COMPARISON BETWEEN 
THE 
SURGICAL DISEASES 
OF 
THE WHITE AND COLORED RACES. 
BY 
LOUIS McLANE TIFFANY, M.D., 
PROFESSOR OF SURGERY IN THE UNIVERSITY OF MARYLAND. 
REPRINTED FROM THE 
TRANSACTIONS OF THE AMERICAN SURGICAL ASSOCIATION, 
MAY 13, 1887. 
PHILADELPHIA: 
WILLIAM J. DORNAN, PRINTER. 
1887. COMPARISON BETWEEN 
THE 
SURGICAL DISEASES 
OF 
THE WHITE AND COLORED RACES. 
BY 
LOUIS McLANE TIFFANY, M.D., 
PROFESSOR OF SURGERY IN THE UNIVERSITY OF MARYLAND. 
REPRINTED FROM THE 
TRANSACTIONS OF THE AMERICAN SURGICAL ASSOCIATION, 
MAY 13, 1887. 
PHILADELPHIA: 
WILLIAM J. DORNAN, PRINTER. 
1887. COMPARISON BETWEEN THE SURGICAL DISEASES 
OF THE WHITE AND COLORED RACES. 
By LOUIS MCLANE TIFFANY, M.D., 
PROFESSOR OF SURGERY IN THE UNIVERSITY OF MARYLAND. 
The following notes are brought to the attention of the 
Association as preliminary to a more extended series of observa- 
tions not yet completed. 
While the number of cases collected is too limited to 
admit of the formulating of rules for a comparison between 
surgical affections of the white and colored races, yet it will 
suggest lines of thought for future research. 
The statistics presented are prepared from a record extend- 
ing over a period of thirty-four months, embracing 4930 
surgical cases, the great majority being out-door patients of a 
general hospital, the minority occupying beds in the wards of 
the same hospital; so far as possible, all patients were studied 
under similar conditions. Of the 4930, 64 per cent, were whites, 
and 36 per cent, were negroes. Under this latter heading are 
classed mulattoes of various shades. Not the least interesting 
observation that I have made, is that where whites and black 
negroes differ in their behavior under a disease, mulattoes are 
apt to occupy a middle position, corresponding more or less to 
their gradation of color. The diseases of the two races will be 
compared in percentages, and it is necessary to remember the 
proportion already stated which the whites bore to negroes- 
64: 36, or nearly two to one. 
Whites. 
Negroes 
Abscess occurred in 
. 57 per cent. 
43 per cent. 
the negro slightly exceeding his proper percentage; when, 
however, abscess by region is studied, a marked difference is 
found. 2 
Whites. 
Negroes. 
Abscess of neck and axilla 
. . 44 per cent. 
56 per cent. 
Abscess of hand and fingers . 
• 75 " 
25 " 
Alveolar abscess .... 
• 45 " 
55 " 
TIFFANY, 
Alveolar abscess was observed very rarely in the dark negro, 
but frequently in the light mulatto. 
The neck and axillary abscesses were often observed in 
association with enlarged lymphatic glands, and examination 
showed enlarged lymphatic glands in 
Neck 1 
Whites. 
Negroes. 
Axilla } 
. 41 per cent. 
59 per cent. 
Groin 
Excessive pus formation occurs in the negro, not only with 
scrofulous affections, but with syphilitic, as well; enlargements 
of lymphatic glands also are apt to be marked in the syphilitic 
negro, compared with the white race. My experience leads me 
decidedly to the opinion that suppuration in the syphilitic 
negro is greater than in the syphilitic white. 
The following table indicates the relative frequency of the 
diseases named : 
Whites. 
Negroes. 
Ganglion .... 
. 83 per cent. 
17 per cent. 
Bursa ..... 
• 77 " 
23 " 
Hydrocele .... 
• 94 " 
6 " 
Fistula in ano 
■ 71 " 
29 " 
In the negro this latter has rarely been noted, unless accom- 
panied by indications of tuberculosis. 
Whites. 
Negroes. 
Internal hemorrhoids 
. . . 82 per cent. 
18 per cent. 
It is not at all uncommon for "piles" to be complained of 
by negroes, who are apt to designate all rectal and anal discom- 
forts by this name. Examination, however, often reveals another 
pathological condition; the above percentages are accurate. 
