THE VENEREAL DISEASES THEIR PATHOLOGICAL NATURE, CORRECT DIAGNOSIS, AND HOMOEOPATHIC TREATMENT by Jahr
AMONG all the diseases that weigh upon suffering humanity, there are probably none which are more extensively discussed by physicians, more dreaded by some, more frivolously regarded by others, and at the same time less definitely determined, with regard to their course and the boundaries of their various forms, than the disease designated as venereal. According to Fallopius, Girtanner, Astruc, Hunter, Van Swieten, etc., among the older, or Carmichael, Bell, Cazenave, Biett, Baumes, and others, among recent physicians there exists nothing more fearful and insidious in the world than these diseases. Fostered in the fatal bosom of a degrading passion, and conceived at a moment of burning lust, they scatter, according to some, silently and mysteriously their poisonous seed whose offspring, which at its first appearance, is but lightly regarded and extirpated from the sphere of observation as speedily as possible by the criminal hand of indiscreet or ignorant physicians, nevertheless continues silently to unfold its manifold germs in the organism, until they break forth anew in a variety of different forms and thus announce to every eye the presence of the still raging malady. Again repressed by external means and again sprouting forth in other parts they penetrate, according to the assertions of observers, all the tissues of the patient, who, far from suspecting the enemy that is gnawing at his vital forces, very frequently sees one organ after the other invaded and destroyed, his face disfigured in the most horrible manner, his muscles and bones perforated, and his frame generally overwhelmed by the most horrid tortures without knowing how his distress can be alleviated were it only in a trifling degree. Whatever revolting and horrifying diseases are met with in large cities, in the huts of misery and in the gloomy abodes of vice: all those wretches who are covered with ugly scars and horrid ulcers; whose faces are disfigured by pustules and suppurating blotches; who are not unfrequently deprived of their noses and even eyes; who are emaciated to skeletons: whose livid and shrivelled skin is dangling around their fleshless bones; and who, spreading a pestilential fetor all around, wander about like half-rotten cadavers from the tombs, or who, removed from human society and avoided even by their own friends are stretched upon the torture- bed of despair, praying for death as their greatest blessing: all these unfortunates, according to the common opinion of the greatest physicians, owe the whole sum of their sufferings to no other cause than to venereal infection, which having been contracted in an unguarded moment, had been neglected, disregarded and afterwards mismanaged throughout. Yea, if these physicians are to be believed, a whole number of the most chronic and most incurable organic affections of various kinds, with which inhabitants of large cities are afflicted, emanate from this cause as their true fountain-head; their true character, unless they had reached the previously described fearful height, being most always misapprehended, so that they are confounded with other less dangerous diseases, and the poison, even if, favored by peculiar circumstances, it should not break forth in actual disease in all cases is transmitted to the children and entails upon them the distressing and irresistible processes of destruction from which the parents had luckily escaped. It is the opinion of the above-named physicians that these diseases contain a virus which, if once introduced into the organism, germinates unless previously neutralized by its specific antidote, and sprouts in the organism, after the fashion of parasitical growths, at the expense of its vital essence and strength, and continues so sprout until the body perishes by the poison. Where, according to the testimony of these physicians, nothing is done against these diseases than merely to obliterate their sprouting growths, the root remains in the organic tissues and may sprout forth again any time until life is annihilated by this murderous destroyer.
