Influenzas (Bl3) by BORLAND

7/24/2019 Influenzas (Bl3) by BORLAND

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Encyclopaedia Homeopathica 1

Copyright 2000, Archibel S.A.

BORLAND D. M., Influenzas (bl3)BORLAND Douglas M.

Influenzas

Gelsemium sempervirens-VISUALISE the ordinary; typical influenza case, probably developing over six to eight hours. The patient feels a little out

of sorts the day before; possibly a little headachy, a little feverish, has a little indefinite pain, is probably a littlecatarrhal; he goes to bed, does not sleep awfully well, and next morning feels rotten.

-Fortunately, there is a drug in the materia medica which produces exactly that picture, and which will cover a largepercentage of the cases of straight forward influenza. The drug is Gelsemium.

-It develops its symptoms fairly slowly and produces exactly the symptom picture give above. Other influenza drugs will bedealt with in due course.-Gelsemium is somewhat slow in onset, and produces primarily a feeling of intense weariness. The patients are very dull and

tired, look heavy and are heavy-eyed and sleepy; not wanting to be disturbed but to be left in peace, and yet - the firstoutstanding symptom - if they have been excited at all, they spend an entirely sleepless night, in spite apparently dull,toxic state.

-The patient is definitely congested, the face slightly flushed - rather a dull kind of flush - the eyes a little injected, thelips a little dusky; the skin generally is a little dusky, and the surface is definitely moist - hot and sticky.

-Another Gelsemium symptom is that with the hot, sticky sensation, the patients have a very unstable heat reaction. Theyfeel hot and sticky, and yet have the sensation of little shivers of cold up and down their backs - not actual shiveringattacks but small trickles of cold, just as if somebody ran a cold hand, or spilt a little cold water, down their back.

-With their general torpor, Gelsemium influenza patients always have a certain amount of tremulousness, their handsbecome unsteady much more quickly than you would expect from the severity of their illness; they are definitely shakywhen they lift a cup to try and drink. Frequently linked with the shakiness is a feeling of instability, and very often asensation of falling. They feel as if they are falling out of bed, particularly when they are half asleep; they wake with asudden jerk and feel as if they have fallen out of bed.

-As one would expect with anyone in this toxic state, the Gelsemium patient does not want to make any effort at all;discomforts of every kind are aggravated by moving. With their unstable circulation they are definitely sensitive to colddraughts, which make them shiver.

-As a rule, their mouths are intensely dry and the lips very dry; very often dry and cracked, or dry with a certain amount ofdried secretion of them. The patients complain of an unpleasant taste, and there is frequently a sensation of burning inthe tongue. The tongue itself usually has a yellowish coating - though, sometimes it is quite red and dry.

-Gelsemium influenzas always include a very unpleasant, severe headache.-Typically; there is a feeling of intense pain in the occipital region, spreading down into the neck with a sensation of

stiffness in the cervical muscles; and, as it is a congestive headache, it is usually throbbing in character.-The patient is most comfortable when keeping perfectly still, propped up with pillows, so that the head is raised without

the patient making any effort. With these headaches, the patients often complain of a sensation of dizziness,

particularly on any movement.-There is another type of headache sometimes met with in Gelsemium.-Again, it is congestive in character, but the sensation is much more a feeling of tightness - as if there were a tight band

round the head, just above the ears from the occiput right forward to the frontal region.-This, also, is very much aggravated by lying with the head low.-Peculiarly, these patients often find relief from their congestive headaches by passing a fairly large quantity of urine.-In nearly all Gelsemium influenzas there is a sensation of general aching soreness, an aching soreness in the muscles; This

is worth remembering; there are other drugs which have similar pains but are much more deep-seated than the


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Gelsemium pains.-Now for a few details of actual local disturbances.-Most Gelsemium patients have that appearance of intense heaviness of the eyelids that is associated with this dull toxic

condition. But there is also a good deal of sensitiveness of the eyes themselves, a good deal of congestion, a definitesensitiveness to light, probably a good deal of lachrymation and general congestive engorgement.

-There is an apparent contradiction here : despite this ocular sensitiveness, occasionally a Gelsemium patient becomesscared in the dark and insists on having a light.-These patients get very definite acute coryza, with a fluid, watery discharge, accompanied by very violent sneezing and a

feeling of intense fullness and pressure just about the root of the nose. It is not uncommon in Gelsemium influenza -where there is this feeling of blockage at the root of the nose - to find a story of epistaxis on forcible clearing of thenose. This, again, is worth remembering, for certain Mercurius cases tend to run in the same way.

-With their acute coryzas, Gelsemium patients, despite a general hot stickiness, very often complain of very coldextremities. (This appears to be a contradiction, and might mislead you when you consider the general heat of the typicalGelsemium patient).

-As a rule, in Gelsemium influenzas, there is no very marked localized tonsillitis, but much more a generalized, puffy, red,congested throat.

-There may be a certain amount of enlargement of the tonsils, but it is not the spotty throat that some of the other drugshave.

-In spite of the absence of acutely localized symptoms there is often acute pain on swallowing. Swallowing may be actuallydifficulty - with a feeling of constriction or of a lump in the throat - and it is much more difficult when the patients takecold fluids than warm; this is unexpected, considering the dryness of their mouths.

-Associated with these conditions of nose and throat, Gelsemium influenzas quite frequently have an involvement of theears. But, in spite of what is recorded in the materia medica, I have not observed the acute stabbing pains that aredescribed under Gelsemium; and, where I have tried to clear up such pains with Gelsemium, I have not had any success.

-Gelsemium is given as one of the drugs that has stabbing pain into the ear on swallowing : in my experience, it has not beeneffective.

-Gelsemium does get a good deal of roaring in the ears, a feeling of blockage and obstruction and you very often get dullnessof hearing, and giddiness; but I have not seen acute earaches respond to Gelsemium.

-Quite frequently there is an extension downwards, with involvement of the larynx and loss of voice. Associated with thelaryngitis there is liable to be an intensely croupy cough which is almost convulsive in character, coming in spasms andassociated with very intense dyspnoea.

