed to meet the sudden strain put upon them by war conditions, had been begun under the War De- partment in April, 1918. It developed out of the efforts made to effect a law-enforcement program suppressing vice and liquor about the military training camps. Its work was preceded and to some extent defined by the popularization of the detention-house idea — the value of a clearing house where all women and girls (except hardened cases) who are arrested may be held while awaiting trial, to be studied and treated medically. The committee on protective work for girls, the first Federal organization to engage in work for girls in the war situation, saw the great need of the detention houses in the camp towns and succeeded in popularizing the idea. Then, in Februaiy, 1918, in the enforcement of section 13 of the act of Congress "to authorize the President to increase temporarily the Military Establishment of the United States," which provided for a penalty of $1,000 fine or one year's imprisonment for conviction in Federal court of prostituting within the 5 -mile zone established about military camps, 19 girls were sentenced from South Carolina to the National Training School for Girls in the District of Columbia, because the State of South Carolina had no provisions for their care. With this action the Federal Government experienced the need of ad- ditional facilities for the custody and rehabilitation of girls and women found to be a menace to the health and morals of the men in training. The 19 girls from South Carolina arrived in Washington to find the national training school filled to capacity. These girls were finally placed in the excellent care of the Massachusetts Re- formatory for Women at Framingham, Mass. The difficulty of their disposal, however, centered the attention of those in authority in the War Department on the lack of institu- tional facilities for the handling of the camp-girl problem. As a result, late in February, President Wilson set aside from his national security and defense fund the amount of $250,000 for the establish- ment of additional facilities for the custody and rehabilitation of girls and women who proved to be a menace to the health and morals of the men in training. The expenditure of this money became the work of the section on reformatories and detention houses of the com- mission on training-camp activities. The reorganization of certain already existing institutional facilities was early included in the scope of the section's work. The director began her work April 8, 1918. The section was organized as a brancli of the law-enforcement division of the com- mission on training-camp activities and Avas coordinated Avith the REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 178 section on women and girls and the section on vice and liquor con- trol. Various plans were, of course, offered for the work. One was to build four human reclamation institutions in the eastern, southern, western, and northern parts of the United States, to which all prosti- tutes, convicted in the Federal courts, could be sent for the period of the war. At first consideration that plan seems to deal with the whole proposition in a summarily satisfactory way. But practical difficulties of execution were paramount : How was commitment to be secured, and how did such procedure develop our program for the immediate care of delinquent women and girls, the opportunity for which development seemed so great in the Federal undertaking ? Most important for the elimination of prostitution seeined to be the further development of suitable places for long-term commit- ment for women and girls. Those who have plied this trade for months and 5^ears can not, without general rehabilitation and train- ing, become economically valuable in legitimate work as the result of an edict or a short-term sentence to idleness. On the other hand, not all women convicted of prostitution need a long-term sentence, and the representatives of the other two sections of the law-enforcement division were appealing for suitable places in which to hold the women, to be studied and treated medically while awaiting trial and for hospitalization facilities where the women could be medically treated. There was the difficulty also that the establishment of a place of long-term commitment would be in some States impracticable, as there was no law providing for the holding of women on a Jong-term sentence. Consideration of all these conflicting claims for immediate action made it appai ent that for many reasons the section could not hope to develop an identical model program for each camp community. Such, in general, would probably have included a detention or clear- ing house, isolation hospital facilities, and a State industrial farm as a place of long-term commitment with facilities for separating young girls from older offenders. Funds were insufficient for this, and many communities could not support the undertaking. It was apparent that the needs of each camp city would have to be consid- ered separately, though in the reorganization and development of all the institutional facilities there were, of course, general principles to be laid down. There were the management of all institutions for women by women, the location of all places of long-term commitment in the country, the provision of adequate medical facilities for the treatment of venereal disease, and the supervision of all institutions Federally aided by a local board of managers composed of both men and women. 174 REPORT U.'S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. The agents sent out to the States in accordance with the plan of the Interdepartmental Social Hygiene Board in administering its civilian quarantine and isolation fund reported that there were on November 1, 1918, only 34 States with reformatories for girls and only 8 States with reformatories for women. There were 14 States with 1 reformatory for either girls or women, and only 1 of the Southern States that had a reformatory for colored girls. No South- ern State had a reformatory for colored women over 18. Obviously there was a big field and the board immediately adopted the policy, as already indicated, of meeting the problem by aiding the States in the construction of reformatories. It was definitely decided by the board to extend the Federal aid in this way and not in any case to make appropriations which would be used in maintaining inmates of the institutions assisted. On November 26, 1918, however, came the decision from the Comp- troller of the Treasury informing the board that it had no authority to make appropriations for the construction, enlargement, or repair of buildings that are not Government property. As a result of this decision, the jDlans of the board for assisting States to build deten- tion houses and reformatories had to be given up immediately and it was impossible for the Government to fulfill certain promises given in good faith of money from the appropriation voted in the Cham- berlain-Kahn Act. At that time application had come in from nine States requesting in total an appropriation of $257,000, to balance which a considerably greater amount had been contributed in total by these States. The contributions by these several States involved appropriations from the Government as follows, each State having raised an amount equivalent to or greater than the amount requested from the Govern- ment : Alabama - $25, 000 Arkansas 50,000 Florida 5, 000 Kentucky 30, 000 Michigan 28,000 North Carolina 25, 000 Pennsylvania 50,000 South Carolina 10,000 Virginia--.. 34,000 • PROGRAM FOR ASSISTANCE OF STATES IN MAINTAINING VENEREAL DISEASE PATIENTS. Acting on the decision of the Comptroller of the Treasury, the Secretary of War and the Secretary of the Navy authorized the Interdepartmental Social Hygiene Board to organize plans in Decem- ber, 1918, for the assistance of States in the maintenance, subsistence, and treatment of civilian persons with venereal diseases who were a REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 175 menace to the safety of the armed forces of the United States. The settled policy previously adopted of not giving assistance for such purposes was necessarily abandoned, as it now appeared that this measure was one of the few which would comply with the wording of the law. Between December, 1918, and June, 1919, inclusive, the board, act- ing for the Secretary of War and the Secretary of the Navy, gave assistance in the following-named amounts for the maintenance of venereally diseased patients Alabama State Training Scliool for Girls, Birmingham, Ala $1,004.21 Chattanooga Detention House and Hospital, Chattanooga, Tenn 5, 237. 64 Dorcas Home, Houston, Tex 1,656.95 Jefferson County Institutions, Louisville, Ky 11, 247. 50 Fairmount Hospital, Kalamazoo, Mich 3, 921. 42 Female Detention Ward, St. Louis City Hospital, St. Louis, Mo 2, 387. 79 Detention Home and Hospital, Lawton, Okla 3, 326. 98 Pine Bluff School, Louisville, Ky 276. 17 Industrial School for Colored Girls, Columbia, S. C 926. 19 Mission Valley Isolation Hospital, San Diego, Calif 5, 691. 01 State Home and Industrial School for Girls and Women, Samarcand, N. C 9, 486. 64 Detention Home and Hospital (Carolyn House), Spartanburg, S. C— 1,403.78 Kansas State Industrial Farm for Women, Topeka, Kans 11, 631. 23 Ward L, San Francisco Hospital, San Francisco, Calif 3, 812. 16 Lake County General Hospital, Waukegan, 111 205. 95 Akron Welfare Home for Women, Akron, Ohio 1, 154. 36 Girls' Training School, Gainesville, Tex 3,000.00 Total 66, 360. 98 Reports from the institutions listed above indicated that the aver- age number of venereally infected persons cared for in those institu- tions for one month is 2,186. The actual number of days' treatment given by all of the institutions is 64,462. This figure is arrived at by multiplying the number of venereal disease patients by the number of days of treatment each received. From the figures thus secured it is interesting to learn that the cost to the Federal Government for mak- ing possible these 64,462 days' treatments and removing from the communities a monthly average of 2,186 sources of danger to the armed forces of the United States amounted to $1.03 per person per day. (See Appendix B2 for application form for appropriation for aid in maintenance of venereal patients.) PROGRAM or PROTECTIVE SOCIAL MEASURES. Service of women agents. In September, 1917, the commission on training-camp activities extended its functions to include work with young women and girls in the vicinities of training camps or in cities frequented by large 176 REPORT TJ. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. numbers of soldiers and sailors. A committee on protective work for girls was formed with the purpose originally of throwing such safe- guards around young girls as would prevent later delinquency. After several months of purely protective work it was found that the women and girls who were already sex offenders presented a serious problem in the camp cities. On May 1, 1918, the policy and name were changed and the committee was reorganized as the section on women and girls of the law-enforcement division of the commission, to. concentrate thereafter on work with delinquent women and girls. At the time this organization was effected 60 protective officers had been appointed. In some cases the city set aside an appropriation to start the work ; in others, the money was raised by the local commit- tee on protective work. The war camp community service and the State councils of defense also helped to support the work in some in- stances. Under the new organization the work was rapidly extended* The policies of the director of the section were executed in the field through district supervisors working through local workers called fixed post representatives, stationed where the presence of camps or training areas created a need. In further conformity with the plan outlined before the Senate committee in June, 1918, the Interdepartmental Social Hygiene Board was authorized, toward the end of the year, to take over a por- tion of the field service of the law enforcement division of the com- mission on training camp activities. The transfer was effected in De- cember, the field staff transferred consisting of 9 district supervisors and 49 fixed post representatives. Having no central administrative resources, the board could not take over at this time the administra- tion of this field service. On April 1, 1919, however, the administrative staff of the section on women and girls was detailed to the Interdepartmental Social Hygiene Board, and the direction of the women on the field staff was carried on for the executive secretary of the board by the execu- tive assistant in charge of the women's work. On May 15 there were 8 district supervisors and 106 special agents. This had been reduced by July 1 to 8 supervisors and 55 special agents. These agents were stationed in the following cities : Allentown, Pa. Chicago, 111. American Lake, Wash. Chillicothe, Ohio. Atlanta, Ga. Columbus, Ohio. Augusta, Ga. Des Moines, Iowa. Baltimore, Md. East St. Louis, 111. Battle Creek, Mich. El Paso, Tex. Boston, Mass. Englewood, N. J. Brooklyn, N. Y. Hattiesburg, Miss. Chattanooga, Tenn. Hempstead, Long Island. REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 177 Junction City, Kans. Piiiladelphia, Pa. Jersey City, N. J. Pittsburgh, Pa. Lawton, Olila. Portsmouth, Va. Little Rock, Arls. Roclfford, 111, Louisville, Ky. San Antonio, Tex. Manhattan, Kans. . San Francisco, Calif. Mobile, Ala. Seattle, Wash. Mount Holly, N. J. Spartanburg, S. C. New Brunswick, N. J. St. Louis, Mo. Newport News, Va. Trenton, N. J. Norfolk, Va. Waukegan, 111. Patchogue, Long Island. Wilmington, Del. In the following cities local workers paid by private individuals or organizations, or by city or county funds, were working also under the direction of this section : Alexandria, La. Lowell. Mass. Birmingham, Ala. Lynn, Mass. Bremerton, Wash. Memphis, Tenn. Cambridge, Mass. Newburgh, N. Y. Chester, Pa. New Orleans, La. Cincinnati, Ohio. New York City. Cleveland, Ohio. Petersburg, Va. Dayton, Ohio. Portland, Oreg. Detroit, Mich. Princeton, N. J. Erie, Pa. Puget Sound, Wash. Fort Worth, Tex. San Diego, Calif. Greenville, S. C. Tacoma, Wash. Highlands, N. J. , Vancouver, Wash. Houston, Tex. The primary purpose of this work is the protection of soldiers and sailors through the control of vice and venereal disease, both by per- sonal work with individual cases and by direct attack on specific con- ditions in communities where this work is carried on. Individual ca^e work has been in a sense the laboratory work of the social hygiene campaign. Approximately 30,000 women and girls have been helped in various ways by our own field staff, although intensive work was done on only 7,600 cases of delinquency. Many of these girls have been arrested. The representatives of the board investigated these cases and were able to give the judge in each case information so that he could base his decisions on the particular needs of each. The keynote of this individual work has been to show the girl a way out of the life she has been leading. In some cases she was returned to her family; in others a congenial occupation was found for her, or it was made possible for her to get additional edu- cation or a special kind of training. All delinquent girls have been given a physical examination when possible; if infected with venereal disease they have been taken to United States Public Health Service or other available clinics or hos- pitals for treatment. In some cases it has been necessary to recom- 15610—20 12 178 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. mend that the girls be Goirmiitted to an institution, and at such times every effort has been made to see that they are sent to real reforma- tories where there is provision for education and training and where they will be kept long enough to effect a change in their lives. The fact that the cases dealt with represent, delinquent women and girls from every part of the country has enabled the board to prepare the first national study of delinquency. This study shows that in general the girls have come from poor homes and have had limited opportunities. They are poorly educated and started to work early at unskilled labor. Such a study shows community needs. It has been found in certain localities that as many as 25.4 per cent of the de- linquent group never attended school and 33.2 per cent left before the age of 14. Such a condition shows the need of added legislation and better law enforcement. Without this combination of individual study, and through it recognition of community needs, no worker can hope to accomplish the full readjustment of the misfit delinquent and thus shut off one large source of venereal disease. It is impossible to show with statistics the effect that the field staff has had on the moral tone of the places where they have been sta- tioned. They have sought to develop community responsibility through local committees. These committees have been shown by local cases the need for adequate facilities for the care of delinquents and the physically and mentally unfit, and have been made to realize that it is easy to make delinquents of girls who live in dark, dirty homes and work at tasks which are uninteresting and poorly paid. In the work with individual cases the board's special agents have found certain instances where public officials, judges, police, and health authorities have used improper and inadequate methods. De- tails of such cases have been given to the male representatives of the board, who have brought them to the attention of the responsible ofiicials. Where no improvement was shown, the influence of the local committee was often brought to bear with good results. The board's workers have made every effort to see that suitable institutions, reformatories, detention homes, hospitals, and institu- tions for the feeble-minded were provided and that the women of the community were acquainted with the conditions in all institu- tions for women and girls. They assisted in maintaining wholesome standards in dance halls, moving picture and burlesque theaters, parks, and similar places of amusement. In many places dance-hall managers have been persuaded to engage satisfactory chaperons. Better lighting and policing of parks has also been secured. This first-hand information which has been spread through the committees cannot fail to do much toward lessening the venereal disease rate by securing the social legislation necessary in suppressing commercialized vice and the exploitation of children in industry, and in promoting proper public recreation and vocational education. REPOET U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 179 While the result of this work may seem intangible, it has been sufficiently concrete and resultful in the local communities to inspire confidence and to secure local financial support aggregating over $500,000 from May 1, 1918 to May 1, 1919. PKOORAM OF PROTECTIVE SOCIAT, ^MKAST'RKS. Service of men agents. On April 1, 1919, the board took over practically all of the field personnel of what had been known up until that date as the section on vice and liquor control of the War Department Commission on Training Camp Activities, together with a limited number of per- sons to constitute! a headquarters staff. The field personnel, composed almost entirely of Army officers who requested their discharge from the service in order to accept appointment with the board, totaled 50, including 13 persons (9 men and 4 women) whose activities were limited to the securing of accurate information as to the existence of conditions that were a menace to soldiers and sailors through the possibility of spread of venereal disease. The headquarters staff consisted of one executive, and in addition a limited stenographic staff provided by the War Department Commission on Training Camp Activities. This staff was gradually reduced coincident with the demobiliza- tion of the Army and Navy until on June 30 the field staff consisted of 32 persons, including 11 whose duties were limited to the securing of accurate information. The following list indicates the location of these agents on June 30 and the territory covered : Location of agents. Location. Number. Territory. Augusta, Ga Baltimore, Md Battle Creek, Mich. . Boston, Mass Chicago, 111 Denver, Colo Detroit , Mich Kansas City, Mo Lancaster, Pa Little Rock, Ark Louisville, Ky Minneapolis, Minn. Newark, N. J New London, Conn. New Orleans, La Newport News, Va. New York City Petersburg, Va Portsmouth , N. H . , San Antonio, Tex. . San Francisco, Calif Washington, D. C. Worcester , Mass Georgia. Maryland, Virginia, Pennsylvania, Delav.are, Dis- trict of Columbia. Michigan. Massachusetts, New Hampshire, Vermont, New York, Rhode Island , Connecticut , Maine. Wisconsin, Illinois, Indiana, Ohio, Michigan. Colorado, Wyoming, Utah, Montana. Michigan, Ohio. Kansas, Missouri. Delaware, Pemisylvauia. Arkansas. Indiana, Ohio, Kentucky, Illinois, Missouri. Minnesota. New Jersey , New York, Pennsylvania. Connecticut. Alabama, Arkansas, Florida, Georgia, Illinois, In- diana, Iowa, Kentucky, Louisiana, Michigan, Minnesota, North Carolina, Ohio, Missouri, South Carolina, Virginia, District of Columbia, Wiscon- sin, Mississippi, Tennessee. Virginia. New York, Coimecticut, Delaware, District of Co- lumbia , Kentucky , Ind iana , Michigan , New Jersey , Pennsylvania, Maryland, Ohio, Virginia, West Virginia, Wisconsin, Illinois. Virginia. Maine, Massachusetts, New Hampshire. Arizona, Arkansas, Louisiana, New Mexico, Okla- homa, Texas. California. West \'irginia, Pennsylvania, Maryland. Connecticut, Massachusetts, Rhode Island. 180 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. These agents, together with the larger group of women previously taken over by the board, and several persons formerly composing the section on reformatories and detention homes of the War Depart- ment Commission on Training Camp Activities, were then com- bined into a single organization known as the field service of the United States Interdepartmental Social Hygiene Board. The members of this service were stationed at important military and naval posts throughout the country ; the women representatives largely on fixed posts or spending a major portion of their time at one place; the men, for the most part, moving from place to place and ha\dng duties in relation to several military and naval places, although at stations of decided importance both male and female agents were assigned to continuous duty. These agents, functioning under the provisions of section 2, of Chapter XV, of the Chamberlain-Kahn Act concerned themselves with activities in accordance with a program which was announced for the field service of the board, men and women, as follows : I. General objective. — Because of the provisions of section 2, Chapter XV, the field service of tlie United States Interdepartmental Social Hygiene Board may very properly continue all of the activities that have been developed under the law-enforcement division of the commission on training-camp activi- ties that are concerned with " assisting the various States in caring for civilian persons whose detention, isolation, quarantine, or commitment to institutions may be found necessary for the protection of the military and naval forces of the United States against venereal diseases." The field agent ghould inform himself concerning: (1) Places of amusement, recreation, loitering, loafing, dance halls, parks, movies, theaters, streets, hotel lobbies, military and naval camp neighborhoods in which carriers of venereal disease are likely to be found. (2) Hotels, houses of ill repute, and other places in which venereal disease carriers may transmit disease, (3) Courts, judges, police, special civic committees, boards of health (city, county, and State), agents of United States Public Health Service, morale offi- cers, and camp committees that are known to be concerned with the care of venereal disease carriers. (4) Detention houses, clinics, hospitals, jails, reformatories, homes, farmSi and reform schools in which venereal disease carriers may be placed for treat- ment, restraint, cure, and rehabilitation. (5) Laws and ordinances that are applicable. (6) Associations, societies, clubs, chambers of commerce, boards of trade, women's clubs, labor unions, parent-teachers' associations, merchant's associa- tions, and other similar organizations that are or ought to be concerned with the protection of the military and naval forces against the carriers of venereal disease. II. Assistance in connection with the detention of disease carriers. — (a) Gen- eral : (1) Inform local agencies concerning existing community conditions. In- volves a relationship with agencies and sometimes involves the organization of new agencies; (2) inform these agencies concerning practical laws and need REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. l8l for new laws that may be invoked for control of these conditions; (3) coordi- nate existing agencies; (4) establish permanency of local agencies. (&) Special: (1) Identify carriers (men and women) in dance halls, parks, etc.; (2) get into contact with individual agents of the law or other authorized local social service agencies and assist in detec-tion and identilication for de- tent on ; (3) assist in securing examinaticm for diagnosis, not only with refer- ence to disease but also for delinquency iuul for the possibility of restoration or rehabilitation; (4) inform the individual woman or girl, boy or man. III. Assistance in connection with isolation, quarantine, and commitment. — (a) General: (1) Inform local agencies concerning available institutions for these purposes. Emphasize importance of detention hospitals, clinics, hospitals, and suitable jails and reformatories; need for age discrimination; color dis- crimination; degree of delinquency; sex. (2) Work for the permanency of wise institutional care. (b) Special: (1) Investigate individual institutions and assist in securing better care, repair, restoration, and enlargement; and treatment and employ- ment of inmates; their hygienic information and advice and a wisely ordered day's program. (2) Help in standardizing for the better care of venereal cases in these institutions. IV. Assistance through the orffanisation, of local agencies, or through their reorganization, in an attempt to conserve and perpetuate what has already been done, and to provide for local self-support and independence when the Govern- ment withdraws. Type of organization to be effected : Locally, a law-enforce- ment committee, made up of influential citizens without reference to political or religious views. Committee must be adequately financed locally. Repre- sentatives should consult Washington office before initiating such organization. V. Assistance through cooperation and coordination. — (1) The individual members of the field service of the board must be mutually cooperative. Team work in the next three months is absolutely essential for success. (2) It is of the gi'eatest importance to make friends and establish confidence with the various agencies in the field, in boards of health, United States Public Health Service, clinic officials, hospital officials, police, .judges, prominent civilians, <>tc. (3) Bring these agencies into a cooperative relationship with each other, yi. Develop local leaders. — (1) Provide understudies so that some one com- petent to do so will carry on your work when you are through. (2) Habituate local leaders in the exercise of these functions. (3) Develop new leaders — ■ safe, informed, and in good standing. (4) Provide for financial support. VII. Organization of field service. — (1) Until further order the local field organization will continue without change for although the three sections of the law enforcement division C. T. C. A. are merged in the single field service of the Interdepartmental Board, the present director of reformatories and houses of detention, the assistant director of the section on women and girls, and a supervisor of the section on vice and liquor control will be retained by the executive secretary as experts in their respective departments. (2) Each field supervisor, man or woman, will be responsible directly to the executive secretajry. (3) Field agents will continue present standard form of reports, omitting sections on liquor. Case reports from women agents will continue. All field agents will send reports directly to the Washington office; women will continue as at present to send copies of reports to their district supervisor. Systematic reports were required of field agents. During th© period from April 1 to June 30, 241 reports were made by special 182 REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. agents on their activity in carrying out the board's program. A summary of these reports is presented herewith : Special agents' report. Number of States in which investigation were made 30 Number of cities in whicli investigations were made 81 Total number of reports 241 Number of reports in each month : April 160 May- 80 June 95 Total number of persons making reports 30 Total number of reports indicating conditions : Good 119 Fair 101 Bad- - _, 21 Total number of places in which conditions changed from — Good to fair 1 Good to bad: ,0 Fair to good 2 Fair to bad . 1 Bad to good 1 Bad to fair 3 Good to fair to good . 4 Good to fair to good to fair .- ■ : 1 Fair to good to fair to good 3 Fair to good to fair to good to fair — 1 Bad to fair to good 1 18 Total number of places in which conditions did not change: Eemained good 9 Remained fair 8 Remained bad 3 20 Total number of places for which only one report was received : Good .22 Fair 18 Bad - 3 43 The words " good," " fair," " bad," relate to conditions in the vari- ous cities reported on. A city is reported " bad " when prostitution is easily accessible to soldiers, where the officials are uncooperative, and where the machinery for protecting soldiers and sailors from venereal disease is either inadequate or inefficient. The term " fair " is used where prostitution is available to a limited extent, where the REPORT U. S. INTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. 