' 
A SURVEY OF THE FACILITIES PROVIDED IN 
SYRACUSE. N*Y* FOR KE PREVENTION AND 
TREATMENT OF GONORRHEA AND SYPHILIS* A SURVEY 
OF THE 
(FACIlVFiteS PROVIDED IN SYRACUSE, N. Y. 
AND TREATMENT 
AND SYPHILIS. (Incomplete) 
.Syracuse wishes you well, 
By I 
Walter M. Brunet, M. D. 
U9 1 
Mary A. Clark, M. A. 
Haven Emerson, M. D., Consultant 
Published by 
Department of Health of Syracuse, N. Y. 
Cooperating in the Syracuse Health Demonstration A SURVEY 
of the facilities provided by Syracuse, New York, for the 
Prevention and Treatment of Syphilis and Gonorrhea. 
Report made through the State Committee on Tubercul- 
osis and Public Health of the Stare Charities Aid Assoc- 
iation of New York to the Health Agencies participating 
in the Syracuse Health Demonstration of the Milbank 
Memorial Fund. 
Syracuse wiwi» <» well, 
By 
Walter M. Brunet, M. D. 
Mary A. Clark, M. A. 
Haven Emerson, M. D., Consultant INTRODUCTORY STATEMENT 
At the request of the Milbank Foundation and with the consent and 
approval of the Commissioner of Health of Syracuse, Dr. Thomas P. 
Farmer, the American Social Hygiene Association was invited to make a 
study of the' facilities in Syracuse for the diagnosis, treatment and public 
health control of gonococcal and spirochetal infections, prepare a detailed 
report and make recommendations. Dr. Walter M. Brunet, Director of 
the Department of Medical Measures of the American Social Hygiene 
Association, made the field study; Miss Mary A. Clark, Statistician of the 
American Social Hygiene Association, prepared the report of the results 
of the inquiry to the physicians; Dr. Haven Emerson, Professor of Public 
Health Administration, Columbia University, acted as consultant. 
The data contained in the report are based upon a number of personal 
interviews, visits to hospitals, clinics, the Medical College, the Syracuse 
Free Dispensary, the Department of Charities of the city, the Visiting 
Nurse Association, and other organizations whose activities touch upon the 
field of the control of the venereal diseases. It is also based upon the re- 
sults of a questionary addressed to the physicians of Syracuse. 
This study deals with the actual disease program at the present time. 
The facts as found are stated. Recommendations for their improvement 
are offered. 
Every facility was cheerfully offered to the field worker. It would 
have been impossible to secure the necessary information on which this 
report is based had not thorough and systematic cooperation been secured 
from those interested in this subject in Syracuse. Acknowledgment is 
hereby made of the cordial assistance which was given the investigators. 
2 GENERAL FACTS ABOUT SYRACUSE 
Syracuse is the county seat of Onondaga County. It is situated at 
the southern end of Onondaga Lake. The city is served by the New York 
Central and Hudson River, the West Shore, and the Delaware, Lackawan- 
na and Western Railways; by the Erie Canal and the Oswego Canal which 
joins the Erie within the city limits. Syracuse is 418 feet above sea level. 
It is set in an amphitheater of hills surrounding Onondaga Lake. 
Location 
Area Covered and Population 
Syracuse occupies an area of square miles or 12,349 acres. It 
has an estimated population for 1923 of 190,000. These figures give an 
average population of 10,000 to the square mile or 14 persons to an acre. 
Of the 190,000 population about 25,000 are foreign born (including 8,000 
Germans, 6,000 Irish, 2,500 English-Canadians, 2,500 English and 2,000 
Negroes). 
Industries 
Syracuse has a number of large industrial establishments which em- 
ploy thousands of workers. A survey of industrial conditions was being 
carried on simultaneously with this one by Dr. Wade Wright. To avoid 
duplication no further consideration to this element in the city will be 
made in the present report. 
The Form of Government 
The city is governed by a mayor and 19 councilmen. One member 
of the council is elected from each of the wards in the city. A councilman 
serves four years. 
Organization of the Department of Health 
The Department of Health is administered by an executive officer 
who is appointed by the mayor to serve four years. He is termed the 
Commissioner of Health. There is no Board of Health but five physicians 
are selected from a list of names submitted by the Syracuse Academy of 
Medicine, and appointed by the mayor to serve as a health advisory council. 
3 Budget of Department of Health 
The total estimated expenditures for the Department of Health for 
the year 1923 were $163,199.75. The per capita expenditures for health 
were 81 cents. In the report of the Committee on Municipal Health De- 
partment Practice of the American Public Health Association, Syracuse 
wias thirteenth on the list of the total group of 81 cities studied in per 
capita expenditures for health service in 1920. 
4 BUREAU OF VENEREAL DISEASE OF THE 
DEPARTMENT OF HEALTH 
Syracuse lacks a carefully planned and well coordinated program for 
the control and reduction of gonococcal and spirochetal infections. The 
Bureau of Venereal Disease of the Department of Health is in substance 
only a paper organization as there is neither director nor staff concerned 
wholly with the control of these diseases. 
The amount appropriated for this Bureau in 1923 was $8,512.50. 
It is divided as follows: 
Personal Service 
Nurse $1,200.00 
Laborer 900.00 
Housekeeper 547.50 
Social Worker (female) Free Dispensary 900.00 
Assistant Physician in Dermatology 720.00 
Two Physicians at $600 each, Free Dispensary 1,200.00 
Nurse 100.00 
Communication Service 
Telephone 60.00 
Postage 5.00 
Contractual Service 
Repairs to Buildings 100.00 
Supplies 
Provisions 1,000.00 
Fuel , 250.00 
Medical and General Supplies 400.00 
Purchase of Equipment 
Furniture and Fittings 50.00 
(Fixed Charges) 
Rent 1,080.00 
Total, Bureau of Venereal Disease $8,512.50 
Of this amount $6,292 is expended for the activities of the Venereal 
Disease Hospital on Noxon Street. The remaining $2,220 is used to pay 
for the services of two physicians in the Syracuse Free Dispensary and a 
social worker. 
The sum of $8,512.50. however, does not represent the entire amount 
which is chargeable to the control of venereal diseases. There is an item 
of $900 for the services of a serologist employed in the Bureau of Labora- 
5 tories of the Department of Health. This appropriation is made for the 
technician who performs the Wassermann blood examinations. Also under 
the appropriations made to the Bureau of Health Supervision upwards of 
$3,000 is expended chiefly for the upkeep and operation of the night ses- 
sions of the syphilis and genito-urinary clinics which are held in the Free 
Dispensary. 
From these statements it can be seen that the City of Syracuse is 
expending upwards of $13,000 per annum in the treatment of persons 
infected with venereal diseases. This amount represents a per capita 
expenditure of 7 cents or 12.5 per cent of the total budget for the Depart- 
ment of Health. The average per capita expenditure by municipal Health 
Departments in 1921 for venereal disease control in 38 cities from which 
exact information was obtained, was 2 1/10 cents. 