On the other hand, these physicians are opposed by others, more particularly by the adherents of the Physiological School founded by Broussais. Starting from the view, which may not be erroneous of itself, that all pathological processes are, primarily, deviations from the normal physiological form, they not only reject all belief in some peculiar contagium or virus, but likewise repudiate the doctrine of idiopathic diseases, tracing as they do, the first cause of all imaginable diseases to a simple inflammation which may have been caused by some mechanical or chemical irritation, and whose ulterior course and form depend exclusively upon the character of the invaded organ, upon the physiological temperament of the individual, and upon the accidental supervention of external, either, ameliorating or deteriorating influences. This school, which in the department of venereal diseases, may be said to be represented by Jourdan, Devergie, and Desruelles, does not deny the existence of the disorders which the opponents of Broussais describe as the products of the syphilitic virus; but it maintains that it is wrong to attribute them to impure coition or, still worse, to some specific contagium, contending as they do that the so- called venereal disease owes its origin to nothing else than a simple inflammation caused by acrid menstrual blood, and acrid hemorrhoidal discharge, or some other acrid humor, and that this inflammation, like any other that had been caused by purely chemical agents, such as lunar caustic, etc., only becomes worse in case the affected individual either has constitutionally had humors, or had been abusively treated with Mercury or some other irritating agents. In corroboration of this view, the Physiological School partly refers to the, total ignorance which prevailed among the ancients, of particular, so called venereal ulcers or venereal effections generally as a special class, and partly to the proportionally small number of cases where accidental discharges or ulcers, that had been occasioned by an inflammatory or irritating coit, were succeeded by derangements of a different kind. By thus attributing a large portion of the disorders that other physicians traced to the venereal virus, exclusively to individual disposition or to the action of irritating drugs, the Physiological School at the same time holds that what are falsely called venereal diseases, have no existence in fact, nor would these supposed venereal diseases ever have existed if we had always taken the precaution of combating, at the outset, the inflammation that might have resulted from an inflammatory or irritating coit, by such antiphlogistic means as leeches, cups, bleeding, etc. Between the physiological physicians-who not only deny the existence of a specific virus, but the pathognomonic character of all venereal diseases-and their above named opponents, there are many physicians who occupy an intermediate position, in so far as they not only accept the essential nature of these diseases, but likewise admit the existence of a specific virus as indispensably necessary to cause venereal infection; but, on the other hand, neither recognize all the phenomena of syphilitic poisoning described by their opponents as such, nor admit the absolute danger which the artificial, extirpation, cauterization or suppression of supervening discharges, ulcers, etc., is said to involve. Some English physicians, for instance, ascribe, if not all the phenomena which are generally supposed to constitute secondary syphilis, at last the affections of the bony system, and variety of cutaneous diseases which others regard as venereal to the abuse of mercury; and other practitioners want to know, with Girtanner, Hecker and Ricord, whether the internal administration of some specific antidote is at all necessary, and whether it is not sufficient to suppress the incipient products of the contagion as speedily as they appear upon the skin, and to prevent them, as they imagine, in this manner from becoming rooted in the organism.
But even among those who believe in the existence of a specific virus as well as in the necessity of annihilating it in the interior of the organism by some specific antidote, the views concerning the pathological nature of syphilitic diseases and the specific poison which produces them, differ a good deal.
It is well known that several physicians, more specially Bell, Carmichael, and others, as well as Hahnemann, whose views, as expressed in the year 1788, had undergone a radical change in the year 1816, held that there are three different kinds of virus leading to three different classes of syphilitic diseases, which have to be combated by three different classes of syphilitic diseases, which have to be combated by three corresponding specific antidotes: 1. syphilis or chancre; 2 sycosis or figwart-disease; and 3. the common or idiopathic gonorrhoea. Any one who is acquainted with modern syphilography, must know that, even among the greatest physicians of France, the dispute concerning the homogeneousness or heterogenousness of chancre, mucous condylomata and gonorrhoea, is not yet ended even at this late period. It is indeed true that more recently the essential oneness of the different forms of syphilis has been advocated by Davasse of Paris, Lancelot of Lyons, and generally by the physicians of this last -named city. They base this advocacy upon the assertion that they had never yet seen in hospitals mucous tubercles that had not been demonstrably preceded by chancre; in opposition to which Parisian physicians continue to assert that these mucous tubercles may be generated protopathically by direct infection, without any previous chancre. We have, moreover to consider that the advocates of the homogeneous oneness of syphilis, notwithstanding they derive mucous tubercles from the Hunterian chancre, which they regard as the only true ulcus regulare, on the other hand attribute to the elevated soft, phagedaenic, and other chancre forms, the property to propagate their own specific forms by infection without engendering constitutional syphilis as in the case of the regular chancre-a