INDIAN TURNIP ARACEAE
Coryza; ACRID, FLUENT; NOSTRILS RAW.
Nose feels stopped up in spite of the watery discharge (compare, Am. c, Samb., Sinap.) ; sneezing < at night. Acrid, ichorous discharge, excoriating inside of nose, alae, and upper lip (Ars., Cepa).
Constant picking at the nose until it bleeds; boring with the finger into the side of the nose.
Pick lips until they bleed; corners of mouth sore, cracked, bleeding (with malignant tendency, Cund.); bites nails until fingers bleed.
Patients pick and bore into THE RAW BLEEDING SURFACES though very painful; scream with pain but keep up the boring (in diphtheria, scarlatina, typhoid).
Children refuse food and drink on account of soreness of mouth and throat (Mer.) ; are sleepless.
Saliva profuse, acrid, corrodes the mucous membrane; tongue and buccal cavity raw and bleeding.
Aphonia: complete, after exposure to northwest winds (Acon., Hep.); from singing (Arg. n., Caust., Phos., Sel.).
Clergyman's sore throat; voice hoarse, uncertain, uncontrollable, changing continually; worse from talking, speaking or singing; orators, singers, actors.
Desquamation in large flakes, a second or third time, in scarlatina.
Typhoid scarlatina, with apathy, scanty or suppressed urine; threatened uraemia.
The sore mouth and nose are guiding in malignant scarlatina and diphtheria.
Useful: after Hep. and Nit. ac. in dry, hoarse, croupy cough; after Caust. and Hep. in morning hoarseness and deafness, and in scarlatina.
Should not be given low or repeated often, as bad effects often follow.
The higher potencies most prompt and effective.
Raw, red, bloody surface of lips, nose, buccal cavity; patients pick and bore into them incessantly, though they are so sore and painful.
Hoarseness, with changing voice when exciting it; from high to low and vice versa.
Discharges generally very acrid or corrosive; exceptionally bland.
This is a very unique remedy. I do not know of one that stands so far apart from any and all others, and its peculiar and characteristic symptoms are capable of such remarkable verification in different diseases as would, or ought to, convince the most skeptical of the truth of SIMILIA SIMILIBUS CURANTUR, etc.
Hering's "Guiding Symptoms" gives it in the best rendering. Let us quote a few of the best symptoms: "APPEARANCE OF RAW, BLOODY SURFACE, ON LIPS, BUCCAL CAVITY, NOSE, ETC." "PATIENTS OFTEN PICK AND BORE INTO THE RAW SURFACES, THOUGH DOING SO GIVES GREAT PAIN, AND THEY SCREAM WITH IT BUT KEEP UP THE BORING." (HELLEBOR. NIG.) There is also one other symptom not so well expressed in Hering, viz.: That these raw surfaces are very red, like a piece of fresh beefsteak in appearance. Notice that in Hering these symptoms of mouth, tongue and nose are given in connection with SCARLATINA mainly. I want to say that they are also found in typhoid and typhus fevers. Whenever, in any disease, this red, raw condition of the mouth, nose and lips, at which the patient bores and picks, continually appears, give ARUM TRIPHYLLUM. Another important use of this remedy is in affections of the larynx and bronchia. Hoarseness or loss of voice, or voice uncontrollable; it breaks when trying to sing or speak in a high tone or key. This is often found in clergyman's sore throat, or in operatic singers. Aggravation of hoarseness from singing is also found under ARGENTUM NITRICUM, ARNICA, SELENIUM, PHOSPHORUS and CAUSTICUM.
(Jack-in-the-Pulpit) Arum maculatum, Italicum, Dracontium, have the same action as the Triphyllum. They all contain an irritant poison, causing inflammation of mucous surfaces and destruction of tissue. ACRIDITY is the keynote of the kind of action characteristic of Arum.
Bores head in pillow. Headache from too warm clothing, from hot coffee.
Quivering of upper eyelids, especially left.