SYRACUSE FREE DISPENSARY 
Organization 
The Syracuse Free Dispensary is the only organized outpatient 
department in the city receiving all sorts of cases and holding general and 
specialized clinic sessions. The Dispensary has been in existence thirty 
years and carries the entire burden of the city for the free treatment of 
the sick poor who are able to visit a dispensary. The organization and 
operation of the Free Dispensary is a tri-partite affair; each party inter- 
ested acts independently in its own sphere and the activities have thus far 
not encountered any serious conflicts. This, however, is not due to any 
well conceived or practical working plan, but rather to a policy of non- 
interference, one with the other. The University provides the building, 
nominally appoints physicians to the staff, and contributes $2,000 per 
annum towards its upkeep. Of the $2,000 contributed by the University, 
a portion is used to pay a salary to the registrar and the balance for other 
operating expenses. The City of Syracuse provides a fund which is used 
to pay salaries to the registrar, three part-time physicians, a matron, a 
nurse, a social worker and a secretary. The trustees of the Free Dis- 
pensary receive from the Community Chest $5,078.36 on the basis of a 
submitted budget. The County of Onondaga contributes $2,500 per 
annum towards the operation of the Dispensary. The management of the 
Dispensary is under the direction of a Dispensary Committee. This com- 
mittee appoints the registrar and presumably dictates the policies. The 
direction of the administrative details is in the hands of the registrar who 
is the administrative officer of the Dispensary Committee. He employs 
the necessary clerical assistance, the nurses, pharmacist, social workers 
and others. The registrar receives a salary from the Dispensary Com- 
mittee, from the college and from the city under the appropriation made 
to the Bureau of Health Supervision, and from the funds contributed by 
the county. 
6 Finances 
In brief then, the Syracuse University furnishes the building, supplies 
the medical staff, and contributes $2,000 toward its support. The city 
through the various divisions of the Department of Health, supplies the 
greater proportion of the money for its support ($17,000), one-third of 
which is appropriated for venereal disease activities. The County of 
Onondaga contributes $2,500 and the Dispensary Committee directs the 
work and secures upon application and submission of a budget the sum of 
$5,078.36 from the Community Chest for this work. 
Location and Quarters 
The Syracuse Free Dispensary occupies the building at 610 East 
Fayette Street. The structure was erected as a dispensary building and is 
a semi-modern three-story, fireproof structure without elevator service. 
The first two floors are given over to the activities of the Dispensary 
proper, and the third floor is used as laboratories for teaching purposes. 
Clinics 
The sessions of the clinic for the treatment of diseases of the skin and 
syphilis are held three afternoons and one evening each week. This service 
is under the direction of the associate professor in the corresponding de- 
partment of the Medical College. There is one assistant physician who is 
also a member of the staff of this division in the college. One nurse is 
assigned to this clinic. She also assists in the weekly session of the 
night clinic. In addition to the director, his assistant and the nurse, there 
is a section from the senior class in the Medical College assigned to this 
clinic for practical instruction. 
The venereal disease clinics are ideally situated from the point of view 
of their being a part of a general dispensary. There is every advantage 
for consultation service with the other departments and privacy during 
the conduction of other activities at the same hour. The space set aside 
for this clinic is on the second floor and is sufficient at this time to handle 
the volume of work. The waiting space for patients is a portion of the 
general waiting space and is opposite the treatment room. Comfortable 
benches are provided for those awaiting treatment. There is no separa- 
tion of the races or sexes. This is particularly noticeable and objection- 
able at the sessions of the night clinic. 
The space for the clinic proper consists of one large room with three 
desks, six chairs and several benches. One desk is provided for the 
physician in charge, one for the social worker and one for the taking of 
specimens of blood for the Wassermann test. There are cubicles on each 
side of the receiving room for the examination and treatment of patients. 
The equipment is poor. 
Admission Routine 
The routine followed is stated briefly. The patient enters the Dis- 
pensary, applies to the admission desk where perfunctory questions are 
7 asked; a small admission fee is collected if the patient is able to pay it; a 
card and a history sheet are made out if patient is new; if a former patient, 
the card and the history sheet are removed from the files in the admitting 
office. He is then directed to go up the stairs to the space provided for 
those awaiting treatment. The records are taken from the admitting office 
by an orderly or a nurse; placed on the physician’s desk, and the patient 
called into the room by name or number by the physician or the nurse, or 
both. 
The history of the patient is taken by the physician in charge of the 
clinic. It consists mainly of the high lights in the present illness. Fol- 
lowing the recording of the history, the patient is directed to go into one 
of the cubicles on either side of the room for examination or treatment. 
The physician follows the patient and requests him to remove the necessary 
amount of clothing. Few complete physical examinations are made. The 
records of physical findings are brief. The physician in charge of the 
clinic records all of the data concerned with the history of the patient, 
physical examination and treatment. The records are of little or no value, 
and the information which could be compiled from a study of them would 
not compensate for the time put upon them. The attitude toward the 
patient is considerate, and the treatment of the disease is apparently good. 
Participation of Medical Students 
No definite tasks are given to students assigned to this clinic. While 
the observer was present the students were engaged in studying a lesson 
for a quiz. The presence of the students was neither ignored nor recog- 
nized by the physician in charge. The attitude seemed to be one of in- 
difference. Only one student took the trouble to walk across the room to 
see a patient with an initial lesion who was being examined One of 
the students took several specimens of blood for Wassermann examina- 
tions. 
Clinic Attendance and Follow-up 
The attendance at the clinic is fair,—the average number of patients 
being ten per clinic session. There is no real attempt made to follow-up 
delinquent patients and have them return for treatment. A number of 
patients in a highly infectious state make only one visit and are never seen 
again. Several attempts have been made to carry out a social service 
follow-up program but without success, as it has been well nigh impossible 
to secure the proper person to carry on this activity. The percentage of 
patients discontinuing treatment without consent will reach upwards of 
25 per cent of those attending the clinic. 
Securing of Economic Data Insufficient 
The few questions asked at the admitting desk regarding the economic 
status of those seeking treatment, are neither sufficient in detail nor care- 
fully enough propounded to obtain sufficient information to determine 
whether the patients are entitled to free treatment or advice. When cases 
are denied admission to the Dispensary it is generally through appear- 
8 ance rather than thorough questioning as to financial condition. Occasion- 
ally a case is referred to the Department of Charities for investigation. In 
any event, the present methods of admitting patients who apply for treat- 
ment without an adequate economic history being taken and followed up 
if necessary, are contrary to the best dispensary practice and results in 
many complaints from physicians. 
Records of Patients Refused Treatment 
There are no records available which will furnish information regard- 
ing the number of patients refused treatment at the Dispensary or denied 
hospital care, or the cause for the refusal. When a patient is not accepted 
for treatment in the Dispensary he receives a slip which is made out by 
the registrar containing his name, address and other social data. The 
patient is then sent to the Department of Charities for investigation. If, 
after investigation the treatment requested is refused, the slip is returned 
to the applicant. If treatment is provided, notice is sent to the hospital if 
the case demands it, or to the Dispensary. The note is an order to admit 
the patient. 
Night Clinic for Patients with Syphilis 
The night clinic for patients suffering from syphilis is under the same 
direction as the one held during the day. The admitting system is the 
same but different treatment quarters are provided for the evening clinic. 
In this clinic there is practically no privacy offered and the mingling of 
the races and the sexes, both in the treatment room and while awaiting 
treatment, is against all recognized clinic practice and is undesirable. The 
equipment is meager, and the records are of the same type and character 
as used in the day clinic. No social service follow-up is being carried 
cut. No medical students are assigned to attend this clinic. 
Clinics for Treatment of Patients with Gonococcal Infections 
There are two clinics for the treatment of gonorrhea in the male. 
One is under the direction of the chief of the Urological Department in 
the Medical School. Three clinic sessions are held during the week in the 
afternoon. The other clinic is supervised by a physician appointed by the 
city. This clinic has only one session,—in the evening at the same hour 
as the syphilis clinic. The physician directing the evening genito-urinary 
clinic is also the attending physician for patients quarantined in the 
Venereal Disease Hospital on Noxon Street. The afternoon genito- 
urinary clinic is conducted by the director and his assistant. It is held on 
the ground floor of the Dispensary building. Two connecting rooms have 
been provided for this purpose. The director of this clinic has been in 
charge for six months and no new plans or any reorganization have been 
put in operation up to date of writing. 
