BORRELIA BURGDORFERI

Scientific name Borrelia burgdorferi Johnson et al. 1984
Family Spirochaetaceae
Homeopathy Borrelia burgdorferi
Borrelia nosode
Lyme nosode

FEATURES

• Named after W. Burgdorfer, the physician who isolated the spirochete from a deer tick in 1981.
• Flexible, spiral-shaped, Gram-negative spirochete propelled by an internal arrangement of flagella, bundled together, that runs the length of the bacteria from tip to tip.
• Microaerophilic, i.e. requires oxygen but less than is present in the air.
• Parasitic on many forms of animal life; found on mucous membranes.
• Transmitted by tick bites.
• The lipid components of Borrelia are unusual in that they include cholesterol, a substance found in only one other bacterial genus, Mycoplasma.
• Also one of the very few bacterial species having linear DNA [typical of organisms with nucleated cells] instead of circular DNA.
• B. burgdorferi is a slow growing [division time is estimated to be 12-24 hours], fastidious organism that requires a complex liquid medium and an optimal temperature of 33-35° C for growth, due to which it is extremely difficult to culture in vitro.
• Glucose provides its major energy source and lactic acid is the predominant metabolic end product.
• Readily adapts to various hosts and “can enter the tissue that is optimal for its survival, and it may evade the immune system and antibiotics by hiding inside certain types of cells. … It is for certain that its ability to kill B-lymphocytes evolved as part of a defence mechanism to evade its own destruction. The observation that it can use the B-cell’s own membrane as camouflage indicates that it may be able to go undetected by our immune system. The way our immune system is supposed to work is that it recognizes foreign invaders as being different from self, and attacks the infection. … The most intriguing fact about Borrelia spirochetes is their well documented ability to change the shape of their surface antigens when they are attacked by the human immune system. When this occurs, it takes several weeks for the immune system to produce new antibodies. During this time the infection continues to divide and hide.” [Grier]
• “Like other spirochetes, such as those that cause syphilis, the Lyme spirochete can remain in the human body for years in a non-metabolic state. It is essentially in suspended animation, and since it does not metabolise in this state, antibiotics are not absorbed or effective. When the conditions are right, those bacteria that survive can seed back into the blood stream and initiate a relapse.” [Grier]
NOTE: While it was first thought that B. burgdorferi was the only species causing Lyme disease, it has since been determined that any number of the different species in the genus Borrelia might be capable of this feat.

The different manifestations of LB do not show an even geographical distribution. This is partly due to the uneven distribution of the different genospecies of B. burgdorferi sensu lato, some of which seem to be associated with particular symptoms. Only one of them, B. burgdorferi sensu stricto, has been implicated as the cause of disease in North America, mainly causing arthritis [60%], but in Europe three genospecies, B. afzelii, B. garinii and B. burgdorferi sensu stricto, are known to be pathogenic. … B. afzelii seems to be associated with a degenerative skin condition, acrodermatitis chronica atrophicans, and B. garinii with neurological symptoms. However, these associations are not clear-cut and there is considerable overlap. B. garinii seems to predominate in western Europe and B. afzelii becomes more prevalent in northern, central and eastern regions, while there is some evidence that B. burgdorferi s.s. has been introduced from the west.
[European Union Concerted Action on Lyme Borreliosis, 1997-2003]

LYME BORRELIOSIS

Borreliosis or Lyme disease occurs in the north temperate zone. It is the most commonly reported tick-borne infection in Europe and North America. A multi-system disorder, borreliosis can affect a complex range of tissues including the skin, nervous and musculoskeletal systems, and to a lesser extent the eyes, kidneys, and liver. [Predilection for the latter three organ systems is more specific for Leptospira.]

The term Lyme disease was first used following investigation into a geographical cluster of juvenile rheumatoid arthritis in the town of Old Lyme, Connecticut, USA, in the mid 1970s. Subsequent studies led to the isolation from the deer tick, Ixodes scapularis [dammini] of a gram-negative spirochete, which was named Borrelia burgdorferi. The disease has, however, been known in Europe under a variety of names [including erythema migrans, acrodermatitis chronica atrophicans, Bannwarth syndrome*] since the 1880s. In 1909, Afzelius had associated a red rash [erythema migrans] with the tick, Ixodes ricinus.
In 1948, spirochetes were observed in erythema migrans [EM] biopsies and in 1951 a Swedish clinician, Hollström, successfully treated EM infected patients with penicillin. Also in 1951, it was suggested that EM, with associated meningitis, was probably the result of an infection by a tick- or other insect-borne bacterium. … However, EM was considered a relatively harmless condition with no connection made between the lesion and subsequent symptoms caused by the same bacterium.
[European Union Concerted Action on Lyme Borreliosis, 1997-2003]

The clinical presentation of borreliosis can be divided according to its progress. Borreliosis runs its course in three stages. The early stage presents in up to 70% of cases with erythema migrans, an expanding red maculopapular rash that can reach a large size in diameter and typically clears from the central area [“bulls-eye rash”]. The rash can be circular, triangular, and cover large portions of the body. Vague or pronounced flu-like symptoms and sometimes glandular swelling accompany the rash. During the second or disseminated stage, which may last for over a year, the spirochete spreads gradually to other tissues via the bloodstream and lymphatics. Manifestations of this stage may include erythematous patches [usually smaller than the initial lesion], fatigue, headache, muscle and joint pains, facial palsy or other cranial nerve lesions, and, rarely, carditis. Progression to the third stage, late borreliosis, involves Lyme arthritis, commonly restricted to the large joints, acrodermatis chronica atrophicans, and neuroborreliosis.
Erythema migrans, the characteristic rash which may appear some days to weeks following infection, is the most common manifestation, next comes arthritis, then neuroborreliosis, while carditis is rare. Some studies report higher disease incidence rates for males, although a recent Swedish study on recurrence of erythema migrans showed the majority of cases to occur in middle-aged women.
In addition, acrodermatitis chronica atrophicans [indurated, erythematous plaques, bluish-red, commencing on feet, hands, elbows, or knees, and gradually progressing to epidermal atrophy with thin, shiny, papery appearance of the involved sites] reportedly occurs mainly in elderly women, whereas bilateral facial palsy is a frequent manifestation in children. The number of cases of Lyme disease reported in the United States is about 17,000 per year, but the actual incidence is estimated to be some 10 times higher. According to a WHO report, the number of European cases approaches 60,000 annually.

* Bannwarth syndrome or Garin-Bujadoux syndrome [“paralysie par les tiques,” tick-induced paralysis] is characterised by intense pain, mostly in the lumbar and cervical regions, and radiating to the extremities, accompanied by migrating sensory and motor disorders of the peripheral nerves, including such symptoms as facial paralysis, abducens palsy, paraesthesias, anorexia, fatigue, headache, diplopia, and erythema migrans.

THE IMITATOR’s NEW CLOTHES

Syphilis was known as the “great imitator” because its multiple manifestations mimicked other known diseases. Lyme borreliosis, likewise, has now entered the stage as “the new great imitator.” P.H. Duray concedes: “Initially thought to be a disorder beginning in the skin and progressing to involve the joints, Lyme disease is now ranked as one of the great mimickers of other diseases, in a manner similar to that once ascribed to syphilis.” Sir William Osler remarked that “to know syphilis is to know all of medicine.” Homeopathy knows the major syphilitic remedy, Mercurius, as the “great masquerader.” Judging by the close family connection between both spirochetes, it does not come as a surprise that one of very first cases of borreliosis, in 1922 in France, had a weakly positive syphilis test and thus was treated with arsenicals, the then current treatment for syphilis.
There are great differences in how borreliosis manifests in Europe versus in the USA. The major presentation of early neuroborreliosis in the USA is facial palsy, whereas it is encephalomyelitis in Europe. In Europe, the erythema migrans lesion is quite indolent and sometimes hardly noticeable, while US patients have intense inflammatory cutaneous reactions with early dissemination. Acrodermatitis chronica atrophicans is only seen in Europe. Conversely, arthritis is uncommon in Europe, but extremely common in the USA in untreated patients. Neuroborreliosis overall seems to prevail in Europe. These differences are attributed to the distribution of the various Borrelia species.
There is a wide range of symptoms associated with Lyme borreliosis. Symptoms vary greatly, one or more systems may be involved, and new manifestations continue to be described. Like syphilis, Lyme borreliosis may remain latent and asymptomatic for a long period of time; progress for many years through successive stages; or fluctuate dramatically and unpredictably.
Many Lyme patients were first diagnosed with other illnesses such as arthritis, juvenile arthritis, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, multiple sclerosis, lupus, early ALS [amyotrophic lateral sclerosis], early Alzheimer’s disease, Crohn’s disease, irritable bowel syndrome and various other more nondescript illnesses.
So bewildering is the range of symptoms that a borreliosis patient conceded that “while one misguided doctor writes in his book on Lyme that the more widespread and peculiar the symptoms are, the more likely the complaint is psychosomatic, I'd have to say that the more widespread and peculiar the symptoms are, the more likely that the problem is Lyme disease.” Diagnosis is controversial; some believe the disorder to be “over-diagnosed,” others think it is “under-diagnosed” and again others speak of frequent “misdiagnosis.” The virulence of the spirochete is equally poorly understood. Involvement of immunological host factors have been proposed, whereas the remission of even psychiatric disorders after antimicrobial treatment is deemed proof that it concerns merely a bacterial infection.
Tracking the culprit, the new elusive spirochete, is riddled with problems, considering that there are asymptomatic seropositive patients, seronegative patients with intractable symptoms, patients with persisting symptoms despite the standard two-to-four-week IV antibiotic treatment regimen, seropositivity despite antibiotics, and so on. Patients may have one or all of the stages, or the illness may not become symptomatic until stage 2 or 3. What initially was held for “Lyme Hysteria” turns out to be linked with long-term, chronic problems. Yet, there is, as one author put it, “chronic persistent denial of chronic persistent infection in Lyme Disease.”

TICK-STRICKEN

Borrelia is transmitted by ticks belonging to the genus Ixodes. The two-year life cycle of the tick consists of four stages: egg, larva, nymph, and adult. Between each stage the tick needs a blood meal in order to mature. It usually becomes the host for the Borrelia spirochetes during its larval stage, when it feeds on small animals such as rodents or birds. After its blood meal the tick drops off the host to transform over a period of months into the next instar. Because off-host ticks are vulnerable to desiccation, an environment with high humidity is required to maintain a stable water balance.
Temperate deciduous woodland with patches of dense vegetation and little air movement coupled with high humidity constitute ideal conditions. Here Ixodes will be encountered, usually in the spring, the season that warrants sufficient humidity. Animals or humans brushing through the vegetation may pick up ticks, then commonly in their nymphal stage, involuntarily assisting in the completion of their life-cycle.
While gorging, ticks increase salivation and with the saliva the spirochetes come along, which resided in the tick’s digestive tract. Ticks are slow feeders, so that spirochetal transmission usually happens after the tick has been feeding for 24 hours. Prompt removal of the attached tick is therefore believed to prevent infection.

Given time, the tick needs to strike only once. That such a relatively short, though unwelcome visit has such devastating long-term effects seems incredible. Although a history of exposure to a tick-endemic area is essential to support the diagnosis of Lyme borreliosis, about one-third of patients do not recall a rash or tick bite “because the nymphal stage of the tick is so tiny and many rashes in body hair and indiscrete areas go undetected.” The dazzling array of borreliosis symptoms has prompted disbelief. Explanations are offered that the tick with the transmission of spirochetes inoculates other parasites as well, such as Ehrlichia canis [ehrlichiosis], Coxiella [Rickettsia] burnetii [Q fever], other rickettsias, Staphylococcus aureus, and Babesia species [babesiosis].
Rather than using the broad spectrum of symptoms as the main guideline, a medical system that so strictly bases its treatment on diagnosis and identification of causative agents is likely to fail. Psychiatrist Robert Bransfield writes: “There has been a recent trend to incorrectly view so called ‘objective’ signs and symptoms as more valid than those which are ‘subjective.’ Often a machine or lab test is perceived as giving validity to these ‘objective’ signs. Many of these ‘objective’ tests are far less valid and are based on questionable techniques, faulty assumptions, and flawed logic. On the other hand, ‘subjective’ complaints are sometimes viewed with excessive suspicion. … In an effort to create predictability, reliance upon cookbook medicine has given us a recipe for disaster.”
And Thomas Grier: “Too often, I have seen the word cured used in Lyme Disease Studies, only to find that the researchers have redefined the word cure to mean seronegative. Seronegativity is not synonymous with cure. The numerous culture positive cases in recent years should have negated that kind of logic years ago, and yet, in 1997, researchers are still publishing studies that use antibodies and PCR as the end point for cure. It’s time to ask the patients one simple question: How are you feeling?”

SYPHILITIC MIASM

We cannot fail to see the close resemblance between Lyme borreliosis and the syphilitic miasm with Syphilinum as its prototype. The correlations even go beyond the symptomatology, encompassing such elements as controversy, denial, stigmatisation, blame, and banishment. Hardly any other subject creates so much alienation as the syphilitic miasm in all its disguises.
With the exception of a few symptoms, borreliosis appears to be a spitting image of the syphilitic miasm in general and Syphilinum in particular, as is evidenced by Boericke’s and Clarke’s summary of the latter:

• Utter prostration and debility in the morning.
• Fears the night, and the suffering from exhaustion on awakening.
• Shifting rheumatic pains.
• Chronic eruptions and rheumatism.
• Alcohol.
• Loss of memory [names, dates, etc.]; remembers everything previous to his illness [i.e. short-term memory deficit].
• Hopeless; despair of recovery, does not think will ever get better.
• Cross, irritable, peevish.
• Violent on being opposed.
• Feels as if going insane or being paralysed.

