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Title:	Syphilis - A Fresh Look
Syphilis – A Fresh Look Using a single term for different meanings often leads to confusion and great misunderstandings. We have so many such words in homeopathic terminology. One of them is 'Syphilis' and the other is its adjective, 'Syphilitic'. The term 'Syphilis', as used by Hahnemann has a completely different meaning than how it was used by 20th century famous homeopaths. It also differs from how most of the contemporary authors and homeopaths use this term. In Hahnemann's terminology, 'Syphilis' refers to the systemic infection which develops after progression of primary venereal 'chancre disease'. Although he described a dynamic chronic disease related to what we now know as Syphilis, you will see later in this article that our current description of Syphilis is not what Hahnemann and Hunter described. Nowadays, homeopaths use this term in different forms. Usually Syphilitic miasm refers to a 'destructive diathesis' and/or a 'hopeless state'. This 'diathetic' use is not how the term 'Syphilis', was used as a chronic miasm in Hahnemann's terminology. Hahnemann was straightly mentioning a venereal infectious disease with its systemic derangements. In this article I am focusing on Hahnemann's description of Syphilis, how it differs from our current definitions in the field of venereal diseases and the necessity to update the related homeopathic data. Now, in today's medical terminology, when the word 'Syphilis' is used, it refers to an venereal disease caused by Treponema Pallidum beginning with the typical ulcer of Chancre in the genital region in its primary phase progressing to the systemic secondary phase and later to the tertiary phase with the Gumma lesions and at last quaternary Syphilis with its cardiovascular and neurological complications associated with its severe psychological derangements. In modern's terminology, all the process is called Syphilis. The definitions in Hahnemann's time were deferent. Hahnemann, before introducing homeopathy in 1796, was an expert in the field of venereal diseases. His book, 'Instruction for Surgeons respecting Venereal Diseases' published in 1789 clearly reflects his mastery in this field in the second half of 18th century. Later, his views on venereal diseases were developed and he began focusing on the dynamic presentation of the natural diseases rather than the responsible agent, the 'virus'. But his view about venereal diseases is a clue for understanding his way of thinking about dynamic and chronic processes. Hahnemann believed in 'Animalculus' model for explaining the contagious nature of certain diseases. Animalculus means small animal. He believed that there are invisible, small living animals which transfer the disease from a person to another one. This is like the known Microbial model introduced after Pasteur's researches. Hahnemann used the term 'Virus' for these small animals. So in Hahnemann's terminology virus is equivalent to all microbial agents now we know in Microbiology. So do not be surprised when Hahnemann uses the term 'Virus' for the agent responsible for transmission of Chancre diseases. Hahnemann, in the introduction of the book 'Instruction for Surgeons respecting Venereal Diseases', clearly reflects the thought pattern of 18th century medicine about venereal diseases. Based on Hunter's researches, he believed that the virus responsible for all venereal diseases is the same. If you read his views in the book 'Chronic diseases' which was published years later, you do not touch this point. The reason is that after introduction of homeopathy, he became focused on the dynamic presentation of the diseases and not the responsible agents. Hahnemann and most of his contemporary physicians believed that the virus responsible for Chancre disease and Gonorrhea is the same. In 7th paragraph of 'Instruction for Surgeons respecting Venereal Diseases' he wrote: 'Many experiments show that true gonorrheal matter when inoculated produces chancre, and that matter from the latter gives rise to true gonorrhea, that consequently both of these affections apparently so different arise from the same virus, which only exhibits different phenomena according as it is applied to different surfaces'. It is worth noting that the term 'gonorrhea' used at that time is not equivalent to what we now know as gonorrhea (Neisserian gonorrhea). 'Gonorrhea' at Hahnemann's time was a common term referring to a suppurative catarrh of genital mucosa. 'Gono-' refers to genital and '-rrhea' means flow. This means that in Hahnemann's period, Neisserian gonorrhea, all types of Non-gonoccocal urethritis (NGUs) like urethritis following infection by Clamidia trachomatis, Mycoplasma genitalis, Herpes simplex virus type 2 and Trichomonas vaginalis were all termed as 'gonorrhea'. Hahnemann believed that when the venereal virus acts on the surfaces of body which is covered by epidermis, it produces 'chancre' lesion and when acts on the mucous membranes, leads to 'gonorrhea'. In 8th paragraph he wrote: 'Parts of the body destitute of epidermis designed for the secretion of natural fluids, when the virus is brought in contact with them, become subject, as Hunter demonstrated, to abnormal fluxes of mucus and pus without loss of substance this phenomenon is called gonorrhea. On the other hand when applied to, or rather rubbed into, surfaces of the body provided with epidermis, it excites specific ulcers, which on account of their corroding character are termed chancres (ulcera cancrosa). In agglomerated glands it gives rise to buboes.' Now we know that this is not true regarding agents responsible for gonorrhea (GU and