History

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

470

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.]

471

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:

	Rate
Enlisted men only:
Negroes	261.64
Non-Negro personnel	27.43
Total	43.30
Officers and enlistd men:
Negroes	259.95
Non-Negro personnel	25.64
Total	40.36

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.

472

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]

Diagnosis	Total Army		United States¹		Overseas²
	Total Army		United States¹		Total overseas		Hawaii		Panama		Philippine Islands
	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate
Gonorrhea	37,645	28.03	34,115	29.94	3,482	29.51	489	13.04	1,108	36.84	667	67.50
Neurosyphilis	262	.20	227	.20	32	.27	9	.24	15	.50	2	.20
Syphilis, other	8,239	6.13	7,181	6.30	1,021	8.65	96	2.56	208	6.92	189	19.13
Chancroid	4,679	3.48	2,902	2.55	1,774	15.03	37	.99	855	28.43	420	42.50
Lymphogranuloma venereum	768	.57	626	.55	142	1.20	2	.05	59	1.96	33	3.34
Granuloma inguinale	16	.01	16	.01	---	0	---	0	---	0	---	0
Diagnosis	Overseas²-Continued
	Puerto Rico		Other areas		Transports		Native troops³
	Puerto Rico		Other areas		Transports		Filipinos				Puerto Ricans
	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate			Number of cases	Rate
Gonorrhea	354	55.52	284	38.01	95	27.28	46	4.09			439	36.64
Neurosyphilis	1	.16	---	0	---	0	2	.18			3	.25
Syphilis, other	205	32.15	48	6.42	13	3.73	14	1.24			248	20.70
Lymphogranuloma venereum	14	2.20	8	1.07	1	.29	2	.18			23	1.92
Granuloma inguinale	---	0	---	0	---	0	---	0			---	0

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.

473

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]

Diagnosis	1942-45		1942		1943		1944		1945
Diagnosis	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate
	CONTINENTAL UNITED STATES
Gonorrhea	464,962	31.52	83,540	31.44	123,920	23.91	130,652	32.87	126,670	43.21
Neurosyphilis	7,499	.51	825	.31	4,015	.77	1,744	.44	865	.30
Syphilis, other	222,906	15.12	18,284	6.88	87,895	16.96	77,827	19.60	38,900	13.27
Chancroid	21,085	1.43	6,465	2.43	8,190	1.58	3,680	.93	2,750	.94
Lymphagranuloma venereum	9,374	.64	1,730	.65	3,080	.59	2,624	.66	1,940	.66
Granuloma inguinale	623	.04	61	.02	100	.02	287	.07	175	.06
	OVERSEAS
Gonorrhea	416,694	38.81	12,038	20.55	33,843	20.05	112,063	29.34	258,750	55.72
Neurosyphilis	2,290	.21	86	.15	296	.18	1,018	.27	890	.19
Syphilis, other	95,474	8.89	3,652	6.23	10,369	6.14	31,678	8.29	49,775	10.72
Chancroid	78,276	7.29	4,114	7.02	12,235	7.25	24,577	6.44	37,350	8.04
Lymphogranuloma venereum	5,625	.52	304	.52	749	.44	1,342	.35	3,230	.70
Granuloma inguinale	260	.02	4	.01	11	.01	75	.02	170	.04
	TOTAL ARMY
Gonorrhea	881,386	34.59	95,578	29.47	157,763	22.96	242,625	31.14	385,420	50.88
Neurosyphilis	9,739	.38	911	.28	4,311	.63	2,762	.35	1,755	.23
Syphilis, other	318,380	12.50	21,936	6.76	98,264	14.30	109,505	14.06	88,675	11.71
Chancroid	99,361	3.90	10,579	3.26	20,425	2.97	28,257	3.63	40,100	5.29
Lymphogranuloma venereum	14,999	.59	2,034	.62	3,829	.56	3,966	.51	5,170	.68
Granuloma inguinale	883	.03	65	.02	111	.02	362	.05	345	.05

