Disease Index Skin Diseases

Ulcers

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Dr. Carleton gives us some basic guidelines and principles, along with illustrative cases and important remedies.

Excerpted from: Homoeopathy in Medicine and Surgery – Edmund Carleton, M. D. 1913

It is my belief that an ulcer, unless of traumatic origin, is the expression of a sick organism and that the ulcer gets well when the individual is restored to health. Local medication is pernicious, its apparent successes are deluding suppressions,which are sure to be followed by relapses or metastases to more important parts. Experience in private and hospital practice confirms this belief. At the Homoeopathic Hospital, Ward’s Island,(now the Metropolitan Hospital- Blackwell’s Island) it has been my privilege to demonstrate, upon a large scale, the truth of the foregoing proposition. A number of wards were filled with ulcer cases, many of them old “rounders,” having large, chronic ulcers of the leg, which had been discharged “improved” (by local treatment, only) from one city hospital after another in turn. Of course these ulcers broke down again as soon as their bearers began to use their legs, and reached us in full bloom. Ulcers of differing character, located in various parts of the body, were observed in the house, in lesser numbers than the ulcers of the legs.

It takes time to cure the individual; some cases seem to be incurable (owing to the limitations of the prescriber)and one must consider the statistics of his hospital. On the other hand, it is always safe to do right and one patient discharged “cured” counts for more than two “improved.” We did our best to cure. Our practice did not cause the statistics of the hospital to suffer. On the contrary, there is reason to believe that our statistics were regarded with envy by some persons. Again, watchfulness, determination and persistence were required to overcome inertia, periodical interruptions, ancient custom and practical skepticism. Frequent inspection of each ulcer disclosed the degree of benefit which had been gained by the use of internal medicine. The ward book told the story of faithful work. That was scanned at every inspection of the ulcer.

My first care, when entering an ulcer ward, was to impress upon the intern, if he was a new man, the importance of securing all the symptoms of each case; of giving the similar medicine; of repeating it only when improvement had ceased and of never changing the remedy in the face of improvement, even though the symptoms had changed.

The late Dr. Selden H. Talcott was the first chief of our house staff and a great executive officer. He inaugurated a system which helped me greatly. Under his supervision the house surgeon caused the dressing-room to be filled with patients and their ulcers to be exposed to view. When these patients had been prescribed for and their ulcers dressed with dry lint, occasionally simple cerate, they retired to the ward and gave place to others.

The dressings were changed when they became foul. Then the ulcer was cleansed, gently, with normal salt solution. The part rested in an easy position. When cicatrization was general (not partial) we debated — especially if the ulcer was of varicose origin — the wisdom of grafting or compressing. My own attitude towards such practices was generally conservative. 

In very hot and very cold weather the ulcer wards were frequently disinfected.

 Observation

It was my custom to observe the location, size, shape and depth of the ulcer; the color, quantity, odor and other qualities of the discharge; the edges, whether everted, undermined, necrotic, and so on; the appearance of the borders and the degree of sensitivity and morbid sensations of all parts involved. A minute sufficed for the inspection, but a longer time was required to make a record of the  observations and this was sometimes imperfectly done, it is to be feared. Then the concomitant symptoms were gathered and also the particular and general history and the appearance and condition of the person of the patient. Modalities were sought for with diligence.

To get the sensations was hard work. After using all one’s skill upon a dullard, in the manner taught by Hahnemann, and finally eliciting the fact of burning pain, it was interesting to hear the next patient, who had listened to the preceding dialogue, promptly declare that he suffered “burning pain!” 

Strange as it may seem to the inexperienced, it is nevertheless true that if the work has been well done up to this point, the task of finding the similar medicine is more than half finished. Commit to  memory the characteristic symptoms of the polychrests; regard closely the modalities; when necessary search the repertory and consult the text of pure materia medica; try upon a few cases the method which has just been outlined and then tell me if I am right.

Many of the therapeutic hints given in the following list of medicines need additional symptoms to make them available in practice.These it is physically impossible to supply here, of course. The prescriber is supposed to follow up the clues that are furnished. Take fluoric acid, for instance. Attention to the clinical hint, furnished by Lippe, “Ulcerations, especially after the abuse of Silicea,” enabled me to cure a stubborn case.

