Speaker 1: With this poison, anything is possible. It assumes the most
Speaker 1: unexpected and disconcerting forms. It almost seems to know the
Speaker 1: ridiculous shame it inspires, so it kills under a disguise.
Speaker 1: It makes its victims die of an intestinal obstruction, for example,
Speaker 1: or a nice little liver disease. You don't recover, but
Speaker 1: your honor is safe. At least the bereave don't have
Speaker 1: to blush at the mention of the deceased. So much
Speaker 1: for its caprices, but it also has its little habits.
Speaker 1: It loves to come out into the daylight, and then
Speaker 1: you get the whole garden full of cutaneous manifestations, those burgeonings,
Speaker 1: those dreadful efflorescences, the lupus. You can find fine examples
Speaker 1: of them all at Saint Louis or in its museum.
Speaker 1: And of course it eats away your bones. But above all,
Speaker 1: you see, the disease attacks the nervous system. That's its
Speaker 1: treat its dessert. It chooses its spot. It snaps the
Speaker 1: network of the nerves at winds. It can cut off
Speaker 1: communication with the outside world, suppress the five senses, and
Speaker 1: then we've got a pretty bouquet of infirmities or It
Speaker 1: plays with a man as if he were a puppet.
Speaker 1: By pinching the nerve at the right spot. It makes
Speaker 1: him jump or dance or start. Then, tired of this,
Speaker 1: it casts him aside, legs broken, and then we have
Speaker 1: a taxia, such a cruel game. You have heard tell,
Speaker 1: for instance, of the acute pain which strikes unendingly in
Speaker 1: the small of your back, or perhaps it lays into
Speaker 1: the brain, the kingpin of it all. And there's your
Speaker 1: general paralysis, sinility, and all its glory, all its regularity.
Speaker 2: I loved that description.
Speaker 1: Yeah, that's from this book called History of Syphilis.
Speaker 2: Well believe it or not. Jumping right into it, jumping
Speaker 2: right in. Oh yeah. So Hi, I'm Aaron Welsh.
Speaker 3: And I'm Erin Almond Updyke.
Speaker 2: And this is this podcast Will.
Speaker 1: Kill You Season three, Season three, and we're starting off
Speaker 1: with a bang by covering.
Speaker 2: A classic, a very classic syphilis. I'm very excited about today.
Speaker 1: Yeah, we've been wanting to do this one for a
Speaker 1: while and it's been highly requested, and I think we've
Speaker 1: been saving it because it's such a.
Speaker 2: Big one and it feels a bit daunting. So hopefully
Speaker 2: you get your fill.
Speaker 3: I think this was kind of on our short list
Speaker 3: for the first season, wasn't it because it's such a big,
Speaker 3: big one.
Speaker 2: It was, But I'm glad that we saved it. Me too.
Speaker 1: So because we're doing syphilis, we should maybe preface this
Speaker 1: with a bit of warning.
Speaker 3: Yes, if you are so, syphilis is a sexually transmitted disease,
Speaker 3: which means we will be talking about genitalia and sex.
Speaker 3: So if you're listening with young ones that you don't
Speaker 3: want to hear those things, maybe skip this episode. Come
Speaker 3: back in two weeks up to you.
Speaker 2: Yeah, okay, So first episode of season three. A lot
Speaker 2: of things have happened.
Speaker 1: So many things have happened, and it hasn't even been
Speaker 1: that long since season two ended.
Speaker 3: No it hasn't. So Aaron, tell us about some of
Speaker 3: the things that happened for you since we ended season two.
Speaker 1: I am back in the United States, and so now
Speaker 1: we get to record in the same time zone at least,
Speaker 1: even if it's not in the same location. But there
Speaker 1: will be upcoming same recordings, which will be excellent.
Speaker 3: That'll be way more fun. But it's really nice to
Speaker 3: be on the same time zone.
Speaker 2: Is and aeron what's up with you?
Speaker 3: Well, you might hear throughout this episode, tiny little squeals
Speaker 3: of my baby human who is sitting here near me,
Speaker 3: the keenest. He's very cute. And hopefully we'll sleep through
Speaker 3: this recording, but if not, we'll take breaks. Yeah, baby,
Speaker 3: no problem. Okay, So right, that's us all caught up.
Speaker 3: Do we have any more business?
Speaker 2: Yeah?
Speaker 1: So we still have merchandise, so go take a look
Speaker 1: at that. And we also will have new soap coming out,
Speaker 1: new new scent which is going to be super delicious smelling.
Speaker 3: Yeah, a kind of fall scent.
Speaker 2: Yeah. Yeah, I'm excited about it. Where can you find
Speaker 2: all of this?
Speaker 3: You can get to it all from our website. This
Speaker 3: podcast will kill You dot com under merch perfect It's
Speaker 3: pretty easy.
Speaker 1: Okay, onto more important things. Yes, it's corn teeny time.
Speaker 3: Oh, it's been so long since we've gotten to say
Speaker 3: those words, and.
Speaker 2: Since you've been able to actually participate.
Speaker 3: I know, And I'm not even right now, which is
Speaker 3: really disappointing, but I will be again soon. Quarantiny time, Aaron,
Speaker 3: What are we drinking today?
Speaker 1: We are drinking the Killer Cure Ooh it has mold
Speaker 1: cider of course, rye whiskey, ginger liqueur okay, and Walnut
Speaker 1: Liqueur or Walnut bitters.
Speaker 2: If you can find them, fantastic.
Speaker 1: I will recommend Templeton Rye because that was al Capone's
Speaker 1: favorite whiskey and he had syphilis. And shout out to
Speaker 1: our friend Sam for telling me that bit of trivia.
Speaker 2: That's amazing.
Speaker 3: Sam in her pocket knew like, oh yeah, and al
Speaker 3: Capone had syphilis. Yeahd Templeton Rye.
Speaker 1: She had to do a report on famous chicagoans when
Speaker 1: she was like in grade school, and so she chose
Speaker 1: al Capone and always remembered that he had syphilis.
Speaker 2: Oh that's amazing. Yeah, well that's perfect.
Speaker 1: Anyways, we will post the recipe to the quarantiney and
Speaker 1: the non alcoholic placey Berita on our website. This podcast
Speaker 1: will kill you dot com and will also blast it
Speaker 1: all over social media.
Speaker 3: Yes, so if you're not following us on social media,
Speaker 3: you should probably get on that.
Speaker 2: Yeah, props.
Speaker 3: Okay, all right, well then shall we begin our first
Speaker 3: episode of season three?
Speaker 2: Absolutely?
Speaker 3: All right, we'll take a quick short break so everyone
Speaker 3: can go make themselves a quarantine.
Speaker 2: All right, So syphilis, yes, give it to me, don't
Speaker 2: give it me?
Speaker 3: Well, yeah, I'll give you the biology, not the disease.
Speaker 2: How about that? Excellent?
Speaker 3: So one thing that I think is very fun that
Speaker 3: we did not do intentionally, at least I don't think
Speaker 3: we did this intentionally. Syphilis is our second spiral keet
Speaker 3: back to he that's right, And we ended season two
Speaker 3: with the Spira keet, and now we're starting season three
Speaker 3: with the spira keet.
Speaker 2: I have thinking about that meanwather.
Speaker 3: Not intentional, but kind of adorable, all right, So that's
Speaker 3: the first thing we already know. Now we've learned something
Speaker 3: new about syphilis. It's caused by a spira keet bacterium,
Speaker 3: which means like the bacterium that causes lime disease.
Speaker 2: It is a.
Speaker 3: Corkscrew shape and it sort of swims like a little
Speaker 3: what am I doing here?
Speaker 2: Erin you really spiral? Yeah, it's just corkscrew corkscrewing.
Speaker 3: So this bacterium that causes syphalis is called trepanima palladum, tripanema,
Speaker 3: trepanema however you want to say it palladum. Now, something
Speaker 3: that's very interesting about syphilis that's different than the last
Speaker 3: spira keet we did. While lime disease is caused by
Speaker 3: a number of different species, of bacteria. Syphilis is not
Speaker 3: only caused just by one species, but by one particular
Speaker 3: subspecies of one bacteria.
Speaker 1: I was hoping that you were gonna cover this because
Speaker 1: I find this super interesting that it's a subspecies and
Speaker 1: what does that mean for the biology of this disease
Speaker 1: versus the other subspecies in Trepenema paladum.
Speaker 3: It's fascinating. So Trepenema paladum has a number of different
Speaker 3: subspecies that cause completely different diseases aside from syphilis. So
Speaker 3: syphilis is caused by Trepanema paladum subspecies palladum. So Trepenema
Speaker 3: paladum paladum, that's what causes the disease that we're going
Speaker 3: to talk about today. Syphilis also used to be called
Speaker 3: venereal syphilis, so this is the sexually transmitted form of syphilis. However,
Speaker 3: other subspecies of Trepenema paladum cause diseases like yaws. Yeah,
Speaker 3: and I'm not sure how you pronounce it be hell.
Speaker 1: Oh, I was hoping that you were going to try
Speaker 1: to pronounce this first, because I have no clue.
Speaker 3: Nope, I even looked it up and I couldn't find
Speaker 3: a consistent pronunciation. So it's also called endemic syphilis.
Speaker 2: It's spelled b E j E L. Yeah, I don't
Speaker 2: know if.
Speaker 3: It's begel or behel, who knows, but anyways, that's another form.
Speaker 3: And then there's another that I actually I saw it
Speaker 3: listed as a subspecies of Treponema paladam and also as
Speaker 3: another species of Treponema that causes a disease called pinta.
Speaker 2: So I'm actually not clear, but.
Speaker 1: They couldn't, so it's it's I think what I read
Speaker 1: is that pinta is caused by a separate species, and
Speaker 1: that's only because they could not get a bacterial isolate
Speaker 1: of it to determine whether it was a subspecies.
Speaker 3: That seems believable. And what's so interesting about these different
Speaker 3: subspecies is that based on the tests that we use
Speaker 3: to diagnose syphilis, you can't distinguish them from each other.
Speaker 3: So morphologically, when you look at them under a microscope,
Speaker 3: they're identical. The test that we used to diagnose them,
Speaker 3: you can't tell them apart. There are tiny, tiny differences
Speaker 3: in their genomes that result in small differences in proteins
Speaker 3: that if you do very specific tests that nobody does
Speaker 3: in real life, you can tell them apart. But The
Speaker 3: reason that we classify them as different subspecies before we
Speaker 3: had those tests is because they're clinical manifestations. So the
Speaker 3: way they present in people is totally different, and the
Speaker 3: way that they're transmitted is different. So these other diseases
Speaker 3: caused by Trepenima paladum different subspecies are not transmitted sexually.
Speaker 3: They're transmitted in other ways that we're not going to.
Speaker 2: Talk about today.
Speaker 3: Right, So that's our first fun fact. Trepenema paladum subspecies
Speaker 3: paladum causing syphilis.
Speaker 2: Fun, very fun fact.
Speaker 3: Such fun. That's as fun as it gets. It's downhill
Speaker 3: from here.
Speaker 2: Okay.
Speaker 3: So syphilis, as most people are aware, and as we've
Speaker 3: said already, is a sexually transmitted infection. It can be
Speaker 3: spread through any type of sexual contact. We're talking all
Speaker 3: the different kinds of sex. So syphilis is a very
Speaker 3: very tiny spiralkeet. So the way it's transmitted is essentially
Speaker 3: just when you come into contact with the bacteria through
Speaker 3: direct skin on skin or skin on mucous membrane contact,
Speaker 3: the bacteria is able to just cork screw its little
Speaker 3: way in between the tiny gaps in your skin cells,
Speaker 3: either if you have microscopic little tears or just through
Speaker 3: your mucous membranes like your genitalia, where the skin is
Speaker 3: very thin and very moist. Syphilis can also pass through
Speaker 3: the placenta and be transmitted congenitally, so from mother to infant,
Speaker 3: and in some cases it can even be transmitted to
Speaker 3: a baby during birth, like through the birth canal Okay,
Speaker 3: And once it penetrates the skin, the bacterium pretty quickly
Speaker 3: makes its way into your bloodstream and from there, as
Speaker 3: we saw in that first hand account, it can travel
Speaker 3: to and invade pretty much any organ. It can even
Speaker 3: cross the blood brain barrier and make its way into
Speaker 3: your nervous system. Yeah yeah, And as it travels through
Speaker 3: your bloodstream, it turns out that it stimulates a lot
Speaker 3: of inflammation on the part of your immune system, and
Speaker 3: this inflammation is what causes a lot of the symptoms
Speaker 3: that we see. There are a few specific organs that
Speaker 3: it tends to infect, like preferentially for some reason or another,
Speaker 3: and we'll talk about those, but it can invade almost
Speaker 3: any organ just by swimming its way through your bloodstream.