Histories 
The records are poor and of little permanent value. The equipment 
is conspicuous by its absence. The few instruments provided are obsolete 
9 in character. There are no modern facilities for urethral or bladder irri- 
gations when indicated and necessary. There is no provision or assignment 
for nursing or orderly assistance. The patients are not followed up in an 
endeavor to have them return for treatment when necessary. No records 
are available as to the number of patients who discharge themselves before 
they are non-communicable or cured. Many of them are in a communicable 
stage. 
Participation of Medical Students 
Students are assigned to this department for clinic instruction as in 
the syphilis clinic. Each student is assigned tasks by the director which 
consist of recording history of patient and examinations of urine. Col- 
lection of material for microscopic examination and other data regarding 
the patients are required on these records. The didactic work in the college 
and the practical work in the clinical branches are not correlated and conse- 
quently the value of the practical work in the clinic is lessened. 
Night Clinic for Patients with Gonococcal Infection 
The night clinic for the treatment of gonorrhea in the male is held 
once each week on Wednesday evening. At the same hour the syphilis 
clinic is operating. The rooms and the equipment provided for the day 
genito-urinary clinic are also used for this clinic. On the evening of my 
visit, the physician in charge saw and discharged eight patients in less than 
thirty minutes. This was the number reporting for treatment at this 
session. Not a single individual treatment was administered. The pro- 
cedure consisted of a few perfunctory questions, and either further advice 
or a prescription was given. Few smears for microscopical examinations 
are taken. The records are valueless save for the small amount of social 
data which they contain. The physician directing this clinic has no assis- 
tant, nor is there any nursing service provided. 
Number of Patients Treated in 1923 
The total number of venereal disease patients given free treatment in 
1923 was 1,274. Of this number 142 cases were reported from the Yen 
ereal Hospital and 1,132 from the Free Dispensary. This gives an aver- 
age of 668 patients per 100,000 estimated population. The standard set 
by the American Public Health Association is based upon 500 treated cases 
for each 100,000 of the estimated population. 
10 The following is a report of the Venereal Disease Clinic (Venereal 
Hospital, 116 Noxon St.)for the year ending December 31, 1922: 
Female 
Male 
Total 
Syphilis cases remaining since 1921 
2 
2 
Gonorrhea cases remaining from 1921 
1 
1 
New cases admitted 
74 
42 
116 
Cases readmitted 
23 
23 
Total cases, remaining since 1921, new, and readmitted 
100 
42 
142 
Syphilis cases new treated 
11 
2 
13 
Syphilis cases new referred to other clinics of physicians.... 
16 
8 
24 
Cases new with gonorrhea and syphilis 
3 
3 
6 
Syphilis readmitted for examination referred 
9 
9 
Syphilis readmitted treated 
2 
2 
Cases admitted new suspicious of syphilis 
3 
3 
Cases readmitted suspicious 
i 
1 
Chancroid 
i 
1 
Cases admitted new gonorrhea treated 
ii 
11 
Cases admitted new gonorrhea referred 
5 
ib 
15 
Cases readmitted gonorrhea referred 
3 
3 
Non-venereal treated 
3 
i 
4 
Cases examined found to be non-venereal 
22 
17 
39 
Cases readmitted for examination 
8 
8 
Total cases, new and readmitted 
97 
42 
139 
Cases received from police 
84 
21 
105 
Cases voluntary 
13 
21 
34 
Total cases, new and readmitted 
97 
42 
139 
Total patients discharged and referred to other clinics or 
physicians 
88* 
42** 
130 
Patients remaining under treatment December 31, 1922.... 
9 
Total cases, new and readmitted 
97 
42 
139 
Patients under 21 years 
51 
21 
72 
Patients over 21 years 
46 
21 
67 
Total cases, new and readmitted 
97 
42 
139 
Patients married 
23 
12 
35 
Patients single 
54 
26 
80 
Patients married, separated 
15 
4 
19 
Patients widowed 
5 
5 
Total cases, new and readmitted 
Total treatments 
Hospital days 
Wassermann tests 
Examinations for gonorrhea 
97 
42 
139 
139 
1,458 
140 
119 
* 11 syphilis cases were given course of treatment and referred; 3 gonorrhea 
cases were apparently cured. 
**2 syphilis cases were given course of treatment and referred. 
***6 patients were in detention and 3 were out-patients. 
11 THE VENEREAL DISEASE HOSPITAL 
History 
The Venereal Disease Hospital on Noxon Street was opened in 1919 
as a place for detention and quarantine of women. The majority of the 
women patients have fallen into the hands of the police for violation of the 
law. After being brought before the court, if their conduct has been such 
as to warrant observation and examination, they have a hearing and are 
sent to this institution for examination, isolation and treatment. A small 
number have been committed voluntarily by their parents or referred by 
other welfare organizations. A few have voluntarily returned to the 
institution for treatment and advice after their cases have been disposed 
of. These patients are called voluntary patients. 
Number of Cases 
The annual report for 1922 shows that of 139 cases received during 
the year, 97 were female and 42 male. The police were responsible for 
detaining 105 cases; 34 were classed as voluntary. Of the 97 females, 13 
were voluntary; of the 42 males, 21 were voluntary. Of the total 139 
cases, 22 were non-venereal. From the careful reading of this report, it 
will be found to be somewhat misleading, as it would seem to convey the 
idea that all of the cases, both men and women, were quarantined, while in 
fact only 34 were kept in this institution. All of them were women. It 
will be noticed that only three cases were dismissed as apparently cured. 
Whether those cases were male or female patients is not stated. Only 13 
patients with syphilis received any treatment before being referred else- 
where; only 11 patients with gonorrhea were reported as receiving treat- 
ment before being referred to some other place for treatment. 
There has been an effort here to have patients who have been dis- 
charged from the custody of the police return to the hospital for treatment. 
This appears to be an attempt to establish an outpatient service,—a func- 
tion which is wholly unnecessary,—a duplication of the services provided 
at the Free Dispensary, and a distinct misuse of the facilities provided for 
quarantine purposes. 
Location and Description 
,The Venereal Hospital occupies a brick building which was formerly a 
private dwelling. The immediate surroundings are depressing, and the 
neighborhood generally decadent. On the first floor of the building is the 
office of the physician and the reception room; the quarters of the nurse-in- 
charge, which consist of a large room, a dining room and kitchen. The 
12 second floor is used as a dormitory. It consists of two rooms, a large well- 
equipped treatment room, bathroom, and one small room which is used for 
isolation of inter-current illness. The beds and rooms are neat and clean 
and the atmosphere good. On the day of my visit there were two patients 
who were sitting in idleness. The facilities for treating patients are good, 
the treatment room is light and clean, and the equipment excellent. The 
building is well kept. All of the cases committed to this hospital are sent 
from the courts with an order for their examination and confinement. 
City of Syracuse, County of Onondaga, ss. 
To the Keeper of the Venereal Hospital of said County—Greeting: 
Receive into your custody, and safely keep for further examina- 
tion 
who is charged with 
Given under my hand, this day of 192.... 
Justice of Special Sessions 
(On the reverse side) 
COURT OF SPECIAL SESSIONS 
City of Syracuse 
The People 
against 
Commitment for Examination 
The hospital has none of the appearance of a prison, nor are there any 
precautions taken to prevent escape of the women confined. Several 
patients have gained their freedom by raising a window on the second 
floor and letting themselves down dropping to the ground, a distance of 
about ten feet. The hospital is under the superintendency of a registered 
nurse. The services of a cook and a janitor are provided. The physician- 
in-charge directs the treatment of the cases and visits the hospital daily. 
The routine treatments such as douches, tamponade, etc., are carried out 
by the nurses, the physician administering the salvarsan and other special- 
ized treatments. 
Histories 
The records of the cases are meager. No reliable opinion based upon 
them can be passed upon the type or quality of the treatment given. The 
young women confined to this hospital are awaiting decision by the court. 
