SYPHILIS COMPARATIVE STUDY OF DIAGNOSIS AND CURE


This shows that we do not succeed in curing syphilis. If our therapeutic means are impotent to cure syphilis and sterilize the system of treponema, they are incapable of curing all syphilitic lesions which arise in the course of the disease, and they cannot hinder the development of all syphilitic lesions. They have, however, the power of preventing hereditary transmission of syphilis.


IN ARRIVING at the present status of syphilitic therapy, research has brought to light the following :.

From Modern Clinical Syphilology, 2nd Edition, 1936, by John H. Stokes, M.D., Professor of Syphilology, University of Pennsylvania, formerly head of the Section on Syphilology at the Mayo Clinic, member of Commission on Syphilis, League of Nations Health Organization, and Consultant in the U. S. Public Health Service.

“At the League of Nations Conference on Syphilis Treatment, Queyrat, from a large French experience, made the informal statement that the detoxification of antisyphilitic medicaments had proceeded to the point where many of them were therapeutically worthless. Other observers, both in this country and abroad, including Kolmer and myself, have mentioned this position.

The work of Dale and White, and of Voegtlin and his associates in demonstrating the extraordinary fluctuations in therapeutic effectiveness that occur in market lots of neoarsphenamine will be more fully discussed later. The recent demonstration by Kolmer, Schamberg and Brown that the currently used trypanocidal test for arsphenamine therapeutic efficiency is not satisfactory as a test of spirillicidal activity” (p. 173).

“To decide with accuracy and promptitude, first, whether the patient has syphilis or not, and second, what form of modern treatment will most nearly approach the curative goal, is anything but a simple matter from the standpoint of the public health” (p. 174).

“Weigh the risks against the benefits : There are risks so serious, especially in the treatment of late cases by intensive methods, that the patient should not be asked to take them. There are benefits so doubtful and methods so double-edged that a hair- line judgment can every properly be drawn between the decision to do or not to do” (p. 175).

“Therapeutic shock : Jadassohn, in 1898, and Finger, in 1910, gave confirmation, the latter observer first noting the much more striking effect of arsphenamine as a source of such reaction. The term “therapeutic shock” used throughout this work impersonalizes the observation but emphasizes its potential gravity and significance, which are often paramount in the later stages of syphilis and in the involvement of vital structures in which local edema and reaction can have serious and even fatal consequences” (p. 177).

“Therapeutic paradox : The intense action, particularly of the arsphenamines, produces not only therapeutic shock but a rapidity of healing which has disadvantages sometimes far exceeding any possible advantage. In early syphilis, rapid healing provided it be accompanied by adequate spirillicidal action, is ideally desirable. In late syphilis rapid healing is tantamount in many cases to a high degree of fibrosis and replacement of organ parenchyma, which may have the most serious effects.

It was presumably with such considerations in mind that the original directions for the use of arsphenamine, as pointed out by Wile, contained explicit cautions against the indiscriminate use of the drug in late syphilis of the visceral and cardiovascular apparatus. To Wile belongs the distinction of having formally revived these cautions after a decade of indiscriminate enthusiasm and to have pointed out the seriousness of what he has called therapeutic paradox as a general problem of treatment. My contacts with the older clinicians have gradually weaned me away from the excessive confidence in the arsphenamines which I shared with the arsphenamine therapeutic generation a decade ago” (p. 179).

“A typical example of arsphenamine therapeutic paradox appears in the treatment of syphilitic cirrhosis of the liver. The patient with a markedly enlarged, diffusely involved cirrhotic liver, but showing no evidence of portal obstruction, is placed at the outset on arsphenamine treatment, and makes an initial rapid response with improvement in general condition and marked reduction in the size of the liver. This therapeutics gain, however, is too often short-lived.

Presently the patient begins to lose ground; the shrinking of the liver by the rapidly developed fibrosis is accompanied by obstruction of portal circulation, ascites appears and serious complications with perhaps an ultimately fatal outcome, too often ensue. In a case of this sort the rapid healing effects have so seriously interfered with the circulation and function of the liver that by virtually reducing an important viscus to a mass of fibrous tissue, the drug has killed the patient while curing the disease.