Speaker 2: Yikes.
Speaker 3: Yeah, let's start talking about the actual symptoms. So now
Speaker 3: we know this is how it's going to cause them. Right,
Speaker 3: it's traveling through your bloodstream causing inflammation.
Speaker 2: As it goes.
Speaker 3: Okay, so what are the actual symptoms. There's three main
Speaker 3: phases of syphilis primary, secondary, and tertiary very creative names.
Speaker 3: And then it can also lay latent, so between the
Speaker 3: secondary and tertiary phase you can have years long latency
Speaker 3: where there are bacteria there, but you don't have active disease,
Speaker 3: so you wouldn't know that you're infected. So the primary
Speaker 3: stage usually presents within three weeks of infection. So the
Speaker 3: incubation period on average is about three weeks. It can
Speaker 3: be less, it can be more, and it usually the
Speaker 3: primary stage is essentially a shanker, that's what it's called.
Speaker 3: It's essentially just an ulcer, so an open wound that
Speaker 3: is most commonly found on the genitalia because again we're
Speaker 3: talking about a disease that's transmitted sexually. So this shanker,
Speaker 3: this ulcer is essentially chalk full of spira keet bacteria.
Speaker 3: It's just a bunch of spira keets swimming around just
Speaker 3: under the surface of your skin, busting out as they
Speaker 3: go into this open wound. Where is the wound, So
Speaker 3: it's most commonly if you have a penis, on the
Speaker 3: shaft of the penis or the glands of the penis.
Speaker 3: It can be on the labia or inside of the vagina,
Speaker 3: or in the anal canal or around the anis. It
Speaker 3: is possible also for it to be in the mouth
Speaker 3: or there's even been reports of it in physicians before
Speaker 3: gloves were a thing.
Speaker 2: They would get it.
Speaker 3: In their nose. Ah, I know, yeah, it's horrific. So
Speaker 3: it can be on basically any mucous membrane okay, yeah,
Speaker 3: but most commonly on the penis, anis, or labia, or
Speaker 3: inside the vagina. But one thing that is really important
Speaker 3: about this ulcer of primary syphilis is that it's completely
Speaker 3: painless and it doesn't itch, and so that's something that
Speaker 3: distinguishes it from a lot of other genital ulcers is
Speaker 3: that you might not ever know that it's there if
Speaker 3: you're not looking for it, because it doesn't hurt at all,
Speaker 3: and even though it might.
Speaker 2: Bleed a little.
Speaker 3: That's in an area where things just kind of lead sometimes, right.
Speaker 1: And especially if you have if it's like up the
Speaker 1: vaginal canal exactly something, it's much more difficult to spot, right.
Speaker 3: Or even like in the anus like you're probably never
Speaker 3: gonna find that, and so yeah, so it's very possible
Speaker 3: to never know that you have this primary form.
Speaker 1: And the site is usually the site of infection as well, it.
Speaker 3: Is yeah, so yeah, this is something where that's the
Speaker 3: site of infection and it's full of bacteria extraordinarily infectious. Okay,
Speaker 3: so these ulcers are extraordinarily infectious. And usually the ulcer
Speaker 3: will persist between three and six weeks, so it's a
Speaker 3: pretty long lasting ulcer. It doesn't just pop up overnight
Speaker 3: and then disappear overnight. It lasts for quite a while.
Speaker 3: So that's primary syphilis. Secondary syphilis is what happens a
Speaker 3: bit later. So this usually happens after between four and
Speaker 3: ten weeks of after infect so a longer incubation period
Speaker 3: in general. And I'm unclear on exactly how many, like
Speaker 3: what percentage of people go on to develop secondary syphilis
Speaker 3: if primary is untreated. Some numbers I saw said twenty
Speaker 3: five percent, but I saw numbers as high as sixty
Speaker 3: or eighty percent, So honestly, who knows. I don't, but
Speaker 3: a number of people will go on to develop this
Speaker 3: secondary syphilis, and this is I think one of the
Speaker 3: main ways that syphilis got one of its nicknames, which
Speaker 3: was the Great imitator, right, And it's kind of what
Speaker 3: you talked about or touched on in the first hand account.
Speaker 3: This can present in so many different ways because the
Speaker 3: bacteria have gone throughout your entire bloodstream and they can
Speaker 3: essentially invade any organ that they choose, So you can
Speaker 3: have GI manifestations where you have inflammation, and like gastro
Speaker 3: intestinal distress. You can have hippatosplenomegaly where your spleen and
Speaker 3: your liver get infected and then they get really large
Speaker 3: because they're full of inflammation. Hippato is liver spleno is spleen.
Speaker 2: I like that word. It's a good word. I like
Speaker 2: to throw it.
Speaker 3: In whenever I can't. Yeah, you can also get meningitis,
Speaker 3: So if it crosses that blood brain barrier in secondary syphilis,
Speaker 3: you can get meningitis. And it's not uncommon to find
Speaker 3: actual bacteria in the CSF, the spinal fluid. But then
Speaker 3: there are a few other manifestations that are kind of
Speaker 3: not kind of classic secondary syphilis, and most commonly that's
Speaker 3: a rash. And this rash is on the trunk and
Speaker 3: the extremities, and specifically it goes to the palm and
Speaker 3: souls of the feet, So palms of the hands and.
Speaker 2: Soles of the feet.
Speaker 3: There are not a lot of infectious diseases that cause
Speaker 3: a rash on your palms and souls. Huh, isn't that bizarre?
Speaker 2: There's only very bizarre. It's very bizarre.
Speaker 3: There's only three main disorders that we learn in medical
Speaker 3: school that give you rashes on the palms and souls.
Speaker 3: It's secondary syphilis, ricketzial diseases like rocky mountain, spotted fever,
Speaker 3: and uh cocksacky virus handfoot in mouth. Oh okay, those
Speaker 3: are the three big ones.
Speaker 2: How interesting. I wonder what why me too?
Speaker 3: I tried to find out an answer, and I don't
Speaker 3: have a good one. There are other things like obviously
Speaker 3: contact dermatitis. If you like grab your hand onto something
Speaker 3: like poison ivy, yeah you'll get a rash there. But
Speaker 3: in terms of infections, those are the three big ones. Huh.
Speaker 1: I know. So the rash thing, so then if you
Speaker 1: have because it wouldn't just be on one hand either,
Speaker 1: it would be on your palms and your feet.
Speaker 3: Yeah, and usually it's kind of throughout your body as well,
Speaker 3: so it's not only on your palms and souls.
Speaker 2: It's like kind all over.
Speaker 1: And this is the whole great pox versus smallpox sort
Speaker 1: of thing, is the big rash.
Speaker 3: Yeah, So this rash can actually look a lot of
Speaker 3: different ways, if you like Google image search it, which
Speaker 3: I'm sure on our social media will post plenty of
Speaker 3: pictures of this. But it sometimes it's just flat red spots.
Speaker 3: Sometimes it can be raised spots. In people who have
Speaker 3: some kind of immunocompromise, like they don't have a great
Speaker 3: immune system response, they can actually get necrotizing rashes. So
Speaker 3: that's where like this tissue starts to die and they
Speaker 3: get these very large, kind of purple, very dark rash.
Speaker 3: So it can look a lot of different ways. Yeah,
Speaker 3: and then you'll also see other signs of kind of
Speaker 3: systemic involvement, things like fever, sore throat, weight loss, hair loss.
Speaker 3: So that's secondary syphilis, okay. And then there's tertiary dun
Speaker 3: dun dun, Yeah, dun dundun is right after secondary. There's
Speaker 3: often a long latent period where we're talking years past
Speaker 3: between secondary and tertiary.
Speaker 2: And it's also.
Speaker 3: Possible that you can get tertiary syphilis or have signs
Speaker 3: of tertiary syphilis without knowing that you had syphilis, because
Speaker 3: if you only had a primary ulcer and you never
Speaker 3: developed those secondary signs, you might never have known that
Speaker 3: you had that ulcer, and then five, ten, fifteen, twenty
Speaker 3: years down the line, you can develop signs of tertiary syphilis.
Speaker 2: So you can jump essentially from primary to tertiary without
Speaker 2: Yeah you could.
Speaker 3: Yeah, So tertiary syphilis if it goes if primary and
Speaker 3: secondary syphilis goes untreated, it can result years down the
Speaker 3: line in this much more severe form of syphilis. And
Speaker 3: this tertiary third form actually has three different forms itself.
Speaker 3: So there's a cardiovascular form of tertiary syphilis, where as
Speaker 3: you can imagine it affects your heart. There's the gammatis gummatis.
Speaker 2: Oh yeah, the gumma.
Speaker 3: The gumma form, and we'll talk about what the heck
Speaker 3: that means in a second. And then there's neurosyphilis, which
Speaker 3: affects your nervous system. Neurosyphilis is the most famous of these,
Speaker 3: I think, and that's because it was the most common
Speaker 3: before there was treatment for syphilis. Tertiary syphilis, specifically, neurosyphilis
Speaker 3: was the most common form of this late phase of syphilis.
Speaker 3: And there's a few different ways that this can present,
Speaker 3: and they're all absolutely horrific. But the two more devastating
Speaker 3: I suppose forms of neurosyphilis are called general paresis and
Speaker 3: Taby's dorsalis. So we'll talk about each of those. General
Speaker 3: paresis is, so parsis means paralysis, but this is much
Speaker 3: more than just a paraphalysis. This is when basically the
Speaker 3: spiro keet invades your brain in such a way that
Speaker 3: your cerebrum, which is the main part of your brain,
Speaker 3: like the brain shaped part of your brain, starts to atrophy.
Speaker 2: Oh my god, yeah, it's horrific.
Speaker 3: And so you get a dementia, which is basically you know,
Speaker 3: things like memory loss, personality change.
Speaker 2: And then you also get.
Speaker 3: These physical symptoms, so things like trouble speaking, tremors, seizures.
Speaker 2: Your muscles will.
Speaker 3: Eventually start to deteriorate because the connection between your brain
Speaker 3: and your muscles is not working correctly, So your muscles
Speaker 3: start to atrophy because of that, and then eventually complete paralysis.
Speaker 2: Why does this happen, great question.
Speaker 3: I don't know entirely, Especially with general paresis, it's as
Speaker 3: far as I understand it's just the invader of your
Speaker 3: brain itself, your brain and your spinal cord that causes
Speaker 3: this atrophy. So as each part of your brain starts
Speaker 3: to atrophy, you'll see these different manifestations. So that's actually
Speaker 3: not the most common form of neurosyphilis. The most common
Speaker 3: and kind of I know what we learned in med
Speaker 3: school is like, the most classic neurosyphilis is Taby's dorsalis tabs.
Speaker 3: I looked this up. Get my etymology hat on. Tabes
Speaker 3: means wasting away, which is horrific, and dorsalis is like dorsal,
Speaker 3: like dorsal fin so the back part, So Taby's dorsalis
Speaker 3: is literally the wasting away, the degeneration of the posterior
Speaker 3: part of your spinal cord.
Speaker 2: Oh my god.
Speaker 3: So instead of your brain kind of wasting away, it's
Speaker 3: the back part, specifically, just the posterior part of your
Speaker 3: spinal cord. Wow, it happens that that section of your
Speaker 3: spinal cord, the nerves that run through it are mostly
Speaker 3: respect for a few specific things vibration sense and discriminative touch.
