Discussion of syphilis miasm. Symptoms and expression of syphilis miasm…

***THE venereal stigmata (or, as Hahnemann called them, miasms), are fundamentally infections of a specific nature. It is well to bear in mind the basis of all infection and of all chronic diseases before we can properly understand the workings of a stigmatic disease. Let us consider syphilis, for instance.

This is one of the comparatively modern diseases, and it is the basis for many constitutional troubles. Syphilis is from its inception a constitutional disturbance. Syphilis is supposed to be contracted from an impure coition. Much of the susceptibility and lowering of the defence toward the specific poison is developed and maintained because of the mental attitude of the individual, in that in its very inception it is a violation of his normal standards and therefore reacts upon and lowers the vitality.

Let us consider what happens after an impure coition. Prophylactics seemingly have very little to do with preventing the development of this condition, but there remains a period of about three weeks after the exposure when no symptoms or no manifestations of any kind show themselves. This is the period when the disease is taking hold on the system constitutionally, while apparently producing no symptoms. Then the vital energy undertakes to expel the poison by forming a chancre on some part of the body surface, usually the genital organs. In other words, the vital energy is attempting to push out the enemy, and so long at this chancre remains on the surface as an expression of the inward turmoil, no constitutional symptoms appear.

This state may last for months, or even years, provided it is not suppressed. In just the degree that this chancre does not suffer interferences does it represent the ability of the vital energy to cope with the intruder. The general treatment among physicians is to cauterize or treat locally this manifestations, such treatment tending to immediately dry the chancre and throw the poison back, by suppression, into the innermost recesses of the system. Then it is that a chain of symptoms begins to develop, showing that the vital energy is profoundly disturbed, and that it is helpless to cope unaided with the enemy.

(Now investigators in the ordinary school of medicine have begun to question whether chancre is not a provision of nature to counteract the syphilitic poison, their theory being that the chancre actually produces within itself antibodies that act defensively against the specific inroads of the disease.)

Usually the next step taken by Nature a is to produce an eruption on the body. If this manifestation is in turn treated by suppressive measures, the disease attacks the internal organs, tending always to attack that part of the organism which is least able to resist. It may be the central nervous system; it may be the arterial system and the heart; it may be the liver or the intestinal tract. Any or all of the tissues of the body feels the deadening influence of this intruder. These manifestations may be suppressed in one place after another, so that the man lives out his days with this incubus in his system, ever ready to develop into some new manifestation at the most trivial provocation. Grief, sorrow and worry are potent influences to develop these manifestations; or it may be exposure to the elements, a slight accident, stress of business relationship, or any one of many other causes, that starts the irritation; but unless this is met by the art of the similar antisyphilitic remedy, he passes his days in discomfort and distress and comes to a premature old age.

This stigma has its effect upon the protozoon, and the offspring shows the effect in many ways. When the offspring is affected with the syphilitic taint he will not show the direct effect in the primary chancre or ulcer, for by the time the disease has passed into the second generation the fault has become thoroughly married to the life forces and it becomes a part of his being. This results in many constitutional tendencies such as deformities, chronic catarrhal conditions of the nose and throat, malformations of the teeth and of the bony structure, ulcers and many other manifestations. In the second generation we find none of the primary local manifestation, for the manifestations have changed their character, showing that the economy is thoroughly impregnated with the deadening and destructive effect of the stigma.

In the primary disturbances we may find that this infection of syphilis becomes grafted on to a psoric base. Here we have a complication of troubles, and just as each of these stigmata is a problem in itself, the union of the two becomes a much more complicated problem, requiring great patience and skill to solve. Usually in this union of psora and syphilis the psoric symptoms predominate, and here the predominant symptoms of psora must be treated first with the antipsoric *simillimum, for the syphilis is largely hidden, and we must strive to help the vital force to throw off the greater and more predominant incubus which the patient manifests.

After the patient responds to the remedy by a decided improvement in the conditions first prescribed for, and the psoric condition is largely obliterated, we must change our tactics, for then the syphilitic dyscrasia will show itself and become prominent. Then the symptoms must be met with the antisyphilitic *simillimum, or the remedy that is most similar and adapted to syphilitic symptoms, to which we will be guided by the similitude of the remedy.

