-Benson.A.R,

Diphtheria

Diphtheria is an acute infectious disease caused by a specific germ known as the Klebs-Loeffler bacillus.
Its onset is usually sudden. There is vomiting, moderately high temperature (101 – 102°), rapid weak pulse, pain in the back and limbs, and chilliness. The breathing is rough, there is sometimes a slight hacking cough, an offensive odor to the breath, and enlargement of the glands of the neck. There may be slight pain on swallowing, and after 12 or 24 hours a white or greyish membrane appears in the throat, usually upon the tonsils. This membrane spreads upward, partially covering the soft palate and the posterior part of the roof of the mouth.
During the early stages, the disease cannot be distinguished from tonsillitis and other infectious diseases except by an examination of a culture from the throat. Such a culture should be made in all cases of sore throat.
The diseases progresses very rapidly and in two or three days the throat may be so filled up with the membrane that breathing is difficult.
The disease sometimes assumes other forms. The membrane may be located in the nose, in which case it is likely to be mistaken for nasal catarrh with a purulent discharge.
The laryngeal form of diphtheria, in which the membrane is in the larynx, was formerly known as membranous (or true) croup. In this form there is present a peculiar cough, characterized by the absence of voice sound. It is simply a forcible expulsion of air without the usual sound which accompanies a cough. Laryngeal diphtheria is a very dangerous form of the disease, and frequently, in order to save the child’s life, it is necessary to place a tube in the larynx, or in extreme cases to perform the operation known as tracheotomy. False croup (so called) may be distinguished from this diphtheritic or true croup by the fact that the cough instead of lacking voice sound is loud, deep and hollow. In fact, to the untrained ear, the sound of the cough in false croup is more alarming than that in true croup.
All forms of diphtheria affect the whole system, and the after effects are fully as important as the disease itself.
There is great danger of paralysis of the heart muscles, and consequently sudden death. Children who are allowed to sit up in bed, or be out of bed before the heart has regained its normal tone, frequently drop dead without the slightest warning. There are also occasional paralyses of other muscles, notably the muscles of the throat, the eye muscles, and the muscles of the legs.
Another frequent complication is acute nephritis (Bright’s disease of the kidneys), which, if neglected, becomes chronic and makes the child an invalid for years.
Treatment and Nursing : Cases of diphtheria require the most skillful treatment and nursing. The patient must be kept in bed, and not even allowed to raise the head from the pillow until all danger of heart failure has passed.
Milk may be given freely, as well as cool water. No other food, however, should be given until convalescence is well established.
Local applications should not be used except when advised by a physician, nor should there be any attempt at home medication. The first and most important point is to establish a diagnosis by means of a bacterial culture. When this point is settled, it remains for the physician to decide whether or not he will use Antitoxin. This is a question which must be largely decided by the individual case, but whatever views may be held as to the occasionally harmful after-effects of Antitoxin there can no longer be any question as to the fact that its use has very greatly reduced the death rate in diphtheria.
If there are other children in the family, their throats must be examined daily for signs of the disease, and bacterial cultures must be made at frequent intervals.
Repeated attacks of diphtheria in the same individual are common.

