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Interestingly, Michigan did not even attempt to pass a TB reporting statute until 1909 and physicians described it as being “far behind twenty other states.” “New York's Tuberculosis Law,” Journal of the Michigan State Medical Society 8 (1909):86; Warthin, Aldred Scott, “The Need of Michigan in the Fight Against Tuberculosis,'” Journal of the Michigan State Medical Society 8 (1909): 78–82.Google Scholar

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In Allen v. Dept. of Health William H. Allen petitioned the health department for access to all typhoid records, including the records of cases. Allen gave “no reason or explanation why he desires to inspect these records” and made the request solely “upon his presumed right as a taxpayer” under Section 1545 of the Charter of the City of New York, which stipulated that “All books, accounts and papers in any department or bureau thereof, except the police and law departments, shall at all times be open to the inspection of any taxpayer, subject to any reasonable rules and regulations.” Laws of 1901, chap. 466, section 1545. Allen made his claim based on section 1545 of the city charter as well as section 1175, which allowed the department of health to establish regulations regarding whey and how “papers, files, reports, record and proceedings” should be made public and publicized. Laws of 1901, ch. 466, section 1175. In the case of Egan, the city had, indeed, ruled that citizens had the right to inspect records regarding the award of city contracts. Matter of Egan, 205 N.Y. 147. But in Allen, the opinion differed dramatically, based on the nature of the records in question. See also “In the Matter of the Application of William H. Allen, Appellant, to Examine Certain Records on File in the Department of Health in the City of New York, Respondent, Opinion of Willard Bartlett, April 1912, 205 N.Y., pp. 158–160.Google Scholar

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See also Johnson, Paul B., “Social Hygiene and the War,” Social Hygiene 4 (1918):91–137, which indicates that these fears would persist among physicians.Google Scholar

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“Enforcement of Reporting in New York City,” Social Hygiene 9 (1923):244. Similarly, in 1935, the Massachusetts Health Commissioner warned that 37.3 percent of physicians had failed ever to report a case of VD and that if the compliance rate was not improved then the state would cease to supply them with free arsenicals for treatment. Chadwick, Henry D., “The Reporting of Syphilis: The Commonwealth of Massachusetts Department of Public Health State House, Boston,” N. Engl. J. Med. 212 (March 14, 1935): 494.Google Scholar

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Gertrude Seymour, PHS, “A Year’s Progress in Venereal Disease Control,” Social Hygiene 5 (1919): 49–66, at 61. Another editorial declared that “early notification is a most important factor in the warfare against disease. … [P]hysicians should rally to the good cause and see to it that their districts are furnished with reliable figures concerning the incidence of communicable disease.” >“Tuberculosis and Notification,” American Journal of Public Health 8 (1918): 924–925, at 925. See also Cole, H.N., “How Physicians of Ohio May Aid in the Campaign Against Venereal Diseases,” Ohio State Medical Journal 15 (February 1919): 68–69, at 68, which stated, “The fighting and industrial needs of the nation demand that sick men be made well quickly and with certainty. Venereal infection among the civilian population must be controlled to maintain the maximum efficiency to work of fight.”Google Scholar

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Vermont developed a two-tiered system of VD reporting in 1913, following in the path of New York City. “Legislation to Prevent the Spread of Venereal Diseases,” Social Hygiene 1; 4 (1915): 635–638. The Vermont legislation stipulated that “All information and reports in connection with persons suffering from such diseases shall be regarded as absolutely confidential, and shall not be accessible by the public nor shall records be deemed public records.” As in New York, Vermont did not require physicians to report the names and addresses of their private patients, providing privacy for this class of patient. But physicians were required to report the name, address, sex, age, nationality, and race of every “charitable patient” they encountered in “hospitals, dispensaries, clinics, homes, asylums, [and] charitable and correctional institutions.” Vermont, Act No. 218, Feb. 3, 1913, reported in “Sanitary Legislation: State Laws and Regulations Pertaining to Public Health,” Public Health Reports 28 (1913): 1173–1180, at 1179.Google Scholar

“Legislation to Prevent the Spread of Venereal Diseases,” Social Hygiene 1; 4 (1915): 635–638. By 1921, only seven states required name reporting. Forty states required reports using serial number and of these, 17 specified that names were to be reported when the patient “fails to observe proper precautions.” Dublin, Louis I., Statistician, Metropolitan Life Insurance Co., and Mary Augusta Clark, Statistician, American Social Hygiene Association, “A Program for the Statistics of the Venereal Diseases,” Public Health Reports 36; 50 (December 16, 1921): 30713088. See also “The Massachusetts Venereal Disease Program,” Boston Medical and Surgical Journal CLXXVII;3 (January 17, 1918): 100–102.Google Scholar

