This Podcast Will Kill You - Ep 36 Shades of Syphilis

Episode Date: October 29, 2019

That’s right, we’re back! And we’re starting off with a bang. Syphilis, aka the Great Imitator, is the subject of today’s long-awaited episode, and it’s got everything you could imagine. When you woke up today, were you hoping to learn about how this spirochete can invade all of your body’s organs? Or how the geographic origins of syphilis are still disputed? Maybe you were wishing to gain some knowledge about a horrific experiment that revolutionized bioethics and defined what it means to give informed consent? One thing is certain - you’re definitely going to want to know about the current status of this ancient disease (yikes, it’s on the rise) and how to cure it (whew, penicillin works). Tune in to have all these wishes granted. See omnystudio.com/listener for privacy information.

This is exactly right. There are already enough things charging your card every month. Dinner should not be one of them, which is exactly why Blue Apron is now subscription-free. You heard that right, Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. Order now at Blue Apron.com. Get 50% off your first two orders plus free shipping with code this podcast 50.

Terms and Conditions Apply. Visit blueapron.com slash terms for more information. This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these quote-unquote fresh dog foods in your fridge are not even 100% human grade, which is why feed your babies, just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies. 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious.

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Janice Torres here. And I'm Austin Hankwitz. We host the podcast, Mind the Business, Small Business Success Stories, produced by Ruby Studio, in partnership with Intuit QuickBooks. We're back for season four to talk to some incredible small business owners. The big thing about working at tech is that it's ever evolving, ever changing. everyone's a rookie. That's how fast the industry is changing. So what I'm really excited about is to be part of that change. So listen on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. With this poison, anything is possible. It assumes the most unexpected and disconcerting

forms. It almost seems to know the ridiculous shame it inspires. So it kills under a disguise. It makes its victims die of an intestinal obstruction, for example, or a nice little liver disease. You don't recover, but your honor is safe. At least the bereave don't have to blush at the mention of the deceased, so much for its caprices. But it also has its little habits. It loves to come out into the daylight. And then you get the whole garden full of cutaneous manifestations, those burgeonings, those dreadful efflorescences, the lupus. You can find fine examples of them all at St. Louis or in its museum. And, of course, it eats away your bones. But above all, all, you see, the disease attacks the nervous system. That's its treat. It's dessert. It chooses its

spot. It snaps the network of the nerves at whim. It can cut off communication with the outside world, suppress the five senses. And then we've got a pretty bouquet of infirmities. Or it plays with a man as if he were a puppet. By pinching the nerve at the right spot, it makes him jump or dance or start. Then, tired of this, it casts him aside, legs broken. And then we have ataxia. Such a cruel game. You have heard tell, for instance, of the acute pain which strikes unendingly in the small of your back. Or perhaps it lays into the brain, the kingpin of it all. And there's your general paralysis, senility, and all its glory, all its regularity. I loved that description. Yeah. That's from this book,

called history of syphilis. Believe it or not. Jumping right into it. Jumping right in. Oh yeah. So hi, I'm Aaron Welsh. And I'm Aaron Alman Updike. And this is, this podcast will kill you.

Season three. Season three. And we're starting off with a bang by covering a classic. A very classic. Cephalus. I'm very excited about today. Yeah, we've been wanting to do this one for a while. and it's been highly requested.

And I think we've been saving it because it's such a big one and it feels a bit daunting. So hopefully you get your fill. I think this was kind of on our shortlist for the first season, wasn't it? Because it's such a big, big one. It was, but I'm glad that we saved it. Me too. So because we're doing syphilis, we should maybe preface this with a bit of warning. Yes.

If you are, so syphilis is a sexually transmitted disease, which means we will be talking about genitalia and sex. So if you're listening with young ones that you don't want to hear those things, maybe skip this episode. Come back in two weeks. Yeah. Up to you. Yeah.

Okay. So, first episode of season three, a lot of things have happened. So many things have happened. And it hasn't even been that long since. Season two ended. No, it hasn't. So, Erin, tell us about some of the things that happened for you since we ended season two. I am back in the United States. Yes. And so now we get to record in the same time zone at least, even if it's not in the same location, but there will be upcoming same room recordings, which will be excellent. That'll be way more fun, but it's really nice to be on the same time

zone. It is. And Aaron, what's up with you? Well, you might hear throughout this episode, So tiny little squeals of my baby human who is sitting here near me. The cutest. He's very cute and hopefully we'll sleep through this recording. But if not, we'll take breaks. Yeah. No baby. No problem.

Okay. All right. That's us all caught up. Do we have any more business? Yeah. So we still have merchandise. So go take a look at that. And we also will have new soap coming out, a new scent, which is going to be super delicious smelling.

Yeah, a kind of fall scent. Yeah. Yeah. I'm excited about it. Where can you find all of this? You can get to it all from our website. This Podcast Will Kill You.com under merch. Perfect.

It's pretty easy. Okay. On to more important things. Yes. It's quarantine time. Oh, it's been so long since we've gotten to say those words. And since you've been able to actually participate. I know, and I'm not even right now, which is really disappointing.

But I will be again soon. Quarantini time, Erin, what are we drinking today? We are drinking the killer cure. Ooh. It has mold cider. Of course. Rye whiskey. Ginger liqueur.

Okay. And walnut liqueur or walnut bitters if you can find them. Fantastic. I will recommend Templeton Rye because that was Al Capone's favorite whiskey. And he had syphilis. And shout out to our friend Sam for telling me that bit of trivia. That's amazing. Sam, just in her pocket knew like, oh yeah, and Al Capone had syphilis and went to Templeton Rye. She had to do a report on famous Chicagoans when she was like in great.

grade school, and so she chose Al Capone and always remember that he had syphilis. Oh, that's amazing. Yeah, that's perfect. Anyways, we will post the recipe to the quarantini and the non-alcoholic placebo ita on our website. This podcast will kill you.com. And we'll also blast it all over social meat. Yes.

So if you're not following us on social media, you should probably get on that. Yeah, props. Okay. All right. Well, then. Shall we begin our first episode of season three? Absolutely. All right.

We'll take a quick short break so everyone can go make themselves a quarantini. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients so there's no meal planning and no extra grocery trip. There, assemble and bake meals take about five minutes of hands-on, prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it. And if there's truly no time to cook, dish by Blue Apron meals are fully prepared. Just heat them in the oven or

microwave, and dinner is ready. And here's the exciting news. Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. Order now at blueapron.com. Get 50% off your first two orders plus free shipping with code this podcast 50. Terms and conditions apply. Visit blueapron.com slash terms for more information. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's Working Hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working Hands creates a protective

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Just visit O'Keef's Company.com slash this podcast and code this podcast at checkout. A timeless wardrobe starts with pieces that are built well from the beginning. From the fabrics to the fit, everything needs to last beyond one season. And that's how Quince approaches design. Quince has all the staples covered, from 100% organic cotton sweaters to premium denim made with stretch for all-day comfort and lux cotton cashmere blends, perfect for the changing seasons. The quality shows in every detail, the stitching, the fit, the fabrics. Every piece is thoughtfully designed to be your new wardrobe essential, and each piece is made

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Yes, give it to me. Don't give it to me. Well, yeah, I'll give you the biology, not the disease. How about that? Excellent. So one thing that I think is very fun that we did not do intentionally, at least I don't think we did this intentionally, syphilis is our second spirokete bacteria. That's right.

And we ended season two with the spirochete, and now we're starting season three with the spirochete. How fun. Me neither. Not intentional, but kind of adorable. All right, so that's the first thing we already know now. We've learned something new about syphilis. It's caused by a spirochete bacterium, which means, like, the bacterium that causes Lyme disease, it is a corkscrew shape, and it sort of swims like a little...

What am I doing here, Aaron? Swind spiral. Yeah, it's just corkscrew movement. I don't know. So this bacterium that causes syphilis is called trepanema palidum. Trepanema, trepanema, however you want to say it. Paladum. Now, something that's very interesting about syphilis that's different than the last

spiroquite we did, while Lyme disease is caused by a number of different species of bacteria, syphilis is not only caused just by one species, but by one particular subspecies of one bacteria. I was hoping that you were going to cover this because I find this super interesting that it's a subspecies. And what does that mean for the biology of this disease versus the other subspecies in trepanema palatum? It's fascinating. So, Trepanema pallidum has a number of different subspecies that cause completely different diseases aside from syphilis. So syphilis is caused by trepanema palatum subspecies pallidum. So trepanema palidum. That's what causes the disease that we're going to talk about today, syphilis. Also used to be called venereal syphilis. So this is the sexually transmitted form of syphilis. However, other subspecies of trepanema palatum cause diseases like yaws. Yeah.

And I'm not sure how you pronounce it. Bejel? Bejel? I was hoping that you were going to try to pronounce this first because I have no clue. Nope. I even looked it up and I couldn't find a consistent pronunciation. So it's also called endemic syphilis. It's spelled B-E-J-E-L.

