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By H. Kayor. Westminster Theological Seminary in California.

It is often Physical exam and a swab of the vagina or penis to found in semen and cervical secretions buy generic suhagra 100mg. Urine testing is transmitted from mother to infant via breast- also used sometimes order suhagra 100mg overnight delivery. Do Certain antiviral drugs (ganciclovir cheap 100 mg suhagra with mastercard, foscarnet, and not have sex until a follow-up test confirms that cidofovir) are helpful. Consistently use condoms has genital herpes, according to the Centers for Dis- and barriers (dental dams). This can mean serious complica- tions at birth or later in life (such as mental (and do) spread genital herpes unknowingly. A that usually show up within 80 days of exposure female may have itching or burning in her vagina, and slough into ulcers. The ulcers can be seen in pain, vaginal discharge, and tiny red bumps or blis- the mouth or genital or anal areas. They are dark ters in the genital area, which turn into painful red and large and often enlarge; the affected skin ulcers. All of your sex partners should take tle signs are irritation around the anus, small skin antibiotics for donovanosis even if they are symp- slits, and skin redness. Anyone you have had sexual contact takenly think he has jock itch, acne, or irritation with in a 60-day time frame before your dono- caused by sexual activity. You also may have perma- ing feeling in the legs—signal that herpes is in an nent scarring of the urethra or other areas. If you use long-term suppres- Most people get genital herpes when a partner has sive medication therapy, you will probably reduce no visible symptoms. An infant in the valacyclovir (Valtrex) control outbreaks and mini- birth canal who has direct contact with herpes mize discomfort of outbreaks. Infection symptoms and work especially well when taken in a mother who has viral shedding at the time of within 24 hours of onset of symptoms. A person delivery can cause serious damage to her baby, with genital herpes can choose either suppressive especially if she has only recently acquired the or episodic antiviral treatments that can help pre- infection. In some During pregnancy, a woman who has had her- cases, suppressive antiviral therapy tends to pes for a long time transmits protective antibod- decrease the risk of transmission as well. Abstinence (no sexual activity at all) is the only If you are pregnant and have a sex partner who surefire way to prevent getting genital herpes. If has herpes, use condoms throughout the nine you are sexually active, use condoms and barriers months and do not have intercourse at all the last (dental dams), but be aware that these should not trimester. If you are in your last months of preg- be viewed as guarantees that you will not contract nancy, avoid all forms of sex with a partner whose this disease. Using latex condoms provides some infection status is unknown or one you know has protection, but not 100 percent, because viral shed- oral or genital herpes. Contact with a toilet seat or nata, genital warts are caused by human papillo- hot tub is very unlikely to spread the virus. Do not have oral sex with someone who has About three weeks to three months after exposure, oral herpes lesions. If you have herpes, even after genital warts appear as small painless bumps on sores are healed, wait several days before having the penis, scrotum, anus, or vaginal area. Use condoms between Untreated, these can develop into larger cauliflow- 274 The Encyclopedia of Sexually Transmitted Diseases erlike growths. Occasionally genital warts occur in aware, however, that a condom definitely cannot the mouth, after oral sex with an infected person. The only sure way to prevent genital Sexual contact, including foreplay, anal inter- warts is not to have sex. Only rarely are in women, and these are also associated with vul- genital warts transmitted by nonliving material var cancer, anal cancer, and cancer of the penis. Some people do not show symptoms for to inspect the cervix and vagina and apply a solu- months. An infected rec- tum can cause itching, discharge, and painful bowel Your sex partners should be checked for genital movements. Also, doctor administers and one that the patient uses at touching infected genitals and then the eyes can home. Use top- individual is symptom-free, he or she can spread the ical treatments only for external genital and peri- infection to sex partners in cases of unprotected sex. A doctor can use a technique such as cryotherapy (freezing) or laser vaporization. Very large warts analysis—Gram stain, culture, or detection of bac- can be surgically removed. Often more than one rence of warts, see your doctor as soon as possible test is needed to diagnose gonorrhea. For pharyn- for