DR. PARRAN SPOKE with a good deal of admiration of attempts that had been made to control VD in the Scandinavian countries before he started on his own campaign in the United States. All these efforts were begun before World War II and before penicillin. Although they have not been completely ineffectual, we know now that they have failed. Even with penicillin and with the many other advances that have been made in the great scientific upsurge since 1945, efforts at VD control in all these places have still failed.

The way Parran framed the problem in 1937 is still valid today, and it can hardly be doubted that if his program could have been made fully effective, especially with the addition of penicillin, it would have worked. Failure of VD control must have resulted from failure to implement his plan.

The first step toward control of VD the key step, and the one in which we can at once see persistent and significant failure is to find people who have VD and to bring them in for diagnosis and treatment. "Case finding" is what we call it. The major stumbling block in control is the patient who runs away, or treats himself, or goes to quacks or inadequate doctors. The three elements here, which are still as Parran saw them, are getting the patient to go, having adequate diagnostic and treatment centers available, and teaching doctors to think of VD and to recognize it when they see it.

We will have to face later the question, why do patients run away? to the degree that the answer may not be obvious. For the moment, the fact that they do leads to the next tactic: to try to find them whether or not they want to be found, and then to try to persuade them to be treated. While "education" intended to get them to come in voluntarily limps along, and often seems to go backward instead of forward, most of the people immediately concerned with control, the public health VD people, do the best they can. In the modem period, in the United States, among civilians, the basis of the approach is persuasion, persistent but not punitive. Local exceptions occur, especially among prison or other institutional populations. Much effort is spent to avoid moralistic or puritanical methods; it is not to be expected that it often succeeds. But the purpose of the approach is to have each patient with VD lead to others: to interrogate, to persuade, to cajole.

If the initial patient comes to a VD clinic, the operation begins there at once. If his illness is reported by a physician, the public health personnel take over for the search. The people who do the tracing are non-medical workers with special training, often nurses or social workers. An attempt is made to respect the patient's anonymity, but the results are not always convincing to suspicious patients, and in fact the attempt itself is not always successful. Other means, sometimes skillful, sometimes clumsy, are used to gain his confidence.

The search for contacts has to be made quickly, partly because people often move considerable distances in brief periods, partly in the effort to find them all before each one has been able to infect so many others that the job may become overwhelming. Dr. James K. Shafer, another former VD chief of the U.S. Public Health Service, called this fast operation "speed zone epidemiology"; and his workers nicknamed it "peppy epi.” (see AFTER PENICILLIN: FAILURE PART II)