Yeah. I don't know if it's Bejel or Bejel. Who knows? But anyways, that's another form. And then there's another that I actually, I saw it listed as a subspecies of trepanema paladam and also as another species of trepanema that causes a disease called Pinta. So I'm actually not clear. But they couldn't.

So it's, it's, I think what I read is that Pinta is caused by a separate species and that's only because they could not get a bacterial isolate of it to determine whether it was a subspecies. That seems believable. And what's so interesting about these different subspecies is that based on the tests that we use to diagnose syphilis, you can't distinguish them from each other. So morphologically, when you look at them under a microscope, they're identical. The tests that we use to diagnose them, you can't tell them apart. There are tiny, tiny differences in their genomes that result in small differences in proteins

that if you do very specific tests that nobody does in real life, you can tell them apart. But the reason that we classify them as different subspecies before we had those tests is because they're clinical manifestations. So the way they present in people is totally different and the way that they're transmitted is different. So these other diseases caused by trepaniuma palidum, different subspecies, are not transmitted sexually. They're transmitted in other ways that we're not going to talk about today. Right. So that's our first fun fact.

Trepanema paladum, subspecies palidum, causing syphilis. Fun, very fun fact. Such fun. That's as fun as it gets. it's downhill from here. Mm-hmm. Okay. So syphilis, as most people are aware, and as we've said already, is a sexually transmitted

infection. It can be spread through any type of sexual contact. We're talking all the different kinds of sex. So syphilis is a very, very tiny spirocate. So the way it's transmitted is essentially just when you come into contact with the bacteria through direct skin-on-skin or skin on mucous membrane contact. the bacteria is able to just corkscrew its little way in between the tiny gaps in your skin cells, either if you have microscopic little tears or just through your mucous membranes like your genitalia

where the skin is very thin and very moist. Siphilis can also pass through the placenta and be transmitted congenitally, so from mother to infant. And in some cases, it can even be transmitted to a baby during birth, like through the birth canal. Okay. And once it penetrates the skin, the bacterium pretty quickly makes its way into your bloodstream. And from there, as we saw in that firsthand account, it can travel to and invade pretty much any organ. It can even cross the blood brain barrier and make its way into your nervous system.

Yeah. Yeah. And as it travels through your bloodstream, it turns out that it stimulates a lot of inflammation on the part of your immune system. And this inflammation is what causes a lot of the symptoms that we see. There are a few specific organs that it tends to infect, like, preferentially for some reason or another, and we'll talk about those. But it can invade almost any organ just by swimming its way through your bloodstream. Yikes. Yeah.

Let's start talking about the actual symptoms. So now we know this is how it's going to cause them, right? It's traveling through your bloodstream, causing inflammation as it goes. Okay. So what are the actual symptoms? There's three main phases of syphilis, primary, secondary, and tertiary. Very creative names. And then it can also lay latent. So between the secondary and tertiary phase, you can have years-long latency where there are bacteria there, but you don't have active disease. So you wouldn't know

that you're infected. So the primary stage usually presents within three weeks of infection. So the incubation period on average is about three weeks. It can be less. It can be more. And it usually, the primary stage is essentially a shanker. That's what it's called. It's essentially just an ulcer. So an open wound that is most commonly found on the genitalia. Because again, we're talking about a disease that's transmitted sexually. So this shanker, this ulcer, is essentially chalk full of spirokee bacteria. It's just a bunch of spirochetes swimming around just under the surface of your skin busting out as they go into this open wound. Where is the wound? So it's most commonly, if you have a penis on the shaft of the penis or the glands of the penis, it can be on the labia or inside of the

vagina or in the anal canal or around the anus. It is possible also for it to be in the mouth or there's even been reports of it in physicians before gloves were a thing, they would get it in their nose. Oh. I know. Yeah. It's horrific. So it can be on basically any mucus membrane. Okay.

Yeah. But most commonly on the penis, anus, or labia, or inside the vagina. But one thing that is really important about this ulcer of primary syphilis is that it's completely painless and it doesn't itch. And so that's something that distinguishes it from a lot of other genital ulcers is that you might not ever know that it's there if you're not looking for it because it doesn't hurt at all. And even though it might bleed a little, that's in an area where things just kind of bleed sometimes, right? And especially if you have, if it's like up the vaginal canal or something, it's much more difficult to spot. Or even like in the anus. Like you're probably never going to find that. And so yeah, so it's very possible. to never know that you have this primary form. And the site is usually the site of infection as well? It is, yeah. So, yeah, this is something where that's the site of infection,

and it's full of bacteria, extraordinarily infectious. Okay. So these ulcers are extraordinarily infectious. And usually the ulcer will persist between three and six weeks. So it's a pretty long-lasting ulcer. It doesn't just pop up overnight and then disappear overnight. It lasts for quite a while. So that's primary syphilis.

Secondary syphilis is what happens a bit later. So this usually happens after between four and ten weeks of after infection, so a longer incubation period in general. And I'm unclear on exactly how many, like what percentage of people go on to develop secondary syphilis if primary is untreated. Some numbers I saw said 25%, but I saw numbers as high as 60 or 80%. So honestly, who knows?

I don't. But a number of people will go on to develop this secondary syphilis. And this is, I think, one of the main ways that syphilis got one of its nicknames, which was the great imitator. Right.

And it's kind of what you talked about or touched on in the firsthand account. This can present in so many different ways because the bacteria have gone throughout your entire bloodstream and they can essentially invade any organ that they choose. So you can have GI manifestations where you have inflammation and like gastrointestinal distress. You can have hepatospinomegaly where your spleen and your liver get infected and then they get really large because they're full of inflammation. Hippato is liver, spleno is spleen.

I like that word a lot. It's a good word. I like to throw it in whenever I can. Yeah. You can also get meningitis. So if it crosses that blood-brain barrier, in secondary syphilis, you can get meningitis, and it's not uncommon to find actual bacteria in the CSF, the spinal fluid. But then there are a few other manifestations that are kind of not kind of classic.

secondary syphilis. And most commonly, that's a rash. And this rash is on the trunk and the extremities. And specifically, it goes to the palm and souls of the feet. So palms of the hands and souls of the feet. There are not a lot of infectious diseases that cause a rash on your palms and souls. Huh. Isn't that bizarre? There's only... Very bizarre. It's very bizarre. There's only three main disorders that we learn in medical school that give you rashes on the palms and souls. It's secondary syphilis, rickettsial diseases like Rocky Mountain Spotted Fever, and Cocksacki virus, hand, foot, and mouth disease. Oh, okay. Those are the three big ones. How interesting. I wonder what, why. Me too. I tried to find out an answer and I don't have a good one. There are other things like,

obviously contact dermatitis, if you like grab your hand onto something like poison ivy, yeah, you'll get a rash there. But in terms of infections, those are the three big ones. Huh. I know. So the rash thing. So then if you have, because it wouldn't just be on one hand either. It would be on your palms and your feet. Yeah. And usually it's kind of throughout your body as well. So it's not only on your palms and souls. It's like kind of all over. And this is the whole great pox versus smallpox sort of thing is the big. rash? Yeah, so this rash can actually look a lot of different ways if you like Google image search it, which I'm sure on our social media will post plenty of pictures of this, but it sometimes it's just

flat red spots. Sometimes it can be raised spots. In people who have some kind of immunocompromise, like they don't have a great immune system response. They can actually get necrotizing rashes. So that's where like this tissue starts to die. And they get these. very large kind of purple, very dark rash. So it can look a lot of different ways. Yeah. And then you'll also see other signs of kind of systemic involvement, things like fever, sore throat, weight loss, hair loss. So that's secondary syphilis. Okay. And then there's tertiary. Dun dun dun dun dun. Yeah. Dun dun dun is right. After secondary, there's often a long latent period. where we're talking years past between secondary and tertiary.

And it's also possible that you can get tertiary syphilis or have signs of tertiary syphilis without knowing that you had syphilis. Because if you only had a primary ulcer and you never developed those secondary signs, you might never have known that you had that ulcer. And then five, 10, 15, 20 years down the line, you can develop signs of tertiary syphilis. So you can jump essentially from primary to tertiary without? Yeah, you could. Yeah.

So tertiary syphilis, if it goes, if primary and secondary syphilis goes untreated, it can result years down the line in this much more severe form of syphilis. And this tertiary third form actually has three different forms itself. So there's a cardiovascular form of tertiary syphilis where, as you can imagine, it affects your heart. There's the gamatus, gummatis. Oh, yeah, the gamma. The gumma form. And we'll talk about what the heck that means in a second.