NGU) cannot produce the chancre lesion. And treponema pallidum cannot induce urethritis. Hunter's mistake was probably based on experimentation on individuals suffering from co-infections. Co-infections in the field of venereal diseases are very common. Hunter's subject for experimentation was infected by both Syphilis and a kind of urethritis (Gonoccocal or non-gonococal). Hahnemann was a follower of Hunter in the field of venereal diseases, so he made the same mistake. Besides this mistake, co-infections were responsible for confounding different types of genital ulcers. Careful reading of Hahnemann's writings both in 'Instruction for Surgeons respecting Venereal Diseases' and 'Chronic Diseases' shows that what he called 'Chancre' is not synonymous to what we now know as the primary ulcer of Syphilis. In 260th paragraph of 'Instruction for Surgeons respecting Venereal Diseases' Hahnemann describes 'Chancre' ulcer: 'A small dark-red elevated spot appears, in some cases thirty-six hours, rarely several days after the impure coitus, and with painful itching it forms a hared, inflamed pimple filled with pus, that rapidly develops itself into an ulcer. When the chancre first appears it is raised above the surface of the skin but its hard, light-red (or dirty yellowish white) base is a little sunk below the suety whitish borders whose periphery is inflamed and indurated, but very defined. When touched the patient experiences severe pains, and we can feel that the hardness of the whole ulcer extends very deep. The matter that exudes is of a greenish yellow colour. Such is the chancre, which gradually increases in superficial extent and depth, accompanied by pains more of a gnawing than shooting character.' There is a shorter description in his 'Chronic Diseases': 'The chancre appears, after an impure coition, usually between the seventh and fourteenth days, rarely sooner or later, mostly on the member infected with the miasma, first as a little pustule, which changes into an impure ulcer with raised borders and stinging pains, which if not cured remains standing on the same place during man's lifetime, only increasing with the years, while the secondary symptoms of the venereal disease, syphilis, cannot break out as long as it exists.' We now know that Syphilitic chancre is a 'painless' ulcer. This is in contrast to Hahnemann's description. Was he confounding Treponema's chancre with other venereal ulcers? Syphilitic ulcers are neither painful nor exudative. Regarding the exuda, we now know that bacterial super-infections may lead to such manifestation but this is not directly related to Syphilis. 'Painful' venereal ulcers which belong to the category of differential diagnosis of syphilitic chancre are 'Chancroid' caused by Haemophilus ducreyi and Genital herpes caused by Herpes simplex virus type 2. It is not possible that Hahnemann is confounding Chancroid with Syphilis. The reason is that Chanroid is prevalent only in Africa and South-east Asia esp at Hahnemann's time when the epidemiological borders were clear. Herpes simplex virus 2 infection can be a good candidate as an agent co-infected with Syphilis in Hahnemann's cases or totally confounded with it. The 'painful' bubo that Hahnemann describes is a confirmatory evidence. Bubo in Hahnemann's terminology is the inguinal lymphadenopathy associated with venereal diseases. Now we clearly know that Syphilis inguinal lymphadenopathy is 'painless'. In Syphilis section of Hahnemann's 'Chronic Diseases' he writes: 'The Allopathic doctor destroys in his blindness, through local applications, the vicarious external symptom (the chancre ulcer), which kind nature intended for the alleviation of the internal extensive venereal general disease and so he inexorably compels the organism to replace the destroyed first substitute of the internal venereal malady (the chancre) by a far more painful substitute, the bubo, which hastens onward to suppuration' Venereal diseases associated with tender lymphadenopathy are Genital herpes (HSV-2), Lymphogranuloma venereum (LGV) caused by Clamydia trachomatis, Chancroid and sometimes Granuloma inguinale (donovanosis) caused by Calymmatobacterium granulomatis. But we know that only Genital Herpes is epidemiologically linked with Europe. LGV can be seen in Europe but it is not associated with a prominent genital ulcer that can be mistaken with Syphilis. So we understand that what Hahnemann calls 'Chancre' is not the pure picture of what we know as Syphilitic chancre. It is either a mixture of 2 or 3 infections or in some cases even totally a non-syphilitic lesion as is defined in modern terminology. The interesting point in Hahnemann's view on venereal diseases is that he uses the term Syphilis only when the venereal disease becomes systemic. His basic idea was that any venereal lesion when enters the phase of 'second infection' becomes systemic and this systemic diseases is called Syphilis. This model even covered the 'gonorrheal' cases! In 6th paragraph of 'Instruction for Surgeons respecting Venereal Diseases' he writes: 'The first infection gives rise only to independent local diseases or idiopathic venereal local affections, gonorrhea and chancre in their essential character buboes and condylomata belong to these, yet as regards the period of their occurrence, they constitute the transition into the second infection, in which the absorption of the hitherto merely local virus of the gonorrhea, chancre and buboe into the general fluids, produces a state of the system that only makes itself known by local affections of another description, which may therefore be called symptomatic venereal disease, and the individual or collective phenomena of which are