Diphtherinum

A nosode prepared from diphtheritic exudate/membrane or toxin, triturated or tinctured and potentised by centesimal dilution and succussion; historically associated with Swan, Burnett and later American prescribers, and collated by Clarke and Boericke as a remedy for malignant diphtheria, membranous croup, septic sore throat and the sequelae of diphtheria (notably bulbar and palatal paralysis) [Clarke], [Boericke], [Allen]. Toxicology of clinical diphtheria explains the remedy’s terrain: necrotising pseudomembranes of fauces and larynx, foetid breath, profound toxæmia with myocarditis, nephritis, peripheral neuritis and post-diphtheritic paralysis (soft palate, pharynx, ocular muscles), nasal regurgitation of liquids, and a “bull-neck” adenitis in fulminant cases [Clarke], [Hughes]. In homœopathy Diphtherinum is used when throat membranes are thick, ashy, grey or almost black, with great prostration out of proportion, foetor, nose–throat involvement, and later paralytic residua; it has also been used in scarlatinal diphtheroid states and ozaena with septic odour [Clarke], [Boericke], [Boger].

No Hahnemannian proving; the picture rests on clinical pathogenesy (nosode usage) and bedside confirmations in malignant diphtheria, croup, septic sore throat, ozaena and post-diphtheritic paralysis, collected by Clarke, Allen, Boger and Boericke [Proving/Clinical—Clarke], [Allen], [Boger], [Boericke]. Early American experience emphasised cases failing Mercurius cyanatus/Lachesis where foetor, dark membrane and profound prostration predominated; sequelae include palatal paralysis with liquids returning through the nose and ocular palsies [Clarke], [Boericke], [Nash].

Diphtherinum is the septic membrane made remedy: ashy-black patches, deadly foetor, collapse out of proportion, and a relentless downward tendency—naso-pharynx to larynx—ending, if unchecked, in suffocation; and then, paradoxically, a backward tide in convalescence—the nerves fail: first the palate and fauces, then eyes and limbs. This two-phase arc—obstructive membrane followed by peripheral paralysis—defines the essence [Clarke], [Boger], [Boericke]. The remedy’s law of care is crystalline: air saves, effort kills. Every paragraph of the case obeys it. In the acute: worse at night, worse warm, close rooms, worse exertion (speaking, swallowing, sitting up), worse swallowing liquids (regurgitate through the nose); better cool, fresh air to the face with the body kept warm, propped posture, gentle handling, and teaspoonful sips—the same ameliorations reappear under Respiration, Sleep, Throat, and Generalities [Clarke], [Boericke]. In the sequel: mind is clear but mechanics fail; eyelids droop on reading a little; liquids betray the swallow while careful solids pass; oxygen and patience win where haste undoes—polarity identical to the Curare-type fatigability but with a diphtheritic signature and liquids-worse deglutition [Clarke].

Kingdom-wise the nosode carries the imprint of toxin: myocarditis (“fatal on effort”), peripheral neuritis (soft palate, ocular muscles), renal strain (albuminuria), and glutinous, sloughing exudates that bleed on touch [Clarke], [Boger]. Miasmatically the syphilitic tone is unmistakable—necrosis, hæmorrhage, paralysis—tempered by psoric exhaustion and sycotic membrane formation [Kent], [Boger]. The remedy’s core polarities are therefore: fresh air ↔ warm, close room; propped posture ↔ recumbency; fractional sips ↔ forced draughts; solids tolerated ↔ liquids regurgitated; quiet nursing ↔ handling/exertion. Micro-comparisons sharpen the outline: Merc.-cyan. is more corrosive–hæmorrhagic but less paralytic; Lachesis is more œdematous, loquacious, left-sided; Kali bich. is stringy, punched-out; Apis oedematous and bright pink; Diphtherinum is ashy-black, foetid, paralytic. For sequelæ, Gelsemium is soporous; Curare is flaccid with clear mind; Diphtherinum is the historical nosode binding cause and consequence.