CASE

An apparently healthy young man (Trans. I. H. A., 1888) had his foot crushed in a railway accident. In consequence he had seventeen operations performed, including five amputations of the leg. The last operation was amputation at the knee-joint. It was performed with great devotion to antiseptics — bichloride of mercury and iodoform. The stump refused to heal. I found it swollen, soft and sore. The edges of the flaps were bluish-red and covered with thin, unhealthy pus. The pulse was rapid, quick, wiry and small. Hectic fever was imminent. Emaciation, anorexia and a sullen disposition contributed to the sad picture. Local medication was stopped and normal salt solution substituted. Silica was given. Destruction went on for twelve days. Then I concluded that my predecessor had given silica and that my prescription had been superfluous. I took the hint given by Lippe and gave fluoric acid, two hundredth centesimal potency, four times a day. In a few weeks the patient was well in every respect. He walks easily with an artificial leg.

A few words of caution as to Lachesis. The clinical fact that more ulcers appear upon the lower third of the outer surface of the left leg than upon any other portion of the lower extremity, combined with the fact that Lachesis is partial to the left side of the person, has led to abuse of the medicine. Other medicines affect the left side. Standing alone, the indication is suggestive but inconclusive. If, in addition, such characteristic symptoms as worse when waking from sleep, intolerance of pressure about neck and waist, and the peculiar sore throat exist, then Lachesis should be chosen.

An example of the ability of homoeopathy to cure is furnished by the following case:

CASE:

She was an apparently healthy girl. When thirteen years old her left ankle became lame and swollen. Her physician, finding the case intractable, referred her to a noted old school orthopaedic specialist in New York, who constrained the limb in a plaster of Paris cast. The patient complained of pain. This was unheeded. At the end of three weeks the foot was found to be dead. Amputation, under antisepsis, was performed just above the ankle joint.

The stump refused to heal and the flaps retracted. The bones protruded and began to die, all notwithstanding the use of local medicine. The leg was re-amputated at its upper third. Generous flaps were formed. Granulation and cicatrization progressed for a while, stopped, relapsed. Amputation at the knee-joint was proposed and rejected. A series of attempts, by other surgeons, to heal the stump failed. I observed an ulcer about three inches long and half an inch wide, of feeble, anaemic appearance, with hard, rough, dry, scabbed edges. There was little sensation and that mostly itching. These symptoms and the history of the case led me to put a dose of Silica, in the two hundredth centesimal potency, on the patient’s tongue. Local medication was excluded.  Improvement was observed in a week. It lasted a number of weeks and stopped. A dose of silica, six thousandth centesimal potency (Jenichen), finished the work in a few weeks more, and left a good stump. She walks well with an artificial leg.

The medicine similar to a given case may not be mentioned in our list. That fact constitutes no bar to its use when the constitutional indications for the medicine are unmistakable.

CASE

For instance (address, R. I. State Society, 1885), an ignorant, dull old man, a regular “rounder” of the hospitals of the city, was brought to the clinic in the Ward’s Island Hospital with an indolent ulcer which occupied most of the space between the knee and ankle. It was deep and raw-looking, but painless. Endeavoring to elicit symptoms I passed my finger firmly over the sore and its edges. The fellow was impassive as a statue and declared that I had not hurt him. What a subjective picture of opium! Yet opium has not produced ulcers and has no clinical reputation for their cure. Objectively it bore no relationship to this case. However one characteristic, subjective indication is worth more than many objective indications. I put a few pellets of opium, two hundredth, from my pocket case, upon the patient’s tongue. Two weeks later, at another clinic, we saw the ulcer. A healthv reaction had been established in it and the entire edge surface was granulating. Convalescence was uninterrupted and the cure was complete.

About the author

Edmund Carleton

Edmund Carleton, M.D., graduated from New York Homeopathic Medical College in 1871. He was president of IHA in 1894. He was also the author of Homeopathy in Medicine and Surgery, published by Boericke & Tafel.

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