Speaker 3: So being able to know like this that you're poking
Speaker 3: me with is sharp and this is where you're poking
Speaker 3: me versus this is soft and this is not. So
Speaker 3: you lose that, you lose any kind of vibration sense, Okay,
Speaker 3: and very importantly proprioception. Proprioception is knowing where your body
Speaker 3: is in relation to your body. So here's where my
Speaker 3: arm is. It's off to my right hand side. And
Speaker 3: if I need to do something like, for example, pick
Speaker 3: up a fork and bring it to my mouth, you
Speaker 3: need proprioception to be able to do that, right, So
Speaker 3: you lose all of that in Taby's door salice, which
Speaker 3: means your brain doesn't know where your leg is in
Speaker 3: relation to your body, so you can't walk properly because
Speaker 3: you can't coordinate between your two legs. Your brain doesn't
Speaker 3: know where they are right space, isn't.
Speaker 2: That Yeah, that's really rough?
Speaker 3: Yeah, so yeah, So that's Tavy's dorsalis. It's it's really gnarly.
Speaker 3: It'll eventually result in complete loss of coordination, loss of
Speaker 3: reflexes because part of the reflex loop goes through the
Speaker 3: back part of your spinal cord as well, and then
Speaker 3: that will also lead to muscle degeneration because you're not
Speaker 3: coordinating your muscles correctly. It's really gnarly.
Speaker 2: Yeah.
Speaker 3: Luckily those manifestations are not common today because we have treatment,
Speaker 3: but they still can't happen. Yeah, uh okay, but that's
Speaker 3: just neurosyphilis. We're not done yet. The cardiovascular form of
Speaker 3: syphilis is actually the most.
Speaker 2: Deadly, so it seems reasonable.
Speaker 3: Yes, And this is this is one of the most
Speaker 3: interesting forms for me when I first learned about it,
Speaker 3: cardiovascular syphilis. What happens is, so, h your aorda, which
Speaker 3: is the giant, largest artery that leads directly off of
Speaker 3: your heart. Right, that's the artery that feeds every other
Speaker 3: artery giving blood to your whole body.
Speaker 1: Right in a blue whale, the aorda, a small human
Speaker 1: can fit through it. Yes, that's my fun fact for this.
Speaker 1: That is a fun pepper, a fun fact in here.
Speaker 3: We need some of those because this is depressing. So
Speaker 3: your aorda is so large and thick and muscular that
Speaker 3: it actually has its own blood supply. So there are
Speaker 3: tens tiny blood vessels that actually feed the muscle surrounding
Speaker 3: your aorda. What happens in cardiovascular syphilis is the bacteria
Speaker 3: replicate and invade those tiny blood vessels. They're called the
Speaker 3: vasa vasorum that feed your aorda, and then the inflammation
Speaker 3: causes those vessels to obliterate whoa, So that means that
Speaker 3: your aorda is not getting blood supply to the muscle
Speaker 3: of your aorda. So then the walls of your aorta
Speaker 3: become weak, and then it dilates and it can eventually
Speaker 3: rupture yikes, because it can't contain the pressure from your
Speaker 3: blood flow from your heart.
Speaker 2: Do we have any breakdown of the proportion of It's
Speaker 2: a good question.
Speaker 3: I don't have exact numbers. I did see that neurosyphilis
Speaker 3: is the most common form of tertiary but cardiovascular is
Speaker 3: responsible for what I read is eighty percent of the
Speaker 3: deaths associated with syphilis. Okay, so if that helps at
Speaker 3: least to get an idea. And then finally there's the
Speaker 3: gumma form. This is the least common, but this is
Speaker 3: what happens when the spier keets invade your skin or
Speaker 3: your bone or other tissue and basically just in small areas,
Speaker 3: destroy all that tissue. So you get these large what
Speaker 3: are called granulomas, which essentially is just a bunch of
Speaker 3: tissue with inflammatory cells and bacteria.
Speaker 2: In these kind of nodules. Is this the one that
Speaker 2: leaves the most traces?
Speaker 1: I mean, you said it invades the bones, but do
Speaker 1: they I didn't even think about this. I just kind
Speaker 1: of assumed that all tertiary syphilis left bone traces.
Speaker 2: But is it just the gumma form?
Speaker 3: Well, I would guess that you can have gummas even
Speaker 3: if you never know that you had.
Speaker 1: Them, Okay, right, it would only be discovered, like you
Speaker 1: could have cardiovascular syphilis and gummas.
Speaker 3: Absolutely, Okay, yeah, but you might like one one is
Speaker 3: going to be the thing that like kind of brings
Speaker 3: it to the attention or something like that. I don't
Speaker 3: think that these are not distinct entities necessarily.
Speaker 2: Right, They're just different shades of right, exactly, different different
Speaker 2: shades of syphilis, shades of.
Speaker 3: And then finally there's congenital syphilis, which is very depressing.
Speaker 3: It's when the spira keets cross the placenta or in
Speaker 3: some cases through the vaginal canal, infect a fetus or
Speaker 3: a baby, and there's a number of different things that
Speaker 3: it can cause in infants and even in children. So
Speaker 3: even after like several years, con genital syphilis can cause
Speaker 3: a lot of different the way that it can manifest
Speaker 3: in a lot of different ways in adults. It can
Speaker 3: cause a lot of different types of disease in children
Speaker 3: as well. But at least about half the time, if
Speaker 3: a pregnant person gets infected with syphilis, what happens is
Speaker 3: just so early fetal loss or still birth. If the
Speaker 3: pregnancy is farther along.
Speaker 2: That's that's really sad.
Speaker 1: So it seems like it's most of the most of
Speaker 1: the time, it's a fatal outcome exactly.
Speaker 3: Yeah, So that's that's pretty much the biology of syphilis.
Speaker 3: The only good thing that I have to say about
Speaker 3: it is that it's very treatable. Still, syphilis is treated
Speaker 3: with penicillin. It's one of the few things that we
Speaker 3: still treat with penicillin, and thus far it shows little
Speaker 3: to no resistance to penicillin, which.
Speaker 2: Is fascinating to me.
Speaker 3: Interesting, it's very very interesting. Unfortunately, everything else is resistant
Speaker 3: to penicillin.
Speaker 2: Within like a several years or race. Yeah, yeah, yeah.
Speaker 3: What I think is very cool is that penicillin is
Speaker 3: so good at treating syphilis that if someone has especially
Speaker 3: if they have a late stage of syphilis and they're
Speaker 3: allergic to penicillin, instead of treating them with a different antibiotic.
Speaker 3: You actually desensitize them to penicillin first, and then you
Speaker 3: treat them with penicillin.
Speaker 2: How do you desensitize someone to penicillin.
Speaker 3: The same way that you would with other allergies? You
Speaker 3: basically give them a tiny bit at a time, and
Speaker 3: you monitor them and then you slowly increase the dosage.
Speaker 2: Does that work for everyone? As far as I can tell,
Speaker 2: it works for most people. That's really interesting. It's interesting,
Speaker 2: but it can take a very long time.
Speaker 1: And so but it's it's worth it to be able
Speaker 1: to use penicillin rather than trying to find it an alternative.
Speaker 3: Yeah, yeah, there are other antibiotics. If somebody has an
Speaker 3: early form of syphilis and is allergic to penicillin, but
Speaker 3: for late syphilis, it's pretty much penicillin or bust.
Speaker 2: Gotcha?
Speaker 3: Cool?
Speaker 2: So yeah, that's syphilis.
Speaker 3: Uh, what the heck?
Speaker 2: Aron?
Speaker 3: Where did this thing come from? And how can it
Speaker 3: reak so much havoc on our bodies?
Speaker 2: Oh?
Speaker 1: Man, Okay, well here we go, here we go. But
Speaker 1: first let's take a little break Syphilis.
Speaker 2: Outbreaks of any.
Speaker 1: Kind of disease don't just happen out of thin air.
Speaker 1: Even though that maybe how it seems when they begin.
Speaker 1: Usually there's a set of very specific circumstances that perfectly
Speaker 1: set the stage for the emergence and spread of a
Speaker 1: particular pathogen. Can you guess what one of the most
Speaker 1: common stage setters is? No, come on, I guess, I
Speaker 1: guess anything? What would lead to an outbreak?
Speaker 2: What I was gonna say, orgies?
Speaker 1: Now I'm not talking specifically about syphilis or or sdis
Speaker 1: I'm just talking about disease.
Speaker 3: A lot of a lot of people in a small area, sure,
Speaker 3: and one.
Speaker 1: Maybe chaos and maybe people from a lot of different
Speaker 1: areas getting together.
Speaker 2: Absolutely could be war.
Speaker 1: Absolutely yeah, So war, war is the answer I was
Speaker 1: looking for.
Speaker 2: What is it good for spreading disease? Absolutely so?
Speaker 1: Yeah, As you mentioned, a bunch of people in close
Speaker 1: contact these they're traveling in areas that are new to them,
Speaker 1: infrastructure is sort of falling apart, and all of these
Speaker 1: things promote the exchange of pathogens, new pathogens and including syphilis.
Speaker 1: It turns out that the question of where syphilis came
Speaker 1: from and when is a bit more complicated than I
Speaker 1: had expected. Really, Yeah, but don't worry, I'll get into
Speaker 1: all of it later.
Speaker 2: But for now.
Speaker 1: Let's first things first. This say first things first. The
Speaker 1: first time that we see what is definitely an outbreak
Speaker 1: of syphilis in Europe, like conclusively is around fourteen ninety five,
Speaker 1: during the First Italian War, which you've heard of that
Speaker 1: you know, this war?
Speaker 3: Of course I know all about it. It was the
Speaker 3: first one.
Speaker 2: Yeah in Italy. Yep, totally no. I had no idea.
Speaker 1: So Wikipedia did so, okay, and here's here's what I
Speaker 1: could glean from just a quick skim.
Speaker 2: So in the fourteen nineties there.
Speaker 1: Was apparently, and I always I like this historical context
Speaker 1: because it just sort of I think it's really interesting
Speaker 1: to I don't know, to talk about why, like how this,
Speaker 1: how this all happened. Okay, you have your extra.
Speaker 3: Joy face on when you're talking about this, so I
Speaker 3: know it's going to be good.
Speaker 2: Yeah. It's sort of those those Wikipedia rabbit holes. Okay.
Speaker 1: So in the fourteen nineties there was apparently a bit
Speaker 1: of a spat between the Pope at the time, who
Speaker 1: was innocent the eighth if you were interested, and King
Speaker 1: Ferdinand of Naples. This kingdom was basically the southern half
Speaker 1: of Italy excluding Sicily. Okay, the king refused to pay
Speaker 1: any money to the pope, and so the Pope was like,
Speaker 1: all right, fine, I'm just going to depose you and
Speaker 1: give your kingdom to King Charles the.
Speaker 2: Eighth of France.
Speaker 1: Naturally, yeah, And so the two, the King of Naples
Speaker 1: and the Pope eventually made up. But the King of France,
Speaker 1: King Charles, was like, excuse me, you offered this to
Speaker 1: me and then you drew it back right away, and
Speaker 1: he never really got over it. So he was he
Speaker 1: was super annoyed. And so a few years later, when
Speaker 1: the proper heir to the Kingdom of Naples was called
Speaker 1: into question because the previous king died whatever whatever, Charles
Speaker 1: gathered some troops and it ended up being this ragtag
Speaker 1: bunch of mercenaries from all over. Some were Flemish, some
Speaker 1: were Swiss, some were Spanish, some were Italian. I mean,
Speaker 1: you get the idea. And then he invaded and met
Speaker 1: like was like almost little to no resistance initially. So
Speaker 1: they kind of hung out in Naples and around Italy
Speaker 1: just partying and pillaging and having a good time. And
Speaker 1: then the people had had enough so they chased them
Speaker 1: out and then they met on this huge battlefield in
Speaker 1: July fourteen ninety five with actually like Italian troops. And
Speaker 1: so from this battle is when we get the first
Speaker 1: known descriptions of syphilis huh quote through sexual contact an
Speaker 1: ailment which is new or at least unknown to previous doctors.
Speaker 1: The French sickness has worked its way in from the
Speaker 1: west to this spot. As I write, the entire body
Speaker 1: is so repulsive to look at, and the suffering is
Speaker 1: so great, especially at night, that this sickness is even
Speaker 1: more horrifying than incurable leprosy or elephantiasis, and it can
Speaker 1: be fatal.