-Typical Gelsemium patients, despite their sweetness and dryness of mouth, are not usually very thirsty. Occasionally a

patient is intensely thirsty, but the typical one is not.-They hardly ever have an appetite - they do not want anything at all.-They very often complain of a horrible empty sensation in the region of their chest, often near the heart. This sometimes

spreads down into the epigastric region, and they may describe it as an empty feeling; but it is not really a sensation ofhunger, and is not associated with any desire for food.

-Associated with the digestive system, Gelsemium patients often have a definitely yellowish tinge, and actual jaundice maydevelop. Again, the patient quite frequently develops very definite acute abdominal irritation accompanied by diarrhoea.Usually, the stool is very loose and yellowish but not particularly offensive.

-There is quite often a story of intense feeling of weakness in the rectum - an incontinence, or a feeling of prolapse - afterthe bowels have acted; an there is sometimes a definite prolapse associated with the diarrhoea.

Baptisia tinctoria-BAPTISIA runs very closely to Gelsemium in symptomatology. Personally, I look at Baptisia as Gelsemium exaggerated,more intense.-In contrast to Gelsemium patients, Baptisia patients are definitely more dusky. They give you the impression that their

faces are a little puffy and swollen; their eyes are heavy, but with a congested, besotted look rather than the droopinglids of Gelsemium; and lip congestion, present in Gelsemium, makes Baptisia lips rather blue.

-Mentally, Baptisia patients are more toxic than Gelsemium patients; they are less on the spot; they are confused, finding itdifficult to concentrate on what they are doing. They grow a little confused as to the sensation of their body; they mayfeel that their legs are not quite where they thought they were. Their arms may have definite disturbed sensations;some patients feel their arms are detached and they are trying to re-attach them, others say their arms are numb.


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-Associated with this is the general Baptisia confusion. The patients themselves are not quite clear why they are there,where they are, what they are talking about or trying to discuss; and they are not quite clear whether there is somebodyelse talking to them, somebody else in the bed. They are simply more fuddled than Gelsemium patients.

-As you would expect with the slightly more intense toxemia, all the local conditions are definitely worse. The tongue isdefinitely dirtier- the typical Baptisia tongue is in a pretty foul state. In the early stages it usually has a central coating

of yellow, brown or black with a dusky red margin all round.-The patient's breath is always foul. With this very foul mouth, there tends to be a lot of ropy, tough saliva which is apt todribble out of the corner of the mouth when the patient is half asleep. In consequence, the lips tend to crack andbecome very foul, and may actually bleed.

-Contradictions arise. The Baptisia patient is obviously much more ill. He appears to be much more toxic, and more drugged;at the same time he is much more sensitive, with more sensitive arms, legs, back - he is tender all over. He complains ofhis bed hurting him; any pressure is painful. And, in spite of his toxicity, he is very often restless, constantly on themove, trying to find a comfortable position.

-The Baptisia patient sweats a lot, but the sweat, in contrast to the somewhat sourish odour of Gelsemium is definitelyoffensive. This is true of anything in connection with Baptisia : it is all offensive.

-Mouth, breath, sweat, diarrhoea (which Baptisia patients incline to) sputum, all are offensive; much more so than one everfinds in Gelsemium.

-Baptisia mouths and throats, as contrasted with those of Gelsemium, are a very much more dusky red - a dusky, dark red.In Baptisia there is a strong liability for definite ulcerative conditions to develop about the tonsils and spread up to thesoft palate. And again here, strongly noticeable is the accumulation of this filthy, glairy mucus, and the extremeoffensiveness.

-Occasionally, you find a Baptisia throat with fairly extensive ulceration that is strangely insensitive. Commonly, however,the Baptisia throat is painful; there is great difficulty and pain on swallowing, a feeling of obstruction, and the swallowingof solids is almost impossible.

-As you would expect with this very foul invective condition, there is liable to be an extension into the ears, with asensation of fullness, obstruction and pain. Very often there is a middle-ear abscess, and not infrequently a tendency tovery early development of mastoid infection.

-In Baptisia , it is much more commonly the right ear and the right mastoid region which is involved. If a mastoid does occur,the prognosis is very serious indeed. Thrombosis occurs very early - and I mean astonishingly quickly - and the prognosisbecomes correspondingly worse.

-In a Baptisia influenza with obvious mastoid developing - tenderness and slight blush over the mastoid region - it isastonishing how the case alters completely within two or three hours of giving Baptisia . The patient, from being obviously

toxic - so toxic that all the signs of starting meningeal irritation are developing - is equally obviously recovering, as aresult of even the first dose of Baptisia .

-In contrast with Gelsemium, Baptisia patients are always thirsty.-They have a constant desire for water, but if they take much at a time if often produces a sensation of nausea. Taking a

little at a time, they are all right, but their thirst is always one of their troublesome features.-Usually, there is not much of a cough in Baptisia cases. There is a good deal of dyspnoea, a feeling of oppression in the

chest, which is very much worse when they are lying down, and rather better for a current of air; when there is a coughit is usually induced by a sense of irritation in the throat rather than a definite accumulation of sputum in the chest.

-In their influential attacks, Baptisia patients are very liable to have a gastric or liver disturbance. Very often it isassociated with acute diarrhoea accompanied by violent tenesmus, a good deal of colic and a bileless stool.

-Baptisia patients always have intense aching pains all over. Any part they press is painful and tender; they also have acutepains in their joints, a feeling as if they were sprained or had been bruised; moving is very painful.

Bryonia alba-The typical Bryonia influenza develops, like the Gelsemium case, over a period of six to twelve hours. And the appearance

of Bryonia patients is not unlike that of Gelsemium patients. They give the impression of being rather dull, heavy, slightlycongested, with a rather puffy face.

-Although they are definitely heavy-looking, they do not have the sleepy appearance that you find in Gelsemium, nor yet thebesotted look of the Baptisia patient - something between the two.

-Mentally, as stated, Gelsemium patients are dull, sleepy, heavy and do not want to be disturbed. Bryonia patients are alsodefinitely dull and do not want to be disturbed - but if they are disturbed they are irritable. Irritability is always


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cropping up in Bryonia patients.-They do not want to speak, and do not want to be spoken to. They do not want to answer because speaking annoys them, not

because they are too tired to do so.-As a rule, Bryonia influenzas are very depressed; they are despondent and not a litt le anxious as to what is happening to

them; they feel they are ill and are worried about their condition.

