Geni epidemicus
of Necrotising Fascitis.
Many Necrotising Fascitis cases are caused by MRSA.
[Jacqueline Smith]
The aim of this review has been realised, in that, by utilising
homeopathic methodology, the genus epidemicus has
been identified and subsequently six main remedies considered as being
appropriate for treatment of the documented stages of the disease process from
inflammation through to necrosis in susceptible individuals. The information
reviewed concerns both the accepted theory and practice of treatment of the
disease process in N.F. which can result in states of inflammation,
suppuration, gangrene or finally necrosis as a consequence of puncture wounds
(caused by drug injection), repeated over time or infected by an exogenous
pathogen in those with a compromised immune system (C.I.S.), and the theory and
practice in homoeopathy for treatment of similar states, with similar causes.
This paper supports the assertion that homoeopathic treatment is a viable
alternative when antibiotics are proving ineffective.
AIM
To identify a group of appropriate homoeopathic medicines, which can
potentially be used in threatening or actual suppuration in abscesses and
necrosis of same or other local sites, in susceptible individuals. In this
review I consider particularly those of homeless status who are also
intravenous drug users (especially of heroin).
To discuss risk factors which
predispose some individuals to a lowered immune system who are therefore more
susceptible to developing or contracting Necrotising Fasciitis (N.F.)
To examine details of
documented and possible bacteria involved in the process of suppuration leading
to necrosis.
To consider relevant
homoeopathic philosophy in relation to susceptibility, maintaining causes, and
predisposition.
To outline the disease process
involved which may lead in some individuals, to developing N.F.
To present a resume of
individualised homoeopathic remedies potentially suitable for use in all stages
of the disease process outlined in Objective Four.
Background
In June 2000, 22 drug users in Scotland and 21 between Dublin and
Manchester, died after contracting (or developing) Necrotising Fasciitis, and
again in July 2001 eight individuals were affected, either fatally or requiring
surgical debridement and/or partial amputation. These cases were thought to be
the result of using contaminated heroin for injecting in cases of drug
addiction. The condition itself is described as “… a rapidly progressive
soft-tissue infection that involves superficial and deep fascia leading to
thrombosis of cutaneous vessels and gangrene of
underlying tissues.” It was first
documented by Fournier in 1883 (4), and Meleney
isolated a particular bacteria as a causative factor in 1924. The term
‘necrotising fasciitis’ was ascribed to Wilson, who, in 1952, noted that an
“essential component” of gangrene with a specific bacteria, involved the deep
fascia. The condition can occur in any anatomical location, usually at a
distance from any trauma but also at affected sites. Other names that it is
known by e.g. Fournier’s Gangrene (genital), Meleney’s
Ulcer or Hospital Gangrene etc., often indicate either anatomical sites or
places where infection was contracted
or developed. Conventional therapy involves antimicrobial treatment with
e.g. Penicillin, aminoglycoside, metronidazole
etc. and Hyperbaric Oxygen Therapy (HBO) and surgical excision, including
debridement and amputation when considered necessary.
Necrotizing fasciitis left leg
There are several factors, which are conventionally regarded as leading
to possible susceptibility in contracting or developing N.F. The greatest of
these is that of having a ‘compromised’ immune system, which is noted in
conditions such as; Diabetes Mellitus, malignancy, renal impairment and trauma.
In this discussion, which is intent on reviewing the specific factors in
relation to the circumstances of intravenous drug users who may be homeless,
two of the above noted conditions are worthy of further exploration. In the
first instance, similar to Diabetes Mellitus II, where a state of ketosis may
develop due to the inability of the body to utilise carbohydrates and glucose,
it is worth pointing out that it is also possible for ketosis to develop in
states of starvation or eating disorders. The result being, that fats and
proteins become the primary energy sources, which may produce ketones in the blood, and thereby lead to ketoacidosis. In the report of a survey carried out in 1999
by the Office of National Statistics titled, ‘Health and Well Being of Homeless
People in Glasgow’ published in June 2000,
“19% of respondents had eaten only once in the day prior to interview
and 5% had not consumed any food at all. 15% of respondents did not consume any
hot food (excluding drinks) in the day prior to interview.”
It would seem probable that in such circumstances, it would be possible
for heroin addicts who are also of homeless status to be at similar risk to
developing a condition akin to ketoacidosis, which
may also result in renal damage. In addition, it is well known that nutritional
deficiencies play a decisive role in the prevalence and severity of microbial
diseases in under privileged people. The rate of wound healing is also markedly
influenced by dietary factors especially in deficiencies of some vitamins
including Vitamins C, E, K, B6 and Minerals such as Calcium and Iron.
The citing of ‘trauma’, as a further risk factor is particularly apt in
the present examination of the incidence of N.F. in intravenous drug users.
