Syphilis has been considered an incurable disease by the profession at large, except by the use of mercury, often in toxic doses, and the iodides. The older physicians of our school believed, with some of these writers, that many of the after symptoms charged to the disease were induced by the mercury. They also believed, that the disease could be cured with perfect satisfaction, especially if taken at the onset, with vegetable alteratives. They also proved that when so treated none of the severer manifestations of the disease, except in extreme cases, would appear.
So strong, in the last fifteen years, has been the sentiment of the old school, that mercury must be used in treatment of this disease, that many of our own physicians have become impregnated with this idea, and have used mercury in their cases. I have long felt that some effort in a general way should be made to convince the profession that this disease is eminently curable with the alteratives we have access to.
With this idea in mind, I began early in this year to collect from some of our best physicians their experiences concerning the treatment of syphilis, which I could present in one article to the readers of this journal, to establish in them a sure confidence in this simple, rational method of treatment. I have succeeded beyond my expectations, in collecting some splendid papers, and I consider the mass of evidence here produced sufficient to establish a fixed and permanent confidence in this course of treatment.
Probably the most satisfactory result of this method is the perfect health of the patient subsequently, and his entire freedom from the permanent sequelae so commonly observed after the mercurial treatment. It will be observed that but few of these prominent men use the iodides, although there can be no objection to these if correctly indicated. Although these individual physicians have been widely separated in their practice, it will be also observed that they use in most part the same remedies.
Among the peculiarities of each, we will note that Prof. Whitford depends upon veratrum. Dr. Farnum, also, uses this remedy, which is also depended upon as a most active alterative by Prof. A. L. Clark, who has used it for many years. Dr. Bloyer tells us plainly how to use the potassium iodide, and names as his dependence our most reliable vegetable remedies. Dr. Farnum uses cascara sagrada to preserve the integrity of the intestinal tract. I believe it does more than that. Some of our physicians on the Western coast believe that syphilis can be cured by the use of cascara amarga alone, another species of this plant (Cascara sagrada is a buckthorn, Rhamnus purshiana, while Cascara amarga is a quassia, Picramnea sp. The two are not related - cascara is Spanish for "bark". -Henriette). I am anxious to learn of the individual experiences of those who have used this latter remedy.
Prof. Boskowitz and one or two others use rumex crispus. This was an especial favorite with the earlier physicians of our school, who believed that its influence was very important. I am certainly inclined to agree with them.
I desire to call especial attention to the marked innovation in the treatment of syphilis, made by Prof. L. E. Russell of Cincinnati. I was so impressed with his statement, when I first received it, that I wrote him an inquiry, as to how he had had this remedy suggested to him in the treatment of this disease. His answer is so plain and so exceedingly interesting, that I have added it as a part of his contribution. It is a surprising thing that two of the most prominent surgeons in our school, whose practice has been widely separated as that of Prof. Russell and Prof. Farnum, should agree upon the fact that iron is a most important remedy in the treatment of this disease.
The plain indications given for the use of each remedy by Prof. Mundy and Dr. King are in line with our specific observations. Dr. Kinnett gives some very excellent reasons for depending upon the tissue remedies and claims superior results. Dr. S. B. Munn is one of the old school of our physicians. His prescription, as given here, was at one-time very popular among the early practitioners and was certainly curative. Lappa, alnus, and galium were great favorites with this class of physicians. Lappa is also suggested by Dr. King, whose grandfather was one of the prominent Eclectics of the state of New York 35 or 40 years ago.
Iris, phytolacca and echinacea, as named by Dr. Hauss, are those that will be found most frequently named by all these writers. The method of Dr. Baker is peculiar in that he depends upon lobelia. The use of this remedy as a powerful eliminant, dates back to the later part of the 18th and to the beginning of the 19th century. It has been superseded in this influence by agents that do not induce nausea, which is to many a very objectional factor. I believe Dr. Baker is right in his observations.
This article is entitled "The Cure of Syphilis Without Mercury." I have received some excellent letters from a few other physicians in which they use the above remedies in conjunction with some preparation of mercury. I have thought best to reserve these letters and publish them in a separate article at an early date, as they are not comprehended under this head. I shall probably present both sides of the subject.