-To their worry about their impending illness they add a very definite anxiety about their business. They talk about it; ifthey become more toxic, they are apt to dream about it, and it is an underlying thought in the back of their illness.-It is also typical of Bryonia influenzas that the patients are difficult to please. They are very liable to ask for something

and refuse it when it comes. They want a drink and, when it comes, do not want it. Or, they may ask for a fruit juicedrink and, when that comes, say they would much rather have had a drink of plain cold water - they are very difficult tosatisfy.

-Typically, they have a good deal of generalized, aching pain.-They will tell you that it hurts them to move, and yet, very often, Bryonia patients are constantly on the move. They are

restless and uncomfortable, and move about in spite of the fact that the movement increases their pain.-Get hold of this fact very clearly, because it is so definitely laid down in textbooks that Bryonia patients are aggravated

by motion.-Apparently it does hurt them, but they get into this restless state when they will not keep still.-When the patients are restless, find out whether it eases them or not. If it does not, they are probably Bryonia cases. If

it does ease them, consider one of the other drugs - possibly Baptisia or one of the restless drugs, such as Rhus tox. Itis a point that needs early clarification.

-Bryonia patients feel hot, and are uncomfortable in a hot stuffy atmosphere; they like cool air about them. This can belinked with their thirst. They are always thirsty, and their desire is for cold drinks - large quantities of cold water -though, as mentioned above, they may ask for cold, sour things and then refuse them when they are brought.

-As a rule, Bryonia patients sweat a fair amount, sometimes profusely, with a damp, hot sweat.-Although these patients are sensitive to a hot room, you occasionally find a Bryonia influenza with definite rheumatic pains

- one or other joint becoming very painful - and who claims that the joint is relieved by hot applications. This is a localcontradiction to the general heat aggravation.

-There are one or two points which help in differentiation, in connection with local conditions.-There is a very typical Bryonia tongue. It is usually a thickly-coated white tongue. The white coating is liable to become

dirty in appearance, and may become brown if the disease condition has lasted long, particularly if there is muchrespiratory embarrassment and the patient is breathing through the mouth.

-With that dry tongue, the patients complain, not unexpectedly, of an unpleasant taste in their months, very often of a

bitter taste, accompanied by fairly intense thirst. As a rule, these patients, have rather swollen, puffy, dry lips whichtend to crack and may bleed very easily.

-In the typical Bryonia throat there is the same sensation of extreme dryness, heat and burning. On examination, thetonsillar region and the back of the throat are usually found to be pretty deeply congested; the tonsils are liable to havesmall, usually white, spots. The throat also is unduly painful on swallowing, which is, of course, the ordinary Bryoniaaggravation from movement.

-All Bryonia influenzas have very intense headaches. Usually, the headache is intense, congestive and throbbing; the mostcommon situation for it is in the forehead.

-Patients often say they feel as if they have a lump in their foreheads, which is settling right down over their eyes. Thepain modality of the headache is that it is very much relieved by pressure - firm pressure against the painful foreheadaffords great relief to the Bryonia headache.

-As one would expect, the headache is very much worse from any exertion - talking, stooping or movement of any kind. It isworse if the patient is lying with the head low; the most comfortable position is semi-sitting up in bed, just half-propped

up.-Definite neuralgic headaches are found sometimes in Bryonia influenzas: general neuralgic pains about the head, withextreme sensitiveness to touch. The whole surface of the scalp seems to be irritated; and it may spread down into theface, on to the malar bones, again with extreme hyperaesthesia.

-All Bryonia influenzas tend to more or less congestion of the eyes, which may go on to a definite conjunctivitis. Theeyeballs themselves are sensitive to pressure; patients sometimes say that it hurts even to screw their eyes up - not anuncommon influenza symptom.

-As a rule, Bryonia patients do not have a very profuse nasal discharge.-More commonly, they complain of feelings of intense burning and heat in the nose, or of fullness and congestion.


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-There is liable to be a very early extension of the catarrhal condition into the larynx with a very irritating, tickling, burningsensation and very definite hoarseness - sometimes actual loss of voice. Also a feeling of rawness, and a very suffocativetight sensation rather lower than the larynx, with a very irritating, bursting, explosive cough.

-I have not observed much tendency to acute ear involvement in Bryonia cases. There is much more a feeling of blockageand stuffing-up of the ears, possibly a certain dullness of hearing, but little more than that.

-Bryonia influenzas do not show any very marked tendency to extend into the digestive tract. There are, of course, Bryoniaabdominal symptoms in other conditions, but I have never seen Bryonia indicated in an influenza with definite abdominalsymptoms.

-There is nearly always troublesome constipation, and a definite lack of appetite which, considering the state of the Bryoniamouth, is not surprising. There may be a certain amount of general abdominal discomfort, a feeling of heaviness - almostof solidity - in the epigastrium.

-The patients do not want any food and, if pressed to eat, are very often more uncomfortable after it. But as a rule, I havenot seen acute gastric disturbances associated with Bryonia influenzas. They are much more likely to have a chestdisturbance, even a definite pneumonic attack, than a gastric attack.

-Of course, if the patient does have a pneumonic attack, it will be the typical Bryonia pneumonia, with violent stabbing painsin the chest, a feeling of acute oppression, extreme pain on coughing, pain in the chest on movement with the desire tokeep it as still as possible. But this is rather going beyond the uncomplicated influenzas.

Eupatorium perfoliatum-The outstanding point which leads to the consideration of Eupatorium is the degree of pain which the patients have. There

are very intense pains all over - of an aching character - which seem to involve all the bones of the skeleton, arms, legs,shoulders, back, hips and, particularly, the shin bones.

-As a rule, Eupatorium influenzas develop rather more quickly than others, and the pains develop very rapidly. The patientssay it feels as if the various joints were being dislocated - it is that type of very intense, deep-seated pain. Associatedwith the pain, there is incessant restlessness; the patients are always moving to try to ease the aching pain in one orother of their bones.

