[This tape was transfered from a 16mm film original by Colorlab for the National Library of Medicine. March 2005. NLM call number HF 4887]

[War Department official Film. P.M.F. 5071. MCMXLVII]

[Pinta]

Mal del pinto, the name given the infection by the Mexicans, affects mainly the dark skinned races:

Indians, Negroes, and mixed breeds.

The Mexicans are vulnerable, for Mexico is one-forth Indian and more than one-half mixed.

But although it is a stranger to cooler climates and other peoples, pinta is not confined to Mexico.

It is common in central America, south America, the Antilles, and Africa --

wherever the climate is hot and humid, and wherever the population is predominantly dark skinned.

Pinta is a disease not only of the tropics, but of poverty.

Among the peons of little outlying villages where standards of living are low and modern sanitary facilities unknown,

pinta is common.

The natives of these endemic rural areas often speak of the Huotes [?] or Empenes [?], the skin lesions that first appear in pinta.

But when the infection reaches its final stage,

its name changes with the color of the strange hued discolorations that spread in blotches over the body.

To faciliate studies, pinta has been introduced experimentally by depositing virulent material

from the lesions of infected persons in light scratchings made on the skin of volunteers.

If the course of the disease remains unchecked, it will in its entire progress go through three separate stages.

A primary lesion will appear in from 7 to 12 days after inoculation and this is regarded as the initial stage.

This primary lesion may take anyone of a variety of forms and may look very much like some other skin ailments.

Because of this close resemblance to other skin diseases,

and the difficulty of distinguishing between them, each variety of pinta lesion is identified according to the disease it resembles.

Each of these three cases, for example, the type of lesion is known as trychophytoid, or "like trychophytosis," because it resembles fungus infections such as ringworm.

This type of lesion is known as psoriasiform, because of its similarity to psoriasis.

Two other types are a lichanoid, a lichen-like capillary eruption, and eczematoid, similiar to eczema.

Because of its resemblence to other skin diseases, the appearance of pinta can be misleading.

The initial phase of pinta lasts as long as the infection remains a single patch, a period varying anywhere from five months to a year.

The secondary phase begins when the first patch spreads to other parts of the body.

By the time this secondary stage is reached, the presence of pinta is usually quite pronounced,

for the lesions become scattered widely over the body, often in large-sized spots, frequently symmetrical.

such lesions are called pintids, the medical term for the patches known colloquially as Huotes or Empenes.

During the course of the disease, various groups of these lesions may appear, merging and expanding,

until at last such damage has been done that great areas become permanently altered and discolored.

In its final phase, pinta brands its victims with great flat spots of discoloration:

blue, violet, black, red, or lead-colored, or, where the pigmentation is destroyed, patches of white.

when this final stage of wide-spread discoloration is reached, organic symptoms are at times observed.

Aside from these symptoms, however, pinta does not make its victims feel sick.

In the first two stages, the lesions may itch a little, but at no time do they cause other discomfort or pain, and they do not interfere with normal activities.

The patient is neither crippled nor disabled, and the disease is never fatal.

But in the areas where pinta is common, it is apt to be considered a life-long curse.

For contagious, but not epidemic, pinta is chronic, often beginning early in life, and running its course for twenty years, or a lifetime.

No age group is immune, but due to its slow development, advanced cases of pinta appear mainly in the older age groups.

In some places, the native term for pinta means "spotted man," a pictorial term for a disease that splashes its victims from head to toe with huge, hideous spots.

The blotches may all be one color, but more often, spots of many different hues appear on the same person --

spots that never fade away, carried like a scar for life.

Pinta is easily distinguishable in its final stage, because of the marked discoloration of the skin.

When this point is reached, diagnosis serves chiefly as a means of minimizing spread of the disease.

For the extensive growth of lesions over a long period of time brings about permanent alterations of the skin,

its vascular system, and pigmentary deposits.

The pronounced coloration makes identification easy, and advanced cases of pinta are usually designated by the color of the spots -- a fairly simple matter when they are all alike.

Nearly always, however, the lesions show mixed coloration, ranging from white to almost black.

Then the type of pinta is given the name of the color most intense or most predominant.

This patient, for example, shows lesions characteristic of the black type of pinta.

The color of the lesions in this case provides the basis for its designation as blue pinta.

In this instance, the pinta lesions are lead-colored.

When the lesions are predominantly hypochromic, or lacking in color, the case is called white pinta.

These blotches of white, spread over great areas, give the patient a piebald appearance.

Also, as frequently happens in pinta, the body hair has completely disappeared from the lesions.

Although skin lesions are pinta's most important manifestation, other signs and symptoms are sometimes reported.

In the tertiary stages of pinta, such as this advanced case of red pinta, so-called because the lesions range from rose to deep, red,

the patient may show symptoms of polyadenitis, glandular inflammation, or in some cases a mild enlargement of the spleen.

Heartbeat may be rapid, or conversely, the heart may beat more slowly.

Mild instances of tachycardia or brachycardia not traceable to any other organic cause.

There may be changes in the nail surfaces, and loss of body hair.

Aortodis is not uncommon, or patients may show a slight lymphocytosis, and oecenophelia.

In this case of red pinta, the color is caused by congestion of the underlying blood vessels, as indicated by response to the pull of gravlty:

disappearing when the arm is elevated, returning when the arm resumes normal position.

On the lower extremities of the body, the red color is especially pronounced.

When pressure is applied, the color blanches, another indication of vascular congestion.