The patient who is suffering from syphilis in a latent state or who manifests the inherited stigma presents a picture that is very easy to recognize; and this is probably the easiest of he miasms, or stigmata, to treat. Patients with inherited or latent syphilis are mentally dull, heavy, stupid and especially stubborn, sullen, morose, and usually suspicious. They are always depressed, but in the depression they keep their troubles to themselves and sulk over them, These are the people who develop fixed ideas, which are not eradicated by any amount of explanation or talk. Their mental powers are slow in reaction; they become melancholy, and condemn themselves. They like to be alone, yet desire to escape from themselves as well as from others. In their slowness of comprehension the thoughts they had starting a sentence will vanish, they forget what they were about to say and they find it hard to get back into the track of their conversation. If they are reading, they read a few lines, and then they must re-read it to comprehend it.

They are always worse at night; all the symptoms develop me after the sun goes down. There is oppression, restlessness and anxiety at night; they dread the night because it is so oppressive. Restlessness is so great that it drives them out of bed.

We must remember that the tubercular patient is manifesting the union of the syphilitic and the psoric dyscrasia. Oftentimes we find the child who has inherited this stigmatic combination has a tendency toward tuberculosis; this child presents the picture of the “problem child” in the school, being slow of comprehension, dull, unable to keep a line of thought; he is unsocial, keep to himself and becomes morose and sullen. No greater service can be rendered to society than to meet these conditions of the problem child of school age and under, with the homoeopathic treatment, using as weapons the antisyphilitic and antipsoric remedies as they are indicated. This is the only treatment that will put these children into the sphere where they will be able to develop normally and become useful, happy citizens.

In patients manifesting the syphilitic stigma, if we are so fortunate as to observe the appearance of external manifestations or unusual discharges we will observe also that the patient is greatly improved in general and his mental state will seemingly become more normal. This is true if a catarrhal or leucorrhoea discharge is established; it is true if an old ulcer, perhaps of the leg, opens up and discharges; and so long as these avenues of escape are active the patient will be more normal. However, the natural avenues of elimination do not ameliorate the patient; sweating aggravates rather than ameliorates, and natural sweat, profuse urination and diarrhoeas never ameliorate the syphilitic conditions, except in constitutions such as the tubercular, which are a combination of the syphilitic and the psoric, and this is due to the general amelioration of all psoric manifestations from these natural avenues of elimination. In tubercular children a haemorrhage from the nose will clear up the mental state for some time; and in tubercular adults nosebleeds will clear up old neuralgias.

Now the degenerates and criminals and criminally insane are either sycotic or syphilitic in their stigmatic inheritances. Many of the criminally insane and degenerates could be very greatly benefited and probably cured by some of the antisyphilitic remedies.

Let us take up some of the symptoms of the head as manifest in the syphilitic patient. These headaches usually some on in the night and are almost always in the back of the head; they will ache all night, get better in the morning, only to come on again at night. The headaches are dull, heavy yet lancinating; they are persistently constant at the base of the brain on one side.

The headache that come on Sundays or when they are away form their usual vocations are usually psoric and syphilitic combinations. Syphilitic headaches are usually worse riding, better by motion, worse by exertion, either mental or physical. They are usually accompanied by a great deal of coldness of the body, sadness and prostration. They are worse by warmth or heat and better by cold applications; worse by quiet rest, by lying down at night and by sleep, and better by nosebleed. (Note the indications for the syphilitic headache as being almost exactly opposite those of the psoric type, which are better by rest, by lying down, better by hot application; the psoric headaches come on in the daytime while the syphilitic are manifest at night.)

Oftentimes the syphilitic patient complains of a band about the head, which is probably due to a slight effusion from the meningeal surfaces. A child with these syphilitic headaches will bore his head into the pillow or roll the head from side to side. Without the antisyphilitic remedy these headaches are not easily amenable to treatment. Some people complain that before these headaches they experience a ravenous hunger; these manifestations are a combination or syphilis and psora.

