OVERVIEW OF SYPHILIS

I.  Physiological Considerations

    Syphilis - commonly called lues, a word derived from Latin meaning pestilence (Lues venereal, venereal pestilence) - is caused by the spirochete organism Treponema pallidum which enters the human body through mucous membranes or skin abrasions, usually by sexual contact from an infected person harboring the organism.  Upon entering an area of contact, a painless lesion called a chancre is formed.  At this point the course of the disease is in the primary stage of syphilis.  Before the lesion resolves itself, examination of the exudate of the chancre can sometimes show the presence of T. pallidum under the darkfield microscope.  The presence of these organisms in the lesion at this point is diagnostic of syphilis.

    One must be experienced to identify treponemes, since some spirochetes (such as T. microdentium in the mouth) can resemble the syphilis organism quite closely.

    The chancre next resolves itself completely, and the course of the disease will progress to the secondary stage (two to ten weeks after the chancre heals) where cutaneous involvement occurs.  A rash will appear in the ano-genital region, axillas, and the mouth.  Secondary syphilis can also occur as meningitis, chorioretinitis, or periostitis.  However, a goodly number of patients will pass through this stage without showing any symptoms.

    The secondary lesions resolve themselves and the insidious spirochete will invade deeper into the surrounding tissue.  This is then the tertiary stage of syphilis.  Here granulomatous lesions (gummas) occur in the skin, liver, bones, and degenerative changes come about in the central nervous system.  In some cases, syphilitic cardiovascular lesions occur causing aneurysms.  Recently treponemes have been demonstrated in the gummas, and the tissue response must be attributed to a hypersensitivity to the organisms at this stage.

    These various stages described are not absolute.  Some people have no outward symptoms in the primary or secondary state, but these individuals may have profound involvement in the tertiary stage or may not show any involvement at all.  It is interesting, too, that 25% of the cases of early syphilis will seemingly resolve themselves completely.  The other 25% of the cases will go into a latent stage and remain so while the remainder will progress to full blown cases of tertiary syphilis.  The time of appearance of late syphilitic manifestations will vary from patient to patient.  In the latent stages, an arbitrary time of two years is selected.  Under two years is called early latent, and the possibility of infection of a partner remains.  After that time, the late latent stage is entered, and infection of another is unlikely although the possibility of tertiary syphilis appearing remains even for these persons.

    Congenital syphilis can occur in the fetus since the treponeme can cross the placental barrier after the 18th week of pregnancy.  The time of initial infection and the duration thereof during gestation will decide if the child will be stillborn, have fulminating syphilis, or be uninfected.  If the mother has primary or secondary syphilis, the chances are quite high that the fetus will be infected.  In late latent syphilis of the mother chances are somewhat better that the child will be well.  These children that are affected and are born alive may have signs of congenital lues: interstitial keratitis, Hutchinson's teeth, Charcot's joints, saddle nose, periostitis, and a variety of central nervous system anomalies.  Early congenital lesions may be shown in the neonate under two years of age. (These lesions may resemble the secondary stage in the adult.) After two years the secondary lesions will resolve as well as all the manifesting congenital signs.  Sometimes the central nervous system symptoms may manifest themselves as late as the late teens.  As in regular syphilis, no definite timetable can be given when late congenital lues will erupt as well as how it will show up.

    There are two schools of thought concerning the origins of syphilis.  One claims that its origin was in the New World when Columbus' men brought it to Europe from the Haitian Indians.  The men passed it on to the prostitutes, who passed it on to the local population and the Spanish soldiers, who bore it to the religious wars that were to plague Europe along with syphilis - which was called then the "Great Pox." The second group maintains that the disease was always present in a benign form until the 1490s.  Some scholars believe that evidences for late syphilis are noted in early records such as the Books of Leviticus and Job where late syphilis symptoms are described in Job's sores that covered him from head to foot and in the Levite's function to look for "leprosy" signs.  The disease in Renaissance times was quite virulent until it evolved into the more mild, chronic form that it is today.  While the disease is milder and usually not fatal in the secondary form, its fatality can result from complications of late syphilis nowadays.

    The diagnosis of syphilis presently is made not only with clinical evidences but also with treponemal and serological tests.  As mentioned before, the darkfield test is run to see the presence of spirochetes.  Also an improvement in this technique is shown by the fluorescent darkfield test (FADF).  In this test, the serum from the lesion containing spirochetes is put on a glass slide and allowed to dry.  Then a fluorescent antibody is put on, rinsed off, and the slide is put under an ultraviolet microscope to see if the organisms are present.  The microbes fluoresce if present.  If they are not present, no fluorescence is seen.  This test is convenient for physicians who do not have a darkfield microscope (the dried slide can be sent to the laboratory by mail).