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]

Theater or area	1942-45		1942		1943		1944		1945
Theater or area	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate
	GONORRHEA
Continental United States	464,692	31.52	83,540	31.44	123,920	23.91	130,562	32.87	126,670	43.21
Overseas:
Europe	220,336	50.09	2,218	26.72	6,423	24.07	41,575	24.79	170,120	71.71
Mediterranean¹	98,512	66.42	724	31.58	15,560	34.07	51,443	79.20	30,785	87.00
Middle East	3,981	27.23	224	37.05	1,287	24.26	1,370	29.64	1,100	26.90
China-Burma-India	9,087	20.72	317	36.25	985	24.86	3,295	19.53	4,490	20.28
Southwest Pacific	44,344	24.15	1,830	25.69	2,184	11.50	4,100	7.60	36,230	34.97
Central and South Pacific	13,658	10.87	1,120	7.42	1,247	4.28	2,571	5.86	8,720	23.21
North America²	3,614	7.34	706	7.02	1,053	5.41	1,145	8.86	710	10.43
Latin America	13,441	35.24	4,383	43.00	4,218	34.91	3,290	38.35	1,550	21.28
Total overseas³	416,694	38.81	12,038	20.55	33,843	20.05	112,063	29.34	258,750	55.72
Total Army	881,386	34.59	95,578	29.47	157,763	22.96	242,625	31.14	385,420	50.88
	NEUROSYPHILIS
Continental United States	7,449	0.51	825	0.31	4,015	0.77	1,744	0.44	865	0.30
Overseas:
Europe	872	.20	9	.11	33	.12	405	.24	425	.18
Mediterranean¹	263	.18	2	.09	50	.11	126	.19	85	.24
Middle East	56	.38	2	.33	24	.45	20	.43	10	.24
China-Burma-India	168	.38	----	----	7	.18	106	.63	55	.25
Southwest Pacific	371	.20	20	.28	59	.31	122	.23	170	.16
Central and South Pacific	309	.25	25	.17	54	.19	125	.28	105	.28
North America²	110	.22	9	.09	26	.13	55	.43	20	.29
Latin America	129	.34	18	.18	42	.35	49	.57	20	.27
Total overseas³	2,290	.21	86	.15	296	.18	1,018	.27	890	.19
Total Army	9,739	.38	911	.28	4,311	.63	2,762	.35	1,755	.23
	SYPHILIS, OTHER
Continental United States	222,906	15.12	18,284	6,88	87,895	16.96	77,827	19.60	39,900	13.27
Overseas:
Europe	43,307	9.84	619	7.46	2,468	9.25	11,395	6.79	28,825	12.15
Mediterranean¹	22,574	15.22	177	7.72	3,560	7.79	11,457	17.64	7,380	20.86
Middle East	1,971	13.48	61	10.09	731	13.78	789	17.07	390	9.54
China-Burma-India	5,828	13.29	65	7.43	576	14.54	2,697	15.99	2,490	11.25
Southwest Pacific	9,020	4.91	352	4.94	562	2.96	2,116	3.92	5,990	5.78
Central and South Pacific	4,572	3.64	361	2.39	388	1.33	1,568	3.57	2,255	6.00
North America²	989	2.01	151	1.50	271	1.39	297	2.30	270	3.97
