The social pathology of syphilis in Africans

The problem of syphilis in South Africa is so closely related to the development of the country that a study of the social factors responsible for its spread is likely to assist in its control. Few countries can have a higher incidence of the disease than has South Africa. Table 1 indicates the extent of the problem. The data include sample studies of men, women, children and babies. They indicate the extent which syphilis has spread to urban and rural areas. In the school children examined by Kark and le Riche 5 in 1938-1939, the incidence of definitely positive Wassermann tests in the total urban group was 23.6%, and in all rural areas it was 23.28%. Cluver's figures, 2 as well as those of the Polela group, 6 also indicate that syphilis is probably as widespread in rural areas as it is in urban areas. Gale 10 estimated that the rate of infection per year in Pietermaritzburg Africans was 2620 per 100 000 as judged by the occurrence of early cases under treatment. A sample study, carried out by the author at Polela 6 in 1942, indicated the annual rate of infection in adult women to be 3.27%, estimated by the incidence of known cases exhibiting primary and secondary manifestations, with a recent history of infection. At Springs 11 the rate of new cases coming to the notice of the Medical Officer of Health (1940) was 2061 per 100 000, of which 577 per 100 000 were early cases. Purcell, 11 after briefly reviewing the incidence of syphilis in various groups of Europeans and non-Europeans in South Africa, indicated that 'the incidence of syphilis in the Union is enormous'. Our present review indicates that not only are we dealing with a large mass of latent syphilis in the African populations, but also with a very high incidence of new infections each year. This process is taking place in highly urbanized areas, as well as in the more remote rural districts. A study of the social pathology of the disease must, therefore, include an historical analysis, as well as an assessment of present trends which are maintaining the spread of syphilis.