No real constructive or rehabilitative activities are attempted. 
13 BUREAU OF LABORATORIES OF THE 
DEPARTMENT OF HEALTH 
Description and Volume of Work 
This Bureau offers adequate facilities for all the necessary diag- 
nostic examinations which might be required in a city of 200,000 inhabi- 
tants. The laboratory is located on the third floor of the City Hall and 
occupies three connecting rooms. All of the routine and many of the 
special laboratory tests for both the city and county are made here, the 
exception being dark field examinations and Wassermann blood tests, which 
are made in the laboratory of the Medical School located on the third 
floor of the Dispensary building. No complement deviation blood tests for 
gonococcal infections or colloidal gold tests on spinal fluid are performed. 
The laboratories are fairly well equipped, the work carefully supervised 
and performed and the results are universally satisfactory to the profes- 
sion. A report of the number of examinations performed in this Bureau 
for the year 1923 shows 830 smears for gonococci; Wassermann tests 
1,716; dark field examinations for spirochete 4. In this annual report it 
will be seen that the figures given for the number of blood Wassermann 
examinations which were made during the year are also in the annual re- 
port of the Syracuse Free Dispensary. This serological work is per- 
formed by a technician who is under the supervision of the city bacteriolo- 
gist. The report properly belongs under the Bureau of Laboratories and 
not under the Syracuse Free Dispensary. 
Child Hygiene 
No study was made of the Bureau of Child Hygiene or of any of its 
clinics. When this study was in progress a survey of this Bureau was 
being made by Doctor Walter Brown. 
Nursing Service of the Department of Health 
The nursing service of the Department of Health was not carefully 
studied, as the relation of this service to the venereal disease program was 
nil, with the exception of assistance which one nurse gives in the operation 
of the prenatal clinic held under the auspices of the Junior League. 
Visiting Nurse Association 
The Visiting Nurse Association has been in operation about ten 
years. It has a board of directors composed of some twenty women. 
Besides the usual committees there is an Advisory Committee, composed 
14 of prominent men to whom it can go for advice and decisions on various 
problems. There are no physicians on any of the committeees of this 
organization, nor is there any connecting link between it and the medical 
profession. This organization is in close contact with the Department of 
Health of Syracuse and supplies nursing and follow-up services in the pre- 
natal clinics, tuberculosis clinics, and in the clinics of the Bureau of Child 
Hygiene. There are no published fundamental rules governing the field 
work of the nurses. The services rendered at the present time by this 
Association include medical, surgical, obstetrical, tuberculosis, prenatal, 
and attendance at prenatal and other clinics. No communicable disease 
cases, including the venereal diseases, are accepted by this service. 
HOSPITAL FACILITIES FOR THE CARE OF 
VENEREAL DISEASE PATIENTS 
Hospitals 
There are three hospitals in the city which are cooperating with the 
University in the training of medical students. They are the University 
Hospital (Hospital of the Good Shepherd), Syracuse Memorial, and St. 
Joseph’s. These institutions will accept patients suffering with a venereal 
disease referred to them from the clinic. 
In the University Hospital, where most of the male cases requiring 
hospital care are referred, sufficient beds are available to care for this class 
of patients. The male cases seen in the Dispensary that require cysto- 
scopic or other special examination are referred to this institution for such 
procedure and for further study and observation. The patients who are 
referred to the hospital are admitted upon a written request of the registrar 
of the Free Dispensary. When such patients are admitted to the hospital, 
the Department of Charities is then notified. If, after an investigation, 
they are found to be entitled to hospital care, the hospital is given an order 
for the patients’ admission and treatment. The city pays the hospital $2 
per diem for this service. The Department of Charities will accept the 
recommendation of the registrar of the Free Dispensary regarding the 
ability of patients to pay for hospital care and treatment. If the registrar 
is in doubt about an applicant’s being entitled to this service, the latter is 
referred directly to the Department of Charities for investigation. No 
records were available in either the office of the Free Dispensary or that of 
the Department of Charities regarding the number of cases referred for 
investigation and treatment, or the number refused such services. 
The record systems of the hospitals, save in one instance, the Uni- 
versity Hospital, are not of the modern type, and it is impossible to secure 
data which would give the investigator the facts as to the number of 
patients admitted for venereal diseases within a given period. In the 
University Hospital a new filing system, a duplication of the plan used in 
Histories 
15 the Presbyterian Hospital of New York City, has recently been installed. 
In a short while, with additional clerical service, the files of this institution 
should be available for detailed studies and analyses of cases. 
PRENATAL CLINICS 
Remarks 
In any carefully considered program for the control of gonococcal and 
spirochetal infections, the importance of preventing the transmission of 
syphilis to the unborn child is paramount. President Wilbur in his annual 
address to the American Medical Association, in San Francisco, June, 
1923, said: “When we can keep the spirochetes of syphilis out of the 
body of every new-born babe, we shall have added enough to human life 
and happiness to heal the wounds of the Great War.” 
Location and Quarters of the Clinics 
There are three prenatal clinics in operation in Syracuse proper and 
one in the village of Solvay. They are located in accessible portions of 
the city: Syracuse Memorial Hospital, West Genesee Street; Free Dis- 
pensary, 610 East Fayette Street, and the Junior League Clinic, 420 East 
Adams Street. These clinics are situated in selected localities; two of 
them are in the most congested districts. One clinic session is held in each 
center every week. The strictly medical activities are under the direction 
of the professor of obstetrics in the University. The quarters in three of 
the four clinics are good; in the fourth the location is not of the best, the 
quarters are dark, the equipment meager and the atmosphere depressing. 
The clinics in the Memorial Hospital and the Free Dispensary are 
used for teaching purposes; sections from the senior class of the Medical 
School are assigned for instruction. In the Junior League Clinic no 
clinical instruction is given to students, as the director is under the im- 
pression that the presence of medical students would prevent patients from 
visiting this center, which is in an Italian district, and that the students 
would be a hindrance rather than a help to him. 
Type of Examination 
Complete physical examinations are not made in the case of every 
new patient in each of the clinics. In one a pelvimetry is the exception 
rather than the rule. Wassermann examinations of the blood are not 
made as a routine procedure and it is only when a suspicious history or a 
puzzling physical finding is discovered that the test is ordered. Frequent 
urine analysis and blood pressure estimations are made on each patient. 
The history forms are good but in many instances hastily and carelessly 
filled out and of little value from a research point of view. 
16 Nursing Service 
The nursing service and the follow-up facilities in all of the prenatal 
clinics are good. The nursing service in three of the clinics is supplied by 
the Visiting Nurse Association, and this service in one,—the Junior League 
Clinic,—is supplied by a nurse from the Department of Health. 
The average number of patients visiting all of the clinics in the past 
six months is 72 per month. A monthly report of the activities in all of 
these clinics is submitted to the Department of Health each month. 
Reports 
The prenatal clinics come under the observation of the Department of 
Health through the submission of monthly reports. From these reports 
it appears that the clinics are operating according to the ideas of the 
several directors rather than through any method of centralized control or 
any attempt at standardization of methods and comparison of end results. 
17 REPORTING OF VENEREAL DISEASE 
There is no provision in the Sanitary Code of the City of Syracuse 
made for reporting the venereal diseases as permitted by state law. The 
cases classed as reported from Syracuse are those which are discovered 
when specimens are submitted to the laboratory for examination. Since 
the law was passed in New York State making venereal disease reportable 
by the submission of a specimen through the laboratory for examination 
after a diagnosis had been made, a great deal of discussion has taken place. 
In making these infections compulsorily reportable, one of the most impor- 
tant objectives is to give the community reasonable protection from the 
risk of contracting an infectious disease from a patient suffering from it. 