-In Eupatorium influenzas - a useful differentiation, point - the sweat is very scanty. Other drugs which have a very similardegree of bone aching all tend to sweat.

-The patients are always depressed, but with a different depression from that of Bryonia. They are acutely depressed anddefinitely complaining; they complain bitterly about the intensity of their pain and, if they are not complaining, they movearound in bed, groaning and moaning; and are very sorry for themselves.

-In appearance, they usually have a fairly bright flush and a dryish skin, with rather pale lips, in contrast to the deepcongested appearance in the other drugs already described. They tend to have a white-coated, ticklish fur on the tongueand, instead of the bitter taste of Bryonia, they simply have a flat, insipid taste.

-Eupatorium patients are always chilly; they feel cold and shivery, are sensitive to any draught of air and very often have asensation of chilliness spreading up the back.

-They usually suffer from quite intense headaches. Typically, they complain of extreme soreness of the head, very oftenmost marked in the part that is resting against the pillow.

-There is one exception to this : they complain of extreme soreness in the forehead, where there is no pressure at all, and asensation of pulsation in the occipital region, accompanied by a feeling of intense heat on the top of the head.

-They sometimes have a strange surging feeling in the head and, oddly, the surging seems to go from side to side across thetop of the head.

-Coryza in Eupatorium is rather distinctive. The patient has a feeling of intense obstruction - as if the the nose iscompletely stopped up- and this is accompanied by most fluent discharge with violent and incessant sneezing.

-With this coryza there is always marked involvement of the the eyes. The margins of the lids look red and inflamed, thereis intense lachrymation and a feeling of generalized soreness. They look congested; and there is some degree ofphotophobia, but not very marked.

-Eupatorium patients sometimes develop and extreme hyperaethesia to smells of any kind. Any odour induces a sense ofirritation, aggravates the the coryza and, very often, makes them feel sick.

-They suffer from an intensely dry throat, which is just generally congested. With it they are very thirsty, with a desirefor ice-cold drinks. I remember a Eupatorium patient whose one desire was for ice-cream. He did not swallow it but heldit in his mouth to cool the burning at the back of this throat.

-Care must be taken, however : if Eupatorium patients have too much ice water, ice-cream or cold drinks, they are very


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prone to gastric attacks. Liable to a good deal of eructation of wind anyway; irritation of cold fluids in the stomach maycause a definite bilious vomit.

-The catarrhal condition usually avoids the larynx, but the patients complain of intense heat and burning in the trachea. Thisis accompanied by a very trying cough, which again is accompanied by intense soreness in the chest walls. There areintense aching pains all through the chest muscles, pains which feel as though they are actually in the ribs.

-The Eupatorium cough is very violent, with scanty sputum, and it seems to hurt the patients from head to toe. It makestheir head burst and increases the chest pains, so that they try to restrain the cough or control the chest movement,even while they are coughing, because of the pain. It is a generalized aching pain - as if they were being broken; not thesharp, stabbing pain of Bryonia, which is equally as sensitive.

Rhus toxicodendron-The onset of a Rhus tox. influenza is usually gradual and without a very high temperature; it is a slowly progressing

feverish attack, which is accompanied by very violent generalized aching.-The aching in Rhus tox. is very typical indeed. The patients are extremely restless; their only relief lies in constant

movement, constant change of position. If they lie still for any length of time, their muscles feel stiff and painful, andthey turn and wriggle about in search of ease. This constant restlessness is the most noticeable thing about Rhus tox.patients on first sight.

-They are very chilly, and very sensitive to cold. Any draught or cold air will aggravate all their conditions, and is enough toaggravate their coryza and start them sneezing; an arm outside the bedcovers becomes painful and begins to ache, and soon.

-Understandably, Rhus tox. patients are extremely anxious; they get no peace at all, and are mentally worried, apprehensiveand extremely depressed. The depression is not unlike that of Pulsatilla ; the patients go to pieces and weep.

-With all the restlessness and worry, they become very exhausted and, considering that their temperature is quitemoderate, unduly tired-out, almost prostrated.

-Rhus tox. patients invariably have extremely bad nights. It is very difficult for them to get to sleep because of theirconstant discomfort; when they do sleep, their sleep is very disturbed, full of all sorts of laborious dreams - either thatthey are back at work, or making immense physical effort to achieve something.

-They sweat profusely. And the sweat has a peculiar sourish odour, the sort of odour one used to associate with a typicalcase of acute rheumatic fever.

-These patients always have intensely dry mouths and lips, and very early in their disease they develop a herpetic eruptionwhich starts on the lower lip - small crops of intensely sensitive vesicles that spread to the corners of the mouth. Theseusually develop within the first twelve hours of their illness.

-The typical Rhus tox. tongue is very characteristic. It has a bright red tip and a coated root, the coating varying fromwhite to dark brown. Instead of the typical triangular red tip, some patients have a generalized dry, red tongue whichtends to crack, is burning hot and very painful.

-Associated with the sensitiveness of their lips and tongue, these influenza patients tend to very acute dental neuralgia;their teeth become very sensitive and are painful if touched.

-They develop extremely sore throats - dry and burning. On examination, the throats appear to be oedematous. They arevery sensitive on swallowing, particularly empty swallowing; and it is easier for them to take solids than fluids.

-Rhus tox. patients have very violent attacks of sneezing. They describe them as usually more troublesome at night, and soviolent as to make them ache from head to foot. As a rule, the nasal discharge is somewhat greenish in colour.

-They get very troublesome tickling irritation behind the upper part of the sternum. This produces a persistent and veryracking cough, with which they develop a raw, burning sensation in the larynx, which very often progresses into definitehoarseness.

-This hoarseness is very characteristic : the patients complain of a feeling as if their larynx were full of mucus. They feelthat they cannot clear their voices until they have coughed the mucus out, and yet the effort of coughing feels as if it isalmost tearing or scalding their larynx.

-As a rule, there is a good deal of congestion of the eyes - generalised congestion, with very marked photophobia and a gooddeal of lachrymation.

-They suffer from rather severe occipital headaches, with a sensation of stiffness down the back of the neck and, veryoften, marked giddiness on sitting up or moving; They often complain of a sensation of weight in the head, as if it were aneffort to hold it up.