183 city officials are half-heartedly functioning under pressure or because of a limited conviction and where either the machinery for protecting soldiers and sailors from venereal disease is only fairly satisfactory in its equipment and operation. Conditions are marked " good " on any places where it is difficult for soldiers or sailors to find prostitutes, where the officials are awake and active and where the cooperation between officials is good and the equipment both in good repair and functioning reasonably well. In addition to the staff of special agents, a staff of 13 persons (9 men and 4 women) known as " under-cover investigators," was avail- able during the year commencing July 1, 1918, for special work. These investigators were assigned to the duty of securing accurate information as to the violation of laws against prostitution ; the pres- ence of, together with detailed information concerning prostitutes, both male and female; and in general to furnish the central office and the field agent with accurate information on which a judgment might be reached as to the effectiveness of the program for the pro- tection of soldiers and sailors from venereal disease. It is evident that, if the whole program functions vigorously, it will be conse- quently difficult for an under-cover investigator to find prostitutes. Probably no better index can be found of the effective functioning of a law enforcement program than the information presented to the under-cover investigator by members of the prostitute class. During the three months' period covered by this report, 116 re- ports were made by these investigators in 85 different cities and 25 States. Conditions were reported " excellent " in one city, " good " in 33, " fair " in 27, " bad " in 50, and " very bad " in 5. On many cities only one report was made during this period. In cities on which more than one report was received a comparison of conditions was possible. This comparison shows that in no city did conditions become worse and in a number of cities they became better. The under-cover agents' reports indicate that up to June 30, 1919, in spite of unsettled conditions incident to demobilization and the gen- eral unsettled state of affairs following the signing of the armistice and the turning over of the law enforcement program from the mili- tary Commission on Training Camp Activities to the civilian Inter- departmental Board, in only one city among those where it was pos- sible to make a comparison was there evidence that the program for protecting soldiers and sailors from venereal disease was not at least maintaining this standard. 2. Scientific Research Fund. Another large activity of the Interdepartmental Board imposed by the act creating it is covered under the scientific research fund of $100,000. This fund is to " be paid tO; such universities, colleges, or 184 REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. other suitable institutions as in the judgment of the Interdepart- mental Social Hygiene Board are qualified for scientific research, for the purpose of discovering, in acordance with rules and regulations prescribed by the Interdepartmental Social Hygiene Board, more effective medical measures in the prevention and treatment of vene- real disease," In January, 1919, the board adopted the rules and regulations to cover appropriations from this fund as follows : 1. Appropriations from this fund will be made only to universities, colleges, or other suitable institutions that give satisfactory evidence of possessing a staff of scientific experts and an equipment of scientific apparatus, supplies, and resources that will guarantee that the researches undertaken will be carried out under approved scientific conditions and in conformity with scientific methods. 2. Appropriations for this fund for scientific research will be made only for definite investigations that are described by the proposers in sufficient detail to satisfy the Interdepartmental Social Hygiene Board that there is a justifiable expectation that these researches " will discover more effective medical meas- ures in the prevention and treatment of venereal diseases." 3. The universities, colleges, or other institutions proposing researches and asking for appropriations will furnish information on the following subjects: (a) Name ot institution requesting appropriation. (b) Name, office, and address of official representative of this institution. (c) Title concisely descriptive of research proposed. (d) Laboratory in which research is to be carried out. (e) List of more important scientific publications from this laboratory. if) Name and concise statement of the scientific training of the laboratory chief or director or other individual responsible for the scientific policy of the laboratory. (fir) Laboratory staff, giving names, degrees/ etc. (h) Laboratory equipment and facilities, with a concise statement indicating scientific and working capacity of the laboratory, and cooperating laboratories, departments, and agencies. (i) Description of research proposed; outline plan in sufficient detail to show clearly its scientific character and justify the expectation that it will dis- cover "more effective medical measures in the prevention and treatment of venereal diseases." Include references to important scientific investigators, but n)ay include salaries for technical assistants. (j) Will this institution be able to carry on the research proposed if it re- ceives no financial aid from the Interdepartmental Social Hygiene Board? 4. Universities, colleges, and other institutions asking for appropriations will furnish the board with a budget made out on forms supplied by the board and will make an accounting of their disbursements in conformity with the rules of the Comptroller of the Treasury of the United States Government. (See Appendix E2 for application form for appropriation.) Up to June 30, 1919, 14 institutions in all parts of the country had met the regulations and had received appropriations for 27 separate scientific investigations from the Interdepartmental Social Hygiene Board. The total of the appropriations from the scientific research fund for these 27 investigations amounted to $97,670, the range of appropriations varying from $1,550 to the Woman's Medical College of Pennsylvania for one investigation to $19,050 to Johns Hopkins University for four investigations. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 185 A glance at the institutions receiving this Federal aid will show that some of the finest scientific laboratories and equipment in the country were set to work on special phases of the venereal disease problem as a result of the appropriations administered by the Inter- departmental Social Hygiene Board. By the same token some of the most expert, highly trained, and best-known scientific investigators of the country are bringing their experienc^ed and trained efforts to bear upon the venereal disease problem. The investigations under way cover a wide range of subjects, each one of very great importance in the fight on venereal diseases. The table following shows a general summary of the appropriations as of June 30, 1919, from this scientific research fund : Data on soientific research fund. Institution. Number ofinsti- tutions. Amount of appro- priation. Number of re- searches. Persons engaged. Scientific investi- gators, technical and chemical assist- ants.! Clerks, stenog- raphers, and dieners.' Total. 97,670 University of Michigan Leland Stanford University Johns Hopkins Univ ersity Cornell University Uni vorsity of Wisconsin University of Nebraska St. Louis University School of Medicine Women's Medical College of Pennsylvania Washington University School of Medicine, Missouri. Jefferson Medical Colle" e Yale University Union University Medical Department, Albany Medical Colle e Harvard Uni , ersity University of Minnesota Medical School 6,000 7,200 19,030 7,440 8,000 5, 000 3,000 1,5£0 13, 200 2,500 5,100 4,380 7,000 8,250 10 1 V IS 7 2 1 13 2 7 2 3 1 4 S 17 2 in 9 11 1 Approximate number; also includes part-time assistants. The first appropriation from this fund was made on March 28, 1918. It is, of course, hardly necessary to point out the fact that none of these researches was completed during the period covered by this resume, but it is equally evident that these 27 scientific inves- tigations now being carried out by a group of men and women con- taining some of the most competent scientific minds in America must inevitably achieve real progress in the better prevention and treat- ment of gonorrhea, syphilis, and chancroid. It is particularly grati- fying that this remarkable series of scientific researches has been stimulated through and because of appropriations specifically set aside for these general purposes by Congress. 186 report u. s. iistterdepartmental, social hygiene boaed. 3. Educational Research and Development Fund. For the purpose of discovering and developing more effective edu- cational measures in the prevention of venereal disease, Congress made available to the Interdepartmental Social Hygiene Board the sum of $300,000. The law provided that this money — shall be paid to such universities, colleges, or other suitable institution or organization as in the judgment of the Interdepartmental Social Hygiene Board are qualified for scientific research for the purpose of discovering and develop- ing in accordance with the rules and regulations prescribed by the Interdepart- mental Social Hygiene Board more effective educational measures in the preven- tion of venereal disease, and for the purpose of sociological and psychological research related thereto. In laying out its plans under the provisions of this section of the act the board has concerned itself with the formulation of a program that would lead to permanency of educational influence and reach the child in the home and the pupil in school. Relative permanency of influence is secured by establishing depart- ments of hygiene in strong normal schools, colleges, and universities. Wherever such a department has been created or has been more firmly implanted or more completely organized because of this board, the United States Government may be said to have achieved thereby a lasting educational influence through the succeeding generations added yearly to the graduate body of the educational institution con- cerned. The normal school, college, and university are sources from which come our college professors, our school superintendents, our school principals, and our secondary-school teachers. The board proposes that these teachers of teachers and these teachers of children shall be as well prepared in the elements of hygiene as they are in the ele- ments of arithmetic and English. Each institution that successfully develops its department of hygiene in cooperation with the board becomes an avenue through which the school children of the next generation will receive better and more complete hygienic instruction. Furthermore, the graduates of our normal schools, colleges, and universities become our citizens of position and influence. They are directly or indirectly teachers in the community, in the school, and in the home. In training these students for graduation our institu- tions of higher learning are training the influential parents of to- morrow. These students will carry into their own homes with their problems of parenthood the education and the information that makes an impression on them to-day. In the further development of its plans the board is convinced that it would be a very serious mistake to support a program of education that would drag the hygiene of the venereal diseases into the academic limelight as a separate and distinct entity in the edu- EEPOET U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 187 cational curriculum. The board is of the opinion that it will meet its obligations under the law much more effectively and that its educational procedure will be much more rational if it supports a program of informational, educational, and applied hygiene that insists on the appropriate inclusion of the hygiene of gonorrhea, syphilis, and chancroid, or of considerations preliminary thereto, giving them the proportionate emphasis which they deserve along with other important subjects in hygiene. The board proposes, therefore, a fairly complete departmental curriculum and organization with the understanding brought out in the written agreement with each normal school, college, or university concerned, that personnel will be selected in each activity covered by the program with special reference to its ability to handle suc- cessfully the problems in venereal disease that may be logically con- sidered by the group of students taking part in that activity. In proposing this organization the board has not undertaken to dominate the educational method or text presentation in any of the educational institutions with which it has come into cooperative relationship. It is assumed that each of these institutions is a high- class educational organization that may be depended upon to select with experienced educational intelligence the methods of instruction that are most likely to fit the special needs of its own particular student body. Each of these institutions may be regarded as being engaged in carrying out a research for the discovery and demon- stration of better methods of education in the prevention of venereal diseases. With these principles and purposes in view, the Interdepartmental Social Hygiene Board adopted rules and regulations to govern the funds provided by Congress for this activity. The appendix con- tains these rules and regulations in full. (See Appendix Fl.) By the end of June, 1919, appropriations had been made to 24 different institutions. (See Appendix F2) for application form for appropriation from " Educational research and development fund.") In the case of 23 normal schools and colleges, the appro- priation went for the organization or extending of departments of hygiene. The other appropriation was made to the psychological laboratory of Johns Hopkins University for the purpose of under- taking a research to determine the informational and educational values of certain motion- picture films and other material used in connection with various compaigns that have been carried on for the control, repression, and elimination of venereal diseases. The total of the appropriations made to these 24 institutions amounted to $166,090. To balance these appropriations from Fed- eral funds the institutions themselves have appropriated as their share in the work a total of more than $161,000. It is entirely safe 188 REPOET U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. to say that the amount spent by the institutions themselves to supple- ment the Federal appropriations from this fund will considerably surpass the Federal appropriation. In the case of one of the largest institutions, for example, the University of Pennsylvania School of Elducation, the amount to be paid by the institution itself is not indicated in the application. The proportion between the amount appropi'iated by the Interdepartmental Social Hj^giene Board and the amount to be spent by the institution itself varies greatly. In some cases the Interdepartmental Social Hygiene Board pays a con- siderably larger share of the expenses, as in the case of the Women's Medical College of Pennsylvania, whose application indicates that the board's appropriation of $2,505 is to be supplemented by $350 by the institution. In other cases the institution pays considerably more, as in the case of the Michigan State Normal College, where the application indicates that the board appropriation of $3,225 is to be balanced by the expenditure of $17,474 by the college. In making these comparisons one must not lose sight of thef act that each of these institutions supports certain very important expenses that cannot be easily estimated in such a relationship. The cost of equipment, supplies, light, heat, ventilation, janitor service, repairs, replacements, and general administration represents essential ex- penses that have not been considered. As to the number of men and women affected by these appropria- tions to aid departments of hygiene, it is a question whether the fig- ures available on the applications for the period under discussion can be considered of very much value. In the first place, the board asked for information from the institutions only as to the numberof students being prepared as teachers, the original thought being that this class would be the most important to influence in the matter of better edu- cational methods for the prevention of venereal disease. Again, the figures given by the institutions did not appear in all cases to be care- ful estimates, and in any case they can be estimates only, as they were made up for the school year which was to begin September, 1919. Bearing these facts in mind, however, it may be stated that the figures available July 1, 1919, indicate over 18,000 men and women under the direct influence of the courses of hygiene to be established with Federal assistance during the coming school year. A summary of the information connected with the expenditures from the educational research and development fund follows. It should be carefully borne in mind that this summary is taken from information carried in the applications presented to the board by the institutions. These applications were intended simply as ten- tative forecasts and will undoubtedly of necessity be changed con- siderably when put into practical operation. However, the figures are of value as indicating the general extent of the work laid out under this fund. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 189 Summary of factx conncctej] iinth expenditurea from cdi(catroniil reftearcJi imd developmetit fund. Number of institutions 24 (23 normul scliools and colleges for departments nf hygiene and 1 psychological lal)oratory of Johns Hopkins University, for investigating the effects of certain motion- picture films.) Total number of students affected (see note above) : Women 11,241 Men 7, 161 Total 18, 402 (At Reed College "260 other physical education students" beside those in A. B. courses. Would make total 18,662. No students counted at Johns Hoiikins. University of Penn- sylvania does not separate men and women; estimate used.) Total budgets - — $327, 185. 85 Amount furnished by Interdepartmental Social Hygiene Board 166, 090. 00 Amount furnished by institutions (see note above) 161,095.85 (Amount furnished by one institution not reported.) An analysis follows showing the amounts made available during the coming college year for teaching services in connection with the instruction in hygiene and the development of better educational methods in the prevention of venereal diseases. Due to the action of ■Congress and to the policies of this board in making appropriations available for this purpose, there will be departments of hygiene estab- lished or enlarged in 23 colleges and universities throughout the country during the school year of 1919-20. At least $327,000 will be spent on hygiene instruction. Two hundred and fourteen special teachers, including directors, health examiners, teachers of hygiene and physical training, will be employed in developing a nation-wide program of health instruction with a proper emphasis on the venereal diseases. The 214 special teachers mentioned does not take into ac- count the additional minor positions necessary for the conduct of such departments — the special public-health lectures by State and National authorities, the special researches and other unique features incidental to the operation of the program. Careful provision has been made for all these. This appropriation has, in fact, made pos- sible the inception of a broad movement in health education. Its finest fruits, perhaps, may not be gathered for a generation. It is desirable, however, to establish the point at this time that it has been by the leadership and financial assistance of the Federal Government that this fundamental work of educating educators in hygiene, in- cluding the part played therein by the venereal diseases, was made possible. 190 REPORT U, S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 4. United States Public Health Ser\ice Venereal Disease Fund. In addition to the appropriations already treated, the Chamberlain- Kahn Act carried an appropriation of $1,000,000 annually for two years to be allotted to the States for the use of their departments of health in the prevention, control, and treatment of venereal diseases. This fund was to be allotted in accordance with rules and regulations prescribed by the Secretary of the Treasury in the usual manner of making such allotments, namely, in the proportion which the popu- lation of each State bears to the population of the continental United States. During the first year of operations it was not necessary for the States to make appropriations of ^.mounts equivalent to the allot- ments for the same purpose, but it will be necessary during the second year in order that the Federal allotments may be legally paid to the States. The regulations governing the allotment of these funds were pro- mulgated under date of September 4, 1918, by the Secretary of the Treasury and are given in detail in the appendix. (See Ap- pendix D.) In accordance with the above regulations it will be noted that the allotmeiits are to be expended in accordance with an accounting sys- tem to be forwarded by the Interdepartmental Social Hygiene Board. The board issued rules and regulations governing expenditures from those State allotments, which are also given in detail in the appendix. (See Appendix D.) During the first year 46 States had complied with the requirements contained in the rules and regulations of the Secretary of the Treasury and have received their allotments from the Chamberlain-Kahn funds. There follows a list of these States, giving in each case the amount of the allotment and the date on which checks covering these amounts were mailed to each State : state. Alabama Arizona..' Arkansas California Colorado Connecticut... Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts, Michigan Minnesota Mississippi Missouri Montana Allotment. S23, 2, 17. 25, 8, 12, 2, 8, 28, 3, 61, 29, 24, 18, 24, 18, S, 14, 36, 30, 22, 19, 35, 4, 247. 15 221.91 118.74 850.72 687.66 120. 57 199. 81 183. 11 368. 56 540. 13 307.51 366. 20 189. 58 385.42 897.77 009. 65 071. 68 084.09 602.51 554. 57 568. 85 539.74 807.91 088. 76 Date. Oct. Nov, Oct. Oct. Oct. Oct. Oct. 1. 1918 12, 1918 28. 1918 1, 1918 3, 1918 4, 1918 1, 1918 Nov. 15,1918 Oct. 1, 1918 13. 1919 1,1918 5, 1918 4, 1918 2, 191S Do. Oct. 29,1918 15,1918 24, 1918 15, 1918 23, 1918 15,1918 Do. June 14,1919 Oct. 4, 1918 Mar Oct. Oct. Oct. Oct. Oct. Oct. Oct. Dec. Oct. State. Nebraska New Hampshire. New Jersey , New Mexico , New York North Carolina. . North Dakota. . . Ohio Oklahoma Oregon Rhode Island. . . . South Carolina. . South Dakota... Tennessee Texas Utah Vermont Virgima Washington West Virginia. . . Wisconsin Wyoming Total 912,168. Allotment. Date. S12, 4, 27, 3, 99, 23, 6, 51, 18, 7, 5, 16, 6, 23, 42, 4, 3, 22, 12, 13, 25, 1, 962.75 681.54 586. 22 558.70 090.89 988. 61 274.24 832.16 017.99 314. 87 899.72 476.71 348. 52 754. 87 366.49 059. 39 870.26 415.58 416.68 277.04 375.70 587.05 Dec. 4, Oct. 3, Oct. 21, May 17, Oct. 1, Nov. 14, Oct. 21, Oct. 15, Oct. 28, Oct. 24, Oct. 15, Oct. 3, Oct. 7, June 26, Oct. 15, Feb. 25, Nov. 20, Nov. 2, Oct. 21, Oct. 4, Oct. 2, Do. 1918 1918 1918 1919 1918 1918 1918 1918 1918 1918 1918 1918 1918 1919 1918 1919 1918 1918 1918 .1918 ,1918 EEPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 191 The allotments not accepted were as follows : District of Columbia .$3,599.66 Nevada 890. 21 Pennsylvania 83,341.55 Total 87,831.42 At the close of the first year all but 4 of the 46 States which re- ceived their allotments had an organized bureau for venereal disease control. The four States are Idaho, Missouri, New Mexico, and Ten- nessee. Of the 46 States which received their allotments for the past fiscal year, 34 have already appropriated funds to entitle them to receive the Federal allotment for 1919-20. A complete statement' covering the work of the States and the United States Public Health Service under the Chamberlain -Kahn funds will be found in the Annual Eeport of the Surgeon General of the Public Health Service of the United States for the fiscal year 1919, under the activities of the Division of Venereal Diseases. Part IV. APPENDICES. Page. A. 1. Federal law under which the United States Interdepartmental Social Hygiene Board operates. (Chap. 15, Pub. No. 193, 65th Cong., H. R. 12281) 197 2. Amendments to law : a. Reappropriations for the year ending June 30, 1920 (Pub. No. 21, 66th Cong., H. R. 7343) 199 h. Extension of duties and powers and appropriations for the fiscal year ending June 30, 1921 199 B. 1. Regulations for assistance of institutions in the maintenance of venereally infected patients . 201 2. Form of request for maintenance of venereally infected patients — 201 C. 1. Functions of the protective social measures staff ^ 203 2. Form of proposal for governmental assistance in the organization of bureaus of protective social measures in State departments of health — 211 D. Regulations governing expenditures of State allotments from the Chamberlain-Kahn Funds 214 E. 1. Regulations governing the scientific research fund 229 2. Application form for scientific research 230 F. 1. Regulations governing the educational research and development fund 232 2. Application form for establishmnt or enlargement of departments of hygiene in normal schools, colleges, and universities 239 G. 1. Regulations governing payments to State universities for the estab- lishment of divisions of educational hygiene in State depart- ments of education 245 2. Form letter of agreement from State universities to assign adminis- trative personnel to State departments of public education 245 H. List of publications on hand June 30, 1920 248 192 SPECIAL APPENDIX. Cost of Venereal Diseases. Estimatas from the financial viewpoint on the meaning of venereal dis- eases in — 1. The United States Army. 2. The State of Massachusetts ( selected group). 3. The St. Louis-Southwestern Railway Lines. 4. England. 1. items eegakding the cost of \tsnereal diseases in the army. [l,etter from the Chief of the Division of Sanitation, Col. Weston P. Chamberlain, M. C, U. S. Army, Office of the Surgeon General of the Army.l War Department, Office of the Surgeon General, Wasliington, October 15, 1920. Dr. T. A. Storey, Executive Secretanj, United States Interdepartmental Social Hygiene Board, 1800 Virginia Avenue, NW., Washington, D. C. Dear Dr. Storey : With reference to your letter of September 29, the Sur- geon General directs me to state that statistics relative to the occuiTence of venereal diseases among the troops of the United States Army have recently been made available to a representative from your office.^ With reference to the cost of venereal disease to the Army during the fiscal year ending June 30, 1920, I regret to say that no figures have yet been com- piled upon which to base an estimate. I have, however, caused a study of this cost to be made for the calendar year 1919. During the calendar year, from January 1, 1919, to December 31, 1919. venereal diseases in the Army caused a loss of 1,923,420 days. Since practically all of this lost time represents days spent in hospital under treatment for gonorrhea, chancroid, or syphilis, and since a fair estimate of the cost of such hospitilization for each patient per day is $7, it may be said that the diref't loss to the Army caused by these diseases, measured in dollars, was ifl3,463,940. During the period of his incapacity for active duty by reason of venereal disease the soldier is deprived of pay, and later at the expiration of his term of enlistment is required to make up the time so lost by equivalent additional service. The loss of his services at the time of his incapacity is thus not a direct loss to the Army except as it reduces the available man power at that 'This table 'under the caption of " Vonoreal disease in the Army" appears on page 94 of this Report. 15610—20 13 193 194 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. time and requires tlie services of another man in the phice of the noneffective. Such loss, while substantial, can not well be measured in money. The Army suffers further substantial loss in the time and effort spent in the training of men who subsequently become noneffective because of venereal disease and are discharged. This loss is not subject to definite measurement. There should be included in the estimates the cost of salvarsan used in the treatment of syphilis, which represents a large item of expense. Exact figures of this are not available. The cost of prophylactic treatments, not measurable in dollars, is considerable and may also properly be added. It may be conservatively estimated, however, that the actual hjss to the Army caused by venereal diseases during the year 1919 was not less than $15,000,000. Very truly, yours, W. P. Chamberlain, Colonel, Medical Corps. Strength of the Army during period {calendar year, 1919) covered by Col. Chamhei'lain's letter. Months, 1919. January February . . March April May June July August September . October November . December. . Total Mean strength per month, 1919 . Officers. 122, 234 104,810 93,008 81, 132 66,918 52,295 39, 191 30,080 25, 189 20, 877 15, 645 15, 273 666, 652 55, 554 American troops. White. 2,212,359 1,879,940 1, 628, 823 1,325,047 996, 038 648, 715 427,064 257, 885 211,405 185,867 172,860 175,403 10,121,406 843, 451 Colored. 230, 288 203, 273 170,919 152, 320 140, 609 114,696 40,870 21,595 14,742 10,989 10,711 10,668 93,473 Total. 2, 442, 647 2, 083, 213 1,799,742 1,477,367 1,136,647 763,411 467,934 279,480 226, 147 196, 856 183,571 186,071 11,243,086 936, 924 Total enlisted, including native troops. 2, 463, 274 2, 099, 774 1, 813, 893 1,490,326 1,148,829 776, 137 478, 883 289, 565 236,420 206, 775 193,563 196, 469 11,393,908 949,492 Total officers and enlisted, including native troops. 