In coronary and myocardial involvement the rapid advance of myocardial fibrosis and embarrassment of circulation by coronary occlusion is one of the distressing sequels of the too ready use of arsphenamine in syphilitic cardiovascular disease. DeSchweinitz has repeatedly emphasized to me the damage done by fibrotic healing under arsphenamine treatment as applied to ocular syphilis” (pp. 179-180).

“Intuitive and experiential factors : It has always been hard to realize that our vision of what is really happening under treatment is indirect and subject to unknown correction in term of peculiarities of host and organism, for which we have no means of measurement or detection. We expect standard results for standard amounts of treatment, as if we were carving a block of known hardness with stools of a known edge.

Instead, we obtain a central group of good results, a margin of medium results, and a fringe of failures which, when seen in itemized form, looms large. It is not too much to say that there is a modern technic whose effectiveness can be expected to range from 50 to 100 per cent for the achievement of every practical therapeutic aim in connection with the disease. To refer to hearsay or to the instructions on the drug wrapper, may lead to a catastrophic denouncement” (pp. 180-180).

“System vs. individualization : While this phase of the disease may tolerate the therapeutic pounding appropriate to the radical cure objective in the early weeks or months of the disease, it is a very proper question, involving many still unsolved problems in the defense mechanism, as to whether such routinized and perhaps overenergetic treatment is necessary or desirable. Certainly, with respect to the older patient suffering under the handicap of increasing years with their attendant incapacities of syphilitic and other origin, therapeutic bludge can not be made a routine” (p. 182).

“The parasitotropic views : A number of investigations have shown that the mode of action of one therapeutic compound upon two different types of organisms or even upon two species within the same family, may vary considerably and that compounds within the same group, as for example, the arsphenamines, may act in different ways upon the same organism. This makes grouping extremely difficult but none the less not wholly impractical” (p.187).

A schematic comparison of arsphenamine, bismuth and.

mercury (p. 188).

Arsphenamines | Bismuth | Mercury

Induces therapeutic |Too slow for |Practically not directly.

paradox & healing

|public health | spirillicidal.

fibrosis. |purposes. |Does not control infectious

Hence dangerous at the | | lesions.

outset in late syphilis | |Totally inadequate

alone.

of vital structure. | | in early syphilis.

Toxic for heart and | |

blood vessels. | |

Toxic for liver and skin.| |

Gastro-intestinal | |

toxicity annoying, not | |

serious. | |

“Treatment allergy : The arsphenamines have a distinctive and unfortunate peculiarity of great importance to the general management of treatment for syphilis. This is the ability, when insufficiently used, particularly, to induce a state of hypersusceptibility in the patient, which results in fulminating relapse, provided the infection has not been extinguished. The analogy of this peculiar state to the umstimmung or allergy of late syphilis is quite apparent clinically, for the allergic type of relapse usually takes on the clinical characteristic of huge and destructive gumma formation in skin, bones, or even the nervous system.

A convenient though by no means an evaluated theory of this sometimes disastrous result of insufficient treatment is the view that the rapid destruction of the organisms of the disease by the arsphenamine group of drugs deprives the body of its one primordial and essential stimulus to fight the infection on its own account, namely, the presence over a long period of time of the pathogenic agent” (p. 197).

“The radical or complete curability of syphilis in man remains to be proved. The control of the disease by prevention of infection is possible” (p. 230).

“Warnings of hepatic complications : Some liver injury probably accompanies all treatment with arsenicals and may be serious” (p. 482).

“Therapeutic shock : as has been stated, occurs in all acute processes in the eye when treatment for syphilis begins, even, paradoxically, when there is no syphilis present, as in nonspecific therapy (see p. 203). Haemorrhages into the vitreous may be precipitated in patients who have had them before, and a nonspecific uveitis may show a marked flare-up with subsequent improvement.