The theme of insanity pervades the borreliosis picture. Pains are described as maddening; patients are labelled as crazy by medical practitioners; patients go out of their minds from falling on deaf ears. Descriptions of the mental state induced by Borrelia depict the despair and darkness, the taking away by force of hopes and dreams:
• “In this darkness that surrounded me, there was no room left to turn or to run. Only to survive. Days passed like an insect caught in tree sap. Enveloping. A strangely warm, amber struggle in slow motion - a quiet resignation to a world that was filled with nightmare images. Trapped in a mind that knew it had gone insane.”
• “I thought I was slowly going crazy, never knowing what the next day would bring.”
• “Some days I haven’t a clue what I did two days ago or even that morning. This continues to drive me crazy.”
• “After years of being told that I was crazy and then suddenly that I had some type of auto-immune connective tissue disease …”
• “I was trying to make sense of it myself, I was grasping at straws for an explanation of what was happening to me. … I felt as if the self I knew was dissolving.”
• “Sometimes one can’t hope for better. One can only hope for different. Death is definitely different.”
• “When I looked in the mirror I saw someone I didn't recognise.”
• “In essence, I was dropping out of life.” [Citations extracted from the Personal Stories collected on the website Lymealliance.org]

MATERIA MEDICA BORRELIA

Sources
Non-existent in homeopathy to date, the extensive literature on Lyme borreliosis provides a fine opportunity for the creation of a provisional symptom picture.
The numbers behind the symptoms refer to the sources below from which the symptoms were collated.

SYMPTOMS

MIND General picture • “In one U.S. study of 27 patients with late neuroborreliosis, 33% were depressed based on their scores on the Minnesota Multiphasic Personality Inventory. 89% of these 27 patients also had evidence of a mild encephalopathy, characterised by memory loss [81%], excessive daytime sleepiness [30%], extreme irritability [26%], and word finding difficulties [19%]. Controlled studies indicate significantly more depression among patients with late Lyme borreliosis than among normal controls and other chronically ill patients.” [2]

• “A diagnostic tip in favour of Lyme disease as the cause of the depression and irritability might be concomitant memory loss, word finding problems, or a concomitant polyneuropathy.” [2]

Hypersensitivity.

Light.
• Photophobia [keynote]; must wear sunglasses or glacier glasses, even indoors, even at night. [3]
• Feeling of faintness or dizziness form exposure to fluorescent lights, making it difficult to go to supermarkets or other public places. [3]
• Panic attacks triggered by light stimulation, esp. flickering bright lights. [3]
• Nausea from flickering bright lights [fluorescent lights, TV or computer screens, strobe lights during EEG testing or the headlights of cars moving in the opposite line of traffic]. [3]

Sound.
• Ordinary conversation perceived as deafening; wears head phones and puts pillows over his head to block out the sound. [3]
• “To one woman even the sound of another person’s breathing seemed unbearably loud. In her case, the sound sensitivity also included vertigo, nausea and nystagmus in response to sounds. Any sudden sound, like the phone ringing, and certain household sounds, like the running of tap water, could cause her to fall or retch. This peculiar short-circuiting of the inner ear’s auditory and vestibular functions is known as the Tullio phenomenon. This phenomenon has been deemed pathognomonic for syphilis but, as it appears, can occur in Lyme disease as well, and thus provides one more example of the ‘new great imitator,’ Lyme disease, imitating the old ‘great imitator,’ syphilis.” [3]

Smells.
• Smells seem overly intense and noxious. [3]

Taste.
• Foods taste abnormally sour or bitter. [3]
• Or the reverse: loss of taste on left side of tongue. [1]

Touch
• Regional or generalised hyperaesthesia of skin to touch or temperature. [1]
• Sensitivity to touch; “the bed sheet resting lightly on my toe would make the toe ache, like a toothache.” [11]
• “Even the thinness of a sheet was too painful for my legs.” [11]

Vibrations.
• Abnormally heightened vibration sense, eg, thinks car were vibrating with unusual violence. [3]

Emotional lability / mood changes / irritability.

• Accompanied by headache and neck stiffness. [3]
• Sudden, intense irritability from sensory stimulation [sound, touch, light] or occurring unprovoked and inexplicably. [3]
• Sudden, unprecedented fits of violence. [3]
• Uncontrollable outbursts. “A woman, typically reserved and eager to please, became uncontrollably irritable one day at work and found herself yelling at her boss in a most uncharacteristic fashion.” [3]
• Sudden bursting into tears from trifles. [3]
• Fluctuations from marked agitation to severe depression with suicidal threats. [8]
• Rapid mood swings [from grandiosity to sudden tearfulness]. [8]
• Violence; striking children and breaking furniture. [8]
Homicidal ideation, urges, and behaviour occur in some of these patients. Some adult patients describe struggling to not act on these urges. When these patients act on a homicidal urge, more commonly it is a child becoming assaultive to a sibling. Dissociative episodes sometimes occur with these patients, occasionally accompanied by aggressive behaviour and loss of memory. [9]

Cognitive impairment - Lyme Fog

• Short-term memory problems, word-finding difficulties, dyslexia, problems with calculations or inability to concentrate. [1]
Many Lyme patients state “I feel like I have become dyslexic.” Impairment of reading comprehension is an earlier sign with the later addition of auditory comprehension difficulties. Acquired left/right confusion is seen with some of these patients displaying what appears to be an acquired Gerstmann’s syndrome or some variant of this syndrome.* They have problems with calculations and often complain of errors when trying to calculate their checkbooks. Fluency of speech is a very significant problem. When interviewing these patients, this is a clearly evident symptom. Stuttering is seen in many of these patients. [9] [Boy aet. 5] “I would mix up stories and get cranky. I tried to tell Mom that my brain was ‘sticky’, but she didn't know what I meant. It didn’t hurt, it just wouldn’t work. I would climb up on the sink and put a wet washcloth on my head. On those days, my behaviour was hyperactive and I would stutter.” [11]

“The kicker, though, was the virtually unexplainable difficulty in writing, typing, speaking, and thinking. I'd use the wrong letters, hit the wrong keys, stutter, reverse things, and find myself unable to say the right word. Everyone does this occasionally, but this was consistent and unrelenting. I felt like something poisonous had taken over my brain.” [11]

On interview, patients with Lyme encephalopathy tend to be vague and disorganized in the presentation of the history of their illness. This is despite their close attention to their symptoms and having recounted them many times before. Although in most cases memory of discreet events - tests, dates, diagnoses, responses to medications -- is intact, the patient is unable to recall them spontaneously or organize them in temporal order. They may be unclear as to their chief complaint. They may completely lose track of what they were saying, sometimes repeatedly, or of what the question was. They may get off on a tangent and have trouble re-orienting themselves. Frequent prompting and refocusing will be necessary. beginning the interview with an open-ended question like “Tell me what the problem is” will allow these qualities to become clear.

However their experience is different from that of ADD, in that rather than having the experience that there are many thoughts competing for attention, the Lyme patient has difficulty bringing any thought into clear focus. They experience difficulty thinking. One patient described it as the universe ending six inches from his face. He can’t process information that is not immediately apparent, immediately experienced. Another said that when he tries to think about something, or figure something out, all he can do is repeat the question - he can't get to the meaning. One patient, a physician, described it as a “mental intention tremor” -- the more she tries to focus on something the more out of focus it becomes. [14]

• Brain fog. Problems with facial recognition. [1]
• Spaced out, as if in a fog. [2]
• Difficulty remembering details such as names or appointment times. Engaged in new compensatory behaviour, such as daily list-making. [1]
• Compensatory compulsions are common in an effort to compensate for the memory deficits. [9]
These [Lyme disease] patients generally come to the office disorganised [despite a supreme effort to be organized], unable to give a coherent history. They will bring copious notes, which are invariably in the wrong order. [7]
I used to have a quick mind and a good memory, now I was dependent on notes plastered everywhere so I could remember things. [10]

Mistakes in speaking and/or writing

• “Patients with no prior history of dyslexia have found themselves writing letters backwards, reversing numbers or routinely reversing the first and second letters of a word.” [3]
• Mistakes in time: says “tomorrow” instead of “yesterday” and vice versa. [3]

Spatial disorientation - sense of position [“spatial dyslexia”]

• Loses his way in well known streets. [3]
• Difficulty with spatial awareness of where front and back doors are in one’s own house. [9]
• Disturbed sense of position. “Repeatedly bumps into things on the left side of her body, drops things from her left hand despite having no weakness in that hand and occasionally places objects several inches short of a table edge with the result that they fall to the floor.” [3]
• Disturbed sense of position, esp. in hands; grasps the air when reaching for objects. [6]
• “Everything around me looked strange. The people sounded like cackling geese. Everyone looked like they were in fast motion, like someone had sped up the projector. Every time I turned, I was dizzy and disoriented. I was sweating, and completely lost.” [11]
• “I was getting lost driving to places that I had been to hundreds of times.” [11]
• “I was getting lost in my own neighbourhood when I tried to drive.” [11]
• “I forgot where I was on my way home.” [11]
• “Difficulty ‘recognizing’ things when driving - familiar landmarks lost their meaning; I stopped at green lights, made wrong turns or drove past my destination, even in territory close to home.” [11]

Hallucinations

• Musical hallucinations with a sudden onset and taking the form of patriotic or operatic music. [1]
• “I was hallucinating both visually and auditory. I heard phones ring when there were none. I saw shadows twist into menacing shapes. I heard voices talking. At night, I saw flashing lights fill my vision, and my ears were constantly buzzing with static and ringing. I felt for the first time that I might be truly going mad.” [11]
• [Upon awakening in the night] “A skeleton hallucination in black and white, looking at me, grinning a very toothy smile, head cocked, propped up by one arm.” [11]

Intrusive thoughts/images

• Intrusive obsessional thoughts with checking; horrific images of killing others; excessive bathing. [8]
• Intrusive images which are more commonly of an aggressive nature but sometimes can be of a sexual or other nature. Occasionally these images are of a homicidal nature. [9]
• “My mind was a hopeless jumble of uncontrolled thoughts - images and sounds that haunted me. It was as if several minds had been merged into one, and there was no way to sort the images.” [11]

Fears

• Chronic morbid dread of vomiting [without actual emesis]. [6]
• Panic attacks in sleep. [11]
• “I woke up several times in pain and experiencing panic attacks.” [11]
* Gerstmann’s syndrome: inability to perceive a stimulus applied to the fingers, impairment of the ability to write, inability to do simple mathematical problems, and confusion of laterality of body.

CHILDREN

The majority, over ninety percent, of the children that we have treated complain of headache. The headache, in a few cases, has been very acute accompanied by papilloedema [oedema of optic disk] but in the majority of cases the headache comes on gradually, becomes quite persistent and does not respond to over-the-counter analgesics. In addition to the headache, the children complain of photophobia, dizziness, a stiff neck, backache, somnolence and, those that are in school, have problems with memory and difficulty concentrating. Some patients have developed progressive weakness.
The parents complain that pre-schoolers develop mood swings and become very irritable and they see a personality change. Among the children that are school age and those who are in adolescence, chest pain is a very frequent complaint. At least seventy percent have complained of chest pain. About fifty percent have complained of abdominal pain. More than half the children have arthralgia usually involving the knee and sometimes the wrist. Other complaints include palpitations, tingling, numbness, rashes that come and go, usually malar [cheek] rashes, and sore throats that are excruciatingly painful.
It is easy to see how this long list can be very non-specific and many of these children are thought to have functional problems. [13]

GENERALS

Typical combination of features
• Joint pain + major cognitive dysfunction [esp. short-range memory] + major sleep disturbances + terrible fatigue + sensory hyper-acuity.

