(3) The affections of the nasal bones are of more easy recognition. If caries or necrosis should set in, we soon perceive painfulness and swelling on one side of the nose, the swelling having a doughy feel, without the color of the skin being in the least altered. Soon, however, the skin assumes a red color, the bones show less resistance to the pressure of the finger; pressure is even attended with a peculiar creaking or cracking sensation; at the same time the patient begins to discharge a purulent matter from his nose, which afterwards is mixed up with small bony splinters; in other cases, which are, however, less frequent, these syphilitic may find a passage through the other integuments, in which case a small abscess forms, that opens spontaneously. After the dead pieces of bone have been removed, the nose caves in at that spot, so that, if both sides of the nose have thus become affected, and if the septum and other cartilages and bones of this organ have been destroyed, the most hideous disfigurement may be the consequence. In case caries of the nasal bones should be associated with syphilitic tubercles, the skin itself may becomes destroyed, and the whole organ be lost, so that nothing remains but the posterior nares lying open, like horrid chasms, on a level with the cheeks. It is scarcely necessary to remark that speech and voice and become impaired in the presence of these disgusting disorganizations.
(4) Destruction of the palatine bones likewise commences with a seated pain in the arch of the palate, soon after which the mucous membrane of the affected part assumes a violet-red color, and becomes swollen and spongy. Soon after, from a small opening in the swelling, an ichorous pus is secreted and afterwards bony a splinters; at the same time the patient’s breath becomes very offensive. In consequence of this destruction of the palatine bones, an outlet is effected from the posterior nares, which, if the loss of substance is not too considerable, may close again; but, if too considerable, may leave an open, oval or irregularly- shaped opening, which can only be partially remedied and covered up by means of an artificial palate.
Secale 145.- Necrosis and Caries of other parts.
Less frequent are syphilitic affections of the jaw-bones, pharyngeal and laryngeal bones vertebrae and articulations; nevertheless they occur likewise, and not unfrequently are overlooked as we shall see presently.
(1) The jaw-bones are generally attacked only with syphilitic necrosis, not caries; the upper maxillary bone is more frequently attacked than the lower.
(2) Carious destructions of the larynx are generally the sequelae of previous syphilitic affections of the mucous membrane, which, by destroying the cartilages, may lead to laryngeal phthisis. These destructions are almost always preceded by syphilitic ulcers at the root of the tongue, the epiglottis, or on the walls of the pharynx, at the same time that the balance of the symptoms do not differ in anything from those of a true laryngeal phthisis, so that the diagnosis can only be cleared up by the previous history of the case, in connection with other simultaneously-existing affections.
(3) In the region of the pharynx likewise, carious destructions of the anterior portion of some of the vertebrae have been observed, which, associated with grave symptoms of syphilitic action in the soft parts of the pharynx, or, rather, spreading from these to the vertebrae, have resulted fatally to the patient.
(4) It is doubtful whether truly syphilitic destruction can occur down the vertebral column, although, some authors assert that they have seen the lumbar vertebrae destroyed by syphilis, or congestive abscess caused in consequence of the lateral portions of the spinous processes of the vertebrae being invaded by the disease, or spinal curvatures result from the anterior portions of the vertebrae being affected and destroyed by the poison. There is no doubt that the lumbar and dorsal vertebrae can be attacked by caries; but, in order that we may be certain whether caries is not of a scrofulous but syphilitic nature, the knowledge that this individuals had been affected when gonorrhoea or chancre once in his life-time is not sufficient. If we desire to be perfectly sure of our diagnosis, other syphilitic phenomena have to be perfectly sure of our diagnosis, other syphilitic even the presence of these phenomena does not furnish indubitable evidence in the case of a scrofulous individual that had been affected with disease of the bones at a previous period.
