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.