2, 585, 508 2,204,584 1,906,901 1,571,458 1,215,747 828,432 518,074 319,645 261,609 227,652 209,208 211,742 12,060,560 1,005,047 Mean strength per month from Jan. 1, 1920, to June 30, 1920 (this includes all native troops as in the statement for 1919): Officers 15, 205 Enlisted men 196, 595 Total 211, 800 2. ITEMS EEGAKDING THE COST OF VENEREAL DISEASES IN THE STATE OF MASSA- CHUSETTS FOR A SELECTED GROUP OF 100 MEN WHO DIED FROM SYPHILITIC INSANITY. [Extract from " The relation of alcohol and syphilLs to mental hygiene," by Frankwood E. Williams, M. D., in the American .Journal of Public Health, vol. 6, No. 12, pp. 1272- 1277, December, 1916.] * * * Here were 100 men, engaged in various pursuits. Seventy-eight were married, 22 were single. They were economic units in the community, each .supporting himself, and in many cases each isupporting others — each of value to himself, to his famirly, and to the community. Each made his daily and .weekly contribution to the work of the world. Syphilis intervened, with insanity and premature death resulting. An estimation of the loss of life, based on insurance tables showing the expectation of life, and taking into considenition such factors as race, occupa- REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 195 tion, etc., shows that tlie loss of life in individutil cases had been from 8 to 38 years. The 100 men lost a total of 2,259 years. By the intervention of this disease these 100 men ceased to be productive. The hospital records show the earning power before connnitment to the hos- pital of only 10 men, so that the loss of earning power can be estimated for but 10. Previous to their connnitment these men were earning from $11 to $37.50 a week. The financial loss created by the premature death of these 10 men, based upon the expectation of life and their earning capacity before com- mitment, was $212,248. But tliese men not only lost their earning power, they became parasitic upon the community. The hospital residence of the 100 men amounted to a little over 126 year's, or an average of a little over 1 year apiece. This, at the cost of $6 per week to the State of Massachusetts for the maintenance of these men, the Commonwealth of Massachusetts expended over $39,312. By the intervention of the disease wives and children were left unsupported. Wives were left to shift for themselves and to care for their children unaided. The continuity of the home life was destroyed ; the chil- dren, who should have continued in school in preiiaration for their life in tlie community, were turned out at an early age upon the community, either to work in unskilled labor for the support of themselves and other members of their family or as public charges in charitable institutions. One hundred and nine were so left. A not unimportant per cent — this per cent has not yet been de- termined — were diseased and thrown upon the community in a crippled condi- tion, their disea.se being directly due to the infection of their fathers. These are figures — 2,259 years' loss of life ; .$212,248 loss of earning power (10 men) ; $39,312 expended by the State for support; 109 children cheated of their rights of home protection — for but 100 male patients in a representative hospital, but from them we may gain some notion of the tremendous loss to the community each year due, and due entirely, to .syphilitic mental disease. Mental disease constitutes a serious public-health problem. Massachusetts in the last 10 years has received over 26,0ersons confined in institution during the past six montlis. Question 15. («) Naval and militnry camps served, (b) Location, (c) Ap- proximate number of men in each, (d) Distance from the institution. Question 16. Does the institution care for persons infected with a venereal disease, who, if free, would be a menace to soldiers, sailors, and civilian pop- ulation? Question 17. Law or regulations under which commitment is made. Question IS. Does the State board of health urgently recommend that the institution be given financial fissistance to the amount requested below? Question 19. Give a concise outline of the personnel employed at the Institu- tion, salaries paid, and the average total cost per month for the maintenance of the institution. Question 20. Average dnily cost for maintenance per person during past six months. Question 21. («) Is any part of cost of maintenance paid by city, county, or State? (6) If so, by whom and how much per person? Question 22. Reasons for requesting this assistance from the United States Interdepartmental Social Hygiene Board. Question 23. Does a temporary emergency exist making financial help from the board an imperative necessity? N. B. — The above questions should be fully answered in the space below, or, If more space is required, an additional sheet may be used, but should be securely fastened to this form. The answers should be carefully numbered to correspond with the numbers of the questions. 24. To the best of my knowledge and belief the above answers are correct and the foregoing information is reliable. 25. It is requested that the United States Interdepartmental Social Hygiene Board allot the sum of $ — , for the period , 19 — , to , 19 — , inclusive. 26. It is further agreed that should this request for financial assistance be granted for the maintenance of venereally infected persons at tliis institution monthly bills will be rendered upon forms provided by the Board, covering the actual cost of maintenance, care, and treatment per capita per diem, and that this per diem charge is not to exceed for any month the maximum of $1.50. 27. It is further agreed that " maintenance " as herein understood will not include rent, insurance, salaries of permanent personnel, or any overhead or other items that do not vary with the number of patients cared for each day by the institution. 28. (Signed) (Official title) 29. Recommended : Executive Secretary, United States Interdepartviental Social Hygiene Board. 30. Recommendation approved : Chairman Executive Committee, United States Interdevartmental Social Hygiene Board. 31. Approved by United States Interdepartmental Social Hygiene Board on . 19—. Appendix C. 1. FUNCTIONS OF THE PROTECTIVE SOCIAL MEASURES STAFF. L Executive Secretary. 1. Autliorized and responsible agent of the boai'tl, operating all of its policies and applying all of its judgments and directing and coordinating all of the several divisions under the board. //. CMef of Division of Relations rvith States. (For the present the executive secretary will act as chief of the Division of Relations with States.) 1. The duties of the chief of this division will be to assist the executive secre- tary of the board in the operation of the protective social measures program and the protective medical measures program of the board in the States; to assist the executive secretary in the disbursement of the allotments from the fund for the assistance of the States through their departments of health for the treat- ment, prevention, and control of venereal diseases in accordance with the rules established by the Secretary of the Treasury and by the Interdepartmental Social Hygiene Board ; to check up on the States that may specifically appro- priate or otherwise set aside funds in order to qualify for their allotments from the Interdepartmental Social Hygiene Board for the, use of their respective boards or departments of health in the prevention, control, and treatment of venereal diseases ; to prevent unnecessary duplication of activities ; to coordi- nate with other similar activities the board and the Government ; to operate a system of accounting that will safeguard the board and satisfy the Govern- ment in tlie distribution of tiiis particular fund to the States. ///. Supervising Assistant and Insiyector. (a) Headquarters in Washington. (&) Service in Washington with field assignments. (c) One woman, one man. id) Functions — 1. Responsible to the chief of the Division of Relations with States and through that officer to the executive secretary, for an intimate, intelligent, and safe judgment-forming knowledge of the need for, the operation of, and the effect of, a protective social measures program in all of its impoitant details in all those parts of the United States in which there, are soldiers or sailors and in which there are agents of the board. This general statement involves the whole functional organization of the Pro- tective Social Measures Section of the Division of Relations with States. 2. Responsible for the selection and recommendation of efficient dependable personnel for service in tlie central office and in the field. 3. To be the sources of instruction to the personnel assigned for protective social measures service under their direction in the central oflice or in the field. This insti'uction should prepare each new appointee for the duties of his posi- tion and should bring to the old appointee important information and instruc- tion whenever necessary. 4. To recommend assignments of agents for service in the fi.eld and supervis- ing assistants for local, regional, or general assignments., 203 204 EEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 5. Responsible for an accurate judgment of the service value of each ap- pointee under his supervision, directly or indirectly by way of a State depart- ment of health. Retirement for good and sufficient reasons should be swift and certain. 6. Responsible for recommendations as to transfers of agents from one assign- ment to another, especially in case of possible dissatisfaction between the agent of the board and the health officer to whom that agent has been assigned. 7. To maintain records of individual field service, safeguarding our agents from unmerited criticism and enabling us to anticipate merited criticism and forestall its appearance. 8. The woman supervising assistant and inspector is responsible for the com- pleteness, sociologic standard, and practicality of case records, both as to form and content. Both supervising assistants are responsible for the form, content, and utility of the statistical and other records that are required from the field service and for the regular delivery of such reports to the central office. These responsibilities involve an important relationship with the division of records, information, and planning. 9. To maintain for the board a directing, dominating relationship to the local program, its organization, operation, and effect, when that local program is directly under the board. The degree of local autonomy justified mider war conditions is not justified under peace conditions. Either the board or the State departments of health must be responsible for the important and major features of each " local " program. 10. To maintain an effective advisory relationship with tlie protective social measures program through the State department of health in those States in which personnel has been assigned to the State department of health. In this relationship there is need for tact, diplomacy, and vision. The supervising assistant must be a good " sales agent." 11. To inform the division chief regularly and concisely concerning the prob- lems, facts, and activities associated with the protective social measures program. 12. To maintain an up-to-date record and forecast of programs in operation in and proposed for each locality to which agents of the board are sent or to which they are about to be sent. 13. To maintain a uniform, discriminating, and stimulating relationship with the local field service through agents sent out from this office, through assign- ments to this office from the field or through conference, and through personal visits to the field. This relationship should achieve satisfying explanation of our policies and the work of the board and should give opportunity for answer to the innumerable practical questions with which these earnest and unselfish workers in the field are concerned — some of them operating at long range from Washington. 14. The supervising assistants are responsible for the letters and other com- munications sent out by them personally or sent out by the central office per- sonnel working for them. Such communications should always carry tlie sig- nature of the supervising assistant for whom they are issued, except on occa- sions of absence of the supervisor from the central office. 15. To recommend to the division chief, and through the division chief to the executive secretary, methods, machinery, and programs whereby the functions outlined above may be performed practically, economically, and effectively, and whereby concise and accurate records luay be compiled covering these functions and their products. rp:port u. s. interdepartmental social hygiene board, g-05 IV. Field supervisor. (a) Headquarters in Washington or in tlie field. (&) Service entirely in tlie field. , (c) StnfT composed of women and men. (d) Functions and regulations of field supervisors are: 1. To be intimately acquainted with all report blanks, case-record foi-ms, statistical forms, expense-account records, and other forms that are developed under the protective social measures program of the board. 2. To be thoroughly informed as to the functions of each and every office under the board. 3. To know personally every officer and agent of the board directly related to his or her work. 4. Should know personally every officer in the various other official organi- zations whose work is directly related to his or her services. 5. To be informed up to date concerning all reports, records, and statistical information bearing on affairs in his or her region, and also in general relation to the whole field. 6. To be informed concerning laws and ordinances relative to protective social measures and venereal disease, especially in his or her own region, and to under- stand their limitations and possibilities. 7. To keep in close touch with all records secured in his or her region and particularly the use made of and results accomplished by evidence or information turned over to law-enforcing agencies in that region. 8. To be informed up to date as to (1) general vice and venereal disease con- ditions in his or her territory ; (2) the enforcement of laws for the repression of prostitution; (3) enforcement of antivenereal disease laws, ordinances, or regu- lations ; and to use proper methods to secure better law enforcement when neces- sary, and to otherwise correct unsatisfactory conditions. 9. To understand the local State or other local variations in the protective social measures program of the board, especially those variations for which the chief State health officer is responsible. 10. To be informed concerning the agreements that have been drawn up be- tween the State health officer and the board so as to advise the executive secre- tary as to their satisfaction. 11. To make every reasonable and proper effort to secure and maintain an effective working relationship between the State health officer and all other agencies on which the local success of the protective social measures program of the board depends. 12. To prepare plans for the executive secretary whereby cooperative com- munity forces may be marshaled, if occasion demands, for the support of the chief State health officer and the Interdepartmental Social Hygiene Board in their plans for securing enforcement of State and local laws and ordinances relative to the prevention and control of venereal diseases. 13. To formulate safe judgments as to the need for new State and local laws and ordinances ; new or larger or improved reformatory, detention house, and other institutional accommodations that are or ought to be available for the care of civilian persons who are detained or committed therein for the protection of soldiers and sailors from venereal diseases, and to stimulate necessary legis- lation and needed improvement in institutions or establishment of new institu- tions. 14. To become expertly informed as to reformatories, detention houses, and other institutions to which venereal-disease carriers may be sent for the pro- tection of soldiers or sailors, keeping in mind the construction regulations, pro- 206 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. grams of information, instruction, training, vocational opportunities, hygienic and recreational opportunities, treatment of venereal diseases, and other health supervisory and disciplinary policies for the successful care and final social and economic restoration of their inmates; and to stimulate needed improvements. 15. To become expertly informed as to State or local need for institutions for the care of subnormal venereal-disease carriers, the hygiene of those institutions, the care of the inmates, their regulations and their support, and to stimulate the establishment of such as are lacking. 16. To exercise careful and judicious supervision over the activities of those agents of the board properly under his or her direction, transmitting to them instructions from headquarters and giving them necessary directions, counsel, and assistance as occasion demands for an effective functioning of the protective social-measures program. 17. To render accurate, systematic, periodical reports to the board as directed. 18. To act as hi w-en forcing officer only when properly appointed by com- petent authority and after such appointment has been approved by the executive secretary. 19. In submitting to law-enforcement agencies information as to prostitution or other related unsatisfactory community social condition, or in recommending to the proper agency a needed improvement in institutions for care and treat- ment of venereal-disease carriers, or for new institutions, or in other simifar matters of recorjmendation or stimulation, it is essential that inquiry first be made as to whether or not such information, recommendation, or stimulation has been previously used or submitted by an agent of the board, and if so, what resulted tlierefrom ; this regulation is designed to pi'event duplication of efifort and to emphasize necessity for closer cooperation between the board's agents iks well as to prevent needless repetition to or " nagging " of official agencies. r. linpervisor or field agent in chary e: (a) Headquarters in che field under the State department of health or in a city, a community, or " region." (?)) Service entirely in the field. (r) Staff composed of women and men. (d) Functions and regulations of supervisor or field agent in charge are: 1. To be intimately acquainted with all report blanks, case record forms, statistical forms, expense account records, and other forms that are developed under the protective social measures program of the board. 2. To be thoroughly informed as to functions of each and every officer under the board. 3. To know personally every agent or supervisor of the board directly related to his or her work. 4. To know^ personally every officer in the various other oflicial organizations in his or her region whose work is directly related to his or her services. 5. To be informed up to date concerning all reports, records, and statistical information bearing on affairs in his or her region and also in general relation to th^ whole field. 6. To be thoroughly informed concerning laws and ordinances relative to protective social measures and venereal disease in his or her region and also understand their limitations and possibilities. 7. To use every available means for securing information relative to the foci of venei'eal-disease infection personally and through his or her subordinates. To be responsible for submitting this information to the proper law-enforcing jigency with such stinuilatory action as may be necessary : and for a careful observation of action taken thereon and results accomplished. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 207 8. To constantly endeavor to discover oi- Identify venereal disease carriers through (1) reports from representatives of the board; (2) i-eports from venereai clinics or other agencies; (3) information secured from police cases, and (4) personal contact with such individuals; and to make report thereof to. proper health authorities. 9. To constantly search for information relative to use made of facts and data submitted to law enforcement agencies and for evidence as to enforcement of antivenereal-disease laws and ordinances. 10. To observe the conduct of persons after treatment as venei-eal disease carriers to ascertain whether or not they have ceased to practice prostitution, with such subsequent action as appears necessai'y. 11. To be informed regarding the agreements that have been entered into, between the chief State health offlcer and the Interdepartmental Social Hygiene. Board (if assigned to a State department of health) and lend all possible, assistance in the fulfillment of the conditions thereof. 12. To make every reasonable and proper effort to secure and maintain aa effective working i-elationship between the State health officer and all other agencies on which the local success of the protective social measures progran) of the board depends. 13. To devise plans and means whereby cooperative community forces may. be marslialed for the support of the cliief health ofiicer and the Interdepart- mental Social Hygiene Board in their plans for securing enforcement of State and local laws and ordinances relative to the prevention and control of venereal^ diseases. 14. To formulate safe judgments as to the need for new State and local lawa aud ordinances ; new or larger or improved reformatory, detention house, and other institutional accommodations that are or ought to be availal^le for the care of civilian persons who are detained therein for the protection of soldiersi and sailors from venereal disease, and to stimulate needed improvement in in-. stitutions or establishment of new institutions. 15. To become thoroughly informed as to reformatories, detention houses, and other institutions to which venereal-disease carriers may be sent for the, protection of soldiers and sailors, as regards : (1) Construction ; (2) regulatiojis :. (3) programs of information, instruction, and training; (4) vocational op- portunities; (.5) hygienic and i*ecreational opportunities; (6) treatment for. venereal diseases ; and other health supervision and disciplinary policies for the successfid care and final social and economic i*estoration of their inmates — and to stimulate needed improvemests. 16. To become well informed as to State or local need for institutions for. the care of subnormal venereal-disease carriers, the hygiene of Ijhese institu- tions, the care of their inmates, their regulations and their support, and to, stimulate the establishment of such as are lacking. 17. To exercise careful and judicious supervision over the activities of those agents of the board properly under his or her direction, transmitting to them, instructions from headquarters and giving them necessary directions, counsel, and assistance as occasion demamls for an effective finictioning of the protec- tive social measures program. IS. To render accurate, systematic, periodical reports as directed. 19. To act as law-enforcement officer only when properly appohited by com]je-. tent authority and such appointment has been approved by the executive secre- tary. 20. In snbnntting to law-enforcement agencies infoi'mation us to prostitu-, tion or other related unsatisfactory connnunity. social conditions, or in recom- mending to the proper agency a ne<>de(l iiiiprovcMnont in institutions for care. 208 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. and treatment of venereal -disease carriers, or for new institutions, or in otlier similar matters of recommendation or stimulation, it is essential that inquiry first be made as to whether or not such information, recommendation, or stimu- lation has been previovisly used or submitted by an agent of the board, and if so, what resulted therefrom ; this regulation is designed to prevent duplication of effort and emphasize necessity for closer cooperation between the boai'd's agents as well as to prevent needless repetition to or " nagging " of official agencies. 21. All agents of the board assigned to a bureau of protective social measuras under a State department of health are to receive instructions from and be responsible to the chief State health officer. It is believed that such direction? will follow closely the directions set forth here and that little if any incompati- bility will result. 22. Special service — Woman supervisor or field agent in charge. (a) To maintain close contact with case work of each agent under her direc- tion and do or cause to be done necessary follow-up work. (b) To place a competent male agent in charge of law-enforcement work. (c) To organize local committees designed to stimulate protective social work with women and girls, either personally or through subordinate agents. (d) To place a competent woman in direct charge of all case work with women and girls. 23. Special service — Man supervisor or field agent in charge. (a) Discovery or identification of houses of prostitution and other premises where prostitution occurs ; observation of burlesque theaters and taxicab prac- tices which make for the spread of venereal diseases, and turning over all such information to regularly constituted law-enforcing agencies for official action and careful observation of action taken thereon aad results thereof. (b) To place a competent woman agent in direct supervision of all case work with women and girls. (c) Organization of local committee for stimulation of law enfoi'cement. (This may be a joint committee with the one designed to stimulate protective social work or may be an organization already existing which will assume re- sponsibility for such community activity.) VI. Field Agents. (a) Located wherever assigned by — ■ 1. State health officer. 2. Interdepartmental Social Hygiene Board, executive secretary. (b) Service entirely in the field. (c) Staff composed of women and men. (d) Functions and regulations of field agents are: 1. To be intimately acquainted with all report blanks, case record forms, statistical forms, expense accoinit records, and other forms that are developed under the protective social measures program of the board. 2. To contact and establish cooperative working relations with all public officials in his or her region who are factors in an effective program of protec- tive social measures, and explain to each the salient features of the program of protective social measures. 3. To be informed up to date concerning all reports, records, and statistical information bearing on affairs in his or her region and also in general relation to the field. 4. To be thoroughly informed concerning laws and ordinances relative to pro- tective social measures and venereal diseases in his or her region and under- stand their limitations and possibilities. REPORT U. S. INTERDEPARTMENTAL. SOCIAL HYGIENE BOARD. 209 5. To procure information as to the existence of prostitution and deliver same to tlie regularly constituted law enforcing agencies and observe action taken thereon and results thereof. It is primarily the duty of the field agents to stimulate law enforcement through contact with law enforcing agencies and at- tendance in courts where matters of importance in the protective social measures program are determined. 6. To make frequent observation of places of public recreation, amusement, or congregation which may carry programs of prostitution and seek to correct any bad conditions noted, through official agencies charged witli that duty. 7. To constantly endeavor to discover or identify venereal disease carriers through (1) reports of representatives of the board; (2) reports from venereal clinics or other agencies; (3) information secured from police cases; and (4) personal contact with such individuals — and to make report thereof to proper health authorities. 8. To constantly search for information relative to use made of facts and data submitted to law-enforcing agencies and for evidence as to enforcement of antivenereal disease laws and ordinances. 9. To observe the conduct of persons after treatment as venereal-disease car- riers to ascertain whether or not they have ceased to be venereaVdisease carriers and whether or not they have ceased to practice prostitution, with such subse- quent action as appears necessary. 10. To ascertain effective means for using cooperative community forces for law enforcement and bring such forces into action. 11. To become well informed as to need for facilities for treatment and de- tention of venereal-disease carriers and foster official action to provide such facilities. 12. To receive directions from directors, supervisors, or other agents of the board who have been properly designated as supervisors and carefully carry out such directions or act upon suggestions given. 13. In submitting to law enforcing-agencies information as to prostitution or other related unsatisfactory community social conditions, or in recommend- ing to the proper agency a needed improvement in institutions for care and treat- ment of venereal-disease carriers, or for new institutions, or in other similar matters of recommendation or stimulation, it is essential that inquiry first be made as to whether or not such information, recommendation, or stimulation has been previously used or submitted by an agent of the board, and if so, what resulted therefrom ; this regulation is designed to prevent duplication of effort and emphasize necessity for closer cooperation between the board's agents as well as to prevent needless repetition to or "nagging" of official agencies. 14. All agents of the board assigned to a Bureau of Protective Social Meas- ures under a State department of health are to receive instructions from and be responsible to the chief State health oflScer. It is believed that such directions will follow closely the directions set forth here and that little if any incompati- bility will result. 15. To organize committees to stimulate law enforcement and protective social work with women and girls. 16. Special Service — Women agents. (a) All investigation, inquiry, and research relative to case work with women and girls, including endeavors to have physical and mental examinations made in each case and to make recommendations to courts or other official or unofficial agencies relative to the final disposition of each case, and follow-up work with such cases. (b) To turn over to male agents or directly to law-enforcing agencies In- formation relative to existence of houses of prostitution. 15610—20 14 210 EEPORT U. S. INTERDEPARTMENTAL, SOCIAL, HYGIENE BOARD. 17. Special Service — Men agents. (a) To discover houses of prostitution or places where prostitution occurs, also the existence of programs of prostitution, and turn over all such informa- tion to law-enforcing agencies or other official agencies directly concerned for official action. The results must be carefully observed. YII. Assistant Field Agefits. VIII. Assistant Special Agents. Same in all respects as field agent except that all assistant agents when work- ing under directions of other agents of the board shall take directions from such agent. When an assistant agent is placed in charge of a station without an immediate superior at that station, he or she will perform duties and be sub- ject to the same requirements as those enumerated for field agents. iX. Confidential Protective Social Agents. (a) Located wherever assigned by executive secretary. (&) Staff entirely in the field. (c) Staff composed of men and women. (d) Functions and requirements. 1. To make confidential investigations of vice conditions. 2. To render confidential reports to the executive secretary immediately upon completion of an investigation as directed. 