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never treated a patient who was not relieved of evil forebodings by the assurance that only a local disease had been taken Lastly, it may be stated that the constitutional form of syphilis cannot be taken but once, or can only have one invasion; while the local variety may be taken a hundred times, or as often as gonorrhoea or pubic parasites. It must be some comfort to a man who has had all the phases of systemic syphilis to believe that he can never have the disease a second time.
The treatment for local sores or chancroids, is to sprinkle upon them twice a day a pinch of pulverised borate of sodacommon borax. The application is attended with neither pain nor inconvenience. Under the influence of this cleansing antiseptic agent the ulcers lose their destructive character, and develop healing, granulating, activity. Is there anything more simple in the practice of medicine? And the method is as efficacious as it is simple. A local disease easily cured cannot be alarming; but at the same time it is picked up, the patient may take the clap, lice, itch and the constitutional kind of syphilis. These are independent forms of disease, and may be imparted and received in a single sexual contact. But, it is to be borne in mind, that the ulcers of the local variety of venereal disease appear in a few days-within a week-of the time of contamination; and the "initial lesion" of true syphilis of the systemic variety, makes its appearance not before the lapse of twenty days, and often not for forty or fifty days. However, the essential principle of the disorder entered the absorbents at once, and proceeded upon its career from the start; but it requires weeks of latency, so to speak, before it evolves the "initial lesion." Then, again, the primitive sore, which is single, and not multiple as in the local disease, is more of an indurated nodule than an excavated ulcer with soft margins or borders. Now if the "hard chancre" be cut out-excised-with curved scissors, not much is gained. Either another will form at the seat of traumatism, or “secondary manifestations" will the sooner appear. The virus in an advanced state of activity has contaminated the entire organism, whether the varied phenomena of the disease come
in regular order or not. Some patients will throw off the virulence so fast that the disease does not reach what have been denominated "tertiary phases."
The earlier of secondary displays are states of waste manifested in loss of flesh, decline of appetite, mental dullness and despondency, disturbed sleep, coated tongue, bad breath, physical feebleness, and a distinctive eruption often preceded by a rigor or chill, and, perhaps, night-sweats. I say "distinctive" eruption, for it is not like that of scarlatina, rubeola, or other common disease. It is sometimes coppery in hue, yet it may be bright red or dusky brown, and even scaly. It is not to be mistaken, even by a novice.
At the time the eruption appears, the irides are likely to become sensitive. It is well known that the iris is in sympathy with the skin. The color of the eye-hue of iris-is in harmony with the general "complexion." A blue eye is not associated with a brunette; or, if it is, a queer combination is noticeable. Well, the iris is inflamed soon after a syphilitic eruption appears; and the sufferer does not see well. It is not a rare concomitant for a syphilitic patient to become quite blind.
By the time the tegumentary efflorescence subsides, which may be in two or three weeks after its earliest manifestation, a sore throat-inflamed or ulcerated tonsils-becomes a feature; and then ulcers of the lips and gums, or fissures of the tongue come along in order. Meanwhile the "initial lesion," "primary nodule," or "hard chancre" on the genitals, disappears whether treated or not. It is not common for primary, secondary, and tertiary phenomena to be present at the same time. One usually succeeds the other, though the phases of syphilis are variable in feature, and in order of sequence.
Inasmuch as the hair and nails are products of the skin, an eruptive disease might be expected to impress those structures. In most instances the hair falls, and in a few two or three of the nails exhibit ulceration at their roots.
The treatment for constitutional syphilis consists in the administration of such nutrients and medicaments as have
been ascertained to arrest progressive anæmia, and to contribute to general recuperation. For, be it known, the virus of syphilis, whether it be a microbe or not, is a potent devitaliser. Fat and muscle melt away under its influence. A patient cannot eat and digest food enough to stay the waste of tissue. The disease enlarges and functionally deranges the lymphatic glands of the entire organism. Though fairly-rich lymph be offered to and taken up by the lacteals, the mesenteric glands are impressed morbidly, and cannot elaborate good leucocytes from the nutritive fluid; hence the sources of blood-making are prevented, if not entirely cut off. If there be no white globules evolved from the lacteal supplies, there can be no hemacytes or red globules elaborated in the arteries. Here, there is a complication of disordered action, which will tax the resources of the average therapeutist. He may flounder in the slough of "specifics," till his lack of success makes him wish he had never seen his patient; and the patient, enduring one pang after another, through long and wearisome nights and days, till weeks and months have. elapsed since the beginning, will be prone to think his medical adviser is inefficient or medicine possesses not the curing powers which he had fondly dreamed. Possibly the doctor has done well-the best that could be done-yet neither he nor the patient appreciate the true condition of affairs. Syphilis cannot be chased from its abode as a ferret drives a hare from its burrow; nor is it to be drenched or washed away with masterly-behaving physic. The allopathist may claim mercury as the only genuine and potent specific; the homœopathist may aim, like David, to strike down Goliath with a pebble or pellet; the Eclectic may pin his faith to a muchcompounded syrup of Stillingia*; and the Botanic concoct "alterative" herbs till his unscientific broth is vile as that of Hecate, yet the syphilitic patient will have a sore mouth, a year or more after the appearance of the "initial lesion."