    Of course, many cases of syphilis do not show in lesions where the organism can be observed (especially after the lesions resolve), so serological tests must be made.  When the treponemes attack body tissue, two reactions occur.  One is the antibody response against the treponeme itself.  The other is the formation of the antibody complex, reagin, which is formed by release from tissue debris of a hapten that in turn joins a protein to be attacked by an antibody.  The ease and the ability to quantitate the reagin which is equivalent to the amount of treponemal involvement make the reagin test the test of choice for screening and to follow treatment.  The effectiveness of treatment can be noted by the drop in titer.  The rise in titer of reagin increases through primary and secondary syphilis and may drop in the latent stages, although the titer can sometimes rise in tertiary involvement.

    The easiest reagin test is the flocculation test where lipiodial or cardiolipid antigen is added to the serum to form a visible aggregate.  If no reagin, then no reaction.  The VDRL slide test is usually done nowadays to test for reagin due to convenience and accuracy.  The fact that it is a slide test (read with a microscope) and a fairly rapid one lends it to common use in the laboratory.  During the early days since the discovery of a practical flocculation test in 19 1 0, many other tests were developed such as the Kahn, Kline, VDRL, Hinton, and Mazzini.  The complement fixation test developed by Wasserman in 1906 (first practical serological test for syphilis developed) has been improved many times since then. (Kolmer in 1922 refined the complement fixation test to such a point that it remained a test of choice until the advent of a practical treponemal antibody test.  It was more specific than the flocculation tests.) The principle is that complement is drawn away by the antigen and reagin from the sheep red blood cells and hemolysin which must have complement to complete the reaction and lyse the blood cells.  If reagin is present, there is no lysis; if not, the lysis occurs.  While a positive reagin test will be indicative of syphilis, reagin will also be formed by the following disease processes:

• Malaria
• Leprosy
• Yaws
• Relapsing fever
• Pinta
• Mononucleosis
• Vaccina
• Pregnancy
• Febrile diseases
• Lupus erythematosis
• Immunological disorders (usually of genetic disorder)

    In these cases, careful screening is needed by the physician.  Reagin tests are not limited to serum alone.  Some, such as the rapid plasma reagin test (RPR), have developed quite recently for fast screening. (This test has been automated to do reagin tests on a mass scale.) The reaction is essentially the same as the flocculation test with the addition of carbon to indicate flocculation.  But the problem still remains to have a specific and sensitive test for treponemial antigen, especially in doubtful cases where the patient gives a negative history.

    The test of preference is the treponemal immobilization test (TPI) developed in 1949.  If the person's serum is reactive, then the live organism (in the presence of complement) is immobilized; if not, then it will remain mobile.  While in theory this test is simple, technically it is very complex, sensitive, and expensive.  The fact that live rabbits must be used to culture the organism (it can't be cultured in vitro) and the factors that can affect the serum to give a false positive (such: as rubber stoppers on the serum tube which give off toxic material into the serum) make this test impractical for routine use.  Rather it is used to be a reference to the fluorescent treponemal antibody-absorbed test (FTA-ABS), or "FTA" for short, developed in 1964 for general use.

II. Rationale of Therapy

    Treatment in the 19th and previous centuries consisted of iodates, mercury, and bismuth.  While these heavy metals were questionable in their bacterial activity in the body, they did seem to resolve the syphilitic lesions and provide a barrier to prevent further involvement of the organisms.  The first good antitreponemal compound came about 1906 with Ehrlicif’s salvarsan "606" arsenic compound that could be injected into the bloodstream without undue toxicity to the patient.  While it could lower the titer, its staying power, unlike the other heavy metals, was not long, and some persons had reactions to it. Treatment was long, and arsenicals had to be used with other heavy metals to have a lasting effect.  In secondary or late syphilis, treatment sometimes had to be repeated as relapses would occur.

    It should be noted that while iodine was thought to be nonantitreponemal, it did help to resolve granulomatous tissue and was less toxic than all the metals used.  Iodine was used with arsenic therapy in central nervous system lues to avoid the allergic reaction (Herxheimer) to arsenic.  The iodates were used since 1836 for treatment of central nervous system syphilis since the French discovered their use.  Mercury (quite toxic to the kidneys) was used since medieval times.  Bismuth was used preferentially to mercury since the 1870s.  It could produce reaction when overused.  Fever therapy (induced malarial infection-cleared up by quinine) was used with arsenic in 1918 (arsenic does not affect the malarial parasite) since the spirochete is sensitive to temperature change.  A modification of this was steam cabinet therapy with arsenic-much to the discomfort of the patient.  The treatments (all modifications) were long, uncomfortable, repeatable, dangerous, and sometimes painful; many patients decided that the cure was worse than the disease.

