Lecture delivered at the Post-Graduate School of the A.H. for H., July 1930. Also read before the Conn. Homoeopathic Medical. Society, Oct. 21, 1930.
H.A. ROBERTS, M.D.
This paper deals only with the homoeopathic treatment of erysipelas. You all know the etiology, the pathology, and you can find in medical books the prognosis and treatment.
It is my understanding practice not to use any local treatment for erysipelas, except occasionally to place over the affected area a soft cloth wrung out of normal saline solution. This relieves somewhat the tension caused by the dryness that is so marked in some cases. This is the only adjuvant that is ever necessary; as for using anything else, it is not to be thought of nor to be tolerated for one minute.
In the homoeopathic treatment of erysipelas we have a very rich field of remedies, and remedies that control the condition promptly and effectively. The cases that come to us call distinctly for the indicated remedy, and almost always for some one of the major deep-acting remedies; for we must remember that this is a sudden eruption of the psoric base.
Erysipelas is so common a condition and there are so many fatalities among those who suffer from the disease that it may be well to point out some of the more prominent remedies that every physician may have occasion to use, and to indicate some of the striking characteristics for the use of each individual remedy for individual cases. In the treatment of erysipelas, as in the treatment of all other conditions, we must bear in mind that it is in the individualizing of each case, and not in the typing of them, that we get satisfactory results. It is well to bear in mind also that under homoeopathic treatment the mortality should be nil, as it is very rarely that a case would end fatally.
The first remedy that I call to your attention is Apis. The patient is usually dull mentally, heavy and listless. There is a hot, heavy feeling in the head, together with a severe headache. The swelling is usually across the nose, which becomes very red, with coldness of the tip of the nose, as the throat begins to be sore. The swelling is intensely red, perfectly smooth and shining, inclining to be white in the middle of the swelling, and excessively sensitive to touch.
The oedematous condition extends very often to the face, to the eyelids and under the eyes, often closing the eyes. It has a marked periodicity, and is very prone to recurrence. It goes form left to right. The constant sharp, stabbing, piercing pains that are so characteristic of Apis are manifested in this condition by the violent stabbing pains that cause the patient to cry out. This patient has intense fever, but with the fever there is no thirst. There is apt to be some kidney involvement in these condition calling for Apis, especially albumen in the urine.
Another remedy to be thought of in phlegmonous erysipelatous conditions, where there is a formation of large bullae, with extreme tenderness and soreness, is Arnica. The swelling is hot, hard and shining, even to a deep red, with a tendency for it to break down and discharge and burrow. Constitutionally, everything is lame and sore. The bed is hard. Arnica represents a low type of fever, characterized especially by the lameness and soreness of the patient. He feels as though he had been beaten all over, notwithstanding that the erysipelatous manifestation are usually in the face. This is a remedy to be thought of in cases that have developed erysipelatous swellings from injuries and bruises.
In the Belladonna patient intensity is noticed in the whole remedy. In the mental symptoms we get the characteristic excitable delirium of Belladonna. There is intense erysipelatous swelling, smooth and shining, and it spreads in streaks darting out from a central point, forming radii. There is very high fever; a great deal of thirst, with dry tongue and parched mouth. There are intense throbbing, beating headaches. The pupils are dilated. He is excessively sensitive to light and to jars, and they aggravate. The sense of touch to the part affected is that of intense heat and burning; in fact, burning is one of the characteristic sensations.
The Cantharis erysipelatous condition has the swelling beginning on the dorsum of the nose, spreading to both cheeks, but more to the right. The inflammation is vesicular, and these vesicles break down and discharge an excoriating fluid. Cantharis acts very quickly, and on the skin it causes an intense blister.
The condition calling for this remedy has the characteristic sensations of fine stinging and burning, as of a fly blister. The pains are burning internally as well as externally. The patient wears an expression of deep-seated suffering. He evinces a great deal of irritability and anxious restlessness, and in some cases there is even cursing, with the restlessness and burning.
The Cantharis patient has an unquenchable thirst, with aversion to all fluids. He drinks and drinks without relief, until he becomes disgusted. There is very apt to be an involvement of the kidneys in these Cantharis conditions. This remedy corresponds to a typhoid type of erysipelas, and these vesicles mat and form great scabs; and if they are not properly cared for they will leave disfiguring scars.
Another of our remedies having the intense vesicular eruption is Graphites. This is more apt to be called for in a recurring type of erysipelas, beginning on the nose; it has a very sticky, honey-like serum in the vesicles, which break and form a gummy scab. There is great burning and tingling, and it spreads over the whole face and head, especially the hairy parts of the head, going from right to left. There is the disposition of this phlegmonous type of erysipelas to continually return. The lymphatics are involved; the glands enlarge and become indurated. There is a peculiar sensation as if something like a cobweb was over the face, and this troubles the patient very much and he continually tries to rub it off.