Practically, cure with Diphtherinum depends on enforcing its law. In the acute membrane state: cool the air (never the patient), lighten the coverings, prop the thorax and head, forbid strain, and feed by teaspoon if at all; watch for the danger-sign of effort-provoked syncope—if pulse tumbles on sitting, return to repose. The positive signs are concrete: membrane lightens and loosens without bleeding, foetor diminishes, expectoration unplugs, first safe sips do not reappear through the nose, and sleep comes without starting. In the paralytic sequelæ: do little, often—eyes closed between brief tasks; drops of tepid fluid; careful test of solids before liquids. Diphtherinum sits at the fulcrum between sepsis and neuro-muscular collapse; it shortens the former and forestalls or repairs the latter. When a once-blue, foetid child breathes quietly with an open window and swallows a spoonful without fear, the nosode has spoken.

• Fauces/soft palate/uvula — Thick, ashy-grey to black membranes; bleeding on detachment; palatal paralysis with nasal voice and liquids returning through nose [Clarke], [Boericke]; see Throat/Swallowing.
  • Larynx/trachea — Membranous croup; rough, sawing respiration; husky–aphonic voice; stridor with imminent suffocation; extension of throat membrane downward [Boger], [Clarke]; see Respiration/Chest.
  • Nose/naso-pharynx — Diphtheritic rhinitis: acrid, bloody, foetid discharge, crusts; ozaena; obstruction with mouth-breathing; excoriated alæ [Clarke], [Allen]; see Nose/Face.
  • Peripheral nerves (post-diphtheritic) — Bulbar and palatal paresis, ptosis, diplopia, accommodation failure; limbs weak; especially swallowing of liquids worse than solids [Clarke], [Boericke]; see Throat/Eyes/Generalities.
  • Heart & myocardium — Toxæmic myocarditis, feeble, irregular pulse; faintness on sitting up; sudden cardiac failure risks during convalescence [Clarke], [Boger]; see Heart/Generalities.
  • Glands/neck cellular tissue — Painful cervical adenitis (“bull-neck”); dusky swelling with septic foetor [Clarke]; see Face/Neck.
  • Skin/mucosa (septic) — Sloughing ulcers, malignant sore throat, dusky eruptions with foetid sweat [Boger], [Clarke]; see Skin/Fever.
  • Kidney — Albuminuria during toxæmia; smoky urine; renal fatigue in convalescence [Hughes], [Clarke]; see Urinary.
  • Ears/Eustachian — Otitis after throat diphtheria; deafness from post-pharyngeal involvement [Clarke], [Allen]; see Ears.
  • Children — Malignant diphtheria, croup, and post-diphtheritic paralysis of palate/eyes; relapse on premature exertion [Boericke], [Tyler]; see Sleep/Generalities.

Dull, oppressed, and apathetic under toxæmia, with a fear of choking and of going to sleep lest the breath fail—this tallies with the night aggravation and suffocative attacks under Sleep/Respiration [Clarke], [Boger]. Children are heavy-eyed, indifferent, yet cling anxiously to the nurse when a paroxysm of dyspnœa threatens; the dread subsides when the window is opened and the head is propped—thus the cool air to face and propped posture ameliorations repeat in the mental sphere [Boericke]. Sensorium is clouded but not wildly delirious; muttering stupor alternates with anxious starting, especially if the membrane threatens the larynx [Clarke]. Irritability appears when the least handling or questioning is pressed—handling exhausts, consistent with “worse exertion” in Generalities. The odour of the room (foetor) nauseates and excites faintness and impatience, a link to Stomach. In convalescence there is fear of swallowing liquids and of attempting to speak; repeated failures induce despondency (bulbar palsy), relieved when small spoonfuls slip down—exactly echoing “liquids worse” and “fractional sips better” [Clarke]. The courage is mechanical: it rises when posture and sips succeed. Children wake in terror, clutching the throat, yet become placid again with fresh air and quiet holding—behavioural confirmation [Tyler]. After illness, a timid, easily-fatigued mood persists; confidence returns slowly with the first safe swallow and the first day without nasal regurgitation [Clarke].

Broken, startled by choking; worse first sleep, child drops off, then starts with laryngeal spasm—must be propped or carried to cool window, precisely mirroring the night aggravation and cool air to face amelioration recorded in Modalities [Boericke], [Boger]. Dreams of smothering; moans with closed eyes; heavy sopor between paroxysms [Clarke]. In convalescence, sleep briefly refreshes but exertion after sleep precipitates faintness—fragile circuit [Tyler]. Cannot lie on the back without choking; prefers side with head high (posture) [Boericke]. Night sweats occur in septic states, foetid; bedding light and room fresh are essential [Clarke]. Return of quiet sleep without starts is an early promise of safety [Clarke].