And then there's neurosophilis, which affects your nervous system. Neurosyphilis is the most famous of these, I think. And that's because it was the most common. Before there was treatment for syphilis, tertiary syphilis, specifically neurocifilis, was the most common form of this late phase of syphilis. And there's a few different ways that this can present. And they're all absolutely horrific. But the two more devastating, I suppose, forms of neurocophilus are called General Poresis

and Tabe's Dorsalis. So we'll talk about each of those. General Poresis is, so Poresis means paralysis, but this is much more than just a paralysis. This is when basically the spirochete invades your brain in such a way that your cerebrum, which is the main part of your brain, like the brain-shaped part of your brain, starts to atrophy. Oh, my God. Yeah, it's horrific. And so you get a dementia, which is basically, you know, things like memory loss, personality change. And then you also get these physical symptoms.

So things like trouble speaking, tremors, seizures, your muscles will eventually start to deteriorate because the connection between your brain and your muscles is not working correctly. So your muscles start to atrophy because of that. And then eventually complete paralysis. Why does this happen? Great question. I don't know entirely, especially with general parisis. As far as I understand, it's just the.

the invasion of your brain itself, your brain and your spinal cord that causes this atrophy. So as each part of your brain starts to atrophy, you'll see these different manifestations. So that's actually not the most common form of neurocophilus. The most common and kind of, I know what we learned in med school is like the most classic neurocphalus is Tabes dorsalis. Tabes, I looked this up, get my etymology hat on. Tabies means wasting away, which is horrific. And dorsalis is like dorsalus, like dorsal fin, so the back part.

So Taby's dorsalus is literally the wasting away the degeneration of the posterior part of your spinal cord. Oh my God. So instead of your brain kind of wasting away, it's the back part, specifically just the posterior part of your spinal cord. Wow. It happens that that section of your spine. your spinal cord, the nerves that run through it are mostly responsible for a few specific things. Vibration sense and discriminative touch. So being able to know like this that you're poking me with is sharp and this is where you're poking me versus this is soft and this is not. So you lose that.

You lose any kind of vibration sense. Okay. And very importantly, proprioception. Uh-huh. Propreoception is knowing where your body is in relation to your body. So here's where my arm is. It's off to my right-hand side. And if I need to do something like, for example, pick up a fork and bring it to my mouth, you need proprioception to be able to do that. Right. So you lose all of that in Taby's dorsalis, which means your brain doesn't know where you're leg is in relation to your body. So you can't walk properly because you can't coordinate between your two legs. Your brain doesn't know where they are in space. Isn't that? Yeah, that's really rough. Yeah. So, yeah, so that's Taby's dorsalis. It's really gnarly. It'll eventually result in complete loss of coordination, loss of reflexes because part of the reflex loop goes through the back

part of your spinal cord as well. And then that will also lead to muscle degeneration because you're not coordinating your muscles correctly. It's really gnarly. Yeah. Luckily, those manifestations are not common today because we have treatment, but they still can happen. Yeah. Okay, but that's just neurosyphilis. We're not done yet. The cardiovascular form of syphilis is actually the most deadly. Seems reasonable. Yes. And this is, this is one. one of the most interesting forms for me when I first learned about it. Cardiovascular syphilis, what happens is, so your aorta, which is the giant largest artery that leads directly off

of your heart, right? That's the artery that feeds every other artery giving blood to your whole body. Right. In a blue whale, the aorta, a small human can fit through it. Yes. That's my fun fact for this. That is a fun fact. Pepper a fun fact in here. We need some of those because this is is depressing. So your aorta is so large and thick and muscular that it actually has its own blood supply. So there are taincy tiny blood vessels that actually feed the muscle surrounding your aorta. What happens in cardiovascular syphilis is the bacteria replicate and invade those tiny blood vessels. They're called the vasa-vasorum that feed your aorta. And then the inflammation causes those vessels to obliterate. Whoa. So that means that your aorta is not getting blood supply

to the muscle of your aorta. So then the walls of your aorta become weak and then it dilates. And it can eventually rupture. Yikes. Because it can't contain the pressure from your blood flow, from your heart. Do we have any breakdown of the proportion of... It's a good question. I don't have exact numbers. I did see that neuro syphilis is the most common form of tertiary, but cardiovascular is responsible for what I read is 80% of the deaths associated with syphilis. Okay. So if that helps, at least to get an idea. And then finally, there's the gumma form. This is the least common, but this is what happens when the spirochetes invade your skin or your bone or other tissue and basically just in small areas destroy all that tissue. So you get these large, what are called

granulomas, which essentially is just a bunch of dead tissue with inflammatory cells and bacteria in these kind of nodules. Is this the one that leaves the most traces? I mean, you said it invades the bones, but do they, I didn't even think about this. I just kind of assumed that all tertiary syphilis left bone traces, but is it just the gumma form? Well, I would, I would I would guess that you can have gums even if you never know that you had them. Okay, right. It would only be discovered. Like, you could have cardiovascular syphilis and gums.

Absolutely. Okay. Yeah. But you might, like, one is going to be the thing that, like, kind of brings it to the attention or something like that. I don't think that these are not distinct entities necessarily. Right. They're just different shades of. Right.

Exactly. Different shades of syphilis. Different shades of syphilis. And then finally there's congenital syphilis, which is very depressing. It's when the spirochetes cross the placenta or in some cases through the vaginal canal, infect a fetus or a baby. And there's a number of different things that it can cause in infants and even in children. So even after like several years, congenital syphilis can cause a lot of different, the way that it can't. manifest in a lot of different ways in adults it can cause a lot of different types of

disease in children as well but at least about half the time if a pregnant person gets infected with syphilis what happens is just so early fetal loss or stillbirth if the pregnancy is farther along that's that's really sad so it seems like it's most of the most of the time it's a fatal outcome exactly yeah so that's that's pretty much the biology of syphilis The only good thing that I have to say about it is that it's very treatable still. Cephalis is treated with penicillin. It's one of the few things that we still treat with penicillin. And thus far, it shows little to no resistance to penicillin, which is fascinating to me.

How interesting. It's very, very interesting. I don't. Because everything else is resistant to penicillin. Right, within like a few years or less. Yeah. Yeah. Yeah.

What I think is very cool is that penicillin is so good at treating syphilis that if someone has, especially if they have a late stage of syphilis, and they're allergic to penicillin, instead of treating them with a different antibiotic, you actually desensitize them to penicillin first and then you treat them with penicillin. How do you desensitize someone to penicillin? The same way that you would with other allergies, you basically give them a tiny bit at a time and you monitor them and then you slowly increase the dosage. Does that work for everyone? As far as I can tell, it works for most people. That's really interesting. It's interesting, but it can take a very long time. But it's worth it to be able to use penicillin rather than trying to find an alternative treatment.

Yeah, there are other antibiotics if somebody has an early form of syphilis and is allergic to penicillin. But for late syphilis, it's pretty much penicillin or bust. Gotcha. Cool. So, yeah, that's syphilis. What the heck, Aaron? Where did this thing come from? And how can it wreak so much havoc on our bodies?

Oh, man. Okay, well, here we go. Here we go. But first, let's take a little break. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something.

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This Podcast and code this podcast at checkout. This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these, quote-unquote, fresh dog foods in your fridge are not even 100% human grade, which is why feed your babies, just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies. 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious. These are foods that you would want to eat.

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And I'm Austin Hankwitz. We host the podcast, Mind the Business, Small Business Success Stories, produced by Ruby Studio in partnership with Intuit QuickBooks. And we are back for season four. We're talking to small business owners who are doing incredible things in their industries, achieving their dreams, being their own bosses, putting in the work, and enjoying. all the benefits that come with it. This is our most exciting season yet. We're talking to more entrepreneurs about how they launched their vision,

and more importantly, how QuickBooks on the Intuit platform helps them do more in less time. Working in QuickBooks just makes it easier to run the business, right? There's so much that you need to do when it comes to running a business, building products, setting up marketing campaigns. And to run a business, you have to make sure that your finances are in order. So it removes my anxiety from, one side of it so that I can focus on everything else.

Whether you're a long-time listener or just getting started, tune in and join us. You'll be so glad you did. Listen on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Syphilis. Outbreaks of any kind of disease don't just happen out of thin air, even though that may be how it seems when they begin. usually there's a set of very specific circumstances that perfectly set the stage for the emergence and spread of a particular pathogen. Can you guess what one of the most common stage setters is?

No. Come on, guess anything. What would lead to an outbreak? I was going to say orgies. I'm not talking specifically about syphilis. Oh. Or STIs. I'm just talking about disease infectious.

A lot of people in a small area. Sure. And maybe chaos and maybe people from a lot of different areas getting together. Absolutely. So could be war. Absolutely. Yeah. So war, war is the answer I was looking for.