The syphilitic stigma show many types of vertigo, but especially those at the base of the brain. These may be present also in the sycotic stigma, but they especially apt to be present in the tubercular diathesis, the combination of syphilis and psora. Since both syphilis and psora have marked vertigo, the union of the two stresses this symptoms in a marked degree.

The symptom of high blood pressure is caused, from the structural point of view, by a thickening of the arterial coats or an attack of nephritic obstruction, and is an expression of an actual change of structure in the arterial system. Change of structure does not occur in uncomplicated psora, but when the psoric dyscrasia is combined with the syphilitic, structural changes do take place, and in this manifestation we have an expression of the combination of the two stigmata.

The appearance of people suffering from the syphilitic stigma often tells the story at a glance, for we observe that he head is large and bulging, the hair is moist, gluey, greasy, and with an offensive odour; the hair falls out in bunches, beginning first on the vertex and then on the temples. The hair on the eyebrows and eyelashes falls, and the hair in the beard fall. The hairs in the beard are often in growing, and suppurate; elderly people often complain that the hairs in the eyelashes break and turn inward, causing much irritation in the conjunctiva.

Closer examination shows that in these greatly enlarged heads the sutures are soft; the fontanelles remain open after the normal time of closing, and there is a general hydrocephaloid appearance of the head.

The scalp is moist in general. The scalp perspires and the hair becomes wet; the scalp perspires when they are asleep or when they are awake. The eruptions on the scalp are almost always moist, with thick yellow crusts, from under which thick yellow pus oozes. The eczemas about and behind the ears having thick foetid pus, and the cracks about the ear and in the aural canal, are a grafting of the syphilitic stigma on to the psoric. In the tubercular patient the eruptions on the scalp are worse by bathing.

The eyes are astigmatic, and this syphilitic dyscrasia has deformities of the lens and of the cornea, and all refractory changes are related to this stigma. Remember that syphilis deforms everything; psora alone and by itself never causes deformities, but in the combination of the two we find great many deformities.

Ulceration is the mark of the syphilitic. You will find in these patients ulcerations of the cornea; ulcerations of the lids. A peculiar reaction of these patients is that they are intolerant of artificial light. You will hear them say that they cannot read or work by artificial light. This corresponds with the period of aggravation of the syphilitic miasm.

Ptosis of the lids and the a neuralgias of the eyes and the head come under the syphilitic group. These neuralgias are worse at night and worse from heat.

Discharges from the eyes in these conditions are greenish or greenish-yellow in colour. This is present also in sycotic people, or in people with tubercular troubles. Granulations of the lids, as well as styes, are of the tubercular type.

In babies and children and young people under twenty years of age you often find very widely dilated pupils; this is an indication of the tubercular diathesis.

In tubercularly inclined children you find structural changes in the ear. Everything that attacks, them such as colds or sore throats or any of the so-called acute diseases, shows its relationship to the stigmatic combination by suppurations of the ear. This suppuration, no matter how painful it may be, is the safety-valve of child life. In all of these ear manifestations, the tendency to the night aggravation is very marked; they will be all right during the day, but from sun-down to sun-up the characteristic aggravation shows itself. In every eruptive disease there is an accompaniment of middle ear trouble in these children, and they will continue this process until the antipsoric and antisyphilitic remedies have done their beneficial work.

Very often in these stigmatic complications of the ear there is more or less discharge, and so long as the discharge from the ear continues the patient improves in general health. Sometimes this discharge from the ear continues the patient improves in general health. Sometimes this discharge from the ear will continue for years, and the health will remain fairly good. However, if the discharge is suppressed, the patient’s health suffers greatly.

In appearance, these patients develop very large ears. The lobe of the ear is pale, white and transparent.

In the syphilitic dyscrasia the sense of smell is lost, and the nose bleeds very readily, especially when there is the complication with psora, in the pre-tubercular stage. The pre- tubercular child will have haemorrhages from the nose at the slightest provocation. At the same time they are subject to severe headaches, but the haemorrhages relieve the head symptoms.

