Chapter first GENERAL DIAGNOSTIC REMARKS.
1. MASKED SYPHILIS
Secale 206. – General Syphilitic Diagnostic Signs.
We have seen that syphilis, in its secondary period may manifest itself in a thousand different shapes, and in every tissue of the organism, and may even continue to exist, in a latent form after every perceptible sign of the disease has disappeared, and the organism seems to be perfectly free from it. Some extraordinary event, severe injury, and dangerous acute disease, a deeply penetrating emotion, and the like, may again rouse it into action; or, even if it should remain in its latent form, it may be transmitted to the offspring. In the former division of this work, we have shown, very fully and satisfactorily, we imagine, in what forms the syphilitic disease chiefly manifests itself, either in its primary or secondary period; all that remains for us to do on this occasion is, to add some remarks concerning latent or masked syphilis, which, in its primary period, sometimes assumes the form of gonorrhoea, and, in its secondary period, it destitute of every sign of outward manifestation. As regards the first of these two points, we have already, when speaking of the different forms of gonorrhoea (No.16), mentioned the signs by which the symptomatic syphilitic gonorrhoea is distinguished from the simple idiopathic form of this disease, but deem it necessary to revert again to this point, because, in our estimation, nothing can be more hurtful to the patient than that these two kinds of gonorrhoea with each other. With physicians who do not suppress the discharge by means of injections, but treat every case of gonorrhoea with internal remedies, the danger is, of course, much less, since, under such treatment, if the discharge is of a syphilitic nature, other diagnostic signs of the syphilitic character of the disease will not fall to make their appearance, as may have been seen in the cases related in No.174. Nevertheless, it believes every physician to be on his guard in managing a case of gonorrhoea, more particularly when no sign of inflammation seems to be perceptible, and the case belongs in the category of the so- called gonorrhoea torpida. The slighter the pain, the less considerable the discharge, the less marked the inflammatory symptoms, the more this apparent mildness of the disease should be distrusted and the more mindful we should be of the proverb, that “still waters run deep.” Nevertheless, these are not the worst cases, for here the physician will have at least one suspicious symptom that appeals to his watchfulness and care. But what about cases where, after the syphilitic disease has been apparently cured, its root is still so deeply planted in the organism, that the disease is transmitted to the offspring; that the milk of nurse thus tainted often communicates to their nurslings the germs of the most hideous and dangerous forms of the syphilitic plague?
How shall the physician, under such circumstances, proceed, in order to become cognizant of the true condition of his patients; and what answer shall he return to those who inquire of him whether they need not fear any relapses; whether it is safe from them to marry, and whether their children will not be born with any syphilitic taint? If not outward sign of disease is any longer present, it is evident that the diagnosis can no longer rest upon pathological phenomena, but has to be determined by therapeutic means. The question, therefore, will be, whether among the different modes of treatment, by means of which the primary or secondary symptoms of the disease had been removed, there is one which, the virtue of its own inherent essence and fixedness, furnishes satisfactory evidence that the root of the disease has been so completely and unmistakably eradicated from the organism, that it cannot possibly germinate anew, and produce another syphilitic monster. It is well known that the different modes of treatment employed against syphilis only secure a superficial removal of the syphilitic phenomena, and preclude the possibility of a thorough eradication of the syphilitic poison; but, supposing that all signs of syphilis have been removed by the most judicious internal treatment, how do we know that the treatment has been sufficient, and by what evidence is this to be determined? If there is any uncertainty regarding the sufficiency of treatment, by what signs can this uncertainty be cleared up? These are questions that we will now proceed to examine more in detail.
Secale 207. – Evidence of a Sure Cure.
