The first thing to look at is the trend of VD in US and elsewhere in so far as we can make it out. Our information on this score is all recent. Mortality statistics began to be published in the United States only in 1900, and included deaths from syphilis. Figures for illness as well as for death were published earlier for members of the U.S. Army as well as for military groups in other countries; but reporting of syphilis as illness in the civilian population of the United States began consistently only after Surgeon General Parran's campaign was under way, in the year 1940 41. So our first national figures for syphilis and other venereal diseases are hardly thirty years old as I write.

Official United States statistics made available by the VD branch of the Center for Disease Control, U.S. Public Health Service, in early November, 1970, selected and summarized, tell us that between fiscal 1941 and 1970:

1. Primary and secondary (infectious) syphilis rates per 100,000 nonmilitary persons rose from 51.7 to a peak in 1947 of 75.6 and then fell steadily to 3.8 in 1957. After that the curve rose again, reaching 12.3 in 1965, where after it fell off to 9.3 in 1969 and rose again to 10.0 in 1970. The total number of reported cases of primary and secondary syphilis for fiscal 1969 was 18,679 and for 1970 was 20,186. The official estimate of actual cases of primary and secondary syphilis in fiscal 1970 was 75,000, about 3.6 times the number reported. Taking into account the unknown as well as the known errors, the true factor may be ten or more. A somewhat lower correction may apply to the number of cases of syphilis reported in "all stages" including "stage of syphilis not stated." This rate has tended to fall from a peak of 575,593 in 1943 to 87,934 in 1970.

2. Comparable figures for gonorrhea show a rise in rate from 146.7 in 1941 to 284.2 in 1947, then a steady decline to 129.3 in 1958 followed by an uninterrupted rise to 245.9 in 1969 and 285.2 in 1970. The number of cases reported in 1969 was 494,227, an all time high figure which went even higher in 1970, to 573,200. These figures may be subject to considerably more than a tenfold correction, although again the official estimate assumes a factor of only about 3.5.

3. The rates for late syphilis (including late latent syphilis) and congenital syphilis have been falling steadily; but there were 49,537 of the former and 1903 cases of congenital syphilis reported in 1970. These figures were included within the "all stages" total given in paragraph 1. It may be taken as a portent that within the declining total of cases of congenital syphilis those reported at 0 1 years of age have risen from 180 in 1957 to 300 in 1970, representing percentages of the total number of cases of congenital syphilis of 3.3 and 15.8, respectively. The declining total is found in the cases five years old and older; most new cases are adults. But it is still doubtful that there has been a real increase: the rate of congenital syphilis under one year of age per 10,000 live births rose from 1957 to 1965 but has since leveled off; so that the increased total in later years seems to reflect a rising birth rate rather than a rising rate of congenital syphilis itself.

4. The number of deaths attributed to syphilis fell steadily from 14,064 in 1940 to 2193 in 1966 and then rose to 2381 in 1967. In 1968 and 1969 there have been fewer deaths. The mortality is more than twice as high among nonwhites as among whites. The document from which this information comes remarks that "since deaths from syphilis represent case finding and treatment failures, mortality due to syphilis may be considered an inverse measure of the success of the syphilis control program." The statement implies that although the control program has been getting better, it is still scandalously short of being good. Remember that even when it goes entirely untreated, syphilis is infrequently fatal, and that treatment can arrest its progress and prevent death at any stage before the fatal accident takes place. Nevertheless the most recent data issued by the U.S. Public Health Service in December, 1969, list only tuberculosis among reportable infectious diseases as exceeding syphilis in mortality, the former with 6910 deaths in 1967 as compared with the 2381 for syphilis. During the same year, however, there were 55,417 deaths recorded as due to pneumonia (not a reportable disease), while 19,700 deaths in the United States were associated with the Hong Kong influenza epidemic of the winter of 1968 1969. (see UNITED STATES VD STATISTICS PART II)