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– TYLER M L
Apis mellifica
-Throat bright-red, puffy, “varnished”. Uvula long; oedematous.
-Nothing must touch throat (Lach.).
Arsenicum album
-Membrane looks dry, shrivelled. The Arsenicum anxiety, restlessness and prostration are present.
-Worse at night : 1-2 a.m.
-Chilliness : incessant thirst for small quantities.
Baptisia tinctoria
-Putridity : with dull red face; drowsiness; patient as if drugged.
-Membrane dark : dry brown tongue.
Diphtherinum
-When the attack from the onset tends to malignancy.
-Painless Diphtheria. Symptoms almost, or entirely objective.
-Patient weak, apathetic. Stupor.
-Dark-red swelling of tonsils and throat.
-Breath and discharges very offensive (Merc. cy.).
-Membrane thick, dark-grey or brownish black.
-Temperature low, or subnormal. Pulse weak and rapid. Vital reaction very low.
-Epistaxis, or profound prostration from the onset. Collapse almost at the very beginning.
-Swallows without pain, but fluids are vomited or returned through nose.
-Laryngeal Diphtheria; post-diphtheric paralysis. (Caust., Cocc., Gels.
-and Lycopodium.).
-When the patient from the first seems doomed, and the most carefully- selected remedies fail to relieve, or permanently improve.
-To remove persistent Diphtheria-organisms, in “carriers”.
-Like all the nosodes, it is practically worthless below the 30th potency while its curative virtues increase with the higher potencies.
-It should not be repeated too frequently.
Kalium bichromicum
-Nasal Diphtheria : ropy discharges.
-Exudation tough and firmly adherent.
Lac caninum
-Patients nervous, imaginative, highly sensitive.
-Skin hypersensitive (Lach.). Touch unbearable, though hard pressure gives no pain.
-Membrane pearly, or silver white.
-Milky coating on tongue.
-Characteristic feature is alternation of sides.
-Pain will jump back and forth from side to side.
Lachesis mutus
-Membrane starts on left side, spreads to right.
-Face and throat look cyanotic. Choking.
-Cold things more easily swallowed than hot.
-Great sensitiveness of neck and throat, so that patient cannot stand the touch of bedclothes, and pulls neck of night attire open.
-General and local aggravation from heat, and all symptoms are worse after sleep. The longer the sleep, the worse he is on waking.
-Characteristics are loquacity and suspicion.
Lycopodium clavatum
-Patient worse from 4 to 8 p.m.
-Starts in nose (Kali bic.) or right side throat, spreads to left.
-Warm drinks more easily swallowed : but reverse sometimes the case.
-Movement of nostrils.
-Diminished urine or copious sediment of urates, or fine red sand.
Mercurius cyanatus
-Fairly rapid onset, with prostration.
-One or both sides of throat affected.
-Membrane spreads rapidly over entire throat.
-Colour white, yellow, or greenish.
-Tongue thickly coated, moist; salivation.
-Odour always putrid. Hot sweats.
-Tepid liquids better swallowed than hot or cold.
-Patient (generally) worse late evening and night.
-Has also proved curative in Vincent’s Angina.
Phytolacca decandra
-Frequently indicated.
-Membrane grey or white, may start on uvula.
-May spread from right tonsil to left (Lyc.). But, unlike Lyc., the pain is worse from heat.
-Fauces dark-red : complains of lump in throat; or as if red-hot ball had stuck in throat.
-Pain goes to ear.

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-PETERSEN F. J.,

It is not the object of the writer to give a full treatise on diphtheria, still an outline of the form of treatment which will generally save the patient where other means fail, will no doubt be welcomed by all well wishers of humanity.
Lachesis 12 or 30d is our best remedy, especially if mucous surface of the throat, not covered by the membrane, is of a bluish red color, and if the membrane first started on the left side. However, it is one of our best remedies in any form. May be given in 6 to 10 drops in 2 ounces of water, 1/2 to 1 teaspoonful every 2 hours. If throat is much swollen apis 2d gtt. v to viii added to above will make it more effective.
Lloyd’s specific echinacea 3 to 4 drachms; Lloyd’s specific phytolacca 2 drachms and kali mur. 3x, v to vi grains in 2 ounces of water, 1/2 to 1 teaspoonful every 2 hours to alternate with above, thus giving the patient a dose of medicine every hour, will assist lachesis and apis in bringing about a rapid cure.

In severe cases a dose of medicine may be given every 1/2 hour; 1/2 hour one and the next 1/2 hour the other.
In some cases, where prominently indicated, lycopodium 12d or mercurius vivus 30d are very good remedies. Sanguinaria nit. 6x is recommended and has proven to be a valuable adjunct to other remedies in many cases.
Depressants should be avoided as well as harsh physics. The recumbent position should be maintained as long as possible, especially in severe cases. Tonics and stimulants should be given as indicated. Any danger of paralysis can be met by argentum nit. 30d.
In all cases as the patient gradually improves give medicine at longer intervals and in smaller doses. Although with above treatment local applications are not necessary, at times they will assist the constitutional remedies, in which case papain (L. and F.) in glycerine with a little carbolic acid added is the best we can use. This can be applied to the parts every 2 to 3 hours to advantage.

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– RUDDOCK.E.H,

DEFINITION.-A specific, contagious, and sometimes epidemic disease, dependent on the growth of a specific bacillus in the throat (Klebs-Loffler), and the poisoning of the system by its toxins, in which there is exudation of lymph on the lining of the mouth, fauces, and upper parts, of the air passages, or, occasionally, on an abraded portion of the skin, attended with general prostration, and sometimes remarkable nervous phenomena.

Bacteria causing diptheria

As just described, it is a general disease, manifesting local distinctive symptoms. It would be incorrect in theory, therefore, and might lead to grave errors in treatment, if the attention were concentrated on the local mischief, rather than in attempting to cope with the whole symptomatic depression.

