The Ebb and Flow of Infection

Ervin Epstein, MD
JAMA. 1976;236(4):344. doi:10.1001/jama.1976.03270040010004.
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To the Editor.—  I read with great interest the article by Thomson (235: 269, 1976). It is significant that the great epidemic diseases of the past— plague, typhoid fever, typhus, smallpox, and diphtheria—waxed and waned for actual or supposed reasons, or even without them. The same has happened with certain plagues of today. For instance, there is little or no reason to accept the thesis that the use of penicillin or public health measures or both are the explanation for a decrease in syphilis. If a curve of the incidence of that disease had been constructed and had ignored the peaks due to wars and depressions, it could have predicted that this scourge would have become rare in the 1950s. It waned in countries that did not have penicillin. It persisted in the male homosexual who had as much penicillin for various ailments as did the heterosexual. The condition is


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