Lobelia Hypodermically in Diphtheria.
Margareta Wilkenloh, M. D., Chicago
For years I have used Lobelia in large doses by the mouth, in croup, and have applied it externally in cases of blood poisoning. I have also used it hypodermically in pneumonia when near the stage of crisis, or when the plastic exudates are exceedingly adherent and there is labored breathing with great oppression in the chest. I am inclined to think that in such cases it is beneficial in assisting in the removal of the plastic deposits.
Until I read the article by Dr. Jentzsch in the June number of this journal, I had never used the remedy hypodermically in diphtheria. The first opportunity I had to try it in such a case, was on the third of December, when I was called to a case of malignant diphtheria in a male child, 11 years old. I immediately concluded that this was an excellent opportunity to test Dr. Jentzsch's method. I therefore at once gave a hypodermic injection of 30 drops of specific Lobelia and repeated it twice a day for six days.
By mouth I gave the patient Phytolacca and echafolta. The throat and nasal passages were free from all diphtheritic deposits by the twelfth of December, and the child made a perfect recovery. There were three other children in the family and I gave these Lobelia by the mouth, alternating it with Phytolacca and echafolta. The second younger child, seven years of age, had considerable exudate in the throat, similar to the first case, but none of the other children were in bed during their illness, and in two weeks' time from the time I saw the first child all the children were free from the disease and the health department fumigated the rooms.
On the morning of the twenty-sixth of December I was called again; this time to attend the youngest child, who had vomited considerably during the night, had a temperature of 104.5° F., and the mucous membranes of the throat and tongue were covered with a dirty grayish coat. I immediately gave the child a hypodermic injection of twenty-five drops of Lobelia, and gave Phytolacca and echafolta by the mouth. On the twenty-seventh of December I gave thirty drops of Lobelia both morning and evening. On the twenty-eighth I increased the dose to thirty-five drops.
On the twenty-ninth the child was very sick. The throat and nasal passages seemed to be closed up, with a dirty greenish gray deposit, and it seemed to me that the child was at the point of death. That morning, to keep my conscience clear, I injected four thousand units of Stearns diphtheria antitoxin. Considerable pain followed this injection and the stench from the child's mouth was unendurable. The next day the child was unconscious, and I concluded to go back to the Lobelia hypodermically again, and gave forty-five drops. I called again in four hours and found there was return of consciousness, the membranes of the throat and nasal passages were very dark colored and there was no abatement in the stench. I then sprayed the throat and nasal passages with a strong solution of asepsin, and much of the exudate came away. I continued the spray at intervals until the evening of the thirty-first, when a hemorrhage occurred from the throat. This I controlled by an application of Thuja. January 2, the membrane from the nasal passages came away, followed by a severe hemorrhage. To control this, I used a spray of Thuja, applying it thoroughly to all the passages. From December to up till January 7, I gave 45 drops of Lobelia, by injection, twice a day. On the seventh I stopped the Lobelia and gave Nux vomica and echafolta by the mouth. The child could swallow, but was somewhat nervous and could not sleep. I then gave Scutellaria with Nux vomica. After a day or two the child wanted to sleep all the time, apparently from pure exhaustion; did not want to be disturbed.
On the seventeenth, the house was again fumigated by the health department. The child is now well, except that she cannot speak clearly. The voice is husky, from injury to the vocal cords. This of course is due to the diphtheritic deposit, or through paralysis, and is not due to the action of either the Lobelia or the antitoxin. There seemed to be an atrophy of the entire structures of the throat. This case will probably be interesting to the readers of this journal.
On the twenty-second of December I had a microscopical examination made from the throats of all of the children, and no bacilli were found. All the children were then in good condition. On December twenty-seventh, when I made the third visit to this last patient, I noticed a Christmas tree standing in the front parlor. I immediately remembered that three years before, a relative of theirs, a young lady, twenty-three years of age, who had just arrived from Europe, had a very severe attack of diphtheria three days after her arrival, which I was finally successful in curing. During her sickness, a Christmas tree had stood in the same spot. Ultimately the tree was destroyed, but the ornaments were packed away in a box. During her illness the children, ten in number, were kept downstairs, and with proper prevention none of them were attacked. I told them at the time that the tree and every thing on it must be destroyed.
It now occurred to me that there might be some relationship between that attack of diphtheria and this one. I found upon inquiry that there had been no Christmas tree at that house since that time, and that in the last of November, 1908, in cleaning house, the children had found the box of tree ornaments, and had played with them for a short time. That accounts for the first attack of diphtheria on the third of December. These were then put away again until the day before Christmas, when they were brought out and the tree was decorated with the result that Margaret came very near death, and one other child was slightly ill. I then demanded that the tree, its fixtures and everything pertaining to it be immediately burned, that there should be no farther recurrence of the disease.
The most of us are slow to believe that things sometimes are harmful, until the fact is demonstrated in some manner often serious, as this was.