Latin America	5,507	14.44	1,803	17.69	1,714	14.18	1,175	13.69	815	11.19
Total overseas³	95,474	8.89	3,652	6.23	10,369	6.14	31,678	8.29	49,775	10.72
Total Army	318,380	12.50	21,936	6.76	98,264	14.30	109,505	14.06	88,675	11.71
	CHANCROID
Continental United States	21,084	1.43	6,465	2.43	8,190	1.58	3,680	0.93	2,750	0.94
Overseas:
Europe	17,062	3.88	133	1.60	584	2.19	2,760	1.65	13,580	5.72
Mediterranean¹	32,991	22.25	299	13.04	8,076	17.68	18,616	28.66	6,000	16.96
Middle East	2,838	19.41	141	23.32	1,331	25.09	846	18.30	520	12.72
China-Burma-India	4,557	10.39	246	28.13	616	15.55	1,955	11.59	1,740	7.86
Southwest Pacific	13,190	7.18	71	1.00	78	.41	96	.18	12,945	12.49
Central and South Pacific	2,406	1.91	115	.76	36	.12	85	.19	2,170	5.78
North America²	84	.17	28	.28	33	.17	8	.06	15	.22
Latin America	4,650	12.19	3,007	29.50	1,358	11.24	155	1.81	130	1.78
Total overseas³	78,270	7.29	4,114	7.02	12,235	7.25	24,577	6.44	37,350	8.04
Total Army	99,361	3.90	10,579	3.26	20,425	2.97	28,257	3.63	40,100	5.29
	LYMPHOGRANULOMA VENEREUM
Continental United States	9,374	0.64	1,730	0.65	3,080	0.69	2,624	0.66	1,940	0.66
Overseas:
Europe	1,333	.30	19	.23	84	.31	320	.19	910	.38
Mediterranean¹	653	.44	5	.22	200	.44	318	.49	130	.37
Middle East	283	1.94	22	3.64	87	1.64	109	2.36	65	1.59
China-Burma-India	1,096	2.50	27	3.09	91	2.30	338	2.00	640	2.89
Southwest Pacific	1,071	.58	10	.14	10	.05	36	.07	1,015	.98
Central and South Pacific	415	.33	11	.07	29	.10	75	.17	300	.80
North America²	27	.05	2	.02	10	.05	10	.08	5	.07
Latin America	609	1.60	197	1.93	233	1.93	119	1.39	60	.82
Total overseas³	5,625	.52	304	.52	749	.44	1,342	.35	3,230	.70
Total Army	14,999	.59	2,034	.62	3,829	.56	3,966	.51	5,170	.68
	GRANULOMA INGUINALE
Continental United States	623	0.04	61	.02	100	0.02	287	0.07	175	0.06
Overseas:
Europe	111	.03	1	.01	---	---	30	.02	80	.03
Mediterranean¹	43	.03	---	---	1	.00	17	.03	25	.07
Middle East	1	.01	---	---	---	---	1	.02	---	---
China-Burma-India	34	.08	---	---	3	.08	6	.04	25	.11
Southwest Pacific	20	.01	---	---	1	.01	4	.01	15	.01
Central and South Pacific	42	.03	---	---	1	.00	16	.04	25	.07
North America²	3	.01	2	.02	1	.01	---	---	---	---
Latin America	5	.01	1	.01	3	.02	1	.01	---	---
Total overseas³	260	.02	4	.01	11	.01	75	.02	170	.04
Total Army	883	.03	65	.02	111	.02	362	.05	345	.05

