Secale 178. Hahnemann’s Sycosic Gonorrhoea.
Whether all excrescences that appear on the sexual organs, and are generally termed fig-warts, are of a contagious nature, or whether there may not likewise exist among these excrescences some that are not contagious and originate in some harmless cause (see No. 75), is a question, which, after the doubts that many physicians have expressed concerning the contagious nature of these condylomata generally, and considering the fact that fig- warts have existed long before the appearance of modern syphilis, may safely be answered in the affirmative. What is certain, however, is that when the fig-warts are associated with gonorrhoea, they contain the syphilitic virus in the modified form of the sycosis. It is to be regretted that Hahnemann did not term, this gonorrhoea, a mucoso tubercular gonorrhoea, since it is these humid or mucous tubercles in which the above mentioned (No. 166) blennorrhagia gallica originates, which is still very frequent in France, and was unknown previous to the year 1540. Ricord, speaking of these tubercles, says that they sometimes engender those suspicious forms of gonorrhoea or balanorrhoea, the suppression of which is frequently succeeded by constitutional syphilis. That Hahnemann, speaking of his sycosis gonorrhoea, meant nothing else than these mucous tubercles, is evident from the fact, that he locates the spread of this disease in Germany between the years 1809 to 1814, during which period these tubercles were imported form France into Germany; but likewise from the fact that he describes his fig-warts (see Chronic Diseases, 1., pages 108 and 109) almost in the very same terms used by the French physicians in describing their tubercles muqueux. He says that they are very seldom dry and wart-shaped, but more frequently soft, spongy, sensitive, of flat elevations, from which a fetid moisture oozes out. Not was Hahnemann quite wrong in connecting this gonorrhoea with a contagium sui generis; for, although this contagium is derived from that of chancre, yet it is a modified chancre-virus, which, as such, is indeed capable of producing all the secondary consequences of chancre, but never chancre itself. In addition to this characteristic, this gonorrhoea with its mucous tubercles, as well as the fungoid chancre, requires for its cure more frequently Nitri acidum, than Mercurius; hence the very same antidote that is required for that stage of chancre in which the modified contagium has originated, and still originates to this day whenever a chancre of this fungoid form, instead of causing chancre, infects the individual with fungoid products. That the sycosic gonorrhoea which we have just now described is identical with the above mentioned chancre- gonorrhoea, or syphilitic gonorrhoea (No. 170-175), in so far as both are admitted products of the chancre, if not according to their form, at least according to their essence, does not apply to the simple inflammatory idiopathic gonorrhoea, which, although originating in impure coit, and hence of a venereal nature, yet differs essentially from the former kinds of gonorrhoea and from all syphilitic products even so far as this, that its chief remedy is Cannabis, which has never yet shown the least curative action against any of the symptoms of syphilis. Considering, moreover, the pathological conduct of certain cases of gonorrhoea, which, although ever so violent and capable of originating orchitis and abscesses of the prostate yet never produce a single symptom that has any of the characteristic signs of syphilis, such as its inflammations, abscesses, swellings ulcers, we must admit that there are kinds of gonorrhoea which, although of venereal origin, yet do not in any respect belong to the province of the ordinary chancrous syphilis. If this is admitted, we are irresistibly led to conclude, that we have indeed two venereal contagia, but only one syphilitic contagium, embracing within its range the so-called sycosis; hence two essentially distinct venereal gonorrhoeas namely, a simple, idiopathic gonorrhoea, which is indeed venereal, but not syphilitic; and a symptomatic gonorrhoea, of an undoubted syphilitic character.
III. CONDITIONS OF VENEREAL INFECTION.
Secale 179. General Remarks.