The demand for the reporting of goncoccal and spirochetal infections is 
not in itself an attempt to deal with immorality or the control of promis- 
cuous intercourse, but rather to compel a person who contracts a venereal 
disease and refuses to conform to such measures as are laid down by the 
health authorities, to do so. 
It has been contended that the reporting of venereal diseases constitutes 
a breach of confidence between doctor and patient. No one will question 
for a moment that professional confidence is one of the precious possessions 
of the medical profession and should be guarded well, but at the same time 
it should be recognized that there are occasions when the safety of healthy 
persons is of greater importance than the individual interest of infected 
persons. Such an occasion does not arise when a patient contracts a 
venereal disease and tries his best with the help of the doctor to get rid of 
it. But by the same token it is suggested that it does arise when a patient 
refuses all measures of protection to his fellows. From the physician’s 
point of view there is no new principle at stake. For the past thirty years 
or more doctors have willingly cooperated in the attempt to control certain 
infectious diseases by notifying the authorities of the existence of such 
cases. No question of a breach of confidence has been or can reasonably 
be put forward regarding the reporting of smallpox, diphtheria and other 
such infections. Even the reporting of venereal diseases is not entirely 
new, for we have had ophthalmia neonatorum on the list of notifiable 
diseases for many years. We have at this time ample legal authority for 
compelling physicians to report their cases of gonococcal and spirochetal 
infections, and no arguments should be necessary to bring the medical 
fraternity to see its obligations in a true light. 
There were reported by the physicians in Syracuse through specimens 
submitted to the laboratory : 
January 1st to December 31st, 1923, 827 cases of syphilis; 371 of gon- 
orrhea ; a total of 1,198 cases. 
18 434 for syphilis; 194 for gonorrhea; 628 for combined venereal diseases. 
Morbidity Rates (Per 100,GOO Population) 
Syphilis 
Gonorrhea 
Cases continuing treatment at beginning of year 
157 
47 
Old cases readmitted during year 
349 
135 
New cases 
193 
251 
Total Cases 
699 
433 
Clinic Cases 
Proportion of 376 Physicians Registered Reporting 
Number reporting syphilis only 
153 
Number reporting gonorrhea only 
23 
Number reporting both 
Number reporting either one or other 
230 
61% 
Total number reporting syphilis 
207 
55% 
Total number reporting gonorrhea 
77 
20% 
A measure for the control of the venereal diseases has been adopted by 
some health departments for all persons whose occupations bring them into 
close contact with the public, such as food handlers, cooks, bakers, barbers, 
butchers, masseurs, waiters, waitresses, etc. In Syracuse no provision 
is made in the Sanitary Code for the examination of food handlers, and 
consequently there are no available figures regarding the number of such 
examinations made or the number of infections discovered. 
The solution of the venereal disease problem is a difficult task, not 
only from the medical, but from the social and educational point of view. 
There is a growing body of public opinion interested in this problem, and 
it is believed that the struggle against these diseases must be faced, and 
that they can be overcome. No one solution is looked for, nor thought to 
be possible, but if the physicians are going to hasten the day when these 
diseases are held within narrow limits, they must give their loyal sympa- 
thetic support to the public health control of these infections, by reporting 
their cases. 
VENERAL DISEASES IN PRIVATE PRACTICE 
A Report of an Inquiry Addressed to the Physicians 
of Syracuse, New York 
Methods of Inquiry 
As a part of the venereal disease survey of Syracuse, an inquiry was 
addressed to all physicians in that city in regard to the number of cases of 
venereal diseases they had been treating in private practice during 1923. 
Included in the inquiry were a number of questions with reference to their 
experience in dealing with these cases and in securing cooperafion from the 
health authorities of the city in matters which might properly be referred 
to them. 
19 The inquiry was carried out by mailing to each physician a printed set 
of questions. Copies of the question blank and of the letter sent with the 
blank to explain the purpose of the inquiry are attached to this report. In 
order to provide for securing frank statements of opinions and criticisms, 
the physicians were asked to return the blanks without signing them. As 
they were returned without signatures, there was no possible way of know- 
ing which of the physicians had filled in a blank. The question blanks 
were mailed early in November to the 376 physicians listed with Syracuse 
addresses in the 1923 Medical Directory of the American Medical Associa- 
tion. 
Views of Physicians 
In general, it would appear from their reports that these physicians are 
favorable to measures already undertaken for the control of venereal dis- 
eases in Syracuse. They are making extensive use of the laboratory facil- 
ities provided by the city and they have no difficulty in obtaining free treat- 
ment for cases unable to pay for private treatment. The fact that very 
few physicians have objections to reporting and that a considerable number 
of them accuse themselves of carelessness in not reporting their cases en- 
courages the hope that, with some urging of the importance of reporting to 
the health authorities, adequate reporting may be secured in Syracuse. 
Most encouraging of all is the fact that these physicians have voiced no 
outstanding grievances. There seem to be no serious obstacles to over- 
come before putting into efifect the suggested program for venereal disease 
control in Syracuse. 
Who Replied 
By January 1st, 116 of the blanks, or nearly a third of them had been 
filled in and returned. In addition, four blanks were returned, because the 
addressee was not found. Of the 116 physicians who returned filled-in 
blanks, 68 stated that they treat venereal diseases and 48, that they never 
treat them. Since most of the questions concerned actual experience in 
handling cases, summaries of the replies of the 68 who treat venereal dis- 
eases constitute this report. 
Before considering the replies of the 68 physicians, it must be noted 
that they do not in any sense furnish a complete survey of the venereal 
situation as regards private patients in Syracuse. Dr. Joseph S. Lawrence. 
Director of the Bureau of Venereal Disease, New York State Department 
of Health, in a recently published paper1 states that 287 physicians of Syra- 
cuse had cooperated during 1922, in venereal disease control with the 
State Department of Health by reporting venereal disease cases either 
directly or through the laboratories. Included in this group of 287 physi- 
cians were 183 who had dealt with active cases and 104 who had sent to 
the laboratories specimens which were not found positive. On the basis 
of a comparison of actual numbers, the group of 68 physicians replying to 
the present inquiry would constitute 24 per cent of the group Dr. Law- 
rence reported. However, there is no evidence to show that the group of 
68 is a fair sample of the total group in respect either to number of cases 
1 The Attitude of the Medical Profession of the State of New York toward the 
Venereal Diseases. Joseph S. Lawrence and Russell B. Tewksbury. New York 
State Journal of Medicine, January, 1916. 
20 treated or to attitudes toward measures for control. The very fact that 
these physicians cooperated in the inquiry may indicate a special interest in 
problems of venereal disease control. The summaries of replies are pre- 
sented, therefore, as indicating the practice of a group of physicians suf- 
ficiently interested in problems of venereal disease control to cooperate in 
the inquiry, rather than as a complete description of the experiences and 
opinions of Syracuse physicians in general. It is further hoped that the 
report will bring to the attention of those physicians who have not yet re- 
turned filled-in blanks, the important information that might be secured 
through a complete response to the inquiry. If they will return the blanks, 
another more comprehensive report will be prepared. 