Dreams of strangulation, dark rooms, being smothered by covers; child dreams of choking and wakes clutching the throat—faithful echoes of the day peril [Tyler]. Sometimes dreams of drinking and fluid running out of nose—mind rehearses palatal palsy [Clarke]. As convalescence stabilises, dreams become neutral; if suffocative dreams recur, guard against premature exertion (clinical warning) [Tyler].

Diphtherinum synthesises a septic, membranous throat–larynx process with foetor, dark ashy membranes, great prostration out of proportion, and a grave tendency to paralysis of palate, pharynx, larynx, and ocular muscles in convalescence [Clarke], [Boger], [Boericke]. Modalities cohere: worse at night/early morning, worse warm, close rooms, worse exertion (sitting up, speaking, swallowing), worse swallowing—especially liquids (regurgitation through nose), worse suppression of discharges; better by cool, fresh air to face with body warmly wrapped, propped posture, small teaspoonfuls, quiet and gentle nursing. Pathophysiologically the picture accords with toxin myocarditis (fatal on effort), peripheral neuritis (late palsy), and membranous obstruction; clinically, when Merc.-cyan., Lach., or Kali bich. fail and foetor with dark membrane predominates, Diphtherinum often turns the tide [Clarke], [Boger]. The polarity is air vs effort: fresh air saves, effort kills; liquids betray, solids sometimes pass; night betrays, dawn lingers. As the child improves, signs are concrete: membrane lightens and loosens without bleeding, pulse steadies when slowly propped, and liquids in teaspoonfuls do not regurgitate. In sequelae, select Diphtherinum when ptosis, nasal voice, diplopia, and palatal paralysis persist in a patient who fails with liquids more than solids—the nosode’s hallmark [Clarke], [Boericke].

Septic fever with low muttering state; surface hot but patient chilly, wants warm wraps yet fresh air to face (thermal split) [Clarke]. Temperature may be moderate while prostration is extreme—disproportion is a keynote [Boger]. Pulse small, frequent, compressible; sweat cold in paroxysm [Clarke]. Hectic evening rises in ozaena cases, with foetor offensive [Clarke]. Favourable turn marked by loosening membrane, reduced foetor, brighter expression [Clarke].

Chilliness with blueness of lips during croup attacks; shivers in warm rooms (air hunger) [Boger]. Heat internal with dusky surface; head hot, limbs cool; child throws covers from face only (seeks air) while body remains wrapped (split) [Clarke]. Sweat cold, clammy in suffocation; night-sweat foetid; sweat aggravates skin excoriations around nares and lips (friction worse) [Clarke]. Fresh air dries the cold sweat and steadies breathing (modalities repeat) [Boericke].

Head heavy, drooping; wants to lie but cannot bear to lie flat without choking (posture contradiction), improved by propping—cross-reference to Sleep [Boericke]. Face and head dusky or pale-waxy; temples feel tight during suffocative attacks [Clarke]. Post-diphtheritic ptosis and ocular fatigue appear (see Eyes), with ache over the brow after slight effort—an exhaustion sign [Clarke], [Boger]. Vertex heat is absent; rather, there is surface chilliness with internal septic heat (polarity repeated under Chill/Heat) [Hughes]. Head swims on sitting up, with faintness and small pulse—exertion-aggravation under Heart/Generalities. Children roll the head on the pillow in night attacks, then lie in stupor between paroxysms [Clarke].

Lids heavy; ptosis after diphtheria is characteristic, with diplopia or accommodation weakness; ocular palsies may lag weeks behind the throat cure—post-diphtheritic paralysis keynote [Clarke], [Boericke]. Conjunctivæ dull, dusky; photophobia slight. Vision blurs on reading a little; effort worsens; rest briefly restores—mechanical fatigability like the palate (cross-link Generalities) [Clarke]. Strabismus may appear transiently in convalescence; handling and excitement aggravate tremor of lids [Boger]. Tears are hot and irritating when ozaena is present, excoriating canthi (nasal–ocular border) [Clarke]. Recovery is graded: first the lids lift for moments, then longer; improvement parallels return of palatal competence for solids before liquids [Clarke].

