If the patient has not yet been treated with Mercury, I always commence the treatment, irrespective of accessory symptoms or the particular nature of the syphiloid, with Mercurius so or Precipit. ruber. and do not discontinue its use (including perhaps a change to Sublim. corr., Mercur. nitros. or Cinnabaris), unless no improvement follows in ten days or a fortnight, or the improvement that had been obtained, ceases to continue. I pursue the same course, if the patient has been treated with Mercury and the primary products have been cauterized at the same time; it is only where the treatment has been exclusively conducted with Mercury, that I at once employ some other remedy, according as one or another remedy may be indicated by the accessory symptoms and the nature of the exanthem.
In regard to the accessory symptoms, every thing depends whether they are primary or secondary. If primary (chancre in the second stage, buboes, mucous tubercles, figwarts) I pay no attention to the exanthem,. as if it did not exist, and content myself with treating the primary symptoms, according to circumstances, either with Mercurius sol., or if the nature of the symptoms should require it, with Cinnabaris, Nitri-ac., or Thuja; by pursuing this course, the syphiloid disappears in the same degree as the cure of the primary products progress favorably. If, instead of the primary symptoms, other secondary symptoms are present (chancres in the throat, bone-pains etc.), I select my remedy agreeably to the whole series, the nature of the secondary phenomena, as well as that of the exanthem.
In regard to the indications furnished by the nature of the syphiloid itself, I distinguish two kinds of exanthems: (a) exanthems of a transitory character, disappearing of themselves; and (b) inveterate exanthems, terminating in destruction by ulceration. If the former are accompanied by secondary phenomena, I pay no attention to the exanthem, and treat the other phenomena according to the method indicated for affection of the mucous membranes, in the following chapter (No. 131, 138, and further), If, on the contrary, the syphiloid is one of the ulcerous and destructive kind, I direct my attention exclusively to the syphiloid, without nothing the secondary phenomena, and, if no Mercury has been used by the allopathic attendant, and the syphilitic products have been treated exclusively with cauterizing agents, derive the most distinguished results from the various mercurial preparations, such as Mercurius sol., Mercurius prec., ruber, etc., which I do no longer administer, as when treating primary chancre, in tow daily doses, of half a grain of the first centesimal trituration each, but give only one dose of the second or third trituration every other day (see also No. 131).
Secale 123.–The leading Remedies for Syphilidae.
For the various syphiloids, we scarcely require any other remedies than those which are used for primary products (chancre, buboes, mucous tubercles, and figwarts); such as mercurial preparations, Cinnabaris, Nitri. ac., Thuja; to which, in case secondary symptoms are to be considered, we may add; Aurum, Lycopodium, Staphysagria, kali iodatum Lachesis, and in some cases, Sulphur, Hepar sulphuris, and Sarsaparilla. There are cases where the syphilitic exanthem stands all alone, without any primary or secondary symptoms. From my own experience, I am prepared to assert that these cases are not very rare, but that the exanthems, in such cases, are trivial and not very dangerous. Nevertheless, if continuing too long, they may become very troublesome to the patient (such as neglected roseolae, scales in the palms of the hands and soles of the feet, papulous scabies, etc.), and, at the same time, evidence the presence of uneradicated remnants of the syphilitic disease. In these forms, which have occurred to me only where the chancre or bubo had indeed been satisfactorily treated with Mercury; but where the treatment had only commenced in the second or fungoid period of this product, Mercurius will scarcely ever do much good, and I have cured most of these syphiloids with Phosphorus, Nitri. ac., Sarsaparilla, and Lycopodium, in the 18th to the 30th attenuation, pellets, much more effectually than with Mercurius. Nor have I seen any good effects from Kali iodatum, although I have administered it in comparatively large doses-four grains, to one ounce of water. Otherwise it is very strange, that, considering the large number of chancre, gonorrhoea, and figwarts cures, with which our homoeopathic literature abounds, we only meet general recommendations of certain remedies, like Kali Iodatum, for syphilitic cutaneous affections, and scarcely a single report of a cure. In general we find recommended.
(1) By LOBETHAL (Allium hom. Zeit., vol. 30), following the recommendations of allopathic physicians, in large doses: The Hydriodate of potash for, so called, tertiary and quaternary multifariously-shaped, cutaneous affections; for cutaneous ulcers, of a sickly color; tubercular and papulous eruptions in the face, etc. The doctor, however, neglects to inform us, what particular forms of syphiloid exanthems (which are, however, always of a secondary character) he understand by “tertiary” and “quaternary” forms.