distinction which we cannot receive from a pathological stand-point without being logically led to the doctrine of essential differences in the nature of the contagium. In our own school, where it seemed to be the chief endeavour of some, at a previous period to differ from Hahnemann, short work has been made of his subject. Without even instituting the least inquiry into this subject, Hartmann’s system of therapeutics, for instance, teaches the doctrine of a homogeneous lues venerea, of which chancre as well as gonorrhoea, are products of equal import and character; whereas, besides Hahnemann, several of the greatest physicians of England and French, such as Baume’s Bell, Bafour, Duncan, Hernandez, even Ricord, contend for the non- malignant character of a simple, idiopathic gonorrhoea as a non- syphilitic disease. These physician are indeed opposed by others, Like Hunter Lagneau, Ritter, Cazenave, Castelnan and others, who do not only consider gonorrhoea a syphilitic disease, but attribute to the gonorrhoeal virus the power unless previously eradicated by specific anti-syphilitic antidotes, to produce the same secondary and constitutional pneumonia as chancre. Now inasmuch as according to the universally received doctrines of our school, so far, at least, mercury continues to be regarded as the sovereign specific against primary as well as secondary syphilis, how can we account for the fact that Hartmann, as well as all those who believe in the homogeneous oneness of the different forms of syphilis can be content with curing a case of gonorrhoea with cannabis, which is no remedy for syphilis, without feeling uneasy regarding ulterior pernicious results of the syphilitic virus? It is plain enough that Hahnemann, who fancied he had discovered three distinct syphilitic miasms and three corresponding antidotes, had a perfect right to imagine that these antidotes would radically annihilate the virus; but if it was proper to upset his theory, what right had one to continue his practice, which was based upon this very theory? And if his practice was correct, with what right was his theory abandoned?
It is an easy thing to oppose Hahnemann’s views and the opinions of those who agree with him, with all sorts of bold assertions of a contrary character, specially if one does not take the trouble to show the scientific correctness of antagonistic arguments. As for ourselves, we frankly confess that we are far from accepting unconditionally everything that this excellent observer has taught on the subject of venereal diseases; but have those who make it their business to contradict him in every thing without rhyme or reason, ever considered why syphilis, if it is indeed a disease one and indivisible, manifests itself under various forms, both protopathically and deuteropathically, each form being endowed with a capacity of reproducing itself specifically by contagion? Have they a more palpable hypothesis in the place of Hahnemann’s which accounts for all contradictions between theory and practice, as well as all apparently contradictory facts in a most natural and comprehensible manner, and explains the most opposite statements to the satisfaction of every body, in such an easy and unaffected manner that each separate fact in the series seems authorized to claim its place as equally possible and legitimate? More than one who knows how to accuse others of a deficient knowledge of pathology, brags of tertiary and quaternary syphilis; but are these gentlemen prepared to show the characteristic differences even between primary and secondary syphilis and to explain why the same remedies that will remove the primary disease, have to be exchanged for others in combating the secondary form? Are they able to say where the primary form ends, and the truely secondary symptoms commence, and what fixed symptoms always characterize the former, and can never, nor ever ought to characterize the latter? Whence do we at all know, provided we do not blindly follow some pathological manual that there exists a secondary syphilis, and that every morbid manifestation which we consider as a secondary symptom of this disease is not, as some of us indeed believe, if not of a mercurial, at least of an herpetic, scrofulous or psoric origin? And if the latter should not be the case; if there are phenomena a that owe their origin to the mismanagement of some primary form, among those which constitute this category, is it that serves in every case as an undoubted basis to the former? As we said before, many authors regard the external suppression of the Hunterian chancre, which they would like to preserve as an everlasting scourge at the spot where it first made its appearance, as the sole cause of all the mischief, whereas they dry up a gonorrhoea as a most innocent precursor of syphilis, or even as a non-syphilitic disease, and cut away figwarts with a pair of scissors as a purely local excrescence of the chancrous disease; others, again, suspect a character of malignancy in either of these two categories of phenomena as much as in chancre itself, and trace every morbid symptom, of whatever name, which is occasioned by an impure coit, to the action of a virus which, unless neutralized by its specific antidote must and always will produce the same ravages of disease. We know what Hahnemann thought of the evil consequences that might result from an unnatural suppression of gonorrhoea and of a chancre on figwarts; but who is able, even in this respect, to show by irrefutable testimony where the truth is to be found, in Hahnemann, who met with the most determined opposition even in his own tanks, or in the writing of his opponents? And, finally, if there are morbid phenomena that owe their origin to the action of some specific contagium, what are the phenomena to which this fact applies with axiomatic certainty, and what specific reason is there, that might justify a belief in the emaciation, from a similar origin, of a variety of other phenomena which often do not show themselves until years after the infection had taken place, and which we nevertheless seek to combat in accordance with such a supposition?
