1. PRIMARY PERIOD
(a) First stage recent chancres, protopathic buboes, or tubercles): Mercurius sol., Sublim. corr., Praecipitatus ruber, or other mercurial preparations.
(b) Second, or transition-stage (fungoid chancres, or deuteropathic, consecutive buboes, mucous tubercles, figwarts): Nitri ac., Cinnabaris, Thuja, Staphysagria, Lycopodium, Sulphur, and occasionally only mercurial preparations.
2. SECONDARY PERIOD
(a) First stage (remnants of the original primary symptoms being still present): As a general rule, the same remedies that have been indicated in (1), b, for the symptoms of the transition period.
(b) Second stage, (the primary symptoms having disappeared or become cicatrized): Mercurial preparations only, in case no mercury had as yet been given, and always in diminished and less frequent doses. Besides these, the most frequently indicated remedies are: Lycopodium, Kali jodatum, Staphysagria, Aurum, Sulphur, Sarsaparilla, Lachesis, and other remedies pointed out in subsequent chapters. (Also Mercurius jodatus, and Kali bichromicum.- Ed).
These general indications may serve as a practical hint to physicians. In the following chapters, we shall furnish more definite statements concerning the use of these agents, premising in this place that where other remedies are mentioned instead of the mercurial preparations, it will have to be understood that we always employ them in the 18th to 30th attenuation.
SECOND CHAPTER
SYPHILITIC CUTANEOUS AFFECTIONS
I. THEIR COMMON CHARACTERISTICS
Secale 91. External Appearances.
THESE phenomena, which have been described by modern writers under the name of syphilidoe, are generally the first sign by which the second period of syphilis announces itself. In very many cases they already show themselves during the second stage of the primary period, that is to say, about the time when the protopathic chancre, bubo, or tubercle, commences to lose its primary syphilitic appearance, to exhibit a dark-red surface instead of its characteristic lardy-looking base, and to pass into the stage of fungoid growth. If the commonly consecutive signs of the primary period (such as buboes, tubercles, etc.) do not appear protopathically, but deuteropathically, or, which is the same thing, as truly consecutive symptoms, they may likewise, in such cases, be at once accompanied by a syphiloid eruption. But they never break out during the first stage of the primary period, and still less as protopathic signs of a syphilitic infection. Only in this case of children, who are affected with hereditary syphilis, they sometimes constitute the first sign by which the hereditary disease manifests itself. In this form, this disease has been noticed on mothers who had inherited it during their pregnancy from the father of their offspring. In by far the larger number of cases, these syphilidae do not break out until the original protopathic phenomena have entirely disappeared, sometimes only after the lapse of two or three months, or even years. All of them, without an exception, run a chronic course in spite of the violence with which they sometimes make their first appearance. Above all things, their whole look is exceedingly characteristic and peculiar; whether they appear in the shape of vesicles, papulae, tubercles, or maculae, their whole look is so peculiar and characteristic that it at once betrays their nature and origin. Among their characteristic peculiarities, we notice, in the first place, their peculiar colour: nobody who has observed this once will ever fail, however difficult it may be to describe it, to recognize it again. It has been described as copper-brown. However, although this color is the most common, yet it cannot be said that it constitutes the peculiar shade of syphiloid eruptions. In some cases, this copper-color is not very distinct, but seems to be an intermediate shade between copper-red and brown-gray, like the color of venison, but always exhibits between these two shades a faint, dark brownish-gray, which, after all, seems to constitute the specific color of the syphilidae. We should not forget, however, that the more recent the eruption, the darker the color, and the longer it has been out on the skin, the more the color will approximate the gray. As regards their common shape, all of them, without an exception, show a disposition to form circular spots or papules: even where they come out in groups, the whole group has a rounded form which, if not a perfect circle, forms at least a segment of a circle or a ring. This peculiarity becomes particularly striking, if the eruption is viewed at a distance, in which case we often notice that even if the single groups deviate from the circular form, the whole mass of these groups together, forms the most perfect exactly-delineated ring. Another characteristic which all these eruptions have in common, is the almost total absence of pruritus, at least in older eruptions; for during the first days of their appearance, in the case of tuberculoid eruptions, for instance, a tolerably violent itching may be felt, which, however, always disappears again in three or four days, without ever reappearing during the whole course of the eruption.
Secale 92. Course of the Syphilidae
It has already been stated that syphiloid eruptions always run a chronic course; this is indeed one of their characteristic peculiarities. It is only when they show themselves already during the transition stage of the primary period that their appearance is sometimes ushered in by constitutional disturbances, with, or without fever, that might lead us to suspect the approach of an acute eruption, but disappears again as soon as the syphiloid has broken out. A similar disproportionate announcement of a product of little magnitude ushers in the eruptions themselves, which sometimes set in with a broad, red base, and tolerable hardness, that might lead us to expect an abscess, but finally run into a small purulent point that does not increase in size; or a vesicle of tolerable size may arise, with a large red areola, which remains for several days without bursting, during which the red areola becomes paler and loses the appearance of inflammation, which latter, indeed, never existed. Some of these syphiloids, not only the pustulous and tuberculoid forms, but, under certain circumstances the maculae, may terminate in long-lasting ulcers, which assume a rounded shape, with somewhat raised, red, abruptly rising edges and ash-coloured base, which, if the ulcers are located on the lower extremities, may assume a bloody appearance. If the ulcer is isolated, it spreads at first in every direction until it has attained a certain size, after which it spontaneously commences to cicatrize. If, on the contrary, two or three ulcers have arisen from a number of neighbouring pustules, they generally run into one large ulcer of two or three inches in diameter, which betrays its threefold origin by the three rounded segments of its edges. Sometimes the little ulcers may become gangrenous and serpiginous; but in every case they become very shortly covered with crusts of a grayish-yellow color, with a brownish tint, arranged in layers, arched above, and not unlike oyster-shells, generally adhering very firmly, and not falling off until the ulcers have become completely cicatrized. Moreover, they greatly incline to spontaneous cicatrization. Nevertheless, after an ulcer has become cicatrized, or even while the process of cicatrization is still going on, new pustules may break out, so that, as might be inferred in the case of many patients from their numerous cicatrices, a multitude of ulcers may co-exist simultaneously with the pustulous eruption, even after it had spread over localities that had not been implicated heretofore. The cicatrices, like the syphiloids and ulcers from which the former had arisen, bear unmistakable signs of their syphilitic character. Like the original chancres, these are rounded, or, in case several ulcers had coalesced, the combined ulcer is, at any rate, provided with arc-shaped edges, and more or less depressed. Recent ulcers are generally quite round, of a more or less violet-red color, and provided with a bronze-colored border, which sometimes, however, may seem quite colorless; in older, ulcers, the centre is white, and shows no sign of vascularity, while the bronze-colored border continues. If the ulcers are several years old, their surface becomes depressed, of a pale- white, without any border, and very similar to the crusts arising from vaccination. In addition, all syphiloid forms show a marked tendency to break out again, so that the course of such an eruption is scarcely ever entirely closed, so that, even before the first pustules, maculae, tubercles, etc., have become cicatrized, dried up, or have otherwise disappeared, yea, even before they are fully formed, a new eruption may become manifest, which, in its turn, runs through all the different stages to the end, so on indefinitely.
