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.
EPITOME OF TREATMENT-
1. Mild Cases.- Aconite, Belladonna, or Baptisia at the commencement; afterwards, if necessary, Merc-Iodium or Ac-Nit.
The treatment recommended in the Sections on Quinsy is often sufficient in Diphtheria, if used early.
2. Malignant Diphtheria.-Merc-Cyan., K-Permang., Ac-Mur., K- Bich., Arsenicum, Ammon-Carb., Laches., Lycop.
3. Sequelae-Phosphorus, Phyto (Hoarseness etc.), Coni., Gelsemium, Rhus., Sulphur, Digitalis (enfeebled heart); China or Quin. (debility).
SPECIAL INDICATIONS- Belladonna.- Mild cases rapidly recover, and more severe cases often yield under this remedy, when perseveringly administered in the 1x dilution. Hughes recommends a freer resort to the aid of Belladonna but very properly adds, that if decided improvement have not resulted within forty-eight hours of commencing its use, or if the symptoms yield at first to the remedy, but soon return, there is no advantage in persevering with it.
Acid-Mur.- Malignant Diphtheria, with foul, greyish ulceration of the throat, foetid breath, and great general prostration. This remedy should be used in a low dilution, in frequently repeated doses; and locally as a paint to the throat, or as a gargle, when the patient is able to use it so.
Merc-Cyan.-Introduced by Dr. Beck, of Switzerland, and first used on the person of Dr. Villers, of Dresden, who recovered by its aid from a desperate attack, and survived to cure large numbers of patients with the same remedy in after life. He gives it mostly in the 30th potency. The indications are the membrane, foetor, great prostration of vital powers. It is perhaps the most generally useful drug.
Merc-Iodium-This remedy has proved of great value in the disease, and should be administered as soon as any diphtheritic patches are observed in the throat, or swelling of the glands of the neck. Difficult swallowing, pain in, and swelling of, the salivary glands, and putrid sore throat, indicated this remedy. The 1x or 2x trituration is the strength on which we place the greatest reliance in this disease.
Kali Permang.-Malignant Diphtheria, with extensive swelling of the throat and cervical glands; pseudo-membranous deposit, partially or completely covering the fauces; obstructed swallowing; a thin, or muco-purulent discharge from the nose, excoriating the parts; thick, obstructed speech, and very offensive breath. There is no remedy with which I am acquainted that will so rapidly and surely remove the offensive odour of the diphtheric breath as the Permanganate. In this respect the Chloride of Potash closely resembles it (Dr. H.C. Allen).
K.-Permang., K.-Chlo., Condy’s Fluid, or dilute Carbolic Acid, should be used as a gargle or wash to the affected parts; or administered by inhalation, or the spray producer.
Baptisia and Phytolacca.-Both these American remedies are strongly recommended in Diphtheria; the former has a more specific relationship with the blood-poison, and the latter with the local effects of the disease.
Arsenicum, in the last stages of the disease, is of immense value, particularly when the prostration of strength is very marked, or is increasing; when there are oedema, putrid odour of the throat and air-passages, and tenacious foetid discharge from the lining membrane of the nostrils.
Ammon-Carb. is as a valuable remedy in malignant cases, and may be administered alternately with Arsenicum
Lachesis is indicated when the affection begins on the left side of the throat and spreads to the right. Intolerance of any pressure about the neck is a good symptom for this drug.
Lycopod. has the opposite characteristic of spreading from right to left. Both this drug and the last are of great value in Diphtheria.
ANTI-TOXIN-After the discovery of the Diphtheria bacillus it was found by Professor von Behring and Dr. Roux that it was the toxin manufactured in the throat that gave rise to the constitutional symptoms, and that the body resists this toxin by developing a neutralizing substance called anti-toxin. By appropriate procedures anti-toxin can be developed in the blood serum of the horse. This serum can then be removed and injected into those suffering from Diphtheria, thus supplying anti-toxin to the patient early in the disease. The great majority of physicians are of opinion that this so-called anti-toxin treatment is of the greatest value. It can be used simultaneously with drug treatment. The great point to remember is that it should be given early, as soon as the disease is recognized.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."