    But the advent of penicillin therapy in 1943 with improvements in early 1946 (oil instead of water base) proved to be a godsend.  Even to this day, it remains a drug of choice since the spirochetes have not developed resistance to the drug.  Unless there is an allergic reaction to penicillin, the drug is non-toxic, spirocidal and can be applied in one course of treament.  In late syphilis, several injections may be needed to kill the hidden, widely scattered organisms.  If the patient is allergic to penicillin, other antibiotics are needed.  The course of treatment here is longer, as these drugs are not as effective.

    As for epidemiology, sexual contact is the fomite - not the poor maligned toilet seat, dirty washrags, or other such nonsense.  The spirochete is fragile, sensitive to temperature and drying (the spirochete will perish in 30 to 45 seconds when removed from the body and exposed to the hostile environment), and is sensitive to disinfectants.  The organism forms no spores and must be spread by sexual contact from one partner to another to survive the generations.  If mankind could refrain from pre- and extramarital intercourse and only have intercourse with uninfected or treated partners, the disease would eventually die out.

    Accidental infection can occur if one touches an open wound or mucous membrane to an active lesion.  Reinfection can occur, as a case of syphilis confers no immunity.  What the doctor and the health department expect from the patient is cooperation in finding contacts to help stop the spread of disease.  It is cruelty to the contact not to be reported.  In this case, the disease is spread and the untreated person may be doomed to eventual death from late syphilis as well as to spreading the disease further.

III.  The Cayce Readings on Syphilis

    Several Cayce readings on syphilis in the male were given.  In reading 862-2, the patient comes to him with a reactive blood test.  All tests made in 1935 were of a reagin nature and thus did not confirm a case of syphilis.  If you note reading 862-1, Cayce warned the patient of toxemia if normal hepatic circulation were not restored.  With a positive reagin present, Cayce's diagnosis of an infectious force that produced a humor is borne out; but with the negative history, an irresolution of the toxemia had seemingly produced this biologic false positive (BFP) as far as syphilis is concerned.  In readings 862-2 and 862-3, a low-acid diet and electrical stimulation by a low-voltage wet cell appliance are given to bring about coordination in the circulatory forces.  Serum injections are suggested in the readings but were not considered necessary.  However, in reading 862-3, it is mentioned that the patient might well be infected with late syphilis, though the information only hints at it and gets on with the treatment.  In 862-4, the infection begins to resolve.  A comment is given that the disease is infectious but not contagious, as is usual with late lues.  Reading 862-5 is but a check reading.  After this reading, [862] had injections (probably arsenicals) which activated the immunological system to reject a sac that contained shrapnel-synovitis.  The treatment prescribed by the information is unusual, but it seemed to work in this person's case until the patient went against the information. (Surgery was suggested in 862-6 to remove the sac.)

    Case [1289] is a sad one, of a child doomed by congenital late syphilis.  The involvement is so profound as to cause Edgar Cayce to sign off with no absolute diagnosis of syphilis although he made the syphilitic nature clear in 1289-2.  The readings gave forgiveness and benediction to the foster parents of the stricken child for whom he made a prophecy of death.  The lack of a question period seemed to add finality to the first reading.  But in 1289-2, hope is offered to the parents to meet their sin of poor attitude by administration of hot castor oil packs along with a diet to aid the child.  While the readings did not offer conventional therapy, it did offer hope in the changes of heart and a possibility of a miracle.

    Case [1854) is an accurate diagnosis of a gumma in the lung which was mistakenly thought to be tubercular in origin.  Here apple brandy inhalations are suggested for relief.  Calcidin (calcium iodate) was taken orally which would supply iodine to resolve the syphilitic tissue.  Atomidine and electrical appliances were used for the stimulation of the lacteal ducts to throw off the infection.  If you note the letters of follow-up, the young man had been diagnosed as a syphilitic and had been treated with arsenic and steam cabinet therapy.  His reaction to the drug was taking its toll on him.  The selection of Calcidin seems in line with traditional therapy to resolve the lesion.

    Case [5061] is an example of paresis.  Only hypnotic sedation is prescribed for the patient.  So far gone was he that any therapy known to us or to Cayce's source of information would not have resulted in a cure.

