The dose employed by these authorities was the first trituration repeated in the same manner as Mercurius Solubilis.
Secale 230.– Sublimatus corrosivus. Mercurius bi iodatus, Mercurius nitrosus.
These three preparations have not been used as much as other mercurial preparations; for the present, the following clinical observations can be offered in reference to their use:
(1) Sublimatus corrosivus. One of the most intensely penetrating mercurial preparations, which, as Hartmann very justly remarks, is chiefly adapted to treatment of phagedaenic chancres; but which, according to Vehsemeyer’s exceedingly practical observation, must not be continued too long in the treatment of simple and Hunterian chancres, in order not to bring about a premature cicatrization of the chancre in the place of a radical cure. We have to speak, however, less approvingly of Goullon’s method (see Arch. xx., 2, page 142). who likewise employed the Sublimates as a wash in cases of confluent chancre. According to our view of chancre, It should never be touched by external applications that might remove it from the surface before the root is destroyed; on the other hand, we agree with this excellent practitioner in opinion, when he advises, in case the itch and syphilis should break out simultaneously on the same individual, to first cure the syphilis with sublimate, and afterwards to prescribe Sulphur for the itch; in a case of this kind, the Sublimate would likewise exert, incidentally, a curative effect upon the itch. Nor can we indiscriminately sanction the use of sublimate baths in treating chronic eruptions combined with syphilis; in all such cases, the chief indications always is top cure the syphilis with internal remedies, from the centre towards the periphery, unless we wish to run the risk of masking the disease, which, although it may seem cured on its present victim, yet may be transmitted to the off-spring. We are able to confirm Hofrichter’s recommendation of the Sublimate fir exostoses on the tibia, as well as for all similar exostoses, when caused by syphilis; we have found it serviceable in exostoses on the cranium, If this practitioner recommends the Sublimate as an external application to fig-warts (see Allium hom. Zeit., vol. 35, pages 68 and 85), we must energetically protest, in the name of humanity and all coming generations, against the incorrect diagnosis that leads to an identification of mucus tubercles and fig-warts (see No. 68-72, 177, 178). Among the dry fig-warts, there are some that bear touching with Thuja, inasmuch as, after the poison has been destroyed, these excrescences are nothing else than abnormal outgrowths from the skin or mucous membranes, the form of which still testifies to the former syphilitic action in the affected parts. In the case of moist tubercles, or such like excrescences, external applications may drive the poison back upon internal organs, and give rise, in the most favorable cases, to a latent syphilitic disease that can still be communicated to the off- spring. Moreover, Sublimate has cured: Small, dusky-red ulcers on the margin of the glans: red ulcers on the breast and abdomen, of the size of lentils, breaking out after cauterization of chancres, attended with swelling of the tibiae, and a sensation at night as if these bones would break; deep ulcers on the corona glandis, with gonorrhoea and bubo.
(2) Mercurius bi iodatus. This is recommended by Trinks for inveterate syphilis of scrofulous individuals; by Clotar Muller chiefly for syphilidoe. Muller has likewise used it, with excellent effect, for ulcers in the face, at whose bottom the bone was seen denuded, rough, dry, and blackish, of the size of a dime.
(3) Mercurius nitrosus. Recommended by Trinks for the most inveterate, most malignant forms of syphilis (which he, however, dose not specify more particularly), and has been used by Rummel with success for sycosic excrescences, and more particularly for dry, filiform fig-warts, in cases where neither Thuja, nor Nitri acidum, nor Staphysagria were of any avail.
(4) Mercurial phosphatus. Recommended by Vehsemeyer as useful in cases of primary chancres, if Mercurius sol. or Sublimate are without any effect.
II. REMEDIES FOR FUNGOID SYPHILIS.
Secale 231.–Cinnabaris.