‘Trauma’, here being defined as: “…any injury caused by a mechanical or
physical agent.”
Heroin addiction most often requires the use of intravenous means
whereby the subjects repeatedly inject the drug, causing puncture wounds, often
several times daily for, perhaps, a duration of some years, with little or any
use of disinfecting measures. Thus creating a higher than usual risk of
infection at multiple sites, most often on arms and legs but the groin area is
also used amongst others, as more accessible veins become unusable.
In the outbreaks of N.F. documented here, this is all the more relevant,
for it has been discovered that all the cases had a significant factor, i.e.
the injection has been made directly into muscle tissue or accidentally into
other tissues when a vein has been missed. This assertion also brings to bear
the immune inhibiting effects of drugs themselves as a risk factor to infection
which include non-steroidal inflammatory preparations such as aspirin,
ibuprofen, naproxen etc. that inhibit the inflammatory mechanism that makes
tissue repair possible. Steroid use is particularly implicated, possibly due to
the fact that cortisone interferes with the production of antibodies under
certain conditions.
This immunologic inhibition cannot account entirely for the infection
enhancing effect. In addition to interfering with antibody production,
cortisone influences many other physiologic processes, some of which may affect
directly or indirectly the response of the body to infection. Interference with
the inflammatory response and with the activity of the reticulo-endothelial
system, disturbance of the intermediary metabolism, and activation of proteo-lyctic enzymes are but a few of the effects of
cortisone that might be important in this regard.
The habitual use of heroin, (the popular name of diacetyl-morphine,
a semi- synthetic compound derived from morphine and stronger than the natural
drug), which has its effects principally on the Central Nervous System (CNS)
and also affects some peripheral organs such as the alimentary tract and the
respiratory system, is a definite factor in compromising the immune system.
Morphine usually neither eliminates the psychological perception of pain nor
blocks the sensation. Although there are exceptions, the person knows that pain
continues, but he or she is not disturbed by it. The associated fear and
tension subside so that the pain becomes bearable. These reactions signify the
effects on the CNS but the opiates may also change the activity of peripheral
nerves that conduct messages to and from the brain. The enkephalins
involved are found in neurons in the spinal cord and portions of the hind and
mid-brain which transmit pain and related sensory signals (for example, heat
and cold), and in parts of the mid-brain associated with movement, mood and
behaviour. The enkephalins are also found outside the
central nervous system in the neurons
of the periphery and the gut. These effects have relevance in two areas in
connection with this investigation: the fact that the addict despite feeling
hunger is able to ignore these feelings. This can result in the production of
acids
in the gut which having no food to breakdown will tend to become
destructive to the alimentary tract itself. The other danger is that by being
able to ignore sensations of heat, pain and even fear for health, any
inflammation, abscess formation or numbness can continue unabated.
In the past, several types of bacteria have been identified as being
involved in the presentation of N.F. On this basis, two types of N.F. had been
labelled, i.e. i) Polymicrobial,
involving a number of organisms in various combinations and ii) Pure group A
Streptococcal, which is said to be haemolytic, (rupture of RBC membrane). In
direct relation to the cited outbreaks, Clostridiun Novyi Type A among others, was isolated from 18 of the
people who developed N.F. in June 2000. Some of these bacteria are known as
being indigenous (ie. present in a healthy state) to
the human body, e.g. Bacteroides, Staphylocci,
Streptococci, Pseudomonas aeruginosa, Clostridium
etc.
Two aspects are known to be observable concerning these micro-biota:
That most micro-organisms
commonly harboured by the body in a state of health are capable of exerting a
wide range of pathological effects under special conditions and,
Many of the micro-organisms
classified as pathogens, indeed probably all of them, often persist in vivo
without causing overt disease.
As has been previously noted, nutritional deficiencies, exposure to
toxic agents, and certain kinds of physiological stress are among the many
causes of disturbances associated with disease processes caused by indigenous microbiota.
In other words, some form of pathological or at least abnormal state
must exist before indigenous bacteria can multiply to such an extent that it
causes deleterious effects. George Bernard Shaw echoed Pasteur who suggested
that a physiological disturbance might in certain cases be the primary cause of
the infectious process rather than its consequence, when he said: “The
characteristic microbe of a disease might be a symptom instead of a cause.”
Early in the investigations of 2000, Dr Laurence Gruer,
Consultant to the Greater Glasgow Health Board commented that:
“It is quite possible that no single cause for the illnesses will be
identified. Many injectors in the affected areas of Glasgow have said that
their recent supply of heroin has required unusually large amounts of citric
acid to be added before it can be dissolved for injecting. A variety of
different bacteria normally found on the skin have been isolated from tissue or
blood from several patients. It is likely that injection of the unusually
strong heroin and acid mixture can cause severe damage to muscle and other
tissue. This may then create the conditions for harmless bacteria present in
heroin or carried on the needle from the skin to cause serious infection.”