W. E. BLOYER, M. D., CINCINNATI, OHIO
With the exception of perhaps four or five cases I think I have been successful in curing all the cases that I have treated in twenty years, and all without mercury.
I depend upon the following vegetable remedies, berberis, iris, phytolacca, corydalis, echinacea, stillingia, and chionanthus, as well, also, as upon the indicated remedy. Podophyllum is frequently the remedy.
I have now under treatment three or four cases that have never had mercury or the iodine compounds. They have never had a skin eruption, nor lost a hair. They had mucous patches and enlarged glands but nothing further. If I give the iodine preparations at all, I give them alone.
For the characteristic skin eruptions or other skin disorders, incident to the disease, I use berberis, iris, or chionanthus, as it is plainly indicated at the time. For ulcerations in the throat, the constitutional treatment as above, of course, contributes very materially to a cure. If local applications are necessary, I use thuja or a solution of carbolic acid locally.
Too many physicians prescribe for the disease, because it is syphilis. They at once prescribe the antis and overlook all the indications. The older Eclectic writers were discerning; they said, give potassium iodide only when the mucous membranes are pale, when the tissues are full and sodden. I believe they were right.
The initial sore mouth should be treated kindly. There should be no caustics nor burning, no more than you would burn the eruption of small pox. The chancre "is the outward sign of an inward faith," or inoculation. No time can be saved nor trouble avoided by burning a chancre.
E. J. FARNUM, M. D., CHICAGO, ILL.
In the treatment of syphilis, if I were to make an approximate estimation of the number of cases that I have reason to believe I have treated during a period of twenty years, here in Chicago, I would say that, there were at least two hundred cases. All of these have been treated without mercury. Those vegetable remedies, which I have learned to depend upon, to accomplish the results, are veratrum viride, echinacea, phytolacca, berberis, and cascara sagrada. In addition to these vegetable remedies, I find iron a most important agent, at times. It is seldom that I do not use it. Furthermore, I have been able to cure these without iodine or its compounds.
I believe that berberis, echinacea and veratrum have an especial influence upon the condition of the skin, in correcting those eruptions that are apt to occur during the course of this disease. For the throat I use some simple, mild, and astringent wash.
In prescribing these remedies, I give them about as follows: Veratrum is given in doses from one to three drops, four times a day. This is persisted in if the pulse continues from about sixty to seventy beats per minute. The pulse must not be too greatly depressed. Echinacea is given for its antiseptic influence within the blood. It exercises a direct influence upon the various eruptions also, and assists in correcting any debility that may be present. Berberis is directly important in relieving the characteristic syphilitic eruptions.
Cascara preserves the integrity of the intestinal tract, and contributes to free normal bowel action. Phytolacca and iris are directly indicated where there is glandular involvement. I would prescribe these remedies to preserve the integrity of the function of these organs.
Shortly after the appearance of the eruptive stage of this disorder, debility begins to show itself, and usually anemia, and for these I invariably prescribe the precipitated carbonate of iron, with gentian if needed.
In addition to the above remedies, I invariably select any other remedy that may be indicated by the conditions I find present, or that may be needed to preserve the healthiest possible state and all the body functions.
GEORGE W. BOSKOWITZ, M. D., NEW YORK, N.Y.
I have been treating syphilis for thirty years, without using mercury. Those vegetable remedies upon which I have learned to depend are iris, Podophyllum, phytolacca, echinacea, thuja, berberis, corydalis, rumex and stillingia. In addition to these, specific indications may appear, which point directly to other specific remedies, in which case they must be prescribed. I use the iodides in combination with the vegetable alterative?, usually by adding a solution of the iodide of sodium, to the vegetable compound which I have thought best to prescribe. Those remedies which I find influence to the best advantage the condition of the skin, are phytolacca, berberis and iris.
For the ulceration of the throat, if I must use an application, I use a solution of the chlorate of potassium, and echinacea.
