Aconite.-In the earlier stages, when the the neuralgic pain is accompanied by febrile symptoms.
Apis.-Burning and stinging pains with swelling; large vesicles, sometimes confluent; better from cold applications.
Arsen. alb.-Confluent eruption with intense burning of the blisters; worse after midnight, and from cold applications; neuralgia; in debilitated constitutions.
Cantharis.-Large blisters, burning when touched; smarting and stinging; mostly on the right side; worse in the open air.
Cistus.-Zoster on the back;neuralgic symptoms; in scrofulous subjects.
Comocladia.-Zoster on the legs; rheumatic pains aggravated by rest; relieved by motion.
Dulcamara.-Zoster after taking cold from damp air, moist, suppurating eruption; glandular swellings in neighborhood of eruption; eruption precedes the menses.
Graphites.-Zoster on the left side; large blisters from the spine to the umbilicus, burning when touched; worse indoors; better in the open air; dry skin, tendency to ulceration; in blonde individuals inclined to obesity.
Iris vers. -Zoster, especially on the right side; following gastric derangement; pain in the liver; neuralgic pains.
Kali mur.-Zoster;vesicles encircling half of the body like a belt; white tongue
Kalmia lat.-Facial neuralgia remaining after zoster; worse at night; palpitation of the heart; rheumatic pains.
Lachesis.-Zoster during spring and fall; the vesicles turn dark and are very painful; all symptoms are worse after sleep.
Mercurius.-Zoster on the right side, extending across the abdomen;worse at night, from the warmth of the bed; tendency to suppuration; easy perspiration without relief.
Mezereum.-Zoster in old people; constant chilliness; neuralgic pains; worse at 9 p.m.; burning, changing location after scratching; in scrofulous persons.
Natrum mur.-Eruptions occurring through the course of any disease.
Peppermint Oil, when applied locally, rapidly allays the pain of zoster.
Prunus spinosa has succeeded in removing the very troublesome neuralgic pain which often remains when the eruption of shingles has disappeared, by means of Prunus spinosa 30x.
Ranunculus bulb-Zoster aggravated by change of temperature; neuralgic sequels; in rheumatic subjects.
Rhus tox.-Burning and stinging pains aggravated by scratching. Small burning vesicles with redness of the skin; confluent vesicles; worse in cold weather; rheumatic pains during rest; sleeplessness with restless tossing about; zoster brought on by getting wet, while over-heated.
Sempervivum tect-In obstinate cases; may be used internally and locally.
Thuja.-Zoster with eruption only on covered parts; better from gentle rubbing, in individuals of lymphatic temperament.
Zincum.-Neuralgia following zoster; pains relieved by touching the parts; worse after dinner and towards evening.
Zincum Phosphorus-When other remedies fail; following brain-fag in literary persons.
Under this name a number of widely varying diseases have been described and one of the earlier writers, mentions upward of a hundred varieties of the affection. We will confine the name to a single disease, embracing but two varieties-namely, pemphigus vulgaris and pemphigus foliacea.
In Childhood two forms are observed; pemphigus acutus neonatorum, appearing during the first two weeks. The whole body is covered with bullae, some of the size of a hazel nut, and its course usually benign. A second form stands in close relationship to acute exanthemata.
In general pemphigus is characterized as regards eruption by the appearance of little separate blebs, usually grouped in threes or fours, seated upon slightly inflamed bases, which are quickly covered over by the enlarged bullae. These blebs may attain a size varying between that of a pea and hen’s egg. They are distended with fluid, which is at first very transparent, but soon becomes milky. The fluid may be quickly re-absorbed, or the blebs or bullae simply shrivel, the distended globe becoming flaccid. Very often the blebs burst in a few days, and then the contained fluid dries into crusts of lamellar aspect, beneath which is very slight ulceration. The contents are sometimes sanguinolent.
