• Blood and capillaries – Septic states with haemorrhagic tendency [Clarke].
• Skin – Dusky, livid eruptions in malignant fevers.
• Mucous membranes – Foul, ulcerative inflammation of throat, mouth, and nasal passages.
• Nervous system – Prostration, low muttering delirium.
• Circulatory system – Tendency to collapse with feeble pulse.
• Glandular system – Enlargement and tenderness of cervical and parotid glands.

• Cool air and a well-ventilated room
• Cold applications to head in high fever
• Rest and lying quietly in a darkened room
• Slight elevation of head during dyspnoea

• Warm, close rooms (increases delirium and oppression) [Hering]
• Motion or exertion (hastens collapse)
• Warm drinks or food (nausea, aggravation of throat pain)
• Nighttime (delirium, restlessness worse after midnight)
• Septic or epidemic influences

A state of low, muttering delirium, with indifference to surroundings [Allen]. Patient lies in a semi-stuporous state, aroused with difficulty, and may answer incoherently. At times, there is a half-conscious picking at bedclothes (carphologia), wandering of mind, and a tendency to relapse into stupor. In malignant fevers, mental symptoms are overshadowed by extreme physical prostration.

Dull, heavy headache with confusion and vertigo. In scarlatina maligna, the head feels hot, heavy, and congested, with delirium and dusky, purplish face [Hering].

Eyes dull, heavy, and injected; lids swollen and often dark-hued. Conjunctivae congested. Pupils sluggish.

Deafness or diminished hearing in septic states. Ears may appear dusky or mottled.

Nasal passages sore, ulcerated, and oozing offensive discharge. Epistaxis may occur in low fevers [Clarke].

Face pale, sunken, or dusky-red; sometimes mottled or cyanotic. Expression is dull, heavy, and bespeaks collapse.

Breath is horribly offensive; tongue swollen, dry, and coated brown or black in the centre, red at edges [Allen]. Ulceration and sloughing of mucosa in malignant sore throat. Excessive salivation in some cases.

Teeth covered with sordes in protracted fevers.

Fauces dark, congested, and swollen, with patches of ulceration or sloughing. Tonsils enlarged; uvula oedematous. In malignant scarlatina, throat livid, covered with foul exudation, breath offensive [Hering]. Swallowing extremely painful; warm drinks aggravate.

Loss of appetite; nausea and vomiting of dark, offensive fluid in septic states. Stomach sensitive; warm drinks increase nausea.

Abdomen tender and distended in typhoid conditions. Offensive, watery stools; sometimes involuntary.

Urine scanty, dark, and offensive; sometimes suppressed.

Frequent small stools; involuntary evacuations in collapse.

Short, shallow, sighing respirations; worse on exertion.

Weak, rapid pulse; tendency to collapse. Heart sounds feeble.

Oppressed breathing; sighing respiration. Pulse rapid, feeble, and compressible. In malignant scarlet fever, the rash may recede with sudden cardiac weakness.

Aching in lumbar region during fevers.

Cold, clammy limbs; mottled or purplish discolouration. Trembling from weakness.

Rash of scarlatina maligna is dusky, purplish, or livid, often patchy or indistinct [Clarke]. Skin mottled in septic states; tendency to petechiae and ecchymoses. Ulcerations may develop.

Drowsy, semi-comatose; can be roused only briefly.

High fever with rapid pulse in onset, soon giving way to adynamic state with low temperature in collapse [Hering]. Heat of head with cold extremities.

Chilliness alternating with flushes; profuse, offensive sweat in low fevers.

Aversion to warm drinks; cold water preferred.

Profound prostration out of proportion to the apparent local disease. Tendency to rapid collapse in septic and malignant conditions. Offensive discharges from all orifices. Haemorrhagic tendency with dark, fluid blood.

• Baptisia tinctoria – Dusky, besotted appearance, stupor; more muscular soreness and decomposition odour.
• Lachesis mutus – Dark, purplish throat, great prostration; but more marked left-sidedness and intolerance of touch.
• Apis mellifica – Oedema of throat, shiny swelling; more stinging pains.
• Arsenicum album – Offensive discharges, great prostration; more restlessness and burning pains.

• Complementary: Baptisia, Lachesis in septic fevers.
• Antidotes: Camphora, strong coffee (in medicinal overdose).
• Follows well: Belladonna (when rash turns dusky), Rhus toxicodendron (in septic complications).
• Precedes well: Arsenicum album in collapse.

Particularly valuable in scarlatina maligna with livid rash, foul throat, and rapid collapse [Hering]. In diphtheria, indicated when the exudate is dark, foul, and ulcerative, and the pulse is failing. Works best in low to medium potencies during acute septic states, repeated according to the urgency of symptoms.

Mind

• Delirium, low muttering
• Stupor, difficult to arouse

Head

• Headache, congestive, in malignant fevers
• Face, dusky-red

Mouth / Throat

• Ulceration, throat, malignant
• Odour from mouth, offensive
• Tongue, brown or black centre, red edges

Skin

• Rash, scarlatina, dusky
• Skin, mottled, septic states
• Petechiae in malignant fever

Generalities

• Prostration, extreme, septic states
• Offensive discharges
• Septicaemia, adynamic fevers

1. Hering, C., Guiding Symptoms of Our Materia Medica – Clinical observations in malignant scarlatina; description of dusky rash and offensive discharges.
2. Allen, T. F., Encyclopaedia of Pure Materia Medica – Toxicological effects and epidemic case reports.
3. Clarke, J. H., A Dictionary of Practical Materia Medica – Affinities for septic states, keynotes in malignant throat disease.
4. Boericke, W., Pocket Manual of Homeopathic Materia Medica – Summary of malignant fever indications and modalities.