Clostridium Novyi, Type A, was isolated in
some, though not all, recent or current cases of N.F. at the time and described
as an “…’anaerobic’ bacteria-that is, they only grow in the absence of oxygen
(dead tissue). Some Clostridium can not only cause severe infection in damaged
tissue but can also produce very powerful toxins. They can also exist in for
years in dust or soil as dormant spores, only becoming activated when the
conditions are right.” But it was only previously been known to cause serious
infection in domestic animals; very rarely in humans and is commonly found in
soil and animal faeces. Other types of Clostridium have been located in
intestinal flora of the human where it is non-spore forming.
It is therefore a matter of postulating whether the Clostridium isolated
in the cases cited, is the actual cause originating in contaminated heroin
supplies and therefore exogenous. In classical infections of exogenous origin,
the determining etiological event of the disease is said to be exposure to the
infective micro-organism. This was yet to be made clear in the present
situation. The author has been unable to locate documentation on this
particular strain of Clostridium (ie. Novyi) in standard textbooks on microbiology and this
raises two questions:
In which conditions, if any,
has it been previously been isolated?
Or, is it a possible new
mutation arising from this particular combination of factors met in this
incidence of drug injectors?
In indigenous microbial disease, the immediate cause is the
environmental factors that upset the biological equilibrium normally existing
between the host and the microbial agents.The
documented factors common to many (but not all) of the affected were:
They are all Heroin Injectors,
whose supply source may or may not have been the same.
Many, if not all, used more
Citric Acid than usual to dissolve the drug for injection.
The subjects all injected into
muscle or tissue other than a vein.
If the source of supplied heroin was the same and all users of this
supply increased the quantity of Citric Acid – plus the involvement of the injection
into muscle and other connective tissue, (which is not particularly uncommon in
heroin addicts), not all heroin injectors likely to have used this batch of the
drug under these circumstances, have succumbed to either infection or
development of N.F. It would have to be considered somewhat as a result of this
combination of factors or it would suggest another unidentified predisposing
factor. Dr. Jai Lingappa, Epidemic Investigation
Officer at the Centers for Disease Control in
Atlanta, commented that:
“A lot more work still needs to be done to clarify how exactly the
Clostridium Novyi is contributing to the illness. We
also want to learn more about why these people became sick and others didn’t.”
Miasmen.:
Even from the viewpoint of conventional medicine, a person in robust
health may easily resist exposure to even the most virulent microorganisms. The
degree of resistance can change from hour to hour and day to day depending
upon exhaustion, starvation, cold, overwork, emotional stress, etc. It
has been stated clearly in a standard textbook on microbiology used in all
universities and medical schools in the U.S., that the susceptibility factor is
so significant that it is virtually impossible to decide the infective dose of
a specific microorganism. In the cited cases of those developing N.F., this
study has identified at least some of the major factors related to increased
susceptibility to developing a seriously life threatening infectious disease
and this is further explained in Homoeopathic philosophy by considering not
just the ‘compromised’ immune system but by also considering the effects on the
Defence Mechanism of the human organism. This defence mechanism is known in
homeopathy as the Vital Force and is considered in terms of electro-dynamic
vibrations, which involves a great degree of complexity.
“The vital force level of the human organism is considered the dynamic
plane, affecting all levels of the being at once with varying degrees of
harmony and strength. It is a highly complex, fluid, flexible, and energetic
process, simultaneously responding to and affecting the surrounding
environment……The whole organism, and any component of it, can be strengthened
or weakened depending upon the degree of harmony, resonance, and force of the morbific or therapeutic influence applied to it.”
When the strength of a noxious trigger is stronger than the strength of
the vital force, the defence mechanism is called into play to counteract the
stimulus. If the vital force is so weakened by exciting and maintaining causes,
any powerful noxious trigger would alter the state of the entire organism
without adequate defence, and death would rapidly ensue. There is a latent
period before actual symptoms develop, during which the defence mechanism
begins
to adjust to the effect of the stimulus. In bacterial infections this
ranges from hours to days.
From this premise it should be clear that disease is a result of a morbific stimulus which resonates with the particular
susceptibility of the organism. This stimulus is known as the exciting cause
and may be a microorganism, a foreign chemical, an emotional shock, a
vaccination, etc.
Maintaining causes are those factors external to the organism which,
because they continue to affect the individual over a period of time, maintain
the individual in a weakened state eg. Lack of
nutrition, unsanitary or damp living conditions, drug addiction; conventional
drugs prescribed for long periods or repeated often in short periods of time
(also regarded as Iatrogenic miasms), repeated
emotional trauma, in short, many of the factors previously mentioned. But yet, the predisposition underlying much
of these areas of susceptibility is the Fundamental Cause.