Whites. 
Negroes. 
Spinal caries 
. 47 per cent. 
53 per cent. 
has been seen in the lower dorsal region of the negro more 
often than elsewhere. Recovery from caries of the spine is 
more frequent among whites. An adult or middle-aged negro keloid in the negro. DISEASES IN WHITE AND COLORED RACES. 
3 
showing the characteristic humpback of cured Pott's disease 
is a great rarity. 
Dislocations have been encountered more often in the whites, 
and taking the shoulder as a standard, the proportion is found 
to be-white, 82 per cent.; negro, 18 per cent. Fractures do 
not show a difference between the races. 
Keloid is very common among negroes, and rare among 
whites. Its occurrence without wound is a matter about which 
I have been able to reach no conclusion, since a traumatism so 
slight as to have been forgotten, may be the starting-point. In 
at least one instance (negro) within my personal knowledge, a 
keloid formed at the seat of an injury, the skin not having 
been broken. The tendency to keloid growths is most pro- 
nounced in early life, less so in adult, while it is highly probable 
that middle and old age are accompanied by a tendency on 
the part of the formations in question to cease growing and 
atrophy. Hence, an aged negro with keloid is exceptionally 
seen. Retrograde metamorphosis is characterized by the 
surface becoming soft and wrinkled, resembling somewhat the 
pendulous tumor of fibroma molluscum. Removal of keloid in 
early life is to be deprecated, speedy recurrence being inevitable; 
when the period of rapid growth has passed an operation can 
be undertaken with the prospect oi relieving the patient from 
a present discomfort, and the expectation of a limited recur- 
rence, if at all. Of benign tumors, lipoma and fibroma are 
recorded as met with more often in the colored race; 
sebaceous cysts occur largely in whites-88 per cent. Telan- 
giectatic formations are extremely rare among negroes; their 
non-recognition may be due in some instances to their being 
obscured by skin pigment, in the same way that an erythema 
or commencing erysipelas may escape notice, but this will not 
hold good for the tuberous naevi so common in white children. 
Of malignant growths, the ones most common in the negro 
are the sarcomata, and these are usually in relation with the 
skeleton (osteo-sarcoma). Carcinoma is very rare in the negro. 
A most interesting observation in this relation is that there is 
not recorded a single instance of epithelioma of the face or 
lip of a negro. My practice, other than here tabulated, shows 4 
DISEASES IN WHITE AND COLORED RACES. 
similar experience. On one occasion only can I recall to mind 
an instance of epithelioma of the tongue of a negro. 
Acute inflammatory gonorrhoea is recorded as more frequent 
in whites, while the reverse is true of chronic urethral dis- 
charge, negroes not paying much attention to such a trifling ail- 
ment. Gonorrhoeal rheumatism is infrequent in the colored race. 
Inflammatory phimosis, usually from local sores (chancroidal) 
occurred in the proportion of white-27 per cent.; negro, 73 per 
cent. The sores are very often situated just inside the preputial 
orifice. 
Lateral curvature of the spine is very rare in the negro ; on 
the other hand, rickets, with more or less bone deformity, 
occurs-white, 37 per cent.; negro, 63 per cent. Congenital 
deformities are very exceptionally seen in the colored race, and, 
if present, the possessor will probably be a light mulatto. 
Cleft palate, harelip, talipes (non-paralytic), exstrophy of 
bladder, epispadias, hypospadias, spina bifida, have not been 
met with in the dark negro. 
One instance of spina bifida, one instance of harelip, and 
two instances of congenital club-foot have been met with in 
negroes having a very large admixture of white blood. 
Comparison made between ward patients of the two races, 
some admitted into hospital when first seen, others treated as 
out-patients, and sent into hospital for operation, have led me 
largely to form the opinions expressed in suggestions 1 and 2, 
hereunto appended. 
In conclusion, I offer the following suggestions : 
1. Surgical affections pursue different courses in the white 
and colored races under identical hygienic surroundings. 
2 Surgical injuries and operations are better borne by negroes 
than whites. 
3. Surgical diseases involving the lymphatic system, especi- 
ally if tubercular, are more fatal in negroes than in whites. 
4. Congenital deformities are more rare in negroes than in 
whites. 
5. Surgical differences observed between whites and negroes 
are due to race peculiarities.