With this poison, anything is possible. It assumes the most unexpected and disconcerting forms. It almost seems to know the ridiculous shame it inspires, so it kills under a disguise. It makes its victims die of an intestinal obstruction, for example, or a nice little liver disease. You don't recover, but your honor is safe. At least the bereave don't have to blush at the mention of the deceased. So much for its caprices, but it also has its little habits.
It loves to come out into the daylight, and then you get the whole garden full of cutaneous manifestations, those burgeonings, those dreadful efflorescences, the lupus. You can find fine examples of them all at Saint Louis or in its museum. And of course it eats away your bones. But above all, you see, the disease attacks the nervous system. That's its treat its dessert. It chooses its spot. It snaps the
network of the nerves at winds. It can cut off communication with the outside world, suppress the five senses, and then we've got a pretty bouquet of infirmities or It plays with a man as if he were a puppet. By pinching the nerve at the right spot. It makes him jump or dance or start. Then, tired of this, it casts him aside, legs broken, and then we have
a taxia, such a cruel game. You have heard tell, for instance, of the acute pain which strikes unendingly in the small of your back, or perhaps it lays into the brain, the kingpin of it all. And there's your general paralysis, sinility, and all its glory, all its regularity.
I loved that description.
Yeah, that's from this book called History of Syphilis.
Well believe it or not. Jumping right into it, jumping right in. Oh yeah. So Hi, I'm Aaron Welsh.
And I'm Erin Almond Updyke.
And this is this podcast Will.
Kill You Season three, Season three, and we're starting off with a bang by covering.
A classic, a very classic syphilis. I'm very excited about today.
Yeah, we've been wanting to do this one for a while and it's been highly requested, and I think we've been saving it because it's such a.
Big one and it feels a bit daunting. So hopefully you get your fill.
I think this was kind of on our short list for the first season, wasn't it because it's such a big, big one.
It was, But I'm glad that we saved it. Me too.
So because we're doing syphilis, we should maybe preface this with a bit of warning.
Yes, if you are so, syphilis is a sexually transmitted disease, which means we will be talking about genitalia and sex. So if you're listening with young ones that you don't want to hear those things, maybe skip this episode. Come back in two weeks up to you.
Yeah, okay, So first episode of season three. A lot of things have happened.
So many things have happened, and it hasn't even been that long since season two ended.
No it hasn't. So Aaron, tell us about some of the things that happened for you since we ended season two.
I am back in the United States, and so now we get to record in the same time zone at least, even if it's not in the same location. But there will be upcoming same recordings, which will be excellent.
That'll be way more fun. But it's really nice to be on the same time zone.
Is and aeron what's up with you?
Well, you might hear throughout this episode, tiny little squeals of my baby human who is sitting here near me, the keenest. He's very cute. And hopefully we'll sleep through this recording, but if not, we'll take breaks. Yeah, baby, no problem. Okay, So right, that's us all caught up. Do we have any more business?
Yeah?
So we still have merchandise, so go take a look at that. And we also will have new soap coming out, new new scent which is going to be super delicious smelling.
Yeah, a kind of fall scent.
Yeah. Yeah, I'm excited about it. Where can you find all of this?
You can get to it all from our website. This podcast will kill You dot com under merch perfect It's pretty easy.
Okay, onto more important things. Yes, it's corn teeny time.
Oh, it's been so long since we've gotten to say those words, and.
Since you've been able to actually participate.
I know, And I'm not even right now, which is really disappointing, but I will be again soon. Quarantiny time, Aaron, What are we drinking today?
We are drinking the Killer Cure Ooh it has mold cider of course, rye whiskey, ginger liqueur okay, and Walnut Liqueur or Walnut bitters.
If you can find them, fantastic.
I will recommend Templeton Rye because that was al Capone's favorite whiskey and he had syphilis. And shout out to our friend Sam for telling me that bit of trivia.
That's amazing.
Sam in her pocket knew like, oh yeah, and al Capone had syphilis. Yeahd Templeton Rye.
She had to do a report on famous chicagoans when she was like in grade school, and so she chose al Capone and always remembered that he had syphilis.
Oh that's amazing. Yeah, well that's perfect.
Anyways, we will post the recipe to the quarantiney and the non alcoholic placey Berita on our website. This podcast will kill you dot com and will also blast it all over social media.
Yes, so if you're not following us on social media, you should probably get on that.
Yeah, props.
Okay, all right, well then shall we begin our first episode of season three?
Absolutely?
All right, we'll take a quick short break so everyone can go make themselves a quarantine.
All right, So syphilis, yes, give it to me, don't give it me?
Well, yeah, I'll give you the biology, not the disease.
How about that? Excellent?
So one thing that I think is very fun that we did not do intentionally, at least I don't think we did this intentionally. Syphilis is our second spiral keet back to he that's right, And we ended season two with the Spira keet, and now we're starting season three with the spira keet.
I have thinking about that meanwather.
Not intentional, but kind of adorable, all right, So that's the first thing we already know. Now we've learned something new about syphilis. It's caused by a spira keet bacterium, which means like the bacterium that causes lime disease.
It is a.
Corkscrew shape and it sort of swims like a little what am I doing here?
Erin you really spiral? Yeah, it's just corkscrew corkscrewing.
So this bacterium that causes syphalis is called trepanima palladum, tripanema, trepanema however you want to say it palladum. Now, something that's very interesting about syphilis that's different than the last spira keet we did. While lime disease is caused by a number of different species, of bacteria. Syphilis is not only caused just by one species, but by one particular subspecies of one bacteria.
I was hoping that you were gonna cover this because I find this super interesting that it's a subspecies and what does that mean for the biology of this disease versus the other subspecies in Trepenema paladum.
It's fascinating. So Trepenema paladum has a number of different subspecies that cause completely different diseases aside from syphilis. So syphilis is caused by Trepanema paladum subspecies palladum. So Trepenema paladum paladum, that's what causes the disease that we're going to talk about today. Syphilis also used to be called venereal syphilis, so this is the sexually transmitted form of syphilis. However,
other subspecies of Trepenema paladum cause diseases like yaws. Yeah, and I'm not sure how you pronounce it be hell.
Oh, I was hoping that you were going to try to pronounce this first, because I have no clue.
Nope, I even looked it up and I couldn't find a consistent pronunciation. So it's also called endemic syphilis.
It's spelled b E j E L. Yeah, I don't know if.
It's begel or behel, who knows, but anyways, that's another form. And then there's another that I actually I saw it listed as a subspecies of Treponema paladam and also as another species of Treponema that causes a disease called pinta.
So I'm actually not clear, but.
They couldn't, so it's it's I think what I read is that pinta is caused by a separate species, and that's only because they could not get a bacterial isolate of it to determine whether it was a subspecies.
That seems believable. And what's so interesting about these different subspecies is that based on the tests that we use to diagnose syphilis, you can't distinguish them from each other. So morphologically, when you look at them under a microscope, they're identical. The test that we used to diagnose them, you can't tell them apart. There are tiny, tiny differences in their genomes that result in small differences in proteins that if you do very specific tests that nobody does
in real life, you can tell them apart. But The reason that we classify them as different subspecies before we had those tests is because they're clinical manifestations. So the way they present in people is totally different, and the way that they're transmitted is different. So these other diseases caused by Trepenima paladum different subspecies are not transmitted sexually. They're transmitted in other ways that we're not going to.
Talk about today.
Right, So that's our first fun fact. Trepenema paladum subspecies paladum causing syphilis.
Fun, very fun fact.
Such fun. That's as fun as it gets. It's downhill from here.
Okay.
So syphilis, as most people are aware, and as we've said already, is a sexually transmitted infection. It can be spread through any type of sexual contact. We're talking all the different kinds of sex. So syphilis is a very
very tiny spiralkeet. So the way it's transmitted is essentially just when you come into contact with the bacteria through direct skin on skin or skin on mucous membrane contact, the bacteria is able to just cork screw its little way in between the tiny gaps in your skin cells, either if you have microscopic little tears or just through your mucous membranes like your genitalia, where the skin is
very thin and very moist. Syphilis can also pass through the placenta and be transmitted congenitally, so from mother to infant, and in some cases it can even be transmitted to a baby during birth, like through the birth canal Okay, And once it penetrates the skin, the bacterium pretty quickly makes its way into your bloodstream and from there, as we saw in that first hand account, it can travel to and invade pretty much any organ. It can even cross the blood brain barrier and make its way into
your nervous system. Yeah yeah, And as it travels through your bloodstream, it turns out that it stimulates a lot of inflammation on the part of your immune system, and this inflammation is what causes a lot of the symptoms that we see. There are a few specific organs that it tends to infect, like preferentially for some reason or another, and we'll talk about those, but it can invade almost any organ just by swimming its way through your bloodstream.