(2) By CLOTAR MULLER (Allium h. Zeit., vol. 34): Mercurius bijodatus for syphilidae. This excellent practitioner at the same time remarks, that in many cases of syphilitic exanthems, the mercurial preparations are altogether inappropriate. This is undoubtedly correct; but I can not agree with him in opinion that, where the mercurial preparations are altogether indicated, Mercurius sol. and Mercurius praec. ruber are less efficient than Mercurius bijodatus. This last named preparation has seemed to me very unreliable, and I do not make much use of it.
(3) By TRINKS (Allium h. Zeit., vol. 15): Prec. ruber as preferable to solubilis in syphilitic exanthems; generally speaking, this observation is correct; but, if presented in too sweeping a manner, may lead to grave errors.
(4) By RUMMEL (Allium h. Zeit., vol. 18): Nitri. ac, for broad, red spots resembling psoriasis, subsequent to the treatment of primary ulcers with large doses of Mercury. According to my experience, this observation is correct.
(5) By FIELITZ (Prak. Beit., vol. 2): Nitri. ac. for isolated, burning, ulcerated surfaces on the hairy scalp, accompanied by ecthymatous pustules in the face, forming crusts, and surrounded by broad, red areolae.
(6) By HOFRICHTER in (Prague Allium h. Zeit., vol. 35),: for brown spots on the glans, of the size of lentils, and vanishing after their membranes become detached, together with brown tubercles near the seam of the scrotum, and on the perineum as far as the anus; these tubercles are of the size of peas, and terminate in ulceration.
(FULLGRAF, in the sixth vol. of North Amer. Journal, relates a case of syphilitic pustules, which was cured in twelve days by three galvanic baths of forty-five minutes each, administered at intervals of two or three days.–H.).
THIRD CHAPTER.
INTERMEDIATE FORMS OF SECONDARY SYPHILIS.
1. DEFINITION AND ENUMERATION OF THESE FORMS.
Secale 124.– Definition of the Intermediate Forms.
IF we consider that the living human, or, more generally speaking, animal body is an organism, whose constant endeavor it seems to be, in a circle of living action, on the other hand, tom receive substances that come in contact with the surface of the body (skin or mucous membrane), and, in a spiral course, as it were, in conduct them onward through the different tissues by a process of assimilation to the very centre of life; and, on the other hand, by a similar course to reconduct all heterogeneous, non-assimilable matters to the periphery, and to excrete, by the skin, all those things which the other excretory organs had failed to remove from the tissues; we shall find that the primary chancre and the syphilidae, of which we have treated in the preceding chapters, are the limbs within which the syphilitic disease runs its course, from the movement of its first appearance to the time when the virus would, perhaps, be forever, eliminated through cutaneous eruptions, if such an elimination were always possible with perfect completeness. As the chancre is, as it were, the initial point of the syphilitic disease, so the syphilitic exanthems should be the termination of all syphilitic phenomena, and perhaps would be, if the excretory process were not in any way disturbed in its course towards completion. This elimination not taking place as completely as it should, it follows that between the above -mentioned two extremes, there must be other points, in greater of less proximity to the periphery of the vital functions, where the organism endeavors to perfect this elimination, but where, if the eliminating process should fail, it sees itself, contrary to its endeavors, assaulted in tissues that are not capable of conducting this process any further. Hence we have between these two terminal points, the chancre and the syphilidae, a whole series of intermediate phenomena, which we have designated as intermediate forms of secondary syphilis. The mucous membrane, being the internal continuation of the external integumentary periphery of the organism, constitute the locality where these intermediate phenomena first manifest themselves. These may, however, if the excretory process should either fail to take place on these membranes, or should only take place imperfectly, become localized in other tissues, such as the bones, as symptoms of an imperfect or unsuccessful elimination. According to this view, syphilitic affections of the bones may, therefore, manifest themselves prior to, or simultaneously with, or subsequent to the affections of the mucous membranes, although the former, in their capacity of pathological retro-formative manifestations of a morbid process that originally tended to find an outlet on the mucous surfaces, are necessarily much less frequent than the diseases of the latter organ. What the affections of the mucous membranes are to the syphilidae, this the affections of the bones, as far as their frequency is concerned, are to those of the mucous membranes. It is not because the different secondary phenomena occur in a certainly chronological order, but because some of them occur more frequently than others, that we place the affections of the osseous system after those of the mucous membranes. We do not regard the former as a new tertiary manifestation, but simply as a purely passive phenomena, occurring subsequently to the ordinary secondary phenomena, occurring subsequently to the ordinary secondary phenomena, which tertiary manifestations may take place from the moment when, after the termination of the protopathic morbid process in the first stage of chancre, the organism makes more or less ineffectual attempts to transmit the syphilitic affection to the external skin, and in case of failure, to the mucous membranes.
