UCLA

ABSTRACT OF THE

DISSERTATION

The Role of United States Public Health Service

in the Control of Syphilis during the Early 20th Century

by

George Sarka

Doctor of Public Health

University of California, Los Angeles, 2013

Professor Paul Torrens, Chair

Statement of the Problem: To historians, the word syphilis usually evokes images of a bygone era where lapses in moral turpitude led to venereal disease and its eventual sequelae of medical and moral stigmata. It is considered by many, a disease of the past and simply another point of interest in the timeline of medical, military or public health history. However, the relationship of syphilis to the United States Public Health Service is more than just a fleeting moment in time. In fact, the control of syphilis in the United States during the early 20th century remains relatively unknown to most individuals including historians, medical professionals and public health specialists. This dissertation will explore following question: What was the role of the United States Public Health Service in the control of syphilis during the first half of the 20th century? This era was a fertile period to study the control of syphilis due to a plethora of factors including the following: epidemic proportions in the U.S. population and military with syphilis; the emergence of tools to define, recognize and treat syphilis; the occurrence of two world wars with a rise in the incidence and prevalence of syphilis, the economic ramifications of the disease; and the emergence of the U.S. Public Health Service with its champions, successes and failures.

Methods: To answer this question, an extensive review of literature was done including primary and secondary sources from the military, public health specialists, medical specialists, historical reviews, etc.

Summary: The control of syphilis was not possible until the U.S. Public Health Service had the tools to define, recognize and treat this disease which became reality in the early twentieth century. The importance of controlling syphilis for the U.S. Public Health Service surged during the First and Second World Wars where it became a major public health and military problem. It was also obvious that there needed to be both Governmental and public support for the control of syphilis in order for the U.S. Public Health Service to succeed in its mission. Clearly the 1920s and the early 1930s demonstrated that the control of syphilis could not be accomplished until the word syphilis metamorphosized from a taboo to a household term where it could be discussed in pubic in such venues as newspapers, radio, theater, etc. Additionally, there was a need for a champion like that of Thomas Parran MD, the 6th Surgeon General of Public Health to ignite that passion towards the control of syphilis with educational problems, increased research and financial aid.

After World War II, a national program for the control of syphilis had less importance to the U.S. Public Health Service due to several reasons. With the advancement in treatment for syphilis and gonorrhea, therapy via the Rapid Treatment Centers was replaced with antibiotics which now included penicillin. This new medication was simple to administer, rapid in onset, safe with minimal adverse side effects and most importantly effective. Secondly, physicians were now able to provide such treatment in their office or clinics. Finally, due to cutbacks in the funding post war by the federal government, treatment of syphilis and gonorrhea became the responsibility of the state rather than that of the U.S. Public Health Service.

With the end of War World II, the focus of U.S. Public Health Service and need for reorganization would be necessary because of an epidemiological transition in the nation's disease patterns from that of communicable diseases (tuberculosis, syphilis, pneumonia, diarrheal diseases and diphtheria) to that of chronic diseases (heart disease, cancer, hypertension and accidents with their sequelae). However, syphilis stills a role to play in the U.S. Public Health Service with the Tuskegee Syphilis Study. Here both moral and ethical decisions about treating patients became paramount and resulted in major policy changes within the Service.