Yikes.
Yeah, let's start talking about the actual symptoms. So now we know this is how it's going to cause them. Right, it's traveling through your bloodstream causing inflammation.
As it goes.
Okay, so what are the actual symptoms. There's three main phases of syphilis primary, secondary, and tertiary very creative names. And then it can also lay latent, so between the secondary and tertiary phase you can have years long latency where there are bacteria there, but you don't have active disease, so you wouldn't know that you're infected. So the primary stage usually presents within three weeks of infection. So the
incubation period on average is about three weeks. It can be less, it can be more, and it usually the primary stage is essentially a shanker, that's what it's called. It's essentially just an ulcer, so an open wound that is most commonly found on the genitalia because again we're talking about a disease that's transmitted sexually. So this shanker, this ulcer is essentially chalk full of spira keet bacteria.
It's just a bunch of spira keets swimming around just under the surface of your skin, busting out as they go into this open wound. Where is the wound, So it's most commonly if you have a penis, on the shaft of the penis or the glands of the penis. It can be on the labia or inside of the vagina, or in the anal canal or around the anis. It is possible also for it to be in the mouth or there's even been reports of it in physicians before gloves were a thing.
They would get it.
In their nose. Ah, I know, yeah, it's horrific. So it can be on basically any mucous membrane okay, yeah, but most commonly on the penis, anis, or labia, or
inside the vagina. But one thing that is really important about this ulcer of primary syphilis is that it's completely painless and it doesn't itch, and so that's something that distinguishes it from a lot of other genital ulcers is that you might not ever know that it's there if you're not looking for it, because it doesn't hurt at all, and even though it might.
Bleed a little.
That's in an area where things just kind of lead sometimes, right.
And especially if you have if it's like up the vaginal canal exactly something, it's much more difficult to spot, right.
Or even like in the anus like you're probably never gonna find that, and so yeah, so it's very possible to never know that you have this primary form.
And the site is usually the site of infection as well, it.
Is yeah, so yeah, this is something where that's the site of infection and it's full of bacteria extraordinarily infectious. Okay, so these ulcers are extraordinarily infectious. And usually the ulcer will persist between three and six weeks, so it's a pretty long lasting ulcer. It doesn't just pop up overnight and then disappear overnight. It lasts for quite a while. So that's primary syphilis. Secondary syphilis is what happens a
bit later. So this usually happens after between four and ten weeks of after infect so a longer incubation period in general. And I'm unclear on exactly how many, like what percentage of people go on to develop secondary syphilis if primary is untreated. Some numbers I saw said twenty five percent, but I saw numbers as high as sixty
or eighty percent, So honestly, who knows. I don't, but a number of people will go on to develop this secondary syphilis, and this is I think one of the main ways that syphilis got one of its nicknames, which was the Great imitator, right, And it's kind of what you talked about or touched on in the first hand account.
This can present in so many different ways because the bacteria have gone throughout your entire bloodstream and they can essentially invade any organ that they choose, So you can have GI manifestations where you have inflammation, and like gastro intestinal distress. You can have hippatosplenomegaly where your spleen and your liver get infected and then they get really large because they're full of inflammation. Hippato is liver spleno is spleen.
I like that word. It's a good word. I like to throw it.
In whenever I can't. Yeah, you can also get meningitis, So if it crosses that blood brain barrier in secondary syphilis, you can get meningitis. And it's not uncommon to find actual bacteria in the CSF, the spinal fluid. But then there are a few other manifestations that are kind of not kind of classic secondary syphilis, and most commonly that's a rash. And this rash is on the trunk and the extremities, and specifically it goes to the palm and souls of the feet, So palms of the hands and.
Soles of the feet.
There are not a lot of infectious diseases that cause a rash on your palms and souls. Huh, isn't that bizarre?
There's only very bizarre. It's very bizarre.
There's only three main disorders that we learn in medical school that give you rashes on the palms and souls. It's secondary syphilis, ricketzial diseases like rocky mountain, spotted fever, and uh cocksacky virus handfoot in mouth. Oh okay, those are the three big ones.
How interesting. I wonder what why me too?
I tried to find out an answer, and I don't have a good one. There are other things like obviously contact dermatitis. If you like grab your hand onto something like poison ivy, yeah you'll get a rash there. But in terms of infections, those are the three big ones. Huh.
I know. So the rash thing, so then if you have because it wouldn't just be on one hand either, it would be on your palms and your feet.
Yeah, and usually it's kind of throughout your body as well, so it's not only on your palms and souls.
It's like kind all over.
And this is the whole great pox versus smallpox sort of thing, is the big rash.
Yeah, So this rash can actually look a lot of different ways, if you like Google image search it, which I'm sure on our social media will post plenty of pictures of this. But it sometimes it's just flat red spots. Sometimes it can be raised spots. In people who have some kind of immunocompromise, like they don't have a great
immune system response, they can actually get necrotizing rashes. So that's where like this tissue starts to die and they get these very large, kind of purple, very dark rash. So it can look a lot of different ways. Yeah, and then you'll also see other signs of kind of systemic involvement, things like fever, sore throat, weight loss, hair loss. So that's secondary syphilis, okay. And then there's tertiary dun
dun dun, Yeah, dun dundun is right after secondary. There's often a long latent period where we're talking years past between secondary and tertiary.
And it's also.
Possible that you can get tertiary syphilis or have signs of tertiary syphilis without knowing that you had syphilis, because if you only had a primary ulcer and you never developed those secondary signs, you might never have known that you had that ulcer, and then five, ten, fifteen, twenty years down the line, you can develop signs of tertiary syphilis.
So you can jump essentially from primary to tertiary without Yeah you could.
Yeah, So tertiary syphilis if it goes if primary and secondary syphilis goes untreated, it can result years down the line in this much more severe form of syphilis. And this tertiary third form actually has three different forms itself. So there's a cardiovascular form of tertiary syphilis, where as you can imagine it affects your heart. There's the gammatis gummatis.
Oh yeah, the gumma.
The gumma form, and we'll talk about what the heck that means in a second. And then there's neurosyphilis, which affects your nervous system. Neurosyphilis is the most famous of these, I think, and that's because it was the most common before there was treatment for syphilis. Tertiary syphilis, specifically, neurosyphilis was the most common form of this late phase of syphilis. And there's a few different ways that this can present,
and they're all absolutely horrific. But the two more devastating I suppose forms of neurosyphilis are called general paresis and Taby's dorsalis. So we'll talk about each of those. General paresis is, so parsis means paralysis, but this is much more than just a paraphalysis. This is when basically the spiro keet invades your brain in such a way that your cerebrum, which is the main part of your brain, like the brain shaped part of your brain, starts to atrophy.
Oh my god, yeah, it's horrific.
And so you get a dementia, which is basically you know, things like memory loss, personality change.
And then you also get.
These physical symptoms, so things like trouble speaking, tremors, seizures.
Your muscles will.
Eventually start to deteriorate because the connection between your brain and your muscles is not working correctly, So your muscles start to atrophy because of that, and then eventually complete paralysis.
Why does this happen, great question.
I don't know entirely, Especially with general paresis, it's as far as I understand it's just the invader of your brain itself, your brain and your spinal cord that causes this atrophy. So as each part of your brain starts to atrophy, you'll see these different manifestations. So that's actually not the most common form of neurosyphilis. The most common and kind of I know what we learned in med school is like, the most classic neurosyphilis is Taby's dorsalis tabs.
I looked this up. Get my etymology hat on. Tabes means wasting away, which is horrific, and dorsalis is like dorsal, like dorsal fin so the back part, So Taby's dorsalis is literally the wasting away, the degeneration of the posterior part of your spinal cord.
Oh my god.
