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University of Toronto Scarborough
Health Studies
Caroline Barakat

PLAGUES AND PEOPLE LEC 7: The Great Pox Syphilis Origin of the term Syphilis Girolamo Fracastoro (1478-1553) -venetian physician -1530 epic – Syphilis sive morbus gallicus poem about a shepherd boy named Syphilis who insulted a God and was punished by that god with the disease Theories: 1. Introduced to Europe from the New World – Columbian Theory -written record -skeletal remains from the Americas -the pattern of spread of the disease 2. Pre-Columbian/ Anti-Columbian theory -unitarian versus non-unitarian theory unitarian – there is only one treponema. Changing physical and sociocultural environment of human beings has caused treponematosis to change into one or another of those four different clinical syndromes – pinta, yaws, endemic syphilis, and syphilis (does not make sense to talk about transmission of syphilis from New York to the Old) Nonunitarian – mutational changes in the treponemal strains themselves -many populations of native Americans themselves were decimated by syphilis in the 16 century after the arrival of the Europeans John Hunter (1728-1793) – founder of scientific undertook self-experimentation -injected himself with gonorrhea and syphilis developed the signs of syphilis and concluded the two infections were the same eventually died of heart problem – tertiary syphilis Philippe Ricord (1799-1889) demonstrated that gonorrhea and syphilis were different diseases determined the 3 stages – primary, secondary and tertiary Rudolph Virchow (1821-1902) established that syphilis was spread through the body by the blood 1905 – Shaudinn and Hoffman discovered the germ that causes syphilis The Tuskegee Syphilis Study consisted 2000 patients 1930, 400 poor uneducated African american men -they had syphilis but were told they had “bad Blood” Etiology causative agent Treponema Pallidum extremely fragile spirochete surviving only briefly outside the host no climatic restrictions only natural host is human being STD – direct person to person through direct contact with sores/close contact with open lesions/ in utero/ transfusion of injected blood Great imitator Epidemiology worldwide – estimated 12 M cases of syphilis/year 1920s – death rate from syphilis; 9000 in US and 60,000 born infected 1940 – 13000 annual death 1949;<6000 annual death 1970; <0.2/10,000 annual death 2002 – over 32,000 cases (four times as many cases as in 1997 in Canada) more males get infected than females do Clinical Manifestations Primary stage marked by the appearance of a single chancre 1-3 months, chancre disappears ( latent stage) Secondary Stage 6-8 weeks after incubation period skin rash and mucous membrane lesions rough, red or reddish spots on the palms of the hands and bottoms of the feet early latent stage(2-50 years) – still infected late latent stage (2-50 years) – no longer infectious Tertiary Stage no longer contagious without treatment, the disease may damage the internal organs, including the blood vessels, bones brain, eyes, heart, joints, liver, nerves , central nervous system Diagnosis and Treatment examine material from a chancre blood test mercury – treatment of choice Penicillin (Sir Alexander Fleming) -treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage done already American South in 1932 -Black Americans became subjects to the Tuskegee Syphilis Study (many died) -government abused the socially vulnerable (poor and uneducated) A Look Back 1493 onward Europe including China, India, and Japan -claimed it was brought to Naples by Spanish troops -portuguese carried it around the Cape of Good Hope with the voyage of Vasco de Gama to India in 1498 -it was in china by 1505 -in Australia by 1515 -and in Japan by 1569 th Syphilis was ubiquitous by the 19 century that it could be considered to be the AIDS epidemic of that era Victims of syphilis suffered from fevers, open sores, disfiguring scars, disabling pains in the joints, gruesome deaths Two main theories of Syphilis contraction: 1. The Columbian theory Columbus arriving Americas in 1492, 3 years later, went home 3 months later in Spain with several Natives of West Indies. brought into Europe from Americas from 1494-1516, first signs were described as genital ulcers, followed by a rash, and then the disease spread throughout the body , affecting the gums, palate, uvula, jaw, tonsils, and eventually destroying the organs (pains in the muscles) 1516-1610: two new symptoms bone inflammation and hard pustules 1560-1610: new symptom  ringing in the ears 1600: “The Great Pox” was an extremely dangerous infection End of 1800s, both virulence and pathogen and number of cases declined -either increased resistance, or the disease’s pathogenicity was changing evidence in the bones and teeth of Columbus’ sailors: bone lesions, scrimshaw patterns and saber thickenings on the lower limbs of adults and notched teeth in children 2. The Pre-Columbian Origin of Syphilis theory human treponemes may have come from animals and that infection similar to pinta (Treponema carateum) true vunereal transmission from spirochetes in the vagina and the penis occurred as a result of a third mutation, coinciding with cities about 3000 BC in the middle east. Then spread to Mediterranean in a mild form; and remained endemic th Fourth mutation in the spirochete occurred in Europe in the 15 century Pinta is restricted to the skin, is disseminated by introduction into skin lesions, and is usually found in persons 15-30 years of age -pigment changes in the skin Pinta is found in tropical Central and South America where hygiene is poor and conditions are crowded Hypothesized that 10,00 BC, the spirochete-causing pinta mutated into a disease very similar to yaws (Treponema pertenue) -restricted to tropical areas of Africa and landmasses -mutation triggered by the tropical climate -brought to Americas by slave trade -yaws exists in warm, moist climate, poor hygiene places -transmitted primarily in children by skin contact -can spread through the blood and cause disfigurement of the face and bones -occurs in Africa, South America, Southeast Asia, and Oceania spirochetes mutated again as humans moved to temperate and drier regions, cooler climates and the wearing of clothing -allowed to invade the mouth and throat and t
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