* Dr. J. Marion Sims recently published an article in a London medical journal in which he gave the credit of devising this mixture to the Indians and the plantation negroes of Alabama. American medical journals at once copied it as important information, while Eclectics laughed. But we had thought that we had a right to expect more honest candor from Dr. Sims.-A. W.
What is there no balm in Gilead? Not much! But something can be done with nutrients and peptics, and with remedies known to be useful in anæmic states of the body. Feed that wasting syphilitic patient on delicacies! Whet his appetite with pickled olives and cranberry jelly! Let the best beef soup be served to him; let oysters in tempting "styles" be offerings unto him. He may relish French pease with "sweet-breads." A meal of a fatty mackerel may go. down, especially if washed with cider or sparkling wine. A slice of boiled ham with mustard and rye-bread, may do for a dinner. A well-done poached egg, buttered, and seasoned with horseradish, will do to end a breakfast. A broiled chicken, with tomatoes, makes a delicious lunch. Need I mention more? No; but exercise your ingenuity, and consult the tastes and caprices of the patient.
Next come medicines. Let them be as palatable as possible. First on the list is arsenic. Let it be in the form of Fowler's Solution. The maximum dose is one drop, which may be repeated three or four times a day. I commonly incorporate the medicine with a syrup of hypophosphites, or with the elixir of cinchona. Secondly, I will mention iodine, and in the form of iodide of ammonium. Let the medicine be dissolved in water or a pleasant elixir. It should not be exhibited in a syrupy mess, lest it create dyspepsia. Three or four grains of the iodide may be administered every four hours during three or four days. Some other medicine should then be given. Let it be iron in an elixir, with strychnia or cinchona. After a few days of such treatment, the patient is to take the elixir of phosphorus. The agents named should be changed often-every two or three days. Two can be given in alternation on the same day. If an attack of dyspepsia come on, the minerals can be dropped for a few days, and nux and pepsin be substituted. The preponderating idea should be to keep the stomach in as good a state as possible, and not over-rate the anti-syphilitic efficacy of any remedy. Recollect, there is no known specific for the cure of syphilis; but there are many medicines which assist in the elimination of the disease. The unaided vital powers will overcome the dis
ease. The sailor, having a chancre, may "ship" on a whaling voyage of two years, and when he returns, he will have no sign of the syphilis, though he has not taken a particle of medicine since he left port. He had all the phases of the disease in its "secondary" stage, but no "tertiary” phenomena. The iodine of ocean-breezes overcome syphilis to an appreciable extent, and so do the soluble minerals of certain spring
To make the hair grow when baldness has arisen from a syphilitic scalp, it is well to make a compound of glycerine, rose water, Fowler's Solution, and tincture of cantharides-a fluid-drachm each of the two latter to two fluid-ounces each of the two former. This is to be rubbed on the scalp twice a day.
Tertiary pains in superficial bones are of periostial origin, and are to be subdued by the internal administration of large doses of iodide of potassium, and by topically treating the sensitive parts with a liniment of equal quantities of the tinctures of aconite and cayenne. If the periosteum be bulged into nodes, they must be slit or incised with a knife. This procedure allows the escape of pent-up jellies, and relieves the tension of an inelastic membrane.
An individual can communicate secondary syphilis, but not tertiary virus, except to the extent of producing local sores or chancroids. It has long been my view that "soft chancres," so called, were sired, or, perhaps, dammed, by tertiary syphilis. I admit this is a hypothesis of my own, yet one that has some grounds of support.
Tertiary phenomena are chiefly confined to the bones; yet they may be observed in connection with soft structures. The muscles and tendons may have cheesy tumors develop in or upon them; and these lumps may degenerate into abscesses and chronic ulcers. When the latter heal, they leave distorting scars.