Alternating states
• Perplexing fluctuation in symptoms. Spry and energetic one day, drained and confused the next day. May be brought on by exertion, stress, or exposure to sensory stimuli, or come without apparent cause. Cannot make plans due to the unpredictable nature of the fluctuations. [3]
• Days of near normality alternate with days of profound debility. [1]
• The symptoms shift in kaleidoscope fashion from one hour to the next in the same patient and seldom present identically in two different individuals. [6]
• “Days of hope and black despair coupled together.” [11]
• “I thought I was slowly going crazy, never knowing what the next day would bring.” [11]

Suddenness
• These patients can become suddenly suicidal. [9]
• Sudden worsening of symptoms. [2]
• Sudden inability to remember how to transfer calls [in a woman who had been a telephone switchboard operator for 20 years]. [2]
• Worse by any sudden sound. [3]
• Sudden intense irritability. [3]
• Sudden soreness of sinuses and throat, then disappearing, then sore again in a seemingly rhythmic way. [6]
• Sudden, complete inability to swallow. [6]
• Awakened in the middle of the night by severe arthritic pains over entire body. Pain sudden, dramatic, and excruciating. Pain gone when waking the next morning. [6]
• Sudden changes in stool consistency from normal to putty-like, to constipation [stools have to be removed mechanically], etc. [6]
• Sudden arrhythmia. [11]
• Sudden falling to the ground. [1]
• Sudden paralysis. “As I stood in front of the bathroom sink brushing my teeth, I suddenly lost the use of my right arm and hand. A quivery, ticklish feeling travelled like lightning from the shoulder to the fingertips; paralysed, the arm dropped down into the sink, hit the enamel hard and broke the skin.” [11]

Neurological
• Left-sided hemiparesis when waking up. [1]
• “The left side of my face was paralysed with the numbness extending to the left side of my tongue and down my throat. Also, my left side felt weaker and my left lung felt somehow affected - cold and heavy.” [11]
• Intermittent paraesthesias. [1]
• Nerve pains severe, burning, tearing, migrating, with characteristic exacerbations at night. [1]
• Clumsiness; “ataxia is common in these patients who are often clumsy, which leads to frequent accidents.” [9]
• The close resemblance between neuroborreliosis and certain neurological conditions has been explained thus: “When the human brain becomes inflamed, cells called macrophages respond by releasing a neurotoxin called quinolinic acid. This toxin is also elevated in Parkinson’s Disease, MS, ALS, and is responsible for the dementia that occurs in AIDS patients. What quinolinic acid does is stimulate neurons to repeatedly depolarise. This eventually causes the neurons to demyelinate and die. People with elevated quinolinic acid have short-term memory problems.” [4]

Energy
• “Too fatigued and sore to even think about moving around.” [10]
• “The best description I can think of for the misery of acute Lyme disease is a combination of debilitating mononucleosis and severe arthritis in the knees and elbows.” [10]
• Debilitating fatigue & periodic attacks of left-sided paralysis. [10]

Sleep - Night aggravation
• Excessive daytime sleepiness. [1]
• Falling asleep while talking with others. [6]
• Falling asleep at work. [11]
• Narcolepsy. “At first, I would fall asleep spontaneously and unpredictably a few times a week, but over the next three months it climbed to four hundred times a day. I would fall when this happened.” [11]
• Can not sleep at night, can not wake up during the day. [11]
• Apnoea - a sudden ‘gasping’ for air just before falling asleep. [11]
• Sleeping disorder. “He [13-y. old boy] would thrash around at night disrupting his bedding, knocking over lamps and rearranging things during the night. I never actually saw any of these episodes but saw the result of them in the morning.” [12]
• “When I did sleep, it was a tortured sleep where I would toss and turn and tear at my covers. I despised warmth and craved cold. My bed in the morning would look like a war zone.” [11]
• “In the beginning, I was horrified to awaken knowing that I was still alive and had not died in my sleep. What a great cop-out, I would think, except the nightmares were actually worse than reality.” [11]
• “Woke up angry in the night that I hadn't just died.” [11]
• “I experienced night terrors, where friends that had died in the last twenty years gathered around my bed nightly, smiling and waving for me to come with them. … I hated to go to sleep at night because of my dead friends appearing.” [11]
• Early morning insomnia with nightmares. [11]
• Sleeplessness due to pain in kidneys. [11]
• Sleeplessness from stabbing pain in feet. [11]

Pains
• Burning [pain] seems quite specific [to neuroborreliosis]; the patient describes a sensation that a blowtorch is burning the skin. [9]
• Feeling as if muscles and nervous system were on fire. [6]
• “The burning pain in my spine was so bad that I broke out in sweats day and night.” [11]
• Sharp shooting or stabbing pains. [1]

Food & Drink
• Anorexia. [1]
• “Eating disorders are common. Invariably these patients either gain or lose weight. Sometimes massive weight gain is also seen.” [9]
• Increased thirst. [1]
• Intolerance for alcohol. “Most patients state, ‘I don’t drink any more’.” [9]
• Exaggerated symptoms or worse hangover from alcohol. [5]

Temperature
• Great chilliness. [1]
• Low body temperature [slightly below normal]. [5]
• Profuse sweating. [1]
• Unexplained sweats. Night sweats. Sweating even in cool temperatures. [5]

Weather
• Symptoms worse in low pressure weather systems. [5]

Miscellaneous
• Lymphocytoma [small solitary bluish-red plaque or nodule], particularly at ear lobes or nipples. [1]
• Delayed development, failure to thrive in infants. [5]

LOCALS

Vertigo
• Sensation of whirling motion of oneself or of external objects. [1]
• Ménière’s disease. [1]
• Vertigo with drop attacks of the Tumarkin type.* [1]
• Motion sickness. [5]
• Balance severely off; would fall when closing eyes. [11]
• Vertigo from even slightly turning head; “the world would swim if I just moved my eyeballs.” [11]
• Floor feels as it were rolling beneath the feet, or as if one were on an elevator or a boat, going up and down in waves. [11]

Head
• Headache frontal or occipital; intermittent [duration] and fluctuating [intensity]. [1]
• Feeling of pressure behind eyes, pain < moving eyes. [1]
• Sore/tender areas on skull/scalp area. [5]
• Pressure migrating from vertex to occiput when turning head. [11]
• “When I would move my head, there was a disturbing gurgle as I heard bubbles move around inside my head.” [11]

Eyes & Vision
• Conjunctivitis. [1]
• Intermittent diplopia and visual blurring. [8]
• Diplopia & vertigo and nystagmus. [1]
• Triplopia in right eye. [11]
• Sparks, spots, waves, floaters before eyes. [5]
• Sensation of a foreign body in eye[s] [keratitis]. [1]
• Twitching. [5]
• Bloodshot eyes. [5]
• Vision reduced to a circle directly in front of eyes; peripheral vision just a blurry swirling mess of lights and images. [11]
• “Seeing ‘trails’ of objects, i.e. my own moving limbs or doorways I walked through.”

Hearing
• Impaired hearing [bilateral] & fatigue, headache, or arthritis. [1]
• Hearing loss & tinnitus. [1]

Face
• Bilateral facial nerve palsy. [1]
• Muscle twitches in face. [4]
• Pain in face, teeth, articulation of jaw, and masticatory muscle. [1]
• Swelling around eyes. [1]
• Facial redness. [5]
• “My chin hurt, and felt ‘ticklish’ - as if something were blowing on it.” [11]
• Audible clicking of jaw when speaking or eating. [11]
• “Around my mouth, all around the lips and down into the chin, a vibrating, biting, humming itch, as though there were a thousand bees swarming over my lips and the majority of them were stinging.” [11]

Mouth
• Numbness/tingling of face or tongue. [1]
• Weakness tongue. [1]
• Sore spots on tongue. [5]
• Speech; slow and laboured; slurred; poorly articulated. [1]

Throat
• Must drink in order to swallow food. [11]

Urogenital
• Irritable bladder; trouble starting/stopping; frequent urination; voiding dysfunction. [1]
• Urinary retention followed by paralysis of lower limbs. [1]
• Numbness genitals. [5]

Chest
• Short stabbing pains in chest lasting only seconds. [1]
• Dry, non-productive cough. [1]
• Awakening in middle of night with chest pains and pain and tingling down my left arm. [11]
• Sensation as of hot water were being poured into lungs. [11]

Back
• Stiffness of nape of neck & headache, pain in joints and/or muscles, or fatigue. [1]
• Weakness nape of neck. [1]
• Tired feeling between shoulder blades, as if neck wouldn’t support weight of head. [11]
• Jabbing pain in the back as if being kicked in the kidneys. [11]

Extremities
• Wandering joint/muscle pains [without swelling]; lasting only hours or days in a given location. [1]
• Pain in joints only on motion. [1]
• Joints sensitive to pressure. [1]
• Localised joint pains/swelling involving mostly the knee[s], and to a far lesser extent the ankles, shoulders, and elbows. [1]
• “I kept looking down at my upper arms to brush off the hair or cobwebs on them, and realised there was nothing there.” [11]
• Sensation as of a band pulled tightly around [right] lower arm halfway between wrist and elbow. [11]
• Tendon problems - hands/fingers temporarily lock into unusual positions. [5]
• Carpal tunnel syndrome; & numbness of fingers < during sleep or using hands. [1]
• Intention tremor hands. [1]
• Fingers on both hands fumble and cannot pick up small objects. [6]
• White spots on fingernails; ridges; brittle nails. [5]
• Deep, aching, burning pains in the hamstring muscles when sitting; sits on the very edge of a seat; cannot bear touch or slightest pressure on hamstrings. [6]
• Leg joints give out or wobbly, rubbery legs. Unable to walk. [5]
• Sensation of a tourniquet wrapped around right leg. [11]
• Restless legs at night in bed, resulting in sleeplessness. [6]
• Throbbing pain in ankles and in long bones in calves and shins; “not an ache, but a feeling that someone had scraped the skin away, thrown salt into the raw tissue, then set it on fire.” [11]
• Severe pain in balls of feet; painful to put any weight on feet. [11]

Skin
• Warm, wet or cold sensations on skin. [5]
• Regional or generalised hyperaesthesia of skin to touch or temperature. [1]
• Excessively itchy skin. Urticaria. [5]

* During Tumarkin’s episodes or Tumarkin’s otholothic crisis patients suddenly fall to the ground without prior warning and without losing consciousness. Thought to be caused by a sudden change of the otolithic organs, the condition is not uncommon in the later stages of Ménière’s disease.

Sources:
[1] Joanne Rubel, Lyme Disease, Symptoms & Characteristics; A compilation of peer-reviewed literature reports. Website Canlyme.com.
[2] B.A. Fallon et al., The Neuropsychiatric Manifeatations of Lyme Borreliosis. Website LymeNet.org.
[3] Jenifer A. Nields, The Clinical Experience of Lyme Disease: Patient Perspectives and the Psychiatrist’s Role. Website LymeNet.org.
[4] T.M. Grier, The Complexities of Lyme Disease. Website Canlyme.com.
[5] Lyme Disease Symptom List. Website Lymedisease.org.
[6] Virginia T. Sherr, The Physician as a Patient: Lyme Disease, Ehrlichiosis, and Babesiosis; A Recounting of a Personal Experience with Tick-Borne Diseases. Website Ilads.org.
[7] Audrey Stein Goldings, Controversies in Neuroborreliosis. Website Ilads.org.
[8] B.A. Fallon, Late-Stage Neuropsychiatric Lyme Borreliosis, Differential Diagnosis and Treatment. Website Wadhurst.demon.co.uk.
[9] R. Bransfield, The Neuropsychiatric Assessment of Lyme Disease. Website Mentalhealthandillness.com.
[10] Lyme Disease: A Diagnostic and Treatment Dilemma; Witness List, Oversight Hearing for the Senate Committee on Labor and Human Resources, August 5, 1993.
[11] Personal Stories. Lymealliance.org.
[12] Faces of Lyme Disease. Lyme Disease Foundation.
[13] Dorothy M. Pietrucha, Neurological Manifestations of Lyme Disease in Children. Lymeallaiance.org.
[14] Marian Rissenberg & Susan Chambers, Distinct pattern of cognitive impairment noted in study of Lyme patients. Lyme Times, Vol. 20, January-March 1998.
TREPONEMA PALLIDUM

Scientific name Treponema pallidum (Schaudinn & Hoffmann 1905) Schaudinn 1905
Synonym Treponema pallidum subspecies pallidum
Common name Syphilis spirochete
Family Spirochaetaceae
Homeopathy Syphilinum - Syph.
Luesinum
Lueticum

FEATURES

• Discovered in 1905 by the German zoologist Fritz Schaudinn, who gave it the name Spirochaeta pallida.
• The anaerobic genus Treponema contains one of the few spirochetes to be pathogenic to humans, T. pallidum which causes syphilis in humans. T. denticola, T. macrodentium and T. oralis all live in the human mouth where teeth and gums meet.
• Treponema, like Mycobacterium spp., have a very high lipid content, which is unusual for most bacteria.
• Gains access to the body by way of minute abrasions of the skin or mucous membranes.
• Readily destroyed by soap and water, drying, or temperatures greater than 42o C.
• Cannot be cultivated in vitro.
• Diagnosis of syphilis is obtained by serology, darkfield microscopy, immunofluorescent staining, and clinical assessment.
• False-positive [test] results can be found in persons with non-venereal treponemal infections, those who have received certain immunisations (eg, smallpox), pregnant women, and patients with malignancy, acute or chronic infections [eg, infectious mononucleosis, malaria], or certain chronic conditions [eg, ageing, intravenous drug usage, auto-immune disorders, malignancy].1
1.R.P. Knudsen, Neurosyphilis; www.emedicine.com/neuro/topic684.htm

THE GOOD …

The biblical Job might have been afflicted with a syphilitic condition. Deprived of both family and wealth, he was covered from head to toe in loathsome sores. The night racked his bones and the pain that gnawed him took no rest, it reads in the Book of Job. He is supposed to understand that suffering is a humbling and a purification of the mind rather than punishment, but, knowing himself blameless, he revolts against the injustice. Carl Gustav Jung called the malady “the poison of the darkness.” Yet, to some, darkness seems nurturing, as is suggested by Deborah Hayden in her book Pox: Genius, Madness, and the Mysteries of Syphilis. By what Hayden calls “creative euphoria” … “the syphilitic was often rewarded, in a kind of Faustian bargain* for enduring pain and despair, by episodes of creative euphoria, electrified, joyous energy when grandiosity led to new vision.” It was believed that syphilis, in rare instances, could produce genius: “The heightened perception, dazzling insights, and almost mystical knowledge experienced during this time were expressed while precision of form of expression was still possible.”
The French novelist Guy de Maupassant [1850-1893] was exalted at having acquired syphilis in 1877, exclaiming: “I’ve got the pox! At last! Not the contemptible clap … no - no - the great pox, the one Francis I died of. The majestic pox … and I’m proud of it, by thunder, and to hell with the bourgeoisie.” Hard as it is to draw the line between good and bad, a clear distinction between madness and genius is even more difficult to make. Hayden has it that “Maupassant’s literary leap from mediocrity in 1876 to the supreme mastery of the short story in 1880 might have been the result of a tremendous stimulation of the brain cells.”
Fyodor Dostojevski [1821-1881] suffered from epilepsy and syphilis. He wrote: “What do I care if it is a disease? What do I care whether it is normal or not normal, if in retrospect and in a healthy state, I still feel that moment as one of perfect harmony and beauty, and if it arouses in me hitherto unsuspected emotions, gives me feelings of magnificence, abundance and eternity, and reconciles me to everyone; if it is like a glorious, heavenly merging with the highest synthesis of life.”
In a general sense all art might be created to preserve the artist’s sanity, Lawrence Block claims in his novel Small Town [Orion, London, 2003].

