Профилактика вензаболеваний в армии США, Вторая Мировая
отрывки из "Medical service in the European theater of operations", на английском языке. Кто переведет с человеческим качеством - тому спасибо
Venereal disease, in spite of rapid and effective treatment with sulfa drugs and penicillin, cost the Army heavily in lost time from duty and diversion of medical resources, as well as being a source of political and social tension between the Americans and their British hosts. Recognizing the importance of this health problem, General Hawley in September 1942 organized a separate Venereal Disease Control Branch in the Preventive Medicine Division. Headed by Lt. Col. Paul Padget, a venereal disease specialist from John Hopkins University, this branch had responsibility for control and prevention, while the Professional Services Division supervised treatment. As the medical service expanded, base sections, air forces, armies, and lower-echelon headquarters acquired their own venereal disease control officers. Padget and his small staff made general policies, gave advice, and held periodic meetings of control officers from other commands to exchange ideas and experiences.
Padget and his colleagues, as well as troop commanders at every echelon, employed the standard Army methods of controlling venereal disease. Commands worked with the Red Cross and Special Services to provide wholesome recreation for their troops and (rarely) took disciplinary action against men who became infected. Units emphasized education. Line officers, surgeons, chaplains, and specially trained NCOs lectured on the dangers of venereal disease and the methods of preventing it. Films and posters, the latter often drawn by enlisted men in contests, graphically presented the same themes. All media urged men on grounds of patriotism, unit pride, faithfulness to loved ones at home, and personal self-interest to avoid illicit sexual contact, which, itwas emphasized, almost invariably led to infection. If the soldiers were unable to comply, the education program urged them to be careful by using correctly the mechanical and chemical prophylactics the Army provided. Getting down to basic details, the Northern Ireland Base Section surgeon suggested that venereal disease lecturers “secure a model penis and show the men the exact method of putting on and taking off a condom.”
The medical service furnished prophylaxis in abundance and in a variety of forms. It issued condoms without charge at a rate of six per man per month and individual chemical prophylactic kits (“V-Packettes”) at a rate of two per man per week. Because many units, especially in the Air Force and Services of Supply, were located some distance away from the hospitals and dispensaries that served them, the Preventive Medicine Division arranged for the Quartermaster Department to distribute individual prophylactics along with its other supplies so that, as Padget put it, organizations “drew their condoms at the same time they drew their soap and brushes.” Prophylactics for women soldiers became the subject of delicate negotiations between General Hawley, General Lee, and the senior officer of the Women’s Army Auxiliary Corps (WAAC). The fact that such equipment had contraceptive as well as hygienic uses was, Hawley declared, “political dynamite.” Nevertheless, all concerned decided that the women’s health had to receive priority. The medical service issued equipment for douches to WAAC organizations while taking pains to emphasize the hygienic purpose and ruling out measures “primarily contraceptive in nature.”
Besides furnishing individual equipment, base sections and other commands set up prophylactic stations in cantonments and, after much haggling with the British-and, according to Gordon,' “relentless” pressure upon them-in towns and cities frequented by men on pass. The Red Cross allowed the Army to place prophylactic stations in its clubs, where most soldiers on leave stayed. Many potentially infected men, as a result, “found a prophylactic station right in their path when they returned to quarters.” Units posted the locations of prophylactic stations in neighboring towns on their bulletin boards and stamped them on passes. The Central Base Section made free condoms and V-Packettes available at every London railroad station and at billeting. and transportation offices and operated sixteen prophylactic stations, many in Red Cross clubs. Reflecting the continued prevalence of racial segregation, these stations included two especially for black soldiers, staffed with black medical personnel. By arrangement with the provost marshal, every soldier confined in the Central Base Section guardhouse, unless arrested on duty, received a prophylactic treatment during booking. During the first half of 1944 the Central Base Section by these methods distributed over 10,000 V-Packettes and 33,500 condoms and gave over 30,000 station prophylactic treatments.