Dull hearing during the septic throat; post-pharyngeal extension provokes Eustachian catarrh and otitis; a thin, foetid discharge may appear in malignant cases [Clarke]. Noise is oppressive; quiet is craved (handling and sound exhaust—general law) [Boger]. Parotid and retro-aural glands swollen and tender in “bull-neck” states; heat locally may soothe while the room is cool (thermal split) [Clarke]. Tinnitus accompanies cardiac weakness in convalescence; resolves as pulse steadies [Clarke]. Stitches in ears during swallowing reflect palatal and Eustachian involvement [Allen].

Diphtheritic rhinitis: acrid, foetid, often bloody discharge with crusts; alæ excoriated and sore; obstruction compels mouth-breathing [Clarke], [Allen]. Membrane may spread from nares to fauces or vice versa; suppression of discharge by cauterants ushers in laryngeal extension—clear warning (aggravation by suppression) [Hering], [Boger]. Sneezing and rawness in warm, close rooms; cool fresh air to face eases oppression (modalities echoed) [Clarke]. Regurgitation of liquids through the nose when palate is paralysed is distinct and diagnostic [Clarke], [Boericke]. Ozaena with septic odour and tenacious crusts is a chronic sphere—Diphtherinum when retrospection shows a diphtheritic past [Clarke]. Epistaxis in malignant sore throat may relieve for a moment, then prostration deepens [Clarke].

Features pinched or puffy (“bull-neck” cellular infiltration and glandular swelling); dusky pallor or waxy yellow with dark rings; lips dry, cracked; foetid odour from mouth and nose is striking [Clarke]. Submaxillary glands and neck tissues markedly swollen; a warm external wrap comforts locally while fresh air is admitted (management matches modalities) [Clarke]. Face grows blue during croupy attacks, with cold sweat on forehead (see Fever/Chill) [Boger]. Nasal speech from palatal failure; cheeks wet with saliva when swallowing fails [Clarke]. After slight exertion colour fades; propping and quiet restore it—exertion-aggravation again [Clarke].

Tongue large, flabby, indented, or dry and brown with a dark centre; breath foetid, sweetish, sickening [Clarke], [Boger]. Saliva tenacious; efforts to clear it exhaust; expelling clots gives relief to breathing (better after spitting) [Clarke]. Taste flat or offensive; children refuse the spoon from dread of choking [Boericke]. Aphthous patches or grey sloughs may extend from pillars to mouth; bleeds on touch (membrane friable) [Clarke]. Gums soft, bleed easily in malignant state [Boger]. Improvement accompanies thinning and easy detachment of membrane without hæmorrhage—favourable sign [Clarke].

Tongue large, flabby, indented, or dry and brown with a dark centre; breath foetid, sweetish, sickening [Clarke], [Boger]. Saliva tenacious; efforts to clear it exhaust; expelling clots gives relief to breathing (better after spitting) [Clarke]. Taste flat or offensive; children refuse the spoon from dread of choking [Boericke]. Aphthous patches or grey sloughs may extend from pillars to mouth; bleeds on touch (membrane friable) [Clarke]. Gums soft, bleed easily in malignant state [Boger]. Improvement accompanies thinning and easy detachment of membrane without hæmorrhage—favourable sign [Clarke].

The throne of the nosode: throat and fauces covered with ashy-grey to almost black membrane, dirty, thick, with foetor; bleeds on attempts to detach; great prostration and collapse out of proportion [Clarke], [Boger]. Swallowing liquids is worse than solids—return through nose from palatal paralysis in sequelae; attempts exhaust and provoke suffocation (worse exertion) [Clarke], [Boericke]. Uvula swollen, oedematous; pillars thick; neck tender; glands enlarged (bull-neck) [Clarke]. Warm room aggravates; cool, fresh air to face with body warmly wrapped allows a few safe swallows (nuanced thermal split) [Clarke]. Membrane threatens larynx: voice husky, then aphonic; breathing sawing; child drowsy, picks at mouth; with each sleep the breathing stops—startling wake (night aggravation), see Respiration/Sleep [Boger], [Clarke]. Gargles and caustics suppressing the surface worsen the case (suppression-aggravation) [Hering]. With improvement, membrane loosens, whitens, detaches with less bleeding, and pallor of palate lessens—bona fide signs [Clarke].

Oppression at upper sternum, sawing laryngeal respiration, aphonia, and whistling inspiration in croupous extension (membranous croup) [Clarke], [Boger]. Worse at night, worse warm room, worse lying; better cool air to face, head and shoulders raised (posture & thermal split) [Boericke]. Mucus tenacious, threatens plugging; expelling clots relieves—better after expectoration [Clarke]. Stitches beneath clavicles during cough; chest wall sore from struggling (effort-aggravation) [Boger]. Cyanosis of lips during paroxysm; cold sweat follows [Clarke].

