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medicine in diphtheria are the puffy, œdematous, bright red color, and glossy appearance of the parts, as if they were varnished. The submaxiliary glands and connective tissue around the neck, face and chest are swollen and puffy; comparatively little pain in throat, and swallowing not very painful. Pain in the head and neck, with periodical aggravation. Fever and slight chills when moving around, worse at 4 P.M. In severe cases great prostration and comatose condition, as if the economy were fully saturated with the poison. The following I quote from Feltenhoff, to complete the indication for Apis: "Diphtheria coming on quite unperceived and progressing so insidiously as to offer but little hope of relief, even when first seen. Painful urination; slight tenesmus; numbness of the extremities; high fever; moist skin; usually very nervous, sometimes slightly delirious; the false membrane had a grayish appearance and was tough. Some of the most malignant cases had no foul breath; some cases had thirst, others not much;" and let me add that if you examine the urine and fird albumen, it is a key-note for this remedy. Sulphur. I have never used this medicine alone for diphtheria, but as an intercurrent, and in that way I have been fully satisfied of its beneficial results. In cases where the disease has begun on the left side and lachesis has been prescribed, I am inclined to assume that Sulphur has well developed the action of that and other remedies, and many cases have run a milder course. Diphtheria, like scarlet fever, has a tendency to arouse the latent hereditary miasmatic taints of scrofula, syphilis, and Hahnemann's psora; but Sulphur undoubtedly has the property of subduing and keeping at bay, if not destroying, their dangerous influence in acute diseases; hence its great value as an intercurrent in diphtheria. Sulphur, besides,has the prostration of strength very marked; sore throat with great burning and dryness, beginning on right side and going to the left.

Sulphur has many analogies with Lycopod., which Goullon calls the vegetable Sulphur, and we have seen already what an important remedy it is in this disease.

Dr. Pearson, of Washington, says in an article on malignant diphtheria: "If we can rightfully speak of anything as being a blood disease, diphtheria and membranous croup should undoubtedly be classed in that category; hence Sulphur should never be lost sight of in their treatment."

As a local application diluted alcohol has proved to cover all the requisites of a reliable, uninjurious solvent of exudations, used in

gargles, or, better still, in the form of spray,
with the common bulb atomizer.
For internal use I am in the habit of mix-
ing two teaspoonfuls of homeopathic alco-
hol (about 90°) with the solution of the
medicine employed; it keeps it fresh, and,
as alcohol goes into the circulation as such,
it is my belief that it must have some bene-
ficial influence in destroying bacteria when
found in the circulatory system, not yet
having observed any bad effects from its
use in this form and quantity. For other
adjuvanta I have adopted and enforced the
free and bountiful supply of fresh air in the
sick room (temperature about 65° F.); the
grate or chimney fire; washing or gradually
bathing the body with soap and water
during the fever; the cold, wet compress
around the neck; change of personal and
bed linen every day, and the prompt re-
moval of all expectoration, evacuations and
fomites. A nourishing diet, composed of
beef tea, clain or oyster broth, milk, cream,
raw eggs beaten with milk, wine whey,
wine jelly, the quantities regulated by the
appetite, and as much water as thirst de-
mands.

As disinfectant in the room I used to em-
ploy the chloride of lime in pow der
or solu-
tion, and carbolic acid; but since becoming
acquainted with the salicylic acid I use in
solution of water and alcohol, hanging in
the room pieces of muslin saturated with it.
It is a thorough deodorizer, the alcohol im-
parting also a pleasant smell to the room.
The lime and carbolic acid are ordered to
be put in the halls, bath-room and water-
closets.

Liquor calcis chlorinate was introduced by Dr. Neidhard, in 1867. The number of cases of diphtheria reported cured by this. remedy induced me to try it in a very severe case from the beginning. The subject was a child two and a half years; the disease was insidious; began in the schneiderian membrane and extended downward to the larynx, and he got well slowly. As sequel he had paralysis of the palatine arches and lower extremities, with convergent strabismus; all disappeared without medication intwo months. The aunt of this child, thirtyeight years old, of weak constitutional powers and delicate, took the disease, I think by contagion, for she lived on the same floor at the time and handled the child often. She was put immediately under liquor cale, chlor., but she died about the fifth day with all the respiratory organs intensely affected by the disease. Mercurius cyanuretus. "Diphtheria maligna, with lips, tongue and inside of cheeks dotted with ulcerations, covered by a grayish-white coating." "Salivation profuse, thin, fœtid,

excoriating the surrounding parts," like Arum tryph. "Great difficulty of swallowing." "Phagedenic ulceration and gangrenous diphtheria." The real indications for this remedy seem to be the great malignity of the attack, with greenish exudations, horrible foetor, and extreme adyhamia. Lac caninum. If lactic acid and lac deflora tum from cows are considered to-day leading remedies for diabetes, the acid being valuable also in morning sickness of pregnancy and croup, and if Koumiss, or fermented milk, is proving an excellent restorative, there is no reason why another kind of milk might not be a therapeutic agent for some other diseased condition.

