The most favourite site of these bacilli to settle down is the pharynx on and around the tonsils, other common seats being nose, soft palate and larynx. They do not enter into the blood but poison the blood from their original seat in the throat. They also poison the nervous system and heart in consequence of which prostration and cardiac exhaustion are noticed all through the course of the disease.


The sphere of this fell disease is rather limited up to the age of ten years although adults are not immune from this dangerous condition. The mortality rate is higher in children above five though cases are often more complicated in little babies below five. This is a very infectious condition, the infection being generally conveyed directly from person to person i.e. from throat to throat.

The cause of the disease is a particular microbe which settle down in the childs throat and multiply themselves. This bacillus may be carried directly as mentioned above or indirectly through vehicles like dirt, milk, slate- pencils, kerchiefs, towels, etc.

It has been noted that the diphtheric bacillus prepare the soil for invasion by various other disease germs to make the cases more complicated. If it is only the diphtheria bacillus in the throat the case is considered as pure and simple; and when aided by other disease germs the case is known as “mixed or complicated” one. The incubation period is seldom more than 4 days, that is to say that after entering into the throat the bacillus hardly take more than four days to make the child sick.

The most favourite site of these bacilli to settle down is the pharynx on and around the tonsils, other common seats being nose, soft palate and larynx. They do not enter into the blood but poison the blood from their original seat in the throat. They also poison the nervous system and heart in consequence of which prostration and cardiac exhaustion are noticed all through the course of the disease.

Diphtheria, a Greek name, is characterised by the appearance of a pseudo membrane on and around the tonsils. This false membrane adheres so firmly to the true membrane that if it is detached it leaves a bleeding patch. In simple cases this false membrane is thin, cream-like and of bluish-grey colour, but in severe cases i.e., when aided by other bacilli the membrane becomes thick, leather-like and of yellowish-white colour. The condition develops gradually and deceitfully as in the early stage even a careful examination of the throat by an experienced eye often does not reveal anything particular there.

Detection is more difficult when the mischief originates in the nose or in the larynx. The child, in this stage, no doubt falls sick, refuses to nurse and perhaps becomes restless and sleepless at night. Elderly children may complain of general malaise in addition but may or may not complain of the throat as in simple cases there is little or no pain in the throat. The temperature too in this stage, is not very high.

When the condition develops further the uvula and the tonsils become swollen and highly congested, and the membranes then come to notice. The temperature now rises to 102 degree–104 degree F and the pulse is rapid. A few days after the temperature suddenly falls down below normal and the pulse becomes slow and irregular. As a rule, in this stage there will be more or less pain in the throat, particularly felt in swallowing and talking. The throat pain sometimes shoots up into the ear.

Stiff-neck and swelling of cervical and submaxillary glands are other common features. The false membrane may spread into the fauces the larynx and the nose. When the larynx is involved it is called “Laryngeal diphtheria” or “Membranous Croup.” This is the most dangerous type of diphtheria the prognosis being usually grave. Breathing difficulty in this condition may terminate into death from suffocation.

Hence if the breathing trouble does not quickly yield to homoeopathic remedies surgical aid should be sought for to insert a tube into the wind pipe below the obstruction. This operation is called “Tracheotomy”.

It has already been stated that this fell disease is often accompanied by other complications, the most common ones being bronchitis and paralysis, the latter complaint usually affects a certain organ, but in some case it may involve one of the sides. Here is a list of the functions that may be affected during the course of the disease in order of their frequency in appearance heart, soft palate, eyes, lips and diaphragm.

It is obvious that paralysis of the first and the named organs makes the condition very grave; the former threatens death from cardiac failure while the latter from suffocation. The possibility of heart failure exists from the 9th day upto the end of 4 weeks and the paralysis of the diaphragm generally occurs after 5 weeks. If the palate is paralysed the voice becomes nasal, and liquid food comes out through the nose when swallowing.

In such cases the patient should be kept on semi-solid diets which he would find easier to swallow. When the eyes are affected strabismus and inability to see letters would be the outcome. Strange it is that in some cases the child could not see the letters while reading 2 or 3 days before an attack of diphtheria.