It will be seen that, the more earnestly we seek to solve the questions which present themselves for our consideration in the domain of disease that, for a period of over four centuries, have been attributed to the action of a specific venereal virus, not every thing, or indeed scarcely any thing that is to be found on this subject in pathological manuals is perfectly positive and certain, and that the different opinions which prevail among authors, even on the most importance points of doctrine, are sufficiently founded in fact to divest the preception of truth, at first, sight of all difficulty. Nevertheless if we mean to practise our art with intelligence and a thorough knowledge of the subject, and do not wish to imitate the crude empiric who employs his remedies for no better reason than because they had helped in other similar cases, we should not content ourselves with individual opinions, not with the dicta of authority or general articles of faith, but we should strive, by a thorough examination of the most essential points to attain to independent, positive and lucid views concerning the true nature of the cases occurring in this particular branch of medicine. And even if we should not find it possible to solve the questions that have presented themselves, and may still present themselves, as satisfactorily as possible, we certainly agree on one point, which is, whether our therapeutic means are properly chosen; whether, if it be true that all venereal phenomena depend upon a virus that never becomes extinct of itself, spontaneously, we may be sure of its utter annihilation without saturating the organism with mercury, not to salivation, as used to be the method in former times, at least to the extent which Hahnemann recommended as late as the year 1788, until a mercurial fever has become developed; or whether we are privileged not only to limit the use of this metal as much as possible, but to substitute in its place other remedial agents whenever the case may seem to demand it. if our present methods of treatment seem to bring about a radical cure of our patients this does not show that, sooner or later, even after the lapse of years, the marked signs of the syphilitic disease may not break forth, unless we are in possession of some diagnostic signs by which a radical cure may be ascertained with infallible certainty, and unless we are likewise enabled to show that the remedial agents which we are in the habit of employing are capable of fulfilling these indications. It is the object of this work to furnish contributions to the solution of these all important questions. Even if it should be found insufficient to solve these questions, yet it may point out the road that may lead to their solution, and may show with sufficient clearness the points that should form the chief object of our inquires. If we do not mean, in these inquiries to go astray at the very first step, it is evident that we should not, after the fashion of pathological manuals, being with the building up of general hypotheses concerning the nature of syphilis generally, but, vice versa, pursue an opposite course, passing from particular and concrete facts to general obstructions, and well considering that we should not hazard general conclusions regarding the specific nature of syphilis until we have considered all the special forms resulting from syphilitic infection, either mediately or immediately, in all their pathological and therapeutic relations, with such completeness and so much accuracy that all further conclusions and deductions result as a matter of course. This course is indicated by Nature herself, in so far as she first displays single forms of the disease which she continues to develop until finally the whole image of the disease is presented to our view. Let us pursue this road, which is only safe one, and let us consider in the following four divisions of this work:
1. Under the designation of primary forms, the indisputable immediate products of venereal infection.
II. Under their designation of secondary forms that category of phenomena which always make their appearance as they more remote consequences of the syphilitic infection, to which they have necessarily to be attributed; and let us afterwards determine.
III. What general pathological conclusions regarding syphilis are suggested by a consideration of these different forms of this disease; as well as.
IV. What diagnostic, therapeutic and pharmaco-dynamic maxims we may derive from these considerations for the practical treatment of syphilis.
In order to enable the reader to study the original works which we have consulted in the composition of this volume, we here subjoin as complete as possible a list of this work, most of which deserve the most attentive perusal with reference to any particular theory of set of opinions.