“Useful to the physician in assisting him to cure, are the particulars
of the most probable exciting cause of the acute disease, as also (are) the
most significant points in the whole history of the chronic disease to enable
him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical
constitution of the patient, his moral and intellectual character, his
occupation, mode of living and habits, his social and domestic relations, his
age,… etc., are to be taken into consideration.” (Para. 5, The Organon of Medicine, Samuel Hahnemann, 5th & 6th
Edition, B.Jain Pub. Reprint 1992)
The theory of Chronic Miasms is complex and
involved and it is not within the scope of this review to give a full
explanation of such. (Please see Bibliography section for further study). In
summary, it is sufficient to say that a miasm is a
resulting stereotypical disease condition, sometimes heredotransmissable,
which can be latent or active, acute or chronic. Nevertheless, it is always the
result of both a maintaining cause (hence the lingering disposition) and an exopathic exciting cause (the noxious trigger).
There is one miasmatic pattern, relevant to
this review that has been recognised for most of Homoeopathy’s history ie., the Luetic Miasm. This particular pattern is in essence one of
destruction and disintegration. There will often be a predilection in the
family history to similar patterns of destructive illnesses, eg. Syphilis, alcoholism, conditions where ulceration has
taken place or a tendency
to necrosis, etc. When active and predominant in an individual, this
pattern will taint and distort expression at all levels, mental, emotional and
physical. In the individuals involved in the outbreaks
of N.F. cited , the destructive pattern is essentially seen in addictive
habits concerning the use of heroin and often several other substances. There
exists a craving for acidic or spicy foods in general, there is a metabolic
tendency to acidity and they are often of a temperament conducive to states of
rage; that is when not suppressed by drugs. The effects of this pattern whereby
heroin addiction is a symptom result in destruction not only of the immune
system and particular bodily organs and systems e.g. the heart and circulatory
system, but as noted, affects the intellectual faculties, the emotional
responses and subsequent behaviour destroys family and social contact.
With regard to the ‘contagious principle’, Hahnemann, (1755-1843,
founder of Homoeopathy), though not having the benefit of a microscope, put
forward an uncannily accurate explanation more than half a century ahead of
Robert Koch and others. He suggested in 1832 (Lesser Writings, p.758) that
cholera, for instance, was caused by “…an enormous …brood of excessively
minute, living creatures.”
He also regarded each epidemic (acute miasm)
as having features of its own (the genus epidemicus)
And since it is always the product of a single cause it will, in all individual
cases, be amenable to one and the same specific remedy, the epidemic’s simillimum.
The Disease or better Illness:
In this section, the disease process taken into account is that which
begins, for our purposes, from the available information on the circumstances
and states of individuals who were involved in cited presentations of actual or
threatening N.F.
They are individuals who are:
Intravenous Drug users i.e.,
heroin injectors;
Experience a chaotic
lifestyle, which often includes bouts of homelessness.
Deaths predominantly in
females.
In the first assertion, two factors are particularly important:
1a). Lowered Immune System due to chronic heroin use (poisoning);
1b). Bodily subjected to repeated trauma from puncture wounds.
In the second assertion, two factors are again considered of import:
2a). Immune system further compromised by chaotic lifestyle, especially
during times of homelessness, resulting in:
Reduced
intake of adequate food and nutrition.
Exposure to the elements.
2b). Less access to medical services when required, unless in an
emergency.
This information provides some clues to the degree of susceptibility at
the general level of health and the particular susceptibility at the physical
sites by repeated trauma and risk of infection.
DISEASE and DRUG ACTION in HOMOEOPATHIC CONGRUITY
Applied therapeutic science requires a coincident parallelism between
the symptom complexes of both the disease and the drug of choice on as many of
the first seven under-mentioned points of comparison as possible. Obvious
incongruity in any comparative aspect frequently amounts to symptom
dissimilarity in the case, allowing for the elimination of many otherwise
eligible remedies, facilitating the process of repertorisation.
1. Generic Similarity
Homoeopathicity of type of affliction; describes
the identity in the class of affections induced by both the natural disease of
the patient and the experimental disease of the drug to be used: eg. I) if the illness is febrile, the remedy must be pyrogenetic; ii) if the disease is an inflammation, the
drug of choice will be an irritant, etc.
Causal Similarity
Homoeopathicity of formative affectors;
means that the antecedent concomitants present when the disease arises will
substantially narrow the field of contenders among drugs to be used: eg. I) neuralgia induced by injury to a nerve is different
from one brought on by shingles and that again is also distinct from one that
comes on with gout.