treatment; do not have sex until these are elim- geal gonorrhea, a throat culture is used. For genital tract infections, drug symptoms appear and before he or she is aware of combinations are used because people with gon- being infected. In day care facilities, children occa- orrhea infections are also routinely treated for sionally spread hepatitis A to other children and chlamydia. Having gonorrhea also you have antibodies, these confer protection gives someone a heightened chance of getting against reinfection with hepatitis A. The result can be an eye infection, blind- ness, joint infection, or a serious blood infection. Vomiting, nausea, appetite loss, fever, yellow skin and eyes, dark urine, and abdominal pain. Hepatitis A can make you very sick, but it resolves Sexual contact, saliva, and blood to blood; often, within a few weeks. You contract hepatitis A from ingesting or blood products, mother-to-child transmission, infected fecal matter. Because hepatitis C is infectious, do not prevalence of hepatitis B, prostitutes, and prisoners. Liver destruction (cirrhosis) is a feared com- Hepatitis C is a common cause of chronic liver dis- plication, as is liver cancer. Hepatitis C usually is not diag- Hepatitis D can be sexually transmitted, but blood nosed initially and proceeds to the chronic state. Avoid sexual practices that include infection to another person by way of blood, oral–fecal exposure. The virus fluids, and do not share needles (for drugs or tat- enters the body via the lining of the vulva, vagina, toos). It is often not noticed, but then, painful, one- sexual activity or skin-to-skin contact (even if the sided enlarged lymph nodes develop. Fever, chills, can spread the infection from one part of the body and/or a rash may occur. Molluscum contagiosum may be trans- someone who is infected can result in mouth mitted by contact with an inanimate object such as ulcers and lymph node enlargement in the neck.

Flavonoids are polyphenolic compounds that occur in a variety of foods of vegetable origin purchase cheap suhagra on-line, such as tea purchase suhagra 100mg visa, onions and apples order suhagra from india. Data from several prospective studies indicate an inverse association of dietary flavonoids withcoronaryheart disease(34,35). However,confoundingmay bea major problem and may explain the conflicting results of observational studies. Sodium and potassium High blood pressure is a major risk factor for coronary heart disease and both forms of stroke (ischaemic and haemorrhagic). Of the many risk factors associated with high blood pressure, the dietary exposure that has been most investigated is daily sodium intake. It has been studied extensively in animal experimental models, in epidemiological studies, controlled clinical trials and in population studies on restricted sodium intake (36, 37). All these data show convincingly that sodium intake is directly associated with blood pressure. An overview of observational data obtained from population studies suggested that a difference in sodium intake of 100 mmol per day was associated with average differences in systolic blood pressure of 5 mmHg at age 15--19 years and 10 mmHg at age 60--69 years (37). Diastolic blood pressures are reduced by about half as much, but the association increases with age and magnitude of the initial blood pressure. It was estimated that a universal reduction in dietary intake of sodium by 50 mmol per day would lead to a 50% reduction in the number of people requiring antihypertensive therapy, a 22% reduction in the number of deaths resulting from strokes and a 16% reduction in the number of deaths from coronary heart disease. The first prospective study using 24-hour urine collections for measuring sodium intake, which is the only reliable measure, demonstrated a positive relationship between an increased risk of acute coronary events, but not stroke events, and increased sodium excretion (38). Several clinical intervention trials, conducted to evaluate the effects of dietary salt reduction on blood pressure levels, have been systematically reviewed (39, 40). Based on an overview of 32 methodologically adequate trials, Cutler, Follmann & Allender (39) concluded that a daily reduction of sodium intake by 70--80 mmol was associated with a lowering of blood pressure both in hypertensive and normotensive individuals, with systolic and diastolic blood pressure reductions of 4. Clinical trials have also demonstrated the 85 sustainable blood pressure lowering effects of sodium restriction in infancy (41, 42), as well as in the elderly in whom it provides a useful non- pharmacological therapy (43). The results of a low-sodium diet trial (44) showed that low-sodium diets, with 24-hour sodium excretion levels around 70 mmol, are effective and safe. Two population studies, in China