Not a word to you. Spreading disease. Absolutely. So yeah, as you mentioned, a bunch of people in close contact. They're traveling in areas that are new to them. them, infrastructure is sort of falling apart, and all of these things promote the exchange of pathogens, new pathogens, and including syphilis. It turns out that the question of where syphilis came from and when is a bit more complicated

than I had expected. Really? Yeah, but don't worry, I'll get into all of it later. But for now, let's first things first this. So first things first, the first time that we see what is definitely an outbreak of syphilis in Europe, like conclusively, is around 1495 during the first Italian war, which you've heard of that. You know this war. Of course.

Yeah. I know all about it. It was the first one in Italy. Yep. Totally. No, I had no idea. So I Wikipedia did. Okay.

And here's what I could glean from just a quick skim. So in the 1490s, there was apparently, and I always, I like this historical context because it just sort of, I think it's really interesting to, I don't know. to talk about why, like, how this all happened. Okay. You have your extra joy face on when you're talking about this, so I know it's going to be good. Yeah, it's sort of those Wikipedia rabbit holes. Okay. So in the 1490s, there was apparently a bit of a spat between the Pope at the time,

who was Innocent the 8th, if you were interested. And King Ferdinand of Naples, this kingdom was basically the southern half of Italy, excluding Sicily. Okay. The king refused to. pay any money to the Pope. And so the Pope was like, all right, fine, I'm just going to depose you and give your kingdom to King Charles the 8th of France. Naturally. Yeah. And so the two, the king of Naples and the Pope eventually made up, but the king of France, King Charles was like, excuse me,

you offered this to me and then you drew it back right away. And he never really got over it. So he was he was super annoyed and so a few years later when the proper heir to the kingdom of Naples was called into question because the previous king died whatever whatever Charles gathered some troops and it ended up being this rag-tag bunch of mercenaries from all over some were Flemish, some were Swiss, some were Spanish, some were Italian.

I mean you get the idea. And then he invaded and was like almost little to no resistance initially. So they kind of hung out in Naples and around Italy just partying and pillaging and having a good time. And then the people had had enough, so they chased them out, and then they met on this huge battlefield in July 1495 with actually like Italian troops. And so from this battle is when we get the first known descriptions of syphilis.

Quote, through sexual contact, an ailment which is new, or at least unknowled, known to previous doctors, the French sickness has worked its way in from the west to this spot as I write. The entire body is so repulsive to look at and the suffering is so great, especially at night, that this sickness is even more horrifying than incurable leprosy or elephantiasis, and it can be fatal. Whoa. Yeah. Even worse than leprosy and elephantiasis, that is heavy words. Right? And so that's a very, remember, that because it's a really interesting facet of the emergence of syphilis in Europe. Okay. So that was from this Venetian doctor named Benedetto, by the way. Oh, I know someone named Benedetto. Really? I love that name.

Yeah, one of Brett's best friends from Hawaii. Oh, cool. Okay, after this battle, the retreating French troops returned to their respective countries and along the way made some stops and may have deposited the syphilis bacterium in various cities and towns. Of course. And from there, it exploded. And I mean, like, within a few years, it was already in medical treatises. It was already all over Europe. I mean, everywhere.

Can I just say that deposited is a really funny way to say it. I didn't know how else to say it. I guess there were probably many ways. I like deposited. Yeah, okay, good. Just a little deposit. And this syphilis, as you could probably tell from the description of during the battle, this was not the syphilis of the 21st century or even that of the 19th or 18th centuries.

And those syphiluses, I guess, are horrifying enough. But this one, if you can believe it, was worse. Whoa. This was a terrible scourge that killed quickly, hugely disfiguring people. and eyewitness accounts at the time read like a horror movie script. It definitely was much more virulent in its early, like in its first emergence. That is so interesting and it's fascinating to me that it was so recent. Oh, okay, we're going to get into that.

Okay, because like, wow, yeah, let's keep going. Keep going. Okay. No, it is. And I think it also makes sense considering if that was a first exposure, that's how we often see epidemics happening is that the first wave is so deadly. Right. Someday we'll do mixomatosis. Oh, of course we will. Can't wait. People quickly realize that the disease was, A, contagious, B, spread through sexual contact, and C often appeared for the first time after people had traveled

through the town, particularly people from out of town. It was viewed as a matter of such huge public health importance that some towns or cities had laws forbidding people with syphilis from entering. Whoa. And this part in particular, this whole, it came from somewhere else, is what gave syphilis its various nicknames, all of which had that general theme. It came from over there, with over there being whatever country or region was your political enemy, or one that you didn't like or thought was unclean. For instance, for instance, in Russia, it was called the Polish sickness. In Poland, it was called the German sickness. In Germany, it was called

the French sickness. In England, it was called the French or the Spanish sickness. In the Netherlands, it was called the Spanish sickness. In Turkey, it was called the Christian sickness. In Japan, it was called the Chinese sickness. And in Spain, it was called Las Bubas. So it's a bit of an outlier. Yeah. But I swear, if you just learn the country-specific nicknames for syphilis during the 15th and 16th centuries, you could tell a lot about the political atmosphere during that time and also the attitudes that one country holds for another. Oh, yeah. Siphilis, like many sexually transmitted infections, was and still is in many places viewed as a

dirty disease with moral implications. The disease was seen as punishment for living an unclean or immoral life. But in terms of origins, which of these accusatory nicknames was right. Was it really the French disease brought over from France or the German sickness? Was it even of European origin? The answer is that we don't know for sure. Oh, you're killing me. But, yeah, the great debate about syphilis and one that still seems to attract fairly high levels of interest is its origins. And not the evolutionary origins of the spirochet necessarily, but the origins of the epidemic. There are two basic thoughts. One,

is that it was brought from the New World to Europe when Columbus returned from his voyage in April of 1493, bringing with him a few hundred people from Hispaniola, and then some of Columbus's crew then joined King Charles the 8th Army, bringing with them syphilis and starting the whole pandemic. And this one is referred to as the Colombian theory. The second called the pre-Columbian theory that's sort of in the name is that syphilis had been present in Europe since antiquity, but increase in incidence and virulence due to an evolutionary leap. Let's go through each of these. Okay.

Okay. The Columbian theory. This is the one that seems to be the best supported by archaeological evidence and also writings from the time. It's also been the more prominent theory of the two for the longest period of time. There are even some historical writings dating back from this first unambiguous appearance of syphilis in 1495. And in the early 1500s, that state that the disease was brought back by Columbus and his crew after his travels to the New World. Because syphilis infections and congenital syphilis can leave traces on skeletons, you can basically just look at the archaeological record to see both the timing and origin of syphilis's emergence. And while there are more than several pre-Columbian New World skeletons in both the northern and southern hemispheres that show signs of syphilis, clear evidence.

of syphilis infections in old world skeletons isn't, well, I guess as clear. There are definitely some cases that appear to be syphilis, but for many of these, the dating or diagnosis is called into question. Interesting. A review from 2011 looked at all 54 published cases of supposed pre-Columbian syphilis in skeletons in the old world, and did not find a single one whose diagnosis or dating was clearly pre-Columbian syphilis. Interesting.

Yeah. And so the timing and severity of that first clear syphilis epidemic in Europe is also a point in favor of the Colombian theory so that it was brought over. Descriptions of syphilis from this time tell of these erupting postules and horrific lesions with death being a primary outcome. And before the 1495 outbreak that I talked about, there aren't unequivocal. descriptions of syphilis and definitely nothing as telling or extreme as that one. Many proponents of the pre-Columbian theory, which is the one that syphilis was present in Europe,

have suggested that many writings about leprosy are actually about syphilis. And there are some instances of something called venereal leprosy, but it's not clear that that's definitely syphilis. And early writings about syphilis distinguished it from leprosy and smallpox. So they were like, this is worse than leprosy as you heard in that description. Right. So the debate still kind of rages on. And it's helped along by sensationalist quote documentaries.

Like I watched this one by timeline, which was like, rewriting history of syphilis. And it had some of the worst sound effects I have ever heard on a documentary. It had these weird like wolf howls and like creepy slamming doors. It was weird. Anyway. Because, you know, slamming doors, that's a sign of syphilis for sure. Exactly.

But these documentaries or these shows don't rely, they often heavily rely on unpublished and not peer-reviewed data or findings. And they also catch a lot of flack for that, and rightfully so. But what is the evolutionary history of the syphilis pathogen? Ciphylus, as you mentioned, is caused by the subspecies. And so one of the ideas, although this isn't clear, or this isn't certain, one of the ideas is that syphilis actually evolved from yaws, most likely, into being a sexually transmissible and more virulent form. Okay. And that could have happened in North America, or in the new world and then been brought over, or it could have, a lot of people of the pre-Columbian hypothesis say, well, it could have happened in both places.

because it is pretty clear that syphilis from skeletons in the new world, it's pretty clear that syphilis was there. Okay. And infecting people before Columbus. And so they say, well, maybe Yaws made the leap to syphilis in the new world, and it also made the leap to syphilis in the old world. And it's kind of an interesting, like that seems highly unlikely. But, yeah, anyway.

