The surgeon general talks about "the next great plague to go." Premarital blood tests are mandatory in nearly all states -- and teams of health workers are kept busy tracing the sexual contacts of anyone who tests positive. Some cities even run checks on food-handlers, beauticians and barbers on the theory that they could spread the disease.
This is not a description of the Reagan administration's plans for combating AIDS. It is an account of how America waged war on another sexually transmitted disease: syphilis.
Launched in the mid-1930s as a kind of medical New Deal, the anti-syphilis campaign has provided important ammunition to both sides in the AIDS testing controversy. It has also fueled a continuing debate over whether sexually transmitted diseases are best combated by education or legislation.
Conservative spokesmen in the administration and in Congress have seized on the war against syphilis -- with its emphasis on identifying and isolating carriers of the disease -- as a case study in how to deal with acquired immune deficiency syndrome. But many public health workers insist that several of the most widely used procedures, including premarital blood tests, can no longer be considered effective preventive medicine.
"It was a wise person who said that it is the hot breath of the sheriff standing behind all of us that keeps the system honest," said Rep. William E. Dannemeyer (R-Calif.), one of the most outspoken congressional advocates of compulsory AIDS blood tests.
At a hearing last month, Dannemeyer said it is "illogical" for doctors and hospitals to report venereal disease cases to public health authorities and not to report AIDS cases. He said health officials opposed to routine AIDS blood testing are out of touch with public opinion.
Legislative action to protect the family from sexually transmitted disease dates back to 1935 when Connecticut became the first state to adopt mandatory premarital blood tests for syphilis. Other states quickly followed suit, extending the laws to cover tests for pregnant women. At the same time, public health officials began seriously tracking down the sexual contacts of venereal patients.
A popular public health poster of the '30s, which could almost be a prototype for the Reagan campaign to encourage premarital tests for AIDS, urges a starry-eyed bride and groom to be tested for VD. "Happiness Ahead -- for the Healthy but not for the Diseased," the poster proclaimed.
According to a book by Allan M. Brandt, an assistant professor of the history of medicine at Harvard, the legislation requiring the testing of pregnant women helped bring about a sharp reduction in the infant mortality rate for syphilis. But the premarital blood tests yielded surprisingly few positive results, although one out of 10 Americans were estimated to be suffering from syphilis.
In New York State, there was an immediate 41 percent drop in marriages after mandatory blood testing went into effect in 1938.
Syphilis is a sexually transmitted disease that, if untreated, can lead to degeneration of bones, heart and nerve tissue, and death.
Today, the disease is rare. From 1978 to 1982, a total of 835,252 tests turned up only 45 cases of infectious syphilis, according to a spokesman for the New York department of health. The state legislature decided to discontinue the tests in 1985 after an independent study showed it cost up to $60,000 to identify each case of syphilis.
According to the federal Centers for Disease Control in Atlanta, a majority of states have dropped premarital blood tests for syphilis. Most public health specialists now say there is little point in screening a relatively low-risk sector of the population for sexually transmitted diseases. They say it would be more effective to concentrate resources on encouraging high-risk groups such as male homosexuals and intraveneous drug abusers to submit to voluntary, confidential tests.
"It's rather like the man who loses his wallet and looks for it under the lightpost because that's where he can see. It doesn't do much good if he has lost his wallet somewhere else," said Brandt, author of "No Magic Bullet," a history of venereal disease in the United States.
Last Sunday, President Reagan appeared to strike a compromise between rival schools of thought within his administration on testing for the AIDS virus. He urged the states to "offer" routine tests to applicants for marriage licenses and drug-abuse patients, but stopped short of insisting that such tests be compulsory. He limited a call for mandatory tests to federal prisoners, immigrants and the military.
A major distinction between syphilis and AIDS is that syphilis can be cured. In the view of many health officials, this further undermines the argument for reporting individual cases of AIDS. Health workers could try to persuade syphilis patients to reveal the names of their contacts to offer them a cure. They cannot use this argument with AIDS victims.
"We have to ask what is the purpose of identifying AIDS carriers. It may be useful for individuals who are infected to know that they are infected, but I am doubtful about the public health utility," Brandt said.
Most states do not require doctors to report the names of individuals who test positive for the HIV, or AIDS, virus. An exception is Colorado, which uses the same kind of reporting procedures for AIDS as it does for syphilis and other contagious diseases. Colorado also makes an active effort to counsel AIDS victims and identify their contacts.
Colorado's chief public health officer, Tom Vernon, said he rejects the idea that the lack of a cure for AIDS makes the attempt to trace possible carriers of the virus less worthwhile.
"Take the case of a woman of childbearing age who learns through contact tracing that she has been in touch with someone with AIDS. It may not be possible to cure her, but she is able to grapple with the possibility that she could produce an HIV-infected baby. That is a very powerful piece of information," Vernon said.
Conservative members of Congress, such as Dannemeyer, have cited the Colorado experience to support demands for mandatory reporting procedures for AIDS. They point out that Colorado has achieved a higher test ratio than states such as California where reporting of AIDS cases is handled on an anonymous basis. This would appear to disprove fears that syphilis-type reporting methods could drive AIDS sufferers underground.
Proponents of wider reporting measures maintain that they are useful in prevention, as well, because informed carriers are more likely to protect future partners.
The counter argument by those who favor anonymous reporting procedures is that even states such as Colorado do not require proof of identification before administering an AIDS test. In testimony to the House Energy and Commerce subcommittee on environment and health last month, Vernon conceded that it is possible for individuals to register as Ronald Reagan or Donald Duck, thus guaranteeing anonymity.
"Coercive methods simply don't work," said June Osborn, dean of the University of Michigan School of Public Health. "Voluntary contact tracing is being done all the time and can be very useful. But you cannot do mandatory contact tracing with an unwilling participant."
Arguing that the best public health methods are those that respect civil liberties, she added: "We should draw lessons from history, but they should be good lessons. We shouldn't simply copy what was done before."