The medicine cured promptly a child whose brother died of diphtheria, after Apis had failed. The case presented partial suppression of urine, a sore throat of an oedematous character, the tonsils badly swollen, and great indisposition to take food or drink. In forty-eight hours lac caninum cured.

A very bad case of relapse from diphtheria. High fever; pulse 130; eyes injected; tonsils enormously swollen, filling the entire pharynx; excessive tenderness to external touch; very foul or putrid odor from breath; he was very impatient and fretful, demanding what would be refused when furnished to him. A constant sense of suffocation, delirium, and great distress from swallowing food or drink. Convalescence in twentyfour hours. (J. A. Terry, Trans. N. Y. S. 1876-7, p. 319.

Therapeutics of.

It

Alcohol. Gargling with diluted alcohol is the best prophylacticum. Alcohol has this advantage over all other substances, recommended externally against diphtheritis, that, being non-medicinal, it allows the use of any homœopathic remedy, high or low, and is still one of the most powerful destroyers of any fungus growth. Besides, where it is desirable, the internal remedy can be dissolved in it for external use. can be used as a gargle or in the form of spray by means of a toilet spray producer, or as steam, or applied with a brush. Apis Mellifica. Violent inflammation of the throat; much dryness, burning, stinging, roughness; sensation of fullness; contraction and suffocation in the throat; difficult swallowing; tonsils very much swollen; t roat swollen inward and outward ; marked prostration and depression; nervous restlessness; itchy eruptions of the skin; oversensitiveness of the skin to touch; much fever; voice grew hoarse; breathing and swallowing very difficult; difficulty of swallowing not caused by the

swelling of the throat, but by the irritation of the epiglottis; sensation as of a rapid swelling of the lining membrane of the air-passages; rough voice; speaking painful; hoarse cough; intense sensation of suffocation; could bear nothing about the throat; hurried, difficult respiration; labored inspiration, as in croup, etc.; paralytic symptoms; crawling as if going to sleep in both arms; very distinct sensation of numbness in the fingers; lower limbs feel paralyzed; weakness of sight, etc. Arsen. Alb. 1. That Arsen. is not the rem

edy for diphtheritis with a severe inflammation of the throat and its accompanying symptoms. 2. That the dynamical influence of Arsen., even on the gangrene of the throat, is very insufficient, as all physicians lay great stress on the external treatment, i. e., on the direct destruction of the fungi. 3. That its sphere of action is only in a later stage of the disease, especially when the above-mentioned group of symptoms prevails. It is, therefore, not a principal diphtheritis remedy, and has not been used much since the attention has been drawn to such as Mercur. hydroc., Carbol, ac., and Salicyl. acidum.

Arsen. Jodat. Girl, æt. 5, scrofulous. Sickly from birth; asthmatic; croupy symptoms prominent; hoarse cough; diphtheritic deposit covering mouth from fauces to outer edge of lips, and also covering external auditory canal; short, difficult respiration; pulse weak, slow; great prostration; bad odor from patient. Arsen. jod., 1st trit., cured.

Baptisia Tinctoria. There is little pain. Sensation of great fullness; ædematous swelling of the affected parts, especially affectng the posterior opening of the nose; little pain or soreness of the fauces, characterizes the most dangerous form of diphtheritis.

Belladonna. The throat has a highly in

flamed appearance; is very red and shining; drowsiness; the eyes are very much injected; the face is flushed; there is throbbing of the carotids; the pulse is very rapid; the child complains occasionally of chilliness; great difficulty in swallowing, with pain running up into the ear. Bellladonna is in its place only in the beginning of the disease, when there is very severe inflammation, or in very mild cases; but it is inferior in every respect to Apis, which takes here its place.

Bryonia alba. The patient is quickly prostrated, shuns all motion, and complains on moving, or when being moved, of pain everywhere; white tongue; feeling of dryness in the mouth, without particular thirst or desire for large quantities of water.