Soreness of nostrils. ACRID, EXCORIATING DISCHARGE, producing raw sores. NOSE OBSTRUCTED; MUST BREATHE THROUGH INOUTH. BORING IN THE NOSE. Coryza; discharge blood-streaked, watery. Nose completely stopped, with fluent, acrid discharge. Hay-fever, with pain over root of nose. Large scabs high up on right side of nose. Face feels chapped, as if from cold wind; feels hot. CONSTANT PICKING AT NOSE UNTIL IT BLEEDS.
RAW FEELING AT ROOF AND PALATE. Lips and soft palate sore and burning. Lips chapped and burning. CORNERS OF MOUTH SORE AND CRACKED. Tongue red, sore; whole mouth raw. Picking lips until they bleed. Saliva profuse, acrid, corroding. Throat. Swelling of sub-maxillary glands. CONSTRICTED AND SWOLLEN; BURNS; raw. Constant hawking. HOARSENESS. Expectoration of much mucus. Lungs feel sore. Clergyman's sore throat. Voice uncertain, uncontrollable. Worse, talking, singing.
Scarlet rash; RAIV, BLOODY SURFACES anywhere. Impetigo contagiosa.
WORSE, NORTHZVEST WIND; lying down.
Compare: AMMON. CARB.; AILANTHUS; CEPA Antidotes: BUTTERMILK; ACET. AC; PULS.
Third to thirtieth potency.
Many boys have wandered in the low grounds where this wild turnip grows, and have taken a nip out of it, and probably remember the sensations in the mouth that they received at that time. I distinctly remember making an endeavor to enjoy a piece of wild turnip. The tingling that is left in the lips and tongue and from the throat to the end of the nose, and wherever sentient nerves come to the surface, is astonishing. The prickling and tingling is painful. It is a sensation that cannot be let alone. It requires a continued manipulation, and from this we gather the sensations that must be present in children when they are suffering from acute diseases and this remedy is indicated. For, in spite of the rawness and bleeding and smarting of the parts, they will insist on pinching and scratching and picking the lips and pressing around the mouth and boring into the nose. It has been a guiding feature in acute diseases, scarlet fever, many throat affections, diseases that take on a low type, such as continued fever and eruptive fevers. Among other complaints, sore throats, zymotic affections, delirium and excitement, even maniacal manifestations. It is manifested to a great extent in these associated symptoms. It must be that there is in the nose and lips painful tingling that the patient persists in boring the fingers into the nose. Manipulating and pinching the lips, picking the lips. It is altogether a different symptom that . occurs in delirium of a low, muttering type, which we call carphologia, picking the bed clothes, picking all the time, picking and handling the clothing, a busy, low form of muttering, must be doing something all the time, groping around with the fingers and feeling for something. This is the carphologia and it is a mental symptom. While "picking the lips" is given under the "mental" symptoms in the repertory, it is not intended to mean that it is a mental symptom like carphologia. Now, you will find two expressions in the repertory, and it is necessary to have two—the one is that "the nose itches," and the other is "he rubs the nose," he does something; that is what an individual would do if his nose itched. One's mind is not always directed towards the two—one is a direct and the other is an indirect expression.
This remedy has not been sufficiently proved to bring out the nature of its chronic manifestations. It has undoubtedly something of that kind, but it has been used in a limited way among acute affections of a zymotic character. It has not been used to any great extent for chronic sick headaches, but it has cured some headaches that are worse in the heat, worse in a warm room and from warm clothing, worse from becoming warm, worse from wrapping up the body. Heat in the head, determination of blood to the head. It has also cured eruptions upon the scalp like eczema. It has also been found useful in catarrhal affections of the nose, eyes and lids. About the nose its affections have been mostly of the acute kind. It has most dreadful coryza. The nose is stopped up, and more stopped up on the left side. Must breathe through the mouth. Sneezing worse during the night; fluent acrid coryza. The discharge of saliva flowing over the lips produces rawness, smarting and burning of the mucous membranes, and the lips bleed. The fluid from the nose as it flows over the skin leaves red streaks. "Acrid ichorous discharge excoriating the inside of the nose, the alas and upper lip." That is expressive and occurs in diphtheria, in various forms of sore throat, in scarlet fever, when this remedy is indicated.
