HLTA01 - Chapter 12

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Health Studies
Caroline Barakat

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 – 00 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 - 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 - 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  Can occur on lips, fingers, or genitals  Infection can spread by kissing or touching a person with active lesions on lips, genitals, or breasts and through breast milk  Chancre disappears within 4-8 weeks if untreated leaving a small scar o Second, disseminated stage – develops 2-12 weeks after chancre stage  Can be delayed for more than a year  T. pallidum is present in all tissue but mostly the blood  General tissue reaction – headache, sore throat, mild fever, and skin rash (in most cases)  Highly infectious stage doesn’t last very long  Early latent stage – patient appears to be disease free (most dangerous because it can be transmitted) o Late latent, tertiary stage – develops after around 2 years  Individual is no longer infectious  Develops in 1/3 of untreated patients 10-25 years after initial infection  Disease is chronic  20% of cases – ulcers appear in muscles, skin, liver, lungs, and eyes  10% of cases – heart is ruptured  40% of cases – spinal cord and brain become involved – incomplete paralysis, complete paralysis and/or insanity  Headaches, pains, joints, impotence, and epileptic seizures o Most untreated patients die after 5 years of initial infection - ‘Canker’ – mouth sore - ‘Acne vulgaris’ – rash - ‘Arthralgia’ – pains in the joints - ‘Gun-barrel sight’ – loss of peripheral vision due to destruction of optic nerve Catching Syphilis - Primary stage – can be spread through kissing or touching a person with active lesions on lips, genitalia, or breasts - Secondary stage – skin lesions render individuals infectious - Early latent stage – no clinical signs but person remains infected - Can be transmitted from mother to developing fetus o Usually when mother is in active stage of infection o If treated in first 4 months of pregnancy, fetus will not be infected o Fetal death/ miscarriage doesn’t occur until after the first 4 months o Surviving child may have same symptoms as mother  Or have deformities, deafness, or blindness  May have Hutchinson’s triad: deafness, impaired vision and telltale groove across peg-shaped teeth The Pre-Columbian Origin of Syphilis - Prior to Christopher Columbus – carbon da
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