Pulse small, soft, irregular; myocardial weakness from toxin; syncope on the least attempt to rise; sudden failure possible in convalescence—“fatal on effort” is a grave keynote [Clarke], [Boger]. Palpitation after a mouthful of liquid or on speaking a little; the palate and heart fail together (bulbar–cardiac linkage) [Clarke]. Precordial anxiety at night with air-hunger; eased by cool air and quiet (modalities echoed) [Boericke]. No valvular lesion peculiar to the remedy; it is the toxic myocardium that shakes [Clarke]. Improvement is shown by steadier pulse when sitting is attempted slowly, and by safe deglutition of teaspoonfuls [Clarke].

Central danger-zone. Membranous croup or laryngeal diphtheria: harsh, sawing, stridulous inspiration; voice dwindles; cough becomes barking, then voiceless; skin dusky; worse at night; worse warm room; better cool air to face, window open, while body warm (local cool vs general warm split) [Clarke], [Boger]. Sleep invites apnœa—child slips into stupor and starts with choking; propping prevents (posture law) [Boericke]. Tenacious plugs dislodged with peril; after expulsion there is deep relief (better expectoration) [Clarke]. In convalescence breathing is shallow; trivial exertion accelerates it and threatens failure—exertion-worse [Clarke]. Diphtherinum is chosen when foetor and dark membrane are marked and when Merc.-cyan., Lach., or Kali bich. fail to check the downward march [Clarke], [Boger].

Aversion from fear of choking rather than from nausea; odour of the room excites nausea and faintness (foetor) [Clarke]. Hiccup and swallowing of saliva provoke suffocative cough—effort aggravation [Boger]. Vomiting of tenacious, blood-streaked mucus may occur in malignant states [Clarke]. Thirst is variable; small sips are tolerated; large draughts return through nose or induce cough (modalities echoed) [Clarke]. Appetite is nil; weakness is profound, and food burdens the heart—faintness after a swallow (heart–stomach link) [Clarke]. When liquids can be taken in teaspoonfuls without nasal regurgitation, recovery is near [Clarke].

Abdomen distended with air from mouth-breathing and swallowing of mucus; cutting not a keynote [Clarke]. Liver and spleen congest in septic cases; right hypochondrium sore; renal area sensitive when albumin appears (see Urinary) [Hughes]. Diarrhœa is rare; stools may be offensive, dark, loose in toxic states, exhausting the patient (collapse synergy) [Boger]. Flatulence increases dyspnœa in recumbency—worse lying; propping eases (posture link) [Boericke]. The abdomen is secondary; the prime danger is above.

Stools dark, offensive; sometimes blood-streaked from intestinal catarrh in malignant sore throat; prostration follows any stool in low states [Boger]. Tenesmus is not marked. Fissures or piles are incidental and not prescriptive. The rectal sphere contributes to the foetor picture rather than guiding to Diphtherinum [Clarke].

Albuminuria during toxæmia; scant, dark urine; suppressed temporarily in collapse [Hughes], [Clarke]. After improvement, urine increases but remains faintly albuminous for days; convalescent kidneys are weak [Clarke]. Micturition may be difficult from general weakness; involuntary dribbling in children during croupy sleep [Boericke]. Haematuria is possible in malignant states [Boger]. Renal fatigue warns against premature exertion (heart–kidney risk) [Clarke].

Liquids worst to swallow (return through nose); solids may pass if carefully cut small; teaspoonfuls only—fractional sips [Clarke], [Boericke]. Aversion from fear; hunger absent. Warm drinks sometimes soothe, but bulk is the enemy more than temperature [Clarke]. Ice-cold fluids may shock and induce cough; tepid tolerated [Clarke]. Post-diphtheritic patients cannot manage thin fluids for weeks—criterion for choosing Diphtherinum in sequelæ [Clarke]. Nausea from room-foetor; appetite returns with first safe swallow [Clarke].

No primary genital proving; convalescent impotence of effort, easy fatigue after coitus; relapse risk if over-exerted early [Clarke]. In boys, post-diphtheritic nocturnal enuresis may appear transiently when palatal palsy coexists—general nerve fatigue [Clarke]. The male sphere is largely indirect.