Now-a-days the old school practitioners are treating the condition with injection of antidiphtheric serum with great success. The sooner the antetoxin is given the greater is the prospect of success; the mortality ratio after injection of the serum being 4 percent when it is given on the very first day of an attack, 7 percent if given on the 2nd day, 11 percent if on the 3rd, 13 percent if on the 4th and 15 percent if on the 5th day.

Prior to the introduction of this autotoxin the death rate in their hands was 50 percent in cases of infants under 5and 75 percent in children below ten. Hence they applaud the invention of the antidiphtheric serum as one of the greatest triumphs of modern science. Yet these very physicians do not believe the law of similimum nor do they consider that the underlying principle of the autotoxins is similar to that law.

The period of convalescence is very long and is often interfered with other complications. The probability of heart failure runs upto 4 weeks and hence the child should not be allowed to exert in any way. Slight exertion may exhaust the heart even in the mildest cases. The young patient should also be carefully protected from all kinds of shocks.

In case of an attack other children should not be allowed to enter into the sick-room, not only during the sick period but also 3 weeks after the disappearance of the membrane. All exertions of the patient should be taken on rags or cotton-wool and burnt immediately. Other children of the family should be given appropriate prophylaxis.


Medicines in general: Ailanthus, Ant-cr., Apis, Ars., Ars-iod., Arum-tr., Bapt., Bell, Brom., Bry., Canth., Caps., Carb-ac.,Carb- veg., Chlor., Con., Crotalus-h. Hydroc-ac., Ign., Iod., Kali-bi., Lac-can., Lach., Lyco., Merc-bin-iod., Merc-cy., Merc-proto-iod., Merc-cor., Mur-ac., Naja, Natrum-ars., Nit-ac., Phyto., Rhus-tox, Sulph.

Under the appropriate similimum the pseudo-membrane loosens and come out in shreds Some may pass into the stomach while others disappear gradually.

Therapeutic Hints: It was Dr. E.B. Nash who first published the usefulness of Apis-mellifica in the treatment of diphtheria and seeing the marvellous benefit that he derived from this drug the routinists are using it as a specific for diphtheria. The other polychrest having a similar credit is Arsenic.

Some Mercury preparations, particularly Merc-bin-iod., Merc-cyanide and Merc- proto-iod. occupy the next positions in merit of their frequent applications. But in the incipient stage Aconite, Belladonna or Bryonia will be sufficient to nip the mischief in the bud. Besides Arsenicum we have Baptisia to deal with the odour business.


Aconite: Early stage with a history of exposure; tonsils inflamed and dark red; fever with dry heat, restlessness and unquenchable thirst.

Apis Mellifica: Oedematous swelling of the uvula and the tonsils; puffiness of the face particularly around the eyes; great exhaustion; absence of thirst; scanty urine; weakness of sight and paralysis of lower extremities.

Arsenicum: This medicine maybe indicated throughout the whole course of the disease. “Prostration out of all proportion to the disease” will lead to its choice. Restlessness, unsuitable thirst, but drinks little at a time; anguish and fear as manifested by the pitiful cry and moaning. Midnight aggravation. Foul breath.

Aurum-triph: A fluent watery discharge from the nose excoriating the nostrils and the upper lip and constant picking at the nose and the lips will decide its selection.

Baptisia: Foetor of mouth and nose, diarrhoea with offensive stools, low type of fever, swelling of submaxillary and cervical glands.

Belladonna: Early stage, great congestion, tonsils and the fauces bright red, face flushed; high fever. The child is sleepy but cannot sleep; starts in sleep and jumps up from sleep.

Bromine should be thought of to relieve the suffocation. Its membrane begins in the bronchi or trachea and extends to the fauces and sometimes to the larynx. When larynx is involved it produces a croupy, suffocative cough and hoarseness.

Bryonia: Suitable in the stage when the membrane begin to form, the child wants to remain on the bed undisturbed and resents when moved, carried or fondled. Thirst prominent, drinks at long intervals but much at a time. If the child is big enough he will complain of headache and pain in limbs, while the younger ones will manifest an expression of relief when those parts are pressed. Constipation, stools dry, hard and large, as if burnt.

B K Goswami