Acne indurata of the nose depends upon the union of the psoric and the syphilitic conditions. By many this condition is considered impossible of cure, yet with the knowledge of its stigmatic origin it may be removed and the patient brought to a better state of health.

One of the cardinal signs of the syphilitic taint is the destruction of tissue. This is the only stigma in which the bones of the nose are destroyed. Infants and children who have “snuffles” are manifesting either the syphilitic or sycotic taint. The syphilitic expression in the nose is by many scabs and crusts, which are dark greenish to brown or black. These are not always offensive in odour, but in the tubercular diathesis these manifestations have the odour of old cheese, and there is a thick yellow discharge the drops back into the throat.

In the hay fever type of troubles, which is one of the most troubles conditions we have to deal with, we have as a base the psoric, the syphilitic and the sycotic. The sycotic remains latent during the active period, but will come out later, after proper treatment has been instituted. These cases are always difficult to treat, and still more difficult when serum or vaccine treatment has been given.

In the tubercular diathesis, there are circumscribed red spots on the cheeks of adults or children, before any other manifestations show themselves; these are also hot flushes other than at the climacteric period. The characteristic appearance of the syphilitic stigma is a greyish, greasy face. There are deep fissures, especially in the lips; swelling and oedema of the face in the pre-tubercular patients, in the morning after waking and after a nap. Moles may be a manifestation of either the syphilitic or sycotic symptoms.

In the fevers of the tubercular patient the face is pale, with circumscribed redness on the cheekbones; in the morning the face is intensely pale. The children with ashy grey faces and the appearance of marasmus are basically syphilitic. The syphilitic stigma destroys not only the tissues, but it destroys also the power of the body to assimilate the proper materials from food. On the other hand, the tubercular child may be plump, with a white, clear skin and long, beautiful silky eyelashes. In these children the face and and about the back of the neck perspire freely.

In the mouth we find the characteristic tell-tale of the syphilitic taint, even though the child may appear well otherwise. Pathological and structural changes take place in the dental arch and the teeth come through deformed, irregular in shape and irregular in order of eruption. The teeth often decay before they are entirely through the gums.

These little patients get sick every time a tooth comes, and they are constantly having trouble with one thing after another; persistently taking cold; persistently having upset stomach; exceedingly susceptible to any change in the weather. They have very flabby muscles and they develop large cervical glands. The adenoid tissue is always involved and the enlarged tonsils are a prominent manifestation.

Actual ulcers occurs in the mouth. Psora never develops ulcers of itself, but the syphilitic taint is very prove to this manifestation. In the tubercular type there is a putrid, sweet taste in the mouth; more of metallic taste in the purely syphilitic dyscrasia; in the union of syphilis and psora we find a saliva that is ropy and viscid with a bloody taste.

The tubercular type of patients have ravenous hunger; hunger immediately after a full meal; hunger at all times; there is no time they cannot eat. There is much craving for unaccountable things, like the craving for acids, for sweets; a longing to chew chalk, lime and pencils; a craving for indigestible things. The carving for salt is particularly noticeable in the tubercular diathesis. It will be noted that here also the psoric influence is strong, in that psora has many cravings, and great hunger.

In these unnatural cravings we have the key to assist many people whom we may consider to lack temperature in eating and drinking. They are particularly prone to crave spirituous liquors and it is the tubercular diathesis which produces the people who are apt to become drunkards, for you must remember that these are the people who bear about with them the combined power of psora and syphilis. By looking well to our indications we can give these people a great deal of help to overcome these unnatural cravings, and at the same time gradually eliminate the stigma.

Disease classification the Syphilitic Stigma Continued

***IT has been said that the patient afflicted with the syphilitic taint suffers from structural changes; yet the emotional sphere in the purely syphilitic patient is not seriously affected. For this reason, in the syphilitic patient we find less subjective symptoms; there is little of the supersensitiveness, and less desires, cravings and longings than in the psoric patient. The syphilitic patient actually suffers much less than the psoric; the mental sphere has not been so much invaded, for the syphilitic stigma is not so thoroughly established through untold centuries of time as the psoric, and because it is not so thoroughly a part of the very essence of man’s spirit we have a far better chance to eradicate the dyscrasia.

