THE CLINICAL APPROACH TO SYPHILIS, WITH SUGGESTIONS FOR ITS REVIVAL AND DEVELOPMENT

JOHN H. STOKES
1920 Archives of Dermatology and Syphilology  
For the past four years, a large part of my time has been occupied with the development of clinical interest in syphilis in the diagnostic group of the Mayo Clinic, through whose hands pass approximately 60,000 patients a year. In developing a diagnostic and therapeutic approach to the disease I have been compelled to give constant and intense thought to the present and future possibilities, limitations, and tendencies of syphilology as a special field of medical activity. As a dermatologist, I
more » ... a dermatologist, I may be pardoned for bringing before you for your criticism and suggestions some of my impressions and perplexities. I have passed through a period of misgivings and distrust of the possibilities of the work, engendered in part by the confusion and lack of cooperation which at first sight appears to pervade the field, and in part by the feeling that the clinical syphilographer as such reached his culmination in Fournier and that others who in these times essay the r\l=o^\lecan be no more than base imitators. In the grip of that depression -I cast yearning eyes on the laboratory, as many a better man has done, and longed for the day when with a corps of trained routinists to buttress me against the demands of patients, I could indulge in a species of endowed reflection in sequestration, and in animal experiment. From this monastic phase I am slowly emerging in response to a new appreciation of the enduring worth and ultimacy of clinical research. The critical problem of the next half century of syphilology, as it has appealed to me during the past several years, is not so much the extension of the laboratory knowledge now so highly developed, as the application of the knowledge already existent, to the pressing clinical problems of the disease. No reasonable man would seek to minimize the worth of the laboratory contribution, whose fundamental character needs no discussion in this assembly. But a decade of trans¬ formations has been superimposed on the clinical syphilology of Fournier, Hutchinson and Morrow as two fluids of different densities may be superimposed the one on the other in a test tube. 1 believe that there has never been a greater need for clinical revision of laboratory specialization in the diagnosis and treatment of syphilis. The Was-Read at the
doi:10.1001/archderm.1920.02350100061009 fatcat:sr2n57nsn5cjnkcxyg3xkyf3cm