Bedside Rounds

45 - The French Disease at 500

Apr 22, 2019
Guest
Tony Breu
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 Evaded Early Germ Tools

  • Treponema pallidum defied Koch's culture-based methods and remained uncultivable for decades, hampering early study.
  • Visualization required dark-field or silver staining until improved culture methods emerged only recently.
INSIGHT

Wassermann Test Transformed Diagnosis

  • The Wassermann complement-fixation test (1906) used cardiolipin to detect syphilis antibodies and transformed diagnosis despite false positives.
  • It became a landmark serologic test even though specificity was imperfect.
ANECDOTE

Salvarsan: The First 'Magic Bullet'

  • Paul Ehrlich screened hundreds of arsenical compounds and found compound 606 (Salvarsan) which cured many primary and secondary syphilis cases.
  • Salvarsan required prolonged, costly treatment and later propaganda despite its toxicity and limits on neurosyphilis.
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