Speaker 2: Whoa, yeah, even.
Speaker 3: Worse than leprosy and elephantiasis.
Speaker 2: That is heavy words.
Speaker 1: Right, and so that's a that's a very remember that
Speaker 1: because it's a really interesting facet of the emergence of
Speaker 1: syphilis in Europe. Okay, so that was from this Venetian
Speaker 1: doctor named Benedetto.
Speaker 2: By the way, oh I know.
Speaker 3: Someone ning Benedetto really bends from Hawaii.
Speaker 2: Oh cool. Okay.
Speaker 1: After this battle, the retreating French troops returned to their
Speaker 1: respective countries and along the way made some stops and
Speaker 1: may have deposited the syphilis bacterium in various cities and towns.
Speaker 1: Of course, and from there it exploded, and I mean
Speaker 1: like within a few years, it was already in medical treatises.
Speaker 1: It was already all over Europe, I mean everywhere.
Speaker 3: Can I just say that deposited is a really funny way.
Speaker 2: I didn't know how else to say it. I guess
Speaker 2: there are probably many of us. I like, deposit Okay, good,
Speaker 2: just a little deposit. Yeah.
Speaker 1: And this syphilis, as you could probably tell from the
Speaker 1: description of during the battle, this was not the syphilis
Speaker 1: of the twenty first century or even that of the
Speaker 1: nineteenth or eighteenth centuries, and those syphilises, I guess are
Speaker 1: horrifying enough.
Speaker 2: But this one, if you can believe, it was worse. Whoa.
Speaker 2: This was a terrible scourge.
Speaker 1: That killed quickly, hugely disfiguring people, and eyewitness accounts of
Speaker 1: the time read like a horror movie script.
Speaker 2: It definitely was much more.
Speaker 1: Virulent in its early like in its first emergence.
Speaker 3: That is so interesting, and it's fascinating to me that
Speaker 3: it was so recent. Oh okay, we're going to get
Speaker 3: into that, okay, because like, wow, yeah, let's keep keep going.
Speaker 2: Keep going.
Speaker 1: Okay, No, it is and I think it also makes
Speaker 1: sense considering if that was a first exposure. That's how
Speaker 1: we often see epidemics happening, is that the first wave
Speaker 1: is so deadly.
Speaker 3: Right, someday we'll do mixamatosis.
Speaker 2: Oh, of course, well I can't wait.
Speaker 1: People quickly realized that the disease was a contagious b
Speaker 1: spread through sexual contact, and c often appeared for the
Speaker 1: first time after people had traveled through the town, particularly
Speaker 1: people from out of town. It was viewed as a
Speaker 1: matter of such huge public health importance that some towns
Speaker 1: or cities had laws forbidding people with syphilis from entering
Speaker 1: WHOA and this part in particular, this whole It came
Speaker 1: from somewhere else is what gave syphilis its various nicknames,
Speaker 1: all of which had that general theme it came from
Speaker 1: over there, with over there being whatever country or region
Speaker 1: was your political enemy or one that you didn't like
Speaker 1: or thought was unclean. For instance, for instance, in Russia,
Speaker 1: it was called the Polish sickness. In Poland, it was
Speaker 1: called the German sickness. In Germany it was called the
Speaker 1: French sickness. In England it was called the French or
Speaker 1: the Spanish sickness. In the Netherlands it was called the
Speaker 1: Spanish sickness. In Turkey it was called the Christian sickness,
Speaker 1: in Japan it was called the Chinese sickness, and in
Speaker 1: Spain it.
Speaker 2: Was called Las bubas.
Speaker 1: So it's a bit of an outlier that one, But
Speaker 1: I swear if if you just learned the country specific
Speaker 1: nicknames for syphilis during the fifteenth and sixteenth centuries, you
Speaker 1: could tell a lot about the political atmosphere during that
Speaker 1: time and also the attitudes that one country holds for another.
Speaker 2: Ah.
Speaker 1: Yeah, Syphilis, like many sexually transmitted infections, was and still is,
Speaker 1: in many places, viewed as a dirty disease with moral implications.
Speaker 1: The disease was seen as punishment for living an unclean
Speaker 1: or immoral life. But in terms of origins, which of
Speaker 1: these accusatory nicknames was right? Was it really the French
Speaker 1: disease brought over from France or the German sickness? Was
Speaker 1: it even of European origin? The answer is that we
Speaker 1: don't know for sure.
Speaker 3: Ugh, you're killing me.
Speaker 2: But yeah.
Speaker 1: The great debate about syphilis, and one that still seems
Speaker 1: to attract fairly high levels of interest, is its origins
Speaker 1: and not the evolutionary origins of the spiral keet necessarily,
Speaker 1: but the origins of the epidemic, there are two basic thoughts.
Speaker 1: One is that it was brought from the New World
Speaker 1: to Europe when Columbus returned from his voyage in April
Speaker 1: of fourteen ninety three, bringing with him a few hundred
Speaker 1: people from Hispaniola, and then some of Columbus's crew then
Speaker 1: joined King Charles the Eighth Army, bringing with them syphilis
Speaker 1: and starting the whole pandemic. This one is referred to
Speaker 1: as the Colombian theory. The second, called the pre Columbian
Speaker 1: theory that's sort of in the name, is that syphilis
Speaker 1: had been present in Europe since antiquity, but increase in
Speaker 1: incidents and virulence due to an evolutionary leap. Let's go
Speaker 1: through each of these, Okay, okay. The Colombian theory this
Speaker 1: is the one that seems to be the best supported
Speaker 1: by archaeological evidence and also writings from the time. It's
Speaker 1: also been the more prominent theory of the two for
Speaker 1: the longest period of time. There are even some historical
Speaker 1: writings dating back from the first. This first unambiguous appearance
Speaker 1: of syphilis in fourteen ninety five and in the early
Speaker 1: fifteen hundreds that state that the disease was brought back
Speaker 1: by Columbus and his crew after his travels to the
Speaker 1: New World. Because syphilis infections and congenital syphilis can leave
Speaker 1: traces on skeletons, you can basically just look at the
Speaker 1: archaeological record to see both the timing and origin of
Speaker 1: syphilis's emergence. Yeah, and while there are more than several
Speaker 1: pre Colombian New World skeletons in both the northern and
Speaker 1: southern hemispheres that show signs of syphilis, clear evidence of
Speaker 1: syphilis infections in Old World skeletons isn't well, I guess
Speaker 1: as clear. There are definitely some cases that appear to
Speaker 1: be syphilis, but for many of these the dating or
Speaker 1: diagnosis is.
Speaker 2: Called into question. Interesting.
Speaker 1: A review from twenty eleven looked at all fifty four
Speaker 1: published cases of supposed pre Colombian syphilis in skeletons in
Speaker 1: the Old World and did not find a single one
Speaker 1: who diagnosis or dating was clearly pre Colombian syphilis.
Speaker 2: Interesting.
Speaker 1: Yeah, and so the timing and severity of that first
Speaker 1: clear syphilis epidemic in Europe is also a point in
Speaker 1: favor of the Colombian theory. So that it was brought over.
Speaker 1: Descriptions of syphilis from this time tell of these erupting
Speaker 1: pustules and horrific lesions with death being a primary outcome.
Speaker 1: And before the fourteen ninety five outbreak that I talked about,
Speaker 1: there aren't unequivocal descriptions of syphilis, and definitely nothing as
Speaker 1: telling or extreme as that one. Many proponents of the
Speaker 1: pre Columbian theory, which is the one that syphilis was
Speaker 1: present in Europe, have suggested that many writings about leprosy
Speaker 1: are actually about syphilis, and there are some instances of
Speaker 1: something called venereal leprosy, but it's not clear that that's
Speaker 1: definitely syphilis. And early writings about syphilis distinguished it from
Speaker 1: leprosy and small pots, so they were like, this is
Speaker 1: worse than leprosy, as you heard in that description, right.
Speaker 1: So the debate still kind of rages on, and it's
Speaker 1: helped along by sensationalist quote documentaries like I watched this
Speaker 1: one by Timeline, which was like rewriting history of syphilis,
Speaker 1: and it had some of the worst sound effects I
Speaker 1: have ever heard on a documentary. Had these weird like
Speaker 1: wolf howls and like creepy slamming doors.
Speaker 2: It was weird.
Speaker 3: Anyway, you know, slamming doors, that's a sign of syphilis
Speaker 3: for sure, exactly.
Speaker 2: But these documentaries are these shows don't rely They often
Speaker 2: heavily rely on unpublished and not peer reviewed data or findings.
Speaker 1: So it's and that they also catch a lot of
Speaker 1: flak for that, and rightfully so. But what is the
Speaker 1: evolutionary history of the syphilis pathogen? Syphilis, as you mentioned,
Speaker 1: is caused by the subspecies, and so one of the ideas.
Speaker 2: Although this isn't clear or this isn't certain, one of.
Speaker 1: The ideas is that syphilis actually evolved from yaws most
Speaker 1: likely into being a sexually transmissible and more virulent form, okay,
Speaker 1: And that could have happened in North America in the
Speaker 1: New World and then been brought over, or it could
Speaker 1: have a lot of people of the pre Columbian hypothesis say, well,
Speaker 1: it could have happened in both places, because it is
Speaker 1: pretty clear that syphilis from skeletons in the New World.
Speaker 1: It's pretty clear that syphilis was there okay and infecting
Speaker 1: people before Columbus.
Speaker 2: And so they say, well, maybe yaws made the leap.
Speaker 1: To syphilis in the New World, and it also made
Speaker 1: the leap to syphilis in the old world, and it's
Speaker 1: kind of an interesting like that that seems highly unlikely,
Speaker 1: but yeah, anyway, I.
Speaker 3: Feel like then you'd be more likely to see like
Speaker 3: two distinct forms of syphilis, which I don't think we
Speaker 3: really see.
Speaker 2: So that's an interesting idea. I mean, it's interesting.
Speaker 1: And also, you know, as you mentioned, this is called
Speaker 1: the Great the great imitator, and so writings are sort
Speaker 1: of yeah, can be interpreted a lot of different ways.
Speaker 1: There's a lot of retrospective diagnosing of famous people that is.
Speaker 2: Interesting.
Speaker 1: It's like, if you were famous, if you were an
Speaker 1: artist or a composer or a dictator, you had syphilis
Speaker 1: for sure.
Speaker 2: Yeah, yeah, which I mean it could.
Speaker 1: It could be possible entirely, but it's just sort of
Speaker 1: like right after the fact, way after the fact.
Speaker 3: Are there And I'm sorry if this is jumping your gun.
Speaker 3: Are there any descriptions of it in other parts of
Speaker 3: the world, like in Asia or in Africa or anything
Speaker 3: like that.
Speaker 2: Not that I could find.
Speaker 1: I didn't see anything that was super distinctive or super
Speaker 1: related to or indicative of syphilis or suggestive of syphilis.
Speaker 3: I should say, Yeah, cool, interesting, Yeah.
Speaker 1: Before I move completely away from this origin part of
Speaker 1: the story, I want to talk, of course about the
Speaker 1: etymology of syphilis. Yes, and not really it's scientific name,
Speaker 1: because I think that's less exciting trepaniina meaning a turning
Speaker 1: thread in Greek and pallada meaning pale yep.
Speaker 2: But the word syphilis, where does it come from?
Speaker 1: The name wasn't actually in heavy use for most of
Speaker 1: the history of the disease, and most people opted to
Speaker 1: call it the blank disease or pox, you know, the
Speaker 1: blank disease being the French disease, this French disease.
Speaker 2: Or great pox or pox or wildwarts. Okay, that's my favorite. Yeah,
Speaker 2: I mean I was like, why isn't that what we
Speaker 2: call it now? Yeah?
Speaker 3: Yeah, swarts, that's got to be the condolo malada because
Speaker 3: they are pretty wild with God.
Speaker 1: It wasn't until the end of the eighteenth century, really
Speaker 1: that people started to use syphilis again. Syphilis is the
Speaker 1: main character of an epic poem, and in this poem, Syphilis,
Speaker 1: who is a shepherd, gets upset when there is a
Speaker 1: bad drought that is killing the land and his sheep.