SYMPTOMS.-Diphtheria is divisible into two classes, simple and malignant. In the simple variety, happily the most common, the symptoms are at first so mild as to excite little complaint beyond slight difficulty of swallowing, or pain in the throat, burning skin, pains in the limbs, etc., and is readily cured by one or more of the following remedies. Malignant Diphtheria is ushered in with severe fever, rigors, vomiting, or purging, sudden great prostration and restlessness, anxious countenance, etc., pointing to some over whelming disease, under which the system is labouring. The skin is hot, the face flushed, the throat sore, and the mucous membrane bright-red; the tonsils are swollen, and grey or white patches of deposit appear on them, small at first, but gradually enlarging, so that one patch merges into another, forming a false membrane in the throat, rendering swallowing and even breathing difficult. In some cases, the false membrane has been detached, and after extreme efforts ejected, presenting nearly an exact mould of the throat. The exudation of Diphtheria may be distinguished from a slough by its easily crumbling, by the facility with which it can often be detached, and by the surface thus exposed being red, but not ulcerated. The false membrane looks like dirty wash-leather; and between it and the true membrane an offensive bloody discharge exudes, imparting to the patient’s breath a most repulsive odour. The glands of the neck are always enlarged, sometimes pain is felt in the ear, and there is generally stiffness of the neck; the inflammation is liable to extend rapidly, in consequence of the continuity of the lining membrane of the throat, with the mouth, nose, wind-pipe. and even the air tubes of the lungs. If the disease progress, the patient passes into a stupor, and the difficulty of swallowing or breathing increases, till the false membrane is forcibly ejected, or the patient dies from suffocation, the exudation blocking up the air-tubes; or, more frequently, he sinks from exhaustion, similar to that observed in Enteric fever.

DANGEROUS SYMPTOMS.- Increased foetor of the breath, a quick, feeble or very slow pulse; persistent Vomiting; drowsiness and Delirium; bleeding from the nose; extension of the disease to the lining of the nose; dyspnoea; suppressed or albuminous urine; increase temperature.

DIAGNOSIS.-The diagnosis of Diphtheria depends on the discovery of the bacillus and from all suspicious sore throats a swab should be sent for bacteriological examination. The disease which used to be called Croup, is an affection of the larynx, either due to diphtheria affecting that organ, or (Spasmodic Croup) to a spasm of the vocal cords dependent on other causes. The name croup should now be given up. Follicular Tonsillitis may be mistaken for Diphtheria. There is no true membrane in this disease, but as mild cases of Diphtheria can exist without much membrane formation, the bacteriological test is the satisfactory one.

CAUSES AND MODE OF PROPAGATION.-The specific poison of Diphtheria is now generally acknowledged to be a specific bacillus, called after the two men who had most to do with isolating and describing it, the Klebs-Loeffler bacillus. The severity of an attack depends largely on the resistance powers of the patient which may be diminished by unfavourable surroundings. Indeed, it can live in throats that give no sign of disease, and can thus be carried about by apparently healthy people till it gains access to a susceptible subject and causes obvious disease. It commonly occurs as an epidemic, and a solitary case may prove a focus for spreading the disease.

SEQUELAE.-After a short period of convalescence-a few days to one or two weeks- sequelae are apt to arise, usually of disordered innervation, varying from defective nervous power in one or more sets of muscles, to a more or less perfectly defined Paralysis. Nerves about the throat, the seat of the local manifestations of the disease, are especially liable to suffer, causing chronic difficulty in swallowing. Hoarseness, etc. The most alarming is loss of nervous power of the heart, with feebleness of action, or, in extreme cases, complete cessation. But recovery from the sequelae is usual, though it is generally tedious.

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– Dewey W.A.