Inflammation of the tongue, with acrid discharge from the nose. Inflammation of the root of the tongue, of the throat and soft palate, of the tonsils. The glands of the neck are swollen. This inflammatory condition is followed by paralytic weakness, making it impossible for him to swallow liquids or food, and when the mouth forces food into the pharynx the oesophagus refuses to operate, and then fluids and liquids are forced up into the nose and run out of the nose. This has been clinically observed many times in diphtheria and sore throats. The sneezing is like an ordinary coryza, with repeated chills over the body, and aching in the bones as if the bones would break, like NUX, EUPATOR., AM., RHUS, BRY. and ARS., that have aching all over during "cold." This is one of the most striking medicines as an illustration of the keynote system, that is, with those who prescribe on one symptom and give this medicine whenever the patient bores his nose or picks his lips, notwithstanding that CINA bores the nose and picks the lips. CINA has more of the congestive and nerve symptoms. The nostrils are really so sore from the acridity of the fluids inside of the nose that it feels as if the nostrils were filled with fire. This is the language of the patients who narrate their symptoms in an Arum triphyllum case. They come into the office with a sore, raw nose, and it tingles and tickles and he cannot let it alone. Fluids run down over the lip and excoriate. The glands of the neck are often enlarged. When he takes cold in the nose there is soreness of the neck and parotid gland. Desire to bore into the nose. This boring into THE SIDE of the nose is another symptom and differs from the one "boring the nose." You will see children boring in the nose, inside of nose. It is an inflammation of the nasal duct, the duct that leads from the eye to the nose, and accompanied by a discharge of tears over the cheeks, with the tickling that extends up there which they cannot reach, but they undertake to reach it. Can hardly talk on account of phlegm in the back part of the nose. He talks through the nose. The nose is filled with mucus and there is great tumefaction of all the mucous membranes, which gives him a nasal tone. "Swollen, bloated face." If you observe the nose and face you will be surprised to see that so much of the trouble is on the LEFT side of the face, left nostril, left lachrymal duct, etc. There is bleeding of the lips, upper and lower. The under lip especially is denuded and drops of blood stand upon it, and the patient is constantly picking and pinching the lips, and when you request of the little one to stop it or take his hands away he yells with a sort of sepulchral yell. "Children will often pick and bore into raw surfaces, though it gives them pain and they scream with it, but they keep on boring." That is a striking symptom. Fluids make the lips raw and then this tickling comes on and he cannot let it alone, he must keep at it. "Appearance of raw bleeding surfaces on the lips, buccal cavity, nose, etc." Great itching tingling describes it. In typhoid, where you would hardly expect much swelling of the parotid, these glands are enlarged. In diphtheria, scarlet fever and sore throat enlargement of the salivary glands. This inflammatory condition with soreness and swelling of these glands; the glands are hard and tender to the touch. The tongue is red, the papillae elevated; the tongue appears to be almost denuded. It is raw and bleeding, sometimes does bleed in a few places, and sometimes, after this has gone on for a few days, when the tongue is projected it looks like a big red strawberry, and for that reason has been called "Strawberry tongue:" "Tongue cracked, bleeding, burning, painful; smarting on tongue and fauces." Putrid odor from the mouth. Mouth foul, so sore that he was unwilling to drink. All this points to tingling and raw condition of the buccal cavity far back into the throat. If you look into the buccal cavity you will see the parts raw, denuded and bleeding. Excessive flow of saliva, which is acrid. Mouth burns and is sore. Cries when anything is offered. Buccal cavity covered with diphtheritic ulcers, also with aphthous patches, which cover the whole mouth and tongue. It says "stinging," but it is a painful tingling, stinging like the sting of a bee, stinging pains in the throat, and the parts are ulcerated, raw and bleed.