The very earmarks of the various stigmata show their respective character. The psoric itches, and appears unclean, unwashed. The syphilitic ulcerate and the bony structure is changed. The sycotic infiltrates and is corroded by its discharges.

Psora is the stigma which shows little on the side of objective symptoms, but expresses itself through the mental and emotional reactions. For this reason the patient of a tubercular diathesis reflects many subjective symptoms in comparison with the purely syphilitic for, as has been pointed out before, the tubercular is the combination of the psoric and syphilitic. In this combination we find all the mental and emotional reactions, the subjective symptoms, of the predominant parent, psora, and the pathological and destructive changes of the younger parent, syphilis.

Syphilis alone has few cravings in the way of food; it is averse to meats, but aside from that negative symptom there is little that we note in the way of appetite. Compare that state with the tubercular cravings, which were pointed out in the last chapter.

The frequent, unsatisfied hunger; the craving for meat and potatoes when nothing else will satisfy; the craving for salt; craving for indigestible things; the inability to assimilate much starch; these marked symptoms of appetite show the psoric parentage of the tubercular diathesis.

In the syphilitic-psoric type we find the changes in the chest wall, which are structural changes is the bone contours. The chest wall is narrow and may be more shallow than normal; even the action of the diaphragm is limited. While there may be no structural changes in the lung itself, there is less air capacity and less residual air in the lung. The very structural changes eventually bring about occlusion of the air cells and the formation of foci, for these people are very poor breathers; the pumping power is so cramped that they are incapable of supplying sufficient oxygen for the body needs. This is shown in the anaemic and chlorotic conditions, as well as in the tubercular. The tuberculosis produces its destruction by first cramping the aeration of the red blood cell through the formation of the bony structure. Because breathing is a difficult process they become averse to fresh air, and will survive for a long time in a close, breathed-over atmosphere.

Long before tuberculosis develops, sometimes even years before, you may notice a symptom of the latent diathesis: on the least exposure to cold the patient develops a deep, hoarse cough. This will be repeated many, many times before there is actual development of the tuberculosis. The purely syphilitic patient has a short, barking cough; this is sometimes true of the early tubercular stages.

The tubercular expectoration is purulent, greenish yellow, often offensive; usually sweetish or salty to his taste. We can usually depend upon the salty or sweetish taste as being a characteristic of this dyscrasia.

There is the everlastingly tired feeling of the tubercular type; (the psoric is always ready to lie down); the tubercular patient is better in the daytime and worse as night comes on, showing the syphilitic influence. The syphilitic patients should be sun- worshippers in type, for they are always better during the daylight hours, and all conditions are worse at night. The tubercular people suffer from neuralgias, prosopalgias, sciaticas, insomnias, hysterias, and all the nervous symptoms peculiar to the diathesis. They may have for years persistent headaches; this may precede the actual tubercular development. Hysterical and other nervous symptoms often precede the tubercular manifestation, and when the lung condition improves the hysteria will return; when the hysteria improves the lung condition takes on renewed activity. Often a severe dysmenorrhoea will stay for a time the disease progress in the lung itself. In other words, the pre-tubercular manifestations are more psoric than syphilitic; but the structure predisposing to develop the lung condition is syphilitic.

When children cry out in their sleep we may take this to be an indication of the tubercular diathesis, which may take on a meningeal form when it develops. Look carefully to all night aggravations, especially in children, to see if they are not pre- tubercular indications.

The tubercular diathesis has many heart symptoms, showing the psoric parentage. There is much palpitation. In the psoric this is due to uterine or gastric irritations and disturbances; in the sycotic patients the heart manifestations are reflexes of rheumatic conditions. In the syphilitic and sycotic stigmata we find little mental disturbance accompanying the heart conditions, even when the conditions are critical; it is the psoric patient who worries about his heart condition and rarely succumbs to it. It is the syphilitic or sycotic patient who may have for years a slight dyspnoea and occasionally slight pains, or perhaps no symptoms at all, but they die suddenly and without warning.