and in Portugal, have also revealed significant reductions in blood pressure in the intervention groups (45, 46). A meta-analysis of randomized controlled trials showed that potassium supplements reduced mean blood pressures (systolic/diastolic) by 1. Several large cohort studies have found an inverse association between potassium intake and risk of stroke (48, 49). The recommended levels of fruit and vegetable consumption assure an adequate intake of potassium. Numerous ecological and prospective studies have reported a significant protective association for coronary heart disease and stroke with consumption of fruits and vegetables (50--53). While the combination diet was more effective in lowering blood pressure, the fruit and vegetable diet also lowered blood pressure (by 2. Most, but not all, population studies have shown that fish consumption is associated with a reduced risk of coronary heart disease. A systematic review concluded that the discrepancy in the findings may be a result of differences in the populations studied, with only high-risk individuals benefiting from increasing their fish consumption (55). It was estimated that in high-risk populations, an optimum fish consumption of 40--60 g per day would lead to approximately a 50% reduction in death from coronary heart disease. In a diet and reinfarction trial, 2-year mortality was reduced by 29% in survivors of a first myocardial infarction in persons receiving advice to consume fatty fish at least twice a week (56). Several large epidemiological studies have demonstrated that frequent consumption of nuts was associated with decreased risk of coronary heart disease (58, 59). Most of these studies considered nuts as a group, combining many different types of nuts. Nuts are high in unsaturated fatty acids and low in saturated fats, and contribute to cholesterol lowering by altering the fatty acid profile of the diet as a whole. However, because of the high energy content of nuts, advice to include them in the diet must be tempered in accordance with the desired energy balance. Several trials indicate that soy has a beneficial effect on plasma lipids (60, 61). Soy is rich in isoflavones, compounds that are structurally and functionally similar to estrogen. Several animal experiments suggest that the intake of these isoflavones may provide protection against coronary heart disease, but human data on efficacy and safety are still awaited. There is convincing evidence that low to moderate alcohol consumption lowers the risk of coronary heart disease. In a systematic review of ecological, case--control and cohort studies in which specific associations were available between risk of coronary heart-disease and consumption of beer, wine and spirits, it was found that all alcoholic drinks are linked with lower risk (63). However, other cardiovascular and health risks associated with alcohol do not favour a general recommendation for its use. The amount of cafestol in the cup depends on the brewing method: it is zero for paper-filtered drip coffee, and high in the unfiltered coffee still widely drunk in, for example, in Greece, the Middle East and Turkey. Intake of large amounts of unfiltered coffee markedly raises serum cholesterol and has been associated with coronary heart disease in Norway (64). A shift from unfiltered, boiled coffee to filtered coffee has contributed significantly to the decline in serum cholesterol in Finland (65). Fats Dietary intake of fats strongly influences the risk of cardiovascular diseases such as coronary heart disease and stroke, through effects on 87 blood lipids, thrombosis, blood pressure, arterial (endothelial) function, arrythmogenesis and inflammation. However, the qualitative composi- tion of fats in the diet has a significant role to play in modifying this risk. The evidence shows that intake of saturated fatty acids is directly related to cardiovascular risk. The traditional target is to restrict the intake of saturated fatty acids to less than 10%, of daily energy intake and less than 7% for high-risk groups. If populations are consuming less than 10%, they should not increase that level of intake. Within these limits, intake of foods rich in myristic and palmitic acids should be replaced by fats with a lower content of these particular fatty acids. The amount and quality of fat supply has to be considered keeping in mind the need to meet energy requirements. Specific sources of saturated fat, such as coconut and palm oil, provide low-cost energy and may be an important source of energy for the poor. This implies that the fatty acid composition of the fat source 88 shouldbeexamined. Aspopulationsprogressinthenutritiontransitionand energy excess becomes a potential problem, restricting certain fatty acids becomes progressively more relevant to ensuring cardiovascular health.

