Sketchy information for some of the tropical African countries comes from a paper by Dr. Guthe dated 1961, and gives curves for gonorrhea and syphilis that begin in 1946 or later and end in 1957 or 1959. In the careful language of the report, the pattern for this region is described as "somewhat different" from that of most other countries:

“There is no indication of a downward trend in syphilis, while the long term component for gonorrhea shows a decided upward tendency.”

Both in terms of trend and even more clearly in terms of actual rates, the facts are alarming, the most recent levels (per 100,000) for early syphilis ranging from more than 300 (Swaziland) to about 3000 (French West Africa, 1958, before independence), and for gonorrhea from more than 1000 (Basutoland) to some 2500 (Bechuana land). A more recent paper by Guthe and Grab dated 1968, on control of yaws, which has been highly successful, gives no statistics for syphilis, but comments as follows:

“Following penicillin mass campaigns the age groups now attaining puberty are without the relative cross immunity from yaws against venereal syphilis which was present in the previous generation. The increasing number of susceptible to this adult Treponematoses may thus represent an epidemiological factor of some importance to be taken into account, in conjunction with other recent ecological changes, which favor national and international spread of venereal syphilis.”

The nature of the "other recent ecological changes" and the word is surely used here in the limited sense of relations between human beings and their environment -- may be suggested by reports going back to 1952 and 1953 of an "epidemic" of syphilis among the Bantu of South Africa as they had migrated during the preceding forty years into the country's newly established industry, where they met social and economic problems "that fall largely outside the concern of existing health services." The notorious doctrine of apartheid has become widely known since that time.

In conversation with me in 1970, Dr. Guthe went much further than the 1968 statement. In areas from which yaws and betel have been cleared through WHO efforts, he said, including Bosnia (Yugoslavia) as well as parts of Africa and elsewhere, syphilis is currently appearing and increasing. The prediction that this would happen has come true.