The usual Army procedure for combating venereal disease included close cooperation with civilian authorities to stamp out prostitution in areas frequented by troops and to trace civilian sexual partners of infected soldiers. In Great Britain, law and social custom stood in the way of both these efforts. Brothels were rare, but individual streetwalkers abounded in London and other large cities. Under laws that treated even commercial sexual arrangements between individuals as entirely private, the police could not interfere with such women unless they caused public disorder. Compounding the problem, most soldiers had their sexual contacts with nonprofessional “pickups.” These “enthusiastic amateurs” were totally out of reach of the police, andthe Venereal Diseases Control Act of 1916, which permitted libel action against a person who implied that someone else was infected, effectively barred British social agencies from helping the Americans trace them. The Privy Council, in Defense Regulation 33B, issued in December 1942, permitted a venereal disease patient privately to name his or her partner to a physician, who then could pass on the information to the appropriate local public health officer. After two separate identifications of the same person as the “source of infection,” the public health officer could compel the individual to report for examination and treatment. This regulation was of little direct use to the theater medical service, because two soldiers rarely identified the same woman definitively enough to meet the evidentiary requirements.
The medical service could do little to check prostitution, except make occasional informal arrangements with local police. In London, for example, American MPs and officers of the Metropolitan force rigorously restricted loitering by soldiers and civilians in Piccadilly Circus and Leicester Square, making pickups at least harder to arrange. The Americans had more success with contact tracing, using Regulation 33B as their opening wedge. Exploiting to the full his cordial relations with the Ministry of Health, Colonel Gordon prevailed on the reluctant British to allow U.S. Army nurses to take names of partners from infected soldiers and then visit the women, warn them they might be infected, and suggest they go to a British clinic for treatment. Because the entire action was confidential and informal and the contacts’ responses were voluntary, the Americans by this means could get around the rigid rules of Regulation 33B. Colonel Padget launched the program in February 1943 in six counties in East Anglia, employing four Army nurses experienced in public health work. Much to the surprise of the sceptical British, the program provoked almost no civilian resentment and had substantial results. Of the first 500 women approached, only one - a professional prostitute - took offense, and over 75 percent eventually sought medical assistance. The Preventive Medicine Division expanded the effort throughout the United Kingdom, doubling the number of nurses assigned, and in February 1944 transferred administration of it to the base sections. British county health officers, impressed with the U.S. Army’s success, organized similar contact teams and gradually began exchanging information with their Allies.
In reciprocity for British acquiescence in this benign invasion of their cherished privacy, General Hawley tried to respond to Ministry of Health and Army Medical Services protests against the introduction into the United Kingdom of American soldiers already infected with venereal disease. He repeatedly called to Surgeon General Kirk’s attention the fact that transports from the United States regularly made port with scores of new syphilis and gonorrhea cases on board, and he warned that apparent American nonchalance on this question jeopardized hard-won British cooperation with his control measures. The chief surgeon arranged to detect and hold for treatment all infected soldiers on arriving vessels. On the other side of the Atlantic the New York Port of Embarkation inspected troops carefully before embarkation and either kept infected men back for treatment or provided treatment on shipboard. Surgeon General Kirk, however, was reluctant to stop altogether shipment of men with venereal disease, lest he create a new medical way for malingerers to avoid overseas duty. Further, many troops became infected during their last preembarkation leaves, twenty-four to forty-eight hours before sailing, and their symptoms did not appear in time to be noted in boarding inspections or to be treated and cured on the voyage. The Army, as a result, continued to import venereal disease into the British Isles, and its doing so remained an unresolved irritant in Anglo-Amer-ican medical relations.68
The medical service’s broad-fronted attack on venereal disease produced encouraging results. The rate of new
cases per 1,000 troops per year, which stood at 58 at the end of 1942, dropped to 21 by late 1943 and to about 20 in mid-1944. Colonel Padget attributed part of this decline to what he called a “dilution factor” resulting from the rapid influx of new troops who had not yet had time to find female company. Nevertheless, he was “reasonably certain that the lowering of the rate . . . was an actuality and not just an artifact brought about by troop movements.” As was true throughout the Army, black soldiers in the European Theater had a venereal disease rate about four and one-half times that of white troops, the result of complex causes largely not correctable by the theater medical service. The black rate did respond, however, to education and prevention efforts, falling from 127 cases per 1,000 troops per year in February 1944 to 83 in June. Its general rise and decline paralleled those for other troops, only at a higher level. Among overseas theaters, which normally had higher venereal disease rates than the continental United States, the European Theater during 1942-44 ranked lower than all other theaters but the Southwest Pacific and Pacific Ocean.
