Pathology of Syphilis – The microscopic anatomy of syphilis is essentially that of an infective granulomata and consists of round-cell infiltration surrounding the blood vessels and lymphatics. The papular, tubercular and gummatous lesions show a variable but scanty number of giant cells. While the initial changes are in the upper part of the corium, the deeper structures are sooner or later involved in the process. Syphilis differs from other new-growths by the absence of any tendency toward organization, the retrogressive steps occurring from fatty degeneration and absorption or from necrosis and ulceration. Renaut claims that the different syphilitic lesions are structurally the same from an anatomical standpoint and that they show a reactionary defence against the pathogenic agent, causing an endarteritis of a special kind, with slow obliteration and a primary tendency to excite hypertrophy of the tissues about the causal agent.
Prognosis of Syphilis – The large majority of acquired cases respond to treatment. Rarely a long neglected or malignant type proves fatal but such an outcome may be expected in many infantile hereditary cases. The chances for a speedy and complete cure of syphilis rest on several factors, namely, the willingness or ability of the patient to lead an approved hygienic life; the possession of the average degree of resistance to syphilitic invasion; and conscientious attention to continued treatment until successive Wassermann tests are invariably negative. Neither the number or size of the lesions, nor their tendency to suppurate, nor the degree of constitutional disturbance is any indication of the future course of the disease. Frequently those who have only slightly annoying secondaries have troublesome tertiary manifestations and vice versa. Secondary syphilids are usually benign and self-limited in duration and the importance of their treatment consists largely in the prevention of later lesions; in fact, inefficient care of this stage is the chief etiological factor in the appearance of tertiary manifestations. In the tertiary period the earlier the recognition of the lesions and the application of treatment, the more favorable the prognosis.
TReatment of Syphilis – Effective public supervision of syphilis seems impossible and impracticable, owing to ignorance or mistaken sentiments. This is remarkable in view of the number of innocent victims of the disease and the dire effects which may follow the mildest primary manifestations. Syphilis should be classed with other contagious diseases and systematic protective regulations enforced for the benefit of the people. Prevention at present rests in the hands of the individual practitioner who can only advise and insist that his patient take proper means to prevent the infection of others.
Primary syphilis can be managed in various ways, depending on equipment and experience. Where the physician is not equipped with the facilities for examining serum smears for the presence of the spirochete pallida and thus making an immediate and positive diagnosis, the treatment of a suspected case consists of local cleanliness and general hygienic measures such as regular exercise, sleep and avoidance of dietary excesses. Cleanliness of the suspicious lesion may be accomplished by thorough bathing of the parts at least three times a day with a solution of mercuric chlorid (1:5000), the lesion in the meantime being covered with an antiseptic powder like boric acid, iodol or calomel and protected by a loose covering of sterile gauze. Excision of the initial lesion is warmly commended by some authors because it rids the patient of the greatest focus of infection. Without specifying the real nature of the disease, the patient should be warned of the possibility of infecting others and be kept under observation until the diagnosis is verified by the advent of such manifestations as general adenopathy, fever, headache and erythema, which occur within six weeks after the appearance of the initial lesion, if the suspected diagnosis proves correct. It is argued that syphilis should not be allowed to progress thus far without treatment and, while I acknowledge the soundness of this argument, I advise against it, for it is far better that a man who has syphilis should run a few days without treatment than that a mistake should be made and a patient condemned to suffer for a lifetime the torments of a subjective syphilis.
The constitutional treatment of active syphilis embraces all the factors that contribute to improve the patient’s hygiene and make for healthy surroundings such as change of air, simple diet including abstinence from alcohol and stimulating, spiced or rich foods, moderate use of tobacco, out of door life, regular sleep and general tonic treatment if anemia be present.
Internal Treatment – Just as soon as secondary symptoms appear or as soon as a positive diagnosis can be made by the finding of the spirochetes in the serum of the initial lesion, active internal treatment should be commenced. The advent of the Wassermann test and its modifications and the introduction of salvarsan and neosalvarsan have revolutionized the treatment of syphilis but it is well to remember that we have other specific means which for a long time have proven efficacious. It will be some years before positive data concerning the permanent effects of salvarsan can be known and at this time our enthusiasm over its action should be tempered by its conservative application.
Mercury is deservedly popular having been successfully used for centuries and while thousands have been cured by its use, some individuals cannot be reached by doses that can be tolerated. It may be administered by mouth, by inunction, by fumigation and by hypodermic and intravenous injections.
The relation of the action of mercury and its salts to the syphilitic processes is most readily understood by comparing the manifestations of secondary syphilis with the provings of mercury as verified and arranged in Allen’s Handbook of Materia Medica. It is the proneness to suppurative and ulcerative destruction of the surface tissues in the action of mercury which points to its applicability in the treatment of syphilids because it is this tendency we most desire to prevent and combat and over which mercury often exhibits a magical influence. A mercurial may be given with the beginning of the secondary symptoms or eruptions in frequent and fairly large doses of the lower decimal attenuations, but never to the extent of producing salivation or for an unlimited time, lest the general health of the patient suffer or a mercury-fast strain of spirochete pallida be developed. Mercury may be omitted every few weeks and another indicated remedy prescribed in the interim of days or weeks, but this alternating mercurial treatment should be continued for two or three years with a gradual lessening of the dose and lengthening of intervals in the last half of the course. However, it is rare that such a course is pursued nowadays because the newer methods of treatment are so well combined with early mercurial medication. I see no reason to change my opinion that the selection of the mercurial should be based upon its symptomatic relations so choice may be made of Mercurius sol. (1x), Mercurius dulc. (1x), Mercurius cor. (2x or 3x), Mercurius protoiodid (1x or 2x), Mercurius biniodid (1x or 2x) and rarely Cinnabar in the lower potencies. According to the needs of the case, the interval of dosage may vary from two to six hours and the one grain decimal tablet triturates are the most convenient form to use.
Inunctions produce a rapid effect and are correspondingly efficient. The process consists in rubbing into a portion of the skin, selected and prepared for the purpose, 20 to 60 grains of a 25 to 50 per cent. mercurial ointment made with fresh lard. It is best to arrange to give inunctions in courses of six. The surface of the body is divided into six portions, (1) right arm, (2) left arm, (3) right leg, (4) left leg, (5) the back, (6) the abdomen and chest. It is not important to include the head, neck or hands but, if inunctions are made in these exposed regions, a white precipitate or calomel ointment may be substituted for the ordinary blue ointment. Before an inunction the portion of the surface to be rubbed should be scrubbed with a lather of soap, washed off with hot water, dried and then wiped over with alcohol. If the operator’s hands are sound he need only protect them with an application of oil or soap before, and thoroughly wash them at the end of the rubbing; if abrasions or cracks exist rubber gloves may be worn. About half an hour is required to make a satisfactory inunction, and it is usually repeated every night, until a course of six has been given. Later another course may be started if needed, or other methods of treatment substituted. The patient should always be examined before each inunction and if any tendency to salivation appears, the treatment should be suspended for a suitable time. It is generally better to wash off the remains of one application just before another is made in a different region, thus keeping only one area anointed at one time.
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war