Carbolicum acidum. Great langor; weakness; great prcstration; general soreness; drowsiness; chilliness; cold perspiration; dizziness; headache, especially in the forehead, or through the temples, as if from a tight band around the forehead; affection of the mucous membrane of the nose; face pale; loss of appetite; nausea; weak pulse, etc.

Chininum arsenicosum. Paleness (anæmia); rapid exhaustion; quick destruction of the mucous membrane (94); foetor oris; swel ling of the submaxillary glands and parotides; violent fever; great prostration. Kali bichromicum. Indicated, where the mucous membrane is deeply affected, and there is much ulceration; the mucus is frequently streaked with blood; pain in the throat; painful, difficult swallowing; great weakness; cachectic look; swollen glands. Frequently the nose is also affected.

Lachesis. The subjective symptoms much severer than the objective; violent pain in throat; extremely painful and difficult swallowing; difficult speaking; sensation of a foreign body in the throat, with stingings extending into the ear; urgency to swallow, and desire to hawk up something, with choking spells; dislike to have the throat touched; pale redness of the fauces; exudate begins or is worse on left side; voice weak and hoarse; aphonia; cough causes pain; foetor oris; fetid discharge from mouth and nose; violent prostration even before the exudation; lassitude; weakness; pulse weak, small; perspiration cold, clammy; somnolency; delirium; symptoms worse after sleep.

Lachnanthes. If the child has a very stiff and painful neck, drawn to one side, with diphtheria (Guernsey's Obstet., 946). Lycopodium. Worse on right side; stoppage of nose, with excoriating coryza, and inability of breathing through the nose; much swelling and pain in throat, with spasms on swallowing, etc.

Mercurius. The mercurial preparations an swer only to the complication with scarlatina, because they have no true relation to the diphtheritic process (Allg. h. Ztg., 84, 152; Hughes).

Mercur. bijod. rub. In the more malignant forms, where there is considerable fetor of the breath, and the symptoms decidedly adynamic, Merc. corrosiv. will be found preferable.

Mercur. jodat flavus. Great difficulty in swallowing, with great pain in the throat; the salivary glands are very much swollen and painful; very offensive smell from the

mouth, and fetid discharge from the fauces and nares; swelling of the cervical glands. Mercur. sublim, corros. Merc. subl. corr., 2d

or 3d trit., is the right medicine when the exudate covers the entire fauces and extends into the nose, from which a profuse discharge flows.

Nitri acidum. Swallowing very difficult and exceedingly painful; excessive salivation; fauces and glands swollen; fœtor oris: great uneasiness; violent fever. Phytolacca decandra and octandra. Chills usher in the disease, appearing irregularly the first days; violent pain in the front or back part of the head, in the back and limbs; great prostration, with fainting or vertigo when rising, preventing the patient from sitting up; loss of appetite; high fever; delirium; tonsils, soft palate, and fauces highly inflamed, very much swollen, sore, and sensitive; deglutition almost impossible; choking sensation; dyspnœa; the exudate mostly of a grayish color; sensation, as if from a lump in the throat; fullness in the throat; roughness and rawness in the pharynx; dryness in the fauces; disposition to hawk up mucus.

Rhus toxicodendron. When the child is restless, wants to be carried about, wakes up every now and then complaining of pain in the throat; when a bloody saliva. runs out of the mouth during sleep; when the parotid glands are a good deal swollen; when there are transparent, jelly-like discharges from the bowels at stool or afterward.

Sulphur. Sulphur possesses an astonishingly quick and sure influence in diphtheritis. The membranes become soft and come off without loss of substance, the inflammation subsides, the swelling of the glands lessens, the fever disappears, appetite and sleep return. Among the fungusdestroying substan es Sulphur, used locally, is the surest, quickest, and most pleasant. The flour of Sulphur may be blown. on the diseased part, or applied with a small brush, and at the same time the flour of Sulphur may be taken internally, or an emulsion used as a gargle. The main object is to bring continually the affected part in contact with Sulphur as much as possible, till the exudate has entirely disappeared The pain and soreness may be quite severe, and even extend into the ear; pain as if from a lump in the throat; empty swallowing more painful than even that of liquids; the inflamed parts not bright-red, but purple; dryness in the throat, especially in cases which have a slow, sluggish course. Where the indicated medicine does not have the desired effect, interpose a few doses of Sulphur.