Venereal disease, in spite of rapid and effective treatment with sulfa drugs and penicillin, cost the Army heavily in lost time from duty and diversion of medical resources, as well as being a source of political and social tension between the Americans and their British hosts. Recognizing the importance of this health problem, General Hawley in September 1942 organized a separate Venereal Disease Control Branch in the Preventive Medicine Division. Headed by Lt. Col. Paul Padget, a venereal disease specialist from John Hopkins University, this branch had responsibility for control and prevention, while the Professional Services Division supervised treatment. As the medical service expanded, base sections, air forces, armies, and lower-echelon headquarters acquired their own venereal disease control officers. Padget and his small staff made general policies, gave advice, and held periodic meetings of control officers from other commands to exchange ideas and experiences.
Padget and his colleagues, as well as troop commanders at every echelon, employed the standard Army methods of controlling venereal disease. Commands worked with the Red Cross and Special Services to provide wholesome recreation for their troops and (rarely) took disciplinary action against men who became infected. Units emphasized education. Line officers, surgeons, chaplains, and specially trained NCOs lectured on the dangers of venereal disease and the methods of preventing it. Films and posters, the latter often drawn by enlisted men in contests, graphically presented the same themes. All media urged men on grounds of patriotism, unit pride, faithfulness to loved ones at home, and personal self-interest to avoid illicit sexual contact, which, itwas emphasized, almost invariably led to infection. If the soldiers were unable to comply, the education program urged them to be careful by using correctly the mechanical and chemical prophylactics the Army provided. Getting down to basic details, the Northern Ireland Base Section surgeon suggested that venereal disease lecturers “secure a model penis and show the men the exact method of putting on and taking off a condom.”
The medical service furnished prophylaxis in abundance and in a variety of forms. It issued condoms without charge at a rate of six per man per month and individual chemical prophylactic kits (“V-Packettes”) at a rate of two per man per week. Because many units, especially in the Air Force and Services of Supply, were located some distance away from the hospitals and dispensaries that served them, the Preventive Medicine Division arranged for the Quartermaster Department to distribute individual prophylactics along with its other supplies so that, as Padget put it, organizations “drew their condoms at the same time they drew their soap and brushes.” Prophylactics for women soldiers became the subject of delicate negotiations between General Hawley, General Lee, and the senior officer of the Women’s Army Auxiliary Corps (WAAC). The fact that such equipment had contraceptive as well as hygienic uses was, Hawley declared, “political dynamite.” Nevertheless, all concerned decided that the women’s health had to receive priority. The medical service issued equipment for douches to WAAC organizations while taking pains to emphasize the hygienic purpose and ruling out measures “primarily contraceptive in nature.”
Besides furnishing individual equipment, base sections and other commands set up prophylactic stations in cantonments and, after much haggling with the British-and, according to Gordon,' “relentless” pressure upon them-in towns and cities frequented by men on pass. The Red Cross allowed the Army to place prophylactic stations in its clubs, where most soldiers on leave stayed. Many potentially infected men, as a result, “found a prophylactic station right in their path when they returned to quarters.” Units posted the locations of prophylactic stations in neighboring towns on their bulletin boards and stamped them on passes. The Central Base Section made free condoms and V-Packettes available at every London railroad station and at billeting. and transportation offices and operated sixteen prophylactic stations, many in Red Cross clubs. Reflecting the continued prevalence of racial segregation, these stations included two especially for black soldiers, staffed with black medical personnel. By arrangement with the provost marshal, every soldier confined in the Central Base Section guardhouse, unless arrested on duty, received a prophylactic treatment during booking. During the first half of 1944 the Central Base Section by these methods distributed over 10,000 V-Packettes and 33,500 condoms and gave over 30,000 station prophylactic treatments.