Sterilize all your dairy foods by heating at the boiling point for 10 seconds order suhagra with a visa, even if you have no symptoms 100mg suhagra free shipping. As soon as a new abdominal pain or discomfort 100 mg suhagra mastercard, or a gassy condition appears, zap bacteria and try to eliminate your bowel contents. Use the herb, Cascara sagrada (follow directions on label) as a laxative, or Epsom salts if necessary. If you have chronic abdominal problems, make sure you eliminate the bowel contents two or three times a day. There are herbs that can kill enteric bacteria, known to our ancestors of various cultures. If your body has lost its ability to kill Salmonellas and Shi- gellas, all the antibiotics and herbs and good bowel habits can- not protect you from these ubiquitous bacteria. There is evi- dence that common antibiotics that kill Streptococcus and Staphylococcus varieties are responsible. No amount of acidophilus culture (which contains ac- tive Lactobacillus) can replace these Streps or Staphs. Your intestines are similarly handicapped after antibiotics, and allow even very small amounts of Salmonella and Shigella to escape and multiply! The metals from dentalware: mercury, silver, copper, thal- lium, first are swallowed and then land in the stomach. Toxins you inhale such as asbestos, formalde- hyde, fiberglass, also are coughed up and swallowed to accu- mulate in the stomach. Even though you regain your tolerance toward minute bits of filth in dairy products, do not go back to unsterilized milk products. Appendicitis The lower abdomen on the right side has the valve that sepa- rates the small intestine (ileum) from the large intestine 9 Sherwood L. It is a common trouble spot because large parasites can attach themselves behind it and keep themselves safe from elimination. It is near this point where the appendix attaches and this, too, is a favorite location of pinworms. With an appendix full of pinworms and their bacteria, is it any wonder when it gets inflamed and causes pain? If there are any suspicions of appen- dicitis, zap pinworms and all enteric parasites and bacteria im- mediately. Because the current does not penetrate the bowel contents very well, zap every day for two weeks and take 2 tsp. Make sure bowel movements are regular after this (see the Bowel Program, page 546, for hints) and hands are washed after bathroom use and before eating. If appendicitis does not clear up it can lead to a burst appen- dix, spewing the dreadful contents into the abdomen. Kill pin- worms and roundworms and enteric parasites regularly (once a week) in children. Urinary Tract Pain Urinary tract infections, including bladder, kidney, and ure- thral infections, are easier to clear up than to test for. Make sure both of you clean up the urinary tract by zapping and doing the Kidney Cleanse. If dairy foods trigger yours, you can guess it is not allergic at all but simply Salmonella or Shigella infection. Boil all dairy foods, stop eating ice cream, cheese and yogurt which you cannot boil. If eating lettuce triggers your intestinal attack, but other roughage does not, it may be a true allergen and cleaning the liver will eventually cure it. Wheat “allergy” is due to the pancreas being full of pancreatic flukes, wood alcohol, Kojic acid (a mycotoxin), and gold. All these bowel diseases are quite easily cured by killing all parasites, bacteria, and viruses. Since reinfection is such a big problem, give your pet away until you are completely cured. For this reason, too, I recommend the Bowel Program (page 546) and Black Walnut Hull Tincture Extra Strength even though you may have gotten immediate relief from zapping alone. This is because sheep liver fluke and pancre- atic fluke are commonly the main parasites and these live in the pancreas and liver. Salmonella and Shigella are always part of the picture, too, as are various amoebae and fungi. The treatment is the same, kill all parasites and remove all pollutants, especially wood alcohol in commercial beverages. Reinfection is very quick too, if the rule about cooking dairy foods is not observed. Michelle Whorton had stomach pain at the middle of her abdomen, not related to eating. We found she had Ascaris (probably in her stomach where they cause indigestion and in- flammation). She