Parallels in Symptom
Modalities
Homoeopathicity of modalities. Meteorological and
thermal influences, cosmic rhythms, mental factors, physical conditions
(including movements and rest), relation to food and drink, location,
laterality and time are circumstances that can contribute to making symptoms I)
better or ii) worse, iii) appear or iv) change.
Symptom Character Resemblance
Homoeopathicity in the quality of abnormal
sensations. All sensations have a distinct character: for instance, a gnawing
pain, a burning pain, a tearing pain etc. are distinctly different from each
other. The character of such sensations are to be alike in both the disease and
the drug action.
Constitutional Compatibility
This describes the aggregate of patients’ common features. It is used to
identify patients according to their temperament, appearance, certain
characteristics of behaviour and their variance from the normal, which should
be compatible with the corresponding remedy.
Synchronicity of Symptom
Evolution
Homoeopathicity of pharmocodynamic
devolution; meaning that various developmental aspects of the disease process
of the patient must synchronise with the developmental pathogenicity
inherent in the drug to be applied.
Concordance of Emotional
Symptoms
Homoeopathicity of disposition; matching emotional
and/ or the intellectual symptoms. Since mental and emotional symptoms are in
evidence well ahead of functional and morphological changes when disease
develops, they frequently provide very early indications for homoeopathic
treatment.
Matching of Three or More
Guiding Symptoms
Multiples of semiological homoeopathicity.
Reliance on the coincidence of three, but preferably more, striking symptoms,
evident in both the artificial illness of a drug as well as in the phenomena of
a disease, rests on the mathematical law of permutations. If three distinctive
symptoms of a case can be found to have been experimentally produced by a
medicine, there is already considerable likelihood of its acting on the same parts
and in the same manner.
Ranking
Many homoeopaths are guided by Robert Gibson Miller, who in 1910
proposed ranking the above points of comparison in the following order of
priority:
matching mental &
emotional symptoms;
correspondence between
modalities of time, season, motion, locality, sensation etc.
similarity of pronounced
cravings and aversions;
menstrual, or hormone-related,
changes in state in both the natural and the artificial diseases;
resemblance between the
particulars as well as the generals of both diseases, where only the peculiar,
unexpected, striking or unaccountable symptoms are of significance;
common symptoms, as featured
in standard non-homoeopathic disease classifications.
The Simillimum is the medicine, which in its
manifestations most clearly reflects the total symptom picture of the
individual’s diseased state, which will certainly cure that patient, if the
patient’s condition is within reversible limits. (28) In relation to the
symptoms available from the documentation in the author’s possession, which
have little or no individuality, it is less likely that the most accurate simillimum will be found. But as will be explained, it is
not always the best remedy to prescribe even if it were possible (ie, by taking information from those who are displaying
symptoms associated with the recent outbreak or who are thought to be at
greatest risk.)
Contra-indication Against Administering Simillimum
In a patient, whose disease is terminal and which may be in its final
stages, namely where the life force is hopelessly overwhelmed by the forces of
disease, or in many emergencies, it is absolutely contra-indicated to prescribe
the individual’s simillimum, which would, in these
circumstances, only be able to produce an aggravation hastening death. In such
an instance functiotropic, organotropic
or pathotropic remedies ought to be the homoeopathic
drugs of choice, with the intention of inducing a measure of improvement for
the limited period remaining to the patient. Therefore, the remedies identified
by using predominantly common, general and particular symptoms which have no
modalities, will be sufficient when given at the appropriate phase in the
disease process and may reflect more the nature of the Genus Epidemicus rather than the simillimum
of the individual patient.
Finding the Genus epidemicus
Although, it is not as yet possible to find, or would in some cases be
inappropriate to utilise the simillimum, many of the
above mentioned principles will still be employed to find the remedy or
remedies that come closest to the picture of the genus epidemicus.
This means that, depending on at which stage of the disease process the remedy
is administered, there is a possibility of preventing the development of N.F.
or reducing the effects of infection before it reaches a life threatening degree.Symptoms will be taken from all general and
particular disease processes outlined above:
Repertorisation using Synthesis (R.H.S.) Edition
5.2 Edit. Dr. Frederick Shroyens
GENERALS:
Wounds:
1. Penetrating (Punctured) +.Stab wounds. Synth.Pg.1720. APIS. Arn. Carb-v. Cic.
Hep. HYPER. lach. LED. Nit-ac. sil.
sulph.
2. Bluish + Black. Synth. Pg.1719. Apis. China. LACH.
3. Suppurating. Synth. Pg 1720. Arn. asaf. Bell. Calc. Calen. Cham.Chin. Hep Lach. Led. Merc. Sil. Sulph
4. Dissecting. Synth. Pg.1719. Anthraci. Apis. Ars. kreos. Lach.
Led. Pyrog.