The usual Army procedure for combating venereal disease included close cooperation with civilian authorities to stamp out prostitution in areas frequented by troops and to trace civilian sexual partners of infected soldiers. In Great Britain, law and social custom stood in the way of both these efforts. Brothels were rare, but individual streetwalkers abounded in London and other large cities. Under laws that treated even commercial sexual arrangements between individuals as entirely private, the police could not interfere with such women unless they caused public disorder. Compounding the problem, most soldiers had their sexual contacts with nonprofessional “pickups.” These “enthusiastic amateurs” were totally out of reach of the police, andthe Venereal Diseases Control Act of 1916, which permitted libel action against a person who implied that someone else was infected, effectively barred British social agencies from helping the Americans trace them. The Privy Council, in Defense Regulation 33B, issued in December 1942, permitted a venereal disease patient privately to name his or her partner to a physician, who then could pass on the information to the appropriate local public health officer. After two separate identifications of the same person as the “source of infection,” the public health officer could compel the individual to report for examination and treatment. This regulation was of little direct use to the theater medical service, because two soldiers rarely identified the same woman definitively enough to meet the evidentiary requirements.
The medical service could do little to check prostitution, except make occasional informal arrangements with local police. In London, for example, American MPs and officers of the Metropolitan force rigorously restricted loitering by soldiers and civilians in Piccadilly Circus and Leicester Square, making pickups at least harder to arrange. The Americans had more success with contact tracing, using Regulation 33B as their opening wedge. Exploiting to the full his cordial relations with the Ministry of Health, Colonel Gordon prevailed on the reluctant British to allow U.S. Army nurses to take names of partners from infected soldiers and then visit the women, warn them they might be infected, and suggest they go to a British clinic for treatment. Because the entire action was confidential and informal and the contacts’ responses were voluntary, the Americans by this means could get around the rigid rules of Regulation 33B. Colonel Padget launched the program in February 1943 in six counties in East Anglia, employing four Army nurses experienced in public health work. Much to the surprise of the sceptical British, the program provoked almost no civilian resentment and had substantial results. Of the first 500 women approached, only one - a professional prostitute - took offense, and over 75 percent eventually sought medical assistance. The Preventive Medicine Division expanded the effort throughout the United Kingdom, doubling the number of nurses assigned, and in February 1944 transferred administration of it to the base sections. British county health officers, impressed with the U.S. Army’s success, organized similar contact teams and gradually began exchanging information with their Allies.
In reciprocity for British acquiescence in this benign invasion of their cherished privacy, General Hawley tried to respond to Ministry of Health and Army Medical Services protests against the introduction into the United Kingdom of American soldiers already infected with venereal disease. He repeatedly called to Surgeon General Kirk’s attention the fact that transports from the United States regularly made port with scores of new syphilis and gonorrhea cases on board, and he warned that apparent American nonchalance on this question jeopardized hard-won British cooperation with his control measures. The chief surgeon arranged to detect and hold for treatment all infected soldiers on arriving vessels. On the other side of the Atlantic the New York Port of Embarkation inspected troops carefully before embarkation and either kept infected men back for treatment or provided treatment on shipboard. Surgeon General Kirk, however, was reluctant to stop altogether shipment of men with venereal disease, lest he create a new medical way for malingerers to avoid overseas duty. Further, many troops became infected during their last preembarkation leaves, twenty-four to forty-eight hours before sailing, and their symptoms did not appear in time to be noted in boarding inspections or to be treated and cured on the voyage. The Army, as a result, continued to import venereal disease into the British Isles, and its doing so remained an unresolved irritant in Anglo-Amer-ican medical relations.68
The medical service’s broad-fronted attack on venereal disease produced encouraging results. The rate of new
cases per 1,000 troops per year, which stood at 58 at the end of 1942, dropped to 21 by late 1943 and to about 20 in mid-1944. Colonel Padget attributed part of this decline to what he called a “dilution factor” resulting from the rapid influx of new troops who had not yet had time to find female company. Nevertheless, he was “reasonably certain that the lowering of the rate . . . was an actuality and not just an artifact brought about by troop movements.” As was true throughout the Army, black soldiers in the European Theater had a venereal disease rate about four and one-half times that of white troops, the result of complex causes largely not correctable by the theater medical service. The black rate did respond, however, to education and prevention efforts, falling from 127 cases per 1,000 troops per year in February 1944 to 83 in June. Its general rise and decline paralleled those for other troops, only at a higher level. Among overseas theaters, which normally had higher venereal disease rates than the continental United States, the European Theater during 1942-44 ranked lower than all other theaters but the Southwest Pacific and Pacific Ocean.