So instead of your brain kind of wasting away, it's the back part, specifically, just the posterior part of your spinal cord. Wow, it happens that that section of your spinal cord, the nerves that run through it are mostly respect for a few specific things vibration sense and discriminative touch. So being able to know like this that you're poking me with is sharp and this is where you're poking me versus this is soft and this is not. So you lose that, you lose any kind of vibration sense, Okay,
and very importantly proprioception. Proprioception is knowing where your body is in relation to your body. So here's where my arm is. It's off to my right hand side. And if I need to do something like, for example, pick up a fork and bring it to my mouth, you need proprioception to be able to do that, right, So you lose all of that in Taby's door salice, which means your brain doesn't know where your leg is in relation to your body, so you can't walk properly because
you can't coordinate between your two legs. Your brain doesn't know where they are right space, isn't.
That Yeah, that's really rough?
Yeah, so yeah, So that's Tavy's dorsalis. It's it's really gnarly. It'll eventually result in complete loss of coordination, loss of reflexes because part of the reflex loop goes through the back part of your spinal cord as well, and then that will also lead to muscle degeneration because you're not coordinating your muscles correctly. It's really gnarly.
Yeah.
Luckily those manifestations are not common today because we have treatment, but they still can't happen. Yeah, uh okay, but that's just neurosyphilis. We're not done yet. The cardiovascular form of syphilis is actually the most.
Deadly, so it seems reasonable.
Yes, And this is this is one of the most interesting forms for me when I first learned about it, cardiovascular syphilis. What happens is, so, h your aorda, which is the giant, largest artery that leads directly off of your heart. Right, that's the artery that feeds every other artery giving blood to your whole body.
Right in a blue whale, the aorda, a small human can fit through it. Yes, that's my fun fact for this. That is a fun pepper, a fun fact in here.
We need some of those because this is depressing. So your aorda is so large and thick and muscular that it actually has its own blood supply. So there are tens tiny blood vessels that actually feed the muscle surrounding your aorda. What happens in cardiovascular syphilis is the bacteria
replicate and invade those tiny blood vessels. They're called the vasa vasorum that feed your aorda, and then the inflammation causes those vessels to obliterate whoa, So that means that your aorda is not getting blood supply to the muscle of your aorda. So then the walls of your aorta become weak, and then it dilates and it can eventually rupture yikes, because it can't contain the pressure from your blood flow from your heart.
Do we have any breakdown of the proportion of It's a good question.
I don't have exact numbers. I did see that neurosyphilis is the most common form of tertiary but cardiovascular is responsible for what I read is eighty percent of the deaths associated with syphilis. Okay, so if that helps at least to get an idea. And then finally there's the gumma form. This is the least common, but this is what happens when the spier keets invade your skin or your bone or other tissue and basically just in small areas,
destroy all that tissue. So you get these large what are called granulomas, which essentially is just a bunch of tissue with inflammatory cells and bacteria.
In these kind of nodules. Is this the one that leaves the most traces?
I mean, you said it invades the bones, but do they I didn't even think about this. I just kind of assumed that all tertiary syphilis left bone traces.
But is it just the gumma form?
Well, I would guess that you can have gummas even if you never know that you had.
Them, Okay, right, it would only be discovered, like you could have cardiovascular syphilis and gummas.
Absolutely, Okay, yeah, but you might like one one is going to be the thing that like kind of brings it to the attention or something like that. I don't think that these are not distinct entities necessarily.
Right, They're just different shades of right, exactly, different different shades of syphilis, shades of.
And then finally there's congenital syphilis, which is very depressing. It's when the spira keets cross the placenta or in some cases through the vaginal canal, infect a fetus or a baby, and there's a number of different things that it can cause in infants and even in children. So even after like several years, con genital syphilis can cause a lot of different the way that it can manifest in a lot of different ways in adults. It can cause a lot of different types of disease in children
as well. But at least about half the time, if a pregnant person gets infected with syphilis, what happens is just so early fetal loss or still birth. If the pregnancy is farther along.
That's that's really sad.
So it seems like it's most of the most of the time, it's a fatal outcome exactly.
Yeah, So that's that's pretty much the biology of syphilis. The only good thing that I have to say about it is that it's very treatable. Still, syphilis is treated with penicillin. It's one of the few things that we still treat with penicillin, and thus far it shows little to no resistance to penicillin, which.
Is fascinating to me.
Interesting, it's very very interesting. Unfortunately, everything else is resistant to penicillin.
Within like a several years or race. Yeah, yeah, yeah.
What I think is very cool is that penicillin is so good at treating syphilis that if someone has especially if they have a late stage of syphilis and they're allergic to penicillin, instead of treating them with a different antibiotic. You actually desensitize them to penicillin first, and then you treat them with penicillin.
How do you desensitize someone to penicillin.
The same way that you would with other allergies? You basically give them a tiny bit at a time, and you monitor them and then you slowly increase the dosage.
Does that work for everyone? As far as I can tell, it works for most people. That's really interesting. It's interesting, but it can take a very long time.
And so but it's it's worth it to be able to use penicillin rather than trying to find it an alternative.
Yeah, yeah, there are other antibiotics. If somebody has an early form of syphilis and is allergic to penicillin, but for late syphilis, it's pretty much penicillin or bust.
Gotcha?
Cool?
So yeah, that's syphilis.
Uh, what the heck?
Aron?
Where did this thing come from? And how can it reak so much havoc on our bodies?
Oh?
Man, Okay, well here we go, here we go. But first let's take a little break Syphilis.
Outbreaks of any.
Kind of disease don't just happen out of thin air. Even though that maybe how it seems when they begin. Usually there's a set of very specific circumstances that perfectly set the stage for the emergence and spread of a particular pathogen. Can you guess what one of the most common stage setters is? No, come on, I guess, I guess anything? What would lead to an outbreak?
What I was gonna say, orgies?
Now I'm not talking specifically about syphilis or or sdis I'm just talking about disease.
A lot of a lot of people in a small area, sure, and one.
Maybe chaos and maybe people from a lot of different areas getting together.
Absolutely could be war.
Absolutely yeah, So war, war is the answer I was looking for.
What is it good for spreading disease? Absolutely so?
Yeah, As you mentioned, a bunch of people in close contact these they're traveling in areas that are new to them, infrastructure is sort of falling apart, and all of these things promote the exchange of pathogens, new pathogens and including syphilis. It turns out that the question of where syphilis came from and when is a bit more complicated than I had expected. Really, Yeah, but don't worry, I'll get into all of it later.
But for now.
Let's first things first. This say first things first. The first time that we see what is definitely an outbreak of syphilis in Europe, like conclusively is around fourteen ninety five, during the First Italian War, which you've heard of that you know, this war?
Of course I know all about it. It was the first one.
Yeah in Italy. Yep, totally no. I had no idea.
So Wikipedia did so, okay, and here's here's what I could glean from just a quick skim.
So in the fourteen nineties there.
Was apparently, and I always I like this historical context because it just sort of I think it's really interesting to I don't know, to talk about why, like how this, how this all happened. Okay, you have your extra.
Joy face on when you're talking about this, so I know it's going to be good.
Yeah. It's sort of those those Wikipedia rabbit holes. Okay.
So in the fourteen nineties there was apparently a bit of a spat between the Pope at the time, who was innocent the eighth if you were interested, and King Ferdinand of Naples. This kingdom was basically the southern half of Italy excluding Sicily. Okay, the king refused to pay any money to the pope, and so the Pope was like, all right, fine, I'm just going to depose you and give your kingdom to King Charles the.
Eighth of France.
Naturally, yeah, And so the two, the King of Naples and the Pope eventually made up. But the King of France, King Charles, was like, excuse me, you offered this to me and then you drew it back right away, and he never really got over it. So he was he was super annoyed. And so a few years later, when the proper heir to the Kingdom of Naples was called into question because the previous king died whatever whatever, Charles gathered some troops and it ended up being this ragtag
bunch of mercenaries from all over. Some were Flemish, some were Swiss, some were Spanish, some were Italian. I mean, you get the idea. And then he invaded and met like was like almost little to no resistance initially. So they kind of hung out in Naples and around Italy just partying and pillaging and having a good time. And then the people had had enough so they chased them out and then they met on this huge battlefield in
July fourteen ninety five with actually like Italian troops. And so from this battle is when we get the first known descriptions of syphilis huh quote through sexual contact an ailment which is new or at least unknown to previous doctors. The French sickness has worked its way in from the
west to this spot. As I write, the entire body is so repulsive to look at, and the suffering is so great, especially at night, that this sickness is even more horrifying than incurable leprosy or elephantiasis, and it can be fatal.