Menses suppressed by the illness; delayed return; post-diphtheritic weakness aggravates dysmenorrhœa temporarily (nerve-fatigue) [Clarke]. Prone to ozaena and chronic post-nasal crusts after diphtheria; Diphtherinum aids when history fits [Clarke]. Suckling mothers cannot tolerate warm rooms, feel stifled; need fresh air—thermally coherent [Tyler]. Pregnancy with diphtheria is beyond scope here; remedy relates to constitution more than obstetric mechanics.

Nape stiff and glands tender; neck muscles ache from “bull-neck” swelling; warmth locally eases while fresh air soothes breathing (nuanced thermal split) [Clarke]. Dorsal weariness on sitting up (heart fatigue); sinking at epigastrium extending to spine in collapse [Boger]. Lumbar weakness in convalescence; over-exertion renews palatal failure (signalling the general law: effort unseats gains) [Clarke].

Lassitude, trembling; after diphtheria, pareses of limbs with easy fatigue; gait uncertain after slight walking; desire to lie yet cannot lie flat (posture contradiction) [Clarke]. Hands cold, damp; nails cyanosed in croup attacks [Boger]. Knee-jerks may be diminished in neuritic sequelae [Clarke]. Pains are dull, heavy—no sharp neuralgia. As the throat mends, ocular and limb weakness may emerge (late paralysis), requiring patience and strict avoidance of effort [Clarke], [Tyler].

Dusky, earthy; cold sweat with suffocative paroxysms; sloughing ulcers of throat/lips in malignant cases; ozaena crusts excoriate surrounding skin [Clarke], [Boger]. Eruptions may be scarlatinoid in diphtheroid scarletina; surface is hot to hand in fever yet patient feels chilly (dissociation) [Clarke]. Bedsores in prolonged collapse; require scrupulous nursing (gentle turning without effort) [Tyler]. The nose–lip groove excoriated by acrid discharge; patting better than rubbing (friction worse) [Clarke].

Aetiology—Malignant diphtheria / septic sore throat
• Mercurius cyanatus — Rapidly destructive membrane, hæmorrhage, great foetor; salivation profuse; tongue swollen. Diphtherinum when post-diphtheritic paralysis looms and liquids regurgitate through nose, or when Merc. cyan. fails to check downward march [Clarke], [Boger].
• Lachesis — Dark, œdematous throat, intolerance of touch, bluish membrane; left-to-right spread; loquacity in toxæmia. Diphtherinum has more paralysis, foetor, and liquids-worse deglutition [Kent], [Clarke].
• Kali bichromicum — Tough, yellow, stringy exudate, punched-out ulcers; nose–throat extension. Diphtherinum has ashy-black membrane, prostration, and palsy sequelæ [Clarke], [Boger].
• Apis — Oedematous, rosy membranes; stinging, scant thirst; better cold. Diphtherinum darker, more septic, more paralytic tendency [Clarke].
• Baptisia — Typhoid foetor and stupor; no specific membranous process or liquids-worse swallowing; Bapt. may support general sepsis but Diphtherinum is the diphtheritic nosode [Boger].

Laryngeal extension / croup
• Spongia — Dry, barking croup; saw-like respiration; less foetor and membrane. Diphtherinum when membrane and toxæmia are evident [Clarke].
• Hepar sulphuris — Croup worse early morning, sensitive to cold air; much pain, sputa purulent; lacks dark membrane and liquids-worse sign [Boericke].
• Sanguinaria — Membranous laryngitis with burning; less paralysis sequelæ [Allen].

Post-diphtheritic paralysis
• Gelsemium — Ptosis, diplopia, motor weakness with drowsiness and tremor; less palatal liquids-worse signature. Diphtherinum for palate first, eyes later, especially clear intellect [Clarke], [Farrington].
• Causticum — Vocal cord paresis with rawness and emotional tone; lacks nasal regurgitation keynote; pains, not septic history, predominate [Kent].
• Curare — Flaccid motor failure with clear mind, marked fatigability; used in post-diphtheritic bulbar states; Diphtherinum is the nosode when diphtheritic history leads, Cur. a functional ally [Clarke], [Boericke].
• Phosphorus — Hoarseness, post-infectious weakness, haemorrhagic tendency; less palatal liquids-worse; more burning and craving for cold [Boericke].
• Naja — Palatal and laryngeal paresis with cardiac oppression and moral anguish; more chest pain; Diphtherinum more septic and nasal-regurgitation marked [Clarke].

