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.
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.
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, **Crot. 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 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 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.
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.
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.