Number of Cases Treated 
The combined reports of the 68 physicians who treat venereal diseases, 
presented in Table 1, show that 1,963 cases had been; handled by them from 
January 1 to October 1, 1923. Included in this group of 1,966 cases were 
1.082 cases of gonorrhea, 602 of syphilis, 159 of vulvo-vaginitis, and 120 of 
chancroid. It is interesting to compare these figures showing the cases 
treated in private practice with statements as to the number of cases re- 
ceiving free treatment during the same period. The following table, based 
on information furnished by Dr. Lawrence, shows the number and classifi- 
cation of cases treated in the Syracuse Free Dispensary from January 1 to 
October 1, 1923: 
Classification 
Syphilis 
Gonorrhea 
Cases at beginning of year 
157 
47 
Old patients readmitted 
265 
118 
Total new cases admitted 
128 
184 
Total cases 
550 
349 
In the practice of the 68 physicians, the ratio of gonorrhea cases to 
syphilis cases was not quite two to one. This is somewhat lower than the 
usual estimate that gonorrhea is from three to five times as prevalent as 
syphilis. It is interesting to compare this ratio with the summaries of case 
reports for New York State outside of New York City, according to which 
during the past three years the ratio of gonorrhea to syphilis has been 
about four to ten. The low ratio in the state reports may be attributed to 
the greater use of laboratories for the diagnosis of syphilis than of gonor- 
rhea. 
About three times as many men as women have sought treatment. 
The exact ratio of men to women cannot be determined because vulvo- 
vaginitis cases were not recorded according to age and it is known that 
many of those reported were children. There were only 36 children in- 
cluded among the patients reported in the questionnaire, 16 having gonor- 
rhea and 20 congenital syphilis. 
More than half of the syphilis cases were in the tertiary stage. There 
were only 133 cases of primary syphilis as compared with 110 of secondary 
syphilis and 313 of tertiary syphilis. These figures are in line with state- 
21 ments by a number of competent observers that fewer new infections of 
syphilis are being seen. An interesting comparison could have been made 
if information had been secured from the Syracuse physicians in regard to 
the number of cases of the different stages of syphilis that they had treated 
in previous years. 
Among the cases of primary syphilis, there were 108 cases in men and 
25 cases in women. Less than 20 per cent of the cases were in women. 
Among secondary syphilis cases, also, about 20 per cent of the cases were 
in women. Among the cases of tertiary sj'philis, on the other hand, 191 
cases were in men and 122 in women. In this stage the proportion of 
cases in women was about 40 per cent, or twice the proportion reported in 
the other stages. Of the congenital syphilis cases 20, or less than half 
were of children. 
The summaries presented in Tables 2 and 3 indicate that the venereal 
disease cases are not evenly distributed among the physicians. Only 14 of 
them treated 10 or more cases of gonorrhea and only 13 of them, as large 
groups of syphilis cases. In terms of percentages, 21 per cent of the phy- 
sicians treated 84 per cent of the gonorrhea cases and 19 per cent of them 
treated 80 per cent of the syphilis cases. Twenty-four per cent of the 
physicians had treated no gonorrhea cases at all and 22 per cent no syph- 
ilis. Again, as regards the syphilis cases, 47 or 69 per cent of the physi- 
cians, had treated no cases at all of primary syphilis and only 14, or 21 per 
cent of them, reported congenital syphilis; while nearly half of the physi- 
cians had treated tertiary syphilis. 
Non-Resident Patients 
Of the 68 physicians who treat venereal diseases, 57 replied to this 
question. Thirty-five, or 61 per cent of those who replied, stated that they 
had treated no cases of non-residents. Of the remaining 22 physicians, 
only one had treated a considerable number of cases. He stated that he 
had treated over 400 patients from January 1 to October 1, and of these, 
25 per cent were non-residents. The other reports either stated that very 
few cases from outside of the city were treated or the percentages given are 
to be applied to such small numbers of cases that the actual numbers 
treated are very small. It may be concluded that a very large proportion 
of the 1,963 cases are residents of Syracuse. 
Use of Laboratories 
Only one of the 68 physicians reported that he never uses laboratory 
tests. One other stated that he had not yet had occasion to send material 
to a laboratory. Five did not reply. The city laboratory was used by 
more physicians than any other laboratory. The number of physicians re- 
porting that they had used each of the laboratories in 1923 is as follows: 
22 Laboratory 
Number of Physicians 
City 
52 
State 
40 
Hospital 
19 
Commercial 
4 
Own 
3 
A few physicians reported the use of only one laboratory for all their 
tests, as follows: 
Laboratory 
Number of Physicians 
City 
12 
State 
3 
Hospital 
1 
Commercial 
1 
Own 
1 
Fourteen had used the city, state and hospital laboratories. Twenty- 
one used both the city and the state laboratories. 
It is evident from the figures presented above that the physicians of 
this group depend to a great extent on the city laboratory for doing their 
tests. The commercial laboratories have been little used. Four physi- 
cians who had treated very few cases in the year reported having sent ma- 
terial to them in 1923. 
The question regarding reporting was stated as follows: “Do you 
report all your cases to the health authorities? If not, what are your ob- 
jections to the law?” Eleven physicians did not reply to this question. 
Of the 57 who did reply, 31, or 54 per cent of them, answered “Yes” and 
26, or 46 per cent of them, answered “No.” Of the 26 who answered 
“No,” nine stated that they did not report directly because their cases 
were reported through the laboratories. Five more said they were merely 
careless about reporting and had no objections to doing so. 
The remaining 12 gave the following objections: five, that patients 
object; one, not necessary to report tertiary syphilis; two, not necessary if 
patient is faithful; two, “none of state’s business, a confidential matter be- 
tween patient and doctor”; one, “one city directory enough”; one, “city 
does not want reports.” It is interesting to find that no one mentioned the 
fact that there is no legal requirement for reporting, and also that in reply 
to the question regarding means used for bringing under treatment patients 
who have discontinued treatment, only three physicians said that they re- 
ferred such cases to the Department of Health. 
Reporting of Cases 
The 68 physicians were practically unanimous in stating they have no 
difficulty in securing free treatment for such patients in dispensaries. 
Four stated they had had difficulty about hospital patients but indicated by 
their comments that they did not anticipate similar difficulty in the future. 
Securing Treatment for Patients Unable to Pay 
23 Criticisms of Health Agencies 
All but eight of the 68 physicians stated their opinions on this point. 
Fifty-two had no complaint and in many cases offered favorable comments. 
Eight had complaints to make and mentioned the following: two, that the 
public agencies take patients who can afford to pay; two, that they meddle 
with matters that only physicians have the proper knowledge to deal with ; 
one objects to teachings about prophylaxis; one thinks hospital facilities 
should be increased; the remaining two did not state the complaint. 
There is virtually no agreement among the 68 physicians in their re- 
plies to the question, “In your experience, are the venereal diseases on 
the increase or decrease in Syracuse? Give reasons for your answer.” 
Twenty-two replied that they did not know. Fourteen more did not 
answer and it is possible that they, too, had been unable to form an opinion. 
Of the 32 who expressed an opinion, 7 thought the prevalence had not 
changed, 11 had observed an increase and 14 a decrease. 
Of the 11 who replied that there was an increase, 2 gave no reasons 
for their answers. The reasons given by the remaining 9 were as follows: 
2 physicians stated that there were more cases; 1 said more cases applied to 
clinics, 2 said there were more cases among little children, one of them 
stating that better diagnosis in pediatrics might account for this fact; 2 
blamed bootlegging and the non-enforcement of prohibition; 1 blamed 
clandestine prostitution and 1, “the girl of today.” 
Only 10 of the 14 physicians who had observed a decrease gave rea- 
sons for their answers. Of these, 6 stated that they saw fewer cases them- 
selves. Two physicians attributed the decrease to the closing of the 
houses of prostitution, one to the provision of free treatment facilities, and 
one to the general use of prophylaxis. 
Opinions About the Prevalence of the Veneral Diseases 
SYRACUSE FREE DISPENSARY 
A. It is recommended that the reports of the activities of the Dis- 
pensary be simplified and made informative so that the number of new and 
old patients receiving treatment for venereal infections be shown rather 
than the total number of treatments administered. 
B. It is recommended that the day and evening clinics in which 
gonococcal infections are treated be placed under the supervision of the 
director of the department in the Medical School. 