Didn’t they all make art the way oysters made pearls? A grain of sand got into the oyster’s shell, which was to say under his skin, and it irritated him, it chafed him. So the oyster secreted something, squeezed out some essence of its own self, and coated the offending grain of sand with it, just to stop the pain. Layer after layer of this mystical substance the oyster brought forth, until the grain of sand and the pain it had occasioned were not even a memory. The by-product of the oyster’s relief was the shimmering beauty of the pearl. And every pearl, every single luminous gem, had at the core of its being a grain of irritation.

Hans Zinsser, in the 1930s, thought it conceivable that the interaction of spirochetes and humans has done much to shape our own species and that, if left undisturbed, “finally a stage may be reached in which mutual adjustment is so nearly perfect that the host may show no signs of injury whatever.”

If mankind could be kept as thoroughly syphilised in the future as it has been in the past, another thousand years might produce a condition not unlike the present spirochaetosis of mice, in which a peritoneal puncture of almost any bon vivant would reveal the presence of a treponema pallidum infection of which the host is all but unconscious.

To his apparent regret the treatment of syphilis with arsenicals “probably ruined the prospect” of the syphilization of mankind.

This might be a loss to civilisation: it has often been claimed that since so many brilliant men have had syphilis, much of the world’s greatest achievement was evidently formulated in brains stimulated by the cerebral irritation of an early general paresis. [Zinsser 1960]

* Featuring in Goethe’s Faust and Thomas Mann’s Doctor Faustus, Faust exemplifies the readiness to make a bargain with the devil to gain creativity and limitless knowledge in exchange for one’s soul.

… AND THE BAD Neurosyphilis was first clearly described in the early 19th century by physicians working in the mental hospitals of Paris. Soon after the Napoleonic wars ‘madness’ was on the rise. It became known as the “disease of the century.” Where syphilis by the avant garde was held to provide drive and restless energy, thus fostering genius, for the great majority of syphilitics the disease was something to conceal. It turned sex into shame, pleasure into guilt, painful life into an often early death. Consistent with the belief that syphilis resulted from sin and depravity, physicians saw their neurosyphilitic patients as hopeless, immoral, and stupid paretics.
Concealment lies in the nature of syphilis. After the initial sores have disappeared, the disease goes into hiding throughout the body to reveal itself again after decades of latency or to remain dormant for its host’s lifetime. In its appearance, or rather disappearance, as a disease it probably behaves in a similar fashion. Medical historians accept that syphilis originated in the army of Charles VIII of France during his invasion of Italy in 1494-95. Among the mercenaries in this army were Spanish soldiers who had accompanied Columbus on his journey to the New World and had brought syphilis back to Europe. Speaking of the “surprising evolution of syphilis,” Jared Diamond writes:

Today, our two immediate associations to syphilis are genital sores and a very slowly developing disease, leading to the death of many untreated victims only after many years. However, when syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall off people’s faces, and led to death within a few months. By 1546, syphilis had evolved into the disease with the symptoms so well known to us today. Apparently, just as with myxomatosis, those syphilis spirochetes that evolved so as to keep their victims alive for longer were thereby able to transmit their spirochete offspring into more victims. [Diamond 1998]

It remains unsettled whether syphilis has newly arrived on the human stage or whether it has been around since ancient times. Ancient texts seem to testify to the latter, as do discoveries in Africa of skeletal remains dating back some 1.5 million years with deposits of new bone on arm and leg bones. The location and the amount of deposits are held to be indicative of yaws. Similar bone deposits were found in southern Italy on a Homo erectus femur dated ca. half a million years ago, suggesting that when early humans spread out from Africa they took the non-venereal syphilitic disease yaws with them. Can it be so that syphilis only since relatively recent times has evolved into a venereal form? “We must begin,” says biologist Christopher Wills, “by realising that syphilis is one extreme of a continuum of diseases, most of them surprisingly little understood, which have afflicted humans and their relatives for a very long time. Syphilis is simply the most extreme manifestation of the attempts of a parasite to spread from host to host.”

Instead of regarding yaws, pinta, and bejel as mere varieties of treponema diseases, Arno Karlen puts them in a broad and evolutionary perspective, reflecting Treponema’s response to changing human culture. The quartet might be actually one disease, which takes different forms with changes in transmission and human lifestyle.

The treponeme’s common ancestor first probably lived on decaying matter and then became a non-venereal parasite of African primates. About 20,000 years ago, it created a zoonosis in humans. This was pinta … transmitted [in tropical climates] by children’s bare, perspiring skin … through casual body contact. Some 10,000 years ago, a mutation of the germ gave rise to yaws, probably in Africa. Like pinta, yaws usually affects the skin of the young; however, it is more severe and can erode the bones. It persists today in the rural tropics of Africa and Latin America. A few thousand years later, the germ spread to Neolithic villages in dry, cool environments, where people were fully clothed.
Because clothes interfered with the germ’s passage to new hosts, it retreated to the warm, moist refuges of the mouth and, secondarily, to the genitals. Transmitted chiefly by common eating utensils and sometimes by kissing, it led to a new disease variously called bejel, endemic syphilis, or non-venereal syphilis. More severe than pinta and yaws, bejel can damage the bones and the heart. It once flourished in European slums from Russia to Scotland [where it was known as sibbens], but if faded as hygiene improved. It is still common in villages in arid and semi-arid parts of Africa and Asia.
Venereal syphilis emerged some 6,000 years ago, in the Middle East, once the bejel germ had adapted to urban life there. More sexual partners were available to everyone, and coitus became the usual means of transmission. Venereal syphilis was not limited by climatic conditions, and eventually it spread worldwide. Opportunities for transmission were less frequent than for pinta, yaws, or even bejel; the germ survived by lingering in the body for long periods, wreaking slow havoc on the heart, nervous system, and other organs. Thus treponemal sickness was transformed from a mild disease of village children to a serious one of urban adults. … Only a single kind of treponeme infection is common in any region; each gives immunity to the others. This confirms that the germs are, if not identical, very closely related. Furthermore, one treponemal disease can replace another as conditions change. Syphilis has ousted yaws in Venezuela, New Guinea, and parts of Africa as people moved from villages to cities. And when people with yaws move from tropical lowlands to cool mountain areas, they lose the sores of yaws and develop bejel. Bejel and venereal syphilis have each been reported to change into the other.
The germ’s tendency to change in transmission, symptoms, and virulence makes the complexity of its disease manifestations less puzzling. … When syphilis first struck during the 1495 outbreak in Europe, its florid symptoms resembled acute yaws almost as much as syphilis. … Syphilis and typhus were typical new plagues of the first age of global exploration and conquest. They came from the new machinery and tactics of war; the hunger and dirt of bigger, denser populations; altered clothing and sex behaviour; changing agriculture; the movements of soldiers, traders, and uprooted peasants. [Karlen 1995]

PSORA … OR SYPHILIS?

Considering the multitude of syphilitic manifestations mimicking other diseases, I cannot help but wonder if syphilis, in terms of symptomatology, would not be a more likely candidate for psora than “the Itch disease” [generally held to have been scabies]. Hahnemann sees psora as the “most ancient, most universal, most destructive, and yet most misapprehended chronic miasmatic disease which for many thousands of years has disfigured and tortured mankind, and which during the last centuries has become the mother of all the thousands of incredibly various [acute and] chronic [non-venereal] diseases, by which the whole civilised human race on the inhabited globe is being more and more afflicted.” Such a definition seems to rule out syphilis, unless we regard syphilis as “one extreme of a continuum of diseases,” syphilis-like in nature.
Due to its recent appearance as a venereal disease, syphilis obviously didn’t qualify as the most ancient miasmatic disease. However, the syphilitic miasm should not be equated with syphilis, although the latter mirrors the former. The syphilitic miasm is a basic constitutional tendency, syphilis one of its manifestations, as are a host of other potentially malignant afflictions.
The British surgeon and pathologist Sir Jonathan Hutchinson [1828-1913], who coined the term “Great Imitator” to describe the puzzling multiformity of syphilis, spent most of his professional life gathering clues and indications to identify the disease, which he published in Syphilis in 1887. The American physician John Stokes followed his example and produced in 1926 his exhaustive Modern Clinical Syphilology [revised editions appearing 1934 and 1944]. Comparing these two symptom collections with Hahnemann’s enumeration of psora symptoms [Chronic Diseases, pp. 52-79] will demonstrate a pronounced resemblance. Detailing the similarities will go beyond the scope of Spectrum, but a few examples, taken from Hayden’s book Pox, might arouse the interest to undertake such a comparison.

• Hahnemann mentions for psora: “Quick change of moods; often very merry and exuberantly so, often again and, indeed, very suddenly, dejection. Sudden transition from cheerfulness to sadness.” And: “Mania of self-destruction. … They are impelled, urged, yea, compelled by a certain feeling of necessity, to self-destruction.”
Hayden: “In the final period … mood shifts become more extreme as euphoria, electric excitement, bursts of creative energy … alternate with severe, often suicidal depression.”
• Hahnemann: “Attacks of passion, resembling frenzy.” “Melancholy by itself, or with insanity, also at times alternating with frenzy and hours of rationality.” Hayden: “… periods of extreme clarity … alternating with episodes of bizarre, uninhibited acts …” “Delusions of grandeur, paranoia, exaltation, irritability, rages, and irrational, antisocial behaviour …”
• Hahnemann: “Disinclination to work, in persons who else are most industrious; no impulse to occupy himself, but rather the most decided repugnance thereto.” “She became suddenly so weary, she had to lie down.” “They often weep for hours without knowing a cause for it.” Hayden: “A calm person becomes emotional, a neat person sloppy, a timid one aggressive.” “Exercise at this time causes exhaustion and the patient becomes inactive, often declining to walk even a short distance.”
• Hahnemann exemplifies the nature of psora as “a thousand-headed monster, pregnant with disease,” by recounting more than 100 disorders “erroneously designated [by the old school] as well-defined, constant and peculiar diseases.” Stokes asserts that syphilis “apes every disease in any field of medicine” and will never yield to one diagnostic key.

It should be noted that Hahnemann believed that “the internal augmentation of the venereal disorder” only takes place when the primary local manifestation, the chancre, is destroyed. He was clearly mistaken in stating that the chancre “never passes away of itself,” with it paving the way for his conception that the secondary stage, following weeks to months after disappearance of the chancre, results from suppression instead of being the natural course of the disease. The latter reflects the failure of the organism to prevent dissemination, which in Hahnemann’s view depends on “complication of syphilis with developed psora.” Psora, then, appears to stand more for the fundamental challenge to assimilate, a basic pattern underlying all development, than to arise solely from suppressed “Itch.” The challenge prompts reaction, which entails balance [health], overcompensation [sycotic], or destruction [syphilitic]. The latter may be absolute or part of an evolution towards construction.
Finally, although Hahnemann proclaims that “the general venereal disease dwells in the body from the first moment of infection,” i.e. is a constitutional affliction, his proposed treatment of its first stage with “one little internal dose of the best mercurial remedy,” conflicts, to my idea, with the golden rule of individualisation. It gives the impression that he underestimated the extent of the syphilitic miasm, limiting it too much to syphilis as a disease. While syphilis may be almost prototypical for the miasm, it is not its only manifestation. The miasm precedes the disease rather than being caused by it, which is in accordance with the law of similars.

TRACING THE SYPHILITIC MIASM

Recognising the syphilitic miasm is not easy. In comparison to other major miasms - psora, sycosis, tuberculinic - it is more difficult to trace due to the element of concealment inherent to it. It can be safely assumed that the extent of the syphilitic miasm, following Hahnemann, is underestimated. Having been “a diligent observer during a long series of years of all that concerns syphilis in the living subject,” it will be to our advantage to take to heart what Hutchinson had to say about its detection. It shows that while a clear aetiology often cannot be ensured, the signs and symptoms will be a sure guide.

Prior to the observations as to the value of the teeth and physiognomy as enabling us to recognise the subjects of inherited taint in adult life, it was not possible to maintain respecting any syphilitic infant that one or other of its parents had incurred a like inheritance. … Without being discourteous to the statements published by others, I may perhaps be allowed to hint that, in all, much of what I would call good-hearted credulity in the reception of evidence is displayed. When a surgeon undertakes to guarantee for his patient that no exposure to the risk of contracting syphilis has ever occurred, I can but suspect that his experience of life has been but small, or that he is habitually not prone to attempt to look below the surface. If it is attempted to strengthen the guarantee by saying that the parties have been well known to him, my suspicions are strengthened, for it is precisely under such circumstances that sexual follies would be concealed. I have no reason to think that my own experience has been worse than the average, but I have known enough of what is possible in reference to the acquisition of syphilis, in all ranks of life and under apparently the most unlikely circumstances, to induce me to disregard almost absolutely the denials of patients and to allow my opinions to rest not upon what I am told, but upon what seems probably true. [Hutchinson 1913]

A well-known characteristic of [hereditary] syphilis is that it leaves behind a physical signature in physiognomy, bones, and skin. The inherited venereal taint can be recognised thus:

Skull presents a somewhat square appearance and is somewhat larger than normal.
Hair dry and thin.
Forehead large and protuberant in regions of frontal eminences.
Often well-marked transverse depressions a little above the eyebrows.
Tendency to frowning, consequent on prolonged intolerance of light [due to keratitis].
Cornea hazy; peculiar, leaden [steel-grey], lustreless appearance of the irises.
Facial skin often thick, pasty, and opaque, although not infrequently remarkably soft and silky. [Soft, pale, earthy-tinted in adults.]
Facial skin often shows pits and scars, the relics of a former eruption.
Bridge of nose usually broad and low, often remarkably sunken and expanded.
Radiating linear scars at the corners of the mouth, running out into the cheeks.
Central upper incisors [permanent teeth] short and narrow, with a broad vertical notch in their edges, and their corners rounded off. “If the upper central incisors are dwarfed, too short, and too narrow, and if they display a single central cleft in their free edge, then the diagnosis of syphilis is almost certain. … In most cases the conditions are symmetrical, but now and then they are notably one-sided.”
[Hutchinson 1913]

Several of Hutchinson’s observations on syphilitic patients are incorporated in medical terminology.