The chief remedies belonging to this category are: Cinnabaris, Nitri acidum, and Thuja, Although Cinnabaris is likewise of good effect in the primitive form of chancre, we mention it in this place, for the reason that it forms the transition from the remedies for destructive syphilis to those for fungoid vegetations. Cinnabaris is particularly effective, if the chancre has not yet assumed the fungoid form, but is on the point of doing so. Clotar Muller has derived benefit from Cinnabaris in cases of neglected Hunterian chancre; and has not only cured with it old and neglected chancres, with or without buboes, or chancres, arising from condylomata (mucous tubercles? Jahr.), but likewise fig-warts accompanied by syphilitic tetter. The cases cured with Cinnabaris by Muller, Sommer, Hofrichter, Lingen, and myself, were characterized by the following symptoms:
(1) Chancre and mucous tubercles. (A) Not very large, oozing ulcer behind the cornea glandis. Wreath shaped ulcer on the inner surface of the prepuce and glans, sprouting upwards. Flat, cheesy ulcer on the cornea glandis, of the size of a pea; after the cheesy lining is wiped off, the bottom of the ulcer exhibits a red, tolerably smooth surface (mercurial ulcer? Jahr.), Horrid ulcer exactly in the middle of the dorsum of the penis; the bottom of the ulcer is raised two lines, and the edges three lines above the level of the skin. Indurated chancre on the dorsum of the penis. Chancrous ulcer on the cicatrix of an old issue on the upper arm. (B) Four raised, lardy looking ulcers on the border of the swollen prepuce; they discharge but little, had sprung from condylomata (mucous tubercles?), became visible after the swelling of the prepuce had subsided, and they afterwards disappeared. Four small, elevated warts, discharging a moisture (Mucous tubercles? Jahr.); they were seated on the border of the swollen prepuce, with phimosis. Elliptic fig-warts on the fraenulum and the inner surface of the prepuce, ranged seriatim side by side. Mucous tubercles on the sexual organs, anus, and lips. Elevated chancres, Neglected, simple and Hunterian chancres, both fungoid and not fungoid. (C) Accompanying phenomena. Painless phimosis from swelling of the prepuce. Swelling of the glans and prepuce. The glans has a dark, blue-gray color, with swelling of the follicles. The bottom of the ulcer seems like lard, with uneven granulations very painful to the touch. Daily discharge of a fetid pus, having a pungent odor, oozing out from behind the prepuce. Copious discharge of a thin, watery pus. Secretion of a quantity of yellow, thin mucus having a putrid smell, accompanied by a pricking, burning pain in the glans. Whitish secretion from the ulcer, having a nauseous-sweetish, pungent odor. Discharge of a quantity of fetid purulent mucus, with bleeding of the prepuce when an attempt is made to draw it back. Offensive smell from the mouth, like amalgam; the whole individual has this odor, notwithstanding the greatest cleanliness. Emaciated, hollow- eyed, cachectic appearance.
(2) Consecutive and secondary phenomena. Bubo in the left inguinal region, of the size of a pigeon’s egg, having existed for some months, and painful only when touched. Chancrous ulcer on the cicatrix of an old issue of the upper arm. Herpetic spots on the extremities, and around the corners of the mouth, oval and sharply circumscribed.
Cinnabaris is, moreover, indicated in the case of patients who come under homoeopathic treatment after having been treated allopathically, without, however, exhibiting traces of mercurial poisoning as plainly as was the case with Hofrichter’s patients (see No. 229). In cases of the latter kind, Nitri acidum, Thuja, or some other remedy has to be prescribed; even Cinnabaris would not be allowed, for the reason that nothing is more dangerous than to combat mercurial symptoms with Mercury. There is, indeed, no danger of latent syphilis being brought about by such a proceeding. The danger is that an inexperienced diagnostician may confound the subsequently reappearing mercurial with syphilitic symptoms, for which he again prescribes Mercury, until the patient falls a victim to mercurial poisoning.
Secale 232. –Nitric Acidum.
Next to Thuja, this is a chief remedy in that stage of syphilis where the chancre-virus changes to the condylomatous poison; hence it is a remedy for all the protopathic products that emanate from this modified chancre-virus, and are known by the names of mucous tubercles, fig-warts, etc.; ion one word, for all kinds of fungoid vegetations, whether they grow out of chancre or manifest themselves as protopathic products. It is likewise an excellent, and indeed indispensable remedy, if mercurial poisoning and syphilis are combined together. Hence, Lobethal recommends it very properly form old chancres, for which large doses of Mercury had been taken without effect; instead of growing smaller, the chancres spread; he likewise recommends it for general syphilis after the ineffectual cures a la Dondi, Berg, Zittman, and Rust. Attomyr’s recommendation of this drug for the second class of this chancres, is very proper; except that the ulcers, which the describes as clean, flesh-colored, spongy seem to coincide with our mucous tubercles (see No. 68). Buchner’s painless ulcers, with gray, everted edges, for which this practitioner recommends Nitri acidum, seems somewhat tainted with Mercury. Nitri acidum is likewise very properly recommended for buboes; i know of no remedy that is more capable of dispersing an inflammatory bubo than Nitric acid, provided always that the suppurative process can yet be prevented. I am likewise able to confirm every thing that Rummel has said in favor of this agent as a remedy for psoriasis. In the cases that have been cured by Attomyr, Buchner, Hahnemann, Hartmann, Fielitz, Hofrichter, Guylas, Langhammer, Liedbeck, Lobethal, Rosenberg, Rummel, Vehsemeyer, and myself, the following chief characteristics were present.
