It appears that the appropriation for 1945 was $12,698,736, and the estimate for 1946 is $11,949,000, or a decrease of $532,936; is that correct?

Dr. PARRAN. That is correct, Mr. Chairman. With your permission, I should like to have Dr. Heller, Chief of the Division of Venereal Diseases, present this item.

Mr. HARE. I assume that the justifications for the different items this year will be the same as for last year.

Dr. HELLER. Essentially so, yes, sir.

Mr. HARE. I notice you have quite a decrease in supplies and materials.

Dr. HELLER. Yes, sir. That is due, primarily, to the decrease in the cost of penicillin, a product of which we bought quite a quantity this year, and some laboratory supplies that we do not have to purchase again.

Mr. HARE. In your grants and subsidies you show a decrease. Dr. HELLER. Yes, sir.

Mr. HARE. Those grants go to the States?

Dr. HELLER. Yes, sir, they go to the States.

GRANTS AND SUBSIDIES

Mr. HARE. Would you mind explaining that just a little bit, so that the record will show what those grants and subsidies are for?

Dr. HELLER. Yes, sir. The majority of the Federal funds appropriated for venereal disease control go to States in the form of grantsin-aid. These grants-in-aid are allotted on the basis of a formula as required by law, which is based primarily upon three factors, the population, the extent of the problem, and financial need.

Through the years it has been found desirable to change the formula somewhat, so that much of the weighting is being given now to extent of the problem. This seems to be reasonable, and meets very well the problem in the field. All States and Territories participate in the grants-in-aid programs. These funds are expended in accordance with budgets and plans submitted to the Surgeon General, and by and large the States cooperate very well. These grants have been reasonably effective in meeting the venereal disease control problem. Mr. HARE. Do you have a table showing the grants this past year by States?

Dr. HELLER. I have, sir.

Mr. HARE. Is that the table appearing on page 211 of the justifications?

Dr. HELLER. Yes, sir.

Mr. HARE. If there is no objection, that will be inserted in the record at this point.

(The statement referred to is as follows:)

Mr. HARE. I note that you are able to decrease your personnel from 1,148 positions in 1945 to 1,115 in 1946.

Dr. HELLER. Yes, sir. Those, primarily, Mr. Chairman, are personnel who were in unclassified positions formerly, and the States have taken them over.

Mr. HARE. That is far as you can go, down to 1,115? You cannot get down to 1,100?

Dr. HELLER. Yes, sir; that is as far as we could go at this time. We hope to get it down more later.

Mr. HARE. Would you mind stating briefly your program for venereal-disease control?

Dr. HELLER. I shall be happy to, sir.

Venereal-disease control, in common with medicine, generally, in wartime, has experienced changes. There has been a transition period. It is in a state of flux, brought about by many factors.

NEW ELEMENTS IN VENEREAL DISEASE CONTROL

We have noticed several new elements in venereal-disease control that I should like, with your permission, to mention briefly.

Mr. HARE. Yes.

Dr. HELLER. One is that venereal-disease control, even more now than ever before, transcends boundaries. We have found it to have international aspects which reflect directly upon programs we have along the Canadian and Mexican borders. In recognition of this international aspect we have worked out, reasonably satisfactory programs with the appropriate governments concerned in somewhat of an informal, and in some instances a formal way to meet the problem.

The next aspect that we note from the war has been that we are experiencing a state of emotional unrest which seems to be coming to a peak. In other words, the psychology has changed. This brings about, in our opinion, many more infections of venereal disease than could have occurred in otherwise normal times.

Mr. HARE. Would you care to elaborate a little bit on that psychological feature of it?

Dr. HELLER. I shall be glad to. For instance, among returning soldiers from abroad, information from the Army, and especially the Army Air Corps, reveals that they return free of venereal infection. They reach this country either on furloughs or for additional training. It has been found that the rate of venereal infection in this group of men is sometimes three times that found in a group of men originally in training. There may be some other factors involved also, but it is believed that primarily this increase is due to the changed psychology of these men. That is transmitted to the civilian population. This emotional unrest can be seen in the group of transients, younger people who go frequently from industry to industry or from job to job, and perhaps war glamour and hysteria and the other unfortunate accompaniments of war contribute to it.

It is very difficult to enumerate or to understand all of the factors, but these are some of them, sir.

Mr. HARE. Do you think there is any emotional reaction or psychological reaction to these men on the part of the people from whom they obtain this infection, or to whom they pass it on?

Dr. HELLER. We believe, sir, that there is some emotional factor involved. Many of these people feel that since these boys have been overseas for many, many months and, in fact, sometimes years, nothing is too good for them, which is true, of course, but they go to the extreme. We find that many times the sex factor is out of all proportion to that which would exist in normal times.

Mr. HARE. In other words, the sex factor is surrendered to the patriotic conception of duty?

Dr. HELLER. That is the belief of some, sir.

Mr. HARE. Do you have any evidence to that effect?

Dr. HELLER. None that we can give you except in the increased rate of infection among these men, and such word of mouth discussion as we have had with them.

EDUCATIONAL APPROACH TO VENEREAL DISEASE PROBLEM

Another factor, Mr. Chairman, is that we have found that the educational approach has not been realistic enough to reach all of the segments of population. There is a greater need of community action. Also promiscuity is involved.

Very wisely, the Surgeon General, in 1936, based the venereal-disease control program primarily on a medical approach.

This medical approach has been made, for the most part, very well, but we have found that there is an element of promiscuity which, if not solved, will make it extremely difficult medically to do the things in venereal-disease control that we know should be done.

COMMUNITY ACTION TO VENEREAL DISEASE PROGRAM

Mr. HARE. Would you mind enlarging a little bit on what you mean by community action?

Dr. HELLER. Yes, sir. There is a group of promiscuous people in every community. It may vary from community to community. These people, apparently, constitute a vicious circle of infection. They acquire gonorrhea or syphilis and are cured of it. This seems to make no appreciable mental impression on them, so that they very promptly acquire the infection again. This same group acquires infection at a greater rate than before, because they are cured very quickly, and in addition to that, they bring into the periphery of this vicious circle many new youngsters who, for various reasons, fall into this orbit. Medically we can treat and cure them, but it is a question of treating and curing many. of those people over and over again. New ones come into this circle in varying rates from each community. Now, until and unless the character-building agencies, the home, the church, the school, and others, on a long-range program can take action, noting the fact that there are certain elements of morality which are involved, we will always be confronted with this very difficult venereal disease problem as long as people are promiscuous. We can get at the problem medically, but until people quit exposing themselves at the present rate, medically we find ourselves up against a pretty tough proposition.

Mr. HARE. What would be your suggestion as to community action or cooperation?

Dr. HELLER. We have been working on that, sir, and health workers have gone to the ministers and to ministerial unions, various civic groups. They have gone to the schools, and to the parent-teachers associations. Attempts have been made to reach the parents promptly to tell them of the problem, and to suggest to them the various things that might be done to meet these problems. There is need for a more realistic attitude on the part of the church, and the need for more information as to how to look after the welfare of children through proper recreation with proper safeguards insofar as their social life is concerned.