3. No difference between service of men and women. The protective social-measures program contemplates no discrimination be- tween male and female prostitutes. All agents of the board are cautioned, therefore, against the somewhat prevalent policy of exempting men from the • operation of laws, ordinances, or regulations designed to prevent the spread of venereal diseases. A wise and effective application of the protective social-measures program in- volves a thorough understanding not only of the essentials of the program, but of the varying shades of distinction between certain of its features. It appears that the lines of demarcation between disease, crime, and immorality have given rise to the greatest confusion. Crime may be defined as the commission (or omission) of an act specifically forbidden (or enjoined) by public law and whereby the offender becomes liable to punishment in a court of justice. Arrest, trial, conviction (or acquittal), and sentence are terms which apply only to crime or criminals. Disease is the antithesis of health ; it may be briefly and simply defined as a morbid condition resulting from disturbance or failure of natural physiological functions. Diseases which are so communicable as to be a menace to the public health are usually controlled by quarantine of the persons so diseased. The public health authorities only are vested with the power of quarantine. The fact that many persons contract disease because of abuses, intemperance, ex- cesses, indulgences, or other acts which may be classed as crimes, does not make It a crime to have the disease. No person falls into the criminal category be- cause he has become a victim of a disease, however loathsome. A person may commit a crime and through the commission of that crime also contract a loath- some communicable disease ; but the remedy for the crime is one to be applied by a court of justice, while the community looks to public health officials for its protection against the disease. Venereal disease is a typical example. Much venereal disease is spread through prostitution ; prostitution is a crime in every State in the United States excepting two; hence many venereal carriers will also be criminals. However, venereal disease may be and frequently is con- tracted innocently; hence not all venereally-diseased persons are or have been criminals. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 211 Thus is emphasized the necessity for divorcing the disease features of the protective social measures program from its law enforcement features. The function of the police department and the courts and those of health depart- ments are separate and distinct, and it is important that the board's agents clearly recognize the distinction. Immorality is a condition of being immoral ; any person who does an act in- consistent with moral rectitude or violates any moral or divine law may be classed as immoral. It is a broad term and covers not only several classes of crimes, but a multitude of other acts which depend for their moral sanction ajwii the person's conscience or public opinion. Many crimes involve immorality, but ijnmorality is not always crime. The Interdepartmental Social Hygiene Board is concerned with Immorality in so far as it may be a factor in the spread cf venereal disease to members of the Army or Navy. The board does not de- preciate the importance of the moral phase of the social hygiene movement, but in conformity with the act of Congress establishing the board and outlining its responsibilities the protective social measures program is confined rather closely to measures for protecting soldiers and sailors from venereal infection. Thus it will be apparent that the board's program is vitally concerned with crime and disease to the extent and in the manner set forth herein, but it is essential that crime and disease be considered as separate and distinct features of the protective social measures program. Owing to the fact that tlie general publid places a stigma upon any person with a venereal disease no publicity more than is absolutely necessary should be given in any case. Communications or conferences with public officials directly concerned in the matter do not constitute publicity, however. Much greater circumspection is necessary in cases of persons only suspected of being venereal disease#?arriers lest the suspicion be a mistaken one and the person subjected to annoyance and embarrassment. Publicity should also be avoided as much as possible in dealing with first offenders and unhardened prostitutes. Public ridicule or censure may very seriously deter the reclamation of such persons by destroying the last vestige of pride or self-respect they may have. T. A. Stokey, Executive Secretary, Irti&~d:eftm^memtal Social Hygiene Board. 2. FORM OF PROPOSAL FOR GOVERNMENTAL ASSISTANCE IN THE ORGANIZATION OF BUREAUS OF PROTECTIVE SOCIAL MEASURES IN STATE DEPARTMENTS OF HEALTH. In conformity with the provisions carried by sections 2 and 5 of Chapter XV, Public 193, Sixty-fifth Congress, Army appropriation bill, July 9, 1918, the United States Interdepartmental Social Hygiene Board proposes to assist those States that contain permanent military and naval establishments by mak- ing allotments for the organization of a division or bureau or section of the State department of health or other appropriate subdivision of the State government of those States which will be concerned with the care of civilian persons " whose detention, isolation, quarantine, or commitment to institutions may be found necessary for the protection of the military and naval forces of the United States against venereal diseases." The board proposes that when these bureaus of protective social measures are established in State departments of health the personnel assigned by the board to serve in such bureaus shall be approved by, directed by, and be responsible to the chief health officer of the State; and the chief State health officer shall operate a program for the prevention of venereal diseases and 212 EEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. the consequent protection of the military and naval forces of the United States satisfactory to the Interdepartmental Social Hygiene Board and properly correlated with all other activities of the State health organization; and that the Interdepartmental Social Hygiene Board shall pay the salaries and trav- eling expenses in accord with standard Government regulations, and the State department of health will provide proper ofRee space and equipment of the assigned personnel necessary to complete the organization of these bureaus, divisions, or sections of protective social measures in the State department of health each month up to June 30, 1921, in accordance with the provisions of the agreement made between the chief health officer of the State concerned and the board. In general the board will expect the chief State health officer or other State official entering into this agreement to be responsible for the operation, through the Bureau of Protective Social Measures, of a program that will cover the following activities : (a) Investigation of social conditions which makes for the spread of venereal disease and search for foci of infection with a view, to securing the proper care or detention of civilian persons infected with venereal disease. (&) Investigation of social influences that produce carriers of venereal dis- eases, and follow-up work with persons who have been carriers to prevent them from again subjecting themselves to conditions which may lead to infection. (c) Investigation of provisions and facilities for the care and maintenance of persons infected with venereal diseases. AppLication to the United States Interdepartmental Social Hygiene Board for the assignment of personnel for service in the division, section, or bureau of protective social measures in the department of healtli. State of , for the year ending .Tune 30, 1921 : Date of application : . 1. Name of State department of health (or equivalent division of the State government) for which this application is made: . 2. Name, official position and address of the chief State health officer who is the responsible and competent agent authorized to ]nake this application and who is making this application for the department of health of the State of . ■ (a) Name: . ( b ) Official position : . (c) Address: . 3. Locations of permanent or important temporary military and naval forces in this State (give number of soldiers or sailors in each at the time this application is made) : • . 4. Provisions that have already been made in this State department of health for the investigation of social conditions which make for spread of venereal disease and seai-ch for foci of infection with a view of securing the proper care or detention of civilian persons infected or likely to be infected with venereal disease : . Additional provisions proposed for sucli investigation and search : . 5. Provisions that have already been made for " Investigation of social in- fluences that produce carriers of venereal disease and follow-up work with persons who have been carriers, to prevent them from again subjecting them- selves to conditions which may lead to infection " : . Additional provisions proposed for such investigation and follow-up work : . REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 213 6. Provisions tliat have already been made for investigation of provisions and facilities for the care and maintenance of persons infected with venereal disease: . Additional provisions proposed for carrying out these investigations: . 7. Personnel now employed by this State department of health for the pur- pose outlined in paragraphs 4, 5, and G above (give concise statement of the duties of each of these persons) : . I, , the chief health otRcer of the State of , designated above in paragraph 2, hereby make application to the United States Interde- partmental Social Hygiene Board for the assignment of personnel to service in the bureau of protective social measures in the department of health, of the State of , from June 30, 1920, until June 30, 1921, or until this agree- ment is terminated, provided that this personnel be approved by, directed by, and responsible to the chief health officer of this State during the period under which such personnel is assigned by the board for service in the bureau of protective social measures in this department of health. In my capacity as chief health officer and responsible agent to the department of health of the State of , and by virtue of authority invested in me by the State board of health, I agree that I will, within the limitations of my power, " operate a program for the prevention of venereal disease and the consequent protection of the military and naval forces of the United States, satisfactory to the United States Interdepartmental Social Hygiene Board and properly correlated with all other activities of the health organization of this State;" said program shall not include any encouragement, recognition, or licensing of prostitution or houses of prostitution ; and further, that I will, to the best of my ability, direct successfully and effectively the investi- gations and other activities included in the protective social measures program of the United States Interdepartmental Social Hygiene Board, and that reports on each of these activities will be made to me by the several responsible mem- bers of the personnel of the bureau of protective social measures, copies of all which reports will be sent directly to the United States Interdepartmental Social Hygiene Board regularly and without delay; that I will receive such suggestions, advice, and counsel as the Interdepartmental Social Hygiene Board may give, and make the best use of such communications as my judgment dic- tates; that I will do every reasonable thing within my power to prevent, con- trol, and eradicate venereal diseases in this State through protective social measures as well as through protective medical measures, and agree that this agreement may be terminated on 30 days' notice by either party concerned. Chief State Health Officer. Approved : Executive Secretary. Appendix D. RULES AND REGULATIONS GOVERNING EXPENDITURES FROM THE STATE ALLOTMENTS OF THE CHAMBERLAIN-KAHN FUNDS. APPROPRIATIONS. 1. Appropriations 1919 and 1920. — The Sixty-fifth Congress appropriated the sum of $1,000,000 for each of the fiscal years 1919 and 1920, to be paid to the various States for the use of their boards or departments of health in the pre- vention, control, and treatment of venereal diseases ; this sum to be allotted to each State on the basis of the 1910 population in accordance with the rules and I'egulations of the Secretary of the Treasury. 2. Chamberlain-EaJm Act. — This act is known as the Chamberlain-Kahn Act and constitutes chapter 15 of the "Act making appropriations for the support of the Army for the fiscal year ending June 30, 1919." This act reads in part as follows : United States Interdepartmental Social Hygiene Board : That there, is hereby created a board to be known as the United States Interdepartmental Social Hygiene Board, to consist of the Secretary of War, the Secretary of the Navy, and the Secretary of the Treasury as ex officio members, and of the Surgeon General of the Army, the Surgeon General of the Public Health Service, or of representatives designated by the Secretary of War, the Secretary of the Navy, and the Secretary of the Treasury, respectively. * * * That there is hereby appropriated out of any moneys in the Treasury not otherwise appropriated * * * the. sum of $1,000,000, which shall be paid to the States for the use of their respective boards or departments of healtli in the prevention, control, and treatment of venereal diseases ; this sum to be allotted to each State, in accordance with the rules and regulations prescribed by the Secretary of the Treasury in the proportion which its population bears to the population of the continental United States, exclusive of Alaska and the Canal Zone, according to the last preceding United States census, and such allotment to be so conditioned that for each dollar paid to any State the State shall specifically appropriate or otherwise set aside an equal amount for the prevention, control, and treatment of venereal diseases, except for the fiscal year ending June 30, 1919, for which the allotment of money is not conditioned upon the appropriation or setting aside of money by the State, provided that any State may obtain any part of its allotment for any fiscal year subsequent to June 30, 1919, by specifically appropriating or otherwise setting aside an amount equal to such part of its allotment for the prevention, control, and treatment of venereal diseases. 3. Rules and regulations of the Secretary of the Treasury. — Under date of September 4, 1918, the Secretary of the Treasury promulgated rules and regu- lations which provided that State allotments shall be expended along general standard lines for all States and in accordance with an accounting system to bo forwarded by the United States Interdepartmental Social Hygiene Board. 214 REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 215 Hence the regulations of this board governing these expenditures are given the effect of law. These regulations of the Secretary of the Treasury are as follows : REGULATIONS. Promulgated by the Secretary of the Treasury, under which State boards or State departments of health receive the allotment of funds provided in section 6, chapter 15, of the act approved .July 9, entitled "An act making appropria- tions for the support of the Army for the fiscal year ending June 30, 1919." The act provides that $1,000,000 shall be distributed to the States for the use of their respective boards or departments of health in the prevention, control, and treatment of venereal diseases, this sum to be allotted to each State, in accordance with rules and regulations prescribed by the Secretary of the Treas- ury, in the proportion which its population bears to the population of the continental United States, exclusive of Alaska and the Canal Zone, according to the last preceding United States census. State boards or departments of health receiving their respective allotments shall agree to the following cooperative measures under which their appropria- tion shall be expended : 1. Put into operation, through a legislative enactment or a State board of health regulation having the effect of law. regulations in conformity with the suggestions approved by the Surgeons General of the Army, Navy, and United States Public Health Service, for the prevention of venereal diseases. The minimum requirements of these rules are : (a) Venereal diseases must be reported to the local health authorities in ac- cordance with State regulations approved by the United States Public Health Service. ( b ) Penalty to be imposed upon physicians or others required to report vene- real infections for failure to do so. (c) Cases to be investigated, so far as practicable, to discover and control sources of infection. (d) The spread of venereal diseases should be declared unlawful. (e) Provision to be made for control of infected persons that do not cooperate in protecting others from infection. (f) The travel of venereally infected persons within the State to be controlled by State boards of health by definite regulations that will conform in general to the interstate regulations to be established. (g) Patients to be given a printed circular of instructions informing them of the necessity of measures to prevent the spread of infection and of the impor- tance of continuing treatment. 2. An officer of the Public Health Service shall be assigned to each State receiving allotments for the general purpose of cooperating with the State health officer in supervising the venereal-control work in the State. This officer to be selected by the State health authorities and to be approved and recommended for appointment by the Surgeon General of the Public Health Service. Tlie salary of this oflicer will be paid by the State out of the funds made availabiS from the allotment, except a nominal sum of $10 per month, which will be paid by the United States Public Health Service. In those States where a bureau of venereal diseases has already been established, with a full-time medical oflicer in charge, the present incumbent may be recommended for appointment by the State health officer, and, with the approval of the Surgeon (;i3iippi Missouri Montana Nebraska 138,093 204,354 5, "4, 449 377, M9 7W,024 114,758 2.J2,322 331,069 752,619 609, 121 325, 594 638, 591 700, 876 224,771 690, 949 289, 905 656,388 742,371 2J5,346 366,416 810,175 075, 708 797,114 293,335 376, 053 192,214 Percentage. 2.324715 .222191 1.711874 2 OS5372 . 868766 1.212057 .219981 .3.59966 .818311 2- 836856 .354013 6 130751 2.936620- 2.418958 1.838542 2 489777 1.800965 . 807168 1.408409 3 660251 3 055157 2.253885 1. 953974 3.580791 .408876 1.296275 State. Population. Nevada New Hamp.shire New Jersey New Me.iico Ne.v York North Carolina. . North Dakota... Ohio Oklahoma Oregon Pennsyhania. .. Rho.ie Island.. . South Carolina.. South Dakota. . . Tennessee Texas Utah Vermont Virginia :... Vv'ashington West Virginia... Wisconsin W^yoming Total 81,875 430, 572 537,167 327,301 113,614 206, 287 557, 0.56 767, 121 657, 155 672, 765 665,111 M2,bia 515,400 583, 888 184,789 896, 542 373,351 355, 956 061,612 141,990 221,119 333, 860 145,965 Percentage. 0.089021 .468154 2.758622 . 355870 9. 909089 2.398861 . 627424 5 183216 1.801799 . 731487 8.334155 . ..589972 1.047671 . 634.852 2.375487 4.236649 .405939 .387026 2 241558 1.241668 1 327704 2. 537570 . 158705 100 UNEXPENDED BALANCES, 1919-20. 8. Comptroller's decision. — Under date of May 18, 1920, the board addressed a letter to the Comptroller of the Treasury, in part, as follows : If a State, in accordance with the above-quoted section of the act, did " speciti- cally appropriate or otherwise set aside " an amount equal to the Federal allot- ment for the fiscal year ending June 30, 1920, and by so doing complied with the act, does this action of the State create a liability against the appropriation made by Congress which may be paid by the board after June 30, 1920? If the action of the State in specifically appropriating or otherwise setting aside an equal amount may be con.sidered as creating a liability against the appropriation, the board would like to continue making monthly disbursements of 50 per cent of the paid vouchers submitted, rather than to pay over to the States before June 80, in a lump sum, the balance due them, and, therefore, it is respectfully re- quested that you advi.se me if the board is authorized to use its .judgment as to the advisiability of making monthly payments, or paying in full, after the ex- piration of the fiscal year, any balance due a State on its allotment for the fiscal year ending June 30, 1920. In reply to that letter the comptroller advised as fallows : The authority to make allotments to the State given by the act of June 30. 1919 (40 Stat., 8§6), is in accordance with rules and regulations prescrilKMl by REPORT U. S. INTERDEPARTMENTAIi SOCIAL HYGIENE BOARD. 219 the Secretary of the Treasury. The allotment itself is in such cases the actual Incurrence of liability against the appropriation, and that having been made within the fiscal year the subsequent data required do not affect the use of the appropriation. board's regulations regarding payment of balances. 9v In accordance with this ruling the board has adopted the following rules regarding payments of the balance due the State for the fiscal years 1920 and 1921: (a) In the discretion of the board no further payments will be made to a given State from its allotment that became available for the Federal fiscal year 1920 until that State has spent and satisfactorily accounted for the allotment paid over to it for the Federal fiscal year 1919. (6) When a given State shall have expended and satisfactorily accounted for the entire allotment paid over to it by the board for the Federal fiscal year 1919 the board, in its discretion, will pay over to the treasurer of that State, la a lump sum, the entire balance of the allotment due that State for the Fed- eral fiscal year 1920, (c) In the discretion of the board no payment will be made to a given State from its allotment for the Federal fiscal year 1921 until that State has expended and satisfactorily accounted for the joint balance on hand ; that is, for its allot- ment from the Govei-nment and also for its own balancing appropriation cover- ing the allotment from the Government for the Federal fiscal year 1920. (d) States will, however, commencing July 1, 1920, begin making disburse- ments from their State appropriations, for the fiscal year 1921, accounting for the same on a pink-colored voucher form to be provided by the board for that purpose. They will do this regardless of whether or not the board is withholding payments for any prior fiscal year. These vouchers, which are to be paid en- tirely from the State appropriations for the fiscal year 1921, will be submitted to -the. b.oard monthly and summarized on the pink-colored monthly report to be provided by the board for that purpose. The board will audit these vouchers as' received, but withhold making 50 per cent payment until the previous allot- CQenf or allotments for prior fiscal years are accounted for and approved by the board. STATE CERTIFICATES. 10. Certifying to State appropriations. — Before any State may receive any portion of its allotment for which it has qualified by specifically appropriating or otherwise setting aside a specified sum of money, it will be necessary for the State treasurer to deliver to the United States Interdepartmental Social Hygiene Board, properly signed and executed State certificates in duplicate, certifying that the State has complied with the act of Congress " by specifically appropri- ating or otherwise setting aside " a stated amount " for the use of its depart- ment or board of health in the prevention, control, and treatment of venereal diseases." One copy of this certificate will be filed by the United States Inter- departmental Social Hygiene Board with the accounting officers of the United States Treasury Department in Washington, D. C, and one copy will be re- tained in the files of the board. These certificates must be accompanied by one printed or properly certified copy of the State legislative bill providing the appropriation to which the State treasurer is certifying. This copy of the State legislative bill will be retained in the files of the board. 220 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD» JOINT STATE AND FEDEHAL BUDGETS. 11. F'ortvardlng budgets. — Before any State may receive any portion of the Federal allotment for which it qualifies it will be necessary to deliver to the United States Interdepartmental Social Hygiene Board a properly made out and signed joint State and Federal budget in triplicate, equaling the total of both the State appropriation and the F'ederal allotment. Should the State appropria- tion exceed the Federal allotment "the budget will be made for only double the "amount of the latter, and should the State appropriation be for a lesser amount than the Federal allotment the budget will be made for only double the State appropriation. In preparing the joint State and Federal budget no division should be made between Stqte and Federal funds. 12. Where State appropriations exceed Federal allotment. — States are advised that where their appropriation for prevention, control, and treatment of venereal diseases exceeds the Federal allotment the board does not require information of any sort whatsoever concerning the excess State appropriation. The ex- penditures therefrom are not to be reported to the board. 13. Budget account numbers. — In view of past experience in disbursing these joint funds, State officers should now be able to prepare their joint budgets in more complete detail and allot the funds with more accuracy so that the budget may meet every contingency and prevent overdrawing on any specified budget account. It is requested that especial care be given to this subject, as the method of accounting by budget account number makes it essential that an individual account be kept with each activity or project, in addition to the four general accounts. If the joint budget is not carefully drawn it .will require numerous transfers and revisions which will complicate the accounting. 14. Where legislatures itemize State appropriations. — If a State legislative body instead of appropriating in a lump sum has made an appropriation in more detail by itemizing certain specific objects and the amounts available for each, it will be necessary when making the budget to state thereon the exact objects and amounts as outlined in the State appropriation. However, this fact need not interfere with a distribution of such amounts under the four general classifications of expenditures, but in no case should any such specific amount be divided. It should be classified as a total, ignoring percentages given. These entries on the budget will be followed by the proposed expenditures of the Federal allotment, and this portion of the budget should be given in as much detail as possible and in compliance, with tho percentages given to each classification. 15. Where States appropriate in a lump sum. — Of course, where a State appro- priation is not itemized but made in a lump sum, it is expected that State officials will give as much detail to the budgeting of the State appropriation as to the Federal allotment and also attempt to comply as far as the particular needs of their State Avill allow with the percentages given to each classification as specified in the regulations promulgated by the Secretary of the Treasury. However, attention is directed to the fact that those percentages are provi- sional and subject to modifications to meet the particular needs of each State. SAMPLE JOINT STATE AND FEDERAL BUDGET. 16. The Boai-d has prepared a " Sample joint State and Federal budget " filled out for the guidance of State departments or boards of health. This sample budget may be useful in suggesting the State form but is not submitted to be copied, as each State has its particular problems to meet and a uniform budget is not practicable or desirable. REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 221 Tip:VI,S)01) Jf)INT S'lA'IK AND FKDKHAT, HUDGET. 17. The board has prepared a blank " Revised joint State and Federal budget " (Form No. 20) for the use of State departments or boards of health. This form is to be used in formulating budgets covering tlie balance of the joint State and Federal account remaining on hand at the close of a liscal year (.Tune 30). This revised budget should be made out promptly after closing the State books for the month of June and forwarding the account for that month to the board. It should be made to cover the exact amount of the joint balance un- accounted for at that time. This revised budget should be made out to meet the needs of the State venereal-disease program without reference to the previous budget. In making this revision consideration should be given by State officials to the joint State and Federal budget to be submitted for the succeeding fi.«ical year beginning .July 1. THE 50-50 PLAN. 18. For the year 1919. — The allotments for the fiscal year 1919 were not con- ditioned upon the States contributing or appropriating any sum, but for the fiscal years ending June 30, 1920 and 1921, they were conditioned upon each State "spe-* cifically appropriating or otherwise setting aside " an equal amount to meet the Federal Government's allotment. Inasmuch as thes^Federal allotments for the fiscal year 1919 were not condi- tioned upon the State's appropriating, and in order to expedite the commencing of the work, it was thought advisable at that time to pay each State's allot- ment in full in a lump sum to be expended subject to a State budget to be sub- mitted, and in accordance with certain regulations furnished by the board. 19. For the years 1920 and 1921. — However, for the fiscal years 1920 and 1921 a different procedure became necessary for the reasons that the law as enacted by Congress and the regulations of the Secretary of the Treasury made it com- pulsory that the United States Interdepartmental Social Hygiene Board see that each dollar paid by it for the purposes stated in the act was matched by a dollar paid by the States. 