-Rhus tox. patients often complain of a feeling of intense heat inside, and yet their skin surface feels the cold. They are


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sweating profusely and any draught seems to chill them - they feel the cold on the surface - but they feel burning inside.-In these influenzas, the patients are very apt to have violent attacks of nodular urticaria, scattered anywhere over the

body and intensely irritable.-The patients are not usually markedly thirsty, though they do like sips of water to moisten their very dry mouths and

throats.

-I have seen a Rhus tox. influenza go on to a definite enteritis with violent abdominal pain; pain down in the right side, downin the cecal region, with extreme restlessness, tenderness and very stinking diarrhoea.-But I have seen only the one case. It responded very well to Rhus tox. There was the typical tongue and general anxiety

and restlessness, general aching pain, sweating and chilliness; and it was more on the general than on the local abdominalsymptoms that I prescribed Rhus tox .

Pyrogenium-PYROGENIUM influenza patients usually run a fairly high temperature.-Typically, they are flushed, hot, sweaty and somewhat congested-looking.-They very often complain of a sensation of burning heat, and feel horribly oppressed by it.-Most of the Pyrogenium influenza patients that I have seen have been overactive mentally. They tend to be very loquacious

and chatter away readily, and become definitely excited in the evening maybe even delirious.-They are very much troubled with sleeplessness, due again to excessive mental activity; if they become toxic, they may get

a slight degree of delirium with a sensation of uncertainty as to where they are. They quite frequently wake up brightand clear and describe unpleasant dreams of having to try and collect themselves from all over the bed - but that is morein their sleep than when they are awake.

-A constant Pyrogenium indication is that, though the patients feel so very hot and uncomfortable, they are sensitive to anydraught.

-It makes them shiver at once - very much as in Mercurius - and they quite frequently get little shivers, almost little rigors,intermingled with their feeling of intense heat. Very often the patient feels chilly for a moment, gets a little shiver,turns horribly hot and then breaks out into a definite sweat. As a rule, the sweat in Pyrogenium is definitely offensive.

-Always, in influenza, they complain of intense, generalized aching pains; they ache from head to foot, and are veryuncomfortable with it; they are sensitive to pressure, and often move restlessly about in order to ease the painful part.

-They suffer from very violent congestive headaches; either severe occipital headaches or, much more commonly, intensethrobbing headaches in the temples with a sensation of heat and pressure in the head and often, a damp hot sweat.These congestive headaches are definitely relieved by pressure.

-A dry mouth is always found in a Pyrogenium case, with a good deal of thirst for small quantities of cold water. The tonguetends to become dry, the mouth offensive.

-There are two types of tongue in Pyrogenium patients. Much the most common is a dry tongue with a somewhat browncoating. Occasionally - less commonly in influenza than in some of their conditions - the tongue has no coating at all; it isdeep red and dry, very sensitive, painful and hot, and it tends to crack. This tongue is found more in the frankly septicfevers of Pyrogenium than in the catarrhal influential states.

-These patients tend to have very violent attacks of sneezing, which are brought on by any cold draught. Uncovering themfor examination is enough to start them sneezing; sometimes they actually sneeze if they put a hand out of bed - it iscold that always sets them going.

-As a rule, the nasal discharge in Pyrogenium is thick and gluey, which is difficult to expel. Patients complain that first oneside of the nose and then the other gets blocked up; they have great difficulty in clearing it. The right side is blockedmore commonly than the left, but it does tend to alternate.

-The typical appearance of the Pyrogenium throat is relaxed and unhealthy-looking, probably with a certain amount of

superficial ulceration of the tonsils and a good deal of offensive gluey postnasal discharge.-In Pyrogenium influenzas there is liable to be involvement of the larynx, with a feeling of intense rawness and burning, andan accumulation of the same kind of glairy, sticky mucus which they have difficulty in expelling. There is a verytroublesome cough and a good deal of mucus to clear away; the patients cough up sticky, yellowish-coloured mucus.

-Most Pyrogenium influenza patients have intense ringing in the ears, with a feeling of obstruction, marked tendernessbehind the ears, and a severe pressing sensation as if the ears were going to burst. The right ear is much more commonlyaffected than the left.

-Associated with the ear condition is a very similar sensation in the accessory nasal cavities. There is a feeling that thefrontal sinuses are blocked, and an intense pressing pain just above the eyes - more commonly above the right eye.


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-There is also likely to be a similar sensation in the upper jaw from involvement of the antrum, with again the same pressingpain. The autumn pains are liable to go from one side to the other, or to spread right across.

-While the condition is acute, the pains are very much aggravated by cold or any active movement of the patient. Coughingtoo, increases the pains; the forehead feels as though it would burst, and there is often intense throbbing in theaffected area.

-There is liable to be an extension further back in the accessory sinuses, very often accompanied by an intense pressingpain deep in the skull. It would seem to be an involvement of the spheroidal cells. The patients very often complain, atthis time, of very severe, distressing headache.

-These patients have a certain amount of pain and tenderness in they eyes, very often tenderness on pressure. It is usuallyaccompanied by acute photophobia. In fact, there is often photophobia without any acute inflammatory condition in theeyes; the patient seems to be disturbed by light quite apart from the local condition. As a rule the eyes are gummy andsticky rather than showing profuse lachrymation.

-Pyrogenium patients always complain of an unpleasant taste just a feeling of flatness or lack of taste, or a definite putridtaste.

-They very often say that a lot of stuff accumulates at the back of their throats and, when they spit it out, it has a foultaste. This gives them complete aversion to food, they have no appetite at all.

-And their very painful throat makes it difficult for them to swallow.-Pyrogenium influenza patients are liable to acute digestive disturbances - enteritis rather than gastritis. They have quite

acute abdominal pains accompanied by very violent diarrhoea, always a very offensive and rather profuse watery stool.-Useful for diagnosis is the point that this stinking profuse diarrhoea is not accompanied by a great deal of urging; there is

no marked degree of tenesmus. But there is marked abdominal pain, very often in the cecal region, on the right side ofthe abdomen, and the pain is very much aggravated by motion. The abdomen is sensitive to touch and the patient rathermore comfortable lying on the right side.