usually termed general venereal disease or Syphilis.' The idea of local infection in contrast to systemic infection was preserved in Hahnemann's approach even in the time of publication of his 'Chronic Diseases'. In the second footnote of Sycosis chapter he wrote: 'The miasm of the other common gonorrhœas seems not to penetrate the whole organism, but only to locally stimulate the urinary organs. They yield either to a dose of one drop of fresh parsley-juice, when this is indicated by a frequent urgency to urinate, or a small dose of cannabis, of cantharides, or of the copaiva balm, according to their different constitution and the other ailments attending it. These should, however, be always used in the higher and dynamizations (potencies), unless a psora, slumbering in the body of the patient, has been developed by means of a strongly affecting, irritating or weakening treatment by Allopathic physicians. In such a case frequently secondary gonorrhœas remain, which can only be cured by an anti-psoric treatment.' In summary, Hahnemann believed that chancre if not suppressed is a local infectious disease and when suppressed becomes systemic and forms 'Syphilis'. The second infection that Hahnemann describes is similar to the current definition of secondary phase of early Syphilis. What we now term tertiary and quaternary Syphilis was not considered as a part of Syphilis by Hahnemann. Later he describes such late complications as manifestations of developed Psora. It is interesting to note that the secondary manifestations of Syphilis is very similar to complications following infection by Herpes simplex virus type 2 (and type 1). The main manifestations of secondary Syphilis are mucosal ulceration, stomatitis, uveitis, rash, hepatitis, proctitis, nephritis, lymphadenopathy, meningitis,… If you study the picture of HSV-2 in Materia Virosa (Data of HSV-2 also available in Minutus Library in Miasm section in Herpesviridae family http://www.minutus.org) you will see the same affections. It seems that what Hahnemann termed as Chancre disease and Syphilis is actually a mixed picture of our current definitions of Syphilis and Genital Herpes (HSV-2 infection). Other infections such as Clamydia trachomatis and bacterial super-infections may also co-exist in Hahnemann's description. The surprising point is that if you study and observe the course of HSV-2 infection with all its complications, the main antimiasmatic remedies suitable for its Genus epidemicus are MERC, Nat-m, Petr, Nit-ac, Calc andThuj. You see that Merc the Hahnemann's specificum for Syphilis is the most important simillimum for the dynamic pathological process of HSV-2! It is worth noting that HSV-2 can deeply penetrate to human genome (This feature is not yet confirmed in Syphilis!) leading to destructive manifestation. All the efforts in miasmatic research were aids to find the best simillimum. If we edit and update our data of Genus Epidemicus we will have much more accurate results and move toward successful prescriptions. That's what Hahnemann did with extracting the picture of Sycosis (currently known as co-infection of HPV and HSV-2) from what French doctors considered a Syphilitic manifestation. I believe that Hahnemann would continue his effort to specify distinct miasms for much more accurate miasmatic prescriptions. Be careful when using the term 'Syphilis' in homeopathy discussions. It is better always to mention whose definition of Syphilis you are using Hahnemann's Syphilis, Kent's Syphilis, Ortega's Syphilis, Sankaran's Syphilis,….. The only common thing is the vague theme of an evil malignant process (or category) leading to destruction. There is not just a single process in nature leading to destruction and hopelessness! Let's have a fresh look at what goes on in nature! Homeopathy is experience based and when reason is involved it is based on 'experienced-based rationalism' model. Unfortunately we rarely see fresh looks to the nature in 20th century homeopathy. Isn't this the reason for gradual decline of homeopathy after beginning of 20th century? Let's stop blaming the opponents of homeopathy for its stagnation! To avoid misunderstandings, I emphasize on the fact that in phenomenological analysis I am not referring to infectious 'agents' in a reductionistic way but to infectious 'dynamic states'. I am showing the importance of a fresh look at dynamic nature of natural diseases the way it was done by father of homeopathy, Samuel Hahnemann. For a better understanding of the role of infectious states in formation of chronic patterns please read my previous articles 'Basic Principles in Treatment of Chronic Diseases' (Parts 1, 2, 3), '40 Points in Analysis of Chronic Patients' and 'Chronic Diseases – The Effective Causal Complex' in Minutus website library (Ardavan Shahrdar section).
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Added on:	January 30 2007
Author/Source:	Dr Ardavan Shahrdar
Author's email/website:	http://www.minutus.org
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By January 30 2007 Great, a nice jump forward into the future of homeopathy. You are an inspiration. I always enjoy your work. Maria Bohle By January 30 2007 Clear, concise, to the point, elloquent exposition of comparisons of old meanings and our new termanology.Refreshing. Thank you Ardavan. Marie Van Stokkum. By January 30 2007 Great article. I teach my students to refer to the Syphilitic miasm as Luetic miasm and to refer to Syphilinum as Luesinum/Lueticum. I once heard a story about a patient who committed suicide after his homeopath described what he had as a syphilitic taint. We really need to be careful when using these terms around patients. Gabrielle Traub