L. E. RUSSELL, A. M., M. D., CINCINNATI, OHIO.
On my return from my vacation I find the Editor's letter in regard to the treatment of syphilis without the use of mercury, and I wish to state that I never gave a dose of mercury in any form in the treatment of syphilis, and I believe that I have treated as many cases of this disease when I was in the general practice of medicine as any other half dozen physicians in my community. Neither did I give these cases the iodides.
My favorite formula in the treatment of syphilis after the eruptive stage had taken place, so that there was no doubt about the lesion, was as follows:
|Muriate tincture of iron||oz. 1|
|Acetate of potassium||dr. 1|
|Water, q. s.||ozs. 8|
Of this I directed the patient to take a dessert-spoonful before meals and at night. I also directed the patient to avoid the use of greasy foods and anything in the line of pork.
I never found a case that I could not clear up in a very few days, so far as the skin eruptions were concerned.
I alternated this prescription with phytolacca and echinacea and, as I remember now, these two prescriptions filled the bill in every particular. I believe the muriate tincture of iron is as much a specific in syphilis as it ever could be in different forms of erysipelas.
This may seem a little strange in the way of medication. I used the glycerin to counteract the burning or escharotic effect of the muriate of iron, and its bad effect on the teeth. Where the case was slow to respond, in clearing up the skin, and if the ulcers in the throat persisted, I often used a little swab with the pure muriate tincture of iron and the results were satisfactory.
I found by observation, that cases that came to me that had been treated for months with mercury and the iodides, when placed on iron we very soon got the proper returns. I do not know that I can refer you to any work or authority for this line of medication, but if the practitioner will give the remedies mentioned a thorough trial he will not be disappointed.
Further, replying to your inquiry in regard to how I came to use muriate tincture of iron in syphilis, I would say that, as near as I can remember, some thirty years ago we had a great many cases of malignant sore throat, and as a local remedy we used muriate tincture of iron with great success. I was then accustomed to using the muriate tincture of iron in erysipelas, painting the tissues involved and anticipating extension with the application of iron.
Reasoning in this direction, I prescribed for a patient who had been broken out for many weeks all over the body and face with syphilis, and I was greatly pleased to notice that under the influence of this remedy the syphilitic eruption also very speedily disappeared. I tried it on several cases following this, adding the acetate of potassium and the glycerin as given in the prescription, and treated the syphilitic sores in the throat, swabbing them with pure muriate tincture of iron; I treated the syphilitic ulcers in whatever part of the body they obtained, with this remedy. So marked were the improvements, that for years my partner and myself used this remedy in a great many cases.
We thought if it was good in zymotic and diphtheritic condition? and in those cases of chlorosis where the face was broken out with sores of the nature of acne, that the remedy was worthy of a place in the treatment of syphilis.
I know that quite a number of cases that I treated had been through the hands of my old school friends, taking mercury and iodide of potassium, and quite like Simon Peter's wife's mother, "were nothing better, but rather grew worse." Under the influence of the iron prescription we had very marked benefit, which seemed as if by magic.
DR. H. K. WHITFORD, ELGIN, ILL.
In reply to your first question, as to how many cases of syphilis I have treated without mercury, I will say all that I have ever treated in 62 years of practice amounting to hundreds of cases. Those vegetable remedies which I find to give the best results are veratrum viride, aconite and belladonna as indicated. I have never used iodine or its compounds unless [ desired to counteract the effect of mercury. If I have used this remedy, I have not combined it with vegetable remedies, but have added one dram of the potassium iodide to three ounces of water, and have given this in teaspoon-ful doses three times .1 day for a week or more at a time, as needed.
For those conditions of the skin, which appear, I use a wash of the sulphuret of potassium in solution. For the throat I apply the dark pinus canadensis, or perhaps some other of our vegetable astringents. For swollen glands I give phytolacca, internally, in sufficient doses. I never use caustics on the chancres, but usually apply the subnitrate of bismuth.