In 1918, for example, Massachusetts adopted what was known as the “West Australian” method for coded reporting, which protected both the patient and physician identity: “At the first visit or consultation the physician furnishes the patient with a numbered circular of information and advice. At the same time he fills out the numbered report blank attached to the circular of advice and mails it to the state department of health. If the patient has been under the care of another physician previously, the second physician consulted notifies the first one on a special blank provided for that purpose. If the patient fails to return to the attending physician for a period of six weeks, the physician notifies the state department, which, in turn, notifies the local board of the community in which the patient resides.” Physicians were only required to report names “only when he will not follow proper medical advice or cease from infecting others.” In this manner, the state felt that it was possible “as far as it is consistent with the best interests of the public health, [to] respect the patient's instinctive desire for secrecy.” “Control of Venereal Disease in Massachusetts,” JAMA 70;17 (1918): 1234–1235. See also “The Western Australia Act for the Control of Venereal Disease,” Social Hygiene 3; 1 (1917): 148–149. By 1924, health officers in Massachusetts reported that it had almost never been necessary to quarantine patients refusing treatment. Eugene R. Kelley, Commissioner, Massachusetts Department of Public Health, and Albert Pfeiffer, Chief, Subdivision of Venereal Diseases, Massachusetts Department of Public Health,” “Some Special Features of Massachusetts' Program for Venereal Disease Control,” JAMA 83;12 (1924): 913–918. See also Johnson, Paul D., “Social Hygiene and the War,” Social Hygiene 4;1 (1918): 91–137.Google Scholar

“New Regulation for Venereal Disease Reports,” California State Journal of Medicine 16 (August 1918); 375. Like Massachusetts, California adhered to the West Australian method for reporting. Patients in Massachusetts were also informed that their case was being reported by code. Johnson, Paul B., “Social Hygiene and the War,” Social Hygiene 4;1 (1918): 91–137. In sharp contrast, the Medical Societies of Ross and Pickaway Counties in Ohio adopted a resolution that if any member of the armed services were to seek treatment that physicians should, “without informing the applicant, report the case immediately to the Division Surgeon's office.” If a soldier failed or refused “to give satisfactory address,” physicians should refuse treatment “on the ground that such identification is expected of all patients.” Physicians were further called on to report other physicians who violated the resolution. “Some Social Hygiene Resolutions of Importance,” Social Hygiene 4 (1918): 242–243.Google Scholar

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Kelley, Eugene R., “The Massachusetts Venereal Disease Program,” Boston Medical and Surgical Journal CLXXVIII;3 (January 17, 1918): 100–102; Thomson, Alec Nicol, “The Massachusetts Plan,” Social Hygiene 5 (1919): 317–335. Massachusetts explicitly protected the identity of physicians who reported patients by name. See also Digest of Laws and Regulations Relating to the Prevention and Control of Syphilis and Gonorrhea in the Forty-Eight States and the District of Columbia (New York: American Social Hygiene Association with the Cooperation of the USPHS, 1940): 174, 78.Google Scholar

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Druggists were also required to keep records of all prescriptions by name and address unless the prescription bore the physician's “key” number. The law specifically protected druggists' records from all but local and state health officials. “Venereal Diseases Regulations Explained: Observance Declared Patriotic Duty,” Illinois Medical Journal 33 (June 1918): 342–345.Google Scholar

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Prior to 1938, the department had used the count of positive laboratory results to estimate the levels of VD. They ceased this practice in 1938 because physician reporting had increased some 126 percent in just one year. Indeed, by the second quarter of 1938, private physicians were exceeded health clinics (whose reporting also increased 135 percent) in reporting cases of syphilis and gonorrhea. Charles Walter Clarke, Supervising Consultant, and Theodore Rosenthal, Director, Bureau of Social Hygiene, New York City Department of Health, “The Private Physician's Role in the New York City Syphilis Control Activities,” JAMA 111 (1938): 2287–2290.CrossRefGoogle Scholar

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Connecticut, for example, began requiring reports by full name, age, address, and occupation with the explicit stipulation that “such reports of infected persons shall be confidential and not open to public inspection” in 1943. Physicians were further required to report individuals who failed to return for observation or treatment. And, in addition, physicians were required to attempt to determine the source of infection and, if successful, report this name “in strict confidence.” “Change in Reporting Cases of Syphilis, Gonorrhea and Chancroid,” Connecticut Medical Journal 7(November 1943): 787–788. The District of Columbia, however, reverted to name-based reporting as early as 1926. “Reports of Venereal Disease, District of Columbia,” JAMA 86(1926):1842.Google Scholar

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The goal of the program was to eradicate syphilis by 1972, leaving a structure in place for the subsequent eradication of gonorrhea. Parts I and II, Venereal Disease Branch Chief’s Statement, Control of Venereal Diseases, December 1963, p. 2, Part I, p. 4, Part II. RG 442, Box 108374, Folder: Program Planning Conference (December 1963), NARA, Atlanta Georgia. See also letter from Bauer, Theodore J., Assistant Surgeon General, to Surgeon and Chief, Bureau of State Services, Re: Task Force Report on Syphilis Control in the United States, January 12, 1962. RG 442, Box 105232, Folder: “Task Force Report on Syphilis Control in the United States,” NARA, Atlanta, Georgia; E-mail communication from Russell Havlak, March 20, 2003. For a critique of the eradication effort, see Aidan Cockburn, T., Assistant Commissioner of Health, Director Division, of Research, Ohio, “Comments on the Proposal to Eradicate Syphilis from the USA,” transcript of proposed article, February 1963. RG 442, VD Manuscript Files, Box 70A470, Folder, “Cockburn, Aiden T.” NARA, Atlanta, Georgia.Google Scholar