Mercurius cyanatus. [Merc-cy]
The mercurial preparations generally have very little, if any, relation to the diphtheritic process, and their efficacy the disease is a matter of doubt. They may be indicated, however, by bilious, glandular or other symptoms. **Mercurius does not produce the sudden and intense prostration of diphtheria. Mercurius vivus and Mercurius solubilis are ***never indicated in this disease. The iodides of mercury are sometimes of use, the **Mercurius biniodide with its left side indications, inflammation, febrile excitement, headache, etc., and the **Mercurius protoiodide with the right side indications, yellow tongue, glandular swelling, etc.; but there is a preparation of mercury which is one of the best remedies in diphtheria that we have, and that is **Mercurius cyanatus. It seems to get most of its symptoms is from the hydrocyanic acid of its composition. Thus we have, as indications, great and sudden prostration and very high pulse. The weakness is extreme, collapse symptoms showing themselves even at the commencement of the disease. There is an exudation in the throat; at first it is white, but it may turn dark and threaten to become gangrenous. The tongue is brownish and blackish, with foetid breath, nose bleed, loss of appetite, profuse flow of saliva, etc. It is especially a remedy in the malignant type of diphtheria and when the disease invades the nostrils. The great prostration will serve to distinguish it from **Kali bichromicum, which has the thick, tenacious exudation, also found under **Mercurius cyanatus. Clinical experience with this remedy has proved that preparations below the 6th are less effective than the higher, and not as safe, since it produces a tendency to heart failure. The 30th potency seems to have been a favorite one. Dr. Villiers, of St. Petersburg, treated 200 cases of all sorts of severity without a single death, using the 6th to 30th potencies. Dr. Neushafer treated 85 cases with three deaths, using the 5th to 15th potencies hypodermically. Dr. Sellden, in 1879-82, reported in a district of Sweden 564 cases of diphtheria, of whom 523 died, a mortality of 92.7 percent. None treated with the cyanide of mercury. In 1883-86, 160 cases were reported, of whom 29 died. In 132 of these 160 cases the cyanide of mercury was used and only one case died. He and his colleagues have treated 1,400 cases with a mortality of 4.9 percent. A strength equal to the 2x was used.–London Lancet, April 24, 1888.
Diphtherinum. [Diph]
The Nosode of Diphtheria and the idea of its use did not urgent with Boerhing, nor with Roux. Long before Pasture, a German homoeopathist named Lux conceived the isopathic idea and successfully treated cases with it. Cartier, whose long experience in the diphtheria pavilion of the Children’s Hospital in Paris advocates **Mercurius cyanatus and **Diphtherinum as the successful remedies in this disease, the latter also being useful in post-diphtheritic paralyses. The higher potencies are used.
Kali bichromicum. [Kali-bi]
This remedy, which is perhaps more useful in the croupoid form of the disease, has marked symptoms. There is apt to be deep ulceration and a thick, tenacious exudation, often streaked with blood; the membrane is yellow looking and the cough is croupy and accompanied with pain in the chest. There is also swelling of the glands. The indication for **Kali bichromicum may be chiefly summarized as follows: 1. The yellow-coated or dry, red tongue. 2. The tough, tenacious exudation. 3. Pain, extending to neck and shoulders. These, and the fact that it is most useful in the later stage of the disease, when the line of demarcation has formed and the slough has commenced to separate, make the indication for the drug certain.
Kali muriaticum. [Kali-m]
The indication for this remedy rest on a clinical basis, and it is one of the legacies of Schuessler to Homoeopathy. That it is a most excellent remedy and deserving of a high place in the treatment of diphtheria cannot be doubted by anyone who has ever tried it. The only indication we have are pain on swallowing, and white deposit in throat; but numerous well-marked cases of the disease have been treated with the remedy and symptoms like prostration, thick exudation over the tonsils, and entire soft palate, foetid breath, etc., have entirely disappeared. Perhaps like Kali bichromicum, it will be found to be better adapted to the croupoid form. **Kali chloratum or the chlorate of potash is useful in diphtheria when gangrenous spots appear; ulcers with foul secretions and offensive discharges. It is one of the best remedies to prevent extension to the nasal mucous membrane.
Kali permanganicum. [Kali-p]
This is another of the potashes which has achieved some reputation in diphtheria, where there is ulceration, gangrenous suppuration and foetid odor. It has been also been used as a local application, but like all local applications in constitutional disease it has done little, if any, good. The indication for its use are, throat swollen both inside and outside. The throat is oedematous and the membrane is horribly offensive; there is a thin discharge from the nose and a **Lachesis difficulty of swallowing and regurgitation. In many respects it resembles **Apis, but the extreme foetor will distinguish. Dr. Van Lennep considers it almost a specific.
Apis mellifica. [Apis]
Oedema stands first among the indications for this remedy. Stinging pains, and sore, blistered tongue are also characteristic. The throat has a glossy-red appearance as if varnished. Membrane forms on either tonsil and is grayish, dirty-looking and tough. Swallowing is most difficult owing to the oedema. The throat is swollen externally and there is much prostration,dry, hot skin and restlessness. Suppression of the urine is a complication that will call for **Apis. **Lac caninum has achieved some reputation in diphtheria; it has swollen both internally and outside as under **Apis; and it has a restlessness something like **Arsenic and Rhus, not a nervous fidgetiness as under **Apis. Scanty urine in diphtheria is a symptoms found under **Apis as well as under **Cantharis and Lac caninum.