Whoa, yeah, even.
Worse than leprosy and elephantiasis.
That is heavy words.
Right, and so that's a that's a very remember that because it's a really interesting facet of the emergence of syphilis in Europe. Okay, so that was from this Venetian doctor named Benedetto.
By the way, oh I know.
Someone ning Benedetto really bends from Hawaii.
Oh cool. Okay.
After this battle, the retreating French troops returned to their respective countries and along the way made some stops and may have deposited the syphilis bacterium in various cities and towns. Of course, and from there it exploded, and I mean like within a few years, it was already in medical treatises. It was already all over Europe, I mean everywhere.
Can I just say that deposited is a really funny way.
I didn't know how else to say it. I guess there are probably many of us. I like, deposit Okay, good, just a little deposit. Yeah.
And this syphilis, as you could probably tell from the description of during the battle, this was not the syphilis of the twenty first century or even that of the nineteenth or eighteenth centuries, and those syphilises, I guess are horrifying enough.
But this one, if you can believe, it was worse. Whoa. This was a terrible scourge.
That killed quickly, hugely disfiguring people, and eyewitness accounts of the time read like a horror movie script.
It definitely was much more.
Virulent in its early like in its first emergence.
That is so interesting, and it's fascinating to me that it was so recent. Oh okay, we're going to get into that, okay, because like, wow, yeah, let's keep keep going.
Keep going.
Okay, No, it is and I think it also makes sense considering if that was a first exposure. That's how we often see epidemics happening, is that the first wave is so deadly.
Right, someday we'll do mixamatosis.
Oh, of course, well I can't wait.
People quickly realized that the disease was a contagious b spread through sexual contact, and c often appeared for the first time after people had traveled through the town, particularly
people from out of town. It was viewed as a matter of such huge public health importance that some towns or cities had laws forbidding people with syphilis from entering WHOA and this part in particular, this whole It came from somewhere else is what gave syphilis its various nicknames, all of which had that general theme it came from over there, with over there being whatever country or region was your political enemy or one that you didn't like
or thought was unclean. For instance, for instance, in Russia, it was called the Polish sickness. In Poland, it was called the German sickness. In Germany it was called the French sickness. In England it was called the French or the Spanish sickness. In the Netherlands it was called the Spanish sickness. In Turkey it was called the Christian sickness, in Japan it was called the Chinese sickness, and in Spain it.
Was called Las bubas.
So it's a bit of an outlier that one, But I swear if if you just learned the country specific nicknames for syphilis during the fifteenth and sixteenth centuries, you could tell a lot about the political atmosphere during that time and also the attitudes that one country holds for another.
Ah.
Yeah, Syphilis, like many sexually transmitted infections, was and still is, in many places, viewed as a dirty disease with moral implications. The disease was seen as punishment for living an unclean or immoral life. But in terms of origins, which of these accusatory nicknames was right? Was it really the French disease brought over from France or the German sickness? Was it even of European origin? The answer is that we don't know for sure.
Ugh, you're killing me.
But yeah.
The great debate about syphilis, and one that still seems to attract fairly high levels of interest, is its origins and not the evolutionary origins of the spiral keet necessarily, but the origins of the epidemic, there are two basic thoughts.
One is that it was brought from the New World to Europe when Columbus returned from his voyage in April of fourteen ninety three, bringing with him a few hundred people from Hispaniola, and then some of Columbus's crew then joined King Charles the Eighth Army, bringing with them syphilis and starting the whole pandemic. This one is referred to
as the Colombian theory. The second, called the pre Columbian theory that's sort of in the name, is that syphilis had been present in Europe since antiquity, but increase in incidents and virulence due to an evolutionary leap. Let's go through each of these, Okay, okay. The Colombian theory this is the one that seems to be the best supported by archaeological evidence and also writings from the time. It's also been the more prominent theory of the two for
the longest period of time. There are even some historical writings dating back from the first. This first unambiguous appearance of syphilis in fourteen ninety five and in the early fifteen hundreds that state that the disease was brought back by Columbus and his crew after his travels to the New World. Because syphilis infections and congenital syphilis can leave traces on skeletons, you can basically just look at the archaeological record to see both the timing and origin of
syphilis's emergence. Yeah, and while there are more than several pre Colombian New World skeletons in both the northern and southern hemispheres that show signs of syphilis, clear evidence of syphilis infections in Old World skeletons isn't well, I guess as clear. There are definitely some cases that appear to be syphilis, but for many of these the dating or diagnosis is.
Called into question. Interesting.
A review from twenty eleven looked at all fifty four published cases of supposed pre Colombian syphilis in skeletons in the Old World and did not find a single one who diagnosis or dating was clearly pre Colombian syphilis.
Interesting.
Yeah, and so the timing and severity of that first clear syphilis epidemic in Europe is also a point in favor of the Colombian theory. So that it was brought over. Descriptions of syphilis from this time tell of these erupting pustules and horrific lesions with death being a primary outcome. And before the fourteen ninety five outbreak that I talked about, there aren't unequivocal descriptions of syphilis, and definitely nothing as
telling or extreme as that one. Many proponents of the pre Columbian theory, which is the one that syphilis was present in Europe, have suggested that many writings about leprosy are actually about syphilis, and there are some instances of something called venereal leprosy, but it's not clear that that's definitely syphilis. And early writings about syphilis distinguished it from leprosy and small pots, so they were like, this is worse than leprosy, as you heard in that description, right.
So the debate still kind of rages on, and it's helped along by sensationalist quote documentaries like I watched this one by Timeline, which was like rewriting history of syphilis, and it had some of the worst sound effects I have ever heard on a documentary. Had these weird like wolf howls and like creepy slamming doors.
It was weird.
Anyway, you know, slamming doors, that's a sign of syphilis for sure, exactly.
But these documentaries are these shows don't rely They often heavily rely on unpublished and not peer reviewed data or findings.
So it's and that they also catch a lot of flak for that, and rightfully so. But what is the evolutionary history of the syphilis pathogen? Syphilis, as you mentioned, is caused by the subspecies, and so one of the ideas.
Although this isn't clear or this isn't certain, one of.
The ideas is that syphilis actually evolved from yaws most likely into being a sexually transmissible and more virulent form, okay, And that could have happened in North America in the New World and then been brought over, or it could have a lot of people of the pre Columbian hypothesis say, well, it could have happened in both places, because it is pretty clear that syphilis from skeletons in the New World. It's pretty clear that syphilis was there okay and infecting people before Columbus.
And so they say, well, maybe yaws made the leap.
To syphilis in the New World, and it also made the leap to syphilis in the old world, and it's kind of an interesting like that that seems highly unlikely, but yeah, anyway, I.
Feel like then you'd be more likely to see like two distinct forms of syphilis, which I don't think we really see.
So that's an interesting idea. I mean, it's interesting.
And also, you know, as you mentioned, this is called the Great the great imitator, and so writings are sort of yeah, can be interpreted a lot of different ways. There's a lot of retrospective diagnosing of famous people that is.
Interesting.
It's like, if you were famous, if you were an artist or a composer or a dictator, you had syphilis for sure.
Yeah, yeah, which I mean it could.
It could be possible entirely, but it's just sort of like right after the fact, way after the fact.
Are there And I'm sorry if this is jumping your gun. Are there any descriptions of it in other parts of the world, like in Asia or in Africa or anything like that.
Not that I could find.
I didn't see anything that was super distinctive or super related to or indicative of syphilis or suggestive of syphilis.
I should say, Yeah, cool, interesting, Yeah.
Before I move completely away from this origin part of the story, I want to talk, of course about the etymology of syphilis. Yes, and not really it's scientific name, because I think that's less exciting trepaniina meaning a turning thread in Greek and pallada meaning pale yep.
But the word syphilis, where does it come from?
The name wasn't actually in heavy use for most of the history of the disease, and most people opted to call it the blank disease or pox, you know, the blank disease being the French disease, this French disease.
Or great pox or pox or wildwarts. Okay, that's my favorite. Yeah, I mean I was like, why isn't that what we call it now? Yeah?
Yeah, swarts, that's got to be the condolo malada because they are pretty wild with God.
