We have already made mention of the syphilitic phenomena on the mucous lining of the larynx, and in the cartilages of the organ (No. 135 and 145); weather these phenomena can spread from those point s to the bronchial mucous lining, or even to the lungs and heart, is another question. At any rate, we shall have to look for further evidence as regards the lungs and liver, whose tissues have not the least affinity either with the mucous membrane or the muscles or bones, any more than with the epidermis. The heart, being a muscular organ, might, under certain extraordinary circumstances be attacked with the muscular swelling described in No. 148, no less than the tongue, lips, and velum palati; in this respect, similar swellings might even become developed in the substance of the stomach. The only case of which we know, that bears upon this point, is a case related by Dr. Baumes, of Lyons, in his treaties on the venereal diseases, where a girl of fifteen years, who had become syphilitic a year previous, and who, not knowing what a chancre and mucous tubercles were, had not pains the least attention to these symptoms, and had employed no other means of treatment than washing with cold water, was attacked a few months after with palpitation of the heart, difficulty of breathing, and an obstinate cough, with which, at a later period, violent headache, severe attacks of cardialgia and hysteric complaints become associated. All these symptoms disappear suddenly, as if by magic, when, all at once, syphilitic pustules broke out on the legs, which has repeatedly shown symptoms of oedema, since out on the legs, which had repeatedly shown symptoms of oedema, since the commencement of her malady. The evidence of her transgression having been laid bare in this undeniable manner, she related the whole history of her case. That the heart, lungs, and stomach were affected in this case is evident beyond a doubt; but whether this was owing to the syphilitic virus is not quite so certain.
(NOTE. In connection with this subject, we wish to direct the reader’s attention to a work of Professor Arnold Beer, of Tubingen, Published by H. Laupp, Tubingen, 1867, and entitled “Eingeweide-syphilis,” syphilis of internal viscera; in this work, the Professor, by means of extensive pathological inquiries and microscopical examinations of the tissue, furnishes satisfactory evidence of syphilitic disorganizations of the ileum, rectum liver, spleen, kidneys, meningeal membranes, lungs, valves of the heart, endocardium, and other organs. The student of morbid anatomy is furnished in this work with a multitude of valuable and interesting contributions to a more extensive and accurate knowledge of the destructive effect of secondary syphilis.
Of the few cases which this work contains, we will relate two, one of them showing the adequateness, and the other the inadequateness, of the allopathic treatment of syphilis.
One was the case of a robust man of thirty years, whose legs were swollen, which he supposed to have been owing to cold. The albuminous deposit in the urine was of moderate quantity, but remained unchanged for a long time; the specific weight of the clear urine varies between 10.11 and 10.15. At first the oedema continued to increase, so that the thigh became somewhat involved; it now remained stationary for several weeks, in spite of all the diuretics and sudorifics that were used against it. The patient then informed me that he had had an ulcer on the penis for some time that would not heal. It had the characteristic form of chancre, and the edges were slightly indurated. The patient was directed to take the Iodide of Potassium, under whose use the diuresis increased considerably, whereas the albuminous deposit and the oedema decreased, until, after using the drug for three weeks, the patient was completely restored.
According to the Professor’s observation, oedema of the lower extremities and albuminous urine, together with sinking of the liver, are characteristic of incipient syphilitic degeneration of the kidneys, provided there is otherwise positive evidence of the existence of syphilis.
In the other case, the patient, a young man, complained of diffuse rheumatalgia in various parts of his body. His complexion had had a peculiarly sallow appearance, somewhat yellowish, although not icteric, properly speaking; this color was particularly marked on the hands. His liver was shrunk considerably. There was no oedema, but the urine was slightly albuminous, and remained so for a long time. This patient had had a chancre some time previous. Although no other syphilitic signs were present, yet I diagnosed incipient syphilitic disorganization of the kidneys, and gave the patient Iodide of Potassium. Very soon he was attacked with the most violent iodism. I diminished the dose, but the iodism continued as violent as ever. The remedy had to be discontinued, and the patient remained uncured.
In this case, if the Iodide was the proper remedy, a much smaller does than the one given would undoubtedly have been sufficient, – HEMPEL)
Secale 150.- Diagnosis of the previously-mentioned Diseases.