5. Gangrene of. Synth. Pg.1719. Anthraci. ARS. Bell. Calen. Carb-v. China. LACH. sil.vip.
Inflammation:
6. Wounds. Synth. Pg.1619. Arn.
hyper. lach. led. sulph.
7. Gangrenous. Synth. Pg.1618. ARS. bapt. Carb-v. hep. Iod. kreos. LACH. merc. Phos .SIL
Abscesses:
8. To abort. Synth.Pg.1547: Apis. arn. bell. bry. calc. calc-s. hep.
merc.
9. Absorption of pus. Synth.Pg.1547. Iod. LACH.
Phos. Sil.
10. Gangrenous. Ars. asaf.
carb-v. chin. hep. kreos.
LACH. merc. nit-ac. phos. sil.
FEVER
Septic. Synth.
Pg. 1487: ANTHRACI. Apis. ARN. ARS. BAPT. Bell. BRY. Carb-v. LACH. Merc. PHOS. PYROG.
SULPH.
Zymotic.
Synth.Pg.1490: Anthraci. apis.
ARN. ARS. BAPT. Bell. BRY. carb-v. hyos. ip. LACH. Merc. op. Phos. Puls. Pyrog. Sulph.
MIND
13. Morphinism: Ars.
bell. calc. cham. hyos. ip. lach. merc.
op. phos. puls.
Each remedy rated by the number of rubrics in which it appears and by
how prominent or characteristic it is in the remedy picture, ie. Those in CAPITALS, are given 3 points; in Italics, are
given 2 points; in plain type are given 1 point.
REMEDIES (present in SIX or more Rubrics) + Points Rating / No. of
Rubrics
MATERIA
MEDICA for GENUS EPIDEMICUS
LACHESIS
Poisoning
Symptoms: All the vipers are venomous; severe pain comes on at the site of a
bite, bloody serous discharge and ecchymoses in the
vicinity of the bite and thrombosis, followed, if not at once fatal, by local
inflammation and sloughing, and even gangrene.
Swelling
and black or purple discolouration of a limb may follow. Fever, with delirium
and blood poisoning, sets in, followed by suppuration, haemorrhage or gangrene.
Death may follow a bite from the following causes:
If a vein has been pierced, quickly from
thrombosis;
after some hours from heart failure,
through paralysis of the vasomotor centres;
after a few days from secondary bleeding;
later from septic infection of the necrotic
area around the bite.
Pharmacology:
The venom of Lachesis contains a full range of potent
enzymes, proteolytic, cytolytic,
neurotoxic and coagulant. One or more of these
effects may predominate. The blood is attacked primarily, while, the nervous
system is at first aroused and excited. The main affinities therefore are with
the blood, causing disintegration of red cells, lowered coagulability
after initial tendency to thrombosis, and impaired resistance to infection with
associated liability to gangrene and necrosis. Also the CNS, with ensuing delerium, coma and paralysis of vital centres. Also with
the cardiovascular system as evidenced by hypotension, cold sweats and
collapse.
Therapeutics:
The great blood-disintegrating (haemolytic) powers of Lachesis
are utilized in a number of febrile, septic, toxic and typhus-like conditions,
present in many named diseases, and in some forms called ‘malignant’ exanthems, where the body resistance has more or less
completely broken down. When this point is attained the distinguishing or
diagnostic features of the particular diseases have largely disappeared.
Professor Teale: “Widely different bacteria may
produce very similar clinical features… when profound poisoning occurs, instead
of the poisoning becoming more, it becomes less characteristic, and clinically
is seen to be in the typhoid state.”
Leading
Indications:
Severe cases where “blood-poisoning” is
marked: ‘low’ fevers, where blood-destruction or haemolysis is conspicuous,
conditions called typhus-like (typhoid), or septic after parturition or autopsy
wounds. Such conditions occur late in many fevers.
Milder cases, where vascular erethism is conspicuous-palpitation, hot flushes,
sleeplessness. Such a state is frequent at the menopause or after arrest of
physiological discharges or the sudden arrest of pathological discharges, and
relieved by the restoration of them. Shock may cause such a state.
Though sensitive to either extremes of
temperature, cases requiring Lachesis are chiefly
noted for intolerance of hot weather, hot rooms, etc. (direct rays of the sun).
Local symptoms are frequently left-sided or
move from left to right.
Sleep is not easily wooed; when it comes it
is restless and the patient usually wakes worse in every respect, so that he
fears to go to sleep.
The mental state varies… Incoherence,
degenerating to muttering delirium in fevers, is characteristic.
Over-sensitiveness to surface contact
(touch), and to constrictions, or even to clothing which is not too tight
(neck, abdomen, etc.)
