ON THE TREATMENT OF SYPHILIS IN INFANTS, PREGNANT WOMEN, AND Influence of the father on the health of a diseased fœtus or infant -Illustrative cases-0 has had syphilis, but exempt at the time of marriage from all symptoms of disease, beget a diseased infant ?-Illus- trative cases-Influence of the mother-Modes in which the mother diseases her offspring-Hereditary syphilis- Congenital syphilis-Acquired syphilis-Illustrative cases -Symptoms of infantile syphilis-Primary and constitu- tional-Period of their occurrence after birth-Treatment of the father, of the mother, of the infant-Treatment of CLINICAL OBSERVATIONS ON THE TREATMENT OF SECONDARY CONSTITUTIONAL AND CONFIRMED SYPHILIS, BY THE MERCURIAL VAPOUR BATH, AND OTHER THE SIMPLE OR NON-MERCURIAL TREATMENT OF SYPHILIS. THE modern history of Syphilis, both as regards its pathology and therapeutics, may be said to date from the time of John Hunter, whose treatise on the venereal disease appeared in 1786. The doctrines of that surgeon have influenced surgical opinions and practice even to the present day. Hunter, regarding syphilis and gonorrhoea as varieties of the same disease, and looking upon mercurial inunction as the grand panacea for both, submitted both to the same treatment.1 This was opposed in his own day by Benjamin Bell, of Edinburgh; but so powerful for good or evil are the doctrines of a great man, that even up to the period of Sir A. Cooper's appointment to Guy's Hospital patients suffering from gonorrhoea were compelled to rub in so many drachms of mercurial ointment till a profuse salivation was induced. Even the late Professor of Surgery in the Uni 1 See chapter vi., part 2, of his Treatise on the Venereal Disease. versity of Edinburgh' charges a father as being unnatural, who, having a son suffering from syphilis, would submit him to any treatment except a mercurial one. Hunter proved the existence of a specific "morbid animal poison," or "virus," by inoculation. M. Ricord has revived this practice, and from a most extended series of experiments has laid the foundation of a pathology which has removed from the study of syphilis much of the confusion by which it was formerly surrounded. When the physiological school of medicine and surgery arose in France, its founders and partisans, reviving the idea of Bru (Méthode Nouvelle de traiter les Maladies Vénériennes,'. Paris, 1789,) denied the existence of a special poison, or virus, altogether, attributing the phenomena, or pathological symptoms, called "syphilitic," to certain modified conditions of ordinary irritation. Richond des Brus (De la Non-existence du Virus Vénérien,' Paris, 1826,) and the learned M. Jourdain (Traité Complet des Maladies Vénériennes), may be named as the most strenuous supporters of physiological doctrines so far as they relate to the pathology of syphilis.3 An eclectic or mixed doctrine was taught in this country by the late Mr Carmichael, of Dublin, in which it was attempted to show that many primary sexual ulcers were due to the action of a specific virus, and were best combated by specific remedies; whilst, on the other hand, a great number of these ulcers were due to other forms of irritation, and required no specific treatment for their cure.1 In 1813, Mr Carmichael first drew the attention of the profession in this country to the treatment of venereal diseases with 1 Sir C. Bell; see his 'Institutes of Surgery.' 2 See 'Traité Pratique des Maladies Vénériennes; ou, Recherches critiques et expérimentales sur l'Inoculation appliquée à l'étude de ces maladies, &c. ;' Paris, 1838. See also the chapter 'On Inoculation.' 3 "Never," says Moreau in his address to the Academy of Medicine, "has so much hereditary syphilis been known as since the antiphlogistic method has been so generally employed against the venereal lesions of adults." 4 An Essay on the Venereal Diseases which have been confounded with Syphilis, and the Symptoms which exclusively arise from that Poison, by R. Carmichael;' Dublin, 4to, 1814. It must be recollected in reference to this title, that Mr Carmichael believed in a plurality of venereal poisons. out mercury, limiting the employment of this medicine to certain forms of primary and constitutional infection. Mr Carmichael inculcated the employment of mercury "in alterative doses" in cases of the "simple primary ulcer of the papular venereal disease which did not yield to rest, the antiphlogistic treatment, and astringent washes, and to produce its full effects in the true Hunterian chancre, with hardened edge and base." In the constitutional forms of disease, this surgeon had recourse to mercury in alterative doses, "when the papular and pustular eruptions became