It has a diarrhoea, such as occurs in idiopathic typhoid. If you have ever seen the yellow corn-meal mush when it is dropped on a plate, it has the appearance of the typhoid yellow stools. When this medicine is suitable diarrhoea is yellow like corn-meal; frequent, faecal, thin, mushy, yellow, is the description of this typhoid stool. There are other times that the stool is dark brown, watery, thin. As is usual, the faeces are acrid. The thin fasces escape from the anus and keep the parts raw and burning. With other complaints, in typhoid especially, in the groin where the thigh bends upon the abdomen an excoriation takes place with acrid moisture. Again, we notice rawness over the coccyx. A moisture and rawness from acrid fluid in the posterior part of the fissure back of the anus so that over the coccyx and back of the anus there is rawness and acrid moisture.
The voice comes in for an extensive part of the trouble. It has been found especially to relate to singers and public speakers. At times when a lawyer has had a long case and he is making a final effort, and has been speaking three or four hours, and while in a sweat has got into a draft or gone out, he finds himself hoarse and cannot finish his Speech, a dose of Arum triph. will enable him to go on with his speech in a clear voice. It clears up the hoarseness. In public speakers and singers who have been compelled to strain the voice and have taken a little cold and the voice is hoarse after prolonged exercise; this is the most striking feature of the Arum triph. voice. "Voice hoarse; from over-exertion of the voice in speaking or singing." "Voice uncertain, uncontrollable, changing continually, now deep, now hoarse, etc." It manifests itself in this way. A person starts in a certain pitch and he cannot talk to you, but he tries another pitch and can talk. It is a queer thing that on certain notes they are voiceless, which shows that there is an irregular and patchy inflammation of the vocal cords; it is not a uniform inflammation or the voice would be uniformly affected. "Clergyman's sore throat," is not a good expression, because it is clergyman's hoarseness that is meant; hoarseness and rawness of the throat of public speakers when talking. Of course you would say any voice that is hoarse is aggravated when talking, but it is not always so. The RHUS hoarseness carries with it its characteristic relief from motion, and the use of the voice is motion of the larynx.
When the RHUS PATIENT commences to use the voice he finds that he is hoarse, but after using the voice a little, it loosens up, becomes freer, or, in other words, it is better from motion. This may be so either in acute or chronic hoarseness. Now, in this remedy as in PHOSPHORUS, the voice is ameliorated from clearing the vocal cords of a little mucus. It is not so in RHUS TOX., for it is a weakness and paralysis from cold. It is well known under RHUS TOX. that the tendons and muscles that are rheumatic become weak, they are stiff on beginning to move and are ameliorated when they are warmed up; so it is with the voice.
Now, in the chest there is burning and rawness when coughing; this extends to the pit of the stomach. "Raw feeling in chest." "Lungs feel sore." "Soreness in 1eft lung." You will notice that many times patients and probers state sufferings are in the lungs, which may not really be the region affected. Most likely from what is known of other symptoms this burning is in the trachea, although it says in the lungs. This remedy does have burning in the trachea, the whole length of it, during an attack of coughing, and burning in the larger branches of the bronchial tubes. The catarrhal state is largely confined to these parts, the trachea and bronchi, but this medicine has cured pneumonia. It has been found useful as a palliative in phthisis. It is used in crude form among the farmers as a domestic medicine for coughs and colds and as a palliative in consumption. In many of the farm houses you will find the wild turnip hung up in strings like beads to be dried and grated and used with sugar and cream.
I mentioned the fact that it seems to favor the left side of the head, the left nostril, the left side of the face. It also prefers the left chest and the left lung. It has soreness in the left side of the chest and left arm. It has a sensation of fullness in the thorax and soreness extending down and involving the left lung.
Here is a clinical picture of fever: "Typhoid forms of fever; picking ends of fingers and dry lips till they bleed, etc."
In most of these complaints the urine is very scanty and is sometimes suppressed. You will very commonly note a good action of this medicine in these complaints by its immediately starting up a copious flow of urine. It is a sign of relief.
It has upon the skin all the scarlet rash that you would expect to find in scarlet fever, and it has also the typoid petechias.