A warning should be given relative to the importance of inquiry into ear symptoms before the first injection of arsphenamine is given, particularly in early syphilis, for the effects of therapeutic shock in such cases are apt to be permanent and disastrous. The other cranial nerves have, in my experience, shown no intrinsic drug reactions, whatever” (p.503).

Studies on Granulocytopenia–Von Bonsdroff, Bertel–Acta Medica Scandinavia, 91:552-609 (April 23) 1937. In three cases the illness was probably caused by antileutic treatment with neosalvarsan and bismuth. Two of the patients succumbed.

FAILURE OF (606) TO CURE SYPHILIS.

At the meeting of the French-speaking dermatologists and syphilographers at Brussels, July 24 to 28, 1926 (Ch. Flandin, Bull. med., Paris, 1926, 1251), the question “Does one cure syphilis ?” was asked by Flandin at the meeting of syphilographers, and it was followed by vehement applause and protest. Flandin is of the opinion that, excepting in the initial stage, preserological chancre, our present-day therapeutic methods, do not enable us to remove treponemata from the organism, where they continue capable of producing late cutaneous and visceral lesions and whence they can be transmitted to the offspring.

This shows that we do not succeed in curing syphilis. If our therapeutic means are impotent to cure syphilis and sterilize the system of treponema, they are incapable of curing all syphilitic lesions which arise in the course of the disease, and they cannot hinder the development of all syphilitic lesions. They have, however, the power of preventing hereditary transmission of syphilis. The above considerations show the necessity of continuing treatment of syphilitics indefinitely at intervals for the sake of prevention of further spread.

The authors patients generally consulted him for some visceral disturbance, such as aortitis, and they had generally been treated correctly, had had repeated examinations and tests, which were negative for years, and still physicians assured them that no more tests or treatment were necessary. In the meantime aortitis developed insidiously, De Keyser, at Brussels, stated that syphilis is cured not only by anti-syphilitic remedies but spontaneously. However, there are the large number of gummata, which develop after 20 to 50 years, as contradictions.

In a discussion by Dr. Lehrfeld on syphilis and blindness, published in the Journal of the American Medical Association, September 4, 1937, p. 782, the following statements were made:

“The most important conclusion of the survey is that the present day treatment of syphilitic patients having optic nerve involvement is entirely unsatisfactory as far as improvement of vision is concerned The preponderance of syphilitic optic trophy among the white patients compared with the Negroes, in whom syphilis is five times more prevalent, may be a basis for suspecting that present methods of treatment may precipitate early optic atrophy, while those who relax in receiving treatment, particularly Negroes, are less likely to develop optic atrophy At the present time the best method of preventing blindness from syphilis is to prevent the disease itself and not to place full reliance on the treatment of the disease”.

Joseph Earle Moore, M.D., has made the statement in Pictorial Review, August, 1938, page 19, as follows :.

“Within the first few weeks after the disease is acquired and at a stage when it is most infectious, the blood test is almost always negative In the later stages of the disease the blood test may be negative in about five per cent of the patients tested, even if there is no previous treatment. If there has been some treatment, even though it may have been inadequate to cure or even to prevent infectiousness, the blood test may be negative in a higher proportion of cases.”.

Dr. W. F. Lorenz, in the Wisconsin Medical Journal, 37; 117 (February) 1938, in an article entitled Clinical Use of Blood Test for Syphilis” states in part :.

“Under no circumstances should a laboratory result, however well performed, replace a clinical diagnosis that has been thoroughly and carefully developed. Under the very best circumstances the laboratory merely supplies some evidence”.

Dr. Louis J. Soffer has written an article for the American Journal on Syphilis, May issue, 1937, entitled : “Postarsphenamine Jaundice,” where we find the following :.

“The available evidence certainly suggests that long- continued use of arsenical compounds may produce progressive damage to the liver. This hazard is further increased if, during the course of treatment with arsenicals, enough liver damage is incurred to produce icterus. It has been shown that patients who have had an attack of catarrhal jaundice may demonstrate evidence of impaired hepatic function for many years after the jaundice has entirely subsided. It is entirely justifiable to assume that the same may be true of patients who at some time or other developed postarsenical icterus”.