The older French physicians, more specially Louvrier, Lafecteur and Fabre, adopted the theory that the disease must terminate in some crisis, or in critical evacuations, such as ptyalism, sweat, diarrhoea, or a copious flow of urine; they maintained that, wherever such critical evacuations had not taken place, the cure that had apparently been obtained, could not be depended upon. Hence the mercurial cures of former times, that were carried to the worst extremes of ptyalism; and the use of purgatives for the purpose of securing critical evacuations of the poisonous matter by the bowels, in case they did not occur spontaneously during the inunction cure. Other physicians sought to obtain critical eliminations by the use of sudorifics, and others again by acting upon the bladder through diuretics. In spite of such critical evacuations, experience showed that a radical cure of the disease could not more be depended upon than if such evacuations did not take place, and it is therefore questionable whether the syphilitic disease cannot be radically cured without such critical changes being secured. I can point to cases in my own practice, where the first signs of an improvement subsequent to the administration of two half-grain doses of the first centesimal trituration of Mercurius for obstinate or malignant chancres, were attended with a copious flow of urine for two or three days, or where, in other cases, the improvement was initiated with slight febrile movements about dusk, followed by tolerably profuse night-sweats. In one case, where two inflamed buboes were present at the same time, the coincidence of a critical improvement and a profuse night-sweat was so remarkable that in the very night when the sweat broke out the buboes diminished in size to a considerable extent, and the cure could be fairly dated from this change. If a crisis takes place in every cases of cure of the syphilitic disease, it is often so inconsiderable-since the body is not drenched with a barrelful of poison-that most patients, who never watch the symptoms very closely, are not aware of it; at all events, if such critical changes occur subsequently to the exhibition of our small doses, they are not the cause but the consequence of a radical; destruction, and elimination of the virus. Such changes, brought about as it were by a re-awakening of the reactive energies of the organism, do not prove anything in favor of any artificially produced critical evacuations, These so-called crises does not, therefore, furnish sufficient evidence that the disease has been really cured; if produced by the small doses of Homoeopathy, these crises are not sufficiently marked to afford adequate scope for observations; whereas evacuations consequent upon the use of massive quantities of non-specific drugs, have no critical significance whatsoever. It is well-known that in 1788, Hahnemann regarded the supervention of a mercurial fever as an indispensable proof that the virus was properly eliminated; and that even at late as 1816, he held that some perceptible mercurial effects were necessary, in order to secure the perfect reliability of a cure; afterwards, however, he abandoned this ground entirely, and taught that, to constitute a perfect cure, it was sufficient that, after the exclusively-internal use of the smallest possible doses of Mercury, the chancre gradually commenced to become cleansed and to heal spontaneously as it were, without leaving behind a single trace of discoloration of the skin. Indeed, until now, this has remained the safest and most reliable criterion of a radical cure, more particularly if such a change is accompanied by an increased appetite and heightened buoyancy of feeling and a perception of well being, as after a severe and protracted malady. If, after a pretended cure, a hard, uneven, badly colored cicatrix or a dirty, unnatural color of the skin remains behind, and if the general feeling of health is not such as it should be, and always is, after a sever sickness has been radically overcome by proper treatment, we may rest assured that the cure is not reliable, and that every imaginable kind of trouble may remain in store for the poor sufferer.
Secale 208. – Syphilitic Reagents.
But it is not always with such specific remedies that a cure of the venereal phenomena is affected in this rational manner; but, even in such a case, after using for a certain period of time more or less adequate or inadequate means of treatment, the most striking primary or secondary phenomena may disappear, and the disease, as we have seen in No.196, 197, may enter upon the stage of involution of secondary syphilis, and may assume the masked form of which we are here speaking, and where, notwithstanding that every sign of the syphilitic disease has vanished from the sphere of observation, this disease still continues to exist, as it were, in a state of slumber, While the disease exists in this condition, several physicians, in order to become sure what they might have to expect or to fear from it, have proposed the use of certain syphilitic reagents, which when introduced into a body affected with a latent syphilis, compel the disease, in a very short time, to show itself in broad daylight. With this view, Swediaur already directed attention to Iron, other physicians to the Sulphate and Phosphate of Soda. However, the facts which these authors adduce to support their assertions are not sufficient to shed light on the point in dispute, since the result obtained is confined to the well-known phenomenon that, when ulcers, concerning whose mercurial or syphilitic nature there is a doubt, are painted with solutions of the above- mentioned substances, the ulcers very soon show their true nature, the mercurial ulcers healing very soon after the syphilitic, on the contrary, becoming very much aggravated. Without entering upon a critical analysis of this statement, which has been introduced into almost every treatise on Pathology, we content ourselves with pointing out the fact, that we do not require a reagent by means of which mercurial and syphilitic ulcers can be distinguished from each other, but one that shall bring the masked syphilis to light again. The physicians of the naturalistic school have named as such reagents :(1) Sulphur, Phosphorus, and most of the Carbonates; (2) China, Angustura, Cascarilla, and other astringents, etc. As regards Sulphur, and more specially the world renowned Sulphur baths of Axilla Chapelle, we have already expressed our opinion regarding them in No.205; in the same manner we may admit that Phosphorus, the Carbonates and tannin-containing substances, will, by their continued use in excessive quantities, not only cause exanthems, but ulcers of every description; but if one would regard these effects, without any further examination of their diagnostic value and meaning, as signs of a re-awakened syphilis, he would be very much mistaken. Considering how often homoeopathic physicians employ Sulphur, Phosphorus, both kinds of Charcoal, an other similar remedies, with the best success, both for consecutive and secondary syphilitic phenomena, it must be plain to any one how little these purely theoretical conjectures of the Naturalistic School can be depended upon in practice. It is indeed questionable whether masked syphilis can be at all roused form its latent condition by any known substance. I know of but one case from my own practice, where a single dose of Arsenicum, three pellets of the thirtieth attenuation, seemed to have an effect of this kind. It was the case of a body ten years old, whose father, previous to his marriage had caught a chancre on two different occasions, which had been removed with caustics, and with large doses of the Iodide of Potassium internally. The boy’s sister had died of syphilitic pemphigus shortly after birth. In consequence of a slight injure, a sore broke out on the tibia, which soon degenerated into a suspicious, looking, but not yet distinctly-characterized tetter, for which I administered Arsenicum. Three days after exhibiting this remedy, the whole body became covered with a characteristic, syphilitic, lichenoid exanthem. I cannot say that I attach much diagnostic value to this case.