The so-called "Jack in the pulpit" is the first drug in the order for our consideration. This drug has an interesting history. Some twenty-five years ago, there appeared an epidemic of scarlet fever, in the course of which, nearly every case that was not promptly cured in the beginning died. The percentage of losses under homeopathic as well as under other systems of treatment, was truly frightful. The reason for this was, we had no remedy which covered the symptom's of the epidemic. In a poor family, living in a small street, there were five children sick with this epidemic form of scarlatina. The physician who was called to attend them, had lost so many cases under the usual remedies, that he thought it useless to have recourse to these. He thought it better to try something new. Arum triphyllum had only been experimented with, to a certain degree, but still it had been known to produce certain symptoms which led him to the selection of the drug, which he administered in a low potency. All the cases recovered. It was afterwards prescribed in other cases during the same epidemic, with marked success. From that time to this, Arum triphyllum has been looked upon as a valuable drug in the treatment of diphtheria, malignant forms of scarlet fever, and also other fevers having a typhoid form.
In scarlatina, we may use Arum triphyllum when these symptoms are present: There is an excoriating discharge from the nose and mouth making the nose and upper lip raw and sore. The tongue swells; its papillae are large and red, giving it that rough feeling comparable to the cat's tongue. The throat is very sore, and the tonsils are very much swollen. Often, too, there is a dry cough which hurts the child so much that he cringes under it and will involuntarily put the hands to the throat as if to modify the pain. The discharge from the mouth, too, makes the lips and surrounding parts of the face sore, cracked and bleeding, the saliva itself being very acrid; scabs form; the child will not open its mouth. He is excitable and irritable in mind as well as in body. Thus, you see that Arum triphyllum is an exceedingly irritating drug. The child is restless, tosses about, is cross and sleepless at night. The eruption may come out very well and there may be double desquamation. At other times, the rash is dark and imperfectly developed; the child picks and bores its fingers into its nose, or nervously picks at one spot till it bleeds. In mild cases, the urine may be quite profuse, or if it is not, the appearance of profuse urination is a sign that the remedy is acting well. ' In very bad cases, however, those in which the malignancy shows itself in both the internal and external symptoms, you will find developed a perfect picture of uraemia, during which, the child tosses about the bed unconscious and has this involuntary picking at one spot or boring the finger into the nose; and the urine is completely suppressed. The brain is very much irritated, as shown by the restless tossing about and the boring of the head into the pillow. In such a case, Arum triphyllum may save the patient, although, at the best, the case is an exceedingly doubtful one.
I have never seen inflammation of the brain yield to Arum triphyllum, unless some one or more of these symptoms were present; either irritation about the throat, mouth, or nose, or else this peculiar picking or boring at the nose or at one spot till it bleeds. I think that it would be indicated only when the cerebral inflammation came from the suppression of some violently acting poison, such as we find present in scarlatina or diphtheria. Nor would I think of giving Arum in uraemia if it arose in the course of ordinary Bright's disease. I do not think it would be the remedy unless the symptoms already referred to are present.
Arum triphyllum has a marked effect on the larynx. It produces a hoarseness which is characterized by a lack of control over the vocal cords. If the speaker attempts to raise his voice it suddenly goes off with a squeak. With this symptom you may use Arum in clergyman's sore throat.
Possibly the most similar remedy here in this hoarseness, and in this uncertainty of voice is GRAPHITES, which is an excellent remedy to give singers when they cannot control their vocal cords; when they get hoarse as soon as they begin to sing and the voice cracks.
Another remedy is SELENIUM. The patient gets hoarse as soon as he begins to sing.
Now let us study for a few moments the analogues of Arum triphyllum ; and first of all we will consider
NITRIC ACID. This was formerly the only remedy we had for scarlatina maligna. It has that excoriating discharge from the nose. No remedy has it more marked, not even the Arum. The discharge from the nose makes the nostrils and lips sore. This is attended with great prostration. The throat is extremely sore and is covered with membrane. This membrane is of a diphtheritic character, and is either dark and offensive or else yellowish-white. The mouth (whether the disease be diphtheria or scarlatina) is studded with ulcers, ulcers which appear principally on the inside of the cheeks, on the lips and on the borders of the tongue. This ulceration is accompanied by salivation, the saliva usually being watery and very acrid, and not thick and ropy. The pulse frequently intermits every third or fifth beat. This is a very bad symptom. Nitric acid is also preferable to any of the other remedies in diphtheria with these excoriating discharges when the disease advances and affects the stomach (whether or not the membrane in these cases spreads to the stomach, I cannot say); when with great prostration and membrane in the throat and nose, there is distress and uneasiness referred to the stomach, with total rejection of all food.