Hutchinson’s facies: Facial expression produced by the combination of drooping eyelids and motionless eyes [in syphilitic paralysis of ocular muscles].
Hutchinson’s mask: Sensation as if the face were covered with a mask or with cobwebs [in tabes dorsalis]. [The mask-like sensation is comparable with the repertory rubric Face, Tension, as if egg white were dried on the face.]
Hutchinson’s crescentic notch: Semilunar notch on the incisal edge of Hutchinson’s teeth.
Hutchinson’s pupil: Dilation of one pupil [on side of meningeal heamorrhage], contraction of the other.
Hutchinson’s triad: Combination of parenchymatous keratitis, labyrinthine disease, and Hutchinson’s teeth [in congenital syphilis].

A method to utilise physiognomy in homeopathy has recently been developed by Australian homeopath Grant Bentley. Understanding that every individual is dominated by one of the miasms, he has identified facial features and matched them to each group, so that the dominant miasm of the patient can be determined on the combination of themes and facial features. [See Case 4 below].

LOCOMOTION

Spirochetes have made a major contribution to the evolution of species, according to Margulis and Sagan, by introducing the element of locomotion. Sperm tails of men, propelling sperm to the eggs of women, as well as oviduct undulipodia [flexible whip-like intracellular extension of cells] derived from spirochete bacteria that became ancestral cell “whips.”

The origin of rapid motion in bacteria seems to be connected to a rotary device that is unknown in cells with nuclei. A flagellum, or whip-like strand, is attached to the disk-shaped base of the bacterium. … In some bacteria, such as the spirochetes, the flagellum is internalised. … The first spirochetes were a form of fermenting bacteria and probably evolved very early in the history of life. … Bacterial mergers … seem to have conferred on life the capacity of motility. By joining the big, new cells, rapidly moving bacteria gave them the basic advantages of locomotion - avoiding danger and seeking food and shelter. Other benefits of travel - a greater selection of habitats, more opportunities for genetic exchange - came within reach. Mobility, however, was only the most obvious benefit of these partnerships. … In sharp contrast to a bacterial cell whose contents are motionless or drift passively about, the interior of eukaryotic cells is swarming like a city. … We believe that the nucleated cell’s ability to move both without and within is the contribution of another symbiotic merger with bacteria, this time with rapid, whiplashing spirochetes. … Our candidate for this common ancestor [of undulipodia] is the spiralling, motile, hairlike spirochete, the fastest bacterium in the microcosm. In the sticky regions of their microworld of gelatinous muds and viscous fluids, spirochetes are often the only bacteria capable of passing through a certain region. The spirochete’s métier is motion. … To us the evidence strongly suggests that ancient pacts were made between the early bacterial confederacies that became cells with nuclei and spirochetes or spirochete-like bacteria. Spirochetes hovered both inside and outside their non-spirochete neighbours, and in the end they provided efficient movement for those who had never even requested it. … Free-living, scavenging spirochetes are still well known today, as are many varieties engaged in symbiotic or parasitic lifestyles with other organisms, such as insects, molluscs, and mammals, humans included. … Spirochetes tend to attach to things, living or not.
When they swim next to each other, they also tend to undulate in unison simply due to their proximity in a liquid medium. As scavenger spirochetes feed on the surface of their host, particularly if they are amassed together on one side, they can propel it through its medium with their coordinated undulations. Those spirochetes and protists that co-evolved elegant attachments swam well. Consequently they found more food and reproduced more often - a clear advantage. Natural selection would undoubtedly have favoured these alliances until the two partners gradually became one. … The advance of spirochete alliances 2,000 million years ago must have altered the microcosm. The new motile eukaryotes must have revolutionised the bacterial world by their sudden boost to microbial transportation and communication. … Modern-day spirochetes still readily enter symbioses for the purpose of mobility.
[Margulis & Sagan 1997]

Elaborating on the symbiotic origins of locomotion, Margulis and Sagan come up with another intriguing thought: “Did the spirochete motility system of the microcosm evolve within the ordered environment of larger organisms to become the basis of their nervous systems?”

Proof of spirochete identity in the cells of the brain, beyond the rich presence in them of microtubules [neurotubules], is slowly accruing. … After maturity, brain cells never divide, nor do they move about. Yet we know mammal brain cells - the richest source of tubulin protein anywhere - do not waste their rich microtubular heritage. Rather, the sole function of mature brain cells, once reproduced or deployed, is to send signals and receive them, as if the microtubules once used for cell-whip and chromosomal movement had been usurped for the function of thought. … If spirochetes are truly ancestral to brain cells or neurons, then the concepts and signals of thought are based on chemical and physical abilities already latent in bacteria. … Could the true language of the nervous system then be spirochetal remnants, a combination of autocatalysing RNA and tubulin proteins symbiotically integrated in the network of hormones, neurohormones, cells, and their wastes we call the human body? Is individual thought itself superorganismic, a collective phenomenon? … All our favourite inventions were anticipated by our planetmates; why not thought? … In a sense we are “above” bacteria, because, though composed of them, our power of thought seems to represent more than the sum of its microbial parts. Yet in a sense we are also “below” them. As tiny parts of a huge biosphere whose essence is basically bacterial, we - with other life forms - must add up to a sort of symbiotic brain which is beyound our capacity to comprehend or truly represent.
[Margulis & Sagan 1997]

With spirochetes seeking out sex cells and brain cells history seems to repeat itself. “Out of all the species,” says Fracastoro, syphilis infects “the one that is great through its mind, the human race.”

THE FINE LINE BETWEEN SURVIVAL AND DESTRUCTION

Treponema pallidum, whose name means “pale twisted thread,” weaves a fragile thread between survival and destruction. Some of its many free-living spirochetal relatives inhabit various places in the human body - skin, mucosa, intestines, and the gum-line around the teeth - and can be grown outside of the human body in artificial media. T. pallidum refuses to do so and if it can be brought to begin multiplying in carefully selected media, it invariably dies or stops growing after only a few divisions. It appears to require human beings as its exclusive hosts.

T. pallidum seems only able to survive under the narrow and highly specific set of conditions found in the human body. A small rise in temperature will kill it, as [Austrian psychiatrist] Julius Wagner von Juaregg found when he introduced the successful malaria therapy for syphilis in the 1920s. [Fascinatingly, the fact that sufferers from high fever could be cured of syphilis had been noted by Ruy Diaz de Isla in 1539, which shows what remarkably keen observers the great doctors of the past could be.] And cold is fatal to it as well - when blood contaminated with Treponema is placed in the refrigerator, the bacteria die off so completely that after two or three days the blood is actually safe to use for transfusions. A bit of soap will kill it, too.
One might think that there is nothing to fear from such a nebbish of a parasite. Paradoxially, its very feebleness seems to enable it to survive in the hostile environment of its host. It is skilled at making do with very little, and its sheer doggedness makes it one of the most infectious organisms known.
Some of this feebleness can be traced to the fact that T. pallidum has very few genes. …The paucity of genes in its genome may help to explain two odd facts about it, one that contributes to its destruction and the other to its survival. First, and most unusually, mutant strains of T. pallidum that are resistant to penicillin have never arisen. Because it is unable to exchange genetic information with other bacteria, it cannot acquire genes from them that would enable it to destroy penicillin, and it does not seem to have the genetic resources to make an enzyme on its own that can break down the antibiotic.
Second, because T. pallidum has so few genes, it manufactures only the merest excuse for an outer cell membrane. This threadbare coat is easily breached by even small changes in the bacterium’s environment, which is an obvious disadvantage. But at the same time it contains few proteins that can alert the host’s immune system. Flimsy though it is, its membrane none the less has the capacity to attract and bind proteins found in the host’s blood. These proteins form an additional protective layer, and because they are invisible to the host’s immune system they also help to conceal the bacterium from host antibodies and patrolling white cells. Such relative invisibility undoubtedly helps to explain why the bacterium can survive its host’s body for years.
The bacterium seems to be adapted to life in humans, and only in humans - most other animals may break out with early lesions when deliberately infected, but the disease progresses no further. Surely then, this fragile web of adaptations implies that Treponema has had a long history of association with humans. Indeed, this association appears to be real - but not, it appears, as the agent of syphilis.
[Wills 1996]

As “team players” bacteria readily exchange genetic information among each other, which will contribute to the virulence of some species and their acquired resistance to antibiotics. Since T. pallidum cannot borrow genetic information from other bacteria for its survival it appears likely that it can neither do so for its virulence. Yaws, bejel, pinta, and syphilis are caused by spirochetes that because of their similarity are all designated Treponema pallidum or have been demoted to subspecies of T. pallidum, although they cannot be distinguished by immunological tests. If there is no difference in the “causative agents,” the differences in the symptomatology can only be produced by the interplay between spirochete and host.
Emerging during the Age of Exploration, more specifically after the ruthless invasion of the New World, resulting in dreadful traffic in human cargo, venereal syphilis and neurosyphilis can just as well be regarded manifestations of the syphilitic miasm instead of as its cause. Adapted to life in humans, and having contributed to it symbiotically, spirochetel development probably runs parallel with human evolution, with its fine line between survival and destruction.

STAGES OF SYPHILIS

Spirochetal diseases typically progress in stages. Syphilis has four stages, which may overlap one another and also do not always follow in the same sequence.

Primary syphilis • Appearance of one or more indurated, round, small, and painless sores or ulcers [chancres] at the site of inoculation. The chancre secretes clear, serous fluid and disappears by itself in one to five weeks. [Highly infectious.]
• Regional adenopathy.
Secondary syphilis • Dissemination of the bacteria through the blood.
• Skin rashes, often generalised and bilateral, consisting of crops of macular, papular, follicular, papulosquamous or pustular lesions. Often involvement of the palms and soles. Copper-coloured spots the size of a penny are typical. All of the skin lesions are highly infectious.
• Condylomata lata [syphilis warts] in the genital tract.
• Circular mucous patches of mouth, pharynx, genitals, anus. Patches often greyish white with a red areola.
• Generalised lymphadenopathy [painless].
• Enlargement of spleen.
• Alopecia areata [syphilitica] [typical “moth-eaten spotty baldness].
• Iritis.
• Periostitis; aching pains in bones.
• Systemic symptoms: fever; malaise; weight loss; tiredness; anorexia.
• Symptoms remit spontaneously after two to six weeks, although they may recur later.

Tertiary syphilis
• After a latency period of indefinite duration, in up to 30% of cases tertiary syphilis develops with a broad range of characteristic signs and symptoms involving the cardiovascular system, bone, skin, eyes, and/or brain and nervous system.
• Tertiary stage symptoms include:
• Muscular incoordination.
• Paralysis.
• Anaesthesia.
• Blindness.
• Glossitis.
• Impotency.
• Shooting pains.
• Aneurysm.
• Tumours or gummas.
• Severe abdominal pain.
• Repeated vomiting.
• Damage to knee joints.
• Bone changes.
• Deep sores on the soles of feet or toes.
• Condylomata all over genitals and rectum.

Tremor is one of the commonest early signs, occurring in about two-thirds of patients. It is typically coarse and irregular, involving the face and hands particularly. Close attention may be required to detect it in the lips and the facial musculature around the mouth, often increased when the patient is given difficult tasks of verbal articulation. The facies may be characteristic when the typical tremor is associated with a dull and mask-like expression. Tremor of the hands and fingers contributes to the clumsiness which is seen on manual tasks. The tongue may be involved and show characteristic back and forth jerking movements when protruded.
Dysarthria, partly due to the tremor of lips and tongue, occurs in 80% of patients. Speech becomes slurred, hesitant, jerky, irregular, and ultimately incoherent. Tremor may appear in the voice, which is also feeble and lacking in intonation.
Reflex abnormalities are seen in approximately 50% of cases. The knee jerks and ankle jerks are usually exaggerated, with clonus and spasticity in the lower limbs. With progression of the disease the plantar responses become extensor, and there is increasing weakness of the limbs leading eventually to severe spastic paralysis. By contrast tendon reflexes may be absent when tabes dorsalis is combined with general paresis.
Ataxia is seen in the clumsy incoordinated movements of the hands, and in the characteristic slouching, unsteady gait.
[Lishman]

Neurosyphilis
• A minority of tertiary stage patients develops neurosyphilis, up to 30 years after initial infection.
Three types of tertiary neurosyphilis are distinguished; these types may occur alone or in combination.

[1] Meningovascular neurosyphilis.