In another case, the pink or rose colored spots stand out clearly against the dark of the surrounding skin.

In this instance also, pressure applied to the skin surface temporarily blanches the area, the blemish returning to its original hue as soon as pressure is released.

Lesions caused by pinta are most frequent on exposed surfaces of the body -- surfaces most subject to trauma, pressure, or friction, for example the face.

The upper shoulders and neck of this man show the effects of clothing rubbing across the shoulders,

and of constant exposure to wind burn and abrasions, accidental pressure, and friction.

Discolorations from pinta are common on the dorsal surfaces of the upper arms and on the elbows,

as well as the dorsal surfaces of the hands and the joints of the fingers.

These blemishes on the hands and fingers illustrates the susceptibility of the parts of the body constantly exposed.

For this reason, pinta lesions are also frequently found over the sacroiliac region,

on the knees, legs, ankles, and the dorsal surface of the foot,

as well as on the buttocks and the exterior surfaces of the thighs.

Rarely, if ever, are pinta lesions found on hollow or protected areas of the body.

They seldom occur, for instance, in the axilla, mid-dorsal regions, the groin, the internal aspects of the thighs, or the popliteal spaces.

White pinta can easily be confused with vitiligo, which also produces white spots caused by loss of pigment in the skin.

In this typical case of vitiligo, however, note that the spots are a flat white.

Unlike pinta lesions, the lesions of vitiligo appear on protected areas of the body, such as the head, axilla, mid-dorsal regions, and the genitals, where they rarely occur in pinta.

Pinta also bears some resemblance to leprosy, for in early leprosy, the patient is marked with whitish patches.

These patches in leprosy, unlike pinta, are insensitive to pain.

Furthermore, the serious organic symptoms occuring in leprosy serve to differentiate it from white pinta.

Note also that in typical cases of leprosy, unlike pinta, the patches may appear on the protected surfaces of the body, the palmar surfaces of the hand, and the genitals.

Because pinta resembles so many other diseases, diagnosis by clinical appearance alone is not dependable.

So for final diagnosis and certain identification of pinta, it is necessary to go to the laboratory for blood tests, serological reactions, and identification of organisms.

The cause of pinta is now know to be a Treponema, and the organism can readily be found in the exudate from the lesion.

This exudate is easily obtained. After the skin is cleansed with alcohol, it is curetted so the serum can be collected as it oozes.

Until fairly recently, pinta was generally tought to be caused by fungi.

About twenty years ago, however, the presence of the Treponema was first suspected, a finding since confirmed in reports from Cuba, Mexico, venezuela, and Ecuador.

Able Mexican investigators report Treponema invariably present in pinta lesions at all stages.

A prepared slide is now ready for examination.

For study of the nature of a Treponema, the serum is examined under a dark field microscope.

Pinta is a Spirochaetosa, or a Treponematosis condition.

That is to say, it is a disease caused by a spirochaete very similar to the spirochaete of syphilis.

The microorganism is generally reported to be about fifteen to nineteen microns in length, made up of a series of spirals.

Screw-like, sharp on both ends, they may occur singly, or be joined end to end.

Like the syphilis Treponema, they usually lose motility in a half to two hours of exposure at room temperature.

Studied in fixed preparations stained with Giemsa, Fontana, or Tribanda[?] stains, the organism appears very similar to the Treponema pallidum of syphilis, and the Treponema pertenue of yaws.

Reaction to Wassermann and other serological tests carried out in a diagnosis of syphillis is also similar.

For in the initial phase of pinta, the Wassermann is consistently negative.

In pinta's secondary stage, about sixty percent of the reactions are positive, and the longer the disease has progressed, the higher the percentage of positive tests.

In pinta's third, or final stage, the Wassermann reaction is one hundred percent positive.

When the stained preparation has been completed, it is ready for examination under oil immersion in the high power microscope.

In the bright field of the microscope, the similarity of the pinta and syphilis Treponema is readily apparent.

There are in fact no readily detectable morphological differences between the two.

Precisely how pinta is transmitted from one person to another is still a question.

From experimental innoculation of human volunteers, it has been proved that the 
disease can be transmitted by direct contact.

Other studies indicate that certain of the insects with short probosces can take up the Treponema from the skin lesions.

This at least gives rise to the suspicion that the insect may carry the Treponema to other persons.

The Simulium hemotypotum, or black fly, is one of the insects known to take up serum from pinta lesions.

Musca hypalades is another likely carrier of pinta infection.

In testing this possibility, the fly is sometimes placed directly on an abraded pinta lesion for observation, and will often appear to be feeding on the exudate.

The presence of Treponema is demonstrated by subsequent tests.

The lesions also attract Musca domestica, the common house fly, another insect with short proboscis being studied as a suspect in the transmission of pinta.

Bed bugs also give evidence of their ability to carry pinta infection.

If it is confirmed that such insects as bed bugs and the common house fly carry the disease,

it can be readily understood why pinta flourishes in impoverished vermin-infested homes, with improper sanitation, and inadequate living space.

Treatment of pinta is carried out with the same drugs used to treat syphilis.

Intravenous injection of the arsenicals and the neo-arsenicals are commonly used in Mexico.

Recent experiments indicate that penicillin is also effective against the Treponema of pinta.

Such effective therapeutic methods can prevent transmission of the disease.

If treatment is administered early enough, pinta can be arrested before it reaches its worst stages, the late manifestations that make it a disagreeable, disfiguring, chronic disease.

[The End. P.M.F. 5071. MCMXLVII]