MURIATIC ACID is still another remedy in these malignant cases of scarlatina and diphtheria. Under this remedy there is the most intense prostration. The patient seems to have scarcely life enough to move. He is worse at about ten or eleven o'clock in the morning. The mouth is studded with ulcers having a black or dark base and dipping deep in. They tend to perforate the parts on which they are situated. Often, too, with the Muriatic acid, you have the intermittent pulse of Nitric acid, but in addition to that, involuntary stool and urine.
In addition to Nitric acid and Muriatic acid in cases having these dangerous groups of symptoms you will think of ALCOHOL. You will remember that Grauvogl found that diphtheritic membrane was dissolved and its growths destroyed by several substances, one of them being Alcohol. So this substance has become a remedy for diphtheria. Alcohol in the form of brandy and water tends not only to destroy the growth, but also aids in counteracting the terrible prostration.
LYCOPODIUM is similar to Arum triphyllum in scarlatina and in diphtheria. It has a similar discharge from the nose, usually associated, however, with dull, throbbing headache at the root of the nose or over the eyes. The nose is so stuffed up that the child cannot breathe at night. The patient bores and picks at the nose just as under Arum triphyllum. You will find in the Lycopodium case that the diphtheritic deposit travels from the right to the left. The patient is always worse from sleep even after a short nap. He suddenly awakens from sleep, crying out as if frightened ; nothing can be done to pacify him. He is irritable and peevish. In still worse cases calling for Lycopodium, you will find the child unconscious and in a deep sleep. The lower jaw drops, the urine is scanty or even suppressed, and what does pass stains the bedding or clothing red and deposits a red sand. The breathing is rapid and rather rattling and a little on the snoring. Every symptom points to impending paralysis of the brain.
AMMONIUM CAUSTICUM was first suggested by Dr. J. P. Dake for diphtheria appearing in the nasal cavities with a burning, excoriating discharge from the nose and great prostration. The symptoms above mentioned led Dr. Dake to use the remedy in an epidemic which appeared in Nashville, Tennessee.
Lastly, let me mention AILANTHUS. The history of this drug is as follows: Dr. P. P. Wells, of Brooklyn, had two cases of poisoning in children. As he states it, it would certainly seem that he had to treat malignant cases of scarlatina; but there being no such epidemic about at the time, he looked for other causes, and found that they had been chewing the blossoms of the Ailanthus. This told him at once that the Ailanthus would probably become a remedy in scarlatina. He made provings of the drug, and found that the proving only confirmed what he had already learned from these poisoning cases. Since then this remedy has been used many times and successfully too. A year ago I attended a poor child with scarlatina. The child lay in a stupor with mouth wide open. The throat was swollen, the nose stuffed up, and what little rash there was out on the body was dark and mixed with dark bluish spots. I gave Lycopodium without any benefit whatever. The child grew worse instead of better. I then thought of Ailanthus, and gave it in the sixth potency, with the result of completely curing the child. I believe that the patient would have died had it not been for the Ailanthus. Wherein does Ailanthus resemble Arum triphyllum ? It resembles it in the acridity of the discharges. There are excoriating discharges from the mouth and nose, making the lips sore. We find a' similar swelling of the throat, both inside and outside. So far as these superficial symptoms are concerned, you have identical cases. But there is a great difference to be recognized in the other symptoms. The Ailanthus patient becomes drowsy and lies in a stupor, hence it is indicated when there is torpidity rather than the restless tossing about as under Arum triphyllum. The Ailanthus rash comes out imperfectly; it is dark red or bluish, and is mixed with petechiae.