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One source indicates that in 1967 27 states required lab reporting. Public Advisory Committee on Venereal Disease Control: A Follow-Up Report of The Surgeon General’s Task Force on Syphilis Control, Atlanta, Georgia, June 16–17, 1966 (US Department of Health, Education, and Welfare, Public Health Service, 1967):7. RG 90, Box 334068, Folder: “Public Advisory Committee on VD Control,” NARA, Atlanta, Georgia. Another, however, suggests that 33 states and 80 locales had mandatory lab-based reporting as early as 1965. The American Public Health Association, The American Social Health Association, The American Venereal Disease Association, The Association of State and Territorial Health Officers, with the cooperation of the American Medical Association, “Today's VD Problem,” February 1966, p. 33. RG 442, Box 318288, File: “VD Program Informational Materials,” NARA, Atlanta, Georgia. See also letter from Donaldson, Alan W., Scientist Director, to Chief, CDC Washington Office, BSS (CH), and Deputy Chief, Communicable Disease Center, Re: Proposal for State Legislation, March 25, 1964. RG 442, Box 108379, Folder: “Legal 1964, Proposed Legislation,” NARA, Atlanta Georgia, which indicates that as of 1964 the following areas required lab-based reporting: Chicago, Connecticut, California, the District of Columbia, Florida, Illinois, Kentucky, Michigan, Missouri, Nebraska, New Jersey, Nevada, New York State, New York City, Oregon, Pennsylvania, Puerto Rico, Tennessee, Utah, and Ohio (regulations only in Ohio).Google Scholar

Health departments, however, were not able to follow-up on all of the lab-based reports, and in 1966 designated some 31 percent of cases as not requiring follow-up. Health departments did not follow up on weakly reactive specimens, specimens among the elderly, and specimens from health department clinics. US Department of Health, Education and Welfare, Public Health Service, Report of the Venereal Disease Branch Fiscal Year 1966 (CDC:Atlanta, Georgia, 1966):9–10. RG 90, Box 334069, Folder: “VD Branch Report, FY 1966,” NARA, Atlanta Georgia. Thus, by 1967, despite a 24 percent increase in physician reporting from 1954 to 1965 and an increase in the percentage of patients contacted and interviewed by health officials (81.8 percent in 1963 and 89.6 percent in 1965), the PHS cut back on visits to private physicians in the face of continuing personnel shortages creating by failure of funding to keep pace with activities. Public Advisory Committee on Venereal Disease Control: A Follow-Up Report of The Surgeon General’s Task Force on Syphilis Control, Atlanta, Georgia, June 16–17, 1966 (US Department of Health, Education, and Welfare, Public Health Service, 1967):1–2, 5–6. RG 90, Box 334068, Folder: “Public Advisory Committee on VD Control,” NARA, Atlanta, Georgia. Instead, the Surgeon General’s Task Force on Syphilis Control recommended intensified contact tracing efforts in all high incidence areas, dubbing the program “Operation Pursuit.” Public Advisory Committee on Venereal Disease Control: A Follow-Up Report of The Surgeon General’s Task Force on Syphilis Control, Atlanta, Georgia, June 16–17, 1966 (US Department of Health, Education, and Welfare, Public Health Service, 1967):1–2, Box 334068, Folder: “Public Advisory Committee on VD Control,” NARA, Atlanta, Georgia.Google Scholar

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Part I, Venereal Disease Branch Chief’s Statement, Control of Venereal Diseases, December 1963, p. 1. RG 442, Box 108374, Folder: “Program Planning Conference (Dec. 1963),” NARA, Atlanta Georgia.Google Scholar

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Guthrie Birkhead, New York State Department of Health, AIDS Institute, personal communication, June 16, 2003.Google Scholar

The California code required laboratory-based reporting not only for syphilis and gonorrhea, but also diphtheria, tuberculosis, and typhoid. The prohibitions against patient contact until a report had been made applied to all conditions. Memorandum from Chief, Venereal Diseases Branch, Public Health Service, Center for Disease Control and Prevention, to Assistant Chief, Communicable Disease Center, February 27, 1964 and attached California Administrative Code. RG 442, Box 108379, Folder: “Legal 1964, Proposed Legislation,” NARA, Atlanta, Georgia.Google Scholar

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E-mail from Russell Havlak, March 25, 2003.Google Scholar

The American Public Health Association, The American Social Health Association, The American Venereal Disease Association, The Association of State and Territorial Health Officers, with the cooperation of the American Medical Association, “Today’s VD Problem,” February 1966, p. 39. RG 442, Box 318288, File: “VD Program Informational Materials,”NARA, Atlanta, Georgia.Google Scholar

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