-There are two other indications for Pyrogenium that should be mentioned. Firstly, before the patients develop any signs ofcold at all, they are conscious of extreme pains starting in the legs and spreading gradually upwards. Secondly, there isalways a marked discrepancy between the pulse rate and the temperature of a Pyrogenium patient.

-The discrepancy can go either way : rapid pulse and comparatively low temperature or high temperature and comparativelyslow pulse.

-The typical Pyrogenium influenza is quite a serious case. However, the patients do respond astonishingly quickly.

Mercurius solubilis-The appearance of the typical Mercurius influenza is much the same as in Pyrogenium, though the patient looks a little

more puffy.-There may be a localized hectic flush, but it is more common to see a generalized flush in Mercurius , often with the face

bright red.-And there is a damp sweat - peculiarly oily-looking, so that the patient looks greasy.-In contrast to the loquacity of Pyrogenium, Mercurius patients tend to be hurried; their speech is hurried and they rather

tumble over their words. There is much more anxiety and restlessness.-Pyrogenium patients, although very ill, are singularly unworried about it. Mercurius patients, however, are usually extremely

distressed, restless and anxious. Very often, they are definitely depressed, in a Pulsatilla way - they weep, when shownkindness.

-Linked, with the hurried outlook is a tendency to impatience and irritability.-Their general temperature reaction is another distinguishing point.-Mercurius patients feel just about as hot as Pyrogenium cases, they have the same sort of hot sweat, and are

uncomfortable if covered too much and chilly if they uncover; but, there is never the same intense sensitiveness to coldas in Pyrogenium - the state is one of alternating between too hot and too cold. If a Mercurius patient is kept in a stillatmosphere at a moderate temperature, he is fairly comfortable.

-Mercurius patients, unlike Pyrogenium, have a very marked nightly aggravation; they are very uncomfortable all night, liableto have a marked rise of temperature and apt to sweat more, which only increases their discomfort.

-It is difficult to distinguish between the headaches of Pyrogenium and Mercurius patients. Bother suffer from exactly thesame type of pressing headache, in just the same situations; both have the same feeling of heat in the head; both seemto get involvement of the frontal sinuses, antrum and ear; and the symptoms are very similar.

-Possibly, Mercurius patients are a little more sensitive to draughts on the painful areas. More helpfully, they find rather


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more relief from firm pressure over the painful area than do Pyrogenium cases.-As far as thirst is concerned, there is little to distinguish between the two drugs; both are thirsty and want cold drinks.

But the actual state of the mouth gives definite indications. The Mercurius mouth always shows a swollen, flabby, palish,coated tongue, with a nasty, greasy feel about it, and there is always troublesome, sticky, fairly profuse salivation. (Cf.the dry, brownish tongue of Pyrogenium ).

-The Mercurius tongue is tremulous; it shows a definite fine tremor when protruded. The excessive salivation makes theirtongues sticky and they find it difficult to speak and articulate.-The Mercurius throat is acutely inflamed, and there is early marked enlargement of the submaxillary glands. The throat

itself is very much swollen, dusky, dark, red, very tender; it feels hot and burning The whole of the tissues round theback of the throat seem to be inflamed, and any movement hurts; swallowing is very difficult and may cause stabbingpains that spread out into the ears.

-The same feeling of soreness and burning extends down the throat, involving the larynx, trachea and bronchi. Any cough isextremely painful; the whole centre of the chest feels raw and as though the mucous membrane had been stripped. Theintense inflammation causes hoarseness and, very often, complete loss of voice.

-Mercurius influenza patients always have an intense conjunctivitis, with profuse lachrymation of hot, burning tears whichseem to excoriate the cheeks. They have severe photophobia, and are peculiarly sensitive to radiant heat - the heat ofthe fire - which makes their eyes smart and burn.

-These patients have a profuse nasal discharge, acrid and watery, which tends to excoriate the upper lip. With it there isintense burning pain in the nose and very violent attacks of sneezing. These attacks will be induced either by going intothe open air or coming into a warm room - either heat or cold will set them going - and any draught is liable to precipitatea violent bout of sneezing.

-There is a tendency for the watery discharge to become thicker, and greenish in colour. It is then that the patients areliable to have intense pains radiating out into the antrum, underneath the eyes or up into the frontal sinuses.

-With the intensely inflamed throat of Mercurius influenzas there is liable to be pretty acute involvement of the middleear. It usually starts with a feeling that the ears are choked and stopped-up; and there may be a certain amount ofbuzzing in the ears. Very quickly the ear becomes painful. There is a feeling of increased tension and the ear throbs.

-Pain tends to spread right up the side of the head and, very often, involves half the head. There is marked tenderness ofthe mastoid region, very often enlargement of the post auricular glands, spreading down into the neck; extremelyinjected drums and early rupture.

-Mercurius patients have complete loss of appetite in influenza.-With their acutely inflamed throats they can hardly swallow. Moreover, there is constant accumulation of unpleasant saliva,

the swallowing of which is both painful and also liable to cause a feeling of intense nausea.

-These patients have generalized muscular pains. They feel stiffness in the back of the neck, down the back, in their armsand legs; and it is painful to move.

-And, not only the tongue but the whole patient becomes tremulous in a Mercurius influenza. Hands become shaky and allfine movements tremulous.

Kalium bichromicum-KALI BIC. is worthy of mention because of its affinity to accessory sinuses.-The typical Kali bic. influenza patient is rather pale, with red blotches about the face.-Discharges are irritating, and the upper lip swollen and reddish, due to coryza.-The mental state of typical Kali bic. influenza patients is one of mild discouragement. They have difficulty in thinking, any

attempt at mental effort is almost impossible, and they are rather discouraged and hopeless. They feel very weak, tiredand weary, and like to be left in peace.

-Kali bic. influenzas are generally definitely chilly.-The patients have a good deal of generalized, wandering rheumatic pains - the wandering character is important - first inthe shoulder, then in the elbow, the back or the knee, and so on. These pains grow ores if the patients are cold; in bed,with plenty of hot-water bottles, they are fairly comfortable.