• Low grade meningitis and/or stroke-like symptoms.
• Poor concentration.
• Mental confusion.
• Lassitude.
• Insomnia.
• Dizziness.
• Headache [often sharply localised and accompanied by tenderness of overlying skull].
• Hearing loss.
• Blurred vision.
• Paresis of external ocular movements.
• Papilloedema.
• Optic atrophy.
• Hemianopia.
• Photophobia.
• Reduced colour perception.
• Aphasia.
• Weakness and atrophy of shoulder and arm muscles.
• Neck stiffness.
• Hemiplegia.
• Polyuria, obesity and somnolence [due to hypothalamic involvement].
• Pseudobulbar palsy [speech and swallowing difficulties due to paralysis of lips and tongue, accompanied by emotional instability and spasmodic, mirthless laughter; sometimes called laughing sickness].

[2] Parenchymatous neurosyphilis [general paresis or dementia paralytica].

• Insidious onset.
• Headache.
• Lethargy.
• Tremor, convulsions.
• Aphasia.
• Disorientation.
• Loss of concentration.
• Loss of memory.
• Slow process of losing ones personality. [see Personality changes.]
• Male to female ratio: 3 to 1; peak age of onset between 30 and 50.
• Congenital general paresis may declare itself in early childhood. It presents as backwardness at school, symptoms of mental deficiency, and epileptic fits.

[3] Tabes dorsalis [locomotor ataxia].

• Sensory deficits including loss of pain sensation, loss of position sense, loss of vibration sense, and loss of temperature sensations.
• Characteristic sites of sensory loss, involving both touch and pain, are the side of the nose, the ulnar aspect of the arms, patchy loss over the trunk and the dorsum of the feet.
• Pupils react to accommodation but not to light.
• Pupils contracted and irregular, or one may be contracted while the other is dilated.
• Episodic pain in viscera, commonly attacks of epigastric pain and vomiting lasting for hours or days.
• Rectal crises consisting of tenesmus.
• Urinary symptoms: incontinence; retention; infections.
• Impotence.
• Laryngeal crises consisting of dyspnoea, cough, and stridor.
• Lightning-like [stabbing] pains in legs [degeneration of spinal nerve roots].
• Burning and tearing pains in legs.
• Lancinating pain extending to chest and abdomen.
• These pains appear suddenly, spread rapidly, and disappear.
• Girdle pains of neuritic distribution around the trunk.
• Paraesthesias in legs and feet; skin may be hyperaesthetic to touch or patient may have a feeling of walking on cotton wool.
• Ataxia < dark.
• Walks with feet wide apart or with a typical ‘high stepping gait’.
• Painless disorganisation of joints may result in gross deformity, most frequently at the knee or the hip.
• Perforating ulcers and other trophic skin changes.
• Males are affected much more frequently than females with a peak age of onset in the fifth decade.

GENERAL PARESIS General paresis, also known as ‘dementia paralytica’ and ‘general paralysis of the insane’, refers to neurosyphilis combined with personality changes which can be divided into three major forms: [1] grandiose or expansive form; [2] dementing form; [3] depressive form.
The latter two forms can be clearly distinguished in the symptom picture of Syphilinum [and other syphilitic remedies], whilst the expansive form occupies a minor place, in spite of it formerly being the most common manifestation of general paresis, in particular in patients from the higher social groups. Over time this form has been gradually replaced by the dementing and depressive forms, both of which are now a great deal more common. The manic form nevertheless has tended to remain the prototype of the disorder in medical teaching,
The dementing and depressive forms have overlapping features.

[Symptoms below extracted from Hutchinson, 1913; Stokes, 1944; Coleman, 1980; Lishman, 1987; Merck Manual, 1992; Hayden, 2003]

Dementing Form and Depressive Form • Onset: insidious change of temperament - moodiness, apathy, outbursts of temper, lessened emotional control with ready tears or laughter, or loss of ambition at work.
• Egocentricity and general loss of refinement.
• Behaviour unmannerly, tactless, unethical.
• Unconcerned with appearance.
• Evading people or important problems or reacting with smug indifference.
• Blunting of affect: ceases to share in the joys, sorrows, or anxieties of loved ones.
• Careless, inattentive, making mistakes at work.
• Deterioration of personal habits, such as hygiene.
• Sentimentality.
• Promiscuity.
• Fleeting delusions, mostly of a persecutory nature.
• Slow, silent, suicidally inclined, delusions melancholic, nihilistic or hypochondriacal [depressive form of general paresis].
• Difficulty with calculation [stressed as an early feature].
• Disturbance of writing, with tremulous lines and omission or transposition of syllables.
• Vacant, dissipated expression with a silly grin.
• Memory deficits, esp. short-term memory impairment.
• Compensatory compulsions or fabrications in an effort to compensate for the memory deficits.
• Intellectual deterioration, inability to comprehend the simplest problems.
• Mental deterioration alternates with episodes of excited overactivity.
• Periods of clouding of consciousness alternate with periods of relative normality.
• Paranoid delusions, ideas of influence, passivity phenomena, and auditory hallucinations of an abusing or threatening nature [paranoid form of general paresis].
• Hand-writing shows tremor quite early, as well as characteristic changes: erasures, writing over, leaving out words and letters, piling up words at the end of a line, and change in the size of letters.

Their demeanour and movements are either altogether inexpressive, or are expressive only of very weak emotions; and here also are presented many childish and capricious habits, such as collecting rubbish, remaining always in bed, pleasure in toys, and dressing fantastically. Sometimes they manifest a wayward refusal of food, and other symptoms of childish obstinacy; more frequently we observe the love of eating - they frequently swallow the most loathsome things.
Very many of these patients who have been long confined in the asylum are addicted to onanism, and we may frequently gather from their conversation indications of considerable disorder of the sexual functions. The physiognomy is generally old and stupid, the expression vacant, and the countenance obscured by neglect and dirt. Not infrequently there is a great tendency to become corpulent.

• An accurate description of the dementing form is given by Griesinger, who calls the condition ‘apathetic dementia’.

The inability to comprehend several ideas and to compare them always increases, and instead of the numerous abrupt disconnected ideas seen in other forms, there gradually ensues almost a total absence of images and thoughts. The sensorial impressions are no longer elaborated, nothing comes out of them; memory is so completely effaced, that not merely what happens in one moment is forgotten in the next, but all reminiscences of bygone times are almost entirely lost.
Language even is to a great extent forgotten, so that patients even in the most favourable cases can employ only a few current, very limited, and little applicable expressions; more frequently the few words themselves are not entire, but are merely ejaculations of accustomed sounds. This very high degree of dulness of the imagination and loss of the intelligence is accompanied by extreme weakness of the will. The patient can no longer actuate himself to do anything, even by the force of former habits; he must rather passively submit to be directed by some extraneous impulse. He is frequently unable to supply his simplest wants, and requires to be fed; he loses himself every moment in his own room, and his ignorance of danger renders it necessary that others should protect him against accidents.
His conduct is uniform, and always the same; sometimes apparently concentrated in self - shy, dull, silent, and inert; sometimes automatic movements are gone through - swaying to and fro of the body, rubbing the hands, murmuring, making unmeaning noises, etc. The gestures are lifeless - the countenance is relaxed or amazed, or apparently attentive without motive, and the vacant look and bursts of laughter show that there exist no ideas which the patient can express.
[Wilhelm Griesinger, Mental Pathology and Therapeutics, 1869]

Grandiose or expansive form • Lapses of social conduct: squandering money; involvement in antisocial acts; law-breaking; outbursts of violence; indecent exposure.
• Euphoria, electric excitement, bursts of creative energy and grandiose self-reflections alternate with severe, often suicidal depression.
• The patient may suddenly begin to gamble, go on absurd spending sprees, or imagines owning vast riches.

The hallmark is the patient’s bombastic and expansive demeanour, with delusions of power, wealth or social position. The patient boasts of fantastic riches, exploits in battle, or tells of his athletic and sexual prowess. He may believe he is some eminent person from the past or present, yet at the same time accepts his stay in hospital without complaint.
The mood is euphoric, good humoured and frequently condescending. Typically the patient enjoys an audience for his display. His recital may be amusing but his jocularity is rarely infectious. Usually the underlying dementia imparts a shallowness and a naïve quality to the prevailing affect. If his beliefs are questioned or his wishes thwarted, the mood may readily turn to petulance or anger. In some cases there may be extreme irritability with outbursts of violent behaviour, but this is rare.
[Lishman]

• Foolish, eccentric or reckless behaviour.

In one case the first whim was the purchase of a quantity of old silver for which payment could not be made; another patient rose in his stall at the theatre and threw sovereigns at a comedienne on the stage; a third ordered 700 hymn books for a hospital ward of 16 beds, and a ton of guano for the ward plants. Another wrote to the War Office demanding three Victoria crosses which he considered he had won in fighting some 10 years before. At the outbreak of hostilities in August 1914, an incipient paralytic sent telegrams to all the crowned heads and rulers, proffering his services as peacemaker.
[Wilson, 1940, cited in Lishman]

• Delusions of grandeur [termed monomanie des grandeurs by 19th century French psychiatrists].

These patients are active, busy, speak a great deal, are constantly in movement, buy and sell, plan great schemes; their manner is, indeed, odd, peculiar, and extravagant, but they are only recognised as mentally diseased by the initiated. Soon they allow themselves greater freedom, become more and more restless; manifest in everything their satisfied, exalted frame of mind; spend lavishly and make magnificent presents; recount imaginary histories, in which they frequently contradict themselves; now and then they give offence by their habits of drunkenness and gross indecencies; in short, they make themselves unbearable. …
In the great majority of cases there are developed the specially characteristic ideas of greatness, in which all what relates to the person of the patient assumes in his eyes colossal dimensions, and is expressed by him in the most superlative language and highest numbers. At the same time, however, the intellect, character, and emotions, all assume the character of weakness.
In their delirious ideas they often contradict themselves; they do not persist in them, but soon forget and pass on to others; the circle of the ideas is, in spite of their apparently active production, very limited; incoherence soon becomes [particularly in writing] marked; and it is in the highest degree remarkable how all things, even the most absurd, are at once accepted as realities without the least internal opposition; the ego becomes quite incapable of resistance, and is entirely taken possession of and subdued by them. Their will is weak; they appear violent, but are pliable as children, easily subdued, and they are also somewhat mobile and lachrymose in their nature.
The weakness of the mental faculties becomes more and more pronounced in proportion as the paralytic appearances becomes more marked; the patient loses his memory, the capability of mental association, all sense of duty; he becomes completely indifferent, dirty in his habits, etc. From this time the dementia progresses step by step with the paralysis: still, in certain patients the course of the disease is varied, sometimes by increased restlessness - sometimes even by attacks of mania, vociferation, and desire to destroy.
Certain patients continue for a long time to manifest, but without any actual sense of what they say, those extravagant ideas of possession of provinces, riches, worlds, millions, etc., variously modified according to the degree of education. The one possesses millions of billions - all the world belongs to him, all things were made by him, etc.
Another has built the most splendid castle, bought all Italy, plundered Asia, destroyed the bridge from the earth to the moon, transferred the Chinese to Paris, is himself 800 feet high, etc. Others walk 100 leagues in a day, write 100 tragedies and 1000 poems in the same space of time - have heads made of diamonds set in gold, horses and palaces made of gold, etc.
In the latter periods of this affliction these ideas completely disappear: the patient is in the extreme stage of mental decay; he is as little capable of having a complete idea as he is of pronouncing a proper word; he is void of any conception of his whereabouts. … It is not generally until the advanced period that the patients become emaciated; gangrenous spots appear in various parts of the skin, especially of the back; large abscesses form; extensive suppurations and infiltrations of the extremities occur, and the patients sink under hectic fever, which in many cases is connected with pyaemia - in others with acute or chronic intestinal catarrh, accompanied by profuse diarrhoea and ulceration of the intestines; at other times it is connected with general tuberculosis.
[Wilhelm Griesinger, Mental Pathology and Therapeutics, 1869]

MATERIA MEDICA SYPHILINUM Syph.

Sources [1] Proving by Swan with 12 provers, 1890; higher potencies; method unknown.
[2] Proving by Carr with 3 provers [2 females, 1 male]; method unknown.

The quality of these provings is dubious, in my opinion. H.C. Allen’s presentation of the symptomatology comes across as somewhat deceptive in giving the impression that the recorded symptoms were the result of provings. Yet, study of Syphilinum in Hering’s Guiding Symptoms, reveals that the majority of the symptoms come from clinical cases of patients suffering from secondary or, mostly, tertiary syphilis. If such data can be accepted as the foundation of the homeopathic Syphilinum picture, it seems obvious, at least to me, that accurate and reliable descriptions of neurosyphilis will give additional keys to its essence.
Jeremy Sherr proclaims that, “When pure provings are deficient or insufficiently studied, clinical information and idle theories take on lives of their own.” True enough, except when the “pure provings” themselves are deficient or insufficient, as is definitely the case with Syphilinum. If clinical information prevails, like it does with Syphilinum, we should ensure that it is sound and solid and proceed from there.