I feel like then you'd be more likely to see like two distinct forms of syphilis, which I don't think we really see. But that's an interesting idea. I mean, it's interesting. And also, you know, as you mentioned, this is called the great imitator. And so writings are sort of, yeah, can be interpreted a lot of different ways. There's a lot of retrospective diagnosing of famous people that is interesting. It's like if you were famous, if you were an artist or a composer or a dictator, you had syphilis.

For sure. Yeah. Yeah. Which, I mean, it could be possible entirely, but it's just sort of like. Right. After the fact. Way after the fact. Are there, and I'm sorry if this is jumping your gun, are there any descriptions of it in other parts of the world, like in Asia or in Africa or anything like that? Not that I could find. I didn't see anything that was super distinctive or super related to or indicative of syphilis or suggestive of syphilis. I should say, yeah. Cool.

Interesting. Yeah. Before I move completely away from this origins part of the story, I want to talk, of course, about the etymology of syphilis. Yes. And not really its scientific name because I think that's less exciting. Trepanema meaning a turning thread in Greek and pallida meaning pale. Yep.

But the word syphilis, where does it come from? The name wasn't actually in heavy use for most of the history of the disease, and most people opted to call it the blank disease or pox, you know, the blank disease meaning the French disease, the Spanish disease, or great pox or pox or wild warts. Okay, that's my favorite. Yeah. I mean, I was like, why isn't that what we call it now? Yeah.

Yeah. Warts. That's got to be the condoloma lot because they are pretty wild looking. It wasn't until the end of the 18th century, really, that people start. started to use syphilis again. Syphilis is the main character of an epic poem, and in this poem, Siphilis, who is a shepherd, gets upset when there is a bad drought that is killing the land and his sheep.

I think it's like an old Roman poem. He blames the drought on the sun god, likely Apollo, or the Roman equivalent, if there is one, whatever, and instead says he's going to worship the king whose sheep he hurts. The king is like, heck yeah. But the sun god is really annoyed. And so he sends a venereal plague upon the countryside where syphilis lives. And syphilis was the first victim.

So, yeah. Interesting. Syphilis, the shepherd. Also, I don't remember if we talked about this in the gonorrhea episodes. I'm just going to repeat it anyway. But the origin of the term venereal disease, did we talk about that? I don't remember. Tell me again. Okay. Well, it tells you a lot about the historical attitudes and even present day, possibly, attitudes of venereal disease, which is no longer a term that we use, because venereal comes from Venus, the goddess of love. There was an old saying that a night with Venus leads to a lifetime on Mercury, which brings me to my next couple of points. So A, it reveals a lot about,

the blame and who is often perceived to be the person responsible for transmitting syphilis or being the harborer of syphilis, which was often a woman who had like a, you know, temptress or that sort of thing. And then also Mercury. And let's just get into the treatment real quick of syphilis, some of these wild treatments. So for a long time, Mercury was the chosen treatment for syphilis. Like even just a few years after that 1495 outbreak, it was started to be used. And it was, I guess, like, maybe effective, somewhat effective. Because it just like poisoned you to... I think so. Yeah. I don't know exactly how it worked or if it truly was effective, but people did use it up until the early 20th century and even a little bit beyond that. Yeah. And so basically they would rub it on themselves.

And this is what inspired the name of our quarantini, by the way, the killer cure, because a lot of the cures that people took for syphilis would kill them. So it was either syphilis would kill you or the cure would kill you. Right. Essentially. Either way you're dead. Yeah. Mercury poisoning is no small thing. So other things like induced sweating and salivation were also treatments.

And you know I can't go. Yeah. You said they would rub mercury on themselves? Mm-hmm. That's awful. Mm-hmm. I'm sure they would take it in other forms also. Right.

Not that that's better if you ingest it, but I can't, ugh. It just sounds terrible. Mm-hmm. Yeah, it's really bad. Cool. So then they also don't touch Mercury. Don't do it. Yeah.

No. You also know I can't go of this entire episode without describing at least one bizarre or horrifying cure. Our favorite. This is already a long episode. So I'm not going to list too many, but here's a great one. Quote, if, and this is directly from this book that I read, by the way, called the history of syphilis. Quote, if the penis is ulcerated and infected, and then the author writes, it is always the male sex for which the doctor feels pity, the woman being strictly confined to the role of contaminator,

whose shanker, moreover, is more difficult to discover. And then continuing with a cure, if the penis is ulcerated and infected, you must immediately wash it thoroughly with soft soap or apply it to a cock, meaning rooster, or pigeon plucked and flayed alive, or else a live frog cut into. What? Uh-huh. You put your ulcerated penis on a flayed bird or a frog that you've sliced in half. That's just asking for a salmonella super infection on top of your syphilis is what you're asking for

the killer cure. This is what I'm saying. Oh my God. Also, what is up with people and like plucking cocks and using them as cures? Didn't they do that for rabies too? There was something. There was something along those lines that was like you have to remove. I mean, poor, I feel terrible for these. Oh, my gracious. Yeah. Here's another, here's another one. I'll just throw one more in there. Just for fun. Yeah. To gain protection, one must wash oneself after the act, then cover the glands with a piece of cloth, which has macerated in a preparation of wine, shavings of Gaelic, I don't know what that is,

flakes of copper, precipitated mercury, gentian root, red coral, ash of ivory, burnt horn of deer. The protective must stay in place for four or five hours. So this is how to prevent syphilis? This is how to. So a lot of the treatments actually were after the fact. It was not really about prevention. It was about it wasn't about prevention before sex. It was about making sure that you didn't get infected after.

Mostly it was like, well, you better wash yourself quickly and then maybe soak your penis in a cloth of some sort of weird, grody disgusting thing. Don't soak your penis in that. Don't do it. Don't follow these. These are not instructions to follow. No, they are anti-structions. Yes, this is a roadmap that you should not go on. Oh, my goodness gracious. Because the signs of syphilis are often less obvious in women, they were often blamed for spreading the disease. As per use. With the whole harlot and evil temptress concept, those sorts of things.

It's like through the 1950s and 60s and 70s. Oh, yeah. We're going to post some posters that are pretty. Yeah. And because in most places, sex outside of marriage for men and basically any sex at all for women was seen as immoral, diseases such as syphilis and gonorrhea were viewed as divine punishment. And the word venereal, as I mentioned, inherently has blame tied to it. In many places, to try to stop the spread of syphilis.

brothels were shut down or made illegal, not that that necessarily decreased the prevalence of infection. Separate hospitals were constructed for people with syphilis, and they were often turned away at normal hospitals. And it's not like these syphilis hospitals were nice care facilities. They were just a place to isolate the people deemed unclean or immoral. And also a lot of diagnosing, especially for women happened just through word of mouth. So if a man said, oh, I had sex, like I have syphilis, I had sex with this woman, so she gave it to me. Then the doctor would say she has syphilis, she has to go to this hospital. I feel like I remember you saying the same thing would happen for gonorrhea as well. Yeah, exactly. Yep. Over time, though, attitudes around syphilis

changed a little bit. The disease itself had been so widespread for such a long period of time. and during that time it had become much less virulent. And so by the time the 1800s came around, it was almost in some ways viewed as a rite of passage. Like it was just something that happened to you. The discussion of morality and syphilis shifted again in the late 1800s, early 1900s. And it had always been sort of focused on the unclean or immoral aspect of it.

But around this time, it was more about the preservation of marriage as an institution, That's what took the spotlight. And a lot of focus was paid to the innocent wife made to be condemned to a life of disease due to her unfaithful husband. And then congenital syphilis at this time, because it wasn't known to be a pathogen, it was more viewed as original sin or a punishment because your parents were, like you were born bad. You were born. Yeah. Yeah. And so, yeah, so this brings me to this point of contagion being a different thing than germ theory. So people, you know, you can think of a disease as being contagious. And even though now we know that that is inherently tied to a specific pathogen, whether it's a virus or bacteria or worm or something, it wasn't necessarily the same thing back then. It was sort of your unclean aspect, your unclean character could be passed from person to person. That is so, so interesting to imagine.

Like, not knowing that a bacteria is what's causing it, but knowing I got this, or believing, at least, I got this from this person. That is such an interesting, like, separation. Right. Oh, wow. Yeah. It's something I hadn't really thought of before this episode, because in a lot of the times, the episodes that we've covered, are, we know. sort of we've traced the concept of disease and infectious disease and it's mostly been to do with my asthma and sort of like oh well bad bad areas swampy areas lowland areas whatever else just bad air

but this was like oh no this is obviously a contagious thing right and so and specifically from like sexual intercourse right right that that is how you get it yeah how that's it's very very yeah huh Yeah. And so the sexual aspect, of course, had been known for a long, long time, but then alternate roots were also accepted or began to come to light. So kissing, wet nurse to infant or vice versa. And this was sort of a question mark, I don't know. And then later on, the big thing was sitting on a toilet seat. And this, so some of these ways are actually ways that you can get syphilis. So kissing, for instance. Yes. But other ones, like sitting on a toilet seat or being or contaminated holy water, which was my favorite one.

