Arum triphyllum

Lecture XIX — Araceae — Arum triphyllum, Caladium, Dracontium and Pothos foetida

ARACEiE.

Thk order of plants which we shall study to-day is the Aracece, or, more correctly speaking, the Aroidece. The plants in this group all contain in their juices an acrid principle in more or less quantity. The Diffenbachia , when taken into the mouth, produces a frightful stomacace; the mouth is covered with a yellowish-white membrane; ulcers form upon the lips, tongue and fauces. This drug was proved by one of the students of this College. Since then it has been used in the treatment of violent forms of stomacace.

The members of this order which we shall consider are Arum biphyllum, Arum dracontium , Caladium seguinum, Pothos fcetida, Acorus (of which we know little or nothing), and Diffenbachia. ' Ailanthus, Ammonium causticum, Nitric acid.

[Arum triphyllum \ Muriatic acid, I^ycopodium.

I Selenium.

(^ Graphites.

Caladium Aracese < Dracontium Pothos fcetida Acorus v Diffenbachia Balsam of Peru.

Pix liquida.

Guaiacum.

I Eryodiction Californicum.

Arum Triphyixum.

The so-called " Jack in the pulpit " is the first drug in the order for our consideration. This remedy has an interesting history. Some twenty-five years ago there appeared an epidemic of scarlet fever, in the course of which nearly every case that was not promptly cured in the beginning died. The percentage of losses under homoeopathic as well as under other systems of treatment was truly frightful. The reason for this was that we had no remedy which covered the symptoms of the epidemic. In a poor family, living in a small street, there arace^:. 209 were five children sick with this epidemic form of scarlatina. The physician who was called to attend them had lost so many cases under the usual remedies that he thought it useless to have recourse to these. He thought it better to try something new. Arum triphyHum had only been experimented with to a certain degree, but still it had been known to produce certain symptoms which led him to the selection of the drug, which he administered in a low potency. All the cases recovered. It was afterward prescribed in other cases during the same epidemic, with marked success. From that time to this, Arum triphyllum has been looked upon as a valuable drug in the treatment of diphtheria, malignant forms of scarlet fever, and also other fevers having a typhoid form.

In scarlatina, we may use Arum triphyllum when there is an excoriating discharge from the nose and mouth, making the nose and upper lip raw and sore. The tongue swells; its papillae are large and red, giving it a rough feeling comparable to a cat's tongue. The throat is very sore, and the tonsils are much swollen. There is often a dry cough which hurts the child so much that he cringes under it and involuntarily puts the hands to the throat as if to modify the pain. The discharge from the mouth, also, makes the lips and surrounding parts of the face sore, cracked and bleeding, even the saliva itself being very acrid; scabs form; the child will not open his mouth. He is excitable and irritable in mind as well as in body. Thus, you see that Arum triphyllum is an exceedingly irritating drug. The child is restless, tosses about, is cross and sleepless at night. The eruption may come out very well and there may be double desquamation. At other times the rash is dark and imperfectly developed; the child picks and bores its fingers into its nose, or nervously picks at one spot till it bleeds. In mild cases, the urine may be very profuse; in severe cases the urine is greatly diminished and the appearance of profuse urination is a sign that the remedy is acting well. In very bad cases, however, those in which the malignancy shows itself in both the internal and external symptoms, you will find a perfect picture of uraemia. The child tosses about the bed unconscious, and has this involuntary picking at one spot or boring the finger into the nose; the urine is completely suppressed. The brain is very much irritated, as shown by the restless tossing about and the boring of the head into the pillow. In such a case, Arum triphyllum may save the patient, although, at the best, the case is an exceedingly doubtful one.

I have never seen inflammation of the brain yield to Arum triphyllum, unless some of these symptoms were present; either irritation about the throat, mouth, or nose, or else this peculiar picking or boring at the nose or at one spot till it bleeds. I think that as a rule it is indicated when the cerebral inflammation comes from the suppression of some violently acting poison, such as we find present in scarlatina or diphtheria. Nor would I think of giving Arum in uraemia if it arose in the course of ordinary Bright's disease. I do not think it can be the remedy unless the symptoms already referred to are present. Arum triphyllum has a marked effect upon the larynx. It produces a hoarseness which is characterized by a lack of control over the vocal cords. If the speaker attempts to raise his voice it suddenly goes up with a squeak. With this symptom you may use Arum in clergyman's sore throat, whether this affection be the result of overstraining the voice or of cold.

Possibly the remedy most similar to it in this hoarseness and uncertainty of voice is Graphites, which is excellent for singers who cannot control their vocal cords, and who develop hoarseness and cracked voice as soon as they begin to sing.