20. The 50-50 plan. — Section 3 of the regulations of the Secretary of the Treasury reads : Funds that may become available from legislative appropriations must not be con- served through the expenditure of funds allotted by Congress. The board has interpreted the above section to mean that a State must not spend the Federal allotment before spending the appropriations made by the State, but that it must be a " 50-50 " plan. 21. Practice of other Government departments. — It is the general practice of Government departments and independent establishments charged with expend- ing Federal appropriations made for State and other activities conditioned upon the matching of dollar for dollar, to require the State to first make the disburse- ments from their appropriation, submitting the paid vouchers for audit. The Government department then pays to the State 50 per cent of such expenditures as may be found to be correct. This procedure serves the double purpose of as- certaining if the disbursements as made are in accordance with the regvdations governing the disbursements, and also that the State has complied with the Federal law by not only appropriating an equal amount, but by actually expend- ing its proportion. 22. 50-50 plan adopted hy hoard. — The United States Interdepartmental Social Hygiene Board has adopted this procedure for disbursing tlie allotments to States for the fiscal year.s* 1920 and 1921, and it is therefore necessary that the State 222 REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. official making disbursements from these funds forward to tliis office at the close of each month, on forms provided by the board, a statement of such ex- penditures accompanied by the paid vouchers. A Treasury warrant covering 50 per cent of such disbursements, the proportion payable by the Federal Gov- ernment, will then be promptly paid to the State treasurer. Paid vouchers submitted by a State and found not to fully comply with the regulations of the board governing expenditures from this fund will be either disallowed and returned or suspended, pending the receipt of further informa- tion, and 50 per cent of the remaining amount will be paid. PAYMENT. 23. Disposition of monthly payments. — State treasurers are advised that these payments made by the United States Interdepartmental Social Hygiene Board are not to be considered repayments to, or reimbursement of, any State appro- priation. They are to be considered as merely monthly or periodical payments by the Federal Government of allotments made for a specific purpose, and, there- fore, can not in any way be considered as State revenues, and must not be so credited. It was not the intention of Congress to appropriate funds for co- operative work with the States which would require a State legislation act to make them available. The United States Interdepartmental Social Hygiene Board will not deposit any portion of a State's allotment in any State where Its officials so construe its laws. These monthly or periodical payments should be considered by State treas- urers as trust funds for the use of the State department or board of health in the prevention, control, and treatment of venereal diseases, and he should so credit them. 24. Suspended vouchers. — ^Any voucher or vouchers suspended by the board pending further information may be resubmitted with the following month's account. Suspended vouchers resubmitted for 50 per cent reimbursement should be listed as the last entries on the monthly report in memorandum form ; that is, they should be given the original voucher numbers, but not added in with the ex- penditures for the current month, inasmuch as they were previously deducted from the available balances on the back of the monthly report when originally submitted. 25. Disposition of paid vouchers. — The United States Interdepartmental Social Hygiene Board having been charged with the duty of paying the Federal allot- ment, making rules and regulations for its expenditure and the supervision of the disbursements, it will be necessary to have on file in the office of the board In Washington, D. C, evidence of the proper disbursement of these funds, and such monthly reports and paid vouchers as may be submitted by the States will be retained and become the property of the board. UNIFORM ACCOUNTING. 26. In order that all States may have a uniform system of accounting, the board has prepared special voucher forms and monthly report forms to be used by all States in transmitting their accounts to Washington for settlement. VOUCHER FOEM. 27. All disbursements made from these funds (both State and Federal), Including salary payments and reimbursements for travel, are to be submitted on the special form of the board. REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 223 28. Year 1919. — In disbursing the remainder of the allotment for the fiscal year 1919 the white voucher, Form No. 8, and white monthly report, Form No. 9, will be used. 29. Years 1920 and 1921.— lu disbursing the balance of the 1920 joint State and Federal fund, the blue voucher, Form No. 8-A, and the blue monthly report, Form No. 9-A, will be used; and in disbursing the joint State and Federal fund for the fiscal year 1921 the pink voucher, Form No. 8-B, and the pink monthly report. Form No. 9-B, will be used, 30. Use of right form. — Special attention is directed to the use of the right form when forwarding disbursements to the board. Vouchers submitted on the wrong forms will be returned. 31. Number of vouchers to he made. — These vouchers may be made in dupli- cate, tiiplicate, or quadruplicate, in accordance with the special requirements of each State. One copy shall be forwarded to the United States Interdepart- mental Social Hygiene Board in Washington, D. C, and one or more copies may be retained by the State. 32. Signatures. — The State ofRc-ers must assume all responsibility for liabili- ties incurred in connection with the expenditures of these funds, must prepare the voucher forms approving the same as correct, obtain the signature of the payee and the certificate of the paying official. The paying official must in all eases obtain the personal signature of the payee and certify to the payment. Vouchers signed for the payee per some one else can not be accepted, unless a satisfactory explanation accompanies the voucher, but salary and travel- ing-expense vouchers under no circumstances will be accepted unless they bear the payee's personal signature. Rubber-stamp signature of the approving ofiicial or the paying ofiicial is not acceptable unless initialed by the person designated to use the same, and in such cases a letter must be forwarded to the board advising the name of the person authorized to initial and submitting a specimen of the rubber-stamp signature and initials of person designated as they will appear on the vouchers. 33. Company or corporation. — Where a voucher is certified in the name of a company or corporation, the name of the person writing the company or corporate name, as well as the capacity in which he signs, must appear. Ex- ample : " Chicago Edison Co., per John Smith, member of firm," or " secretary " or " treasurer," as the case may be. A complete signature with a rubber stamp is not acceptable. 34. More than one item. — One voucher may contain any number of items, but must be made out in the name of but one individual, firm, or corporation. Where there are a number of items appearing on the bill, the invoice of the payee may be attached to the vouclier and a statement made on the face of the voucher " as per invoice hereto attached," extending the total and classifying as if one item, but in all such cases the itemized invoice must be attached to the voucher transmitted to this office. 35. Reimbursement for cash purchases. — An official making numerous small purchases and paying cash at the time from his personal funds and obtain- ing receipted bills for such purchases may, by attaching such miscellaneous receipts to a voucher drawn payable to himself, obtain reimbursement for such expenditures. In all such cases he will be required to list on the voucher the vendors' names and the amounts paid each. The voucher forwarded to this office must also have the receipted bills attached. This procedure is authorized only in cases of emergency or where the purchase amounts to less than $1 and Is not to be interpreted as authorizing the use of subvouchers covering small monthly or periodical payments, such as telephone, ice, rent, etc., to avoid forwarding individual vouchers, and in no case must such a reimburse- ment voucher contain a payment for personal service. 224 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 36. Travel ea-'penses.— Reimbursement of travel expenses must be handled as follows : In no case will travel expenses be allowed which are not confined to the usual expenses incurred for the ordinary comforts of a traveler. Receipts should be obtained for transportation and hotel bills, when possible to do so, but it will be unnecessary to obtain receipts for meals and the various small incidental expenses of travel unless required by the State. When supplies are purchased while in a travel status, receipted invoices of the dealer must be attached to the travel voucher to substantiate the claim. If certified statements of travel expenses made on a State form are available, it is requested that the same be attached to the voucher transmitted to this office. If, however, State officials require these statements and invoices, copies should be made for transmittal with the voucher. In the absence of such a statement or copy, the travel expense should be itemized as completely as pos- sible on the face of the voucher, as the mere statement " Traveling expenses " is not considered sufficient. If it should be necessary to use taxicabs or automobiles while in a travel status, the voucher should contain the following notation : " No other means of transportation available." Where a State authorizes automobile mileage and the same is paid from the State appropriation and submitted on the special State form' covering such expenditure it will be allowed by the board. Travel outside of the State will not be approved unless authorized by the board. Books containing blank receipts conveniently printed and small daily expense account books for travelers will be supplied by the board upon request. 37. Salaries. — In making vouchers covering payment of salary for services rendered the date " from " and " to " which payment is being made (both these dates inclusive) must be shown on voucher as well as the designation of posi- tion (i. e., stenographer, V. D. oflScer, etc.) and the monthly or annual rate of compensation. 38. No employee of the United States Interdepartmental Social Hygiene Board shall receive any salary, travel expense, allowance, or compensation of any nature whatsoever from any State for services rendered in connection with their official duties. 39. Preparation of voucher. — In pi'eparing voucher to cover reimbursement to clinics, detention houses, and like institutions for salaries, treatment, main- tenance, supplies, or equipment the voucher must be accompanied by an itemzied statement giving details of the expenditures incui-red. 40. Advance payments. — In no case shall any amounts be advanced to these institutions or clinics before the liabilities are actually incurred by them-. 41. Subsidies to clinics. — Payments in advance of the actual performance of the service or the delivery of the supplies is strictly forbidden by Federal law and will not be allowed under any circumstance. Therefore advance payments to clinics under the name of " subsidies " is prohibited by the board, and no such payments shall be made in advance of the expiration of the period covered by the designated " subsidy." However, there is no objection to making such payments on a monthly basis, provided the payments are not made until the expiration of the month designated in the voucher. OBTAINING SIGNATUEES TO VOUCHEES. 42. In advance of payment. — In order to secure signatures to vouchers promptly and thus avoid any delay in obtaining reimbursement it is suggested that the vouchers be completely prepared, with the exception of the approvals KEPOET U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 225 and voucher number, and forwarded to the payee with a foi'in lettoi- requestinfc that the voucher be properly signed and returned, stating that check will be forwarded promptly upon the return of the same. This is the procedure fol- lowed by all the Government departments and is recomm'ended in the disljurse- inent of this fund by the States. There can be no reasona))le objection raised by the payee, for the reason that the States are responsible and reliable, and the form letter requesting the signature in advance of the payment is ample protection to the payee in case the payment should not be made as promised. 43. After the payment is made. — In States where the procedure is to forward the vouchers for signature with the State warrant or after the payment has been made the voucher so forwarded should not be given a number until it. is returned. This will avoid the necessity for holding vouchers otherwise ready to submit pending the receipt of one or two vouchers forwarded for' signature and not returned in time to be included in the disbursements for the month. Tliese delayed vouchers may then be given a number whenever received and transmitted to the board with the next regular report. BOOKS, PEKIODICALS, AND AUTOMOBILES. 44. ProMMted. — Particular attention is called to the fact that the use of this' appropriation for the purchase of boolis, newspapers, or periodicals, or the purchase of any motor-propelled or horse-drawn vehicle for carrying passengers or any expenses in connection with the operation thereof is prohibitetl. The board prohibits also the hiring of such vehicles where the hiring by its con- tinuousness is the equivalent of a purchase. 45. Hire of taxicabs and automobiles. — However, when a person is in a travel status temporary hiring of vehicles as a means of transportation between places inaccessible by common carrier is authorized, but when it is found necessary to temporarily hire taxicabs or automobiles the voucher should contain the following notation, " No other means of transportation available." 46. Purchase of books and periodicals. — Regarding the purchase of books and periodicals the board feels that resources of this type should already be in the possession of a State department or board of liealth, and if it should be- found necessary to make any additions thereto it should be done with strictly- State funds and vouchers covering siich payments not submitted to the board. 47. Purchase of office furniture. — The cost of strictly ofBce furniture, sucb. as desks, chairs, typewriters, adding machines, electric fans, etc., is not con- sidered an authorized cliarge against these funds if the articles are for use in the offices of State boards or departments of liealth. The above ruling is based upon the wording of the Federal act appropriating these funds which specifies that the funds are to be used for " the prevention, control, and treatment of venereal diseases." The use of these funds for enlargement, repair, or construction of buildings is prohibited. 48. No other State funds available.- — However, if there are no other State funds available from which to make purchases of equipment necessary for the successful prevention, treatment, and control of venereal diseases, the matter may be taken up with the board prior to incurring the liability and the applica- tion will be given full consideration. CLASSIFICATION OF EXPENDITURES. 49. Classification. — Each voucher must be distributed under its appropriate classification, viz, " Administration," " Treatment," " Repressive measures," " Educational and publicity," and the proi^er budget account number to vdiicl* the expenditure is chargeable must be given. Particular attention is directeci 15G10— 20 15 226 REPORT U, S. INTERDEPARTMENTAL SOCIAL HYGIEiSrE BOARD. to the fact that care must be used in debiting the expenditure to the proper budget account number tliat tlie disbursements may be correctly charged against tlie proper allotment as given on your budget under " Activity or project." It is very necessary that account numbers be shown on all vouchers, as those not bearing account numbers will be returned. 50. Account ledger. — It is suggested that State "boards of health keep an account ledger in order that they may know at all times the balance available under each of the budget accounts. The keeping of such a book will be very necessarj^ beginning July 1, 1920, in order that boards of health may be in a position to submit quarterly statement of budget balances (Form No. 22) promptly at the end of each quarter. QUAETEELY STATEMENT OF BUDGET BALANCES. 51. This form is to be submitted to the board in duplicate at the expiration of each quarter, viz, September 30, December 31, March 31, and June 30. ' A separate report will be submitted for the 1920 " Revised joint State and Federal budget " and the 1921 " Joint State and Federal budget " in accordance with instructions printed on the back of the form. Upon receipt of this quarterly statement of budget balances it will be compared with the books--of the board. Corrections will be entered in the columns printed thereon for that purpose and the duplicate copy approved and returned to the State board of health, thus keeping the State's record and board's in agreement. It is believed that this plan will be found of great advantage to the States and will prevent the overdrawing of amounts allotted to the various account numbers on the State budget. DISPOSITION OF VOUCHEES. 52. Numhering. — All paid vouchers must be retained in the files of the paying official until the close of the month and then be numbered in the space provided therefor on the face, each State commencing the 1921 series Avith No. 1 and *continuing consecutively until the entire allotment for the fiscal year 1921 has been disbursed. However, for the fiscal years 1919 and 1920, vouchers should continue the present series of numbers until the funds for those fiscal years- have been entirely accounted for. The "brief" on the back of the voucher form should be completely filled in by the paying official before transmitting the paid vouchers to the board for reimbursement. 53. Unused voucher numbers. — All voucher numbers must be accounted for, and should a voucher be canceled or a number not used for any reason a nota- tion to that effect should be made on the monthly report opposite the numbers in question. 54. Summarising. — Vouchers must be summarized on the monthly report form in numerical order and distributed thereon in accordance with the classification shown on the voucher. 55. Disposition. — One copy of all paid vouchers must be transmitted monthly^ together Avith one copy of the monthly report form, to the United States Inter- departmental Social Hygiene Board, ISOO Virginia Avenue NW., Washington, D. C, and one or more copies of each retained in the files of the State depart- ment or board of health or the State official making the payment. 56. Registering. — All vouchers and monthly reports should be forAvarded to the board under registered cover. This may be done Avithout cost to the depart- ments or boards of health by having the same registered as official under the ■Government frank. 57. Signatitres. — All vouchers and monthly reports should be carefully ex- amined before transmitting them to the lioard in order to make sure that they KEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 227 meet tlie requirements of the regulations and that all necessary signatures are affixed. Careful attention given to this suggestion may prevent vouchers being suspended or returned. MONTHLY KEPORT. 58. Number to be made. — This report shall be made promptly at the close of each month and may be prepared in duplicate, triplicate, or quadruplicate in accordance with the special requirements of each State. All vouchers paid dur- ing the month for which this report is rendered must be summarized thereon ijQ numerical order and the amount paid distributed in accordance with the classification given on the voucher. The budget-account number given on the voucher need not be shown on this report. 59. Disposition. — One copy shall be forwarded to the United States Interde- partmental Social Hygiene Board, 1800 Virginia Avenue NW., Washington, D. C, accompanied by the paid vouchers summai-ized thereon, and one or more copies may be retained by the State officials. It is suggested that this report be prepared on the typewriter. 60. Report for each budget. — A monthly report should be submitted every month for each budget under which there are funds remaining unaccounted for. 61. Last day for forioarding vovA^liers and monthly reports. — Monthly re- ports and vouchers should be forwarded as soon after the close of a month as possible and must reach Washington not later than the 25th of the month fol- lowing that covered by the report. 62. Where no disbursements are made. — If no expenditures are made dur- ing a month, a monthly report should be forwarded any way with the notation thereon, "*No disbursements made." SUMMARY RECORDED ON MONTHLY REPORTS. 63. Before transmitting the monthly report to the board, the summary on the back of the same must be properly filled out, in accordance with the printed in- structions thereon. The summary should represent the joint State and Federal account and be- gin with the total of both the State appropriations and the Federal allotment as shown on your budget. The total disbursements of the two funds during a month, as shown on the face of the report, is to be deducted, and the balance remaining will be the " available balance for the continuance of the work.'' Repayments made by Federal Government are not to be considered in making this summary. 64. Interest, fees, and sales. — Money received on account of interest on bank deposits, sale of medicines, fees, etc., should be taken up in the summary on the back of the proper monthly report by a special entry and the Board advised by letter as to the budget-account number to which the funds have been credited by the State. Interest should be taken up immediately upon the receipt of notification from the bank as to tlie amount of interest credited. Receipts from the sale of arsphenamine and other medicines or fees received for treatment should be taken up monthly and credited to the budget-account number charged with the original expenditure'. STATE LAWS. 65. These rules shall not in any way conflict witli State laws or prevent State accounting departments from requiring such vouchers, receipts, and other records as may be necessary to comply with the State laws or the State's accounting system. 228 EEPOET U. S. INTEKDEPAETMENTAL SOCIAL HYGIENE BOARD. CONCLUSION. 66. In conclusion, the board desires to thanlv all State officials for their hearty- cooperation in the past and to assure them that these rules and regulations for disbursing the joint State and Federal funds will present no obstacle either in connection with State laws or the manner in which State appropriations may^ be made that can not be overcome, and the very liberal Federal assistance shoald be well worth the little extra clerical labor required by these regulations. How- ever, should any State official find it difficult to comply with these regulations,, it is suggested that the matter be taken up promptly with the United States Interdepartmental Social Hygiene Board, but this suggestion is not made antici- pating that it may be advisable in any case to modify these regulations, and it is not the present intention of the board to do so unless they should conflict witk State laws. It is the desire of the Interdepartmental Social Hygiene Board to fully co- operate with each State and assist in every way possible within the limitations of its responsibilities and in accordance with the laws and regulations surround- ing the disbursing of Government funds. All correspondence in connection with these regulations or the Chamber- lain-Kahn funds to be addressed to the Executive Secretary of the Board, 1800 Virginia Avenue NW., Washington, D. O. T. A. Stokey, Executive Secretary, United States Interdepartmental Social Hygiene Board. Approved : 0. C. Pierce, Assistant Surgeon General, United States Public Health Service. APPENDIX E. 1. REGULATIONS GOVERNING THE SCIENTIFIC RESEARCH FUND,i 1919-20. The United States Interdepartmeutal Social Hygiene Board prescribes the following rules and regulations in conformity with that part of section 6, Chapter XV, Public 193, Sixty-fifth Congress, which provides that the sum of $100,000 " shall be paid to such universities, colleges, or other suitable institu- tions as in the judgment of the Interdepartmental Social Hygiene Board are •qualified for scientific research for the purpose of discovering, in accordance with the rules and regulations prescribed by the Interdepartmental Social Hygiene Board, more effective medical measures in the treatment and preven- tion of venereal diseases." 1. Appropriations from this fund wih be made only to universities, colleges, or other suitable institutions that give satisfactory evidence of possessing a staff of scientific experts and an equipment of scientific apparatus, supplies, and re- sources that will guarantee that the researches undertaken will be carried out under approved scientific conditions and in conformity with scientific methods. 2. Appropriations from this fund for scientific research will be made only for •definite investigations that are described by the proposers in sufficient detail to satisfy the Interdepartmental Social Hygiene Board that there is a justifi- able expectation that these researches "will discover more effective medical measures in the prevention and treatment of venereal diseases." 3. The universities, colleges, or other institutions proposing researches and asking for appropriations will furnish information on the following subjects : (a) Name of institution requesting appropriation. (b) Name, office, and address of official representative of this institution. (c) Title concisely descriptive of research proposed. (d) Laboratory in which research is to be carried out. (e) List of more important scientific publications from this laboratory. if) Name and concise statement of the scientific training of the laboratory ' •chief or director, or other individual responsible for the scientific policy of the laboratory. (g) Laboratory staff, giving names, degrees, etc. (h) Laboratory equipment and facilities, with a concise statement indicating scientific and working capacity of the laboratory, and cooperating laboratories, ■departments, and agencies. (i) Description of research proposed; outline plan in sufficient detail to show clearly its scientific character and justify the expectation that it will discover " more effective medical measures in the prevention and treatment of venereal diseases." Include references to important scientific literature bearing on re- search proposed. (;■) Probable cost. Give general items covering the necessary equipment and supplies, with an estimate of the probable cost of preparing and printing a 1 See sec. 6, Chap. XV. Public No. 193, 65th Cong., Army appropriation bill of July 9, 1918. 229 230 REPOKT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOAED. report. Should not include the salaries of scientific investigators, but may include salaries for technical assistants. (k) Will this institution be able to carry on the research proposed if it re- ceives no financial aid from the Interdepartmental Social Hygiene Board? 4. Universities, colleges, and other institutions asking for appropriations will furnish the board -with a budget made out on forms supplied by the board and will make an accounting of their disbursements in conformity with the rules of the Comptroller of the Treasury of the United States Government. 2. APPLICATION FORM FOR ASSISTANCE IN SCIENTIFIC RESEARCH. Application for appropriations to " universities, colleges, or other suitable institutions, for the purpose of discovering, in accordance with the rules and regulations prescribed by the United States Interdepartmental Social Hygiene Board, more effective medical measures in the treatment and prevention of venereal diseases." ^ [Form for 1920-21 appropriations.] Date of application : • . (1) Name of institution requesting appropriation. (2) Name, position, and address of official representative of the institution. (3) Title concisely descriptive of research proposed. (4) Laboratory in which research is to be carried on. (5) List of more important scientific publications from this laboratory. (May be appended.) (6) Name and concise statement of the scientific training of the laboratory chief, or director, or other individual responsible for the scientific policy of the laboratory. (7) Laboratory staff, giving names, degrees, positions, etc. (May be ap- pended. ) (8) Name of individual to be in charge of the research and names of men and women working with him. (9) Laboratory equipment and facilities, with a concise statement indicating scientific and working capacity of the laboratory, cooperating laboratories, departments, and agencies. Send catalogue or register describing work of the department in which this laboratory is located. (10) Description of research proposed: Outline plan and method of investi- gation in sufficient detail to show clearly its scientific character and justify the expectation that it will discover " more effective medical measures in the prevention and treatment of venereal diseases." (Description may be ap- pended. ) (11) How soon will this research begin after appropriation is received? How long is it estimated that it will take to complete the investigation? (12) Include references to important scientific literature bearing upon the research proposed. (May be appended.) (13) Probable cost. Give general items covering necessary salaries, equip- ment, supplies, etc., and the probable cost of preparing and printing a report, 500 copies of which are to be placed with the United States Interdepartmental Social Hj'giene Board without further cost to the board. 1 To be made in triplicate ; one copy to be kept by the ofBcial representative of the institution. REPORT V. S. IXTERDEPARTMEKTAL SOCIAL HYGIENE BOARD. 