SYMPTOMS MIND Vile indignity • Delusion he is dirty.
• Delusion he is stinking.
• Delusion of being neglected by members of family.
• Delusion he will become insane.
What imagery comes to our minds when the word syphilis is spoken? … Is it not DISGUST? Syphilis has a special connotation. There is almost an objective impression felt by all people in the collective unconscious. We often think of it as something dirty and disgusting to have, something of a low order which corrodes the organism and cripples it. Even the word phonetically seems to produce such a reaction.
The word syphilis was taken from a poem written by Fracastoro circa 1530 and was the name of a swine herd who contracted the disease. There is some discrepancy as to the correct origin of the word. The word sys in Greek means pig and philos, lover; pig lover. Others claim syph means ‘along with’ and philos, loving. In other words a disease that comes along with loving. And finally the word siphlos again in Greek means crippled. And yes, syphilis cripples. … All translations capture the essence of syphilis very well. From ‘pig lover’ we get the imagery of an unclean sex which we often associate with syphilis, a licentious sex fuelled by extreme lasciviousness and lust.
The image of disgust and dirt come into my mind and is borne in the feelings of the prover and the person whose disease state is similar to the state wrought by the remedy on the human organism. Syphilinum feels dirty in himself; fears dirt, infection, contamination; feels loathsome; she finds her physical complaints dirty; she feels full of poison, consequently she was always washing her hands. … This is one of the most striking and central features of the mental state of Syphilinum. The patient feels horrid, a hopeless mass of filth; often they feel good for nothing. Loathing of oneself. I feel that it can be added under delusions, dirty everything is and delusions, dirty he is and under dreams of dirt.
The organism which is encompassed and overwhelmed by the feeling of disgust and dirt seeks to remedy the state by attempting to wash, hoping that this will ease the feeling of being dirty. This is a compensation and survival mechanism for the organism.
[Roberto Bianchini, Syphilinum, the remedy. The Homoeopath, Dec. 1992]

Obsessional behaviour; thoughts; anxiety. • Obsessive checking.
• Obsession with cleanliness.
• Ritualistic.
• Superstitious.
• Compulsive neurosis.
• “Expresses an artistic talent, though tained with morbidity and obsession.”
[Sonawala]
• Relentless self-reproach.
• Self-chastiment [self-mutulation].

Loss of sense of self
• Indifferent to friends and feels no delight in anything; he always says he is not himself and cannot feel like himself. [Margaret Burgess-Webster]
• Stranger; loner; hider.
• Estranged. Strangers <.
• Evasiveness [avoids others, confrontation, challenges, consequences]. Let us think of what could occur in someone who has contracted syphilis. Their contact with people would be limited as they would be considered unclean. They would be isolated, a kind of outcast, somewhat like a leper and feel degraded. This in essence is what Syphilinum can feel like. Syphilinum will often say they feel like a stranger, separate from the world, separate from people and society and even from themselves. It is not in the rubric estranged from society but I have heard several Syphilinum patients relate this. There is an expression in the materia medica which states ‘a far away feeling’. This feeling is felt on many levels; far away from themselves, from their feelings, from the world. Because of this distance they feel that they have to hide themselves from society and from people. Thus Syphilinum becomes markedly secretive; they feel they have to keep things hidden from others. This is so deeply ingrained in the psyche it is often involuntary and unconscious. This is one of the most frequent characteristics that I have observed so far in cases requiring Syphilinum. [Bianchini]

Grandiosity - needs an audience
• Boasting; reckless; heedless; unrestrained.
• Expansive; eccentric; bouts of euphoria; elevation of self.
• Loss of judgement; impulsive.

Cognitive impairment • Short-term memory loss; cannot remember faces, names, dates, events, books, places.
• Difficulty in finding words, in expressing oneself.
• Difficulty with calculation.

See also section ‘Personality changes’.

GENERALS Modalities - Aggravation Time
Night. Pains. Mental state. Sensation of hot water boiling in veins.
Headache. Pain in eyes. Obstruction nose. Salivation.
Urging to urinate.
Ovarian pain. Leucorrhoea. Asthma. Cough.
Cardiac pain. Pain in limbs.
Rheumatic neuralgic pains in all the muscles.
Swelling of legs. Soreness of soles of feet. Sleeplessness.
Biting sensation in different parts of body, as if bitten by bugs. Itching.*
Morning on waking/rising. Prostration. Swelling of upper eyelids. Intense itching of vulva. Urethra as if clogged.

Seasons / weather
Winter. Bronchial cough. Pain in legs. [Aggravation generally due to the long nights in winter time.]
Damp weather. Rheumatic neuralgic pains in all the muscles.
Frosty weather. Rheumatic neuralgic pains in all the muscles.
Warm weather. Asthma.
Warm, damp weather. Asthma.
Summer. Asthma.
Thunderstorm. Asthma.
Temperature
Coldness. Copper-coloured spots become blue.
Severe bone pains.
Cold drinks. Pain in throat.
Draft of air. Chilliness.
Extremes of heat and cold. “Often bring out the symptoms.”
Hot or cold things. Toothache.
Heat. Varicose veins.
Heat of sun. Headache.
Position / activity
Exertion. Pulsating in vertex.
Lying on affected side. Pain in face.
Lying on right side. Cough.
Micturition, after. Pain in renal region/lumbar region.
Motion. Chilliness up the back.
Protruding tongue. Pain above right eye.
Raising arm laterally. Pain in shoulder/deltoid.
Sitting. Pain in coccyx/sacrum.
Standing. Pain in soles of feet.
Touch. Pain in tibia.

Environment Seaside. Profound depression. Bilious diarrhoea.

Sensory Light. Headache. Pain in eyes [lamplight].

* Such a litany of complaints will drive the syphilitic patient most likely out of bed at night and into the arms of a poor sleep during daytime. Both in its extreme forms reversing the day-night rhythm, there is no other way out for the syphilitic, contrary to the sycotic [eg, Medorrhinum], for whom the night opens up new horizons. The shadowy, transparently pale spirochete favours darkness, so much twisting and distorting ‘normal’ life that, for example, Osvald Alving, a victim of congenital syphilis in Henrik Ibsen’s 1881 play Ghosts, cannot tell the difference between night and day. Having a screw loose and being screwed up, so to speak, gain additional meaning in view of the spirochete’s cork-screw shape.

Modalities - Amelioration Time Daytime. General.
Evening. Anxiety.

Temperature Cold bathing/applications. Pain in eyes. Pain in limbs.
Warmth. Temporal headache extending into or from eyes.
Cramping pain umbilical region.
Warm applications. Headache. Pain in limbs.

Position / activity
Bending head back. Pain in neck.
Changing position. Nocturnal pains [temporary].
Continued or slow motion. Headache. Sciatica.
Lying on abdomen. Cough.
Pressure. Pain in face. Cramping pain umbilical region.
Pressing teeth together. Toothache.

Environment
Mountains. Bilious diarrhoea. Asthma.

Succession of boils; abscesses; suppurations. Foul secretions; fetid discharges.
Peculiar disagreeable odour to body.

Accumulation of adversities and linear progression

Syphilinum diseases can have an onset over night. One goes to bed as a healthy man and wakes in the morning with a chronic disease. For example, rheumatoid arthritis in a Syphilinum patient sets in over night with strong and persistent pains in various joints already on the first morning.
In Syphilinum patients you often see a ‘worst case scenario,’ i.e. they suffer from all adversities that possibly can accompany their main complaint. Examples are the symptoms “discharge from ear with pains” [a discharging ear usually does not hurt any more] or “fissure in anus and in rectum.” A vaginal discharge will not only be massive, but also excoriating and accompanied by intense itching. Another patient suffered from sneezing and coughing at the same time.
Another important trait of Syphilinum is linearity. On the one hand the patient is faced with a linear progression from health to destruction. The course of his disease is usually a continuously progressing one and not a story characterised by ups and downs of recoveries and relapses [otosclerosis, rheumatoid arthritis, multiple sclerosis, etc.]. On the other hand one often finds linearity in physical Syphilinum symptoms. If any physical phenomenon occurs in two parallel lines [eg, pain, cracks in tongue, eruptions, inflammation, etc.] you definitely know what remedy to prescribe.
[W. Springer & H. Wittwer, Syphilinum: Past and Present; Hom. Links 2/00]

LOCALS
[Some peculiar locals extracted from Margaret Burgess-Webster, Syphilinum; Hom. Recorder, No. 3, 3rd quarter, 1934; RefWorks]

• Terrible vertigo, under any conditions, but particularly worse rising up suddenly from bed; turning over in bed; or going into the prone position on lying down; on stooping; on looking up, seems to be caused by heat. Vertigo accompanied by easy fatigue, great weariness in limbs. Much vertigo; tendency to fall forward.

• Headache begins in occiput or back of neck, extending through to eyes or works over the head and settles over one eye or the other, with soreness of eyeball, or may change sides. Pains start at 4 p.m. and continue all night, cold sweat on back, arms and feet.

• Violent pain in whole head as if head would be crushed in, with red face, enlarged veins of face, restlessness and sleepless nights.

• Headache.
Preceded by sensation of choking, as if throat were closing, on stooping. Pain bursting, violent, maddening; as if head would be crushed in or as if top of head would come off.
Worse light, must lie down in dark room; worse effort of speaking or being spoken to.
Better by walking and better wrapping head up.
Hungry during headache.
Much urine as headache is relieved.
After headache neck and between shoulders stiff; subjective trembling; hungry.
• Nose and sinuses painful to inhaled air.

CASES

• Congenital Malformation of Intestines.
Is interesting because of its pathological aspects, said to be congenital and also because of the unexpected response to the homeopathic remedy which was selected chiefly on one unusual symptom. This case was referred to me by Dr. W. J. Gier of San Diego, California. It is that of a young college student of abdominal pain and bowel dysfunction, occurring about every week to ten days since early life, but the attacks are gradually becoming more severe and more frequent.
The patient is fond of meat and it agrees; coffee aggravates. Desires sweets, no thirst for water. No serious disease in his lifetime. Father is living at fifty-one, but has a stomach ulcer. Mother living at forty-seven is anaemic. X-ray of intestines shows a congenital malformation of intestinal tract. Not much affected by temperature changes; sleeps well and is rested after sleep.
Any prescription based on the symptoms, findings and history of this case would insure little change to find a curative remedy. On taking the patient’s blood for testing the patient fainted and fell to the floor. When he regained his composure, he said that the sight of even a little blood always made him faint; this was the key to the remedy. Syph. 10M was given, and the blood was tested only to confirm the correctness of the prescription which was proved to be the case. The remedy was given on July 11, 1955.
July 26, 1955. Patient reported improvement, and the remedy was continued.
September 15, 1955. Syph. 10M.
October 13, 1955. Better until recently. Syph. 50M.
December 15, 1955. Better except for a great deal of gas. Syph. CM.
February 10, 1956. Syph. CM.
April 24, 1956. Continued on Sacch-l.
June 19, 1956. Always perspired profusely in hot weather. Lyc. 10M. At times even while eating he fills up and is satiated. Specific indications like gas and distension and easy satiety with sensitiveness to hot weather mark Lyc., a sure winner in intestinal and nutritional troubles. Syph. in ascending potencies helped and strengthened the patient in a wonderful way, but finally there was needed the deep anti-psoric Lyc. to complete the cure of an apparently surgical case without the need for surgery.
Many of our master prescribers have observed that a nosode rarely completes a cure of a chronic case; but, on the other hand, I believe we would fail to cure some cases without the searching and unfolding power of these subtle specifics.
[Grimmer, Collected Works]

• Female: age 25; PC dysmenorrhoea.
First visit 2 May 1990. Severe cramps during menstruation, copious flooding, wakes her 10 times every night. Periods every 6 weeks. One heavy followed by one normal. Menstruation up to six days long. Takes BCP one cycle on and one cycle off. Soreness in breasts before period. Has had herbal treatment to no effect. Constipation for 5 days before menses. Feels in a constant state of stress. Great irritability towards husband. Her main occupation is sculptor, keeps another part time job on the side. Nervous flushing < round neck, bright red, comes about during stress or when in company.
Memory poor. Lack of confidence. Feels insecure. Low sense of self-esteem. When criticised gets angry. Strikes self - self-torture. Three years ago she would strike herself, esp. punching herself in the head. When young would not feel like seeing anyone, feels distant from people and world. Remember as a child sitting on a tree and feeling distant from everyone and everything. Averse company. Ill at ease, anxious in company. Heightened feeling of what people are thinking of me. Feels alone. Often in a rage destroys her pieces of sculpture. Fear swimming. Dreams: boyfriend doesn't want to see her; of toilets; dirt. Doesn't show grief. H/o anorexia.
Observation: very quiet, distant and difficult to get information from. Sensitive nature, anxious and flushing around people, but strong character. Rubrics chosen: Company, aversion to. Secretive. Delusions, people talking about her. Delusions of dirt [dreams]. Strikes with fists Symptoms not in repertory but confirmative: A feeling of distance from the world and people [far away feeling]. Strikes self; self mutilation. Low sense of self-esteem. Destructive.
Rx Syphilinum 1M
15 June 1990. Feeling better all round. Does not feel so stressed, general feeling of well being. For three days after Rx there was aggravation felt distressed. Menses >, should have had a bad cycle but was not so severe. More open, responsive, less depressed. Feels better in her work, happier in self. Better in company. Flushing >. Constipation >. Only one toilet dream - she was happily sitting on toilet, and thought that the toilet problem was in her homeopath’s imagination.
August 1990. Feels well in general, still improving, happier in self. Periods good, no flooding. General all round improvement. Advised her to return sometime in six months.
[Roberto Bianchini]