Speaker 1: I think it's like an old Roman poem. He blames
Speaker 1: the drought on the sun god, likely Apollo or the
Speaker 1: Roman equivalent, if there is one, whatever, and instead says
Speaker 1: he's gonna worship the king whose sheep he hurts. The
Speaker 1: king is like, heck yeah, but the sun god is
Speaker 1: really annoyed, and so he sends a venereal plague upon
Speaker 1: the countryside where syphilis lives, and syphilis was the first victim.
Speaker 1: So interesting, interesting syphilis the shepherd. Also, I don't remember
Speaker 1: if we talked about this in the Ganneria episodes. I'm
Speaker 1: just going to repeat it anyway, But the origin of
Speaker 1: the term venereal disease?
Speaker 2: Did we talk about that?
Speaker 3: I don't remember.
Speaker 1: Tell me again, Okay, Well, it tells you a lot
Speaker 1: about the historical attitudes and even present day possible attitudes
Speaker 1: of venereal disease, which is no longer a term that
Speaker 1: we use because venereal comes from Venus, the goddess of love.
Speaker 1: There was an old saying that a night with Venus
Speaker 1: leads to a lifetime on mercury, which brings me to
Speaker 1: my next couple of points. So a, it reveals a
Speaker 1: lot about the blame and who who was often perceived
Speaker 1: to be the person responsible for transmitting syphilis or being
Speaker 1: the harborer of syphilis, which was often a woman who
Speaker 1: had like a you know, temptress or that sort of thing.
Speaker 1: And then also mercury, and let's just get into the
Speaker 1: treatment real quick of syphilis, some of these wild treatments.
Speaker 1: So for a long time, mercury was the chosen treatment
Speaker 1: for syphilis. Like even just a few years after that
Speaker 1: fourteen ninety five outbreak, it was started to be used,
Speaker 1: and it was I guess like maybe effective, somewhat effective,
Speaker 1: because it's just like poisoned you to I think, so, Yeah,
Speaker 1: I don't know exactly how how it worked or if
Speaker 1: it truly was effective, but people did use it up
Speaker 1: until the early twentieth century and even a little bit
Speaker 1: beyond that.
Speaker 2: Yeah, And so basically they would rub it on themselves.
Speaker 1: And this is what inspired the name of our quarantini,
Speaker 1: by the way, the killer cure, because a lot of
Speaker 1: the cures that people took for syphilis would kill them.
Speaker 2: So it's either syphilists would.
Speaker 1: Kill you or the cure would kill you, right, essentially,
Speaker 1: mercury poison Yeah, mercury poisoning is no small thing. So
Speaker 1: other things like induced sweating and salivation were also treatments,
Speaker 1: and you know I can't go.
Speaker 3: Yeah, you said they would rub mercury on themselves.
Speaker 2: Mm hmm. That's awful.
Speaker 1: I mean, I'm sure they would take it in other
Speaker 1: forms also, right, not that that's better for you, like
Speaker 1: ingest it, but I can't.
Speaker 2: Ooh, it just sounds terrible. Mm hmm. Yeah, it's really bad. Cool.
Speaker 3: So then they also don't touch mercury, do it?
Speaker 2: Yeah?
Speaker 1: No, Well, you also know I can't go this entire
Speaker 1: episode without describing at least one bizarre or horrifying cure
Speaker 1: and our favorite.
Speaker 2: This is already a long episodes.
Speaker 1: I'm not going to list too many, but here's a
Speaker 1: great one. Quote if and this is directly from this
Speaker 1: book that I read, by the way, called The History
Speaker 1: of Zyphilis. Quote, if the penis is ulcerated and infected,
Speaker 1: and then the author writes, it is always the male
Speaker 1: sex for which the doctor feels pity the woman being
Speaker 1: strictly confined to the role of contaminator, who's shanker, moreover,
Speaker 1: is more difficult to discover. And then, continuing with the cure,
Speaker 1: if the penis is al strated and infected, you must
Speaker 1: immediately wash it thoroughly with soft soap, or apply it
Speaker 1: to a cock meaning rooster or pigeon plucked and flayde alive,
Speaker 1: or else a live frog cut intwo, what uh huh?
Speaker 2: You put your your ulcerated.
Speaker 1: Ulcerated penis on a fladed bird.
Speaker 2: Or a frog that you've sliced in half.
Speaker 3: That's just asking for a salmonella superinfection on top of
Speaker 3: your syphilis.
Speaker 2: Is what you're asking for the killer cure. This is
Speaker 2: what I'm saying.
Speaker 3: Oh my god.
Speaker 1: Yeah.
Speaker 3: Also, what is up with people and like plucking cocks
Speaker 3: and using them as cures.
Speaker 2: Didn't they do that for rabies too?
Speaker 1: There was something, there was something along those lines that
Speaker 1: was like you have to remove I mean poor, It's
Speaker 1: just I feel terrible for these.
Speaker 2: Oh my gracious.
Speaker 1: Yeah, here's another, here's another one.
Speaker 2: I'll just throw one more in there, just just su
Speaker 2: for fun. Yeah.
Speaker 1: To gain protection, one must wash oneself after the act,
Speaker 1: then cover the glands with a piece of cloth which
Speaker 1: has macerated in a preparation of wine, shavings of gaic
Speaker 1: I don't know what that is, flakes of copper, precipitated mercury,
Speaker 1: gentien root, red coral ash of ivory, burnt horn, of deer.
Speaker 1: The protective must stay in place for four or five hours.
Speaker 3: So this is how to prevent syphilis.
Speaker 1: This is how to So a lot of the treatments
Speaker 1: actually were after the fact. It was not really about prevention.
Speaker 1: It was about It wasn't about prevention before sex. It
Speaker 1: was about making sure that you didn't get infected after.
Speaker 2: Mostly it was like, well, you better wash yourself quickly and.
Speaker 1: Then maybe soak your your penis in a cloth of
Speaker 1: some sort of weird, really disgusting thing.
Speaker 3: Yeah, don't don't soak your penis in that.
Speaker 2: Don't do it. Don't follow these These are not instructions
Speaker 2: to follow. No, they are anti structions. Yes, this is
Speaker 2: a roadmap that you should not go on. Oh my goodness,
Speaker 2: gracious m hmm.
Speaker 1: Because the signs of syphilis are often less obvious in women,
Speaker 1: they were often blamed for spreading the disease with the
Speaker 1: whole as per used with the whole harlot and evil
Speaker 1: temptress concept, those sorts of things like.
Speaker 3: Through the nineteen fifties and sixties and.
Speaker 1: Oh yes, we're going to post some posters that are
Speaker 1: pretty yeah, and because in most places sex outside of
Speaker 1: marriage for men and basically any sex at all for
Speaker 1: women was seen as immoral. Diseases such as syphilis and
Speaker 1: gonrhea were viewed as divine punishment, and the word venereal,
Speaker 1: as I mentioned, inherently has blame tied to it. In
Speaker 1: many places, to try to stop the spread of syphilis,
Speaker 1: brothels were shut down or made illegal, not that that
Speaker 1: necessarily decreased the prevalence of infection. Separate hospitals were constructed
Speaker 1: for people with syphilis, and they were often turned away
Speaker 1: at normal hospitals.
Speaker 2: And it's not like these.
Speaker 1: Syphilis hospitals were nice care facilities. They were just a
Speaker 1: place to isolate the people deemed unclean or immoral. And
Speaker 1: also a lot of diagnosing, especially for women, happened just
Speaker 1: through word of mouth. So if a man said, oh,
Speaker 1: I had sex, like I have syphilis. I had sex
Speaker 1: with this woman so she gave it to me, then
Speaker 1: the doctor would say, she has syphilis, she has to
Speaker 1: go to this hospital.
Speaker 3: I feel like I remember you saying the same thing
Speaker 3: would happen for gonrhea as well.
Speaker 2: Yeah, exactly.
Speaker 3: Yep.
Speaker 1: Over time, though attitudes around syphilis changed a little bit,
Speaker 1: the disease itself had become so wide, had been so
Speaker 1: widespread for such a long period of time, and during
Speaker 1: that time it had become much less virulent, and so
Speaker 1: by the time the eighteen hundreds came around, it was
Speaker 1: almost in some ways viewed as a rite of passage,
Speaker 1: like it just something that happened to you. The discussion
Speaker 1: of morality and syphilis shift did again in the late
Speaker 1: eighteen hundreds early nineteen hundreds, and it had always been
Speaker 1: sort of focused on the unclean or immoral aspect of it,
Speaker 1: but in around this time it was more about the
Speaker 1: preservation of marriage as an institution.
Speaker 2: That's what took the spotlight, and a.
Speaker 1: Lot of focus was paid to the innocent wife made
Speaker 1: to be condemned to a life of disease due to
Speaker 1: her unfaithful husband and then congenital syphilis. At this time,
Speaker 1: because it wasn't known to be a pathogen, it was
Speaker 1: more viewed as original sin or a punishment on because
Speaker 1: your parents were like, you were born bad, you were
Speaker 1: born yeah, and so yeah, So this brings me to
Speaker 1: this point of contagion being a different thing than germ theory.
Speaker 1: So people, you know, you can think of a disease
Speaker 1: as being contagious, and even though now we know that
Speaker 1: that is inherently tied to a specific pathogen, whether it's
Speaker 1: a virus or bacteria or worm or something.
Speaker 2: It was isn't necessarily the same thing. Back then, it was.
Speaker 1: Sort of your unclean aspect, your unclean character could be
Speaker 1: passed from person to person.
Speaker 3: That is so so interesting to imagine, like not knowing
Speaker 3: that a bacteria is what's causing it, but knowing I
Speaker 3: got this, or believing at least I got this from
Speaker 3: this person. That is such an interesting like separation, right,
Speaker 3: Oh wow.
Speaker 1: Yeah, It's something I hadn't really thought of before this
Speaker 1: episode because and a lot of the times the episodes
Speaker 1: that we've covered are we know sort of we've traced
Speaker 1: the concept of disease and infectious disease, and it's mostly
Speaker 1: been to do with my asthma and sort of like
Speaker 1: oh well, bad bad areas, swampy areas, lowland areas, whatever else,
Speaker 1: just bad air.
Speaker 2: But this was like, oh no, this is obviously a
Speaker 2: contagious thing, right, and so.
Speaker 3: And specifically from like sexual intercourse, right right, that is
Speaker 3: how you get it. Yeah, Oh that's it's very very yeah.
Speaker 3: Huh yeah.
Speaker 1: And so the sexual aspect, of course, was had been
Speaker 1: known for a long long time. But then alternate roots
Speaker 1: were also accepted or began to come to light, so
Speaker 1: kissing wet nurse to infant or vice versa. And this
Speaker 1: was sort of a question mark, I don't know. And
Speaker 1: then later on the big thing was sitting on a
Speaker 1: toilet seat and this so some of these ways are
Speaker 1: actually ways that you can get siphlis so kissing, for instance, yes,
Speaker 1: but other ones like sitting on a toilet seat or
Speaker 1: being or contaminated holy water, which was my favorite one,
Speaker 1: Like excuse me, what, oh my god?
Speaker 2: That is such a tryhard.
Speaker 1: Right, And so these were probably ways to preserve invented
Speaker 1: to preserve the virtue of certain people who had gotten syphilis.
Speaker 2: And we're like, oh, i've I'm.
Speaker 3: You know, we should probably clarify that you cannot get
Speaker 3: syphilis from a toilet seat.
Speaker 1: You cannot know and cannot or contaminated holy water, definitely
Speaker 1: in case you were worried about that too.
Speaker 3: It's also a human specific disease, so that's I think
Speaker 3: worth mentioning. Yes, is not found in other animals, it's
Speaker 3: not present in the environment. This is human to human exclusive.