Lachesis. [Lach]
Dr. J.E.Gilman thinks no remedy is so frequently indicated in diphtheria as **Lachesis and it is wellknown that animal poisons in general are suitable to low forms of disease, so **Lachesis is a wonderfully good remedy in diphtheria. Great sensitiveness of the throat will always bring it into mind. Further indications are the appearance of the disease first on the left side of the throat, spreading to the right. Extremely painful and difficult swallowing, violent prostration and great foetor, the patient sleeping into an aggravation of all symptoms. The dyspnoea is so marked that the patient must sit up to breathe. Gangrenous tendency and septic condition. There is a purplish throat and much swelling and infiltration externally, here resembling **Apis. Very similar symptoms are obtained under two other of the snake poisons, namely, **Crotalus and Naja. A characteristic symptom of **Lachesis is that the throat feels worse from empty swallowing. **Carbolic acid. Low fever, no pain, great accumulation of exudate, foetid odor, prostration, violent fever, headache, thready pulse, nausea and weakness. The septicaemia of the disease is met by this remedy. The secret of antitoxin success in diphtheria may be due to this remedy. Most antitoxin is preserved with phenol or tri-kresol in amounts 3X potencies of these preparations. **Baptisia is a powerful agent to counteract septic poisoning, foetid, feverish breath, dark red fauces, swelling of glands, aching of back,body and limbs as if pounded, face dark, flushed like the intoxication of a poison, tongue dry and red, typhoid conditions. **Rhus. Putrid as in Baptisia, swelling glands, tongue dry or cracked.
Lycopodium. [Lyc]
Lycopodium bears the same relation to the right side of the throat that **Lachesis does to the left. There is stoppage of the nose, with inability to breathe through it; the disease begins on the right side, or is worse on that side. Like **Lachesis, the patient is worse after the sleep and after swallowing drinks, especially cold ones. Especially is to be remembered the **Lycopodium aggravation from 4 to 8 P.M. Fan like motions of the wings of the nose is also an indication. The symptoms of **Lycopodium are quite clear, but the remedy is less often indicated than some of the others.
Bromine. [Brom]
**Bromine produces a pseudo-membrane, but it has little effect in gangrenous conditions. It is especially a remedy in the laryngeal form, and much rattling of mucus in the larynx is a characteristic indication. There is a suffocating,hoarse whistling cough,having a croupy sound. **Bromine is decidedly a remedy for the croupoid form of diphtheria. **Hepar and **Kali bichromicum are useful remedies in laryngeal form.
Muriatic acid. [Mur-ac]
Perhaps the most characteristic symptom calling for this remedy is the extreme weakness; nose bleed of dark and putrid blood is also a prominent symptom. There is a foetid breath and oedematous uvula, a yellowish-gray deposit on fauces, tonsils, uvula and posterior pharyngeal wall; excoriating thin discharge from nose; pulse intermittent and patient weak; tongue dry, lips dry and cracked. It is a remedy decidedly applicable to low, poisoned states of the blood, such as are found in diphtheritic conditions . Albuminuria is present.
Nitric acid. [Nit-ac]
Excoriating discharges are characteristic of this remedy. In diphtheria, however, there is a peculiar symptom; there is much distress and uneasiness at the stomach and vomiting of all food; withal,there is prostration and a membrane in the nose and throat. Especially is **Nitric acid a remedy in nasal diphtheria, with a white deposit in the nose and ulcerative conditions which are sensitive, thus differing from the potashes; there is foetid odor and sticking pains in throat; the pulse is intermittent; swallowing is difficult and painful.
Phytolacca. [Phyt]
Pain in the back and limbs, a general aching all over with great prostration are general characteristics of this remedy, and if we get, in addition to these, highly-inflamed throat, which is much swollen, so sore and sensitive that deglutition is almost impossible, pain shooting to ears, thick- coated tongue, foetid breath, swollen glands, high, rapid and weak pulse and a grayish membrane, we have a picture of diphtheria that **Phytolacca will cure. Great burning in the throat is also an indication, and chilliness as the disease commences. Drs. Burt and Bayes recommend the tincture and also the use of a gargle. Other observers also consider the remedy as specific, and it probably is with the foregoing indications.
Arsenicum. [Ars]
Last, but not least, we have **Arsenicum, and it may save when no remedy will. It is mainly a remedy indicated by its general symptoms alone, such as low fever, prostration, restlessness, thirst, foetid breath, etc., hence it is not a true diphtheria remedy. It is most useful in the later stage of the disease when indicated by these very symptoms, and when, perhaps, in spite of other remedies, the patient has been constantly going down hill, until the very adynamic condition, met so well by **Arsenicum, has been reached. The throat will be much swollen inside and out, the membrane will be dark, and there will be much foetor, and there will be present considerable oedema. It may correspond to the prodromal stage also, with the tired-out feeling, thirst and feverish flush. **Arsenic iodide may prove curative for the septic conditions and hoarseness which sometimes remain after diphtheria.

