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HLTA01 - Chapter 12


Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat

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HLTA01
Plagues and People
Chapter 12: Syphilis
The Great Pox Syphilis
- 1932 South America
- U.S. Public Health Service enlisted 399 poor, black sharecroppers with latent syphilis
o Co-operation by: free burial service if they agreed to autopsy, free physical
exams and local health nurse
o Told they had “bad blood” rather than syphilis
o Deprived of treatment of syphilis
o Enrolled in Tuskegee Syphilis Study
Denied access to treatment even after use of penicillin in 1947
Left to degenerate
- James Jones’s book – ‘Bad Blood’
- Play ‘Miss Evers’ Boys’
- 28 deaths from syphilis; 100 deaths with complications; 40 wives infected; 19 children
contracted disease at birth
- Tuskegee Syphilis Study designed to document natural history of syphilis, but came to
symbolize racism in medicine, ethical misconduct in medical research, paternalism by
physicians, and gov’t abuse of society’s most vulnerable (poor and uneducated)
- Surviving participants in the study were invited to the White House where Bill Clinton
admitted to the study and asked for forgiveness May 16, 1997
A Look Back
- 1996 00th anniversary of arrival of syphilis ‘Great Pox’
- 1493 and onward spread the Europe and the rest of the world (China, India, Japan)
- Claim brought to Naples by Spanish troops
o Troops contracted disease with lead to their withdrawal against French King
Charles VIII
o Soldiers of Charles were infected by Neapolitan women
Pox spread through Europe
- Disease became epidemic after 5 years in Europe
- Considered to be the AIDS of that era
- French called syphilis ‘disease of the Naples (blaming Italians)
- Italians ‘ French Disease’ (blaming French)
- Troops brought the diseases back to their home towns

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- Russians ‘ Polish Disease’
- Japan ‘Chinese Disease’
- England ‘Spanish Disease’
- Victims suffered with fevers, open sores, disfiguring scars, disabling pains in joints, and
gruesome deaths
- Theories of contraction
o Pre-Columbian theory (anti-Columbian)
o Columbian theory Christopher Columbus visited Americas and brought back
several natives of the West Indies
o The crew of 44 disbanded and some joined Charles VIII’s army
First mention of disease by Emperor Maximillian ‘evil pox’
Francisco Lopes de Villalobos claimed syphilis had been imported into
Europe from Americas
o First signs in 1494-1516 genital ulcers followed by a rash, disease spread
through body, affecting gums, palate, uvula, jaw and tonsils and eventually
destroyed those organs
Two new symptoms in 1516-1526 bone inflammation and hard pustules
o Died down from 1526-1560 but then another symptom arose: ringing in the ears
- 1700 dangerous but not an explosive infection
o 1800 virulence and number of cases declines
1900 10% of population was infected
People were developing resistance or the disease’s pathogenicity was
changing
- Hypothesis of production
o Transmitted by sexual means making it more virulent
o Derived from yaws, initially infected by direct contact
- Treatments varied
o George Sommariva tried mercury for ‘French pox’
‘salivation’
o Guaiacum (holy wood) from trees useless but popularized due to Americans
origins
- Some disagreed with Columbian theory sailors were all healthy
o Others believed some had syphilitic lesions bone and teeth lesions
- Syphilis was not present in ancient Greece or in Roman Empire
- Bones were found dating to 70 years before Columbus’ voyage
o Had signs of syphilis
- Cities with high sexual activity and prostitution increase possibility of high transmission
rates for STDs

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- Immigration increases possibility of foreign illnesses
Spirochete Discovered
- Believed that syphilis was God’s punishment for human sexual excesses
Platonic love emerged as a social cult
o Syphilis had an astrological basis
- Girolamo Fracastoro recognized that the disease was contagious and he called it syphilis
after a fictitious shepherd
o Theorized that syphilis was a result of ‘seed of contagion’
- Fritz Schaudin and Erich Hoffman
o Identified spiral-shaped bacterium (spirochete) in syphilitic chancres
o Hideyo Noguchi isolated same bacterium
Stages of disease were clearly linked to the bacterium Treponema
pallidum
Divides slowly and requires moist environment
Confused with gonorrhea
o John Hunter tested it on himself to decipher whether pox was one disease or
could be separated
Wet disease gonorrhea
Produced chancres syphilis
o Syphilis had 3 stages
Last stag attacked a variety of organs including heart, brain, spinal cord,
and aorta
The Disease of Syphilis
- Called venereal diseases (VD)
o Venereal refers to Roman goddess of Love (Venus)
Under most circumstances, the diseases were transmitted by sexual
contact
Now referred to as STD’S since not all sex is love
- ‘Great Imitator’
o Lateral stage developed neurosyphilis, destructive ulcers, cardiovascular
disease,
Syphilis was primary cause of death
o Chancre stage earliest clinical stage
After initial infection (~21 days, ranges from 3-90 days), after initial
contact, a painless, pea-sized ulcer (chancre) appears at the site of
spirochete inoculation
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