A male aged 41 years presented the complaints of ulcer on the right lower extremity since one month. The ulcer started as a reddish eruption and blister formation over with chills, rigors and fever. He was taken to the nearby allopathic hospital and there it was diagnosed as having cellulitis and the surgeon has done extensive excision. Later he was advised to undergo skin graft for the recovery which would cost him around rupees sixty thousand for the procedure and hospital expenses. Patient being a document writer and very poor who has already spend nearly twenty thousand could not afford to do it so came for homoeopathic treatment. He presented the complaints as follows

History of presenting illness

    Patient had a fever and chilliness one and half months back. Along with this he developed redness and swelling of the leg. Consulted and allopathic hospital where they did the surgery and then the patient developed the ulcer. He was treated and then advised by the doctor to undergo skin grafting.

Patient as a person

· Appetite : Normal

· Thirst : Normal

· Stool : Regular

· Urine : Normal

· Sweat : Normal

· Sleep : Good

· Desires: Sour, Spicy things

· Desires: Fanning, Summer, Cold bathing

· Cigarette smoking 6/day

· Alcohol once in a week

Mental State

· Easily Angered
· Desires Company
· Introvert
· Irritable
· Fastidious
· Worried about financial problem

Physical Finding

· Mild Pallor
· BP: 104/ 60 mm Hg
· Temp: 98.4oF
· RR: 18/min
· Wt: 48 Kgs

Ulcer Examination
· Ulcer of 13x11 cm
· Extending from the Malleolus to above
· Edges punched out
· Floor with granulation tissue
· Base is the bones

Analysis and evaluation:
    Even though the case presents with the physical and mental generals they are not the representation of the original unmodified picture as the surgeon has suppressed with surgery and heavy antibiotics. So we have to go for the original unmodified picture. The original unmodified picture is that the patient had developed cellulitis which had apart from the common symptoms of cellulitis the pain is > by walking is taken into consideration and prescription of Rhus tox 0\6 was prescribed as first prescription on 3-1-09

Refer the plates I, II, III & IV, the photographs taken during the course of treatment

Discussion:
    The case was prescribed with Rhus tox and then as the totality changed the remedy was also changed. The sensitivity was the clue which remains same throughout but the pathology went on changing. So a different remedy was chosen. (Reference § 172-173).

    This patient was a very poor document writer who had already spent nearly 60000 rupees for getting treated for cellulitis and for getting an ulcer. He was also given and estimate of another 750000 for the skin graft which he was not able to bear because of his very low economic status. Patient was admitted in the hospital for one month and dressing was done with calendula dry dressing.

Conclusion:
    This case clearly demonstrates that when there is paucity of symptoms to affect a cure one or more remedy needs to be used as the pathology and totality changes. This case also demonstrate that homoeopathy can be effective even in surgical diseases with much cost effectiveness.