Secale 131.-Treatment of these Ulcers.
Regarding the diagnosis and prognosis of these ulcers and rhagades, we have nothing to add to what has already been said on the same subject in previous chapters, when speaking of other forms of secondary disease. The complaints of old-school physicians, regarding the desperate obstinacy with which these ulcers and rhagades resist all treatment, only refer to the foolish use of cauterizing agents with which these appearances ar sought to be managed, specially in hospitals. Under homoeopathic treatment, with truly rational, and rationally used remedies the management of these ulcers becomes comparatively easy, and the cure certain and complete. Among these remedies, Mercurius, occupies the first rank; for this reason, that such secondary ulcers almost always break out as ultimate sequelae, where the primary symptom had either been treated without Mercury, or with cauterizing agents and external mercurial applications. I always accomplish a cure with Mercurius sol. 2, giving half a grain at a dose every other day; nor have I ever been obliged to resort either to another remedy, or to another mercurial preparation, except in two cases, where these secondary chancres came to me out of the hands of beginning colleagues, who, by deluging the patient with Mercury, had aggravated his case; and where, in one case, I derived benefit from Lachesis, and in the other case from Sulphur and Nitri. ac., and where, in both cases, the rest of the diseases was radically and permanently removed by means of two doses of Mercurius sol. 3, giving one dose every four days. If, in treating secondary affections, I give Mercurius in smaller and less frequently repeated doses than when treating primary phenomena, I do this for the simple reason that, be the organism “saturated” ever so thoroughly with Mercury, the cure of secondary affections will not be hastened by such a course, were it only because these affections naturally run a slower course than primary products of the syphilitic disease. Owing to this more inveterate duration of secondary ulcers, Mercurius will have to be continued in all such cases for a longer period. If it is given as often as in primary ulcers, double and treble the quantity that may be required for the cure of a primary chancre, may have already been used before the treatment of the secondary ulcer is half accomplished; if, at this stage, the use of Mercury is continues, it frequently happens not only that the cure of the ulcer remains stationary, but that the symptoms of the case become terribly aggravated. Such aggravations are exclusively due to an excess of mercurial action. Such aggravations have occurred in my own practice, when, dozzled by the hae and cry of anti-Hahnemannians against triturations and attenuations, I was induced to try the use of massive doses in syphilis. I, too, undertook to saturate my patients with Mercury, until, taught and made wiser by experience, I returned to my former employment of Mercury, giving one dose every other day, since when I cure my patients not only more rapidly, but without exposing them to the pernicious effects of Mercury. No chancres on the penis and scrotum that were most likely of a secondary character, Clotar Muller (Allium h. Zeit., vol. 37) has employed, with great benefit, the Muriate of Gold. Others have employed Prec ruber Cinnabaris, Mercurius sol. and Biniodide of Mercury. H.)
II. SECONDARY AFFECTIONS OF THE MUCOUS MEMBRANES.
Secale 132.– General view of these Affections.
Secondary affections of the mucous membranes are really nothing else than secondary chancres and syphilidae of every variety, transferred from the external skin to the mucous surfaces. It may be asserted, without fear of contradiction, that they occur most frequently in the form of ulcers, which may be classed in four more or less distinct categories: (1) superficial ulcers that may break out in any part of the mouth and throat, and which form a sort of whitish-gray, obscurely-circumscribed tetter or cyst, with a dark-red border, and showing but indistinct traces of ulceration. By French pathologists these appearances are attributed to their so-called blennorrhagia, and by the Germans to gonorrhoea pure and simple. (2) Deeper ulcers, resembling simple chancre, which though not very deep, penetrate the whole thickness of the mucous membrane, are distinguished by their lardaceous and granular base, as well as by their shaggy, somewhat everted edges, and their slightly reddened areola, and are mostly located in the throat, and very frequently in the region of the wisdom-teeth, where they are easily confounded with the little ulcers which sometimes break out about the time when the wisdom teeth are about to protrude; (3) the so-called chancres of the throat, which appear more particularly upon the tonsils, and resemble the Hunterian chancre; without any previous swelling of the subjacent tissue, they cause a cup-shaped perforation of the affected part, have a yellow base with a dark- red border, and not only penetrate to the subjacent tissues, but likewise spread on the surface; and, (4) Phagedaenic ulcers, which betray the analogous chancre at the very outset, and if they break out in the throat, may not only destroy the uvula, the velum and pharynx, but the palate-bones themselves.