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– – John H.Clarke.
This is a specific infections disease, which manifests itself in a peculiar ulceration of the throat and great general prostration and fever. The throat is covered with a dark- grey membrane, which emits an exceedingly offensive odour. The contagious principle is contained in the breath and in the expectoration containing fragments of the membrane.

Diagnosis.-Diphtheria is distinguished from all other throat affections by the presence of a dirty grey, tough coating on the mucous membrane of the throat. This coating contains numerous micro-organisms and a specific one termed the bacillus of Klebs- Loeffler.

There is no other kind of sore throat which is accompanied and followed by such grave constitutional symptoms. The heart is very frequently affected, and almost always weakened temporarily; and for a long time after the throat is well there is a danger of paralysis coming on. This may affect any of the muscles of the body, and sometimes attacks the heart.

General Treatment.-The great object is to keep the patient nourished, and support the strength, Strong beef-tea and milk, when it is tolerated, should be given at frequent intervals. Patients suffering from diphtheria should never be raised up from the recumbent position, except with greatest care, as the prostration is so great it may bring on fainting which may prove fatal.

Medicines.-(Every few minutes to every hour or longer, according to the urgency of the symptoms.)

Bry. 3.-

Great prostration; patient cannot bear to be moved; complains of pains everywhere when moved; white tongue; dry mouth; thirst for large quantities of water.

Bell. 3.-

Restless; complains of sore throat, which looks highly inflamed; pupils large; drowsy, but unable to sleep; starts suddenly out of sleep.

Lach. 6.-

After Bell.; worse after sleep; patches on tonsils, worse the left side; croupy symptoms; patient cannot bear to have anything touch the neck and throat.

Lyc. 6.- Throat brownish red; worse right side; worse from swallowing warm drinks; nose stopped up; patient cannot breathe with mouth shut; keeps mouth constantly open, slightly protruding the tongue, which gives a silly expression; unsteady step; on awaking from short nap he is cross; kicks; is naughty (if a child); or jumps up in bed, stares about, and knows nobody, seemingly dreaming with open eyes; frequent jerkings of lower limbs, mostly with a groan, awake or slumbering; great fear of being left alone.

Rhus. 3.

-Restless; wants to be carried about; wakes complaining of pain in throat; bloody saliva runs out of mouth during sleep; parotid glands good deal swollen; transparent jelly-like discharges form bowels at stool or afterwards.

Apis. 3.

-Great debility from the beginning; membranes at once assume dirty greyish colour, or there is great oedema of soft palate and much puffiness round the eyes; pain in ears on swallowing; an itching, stinging eruption on skin; sensation of weakness in larynx; numbness of feet and hands and even paralysis. (Apis is incompatible with Rhus, and should not be given immediately after it, nor Rhus after Apis. )

Ignat. 3.

-Pain in throat worse when not swallowing; relieved by swallowing, membrane more abundant on right side; much prostration; sensation of lump or marble in the throat.

Merc. 6.-

Tongue coated thickly, white or yellowish; much salivation; glands swollen; much membrane on tonsils.

Merc. cyan. 30.-

Is specific in many cases where there is intense vital depression along with the other symptoms.

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– Kent J. T.

This disease is generally looked upon with terror, and well it may be, as it demands more than ordinary knowledge to conduct its victims to safety. To say that Homoeopathy is wanting at the bedside of these cases is far from true. It cures all cases where good vitality is present and where its remedies are wisely administered. To assume or admit that our lack of knowledge must be a common cause of so many failures is both true and untrue. It is true that more knowledge is required than the ordinary homoeopath possesses, or he would not be compelled to admit the several deaths in his confessions and reports. But to say that our knowledge and Homoeopathy in its present state of development could not be expected to do better is far from true. Our science is now developed to a high state of perfection, but individuals often fail to apply it in this disease with wisdom and judgment, and therefore lose many subjects.