Erich Hoffman, writing for the Journal of Pediatrics, 9: 569 (November) 1936, on Congenital Syphilis: In the Light of Thirty Years Investigation of the Spirochete and Twenty-five Years Experience with Salvarsan,” makes the statement :.

“Congenital syphilis shows a characteristic tendency toward spontaneous healing The writer has usually avoided dosages of more than 0.01 gm. neosalvarsan per kilogram and has had success with these small doses”.

RELIABILITY OF DIAGNOSIS.

Allopathy is dependent in the treatment of disease on a proper diagnosis, while in homoeopathic prescribing diagnosis is not a requisite. There is hardly any disease extent that so baffles, as does syphilis, the intelligence of a physician in making a correct diagnosis, even where combined laboratory and clinical evidence seems clear.

The following startling statements are found in “Modern Clinical Syphilology,” by John H. Stokes, Professor of Syphilology at the University of Pennsylvania :.

“Inevitable margin of error : Shows that there is no such thing as errorless serological tests for syphilis. Even when the test is performed by originators, this error may be extremely serious. In spite of the superior accuracy of spinal fluid test, no doubt false positives, both technical and biological do occur. It is even possible for the spinal fluid to contain spirochaeta and pallida and yet be entirely negative in all four tests, in spite of the fact that spinal fluid offers the most accurate means within present knowledge in the diagnosis of syphilis (p. 161).

COMPARATIVE THERAPEUTICS.

The question of prime importance in the treatment of the sick is: What means constitutes the most rapid and safe restoration to health ?.

Alexis Carrel. in “Man, The Unknown,” p. 206, makes this statement :.

“Among human beings some are subject to disease and others are immune. Such a state of resistance is due to the individuals constitution of the tissues and the humors which oppose penetration of pathogenetic agents or destroy those that have invaded our body. This is natural immunity. This form of immunity may preserve certain individuals from almost any disease.”.

In Tices Practice of medicine, Vol. I, pp. 195-196 we find the following ;.

“There is evidence to show that natural immunity in certain diseases may depend in part if not altogether upon natural anti- toxic content of the blood.”.

The autonomic nervous system, including sympathetic and para-sympathetic systems, with their control of the endocrine system, sensorium commune, and the diencephalon, including the hypothalamus, constitute the defense mechanism necessary to bring about the cure. It has been well established that cures are possible ONLY through this defense mechanism.

The allopathic school of medicine makes use of the physiological effect only, and the effect of this physiological dose is to depress the defense mechanism, while homoeopathic remedies by their antigenic action favor the formation of anti- bodies through their stimulation of the defense mechanism.

Large doses of arsphenamine and mercury tend to suppress anti-body formation and cause decrease in complement. Small doses tend to decrease the production of agglutinin and augment the complement.

Drugs prescribed in physiological dose have their effect solely upon bacteria, while drugs prescribed according to the Law of Similia have no bactericidal action. Bactericidal drugs having their effect primarily on bacteria or spirilli produce endotoxins–toxins liberated from the protoplasm of dead spirilli and bacteria.

Endotoxins produce degeneration of organs thus sterile death is produced where cultures from the organs and tissues with the spirilli in question have been destroyed but still the individual dies. The effort to produce passive immunity against disease by means of bactericides may fail in spite of the destruction of all the spirilli present in the body by reason of the liberation of endotoxins.

From the foregoing we see clearly the danger of destroying normal susceptibility or the reactivity of the human because of the interference of the normal susceptibility brought about by physiological prescribing. The homoeopathic remedy will establish immunity but does not suppress the defense mechanism nor diminish the state of susceptibility. It is possible to cure syphilis by the high and highest dilutions, by which permanent cures have been made within a period of a few months.