Like, excuse me? What? Oh, my God. That is such a try hard. Wow. And so these were probably ways to preserve, invented, to preserve the virtue of certain people who had gotten syphilis. And we're like, oh, I've, I'm, you know. We should probably.

clarify that you cannot get syphilis from a toilet seat. You cannot. No, you cannot. Or contaminated holy water. Definitely not contaminated. It's also a human-specific disease. So that's, I think, worth mentioning. Yes. This is not found in other animals. It's not present in the environment. This is human-to-human exclusive. Mm-hmm. Yeah. And so around the late 1800s and early 1900s morality plays were written and performed poems about the dangers of syphilis and, you know, evil temptresses and all that and how they're going to poison your household and etc. And in all of these, of course, it was the husband that got the disease from a woman of ill repute and he was often portrayed as a victim himself. It was one of the three, like it was genuinely

called a social disease. One of the three being, the other two being tuberculosis and alcoholism. They were all viewed as sort of these unclean, the unclean holy trinity or something. Fascinating. That is so interesting to me that it was alcoholism and tuberculosis. Mm-hmm. Wow. And it was thought that if we have enough social reform and morality campaigns to preserve marriage or to clean up this and that, then we could wipe these things out. Wow.

So, yeah. And other people believed it to be hereditary, as I mentioned, and often the cause of genius or creativity, something that has in common with tuberculosis. So syphilis is, as I mentioned, one of these diseases that people like to, you know, retrospectively diagnose. So we've got some, these are both confirmed and suspected cases. I'll just list some famous peeps. Okay. Franz Schubert and other composers like Smetana and Dahliaz. I don't know if I'm saying that right. Al Capone again. Bing, Bing. Nietzsche, Tolstoy, Karen Blixen, who wrote Out of Africa, Lenin, Hitler, and then like many, many other people. There's even a book called Pox, something about, I can't remember who wrote it.

I didn't read it because from my understanding, it's a lot of this hand-wage. baby retrospective diagnosis. So, anyway, it seems like it would be a fun book to read, I would imagine. Is it all about syphilis specifically? Yes, okay, interesting. Throughout much of the history of syphilis, people debated whether gonorrhea and syphilis were the same disease, just different forms or stages, and there was some horrific self-experimentations to try to clear this issue up.

And I think I mentioned one of these experiments, self-experiments, during the gonorrhea episode and he died of syphilis, but he thought he was infecting himself with gonorrhea. Anyway, the syphilis bacterium was finally seen under the scope and identified almost 30 years after gonorrhea, which finally was like, oh, this is a different one. So what year was that, remind me? February, so, well, syphilis was discovered, were seen in February 1905. Okay. Wow, that's actually earlier than I expected considering how tiny it is.

Yeah. Yeah. Yeah. And then the Borddette-Borda-Voserman diagnostic test was developed a year later in 1906. And then Paul Ehrlich, along with another microbiologist named Hata, came across an effective treatment for syphilis. And it was called Salversan, and that was a substitute for mercury, which people started using it. And then there was an even better version called Neo-Salversan. Okay. So prior to 1945, about 5 to 10% of all psychiatric admissions were neurosyphilis.

Whoa. Yeah. It was a huge problem. And although mercury and arsenic-based compounds were available from the early 1900s on, they weren't really much help for, well, most people, but also people with neurosophilis. Okay. But an alternative was discovered. Pyrotherapy, so pyro meaning fire.

So essentially using induced fevers to treat another disease. Oh. Yeah. This had been observed for a really long time, like the fact that fevers could cure whatever preexisting disease that you had. Like, I'm talking a really long time, like ancient Greeks, Hippocrates and Galen. Yeah. Okay.

But it wasn't really until the late 1800s that this observation was made into application. This Austrian psychiatrist. Julius Wagner Yareg, I don't know how you say his name, which is going to be a problem because I have to say it a couple times. He had become convinced that a fever from an infectious disease could cure mentally ill patients. And that's something that he had observed during his time in psychiatric hospitals. And so naturally, because this was the early 1900s, he experimented on humans without consent. Like you do. Like you do. With different fever inducing compounds or pathogens, but eventually he made his way to malaria. During World War I,

he drew blood from malaria infected soldiers and then injected that blood into his patients. Stop it. Some of whom died. Of course. Some of whom did not show any improvement. And some who did, even if it was just for a short while. Oh my goodness. Yeah. So this was far from a fail-safe cure. But he was encouraged by the result, so he kept doing it. And it was basically the same sort of thing. Like people died, people got better, people got worse, whatever. And so this practice wasn't widely accepted, really. Okay.

But regardless of that, in 1927, he became the first psychiatrist and only one of three, I think, ever, to be awarded a Nobel Prize for using malaria to treat neurosophilis. He got a Nobel Prize for that? Yeah. Whoa. Yeah. Oh, also, I'd want to mention that one of the other three psychiatrists, or one of the other two psychiatrists who was awarded a Nobel Prize was the guy who developed the lobotomy. Okay.

Yeah. Cool. Yeah. Mm-hmm. The last one was about the physiological basis of memory. That's cool. That's cool. Yeah.

Actually cool. Yeah. But this, basically using malaria to treat syphilis, neurosifilis, didn't see. stick around for obvious reasons. Like it was super unethical and could kill you. Right. This therapy will kill you. I don't know.

Hence the killer cure again. And Wagner Yareg, he fell from grace and basically slipped from public consciousness after World War II because he had really close ties with the Nazi party. And this was around the time when like bioethics and human experimentation started to really take focus. But yeah, there you have it. So an interesting little chapter in the history of syphilis. Malaria, man.

Isn't that cool? Yeah. Also, at the turn of the 20th century, a lot of developments for syphilis were taking place. A lot of both in terms of microbiology, in terms of treatment, and so on. And because syphilis was still a very huge problem and a big focus. of both social reform and microbiology and public health. And then World War I breaks out.

And as we know, war is a great place for syphilis to spread. Syphilis caused almost as many service days to be lost from troops, I think U.S. troops specifically, in World War I, than like almost as much, just a little bit less than the 1918 flu. Wow. So between April 1917 and December 191919, there were 383,000 cases of syphilis and gonorrhea in the American army. Just in the American army. Just in the American army.

Whoa, bro. Yeah. So lots and lots and lots of syphilis. And a lot of the public health campaigns during this time really focused on avoiding brothels, avoiding, you know, loose women, et cetera, that sort of thing. And after World War I, the fear, the public fear of syphilis was at an all-time high. Like, people were terrified of it. And this is when this toilet seat rumor got started.

There was pre-marital, like required mandatory pre-marital screening for syphilis and tuberculosis. So both partners had to be screened. Wow. And then you had to, if you did get diagnosed, you had to list all of the partners and then they would all be identified. But it wasn't like in a way that was respectful. Right. Of course not.

Of course not. It was much more sort of condemning and accusatory. Exactly. Yeah. Okay. And so all of this. So the fear of syphilis and gonorrhea remained heightened. throughout the time between the World War I ended and between when World War II began.

So between 18 and 1939 was like just 20 years of fear. Syphilis terror? Syphilis terror. Yeah. It held the world and it script. And then World War II broke out. And it was during World War II that we see the release and widespread distribution of one of the best inventions of all time. Penicillin.

Penicillin. And that really knocked it out. And so then you see these posters that are much more focused on like, hey, go down to the clinic and get a shot. Go down to the whatever and get a shot. A little bit more positive. A little bit more positive. And with the deployment of penicillin and the widespread use, I mean, syphilis cases dropped to almost nothing. It was like magic.

And it kind of became a disease that was forgotten. Like people, you know, people kind of stopped considering it. Even now you say syphilis and you think of the 1800s. Well, I thought of like different composers and stuff that had syphilis. But then in 1972 is when syphilis took the headlines again. Yeah. This is when it gets to be the most depressing, I think. I think this is one of the most important, probably the most important lesson of syphilis.

Yep. At the end of July in 1972, the announcement was made that the U.S. Public Health Service had been conducting a study on the effects of untreated syphilis on the human body. The exact title of this study is the Tuskegee study of untreated syphilis in the Negro male. There's a lot in that title. that can tell you about this experiment. Okay. This story needs to be told. This story needs to be.