¹Includes North Africa.

²Includes Alaska and Iceland.

³Includes cases on transports.

477

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

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

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

Diagnosis	Total days lost¹	Average duration²	Rate
Gonorrhea	842,738	22.4	1.72
Neurosyphilis	24,484	92.4	.05
Syphilis, other	184,718	22.4	.38
Chancroid	77,635	16.6	.16
Lymphogranuloma venereum	18,692	24.3	.04
Granuloma inguinale	434	27.1	.00

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, bydiagnosis, 1942

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

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

Diagnosis	Total days lost¹	Average duration²	Rate
Gonorrhea	1,859,910	19.5	1.48
Neurosyphilis	66,230	72.7	.04
Syphilis, other	453,840	20.7	.38
Chancroid	172,140	16.3	.14
Lymphogranuloma venereum	45,480	22.4	.04
Granuloma inguinale	2,500	38.5	.00

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

478

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

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

Admissions¹ and average duration	Gonorrhea	Neurosyphilis	Syphilis, other	Chancroid	Lymphogranuloma venereum	Granuloma inguinale
United States:
Admissions:
Including CRO	122,780	705	32,385	2,340	1,800	130
Excluding CRO	31,135	695	24,380	2,280	1,765	130
Total days lost	237,335	89,425	412,805	36,025	41,980	6,970
Average duration (days):
Including CRO	1.9	126.8	12.7	15.4	23.3	53.6
Excluding CRO	7.6	128.7	16.9	15.8	23.8	53.6
Overseas:
Admissions:
Including CRO	271,115	665	42,205	35,005	2,685	120
Excluding CRO	120,500	660	41,995	33,670	2,665	120
Total days lost	723,185	85,494	781,490	417,230	62,420	7,330
Average duration (days):
Including CRO	2.7	128.6	18.5	11.9	23.2	61.1
Excluding CRO	6.0	129.5	18.6	12.4	23.4	61.1
Total Army:
Admissions:
Including CRO	393,895	1,370	74,590	37,345	4,485	250
Excluding CRO	151,635	1,355	66,375	35,950	4,430	250
Total days lost	960,520	174,920	1,194,295	453,255	104,400	14,300
Average duration (days):
Including CRO	2.4	127.7	16.0	12.1	23.3	57.2
Excluding CRO	6.3	129.1	18.0	12.6	23.6	57.2

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]

Diagnosis	Total Army				United States				Overseas
	1944		1945		1944		1945		1944		1945
	Number	Rate	Number	Rate	Number	Rate	Number	Rate	Number	Rate	Number	Rate
Gonorrhea	242,625	31.14	412,185	54.41	130,562	32.87	128,720	43.91	112,063	29.34	283,465	61.05
Neurosyphilis	2,762	.35	1,755	.23	1,744	.44	865	.30	1,018	.27	890	.19
Syphilis, other	109,504	14.06	86,775	11.46	77,826	19.59	37,605	12.83	31,678	8.29	49,170	10.59
Chancroid	28,250	3.63	40,835	5.39	3,679	.93	2,780	.95	24,571	6.43	38,055	8.20
Lymphogranuloma venereum	3,966	.51	5,345	.71	2,624	.66	2,030	.69	1,342	.35	3,315	.71
Granuloma inguinale	362	.05	355	.05	287	.07	185	.06	75	.02	170	.04

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]

Year and area	Gonorrhea		Neurosyphilis		Syphilis, other		Chancroid
Year and area	Number	Rate	Number	Rate	Number	Rate	Number	Rate
1941
United States²	5	0.44	4	0.35	11	0.97	---	0
Overseas³	---	0	---	0	---	0	---	0
Total	5	.37	4	.30	12	.89	---	0
1942
United States	6	.23	3	.11	10	.38	---	0
Overseas	---	0	1	.17	1	.17	---	0
Total	6	.19	4	.12	11	.34	---	0
1943
United States	14	.12	5	.10	14	.27	---	0
Overseas	2	.27	1	.06	2	.12	---	0
Total	16	.23	6	.09	16	.23	---	0
1944
United States	---	0	6	.15	7	.18	---	0
Overseas	2	.05	1	.03	3	.08	---	0
Total	2	.03	7	.09	10	.13	---	0
1945
United States	---	0	4	.14	3	.10	---	0
Overseas	---	0	3	.06	6	.13	1	.02
Total	---	0	7	.09	9	.12	1	.01

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 diagnosisand 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]

Diagnosis	Total Army		Non-Negro personnel		Negroes
Diagnosis	Number of cases	Rate	Number of cases	Rate	Number of cases	Rate
Gonorrhea	495,966	27.70	324,958	19.71	171,008	121.07
Neurosyphilis	7,984	.45	5,795	.35	2,189	1.55
Syphilis, other	229,705	12.83	96,046	5.82	133,659	94.63
Chancroid	59,261	3.31	28,632	1.74	30,629	21.69
Lymphogranuloma venereum	9,829	.55	1,826	.11	8,003	5.67
Granuloma inguinale	538	.03	59	.00	479	.34
Total	803,283	44.87	456,316	27.73	345,967	244.95