I note an item published in the New York Herald Tribune of May 11, 1938, by Paul Hale Leary, Head of Section of Dermatology at the Mayo Clinic, in which he states that one-third of those contracting the disease are cured spontaneously, often without medical aid, through defense body mechanism; another third, he states, get only a mild reaction, and the rest are those suffering all horrible effects. This would seem to plainly point to the fallacy of treating syphilis by drugs prescribed according to the physiological effect.

HOMOEOPATHIC TREATMENT.

I wish to report an experience of my own where a patient whom I treated more than ten years ago in the tertiary stage of syphilis, there being complete destruction of the nasal septum with extension to both superior maxilla, with the extreme foul odor so characteristics of bone necrosis, was entirely cured by Nitric Acid, in potencies 10M, 50M and CM, with a period of six months. All of the diseased surfaces entirely healed with complete disappearance of the foul odor.

The Organon, a quarterly Anglo-American journal of homoeopathic medicine and progressive collateral science, Vol. I, p. 359, has reported the following cases :.

Case 1 :

A patient consulted Dr. Morrison, M.D., of London, after he had had an illness of twelve months. He supposedly recovered under allopathic mercurial treatment, although the second finger of the right hand remained swollen and stiffened. At the time of reporting to Dr. Morrison the syphilitic rash had recently appeared, and was in full bloom, very prominent on forehead, chin, arms and front of thorax, with small ulcer on fraenum of penis.

Patient was a short, muscular man, around 30 years of age, active habits, fair complexion, and excitable temperament. Merc. Sol. 6 given thrice daily. This benefited the ulcer, but failed to touch the rash. Merc.Iod.3 was prescribed. One month later new complication arose in acute conjunctivitis, affecting left eye. Ulcer on fraenum healed, but rash, from which peeled off an abundance of fine scales, scarcely altered. A large prominent spot in the centre of the forehead, filled with fluid. Ruta-g.6, with Ruta lotion.

Six days later iritis supervened, with nocturnal achings in eyeball. Ruta 6 continued, with directions to bathe eye freely with hot water. In three days the nocturnal aching increased in severity, lasting from 2 to 5 A.M., extremely violent. Syph. given at bed-time. For five days no return of pain; eye greatly improved, both in appearance and sight with general rash showing signs of abating. Week later Syph. again prescribed for slight return of aching pains in eyeball. After Syph. being taken for four days, rash became stationary and, with exception of arrest of pain, eye-symptoms ceased to improve.

Medicine therefore discontinued. Improvement again set in. In eight days eye could bear light fairly well and sight, though misty, decidedly improved. No medicine given. Fifteen days later no pain whatever; sight still dim; rash steadily dying of. Week later eye clearer and stronger; bore light well with rash abating and appetite excellent. Syph. one dose. In eight days improved in all respects with fluid in prominent spot in centre of forehead entirely absorbed. Nine days later one dose Syph. given.

In ten days sight “almost as good as ever”; face nearly clear with spot on forehead scarcely noticeable. Faint rash, chiefly on arms. No medicine given. About a month later patient continued to improve and stated did not intend to call on the doctor again. The swelling on the ankylosed finger had decidedly diminished. Month later reported as perfectly cured and remains well.

Case II :

A woman aged about twenty-five; married three years; one child; contracted syphilis eighteen months prior to calling upon Doctor Morrison. At that time had a fistulous ulcer under right lower maxilla; leucorrhoea; alopecia; mental depression; malaise. Came especially because of ulcer, which allopathic treatment had failed to cure. Silicea 12, given 3 times a day. Within a week ulcer diminishing. She still had leucorrhoea and complained of severe aching in legs. Silicea 30 prescribed 3 times a day.

Ten days later, there being general improvement, Silicea continued. Silicea 200, morning and night eleven days later, with ulcer still lessening but patient suffering severe shock to nervous system. Fistulous opening nearly healed within three days but patient complained of severe attacks of achings in lower limbs, but could not remember whether during day or night; also, coronal headache. Few days previous sore formed on right labia majora and extended to left, but had improved. Syph prescribed, one dose.

C.P.Bryant
C.P.Bryant