Hazen, H. H.

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The Linacre QuarterlyVolume 14 | Number 3 Article 2July 1947The "V.-D." PatientH. H. HazenFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationHazen, H. H. (1947) "The "V.-D." Patient," The Linacre Quarterly: Vol. 14: No. 3, Article 2.Available at: http://epublications.marquette.edu/lnq/vol14/iss3/2THE LIN ACRE QUARTERLY 5 THE "V.-D." PATfEN'l' H. H. HAZEN, M.D. <i' Wash i llg/IIII, n. c. FHOM tillle to time there have appeared various a rticles dealing, rather superficially it is feared, with the psychology, mentality, alcohol ic habits, educatioll on venereal diseases, economic status, race, occupa-tion and what-not of the patient suffering from syph ilis or gOllorrhea . Un-fortunatciy most of these studies have been made where large groups of individuals could be conveniently collected, as in the armed service, or in the clinics, and have totally ignored' the private patient. In other words the individuals studied have all been those living under an approxim ately similar environment., that is on those who li ved more or less en masse, and who were la rgely deprived of the benefits of h0111c life. So far as the author is aware, up to the t ime this is written, there has never been any carefull y cOlltrolled study to show what may be the beneficial effect s of home or religious trainillg, of the exposure to social hygienc teaching in the broad sense, of the effects of liquor, or of the intelligence, character or sexual habits of the patient. 'i\Te do know that the prevalence of these cliseases is disproportionately high in certain races, in prostitutes, both public and private, and also in the younger age groups, and in those of poor economic status . Practically speaking that is all that we do know. After many years of active practice, both private and in the dis-pensary, the author believes that patients suffering from ven ereal diseases can he divided into several great groups: 1. Private pat.ients, who, of course, vary greatly in all of t.he parti-culars mentioned in the first sentence of this paper. 2. Dispensary or hospital patients. 3 . :Members of government services who live either abroad or in the United States under distorted social condition s. These persons are seen either as private or clinic patients. 4. Innocently infected persons. 5. Persons whose only sign of syphilis is a highly conflicting serology, and are apt to be false positives . *Editor's Note: Dr. H azen is Chairman of the Advisory Committee on Public Educa-tion for the Prevention of Venereal Disease of the United States Public H ealth Service. H e has served for many years in fllrthering social hygiene and in the pre-vention and cure of the venereal diseases. TII~: LlNACItE (,) IJ AH'I' EHJ.Y Among private p a tients a re seen: (ft) members of high or low polit.ical, diplomatic, trained scientific se rvices, or of t he a rmed forces ; (b) literary or scient ific person s connected with university life ; ( c ) members of all professions ; (d) students, even those of high a U Il inments ; ( e) business men ; (f) "clerks," and t he rank and fil e of business or govel'l1ment; (g) high g rade prostitutes, bot h mal'l'ied and single ; (h) the innocently in-fected ones, as the congenital syphilit.ics, those who have had ext ragenit a l chancr es, not always so innocently acquired, and those who ha ve been infec ted by their wives 0 1' husba nds, The innocent infect ions are usuall y es timated at about fift een p el' cent. Since Surgeon General P a n 'an has hrough t venereal diseases int o the opell there has been a marked change of attitude on the part of t he p atient , part.iculal'ly the syphilitic, towards his disease. Some twent y or more years ago these patients frequently felt as t hough they had been branded with the rnark of Cain , and t heir morale required t he most cll reful holstering. In addition they sadly lacked a sense of security. At least four of my p a tients, during this early period, committed suicide. In the las t. two decades no such t r agedies have occurred, alt.houg h there is often some dread as t o t.he fin al outcome. It should be remarked tha t before the " Parra n P eriod" the vast major-ity of venereal disease p atients attending "he dillics accept ed their infec-tions more or less as a matter of COUI'se, and only lin occasional one, espe-cially one of It hig her economic or illtellectual type, was mueh disturhed. Probahly it more eareful study of these p a tients would have shown more Illen t a l di sturbanee t han the author's rema rks would indicate. The llues tion immedi a t ely arises as to the results of the various r apid t.rea tment with sulfa drugs and penieiIJin upon t he sexual hahits of those t.reat.ed . It is to he fear ed that the literatUl'e extolling the r esul t obtained has !