The Third Great Plague | Page 7

would either have forgotten the trivial beginnings of it, or with the
germs of it still in their brains or the walls of their arteries or other
out-of-the-way corners of their bodies, would think themselves free of
the disease--long since "cured" and out of danger.
+How Much Syphilis is There?+--Our entire lack of a tangible idea of
how much syphilis there really is among us is, of course, due to the
absence of any form of registration or reporting of the disease to
authorities such as health officers, whose duty it is to collect such
statistics, and forms the principal argument in favor of dealing with
syphilis legally as a contagious disease. Such conceptions of its
prevalence as we have are based on individual opinions and data
collected by men of large experience.
+Earlier Estimates of the Prevalence of Syphilis.+--It is generally
conceded that there is more syphilis among men than women, although
it should not be forgotten that low figures in women may be due to
some extent to the milder and less outspoken course of the disease in
them. Five times more syphilis in men than women conservatively
summarizes our present conceptions. The importance of distinguishing
between syphilis among the sick and among the well is often

overlooked. For example, Landouzy, in the Laënnec clinic in Paris,
estimated recently that in the patients of this clinic, which deals with
general medicine, 15 to 18 per cent of the women and 21 to 28 per cent
of the men had syphilis. It is fair to presume, then, that such a
percentage would be rather high for the general run of every-day people.
This accords with the estimates, based on large experience, of such men
as Lenoir and Fournier, that 13 to 15 per cent of all adult males in Paris
have syphilis. Erb estimated 12 per cent for Berlin, and other estimates
give 12 per cent for London. Collie's survey of British working men
gives 9.2 per cent in those who, in spite of having passed a general
health examination, showed the disease by a blood test. A large body of
figures, covering thirty years, and dating back beyond the time when
the most sensitive tests of the disease came into use, gives about 8 per
cent of more than a million patients in the United States Public Health
and Marine Hospital Service as having syphilis. It should be recalled
that this includes essentially active rather than quiescent cases, and is
therefore probably too low.
+Current Estimates of the Prevalence of Syphilis.+--The constant
upward tendency of recent estimates of the amount of syphilis in the
general population, as a result of the application of tests which will
detect even concealed or quiescent cases, is a matter for grave thought.
The opinion of such an authority as Blaschko, while apparently
extreme, cannot be too lightly dismissed, when he rates the percentage
of syphilitics in clerks and merchants in Berlin between the ages of 18
and 28 as 45 per cent. Pinkus estimated that one man in five in
Germany has had syphilis. Recently published data by Vedder,
covering the condition of recruits drawn to the army from country and
city populations, estimate 20 per cent syphilitics among young men
who apply for enlistment, and 5 per cent among the type of young men
who enter West Point and our colleges. It can be pointed out also with
justice that the percentage of syphilis in any class grouped by age
increases with the age, since so few of the cases are cured, and the
number is simply added to up to a certain point as time elapses. Even
the army, which represents in many ways a filtered group of men,
passing a rigorous examination, and protected by an elaborate system
of preventions which probably keeps the infection rate below that of the

civil population, is conceded by careful observers (Nichols and others)
to show from 5 to 7 per cent syphilitics. Attention should be called to
the difference between the percentage of syphilis in a population and
the percentage of venereal disease. The inclusion of gonorrhea with
syphilis increases the percentages enormously, since it is not
infrequently estimated that as high as 70 per cent of adult males have
gonorrhea at least once in a lifetime.
On the whole, then, it is conservative to estimate that one man in ten
has syphilis. Taking men and women together on the basis of one of the
latter to five of the former, and excluding those under fifteen years of
age from consideration, this country, with a population of
91,972,266,[5] should be able to muster a very considerable army of
3,842,526, whose influence can give a little appreciated but very
undesirable degree of hyphenation to our American public health. In
taking stock of ourselves for the