A Comparative Study of Syphilis in Whites and in Negroes

Variations in the reaction of persons to syphilitic infection have caused much speculation.Fifty years ago Fournier emphasized the impossibility of predicting the course of a syphilitic infection.Even today we can offer a prognosis only on the basis of efficient treatment.Quoting Krause,1 "two really fundamental factors can possibly have an influence on disease.These are inheritance, or the nature and activ- ities of tissues as born into the world; and environment, which includes every mundane experience which, directly or indirectly, may have an effect on the constitution and function of tissues."Inheritance probably explains in part certain differences in tissue reactions in syphilis, such as the early development of allergy in syphilis maligna, and the apparent absence of such a process in syphilis sec- ondaria tarda.Inherited differences may have a determining influence on the localization of syphilitic lesions in various tissues or on the character which these processes assume.Environment, employed in its broadest sense, embraces numerous considerations.It includes occupation, habits, associated disease and the effect of treatment.The latter is obviously of paramount impor¬ tance in influencing the course of syphilis, when we consider the power¬ ful antisyphilitic action of the drugs employed, with their varied chem¬ ical composition and their fundamental differences in mode of action on spirochetes and on syphilitic processes.In syphilis there may be added as an additional influence on the course of the disease, variations in strain of Spirochaeta pallida, a con¬ ception long suggested by clinical observation and apparently sub¬ stantiated by recent animal experimentation.It is, however, hardly conceivable that strains infecting the negro differ from those harbored by whites, except in so far as racial antipathy and the legal restrictions placed on miscegenation prevent intimate personal contact between the races and pave the way for the evolution of strain variations.It should From the syphilis department of the medical clinic, Johns Hopkins Hospital.