231 o) Salaries (including compensation for estimated actual time to ))e spent in connection with this proposed research by scientific in- vestigators, clerks, janitors, etc., and estimated full time of such technical assistants, and others, as may be employed entirely on this proposed investigation. These positions to be itemized as fully as practicable) ^ $ (h) Equipment (including such laboratory equipment as may be necessary for properly conducting the proposed investigation). Do not itemize in detail (c) Supplies (including chemicals, glass, animals, feed, etc.). Do not itemize in detail (d) Incidentals (including travel expenses, car fare, freight, and ex- press, postage, etc., specifically related and essential to the re- search proposed). Do not itemize in detail (e) Report (cost of preparing and printing a report covering the re- sults of the proposed research) Total ', (14) Will the institution be able to carry on the research proposed if it receives no aid from the United States Interdepartmental Social Hygiene Board or some other outside source? (15) On the basis of the above presentation, I, , the under- signed, being the duly authorized and competent agent of the , in the city of , do agree that a research entitled ■ — Avill be carried on in this institution under the direction of ■ , and in the laboratory of , in accord with the plans described above, and I agree that every reason- able effort will be made by this institution to bring this research to a conclu- sion that will discover or lead to the discovery of a better method for the prevention or treatment of and that the shall furnish for this purpose the sum of — dollars for this research : Provided, That the United States Interdepartmental Social Hygiene Board shall allot to this institution the sum of dollars for the same purpose, and I further agree that the will submit a budget of proposed expenditures to be paid from the joint fund thus established, and that it will transmit monthly a sworn statement of its disbursements therefrom in accordance with instructions to be provided and upon forms to be supplied by the United States Interdepartmental Social Hygiene Board, and that it will report the progress of its research activities quarterly (December, March, June, and September), and that it will prepare and have printed without further cost to the board a final report covering the completed research, and that five hundred (500) copies of this report will be fur- nished the Interdepartmental Social Hygiene Board without additional cost to the board. I further agree that this institution will furnish in duplicate a certified copy of the official action taken by the duly constituted authorities of this institution showing that this institution has set aside a sum for the dis- covery of more effective methods in the prevention and treatment of the venereal diseases at least equal to the amount to be received from the United States Interdepartmental Social Hygiene Board. Signature : Representing the Approved : Executive Secretary, — Interdepartmental Social Hygiene Board. Date approved by executive committee : Date approved by United States Interdepartmental Social Hygiene Board : Appendix F. <1.) REGULATIONS GOVERNING THE EDUCATIONAL RESEARCH AND DEVELOPMENT FUND.i [Proposed revision for 1920-21.] Allotment from Appeopeiations Made foe the Fiscal Yeaes 1919 and 1920. The Sixty-fifth Congress appropriated the sum of $300,000 for each of the iiscal years 1919 and 1920, to be paid to such universities, colleges, or other suitable institutions or organizations as in the judgment of the United States Interdepartmental Social Hygiene Board are qualified for scientific research, ■for the purpose of discovering and developing, in accordance with the rules and regulations prescribed by the United States Interdepartmental Social Hygiene Board, more effective educational measures in the prevention of venereal dis- eases, and for, the purpose of sociological and psychological research related thereto. geneeal eegulations governing allotments. The United States Interdepartmental Social Hygiene Board prescribes the following rules and regulations governing allotments in conformity with sec- tion 6, Chapter XV, Public 193, Sixty-fifth Congress : 1. Allotments will be made from this, the " educational research and develop- ment fund," only to universities, colleges, or other institutions that give satis- factory evidence of administrative responsibility, educational effectiveness, and scientific standards that will not depend on the support of the United States Interdepartmental Social Hygiene Board for their continuity. 2. Proposals for assistance will be favored from established normal schools, colleges, and universities which exhibit understanding and appreciation of the significance of hygiene in the educative process ; especially from such normal schools, colleges, and universities as are concerned with the development of more effective methods of educating teachers in training. 3. The board in general will favor the development of educational methods under this appropriation that combine instruction and training for the preven- tion of venereal diseases in a wise proportion with and relation to instruction and training along other intimate and nearly related lines of hygiene. SOCIOLOGICAL AND PSYCHOLOGICAL EESEAKCH. 4. For the purpose of " discovering more effective educational measures in the prevention of venereal diseases " appropriations will be made from the funds of the board for such special researches as may be proposed to and approved by the board under the rules and regulations laid down above and under the rules and regulations laid down for the allotment of appropriations from the scientific research fund. 1 See sec. 6, Chap. XV, Public 193, 65th Cong., Army appropriation bill, July 9, 1918. 232 HEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 233 ESTABLISHMENT OF DEPARTMENTS OF HYGIENE. 5. For the purpose of developing more effective eflucationnl measures in the prevention of venereal diseases allotments will be made from the educational ■research and development fund to normal schools, colleges, and universities, and especially to the chief normal training schools or college training schools jCor teachers in the several States, to assist such normal schools, colleges, and universities in organizing or completing the organization of departments of hygiene, the curriculum of which shall include course and conferences in informational hygiene, and courses, conferences, and training in the application of hygiene, emphasizing with appropriate and due proportion and with proper tact and persistency the serious importance of venereal diseases, their causes, carriers, and prevention ; and emphasizing at the same time the other important facts and applications of general hygiene, individual hygiene, group hygiene, .and intergroup hygiene. DEPAKTMENTAL OBGANIZATION. 6. In general the departmental organization contemplated by the board is outlined below : The integrated organization of all the hygienic factors and resources of the institution is the form of organization which, as demonstrated by experience, guarantees largest results. It is recognized, however, that each institution has its own administrative traditions and administrative problems. Bach institution receiving aid from this fund will be expected, therefore, to bring about equal efficiency of all the factors in the departmental program as outlined and to realize as completely and rapidly as possible the benefits of unified -organization in accordance with its own traditions and its own special con- ditions. I. Division of informational hygiene.- — (Stressing in each of its several divi- sions with due proportion and with appropriate emphasis, the venereal diseases, their causes, carriers, injuries, and prevention.) (a) The principles of hygiene. Required of all students at least twice a "week for at least four semesters. (1) General hygiene (the agents that injure health, the carriers of disease, the contributory causes of poor health, the defenses of health, and the sources of health). (2) Individual hygiene (informational hygiene, the care of the body and its organs, correction, and repair, preventive hygiene, constructive hygiene). (3) Group hygiene (hygiene of the home and tlie family, school hygiene, occu- pational hygiene). (4) Intergroup hygiene (interfamily, community, intercommunity. State, Interstate, and international hygiene). (&) Principles of physical training (i. e., gymnastics, exercise, athletics, re- •creation, and play). The physiological, developmental, and social significance of physical training. Required of all students preparing as teachers. To be given at least twice a week for- one semester, preferably in the junior or senior years. (c) Health examinations : (1) Medical examination (making reasonable provisions for a private, per- sonal, confidential relationship between the examiner and the student). (2) Sanitary surveys and hygiene inspections applied regularly to all divisions of the institutions, their curriculums, buildings, dormitories, equipment, per- gonal service, and surroundings. 234 EEPORT U. S. INTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. II. Division of applied hygiene. — (a) Health conference. (1) Every student advised under (c) above (health examinations) must report to his health examiner within a reasonable time, as directed, with evi- dence that he has followed the advice given, or with a satisfactory explanation for not having done so. (2) Must provide student with opportunities for safe, confidential consulta- tions with competent medical advisors concerning the intimate problems of sex life as well as those of hygiene in general. (&) Physical training. One hour daily each school day required of all students. (1) Gymnastic exercises, recreation, games, athletics, and competitive sports. (2) Reconstructional and special training and exercise for students not qualified organically for the regular activities covered in (1) above. It is as- sumed that every student, and especially every teacher in training physically able to go to school, is entitled to and should take some form of physical exercise.. III. Division of records and planning. — (a) Investigations, tests, evaluating measurements, records, and reports re- quired each term covering progress made under each division and subdivision of the department, for the purpose of discovering and developing more effective educational methods in hygiene. (6) Provide facilities for the sifting, selection, and investigation of problems in hygiene that may be submitted to or proposed by the department of hygiene. (c) Arrange for occasional lectures on public hygiene and public health from competent members of municipal. State, and national departments of health, and from other appropriate sources. IV. Personnel requisite for such a, department. — Men and women should be chosen for service in the several divisions of the department who have a sane, well-balanced, and experienced appreciation of the importance of the whole field of hygiene, as well as of the place and relations of the venereal diseases. (1) Director: Must have satisfactory scientific training and special expe- rience, fitting him for supervision, leadership, teaching, research, and admin- istrative responsibility. (2) Teachers of hygiene: To be selected with special reference to their whole- some influence on students and because of their ability to make successful use of their peculiar opportunities to emphasize appropriately and with due propor- tion, proper tact, and with persistency the serious importance of the venereal diseases, their causes, carriers, injuries, and prevention, and emphasizing at the same time the other important facts and applications of general, individual, group, and intergroup hygiene. (3) Teachers of physical training: There should be not less than one teacher of physical training for each group of 300 students. There must be men teach- ers for the men and women teachers for the women students. The physical- training instructors employed in this department should be in charge of and should cover satisfactorily all the directing, tra-ining, and coaching carried on in the department and in the institution in its relation to athletics and com- petitive sports. The men and women who are placed in charge of individual stu- dents and groups of students engaged in the various activities of physical training (gymnastics, athletics, recreation, and play) should be selected with special reference to their wholesome influence on young men and young women. (4) Health examiners for men and health examiners for women: There should be not less than one examiner for each 500 students. Must be selected with special care because of extraordinary opportunities to exercise powerful KEPOKT U. S. INTEKDEPAETMENTAL SOCIAL HYGIENE BOARD. 235 intimate influence upon tlie mental, moral, and physical health of the students with whom such examiners come in contact. (5) Clerical and stenographic service to meet the needs of the department. (6) Special lectures on the principles and progress of public hygiene and public healtli. A close coordination should be secured between this department and community agencies like the department of liealth that are concerned with public hygiene. 7. For the purpose of eslablishing such a department in a normal school, college, or university, the United States Interdepartmental Social Hygiene Board will furnish financial assistance for necessary personal service. Origi- nal application for sucli assistance should be approved by the chief educational authority of the State concerned. 8. In order to secure such an allotment, the normal school, college, or uni- versity applying for such assistance shall furnish the United States Interde- partmental Social Hya'iene Board with all necessary information and shall give the board satisfactory assurance that there will be organized a department and a program of hygiene in general conformity with the plans of the board. 9. The normal school, college, or university to which allotments are made by the board will furnish the board with a budget covering its probable ex- penses for personal service on forms supplied by the board, and will make an accounting of their disbursements in conformity with the rules of the United States Interdepartmental Social Hygiene Board governing expenditures from this fund. (Details relative to application will be found below under title "Form of application for allotment.") II. EEGULATIONS GOVERNING PAYMENTS OF ALLOTMENTS FOE DEPAETMENTS OF HYGIENE. The $300,000 appropriations for the two fiscal years of 1919 and 1920 as provided by Congress were not conditioned upon the universities, colleges, or other institutions or organizations setting aside or contributing any special amount, and in order to expedite the commencing of the work the board thought it advisable at that time to pay the allotments in full in a lump sum to be expended by the recipient, subject to a budget submitted to and approved by the board and in accordance with certain accounting instructions. For the fiscal year 1921 Congress reduced its appropriation to $250,000, and also added the following proviso : " No part of the sum contained in the preceding paragraph shall be paid tO' any university, college, or other institution or organization which does not set aside an additional sum for the same purpose at least equal to the amount to- be received from the United States." On account of the above proviso, a different procedure in paying all future allotments to be made from this fund is found to be necessary. In accordance with the wording of the appropriation as made by Congress, the board has ruled that in order to qualify for an allotment a university^ college, or other institution or organization otherwise meeting the requirements as specified in the regulations governing allotments must in addition set aside or agree to set aside a sum for the same purpose at least equal to the allotment to be received from the United States Interdepartmental Social Hygiene Board. The Comptroller of the United States Treasury has ruled that buildings, equip- ment, or other estimated values can not be accepted as complying in whole or in part with the requirements specified by Congress in the appropriation act. However, when a university, college, or other suitable institution or organiza- 236 REPORT U. S. INTERDEPARTMENTAL SOCIAL, HYGIENE BOARD. tion qualifies under the regulations approved by the board for an allotment from the appropriation for the fiscal year 1921 the board will not require the depositing of the funds in any special account with a bank or other depository, but will accept evidence of the institution's willingness to meet the obligation, and will enter into a written agreement with the institution whereby it will bind itself to fully comply with the act of Congress by agreeing: (1) To "set aside an additional sum for the same purpose at least equal to the amount to t)e received from the United States," and (2) to furnish in duplicate a certified copy of the oflicial action on the part of the institution showing that it has a department of hygiene and that it has set aside such additional amount. In view of the fact that the board accepts this agreement as complying with the act of Congress, it has revised somewhat its method of payment as follows : The 50-50 plan. — The practice of a raimber of Government departments and independent establishments charged with expending Federal appropriations made for allotment to States and institutions conditioned upon the matching of dollar for dollar is to require the State or institution to first make the dis- bursements from its own appropriation, submitting the paid vouchers for audit. The Government department then pays the State or institution 50 per cent of such expenditures as may be found to be correct. This procedure serves the double purpose of knowing the disbursements made are in accordance with the approved budget and regulations governing the disbursements and that the State or institution complied with the Federal law by not only appropriating or setting aside an equal amount but by actually expending from its own resources dollar for dollar. Tlie 50-50 plan adopted hy the hoard for 1921. — The United States Interde- partmental Social Hygiene Board has adopted this plan for disbursing the allotments to be made to universities, colleges, and other institutions or organi- zations from the " educational research and development fund " appropriated by Congress for the fiscal j^ear ending June 30, 1921. It will, therefore, be necessary for institutions reporting" disbursements from the joint account com- posed of the allotment given by the board and funds contributed by the insti- tution to forward to the board promptly at the close of each month on forms to be furnished for that purpose an itemized monthly report of disbursements, properly executed in accoixlance with the " instructions for reporting expendi- tures from allotments" (Part III). In the absence of receipted individual vouchers, it is required that this report be sworn to before a notary public before transmitting the same to the board. Upon the receipt of this itemized statement of disbursements the board will promptly audit the same in accord- ance with the approved budget, and a Treasury warrant payable to the institu- tion submitting the account will be drawn covering 50 per cent of the total disbursements found to be correct. The board wishes to assure the institutions there will be no delay on its part in making payment. Disbursements made from the joint fund and not found to comply with the regulations or the approved budget will be disallowed or suspended pending the receipt of further information and 50 per cent of the remaining amount will be immediately paid. Suspended disbursements. — Any item suspended on a monthly report of ex- penditures pending further information may be resubmitted on the following month's account for 50 per cent reimbursement by listing as the last entry in memorandum form ; that is, the entry should be given the original date of pay- ment, but the amount not added in with the expenditures for the current month, inasmuch as it was previously deducted from the available balance as shown in the summary on the back of the monthly report when originally submitted :for audit. KEPORT U. S. INTERDEPARTMENTAL SOCIAL* HYGIENE BOARD. 237 in. INSTRUCTIONS FOR REPORTING KXPENDITrRKS FROM ALL()T^rENTS. After an allotment is made to an institution a supply of monthly report forms will be furnished for reporting monthly disbursements from the joint fund provided by the institution and the United States Interdepartmental Social Hy- giene Board for establishing a department of hygiene. This form should be prepared in duplicate promptly upon the close of each month. One copy of the report to be forwarded to the United States Interde- partmental Social Hygiene Board in Washington, D. C, and one to be retained in the files of the institution. The report should be full and concise, and be sworn to before a notary public. In reporting expenditures on this form attenton is directed to the following : {a) The report should be made to cover all disbursements made from the joint fund ; that is, from the funds furnished by the institution as well as the funds allotted by the board. Only personal services should be reported. (b) Fill in name and the location of the institution and also show the month the report is made to cover. (c) Insert in the spaces provided in the upper right-hand side of the form "Amount furnished by institution," "Amount furnished by the United States Interdepartmental Social Hygiene Board," and " Total fund." {(I) " Date of payment " should be the date payment is actually made or the check drawn. These entries should be made in chronological order. (e) "Name of payee": If a salary payment, should also state title, or the position, as described on the budget. if) " Purpose for which paid " : If a salary payment, should state the month or period " from and to " for which payment is made and the rate of com- pensation in order that it may be properly audited. {g) " Budget item number " : In this space there should be placed the item number as given on the budget and against which the expenditure is properly chargeable, as follows : (h) Item 1, director; item 2, teachers of hygiene; item 3, teachers of physical training ; item 4, health examiner ; item 5, clerical and stenographic services ; item 6, special public health lectures. (See also application under "Budgetary forecast.") (i) Attention is directed to the " Summary " on the back of the report. This summary is to be completed by the institution before forwarding the report to the board and should at all times be in agreement with the books of both the institution and the board. The summary represents the joint institution and Federal account and should begin with the total of both the institution's appropriation and the Federal allotment. The amounts to be given under the budget item Nos. 1 to 6, inclusive, are to be taken from the joint budget as approved by the board. The disburse- ments of the joint fund during a month, as shown on the face of the report, are to be deducted from the amounts provided under the item numbers and the balances remaining will be the amount available for the continuation of work. {}) Attention is also directed to the "Note," in italics, which directs that should no disbursements be made during a month, report should carry the state- ment " No disbursements made." This is necessary in order that the board may be in a position to know whether reports have been lost in transmission through the mail. 238 REPORT U. S. INl^ERDEPARTMENTAL SOCIAL HYGIEIsTE BOARD. Care should be used in preparing these reports and the same mailed promptly at the expiration of each month. Should the instructions not be entirely clear, the board will be glad to explain any point should the matter be brought to its attention. For guidance in making out the monthly report of expenditures there follows a sample report to be used as a model. All correspondence in connection with these regulations or the joint institution and board funds to be addressed to the executive secretary of the board, 1800 Virginia Avenue NW., Washington, D. C. T. A. Stoeey, Executive Secretary, United States Interdepartmental Social Hygiene Board. Adopted by the board , 1920. [Sample of monthly financial report form.] United States Intekdepaetmentai. Social Hygiene Board. Educational research and development fund, monthly report. State Normal School, Coe City, Fla. : Institution $5, 000 United States Interdepartmental Social Hygiene Board 5,000 Total joint fund 10, 000 Itemized statement of disT)ursements, month of Septem'ber, 1920. Date of pay- ment, 1920. Name of payee. Purpose for which paid. Budget item No. Amount paid. Sept. 2 Sept. 16 Sept. 17 Sept. 21 Sept. 30 Do... Do... Do... Do... Do... Dr. John Fisherman, director Miss Ruth Pick, teacher of hygiene. Dr. Geo. Bresline, health exam- iner. Mr. John Doe, teacher of physical training. Dr. John Fisherman, director Mr. John Doe, teacher of physical training. Miss Ruth Pick, teacher of hygiene. Dr. Geo. Bresline, health exam- iner. Miss Frances Hurley, stenog- rapher. Salary month of August, at $360 per month. Salary period Sept. 1 to 15, at $150 per month. Salary period Sept. 1 to 15, at $120 per month. Salary period Sept. 1 to 20, at $180 per month. Salary month of September, at $-360 per month. Salary period Sept. 21 to 30, at $180 per month. Salary period Sept. 16 to 30, at $150 per month. Salary period Sept. 16 to 30, at $120 per month. Salary for September, at $90 per month. Salary for September, at $60 per month. 4 lectures (Sept. 1, 3, 9, and 29), at $15 each. 1 2 4 3 1 3 2 4 5 5 6 $360 75 60 120 360 60 75 60 90 60 Do... Dr. Charles River, special lec- turer. Total 60 1,380 Sworn and subscribed before me this 4th day of October, 1920, at Valley City, N. Dak. Robert A. Ekskine, Secretary-Registrar. [l. s.] J. M. Manning, Notary Puhlic. EEPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 239 Summary. [On reverse side of report.] Budget item number. 1 2 3 4 5 6 Balance brought forward from previous 3,600 720 1,500 150 1,800 180 1,200 120 1,500 150 400 Disbursements shown on this report 60 2,880 1,350 1,620 1,080 1,350 340 2. APPLICATION FORM FOR ASSISTANCE IN THE ESTABLISH- MENT OR ENLARGEMENT OF DEPARTMENTS OF HYGIENE IN NORMAL SCHOOLS, COLLEGES, AND UNIVERSITIES— EDUCA- TIONAL RESEARCH AND DEVELOPMENT FUND, UNITED STATES INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. [Proposed revision for 1920-21.] A. Name and location of institution selected. Date of application. B. Name, position, and address of agents representing this institution and .authorized to act for it. C. Average number of students enrolled : All departments. In preparation to teach. Men. Women. Total. Men. Women. Total. First year Second year Third year Fourth year t Total '. 1 i 1 D. Give present and proposed organization for the establishment or enlarge- ment of the department of hygiene in this institution, in accordance with the program suggested by the Interdepartmental Social Hygiene Board (pages — and — , Revised Regulations), as follows: (I) Division of Infoemational Hygiene. (a) THE PRINCIPLES OF HYGIENE. (1) General hygiene. — (The agents that injure health, the carriers of disease, the contributory causes of poor health, the defenses of health, and the sources of health.) Should be required at least for two periods a week. Most appro- priately given during the first term of the first year. Indicate the curriculum provisions available or proposed for this course ; the number of students that will take it, and the officer that will teach it (the director or a special teacher). (2) Individual hygiene. — (Informational hygiene, the care of the body and its organs, correction, and repair, preventive hygiene, constructive hygiene.) Should be required at least for two periods a week during the second term of the first year. 240 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. Indicate the curriculum provisions available or proposed for this course ; the number of students that will take it, and the officer that will teach it. (3) Grou2) hygiene. — (Hygiene of the home and the family, school hygiene,, occupational hygiene, institutional hygiene.) Required for one term at least two periods a week in the second or third year. Indicate curriculum provisions, etc., as in (2) above. (4) Intergrouj) hygiene. — (Rural, community, municipal. State, national, and international hygiene. ) Required for one term for at least two periods a week: in the third or fourth year. Indicate curriculum provisions, etc., as in (2) above. (&) PEINCIPLES OF PHYSICAL TRAINING. (Physiological, developmental, and social significance of gymnastics, exercise, athletics, recreation, and play.) To be required for one term two periods a. week in the third or fourth year. Indicate curriculum provisions, etc., as in (2) above. (C) HEALTH EXAMINATIONS. (1) Medical examinations. — (Making reasonable provisions for a private, per- sonal, confidential, relationship between the examiner and the student.) To be required of all students once each term. It is recommended that satisfactory examinations be required of each applicant for admission to the institution before matriculation is permitted. State plans and provisions for these examinations and give number of students covered each term of year. (2) Sanitary surveys and hygienic inspections applied regularly to all divi- sions of the institutions, their curriculums, buildings, dormitories, equipment,, personal service, and surroundings. State plans and provisions for these surveys. (II) Division of Applied Hygiene. (a) HEALTH CONFERENCES. State plans and provisions for health conferences. (1) Every student advised under (c) above (health examinations) must: report to his health examiner within a reasonable time, as directed, with evi- dence that he has followed the advice given or with a satisfactory explanation for not having done so. Give number of conferences expected each term. (2) Must provide student with opportunities for safe, confidential, consulta- tions with competent medical advisers concerning the intimate problems of sex. life, as well as those of hygiene in general. Give number of consultations expected each term. (&) PHYSICAL training. Six hours a week (to be covered by required courses, optional requirements., electives, and recreational assignments). State plans concisely, giving proposed curriculum, scheduled requirements., optionals, electives, assignments, and number of students required to take this, work. (1) Gymnastic exercises, recreation, games, athletics, and competitive sports^ (intramural and intercollegiate). KEPOKT U. S. INTERDEPARTMENTAL SOCIAL. HYGIENE BOARD. 