Contents

APPENDIX D

A Summary of Venereal Disease Statistics During World War II

The methods of reporting venereal disease before and during the first part of World War II made it extremely difficult to determine true incidence rates. In the first place, many men were inducted into the Army who either had an undiagnosed infection or who developed the symptoms of a venereal disease very soon after induction. In these instances, the case was reported at time of diagnosis and charged against the Army rate. Secondly, there were many patients with chronic cases of venereal disease who were transferred from one Army hospital to another, and many of these patients were reported numerous times as representing new venereal infection. Beginning on 1 November 1942, infections acquired by soldiers before induction were not charged against the overall Army rate. Other measures were taken to prevent repeated reporting of the same case, and from this date on the actual rate per thousand men per year is believed to be fairly accurate. In addition, the statistical branch of the Venereal Disease Control Division prepared weekly and monthly statistical tables showing infection rates from venereal diseases, rates for noneffectiveness due to venereal diseases, and days lost per case of venereal disease, broken down by various service commands, theaters of operations, and so forth. This service was essential to the effective operation of the office and was continued throughout the war under the direction of Capt. Stanley Brooks Russell, MAC.

Under each of the various parts of chapter X, reference was made to certain statistics such as incidence rates, rates for noneffectiveness, and so forth, as they pertained to the material being discussed. It must be emphasized that these statistics were often tentative and based on whatever records were available during the war. Obviously, such data cannot be considered to be more than suggestive and were used primarily to indicate trends. They have been checked, whenever possible, by the Medical Statistics Division, Office of the Surgeon General, and have been revised, when necessary, to reflect the latest and most complete information available. Parts I and III of chapter X were reviewed to reflect data available as of December 1954. The data in parts II, IV, and V and in this appendix were checked in view of all information which had been gathered, analyzed, and summarized as of December 1956. In the latter instance, statistics compiled as a result of summarizing statistical health reports from the various commands were substituted for the less accurate statistics presented in other reports from these commands during the war.

The extent of error which will exist in the final statistics probably will never be known. It was recognized that many cases of venereal diseases were never diagnosed as such. It was also known that other cases were deliberately concealed and never carded for record, particularly during the period when punitive measures were in effect. No reliable studies were ever done to determine the actual extent of concealed cases, but various authorities have suggested that as much as 30 percent of venereal disease occurring in the U.S. Army in the continental United States was never known to the Army. The soldiers concerned obtained treatment through outside sources and, unless complications developed, were frequently able successfully to conceal their infection despite scheduled and unscheduled physical inspections.

It was doubted that the extremely low venereal disease rates for officers reflected the true situation because it was even less of a problem for officers to obtain outside

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treatment or, in some instances, to be treated clandestinely at Army medical installations without being carded for record.

In order that some comprehensive estimate of venereal disease incidence and morbidity might be available in this volume, the tables which follow were prepared by the Medical Statistics Division, Office of the Surgeon General. In summary, it can be stated very simply that the lowest venereal disease rates in the U.S. Army occurred during 1943 and that the rates began to rise in 1944, further increased in 1945, and showed marked increases after the cessation of hostilities. The most striking factor, however, was that during this same period rates for noneffectiveness because of venereal disease, which had been very high in 1941 and 1942, dropped to new record lows by the end of the war in spite of increased incidence of the diseases. This decrease in noneffectiveness undoubtedly reflected the tremendous advances in treatment made during the war which are described in chapter X of this volume and also in another volume of the history of the Medical Department in World War II.¹

The following 18 tables show statistical data on venereal diseases during the period 1941 through 1945 by geographic distribution and specific diagnosis. Diseases shown include gonorrhea, neurosyphilis, other syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale. The samples used to obtain tabulations of admission data, incidence data, or both were as follows: For 1942, 100 percent; for 1943, 20 percent in the United States and 100 percent in oversea areas; for 1944, 20 percent in Europe and 80 percent in other areas; and, for 1945, a 20 percent worldwide sample. Appendix table 9, which shows comparative rates of Negro troops versus non-Negro troops, varied from the cited sampling in that only 18 percent of individual medical records were used to obtain the 1944 statistics. Moreover, appendix table 8, which presents statistics on deaths due to venereal disease, was compiled from a review of all deaths recorded in the Army during the period.

Incidence (total cases) includes not only those cases in which the specified diagnosis was the primary cause of admission to medical treatment but also those cases for which the disease existed concurrently with another admission diagnosis or those cases which developed after admission to treatment. The data include cases contracted before Army service and, unless stated otherwise, CRO (carded for record only) cases; that is, patients treated on an outpatient basis without loss of time from duty. Tabulations of cases contracted before Army service were, however, available only for 1945; for this one year, 2 percent of the gonorrhea cases, 48 percent of the neurosyphilis cases, and 25 percent of the other syphilis cases were reported as having been contracted before Army service.