The disease is not constantly with us, and when it comes it generally assumes a form unlike its previous appearances; and by the time the physician has carefully looked into the epidemic phases and remedial agents it has gone, leaving upon his hands severe and unfavorable terminations to cause regret and disappointment. The physician of studious habits and active practice, however, may so keep in touch with his principles and Materia Medica as to keep his death list remarkably small, but it must be observed that he, does not prescribe for every symptom that shows itself on the instant of its appearance. I will venture to say that any physician’s death list will be large if he hurries into bed chambers, looks at the tongue, takes the temperature? feels the pulse, looks into the throat, makes a culture, disinfects the house, washes the throat with antiseptics, etc. I will also venture to say that any physician’s death list will be remarkably small if he goes to the sick room and observes all the symptoms of the patient, all the surroundings of the house and room, sees all the obstructions, and knows the full purport of all things there, waits and watches the development of the sickness until its every feature has been manifested, if he knows when that time has come, and then carefully compares all the symptoms of this sickness with the symptoms of the Homoeopathic Materia Medica, and knows how to select the potency, how to administer it, and when not to give it.

How many of you can say all these things to yourself? How many of you do it in just this way. Do not most of you entertain the idea that you must make great haste to get medicine into that child’s stomach or it will get worse? Do not the most of you fear that the people will turn you off and get another physician if you do not do something at once? Do you know of any other class of work that would not be jeopardized and ruined by such haste as all of you do at the bedside in one of these serious sicknesses? If you are not guilty of this charge then you are not hurt, but it is so true of so large a number of our best men that no harm can come from hearing about it. To go to the bedside with fear and trembling is death to the sufferer. To go to the bedside with confidence born of knowing and from having trusted our means of cure so long, means life to the patrons of Homoeopathy. It is not that you are ignorant of your principles and your Materia Medica, but that these are not invoked at the time of greatest need. Through fear and haste you act and fail, whereas you should watch and wait and discover there is no hurry, and if the sickness has not yet shown what medicine this life stands in need of, wait even if you go and come repeatedly. Let it develop until its character is stamped upon the case so that no mistake can be made. A mistake in the first remedy nearly always means death, or at least it masks the case. It would be strange if you, who know so much about the art of healing, could make a first prescription of a remedy so far from similar that it did not act. You know if it is similar at all it will make changes in that symptom image, and if it is similar enough it will cure; therefore you need not hope that if your first prescription did not cure it was so dissimilar it was harmless. You must expect to cure, or begin the cure with the first prescription; then all is easy, as the changes now observed are such as bring joy to the hearts of the family and to the doctor. You must, therefore, never prescribe on the first flitting evidences of the sickness, but according to the true saying: “First be sure you are right and then go ahead.”

The first prescription, when correctly adjusted to the symptoms, will cause the membranes to fade out and all the characteristics of sickness with it.

The first prescription, when incorrectly chosen, will most likely change the symptoms, but the patient will go on from bad to worse and the next prescription must be a matter of guesswork, as the index has been spoiled, and hence the mortalities.

You know enough about your Materia Medica to do good work if you apply it properly. The Materia Medica is full and rich, and the Repertory points out the general and particular features. Guernsey’s cards are most useful aids. They are correctly compiled and within the reach of all. It is not more Materia Medica that is needed, but a correction in the faults at the bedside. The careful follower of all Hahnemann’s instructions in taking the case will avoid the errors I have mentioned, and save the necessity for a kind and generous counsel to say: “The treatment is just such as we would have given had we been here in the beginning!”

To find out which remedy to give is the important matter to be considered. The characteristics of a fatal case of this disease are as follows: 1st. No individualizing symptoms. 2nd. An ignorant physician, and this is the commonest cause of failure. The patient might as well be sick without symptoms as have plenty of symptoms and a doctor who knows not the meaning of symptoms.

A favorable prognosis may be made where there are plenty of symptoms to indicate a remedy and there is a doctor present who knows how to read these signs of nature. Always consider first that which is not commonly found in this disease and examine the remedies having such striking features.

The exudative inflammation in the throat, nose or larnyx, with the marked weakness and zymotic manifestations grouped as diphtheria, finds for remedies the following: Acet. ac., Ail., Am-c., Apis, Ars., Arum-t., Bapt., Brom., Bry., Canth., Caps., Carb-ac., Crot-h., Elaps., Hep., Iod., Kali-Bi., Kali-chl., Kali- mang., Kali-ph., Kreos., Lac-c., Lach., Lyc., Merc., Merc-c., Merc-cy., Merc-i- f., Merc-i-r., Mur. ac., Nit-ac., Phos., Phyto., Rhus-t., Secale, Sul-ac., Sulph., and no doubt many others.