In Carbo veg. the voice is deep, failing when the endeavor is made to raise it.

Another remedy for this condition is Selenium. The patient gets hoarse as soon as he begins to sing.

Other remedies for the effects of increase of the voice are Arnica, Rhus tox., Causticum, Phosphorus and Natrum muriaticum. Now let us study for a few moments the analogues of Arum triphyllum. First of all we shall consider Nitric acid.

This was formerly the only remedy we had for scarlatina maligna. It has the excoriating discharge from the nose. No remedy has it more marked, not even Arum. The discharge from the nose makes the nostrils and lips sore. This is attended by great prostration. The throat is extremely sore and is covered with membrane of a diphtheritic character, either dark and offensive, or else yellowish-white. The mouth (whether the disease be diphtheria or scarlatina) is studded with ulcers, which appear principally on the inside of the cheeks, on the lips and on the borders of the tongue. This ulceration is accompanied by salivation, the saliva usually being watery and very acrid. The pulse frequently intermits every third or fifth beat, a very bad symptom. Nitric acid is also preferable to any of the other remedies in diphtheria with these excoriating discharges when the disease advances and affects the stomach (whether or not the membrane in these cases spreads to the stomach, I cannot say); when, with great prostration and membrane in the throat and nose, there is distress and uneasiness referred to the stomach, with total rejection of all food. Muriatic acid is another remedy in these malignant cases of scarlatina and diphtheria. Under this remedy there is the most intense prostration. The patient seems to have scarcely life enough to move. He is worse at about ten or eleven o'clock in the morning. The mouth is studded with deep ulcers having a dark or black base. They tend to perforate the parts on which they are situated. Muriatic acid frequently has the intermittent pulse of Nitric acid, but accompanying this symptom there are involuntary stool and urine. In addition to Nitric acid and Muriatic acid in cases having this dangerous group of symptoms you should think of Alcohol. Grauvogl, you may remember, found that diphtheritic membrane was dissolved and its growths destroyed by several substances, one of them being Alcohol. So this agent has become a remedy for diphtheria. Alcohol in the form of brandy and water tends not only to destroy the growth, but also aids in counteracting the terrible prostration. Lycopodium is similar to Arum triphyHum in scarlatina and in diphtheria. It has a similar nasal discharge, usually associated, however, with dull, throbbing headache at the root of the nose or over the eyes. The nose is so stuffed up that the child cannot breathe at night. The patient bores and picks at the nose just as under Arum triphyllum. But in the Lycopodium case the diphtheritic deposit travels from the right to the left side. The patient is always worse from sleep even after a short nap. He suddenly awakens from sleep, crying out as if frightened; nothing can be done to pacify him. He is irritable and peevish. In more advanced cases calling for Lycopodium, you will find the child unconscious and in a deep sleep. The lower jaw drops, the urine is scanty or even suppressed, and what does pass stains the bedding or clothing red and deposits a red sand. The breathing is rapid, rattling, with waving of the alse nasi and snoring. The mucous membrane of the throat is ulcerated and oedematous. Hvery symptom points to impending paralysis of the brain.

Ammonium causticum was first suggested by Dr. J. P. Dake as a remedy in diphtheria appearing in the nasal cavities, with a burning, excoriating discharge from the nose, and great prostration. The symptoms above mentioned led Dr. Dake to use the remedy in an epidemic which appeared in Nashville, Tennessee.

I^astly, let me mention Ailanthus. This drug is a member of the order of Simarubaceae. It is analogous to Quassia, Cedron, Brucia, etc., all of which are of bitter taste and have anti-malarial properties. Its history is as follows: Dr. P. P. Wells, of Brooklyn, had two cases of poisoning in children. From his statement of the symptoms, it would certainly seem that he had to treat malignant cases of scarlatina; but there being no such epidemic about at that time, he looked for other causes, and found that the little patients had been chewing the blossoms of the Ailanthus. This told him at once that the Ailanthus would probably become a remedy in scarlatina. He made provings of the drug, and found that they fully confirmed what he had already learned from these poisoning cases. Since then this remedy has been successfully used many times. A year ago I attended a boy with scarlatina. The child lay in a stupor with his mouth wide open. The throat was swollen, the nose stuffed up, and the slight rash that had appeared on the body was dark and mixed with bluish spots. I gave Lycopodium, without any benefit whatever. The child grew worse instead of better. I then thought of Ailanthus, and gave it in the sixth potency, with the result that the child was completely cured. I believe the patient would have died had it not been for the Ailanthus.