scaly, and obviously on the decline, and had not yielded to sarsaparilla, antimonials, and the hydriodate of potass," to produce its full effects in iritis, in nodes when iodine had failed, and for the scaly eruption, the lepra or psoriasis which attends it, and the deep excavated ulcer of the tonsils. In 1817, Mr Rose read before the Medico-Chirurgical Society his paper on the Treatment of Syphilis, with an account of several cases of that disease in which a cure was effected without the use of mercury.' A careful perusal of Mr Rose's cases will show, as far as the primary diseases were concerned, that although the ulcers had healed, the disease was not cured, for many of the patients left the hospital with a "hard and elevated cicatrix;" the treatment did not prevent constitutional infection, for many of the cases were followed by secondary symptoms; whilst, as far as the treatment of the latter were concerned, they were a long time disappearing, and had a great tendency to recur. Many of the cases were apparently quite cured; the confusion in Mr Rose's paper doubtless arises from the want of discrimination between the two classes of primary sores-the soft and indurated, or the infecting or non-infecting—a point in the pathology of syphilis not recognised in Mr Rose's day. The simple or rational treatment is directed towards the removal of all the local and constitutional irritation which accompanies a venereal sore, by which the sore itself in many instances heals, and the disease is cured. It is especially indicated in soft chancres; those which secrete pus more or less abundantly, and which are free from a hard base. It consists in placing the patient on a regulated diet, suited to his constitution, not always on a low diet; in confining him to the recumbent position, or to bed; in destroying the ulcer by caustics, or cover ing it with lint soaked in weak solutions of sulphate of copper, sulphate of zinc, the diacetate of lead, or nitrate of silver; and giving internally aperients, antimonials, the mineral acids, or the preparations of iron, according to the circumstances of the case. In all venereal affections, whether primary or secondary, a proper diet is of essential service, and a neglect of this element in the treatment frequently nullifies the effect of otherwise the most suitable remedies.1 On this point no fixed rules can be laid down; they must be dictated by the circumstances of the case, and call for the exercise of much judgment on the part of the practitioner. It may be easily conceived that the severity of the regimen must vary according to the constitution and habits of the patient we have to treat. Some subjects are soon weakened or rendered irritable by abstinence, or quickly placed in conditions favourable to the 1 In Sweden and Denmark, venereal diseases are treated systematically by diet alone, and to this plan the name "cura famis" has been given. It consists in submitting the patient to a very severe regimen, and the administration of the extracts of bark and conium as medicines. The regimen of the patient during the first six weeks consists of five ounces of roast meat without gravy or condiment of any kind, and six ounces of white bread soaked in water; this quantity is divided into two or three portions, but it is the whole quantity allowed for one day's consumption. The extract of conium is given in doses of four or six grains night and morning. At the end of six weeks the patient resumes his ordinary diet. All kinds of venereal diseases may be treated on this plan, whether recent or inveterate; but it is particularly indicated where mercury has been used without success, or where syphilis exists in a gouty or scrofulous constitution. A decoction of the root of the "smilax china" is given for drink to the extent of two pints in the day. (Exposé de la Méthode pour guérir les Maladies Vénériennes dégénérées, par Osbeck ;' Stockholm, 1811.) The commission appointed to examine into the merits of this plan of treatment decided that the cure was due to the regimen alone, and the medical treatment had little or no effect. The Swedish physicians restrict the "cura famis" to cases of constitutional, inveterate, or protracted syphilis. In primary syphilis it is considered injuriors, and is supposed to favour the development of constitutional disease by rendering absorption more active.-For a further account of this mode of treatment, see Bibliothèque Médicale,' tomes 60 et 61; Journal de Hufeland,' Juin, 1817; Quelques Notices sur les Institutions Médicales de Stockholm, et sur le Traitement par la Faim, usité dans les hôpitaux de cette ville;' Gibert, Manuel des Maladies Vénériennes,' Paris, 1837. |