• In May, 1894, Dr. B., an allopathic physician, age seventy years, consulted me. Has had for seven or eight years a number of sores on his face, which have been pronounced by several allopathic dermatologists to be cancerous in their nature. They came first as raw places on the face, and then covered with perfectly black scabs, which either do not come off or, if they do, leave raw sore places, which will not heal, but become again covered with the black scabs. Under each eye, and especially at the outer canthus of the right eye, the spots or sores look decidedly like epithelioma. The one under the corner of the right eye is threatening to involve the lower lid and the internal structure of the eye. On this eye, a few years since, there was an ulcer on the cornea, which nearly destroyed the sight. He can only distinguish daylight from darkness.
The conjunctiva of this eye is very red and inflamed, and there is ectropion of the lower lid. He is in bad health, and drinks a good deal of whisky. He had been treated by himself and all the “eminent” dermatologists and general practitioners in this part of the country and in New Orleans, and they had given the comforting assurance “that he might live several years, but that it would finally kill him.” I put him on Syphilinum CM [Swan]. To make a long story short, he has gradually improved with occasional relapses, until today he appears to be entirely well. He says for the first time in ten years there are not sores or scabs on his face.
Where the worst ones were there are now cicatrices, but they look perfectly healthy and are gradually becoming smaller. The inflammation is entirely gone from his right eye, the ectropion is nearly removed, and he can see small objects six feet distant with his lame eye.
What perhaps is the most remarkable of all, he has stopped drinking whisky, thus verifying Dr. Thomas Wildes’ observation, made some years since, upon the great efficacy of Syphilinum in alcoholism, although I am not prepared to agree with his second observation, that all chronic drunkards are syphilitics. My patient’s skin troubles were always worse from the light and heat of the sun. There was but little local discomfort, but from the inroads the sore spot at the corner of his right eye was making on that structure, I have no doubt it was epithelioma.
There can be no question of the great value of this remedy for cancer. I believe every case of cancer to be the direct offspring of either syphilis or sycosis, or perhaps both, either acquired or inherited, and no case should be allowed to die or pass under the surgeon's knife, which alternative is about equivalent to death, without being given the benefit of a trial of Syphilinum.
[H.C. Morrow, Syphilinum in Cancerous Ulceration; Hom. Physician, May 1896; RefWorks]

• Ms T.L. presents with eczema and stress symptoms. She is an engineering student and the pressure of impending exams is difficult for her. Her mother had previously contacted me concerned about the degree to which she will study as she forgets to eat and drink unless meals are placed in front of her and she is made to stop. Sometimes she will not leave her room for two days. It is as if the rest of the world is forgotten.
The eczema has developed slowly over the last eighteen months and is copper coloured and concentrated in both armpits, the legs and around the genitals. Many natural substances have been tried without result. Further discussion around her study habits reveals that when she concentrates she unknowingly pulls the hair from her arms, legs and head. She is later surprised to find blood on her arms, legs and face.
The rubrics chosen for her case were: Mutilate his body, inclination to. Aversion to society. Compulsive disorders. Eruptions, coppery. Ms T.L. displays classic destructive blue tendencies and her facial features also show the dominance of blue. [Note: Blue is the colour coding for the syphilitic miasm.] Syphilinum 1M single dose resulted in a complete clearing of the eczema and a less obsessive attitude towards studying. She no longer pulls the hair from her body. No further dose was required. Three months later on seeing her mother as a patient she reports that her daughter is still doing well.
[Grant Bentley, Appearance and Circumstance]

• Miss B.P. Only glimpses of the history can be given. She belongs to a family full of mixed miasmas, very difficult to treat. Her father had epilepsy. Temperamentally she is the odd one of the family, inclined to withdraw, to be silent, to make blunt, offending remarks, misunderstanding and misunderstood.
Difficult concentration. Memory poor. Cannot recite in school, mind goes blank. Irritable. Self-centred. Feeling as if nothing is worth while. Depression, marked before menses. Menses late, scanty. Face flushed and then very pale. Hands and feet icy cold. Piles bedclothes on all year around. Dreams much, busy, tiring dreams, often when half awake. Worse in morning, very hard to get up, slow, fussy. Constipation chronic. Haemorrhoids which bleed. Vision blurred occasionally. Eyeballs burn after using eyes. Numbness of the fingertips. Skin very scaly, dry. Styes, abscesses, pustules. Cracks behind ears.
This patient went stumbling on, not succeeding at anything, until she fell madly in love with a soldier who went to France. She married him on his return, only to find later that he became insane at times, when he would desert her. She discovered a fresh infection of syphilis. 1921-22 found her in Reno seeking a divorce, and while there she became infected at least once more, having the initial lesion and the eruption. Mentally she grew gradually worse. Her mind would go blank for a moment. She became more indicative and mean, saying horrid things. Her nights were terrible, sleepless, and filled with thoughts which frightened her. Her head was full of distressing confusion with areas of pressure; she complained that she could not think, could decide nothing.
August 1924 she began to notice slight dragging in left leg. June 1925 there was a left-sided paralysis which cleared gradually. The left arm has been heavy ever since and muscles of hand somewhat wasted. This experience made her bitter against all the world and she retired more than ever from people, spending most of her time in bed, not caring to try to take any place in the home.
For remedies, I began way back with Sulphur, followed by Calc-carb. and much later Ferrum. In 1914 Dr. Kent advised Calc-phos. as long as it would hold and then Tub. Tub. was finally followed by Med. When paralysis came, Lachesis was chosen by Dr. Dienst and myself working independently. The mind and head grew worse.
In 1926 I first gave her Syphilinum and have kept her on it. She was sure for a long time it did no good but her family began to see a change. Very gradually mental characteristics dating back to girlhood have become softened and lessened. She has ceased to complain of her head all the time, has left her room, efforts to be helpful, has ventured out alone, and has welcomed guests in the home. She has a better colour and expression than of many years. She will not admit much of this but actions speak louder than words.
[J.M. Green, Syphilinum; Hom. Recorder, Aug. 1930; Enc.Hom.]

• In March 1938, M.D. came to consult me asking for any medicine that might cure his epilepsy. He was a young man [30] whose family antecedents and personal antecedents gave me no information. His present affliction began when he was 15 years of age.
The patient had a swollen face, full of acne, and he seemed depressed. He responded hesistantly to my questions, which appeared to bring back his thoughts from far away. Rather than his pathology this condition seemed more likely a result of the 40mg Luminal [phenobarbital] he took daily since 4 to 5 years; even such a high dose had been without any result, instead he had become severely intoxicated by it. He had great weakness of memory and copious salivation particularly at night. Besides that there were hardly any symptoms. Regarding the epilepsy, for the last 15 years he had every night, without exception, 4 to 6 epileptic attacks; violent attacks during sleep, without any aura noticed by his environment [the patient is married]; congested face, trismus, terrible jerkings. Of all this he does not remember anything on waking up in the morning. His whole body hurts and he often bites his tongue. Never an attack during the day, not even during the siesta after meals.

Based on the symptom aggravation at night and a few others mentioned above, I prescribed Syphilinum 200, with the advice to stop all sedatives.
After one month the patient comes back. No change. Stopping the Luminal didn’t make it worse. I prescribed Syphilinum 30 followed after 8 days by Syphilinum 1M. No improvement after one month.
I abandoned Syphilinum and replaced it with Bufo 30. No result. I then prescribed a single dose of Ignatia 1M because of the changeable temperament he had started to show since some time. That dose was taken in the morning and in the evening I received an urgent call. He had become furiously mad, breaking everything, beating his wife and his father and causing some injuries. He recognised me. I managed to calm him down and told the family to send him to a psychiatric hospital.

He was in the hospital for eight months, without having a single epileptic attack during this period. His nights were perfectly calm. Finally one night the attack reoccurred and the next morning he woke up in a perfectly healthy state of mind. The attacks became again regular, 4 to 6 each night. I didn’t feel much for repeating the experience, but he insisted.

Since I could not find any other remedy than Syphilinum, I prescribed this in 10M. It was taken at 7 p.m. The night was worse than ever. The attacks came with 30 minutes intervals and for the first time instead of ceasing in the morning the attacks increased to the point of becoming proleptic [recurrence of attacks at regularly shortening intervals]. Between the attacks the patient was unconscious. This condition lasted for 21 hours.
Finally, after an entire day, the attacks stopped. The patient slept for 3 days an almost comatose sleep and woke up cured, completely cured, to have never an attack again.
[Adapted from: R. Paturiaux, Luesinum in epilepsy; cited in Julian, Materia Medica of Nosodes]

TREPONEMA PERTENUE

Scientific name Treponema pertenue (Castellani 1905) Castellani & Chalmers 1910
Synonym Treponema pallidum subspecies pertenue
Family Spirochaetaceae.
Homeopathy Framboesinum - Fram.

FEATURES

• Spiral-shaped, motile, pale bacterium.
• Requires a pH in the range of 7.2 to 7.4 and grows at temperatures in the range of 30 to 37o C.
• Endemic in rural, tropical areas; associated with high humidity and rainfall.
• Isolated by Castellani in 1905 and named Spirochaeta pertenuis, Spironema pertenue, or Spirillum pertenue.
• Serologically and morphologically indistinguishable from Treponema pallidum, the spirochete associated with syphilis, as are Treponema carateum [pinta] and Treponema endemicum [bejel or endemic syphilis].
• Transmitted by direct contact to abraded skin with skin lesions of infected people.
• Primarily present in the epidermis.
• Differs from T. pallidum in its geographic distribution, in its non-venereal transmission, and in its clinical manifestations [does not produce central nervous system or cardiovascular pathology].

YAWS

Analysis of Homo erectus skeletal remains suggests that yaws had its origins in Africa 1.5 million years ago. An estimated 50-100 million persons were infected before mass antibiotic treatment campaigns in the 1950s. In 1997, the World Health Organization estimated that 460,000 new cases of endemic treponematoses [yaws, bejel, pinta] occurred worldwide.
Yaws currently presents mainly in children younger than 15 years in Latin America, West Africa, India, Southeast Asia, and the Caribbean Islands in areas where conditions of overcrowding and poor sanitation prevail.
Its name derives from yaw, an African word for raspberry, in allusion to the raspberry-like appearance of the initial sore at the site of infection. Its alternative name “frambesia tropica” has the same origin; it comes from ‘framboise”, French for raspberry.
Around the world yaws is known by many different names that include pian, patek, parangi, bouba, granuloma tropicum, polypapilloma tropicum, Breda’s disease, and Charlouis’ disease.
Contrary to syphilis, which seemingly required the social conditions of urbanisation, yaws was considered a “village disease.” In order to retain its spread in North America, yaws-infected African slaves were isolated in specially constructed “yaw houses.”

The three or four stages of yaws

• Stage 1 symptoms typically occur in childhood [peak incidence in children aged 6-10 years] and consist of a papillomatous lesion, termed mother yaw, at the site where the organism entered the body, usually on the foot, leg or buttock. The sore commonly enlarges and becomes crusted. It may coalesce with satellite lesions to form a plaque. Lesions are considered highly infectious. Lymphadenopathy, fever, and joint/muscle pain may accompany this stage. The mother yaw leaves an atrophic scar with central hypopigmentation. Hairs at the seat of a yaw turn white.

• Stage 2 follows several weeks or months after the initial symptoms, involving the appearance of similar reddish skin sores, daughter yaws. These lesions are frequently located near body orifices, particularly the mouth and nose, but may also appear on forehead, legs, arms, groin, genitals, perineum, and buttocks. The daughter yaws do not all arise in one crop: some are found mature while others are only starting. They expand, ulcerate, and exude a fibrinous fluid, which dries into a crust and attracts flies. They heal slowly and are usually painless when rubbed or irritated. A traditional diagnostic tool involved the opening of a yaw and dropping a little Capsicum juice in it. Where the acrid juice normally would lead to flinching, no smarting would be felt in case of a yaw.
Sores on the soles of the feet may produce painful ulcerations and result in an awkward crab-like gait or “crab yaws.”
Other symptoms include inflammation of the bones and fingers, hyperkeratosis of palms and soles, generalised lymphadenopathy, malaise, and anorexia. Climate influences the morphology and the number of lesions. In the dry season, lesions are fewer in number and macular in appearance. Papillomas are found in moist areas of axilla, skin folds, and mucosal surfaces.
The skin lesions, especially those around the mouth, anus and axilla, may relapse for as long as 5 years after the initial infection. The disease then enters a non-infectious latent period, and patients do not exhibit any signs or symptoms.

• Stage 3 occurs in one-tenth of affected individuals. It appears after 5-15 years of latency [typically around the time of puberty] and includes deformities of bone, joint, and soft tissue. Most patients, however, remain in a non-infectious latent stage for their lifetime.
Deformities and disability are typical of stage 3. Granular nodules [gummatous lesions] in subcutaneous tissue of the face lead to disfigurement, whereas destructive lesions of bone and cartilage reduce function and mobility. There may also be shortening of the ligaments in the joints. An hypertrophic osteitis known as Goundou syndrome or “dog nose” may develop in this stage. On both sides of the nose painless exostoses develop that overgrow the maxillary bones, producing a symmetrical swelling of the middle section of the face. The syndrome may be accompanied by headache and excessive nasal discharge.
Another stage 3 manifestation is Gangosa syndrome or rhinopharyngitis mutilans. It is characterised by degenerative ulcerations beginning on the soft palate and extending thence to the hard palate, nasopharynx, and nose. The destruction of nasal cartilage and the scarring of tissue results in obstructed nasal respiration, similar as in congenital syphilis, to which the name refers, ‘gangoso’ being Spanish for ‘snuffling’.
Due to chronic osteoperiostitis of the tibia a third characteristic deformity may arise, which is known as saber shins, sharp-edged anteriorly convex tibia. Other lesions observed in patients with late yaws are monodactylitis [inflammation of one finger] and juxta-articular nodules.

MATERIA MEDICA FRAMBOESINUM Fram. Sources No provings, no clinical cases, no materia medica except for Julian’s remark that “as homeopathic indication it has some common points with Psorinum: chilliness often accompanied by lowering of body temperature.”

In addition, the clinical differential diagnosis of yaws may deserve consideration:
• Atopic dermatitis.
• Plaque psoriasis.
• Rhinoscleroma.
• Sarcoidosis.
• Scabies.
• Impetigo.
• Molluscum contagiosum.
• Tinea versicolor.