Speaker 1: Yeah, And so around the late eighteen hundreds and early
Speaker 1: nineteen hundreds, morality plays were written and performed, poems about
Speaker 1: the dangers of syphilis and you know, evil temptresses and
Speaker 1: all that, and how they're going to poison your household
Speaker 1: and et cetera. Yeah, and in all of these, of course,
Speaker 1: it was the husband that got the disease from a
Speaker 1: woman of ill repute, and he was often portrayed as
Speaker 1: a victim himself. It was one of the three, like
Speaker 1: it was genuinely called a social disease, of the three
Speaker 1: being the other two being tuberculosis and alcoholism. They were
Speaker 1: all viewed as sort of these unclean, the unclean Holy
Speaker 1: Trinity or something unh trinity.
Speaker 3: That is so interesting to me that it was alcoholism
Speaker 3: and tuberculosis.
Speaker 1: Well, and it was it was thought that if we
Speaker 1: have enough social reform and morality campaigns to preserve marriage
Speaker 1: or to clean up this and that, then we could
Speaker 1: wipe these things out.
Speaker 2: Wow.
Speaker 1: So yeah, and other people believed it to be hereditary,
Speaker 1: as I mentioned, and often the cause of genius or creativity,
Speaker 1: something that has in common with tuberculosis. So syphilis is,
Speaker 1: as I mentioned, one of these diseases that people like
Speaker 1: to you know, retrospectively diagnose so we've got some These
Speaker 1: are both confirmed and suspected cases. Just list some famous peeps,
Speaker 1: Franz Schubert and other composers like Smetana and Dalias. I
Speaker 1: don't know if I'm saying that right, Al Capone again, Nietzsche, Tolstoy,
Speaker 1: Karen Blixen who wrote Out of Africa, Lenin Hitler, and
Speaker 1: then like many many other people, there's even a book
Speaker 1: called pos something about I can't remember who wrote it.
Speaker 2: I didn't read it because.
Speaker 1: From my understanding, it's a lot of this hand wavy
Speaker 1: retrospective diagnosis.
Speaker 2: So anyway, it seems like it would be a fun
Speaker 2: book to read, I would imagine. But is it all
Speaker 2: about syphilis specifically?
Speaker 1: Yes? Or Throughout much of the history of syphilis, people
Speaker 1: debated whether gonorrhea and syphilis were the same disease, just
Speaker 1: different forms or stages, And there was some horrific self.
Speaker 2: Experimentations to try to clear this issue up.
Speaker 1: And I think I mentioned one of these experiments self
Speaker 1: experiments during the ganeria episode, and he died of syphilis,
Speaker 1: but he thought he was infecting himself with gonnerhea. Anyway,
Speaker 1: the syphilis bacterium was finally seen under the scope and
Speaker 1: identified almost thirty years after gonnerihea, and which finally was like, oh,
Speaker 1: this is a different one.
Speaker 2: So what year was that?
Speaker 1: Remind me of February? So well, syphilis was discovered. We're
Speaker 1: seen in February nineteen oh five.
Speaker 3: Okay, wow, that's actually earlier than I expected considering how
Speaker 3: tiny it is.
Speaker 2: Yeah.
Speaker 1: And then the Bordette Borda Vostermann diagnostic test was developed
Speaker 1: a year later in nineteen o six. And then Paul Erlik,
Speaker 1: along with another microbiologist named Hata, came across an effective
Speaker 1: treatment for syphilis and it was called salver sand and
Speaker 1: that was a substitute for mercury, which people started using it,
Speaker 1: and then there was an even better version called neo
Speaker 1: salver sand. So prior to nineteen forty five, about five
Speaker 1: to ten percent of all psychiatric admissions were neurosiphalis.
Speaker 2: WHOA, Yeah, it was a huge problem.
Speaker 1: And although mercury and arsenic based compounds were available from
Speaker 1: the early nineteen hundreds on, they weren't really much help
Speaker 1: for well most people but also people with neurosphalis. But
Speaker 1: an alternative was discovered pyrotherapy, so pyro meaning fire, so
Speaker 1: essentially using induced fevers to treat another disease. Oh yeah,
Speaker 1: this had been observed for a really long time, like
Speaker 1: the fact that fevers could cure whatever pre existing disease
Speaker 1: that you had, Like I'm sacking a really long time,
Speaker 1: like ancient Greeks, Hippocrates and Galen. Yeah, okay, but it
Speaker 1: wasn't really until the late eighteen hundreds that this observation
Speaker 1: was made into application. This Austrian psychiatrist Julius Wagner Jauregg.
Speaker 1: I don't know how you say his name, which is
Speaker 1: going to be a problem because I have to say
Speaker 1: it a couple times. He had become convinced that a
Speaker 1: fever from an infectious disease could cure mentally ill patients,
Speaker 1: and that's something that he had observed during his time
Speaker 1: in psychiatric hospitals, and so naturally, because this was the
Speaker 1: early nineteen hundreds, he experimented on humans without consent with yeah,
Speaker 1: you do, with different fever inducing compounds or pathogens. But
Speaker 1: eventually he made his way to malaria. During World War One,
Speaker 1: he drew blood from malaria infected soldiers and then injected
Speaker 1: that blood into his patients stop it, some of whom died,
Speaker 1: of course, of course, some of whom did not show
Speaker 1: any improvement, and some who did, even if it was.
Speaker 2: Just for a short while. Oh my goodness. Yeah, so
Speaker 2: this was.
Speaker 1: Far from a fail safe cure, but he was encouraged
Speaker 1: by the results, so he kept doing it. And it
Speaker 1: was basically the same sort of thing like people died,
Speaker 1: people got better, people got worse, whatever, And so this
Speaker 1: practice wasn't widely accepted.
Speaker 2: Really okay, but regardless of.
Speaker 1: That, in nineteen twenty seven, he became the first psychiatrist
Speaker 1: and only one of three I think ever, to be
Speaker 1: awarded a Nobel Prize for using malaria to treat neurosyphalis.
Speaker 3: He got a Nobel Prize for that.
Speaker 2: Yeah, whoa yeah. Oh.
Speaker 1: Also, I want to mention that one of the other
Speaker 1: three psychiatrists, or one of the other two psychiatrists who
Speaker 1: was awarded a Nobel Prize was the guy who developed
Speaker 1: the lobotomy.
Speaker 2: Okay, yeah, cool, ye, the last.
Speaker 1: One was about the physiological basis of memory.
Speaker 2: That's cool, that's cool, yeah, actually cool.
Speaker 1: Yeah, But this basically using malaria to treat syphilis neurosiphalus
Speaker 1: didn't stick around for obvious reasons, like it was super
Speaker 1: unethical and could.
Speaker 2: Kill you, right, this therapy will kill you. I don't know.
Speaker 2: Hence the killer cure again. Uh. And Wagner Jareg.
Speaker 1: He fell from grace and basically slipped from public consciousness
Speaker 1: after World War Two because he had really close ties
Speaker 1: with the Nazi Party. And this was around the time
Speaker 1: when like bioethics and human experimentation started to really take focus.
Speaker 1: But yeah, there you have it. So an interesting little
Speaker 1: chapter in the history of syphilis.
Speaker 3: Huh malaria, man.
Speaker 2: Isn't that cool? Yeah?
Speaker 1: All So, at the turn of the twentieth century, a
Speaker 1: lot of developments for syphilis were taking place, a lot
Speaker 1: of both in terms of microbiology, in terms of treatment
Speaker 1: and so on. And because syphilis was still a very
Speaker 1: huge problem and a big focus of both social reform
Speaker 1: and microbiology and public health. And then World War One
Speaker 1: breaks out, and as we know, war is a great
Speaker 1: place for syphilis to spread. Syphilis caused almost as many
Speaker 1: service days to be lost from troops I think US
Speaker 1: troops specifically.
Speaker 2: In World War One then.
Speaker 1: Like almost as much, just a little bit less than
Speaker 1: the nineteen eighteen flu.
Speaker 2: Wow.
Speaker 1: So between April nineteen seventeen and December nineteen nineteen, there
Speaker 1: were three hundred and eighty three thousand cases of syphilis
Speaker 1: and ganeriea in the American.
Speaker 3: Army, just in the American Army, just in.
Speaker 2: The American Army. Whoa b Yeah.
Speaker 1: So lots and lots and lots of syphilis. And a
Speaker 1: lot of the public health campaigns during this time really
Speaker 1: focused on on avoiding brothels, avoiding you.
Speaker 2: Know, loose women, et cetera, that that sort of thing.
Speaker 1: And after World War One, the fear, the public fear
Speaker 1: of syphilis was at an all time high, Like people
Speaker 1: were terrified of it. And this is when this total
Speaker 1: toilet seat rumor got started. There was pre marital like
Speaker 1: required mandatory pre marital screening for syphilis and tuberculosis, So
Speaker 1: both partners had to be screened. Wow, and then you
Speaker 1: had to if you did get diagnosed, you had to
Speaker 1: list all of the partners and then they would all
Speaker 1: be identified. But it wasn't like in a way that
Speaker 1: was respectful, right of course, not, of course not it was.
Speaker 1: It was much more sort of condemning, accusatory exactly. Yeah, okay,
Speaker 1: And so all of this so the fear of syphilis
Speaker 1: and gonorrhea remained heightened throughout the time between the world
Speaker 1: War One ended and between when World War Two began,
Speaker 1: So between between nineteen eighteen and nineteen thirty.
Speaker 2: Nine was like just twenty years of terror. Syphilis terror. Yeah,
Speaker 2: it held the world and its script.
Speaker 1: And then World War two broke out. And it was
Speaker 1: during World War Two that we see the release and
Speaker 1: widespread distribution of one of the best inventions of all time,
Speaker 1: penicillin pailin, and that really knocked it out. And so
Speaker 1: then you see these posters that are much more focused
Speaker 1: on like, hey, go down to the clinic and get
Speaker 1: a shot, go down to the whatever and get a shot.
Speaker 2: A little bit okay, positive, a little bit more positive.
Speaker 1: And with the with the deployment of penicillin and the
Speaker 1: widespread use, I mean, syphilis cases dropped to almost nothing.
Speaker 1: It was like magic, and it kind of became a
Speaker 1: disease that was forgotten like people, you know, people kind
Speaker 1: of stopped considering it. Even now you say syphilis and
Speaker 1: you think of the eighteen hundreds, well, I thought of
Speaker 1: like different composers and stuff that had syphilis. But then
Speaker 1: in nineteen seventy two is when syphilis took the headlines again.
Speaker 3: Yeah, this is when it gets to be the most depressing.
Speaker 1: I think I think this is one of the most important,
Speaker 1: probably the most important lesson of syphilis.
Speaker 2: YEP.
Speaker 1: At the end of July in nineteen seventy two, the
Speaker 1: announcement was made that the US Public Health Service had
Speaker 1: been conducting a study on the effects of untreated syphilis
Speaker 1: on the human body. The exact title of this study
Speaker 1: is the Tuskegee Study of Untreated Syphilis in the Negro Mail.
Speaker 1: There's a lot in that title that can tell you
Speaker 1: about this.
Speaker 2: Yeah, this story needs to be told.
Speaker 1: The story needs to be It's a hugely important story. Yes,
Speaker 1: this experiment.
Speaker 2: Had gone on for forty years.
Speaker 1: It involved six hundred black men, three hundred and ninety
Speaker 1: nine of which had syphilis at the start of the experiment.
Speaker 1: It came out that during this news release, came out
Speaker 1: that the men had not been informed that they had
Speaker 1: syphilis at the beginning, had not been informed that there
Speaker 1: was a treatment available either at the very beginning of
Speaker 1: the study when mercury or arsenic based medicines were used
Speaker 1: to varying degrees of efficacy, and they were not told
Speaker 1: about a decade after the study began, when penicillin was introduced.
Speaker 1: This wasn't a study to find out the best way
Speaker 1: to treat syphilis. It's in the title the Effects of
Speaker 1: Untreated Syphilis. This wasn't a treatment based study, this wasn't
Speaker 1: an intervention study. This wasn't a diagnostic study.
Speaker 2: It was just.
Speaker 3: Let's see what happens when we withhold treatment from human beings.
Speaker 3: How far can this disease go? How much havoc can
Speaker 3: it reak on the human body.