>eell entirely too optimistie. Cert a inl y there has heen Iln app alling nUll lhcl' of nclI' infections with both syphili s and gonorrhea. There is a tl'llClcney to r('gard gonorrhea as less se rious t han a common eold. It. would b(· intc'rc'sting to cOlllpare the lI ew infections with ti l(' education givl'n at. thp rapid tl'<' a tmcilt. cpntcTs, at which they w(' rc treatC'd , The a ttitude of the .phys ician hal!(lIing' any of these pa tipnt s is of thc utlllOSt illlportallce. They lIIU S t. he tre~lt ed as sick indi vidual s, and not. Hot fon' cd t o listen to a series of " SlllUtty" stories, or promises, too often fa lse. The physiciall must. he finn and dignified, and take the responsi-bility both for treating the disease a nd the domes tie or soeial eomplieation s that may ensue. P a tients a re usually very g ra teful to have some one help bellI' their burdens. The attempt must always be made to eduea te the p a ticnt as to the dangers of illicit. sexual intereourse, and this is often ext.remely difficult on ee he is past t he "bromo-seltzer" stage of I'epent l.l nee, when he is only too glad to p romise any thing. 'iVe must remember that the sex u rge is a most powerful one 0 1' the huma n r ace would die out. Also THE I.INACIU: QUAHTEHLY 7 the enlOtiun s arc a lways prone to dominate the in tellect, ve ry few uf us arc pure "thinking machines." The mass hyste l'i a that invllriably results from a war scare, an election, ur a great lIlass tragedy is suffi cient proof on this point. The number of infections that uccur among medical s tuden ts, physicians, trained nurses, and even the staff of social hygiene sucieties is thus explainable. The author has spent hours in attempting to show a patient the value of self-respect, the dangers uf illici t intercourse, and in suggesting possible . ways of sublimating the sex urge in t o other channels only to have the pat ient ret urn in a week or two in a badly fright ened condition. Thi s is t rue among a ll classes of the young, no matte r how educated. This moraliz-ing is, of course, no excuse fur IlOt continuing our attempts to educate, which may alleviate our III en tal anguish when we fail to accolllplish the desired result s. In the older private patients education seelllS much nlOl 'e effective. Ano t her grave dut)' uf th" physician is to trace "sources" and "con-tacts." This must ' be done with g reat tact. COlltacts should be wal'lled somew hat as folluws: "You IlIaY have been expused to a dangerous, cun-t agiuus disease. }'O1' your own prutectiull you shuuld repur t to yuur own physiciall, or to the ..... clinic." Innocent ly infected persuns arc uften Yco ry bitt co r against those wholll they believe ha ve infected them, a nd to some extent against the world at large. They sOlllctinles become ahnost paranoid, believing that thuse with whom t hey come in contact r ecognize sOllie trace o f the disease in thelll. To properly r eassure such indi vidual s nlaY reyuire the services of a trained psychiatrist. Persons, who, as t he r esul t of a Illore 01' less routine blood test, arc found to have a positive reaction with sUllie tl'st s negative and othco r t ests positive affurd a rea l problem. SOllie venereal di sease contrul officl' rs, with Ii t tle j udglllell t , hound such unfortunates wi t h a series of fullow-up letters so that they are tried all1lost beyond the limit s of hUlllan endurance, despite the fact that sOllie conscientious physician is trying tu solve the riddle by repeated serologic tests, other laboratory aids, and physical examinations. Such patients test the skill and adaptability of t he practi-tioner to a very great degree. To SUlllIIHlrize briefly, venereal di~ease~ arc nlOst frequently acquirl'd b'y the young in II'honl the sex urge is strongest, ami by the under-privi -leged, the victilll~ of adverse eCOllOlllic conditions. Alllong prinlte patientl; the diseases arc found in all classes, apparl'ntly irrespective of econoillic st atus, character, ed ucation or religiun. The method of approach of the physician to these patients is of the utmost importance. Education of persons past thirt'y is easier than in the younger groups. 

The  V.-D.  Patient

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The V.-D. Patient

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