45 - The French Disease at 500

Apr 22, 2019

In this engaging discussion, Tony Breu, a hospitalist and pathophysiology expert, delves into the intriguing history of syphilis, from its arrival in Naples in 1495 to the profound impact it had on modern medicine. He shares fascinating topics, including the historical use of mercury in treatments, experiments involving malaria, and the evolution of germ theory. Listeners will be captivated by bizarre past practices and ethical dilemmas surrounding syphilis treatments, as well as the disease's surprising resurgence in contemporary public health.

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INSIGHT

Syphilis Shaped Internal Medicine

William Osler argued that mastering syphilis required understanding medicine as a whole because it affects many organs.
This multi-system nature helped spur internal medicine as a specialty in the late 19th century.

ANECDOTE

1495 Naples Sparks A Pandemic

In 1495 an outbreak in Naples produced a new illness called the French disease that spread rapidly across Europe.
Chroniclers quickly described primary chancres, rashes, and congenital cases within a decade of the outbreak.

INSIGHT

Why The Chancre Is Painless

Primary syphilis chancre is characteristically painless, likely because Treponema invades deep sensory nerves beneath the lesion.
Early nerve invasion also offers a direct path for central nervous system spread, explaining early neurosyphilis cases.

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In 1495, a mysterious and deadly plague struck the city of Naples. Over the next 500 years, the medical attempts to understand and treat this new disease -- syphilis -- would mold and shape medicine in surprising ways. In this episode, Tony Breu and I will perform an historical and physiological biography of syphilis, covering the development of germ theory, epic poetry, mercury saunas, intentionally infecting patients with malaria, magic bullets, and lots and lots of experiments on poor rabbits. This presentation was performed live at the American College of Physicians’ national meeting in Philadelphia on April 11, 2019.

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