In the tubercular, as in the psoric heart conditions, the patients want to keep still; they are much worse by higher altitudes; cannot climb stairs or ascend hiss; cannot breathe well on ascending; have not the proper amount of room for air. They have difficulty in descending. With this heart condition there is a cyanosis that is often painful. There is a gradual falling away in flesh in these conditions. The syphilitic dropsies and anasarcas are greater than the sycotic.

Lymphatic involvement of the abdomen is of tubercular origin, as are the hernias; the muscles lack tone.

Hereditary syphilitic troubles in children sometimes produce a very watery discharges that almost completely drains the system of its vital fluids and unless promptly corrected death ensues. The cholera infantum types of diarrhoea are syphilitic; we often find tubercular diarrhoeas which simulate the cholera infantum, but they do not as rapidly drain the system. In the tubercular diarrhoeas we find the worse in the night or the early morning, driving the patient out of bed, and worse by cold, showing the syphilitic relationship. The tubercular child often cannot assimilate cows’ milk in any form; the casein has to be modified before it can be digested at all. These are the children who have undigested curds in the loose stool.

There is a close relationship between the ability to take the lime salts from food and these diarrhoea of tubercular children; this is the reason for the difficult and irregular dentition and the craving for the elements which the body needs; they cannot assimilate the necessary elements from their food. The diarrhoeas of the syphilitic child who is strongly tainted with sycosis will probably call for some such remedy as *Croton tig. or *Sarsaparilla.

The tubercular stool is apt to be slimy, bloody, with a musty, mouldy smell; nausea and gagging before stools and prostration with a desire to be left alone after stools. Haemorrhages from the rectum are signposts of tuberculosis, although there are bleeding haemorrhoids in sycosis. Tubercular patients are troubled alternation of symptoms in the tubercular patient may be noted in the alternation of rectal diseases with heart, chest or lung troubles, especially in asthma or respiratory difficulties. Very often, operated or suppressed haemorrhoids will be followed by asthmatic manifestations, often accompanied by heart troubles.

In the rectum, strictures, sinuses, fistulas and pockets are all of tubercular origin, but these conditions are much more frequent and in much aggravated form when combined with the sycotic stigma. Cancerous manifestations of the rectum are a combination of the tubercular and sycotic; in other words, they are a manifestation of the combined destructive force of the three stigmata. Psora alone never reaches to pathological changes; yet without the psoric element malignancies will never develop.

In the urinary tract all of the stigmata may manifest themselves, but most frequently these manifestations are psoric and sycotic; here also the combined assault of all three stigmata are represented in the malignancies. The diabetic patient is as a rule strongly tubercular; sometimes in these conditions there is a strong taint of the sycotic, which makes the condition much more malignant. We never see marked tissue changes or fibrous growths without the presence of the three stigmata, although the tubercular and sycotic are represented in the majority of cases of Bright’s disease. While the psoric element is present in these conditions, it is not in as marked degree as the syphilitic and sycotic.

Nocturnal enuresis, with the worse during sleep and soon after falling asleep, are tubercular; and nightly emissions also are a combination of the syphilitic and psoric taints. Usually prostatic troubles may be classed under the union of these two stigmata.

Syphilis seldom attacks the ovaries or the uterus. In pathological conditions we occasionally find a manifestation of the tubercular diathesis, but this is because of the psoric affinity for functional and emotional disturbances and not because the syphilitic influence toward these organs.

The syphilitic stigma attacks the long bones; the growing pains of children are syphilitic, especially when worse at night, worse in storms or on change of weather. This stigma causes destruction of tissue partly because it hampers assimilation of the necessary elements, and we see the result in rickets of children; they cannot assimilate from their food what they require to make the bones sufficiently hard to support their weight without bending.

The nails of these patients are characteristic, being paper- thin, spoon-shaped and bending and tearing easily. Where the nails are irregular, brittle, break and split easily, and with many hangnails, this is an unfailing sign of the tubercular; these nails are also spotted, or with white specks, and scalloped edges. Felons about the nail are a manifestation of the combined effects of syphilis and psora, as are all periosteal affections.

The psoric-syphilitic patients cannot endure much cold, yet they cannot endure much heat; the heat from the stove may drive them from the room.