-A characteristic of Kali bic. influenza is the patient's really bad period in the morning. They have a temperatureaggravation about 2 or 3 in the morning. Their real discomfort, however, is between 6 a.m. and 8 a.m. - very much laterthan one would expect from a Kali salt.

-There is a very copious nasal discharge which feels hot and burning.-It is usually white, or slightly yellow, in colour; rather stringy, and always accompanied by a feeling of extreme obstruction


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at the root of the nose. The patient feels as if the root of the nose were completely blocked, swollen, full and hot; hehas violent sneezing attacks, with pain spreading out from the root of the nose to the external angle of the eye.

-The same blockage occurs in the frontal sinuses or antrum, again with the feeling of tension. The headache, or face pain, isvery much aggravated by movement, but definitely relieved by pressure. It usually tends to be confined to one side.

-When the pain becomes intense, it is very liable to produce a sensation of nausea and may actually make the patient sick. It

is definitely relieved by hot applications and is sensitive to cold.-Occasionally, one meets a case in which the pain is located in one small spot just above one of the frontal sinuses : this isalmost diagnostic of Kali bic.

-As a rule, the mouth is dry; and the tongue has a slight coating, either white or yellowish. There may be a certain amountof ropy saliva, but it is much more likely to be a postnasal discharge and stringy in character.

-The throat in Kali bic. tends to be very red and swollen, with a very definite oedematous appearance. There may be a verymuch swollen, oedematous uvula and, almost certainly, signs of acute follicular tonsillitis. The throat is always verypainful, and - a Kali bic.

-characteristic - it is very painful for the patient to put out his tongue; the pulling on the muscles at the root of the tonguehurts.

-Another characteristic is the strange sensation of a hair across the soft palate.-There is very early hoarseness in Kali bic. influenzas, with an accumulation of mucus in the larynx. It is the same kind of

stringy white, or whitish yellow, mucus and is coughed up with great difficulty.-As a rule, there is spread downwards from the larynx, with a feeling of great tightness in the chest. Very often, there is

accumulation of mucus in the larger bronchi, sometimes spreading into the smaller bronchi, becoming a definite bronchitisand accompanied by wheezing. There is a very violent, difficult cough, and expectoration of large quantities of verystringy, adherent mucus.

-Short of that, the accumulation of stuff on the larynx is liable to cause an intensely irritating, tickling sensation whichexcites a very spasmodic cough, almost like whooping cough.

-The patients nearly always say that they are very exhausted by the effort of coughing; they are often sweaty, and getextreme palpitation.

-There is some involvement of the ear, with blockage of the Eustachian tube and fullness in the ears; it may develop into adefinite middle ear abscess. Where this occurs in Kali bic. , there may be extreme swelling of the external ear as well asthe involvement of the middle ear.

-Most Kali bic. influenzas have gastric catarrh. They may have acute gastritis, with troublesome nausea and vomiting of aquantity of unpleasant glairy mucus. This is very difficult to bring up, and the effort of vomiting is apt to produce a mostintense headache.

-The gastric catarrh may spread down and become a duodenal catarrh, with a certain amount of jaundice.-The Kali bic. chilliness is rather "different": it is particularly situated in the back of the neck. Patients hate to have their

necks uncovered; they are much more comfortable with a hot-water bottle tucked into the nape of their neck. Thechilliness sometimes spreads down the back, and they then complain of feeling chilly in the small of their back.

-Some Kali bic. influenza patients have an astonishing sensitiveness of the hand; they feel as if their hands were bruised.Shaking hands is apt to cause them pain; they describe the same feeling of bruisedness in the soles of their feet if theystand on them.

BORLAND D. M., Pneumonias (bl4)

BORLAND Douglas M.

Introduction-Before discussing the question of prescribing for acute pneumonias I would like to make certain that you all understand the

rudiments of what one is attempting to do when tackling cases from the homoeopathic point of view. The point is this. Inhomoeopathic prescribing your endeavour is to find a drug which will cover not only the actual pathological picture butalso the reaction of the individual patient to that disease. Suppose you consider an acute illness, you want a drug whichwill cover the symptoms that are produced by the infective organism, that is to say, the ordinary symptoms on which you


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found your diagnosis. The patient is infected, say, with pneumococcus, and has the symptoms of pneumonia, so you want adrug which will cover the pneumonic symptom complex. Well, so far there is no difference from what is done in ordinarymedicine.

-But, in addition to that, in homoeopathic prescribing you endeavour to find out in what way any one patient A infected witha pneumonococcus will react differently from a patient B infected with the same strain of pneumococcus. Your first

endeavour is to find the group of drugs which produces the symptom complex of a pneumococcal infection; your second isto choose from that group the individual drug which covers not only the pneumococcal symptoms but also the manner inwhich the patient A reacts to his pneumococcal infection. The drug which covers the combined picture is the one youwant for patient A, but it would not be successful for patient B who is reacting differently to the same infection. So

your whole endeavour is to establish the differences between one patient with a pneumococcal infection and another.First of all you find the common ground, on which you make your diagnosis; then you look for the contrasting points in

your different cases in order to make your individual prescription.-The whole of your success in homoeopahtic prescribing depends on your power of recognizing which symptoms are common

to every case of infection by a specific organism and which are dependent on the individual reaction of the patient who isinfected. It is your ability to recognize differences in identical diseases which determines your success, and that is whythe experienced clinican is a far more successful homoeopathic prescriber than the inexperienced; he knows what apneumonia should do, how it should behave, what are its constant symptoms, and he comes to a case and says, "Hello, thisman is a little different". It is on that difference that he founds his prescription, and it is because he recognizes thatdifference that he is successful. So do not imagine that the practice of Homoeopathy is going to make your clinicalmedicine of less use to you; on the contrary, it is going to take advantage of every atom of knowledge and experiencethat you have, and the greater your clinical experience the more successful you are going to be. We are always hearingthat we homoeopaths are symptom hunters, that we prescribe on symptoms alone. We do nothing of the kind. The onlysuccessful homoeopathic prescribers I have known have been most observant clinicans. Instead of tending to neglectone's clincal work one pays more and more attention to it and it steadily improves, and it is on that that successfulhomoeopathic prescribing depends.