E. H. KING, M. D , SARATOGA, N. Y.
In the treatment of syphilis, it would be impossible for me to state how many cases I have treated without mercury, as I have not kept a record of my cases. Those vegetable remedies which I have found to give the best results are iris, phytolacca, stillingia, rumex and lappa major. As a part of my routine treatment I always use potassium or sodium iodide. I prescribe the iodides in conjunct ion with the vegetable alteratives, but give them in gradually increasing doses.
Those remedies which best influence the skin disorder are berberis and lappa major. In the treatment of the ulcers in the threat I apply thuja, first, and to the throat in general I apply Churchill's tincture of iodine, either in full strength or diluted, as seems to be indicated.
I give iris where there is an inactive, stagnant or congested condition of the abdominal viscera; I give Podophyllum according to the strict specific indications which are well known to every one of our practitioners. I prescribe phytolacca where there are enlarged and inflamed glands, or where the throat is ulcerated, or where there are nodular manifestations in the skin. In addition to the application of this remedy to the throat ulcers, I use thuja locally, in the treatment of the chancre. I use berberis in all the skin manifestations, especially those of pustular or vesicular character.
As general treatment, I advise that these patients take plenty of water; often I have them drink freely in preference of some alterative mineral water. I also believe in the free use of baths during the course of the treatment.
W. N. MUNDY, M. D., FOREST, OHIO
In the treatment of syphilis I have seldom, if ever, used any mercury. I recall distinctly the satisfactory cure of cases in the early years of my practice, without either mercury or the iodides. Those remedies which I find give the best results are stillingia, berberis, phytolacca and iris. If I give the iodides at all, it is for the tertiary state, though not always in this. I would not hesitate, if giving iodine in any form, to combine it with the vegetable remedies.
Those agents which I have found to act best upon the skin are berberis and phytolacca. In the treatment of ulceration in the throat, I use phytolacca internally and pencil the throat with a solution of the nitrate of silver.
If I prescribe echinacea, it is as a general blood maker, and where ulcerations exist, as in tertiary syphilis. Iris is indicated where there is glandular involvement. I use Podophyllum to increase waste, where I have a full-blooded patient; where the bowels are inclined to be constipated and where there is a jaundiced skin. Phytolacca, I prescribe where there is sore throat, or where the cervical glands are enlarged.
In addition to the action of berberis on the skin, this remedy is a general stomachic of much power, where the condition of the digestion is poor, dyspeptic conditions being conspicuous. I have not used thuja to any great extent except where I had bladder complications.
W. E. KINNETT, M. D., PEORIA, ILL.
I am very much interested in your symposium on the treatment of syphilis, and am glad of an opportunity to contribute to it.
In reply to your first question as to about how many of cases of syphilis I have cured without mercury, I have kept no record, but it is certainly all that I have ever cured, as I do not use mercury in the treatment of syphilis or of any other disease. I very much doubt if any case was ever cured with mercury. Usually this remedy produces gastralgia, diarrhea, causes necrosis of the bones and teeth, and leaves the patient in a worse condition than he would be in from the disease for which the remedy was prescribed, if the patient had had no medication. I believe that many of the awful effects ascribed to syphilis are caused by the mercury, and not by the syphilis. (This was a common belief of many of our old writers.—ED.)
Those vegetable remedies, upon which I depend the most in this disease, are echinacea, iris, berberis aquifolium and phytolacca. I have cured cases without iodine in any form; but I have sometimes thought best to use this remedy, believing it was directly indicated. I do not combine iodine or its compounds with my vegetable compounds, but I give this remedy alone, only during the time its indications are present.
For the characteristic eruptions of the skin, I use echinacea, berberis, iris, and the tissue remedies. These I also depend upon if there is ulceration of the throat.
If I prescribe echinacea, iris, podophyllum, phytolacca, thuja, berberis, corydalis, or any other of our remedies, I endeavor to prescribe them according to the specific indications present, which I know demand them.
