(1) CLOTAR MULLER (Allium h. Zeit., vol. 37), recommends very properly Corr Subl. for chancres in the throat. This may, however, apply more particularly to phagedaenic chancres, where Corr. subl. is undoubtedly preferable to any other mercurial preparation.
(2) HARTMANN (Therapeutics, vol. 2), prefers Acidum phosph, to Nitri. ac. in cases of sore, ulcerated velum palati (syphilitic ulcerated, tetter in the throat), I cannot share this opinion. Phosphoric ac., in my hands, has never seemed as effectual as Nitri acidum. This author’s remarks concerning the curative virtues of Lycopodium, in herpetic affections of the mouth and pharynx, are abundantly confirmed by the results of my own experience.
(3) TRINKS (Allium hom. Zeit., vol. 15), denies the curative virtues of Mercurius sol., as utterly insufficient in secondary affections, whereas he recommend this very agent for recent affections of the soft parts of the mouth and fauces, and even for syphilitic iritis, without in forming us whether by “recent affections,” he means chancrous or herpetic phenomena; for in the former, Mercurius sol. would help as surely as it would be absolutely inappropriate in the later. It is true that, in destructive ulcers of the fauces, Mercurius prec, is more efficient than Mercurius solubilis; Mercurius subl. is superior to either as a curative agent in these affections. Nitri. ac., recommended by Trinks, is most likely superior to Mercurius sol., only if Mercury had already been used, or where fungoid growths have made already made their appearance.
(4) WOLF, in Dresden (Archiv., vol. II, number I),. considers Thuja as adapted to syphilitic ulcers of the throat after abuse of Mercury. This is undoubtedly correct in some cases, specially where condylomata are present.
Moreover, the following remedies have been used by myself and others with advantage:
(a) for herpetic eruption in the mouth and throat; Lycopodium, Nitri. ac., Phosphori ac., Zincum.
(b) for excoriations, erosions: Mercurius sol., nitri. ac., Phosphori. ac., Lachesis.
(c) for ulcers on the tongue; Mercurius praec., Nitri acidum.
(d) for ulcers on the throat; Mercurius sol., Praec. ruber, Sublimat. corr., Lachesis, Aurum, Lycopodium, Iodium, Kali iod.
(e) for angina syphilitica: Lycopodium, Lachesis, Aurum, Nitri. ac., Mercurius sol.. Argentum, Mezereum.
(f) for affections of the nose: Mercurius sol., Aurum, Lachesis, Kali iodatum.
(g) for iritis syphilitica: Sublim. corr., Nitri. ac., Thuja.
Where mercurial preparations were indicated, they were generally employed in the first and second or third trituration, all other remedies in an attenuated form, even globules of the thirtieth attenuation. After a practice of forty years,. during which I have tried every imaginable size of dose, I have come to the conclusion that this mode of exhibiting the drug is about the most efficient and successful.
IV. SYPHILITIC AFFECTIONS OF BONES.
Secale 140.–General Review of these Affections.
Without overlooking the anatomical difference existing between bone and periosteum, we range the affections of both in one category not only because the periosteum is part of the the osseous system as well as the bone itself, but likewise because in syphilitic affections both are generally involved, and, though the organs are different, yet the disease with which we have to deal is one and the same. however, if we wish to distinguish the affections of the bony system with reference to their anatomical locality, we may distinguish three essentially distinct varieties; a diagnosis are concerned, but may be somewhat useful with regard to our prognosis, which it may enable us to determine more satisfactorily to ourselves, and perhaps to the patient.
(1) If the periosteum alone is diseased, we ascertain this fact by a thickening of the membrane, attended with a keen painfulness to pressure; the disease generally terminated in a depositing of bony matter under the periosteum, in consequence of which the bone at the affected part becomes hypertrophied. Such a hypertrophy is termed syphilitic node, or syphilitic exostosis, and is generally seated on the tibia. If the periosteum should become ulcerated (which is a rare occurrence), it may happen that a portion of the subjacent bone becomes necrotic, and exfoliates, which, however, does not constitute caries, but simply a syphilitic necrosis.