241 (2) Reconstructional and special training and exercise for students not qualified organically for the regular activities covered in (1) above. It is assumed that every student in training physically able to go to school is entitled to and should take some form of physical exercise. (Ill) Division of Records and Planning. State plans for making the reports and for carrying on the activities noted belovv^. (a.) Investigations, tests, evaluating measurements, records, and reports required each term covering progress made under each division and subdivision of the department for the purpose of discovering and developing more effective educational methods of hygiene. (&) Provide facilities for the sifting, selection, and investigation of problems in hygiene that may be submitted to or proposed by the department of hygiene. (c) Arrange for occasional lectures on public hygiene and public health from competent members of municipal, State and national departments of health, and from other appropriate sources. (IV) Organization Proposed. (1) Director. — Selected because his scientific training and special experience fit him for supervision, leadership, research and teaching, and for adminis- trative responsibility. He will direct and administer the department of hygiene in the . The curriculum of this department of hygiene shall include " courses and conferences in informational hygiene, and courses and con- ferences and training in the applications of hygiene, emphasizing with appro- priate and due proportion and with proper tact and persistency the serious importance of the venereal diseases, their causes, carriers, and prevention, and emphasizing at the same time the other important facts and applications of general hygiene, individual hygiene, group hygiene, and intergroup hygiene." (See Revised Regulations Governing Educational Research and Development Fund , 1921, pages . ) (2) Teachers of hygiene. — Selected with special reference to their wholesome influence on students and because of their ability to make successful use of their peculiar opportunities to emphasize appropriately and with due propor- tion, proper tact, and with persistency, the serious importance of the venereal diseases, their causes, carriers, injuries, and prevention; and emphasizing at the same time the other important facts and applications of general, individual, group, and intergroup hygiene. Number of women teachers . Number of men teachers . (3) Teachers of physical training. — Selected with special reference to their wholesome influence on students and because of their ability to make successful use of their peculiar experiences to "stress with due proportion and appro- priate emphasis the venereal diseases, their causes, carriers, influences, and prevention." Number of women teachers, . Number of men teachers, • . (4) Health examiners.— "Selected, with special care because of the extra- ordinary opporturlfties presented in these health examinations to exercise a powerful and intimate influence upon the mental, moral, and physical health of the students with whom such examiners come in contact." Will make medi- cal examinations, sanitary surveys, and give hygienic instruction and counsel in general and individual hygiene; meet students in health conferences and consultations ; and " stress with due proportion and with appropriate emphasis the venereal diseases, their causes, carriers, injuries, and prevention." 15610—20 16 242 KEPORT V. S. INTEEDEPAETMENTAL SOCIAL HYGIENE BOARD. Number of women physicians, . Number of men physicians, . Number of other health examiners, . (5) Clerical and stenographic service. — To cover the work associated with the several activities covered by this department. Number, . (6) Coordinator. — (This function should be satisfied by one of the personnel covered by (1), (2), (3), or (4) above.) Will serve to influence every teacher in every department on the entire staff of the institution to meet his obligations in relation to the individual hygiene of the students in his classes and to the sanitation of the classrooms in which he meets his students. The coordinator should bring information to all teachers and assist them to meet more satis- factorily their opportunities to help students in their individual problems in social hygiene. Give name, position on staff, and concise statement of special qualifications for this type of work. (7) Special public health lectures. — Special lectures on the principles and progress of public hygiene and public health. A close coordination should be secured between this department and community agencies like the department of health, that are concerned with public hygiene. Give very concise outline of plan and sources from which these lecturers will be secured. (V) Budget AEY Fobecast. Institution, , 1920. (1) Total number of students affected by the courses: Men: First year, ; second year, ; third year, ; fourth year, . Women: First year, ; second year, ; third year, ; fourth year, . Total : Men, ; women, ; complete total, . (2) Amount of resources furnished by institution $ Amount requested of Interdepartmental Social Hygiene Board Total joint resource Institution, , 1920. (V) Budgetary forecast: (1) Total number of students affected by the courses. Men : First year, ; second year, ; third year, . ; fourth year, Women : First year, ; second year, ; third year, ; fourth year, Total : Men, ; women, ; complete total, (2) Amount of resources furnished by institution, Amount requested of Interdepartmental Social Hygiene Board, Total joint resource. REPORT U. S. INTERDEPARTMENTAL, SOCIAL HYGIENE BOARD. 243 (3) Itemization. Present bud- get. Proposed budeet. Number payments. 1. Director salary. . 2. Teachers of hydSne: (a) Men teachers total salaries. . No. @ $ No. @ $ (b) AVomen teachers total salaries. . No. @ $ No. @ $ 3. Teachers of physical training: (a) Men teachers total salaries. . No. @ $— — No. @ S (b) Women teachers total salaries. . No. @ $ No. @ $ 4. Health examiners: (a) Men physicians total salaries. . No. @ S No. @ $ (b) Women physicians total salaries. . No. @ S No. @ $ (c) Other examiners total salaries. . No. @ $ No. @ I 5. Clerical and stenographic service total salaries. . No. @ $ No. @ $ 6. Special lecturers total salaries. . Grand total (VI) Ageeement. On the basis of the above presentation, we, the undersigned, being duly authorized and competent agents of the in the city or town of do agree that a department of hygiene shall be organized and established in this institution for the instruction and training of all students, men and women, who enter this institution in any of its departments and especially of those who enter for the purpose of preparing themselves as teachers ; that this instruction and training in hygiene shall conform in its general plan and requirements with the organization suggested by the United States Interdepartmental Social Hygiene Board and described on pages of its " Revised Regulations Governing the Educational Research and Development Fund," issued by said board in 1920 ; that every reasonable effort will be made by this institution to secure and to maintain a fine quality and a high standard of instructional service in this department of hygiene ; that the proposed depart- ment shall become active and be ready for the instruction and training of the students at the opening of the academic year in the month of ; that the shall furnish for this purpose the sum of dollars for conducting this department for the academic year beginning in the month of , 19 — , and ending in the month of , 19 — ; and that the • '■ — shall make every reasonable effort to maintain and fully expects ta succeed in maintaining this department of hygiene as a permanent part of its organization : Provided, That the United States Interdepartmental Social Hy- giene Board shall allot the sum of dollars for the purpose of assisting this institution during the academic year in conducting the department of hygiene, the organization and establishment of which department is herein proposed in general conformity with the regulations governing the educational research and development fund of the Interdepartmental Social Hygiene Board ; and that the agrees that it will submit a budget of proposed expenditures to be paid from the joint fund established ; that it will transmit monthly, beginning with the month of and ending with the 244 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. month of , a sworn statement of its disbursements therefrom, in ac- cordance with instructions to be furnished and upon forms to be provided by the Interdepartmental Social Hygiene Board ; and that it will submit, on or before January 30 and on or before June 30, a written report to said board covering all the activities of the department of hygiene during the immediately preceding period. The further agrees that it will furnish in duplicate a certified copy of the official action on the part of this institution showing that it has a department of hygiene and that it has " set aside an additional sum for the same purpose at least equal to the amount to be received from the United States." Representing the Representing the Approved : Chief State Educational Officer. Approved : Executive Secretary, U. 8. Interdepartmental Social Hygiene Board, Washington, D. C. Appendix G. 1. REGULATIONS GOVERNING PAYMENTS TO STATE UNIVERSI- TIES FOR THE ESTABLISHMENT OF DIVISIONS OF EDUCA- TIONAL HYGIENE IN STATE DEPARTMENTS OF EDUCATION. To the United States Interdepartmental Social Hygiene Board, Washing- ton, D. C. Gentlemen : In order to assist the United States Interdepartmental Social Hygiene Board in its plans and program to influence normal school, college, and university officials, school superintendents, school principals, school boards, and school teachers to devise, establish, and carry out program and activ- ities of hygiene in the elementary, secondary, and higher educational institu- tions of the State of in conformity with the general plan of the UnitecJ States Interdepartmental Social Hygiene Board, relative to instruction in hygiene, " emphasizing with appropriate and due proportion, and proper tact and persistency, the serious importance of the venereal diseases, their causes, carriers, injuries, and prevention, and emphasizing at the same time the other important facts and applications of general hygiene, individual hygiene, group hygiene, and intergroup hygiene," I, , chancellor of the University of the State of , agree to assign to the State superintendent of public education of in conformity with, and because of the conditions stated in my agreement with the State superintendent of public education, a director of educational hygiene, and a secretary, and I agree to pay the travel- ing expenses of the director, provided financial resources for the purposes pro- posed in the program of the United States Interdepartmental Social Hygiene Board, and referred to above, are supplied by the United States Interdepart- mental Social Hygiene Board as follows : Director of Educational Hygiene, for annual salary, . Secretary to the Director of Educational Hygiene, for annual sal- ary, . Appropriation for traveling expenses of director, . I agree further to place before the United States Interdepartmental Social Hygiene Board at the end of each academic term in this State a full report covering the activities of and under this personnel during the preceding term, and I will make monthly reports to the United States Interdepartmental Social Hygiene Board of all disbursements made from the appropriation paid to the University of the State of because of this agreement, these reports to be made on forms supplied by the board. Chancellor of the University of the State of . 2. FORM LETTER OF AGREEMENT WITH STATE UNIVERSITIES TO ASSIGN ADMINISTRATIVE PERSONNEL TO STATE DEPART- MENTS OF PUBLIC EDUCATION. To , cJtancellor of the Umversity of , Address, My Dear Chancellor : Acting on the proposals of the University of , for Hie oi'ganization of a division of educational hygiene in the Stiite Department of Public Education, I, the imdersigned, 245 246 REPORT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. being the State superintendent of public education of tlie State of hereby make application to the University of for the assignment of a director of educational hygiene, qualified to carry out under my directions the purposes outlined in this agreement, this director to be acceptable to me, his salary and traveling expenses to be paid and his secretarial help to be supplied by the University of . With this assistance from the University of , I, as the authorized State superintendent of public education of the State of , agree to establish in the State depart- ment of public education of a division of educational hygiene under the following conditions: 1. Organisation. — The division of educational hygiene shall include all the activities and personnel in the State department of piablic education that have to do with health teaching, physical education, and health care of pupils (and students) in the schools of the State. 2. Purposes. — The division of educational hygiene " shall be concerned with the development and permanent maintenance of departments of hygiene or courses in the principles and practices of hygiene in all the educational insti- tutions of this State, public, institutional, and private ; elementary, secondary, normal, collegiate, university, and professional." (a) The division of educational hygiene will make every reasonable effort to encourage and develop in the schools of the State effective teaching of hygiene, which shall include " courses and conferences in informational hygiene, and courses, conferences, and training in the application of hygiene, emphasizing with appropriate and due proportion and with proper tact and persistency the serious importance of the venereal diseases, their causes, carriers, and prevention, and emphasizing at the same time the other important facts and applications of general hygiene, individual hygiene, group hygiene, and inter- group hygiene " in general conformity with the program of the United States Interdepartmental Social Hygiene Board." ( 6 ) The division of educational hygiene will " within the limits of the author- ity and educational influence of the State department of which it is a part, in every reasonable way, assist all normal schools, colleges, and universities and similar institutions in the State to instruct all their students, and particu- larly those students that are preparing to teach, concerning the principles and practices of hygiene in general conformity with the program proposed by the United States Interdepartmental Social Hygiene Board." (c) The division of educational hygiene shall make every reasonable effort to effectively influence " selected schools to train teachers of hygiene in all of its subdivisions," and it " shall influence elementary and secondary schools to organize and carry on courses and classes for all children whereby they may be safely, wisely, and properly instructed in the principles and practices of hygiene that are fitting and appropriate to the age period, the maturity and the develop- ment of the child concerned." {d) The division of educational hygiene will make every reasonable effort to bring about an educational condition whereby every teacher will be as well educated and informed in hygiene as he is in English or arithmetic. 3. Administration. — Under the general administrative direction of the State superintendent of public education this division of educational hygiene shall be conducted by a director of educational hygiene. (a) Qualifications: The director of educational hygiene shall have the fol- lowing qualifications or their satisfactory equivalent: A college education; a medical education with degree or equivalent postgraduate study in hygiene; satisfactory teaching and administrative experience in a well-organized educa- REPOKT U. S. INTERDEPARTMENTAL SOCIAL HYGIENE BOARD. 247 tional system ; some experience in municipal, county, State, or National health service (not a fixed requirement). (b) Duties: The duties and functions of the director of this division of edu- cational hygiene shall be to supervise and direct the division of educational hygiene and to focus the powerful influence of the State department of public education upon every educational institution in the State for the purpose of bringing each institution to meet its obligations to train and prepare pupils and students and to educate teachers in the important and practical facts of in- formational and applied hygiene in general conformity with this agreement. 4. Reports. — It is agreed that semiannual reports, January and July, will be made to the University of the State of , covering all the activities of this division of educational hygiene so long as the division receives help from the State university, and that I will receive such advice, help, and counsel as the :tate university may offer, and make such use of said communications as my judgment dictates. State Superintendent of Public Education. Approved : (1) (2) Chancellor, University of the State of Executive Secretary, United States Interdepartmental Social Hygiene Board. (3) By the executive committee under date of . (4) By the United States Interdepartmental Social Hygiene Board under date of -, Appendix H. PUBLICATIONS ON HAND JUNE 30, 1920. 1. General and Miscellaneous. The Work of the United States Interdepartmental Social Hygiene Board, by T. A. Storey, M. D. October, 1919. Venereal Disease Control in the Army, by William F. Snow, M. D., and Wilbur A. Sawyer, M. D. April 10, 1918. "Why Let it Burn?" (American Social Hygiene Association pamphlet) 1919. Alias Hygiene, by T. A. Storey, M. D. March, 1920. Factors Making for a Low Venereal Record in the American Expeditionary Forces, by P. M. Ashburn, M. D. December 13, 1919. Senate Document No. 230, Sixty-sixth Congress, second session. Statement showing activities and disbursements of board pertaining to public health for fiscal year, 1919. February 18, 1920. Hearings on the Sundry Civil Bill before the Committee on Appropriations, United States House of Representatives, Sixty-sixth Congress, second session, February, 1920. War Department, General Orders, No. 135, 1919. (1920.) 2. Peotective Social and Medical Measures. Program of Protective Social Measures. February. 1920. Functions of Protective Social Measures Staff. April 1, 1920. Memorandum on Distinguishing Between Crime and Disease. March 22, 1920. Publication of the United States Navy Department, " Morale." April, 1920. Social Hygiene and the War Work with Women and Girls, by Jane Deeter Rippin. January, 1919. Regulations Governing Allotments of Funds for Venereal Disease Prevention Work. September 13, 1918. Rules and Regulations Governing Expenditures from the State Allotments of Chamberlain-Kahn Funds, for the fiscal year 1920. June, 1919. Rules and Regulations Governing Expenditures from the State Allotments of Chamberlain-Kahn Fund, for the fiscal year 1921. June, 1920. Statistical Study of Case Records of 15,000 Women and Girls, (In prepara- tion. ) 3. Educational Research and Development. Regulations Governing the Educational Research and Development Fund. January, 1919. Universal Physical Education — A State and National Obligation, by Thomas A. Storey, M. D. December 18, 1918. National Collegiate Athletic Association — Report of the Committee on Ex- tending the Influence of the Association. December 30, 1919. The Reconstruction Program for Physical Education in the Colleges, by Dean J. R. Angell. December 27, 1918. 248 KEPOET U. S. INTERDEPAETMENTAL, SOCIAL HYGIENE BOARD. 249 War Emphases on Physical Training, by Thomas A. Storey, M. D. 1919. War-Time Revelations in Physical Education, by Thomas A. Storey, M. D. February, 1920. A General Outline and Syllabus on Hygiene. Revised edition, 1920. Physical Training and Athletics. Resolutions adopted by the National Col- legiate Athletic Association. 4. Scientific Researches. Experimental Medicine and the Venereal Diseases, by William F. Snow, M. D.. and Thomas A. Storey, M. D. 1920. Regulations Governing the Scientific Research Fund. January, 1919. Scientific Researches — Outline of Work in Progress January 1, 1920. 1920. Scientific Researches — Second Announcement. April, 1920. A New Germicide for Use in the Genito-Urinary Tract : " Mercurochrome- 220." Preliminary report, by Hugh H. Young, M. D., Edwin C. White, Ph. D., and Ernest O. Swartz, M. D. November 15, 1919. A Simplified Plate Method of Partial Oxygen Tension in the Cultivation of the Gonococcus. June 19, 1920. A Series of Studies for the Recognition and Diagnosis of Treponema Pallidum in Venereal Diseases and the Effect of Various Drugs and Materials as Germi- cidal Agents against Treponema Pallidum researches conducted by Dr. Randle C. Rosenberger and Dr. John I. Fanz. October, 1919. A More Rapid and Improved Method of Demonstrating Spirochetes in Tissues, by Alfred S. Warthin, M. D., and Allen C. Starry. January, 1920. Axi Improved Method for the Preparation of Primary Arsanilic Acid, by Har- rold C. Oheetham and John H. Schmidt. April. 1920. INDEX. Page. Act making appropriations (Appendix A) 199 Activities 171 Acriflavine in gonorrlaea 128 Adams, Dr. Roger 126 Additon, Miss Henrietta 171 Administrative fund 28,29 Agents : Acting as law enforcement officers 44 Confidential protective social, duties of 183 Field service 204 of board, local assistanre by 16, 89 of board, location of 20, 179 of board, reports by 95 Protective Social 44, 48 Aid to States 17, 21, 28, 31, 98, 156, 162, 168, 171, 174 Akron Welfare Home for Women 99, 157, 175 Alabama 48, 49, 50, 97, 157, 174, 179, 190, 218 University of 158 State Training School for Girls 175 Albert, Dr. Henry 114 Alderson, Dr. H. E 116 Allentown, Pa 176 Alexandria, La 177 Allotments (see also Funds) : Numbers, amounts, purpose, distribution, and relevant facts 133 Percentage, population 218 To States, institutions, and organizations 168 To States, 1921, appropriations 217 Albany, Ga 98 Amendments : Proposed, and their fate 169 To law 199 American Association of Genito-Urinary Surgeons 153 American Journal of Public Health, extract from 194 American Journal of Syphilis 116 American Lake, Wash 176 American Psychopathological Association 153 American Social Hygiene Asssociation 136, 137, 153, 161 Estimates of venereal disease : — 11 Report by general director of 154 Fourteen researches 158 Anna Finstrom Detention Hospital, Columbia, S. C 99, 157 Appendices 193fC Applications and allotments, tabular summary on June 30 132 251 252 INDEX. Application forms : Page. For educational research and development 239 For scientific x'esearcli 230 Applications for assistance from the educational research and develop- ment fund, number, purpose, and disposition 131 Appropriation. (See also Fund) : Aid to States in protection of military and naval forces 156, 157 Bill, Army, Chap. XV., July 9, 1918 43, 44 Congressional 162 For allotment to States for the prevention, treatment and control of venereal diseases. {See Payment to States fund) 17, 19, 20, 23 For the care of civilian persons. (See Aid to States fund.) . For the purpose of discovering more effective medical measures in the prevention of venereal disease. {See Scientific research fund) 18 Interdepartmental Social Hygiene Board 156 Payment to States for the prevention, treatment, and control of venereal diseases 156, 218 Payments to universities, etc., for research in educational measures, 1920 156 Payments to universities, etc., for research in venereal diseases, 1920 156 Ruling of Comptroller of Treasury regarding 168 Arkansas 48, 50, 97, 157, 174, 179, 190, 195, 218 Arizona 10, 48, 49, 50, 97, 157, 179, 190, 218 Army 11, 12, 17, 24, 85, 93, 95, 161, 164 Appropriation act 169. 217 Cost of venereal disease in 193 Medical service 160 Officers 179 Protection from venereal disease 43 Sources of infection 45 Stations 49 Strength of 194 Venereal infections in 1 162, 164 Illustration follovping page 85 Arsanilic acid 119, 128 Arsenic, the Gutzeit method 119' Arnstein, Miss Natalie 111 Arsphenamine 117, 118, 216, 217 Distribution of by State boards of health lOa Ashburn, CoL P. M 2 Studies on venereal diseases in the Army 12 Assignation houses 1& Assistant Secretary of the Treasury 166 Athens, Ga 96 Atlanta, Ga 176 Augusta, Ga 176, 179 Baker, Newton D., Secretary of War 166 Baldwin, Dr. W. M 121 Baltimore, Md 96-99, 176-179 State Department of Health Hospital 99-157 Bangor, Me 98 Barnes Hospital, St. Louis, Mo 120 INDEX. 253 Page. Bartlett, Dr. Bernice 125 Bath, Me 98 Battle Creek, Mich 176-179 Beaumont, Tex 98 Bellingham, Wash., State Normal School 159 Bergehu, Frank H 126 Bethlehem, Pa 96 Biloxi, Miss 98 Birmingham, Ala i 99, 175-177 State Training School for Girls 99-157 Boards of Health. (See Departments of Health.) Boston, Mass 179 Boy Scouts __; 151 Bradley, Dr. H. C 1 119 Brady Laboratory of Pathology and Bacteriology , 113 Brady Urological Institute 107, 108, 109, 118 Bremerton, Wash 177 Brooklyn, N. Y , 176 Brooklyn Rapid Transit Co 153 Brown, Dr. G. O 111 Brownwood, Tex 98 Buckell, George T 112 Bureau of Education, United States 137 Business office : Chart of 36 Report on 155 Cairo, 111 98 California 48, 51, 97, 157, 179, 190, 218 State Normal School, San Diego 158 University of California, Berkeley 115,129,159 Cambridge, Md 158 Cambridge, Mass 177 Camp Fire Girls 151 Camp Holabird 153 Canal Zone 77 Carlisle, Pa 96 Carolyn House, Spartanburg, S. C 175 Carson City, Nev 98 Case histories 85ff Case records 204 Case work : Individual, in social hygiene 177 With women and girls 78 Table 1. Number of cases 78 Table 2. Color of new cases 78 Table 3. Men involved in new cases 78 Table 4. Sex relations of new cases 78 Table 5. Source of complaint of new cases 78, 79 Table 6. Reason for complaint of new cases 78, 80 Table 7. Disposition of new cases 78, 81 Table 8. Disposition of continued and reopened cases 78, 82 Table 9. Record of total dispositions 78,83 Table 10. Special data 78,84 254 INDEX. Chace, Archibald E., M. D., chief surgeon, St. Louis Southwestern Rail- Page. way Lines 195 Chamberlain, Col. Weston P 2,193 Chamberlain-Kahn Act. {See Fund, payments to States) 214 Chancroid as a factor in war (see also venereal diseases) 92, 160, 161, 195, 196 Chancroids : Organic dyes in the treatment of 107 Study of the etiology of 108 Chancroids and others : Cases of, reported to State boards of health in 1919 . 102 Cases of, reported to State boards of health in 1920 102 Chapter XV of the act making appropriations 199 Charts : Charts of appropriations, functions, and personnel, compiled in satisfac- tion of congressional action .. 28ff Administrative fund, purposes and personnel 29 Aid to States fund, purposes and personnel 31 Business office 37 Division of Educational Research and Development 41 Division of Records, Information, and Planning A 38 Division of Relations with States (protective medical measures) 39 Division of Relations with States (protective social measures) 40 Division of Scientific Research 42 Educational research and development fund, purposes and personnel 32 Executive office 35 Funds and their purposes 28 General organization ^ 34 Payment to States fund, purposes and personnel 30 Personnel section 36 Scientific research' fund, purposes and personnel 33 Chattanooga, Tenn 175, 176 Chattanooga detention house and hospital 175 Chattanooga venereal quarantine hospital 99, 157 Cheetham, Harold C 119, 126, 128 Cheney Normal School, Wash 159 Chester, Pa 177 Chicago, 111 176, 179 Chief health officer, support of 48 Chillicothe, Ohio 176 Christiansen, W. G 121 Cincinnati, Ohio 177 Cincinnati General Hospital 99 University of . 159 Cities in which agents were stationed ^ 176, 179 Civil Service Commission 36 Civilian quarantine and isolation fund (see Fund, aid to States) 174,216 Clark, Dr. P. E 119 Cleveland, Ohio 177 Clinic, Massachusetts State Psychiatric Institute 125 Clinical examination; value of, Cornell students 149 Clinics 102, 103 Establishment of 102 Efficiency of treatment of gonorrhea 104 INDEX. 255 Clinics — Continued. Page. Efficiency of treatment of syphilis 104 For treatment of venereal disease 216 Per capita cost of treatment in 104 Venereal disease 23, 44, 81, 82, S3, 106 Coe, H. C 116 Colleges. ( See Educational research and development ; Scientific research. ) Colorado 48, 97, 157, 179, 190, 218 State Teachers' College, Greeley 141, 158 Columbia, Pa 96 Columbia University 108, 129, 137, 152, 158 College of Physicians 1.59 Special courses for graduates 103 Columbus, Ga 96 Columbus, N. Mex 96 Commission on Training Camp Activities 99, 163, 164, 170, 175, 179, 183 Law Enforcement Division — section on women and girls (see also Section) 176 Community organization 47 Comptroller of Treasury, ruling of 168 Congress .^ 161 Conklin, Luther 112 Connecticut 48, 52, 97, 129,, 157, 179, 190, 218 Cook, Dr. Marjorie W 115 Cornell University, Ithaca, N. Y 129, 141, 145, 158, 185 Report 147 Report on application of educational program, quotation from 149 Medical college 112 Corpus Christi, Tex . 98 Cost of venereal disease (see also venereal diseases) 193fE Cumberland, Md 98 Dance halls 16 Daniels, Josephus, Secretary of the Navy 2, 166 Davis, Dr. D. M 118 Davis, Dr. Edwin G 110, 128 Dayton, Ohio 177 Delaware 48, 52, 97, 157, 179, 190, 218 Delinquency, cases of 177 National study of 178 Prevention of 91 Delinquent women and girls (see also Prostitute) 163,178 Care of 173, 174 Case histories of 85fE Case work with 78ff School for _*1 91 Statistical study of 15,000 cases of 12, 14 Delinquents, care of 178 Denver, Colo 96, 179 Departments of health, State. (See also Fund, payments to States) 190 Allotments to 16, 17, 20 Cases of veneral disease reported to 11,23 Departments of Hygiene 137 (See also Hygiene.) Allotments to educational institutions of 135 256 INDEX. Departments of Hygiene — Continued. Page. Establishing of - 131 In colleges, etc 15, 19, 24, 132, 133, 134 Support of 135 Establishing of, in colleges, etc. (see also Educational research) 130, 186 Des Moines, Iowa 85, 98, 176 Detention hospitals 177fe Detention houses 177ff Assistance of 17, 19, 22, 98, 99, 171, 172 Need of, in camp towns 172 Detroit, Mich 177, 179 Diphenoxychlorasine ; 126 District of Columbia 48, 52, 97, 157, 179, 190, 198, 199, 218 Dibromfluorescein 109 Divisions of Educational Hygiene, cooperation of State universities with State departments of education in establishing 131 Divisions, of the board (see Charts) 27 Educational Research and Development 129 Report on 129 Records, Information and Planning 37,204 Relations with States 39,40,43 Scientific Research 42 Report of 107 Division of: Venereal Diseases in State Departments of Health 17, 20, 100 Venereal Diseases in the Bureau of the Public Health Service 198 Venereal Diseases, United States Public Health Service. {See also Public Health Service, United States, Division of Venereal Dis- eases. ) Dodge, Kansas 98 Dorcas Home 175 Drug law, violation of the State 88 Drugs : Antisyphilitic 117 Use of 88,89 Duties and powers of the United States Interdepartmental Social Hygiene Board 197, 217 East St. Louis, 111 176 Easton, Pa 96 Eberson, Dr. F 23, 124 Education, physical 166 Regarding venereal diseases 165 Educational measures 232, 233 Developing more elTective 149, 150 Educational research in the development of motion-picture films and new literature 154 Educational research and development ^ 165 Division of 129 Plans of 130 Educational research and development fund 15, 16, 19, 20, 27, 31, 129, 131, 133, 136, 153, 156, 158, 163, 186, 232, 241, 245 Administration of 139 Appropriations from 19,24 Expenditures from 189 Revised regulations governing 243 INDEX. 