Read before the Annual Meeting of The International Hahnemannian Association, Philadelphia, July, 1926.
Primary Stage.
Duration–six to twelve weeks or until the beginning of secondary symptoms.
Chancre or initial lesion appears in seven to forty-two days, usually at sight of a small abrasion, edge of glans penis, or adjacent tissues. In women, often a labia minora, but may be located in vagina or on cervix uteri. The disease is, therefore, seldom diagnosed in women during the primary stage and, in fact, its presence is rarely suspected before the appearance of secondary manifestations.
The chancre occurs at the point where the infection gained entrance to the body and may be located anywhere. It often appears on the lips, in the mouth, on the hands or at the sight of any wound, even though slight. Many vaccination wounds are infected with Syphilis either at the time vaccination is performed or at some time before healing.
Extra genital or innocently-acquired Syphilis is much more common than was formerly supposed.
Any sore that persistently refuses to heal may be Syphilitic and may be an expression of the disease in any one of its stages.
Appearance of Chancre:
1. Hard, usually, and slightly elevated.
2. A reddish pimple or like a small wart.
3. Breaks down with irregular, hard margins.
[a] Depressed;.
[b] Punched-out appearance;
[c] Seldom itches;
[d] Relatively painless.
4. Chancre is usually single but may be multiple.
5. Inguinal gland involvement [buboes] on same side as initial sore, later extends to the other side. The inguinal glands seldom suppurate in Syphilis, whereas suppuration is quite frequent in chancroid or soft chancre.
Note.-The appearance of the initial lesion may be totally altered when occurring in a vaccination wound (mixed infection) or in cases where the chancre is located in lacerated or bruised tissues and thus again the disease may not be suspected until secondary symptoms appear.
Secondary Stage.
Duration-usually several months; some of the manifestations holding over into the third stage and persisting, or recurring, for years.
1. Sore throat.
2. Mucus patches or denuded areas.
[a] On tongue;
[b] On other buccal membranes;
[c] On tonsils;
[d] In nose;
[e] In vagina and on cervix;
[f] Similar patches in moist locations-between the toes, in groin and axillae.
3. Roseolar rash-usually non-itching.
[a] On back;
[b] On abdomen;
[c] On front of arms;
[d] Rarely on face. When on face, reddish, smooth, rubbed- off appearance;
[e] Rash has elusive appearance, requires quick glance at a little distance-patient sometimes may not notice it-best seen in daylight;
[f] Rash may resemble any skin disease, color changing to reddish-brown or coppery appearance. Often in groups. Duration one to several weeks with relapses, i.e., clears up and reappears for a long time.
4. Peculiar white spots, especially on back of neck. (Irregular deposits of pigment in the skin.)
5. Muddy pallor.
6. Yellowish tinge to conjunctiva.
7. Yellowish tinge to skin becoming copper-colored,
8. Sudden thinning of hair, especially in temporal region.
9. Enlargement of cervical axillary, epitrochlear and inguinal glands, with some soreness.
10. Iritis-usually one eye, then the other.
[a] Photophobia;
[b] Contraction of pupil;
[c] Discoloration of iris.
11. In some cases, mild febrile reaction.
12. Slight malaise, draggy and achy like a mild attack of Grippe but seldom severe enough to compel patient to go to bed or even stop work.
Third Stage.
Duration-indefinite.
1. Old, eroded, smooth skin eruptions on face or other parts.
2. Gummatous manifestations which begin at some point of irritation-in the skin, subcutaneous tissues, muscles, in the lungs, liver, spleen, eyes, ears, nose, throat, bone rectum or other situation either superficial or deep.
They are expulsive or eliminating efforts on the part of nature to get rid of the infection.
[a] They break down and often form chronic abscesses;
[b] Heal slowly;
[c] Leave hard, puckery scars;
[d] When occurring in throat or rectum the healing may markedly constrict the passages.
Note.-Abscesses of rectum are usually either Syphilitic or Tuberculous.
It is the boast of modern syphilographers that Gummata are now rarely seen-due to their treatment which suppresses the Syphilis and paves the way for worse troubles.
An untreated case of Syphilis runs a more benign course than when treated by ordinary Allopathic means. In other words, that treatment is worse than the disease.
3. Persistent bone pains-especially at night. The syphilitic aggravation is commonly at night and often from sunset until sunrise.
4. Frequent, intense, persistent or periodic unilateral, parietal and occipital headaches.
Remote Manifestations.
Due to Syphilis plus suppressive treatment. May be years after first infection.
1. Aneurism;
2. Aortic heart disease;
3. Degeneration of blood vessel walls and sclerosis of. vessels;
4. Locomotor Ataxia (Tabes Dorsalis), a syphilitic degeneration of posterior columns of the spinal cord;
[a] Paroxysms of intense pain;
[b] Muscular incoordination;
[c] Disturbance or loss of sensation;
[d] Altered reflexes, at first increased, later lost;
[e] Abdominal cries or acute paroxysms of abdominal pain;
[f] Failing sexual power;
[g] Sensation of rope or band around body;
5. Affections of stomach-symptoms of chronic Gastritis, Ulcer, Cancer;
6. Ulcers of nose and throat;
7. Bone and joint affections;
8. Blindness;
9. Insanity-commonly Paresis (general paralysis of the insane), Melancholia, Mania.
Examining Patients.
Look for any or all of above symptoms.
1. Inquire about skin rashes;
2. Sore throat (recurring or persistent);
3. Falling out of hair;
4. Look for old throat and skin lesions;
5. For old, copper-colored scars on legs;
6. Examine bones for nodes (knots or elevations), especially shin bones;
7. Look for scar of primary sore (may not find it);
8. For atrophy or hardening of testes;
9. In women, frequency of miscarriage is very suggestive;
10. Rombergs sign (eyes closed, swaying of body);
11. Test for Argyle Robinson pupil-it means little in respect to Syphilis but is so accepted;
12. Have Wassermann test made by a well-known reliable laboratory.
Note.-The Wassermann may be negative in the presence of Syphilis and positive in its absence.
This test is useful from the fact that it is accepted by some as an important diagnostic sign. Very few well-informed physicians really believe it to be of much value.
Salvarsan or similar arsenical preparations, Mercury and Potassium Iodide only suppress the disease and force it to deeper levels and toward more vital structures so that the last state of that man is worse than the first.
Finally-record your findings and treat the patient, not the disease, in accordance with the law of cure.
Eugene passed away at his country home on Spring Hill, Tuscarora Township, Bradford County, PA. He had been in ill health for several months. His wife, the former Caroline Davis, whom he had married in Philadelphia in 1910, had passed away in 1961. They spent most of their marriage lives in Swarthmore, PA.
Dr. Underhill was a member of the United Lodge of Theosophy, a member of the Philadelphia County Medical Society, and the Pennsylvania Medical Society. He was also the editor of the Homœopathic Recorder.