Phosphorus is especially useful when the violence of the croup attack has been broken by some of the foregoing, but there remains a tendency to relapse; the child grows worse again every evening, or the cough goes down in the tubes and lungs. It will often clean up the case, in desperate cases where other remedies have failed in both forms of croup.
Phosphorus is very different. There is greater oppression of the chest, feels as if there were a load pressing it down. The parenchyma of the lung is the center of action and the pleura not so much involved, if at all; the expectoration is often profuse, and when falling on paper, on a hard surface, will break and fly like batter; the temperature is very high with circumscribed red cheeks ( Sang ), cough hurts and makes him tremble and is worse lying on the left side; the patient moans or grunts with every breath, and suppresses the cough by it, just as long as he can because it hurts him so. Phosphorus attacks by preference the lower right lung or lobe. It may be indicated by the symptoms at the beginning of the stage of hepatization, when it puts a stop to the further progress of the disease, but its more brilliant effect is when the stage of hepatization is completed and we want to break it up and promote resolution. Here it has no equal. Under its action the hitherto restless patient will, (in the 30th, 200th or 1000th potency), sink into a sweet sleep, profuse perspiration will set in, and with the waking we are in full tide of convalescence, the expectoration becomes free and easy, the mind tranquil, and, in short, all the violence of the storm is past. Pneumonia.
Considerable “talk has been said” about this being, a dangerous remedy to use in pulmonary tuberculosis or phthisis.
Farrington says “I would not advise you to give Phosphorus in well marked tuberculous patients. If tubercles have been deposited in the lungs you should hesitate before giving it, unless the picture calling for it is so strong that you cannot possibly make a mistake.” I think the “picture” should be strong for any remedy, and if not strong should be cause for hesitation.
The greatest danger in giving a well indicated remedy in tuberculosis in any stage of the disease is in giving it too low or too frequently repeated. And this danger is not confined to Phosphorus. Rummel says only once in fifteen days. Dr. Charge, of Paris, confirms him. But the safest rule is not to repeat as long as improvement continues, and then in another potency. Now for a few “leaders.” This remedy is generally found indicated in tall, slender, narrow chested persons, with fair, delicate skin, long silky eyelashes, highly sensitive organization; brilliant mental faculties but defective physical development. Especially young persons who have grown too rapidly, incline to stoop in walking (like Sulphur ), hollow chested and anaemic or chlorotic. There is often pronounced nervous debility; trembling; weakness and prostration. Haemorrhagic tendency, vicarious, epistaxis, or even small wounds bleed much. Haemorrhage of the lung is sometimes the first symptom. Takes cold easily and every cold inclines to settle on the chest, Pneumonia is easily contracted and for its treatment, to save repetition, I will refer you to the article on that disease. These are the general indications. The local are: Hoarseness, worse in the evening ( Carbo veg. ). Cannot talk, the larynx is so painful.
Breathing short, oppressed, sense of heaviness in chest. Cough Dry constant, from tickling in the throat – pit, with tightness or constriction across the upper third of chest; spasmodic, hollow, from tickling or irritation under sternum; hurts chest, holds it with hands for relief ( Bryonia, Eupat. perf ), severe, shakes the whole body; worse in cold air, from laughing, talking or singing ( Spongia ), and especially when lying on left side, also apt to be worse in evening until midnight (Raue). Expectoration scanty at first; in first stage; later, bloody, purulent, rust colored, salt, sour or sweet. Of course there are many other symptoms that may be present, but these are leading ones, and when present the remedy properly exhibited as to dose and repetition is capable of great good, no matter at what stage of the disease.
Frequent blowing of blood from the nose; handkerchief is always bloody, chronic catarrh. Chronic nasal catarrh.
Hoarseness; lining of vocal cords highly injected, cough worse by talking, laughing, singing, cold air or lying on left side; tickling in the larynx and spasmodic cough, followed by dryness and burning in the throat. Laryngitis.
Larynx so painful he can hardly talk, which aggravates the constant cough. Trembles all over with cough, and it is especially worse in the evening, and lying on the left side. Cough hurts and the patient holds the breath and lets it out with a moan because it hurts him so. There is great tendency to extend into the lungs with sense of oppression of the chest. (See Pneumonia.). Acute bronchitis.
When the pleuritis spreads and involves the lungs and bronchi, as it sometimes does, constituting a case of pleuro pneumonia, which it sometimes does, though it is oftener the other way in my experience, i.e., beginning in the lung first; the pneumonic remedies must come into the case, viz., Phosphorus, bronchitis with severe cough, which is worse in the evening, and when lying on the left side, dyspnoea with a sense of heaviness in the chest. It generally comes in the later stages of the disease with purulent infiltration, and in flat chested people of a consumptive build. It must be used in those cases which “hang fire” in the process of convalescence, after improvement sets in and consumption threatens, or in those cases which show decided tubercular signs, and just here is where Tuberculinum may do good work in cases having a decided tubercular family history. I have seen such cases do well on a dose of this remedy once a week, interpolated with the other indicated remedies, just as we give Psorinum in psoric cases.
Cough character – Dry tickling cough; hollow cough; harsh, irritating cough; loose cough, with mucopurulent expectoration.
Cough aggravated by – worse When entering a room; or going from warm into cold air; from odors; before a thunder storm; evening till midnight; laughing, talking, eating, drinking; lying on left side.
Cough ameliorated by – better after sleeping, lying on right side; from cold drink; pressure on chest.
Accompaniments – Tightness across chest; burning soreness, pain in larynx (aching); splitting headache; night sweats, burning in back between shoulders. Thin, light haired, slender people, inclined to cough. Flat chested short breathed.
Many more symptoms, both objective and subjective, might be added, but these are leading. The rest of the picture must be found in the Materia Medica, as must those of all the other remedies. In acute inflammations of the respiratory organs as well as in chronic, this is one of the most valuable of remedies.
See pneumonia for its especial sphere of action there. Also tuberculosis for indications there. Phosphorus and Bryonia come quite close together, yet there are generally diagnostic points that are quite reliable. They follow each other well, as do also Sulphur and Phosphorus. Rumex is another remedy that should come into the list for comparison and Causticum must not be left out. Bryonia, Phosphorus, Sulphur, Causticum, Rumex, quintette.