It wasn't until the end of the eighteenth century, really that people started to use syphilis again. Syphilis is the main character of an epic poem, and in this poem, Syphilis, who is a shepherd, gets upset when there is a bad drought that is killing the land and his sheep. I think it's like an old Roman poem. He blames the drought on the sun god, likely Apollo or the Roman equivalent, if there is one, whatever, and instead says
he's gonna worship the king whose sheep he hurts. The king is like, heck yeah, but the sun god is really annoyed, and so he sends a venereal plague upon the countryside where syphilis lives, and syphilis was the first victim. So interesting, interesting syphilis the shepherd. Also, I don't remember if we talked about this in the Ganneria episodes. I'm just going to repeat it anyway, But the origin of the term venereal disease?
Did we talk about that?
I don't remember.
Tell me again, Okay, Well, it tells you a lot about the historical attitudes and even present day possible attitudes of venereal disease, which is no longer a term that we use because venereal comes from Venus, the goddess of love. There was an old saying that a night with Venus leads to a lifetime on mercury, which brings me to
my next couple of points. So a, it reveals a lot about the blame and who who was often perceived to be the person responsible for transmitting syphilis or being the harborer of syphilis, which was often a woman who had like a you know, temptress or that sort of thing. And then also mercury, and let's just get into the treatment real quick of syphilis, some of these wild treatments. So for a long time, mercury was the chosen treatment
for syphilis. Like even just a few years after that fourteen ninety five outbreak, it was started to be used, and it was I guess like maybe effective, somewhat effective, because it's just like poisoned you to I think, so, Yeah, I don't know exactly how how it worked or if it truly was effective, but people did use it up until the early twentieth century and even a little bit beyond that.
Yeah, And so basically they would rub it on themselves.
And this is what inspired the name of our quarantini, by the way, the killer cure, because a lot of the cures that people took for syphilis would kill them.
So it's either syphilists would.
Kill you or the cure would kill you, right, essentially, mercury poison Yeah, mercury poisoning is no small thing. So other things like induced sweating and salivation were also treatments, and you know I can't go.
Yeah, you said they would rub mercury on themselves.
Mm hmm. That's awful.
I mean, I'm sure they would take it in other forms also, right, not that that's better for you, like ingest it, but I can't.
Ooh, it just sounds terrible. Mm hmm. Yeah, it's really bad. Cool.
So then they also don't touch mercury, do it?
Yeah?
No, Well, you also know I can't go this entire episode without describing at least one bizarre or horrifying cure and our favorite.
This is already a long episodes.
I'm not going to list too many, but here's a great one. Quote if and this is directly from this book that I read, by the way, called The History of Zyphilis. Quote, if the penis is ulcerated and infected, and then the author writes, it is always the male sex for which the doctor feels pity the woman being strictly confined to the role of contaminator, who's shanker, moreover,
is more difficult to discover. And then, continuing with the cure, if the penis is al strated and infected, you must immediately wash it thoroughly with soft soap, or apply it to a cock meaning rooster or pigeon plucked and flayde alive, or else a live frog cut intwo, what uh huh?
You put your your ulcerated.
Ulcerated penis on a fladed bird.
Or a frog that you've sliced in half.
That's just asking for a salmonella superinfection on top of your syphilis.
Is what you're asking for the killer cure. This is what I'm saying.
Oh my god.
Yeah.
Also, what is up with people and like plucking cocks and using them as cures.
Didn't they do that for rabies too?
There was something, there was something along those lines that was like you have to remove I mean poor, It's just I feel terrible for these.
Oh my gracious.
Yeah, here's another, here's another one.
I'll just throw one more in there, just just su for fun. Yeah.
To gain protection, one must wash oneself after the act, then cover the glands with a piece of cloth which has macerated in a preparation of wine, shavings of gaic I don't know what that is, flakes of copper, precipitated mercury, gentien root, red coral ash of ivory, burnt horn, of deer. The protective must stay in place for four or five hours.
So this is how to prevent syphilis.
This is how to So a lot of the treatments actually were after the fact. It was not really about prevention. It was about It wasn't about prevention before sex. It was about making sure that you didn't get infected after.
Mostly it was like, well, you better wash yourself quickly and.
Then maybe soak your your penis in a cloth of some sort of weird, really disgusting thing.
Yeah, don't don't soak your penis in that.
Don't do it. Don't follow these These are not instructions to follow. No, they are anti structions. Yes, this is a roadmap that you should not go on. Oh my goodness, gracious m hmm.
Because the signs of syphilis are often less obvious in women, they were often blamed for spreading the disease with the whole as per used with the whole harlot and evil temptress concept, those sorts of things like.
Through the nineteen fifties and sixties and.
Oh yes, we're going to post some posters that are pretty yeah, and because in most places sex outside of marriage for men and basically any sex at all for women was seen as immoral. Diseases such as syphilis and gonrhea were viewed as divine punishment, and the word venereal, as I mentioned, inherently has blame tied to it. In many places, to try to stop the spread of syphilis, brothels were shut down or made illegal, not that that
necessarily decreased the prevalence of infection. Separate hospitals were constructed for people with syphilis, and they were often turned away at normal hospitals.
And it's not like these.
Syphilis hospitals were nice care facilities. They were just a place to isolate the people deemed unclean or immoral. And also a lot of diagnosing, especially for women, happened just through word of mouth. So if a man said, oh, I had sex, like I have syphilis. I had sex with this woman so she gave it to me, then the doctor would say, she has syphilis, she has to go to this hospital.
I feel like I remember you saying the same thing would happen for gonrhea as well.
Yeah, exactly.
Yep.
Over time, though attitudes around syphilis changed a little bit, the disease itself had become so wide, had been so widespread for such a long period of time, and during that time it had become much less virulent, and so by the time the eighteen hundreds came around, it was almost in some ways viewed as a rite of passage,
like it just something that happened to you. The discussion of morality and syphilis shift did again in the late eighteen hundreds early nineteen hundreds, and it had always been sort of focused on the unclean or immoral aspect of it, but in around this time it was more about the preservation of marriage as an institution.
That's what took the spotlight, and a.
Lot of focus was paid to the innocent wife made to be condemned to a life of disease due to her unfaithful husband and then congenital syphilis. At this time, because it wasn't known to be a pathogen, it was more viewed as original sin or a punishment on because your parents were like, you were born bad, you were born yeah, and so yeah, So this brings me to this point of contagion being a different thing than germ theory.
So people, you know, you can think of a disease as being contagious, and even though now we know that that is inherently tied to a specific pathogen, whether it's a virus or bacteria or worm or something.
It was isn't necessarily the same thing. Back then, it was.
Sort of your unclean aspect, your unclean character could be passed from person to person.
That is so so interesting to imagine, like not knowing that a bacteria is what's causing it, but knowing I got this, or believing at least I got this from this person. That is such an interesting like separation, right, Oh wow.
Yeah, It's something I hadn't really thought of before this episode because and a lot of the times the episodes that we've covered are we know sort of we've traced the concept of disease and infectious disease, and it's mostly been to do with my asthma and sort of like oh well, bad bad areas, swampy areas, lowland areas, whatever else, just bad air.
But this was like, oh no, this is obviously a contagious thing, right, and so.
And specifically from like sexual intercourse, right right, that is how you get it. Yeah, Oh that's it's very very yeah. Huh yeah.
And so the sexual aspect, of course, was had been known for a long long time. But then alternate roots were also accepted or began to come to light, so kissing wet nurse to infant or vice versa. And this
was sort of a question mark, I don't know. And then later on the big thing was sitting on a toilet seat and this so some of these ways are actually ways that you can get siphlis so kissing, for instance, yes, but other ones like sitting on a toilet seat or being or contaminated holy water, which was my favorite one, Like excuse me, what, oh my god?
That is such a tryhard.
Right, And so these were probably ways to preserve invented to preserve the virtue of certain people who had gotten syphilis.
And we're like, oh, i've I'm.
You know, we should probably clarify that you cannot get syphilis from a toilet seat.
You cannot know and cannot or contaminated holy water, definitely in case you were worried about that too.
It's also a human specific disease, so that's I think worth mentioning. Yes, is not found in other animals, it's not present in the environment. This is human to human exclusive.
