Treatment :

-JAHR Georg Heinrich Gottlieb

If old-school physicians assert that nothing is easier than to cure these tubercles, since they yield very readily to appropriate external applications, their assertion is undoubtedly correct, provided we understand by the term "cure," a simple removal of these tubercles from the skin by external means. But if we consider that a mere external suppression may superinduce all the symptoms of constitutional syphilis, and that a cure implies not only their suppression, but a complete annihilation of the internal syphilitic disease, we may be willing to admit that the healing of such tubercles is attended with the same greater or less difficulties as that of any other form of primary syphilis. If there ever was a case of syphilis, where it is of the utmost importance to heal the disease with internal means, it is mucous tubercles. These tubercles, like buboes, appertain to a period of development of the syphilitic disease (as we shall show in the second division of this work, § 79, etc.) where they still constitute a primary form of syphilis, although the whole organism may already be tainted, and where they may lead to consecutive, but not strictly speaking secondary, phenomena; inasmuch as the contagious virus is not yet, as in the secondary period, chemically combined with the fluids of the body (for this is evident from the fact that its products are still possessed of a capacity to transmit the disease),



Tubercles on trunk

  but still exists in a state of freedom, and hence is much more readily excreted than at a later period. However, inasmuch as the period when tubercles make their appearance already constitutes a transition-period, Mercurius, which is a chief remedy even in this period, particularly Merc. subl. and Cannabaris, may not always be sufficient, but has frequently to be replaced, or assisted in its action, by other agents, such as Nitri ac. and Thuja, which will always prove curative, as I have seen in a number of cases, as long as no real symptoms of secondary syphilis have yet made their appearance. In these last-mentioned cases, of which, until now, I have only seen one with simultaneous Corona veneris, and where the tubercles were seated on the tonsils, inducing a sort of angina syphilitica, other remedies may have to be resorted to. In the case I have just alluded to neither Merc. nor Nitri ac., nor Thuja proved of any avail; Lycopodium effected a cure, It is strange that, in our own literature, not a single case of these tubercles should as yet be mentioned. Have they been confounded with chancres; or, as in Hartmann's Therapeutics, with figwarts; or do they occur less frequently in Germany than in France? Attomyr's description of his second form of chancre, which he cures with Nitri. ac. (see his "Venerische Krankheiten," page 23), leads me to suspect the former; for his statements: "Ulcers flat and raised; clean, flesh-colored, almost fungous appearance, and simultaneous breaking out of several ulcers," may refer to numerous tubercles, rather than to the elevated ulcer. As for the rest, these tubercles occur much less frequently than chancre, buboes, and figwarts, perhaps; only in hospitals, where chancres are generally removed by ointments and cauterization. Indeed, most of those who come to me for treatment, when afflicted with such tubercles, are poor servant-girls, who leave the hospitals with all the symptoms of a badly-healed chancre still upon them. Thorer's cases (Arch, vol. XIII., part 3, pages 80-86) most likely belong to this same class of mucous tubercles.