It's a hugely important story. Yes. This experiment had gone on for 40 years. It involved 600 black men, 399 of which had syphilis at the start of the experiment. It came out that during this news release, out that the men had not been informed that they had syphilis at the beginning, had not been informed that there was a treatment available either at the very beginning of the study when mercury or arsenic-based medicines were used to varying degrees of efficacy, and they were not told

about a decade after the study began when penicillin was introduced. This wasn't a study to find out the best way to treat syphilis. It's in the title. The effect of untreated syphilis. This wasn't a treatment-based study. This wasn't an intervention study. This wasn't a diagnostic study. It was just... Let's see what happens when we withhold treatment from human beings. How far can this disease go? How much havoc can it wreak on the human body. So you might ask, why would anyone agree to participate in this study? Well, the men, of course, were not told what the study was. Most of them were poor and could not read. And the public health service offered a few perks, such as free physical examinations, free rides to and from the clinics,

hot meals on examination days, free treatment for some minor things, and a guarantee that their family would get a burial stipend if they agreed to an autopsy of the body. These men were not viewed as men. They weren't viewed even as patients or subjects. They were viewed as cadavers. They were just cadavers in waiting. These, and if you think about these, quote, benefits, they're meager at best. A hot meal, free physical examinations.

$50 for burial. That tells you that this is not, these are not volunteers, right? No, this is, you cannot. And this is, we're going to get in, yeah, I'll get into a bit of this, but this really had a huge importance in later ethical guidelines for what can be considered volunteering, what can be considered informed consent. Yeah. These benefits alone, just, just that little bit shows that in the words of one editor, quote,

the basic rights of Americans, particularly the poor, the illiterate, and the friendless are still subject to violation in the name of scientific research. And people of color were particularly preyed upon. Of course. Like entirely. Oh, entirely. I mean, they were sought out. Yeah. Yeah.

Some of these circumstances surrounding the experiment have been disputed, like whether the participants were told they had syphilis. they were not. They were told they had bad blood. Bad blood was a colloquial term that sometimes referred to syphilis, could be indigestion, could be just not feeling great that day. It wasn't specific to syphilis. In many doctors in the study confirmed that these men were told that they were being treated for rheumatism or bad stomachs, and they were given either just straight-up placebo or an aspirin. Wow. When any of the men were brought to a clinic and seen by a doctor that wasn't involved in the

study, these doctors would try to treat them, but then they would be forbidden to do so. Someone would intervene and pull the person away from that doctor. One of these doctors said that the men were told, if they received treatment, they would be dropped from the study and lose all of their benefits. At least 28 and possibly over 100 men in the study died as a direct result of untreated syphilis. Many other people were infected as a result of these men not receiving treatment, and many children were born with congenital syphilis. This is... Yeah.

When news of this horrifically unethical experiment broke, a lot of the discussion about the ethics centered around the withholding of penicillin when it became recognized as a suitable cure, which was about 10 years after it began. Like, that's the only thing that they did wrong. Right. That barely scratches the surface of the problems with this study. And to be clear, withholding treatment was hugely unethical, but that happened a decade after the study began.

That this study could be dreamt up and executed at all and receive funding for 40 years by the United States Public Health Service reveals a great, deal about how your right to be treated as a human being is inextricably tied to race and class. Yep. The premise of the experiment is the moral issue. It's not surprising that the creators of this experiment would choose to withhold penicillin after designing the experiment in the first place. And this is, you know, probably depressing but unsurprising.

There were many defenders or apologists of the Tuskegee Syphilis experiment. When it first came out, the Public Health Service, barely apologized for it, saying it had never been kept a secret. Results from the experiment had been published in many journals, and there had never been outcry in the 40 years it was going on. And other people defended the withholding of treatment, especially the arsenic and mercury compounds used prior to penicillin, saying that those drugs were more likely to harm than cure.

These people had a bit more difficulty explaining why penicillin was withheld, so reporters turned to the man who was the director of venereal disease during the time penicillin. villain use was widespread. He, he being Dr. John Heller, denied any responsibility for the study and declared, quote, there was nothing in the experiment that was unethical or unscientific. I'm sorry. Can you say that again? Right. Okay. There's so much here. I'm like bursting with information with this and rage. And rage. Yeah. So, well, first of all, of course it was unethical. We can list a hundred million different ways it was unethical. And then in terms of it being unscientific, the whole thing was unscientific. Many of these men had received treatment at the very

beginning of the study, but not all of them. It was inconsistent. Some of the men started out being negative for syphilis and then later tested positive for syphilis, but they weren't shifted into groups. This study contributed nothing to the body of knowledge on ciphilis. syphilis. And many people who were on the outside of the study, who were horrified when they learned of this, said the same things. Even the people who were involved in the study would say, like, but not directly, would say, but what are you hoping to learn from this? It was the curiosity of these men, is particularly one who wanted to, he was entranced by autopsies and by seeing all of the different ways that the body could. Yeah, it was, it's really, really horrible.

Oh, God, that's just. Other people at the CDC said that they doubted that penicillin would have done any good at that point. And then in fact, it probably could have caused more harm than good due to allergic reactions. Absolutely false. Right. Other people went the root of the, it was a different era. We can't apply our 1972 morality to 1930. 32. Gross. Then you have a few physicians defending the study saying that it was their own fault they got syphilis in the first place. The amount of rage. Right. These are physicians, you know, never mind the Hippocratic oath or just basic human decency. They could still be physicians, quite honestly. 1972 wasn't that long ago. Yeah, that's true. The Tuskegee experiment wasn't even the first of its kind.

About 30 years before this experiment began, a similar study in Norway was underway. So why did it need to be repeated? One of the reasons that they gave was because the doctors wanted to see whether syphilis manifested differently in black people compared to white people. And there's a whole lot of historical. context to this, because at this time, there was still this belief that races were biologically based, which is not true. Not true at all.

Right. And that the higher rates of syphilis in certain groups were somehow biologically based rather than socioeconomic. Overwhelmingly, the response to the news of the Tuskegee experiment was horror and a feeling of betrayal. The United States, rather than protecting its citizens from being taken advantage of, was actively preying upon them. For many, that may not have come as a big surprise. And all it did was to increase the distrust of the government, including the branch that was supposed to help and heal people, the public health service.

The Tuskegee Siphilis experiment started a discussion of medical ethics, raising questions about the difference between volunteering and being coerced, and about how medical research, in their quest for objectivity start to see people as subjects, or in this case, cadavers, and left people wondering how many other unethical experiments will come to light in the future? Answer, a lot. A lot. And if any of you have, so this Tuskegee study is not news to you, Aaron. It's not news. It wasn't news to me, although a lot of the details were, because it isn't mentioned in

every single ethical, biomedical ethics course or training. program that you do throughout any public health. You know what's interesting, though, in reading about the biology of it, of syphilis, this comes up often because you can't talk about syphilis without talking about the Tuskegee experiments. But in some of the papers and books that I've read, they mention it in such passing as though it was, oh, regrettable. Like, that's it. Right. It's more like, oh, it's from another era that's sort of like... Rather than like gut-wrenching horror that it should provoke. It's just...

Well, I think, I mean, both gut-wrenching horror and also the realization that a lot of the circumstances that led to people doing this study and thinking this was okay are still in existence today. Yeah, totally. This is, there's a lot more than just... Like, to me, there's a lot more in this study than just, oh, well, this is a course in medical ethics. Right. This is all about how much your rights are tied to your circumstances. Right. You can't look at a study like this, that a study like this took place and was funded for so long and not realize how deeply systemic racism and classism is in our society.

Like, it just boggles my mind that people can try and pretend like that doesn't exist when this was in our lifetime. Yes. Yeah. I encourage everyone who listens to this to go seek out more information. There's a fantastic book, which is a classic that I got all this information from. It's called Bad Blood by James Jones. It's incredible. It is so well researched.

And for someone who doesn't have the time or the design. to read a book. I also watched this Yale lecture on YouTube about it, and it was amazing. I mean, so perfectly done, much better than I could ever do. But a lot of good information there. So after the study came out, there were lawsuits, there were investigations into the ethics of this study. And it did really change the way that biomedical studies are done. It changed the whole process of how to ensure that you are finding volunteers and not coercing people, what informed consent really is. But it did instill a lot of distrust into the U.S. government, rightfully so.

And it should still be such a huge part of the conversation about STIs in general and sort of this, a, shame, blame, and being taken advantage of. and withholding treatment. All of these things sort of go together. And yeah. So my part of this really kind of ends with the breaking of the news of the Tuskegee experiment. Yeah.