Yeah, And so around the late eighteen hundreds and early nineteen hundreds, morality plays were written and performed, poems about the dangers of syphilis and you know, evil temptresses and all that, and how they're going to poison your household and et cetera. Yeah, and in all of these, of course, it was the husband that got the disease from a woman of ill repute, and he was often portrayed as a victim himself. It was one of the three, like it was genuinely called a social disease, of the three
being the other two being tuberculosis and alcoholism. They were all viewed as sort of these unclean, the unclean Holy Trinity or something unh trinity.
That is so interesting to me that it was alcoholism and tuberculosis.
Well, and it was it was thought that if we have enough social reform and morality campaigns to preserve marriage or to clean up this and that, then we could wipe these things out.
Wow.
So yeah, and other people believed it to be hereditary, as I mentioned, and often the cause of genius or creativity, something that has in common with tuberculosis. So syphilis is, as I mentioned, one of these diseases that people like to you know, retrospectively diagnose so we've got some These are both confirmed and suspected cases. Just list some famous peeps,
Franz Schubert and other composers like Smetana and Dalias. I don't know if I'm saying that right, Al Capone again, Nietzsche, Tolstoy, Karen Blixen who wrote Out of Africa, Lenin Hitler, and then like many many other people, there's even a book called pos something about I can't remember who wrote it.
I didn't read it because.
From my understanding, it's a lot of this hand wavy retrospective diagnosis.
So anyway, it seems like it would be a fun book to read, I would imagine. But is it all about syphilis specifically?
Yes? Or Throughout much of the history of syphilis, people debated whether gonorrhea and syphilis were the same disease, just different forms or stages, And there was some horrific self.
Experimentations to try to clear this issue up.
And I think I mentioned one of these experiments self experiments during the ganeria episode, and he died of syphilis, but he thought he was infecting himself with gonnerhea. Anyway, the syphilis bacterium was finally seen under the scope and identified almost thirty years after gonnerihea, and which finally was like, oh, this is a different one.
So what year was that?
Remind me of February? So well, syphilis was discovered. We're seen in February nineteen oh five.
Okay, wow, that's actually earlier than I expected considering how tiny it is.
Yeah.
And then the Bordette Borda Vostermann diagnostic test was developed a year later in nineteen o six. And then Paul Erlik, along with another microbiologist named Hata, came across an effective treatment for syphilis and it was called salver sand and that was a substitute for mercury, which people started using it, and then there was an even better version called neo salver sand. So prior to nineteen forty five, about five to ten percent of all psychiatric admissions were neurosiphalis.
WHOA, Yeah, it was a huge problem.
And although mercury and arsenic based compounds were available from the early nineteen hundreds on, they weren't really much help for well most people but also people with neurosphalis. But an alternative was discovered pyrotherapy, so pyro meaning fire, so essentially using induced fevers to treat another disease. Oh yeah, this had been observed for a really long time, like the fact that fevers could cure whatever pre existing disease that you had, Like I'm sacking a really long time,
like ancient Greeks, Hippocrates and Galen. Yeah, okay, but it wasn't really until the late eighteen hundreds that this observation was made into application. This Austrian psychiatrist Julius Wagner Jauregg. I don't know how you say his name, which is going to be a problem because I have to say
it a couple times. He had become convinced that a fever from an infectious disease could cure mentally ill patients, and that's something that he had observed during his time in psychiatric hospitals, and so naturally, because this was the early nineteen hundreds, he experimented on humans without consent with yeah, you do, with different fever inducing compounds or pathogens. But
eventually he made his way to malaria. During World War One, he drew blood from malaria infected soldiers and then injected that blood into his patients stop it, some of whom died, of course, of course, some of whom did not show any improvement, and some who did, even if it was.
Just for a short while. Oh my goodness. Yeah, so this was.
Far from a fail safe cure, but he was encouraged by the results, so he kept doing it. And it was basically the same sort of thing like people died, people got better, people got worse, whatever, And so this practice wasn't widely accepted.
Really okay, but regardless of.
That, in nineteen twenty seven, he became the first psychiatrist and only one of three I think ever, to be awarded a Nobel Prize for using malaria to treat neurosyphalis.
He got a Nobel Prize for that.
Yeah, whoa yeah. Oh.
Also, I want to mention that one of the other three psychiatrists, or one of the other two psychiatrists who was awarded a Nobel Prize was the guy who developed the lobotomy.
Okay, yeah, cool, ye, the last.
One was about the physiological basis of memory.
That's cool, that's cool, yeah, actually cool.
Yeah, But this basically using malaria to treat syphilis neurosiphalus didn't stick around for obvious reasons, like it was super unethical and could.
Kill you, right, this therapy will kill you. I don't know. Hence the killer cure again. Uh. And Wagner Jareg.
He fell from grace and basically slipped from public consciousness after World War Two because he had really close ties with the Nazi Party. And this was around the time when like bioethics and human experimentation started to really take focus. But yeah, there you have it. So an interesting little chapter in the history of syphilis.
Huh malaria, man.
Isn't that cool? Yeah?
All So, at the turn of the twentieth century, a lot of developments for syphilis were taking place, a lot of both in terms of microbiology, in terms of treatment and so on. And because syphilis was still a very huge problem and a big focus of both social reform and microbiology and public health. And then World War One breaks out, and as we know, war is a great place for syphilis to spread. Syphilis caused almost as many service days to be lost from troops I think US troops specifically.
In World War One then.
Like almost as much, just a little bit less than the nineteen eighteen flu.
Wow.
So between April nineteen seventeen and December nineteen nineteen, there were three hundred and eighty three thousand cases of syphilis and ganeriea in the American.
Army, just in the American Army, just in.
The American Army. Whoa b Yeah.
So lots and lots and lots of syphilis. And a lot of the public health campaigns during this time really focused on on avoiding brothels, avoiding you.
Know, loose women, et cetera, that that sort of thing.
And after World War One, the fear, the public fear of syphilis was at an all time high, Like people were terrified of it. And this is when this total toilet seat rumor got started. There was pre marital like required mandatory pre marital screening for syphilis and tuberculosis, So both partners had to be screened. Wow, and then you had to if you did get diagnosed, you had to list all of the partners and then they would all
be identified. But it wasn't like in a way that was respectful, right of course, not, of course not it was. It was much more sort of condemning, accusatory exactly. Yeah, okay, And so all of this so the fear of syphilis and gonorrhea remained heightened throughout the time between the world War One ended and between when World War Two began, So between between nineteen eighteen and nineteen thirty.
Nine was like just twenty years of terror. Syphilis terror. Yeah, it held the world and its script.
And then World War two broke out. And it was during World War Two that we see the release and widespread distribution of one of the best inventions of all time, penicillin pailin, and that really knocked it out. And so then you see these posters that are much more focused on like, hey, go down to the clinic and get a shot, go down to the whatever and get a shot.
A little bit okay, positive, a little bit more positive.
And with the with the deployment of penicillin and the widespread use, I mean, syphilis cases dropped to almost nothing. It was like magic, and it kind of became a disease that was forgotten like people, you know, people kind of stopped considering it. Even now you say syphilis and you think of the eighteen hundreds, well, I thought of like different composers and stuff that had syphilis. But then in nineteen seventy two is when syphilis took the headlines again.
Yeah, this is when it gets to be the most depressing.
I think I think this is one of the most important, probably the most important lesson of syphilis.
YEP.
At the end of July in nineteen seventy two, the announcement was made that the US Public Health Service had been conducting a study on the effects of untreated syphilis on the human body. The exact title of this study is the Tuskegee Study of Untreated Syphilis in the Negro Mail. There's a lot in that title that can tell you about this.
Yeah, this story needs to be told.
The story needs to be It's a hugely important story. Yes, this experiment.
Had gone on for forty years.
It involved six hundred black men, three hundred and ninety nine of which had syphilis at the start of the experiment.
It came out that during this news release, came out that the men had not been informed that they had syphilis at the beginning, had not been informed that there was a treatment available either at the very beginning of the study when mercury or arsenic based medicines were used to varying degrees of efficacy, and they were not told about a decade after the study began, when penicillin was introduced. This wasn't a study to find out the best way to treat syphilis. It's in the title the Effects of
Untreated Syphilis. This wasn't a treatment based study, this wasn't an intervention study. This wasn't a diagnostic study.
It was just.
Let's see what happens when we withhold treatment from human beings. How far can this disease go? How much havoc can it reak on the human body.