was to be very careful with sanitation since they owned a number of farm dogs. Next seen after six weeks, she stated that all her previous problems were gone but she had a different pain in the mid-lower abdomen that got worse during her period and sent pain shooting down both legs. Her uterus was full of asbestos, arsenic, gold, silver, titanium, propyl alcohol, benzene, styrene, toluene and carbon tetrachloride. Mark Lippman, age 51, came in for his irritable bowel syndrome, hop- ing we would find Giardia and put an end to it quickly. He also had propyl alcohol built up in his body giving him a precancerous con- dition that needed immediate attention. The flukes were killed in twenty minutes, along with Ascaris (he had swollen eyelids). His young body also had a buildup of benzene, moth balls and carbon tetrachloride that he was eating, drinking, and breathing. His other problems recurred until he was older and could stop licking his fingers when eating. Tom Ochs, age 36, had chronic stomach problems, alternating consti- pation and diarrhea, was labeled “lactose intolerant” after an elaborate test, and finally had been diagnosed with irritable bowel syndrome. He was also toxic with cesium from drinking beverages out of clear plastic bottles. This frequently causes depression and he was happy to understand his mood changes. After changing to purer food and products and killing his parasites, he did not need to come back. Rex Callahan, age 5, had dark circles under his eyes, numerous ear infections until tonsils were removed and tubes put in, and many strep throat infections. We found he had sheep liver flukes and all their developmental stages in his blood and intestine.

Epidermoid cysts may occur anywhere cheap 100 mg suhagra amex, but are most common over the head suhagra 100mg mastercard, neck and upper trunk generic 100 mg suhagra visa. They contain tiny accretions of horn, which can be expressed by slitting the thin epidermis over them with a needle tip. Pilar cysts are usually multiple and are often genetically determined as an auto- somal dominant trait. Large numbers of small cysts are distributed over the body, but particularly over the upper trunk. They may occur anywhere, but are especially often found around the eyes as oval, firm, smooth-walled swellings. Often, these cysts rupture, causing inflammation, but sometimes this does not happen and quite large swellings are produced. This seems to occur particularly frequently over the back in the elderly, when they are sometimes known as giant comedones. Treatment of benign tumours, moles and birthmarks It should be remembered that on many occasions it is the appearance of the lesion that is the predominant concern of the patient and it is not helpful, for example, to substitute a simple facial mole with an ugly surgical scar. One overriding prin- ciple is important to remember: if any form of surgical removal or destruction is planned, histological evidence of the nature of the lesion is required. Even the most experienced dermatologist is not more than 65–70 per cent accurate in the clinical diagnosis of non-typical pigmented lesions, and is only a little better with non-pigmented tumours. Minimally scarring procedures such as curettage and cautery and shaving of small, benign, dome-shaped lesions flush with the skin may be adequate and prevent unpleasant scar formation. Treatment by lasers requires specialized instrumentation and personnel with experience and skill. She already had ordinary acquired naevi on her face and arms, as well as a large, pigmented patch of 2 cm2 diameter over her upper back that she had been born with and that had been termed ‘a congenital mole’. The new brown, warty spots over her abdomen and back irritated and worried her and she didn’t like the look of them. Her doctor told her that these new pigmented lesions were nothing to worry about, but were common seborrhoeic warts that could easily be removed by scraping them off – curettage under a local anaesthetic. Summary ● Seborrhoeic warts are extremely common, benign ● Acquired naevi appear after birth and include epidermal tumours of ageing skin. They are usually junctional naevi, which are flat, brown lesions brownish and warty and may occur in large numbers containing clumps of