A bluish hue around wounds, ulcers, etc.
from blood pigment, or venous stasis.
Difficulty of swallowing, especially
fluids, regurgitation through the nostrils.
Onset of discharges tends to relieve most
symptoms.
Craving for alcohol, even in teetotallers.
Bleeding in many parts, blood dark and
thin; ecchymoses.
The type of patient a thin, melancholy,
indolent person, changed physically and temperamentally by illness.
<:
Morning/after sleep/extremes of temperature/constriction/contact/acids/alcohol/spring/summer/empty
swallowing/hot drinks/motion/stooping/lying/emotions/lying on left side
(palpitation);
>:
From onset of discharges;
Causation:
Injuries. Punctured wounds. Poisoned wounds. Vexation. Anger. Jealousy.
Alcohol. Sun.
DD.:
Ars.: Tendency to rapidly proceed to a condition
of malignancy, ie., diseases assume a grave form, to
the destruction of tissue, to a general lowering of the vital forces, and
haemolysis, ending, if not checked, in death.
Another characteristic is prostration, a
prostration that is out of proportion to the severity of the complaint. The
patient is exhausted after the slightest exertion.
Nevertheless, they are extremely restless.
Restless with the pains, must walk about, which helps. Also mental restlessness,
feels impelled to move and when too prostrate wants others to move them from
bed to bed or room to room.
Pains have a burning character where-ever
situated in the body and there is often a sensation of hot fluid coursing
through the veins.
Generally chilly, despite the burning
pains.
Periodicity is a feature of Arsenicum. It occurs every other day, every fourth,
seventh, or fourteenth day: the more chronic the complaint the longer the
cycle.
Putridity of discharges. This is an accompaniment
of its ulcerations whether internal or external, and of the tendency of its
ulcerations to go on to necrosis and its inflammations to become gangrenous.
Allied with this is Inflammed
and ulcerated parts bleed readily. Haemmorrhages
occur from the lungs, bowels, kidneys and uterus.
<:
midnight/after 3 h./cold/lying with head low/exertion/after (cold) food and
drink;
>:
From warmth, movement;
Merc.: A feature of Mercurius
is very easy exhaustion after quite slight exertion. Tends to emaciation and
paretic weakness, associated with a liability to fainting attacks or sudden
myocardial failure.
Blood
dyscrasias occur, resulting in profound anaemia which
renders the subject liable to ready suppuration, characterised by sanious pus or necrotic ulceration.
Leading
Indications.
Cachexia,
anaemia, exhaustion, emaciation.
Salivation; stomatitis.
Increase and alteration of secretions,
which become thin and excoriate.
Ulceration of skin and mucous membranes.
Perspirations which do not relieve and are
foul-smelling.
Thirst, with moisture of mouth and tongue.
Aggravation of all symptoms at night and
from warmth of the bed.
Moist eczema and intetrigo.
Nocturnal bone pains.
Low-grade suppurations, which are acrid and
blood-stained.
Tremors of course character that tend to
become convulsive.
Green, bloody or mucous stools with tenesmus, “a cannot get done feeling.”
Foul body smell.
Mercurial symptoms occurring in syphilis.
Catarrhs of mucous membranes, with
increased mucous.
<:
at night/heat & cold/warmth of bed/draughts/bending forwards/after
eating/lying on right side/touch & pressure/motion & exertion/sweet
food/lamplight & firelight;
>:
rest/weeping/coitus;
Apis.: In addition to haemolysis, coagulation of
fibrinogen and increased permeability of capillaries, there is also a lowering
of surface tension and membranes potential, which results in reduction of
osmotic pressure and facilitates diffusion of fluids, leading to oedema and
effusion.(38)
Leading
Indications:
Aggravation from heat in any form.
Over-sensitiveness: of skin, of mind, of
organs.
Sadness, indifference, suspicion, jealousy.
Foolish or childish behaviour.
Stinging, burning pains, with rapid change
of site.
Violence and rapidity of complaints.
Right-sided; symptoms go from right to
left.
Absence of thirst where it is expected, ie., during heat, and also generally.
Tight, constrictive sensations: in throat,
larynx, chest, abdomen.
Inflammation and oedema: of skin, mucous
membranes, serous membranes, synovial membranes, subcutaneous tissues.
Urticaria and
erysipelas.
Cerebral affections, especially in
children; meningitis, cri cerebral.
Morning diarrhoea.
Prostration; faintness.