And I don't really know much about what's going on in terms of syphilis today. I've definitely seen some news articles flash across my screen that are, I would say, somewhat alarming. Mm-hmm. But Aaron, tell me what's going on. syphilis today? I'd love to. We'll take another short break before we get into it. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand

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Cephalis today. I think you're not alone, Erin, you said that when you think of syphilis, you think of like the past, old-timey. But it is certainly still a disease that's prevalent today. So looking worldwide, the World Health Organization estimates in 2016 was the most recent numbers that I found, that 19.9 million people around the globe were living with syphilis, mostly between the ages of 15 to 14. 49. Okay. And that there were 6.3 million new cases in 2016. That's the estimate. So the prevalence was 19.9, but the incidence was 6.3? Exactly. Million. Okay. Yep. And that's worldwide. Okay. That's, those are lowish numbers. I mean, they're not, yeah, it's not, it's not

nearly as prevalent as other STIs or a lot of other diseases. But here's, but here's, where it gets to be a bummer. Oh, great. Siphilis is on the rise. Yeah, and it has been for kind of a very long time. So in the 80s and early 90s was actually the low of syphilis, especially in the United States. So syphilis, after the 70s, sort of started to decline. But since the year 2000, it has been on the rise again.

So the peak was in the 90s, I think 1990. In the U.S., the, like, cases per 100,000 were 20. That was the peak since the introduction of penicillin. Then they started to fall. But since 2000, they've been increasing every year since then. So in 2017, there were 30,000 cases of syphilis reported in the U.S. That's, 10% more than the year before and the highest rate that we've seen since 1993. Wow. Yeah. Okay. So it's like every year it's been increasing and increasing. Is this a reportable illness? It is.

What's very interesting, and I got a real kick out of this. It's been nationally notifiable, so reportable since 1944, which is like the year after they started treating it. And so if you read up to date, which is like Dr. Wikipedia, it says that because it's been notifiable and it's got unique diagnostic features, most cases are reported. Like, we've got a great handle on syphilis. How would you know? Yeah, great question.

I entirely disagree with that sentiment. Like, because the problem is we only know about. cases that are diagnosed, obviously. We don't know about cases that people never come to treatment for. People who don't have access to health care are not going to be diagnosed. And when we have free clinics and Planned Parenthoods being shut down across the country, you can't assume that people have access and are getting treatment, especially considering that primary syphilis, often you would never know that you have this ulcer. And those numbers that I said, so like 30,000 cases in 2017, that's of primary and secondary syphilis. So that's not including late or tertiary syphilis. We don't,

we definitely don't have a good handle on how many people get late syphilis or what proportion of people that get infected end up getting late syphilis. There has also been an upward trend in late syphilis. Like there's been more cases reported in recent years compared to the early 2000s. but we're still unclear on how, like, exactly what the proportion of people are that present with late syphilis versus early, if that makes sense. Because most people are going to probably present early, but the ones who don't, it's years and years down the line that they're going to end up with tertiary. So there's such a long latent period. There's a lot of numbers out there on, you can look on the CDC, even on Wikipedia, that'll tell you who, quote unquote, gets cephalus, what groups of people. people, I put that in quotes, air quotes, are at the highest risk. And I am not going to get into

the details of that on this podcast. And here's why. Ciphalis is an extremely infectious disease. As few as 10 organisms, usually it's around 50, but as few as 10 microscopic bacteria in an extremely teeming sore can cause infection. And what that means is that anyone having sex of any kind can get syphilis. And that's the reality of it. Right. So there are recommendations on these groups of people should be screened and these groups of people should be screened.

But realistically, in my opinion, this is where we veer into Aaron's opinion territory, if you're a person having sex of any kind with anyone, you should probably get screened. At least once, right? It doesn't hurt. Yeah. And the more people that get screened, the more cases we identify, the greater our chances of reducing the burden of this disease among the entire population, not just in certain groups. Well, and also, STIs have a huge stigma.

There's a lot of shame and blame and all of these things associated with them, and there doesn't need to be. Because these things happen to people. They don't happen just to certain groups of people. they happen to everyone. And so the only way that you can help yourself and help everyone else around you is just get screened. Just get screened.

Yeah. Yeah. In my opinion, if you're having sex, then you should be talking about sex and you should be talking with your partners about sex. And if you're doing that, then you should both be talking about getting screened. I've even seen campaigns that are like, make it sexy, go get screened together, whatever. Who cares? Whatever it takes, just go get screened.

For syphilis, for HIV, for chlamydia, gonorrhea, for all the things. You know what I mean? Yeah. Because, again, this is such a treatable disease. Right. Syphilis is one shot and it's traded, unless it's late and latent, and then it's harder to treat, right? And also deadly, so that's horrific. Um, I will say, so in terms of congenital syphilis,

The numbers also aren't that reassuring because the rates of congenital syphilis mirror the rates of adult syphilis in the population. Yeah. So again, there were downward trends through the 90s, but it's been on the rise since. In 2017 in the U.S., there were 918 reported cases of congenital syphilis. Wow. This includes 64 stillbirths and 13 infant deaths, so after birth. And that's a 44% increase between 2016 and 2017. Oh, my goodness.

Yep. And worldwide, it's estimated that one million pregnancies per year are complicated by congenital syphilis. Wow. And again, 40% of these will result in loss. Yeah. Yeah. So that's very depressing. Go get screened for syphilis.

Every pregnant person that gets prenatal care in the U.S. is screened for syphilis. Right. But that's only if you can afford prenatal care. Exactly. And not everyone can. Thank you, U.S. There's also really high rates of co-infections with syphilis and HIV. Yes.

And that's really important because there's actually evidence that syphilis, having an infection with syphilis, can increase the risk of HIV transmission because it's basically, especially primary syphilis is an open wound. And HIV is not very infectious, but if you have open sores, then it's a lot easier for HIV to infect or be transmitted. And then I saw actually some possible evidence that infection with HIV can also facilitate the transmission of syphilis as well. Okay. So it might work both ways, kind of they co-facilitate each other in terms of infection. Mutualistic. Yeah. Yikes. Yeah. So that's a big time bummer. I wanted to say let's talk about the positives and the current research, but there's not really much positive in terms of the current status of syphilis research. So there are a few groups

and there have been a few recent studies that are trying to come up with a vaccine. And it's seems like it's at least theoretically possible to develop a vaccine for syphilis. But so far, these studies are still in animal models, as far as I can tell. So they're very early studies. Every paper that I read, like in terms of the papers, which I will post these on our website, of course, that's like, what's the status of vaccine research? Essentially is like, hey, we really need to work on this. We need more funding to do so. So, but yeah, so that's pretty much the current status of syphilis. It still exists. It's not as prevalent as other diseases, but it's on the rise. I think, I mean, isn't that the general trend for STIs at the on rise?

It is. Yeah, they are. Yeah. Yeah. I learned a lot today. I did too. I did too. This was a very interesting episode and one of our big ones. Yes. Yeah. Well, before we do sources, I want to give a amazing shout out to Lagusta's Luscious. So this person owns a vegan chocolate shop in Brooklyn, and they reached out to us to send us chocolates for Halloween time. And they are incredible. So, so cool. There's like a bleeding heart that like actually bleeds.

Oh my God, they're so good. We cannot thank you enough. Yes. Thank you so much. it means a lot and is really thrilling. We also never said a public thank you to another listener who sent us these beautiful watercolor drawings of cholera and plague, Yersinia Pestis. Oh my gosh, they're so cool. They're gorgeous. Aaron Welsh took the plague because that's her favorite in the entire world and I got cholera, which is so gorgeous. So thank you to Jen

for that. We love them. And sorry that it took us so long to say thank you. We're first. Okay. Sources. Sources now. So I read a few books for these. I got a lot of the history part from this book called, as you might guess, as I've mentioned, the history of syphilis by Claude Ketel, I don't know how you say his name. And there's a lot of good information there. And then I also read Bad Blood, the Tuskegee Siflis Experiment by James Jones. Incredible book. I highly recommend to you check it out. I'll also post a link to that Yale lecture. And then I read a bit of a book called I love this title, That Jealous Demon, My Wretched Health, which is by Petrick Trelawney, and that's about composers and disease. So, like, each chapter is a different disease,

and then it talks about composers that had them. Oh, how fun. And it's really great because he's like, well, you know, this book says that this person had any, I'm not going to go into it. And then there are a couple papers that I'll post also. As always, we post all of our sources. I had a number of different papers and actually a textbook chapter this time too. We'll post all of our sources and links when possible on our website. This podcast will kill you.com under the episodes tab. You can find the sources from this and every single episode we've ever done. Thank you to Bloodmobile

for providing the music for this episode and all of our episodes. We love it. And thank you all for listening. This is so fun for us. Season three, off with a bang. And with that, wash your hands. You filthy animals.

This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural. healthy. Sounds great, but a lot of these quote-unquote fresh dog foods in your fridge are not even 100% human grade, which is why feed your babies. Feed your babies, just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies. 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious. These are foods that you would want to eat. Not that the babies would ever share. Just food for dogs is the number one vet recommended fresh dog food back by over a decade of research. No marketing fluff. My dogs lose their minds at dinner. They run to the bowl, tags wagging, paws tapping, full Broadway performance every single night.

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