So you might ask, why would anyone agree to participate in this study? Well, the men, of course, were not told what the study was. Most of them were poor and could not read. And the Public Health Service offered a few perks such as free physical examinations, free rides to and from the clinics, hot meals on examination days, free treatment for some minor things, and I guarantee that their family would get a burial stipend if they agreed to an autopsy of the body. These men were not
viewed as men. They weren't viewed even as patients or subjects. They were viewed as cadavers. They were just cadavers in waiting these and if you think about these quote benefits, they're meager at best. A hot meal, free physical examinations eighty dollars for burial.
That tells you that this is not these are not volunteers.
Right, No, this is you cannot and this is we're gonna get in.
Yeah, I'll get into a bit of this, but this really had a huge importance in later ethical guidelines for what can be considered volunteering, what can be considered informed consent.
Yeah, these benefits alone.
Just that little bit shows that, in the words of one editor quote, the basic rights of Americans, particularly the poor, the illiterate, and the friendless, are still subject to violation in the name of scientific research.
And people of color were particularly preyed upon, of course, like entirely, oh entirely, I mean they were sought out. Yeah.
Yeah. Some of these circumstances surrounding the experiment have been disputed, like whether the participants were told they had syphilis.
They were not. They were told they had bad blood.
Bad blood was a colloquial term that sometimes referred to syphilis, could be indigestion, could be just not feeling great that day.
It wasn't specific to syphilis.
In Many doctors in the study confirmed that these men were told that they were being treated for rheumatism or bad stomachs, and they were given either just straight up placebo or an aspirin wow. When any of the men were brought to a clinic and seen by a doctor that wasn't involved in the study, these doctors would try to treat them, but then they would be forbidden to do so someone would would intervene and pull the person
away from that doctor. One of these doctors said that the men were told if they received treatment, they would be dropped from the study and lose all of their benefits. At least twenty eight and possibly over one hundred men in the study died as a direct result of untreated syphilis. Many many other people were infected as a result of these men not receiving treatment, and many children were born with congenital syphilis.
This is yeh. When news of this.
Horrifically unethical experiment broke, A lot of the discussion about the ethics centered around the withholding of penicillin when it became recognized as a suitable cure, which was about ten years after began.
But that's the only thing that they did wrong, right.
That barely scratches the surface of the problems with this study, and to be clear, withholding treatment was hugely unethical, but that happened a decade after the study began. That this study could be dreamt up and executed it at all and receive funding for forty years by the United States Public Health Service reveals a great deal about how your right to be treated as a human being is inextricably tied to race and class. The premise of the experiment
is the moral issue. It's not surprising that the creators of this experiment would choose to withhold penicillin after designing the experiment in the first place. And this is, you know, probably depressing, but unsurprising. There were many defenders or apologists of the Tuskegee syphilis experiment when it first came out. The Public Health Service barely apologized for it, saying it
had never been kept a secret. It results from the experiment had been published in many journals, and there had never been outcry in the forty years it was going on. And other people defended the withholding of treatment, especially the arsenic and mercury compounds used prior to penicillin, saying that
those drugs were more likely to harm than cure. These people had to a bit more difficulty explaining why penicillin was withheld, so reporters turned to the man who was the director of venereal Disease during the time penicillin use was widespread. He he being doctor John Heller, denied any responsibility for the study and declared, quote, there was nothing in the experiment that was unethical or unscientific.
I'm sorry, can you say that again?
Right? Okay, there's so much here's I'm like bursting with information with this and range rage.
Yeah.
So well, first of all, of course, it was unethical. We can list one hundred million different ways it was unethical. And then in terms of it being unscientific, the whole thing was unscientific. Many of these men had received treatment at the very beginning of the study, but not all of them. It was inconsistent. Some of the men started out being negative for syphilis and then later tested positive
for syphilis, but they weren't shifted into groups. There was no this This stuff contributed nothing to the body of knowledge on syphilis. And many people who were on the outside of the study who were horrified when they learned of this said the same things. Even the people who were involved in the study would say, like but not directly would say, but what are you hoping to learn
from this? It was the curiosity of these men is particularly one who wanted to He was entranced by autopsies and by seeing all of the different ways that the body could.
Yeah, it was it's really really God, that's just.
Other people at the CDC said that they doubted that penicillin would have done any good at that point, and then in fact it probably could have caused more harm than good due to allergic reactions.
Absolutely false, right.
Other people went the root of the It was a different era. We can't apply our nineteen seventy two morality to nineteen thirty two.
Gross. Then you have a few physicians defending the studies.
Saying that it was their own fault they got syphilis in the first place.
The amount of rage, right.
These are physicians, you know, never mind the hippocratic oath or just basic human decency.
They could still be physicians. Quite honestly. Nineteen seventy two wasn't that long ago.
Yeah, that's true. The Tuskegee experiment wasn't even the first of its kind. About thirty years before this experiment began, a similar study in Norway was underway, So why.
Did it need to be repeated.
One of the reasons that they gave was because the doctors wanted to see whether syphilis manifested differently in black people compared to white people. And there's a whole lot of historical context to this, because at this time there was still this belief that races were biologically based, which is.
Not true, not true at all, right, and that the.
Higher rates of syphilis in certain groups were somehow biologically based rather than socioeconomic. Overwhelmingly, the response to the news of the Tuskegee experiment was horror and a feeling of betrayal. The United States, rather than protecting its citizens from being taken advantage of, was actively.
Preying upon them.
For many, that may not have come as a big surprise, and all it did was to increase the distrust of the government, including the branch that was supposed to help
and heal people, the Public Health Service. The Tuskegee syphilis Experiment started a discussion of medical ethics, raising questions about the difference between volunteering and being coerced, and about how medical researchers, in their quest for odds rejectivity, start to see people as subjects or in this case, cadavers, and left people wondering how many other unethical experiments will come to light in the future.
Answer A lot, a lot.
And if any of you have so this, this Tuskegee study is not news to you, Aaron, It's not news. It wasn't news to me, although a lot of the details were, because it isn't mentioned in every single ethical biomedical ethics course or training program that you do any public.
Health you know.
What's interesting though, in reading about the biology of it of syphilis, this comes up often because you can't talk about syphilis without talking about the tuskeke experiments. But in some of the papers and books that I've read, they mention it in such passing as though it was oh, regrettable, like that's it right.
Any more, Like oh, it's from another era. That's sort of like it's.
Rather than like gut wrenching horror that it should provoke.
It's well, I think I mean both gut wrenching horror and also the realization that a lot of the circumstances that led to people doing this study and thinking this was okay are still in existence today.
Yeah, totally. There's a lot.
More than just like to me, there's a lot more in this study than just oh well, this is a course in medical ethics, right. This is all about how much your rights are tied to your circumstances.
Right.
You can't look at a study like this, that a study like this took place and was funded for so long and not realize how deeply systemic racism and classism is in our society, like you. It just boggles my mind that people can try and pretend like that doesn't exist when this was in our lifetime.
Yes.
Yeah, I encourage everyone who listens to this to go seek out more information. There's a fantastic book which is a classic that I got all this information from. It's called Bad Blood by James Jones. It's incredible. It is so well researched, and for someone who doesn't have the time or the desire to read a book. I also watched this Yale lecture on YouTube about it.
And it was amazing.
It was so so perfectly done, much better than I could ever do, but a lot of good information there.
So after the study.
Came out, there were lawsuits, there were investigations into the ethics of this study, and it did really change the way that biomedical studies are done. It changed the whole process of how to how to ensure that you are finding volunteers and not coercing people what informed consent really is. But it did instill a lot of distrust into the
US government ren rightfully so. And it should still be such a huge part of the conversation about STIs in general, and sort of this a shame blame and being taken advantage of and withholding treatment, all of these things sort of go together. And yeah, so my part of this really kind of ends with the breaking of the news of the Tuskegee experiment. Yeah, and I don't really know much about what's going on in terms of syphilis today. I've definitely seen some news articles flash across my screen
that are, I would say, somewhat alarming. But Aaron, tell me what's going on in syphilis today.
I'd love to. We'll take another short break before we get into it.
Syphilis today.
I think you're not alone, are And you said that when you think of syphilis, you think of the past, old timey, but it is certainly still a disease that's prevalent today. So looking worldwide, the World Health Organization estimates in twenty sixteen was the most recent numbers that I found that nineteen point nine million people around the globe were living with syphilis, mostly between the ages of fifteen to forty nine, and that there were six point three million new cases in twenty sixteen.