Nasal diphtheria / ozaena
• Arum triphyllum — Acrid, excoriating nasal discharge, nose picking, blood; patient restless and bores into pillow; not specifically paralytic; Diphtherinum when diphtheria history clear and crusts/foetor persist [Clarke].
• Kali bichromicum — Thick, stringy plugs; less septic foetor than Diphth.; choose by exudate quality [Clarke].

• Complementary: Lachesis — Septic low states of throat and larynx; Lach. often precedes in œdematous, left-sided throats; Diphtherinum consolidates when paralysis/foetor lead [Clarke], [Kent].
  • Complementary: Kali bichromicum — Follows in persistently stringy, punched-out ulcer phases of ozaena post-diphtheria [Clarke].
  • Complementary: Curare — For post-diphtheritic bulbar/respiratory paresis with clear mind and fatigability; Diphth. as nosode backdrop [Clarke], [Boericke].
  • Follows well: Mercurius cyanatus — When destructive phase controlled yet paralysis threatens; Diphth. to meet sequelae [Boger], [Clarke].
  • Follows well: Spongia/Hepar — After acute croupy crisis, if membrane/toxæmia persist [Boericke].
  • Precedes well: Phosphorus — For lingering hoarseness and chest weakness after membrane clears [Boericke].
  • Precedes well: Gelsemium — For late ocular ptosis/diplopia with somnolence [Clarke].
  • Related/Compare: Baptisia, Pyrogenium — Septic low states; choose Diphtherinum when diphtheritic history and membrane/palsy define case [Boger], [Boericke].
  • Antidotes (functional): Fresh air, quiet nursing, fractional sips, and careful propping—nursing acts that extend the prescription’s law [Clarke].
  • Inimical: None recorded in classical sources [Clarke], [Boericke].

• Choose Diphtherinum in malignant diphtheria/membranous croup with ashy-black membranes, foetor, great prostration, worse at night/warm rooms, better cool air to face, and where Merc.-cyan., Lach., Kali bich. fail to stop downward extension [Clarke], [Boger].
  • Post-diphtheritic paralysis: liquids worse than solids; nasal regurgitation; ptosis/diplopia after the throat has healed—use Diphtherinum to address the imprint, supported by Curare/Gels. when mechanics dominate [Clarke], [Boericke].
  • Danger sign: syncope on effort in convalescence—do not urge sitting/walking; Diphtherinum with strict rest averts catastrophe (toxin myocarditis) [Clarke], [Boger].
  • Ozaena with septic odour and crusts in a patient who “never was well since diphtheria”—Diphtherinum internally with gentle local care [Clarke].
  • Potencies: acute malignant states 6C–30C repeated according to risk; some masters used higher (200C/1M) when the totality is unmistakable; in sequelæ 30C–200C less often; always stop on clear improvement [Boericke], [Nash], [Clarke].
  • Nursing is half the prescription: fresh air, quiet, propped posture, fractional sips, no forced gargles—these enact the remedy’s modalities [Clarke], [Boger].

Mind
• Fear—suffocation, at night; starts from sleep. Matches laryngeal extension [Boger], [Clarke].
• Apathy—prostration with foetor; muttering. Septic low state [Clarke].
• Sensitive to being handled or questioned. Handling exhausts [Boger].
• Anxiety—on attempting to swallow. Effort-worse [Clarke].
• Better—fresh air; window open. Modality hallmark [Clarke].
• Despair—after repeated choking on liquids. Palsy sequelæ [Clarke].

Head/Eyes
• Ptosis—post-diphtheritic. Ocular sequelæ [Boericke], [Clarke].
• Diplopia—after diphtheria. Ocular palsy [Clarke].
• Vision—accommodation weak; worse exertion. Fatigability [Clarke].
• Head—heaviness; cannot lie flat. Posture aggravation [Boericke].
• Brow ache—after effort in convalescence. Exhaustion sign [Clarke].
• Photophobia slight; lids heavy. Septic torpor [Clarke].

Nose/Face
• Nose—diphtheria; acrid, bloody, foetid discharge; crusts. Nasal sphere [Clarke], [Allen].
• Ozaena—post-diphtheritic; fetor; crusts. Chronic sequel [Clarke].
• Regurgitation of liquids through nose on swallowing. Palatal palsy keynote [Clarke], [Boericke].
• Face—“bull-neck”; cervical glands swollen. Glandular swelling [Clarke].
• Lips—cracked; foetid breath. Septic mouth [Clarke].
• Cyanosis—during croupy spells. Gravity index [Boger].