C. It is recommended that the genito-urinary and syphilis clinics be 
thoroughly and modernly equipped. In the purchase of the necessary 
instruments and appliances the directors of the two departments should 
be consulted and given the opportunity of selecting the apparatus. 
24 D. It is recommended that the history form used in the genito- 
urinary and syphilis clinics be carefully studied and revised to meet the 
present standard of clinic procedure. (Suggested forms for study are 
attached.) 
E. It is recommended that the obsolete wooden files in the record 
room be replaced with modern steel units. While the scientific value of 
the present records is small, to lose them by fire or other preventable acci- 
dent would be a serious matter. 
F. It is recommended that two trained social workers, preferably 
graduate nurses, be employed to bring under treatment and keep under 
observation, those patients with a venereal disease, who voluntarily dis- 
charge themselves from the clinic while in a communicable stage, and to 
investigate and bring to the clinic for examination and treatment, if neces- 
sary, contacts who may be infected. (Suggestions for standard of medi- 
cal case work attached.) 
G. It is recommended that provision be made for the separation of 
the races and sexes in the present plan of providing waiting space and 
treatment room facilities in the night clinic. Separate treatment rooms 
should be provided and in this manner the separation will be a simple and 
practicable procedure. 
H. It is recommended that suitable posters be placed on the walls 
of the general waiting room in close proximity to the designated clinics 
in order that the patients while awaiting treatment may secure additional 
information regarding all phases of health habits. 
25 RECOMMENDATIONS 
General 
Inasmuch as this study is but a part of the preliminary inquiry neces- 
sary for the Health Demonstration program in the entire city, it is 
recognized that no plan for a special section of prevention should be 
considered by itself. At the risk of duplicating a proposal of venereal dis- 
eases which may be offered by other surveyors the following recommenda- 
tion is made: 
There should be formed in Syracuse a Public Health Com- 
mittee which will include in its membership representatives of 
the professions dealing with the prevention and treatment of the 
sick, private and public agencies engaged in health protection, 
representatives of the Medical Department of the University 
of Syracuse, important labor groups, women’s clubs, and such 
organizations of business men as the Rotary and Kiwanis Clubs, 
Chamber of Commerce, and others for the purpose of assisting 
the constituted authorities in promoting a comprehensive pro- 
gram of constructive health activities. 
DEPARTMENT OF HEALTH 
Organization 
A. It is recommended that the Bureau of Communicable Disease 
in the Department of Health be reorganized with a full-time, trained 
physician in charge and such assistance as is necessary. Such an impor- 
tant position should carry with it a salary commensurate with the responsi- 
bilities. 
B. It is recommended that the Bureau of Venereal Disease be 
included as a sub-division of the Bureau of Communicable Disease and 
that a part-time, trained physician with a suitable salary, be placed in 
charge of all of these activities in the city. 
C. It is recommended that the Bureau of Venereal Disease prepare 
and carry out a program which will include in its activities educational 
measures, recreational measures, protective social measures, law enforce- 
ment measures and medical measures. In the preparation of any program, 
all of the coordinating agencies,—national, state, and city, both voluntary 
and official,—should be approached through the Public Health Committee 
of the Academy of Medicine and the plan of procedure so correlated that 
there will be no overlapping or just cause for criticism in the carrying on 
of the work. 
26 D. It is recommended that an educational program be adopted 
which will include as an integral part of the activities of the Bureau of 
Venereal Disease the following: 
1. Addresses to clubs, faculty groups, Y. M. C. A., Y. W. C. A., 
Boy Scouts, Girl Scouts, High Schools and other groups for the purpose 
of character building and to present the proper aspect of sex social ques- 
tions. 
2. Instruction of the public regarding health and hygiene; the pre- 
valence of venereal diseases, method of spread, economic and social loss; 
the damage and effects upon posterity of the venereal diseases and the 
serious consequences to the individual. Such lectures can be illustrated 
with moving pictures, lantern slides and other visual aids. 
3. Exhibitions of various kinds by the use of display cards and 
posters. 
4. Distribution of pamphlets. 
5. Circular letters sent periodically to physicians, dentists, nurses, 
and interested laymen. 
Recreational Mleasures 
Improvement and regulation of amusements, entertainment and rec- 
reational facilities through playgrounds, clubs, theaters, and literary, 
musical and athletic organizations, and stimulation of group activities. 
Protective Social Measures 
1. Safeguarding and bettering home surroundings and influences 
by measures tending to increase home comforts and attractions and better 
housing and living conditions. 
2. The proper care of the feeble-minded. 
Law Enforcement 
1. Elimination of all environmental conditions favoring the dissemi- 
nation of the venereal diseases by suppression of prostitution, prevention 
of solicitation and enforcement of prohibitory laws effective equally against 
both sexes. Provision and maintenance of facilities for diagnosis, treat- 
ment and control of infected persons. Discovery of infected individuals 
through laboratory aids to diagnosis, through the stimulation of better 
diagnostic service by dispensaries and hospitals, and through an examina- 
tion made by the general medical profession in private, public and industrial 
practice. 
2. Provision of treatment through the maintenance of dispensaries 
with adequate equipment and personnel to supplement the service afforded 
by the medical profession and the enforcement of legislation against treat- 
ment by unqualified persons. 
27 3. Control of infected persons through thorough instruction regard- 
ing the venereal diseases by the physician responsible for the treatment 
of such patients, through the provision of hospital facilities, the quarantine 
of cases under certain circumstances and the enforcement of penalties for 
exposing others to infection. 
Prenatal Clinics 
1. It is recommended that the prenatal clinics receive more direct, 
thorough and active supervision from the Department of Health. 
2. It is recommended that a single type of history form be adopted 
for all of the clinics so that studies of the end results in each center will 
be comparable. 
3. It is recommended that the minimum requirement for examination 
shall include a complete physical examination, pelvimetry and a routine 
Wassermann on each new patient. 
4. It is recommended that sections from the third and fourth year 
classes in the Medical College be assigned to the clinics and definite tasks 
outlined. 
Ordinances 
A. It is recommended that there be added to the Sanitary Code of 
the city a section requiring the reporting of venereal diseases by the phy- 
sician who makes such a diagnosis. Reports can be required to be made 
by name or number. It would be wholly consistent to approach the 
physician through the Public Health Committee of the Academy of Medi- 
cine for suggestions and recommendations on this question. 
B. It is recommended that there be added to the Sanitary Code of 
the city a provision regulating the employment of, and requiring a physical 
examination of such workers as food handlers, cooks, barbers, bakers, 
masseurs, butchers, waiters, waitresses, beauty parlor operators, and others. 
INSTITUTIONS 
A. It is recommended that the Venereal Hospital on Noxon Street 
be closed and the patients transferred to the unused building of the City 
Hospital. 
B. It is recommended that in the plans for the construction of the 
new Communicable Disease Hospital, provision be made for both male and 
female patients having a venereal disease, who are committed by the courts. 
C. It is recommended that the present system of providing services 
for the Free Dispensary in the budget of several bureaus of the Depart- 
ment of Health be changed. In studying the expenditures of the several 
bureaus of Department of Health it is impossible to get correct knowledge 
from the items given as to the cost of the various services provided. 
Remarks : In the proposals and discussion of the erection and staff- 
ing of the new hospital, the cooperation of the Medical Department of the 
28 University should be sought with the idea in mind of having the college 
authorities responsible for the medical services and the municipality for 
the administration and upkeep. Such a plan would insure the best pos- 
sible service to the patients, be an excellent center for the training of 
students and physicians, and be of immense educational value to the public. 
Medical College 
1. It is recommended that the Dean of the Medical College so 
correlate the didactic work of the curriculum in genito-urinary diseases 
and syphilis that the clinical practice in the Dispensary will coincide with 
the lectures. 
