Class Notes (905,915)
CA (538,528)
UTSC (32,637)
Health Studies (1,217)
HLTB21H3 (204)
Lecture

Term 2 Notes

25 Pages
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Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat

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SYPHLLIS (textbook)
- Tuskegee study: 399 poor black men all with latent syphilis
- cooperation obtained by offering financial incentivesfree burial service that they agreed to autopsy, free physical
exams, incidental medications
- men not told they had syphilis, instead bad blood”
- annually, doctor take blood pressure, listen to hearts, obtain blood sample, advice on diet to help with bad blood”
- men not told they would be deprived of treatment for syphilis
- denied access to treatment for syphilis even after penicillin came into use in 1947
- left to degenerate under ravages of tertiary syphilis
- 28 men died, 100 others dead of related complications, 40 wives infected, 19 children contracted disease at birth
document natural history of syphilis but came to symbolize racism in medicine, ethical misconduct in medical
research, government abuse of most vulnerable- poor, uneducated
- Syphilis, Great Pox from 1493 onward swept over EU and rest of world, China, India, Japan
- claim new disease brought to Naples by Spanish troops to fend against French king Charles VIII
- troops of Charles VIII, infected by Neapolitan women – pox spread rapidly through EU
- pox evident in invading troops of Scotland
- within 5 year of arrival in EU, disease epidemic
- French called pox – disease of Naples, blaming Italians; Italians called it French disease”
- came to be called after national origins of those people who were disliked, considered unclean
- victims of syph: fevers, open sores, disfiguring scars, disabling pains in joints and gruesome deaths
- two main theories:
1. Columbian (Unitarian)
- Columbus visited Americas and then set sail back home to Spain; bringing with him several natives
- upon arrival in Spain, crew disbanded, some joined army of Charles VIII
- first mention disease occurs by Emperor Maximillian- refer to as evil pox
- 25 years later by Francisco Lopes, claim syph imported into Europe from Americas
www.notesolution.com
- indicative of new import was severity of outbreak
- first signs: genital ulcers, rash, disease spread throughout body, affecting gums, palate, uvula, jaw, tonsils and eventually
destroying these organs
- pains in muscles, early death
- 1516- 1526 new symptoms: bone inflammation and hard pustules; mortality declined
- 1560-1610 new symptom: ringing in ear
- 1600, Great Pox extremely dangerous
- 1700s, syph dangerous but not explosive infection
- end of 1800s. pathogen and number cases declined – still 10% population EU infected
- causation? Possible hypotheses:
- increased rate of sex transmitted diseaseshighly virulent (from intro of native populations)
- EU syph derived from yaws (infection of direct contact- kissing, sharing cupscustomary in England)
- rapid spread due to precautions unobserved since later stages not recognized as associated with earlier
stages(skin, chancre)
- treatments varied with time
- Sommariva of Italy tried mercury applied topically to sores or in form of drink (called salivation because
mercury salts produce copious amounts of saliva)
- guaiacum (holy wood) resin from trees indigenous to West Indies, South America
- resin useless but popularized because of concept of American origins
- limitation of theory: crew of Columbus were healthy – may have had syphilitic lesions (never showed)
- best evidence for Columbus theory- bones and teeth: bone lesions, scrimshaw patterns and saber thickenings on lower
limbs of adults and notched teeth in children (diagnostic of syphilis) found in skeletal remains of Amerindians (and not of
such in prior EU, China)
- not present in ancient Greece or Roman Empire
- Blackfriar skeletons in England date 70 years before Columbus voyageshow signs of syphilis
- signs of notched teeth in remains of individuals from Pompeii, Italy – syphilis present in EU thousands years
- exact origin unknown
- port city characteristics of high sexual activity nad prostitution – possibility for high transmission rates of STD
- immigration introduction of foreign illness, greater frequency
- early observers believed syph God’s punishment sex excess
www.notesolution.com
- public bathhouses closed; mistrust btw lovers and friends
- Fracastoro recognized disease contagious, described earliest stages as small ulcers on genitals, followed by skin rash,
severe cough, lips and eyes eaten away, swellings appeared, pains in joints and muscles
- Schaudinn and Hoffman identified slender, spiral shaped bacterium, spirochete in syphilitic chancres
- all stages of disease linked to one okind of spirochete
= Treponema pallidum – no spores, cannot be cultured but can be grown in lab animals but humans only natural host
- divides slowly and quite fragile, require moist enviro
- reason took so long to identify cause of syph – confused with gonorrhea
- John Hunter deliberately infected himself with gonorrhea and died (aorta ruptured)believed gonorrhea and syphilis the
same; 3rd stage killed Hunter (wet onegonorrhea; dry, produced chancre was syph)
- syphilis called Venereal Disease (also include gonorrhea, herpes, HIV)
- syphilis called great imitator
- many studies: Oslo study, Tuskegee Study
- patients died from destructive ulcers, neurosyphilis, cardiovascular disease, inflammation of aorta
- chancre stage earliest clinical sign of diease
- after initial infection, 21 days after initial contact, painless pea sized ulcer appears at site of inoculation – chancre is a
local tissue reaction and can occur on lips, fingers, genitals
- infection can be spread by kissing or touching person with active lesions on lips, genitalia, breasts and through breast
milk
- untreated, chancre disappears within 4-8 weeks leaving small scar
- presence of lesions larger than that of small pox gives diseases = Great Pox
- secondary stage usually develops 2-12 weeks after chancre stage
- T. pallidum present in all tissues but especially in blood
- general tissue reaction- headache, sore throat, mild fever, skin rash
- then entering latent stage, appears disease free, no clinical signs
- most dangerous time is during early latent stage because infected individual can still transmit to others
- transmission also occur by blood transfusion but rarespirochetes do not survive longer than 48 hrs under blood bank
storage conditions
- progress after 2 years, late latent or tertiary stage develops
www.notesolution.com