We have already stated, in speaking of each of these diseases in particular, in what respect gummata, tendinous tophi, and tubercles of the muscles are distinguished from analogous non- syphilitic products; nevertheless, the diagnosis of these affections, as the reader may have already inferred from out statements, is not very easy, since even practitioners of considerable experience, through inadvertence and deficient investigations concerning the previous history and circumstances of the cases, have mistaken gummatose swellings and tubercles of the muscular tissue for carcinomatous affections, and tendinous tophi for simple ganglia. On the other hand, true carcinomatous ulcers, purely inflammatory abscesses in the muscles of cellular tissue, and harmless ganglia, might be mistaken for constitutional syphilis. For this reason, whenever physicians are called upon to treat swellings and abscesses in the above- mentioned parts, or even simple inflammations or contractions of tendons, and circumstances justify the suspicion of a syphilitic taint, we advise such physicians never to neglect the most minute investigation of the anamnestic circumstances of the case; and even to examine the condition of the skin and of the mucous lining of the mouth, throat, and nose. By pursuing this course, I have often succeeded in discovering the syphilitic character of such products, and, tracing them back though a whole series of successive crops of syphilitic phenomena, in being led to the primary chancre as the fountain-head of the existing disorganization. I may remind the reader of the case of a married woman, mentioned in No. 147, where tubercles had formed under the integuments of the thighs and legs, that evidently were located in the cellular tissue, and, at first sight, would at once have been taken for gummata, if this opinion not been somewhat shaken by the fact, that these swellings were totally scattered by suppuration; and likewise by the shape of the subsequent ulcers, which, without having the lardaceous base of the gummata, resembled the holes that are seen immediately after the cellular tissue of a boil becomes detached; and finally, by the long- continued suppuration of these swellings, and by their size, which, in some of them, increased to the size of half a dollar. That all these symptoms must emanate from a syphilitic origin was made evident to me by the fact, that during the suppuration of the tubercle, the ulcer became surrounded by a brown-red areola; and likewise by this other fact, that previous to the last cicatrization, new tubercles continued to make their appearance, and that the disease, which was said to have been cured several times had broken out again. after the lapse of six or nine months. There were no other syphilitic symptoms perceptible; after questioning this woman’s husband, he finally admitted, that more than six years ago, he had a chancre, which he had cauterized immediately; shortly after which, however, his wife had become attacked with a suspicious-looking discharge from the vagina, on account of which he had sent her, under cover of some plausible pretext, to her relatives in the country, and had placed her under the care of a physician of his acquaintance. Subsequently to this period his wife, who had remained in perfect ignorance of her true condition, had been attacked with pains in the throat, rhagades between the toes, and other eruptions, until, with the appearance of the tubercles, all these symptoms vanished. Since that time, the husband himself had never been free from suspicious eruptions, and was even to the present time affected with a slight syphilitic angina.
Secale 151.- Prognosis and Treatment.
Beside the prognosis common to all syphilitic affections, the prognosis in the case of all these disorganizations in unfavorable, in so far as these swellings constitute some of the most obstinate phenomena in the whole domain of syphilis. What, in all such cases, renders the prognosis still more dubious, is the succession of such attacks which authors very improperly designate as “relapses.” True relapses, rigorously speaking, only occur under allopathic treatment, or under homoeopathic treatment with overwhelming allopathic doses; if the disease is once arrested by the specially appropriate remedy, a true relapse can no longer take place. Most previous writers on syphilis having been allopathic practitioners, who were in the habit of treating syphilis with the most massive doses, they most necessarily have regarded as relapses what was really a mere recurrence of the syphilitic phenomena, which must continue to take place until the disease itself is eradicated from the organism. Inasmuch as a period of six or twelve months may elapse before the syphilitic symptoms break out again, the physician, ever under homoeopathic treatment, cannot be sure whether his remedy acted merely as by; more particularly if the patient had been previously drugged with large quantities of the hydriodate of Potash. Such recurrences scarcely ever, or perhaps never, take place if the syphilitic phenomena are removed by means of small, or even the smallest homoeopathic doses, he, after all, is a true master of the healing art, who knows how to cure a disease with the smallest possible dose; not he who prides himself in prescribing massive doses for mere names of diseases, such as tertiary or quaternary syphilis.