<:
3 h. (chills)/morning/evening/night/(radiant) heat/close rooms/touch &
pressure/lying down/getting wet;
>:
cold/cold washing/expectoration/sitting/changing position;
Arn.: Cause: any injury, however remote seems to
have caused the present trouble. After traumatic injuries, overuse of any
organ, strains. Arnica is disposed to cerebral congestion. It acts best in
plethora, in debilitation with impoverished blood, cardiac dropsy with
dyspnoea. A muscular tonic. Traumatism of grief, or remorse. Influenza. Limbs
and body ache as if beaten; joints as if sprained. Bed feels too hard. Sore,
lame, bruised feeling.
Marked
effect on the blood. Affects the venous system inducing stasis. Thrombosis.
Haematocele. Ecchymoses and haemorrhages. Relaxed
blood vessels, black and blue spots. Tendency to haemorrhage and low-fever
states. Tendency to tissue degeneration, septic conditions, abscesses that do
not mature. (41)
If
the malady advances more definite stupor develops, and though when roused the
patient begins to answer a question correctly, he lapses in the middle of a
sentence into muttering delerium or unconsciousness.
When a patient has arrived at this mental state he is well on in a typhus,
enteric, malignant malaria, yellow fever, or sepsis (surgical, peurperal or other). The concomitants in the shape of
muttering delerium, fever, rapid, weak pulse, dusky
skin, possibly with ecchymoses, or congestive
patches, dry tongue, sordes etc. some or all of these
will now be present. (42). Prophylactic of pus infection. (Shroyens,
Synthesis, Edit.5.2., Pg. 1790)
<:
Walking/going upstairs/movement/spinal pain/wrist pain/various pains <
inspiration;
>:
Movement. (Sore feeling from lying on one part, but the relief is only
temporary);
Phos.: Therapeutics: In typhoid-like conditions
Phosphorus is recognisable by:
Abdomen
distension; sore, very sensitive to touch. Stools offensive, bloody,
involuntary. The anus appears to remain open. Worse lying on left side: better
right. Burning in stomach: burning thirst for cold water. Desire for ice cream.
Fear
alone; in dark; of thunder. Suspicious.(44)
Sil.: Skin: Lymphatic swellings and abscesses,
even with fistulous ulcers.-Engorgement, induration
and suppuration of glands.-Abscesses which do not break, but burrow under the
skin; exanthemata in general which corrode and spread. Ulcers in general;
wherever pus is discharged from any part of the body; ulcers burning, scabby;
indolent; when circumscribed with redness; very high, hard ulcers; with proud
flesh; with corroding pus; smell very offensive. Inflammation,
softening(swelling), and ulceration of bones. Mild and malignant suppurations,
esp. in membranous parts. Small wounds heal with difficulty, and suppurate
profusely. Mental & Emotional: weak, nervous, easily irritated, faint-hearted;
yielding, giving up disposition, “grit all gone.”
<:
cold or draft/motion/open air/at new moon;
>:
warm room/wrapping up head/magnetism and electricity;
Bell.:
Leading Indications
Congestions and inflammations of a violent
and intense character.
Pains and symptoms come and go suddenly and
are violent.
Tendency to delirium of an active and
violent kind: hallucinations, fears of imaginary things with desire to escape.
Tendency to twitchings,
jerkings and convulsions.
Burning fever and rapid pulse, which is
strong and bounding; early stages of inflammations.
Dryness and heat of the skin and mucous
membranes.
Hypersensitivity to all impressions,
drafts, noises, pressure etc.
Great thirst not relieved by drinking.
< in the afternoon (15 h.) and till
after midnight.
Predominance of affections on the right
side.
Symptoms are worse in the horizontal
position (especially the head).
Tendency to rapid formation of pus in
external inflammations.
Carb-v.: Charcoal has the property of absorbing
gases in its intestines, and thus ordinarily contains quantities of oxygen
which, when the charcoal is brought into contact with decomposing organic
matter, is released, and oxidises the putrefying mass, while at the same time
the charcoal adsorbs the gases that are formed by the oxidising process. It has
no direct action on the microbes of putrefaction, but favours the development
of the aerobic organism at the expense of the anaerobic.
Leading
Indications:
Desire to be fanned rapidly on stomach and
respiratory complaints.
Burning internally, cold externally;
burning characterizes Carbo-v.
Surface cold; dusky blue nails; dilated
capillaries and veins, cold sweat. Numbness of parts lain on.
Haemorrhages, passive oozing of dark thin
blood.
States of collapse, surgical shock.
Septic conditions, putrid discharges.
Conditions where there is a lack of
reaction.
Low states of vitality with venous
engorgement.
Fever: tertian type, beginning 9 – 10 h.
Thirst in cold stage, none in hot.
<:
morning on waking/evening/hot, damp air/warmth/brandy &
wine/butter/pork/rich food/abuse of quinine and mercury;
>:
eructations/warm covering/being fanned;
Vorwort/Suchen. Zeichen/Abkürzungen. Impressum.