The bullae generally occur in successive crops; they develop in the course of a few hours; their outline is generally round or oval; they may be confluent, but are usually distinct. Now and then a species of false membrane is contained in the bullae. The reaction of the fluid is generally alkaline, but with the turbidity comes acidity. The local symptoms are, slight itching and smarting at the outset, and more or less soreness. The healing, process in pemphigus is sometimes tardy, a thin ichor being secreted by the surface originally blebbed, and so a quasi-impetiginous crust is often produced. In rare cases, in cachectic subjects, sloughing may occur. The disease attacks all parts of the body-but rarely the hand, the palms of the hands, or the soles of the feet. Sometimes the mucous surfaces- for example, the intestines, vagina, etc., are the seat of bullae in pemphigus.
Pemphigus Vulgaris.
This variety is characterized by an eruption of bullae of varying size, some of which may be as large as a pigeon’s egg. They may exist singly or in considerable number, and successive outbreaks may prolong the affection for an indefinite period.
In pemphigus vulgaris the bullae are well distended with a thin, not very plastic fluid, and usually remain intact for several days. Sometimes the fluid is reabsorbed, and the uplifted epidermis applies itself to the skin, with out, however, becoming permanently attached, but exfoliates as soon as a new stratum corneum has formed beneath it.
More frequently, however, the bulla ruptures and becomes detached, leaving a raw and reddened surface, giving rise to a slight serous discharge. This gradually lessens, however, until and newly-formed, horny layer replaces the old.
Solitary bullae may succeed each other at more or less regular intervals, or there may be crops of smaller bullae, appearing weeks or months apart.
The disease may persist unchecked for several years, terminating in spontaneous recovery, or quite frequently ending fatally.
Pemphigus Foliaceus.
In this variety the bullae, instead of being freely distended and tense, are only partly filled with fluid, and are flaccid, and often attain a considerable size. As a rule, they are accompanied with more or less debility and impairment of the vital forces. Contiguous bullae may coalesce, thus forming a large, flat, watery tumor, containing a lymphy exudation. The prognosis of pemphigus Foliaceus is grave, as the majority of cases go on to a fatal termination.
In some instances pemphigus foliaceus is said to begin as a single blister, which continually enlarges until the whole surface of the body is skinned and covered with a brownish crust; it is always fatal.
The causes of pemphigus are involved in obscurity.
Prognosis-The cure is not rapid, but slow; recurrence of the disease is frequent. In old people, where the disease is general, and in children, when there is ulceration, the issue of the case is often unfavorable. The general condition of the patient must be the guide, and in these cases a cautious opinion should always be given.
Diagnosis-Pemphigus can scarcely be confounded with anything else, the bullae are so diagnostic a sign. In eczema of the hands, bullae may be produced secondarily by the confluence of vesicles, but their origin is readily traced, and co-existent eczema is to be found elsewhere. Pemphigus is rare on the hands and fingers, per se. General eczema and P. foliaceus should not be confounded; in the latter abortive bullae are present, the scales are larger and peculiar, and the skin is not infiltrated.
In ecthyma cachecticum the pustules contain bloody fluid; there are no true bullae in the disease; the crusts are also thick and dirty; whilst the ulceration is deep. In rupia, the bullae are smaller and flatter, the contents sanious, the crusts thick, dark, prominent-cockleshell like; the ulceration deep and foul. Pemphigus foliaceus resembles pityriasis rubra; but in the latter there is no history of bullae; the scales are altogether smaller, and they are imbricated in a peculiar manner.
Sometimes in impetigo contagiosa, the bullae become somewhat large, butt they are never distended as in pemphigus, but flat; the contents soon become purulent, and flat yellow scabs form, which are characteristic. The disease is clearly pustular.
Treatment-The patient should be placed on a full animal diet, with plenty of fresh air and exercise. Means must be taken to bring the health up to a normal standard.
Locally, bran, starch or gelatine baths are of decided benefit. The continuous bath, as recommended by Hebra, may be resorted to in some causes.
The old school rely upon quinine, the mineral acids, and arsenic, as internal remedies. They recommend cod-liver oil, combined with either of the above, it is a favorite prescription with many.
Dr. Cooper has cured pemphigoid eruptions, particularly those occurring in the ears, with an ointment of scrophularia nodosa. The same medicine was very useful in bullae surrounded by an inflamed ring.