Sulphuris acidum. Throat inflamed; tonsils bright-red, swollen; exudate thick, grayish, or yellowish-white, sticky, tenacious; swallowing very difficult, liquids run out of the nose; swallowing almost impossible; breathing difficult on account of the accumulation of the exudate in the fauces; obstructed breathing; speech thick, indistinct, very difficult; violent salivation; excessive foetor oris; pulse frequent, small, weak; apathy; somnolency; excessive paleness, weakness, and languor.

Tartarus emeticus. Difficult breathing; gasping for air; rattling in the chest; retching; vomiting of tenacious mucus; small circular patches, like small-pox pustules, in and upon the mouth and tongue; oedema of the lungs.

*

The internal treatment. Although diphtheritis appears as various as many other diseases, yet most physicians have entirely neglected to individualize. Many have chosen some one particular remedy, administered it in all cases without distinc tion, and justified themselves by their success. If their success has been so satisfactory with one remedy for all cases, it would have been much better still if they had individualized and used various medicines, just as they would have done in the treatment of any other disease. Nature nor homeopathy has made an exception in diphtheritis. The evil effects of this oneremedy doctoring is seen in the quality of our Therapeia on diphtheritis, which is very inferior to that of any other disease in the whole homoeopathic literature. The general remarks are often nothing but sweeping assertions how this or that drug cured all cases. Frequently is added, with the greatest naiveté, that, notwithstanding, in some instances the administration of this one remedy had to be persisted in for several days, before any improvement was pereeived. Now, we say that just these cases should have been treated with some other medicine, because if a remedy is the right one, it acts at once, and the recovery is quick. The majority of the clinical cases are insufficiently and incompletely described and the cures not convincing. We do not wish to be misunderstood; we do not demand perfection; but, when we see so generally not the least inclination to individualize, and read so many worthless clinical cases, it is time to reprove. The modus operandi and results of a physician in his practice is one thing, and his publica

By general remark, in contrast to clinical case, we understand the indications for the selection of a remedy, such as we find in works on therapeutics.

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tions another; with the first we wish to be lenient as possible, with the other we reserve the right to exercise a severe but just criticism. If physicians had individualized in their practice, and published only such cases wherein the influence of the medicine was quick and unquestionable, * our Therapeia on diphtheritis would have a much higher standing and be of more practical use. Hand in hand with the lack of individualizing is the almost universal practice of using unusually low attenuations, with a tendency of going still lower, if the previous seems insufficient. Both deviations from the usual method of homoopathic practice have been unmistakeably caused by the presence of the fungous growth, which has been altogether too much of a bugbear to most physicians.

2. The external treatment. Alcohol de stroys the fungi as quickly as any of the substances used for this purpose. But as its external use allows at the same time a strictly homeopathic treatment, it has the advantage over all other drugs.

The diet should receive particular attention, even after recovery, as improper food may cause death, especially with children. (F. G. Oehme, N. A. J. of Hom., August, 1876.)

A fresh trituration of Mercur. jod. flav. in alternation with Kali chlor.

Croup symptoms setting in were controlled by the continued use of Hep. sulph. Diphtheritic croup: severe case cured by alternate administration of Hepar, Spong, Brom., with Kali chloricum, Phosph., Kali jod., in succession. (H. Goullon P., vol. VII., pp. 292, 334.)

H.

Complicated with diphtheritic croup. Brom. 3 decim.: 5 drops in water every half to one hour; afterward when suffocative attacks were eased Hepar sulph. 3 decim. Cured. (Sorge H. K., vol. XXI. p. 31.) With laryngeal complications (2 cases); cured with Bromine and Hepar sulph. in alternation. (Dr. Windelband, A. H. Z., 93 p. 94.)

We cannot express too strongly our opinion on this of a drug is only probable, or nearly so point. We are not satisfied with cases where the operation There can be no other reason for publishing a clinical case, otherwise than to show the effect of a medicine; and the writer should fore, its history should be given as completely as possible, the language concise and clear, symptoms well arranged, there can be no shadow of a doubt. Many drugs may in

bear in mind that the reader does not see the case. There

and, above all, the effect of the medicine so decided that

fluence a case, but only one will cause a rapid and indisputable improvement or cure. Before estimating the effect of a medicine, we should first ask, how soon, most likely, would the case have improved or recovered without any medicine.