Speaker 1: So you might ask, why would anyone agree to participate
Speaker 1: in this study? Well, the men, of course, were not
Speaker 1: told what the study was. Most of them were poor
Speaker 1: and could not read. And the Public Health Service offered
Speaker 1: a few perks such as free physical examinations, free rides
Speaker 1: to and from the clinics, hot meals on examination days,
Speaker 1: free treatment for some minor things, and I guarantee that
Speaker 1: their family would get a burial stipend if they agreed
Speaker 1: to an autopsy of the body. These men were not
Speaker 1: viewed as men. They weren't viewed even as patients or subjects.
Speaker 1: They were viewed as cadavers. They were just cadavers in
Speaker 1: waiting these and if you think about these quote benefits,
Speaker 1: they're meager at best. A hot meal, free physical examinations
Speaker 1: eighty dollars for burial.
Speaker 3: That tells you that this is not these are not volunteers.
Speaker 2: Right, No, this is you cannot and this is we're
Speaker 2: gonna get in.
Speaker 1: Yeah, I'll get into a bit of this, but this
Speaker 1: really had a huge importance in later ethical guidelines for
Speaker 1: what can be considered volunteering, what can be considered informed consent.
Speaker 2: Yeah, these benefits alone.
Speaker 1: Just that little bit shows that, in the words of
Speaker 1: one editor quote, the basic rights of Americans, particularly the poor,
Speaker 1: the illiterate, and the friendless, are still subject to violation
Speaker 1: in the name of scientific research.
Speaker 2: And people of color were particularly preyed upon, of course,
Speaker 2: like entirely, oh entirely, I mean they were sought out. Yeah.
Speaker 1: Yeah. Some of these circumstances surrounding the experiment have been disputed,
Speaker 1: like whether the participants were told they had syphilis.
Speaker 2: They were not. They were told they had bad blood.
Speaker 1: Bad blood was a colloquial term that sometimes referred to syphilis,
Speaker 1: could be indigestion, could be just not feeling great that day.
Speaker 2: It wasn't specific to syphilis.
Speaker 1: In Many doctors in the study confirmed that these men
Speaker 1: were told that they were being treated for rheumatism or
Speaker 1: bad stomachs, and they were given either just straight up
Speaker 1: placebo or an aspirin wow. When any of the men
Speaker 1: were brought to a clinic and seen by a doctor
Speaker 1: that wasn't involved in the study, these doctors would try
Speaker 1: to treat them, but then they would be forbidden to
Speaker 1: do so someone would would intervene and pull the person
Speaker 1: away from that doctor. One of these doctors said that
Speaker 1: the men were told if they received treatment, they would
Speaker 1: be dropped from the study and lose all of their benefits.
Speaker 1: At least twenty eight and possibly over one hundred men
Speaker 1: in the study died as a direct result of untreated syphilis.
Speaker 1: Many many other people were infected as a result of
Speaker 1: these men not receiving treatment, and many children were born
Speaker 1: with congenital syphilis.
Speaker 2: This is yeh. When news of this.
Speaker 1: Horrifically unethical experiment broke, A lot of the discussion about
Speaker 1: the ethics centered around the withholding of penicillin when it
Speaker 1: became recognized as a suitable cure, which was about ten
Speaker 1: years after began.
Speaker 2: But that's the only thing that they did wrong, right.
Speaker 1: That barely scratches the surface of the problems with this study,
Speaker 1: and to be clear, withholding treatment was hugely unethical, but
Speaker 1: that happened a decade after the study began. That this
Speaker 1: study could be dreamt up and executed it at all
Speaker 1: and receive funding for forty years by the United States
Speaker 1: Public Health Service reveals a great deal about how your
Speaker 1: right to be treated as a human being is inextricably
Speaker 1: tied to race and class. The premise of the experiment
Speaker 1: is the moral issue. It's not surprising that the creators
Speaker 1: of this experiment would choose to withhold penicillin after designing
Speaker 1: the experiment in the first place. And this is, you know,
Speaker 1: probably depressing, but unsurprising. There were many defenders or apologists
Speaker 1: of the Tuskegee syphilis experiment when it first came out.
Speaker 1: The Public Health Service barely apologized for it, saying it
Speaker 1: had never been kept a secret. It results from the
Speaker 1: experiment had been published in many journals, and there had
Speaker 1: never been outcry in the forty years it was going on.
Speaker 1: And other people defended the withholding of treatment, especially the
Speaker 1: arsenic and mercury compounds used prior to penicillin, saying that
Speaker 1: those drugs were more likely to harm than cure. These
Speaker 1: people had to a bit more difficulty explaining why penicillin
Speaker 1: was withheld, so reporters turned to the man who was
Speaker 1: the director of venereal Disease during the time penicillin use
Speaker 1: was widespread. He he being doctor John Heller, denied any
Speaker 1: responsibility for the study and declared, quote, there was nothing
Speaker 1: in the experiment that was unethical or unscientific.
Speaker 3: I'm sorry, can you say that again?
Speaker 1: Right? Okay, there's so much here's I'm like bursting with
Speaker 1: information with this and range rage.
Speaker 2: Yeah.
Speaker 1: So well, first of all, of course, it was unethical.
Speaker 1: We can list one hundred million different ways it was unethical.
Speaker 1: And then in terms of it being unscientific, the whole
Speaker 1: thing was unscientific. Many of these men had received treatment
Speaker 1: at the very beginning of the study, but not all
Speaker 1: of them. It was inconsistent. Some of the men started
Speaker 1: out being negative for syphilis and then later tested positive
Speaker 1: for syphilis, but they weren't shifted into groups. There was
Speaker 1: no this This stuff contributed nothing to the body of
Speaker 1: knowledge on syphilis. And many people who were on the
Speaker 1: outside of the study who were horrified when they learned
Speaker 1: of this said the same things. Even the people who
Speaker 1: were involved in the study would say, like but not
Speaker 1: directly would say, but what are you hoping to learn
Speaker 1: from this? It was the curiosity of these men is
Speaker 1: particularly one who wanted to He was entranced by autopsies
Speaker 1: and by seeing all of the different ways that the
Speaker 1: body could.
Speaker 2: Yeah, it was it's really really God, that's just.
Speaker 1: Other people at the CDC said that they doubted that
Speaker 1: penicillin would have done any good at that point, and
Speaker 1: then in fact it probably could have caused more harm
Speaker 1: than good due to allergic reactions.
Speaker 2: Absolutely false, right.
Speaker 1: Other people went the root of the It was a
Speaker 1: different era. We can't apply our nineteen seventy two morality
Speaker 1: to nineteen thirty two.
Speaker 2: Gross. Then you have a few physicians defending the studies.
Speaker 1: Saying that it was their own fault they got syphilis
Speaker 1: in the first place.
Speaker 3: The amount of rage, right.
Speaker 1: These are physicians, you know, never mind the hippocratic oath
Speaker 1: or just basic human decency.
Speaker 3: They could still be physicians. Quite honestly. Nineteen seventy two
Speaker 3: wasn't that long ago.
Speaker 1: Yeah, that's true. The Tuskegee experiment wasn't even the first
Speaker 1: of its kind. About thirty years before this experiment began,
Speaker 1: a similar study in Norway was underway, So why.
Speaker 2: Did it need to be repeated.
Speaker 1: One of the reasons that they gave was because the
Speaker 1: doctors wanted to see whether syphilis manifested differently in black
Speaker 1: people compared to white people. And there's a whole lot
Speaker 1: of historical context to this, because at this time there
Speaker 1: was still this belief that races were biologically based, which is.
Speaker 2: Not true, not true at all, right, and that the.
Speaker 1: Higher rates of syphilis in certain groups were somehow biologically
Speaker 1: based rather than socioeconomic. Overwhelmingly, the response to the news
Speaker 1: of the Tuskegee experiment was horror and a feeling of betrayal.
Speaker 1: The United States, rather than protecting its citizens from being
Speaker 1: taken advantage of, was actively.
Speaker 2: Preying upon them.
Speaker 1: For many, that may not have come as a big surprise,
Speaker 1: and all it did was to increase the distrust of
Speaker 1: the government, including the branch that was supposed to help
Speaker 1: and heal people, the Public Health Service. The Tuskegee syphilis
Speaker 1: Experiment started a discussion of medical ethics, raising questions about
Speaker 1: the difference between volunteering and being coerced, and about how
Speaker 1: medical researchers, in their quest for odds rejectivity, start to
Speaker 1: see people as subjects or in this case, cadavers, and
Speaker 1: left people wondering how many other unethical experiments will come
Speaker 1: to light in the future.
Speaker 2: Answer A lot, a lot.
Speaker 1: And if any of you have so this, this Tuskegee
Speaker 1: study is not news to you, Aaron, It's not news.
Speaker 1: It wasn't news to me, although a lot of the
Speaker 1: details were, because it isn't mentioned in every single ethical
Speaker 1: biomedical ethics course or training program that you do any public.
Speaker 2: Health you know.
Speaker 3: What's interesting though, in reading about the biology of it
Speaker 3: of syphilis, this comes up often because you can't talk
Speaker 3: about syphilis without talking about the tuskeke experiments. But in
Speaker 3: some of the papers and books that I've read, they
Speaker 3: mention it in such passing as though it was oh, regrettable,
Speaker 3: like that's it right.
Speaker 2: Any more, Like oh, it's from another era. That's sort
Speaker 2: of like it's.
Speaker 3: Rather than like gut wrenching horror that it should provoke.
Speaker 1: It's well, I think I mean both gut wrenching horror
Speaker 1: and also the realization that a lot of the circumstances
Speaker 1: that led to people doing this study and thinking this
Speaker 1: was okay are still in existence today.
Speaker 2: Yeah, totally. There's a lot.
Speaker 1: More than just like to me, there's a lot more
Speaker 1: in this study than just oh well, this is a
Speaker 1: course in medical ethics, right. This is all about how
Speaker 1: much your rights are tied to your circumstances.
Speaker 2: Right.
Speaker 3: You can't look at a study like this, that a
Speaker 3: study like this took place and was funded for so
Speaker 3: long and not realize how deeply systemic racism and classism
Speaker 3: is in our society, like you. It just boggles my
Speaker 3: mind that people can try and pretend like that doesn't
Speaker 3: exist when this was in our lifetime.
Speaker 2: Yes.
Speaker 1: Yeah, I encourage everyone who listens to this to go
Speaker 1: seek out more information. There's a fantastic book which is
Speaker 1: a classic that I got all this information from. It's
Speaker 1: called Bad Blood by James Jones. It's incredible. It is
Speaker 1: so well researched, and for someone who doesn't have the
Speaker 1: time or the desire to read a book. I also
Speaker 1: watched this Yale lecture on YouTube about it.
Speaker 2: And it was amazing.
Speaker 1: It was so so perfectly done, much better than I
Speaker 1: could ever do, but a lot of good information there.
Speaker 2: So after the study.
Speaker 1: Came out, there were lawsuits, there were investigations into the
Speaker 1: ethics of this study, and it did really change the
Speaker 1: way that biomedical studies are done. It changed the whole
Speaker 1: process of how to how to ensure that you are
Speaker 1: finding volunteers and not coercing people what informed consent really is.
Speaker 1: But it did instill a lot of distrust into the
Speaker 1: US government ren rightfully so. And it should still be
Speaker 1: such a huge part of the conversation about STIs in general,
Speaker 1: and sort of this a shame blame and being taken
Speaker 1: advantage of and withholding treatment, all of these things sort
Speaker 1: of go together. And yeah, so my part of this
Speaker 1: really kind of ends with the breaking of the news
Speaker 1: of the Tuskegee experiment. Yeah, and I don't really know
Speaker 1: much about what's going on in terms of syphilis today.
Speaker 1: I've definitely seen some news articles flash across my screen
Speaker 1: that are, I would say, somewhat alarming. But Aaron, tell
Speaker 1: me what's going on in syphilis today.
Speaker 3: I'd love to. We'll take another short break before we
Speaker 3: get into it.
Speaker 2: Syphilis today.
Speaker 3: I think you're not alone, are And you said that
Speaker 3: when you think of syphilis, you think of the past,
Speaker 3: old timey, but it is certainly still a disease that's
Speaker 3: prevalent today. So looking worldwide, the World Health Organization estimates
Speaker 3: in twenty sixteen was the most recent numbers that I
Speaker 3: found that nineteen point nine million people around the globe
Speaker 3: were living with syphilis, mostly between the ages of fifteen
Speaker 3: to forty nine, and that there were six point three
Speaker 3: million new cases in twenty sixteen.
