WORLD-WAR-I ORIGINS OF THE SYPHILIS EPIDEMIC AMONG 20TH-CENTURY BLACK-AMERICANS - A BIOHISTORICAL ANALYSIS

Syphilis outbreaks and differentials have been an ongoing issue in mod ern preventive medicine and public health. Since the early 20th Centur y, a variety of approaches has been employed to explain demographic an d temporal variations in the prevalence of syphilis in the U.S. Public health experts and physicians have tended to rely on case-by-case app roaches to explain group-specific patterns. This study, however, shows that population-level disease dynamics cannot be ascertained from the se individual-level studies. We offer a biohistorical methodology to s tudy syphilis prevalence differentials in U.S. populations. Using hist orical health data, this study suggests that the social disruption bro ught on by World War I was the critical and unique environmental condi tion which ignited an epidemic of syphilis among black Americans. By e stablishing this beginning point for the epidemic, this study further shows the persistence of the epidemic for the next 40 years and its de cline. This biohistorical methodology could be applied to the analysis of STD epidemics in other populations and regions experiencing mass e xposure events. (C) 1997 Elsevier Science Ltd.