Still another remedy having this vesicular type of erysipelas is Euphorbium. It has very dark red cheeks, which are covered with large yellow vesicles, sometimes as large as peas. The cheeks are a livid, dark hue, with threatening gangrene. The pains are boring, gnawing, digging, extending into the teeth and into the ear, with itching and crawling. This remedy is especially applicable in erysipelatous conditions of the mouth. This is a thirstless remedy, vying with Apis in this respect, although it is not at all like Apis in other respects.
Lachesis is another great remedy in erysipelatous swellings especially of the left side. At first the color is bright red, then becomes a dark purplish hue. There is much inflammation of the cellular tissue. The eyes are often closed by the swelling. There is a low muttering delirium, yet there is a great deal of loquacity. The headache is very intense , and all the conditions are aggravated in sleep, causing the patient to waken with a start. Lachesis is likewise a valuable remedy with this cellular involvement in any part of the body, with the great aggravation from sleep and the horrible dreams that are always present where Lachesis is indicated.
The Rhus tox. erysipelas may be covered with small vesicles, or with the larger blebs that are filled with bloody serum. In this condition the swelling usually begins on the left side of the face and spreads to the right. There is itching, especially on the hairy parts, and stinging and burning pains. The patient persists in scratching the parts, which aggravates the burning.
There is great swelling and dusky redness of the face that rapidly affects the cellular tissue to the point where the eyes are closed. There is a bruised feeling in the bones, something like that of the Arnica patient. These local symptoms are somewhat relieved by hot applications, but in general they are aggravated by heat.
In Hydrastis we have an erratic form of erysipelas, which begins on the left side of the face and extends to the right ear and especially to the scalp, with intense lumbar pains; then it appears again in the lower extremities.
These are but a few of the remedies that may be called for. Let us think of some of the characteristic groups that may be thought of, without going deeply into their symptoms, merely as suggestions.
In the erysipelas of old people with with a tendency to gangrenous conditions, think of Ammonium carb. In erysipelas of the lower limbs and joints, bear in mind Arsenicum. In erysipelas of the joints where there is sudden recession of the eruption, bear in mind Bryonia. In cases that are directly traceable to bites of insects, think of Ledum.
In the oedematous type, consider Arsenicum, Apis, Rhus and Sulphur. In the vesicular type, Arsenicum, Graphites, Lachesis, Rhus and Sulphur.
In the gangrenous type, think of Arsenicum, Carbo veg., Lachesis, Camphor, China, Rhus, Secale, Silica. In the erratic type, Arnica, Belladonna, Manganum, Pulsatilla, Hydrastis, Sulphur.
On the face, Belladonna, Graphites Lachesis, Rhus, Apis, Carbo animals, Hepar, Pulsatilla, Sulphur, On the hairy parts, Arnica, Arsenicum, Belladonna, Graphites, Hepar, Rhus, Sulphur. Erysipelas of the ears, Lachesis and Mephitis. Of the nose, Cantharis, Graphites, Plumbum. Of the mammae, Chamomilla, Carbo an., Phosphorus, Sulphur. Of the genital organs, Carbo veg., Mercury, Sulphur, Sepia, Belladonna, Cantharis.
On the body or trunk, Arsenicum, Graphites, Mercury, Pulsatilla, Rhus. On the extremities, Borax, Calcarea, Graphites, Hepar, Petroleum, Phosphorus, Rhus, Zincum. In cases that have a tendency for metastasis to the brain, think of Apis, Belladonna, Hyoscyamus, Stramonium.
It is well to bear in mind that the Belladonna swelling is bright red; the Rhus is dark red; the Apis a pinkish rosy hue,with oedema, white in the center; the Lachesis is a dark bluish black.
With these few suggestions in mind, you will find other cases that will call for other remedies not mentioned here, but they will do your mans duty. Erysipelas is one of the conditions where homoeopathy shines, not by reflected light, but by its own guiding illuminating radiance. DERBY, CONN.
“The more prominent, uncommon and peculiar (Characteristic) features of the case are especially and almost exclusively considered and noted.” For these in particular should bear the closest similitude to the symptoms of the medicine. The more general and indefinite symptoms, such as want of appetite, headache, weakness, restless sleep, distress, etc., unless more closely defined, deserve but little notice because of their vagueness, and because such generalities are common to every disease and to almost every drug.-D.S. KISTLER, M.D., 1895.