Speaker 2: That's the estimate. So the prevalence is nineteen was nineteen
Speaker 2: point nine, but the incidents was six point three exactly million. Okay, yep,
Speaker 2: and that's worldwide. Okay, that's those are lowish numbers. I
Speaker 2: mean they're not. Yeah, it's not.
Speaker 3: It's not nearly as prevalent as other STIs.
Speaker 2: Or a lot of other diseases.
Speaker 3: But here's where it gets to be a bummer. Oh great,
Speaker 3: syphilis is on the rise. Yeah, and it has been
Speaker 3: for kind of a very long time. So in the
Speaker 3: eighties and early nineties was actually the low of syphilis,
Speaker 3: especially in the United States. So syphilis after the seventies
Speaker 3: sort of started to decline, But since the year two
Speaker 3: thousand it has been on the rise again. So the
Speaker 3: peak was in the nineties, I think nineteen ninety in
Speaker 3: the US, the like cases per one hundred thousand were twenty.
Speaker 3: That was the peak since the introduction of penicillin. Then
Speaker 3: they started to fall, but since two thousand, they've been
Speaker 3: increasing every year since then. So in twenty seventeen there
Speaker 3: were thirty thousand cases of syphilis reported in the US.
Speaker 3: That's ten percent more than the year before and the
Speaker 3: highest rate that we've seen since nineteen ninety three.
Speaker 2: Wow.
Speaker 3: Yeah, okay, so it's like every year it's been increasing
Speaker 3: and increasing.
Speaker 2: Is this a reportable? It is?
Speaker 3: What's very interesting and I got a real kick out
Speaker 3: of this. It's been nationally notifiable, so reportable since nineteen
Speaker 3: forty four, which is like the year after they started
Speaker 3: treating it. And so if you read up to date,
Speaker 3: which is like doctor Wikipedia, it says that because it's
Speaker 3: been notifiable and it's got unique diagnostic features, most cases
Speaker 3: are report like we've got a great handle on syphilis
Speaker 3: and how did you know? Yeah, great question. I entirely
Speaker 3: disagree with that sentiment, like, because the problem is we
Speaker 3: only know about cases that are diagnosed. Obviously, we don't
Speaker 3: know about cases that people never come to treatment for
Speaker 3: people who don't have access to health care are not
Speaker 3: going to be diagnosed. And when we have free clinics
Speaker 3: and planned parenthoods being shut down across the country. You
Speaker 3: can't assume that people have access and are getting treatment,
Speaker 3: especially considering that primary syphilis often you would never know
Speaker 3: that you have this ulcer. And those numbers that I said,
Speaker 3: so like thirty thousand cases in twenty seventeen, that's of
Speaker 3: primary and secondary syphilis, so that's not including late or
Speaker 3: tertiary syphilis. We don't we definitely don't have a good
Speaker 3: handle on how many people get late syphilis or what
Speaker 3: proportion of people that get infected end up getting late syphilis.
Speaker 3: There has also been an upward trend in late syphilis,
Speaker 3: like there's been more cases reported in recent years compared
Speaker 3: to the early two thousands, but we're still unclear on how,
Speaker 3: like exactly what the proportion of people are that present
Speaker 3: with late syphilis versus early, if that makes sense, because
Speaker 3: most people are going to probably present early, but the
Speaker 3: ones who don't, it's years and years down the line
Speaker 3: that they're going to end up with tertiary. So there's
Speaker 3: such a long latent period. There's a lot of numbers
Speaker 3: out there on you can look on the CDC, even
Speaker 3: on Wikipedia that'll tell you who quote unquote gets syphialis
Speaker 3: what groups of people I put that in quotes. Air
Speaker 3: quotes are at the highest risk, and I am not
Speaker 3: going to get into the details of that on this podcast.
Speaker 3: And here's why. Syphilis is an extremely infectious disease. Ten organisms.
Speaker 3: Usually it's around fifty, but as few as ten microscopic
Speaker 3: bacteria in an extremely teeming sore can cause infection. And
Speaker 3: what that means is that anyone having sex of any
Speaker 3: kind can get syphilis. And that's the reality of it.
Speaker 3: So there are recommendations on these groups of people should
Speaker 3: be screened, and these groups of people should be screened,
Speaker 3: but realistically, in my opinion, this is where we veer
Speaker 3: into Aaron's opinion territory. If you're a person having sex
Speaker 3: of any kind with anyone, you should probably get screened
Speaker 3: at least once.
Speaker 2: Right, it doesn't hurt.
Speaker 3: Yeah, And the more people that get screened, the more
Speaker 3: cases we identify, the greater our chances of reducing the
Speaker 3: burden of this disease among the entire population, not just
Speaker 3: in certain groups.
Speaker 1: Well.
Speaker 2: And also STIs have a huge stigma.
Speaker 1: There's a lot of shame and blame and all of
Speaker 1: these things associated with them, and there doesn't need to
Speaker 1: be because these things happen to people They don't happen
Speaker 1: just to certain groups of people.
Speaker 2: They happen to everyone.
Speaker 1: And so the only way that you can that you
Speaker 1: can help yourself and help everyone.
Speaker 2: Else around you is just get screened, just get a
Speaker 2: be deemed. Yeah.
Speaker 3: Yeah, In my opinion, if you're having sex, then you
Speaker 3: should be talking about sex, and you should be talking
Speaker 3: with your partners about sex. And if you're doing that,
Speaker 3: then you should both be talking about getting screened. I've
Speaker 3: even seen campaigns that are like make it sexy, go
Speaker 3: get screened together, whatever, who cares, whatever it takes. Just
Speaker 3: go get screened for syphilis, for HIV, for chlamydia, gonerieat
Speaker 3: for all the things, you know what I mean.
Speaker 2: Yeah, because again, this.
Speaker 3: Is such a treatable disease. Right, syphilis is one shot,
Speaker 3: and it's treated unless it's late and latent, and then
Speaker 3: it's harder to treat right and also deadly. So that's horrific,
Speaker 3: I will say so. In terms of congenital syphilis, the
Speaker 3: numbers also aren't that reassuring because the rates of congenital
Speaker 3: syphilis mirror the rates of adult syphilis in the population. Yeah.
Speaker 3: So again, there were downward trends through the nineties but
Speaker 3: it's been on the rise since. In twenty seventeen, in
Speaker 3: the US there were nine hundred and eighteen reported cases
Speaker 3: of congenital syphalis. This includes sixty four stillbirths and thirteen
Speaker 3: infant deaths so after birth, and that's a forty four
Speaker 3: percent increase between twenty sixteen and twenty seventeen.
Speaker 2: Oh my goodness. Yeap.
Speaker 3: And worldwide it's estimated that one million pregnancies per year
Speaker 3: are complicated by congenital syphilis.
Speaker 2: Wow.
Speaker 3: And again, forty percent of these will result in loss
Speaker 3: of yah. Yeah, so that's very depressing. Go get screened
Speaker 3: for syphilis. Every pregnant person that gets prenatal care in
Speaker 3: the US is screened for syphilis.
Speaker 2: But that's only if you can afford prenatal care.
Speaker 3: Exactly, and not everyone can, thank you US. There's also
Speaker 3: really high rates of co infections with syphilis and HIV. Yes, so,
Speaker 3: and that's really important because there's actually evidence that syphilis.
Speaker 3: Having an infection with syphilis can increase the risk of
Speaker 3: HIV transmission because it's basically, especially primary syphilis is an
Speaker 3: open wound and HIV is not very infectious, but if
Speaker 3: you have open soores, then it's a lot easier for
Speaker 3: HIV to infect or be transmitted. And then I saw
Speaker 3: actually some possible evidence that in infection with HIV can
Speaker 3: also facilitate the transmission.
Speaker 2: Of syphilis as well.
Speaker 3: Okay, so it might work both ways kind of ye,
Speaker 3: the co facilitate each other in terms of infection.
Speaker 2: Mutualistic Yeah, yikes.
Speaker 3: Yeah, so that's a big time bummer. I wanted to say,
Speaker 3: let's talk about the positives and the current research, but
Speaker 3: there's not really much positive in terms of the current
Speaker 3: status of syphilis research. So there are a few groups
Speaker 3: and there have been a few recent studies that are
Speaker 3: trying to come up with a vaccine, and it seems
Speaker 3: like it's at least theoretically possible to develop a vaccine
Speaker 3: for syphilis.
Speaker 2: But so far these.
Speaker 3: Studies are still in animal models as far as I
Speaker 3: can tell, so they're very early studies. Every paper that
Speaker 3: I read, like in terms of the papers which I
Speaker 3: will post these on our website, of course, that's like
Speaker 3: what's the status of vaccine research essentially is like, hey,
Speaker 3: we really need to work on this, we need more
Speaker 3: funding to do so. So but yeah, so that's pretty
Speaker 3: much the current status of syphilis.
Speaker 2: It still exists.
Speaker 3: It's not as prevalent as other diseases, but it's on
Speaker 3: the rise.
Speaker 2: I think. I mean, isn't that the general trend for
Speaker 2: STIs that the rise.
Speaker 3: Yeah they are.
Speaker 2: Yeah, yeah, yeah, I learned a lot today. I did too,
Speaker 2: I did too.
Speaker 1: This is a very interesting episode and on one of
Speaker 1: our big ones.
Speaker 3: Yes, yeah.
Speaker 1: Well, before we do sources, I want to give a
Speaker 1: amazing shout out.
Speaker 2: To Augusta's Luscious.
Speaker 1: So this person owns a vegan chocolate shop in Brooklyn
Speaker 1: and they reached out to us to send us chocolates
Speaker 1: for Halloween time, and they are incredible.
Speaker 2: So it's like a.
Speaker 1: Bleeding heart that like actually bleeds. Oh my god, they're
Speaker 1: so good. We cannot thank you enough.
Speaker 3: Yes, thank you so much. It means a lot and
Speaker 3: is really thrilling. We also never said a public thank
Speaker 3: you to another listener who sent us these beautiful watercolor
Speaker 3: drawings of cholera and plague. You're sinning a pestis.
Speaker 2: Oh my gosh, they're so cool.
Speaker 3: They're gorgeous. Aaron Welsh took the plague because that's her
Speaker 3: favorite in the entire world, and I got cholera, which
Speaker 3: is so gorgeous. So thank you to Jen for that.
Speaker 3: We love them and sorry that it's just so long
Speaker 3: to say thank you.
Speaker 2: Okay, soursus sources. Now, So I read a few books
Speaker 2: for these.
Speaker 1: The I got a lot of the history part from
Speaker 1: this book called as you Might Guess As I've mentioned
Speaker 1: the History of Syphilis by Claude Kettel and how you
Speaker 1: say his name, and there's a lot of good information there.
Speaker 1: And then I also read Bad Bloe The Tuskegee Siphliss
Speaker 1: Experiment by James Jones.
Speaker 2: Incredible book. I highly recommend you check it out. I'll
Speaker 2: also post a link to that Yale lecture. And then
Speaker 2: I read.
Speaker 1: A bit of a book called I Love this title
Speaker 1: That Jealous Demon My Wretched Health, which is by Petrick Trelawney,
Speaker 1: and that's about composers and disease, so like each chapter
Speaker 1: is a different disease and then it talks about composers
Speaker 1: who had that Oh so fun and it's really great
Speaker 1: because he's like, well, you know, this book says that
Speaker 1: this person had any I'm not going to go into it.
Speaker 2: And then there are a couple papers that I'll post also.
Speaker 3: As always we post all of our sources. I had
Speaker 3: a number of different papers and actually a textbook chapter
Speaker 3: this time too. We'll post all of our sources and
Speaker 3: links when possible on our website, This podcast will Kill
Speaker 3: You dot com. Under the episode's tab, you can find
Speaker 3: the sources from this and every single episode we've ever done.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our episodes.
Speaker 3: We love it, and thank you all for listening. This
Speaker 3: is so fun for us. Season three off with a bang, and.
Speaker 2: With that, wash your hands
Speaker 3: You filthy animals.