naevus cells at the over the trunk. The differential diagnosis includes dermoepidermal junction, dermal cellular naevi, with epidermal naevus, solar keratosis, viral wart and, clumps of naevus cells in the dermis, and most important of all, malignant melanoma. In the type of epidermal naevus, which contains dysplastic naevus syndrome, the naevi are irregular sebaceous glands and maybe other adnexal and odd looking and there is an increased risk of structures. Juvenile melanoma occurs in ● Benign tumours of sweat gland origin include children and adolescents and is so called because syringoma, cylindroma, nodular hidradenoma and of the histological appearance, which can simulate eccrine poroma. The latter ● Sebaceous gland hyperplasia is often seen in tend to flatten and disappear at puberty. Larger elderly facial skin as one or several yellowish ones may cause problems from bleeding and/or nodules. Cavernous haemangiomata are larger and ● Melanocytic naevi (‘moles’) are extremely common compressible, containing large vascular spaces. They are usually more than 1 cm2 Morgan spot) are bright-red papules on the trunk of in diameter and dark brown in colour. Some, such the elderly, with a similar histological appearance to as those that cover large areas of the shoulder or capillary angiomas. A few of from arteriovenous shunts at the fingertips and these develop malignant melanoma. Pyogenic granuloma suddenly arises as a moist, red papule and spontaneously 205 Benign tumours, moles, birthmarks and cysts subsides after a few weeks. It contains primitive ● Connective tissue naevi are uncommon, but are of connective tissue, inflammatory cells and importance in the inherited disorder known as thin-walled blood vessels. Several may develop ● Mastocytosis (urticaria pigmentosa) causes simultaneously on the limbs. Common ● Neurofibroma is a benign tumour of neural sheath, epidermoid cysts have a lining epidermis that which is mostly seen as part of a dominantly produces horn. Pilar cysts lined with hair-sheath inherited disorder (Von Recklinghausen’s disease) epithelium produce a different type of horn. Cysts in which multiple lesions occur alongside flat, brown also develop from sebaceous gland tissue – known macules (café au lait patches). Neurilemmoma is congenital in origin and contain a mixture of another benign tumour of neural sheath. Clinical features The typical solar keratosis is a raised, pink or grey, scaling or warty hyperkeratotic Figure 13. They are found on the exposed areas of skin of elderly, fair-skinned subjects who show other signs of solar damage. Multi- ple lesions are the rule, and when a solitary solar keratosis is found, it may be assumed that there is widespread solar damage and that further solar keratoses will appear. The differential diagnosis of small scaling or warty lesions of exposed skin sites is given in Table 13. The clinical diagnosis of solar keratosis may be difficult and with ‘not quite typical’ lesions, an accuracy of more than 65 per cent is good, even for experienced clinicians. There is always a subepidermal inflammatory cell infiltrate of lymphocytes, which is occasionally a dense ‘lichenoid band’. It is thought that solar keratoses represent one pre-malignant phase on the path to squamous cell carcinoma, even though only a tiny proportion (perhaps 0. The role of papillomaviruses in the causation of skin cancer has long been debated. In the equable damp cli- mate of South Wales, approximately 20 per cent of the population aged over 60 have been found to have these lesions. They are much more common in fair-skinned subjects, particularly those with reddish hair and blue eyes. Chemotherapy is sometimes appropriate when there are very large numbers of lesions present, for individuals who are seriously ‘photodamaged’, and three types are available. This agent is applied daily or twice daily to the lesions over a 10-day or 14-day schedule. The lesions often become sore and inflamed, and the patient should be warned and given a topical corticosteroid to improve the symptoms. This treatment is effective in some 50 or 60 per cent of cases and often saves con- siderable inconvenience and discomfort for elderly patients. Imiquimod – the immune response-modifying agent – may also be used for topical treatment.