In regards to syphiloid affections of the mucous membranes, we have: (1) the exanthematic form, consisting in the breaking out of more or less irregular, not always very red, spots, sometimes white in the centre, occurring at every point of the fauces, and on the inside of the cheeks, and frequently disappearing of themselves after a short period; (2) the papulous form appearing in the shape of small, rough, oblong granules, of the size of a pin’s head, and most generally seated on the edges and at the tip of the tongue; this eruption often disappears again spontaneously; (3) the tubercular, coming out in the shape of flattened, so-called mucous tubercles, in the corners of the mouth, on the inside of the cheeks and lips, on the velum palati and root of the tongue; it is, in fact, nothing else in than the mucous tubercles that have been transferred from the sexual organs to other mucous surfaces; and, (4) an eruption of circular patches, resembling syphilitic psoriasis, which may break out anywhere in the mouth, and throat, and is one of the most obstinate of these different forms.
All these ulcerous and non-ulcerous forms, which it s true, occur most frequently in the mouth and throat, may yet break out on other portions of the mucous membranes, more particularly on the sexual organs, and likewise in the nasal cavity, the larynx, meatus auditorius, eyes, etc., in which case they show a variety of modifications that deserve a more particular notice.
Secale 133.–Syphilitic Affections of the Mouth and Throat.
Rigorously speaking, we might omit these parts, inasmuch as every thing that we have seated in the preceding paragraph applied more particularly to these organs; nevertheless, inasmuch as these different forms do not manifest themselves with equal frequency, a few additional remarks, having reference thereto, may not be out of place.
(1) The most distinctly-marked form of syphilitic ulcers of the throat, which resembles most closely the Hunterian chancre, breaks out on the tonsils, where, first along, so little pain and swelling are experienced, that the patients do not heed the symptoms until the ulcer has become distinctly recognizable. This has a yellowish or brownish scurf, which dips down into the interior of the tonsils without the surrounding parts being either much swollen or red, and without any other pain being felt except a stinging sensation, more particularly during the act of deglutition, which, however, is not near as much interfered with as the extent and appearance of the ulcer might lead one to suppose. It is only if the ulcer continues to spread that deglutition become more difficult, the voices acquired a peculiar husky sound, and the sense of hearing becomes impaired.
(2) Phagedaenic chancres in the throat set in with putrid ulceration that soon changes to a widespread gangrenous destruction,. These ulcers not only break out on the tonsils, but likewise on the velum palati, and in the pharynx, but break out most frequently on the superior and posterior wall of the pharynx, and behind the pillars of the palate, where they sometimes, unless the parts and examined by turning them up with the spatula, have made considerable progress before they are discovered. In most cases, they are accompanied by great pain, inflammation, and some swelling of the parts; the least attempt at deglutition causes the most violent pain; there is considerable ptyalism, and a good deal of cough, so that one might suspect a tolerably far advanced laryngeal phthisis, which suspicion may be heightened by the fact, that with the purulent expectoration a general emaciation and an accelerated pulse are apt to supervene. In regard to the destructions which these ulcers may cause, they are not inconsiderable; at the posterior nares, the bones are sometimes denuded of all their coverings, the nose destroyed, and even the cervical vertebrae invaded and attacked with fatal caries. Even if these phagedaenic ulcers do not terminate in gangrene, and present a less formidable appearance, their destructive progress is ever onward; beginning at the velum with a small yellow scurf, which is surrounded by a crimson areola, they often spread with incredible rapidity, and frequently succeed in destroying a large portion of that organ before their disorganizing action is checked in the least. In most cases, these ulcers are accompanied by a cutaneous exanthem resembling rhypia.