(2) If the bone itself is affected, caries begins independently of the periosteum, in the retiform tissue of the bone, gradually perforating the outer layer of bone, in which case the disease does not result in the formation of a hard swelling, like exostosis, but in that of a soft swelling, which can be seen and felt externally, and which, when opened, discharges a slimy fluid; the periosteum, at this place, is somewhat thickened and detached from the bone. In the centre of this denuded portion of bone, a small perforation is seen passing through the cortical layer of bone, until it reaches its inner substance. These carious swellings occur most frequently on the skull-bones, but are likewise seen on the lower jaw and the radius. They constitute the worst of all syphilitic affections of the osseous system, and frequently invade a large surface of the skull.
(3) Beside these swellings, there occurs another phenomenon, although less frequently than the former, likewise more particularly on the skull-bones,. At first, it seems to have been a simple inflammation of the bone, in consequence of which the bone has become hypertrophied, and its tissue has become thickened and heavier. The periosteum may remain sound for a long time, but may likewise, in the course of the malady, become inflamed at some points, and may become raised in the shape of small periostoses or tophi. These tophi frequently disappear of themselves sometimes in the space of ten days or a fortnight, but are generally replaced by others in a short time, which likewise again in order to give place to new ones; if suppuration sets in, carious ulcers form, which soon, however, likewise become cicatrized.
These three anatomical changes may occur with or without bone- pains; the last-mentioned, when the bone alone is affected, may take place without any alteration of substance, so that, if we desire to acquire a perfect knowledge of syphilitic affections of the bony system, we have to consider the following four points, each by itself: (1) bone-pains; (2) inflammation of bones; (3) exostoses; and (4) caries.
Secale 141.–Syphilitic Bone-pains.
These pains may make their appearance either long or shortly after the primary symptoms have been got rid of. They generally manifest themselves by keen tearing, deep-seated pains, accompanied by a disagreeable sensation of pressure, boring, stinging, and other similar pains following the direction of the long bones, sternum, clavicles, or other the bones of the skull. At night these pains generally exacerbate, when they almost become intolerable. Unattended by any change in the pulse, or by a swelling of the affected parts, and neither aggravated by contact nor pressure upon the parts, they neither resemble neuralgic pains following the course of a nerve, nor rheumatic pains which are disposed to wonder about, decrease rather than increase in the warmth of the bed, and are felt in localities that can be definitely pointed out; whereas the patient is unable to indicate the precise spot where are syphilitic bone-pains are seated. When affecting the skull, these pains are severe than in other parts, and may lead to very dangerous symptoms; whatever bone, however, they may attack, they always the night’s hinder the night’s rest, raging, in most cases, from nine o’clock in the evening until two or three o’clock in the morning, interfering with the proper preservation of the body, undermining the patient’s and often causing considerable emaciation. In many cases these pains remain seated in one bone without producing the least material change in its tissues: but very often they are the precursors of subsequent exostosis, necrosis or caries; at all events, however, they do not constitute an independent diseases per se, but must always be considered, wherever they appear, at the first stage of all other syphilitic affections of bones. The disease may, indeed, remain stationary in this first period, but, in most cases, these pains are preliminary to the structural alteration of the bones.
These pains are generally associated with other simultaneously appearing phenomena of secondary syphilis, such as syphilidae, effections of the mucous membranes, etc., in which case it is not difficult to determine their true pathological nature; whereas, in difficult to determine their true pathological nature; whereas, in cases where these symptoms are wanting, the diagnosis of syphilitic bone-pains is not always as easy as some people imagine. What we have said above of the nocturnal appearance of these pains as a diagnostic mark by means of which they can be distinguished from rheumatic pains, is not true as a rule without exception, since rheumatic pains, although usually abating in the warmth of the bed, very frequently exacerbate at night; on the other hand are syphilitic bone-pains that are felt only during the day, but leave the patient perfectly easy at night, as I have seen in more than one case. In such cases, however, the seat of these pains, together with their nocturnal appearance and the difficulty of fixing their exact locality in the affected bone, may render the diagnosis certain beyond all doubt. This difficulty is principally owing to the fact, that the true seat of these pains is not, as in rheumatic pains, in the coverings, nor at the surface of the bones, but most generally in the medullary membrane; although it may likewise be located in the periosteum, in which case it increases on pressure, and its precise locality can be definitely ascertained; so that this definiteness regarding the precise seat of the pain, becomes just as sure a diagnostic sign, as its indefiniteness in the former case. Nevertheless, however excruciating these pains may be, their prognosis is not, by any means, the worst in the different forms of syphilis; since they yield more easily than many other syphilitic phenomena, to a truly rational treatment.
