There is so much horse shit being put out about the Tuskeegee Study, most recently this weekend, that it is time to add a few facts. Syphilis was a great scourge brought to Europe from the Americas by Columbus’ crew when they returned. It was ferocious when the epidemic was still new. With time, the manifestations of the disease were less horrible but it was very common. By 1600, one third of Paris was infected. With time, as in all infectious diseases, the virulence declined but it was still a serious disease.
The first successful treatment was with the use of Mercury, first described by Paracelsus who cured nine syphlitics with mercury in 1530. He also provided the first accurate description of the disease and described its manifestations. For centuries after, it was said “One night with Venus may lead to a life with Mercury.” The treatment was onerous and needed to be repeated periodically for life. The discovery of mercurial diuretics in the 1920s came about accidentally through the treatment of syphlis cases with heart failure from syphlitic heart lesions. When I was a medical student, the only powerful diuretics we had were still mercurials.
In 1905, Paul Ehrlich was searching for an antibiotic for syphilis when he stumbled upon the use of organic arsenic. Eventually, by 1910, he announced the new drug called compound 606, or Salvarsan. This was more effective than Mercury and moderately less toxic but it was not the “silver bullet” that he had been searching for. Of course, we currently have hysteria over tiny doses of Mercury in vaccines to prevent contamination.
In 1932, the Public Health Service began a study of negro males who were infected with syphilis. No one was “given” syphilis. This Wikipedia entry, while somewhat biased in tone, gets the facts right in the beginning. The group of subjects was divided into those with early signs, such as genital lesions, and those who were in what is called the “latent phase.” Those with early signs were treated with arsenicals. There was no evidence that latent phase syphilis was treatable.
Instead, we get this sort of thing;
And, you know, you can explain them, as he explained, for instance, the idea that the government in fact would infect blacks with AIDS, by saying, well, remember Tuskegee, when the government actually did infect blacks with syphilis. He does come from a different era, a different age. And so the way he presents himself is very different.
from Sally Quinn of the Washington Post who should know better but probably doesn’t do science.
The discovery and manufacture of penicillin came about in the 1940s and by 1950 there are serious questions about whether treatment should have been offered to those men. The treatment of tertiary syphilis, especially neurosyphilis, requires very high doses of penicillin, doses that were not available until after 1950.
Penicillin remains the treatment of choice for all stages of syphilis, although it penetrates the blood brain barrier poorly. Treatment with intramuscular benzathine penicillin 2.4 million units stat, or 600,000 units procaine penicillin daily does not produce treponemicidal levels within the CSF. However, the incidence of neurosyphilis is low in immunocompetent patients treated with such regimens during early syphilis.
In late syphilis, it is the policy to treat everyone.
Does penicillin cure tertiary syphilis ? Sometimes.
Should the “Tuskegee Boys” have been offered penicillin in 1950 and after ? Yes.
Would it have made a difference ? I don’t know.
I do know that Reverend Wright and Sally Quinn are ignoramuses although he may actually know better.