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Erysipelas gangrenosum is most apt to occur in weak and nervous individuals. The inflamed part is of a dark red or livid color; the vesicles are large, and frequently terminate in gangrene; sloughing of the cellular tissue takes place, producing sinuses filled with an unhealthy, ill-conditioned pus; and the accompanying fever is very prone to assume a typhoid character, attended by low delirium during the greater part of its course.
In addition to the foregoing there is yet another variety of this disease, which is denominated
Erysipelas neanatorum.—It occurs soon after birth, and is of an obstinate and dangerous character. The inflammation commences on the lower part of the body, about the genitals and umbilicus, and gradually spreads over the abdomen, along the back and inside of the thighs. It first appears in small red spots, which spread irregularly over the adjacent skin; the parts affected swell, are extremely tender to the touch, and become of a dark red or purplish hue; vesicles appear with inflamed bases, which rapidly tend to gangrene. There are many symptoms noted by some, as attendants, or as forming the group in this affection, such as frequent, painful, alvine evacuations of a grass-green color, constipation, and colicky affections, jaundiced skin, and aptha, which are so very common during early infancy, that I doubt very much, indeed, whether they have anything to do as a part of the diagnosis, with this variety of Erysipelas.
Causes.—The causes of Erysipelas, in many instances, appear to be veiled in obscurity, particularly in cases where there is a constitutional predisposition to it, and it i3 quite common to occur in such constitutions without reference to any special cause. Sometimes there is a peculiar irritability of the skin, whiok upon the slighest wound or bruise, favors its production, and it has also been caused by Turpentine and many of the resinous and balsamic preparations. I have known the most violent Erysipelas of the abdomen to be produced in two or three instances by the internal administration of Balsam Copaiva in large doses.
Dr. Eberle says that "the inflammation which is produced by the Rhus-toxicodendron, is strictly of an erysipelatous character." Cold, suppressed perspiration, the immoderate use of spirituous beverages, and violent mental emotions, together with visceral obstructions are to be classed among the most prominent causes. It does, however, prevail sometimes rather epidemically which would lead us to suppose that it might depend on some miasm, or a peculiar state of the atmosphere.
Treatment.—During the inflammatory stage, when the pulse is tense, tongue dry, thirst, skin dry and burning, with swelling of the affected part. . Aconite.
When the skin is of a bright scarlet or crimson hue, with swelling of the part, pricking, burning, stinging and painful to the touch, or when vesicles are formed.
And especially if headache or delirium be present, Belladonna is unquestionably the best drug.
When the inflammation is confined to the skin and small burning vesicles are formed; the patient complains of dull aching pains, or pains as if the parts were bruised, especially at night. Rhus-tox.
When the erysipelatous inflammation is principally located about the joints, with, swelling and pains greatly aggravated by motion. Bryonia.
When the inflammation shifts from place to place, and the patient experiences an occasional creeping or shuddering chill. Pulsatilla.
And especially if attended with gastric and intestinal derangement.
When there is a dry burning sensation of the lips and throat; the tongue red and dry; urgent thirst for cold drinks; the erysipelatous inflammation terminates in ulcers,with a disposition to gangrene. Arsenicum.
When the inflammation is principally of the face; or it occurs in small red spots on the face, neck and arms; and especially if it terminates in gangrenous blisters.
When the erysipelas is of the phlegmonoid variety; the inflammation extending to the cellular tissue, and symptoms of suppuration supervene, such as beating and throbbing in the part. Belladonna and Silex in alternation.
When it attacks infants; the skin is prone to ulcerate, with pain, burning and smarting; constipation of the bowels, with colicky pain, or a green watery diarrhoea.
If the skin appears rough and unhealthy, with an occasional itching; or continues in an irritable state after the erysipelatous inflammation has subsided. Sulphur.
Many other remedies are recommended for the cure of Erysipelas, such as Carbo-veg., Euphorbium, Phosphorus, and the acids which may prove very serviceable in some instances, but I have never found it necessary to go beyond the remedies enumerated for their respective conditions, viz.: Aconite, Belladonna, Rhus-tox., Bryonia, Pulsatilla, Arsenicum, Lachesis, Silex, Chamomitta, and Sulphur.
Administration.—In severe cases, when the inflammation and attending fever is of a violent grade give the drugs indicated [Aconite and Belladonna) every two hours until there is an amelioration of the symptoms; then every three or four hours, judging from the severity of the symptoms and the efficiency of the drug. When the condition exists that requires the use of Sulphur, (as above expressed,) one or two administrations a day will be quite sufficient.
During the treatment all wet and greasy applications must be strictly avoided. But powdering the part with scorched flour, or covering it with silk oil-cloth will in many instances prove beneficial.
Diet And Regimen.—The diet must be plain, and all seasoned dishes strictly avoided; drinks should consist of black tea or cold water. Take care to shun cold and damp atmospheres.
Cataract, (from the Greek, to confound, or disturb;) is applied to the condition under consideration, because the sight is disturbed. It is a species of blindness arising from an opacity of the crystalline lens, or its capsule, which prevents the rays of light passing to the retina.
It generally commences with a disturbed sight, as if motes or particles of dust were in the eye, or floating before it, which are termed muscae volitantesj and as the opacity increases, the sight becomes less perfect, until it is entirely lost. The cataract may exist sufficiently to impair the vision to a considerable extent, before it can be distinctly observed; but as it becomes more opaque, it seems a little turbid at first, and as its density increases, it appears of a greyish,ash color, or white; the cataract is sometimes hard, soft or fluid, or like curd, of the anterior or posterior layer of the capsule, and sometimes occurs after an operation; these are distinctions sufficient to enable authors to classify many varieties.
Causes.—I have no hesitation in saying that cataract accurs more frequently without any assignable cause than otherwise. But still there are causes which have been known to produce itr such as injuries to the eye from mechanical violence, deep-seated inflammation, the exposure of the eye to intense bright light, or light-reflect