Chilblains are a combination of all the stigmata. Anyone who has endured the torments of this affliction can readily understand how willing these sufferers are to accept any from of treatment which promises some relief; yet a suppression of this manifestation brings in its train a succession of all sorts of nervous diseases and many other serious conditions, even to malignancies.

Corns and like hypertrophies are tubercular manifestations. Boils are usually psoric, but when there is much suppuration and pain it is usually a combination of the psoric and syphilitic manifestations. It is characteristic or psoric eruptions that they tend to dry down and scale off rather than to suppurate. However, the appearance of boils after the administration of the antipsoric remedy is a welcome and encouraging indication.

Children who have weak wrist and ankle joints, who have difficulty in holding on objects, who drop things easily, who are clumsy in getting about and stumble over a straw, are manifesting the effects of the combined syphilis and psora, for this combination affects the tendons about the joints by weakening them so that they will not stand the strain of much use.

As we naturally expect, there are a great many skin manifestations with the syphilitic miasms and in the tubercular dyscrasia. There are pustular eruptions which suppurate, and eruptions occur especially about the joints or in the flexures of the body. These eruptions are quite prone to arrange themselves in crescentic formation. In colour they are coppery or brownish, but sometime very red at the base of the pustules. The most striking characteristic of these syphilitic eruptions is that they do not itch, and there is very little soreness. If these eruptions progress to scaling and crusts, as they usually do, these are very thick and occur in patches or circumstances spots.

The gangrenes of the skin and dry gangrenes show the destructiveness of the syphilitic stigma.

Skin affections with glandular involvement are frequent.

Occasionally psoriasis shows itself. Psoriasis has been called the marriage of all the miasms, or stigmata, but its characteristics are predominantly psoric and sycotic. Another type of eruption where all the stigmata are present is the fishscale eruption. In this condition we have the dryness of psora, the squamous character of the syphilitic eruption and the moles and warts of sycosis.

Varicose veins are of tubercular origin. Varicose ulcers are the last destructive manifestation on the skin of the syphilitic taint. In this stigma, too, we see the ecchymoses and haemorrhagic conditions into the skin; purpureal conditions are all manifestations of the syphilitic taint.

Erysipelatous and carcinomatous conditions, epithelioma and lupus, are all manifestations of the union of the three stigmata. In acute exanthematous diseases we see the tubercular diathesis. These conditions show the psora in the severity of the attack, but the profound prostration from the lowered vitality is the mark of the syphilitic taint. Urticarias occur in the tubercular diathesis. Marked freckling is also a manifestation of the tubercular diathesis; this has the clear, almost transparent skin of the tubercular patient, with the pigmentation of the psoric. Impetigo will readily develop in the combination of the psoric and syphilitic stigmata, while those without this dyscrasia will not become infected.

We often find patients with slight wounds that heal very slowly or not at all; this condition is due to the union of the syphilitic and psoric influences. In this same category we may place the stitch abscesses which occur following operative measures, in hospitals and under the best of sanitary conditions.

We have spoken a great deal of the tubercular diathesis as being a combination of the syphilitic and psoric stigmata. The scrofulous diathesis is also a combination of these two stigmata, but it differs in the proportionate degree of the presence of the taints, and is further influence by the suppressive measures of crude drugging. Probably environment and circumstances have some bearing on it also. However, the suppression is a strong factor in its individual expression, because this has buried it deeper in the system.

The scrofulous diathesis manifests itself largely by the involvement of the glandular system, particularly the lymphatics. While many authorities have classed scrofula as psoric, its relation may be traced by its manifestations. Psora has no glandular involvement, by syphilis has a particular affinity for glandular tissue. Scrofula has many symptoms in common with psora, but it has the same tendency to ulceration as syphilis; the relationship may be seen also in the purulent discharges and decomposition of the exudations. Scrofula has the same tendency as syphilis to locate in the organs of the special senses, such as the eyes, ears, nose, lips, etc. The pernicious anaemia of the scrofulous patient resembles very closely the syphilitic parent, and shows its kinship to the tubercular diathesis.