But when the physician enquired more particularly buy suhagra overnight delivery, the mother confessed that the little boy had some vesicles of itch on the sole of the foot buy suhagra 100mg low price, which had soon yielded to lead ointment; the child order 100 mg suhagra with mastercard, as she said, had no other sign of the itch. Another surgeon, through frequent blood-lettings and many medicines, effected that he remained free from epilepsy for four weeks, but soon afterwards the epilepsy returned while he was taking his noonday nap, and the patient had two or three fits in the nights; at the same time he was attacked with a very severe cough and suffocating catarrh, especially during the nights, when he expectorated a very fetid fluid. At last, after much medicine, the disease increased so much that he had ten fits at night and eight during the day. Nevertheless he never in these fits either clenched his thumbs or had foam at his mouth. During his nightly attacks he remains in the deepest sleep without awaking, but in the morning he feels as if bruised all over. The only warning of a fit consists in his rubbing his nose and drawing up his left foot, but then he suddenly falls down. In the same place the author mentions also a woman whose fingers contracted from an itch driven out by external means; she suffered of them a long time. He became insane, sang or laughed where it was unbecoming, and ran until he sank to the ground from exhaustion. From day to day he became more sick in soul and in body, until at last hemiplegy came on and he died. The intestines were found grown together into a firm mass, studded with little ulcers full of protuberances, some of the size of walnuts, which were filled ,with a substance resembling gypsum. Artificial irritants applied to the skin and a strong emetic brought back the itch again; when the eruption extended over the whole body all the former accidents disappeared. Who, after reading even the few cases described, would hesitate to acknowledge that the Psora, as already stated, is the most destructive of all chronic miasmas? Who would be so stolid as to declare, with, the later allopathic physicians, that the itch-eruption, tinea and tetters are only situated superficially upon the skin and may, therefore, without fear, be driven out through external means since the internal of the body has no part in it and retains its health? If the examples here adduced by me from both the older and from modern non-Homoeopathic writings have not yet enough convincing proof, I should like to know what other examples (even my own not excepted) could be conceived of as more striking proofs? How often (and I might say almost always) have opponents of the old school refused all credence to the observations of honorable Homoeopathic physicians, because they were not made before their own eyes and because the names of the patients were only indicated with a letter; as if private patients would allow their names to be used! And do I not prove my point in a manner most indubitable and most free from partisanship through the experience of so many other honest practitioners? The man who, from the examples given and from innumerable others of a like nature, is not willing to see the exact opposite of that assertion blinds himself on purpose and works intentionally for the destruction of mankind. Or are they so little instructed as to the nature of all the miasmatic maladies connected with diseases of the skin that they do not know that they all take a similar course in their origin? And that all such miasmas become first internal maladies of the whole system before their external assuaging symptom appears on the skin? We shall more closely elucidate this process, and in consequence we shall see that all miasmatic maladies which show peculiar local ailments on the skin are always present as internal maladies in the system before they show their local symptom externally upon the skin; but that only in acute diseases, after taking their course through a certain number of days, the local symptom, together with the internal disease, is wont to disappear, which then leaves the body free from both. In chronic miasmas, however, the outer local symptom may either be driven from the skin or may disappear of itself, while the internal disease, if uncured, neither wholly nor in part ever leaves the system; on the contrary, it continually increases with the years, unless healed by art. I must here dwell the more circumstantially on this process of nature, because the common physicians, especially of modem days, are so deficient in vision; or, more correctly stated, so blind that although they could, as it were, handle and feel this process in the origin and development of acute miasmatic eruptional diseases, they nevertheless neither surmised nor observed the like process in chronic diseases, and therefore declared their local symptoms as secondary growths and impurities existing merely externally on the skin, without any internal fundamental disease, and this as well with the chancre and the fig-wart as with the eruption of itch, and fore - since they overlooked the chief disease or perhaps even boldly denied it - by a mere external treatment and destruction of these local ailments they have brought unspeakable misfortunes on suffering humanity. With respect to the origin of these three chronic maladies, as in the acute, miasmatic eruptional diseases, three different important moments are to be more attentively considered than has hitherto been done: First, the time of infection; secondly, the period of time during which the whole organism is being penetrated by the disease