(5) The same remark applies to caries of the joints, where, according to some authors, syphilis may likewise erect its throne causing the so-called “white swelling,” where a nocturnal exacerbation of the pain is supposed to constitute a diagnostic sign. Syphilis may possibly cause such disorganizations; but it is equally true that a good deal that owes its origin to other causes, has been set down to the account of syphilis. If so much has been said against Hahnemann’s psora, what shall we say of those who behold in every abnormal structural change a result of syphilitic or even gonorrhoeal poisoning dating perhaps back to the third or fourth generation
(6) We need hardly state that necrosis or caries may befall all those parts where periostoses or exostoses may develop themselves, such as the tibia, sternum, clavicle, etc.
Secale 146.- Diagnosis, Prognosis and Treatment of Syphilitic Affections of the Bones.
As regards diagnosis, it is evident that, if there is any difficulty, it can only be, to determine whether the disease is of a scrofulous or mercurial nature, excepting, however, the bone-pains, the diagnosis of which has been indicated, in No. 141. In such cases, a most careful investigation of the previous circumstances sometimes affords all the light that can be obtained. If neither scrofulous complaints nor abuse of Mercury, but a whole list of syphilitic phenomena had preceded, the syphilitic nature of the case is all but certain, more particular if the existing symptoms had been preceded by nocturnal bone- pains. In the absence of all syphilitic signs, however, all suspicious of a syphilitic taint must be abandoned, and, if signs of scrofulosis and mercurial abuse are present, the diagnosis can only turn upon the difference between these two orders of symptoms. The case is different if scrofulous and mercurial symptoms exist, mixed up with old symptoms of constitutional syphilis. In most of these cases, a correct and satisfactory diagnosis is all but impossible; and all we can accomplish is to obtain, by means of a careful and discreet investigation of the previous history of the case, a certain degree of probable knowledge concerning that one of these three different diathesis which the phenomena that happen to be the most prominent, for the time being may lead us to regard as their exciting cause.
In regard to prognosis, which has been said in treating of the other syphilitic affections is likewise applicable in these cases. So far as particular affections are concerned, we may state that, of all syphilitic affections of the bones the periostoses are the lightest, and the least dangerous. These periostoses often disappear of themselves, whereas the exostoses sometimes did obstinate defiance to all treatment. In caries and necrosis as well as in the simple inflammation (ostitis, periostitis, and bone-pains), the prognosis is almost exclusively dependent of the treatment instituted against these conditions; a complete cure can always be promised, provided the treatment is conducted in rational manner, with appropriate specific remedies.
As regards the treatment of these syphilitic affections of the bones, I sought to state that, except ulcerous destructions of the nasal and palatine bones, arising from syphilitic affections of the mucous membranes (for which I always use Mercurius sol. and Aurum, with the best effect), I have never yet met with syphilitic affections of the skull-bones, tibia, clavicle, sternum etc., where the patients had not already been drugged with Mercury, and where Aurum proved the most efficient remedial agent. Only in two cases of caries of the tibia, associated with chancres in the throat, and where no Mercury had been previously used, this agent cured both the caries and the chancrous ulcerations. Beside the remedy, I have used, with the utmost advantages:
For bone-pains, ostitis and periostitis; Mezereum, Phosphorus, Staphysagria, Phosphori acidum, Nitri. acidum, Aurum, Guaiacum.
For smelling of bones periostoses and exostoses: Aurum, Fluoric acidum, Phosphorus Staphysagria, Mezereum (Calcarea), Silicea, Sulphur, Phosphoric acidum.
For caries and necrosis; Aurum, Nitri. acidum, Fluoric acidum, Silicea.
I have likewise used Kali Iodatum in affections of the bones, even in large doses, as recommended by allopathic physicians, and I have seen excellent effect from its use in such quantities; but they were never as lasting as the good effects obtained by means of small doses of other remedies. Usually, the symptoms yielded to Kali Iodatum in a very short time, but returned again ( perhaps in the shape of excessive effects of the drug?), in six or twelve months, which never occurred in cases that had been cured with the eighteenth or thirtieth attenuations of other drugs. This has induced me to adhere to the latter, without ever using Kali Iodatum. As regards Aurum, I give it in the third trituration, one half of a grain every four days.
