Sidney Olansky

Twenty years of followup experience in a long-range medical study.

ONE OF THE longest continued medical surveys ever conducted is the study of untreated syphilis in the male Negro. This study was begun by the Public Health Service in the fall of 1932 in Macon County, Ala., a rural area in the eastern part of the State, and is now entering its twenty-second year (1-4). This paper is the first report dealing with the nonmedical aspects of the study. The experiences recounted may be of value to those who are planning continuing studies in other fields. In beginning the study, schedules of the blooddr awing clinics throughout the county were announced through every available source, including churches, schools, and community stores. The people responded willingly, and 600 patients were selected for the study-400 who had syphilis and, for controls, 200 who did not. The patients who had syphilis were all in the latent stage; any acute cases requiring treatment were carefully screened out for standard therapy. At Tuskegee, each of the 600 patients initially was given a complete physical examination, including chest X-rays and electrocardiograms. Careful histories were taken and blood tests were repeated. Thereafter, each of the patients was followed up with an annual blood test and, whenever the Public Health Service physicians came to Tuskegee, physical examinations were repeated.

Untreated syphilis in the male Negro: X. Twenty years of clinical observation of untreated syphilitic and presumably nonsyphilitic groups

Abstract This report is one of a series in a continuing study of untreated syphilis in the male Negro by the United States Public Health Service. The study consists of 600 men who have been followed clinically, serologically, and pathologically (to post-mortem examination in over 63 per cent of the deceased patients). This study is unique because of the inclusion of nonsyphilitic individuals of comparable ages to the syphilitic patients at the onset of the study; furthermore, these “controls” have been followed as intensively for the past twenty years as have the syphilitic men. In this report, methods and problems in diagnosis of clinical syphilis are described as they were encountered in the collection of the statistical data obtained. Clinical findings are reported from physical examination, medical history, x-ray and fluoroscopy, serologic testing, electrocardiography, and neurologic examination; comparisons between syphilitic and nonsyphilitic individuals are shown usually by age groups; these comparisons have been subjected to statistical tests for significance. 1. 1. Findings in this study seem to confirm the impression that, in male Negroes with untreated syphilis, the cardiovascular system frequently is involved. 2. 2. Among the 23 living men who have developed some form of late syphilis, not one has received adequate therapy prior to the recent survey. 3. 3. Problems of diagnosis of syphilis among the aged are complex, especially in evaluating findings related to the cardiovascular system.

TPI Test in Treated Syphilis

The Treponema pallidum immobilization (TPI) test has received wide attention as a diagnostic test for syphilis, but few studies have appeared on the response of this test to adequate treatment for syphilis. The Blue Star study of the Public Health Service (Bauer, 1951 ; Shafer, Usilton, and Price, 1954) offered a group of patients who had had bonafide syphilis, who had been adequately treated, and who had been closely observed for many years after treatment. The purpose of the present study is to determine the TPI results in these patients and to compare them with results of the VDRL slide and Kahn quantitative tests. When the Blue Star study patients were seen for their latest evaluation (5 to 9 years after treatment) blood was drawn and sent to the Venereal Disease Research Laboratory for the performance of the TPI, VDRL slide, and Kahn quantitative tests. During the early years of the Blue Star study, which was initiated in 1945, patients with any syphilitic diagnosis were accepted for study. As the study progressed and it was found that patients with secondary syphilis were the most satisfactory group for evaluating schedules of treatment, selections were limited to this stage. Therefore, of the 366 Blue Star patients who had TPI tests as of August, 1955, 213 were in the secondary stage at time of original treatment, 91 in the primary, 36 in the early latent stage, and only 22 in the late stages (twelve were diagnosed as having late latent syphilis, and ten as having symptomatic or asymptomatic neurosyphilis). In four patients treated before admission to the Blue Star study, the diagnosis at time of first treatment is unknown. As shown in Table I (opposite), 305 of the patients received only one course of treatment. The remaining 61 patients were treated two or more times, some for relapse or resistance, others for re-infection. No