That's the estimate. So the prevalence is nineteen was nineteen point nine, but the incidents was six point three exactly million. Okay, yep, and that's worldwide. Okay, that's those are lowish numbers. I mean they're not. Yeah, it's not.
It's not nearly as prevalent as other STIs.
Or a lot of other diseases.
But here's where it gets to be a bummer. Oh great, syphilis is on the rise. Yeah, and it has been for kind of a very long time. So in the eighties and early nineties was actually the low of syphilis, especially in the United States. So syphilis after the seventies sort of started to decline, But since the year two thousand it has been on the rise again. So the peak was in the nineties, I think nineteen ninety in the US, the like cases per one hundred thousand were twenty.
That was the peak since the introduction of penicillin. Then they started to fall, but since two thousand, they've been increasing every year since then. So in twenty seventeen there were thirty thousand cases of syphilis reported in the US. That's ten percent more than the year before and the highest rate that we've seen since nineteen ninety three.
Wow.
Yeah, okay, so it's like every year it's been increasing and increasing.
Is this a reportable? It is?
What's very interesting and I got a real kick out of this. It's been nationally notifiable, so reportable since nineteen forty four, which is like the year after they started treating it. And so if you read up to date, which is like doctor Wikipedia, it says that because it's been notifiable and it's got unique diagnostic features, most cases are report like we've got a great handle on syphilis
and how did you know? Yeah, great question. I entirely disagree with that sentiment, like, because the problem is we only know about cases that are diagnosed. Obviously, we don't know about cases that people never come to treatment for people who don't have access to health care are not going to be diagnosed. And when we have free clinics
and planned parenthoods being shut down across the country. You can't assume that people have access and are getting treatment, especially considering that primary syphilis often you would never know that you have this ulcer. And those numbers that I said, so like thirty thousand cases in twenty seventeen, that's of primary and secondary syphilis, so that's not including late or
tertiary syphilis. We don't we definitely don't have a good handle on how many people get late syphilis or what proportion of people that get infected end up getting late syphilis.
There has also been an upward trend in late syphilis, like there's been more cases reported in recent years compared to the early two thousands, but we're still unclear on how, like exactly what the proportion of people are that present with late syphilis versus early, if that makes sense, because most people are going to probably present early, but the ones who don't, it's years and years down the line that they're going to end up with tertiary. So there's
such a long latent period. There's a lot of numbers out there on you can look on the CDC, even on Wikipedia that'll tell you who quote unquote gets syphialis what groups of people I put that in quotes. Air quotes are at the highest risk, and I am not going to get into the details of that on this podcast. And here's why. Syphilis is an extremely infectious disease. Ten organisms. Usually it's around fifty, but as few as ten microscopic
bacteria in an extremely teeming sore can cause infection. And what that means is that anyone having sex of any kind can get syphilis. And that's the reality of it. So there are recommendations on these groups of people should be screened, and these groups of people should be screened, but realistically, in my opinion, this is where we veer into Aaron's opinion territory. If you're a person having sex of any kind with anyone, you should probably get screened at least once.
Right, it doesn't hurt.
Yeah, And the more people that get screened, the more cases we identify, the greater our chances of reducing the burden of this disease among the entire population, not just in certain groups.
Well.
And also STIs have a huge stigma.
There's a lot of shame and blame and all of these things associated with them, and there doesn't need to be because these things happen to people They don't happen just to certain groups of people.
They happen to everyone.
And so the only way that you can that you can help yourself and help everyone.
Else around you is just get screened, just get a be deemed. Yeah.
Yeah, In my opinion, if you're having sex, then you should be talking about sex, and you should be talking with your partners about sex. And if you're doing that, then you should both be talking about getting screened. I've even seen campaigns that are like make it sexy, go get screened together, whatever, who cares, whatever it takes. Just go get screened for syphilis, for HIV, for chlamydia, gonerieat for all the things, you know what I mean.
Yeah, because again, this.
Is such a treatable disease. Right, syphilis is one shot, and it's treated unless it's late and latent, and then it's harder to treat right and also deadly. So that's horrific, I will say so. In terms of congenital syphilis, the numbers also aren't that reassuring because the rates of congenital syphilis mirror the rates of adult syphilis in the population. Yeah. So again, there were downward trends through the nineties but
it's been on the rise since. In twenty seventeen, in the US there were nine hundred and eighteen reported cases of congenital syphalis. This includes sixty four stillbirths and thirteen infant deaths so after birth, and that's a forty four percent increase between twenty sixteen and twenty seventeen.
Oh my goodness. Yeap.
And worldwide it's estimated that one million pregnancies per year are complicated by congenital syphilis.
Wow.
And again, forty percent of these will result in loss of yah. Yeah, so that's very depressing. Go get screened for syphilis. Every pregnant person that gets prenatal care in the US is screened for syphilis.
But that's only if you can afford prenatal care.
Exactly, and not everyone can, thank you US. There's also really high rates of co infections with syphilis and HIV. Yes, so, and that's really important because there's actually evidence that syphilis. Having an infection with syphilis can increase the risk of HIV transmission because it's basically, especially primary syphilis is an open wound and HIV is not very infectious, but if you have open soores, then it's a lot easier for
HIV to infect or be transmitted. And then I saw actually some possible evidence that in infection with HIV can also facilitate the transmission.
Of syphilis as well.
Okay, so it might work both ways kind of ye, the co facilitate each other in terms of infection.
Mutualistic Yeah, yikes.
Yeah, so that's a big time bummer. I wanted to say, let's talk about the positives and the current research, but there's not really much positive in terms of the current status of syphilis research. So there are a few groups and there have been a few recent studies that are trying to come up with a vaccine, and it seems like it's at least theoretically possible to develop a vaccine for syphilis.
But so far these.
Studies are still in animal models as far as I can tell, so they're very early studies. Every paper that I read, like in terms of the papers which I will post these on our website, of course, that's like what's the status of vaccine research essentially is like, hey, we really need to work on this, we need more funding to do so. So but yeah, so that's pretty much the current status of syphilis.
It still exists.
It's not as prevalent as other diseases, but it's on the rise.
I think. I mean, isn't that the general trend for STIs that the rise.
Yeah they are.
Yeah, yeah, yeah, I learned a lot today. I did too, I did too.
This is a very interesting episode and on one of our big ones.
Yes, yeah.
Well, before we do sources, I want to give a amazing shout out.
To Augusta's Luscious.
So this person owns a vegan chocolate shop in Brooklyn and they reached out to us to send us chocolates for Halloween time, and they are incredible.
So it's like a.
Bleeding heart that like actually bleeds. Oh my god, they're so good. We cannot thank you enough.
Yes, thank you so much. It means a lot and is really thrilling. We also never said a public thank you to another listener who sent us these beautiful watercolor drawings of cholera and plague. You're sinning a pestis.
Oh my gosh, they're so cool.
They're gorgeous. Aaron Welsh took the plague because that's her favorite in the entire world, and I got cholera, which is so gorgeous. So thank you to Jen for that. We love them and sorry that it's just so long to say thank you.
Okay, soursus sources. Now, So I read a few books for these.
The I got a lot of the history part from this book called as you Might Guess As I've mentioned the History of Syphilis by Claude Kettel and how you say his name, and there's a lot of good information there. And then I also read Bad Bloe The Tuskegee Siphliss Experiment by James Jones.
Incredible book. I highly recommend you check it out. I'll also post a link to that Yale lecture. And then I read.
A bit of a book called I Love this title That Jealous Demon My Wretched Health, which is by Petrick Trelawney, and that's about composers and disease, so like each chapter is a different disease and then it talks about composers who had that Oh so fun and it's really great because he's like, well, you know, this book says that this person had any I'm not going to go into it.
And then there are a couple papers that I'll post also.
As always we post all of our sources. I had a number of different papers and actually a textbook chapter this time too. We'll post all of our sources and links when possible on our website, This podcast will Kill You dot com. Under the episode's tab, you can find the sources from this and every single episode we've ever done.
Thank you to Bloodmobile for providing the music for this episode and all of our episodes.
We love it, and thank you all for listening. This is so fun for us. Season three off with a bang, and.
With that, wash your hands
You filthy animals.