Some little time ago, some members of the class requested that I would speak of the remedies useful in diphtheria; so, while I am on the subject of Arum and its analogues in this affection, I will take the opportunity to accede in part to that request.
BAPTISIA TINCTORIA, you know, has long enjoyed a great reputation in typhoid fever. It has lately been used in diphtheria, and in scarlatina also when the child is very much prostrated and lies in a half-stupid state almost like one intoxicated. The face is dark red and has a besotted look, and the discharges from the mouth and nose are horribly offensive; so much so, indeed, that one might suppose that gangrene of the affected parts had taken place.
RHUS TOX. we find indicated in pretty severe cases, when the membrane is dark in color and bloody saliva runs out of the mouth during sleep. These symptoms are associated with inflammation of the glands about the neck, with a dark, erysipelatous hue.
PHYTOLACCA DECANDRA we find useful when, in the beginning of the disease, there are creeps and chills and backache. The patient is weak, and feels faint when he sits up in bed. On looking into the throat you find it dark red, almost purple. There is great burning in the throat, with aggravation from hot drinks.
AMYGDALA AMARA, when there are sharp, lancinating pains through the swollen tonsils. The palate and fauces have a dark red hue, and the patient is very much prostrated.
NAJA TRIPUDIANS is to be administered when there is impending paralysis of the heart. The patient is blue. He awakens from sleep gasping. The pulse is intermittent and thready. Dr. Preston, of Norris-town, has been very successful with Naja when the symptoms I have mentioned were present.
APIS MELLIFICA is, I think, indicated in diphtheria. From the very beginning the child is greatly prostrated. There is not much fever; in fact, there is a suspicious absence of heat. The pulse ranges from 130 to 140, and is very weak. At first, you find the throat having a varnished appearance as though the tonsils and fauces were coated with a glossy red varnish. The membrane forms on either tonsil, oftener on the right than on the left, and it is thick like wash-leather. The tongue is often swollen. If the child is old enough, he will complain of a sensation of fulness in the throat, which necessitates swallowing but making the act very difficult. The uvula, in fact the whole throat, is oedematous and swollen. The RIMA GLOTTIDIS is swollen, red, and oedematous, making breathing difficult. In some of these cases the breath is very foetid, while in others it is not so in the least. In some cases there appears a red rash over the body; this rash greatly resembling that of scarlatina.
ARSENICUM ALBUM is called for in rather severe cases of diphtheria when the throat is very much swollen both internally and externally, when the membrane has a dark hue and is very foetid. There is a thin, excoriating discharge from the nose. The throat is oedematous, just as it is under Apis. The patient is restless, especially after midnight. The urine is scanty. The bowels are constipated, or else there is an offensive watery diarrhoea.
NATRUM ARSENICOSUM is the remedy when there is a dark purplish hue to the throat, with great swelling and great prostration and without much pain.
KALI PERMANG. is useful when the membrane in the throat is horribly offensive. The throat is cedematous, and there is a thin discharge from the nose; the main characteristic of the drug being this extreme fcetor.
LACHESIS is called for when the membrane forms first on the left tonsil and spreads thence to the right. How are you to distinguish it from other drugs which act in a similar manner ? By the following symptoms : The symptoms are worse from empty swallowing, and they are often relieved by eating or swallowing solid food. There is a constant feeling of a lump on the left side of the throat; this descends with each act of deglutition, but returns again. Sometimes, on arousing from sleep there is a feeling as if there were needles in the throat, which creates suffocation. Sometimes, when the tonsils are very much swollen, fluids return through the nose. The fauces are of a dark purplish color, and there is great prostration. The heart is weak in its action. There is aggravation after sleep, and the throat is sensitive to the slightest touch.
BELLADONNA is not a prominent remedy in diphtheria. When you do give it in this disease, make sure that it is the remedy or you will lose valuable time. It may, however, be the remedy in the early stages when the violence of the attack calls for it, when there is congestion of the head before the membrane has formed.
Other remedies than those just mentioned are frequently indicated, for example, KALI BICHROMICUM, IODINE, BROMINE, MERC. BIN., MERC. CYAN., and others. The indications for these you will get in future lectures.