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Croup, commencing with a chill and great prostration, so that they were at once confined to bed; fever now appears, and pulse may be so fast that they cannot be counted; mouth and fauces soon covered with a thin, grayish coat; tongue coated, elongated, ridged, and trembling; through the coating protruded bright-red papillæ, and edges of the tongue were dark-red and glistening. Breath fated, throat swollen somewhat outwardly, with pains shooting to the ears. Nasal passages soon fill up, and breathing is carried on through the mouth, and in some cases typhoid symp toms were prominent. Treatment, Baptisia tinct and 1st cured eight cases; the indications being stupefaction and drowsiness; tongue coated white, with red papillæ protuberent, followed by yellow brown coating in the center, edges red and shining; breath fœted. Intense heat of the skin, moist or dry; pulse 120, and thready; lips parched and cracked; pasty tongue, heavily coated; thirst; mind wandering; could not give a direct answer; delusion at night; low muttering; great prostration. (Hugh Ross, M. I., vol. III, p. 253, 1876.)

Croup in a girl of 15 years of age. She had had Merc. corros., and the spots of exudation had been treated with alcohol, when the disease invaded the larynx. There were hoarseness and impeded breathing. Hepar sulph. was given; next day being worse she had Bromium, and Rhine wine was administered; bronchial breathing was heard all over the chest, and great heat of the body existed; in two or three days. the larynx was cleared of membrane, pieces of it having been coughed up, but there was rattling in the chest, and the urine contained albumen. Hepar sulph, was next prescribed; she grew gradually better, and in five days the albumen had disappeared from the urine; but in swallowing the food often "went the wrong way.' Tinct. Cupri acetici Rademacheri was then given and shortly all morbid symptoms except the hoarseness were removed. (Dr. Sorge, A. H. Z., 92, p. 93.).

99

- Croup under Bapt. the pseudo-membrane is absorbed. (Hugh Ross, M. I., vol. III, p. 286, 1876.)

Carbo veg. never fails in the Epistaxis. Gels. for the drowsiness and nervous twitchings. Cold salt water, externally, prevented discoloration. (J. J. Shaw, N. E. M. G., vol. XI, p. 497.)

Sequels of.

Paralysis of glottis.-Apis mel. Gelsem., Plumbum, Secale, Thuya, Zincum.

Paralysis of lower extremities.-Arsen.
Mercur. cyan, Rhus tox.
Paralysis of face.--Cocculus.
Albuminuria.-Cantharis, Merc. corr.

Amaurosis.- Gelseminum.
General debility.-China, Sulph.
Loss of sensation, especially in palate.--
Kali Bichrom.

Hemiplegia.-Nux Vom. (A. Chargé, Riv.
Omiop., Roma, vol. XXII, p. 36.)

In post diphtheritic paralysis of the fauces. Caust. (A. H. Tompkins, N. E. M. G., vol. XI. p. 491.)

For paralysis following.-Kali Phosph. (Dr. Feichtmann, A. H. Z., 92, p. 24.) Arsenicum and Carbo Veg. are best reme dies for the septicemia. Nux Vomica and Rhus Toxicodendron and use of electricity are recommended for muscular weakness and paralysis following the disease. A nourishing diet of concentrated extracts, etc., should be given from the commencement. (J. W. Dowling, A. O., 1876, p. 233.) Miss A. applied for relief from a difficulty in articulating some words, occasional strangling on attempting to swallow small quantities of fluids, and escape of fluids. through the nose on swallowing; a sensation of "clumsiness" in back part of throat. All these were aggravated in the after part of the day, or when getting tired. Patient had had diphtheria. Five doses of Gelseminum 200 cured entirely. (J. T. Greenleaf, Trans. N. Y. S., 1876-7, p. 148.)

Voice.

LARYNX.

Medicine for. (H. W.; vol. XI, p.

246.) Hoarse ess. Worse at night. Phos. (Dr. Marks, Trans. N. Y. S., 1876-7, p. 22.) In chronic. Dr. Fischer usually gives at first Phosphor., and, if that does not cure, Carbo veg. (A. H. Z. 92, p. 93.)

Aphonia. In a woman of 40 years of age, following a cold; head feels uncomfortable; eyes full of tears; frequent sneezing, with watery discharge from nose, which is red around the nostrils; marked catarrhal condition of the pharynx, with enlargement of the mucous follicles; the voice is hoarse, lacking more or less its clearness, and always helped by clearing the throat; considerable cough, quite sonorous; the expectoration comes without any special difficulty. Mercur. solubl. 3 helped very soon. She then over-exerted her voice, and became completely aphonic; there was slight burning in the region of the larynx.

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