April 26, 2017

Sexually transmitted diseases in the World War II shipyards

Ordinary workers on the home front confronted venereal diseases, and the Permanente Health Plan stepped up to reduce that harm.

1944 posters warning workers of the dangers of venereal disease
VD posters in Fore 'n' Aft, 3/3/1944.

During World War II, venereal diseases were called “the enemy in your pants,” and soldiers were warned that “your carelessness is their secret weapon.” But ordinary workers on the home front also confronted these communicable diseases, and the Permanente Health Plan stepped up to reduce that harm.

April is designated STD (Sexually Transmitted Disease) Awareness Month by the Centers for Disease Control and Prevention. Most of the research on pre-AIDS World War II focuses on venereal diseases in the military, but home front workers suffered as well.

Some of this threat appears to have been exaggerated at the time. An article in the Portland, Ore., area Kaiser shipyard newspaper The Bos’n’s Whistle dated April 14, 1944, about venereal disease on the home front reported an alarming — but false — statistic:

Health experts report syphilis and gonorrhea near top of list of most common communicable diseases; the toll since the war began is greater than total battle casualties.

Reviewing the actual numbers, this claim was both inaccurate and alarmist. U.S. military deaths for that war was 416,800. Home front data found in Vital statistics of the United States, published by the U.S. Bureau of the Census under “General Tables – Deaths from Selected Causes” gives us a total death toll for syphilis (the only STD singled out, which is unfortunate since gonorrhea was also prevalent; a 1944 Kaiser shipyard article on illnesses in Washington state lists 1,666 cases of syphilis and 1,929 cases of gonorrhea) between 1942 and 1945 as 58,698. Still, that was a lot of people to see dying from a preventable disease.

“VD vs. Victory” in the Richmond, Calif., Kaiser shipyard paper Fore'n'Aft in early 1944 warned of the danger:

Four in every 100 industrial employees have syphilis… venereal disease is one of the greatest enemies of industry. The [California] State Federation of Labor considers it so important that the executive board has recommended a compulsory blood test for all union members.

A quack cannot cure you. You cannot safely treat yourself. The only way you can be sure you do not have syphilis is by a blood test. You should have a test once a year. If you find that you have caught the disease, it will still be in the early stages and a doctor can treat and cure you.

1944 newspaper clipping with image of doctor performing a blood test.
Blood test for VD in The Bos'n's Whistle, 4/4/ 1944.

In the early years of the war the standard treatment for syphilis and gonorrhea were sulfa (sulfonamide) drugs, the first and only effective antibiotics available. The best cure — penicillin — wasn’t proven until 1943, when doctors at a U.S. Marine Hospital on Staten Island in New York successfully used it to treat four patients. And even then, this “wonder drug” was rationed for military use. It first was made available to home front workers in May 1944 to treat pneumonia, due to the efforts of Kaiser shipyard physician Dr. Morris Collen.

In language foreshadowing the challenge of treating the AIDS epidemic in the 1980s, the Bos’n’s Whistle article concluded that the biggest obstacle in attacking the problem of venereal disease was the stigma attached to it.

The important thing to remember is that to have a venereal disease does not constitute a crime, but to transmit it to others is definitely criminal. Authorities emphasize that most of the individual problems of persons having a venereal disease can be handled without resorting to law enforcement.

VD didn’t just affect men- the new shipyards were full of women as well. Hannah Peters, MD, was the Kaiser Richmond shipyard gynecologist and she co-authored Gynecology in Industry” in the Kaiser Foundation Medical Bulletin, July, 1945. There she outlined what she’d learned during her first two years serving a workforce composed of as many as 23,000 female employees.

Dr. Hannah Peters, Kaiser shipyard gynecologist
Dr. Hannah Peters, Kaiser shipyard gynecologist

Her section on VD education explains the scope of the problem and efforts to reach out to women. She noted that during the period between March 1, 1944, and February 28, 1945, 2832 new cases were seen in the Gynecology Department of the Permanente Field Hospital in Richmond alone. Among these, there were 390 cases of gonorrhea. This meant that 13% of all new gynecological cases proved to be infected with gonorrhea. The article goes on to report that the high percentage of infected women led physicians to introduce an educational outreach program in the shipyards:

Venereal disease educational material was placed in all women's restrooms in the yards. Literature, folders as well as booklets, supplied by the Public Health Department, were made easily available in wooden racks which were hung in conspicuous places in every women's restroom. We were encouraged to find how quickly the literature disappeared. We know that the pamphlets were not only taken out of the rack, but they were actually read. We cannot measure their educational value; however, innumerable women have come into the clinic asking to be examined for a venereal disease because they think they might have some of the symptoms described in the literature that they found in the restrooms.

The struggle for quality, affordable health care was vital to the war effort, which included the crop of STDs that debilitated the home front workforce. And just as the Permanente health plan rolled up its sleeves and took on that battle during World War II, it continues to do so today.

Last year, Kaiser Permanente led the nation in 21 quality measures, including screening for chlamydia. On top of our preventive testing practices, our doctors encourage a healthy conversation about STDs. A recent Total Health Radio podcast “So ... This is Awkward” by a guest expert from Sexual Health Innovations offers helpful advice on how to talk about STDs to friends and loved ones.

Special thanks to Michael Sholinbeck, Outreach & Instruction Librarian at the Sheldon Margen Public Health Library, University of California Berkeley, for guidance on U.S. Census data.