Throat
• Diphtheria—membrane ashy-grey/black; foetor; bleeds on touch. Central rubric [Clarke], [Boger].
• Uvula—oedematous; pillars thick. Local picture [Clarke].
• Swallowing—liquids worse than solids; liquids return through nose. Post-diphtheritic palsy hallmark [Clarke], [Boericke].
• Laryngeal extension—membranous croup. Downward march [Clarke], [Boger].
• Warm room aggravates; fresh air ameliorates. Thermal split [Clarke].
• Suppression of discharges—aggravates. Cautery warning [Hering].

Respiration/Chest
• Croup—membranous; sawing respiration; voice failing. Acute sphere [Clarke], [Boger].
• Suffocation—worse night, worse lying, worse warm room; better cool air to face. Key modalities [Boericke], [Clarke].
• Aphonia—diphtheritic. Laryngeal involvement [Clarke].
• Expectoration—tenacious plugs; better after expelling. Relief sign [Clarke].
• Propped position—must be. Posture law [Boericke].
• Cyanosis with cold sweat. Crisis snapshot [Boger].

Heart
• Myocarditis—toxic; syncope on least exertion. Fatal-on-effort warning [Clarke], [Boger].
• Pulse—small, irregular; compressible. Septic heart [Clarke].
• Palpitation—on attempting to swallow/speak. Effort link [Clarke].
• Faintness—on sitting up. Postural test [Clarke].
• Anxiety—precordial at night; better cool air/quiet. Modality echo [Boericke].
• Convalescence—relapse after exertion. Management rule [Clarke].

Generalities
• Prostration—out of proportion to fever. Keynote [Boger].
• Worse: night; warm close room; exertion; swallowing liquids; suppression. Coherent cluster [Clarke], [Hering].
• Better: cool air to face; body warm; propped; quiet; teaspoonful sips. Practical law [Clarke], [Boericke].
• Paralysis—post-diphtheritic; palate/ocular/limbs. Sequelæ [Clarke], [Boericke].
• Albuminuria—during toxæmia. Renal sign [Hughes].
• Offensive odour—whole patient. Foetor hallmark [Clarke].

Sleep/Fever/Chill
• Sleep—starts from choking; worse first sleep; must be propped. Nocturnal peril [Boericke].
• Dreams—of strangling; of fluid escaping via nose. Palatal palsy mirror [Tyler], [Clarke].
• Fever—septic; surface hot, patient chilly. Dissociation [Clarke].
• Sweat—cold, foetid with suffocation. Crisis marker [Clarke].
• Chill—blueness; shivers in warm room. Air hunger [Boger].
• Better—window open; fresh air. Non-negotiable [Clarke].

Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): nosode preparation; malignant diphtheria and croup picture; foetor; liquids-worse swallowing; post-diphtheritic paralysis; cardiac risk; nursing modalities.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1927): keynotes—membranous croup, foetor, prostration, liquids-worse; propped posture; sequelæ.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): septic low states; modalities (night, warm room, exertion); Merc.-cyan., Lach., Kali bich. comparisons; myocarditis warning.
Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–79): collated clinical notes on diphtheria, nasal diphtheria, ozaena, and Eustachian/ear involvement.
Hughes, R. — A Cyclopædia of Drug Pathogenesy (1895): toxicology of diphtheria—membrane, toxæmia, myocarditis, neuritis; albuminuria context.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): miasmatic colouring; differential insights (Lachesis, Causticum); management by modalities.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1898): sequelæ after diphtheria; potency suggestions; clinical cautions.
Dewey, W. A. — Practical Homœopathic Therapeutics (1901): throat therapeutics; malignant diphtheria and croup groupings; repetition guidance.
Farrington, E. A. — Clinical Materia Medica (1887): comparisons in post-infectious paralyses (Gelsemium, Curare); organ affinities.
Tyler, M. L. — Homœopathic Drug Pictures (1942): remedy essence; dreams of suffocation; nursing emphasis; “never well since diphtheria.”
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879): suppression warnings; downward extension; septic signs; clinical confirmations.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (1977): concise keynotes—foetor, dark membrane, liquids-worse, post-diphtheritic palsy; modalities recap.