After the conclusions at which we arrived at the termination of the preceding chapter, we shall have no difficulty in comprehending that the much more harmless, almost local contagium of the idiopathic gonorrhoea, whose sphere of action seems to be confined to the sexual and urinary organs, has engaged the attention of physicians much less than the syphilis virus which pervades the whole organism during the whole lifetime of the patient. For this reason most writers on syphilis have, since this disease has been known, busied themselves more particularly with the chemical nature of the syphilitic contagium, trying to find out whether it is an acid, or an alkali, etc. All have agreed that it must be of a corrosive nature, since syphilis spreads about with so much violence and rapidity; Broussais’ Physiological School, that rejects every kind of virus, goes so far as to proclaim all the primary phenomena of syphilis as a purely local, chemico-physiological result of an accidental acridity, by which the parts that come in contact with it, are corroded neither more nor less than by any other corrosive substance. However, inasmuch as this view, which had already been entertained by others before Broussais, has been refuted by the course of the infectious products, and it was found that the disease seemed to have a parasitical life of its own, other physicians have undertaken to explain the contagium as an organic germ, of a vegetable or animal nature. We have already shown, No. 172, that Dr. Donne, of Paris, has discovered small infusoria in the matter of certain chancres, not uniformly present, however, in every chancre, and not even absolutely indispensable to secure the contagious nature of the pus, since this pus has remained equally efficient for purposes of inoculation, even after the animalcules had been destroyed by vinegar. Whatever peculiar constituent may hereafter be discovered in the venereal pus, be it a salt, an alkali, or an acid, may perhaps secure a more perfect distinction of the venereal from any other infectious matter, but will shed no more light upon its physiological or pathogenetic properties, than the chemical analysis of any other substance will shed light upon its special medicinal properties; for the reason, that the effect which the immaterial contagium, contained in any substance, produces in consequence of stimulating the organism to morbid or abnormal movements, is not a chemical, but a dynamic property (see No. 167), that is, a property, which, like warmth, magnetism, the germinating force, and other mechanical or organic movement-principles, can only be recognized by its manifestations. As Chemistry and Physics are related to each other, the former being the science of matter, the latter the science of the movements or the moving properties of matter: so are Anatomy and Physiology related to each other, the former teaching a knowledge of the dead material tissues and organs of the body, the latter a knowledge of the living movements of these organs. If we desire to acquire a knowledge of the specially morbific properties of a contagium, by which we understand properties that transform the normal living movements into abnormal movements; and if we desire to observe what pathological movements such a contagium can impress upon the organism, either permanently or only temporarily, neither Chemistry nor Anatomy will furnish the desired information, but we shall have to apply to one of the movement-sciences, more specially to the Physiology of Diseases, that is, to Pathology exclusively; it is in the domain of Pathology alone that we can find out what effects such a contagium produces, when brought in contact with the living organism. Let us enter upon the same road, and inquire, above all things, through what substances, and in what way, this morbific movement-principle can be forced upon the organism.
Secale 180. Carries of the Contagium.
Even to this day, many pathological manuals, even Schoenlein’s teach, as an article of faith, that the contagium when first appearing in 1491-1540, was of a volatile nature; that it selected the air as a carrier, and communicated the infection through the agency of this gas. This story might be repeated as a traditional romance, but it is too little substantiated to be taught as a scientific theorem. The history of this tradition shows that it originated in a desire to make the common people understand that even princes, abbots, prelates, monks, and nuns could be attacked with the reigning epidemic. Nothing, according to these apologists of the privileged classes, was easier than that the disease could be contracted by touching the hands, clothes, or any other piece of property of an infected person; that it spread most readily in places where large crowds congregated in churches, for instance; that the breath of the faithful communicated it in the confessional to their confessors; and that the pestiferous air might transmit the disease from the place of a infected person to a distinct locality. “The French disease,” writes Victorius, in the year 1551, “spreads without any intercourse of a man with a woman or a woman with a man. I have known honorable nuns who, notwithstanding that they were carefully guarded, and protected by iron bars, were attacked with this disease by the atmospheric air, and the foul condition of their humors.” But supposing that this was no attempt to explain suspicious facts in a comprehensible manner, and that a disease which spread in this manner was no variolous typhus, but out modern syphilis, it is certain that, at the present time, the disease is no longer communicated by the air, nor by the mediate contact of the clothes, or other pieces of property of infected person, but only by the immediate contact of the infectious matter with a spot that is specially susceptible of its influence. According to some, this carrier is the pus, or the morbid secretion from syphilitic ulcer, or some other syphilitic product; whereas, others maintain that the infection can be communicated by touching a spot that is simply inflamed, and, without secreting anything, is already tainted with the venereal poison, or that the communication may even take place by means of remaining syphilitic indurations that have ceased to secrete anything. Some even go so far as to contend that the naked body of a syphilitic person can communicate the infection by simply touching the naked body of some other persons. That nurslings can be infected by the milk of nurses who have constitutional syphilis, even without any ulcers on the mammae, is a fact to which we shall advert in a subsequent paragraph, as well as to the infection being communicated to persons who lie naked in the same bed with individuals affected with constitutional syphilis. As regards becoming infected with primary products: I know of cases where gonorrhoea was communicated even before any discharge had become perceptible from the male urethra; or chancre, from a badly-healed cicatrix, where no secretion was any longer visible, and nothing more remained of the disease than a coppery color of the affected locality; but I have always found, in such cases, that a careful examination of the parts still showed, if not a decided secretion of matter, at least a scarcely perceptible exhalation. In case the infection was communicated by the spittle. I have always found that there were chancre in the mouth. Facts like these induce me to be of the opinion that those who regard the secretions form the affected parts as the true carriers of the contagium, are correct.
