As regards diagnosis, there is not the remotest doubt of the nature of the malady, whenever the above-described pustules are present simultaneously with chancres, resembling those of full- grown persons; or if rhagades on the lips, at the anus, or umbilicus, are seen, or lymphatic swellings in various parts of the body. Moreover, it is well known that scrofulous swellings develop themselves only at a later period. Less sure as a diagnostic sign in erysipelas (erysipelas neonatorum), which may likewise exist in otherwise perfectly sound children; but the above-mentioned erysipelatous redness of syphilitic children is quite different from ordinary erysipelas; it resembles the redness which, in full-grown persons, is seen on the velum palati and in the fauces whenever these parts are invaded by the disease. Whether, in certain dubious cases, it is safe to decide whether the nurse has infected her nursling, or whether the infection has proceeded from the latter to the former, it must be evident, after what we have said in No. 188, that this point must always remain obscure, unless all doubt can be cleared up by a perfect knowledge of all the previous circumstances bearing upon the cases; since it is an established fact that syphilis can be communicated through the milk, even if the mammae do not show the remotest trace of syphilitic disease. In such a case, the matter can only be cleared up by a most careful investigation of the previous circumstances of the nurse, as well as of those of the parents.
As far as the prognosis is concerned, it is evident that the danger connected with infantile syphilis has been deemed greater than it really is. If such children are at once placed under suitable influences, in hands where their health is well cared for, and where they enjoy the benefit of a perfectly rational treatment, there, is no doubt that most of them can be saved. I have preserved more than one child of this class, and have succeeded in freeing their constitutions from every vestige of syphilitic taint. Where such a child has not only to struggle with every species of distress and misery, and the physician is moreover interfered with at every turn of the road by silly and stupid parents, it may perhaps be advisable not to undertake the treatment of such a case. Moreover, some forms of the disease are more dangerous than others; pemphigus for instance, which almost always terminates fatally; likewise chancres on the lips and in the mouth, which may destroy the infant in an indirect way, by interfering with the introduction of food; and lastly, ozaena syphilitica, which may likewise have the same effect. An improper suppression of discharges from the nose and vagina, by the absurd use of astringents and the like, may be followed by a sudden destruction of life. Ophthalmia, if properly managed, is a curable disease, and need not necessarily result in blindness. The same thing may be said of chancres pustules, swellings, even when located on the skull-bones; all these symptoms generally yield to a truly rational treatment with specific means, provided they are used with care and discretion.
As regards the treatment of this form of syphilis, nothing need be remarked in addition to what has already been stated in the course of this work, concerning the use of the different anti- syphilitica, such as Mercurius Cinnabaris, Nitri acidum, Thuja, etc. On thing is required: the infant must be once be taken form breast, whether it is nurse by the mother or by a strange woman, and both must be subjected to proper treatment. This is an indispensable precautionary measure; I know from abundant experience that too much leniency in this respect may entail a good deal of mischief.
III. MERCURIAL SYPHILIS.
Secale 214. – General Observations.
The older physicians already knew, and stated in their writings, that Mercury, if administered in excessive and improperly continued doses, is not only an extremely dangerous remedy to itself, but, unless employed with great precautions, aggravates the syphilitic disease instead of curing it. With some this opinion went so far as to induce them to attribute the phenomena of secondary syphilis exclusively to the employment of Mercury, and consequently to reject the use of this metal in the treatment of syphilis. Between these two extremes our School formerly held a middle position; on the one hand, we have admitted the injury arising from the use of excessive and of too frequently repeated doses of Mercury, whereas on the other hand, we contend that small and properly administered doses of this agent are indispensable to a successful treatment of the syphilitic disease. It is true that recent critics have undertaken to sneer at the idea that the incautious use of Mercury may involve pernicious consequences; but we do not hesitate, even at the risk of being considered servile imitators of Hahnemann, to make the statement that if the destructive effects of Mercury do not seem as marked at the present time as they were when it was deemed necessary to give Mercury in sufficiently large doses to excite ptyalism, some of the perceptible effects of this agent are witnessed, even tot his day, not only under allopathic, but even under homoeopathic treatment. Even from the first trituration, I have noticed the following effects on persons somewhat sensitive to mercurial action: Ulcers that were mostly superficial, though sometimes more deeply penetrating, and lined with a cheesy matter, healing spontaneously in ten or twelve days, but sometimes breaking out again in eighteen months, even if the remedy had been discontinued during this whole period; – aphthae and milky- white ulcers on the inside of the lips, and similar rhagades on the margin of the tongue, or between the cheek and gums; – superficial flat ulcers on the dorsum of the hand, arising from itching vesicles; these ulcers looked as if they had been gnawed at by insects, became covered with a scurf that frequently fell off and formed anew, and finally disappeared in from twenty-five to thirty days, without leaving a trace of the ulcer; – itching blotches on the legs, resembling mosquito-bites becoming covered with scurfs after being scratching open, and, after being removed by scratching, showing superficial ulcers on the skin, of the size of split peas; a bloody serum oozed from these ulcers, which, after having become covered with a new scruf, began to itch, and finally dried up; – similar pimples on the hairy scalp, itching and changing to ulcers of the size of a three cent piece to that of a dime; they would dry up in two or three weeks, and, in the course of two years, frequently break out again. A very disagreeable effect of Mercury, which I have only witnessed three or four times, and which came on six, eight or ten months, and, in one case twelve months after using the metal uninterruptedly for two months, was a highly characteristic debility with slow fever, complete loss of appetite, intolerable pains in the limbs, trembling walk, desponding melancholy, and an indescribable feeling of bodily and mental malaise. Let us now pass in review the effects of allopathic doses of Mercury, so that we may at once be able to distinguish them from other symptoms whenever such effects occur.
Secale 215. – Acute Effects of Mercury.
Any one who wishes to obtain a correct and full knowledge of the poisonous effects of Mercury, will have to consult the excellent works of Dieterich, Humann, Heim, and Ludolph, of which mention has already been made in the Introduction of this work. Here follow some of the most important facts from these works.
(1) Mercurial fever, of which we have already spoken. It sometimes sets in with such a violent headache, that one might apprehend the approach of acute typhus; there is chilliness mingled with heat, great dryness of the mouth, with thirst; general languor, weariness and debility; extreme prostration and sadness; heat and dryness of the skin; red urine, a full and rapid pulse. These symptoms are sometimes, but not always, accompanied, by an inclination to vomit, tooth-ache, ear-ache, rheumatic pains in the limbs, and other complaints which, however, are not constant. The fever often terminates critically between fourth and seventh day, specially if it begins while Mercury is still used by the patient; whereas, if it only breaks out at later period, three or six months after the use of the metal had been abandoned, the fever is apt to continue twenty- five to thirty days. In other cases the fever sets in as a dynamic fever, with sallow complexion, with a dim and glassy expression of the eyes, which are surrounded with blue margins; coldness of the extremities, nose and face, evening chills, rapid and small pulse, deathlike pallor; the patient lies down in a stage of apathy, without strength etc.; lastly, inclination to vomit, delirium, starting up in bed, as from terror, and even death.
(2) Ptyalism. – This symptom is so well known that it seems unnecessary to describe it any further. The present treatment of syphilis with Mercury, even in allopathic hands, is modified to such an extent, that ptyalism now-a-days never reaches the fearful height to which it was carried in former times, when chronic ulcers of the mouth, necrosis of the teeth and jaw-bones, scorbutic gums, and many other affections, were among the ordinary consequences of the terrible disorder.