Ailanthus resembles Arum triphyllum in the acridity of the discharges. There are excoriating discharges from the mouth and nose, making the lips sore. We find a similar swelling of the throat, both inside and outside. So far as these superficial symptoms are concerned, the remedies are identical. But there is a great difference to be recognized in the other symptoms. The Ailanthus patient becomes drowsy and lies in a stupor, hence this drug is indicated when there is torpidity rather than the restless tossing about of Arum triphyllum. The Ailanthus rash comes out imperfectly; it is dark red or bluish, and is mixed with petechise.

Some little time ago, several members of the class asked me to speak of the remedies useful in diphtheria, and while I am on the subject of Aru?n and its analogues in this affection, I shall take the opportunity to comply with that request.

Baptisia tinctoria has long enjoyed a great reputation in typhoid fever. It has lately been used in diphtheria, and in scarlatina also when the child is very much prostrated and lies in a half-stupid state, almost like one intoxicated. The face is dark-red, and has a besotted look, and the discharges from the mouth and nose are horribly offensive, so much so, indeed, that one might suppose that gangrene of the affected parts had taken place.

Rhus tox. we find indicated in rather severe cases, when the membrane is dark in color and bloody saliva runs out of the mouth during sleep. These symptoms are associated with inflammation of the glands about the neck, of a dark erysipelatous hue.

Phytolacca decandra we find useful when, in the beginning of the disease, there are creepy chills and backache. The patient is weak, and feels faint when he sits up in bed. On looking into the throat you find it dark-red, almost purple. There is great burning in the throat, with aggravation from hot drinks.

Amygdala amara is indicated when there are sharp, lancinating pains in the swollen tonsils. The palate and fauces have a dark-red hue, and the patient is very much prostrated.

Naja tripudians is to be administered when there is impending paralysis of the heart. The patient is blue. He awakens from sleep gasping. The pulse is intermittent and thready. Dr. Preston, of Norristown, has been very successful with Naja when the symptoms I have mentioned were present.

Apis mellifica is indicated in diphtheria, when, from the very beginning, the child is greatly prostrated. He is feverish and drowsy at 3 p. m. The pulse ranges from 130 to 140, and is very weak. At first the throat has a varnished appearance as though the tonsils and fauces were coated with a glossy red varnish. The membrane forms on either tonsil, oftener on the right than on the left, and it is thick like wash-leather. The tongue is often swollen. If the child is old enough to talk to you, he will complain of a sensation of fulness in the throat, necessitating swallowing but making the act very difficult. The uvula, in fact the whole throat, is cedematous and swollen. The rima glottidis is swollen, red, and cedematous, making breathing difficult. In some of these cases the breath is very foetid, while in others it is not so in the least. In some cases a red rash appears over the body, greatly resembling that of scarlatina. The child is often thirstless in spite of the presence of fever.

Arsenicum album is called for in rather severe cases of diphtheria, when the throat is very much swollen both internally and externally, and the membrane has a dark hue and is very foetid. There is a thin, excoriating discharge from the nose. The throat is ©edematous, just as it is under Apis. The patient is restless, especially after midnight, and is greatly prostrated. The urine is scanty; the bowels are constipated, or else there is an offensive, watery diarrhoea. Natrum arsenicosum is the remedy when the throat is of a dark purplish hue, with great swelling and prostration, but without much pain.

Kali permanganatum is useful when the membrane is horribly offensive. The throat is oedematous, and there is a thin discharge from the nose; the chief characteristic of the drug is this extreme foetor.

Lachesis is called for when the membrane forms first on the left tonsil and spreads thence to the right. It is to be distinguished from other drugs which act in a similar manner by the fact that the symptoms are worse from empty swallowing, and are often relieved by eating or swallowing solid food. There is a constant feeling as of a lump on the left side; this descends with each act of deglutition, but returns again. Sometimes, on waking from sleep, there is a feeling as if there were needles in the throat, which create suffocation. When the tonsils are very much swollen, fluids are apt to return through the nose. The fauces are of a dark purplish color, and there is great prostration. The heart is weak in its action. There is aggravation after sleep, and the throat is sensitive to the slightest touch. Belladonna is not a prominent remedy in diphtheria. When you do give it in this disease, make sure that it is the remedy or you will lose valuable time. It may, however, be the remedy in the early stages when the violence of the attack calls for it, if there is congestion of the head before the membrane has formed.

Other frequently indicated remedies are Kali bichromicam , Iodine, Bromine, Mercurius biniodatus, Mercurins cyanalus, etc. Some of these I have already given you, and the others you will get in future lectures.