It often happens that the nurses speak of the suffocation as soon as sleep comes, which is a symptom that often leads the neophyte to Lachesis, but this remedy may not cover the rest of the symptoms. The following remedies should be consulted, as they all have it as well as the general zymotic state, weakness and exudation: Am-c, Bry., Arum-t., Crot-h., Hepar., Kali-bi., lac-c., LACH., Lyc., Secale, Sulph.

The constant picking at the lips and nose has often pointed to Arum-t.

A type of case often observed where bleeding is an alarming sign; bleeding from nose, mouth and throat, when Bry., Crot-h, Lach., Phos., Secale, Sulph-ac., would be the group to examine.

The odours from the mouth sometimes become important and lead to the study of remedies having putrid odours:

Apis, Arum-t., Bapt., Bry., Carb-ac., Crot-h., Kali-bi., Kali-chl., Lach., Lyc., Merc., Merc-c., NIT-AC.,, PHYTO., Rhus-t., Secale, Sulph.

The well known mercury breath always leads to the examination of the various preparations of that remedy, such as MERC., Merc-c., Merc-cy., Merc-i-f, Merc-i-

r.

The ropy, stringy mucus coming from the throat and air passages is often an important factor and the following remedies are to be examined: Apis, Arum-t., Carb-ac., KALI-Bi., Lach., Merc., Merc-c., Merc-i-f., PHYTO.

If white, Lach.

If Yellow, KALI-BI., Lach.

If the liquids which the patient attempts to swallow come out of the nose, consult ARUM-T. Canth., Carb-ac., KALI-BI., Kali-ma., Lac-c., Lach., Lyc., Merc., Merc-c., Merc-cy., Phyto., Sul-ac.

The gangrenous aspect of the throat is found in: Ail., Am-c., ARS., Arum-t., Bapt., Carb-ac., Crot-h., Lach., Kali-ph., KREOS., Mur-ac., Nit-ac., Phyto., Secale, Sul-ac., Sulph.

When ulceration is notable: ARS., Arum-t., Bapt., Chlor., Hep., Iod., Kali-bi., Lac-c., Merc., Merc-c., Merc-cy., Mur-ac., NIT-AC., Phyto. When swelling of the external throat and cervical glands is a marked feature: Arum-t., Lach., MERC., Merc-c., Nit-ac., RHUS-T.

The following remedies have the disposition to constant swallowing observed in some cases: Arum-t., Hep., Lac-c., Lach., Lyc., Merc., Merc-i-f.

From a lump in the throat: LACH.

The difficult swallowing in this disease is so common it can scarcely be taken as a guiding feature. Yet sometimes empty swallowing is very painful when solids can be swallowed easier and then the following should be inspected: Crot-h., LACH., Lac-c., Merc., Merc-i-f-, Merc-i-r.

Pain when not swallowing or pain ameliorated by swallowing is often important. CAPS., IGN., Lac-c., Lach.

The marked distress in touching the throat is often a guiding feature and then Apis, Brom., Bry., Lac-c., LACH., PHYTO., become a group of importance.

The pain is marked in some cases when anything warm is brought in contact with the throat, warm drinks, etc.: Apis, Lach., Lyc., PHYTO.

When cold things aggravate: Ars., HEP., LYC., Sabad., Sulph. are to be considered.

The membrane has too many features to be examined in this short paper, and hence a repertory must be consulted. But when the exudation is predominantly on the right side: Apis, Ign., Lac-c., LYC., Merc-i-f., Phyto., Rhus-t.

When it extends to the left: Lac-c., LYC., Sulph. When predominantly on the left: Brom., Crot-h-, Lac-c., LACH., Merc-i-r. Extending to the right: Lac-c., LACH.

When the exudate alternates sides, LAC-C, stands alone. When the exudate is predominantly in the nose: Am-c., Kali-bi., Lyc., Merc-c., Merc-cy.

When it extends to the nose: Kali-bi., Merc., Merc-c., Nit ac.

When the larnyx is the locality affected the state is far more serious and the following remedies must be consulted: Am-c., Apis., Arum-t., BROM., Carb-ac., Hep., Iod., Kali-bi., Kali-mang., Lac-c., Lach., Merc-cy., Merc-i-f., Nit-ac., PHOS., Sang.

When extending into the trachea: Iod., KALI-BI., Phos,.

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