infused, until it has developed within; and thirdly, the breaking out of the external ailment, whereby nature externally demonstrates the completion of the internal, development of the miasmatic malady throughout the whole organism. When the smallpox or the cowpox catches, this happens in the moment when in vaccination the morbid fluid in the bloody scratch of the skin comes in contact with the exposed nerve, which then, irrevocably, dynamically communicates the disease to the vital force (to the whole nervous system) in the same moment. After this moment of infection no ablution, cauterizing or burning, not even the cutting off of the part which has caught and received the infection, can again destroy or undo the development of the disease within. The same is the case, not to mention several other acute miasmas, also when the skin of man is contaminated with the blood of cattle affected with anthrax. If, as is frequently the case, the anthrax has infected and caught on, all ablutions of the skin are in vain; the black or gangrenous blister, nearly always fatal, nevertheless, always comes out after four or five days (usually in the affected spot); i. Does it not take three, four or five days after vaccination is effected, before the vaccinated spot becomes inflamed? Does not the sort of fever developed - the sign of the completion of the disease-appear even later, when the protecting pock has been fully formed; i. Does it not take ten to twelve days after infection with smallpox, before the inflammatory fever and the outbreak of the smallpox on the skin take place? What has nature been doing with the infection received in these ten or twelve days? Was it not necessary to first embody the disease in the whole organism before nature was enabled to kindle the fever, and to bring out the emption on the skin? Measles also require ten or twelve days after infection or inoculation before this eruption with its fever appears. After infection with scarlet fever seven days usually pass before the scarlet fever, with the redness of the skin, breaks out. What else but to incorporate the whole disease of measles or scarlet fever in the entire living organism before she had completed the work, so as to be enabled to produce the measles and the scarlet fever with their eruption. Among many persons bitten by mad dogs - thanks to the benign ruler of the world only few are infected, rarely the twelfth; often, as I myself have observed, only one out of twenty or thirty persons bitten. The others, even if ever so badly mangled by the mad dog, usually all recover, even if they are not treated by a physician or surgeon. Now if the venomous spittle of the mad dog has really taken effect, the infection usually has taken place irrevocably in the moment of contagion, for experience shows that even the immediate excision and amputation of the infected part does not protect from the progression of the disease within, nor from the breaking out of the hydrophobia - therefore, also, the many hundreds, of other much lauded external means for cleansing, cauterizing and suppurating the wound of the bite can protect just as little from the breaking out of the hydrophobia. From the progress of all these miasmatic diseases we may plainly see that, after the contagion from without, the malady connected with it in the interiors of the whole man must first be developed; i. A surgeon immediately, exsected the wound altogether, kept it suppurating and gave mercury until it produced a mild salivation, which was kept tip for two weeks; nevertheless hydrophobia broke out on the 27th of April and the patient died on the 29th of April. Of these chronic miasmata I shall for this purpose only adduce those two, which we know somewhat more exactly; namely, the venereal chancre and the itch. In impure coition there arises, most probably at the very moment in the spot which is touched and rubbed, the specific contagion. If this contagion has taken effect, then the whole living body is in consequence seized with it. Immediately after the moment of contagion the formation of the venereal disease in the whole of the interior begins. In that part of the sexual organs where the infection has taken place, nothing unnatural is noticed in the first days, nothing diseased, inflamed or corroded; so also all washing. The spot remains healthy according to appearance, only the internal organism is called into activity by the infection (which occurs usually in a moment), so as to incorporate the venereal miasma and to become thoroughly diseased with the venereal malady. On the other hand, are not the chronic miasmas disease- parasites which continue to live as long as the man seized by them is alive, and which have their fruit in the eruption originally produced by them (the itch-pustule, the chancre and the fig-wart, which in turn are capable of infecting others and which do not die off of themselves like the acute miasmas, but can only be exterminated and annihilated by a counter-infection, by means of the potency of a medicinal disease quite similar to it and stronger than it (the anti- psoric), so that the patient is delivered from them and recovers his health? This is therefore manifestly a chancre ulcer which acts vicariously for the internal malady, and which has been produced from within by the organism after it has become venereal through and through, and is able through its touch to communicate also to other men the same miasma; i. Now, if the entire disease thus arising is again extinguished through the internally given specific remedy, then the chancre also is healed and the man recovers.

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