Nux vomica- Nose stopped. Cough dry in the evening and loose in the morning.
Phosphorus.- In complication with pneumonia, or typhoid symptoms come on. Violent exhaustive cough with tightness across the chest. Dry cough with vomiting. Hoarseness, and aphonia. Stitching pains in the chest, worse from coughing or breathing.
Pulsatilla.- Inflammation of the eyes and photophobia; thick, yellow discharge from the nose; dryness of the mouth, without thirst; nightly diarrhoea, after previous rumbling in the bowels; rattling, loose cough, with expectoration of thick, yellow mucus; increase of all the symptoms towards evening; chronic, loose cough after measles.
Sticta pulm.- Incessant dry or spasmodic cough, worse in the evening and during the night, with oppression of the chest and feeling as if a hard mass had collected there.
Stramonium.- Sometimes before the eruption there is delirium with frightful visions of rats and mice, from which the patient tries to hide. Spasmodic symptoms in the pharynx and difficulty of swallowing.
Sulphur.- The eruption does not come out and the catarrh becomes continually worse. Violent otalgia with purulent discharge. Chronic after complaints, otorrhoea, diarrhoea.
Veratrum alb.- Eruption develops slowly and is of a pale, livid color. Hemorrhages without relief. Burning heat with alternate cold extremities. Very frequent weak intermittent pulse.
Veratrum vir.- In the early stage with fever and pulmonary congestion. Cough, dyspnoea and pains in the chest. Convulsions preceding the outbreak of the eruption.
Scarlatina.
On the second day of illness the rash appears on the neck and face, and is made up of small red dots, which crowd together, forming patches of various fixed and extent; after a while the whole surface becomes of an uniform hue; on the third day, the eruption is seen on the body generally, the upper extremities, and the mucous surface visible to the eye; on the fourth day, the lower limbs are scarlet, whilst the surface is hot, dry, and harsh. The eruption, which may be called a general efflorescence of boiled lobster color, is most marked about the third or the fourth day, and it is generally more intense in color towards evening, especially in the loins and flexures of joints. On the trunk it is often “patchy.” The eruption fades on the fifth day- first on the face; desquamation follows about the eighth or ninth day.
The diagnosis between scarlatina and rubeola is the only one that requires notice.
In scarlatina the rash appears on the second, in measles on the fourth day after the first onset of symptoms. In scarlatina the rash is bright red (boiled lobster color); it is not crescentic, and it is uniform or not patchy, or associated with intervals of normal integument. In measles the rash is of dull red color, and it takes the form of little crescentic patches, with intermediate lines of healthy skin. The skin in scarlatina is very dry, harsh, and pungent. In measles this is not so marked, not is the subsequent desquamation so distinct or characteristic.
In measles the changes in the mucous membranes are accompanied by secretion; there are coryza, suffusion of conjunctivae-in scarlatina, the mucous surfaces are red, dry, ulcerated; there is also sore throat of marked kind, but this is absent in rubeola. The aspect of the tongue is characteristic in scarlatina, and the pulse is very rapid and irritable.
Erysipelas.
For generations past, the old school has been enunciating learned theories regarding the etiology of this disease. The “status bilious” and the “status saburralis” each had its day. Clogging of the pores of the skin, and consequent accumulation of acridities, which nature should have eliminated; and the theory that some noxious principle from without found entrance in some mysterious manner, each claimed due regard. Simple inflammation on the one hand, and specific inflammation, involving the lymphatics, on the other, have also had their advocates. Thus, most opposite theories have been advanced, have been held for a season, and then have fallen again into disrepute. It appears quite probable that some microgerm may be the abnormal excitant, it serving as the agent through which the perverting force is enabled to act upon the vital dynamis. However, the observations of different investigators are not in harmony.
Erysipelas is an acute febrile disease, characterized by a peculiar inflammation of the skin and enlargement of the neighboring lymph-glands, which is accompanied by more or less severe general symptoms. It is contagious and inoculable, and arises spontaneously under conditions not accurately determined; in the latter case it is called idiopathic. When spreading by its own contagion, which diffuses itself through the air or is carried by linen or instruments previously used for dressing patients with erysipelas, or by flies-it is called Traumatic, and is mostly found in the surgical wards of hospitals. As the slightest scratch may be the recipient of the poison, the disease is often communicated to nurses and physicians. DaCosta found that the idiopathic form was almost invariably attended by albuminuria, which in the traumatic from was either absent or present only in a decidedly less marked degree.
Erysipelas affects the skin in its whole thickness and the subcutaneous cellular tissue. All the layers of the corium and of the subcutaneous cellular tissue are edematous, swollen, and penetrated by large, finely granulated, white blood-corpuscles. The most important distinctive feature of erysipelas is its disposition to spread only by creeping uninterruptedly onwards without making jumps; it spreads like water in blotting paper. When on the scalp or face it is limited mostly to a more or less extensive portion of the skin of the head and face, and seldom descends over the neck to the trunk; on other parts of the body it is apt to spread over larger surfaces.
The local symptoms are frequently preceded a day or two by a feeling of general malaise, chilliness and feverishness. Then the part affected begins to feel hot and tense; the skin reddens and swells, and becomes very sensitive to the touch. At the same time the adjacent lymphatic glands commence to swell. This inflamed portion assumes a red, smooth and shiny appearance, which is, however, darker and duller on the scalp than on other parts, and to the touch it gives the impression of a hard, stiff, caked mass. The inflammation gradually creeps on until it reaches from side to side of the scalp, down into the face, and even to the neck and shoulders.
On the second or third day, generally, the redness and swelling reach their height, and, at this stage, in some cases, the epidermis becomes raised and filled with a yellowish, limpid fluid, sometimes tinged with blood, in the shape of large blister-Erysipelas bullosum-which either dry up, or burst and become covered with crusts.
During the height of the disease, the patient has high fever, with evening aggravations; his sleep is restless and full of dreams; he sometimes becomes delirious. On the fourth day the redness and swelling gradually subside on the places first attacked; while those parts which were invaded later stand yet in full bloom. By and by, however, they grow paler, softer, and assume a wrinkled appearance, as the swelling leaves; the crusts dry off, and on the whole surface the epidermis peels off in large flakes; the entire process lasting from about eight days to two weeks.
But this is not invariably its course. Just in its very nature to creep on lies its danger. It may, by continuity of tissue, wander to the mucous membrane of the nasal and pharyngeal cavities, cause and oedema of the glottis, and affect the larynx, the bronchial tubes, and even produce pneumonia and pleuro- pericarditis.
The tongue usually is covered with a white creamy coat, which dries gradually, becomes dirty yellow and, when the fever is protracted, blackish and crust-like; there is nausea and vomiting; sometimes diarrhoea and, what seems very remarkable, in rare cases profuse intestinal hemorrhage, in consequence of ulcers in the duodenum, which generally have proved fatal, and remind one of similar symptoms which are occasionally observed after severe burns of the skin. In almost all idiopathic cases there is albuminuria. The fever, accompanying erysipelas, is characterized by a sudden rise of the temperature to even 104 degree F., or higher often within from eight to twelve hours, still rising, in some cases, to 107.6 degree F. When recovery approaches, it usually sinks as rapidly as it rose, and may attain its normal standard within a few hours, or in a single night; then desquamation of the epidermis, in the form of large or branny scales, and wrinkling of the skin terminate the local process. The hair usually falls out, but quickly grows again. The skin, too, recovers its normal state; only upon the eyelids, the scrotum, the prepuce and vulva, where it is naturally tender, it may in severe cases undergo a more or less extensive gangrenous destruction, and its duration be prolonged to several weeks, even months.
