So there are factors in our failure to control VD that are due to professional ignorance, carelessness, lack of interest, negligence, and similar vices that public awareness and pressure might conceivably correct. To correct such things was part of Dr. Parran's objective. If we could make full use of the resources we have, we could accomplish something. But again, if we assume that Sweden, Denmark, and some other countries are better in these respects than we are and there is reason to believe they are, although they too might be still further improved we glimpse the idea that such failure is no more than part of the problem.

As for technical deficiencies themselves, they are a significant but probably even smaller segment of the whole difficulty. The painless vaginal chancre, and the existence in women of a mild but infectious gonorrhea, also have their counterparts among males, especially homosexuals; here it appears to be syphilis (with a rectal chancre) more than gonorrhea that is likely to go undetected. Syphilis can be diagnosed in the primary stage if the patient suspects it and has himself examined. Untreated, it will show up later in the blood test by which time it may, of course, have been passed on. So in part this is a problem of public education and cooperation of the patient, actual and prospective. But the difficulty in detecting gonorrhea in women is technical. Thayer and Moore reported in 1964 that the best available tests had been negative in nearly half of a group of "bona fide female contacts." Thayer and Martin subsequently improved a culture medium for the gonococcus that has come to be used all over the world. One recent paper by the Atlanta group reports that the use of this medium with cultures from several sites in the vagina and from the rectum cut the number of failures to 6 8 per cent and suggests that the figure could be reduced further by repeated tests. Studies reported in 1969 from Denmark give reason to expect that the failure rate could be reduced even further with additional technical refinements, including a combination of cultures on Thayer's medium with a fluorescent antibody method of identifying gonococci taken directly from the patient. Meanwhile work continues on a blood test for the gonococcus. Problems of this kind can be expected to crack open if given enough of the combination of time and pressure, the latter meaning money for research.