In appendix tables 4, 5, and 6, the loss to the Army in manpower as a result of venereal diseases is summarized. Average duration means the average time lost per admission, while rates for noneffectiveness reflect the average number of patients in hospitals or sick in quarters per 1,000 average strength. Admissions for venereal diseases and data on average duration, it is to be noted, are separately shown in appendix table 6 for 1945 to exclude and include CRO cases. Obviously, those cases carded for record only must be differentiated in that they do not contribute to the noneffectiveness shown in appendix tables 4 and 5.

Concerning the rate for noneffectiveness, it is worthy of note that in the years immediately preceding World War II venereal disease was one of the major causes of noneffectiveness at a daily rate of about 3.5 per 1,000 troops. This daily rate represented approximately one-half of the noneffectiveness caused by all infectious and parasitic diseases. By the last year of the war, the rate for noneffectiveness because of

¹Medical Department, United States Army. Internal Medicine in World War II. Volume II. Infectious Diseases. [In preparation.]

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venereal disease had dropped to about 1 per 1,000 troops, or approximately one-fifth of the noneffectiveness caused by all infectious and parasitic diseases.

Aforementioned appendix table 9 includes pooled data for both officers and enlisted men and reveals that venereal disease prevailed to an appreciably greater extent among Negro troops. Even though officers are confined mainly to the non-Negro category and show lower rates, according to the data for 1942 (the only year for which this type of data are available), the exclusion of officers would have had only a slight influence on the relative annual rates per one thousand average strength of the racial dichotomy. The rates per one thousand average strength for all venereal diseases, with and without officer cases, for 1942, follow:

Finally, the data presented in chapter X for the years 1942 through 1945 must be considered preliminary pending completion of final tabulations of individual medical records.

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APPENDIX TABLE 1.-Incidence of venereal diseases in the U.S. Army, by diagnosis and area, 1941

[Rate expressed as number of cases per annum per 1,000 average strength]

¹Enlisted men only; includes Alaska.

²White enlisted men and native troops only.

³Native troops have not been distributed by geographic locations.

Source: Annual Report, Surgeon General of the Army, 1941.

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APPENDIX TABLE 2.- Incidence (total cases) of venereal diseases in the U.S. Army, by diagnosis, broad geographic area, and year, 1942-45

[Preliminary data based on sample tabulations of individual medical records]
[Rate expressed as number of cases per annum per 1,000 average strength]

474-476

APPENDIX TABLE 3.- Incidence (total cases) of venereal diseases in the U.S. Army, by diagnosis, theater or area, and year, 1942-45

[Preliminary data based on sample tabulations of individual medical records]
[Rate expressed as number of cases per annum per 1,000 average strength]

¹Includes North Africa.

²Includes Alaska and Iceland.

³Includes cases on transports.

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APPENDIX TABLE 4.- Noneffectiveness caused by venereal diseases in the U.S. Army, by diagnosis, 1942

[Preliminary data based on sample tabulations of individual medical records]

[Rate expressed as average number of noneffectives per 1,000 average strength]

¹Total days lost during the calendar year.
²Based on days lost and incidence (total cases) during the calendar year.

APPENDIX TABLE 5.-Noneffectiveness caused by venereal diseases in the U.S. Army, by diagnosis, 1942

[Preliminary data based on sample tabulations of individual medical records]

[Rate expressed as average number of noneffectives per 1,000 average strength]

¹Total days lost for all 1942 admissions.
²Average number of days lost per 1942 admission.

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APPENDIX TABLE 6.-Average duration for venereal diseases, with and without cases carded for record only (no time lost) in the U.S. Army, 1945

[Preliminary data based on sample tabulations of individual medical records]

¹Admissions with known days lost.

APPENDIX TABLE 7.-Cases of venereal diseases in the U.S. Army, by diagnosis, 1944-45

[Preliminary data based on sample tabulations of individual medical record primary and secondary diagnoses]
[Rate expressed as number of cases per annum per 1,000 average strength]

479

APPENDIX TABLE 8.-Deaths due to venereal diseases in the U.S. Army, by diagnosis and year, 1941-45¹

[Years 1942-45 based on preliminary tabulations of individual medical records]
[Rate expressed as number per annum per 1,000 average strength]

¹No deaths due to granuloma inguinale or lymphogranuloma venereum during 1941-45.
²Enlisted men only; includes Alaska.
³White enlisted men and native troops only.

APPENDIX TABLE 9.-Incidence of venereal diseases in the U.S. Army, by diagnosis and race, 1942-44

[Preliminary data based on sample tabulations of individual medical records]
[Rate expressed as number of cases per annum per 1,000 average strength]

480

APPENDIX TABLE 10.-Incidence (total cases) of gonorrhea in the U.S. Army, by theater or area and month, 1942

481-482

APPENDIX TABLE 11.-Incidence (total cases) of gonorrhea in the U.S. Army, by theater or area and month, 1943