    In readings 5067-1 and 5067-2 we find a case of a malignant form of advanced tertiary syphilis throughout the body of the patient.  The disease was so advanced that no treatment known at that time could have helped the person.  An ultraviolet light filtered through a green glass was to be held over the area of the spine along with the application of a shortwave oscillator.  This was probably for the encouragement of the immunological and cell forces throughout the body.  Penicillin was a rare and expensive drug (rationed during World War 11) and was in an aqueous state but had not proved to be reliable to clear up lues, especially in late cases.  Injections had to be given over a long time, since an oil carrier had not yet been found (discovered in 1946) to provide staying power for the drug.  Arsenic and bismuth were not used by the physican since it may have been too late to utilize these drugs with the patient in such a weakened condition.  Even if the microbes were killed Off, it would not have resolved the gummas present that were affecting the patient.  We do not know if the treatment would have worked since not all the steps were carried out as prescribed.  As is usual with severe late syphilis, the patient died.

    In the cases of syphilis in the female we have an example of an early case of lues in [3120].  Not only is the disease diagnosed correctly, but also congenital malformation and possible death for the fetus was predicted. (The infant did die soon after birth.) Adjustments were given to the spine in preparation for childbirth.  Internal and external applications of iodine were given in the form of Atomidine (taken orally and by douches).  Shots given by a medical doctor previously (no mention of drug given) had not cured the infection.  The follow-up reading, 3120-2, indicated no central nervous system lues and urged the patient to keep up the treatment, along with a pep talk.  Here a good follow-up was done; and it indicates that the patient was still living in 1962 with no apparent relapse of symptoms.  Since the reading took place in 1943, the time period with no evidence of a relapse is a good prognosis.

    The patient in reading 4418-1 had pain and discomfort with the formation of a gumma.  A codeine medication was given to ease pain and to prepare her for a following reading.  Reading 4418-2 prescribes an herbal tonic, steam cabinet therapy with iodine, followed by oil of wintergreen (stimulates the pores) and a salt massage.  This does sound like the steam cabinet treatment with iodine substituted for arsenic.  There is no follow-up on this case.

    Admittedly, the information by Cayce did not always agree with medical advice for syphilis at that time or even in our era.  However, when his advice was followed, it did work (such as in [3120]).  The treatments went into areas neglected by present medical science because of the advent of penicillin.  Late and congenital syphilitic cases are rarely seen today due to early diagnostic techniques with routine screenings of people (premaritals, prenatals, and new hospital patients have their blood drawn nowadays for reagin tests as well as possible contacts) and eradications of treponemes by penicillin in one treatment.  One can conclude from the readings the following:

1.  Therapy consisted of iodine and the iodates - these being less toxic than arsenic and bismuth.  Penicillin may not have been suggested since there was no practical treatment by it during the psychic's lifetime.

2.  Where the system was overtaxed by the spirochete, stimulation was given to the lacteal ducts by ultraviolet light, wet cell application with noble metals and iodine.  Electrical oscillation was used for severe cases.

3.  Prescriptions were individual and could call for any of the combinations of the above.

4.  Psychological and spiritual counsel was given as an adjunct to the treatment where applicable.  Treatment was not limited to the body alone.

5. Applications of other drugs (the herbal tonic) were sometimes prescribed.

6.  Treatments could be applied as long as the body and the mind were still capable of responding.  Severe late syphilis lies beyond any help (such as cases [5067], [12891, and [5061]).

7.  When treatments were applied, remission of symptoms occurred with no relapses.

    Today's science has a long way to go to explain completely why these treatments worked.  Such explanation would call for a complete understanding of the immunological, cellular, and organ systems.  Some of the medications that were suggested should be studied for their effects upon the human body.  The source of cellular resistance stemming from the lymphatic system are yet to be proven.  The record remains open.  As one physician said: "He who understands syphilis, understands medicine."

References:

Bernet, C.W. Clinical Serology.  Springfield, Ill., Charles C. Thomas Co., 1968.

Brown, et. al.  Syphilis and Other Venereal Diseases.  Cambridge, Massachusetts, Harvard University Press, 1970.

Stokes.  J.  Modern Clinical Syphology.  Philadelphia, W.B. Saunders Co., 1926.

Syphilis, Synopsis.  U.S. Department of Health and Welfare: Washington, D.C., U.S. Printing Office, 1967.

Jawetz, et. al.  Review of Medical Microbiology.  Los Altos, California, Lange Medical Publications, 1966.

Eagle, H. The Laboratory Diagnosis of Syphilis.  St. Louis, Missouri: The C.V. Mosely Co., 1937.

[Note: The preceding overview was written by Richard M. Wright and is excerpted from the Physician's Reference Notebook, Copyright © 1968 by the Edgar Cayce Foundation, Virginia Beach, VA.]