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Description
SYPHLLIS (textbook) - Tuskegee study: 399 poor black men all with latent syphilis - cooperation obtained by offering financial incentives free burial service that they agreed to autopsy, free physical exams, incidental medications - men not told they had syphilis, instead bad blood - annually, doctor take blood pressure, listen to hearts, obtain blood sample, advice on diet to help with bad blood - men not told they would be deprived of treatment for syphilis - denied access to treatment for syphilis even after penicillin came into use in 1947 - left to degenerate under ravages of tertiary syphilis - 28 men died, 100 others dead of related complications, 40 wives infected, 19 children contracted disease at birth document natural history of syphilis but came to symbolize racism in medicine, ethical misconduct in medical research, government abuse of most vulnerable- poor, uneducated - Syphilis, Great Pox from 1493 onward swept over EU and rest of world, China, India, Japan - claim new disease brought to Naples by Spanish troops to fend against French king Charles VIII - troops of Charles VIII, infected by Neapolitan women pox spread rapidly through EU - pox evident in invading troops of Scotland - within 5 year of arrival in EU, disease epidemic - French called pox disease of Naples, blaming Italians; Italians called it French disease - came to be called after national origins of those people who were disliked, considered unclean - victims of syph: fevers, open sores, disfiguring scars, disabling pains in joints and gruesome deaths - two main theories: 1. Columbian (Unitarian) - Columbus visited Americas and then set sail back home to Spain; bringing with him several natives - upon arrival in Spain, crew disbanded, some joined army of Charles VIII - first mention disease occurs by Emperor Maximillian- refer to as evil pox - 25 years later by Francisco Lopes, claim syph imported into Europe from Americas www.notesolution.com- indicative of new import was severity of outbreak - first signs: genital ulcers, rash, disease spread throughout body, affecting gums, palate, uvula, jaw, tonsils and eventually destroying these organs - pains in muscles, early death - 1516- 1526 new symptoms: bone inflammation and hard pustules; mortality declined - 1560-1610 new symptom: ringing in ear - 1600, Great Pox extremely dangerous - 1700s, syph dangerous but not explosive infection - end of 1800s. pathogen and number cases declined still 10% population EU infected - causation? Possible hypotheses: - increased rate of sex transmitted diseases highly virulent (from intro of native populations) - EU syph derived from yaws (infection of direct contact- kissing, sharing cups customary in England) - rapid spread due to precautions unobserved since later stages not recognized as associated with earlier stages(skin, chancre) - treatments varied with time - Sommariva of Italy tried mercury applied topically to sores or in form of drink (called salivation because mercury salts produce copious amounts of saliva) - guaiacum (holy wood) resin from trees indigenous to West Indies, South America - resin useless but popularized because of concept of American origins - limitation of theory: crew of Columbus were healthy may have had syphilitic lesions (never showed) - best evidence for Columbus theory- bones and teeth: bone lesions, scrimshaw patterns and saber thickenings on lower limbs of adults and notched teeth in children (diagnostic of syphilis) found in skeletal remains of Amerindians (and not of such in prior EU, China) - not present in ancient Greece or Roman Empire - Blackfriar skeletons in England date 70 years before Columbus voyage show signs of syphilis - signs of notched teeth in remains of individuals from Pompeii, Italy syphilis present in EU thousands years - exact origin unknown - port city characteristics of high sexual activity nad prostitution possibility for high transmission rates of STD - immigration introduction of foreign illness, greater frequency - early observers believed syph Gods punishment sex excess www.notesolution.com
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