257 Page. Educational work of erliicational section, Public Health Service 106 Egerer, Dr. Grote 122 El Paso, Tex 176 England, cost of venereal disease in 193, 196 Englewood, N. J 176 Engman, Dr. M. F 124 Rosin 109 Briclvson, Dr. Mary 114 Erie, Pa 177 Evanston, 111., Northwestern University 159 Exaniinei'S, health _ 241 Executive committee 2, 166 Executive office 34 Executive secretary 167, 171 Expenditures : From appropriations 8,9,156,157 Report of 238 Extensions of duties and powers from appropriations for the fiscal year ending June 30, 1921 199 Fairmount Hospital 175 Falconer, Mrs. Martha P 171 Fanz, Dr. John I 118-119,128 Ferguson, Hazel 123 Frankel, Dr , 115 Field agents. {See Agents.) Field Service - — 163, 170, 176, 203, 204 Educational 139 [See " Interdepartmental Social Hygiene Board " ; " Agents.") Field staff 178-179 Having headquarters in State with civil-service classification of each_ 49ff Fifty-fifty plan 236 Film, for use with policemen^ 136 Describing the protective social measures program of the United States Interdepartmental Social Hygiene Board 136 ^ " Fit to win " 152-153 Informational and educative effects of _ 153 Preliminary study of — 152-154 A preliminary study of all 151-152 Financial summary 156fe Fisk University, Nashville, Tenn 135-159 Florence Crittenden League, New York, N. Y 99-157 Florence, S. C 98 Florida 48, 52, 97, 157, 174, 179, 190, 218 Form : Application for assistance in scientific research 230 Application for assistance, educational research and development fund__-l 239 Financial report, educational 238 Request for maintenance of venereally infected persons 201-202 Fort Worth, Tex ' 177 Franiingham, Mass 172 1.^610—20 17 258 INDEX. Page. Franz, Dr. S. I 152 Functions of protective social measures staff 203 Funds, details of appropriations from 156, 157, 158, 159 Payment to States fund; Aid to States fund (see Educational re- search and development fund ; Administrative fund ; Scientific research fund.) Funds that are allotted by the Congress through the United States Inter- departmental Social Hygiene Board 216 Fund : Administrative 28, 29 Aid to States 17, 21, 28, 31, 98, 156, 162, 168, 171, 174 Educational research and development fund 15, 16, 19, 20, 27, 31, 32, 129, 131, 133, 136, 156, 158, 163, 186, 232, 241, 245 Payment to States fund 19, 23, 28, 30, 101, 105, 156, 162, 174, 190 Scientific research fund 16, 23, 28, 33, 136, 156, 183, 185, 229 Gaebe, Dr. R 124 Gainesville, Fla. : University of Florida . 158 Gainesville, Tex 175 Girls' Training School 99-157-175 Gallup, N. Mex 98 Galveston, Tex 98 Gay, Dr. Frederick P : 115 General Electric Co., Schenectady, N. Y 122 Georgia 48, 49, 50„97, 157-179-190-218 Glass, Carter 2 Goldsboro, N. C 98 Gonococcus : Isolation and cultivation of 114 ■ Studies in the bacteriology of 111 Study for the isolation and identification of 113 Gonococcus group : A serological study of 112 Gonorrhea 92-104-108-160-161-195-196 As a factor in vpar 160 Cases of, reported to State boards of health 102 Certain anilin dyes in the treatment of 110 Development of new synthetic drugs in treatment of 115 Fixation reaction in 115 Investigation of acriflavine in the treatment of 110-111 Investigation into treatment in acute and chronic 108 ■ Serologic tests for 114 Subacute and chronic 115 Plans for the control of 161 (See also Venereal diseases.) Gonorrheal infection in the male 114 Graham, Dr. George S 122,123 Great War 14 Greenville, S. C _' 177 Grigg, Walter K 123 Group hygiene - 233-234 Hagerstown, Md ■ 98 Hale, R. W., jr , 108-109 Hall, J. L 126 Hamilton, C. S , 126 INDEX. 259 Page. Hampton Normal and Agricultural Institute, Hampton, Va 135, 159 Harris, Dr. Mary B 171 Harrisburg, Pa , , 85-98 Hart, Merrill 112 Harvard, program . 149-151 Report, quotation from 151 Medical School, Boston, Mass__ 121-159 University, Cambridge, Mass 129-141-158-185 Hattiesburg, Miss ,__, 176 Hawaii , 77 Hazleton, Pa , , 96 Health conferences, individual, at Hai'vard, at Cornell, as instrument of instruction 149 Health conferences and consultations 144-23'^240 Health, departments of 234 In colleges, etc. (see also Departments of hygiene) 235 Examinations 143, 240 Instruction , 189 General problem of Industries and communities 151 Health officer, responsibilities 48 Hearings of June 18, 1918, record of 167 Hektoen, Dr. L 114 Hempstead, Long Island 176 Herrold, Dr. Russell 114, 128 Herrold, Ursula, S 114 Herschler, Dr. Rose 123 Highlands, N. J 177 Hirschfeld, Dr. M. H 125 Hirschfelder, Dr. A. D 112 Hoffman, Dr. R. V 171 Hospitals, assistance to 20, 22, 98, 99, 171, 172, 177 Venereal disease 81, 82, 83 Houston, David F 2 Houston, Tex 175-177 Hunt, Dr. Reid ^ 121 Hygiene : Applications of, courses and conferences in 165, 188, 233 Division of applied hygiene 234-240 Defensive hygiene of venereal diseases 162 Departments of 131, 134, 137, 141, 142, 151, 165, 166 Departments of, application form for the establishment or enlarge- ment of 239 Departments of, director 241 Organization proposed 241 Progress in organization of 131-140 Establishment or enlargement of 237-239 In colleges, etc 15, 24, 130, 132, 133, 134, 234 Instruction and training in 147 Division of- 246, 247 Educational methods in 234 Educational, of venereal diseases 14, 15 Establishment of departments of hygiene 233 Hygiene factors 233 260 INDEX. Hygiene — Continued. Page. General . 165, 233, 234, 239, 241 Government investments 15 Governmental obligations 12 Group liygiene 165, 166, 240, 241, 245, 246 In board's program of instruction 142-189 Individual hygiene 239, 241, 245, 246 Separation of sexes; in courses 150,165,166 Influence, departments of hygiene 1.50 Information of venereal diseases 14 Informational, courses in, Cornell, Harvard 149, 150, 154, 122, 239 Informational, courses and conferences in 165 Inspections 233 Instruction 15-19 Instruction and training : 141,142,143 Intergroup 165, 166, 240, 241, 245, 246 Hygiene of venereal diseases (see also Venereal diseases; also Edu- cational research and development) 23-24 Opportiuiities in informational courses 149 Prevention 15-16 Principles of 143, 233, 239 Problems in 234 Program of 137, 147, 1.51, 235 Adoption by preparatory schools 151 Protective 14,16 Public — 235 Reconstruction 15, 17 Remedial, support of, in States 15, 16, 17 Scientific research for informational 16 Sex - 165 Social, instruction in summer schools 131 Summary of factors 148 Syllabus and outline on — 136, 148 Teachers of 241 Teaching of informational 138, 147 Idaho 48, 54, 157, 190, 218 Illinois 48, 97, 157, 179, 190, 218 University of — 126, 129, 159 Indiana - 55, 56, 97, 157, 179, 128 University of, Bloomington, 111 158 Indianaiwlis, Teachei's' College of 158 Individual hygiene 233, 238 Industrial School for Colored Girls, Columbia, S. C 175 Infections. (See Venereal disease.) Information courses, opportunities in 149 Insane, Government Hospital for the 152 Institutions for delinquent women and girls 177 Instructions for reporting expenditures from allotments 237 Interdepartmental Social Hygiene Board : Accomplishments 21 Act under which board operates 197 Activities 171 Charts of -. 28ff Duties— 167 INDEX. 261 Interdepartmental Social Hygiene Board — Continued. Page. Establishment of 161 Field Service 18,20,21,22 Menil)ers 102 Organization 38, 28fl: Personnel assigned from another Gov't dep't in central office 21 Through Civil Service ' 20 Policy with cooperating educational institutions 138 Program 15 Intergroup hj^giene 233, 234 Iowa 48, 97, 157, 179, 190, 218 State College of Agriculture and Mechanic Arts, Ames 158 State University of Iowa, Iowa City . 158 University of Iowa, College of Medicine 114 Jacks, Dr. William 108 Jackson, Miss 98 Jacksonville, Fla 98 Jacobs, Dr. F. M : 124 Jeans, Dr. P. C ; 120 Jefferson County Institutions, Louisville, Ky 99, 175 Jefferson Medical College, Philadelphia, Pa 118, 129, 185 Jersey City, N. J 177 Johns Hopkins Hospital 118, 128 Johns Hopkins Medical School 107, 108, 109 Johns Hopkins University, Baltimore, Md__-'__ 129,136,158,159,184,185,189 Johns Hopkins University, Psychological Laboratory 152 Johnson, J. R 126 Journal, American Chemical Society 119, 121 Journal, American Medical Association 109, 114 Junction City, Kans 177 Kalamazoo, Mich 99, 175 Fairmount Hospital 99, 157 Kansas 48, 56, 57, 97, 157, 179, 190, 218 Kansas City, Mo 179 Kansas State Industrial Farm for Women, Topeka 175 Kentucky 48, 56, 57, 97, 186, 157, 174, 179, 190, 218 University of, Lexington 136,158 Keokuk, Iowa 98 Key West, Fla . 96 Kinsella, Dr. R. A 111 Kinston, N. C 98 Knudson, Dr. Arthur 123 Kucera, F. J 112 Lake County General Hospital, Waukegan, 111 175 Lancaster, Pa 179 Larson, Dr. W. P 111 Lashley, Dr. K. S 152 Law creating the board, background of and purpose 160' Law enforcement 172, 17S Law-enforcing agencies, relation of the Interdepartmental Social Hygiene Board to 44, 45 Law-enforcement division 163, 172, 173 Law enforcement, public health . 105 262 INDEX. Page. Law-enforcement section, direction of 21 Stimulated by representatives 96 Law under which the Interdepartmental Social Hygiene Board operates- 167, 197 Lawton, Okla 177 Detention home and hospital 175 Lebanon, Pa 98 Lectures, value in colleges 148 Lee, M. M 123 Leland Stanford University 129, 185 Leland Stanford, Junior, University Medical School 108, 116, 117, 159 Levaditi method 116, 123 Lewis, Dr. W. Lee 126 Little Rock, Ark ^^ 177-179 Literature 154 Preparation of new ■ 154 Loevenhart, Dr. A S 119, 126, 127 Lorenz, Dr. W. F 119 Louisiana 48, 58, 97, 99, 157, 177, 179, 190, 218 State Normal School, Natchitoches 158 Louisville, Ky: Jefferson County institutions 1 157 Lovett, R. H 171 Lowell, Mass 177 Lowry, C. D -' 126 Lynn, Mass 177 McAdoo, WilUam G 2, 166, 217 McArthur, C. A 117 McClendon, Dr. J. F 111 McCormick, John, Institute for Infectious Diseases 114, 159, 128, 129 McFadden, John H., Research Laboratory, Jefferson Medical College, Philadelphia, Pa 128 McKay, Dr. WiUiam 117 McNarama, Dr. Frank P 123 Maine 49, 59, 97, 157, 179, 190, 218 Maintenance of venereal disease patients. (See Venereal disease patients, maintenance of.) Manhattan, Kans 177 Mann Act, violation of 89 Manual for the various agents of the Interdepartmental Social Hygiene Board 18, footnote— 160 Maryland 48, 59, 60, 97, 129, 157, 179, 190, 218 Maryland Normal and Industrial School (Colored), BoAvie 135,158 Maryland State Normal School, Towson, Md . 158 Mason City, Iowa 98 Massachusetts 97, 129, 157, 179, 190, 195, 218 Cost of venereal diseases in ; 193, 194 Massachusetts Reformatory for Women 172 Massachusetts State Psychiatric Institute, Boston, Mass 125, 127, 129, 136, 158, 159 Medical examination, individual, Cornell 149 Medical measures, report on 100 Meharg, Virgil E 127 Mehrtens, Dr. H. G 117 Meine, Dr. Bertha M . 125 IKDEX. 263 Page. Memphis, Tenn 177 Men arrested, number of 22 Men involved with delinquent women and girls 78,89 Mercurochrorae 220 107, 109, 128 Mercury 109,118 Bichloride of 112 Meyer, Dr. Adolph 152 Michigan 49, 61, 97, 129, 157, 174, 179, 190, 218 College of Medicine and Surgery, University of Michigan 116 State Normal School, Ypsilanti, Mich 141, 147, 152, 188 University of Michigan 116, 128, 129, 185 Milwaukee State Normal School, Milwaukee, Wis 159 Miner, O. E ^ 171 Minneapolis, Minn ; 179 Minnesota 49, 61, 97, 129, 157, 179, 190,218 University of, Medical School 111, 112, 122, 129, 159, 185 Mission Valley Isolation Hospital, San Diego, Calif 175 Mississippi 49, 61, 62, 97, 136, 157, 170, 190, 218 Mississippi, University of 151, 158 Missouri. 48, 62, 63, 97, 129, 157, 159, 179, 190, 218 Baptist Sanitarium Hospital 120 State Teachers' College, Kirkville, Mo 158 University of, Columbia, Mo 158 Mobile, Ala 177 Monessen, Pa 96 Montana 49, 63, 158, 179, 190, 218 Motzkau, A _— 117 Motion picture films. (See Films.) Mount Holly, N. J .— 177 Moyle, Judge J. H 166 Muscatine, Iowa — — 98 N-arsenetripiperidonium chloride 120 Nashville, Tenn 98 Natchez, Miss 98 National security and defense fund 169, 170, 172 National Training School for Girls in District of Columbia 172 Navy 161,164 Complements 49 Department 161 Medical Service of 160 Protection from venereal disease 43 Sources of infection 45 Stations, illustration following page 85 49 Venereal disease in :__ 11, 17, 23, 85, 95, 164 Venereal Infections in the 164 Nebraska 49, 63, 158, 190, 218 ^ State Medical Journal 111 University of. College of Medicine 110 University of 128, 129, 185 Neighborhood settlement house 87 Neoarsphenamine (see also Arsphenamine ; salvarsan) 118 Neosalvarsan 120 Neurosyphilis, changes produced by the treatment of 125 264 INDEX. Page. Nevada _ 49, 63, 158, 190, 218 University of, Reno, Nev 158 Newark, N. J 179 Newburgh, N. Y . 177 New Brunswick, N. J 177 New Hampshire 48, 64, 97, 179, 190, 218 New Jersey ■ 179, 190 New London, Conn 179 New Mexico 49, 65, 97, 158, 179, 190, 218 University of Albuquei-que, N. Mex 158 New Orleans, La 177, 179 Newport News, Va 177, 179 New York ' 49, 65, 66, 97, 158, 179, 190, 218 City 177, 179 College of the City of. New York 158 State Board of Health venereal disease prevention exhibit 148 State Teachers' College, Albany, N. Y 147, 148, 150, 158, 159 University 129 University and Bellevue Hospital Medical College 115 Niagara Falls, N. Y 96 Nixon, Dr. C. E 122 Noble, Dr 115 Norfolk, Va 177 Norfolk, Va., City Hospital and City Home 99, 157 Normal School. ( See Educational research and development. ) North Carolina 48, 67, 97, 158, 174, 179, 190, 218 College for Women, Greensboro, N. C 159 North Dakota 49, 67, 158, 190, 218 Normal school 147 Northern Normal and Industrial School, Aberdeen, S. Dak 159 Northern Illinois State Normal School, Dekalb, 111 158 Northwestern University, Evanston, 111 126, 127, 158 Ohio 49, 67, 68, 97, 158, 179, 190, 218 Oklahoma 49, 69, 97, 158, 179, 190, 218 Old Forge, Pa 98 Ordway, Dr. Thomas 123 Oregon 49, 69, 97, 158, 190, 218 University of, Eugene , 159 Organization, period of 166 Oswego, N. Y., State Normal and Training School 141, 158 Ottumwa, Iowa ; 98 Outline and syllabus on hygiene 136 Palmer, C. S 126 Pamphlets printed in Italian, Spanish, and Yiddish 155 Parent teachers' associations 151 Park, Dr. William H 115 Park City, Utah 86 Patchogiie, Long Island 177 Paterson, N. J 85,98 Payment to States 162 Payments to States fund 19, 23, 28, 30, 98, 101, 105, 156, 174, 190 Payments to universities. {See Educational research and development fund.) INDEX. 265 Page. Peabody College for Teachers, Nashville, Tenn_l 159 Pennsylvania 48, 69, 70, 71, 97, 157, 158, 174, 179, 190, 218 University of 141 Pensacola, Fla 98 Peoria, 111 98 Personnel Section 35 Petersburg, Va 177, 179 Phelps, Lieut. Commander J. R., Medical Corps, United States Navy 2, 166 Philadelphia, Pa 177 Philippine Islands 76 Phipps Psychiatric Clinic, Baltimore, Md 152, 153 Physical education, department of (see also Hygiene, departments of) 141 Physical training 143, 144, 145, 234, 240 Activities (see also Hygiene, departments of) 141 Opportunities in « 149 Principals of 233, 240 Supervision of, Harvard 149 Teachers of 241 Pierce, C. C, Assistant Surgeon General 2, 166, 101 (footnote) Pine Blulf School, Louisville, Ky 175 Pittsburgh, Pa 177 Population of Continental United States, census of 1910 218 Port Arthur, Tex 98 Porto Rico , 77 Portland, Oreg 177 Portsmouth, N. H 179 Portsmouth, Va 177 Posters, for the use of State boards of health and educational authorities- 155 Pottsville, Pa : 96 President of the United States 169, 172 Princeton, N. J I 177 Principles and regulations, educational researches, and development fund_ 129 Prostitutes 96, 97, 161 Case histories of 85ff Case vi^ork with, table 78 Commitment of 17 Disseminator of venereal diseases 12, 22 Observed 22 Rehabilitation of 17, 47 School for 91 Prostitutes. {See also Delinquent women and girls.) Prostitution 21, 22, 23, 25, 91, 173 Control of — 12, 47 Houses of 16, 21, 22, 45, 92, 96, 97 Programs of 96 Programs and machineries of 16,21,22,45 Sources of 90 Suppression of, clandestine and public 216 Prostitution in New York City, report on 22 Protection of soldiers and sailors through the control of vice and venereal disease 177 Protection against veneral diseases. (See Veneral diseases.) Protective hygiene program 161 266 INDEX. Page. Protective social measures 2 16, 20, 21, 22, 42 Program of 85, 180, 203, 204 Cities and towns of greater military and naval importance in which the program of protective social measures has been put into op- eration 49ff Program of, service of men agents 179 Program of, service of women agents 175 Protective work for girls 176 Pychological research 19, 20, 24, 130, 131, 134 Purpose of 131 Public-health officer -— 215 Public-health lectures in educational institutions 146 Public Health Service 17, 137, 154, l62, 164, 191 Appropriation for the establishment of a Division of Veneral Diseases in the United States Public Health Service 162 Division of Veneral Diseases of the United States Public Health Service 20, 23, 29, 38, 100, 163 Division of Veneral Diseases, statement summarizing progress made, etc 101 Survey of clinics made by 103, 104 Publications of the United States Interdepartmental Social Hygiene Board on hand June 30, 1920 — 248 Puget Sound, Wash 177 K-Hg-0-CO-R' 127 Raleigh, N. C 98 Reappropriations for the year ending June 30, 1920 199 Records and Planning, division of 241 In departments of hygiene 150 In educational institutions 146 Red Cross 79 Red-light districts-r 16, 21, 22, 48, 85, 96, 98 Relationship to the Army and Navy 85 Reduction in appropriation for 1921 217 Reed College, Portland, Oreg 159, 189 Reformatories 1'^'^ Assistance to 19, 22, 99, 171, 172 Regulations for assistance of institutions in the maintenance of venereally infected patients 98, 201 For the establishment of divisions of educational hygiene in State departments of health 245 Governing allotments to colleges 232, 235, 236 Governing educational research and development 129, 232 Governing payments of allotments for departments of hygiene 235 Governing scientific-research fund 229 Reno, Nev 98 Research : Educational. {See Educational) 165 Educational, in the prevention of disease 137 Psychological (see also Sociological) 130,133,136,152 Scientific. {See Scientific research.) Sociological (see also Psychological) 130,133,136,152 Rhode Island - 49, 71, 97, 158, 179, 190, 218 Rigdon, Dr. R. L 108 INDEX. 267 Page. Robinson, Dr. Elliot B 113 Rockford, 111 177 Rosenberger, Dr. Randle C 118, 119, 128 Roundtree, Dr. L. G 122 Rules and Regulations : Governing allotments from Payments to States fund {see also Ap- pendix for) 20, 202 Governing Chamberlain Kahn Fund. (Seel Payments to States funds ; see Appendix. ) Governing educational research and development fund {see also Ap- pendix for) 130 Governing expenditures from Payments to States 214 Secretary of the Treasury 215 Scientific Researches. (See Scientific research fund; see also Ap- pendix for.) Russell, Col. F. F 2 St. Louis, Mo 177 Female detention vp^ard 157, 175 City hospital 99-120 Maternity dispensary 120 St. Louis Southwestern R. R., cost of venereal diseases 193 St. Louis University , 129 St. Louis University School of Medicine 111,159,185 St. Luke's Hospital 120 Saligenin, sodium salt of mercury 112 Salisbury, Md 153 Salvarsan 118, 120, 127 Saraarcand, N. S., State Home and Industrial School for Girls and Women 99, 157, 175 Sample of monthly financial report from 238 San Antonio, Tex 177 San Diego, Calif 179 San Francisco, Calif 99,177,179 San Francisco Hospital 99,157,175 Sanitary supervisions 144 Sanitary surveys 233 Savannah, Ga 85-98 Sawyer, Maj. W. A 2 Schmidt, John H 128 Scientific research 19, 107, 162, 163, 165, 170, 184 Scientific researches : Government investments, value of 24 Scientific research fund 16, 23, 28, 33, 136, 156, 183, 185. 229 Appropriations from 184, 185, 233 Classification of and description of 107 Data on scientific research fund 129 Scranton, Pa '. 98 Seamen's Institute, New York . 153 Seattle, Wash 177 Secretary of the Treasury 2,162,214 Secretary of the Navy 2,162,166,171,214,216 Secretary of War 2, 162, 166, 171, 214, 216 Section II of Chapter XV of the Chamberlain-Kahn Act 180 Sections 5, 6, and 7 of Chapter XV of the Army appropriation bill 199 268 INDEX. Page. Section VII of the act, etc 198 Section VIII of tlie act, etc 198 Section 13 of the act of Congress, etc 172 Section on reformatories and detention houses, Commission on Training- Camp Activities 170 Section on vice and liquor control, Commission on Training Camp Activities 173,179 Section on women and girls. Commission on Training Camp Activities 173 Segregated districts. {See Red-light districts.) Senate committee 167 Sex life, problems of 234 Sex and venei-eal prevention, instruction in hygiene concerning 148 Sex, methods of presenting to high-school students 148 Sex education 15, 152, 153 Problems in 153 Shelby jHospital, Memphis, Tenn 99,157 Shepardson, Mrs. R. T 117 Sioux City, Iowa 98 Smith, Dr. George H 113 Snavely, Miss Marion E 113 Snow, Lieut. Col. W. F., Medical Corps, United States Army 2, 166 Social hygiene, instruction by lectures not sufficient 149 Social protective agents 48 Sociological -and psychological research related thereto 198 Sociological research 19, 20, 24, 130, 131, 134 Purpose of 131 Solomon, Dr. H. C 125 Sources of infection, named in Army and Navy reports {see also Venereal disease) 45 South Carolina 48, 71, 97, 158, 172, 174, 179, 190, 218 University of, Columbia, S. C '. 159 South Dakota 190' Spalding, Dr. A. S 48,71,108,158,218 Spartanburg, S. C 177 Spiroehseta pallida in human tissues, a research for 115 Springfield, 111 98 Stafeord, Douglas D 115 Starry, Allen C 116, 128 State commissioners of health, cases of infection reported to 91 State councils of defense 176 State department of health 204 State divisions of hygiene 132 State health departments, cooperation of 48 States in which plans for bureaus have not yet been perfected 48 States, bureaus of protective social measures in 48 Statistical study, 15,000 cases of delinquent women and girls 14 Statistics of cases, Table No. 1 : Texarkana Hospital, St. Louis, Southwestern Ry Lines 195 Statistics, protective social measures 22 Stovall, Dr. W. D 1 119 Storey, Dr. T. A 2,171 INDEX. 269 Page. Stroudsburg, Pa 96 Summary of the work of the board for period ending June 30, 1919 162 Sundry civil bill 169,217 Supervising assistant 203, 204 Surgeons General of the Army, Navy, and United States Public Health Service 197, 214, 215 Surgeon General of the Army, report furnished by 13 Surgeon General of the Navy, sources of infection reported to 91 Surgeon General, Public Health Service 197,216 Suspended disbursements 236 Swartz, Dr. E. O 107,109 Svvartz, Ernest O 128 Syllabus, outline and syllabus on hygiene. (See Hygiene.) Syphilis {see also Venereal disease) 92, 104, 115, 160, 161, 196, 199 cases of, reported to State board of health, 1919-20 102 cerebrospinal 117 A study of hereditary 127 Hereditary 120 Methods of treating 116 In pregnant women and new-born children 122, 123 New organic compounds in the treatment of 118 In the rabbit, a study of 121 Of the central nervous system, treatment of 126 Of the innocent 125 . Social and economic effects of 125 Standardization of the treatment of .. 117 Study of hereditary transmission of 120 Treatment of, of the central nervous system 119 As a venereal disease 125 Syphilitic, the latent 124 An investigation on the family of the 136 The family of 125 Tables : Case work — Table 1. Number of cases 78 Table 2. Color of new cases 78 Table 3. Men involved 78 Table 4. Sex I'elations of new cases 78 Table 5. Source of complaint of new cases ._ 79 Table 6. Reason for complaint of new cases 80 Table 7. Di.sposition of new cases 81 Tables. Disposition of continued and reopened cases 82 Table 9. Total disiwsition 83 Table 10. Special data 84 Statistics — Table 1. Statistics of cases from free venereal service at Tex- * arkana Hospital medical department, St. Louis Southwestern Railway lines 195 Table 2. Cost of venereal service at Texarkana Hospital, St. Louis Southwestern Railway lines 196 270 INDEX. Tabulations : Fane. Showing program of assignment of bureaus of protective social measures 48 Showing location of Army and Navy complements, known localities from which venereal infections have been received by soldiers, and the distribution of agents of the board for the application of pro- tective social measures as of June 30, 1920 49ff Showing analysis of the nine consolidated reports of individual venereal disease reports Nos. 1 to 10,000, submitted in compliance with Surgeon General's Oifice Circular Letter No. 293, between September 10, 1919, and September 13, 1920 91 Showing red-light districts which were closed through the assistance of the board's field representatives, giving number of houses and inmates thereof ^_ 95 Of certain observations made by protective social agents of the board in their search for the foci of venereal diseases from No- vember 1, 1919, to June 30, 1920 96 Showing red-light districts discovered by the board's agents which remained open on June 30, 1920 97 Tabulation showing strength of the Army during period (calendar year, 1919) covered by Col. Chamberlain's letter 194 Tacoma, Wash 85, 98, 177 Tait, Jean 123 Tampa, Fla 98 Teague, Dr. O^car 108 Tennessee 48, 71, 72, 97, 158, 179, 190, 2XS University of, Knoxville, Tenn 159 Texarkana, Ark 195 Texas 48, 71, 72, 97, 158, 179, 190, 195, 218 Thing, Miss Alice 123 Thompson, Dr. L. J 125 Tonopah, Nev 98 Torrey, Dr. John C 112 Travelers' Aid Society , 97, 98 Treasury 198 Treasury Department 161 Treatment, prevention, and control of venereal diseases 203 Trenton, N. J 177 Treponema Pallidum method for intervitam staining 118 Troy, N. Y 98 Tuskegee Normal and Industrial Institute, Tuskegee 135, 158 Undercover investigators, (See Confidential protective social agents) 183 Union University 129 Medical department, Albany Medical College 185 Medical School, Albany, N. Y 121,123 United States census ^ 214, 215 United States Interdepartmental Social Hygiene Board (see also inter- departmental) 164, 166 United States Public Health Service (see also Public) 197, 215, 216, 217 United States Public Health venereal disease fund (see also payments to States ' fund 190 Utah 49, 73, 97, 158, 179, 190, 218 University of Utah, Salt Lake City, Utah 141, 151, 159 Universities. (See educational research and development.) Valley City, N. Dak., State Normal School 159 INDEX. 271 Page. A''ancoiiver, Wash__ 177 Veeder, Dr. Borden S 127 Venereal diseases (see also Chancroid, Gonorrhea, and Syphilis) 91, 148, 161, 189, 195, 196, 215, 234 Venereal diseases : Bureau of 215, 216 Carriers of (see also Prostitute) 12,17,20,21,23,44,45 Carriers, causes and prevention 165 Cases reported to State board of health 23 Cases of, treated at clinics 23 Cities and towns in which infections have been reported by soldiers-- 49 Clinics for the treatment of 17, 45, 81, 82, 83, 216 Control, organized bureau of 191 Control, outlook 18 Control of 14, 23, 25 Cost of 12,193 Cost of treatment in clinics per capita 104 Early treatment of 109 Educational nveasui-es in the prevention of 130,152 Extent of, in United States 101 Films for _- 152 Funds for the use of boards or departments of health in the preven- tion, control, and treatment of 214 Hospitals {see also Hospitals) 86 Hygiene of (see Hygiene) 186 Importance of 241 Incidence of in the United States ^ ^ 102 In the Army 12, 24, 164 Records for 13 years 93 Ten thousand cases of 92 In the civilian population 11,23,24,91 In the Navy 11,24,164, Informational hygiene of 154 Instruction in 130, 137, 142, 147, 233, 234 Number of women and girls examined for 84 Organized plans for the control of 161 Patients 175 Maintenance of 98, 157, 175 Preliminary reports of search in the prevention and treatment of — 128 Prevalence of 11 Prevention control, and treatment of 130, 148, 214, 215, 217, 219, 220, 222 Problems in 130 Program of the Army 161 Program of the Navy 161 Protection of soldiers and sailors from 43 Recognition and diagnosis of treponema pallidum in— 128 Reporting cases of 102 Reporting of, by physicians 101 Scientific research for informational hygiene on (see also Scientific research) 16 Search for foci 97 Sources of infection, illustration 91 Spread of 215, 216 272 .. INDEX. Venereal diseases — Continued. Page. Study of organisms of i 111 Study of the serology and pathology of 122 Treatment, voluntary 81, 82, 83 Treatment, prevention and control of 100 Treponema pallidum in ^ 118 "Venereal infection in the Army 164 Venereal prophylaxis : Study of various methods of 108 Use in the Army • 108 Vermont 49, 74, 97, 158, 179, 190, 218 Vicksburg, Miss 98 Virginia 48, 74, 97, 1.58, 174, 179, 190, 218 War Camp Community Service , 176 War Department 161, 170, 171, 172 Warthin, Dr. Aldred Scott 116, 128 Washington 48, 75, 97, 158, 190, 204, 218 Washington, D. C 179 Washington University ; 129 Washington University Dispensary ^^1 120 Washington University School of Medicine. St. Louis, Mo_ 120, 124, 127, 159, 185 Wassermann tests, number made in 1919 and 1920 103 Wassermann reaction, studies on the nature of 123 Watson, Dr. John B 152, 153 Waukegan, 111 179 Weiss, Dr. R. S 124 West Palm Beach, Fla 96,98 West Virginia 49, 75, 158, 179, 190, 218 Wheeling, W. Va Jl 96 White, Dr. Edwin C 109,128 Whitmore, Dr. Frank C 127 Whitney, Dr. William R 122 Wieber, Miss Ida 116 Williams, P. S 117 Wilmington, Del 153, 177 Wilson, Miss 115 Wilson, N. C 98 Winona Normal School 148,158 Winternitz, Dr. M. C 123 Wisconsin 49, 76, 97, 158, 159, 179, 190, 218 University of 126, 127, 128, 129, 1.59, 185 University of. Medical School 119 Women's Medical College of Pennsylvania... 123, 129, 133, 135, 159, 184, 185, 188 Woman supervising assistant and inspector 204 Woodworth, Dr. Robert S - 152 Worcester, Mass 179 Wyoming 49, 76, 97, 158, 179, 190, 218 Yale University 129, 185 Medical School of 113,123 Young, Dr. Hugh H 107, 108, 109, 118, 128 Young Women's Christian Association 79 Younie, John C 123 o DUE DATE -o jI^jl-' Sji'iS&iSr itmmt o l-Vio m\il imWi 131998 ?, as — ,,: tu — ii_. /■■- ! '1 ^ ' .■,v?», 1 201-6503 Printed in USA COLUMBIA UNIVERSITY LIBRARIES 0037547321 RC201 Un38 U«S. Interdepartmental social hygiene board. 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