2. It is recommended that the Dean of the Medical College hold the 
heads of the departments in the Medical School responsible for the conduct 
and operation of the genito-urinary and syphilis divisions in the Dispen- 
sary. Attendance upon the clinic by the head of each division in the 
College should be made obligatory. The attendance required might be 
only once a week, and then only for cases requiring consultation; but 
unless the chief of each department assumes responsibility and takes an 
active part in this important function in medical education and training, 
the value of such instruction will be lessened. 
29 GROUPS TREATED 
Total Group, all 
Venereal Diseases 
Gonorrhea 
Syphilis 
Chancroid 
Vulvo- 
vaginitis 
ah 
Syphilis 
Sec- Con- 
Primary ondary Tertiary genital 
0) 
(2) 
(3) 
(4) 
(5) 
(6) 
(7) 
(8) 
(9) 
(1) Men 
1380 
885 
404 
108 
87 
191 
18 
91 
(2) Women 
388* 
181 
178 
25 
23 
122 
8 
29 
(3) Children 
36* 
16 
20 
0 
0 
0 
20 
0 
(4) Total, all cases treated. 
1963** 
1082 
602 
133 
110 
313 
46 
120 
159 
Number of physicians re- 
porting number of cases 
treated 
63 
67 
64 
64 
64 
64 
64 
66 
67 
* Vulvo-vaginitis not included as only total was given. 
** Including 159 cases of vulvo-vaginitis. 
TABLE 2. TABLE SHOWING THE NUMBER OF PHYSICIANS WHO REPORTED 
THAT 
THEY 
HAD TREATED 
THE SEVERAL TYPES OF VENEREAL DISEASES JANUARY 1, TO 
OCTOBER 1, 1923 
classification of physicians 
One or More of the 
Gonorrhea 
Syphilis 
Chancroid 
Vulvo- 
Venereal Diseaes 
vaginitis 
All 
Sec- 
Con- 
Syphilis Primary ondary Tertiary genital 
(1) 
(2) 
(3) 
(4) 
(5) 
(6) 
(7) 
(8) 
(9) 
(1) Report treating one or 
more cases 
58 
51 
49 
17 
20 
32 
14 
17 
19 
(2) Have treated cases, but 
do not give complete 
report of number of 
cases or type of dis- 
ease 
5 
1 
4 
4 
4 
4 
4 
2 
1 
(3) Have treated no cases 
in this period 
5 
16 
15 
47 
44 
32 
50 
49 
48 
(4) Total number of physi- 
cians who accept vene- 
real disease cases 
68 
68 
68 
68 
68 
68 
68 
68 
68 
TABLE 1. TABLE SHOWING THE NUMBER OF CASES TREATED JANUARY 1, TO OCTOBER 1, 1923 
30 TABLE 3. TABLE SHOWING THE DISTRIBUTION OF CASES AMONG 
PHYSICIANS JANUARY 1 TO OCTOBER 1, 1923 
GONORRHEA 
SYPHILIS 
Total Cases 
Total Cases 
NUMBER OF CASES 
Physicans 
Treated 
Physicians 
Treated 
TREATED 
No. 
Per cent 
No. 
Per cent 
No. 
Per cent 
No. 
Per cent 
(1) 
(1) 
(2) 
(3) 
(4) 
(5) 
(6) 
(7) 
(8) 
10 or more 
. 14 
20.6 
905 
83.7 
13 
19.1 
481 
79.9 
(2) 
4 to 9 inclusive 
23 
33.8 
144 
13.3 
12 
17.6 
78 
13.0 
(3) 
3 
. 6) 
181 
4 1 
121 
(4) 
2 
■ 7 } 
20.6 
14 ) 
3.0 
ii y 
35.3 
22 
- 7.1 
(5) 
1 
• U 
1J 
9 1 
9 J 
(6) 
No cases at all. . 
16 
23.5 
0 
0 
15 
22.0 
0 
0 
07) 
Records not 
available 
. 1 
1.5 
? 
4 
6.0 
? 
(B) 
Total group ... 
. 68 
100.0 
1082 
100.6 
68 
100.0 
602 
100.0 
VENEREAL DISEASE SURVEY OF SYRACUSE 
1. Questionnaire for Physicians 
1. Do you treat patients with venereal diseases; gonorrhea, syphilis, chancroid, 
and vulvo-vaginitis ? 
2. How many cases have you treated from January 1st to October 1st, 1923, of 
each of the following: 
Male Female Children 
A. Gonorrhea Adults Adults Under 16 
1. Primary 
B. Syphilis 2. Secondary 
3. Tertiary 
4. Congenital 
C. Chancroid 
D. Vulvo-vaginitis 
3. What proportion of your venereal disease patients are non-residents ? 
4. In confirming your diagnosis do you make use of laboratory tests ? Check in 
the following list the laboratories to which you have sent material for tests during 
1923. 
City Laboratory State Laboratory Hospital Laboratory 
Commercial Laboratory Others (specify) 
5. Do you report all of your cases to the health authorities? If not, what are 
your objections to the law? 
6. What proportion of your patients stay under your treatment until discharged 
as cured? 
Male? Female? 
7 What methods do you use in bringing patients under treatment who have 
discontinued treatment: 
A. While still on the communicable stage of the disease? 
B. While still uncured? 
8. In your experience are the venereal diseases on the increase or decrease in 
Syracuse ? Give reasons for your answer. 
31 9. If you do not treat venereal disease patients, what advice do you give those 
coming to you for treatment? 
A. Do you refer them to a specialist? 
10. Do you have any difficulty in obtaining hospital or dispensary care for pa- 
tients with venereal disease who cannot afford to pay a reasonable fee to a physician 
for care at home or at his office? 
11. Do you have any difficulty in obtaining hospital care for patients with vene- 
real disease who can afford to pay? 
12. Have you any complaint against public or private health agencies because of 
their activities in the field of venereal diseases ? 
13. Additional remarks. (Write on other side of this paper.) 
November 1, 1923. 
Dear Doctor : 
In conjunction with the tuberculosis and general health demonstration which is 
being carried on in Syracuse, a study of the venereal disease problem is to be made. 
This survey will include prevalence, treatment, facilities, reporting, social service 
follow-up and other public health measures. 
To make this study of the greatest value, a direct and personal appeal is being 
made to each physician for his whole-hearted support and cooperation. Without cer- 
tain information which only physicians can give, no worthwhile conclusions can be 
drawn as to the number of cases of gonococcal and spirochetal infections which are 
under treatment, and the number which need treatment. 
The questionnaire method has been selected as the best and simplest means for 
obtaining this information so that time and effort will be conserved for the busy 
doctors and field workers. In the preparation of the inquiry we have endeavored to 
make it as brief and simple as possible. Every question is important and should be 
answered completely. 
The information requested will be kept wholly confidential and, as will be noted, 
the form does not call for the signature of the physician reporting. A statistical 
summary only will be used in a publication of the results of this study. 
Will you kindly let me have a prompt reply using the enclosed stamped envelope? 
Very truly yours, 
WALTER M. BRUNET, M.D. 
References 
Special documents which may be obtained on request through the Health Dem- 
onstration office were presented with the text of the report under the following 
headings: 
Suggestions for Staff Organization of Venereal Disease Clinics. 
Suggestions for History taking—Syphilis. 
Suggestions for History baking—Gonorrhea. 
Suggestions for making physical examination—Syphilis. 
Suggestions for making physical examination—Gonorrhea. 
Instructions for patients having syphilis. 
Instructions for patients having gonorrhea. 
Suggestions Standard of medical case work. 
Suggestions for careful follow-up by mail. 
Suggestions for clinic organization and routing of traffic in a clinic. Chart 
supplies by Dispensary Development Committee of the Associated Out- 
Patient Clinics, New York City. 
32