In addition to these remedies, I believe I have obtained splendid results from the use of the tissue remedies, which I administer as follows: Where there is a chancre with a white discharge, and the patient has a white coated tongue, I give kali mur. Where the chancres are phagedenic, I add kali phos., and where they are hard and indurated I give calcaria fluor. Bubos that are tender, hot and throbbing are cured by ferrum phos. and kali mur., both internally and externally. For external use I make a solution of these remedies and apply hot on compresses, changing frequently. Kali mur. is the chief remedy when using the tissue remedies, and if indicated I give it from start to finish.
It is my opinion that many cases of syphilis are made worse by meddlesome medication. The doctor and the patient desire to get too quick results, and they are prone to use harmful medication. My plan is to treat the patient and not syphilis; to treat the conditions present, as we treat other diseases—give the indicated remedy.
S. B. MUNN, WATERBURY, CONN.
I have kept no record of the cases of syphilis that I have treated during the fifty years in which I have been actively engaged in the practice of medicine, but for the last forty years I have had cases on hand nearly all the time.
I do not use mercury in the treatment of this disease. The combination that I depend most upon is a compound fluid extract which is made from the following remedies in about the proportions named:
Stillingia, phytolacca, corydalis, xanthoxylum berries, lappa minor, of each four ounces; euonymus and iris, of each two ounces; I give this fluid extract, according to the age and condition of the patient, as is indicated.
Most of my cases I treat without iodine. In those in which this remedy is demanded, I have added one or two drams of the potassium iodide to four ounces of the above compound, and given this in teaspoonful doses three times a day. Sometimes I have used soluble iodine, half of a dram, in four ounces of the above formula.
Those remedies which I find act best upon the skin are apis, asceplias tuberosa, alnus rubra, and galium aparine. For the throat symptoms I use one part of the oil of sassafras to seven parts of the tincture of myrrh, painting the throat with this, using a camelshair brush.
I find echinacea of much service in this disease, and have used it also in anthrax. I find iris excellent where the glands are enlarged. In addition to its use in syphilis, I have used it both internally and externally in the treatment of goitre. I use podophyllum in combination with other alteratives at times, to stimulate the action of the liver, giving it where there is a full tongue, covered with a yellowish coating. Phytolacca is indicated for almost any glandular involvement that may arise in this disease. Thuja acts upon the urinary apparatus, correcting irregularities and incontinence in addition to its influence upon the skin, which is important. I have used it successfully in skin cancers. Corydalis, when indicated, is an important remedy in this disease.
Q. R. HAUSS, M. D , SELLERSBURG, IND.
I cannot at this time, approximately even, state the number of cases of syphilis which I have treated without mercury. I depend mostly upon iris, echinacea and phytolacca. I usually employ iodine in some form. A favorite prescription of mine is to give the iodide of potassium and phytolacca in conjunction. For the skin troubles I rely upon active elimination and frequent baths, and give the acetate of potassium internally as a waste remover. For the throat I have found nothing better than echinacea and phytolacca.
V. A. BAKER, M. D., ADRIAN, MICH.
In the treatment of syphilis during the years of my long practice, I have treated several hundred cases that were apparently cured. The course of treatment that I have depended upon, and that which has given me very satisfactory results, is the use of the ethereal tincture of lobelia, which I have always kept up until the symptoms disappeared. If I have used the iodides, I have used them with a compound syrup of stillingia, but I regard lobelia inflata as the best single remedy. For me it has been very nearly a specific. My method of using the iodides in conjunction with vegetable remedies has been that which is recommended in the American Dispensatory.
The condition of the skin with me has been always relieved by the influence of the internal treatment. I have depended upon this also for the throat symptoms, unless they were quite severe, in which case I have sprayed the throat with echinacea. Later I have added echinacea to the above internal treatment and I have kept this treatment up for a period of from six to nine months.
Discipline in diet I find absolutely essential. Highly seasoned victuals must be prohibited, especially meats. This is imperative. The patient must be perfectly regular in his habits of eating, and I believe that the use of boiled water, exclusively, for drinking purposes is of advantage. No alcoholic liquors whatever are to be allowed, but an alcoholic vapor bath once or twice each week should be ordered, inducing free perspiration. This should be followed by rubbing with considerable friction with towels and a flesh brush.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.