Clinical investigation of chronic diseases: Its successful pursuit in an outpatient setting

Abstract

With the great discoveries made during the first decade of the 20th century in relation to syphilis—transmission to animals, identification of the spirochete, the Wassermann test and Ehrlich's introduction of Salvarsan—the clinical and experimental aspects of this disease underwent a dramatic change. Knowledge directly applicable to treatment was gained by studies of immunity and of the principles of arsenical therapy in animal models of the disease. In 1915 the Johns Hopkins Hospital made a major innovation by establishing a syphilis clinic where the disease could be studied clinically and experimentally. This led to more effective care of patients and to important new knowledge of the disease. With the discovery that penicillin was treponemicidal, the prospect of eliminating syphilis as a major disease problem seemed at hand. This did not eventuate, but in the early 1950s there was such a dramatic decline in the number of new cases that the syphilis clinic at Johns Hopkins was reorganized. The clinical and epidemiologic facilities that had been created for the study and management of this single disease were utilized to investigate other chronic diseases and finally to form the base for a pioneering program in medical genetics.