-From what I have said, you will see the significance of the statement that you must cover the totality of your symptoms, inother words, the symptoms of the disease and all the other symptoms as well. In practice you select the drugs which youknown have an affinity to the symptoms of the disease you are treating possibly a dozen or so drugs and you can thenneglect these diagnostic symptoms, as you know these drugs all have them, and concentrate on finding symptoms whichfrom a diagnostic point of view are not normally considered at all.

-Suppose you take a case of pneumonia; it does not interest you that the patient has a temperature, a rapid pulse, rapidrespiration, rusty sputum, because all the drugs you consider for the treatment of a pneumonia have these symptoms and

you do not need to bother about them at all. But it does matter to you whether the individual patient has a generallyevenly coated tongue, whether he has a dry mouth or a moist one, whether he is thirsty or thirstless, whether he is morecomfortable lying on the affected side or on the opposite one, whether he is drugged and toxic or delirious and excited,whether he is more at peace with somebody by his bed or prefers to be left alone. All that sort of thing you verydefinitely want to know; it is on that sort of thing you prescribe; but you only take it into account after you have decidedthat the drugs you are considering have the constant features on which you have made your diagnosis. It is not a questionof neglecting your clinical side; it is a question of knowing which drugs have the clinical picture, and adding to that thepoints on which you are going to prescribe.

-Then there is another difficulty which, from the purely practical standpoint, I want to make very clear, and that is thisvexed question of what strength of drug, i.e. potency, you are going to use and what repetition you are going to give.

-Where you are dealing with acute disease your choice of potency is very much simplified. It is very much more difficultwhere you are dealing with chronic disease.

-You will find from experience that where you are dealing with acute disease there are two attitudes of mind you can adopt.

One is "play for safety", and this was advocated by some of the senior men when I first came here. There maintainedthat in acute disease if you restricted your prescription to low potencies you avoided the complications of the disease, you made your patients more comfortable, and you reduced your mortality rate.

-But by this method you do not reduce your duration of disease.-Suppose you were dealing with the average case of penumonia in which you expected your crisis from the seventh to the

tenth day.-By prescribing low potencies you would relieve the patient's distress, you would diminish the severity of the attack, you

would avoid complications such as a developing pleural effusion and possibly empyema; the patient would run a normalcourse, with a slightly lowered temperature; he would have a perfectly good, well-sustained pulse; there would be no signs


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of a flagging heart; the crisis would be very much more of a lysis than a crisis, but it would not occur before the normalperiod of seven to ten days.

-The patient would never cause a moment's anxiety, he would just steadily get better.-That you can do. I have seen it done repeatedly, and it is a course of action which was strongly advocated in this hospital.

They said the mortality rate under that line of treatment was enormously better than he mortality under the orthodox

treatment, whether it was the expectant treatment or the active treatment of pneumonia; and I think that is true, yourmortality rate will be better.-The second method of treating these acute conditions is by the administration of higher potencies something above a

thirty. You will find that by the administration of these higher potencies you abort the disease. It does not run itsnormal course; the duration of the illness is very much shortened and you have an anticipated crisis.

-Instead of getting the crisis from the seventh to tenth day you get it from twelve to forty-eight hours after startingtreatment, irrespective of the day of disease.

-The relative advantages of the two methods of treatment are obvious.-If you can cut short the duration of an acute illness of that sort you are still further diminishing your complications, you

are still further diminishing the stress your patient has to endure, and you are less liable to get any signs of weaknessdeveloping. But you have precipitated a crisis, and a crisis is always attended by a certain amount of stress, possibly acertain amount of risk although this is not so likely when the crisis occurs early in the disease as when it occurs afterseven to ten days of continous fever. The temperature crashes over a few hours, but you do not get a collapse because

you have a perfectly healthy patient to start with instead of one whose vitality is impaired by long toxaemia.-Another point of contrast in the two systems is this. By using the lower potencies your matching of the drug symptoms

with the symptoms of the patient does not require to be quite so accurate as it does when you are using the higherpotencies. Where you are using the higher potencies you must get a very accurate correspondence between thesymptoms of your patient and the symptoms of your drug.

-If you are using the lower potencies you can produce a modifying effect without necessarily covering the whole case, so your work is less difficult. It is easier to prescribe the lower potencies and get a general similarity, whereas if you areprescribing the higher potencies you have to get a much more accurate matching. I am quite sure that anyone who hastried the two systems, and has had a bad case and seen the crisis in twelve hours, never rests satisfied with merelymaking the patient safe and comfortable over ten days; once you have experienced the power of the one you will never goback to the other. One is more difficult, but it is much better; the other is easier, and is better than treating cases onorthodox lines. One requires more detailed drug knowledge than the other, but I think it is worth while acquiring thatknowledge in order to obtain the better results.

-Then as far as repetition is concerned. Where you are using low potencies you have to keep up your drug administration

right throughout the course of the disease. You will probably find that you have to give more than one drug; your firstdrug modifies the picture and you then get indications for a second prescription, and possibly a third, before the crisistakes place.

-Where you are using the higher potencies, it is advisable to continue the administration of the selected drug until thetemperature has reached normal and has remained normal for at least six hours.

-Otherwise you will find the patient tends to get a further rise of temperature and will require a second course ofmedicine, possibly the same but possibly different, say, twenty-four hours later, whereas if you have kept up youradministration for six hours after the temperature has become normal you do not, as a rule, get any relapse at all.

-As regards the frequency of administration of the drug, in the average case, where you are using a low potency it is quitesufficient to give the drug about once in four hours; and, as far as I can see, there is no particular advantage in giving itmore frequently. As far as the high potencies are concerned, I think it is wiser to give the drug every two hours, thereason being that you want a number of stimuli in a comparatively short period of time in order to obtain the crisis withintwelve to twenty-four hours. So in ordinary practice if giving a low potency, one repeats four-hourly and is perfectly

happy to go back in twenty-four hours, not expecting to have to change the drug or the potency, and expecting to findthe patient more comfortable, without much change in temperature. In another twenty-four hours the temperatureshould be coming down, the patient obviously doing well, and all anxiety disappearing; possibly by then a freshprescription will be required, but there will be nothing dramatic, and no reason to hurry.

-Where you are using a high potency, you start off giving the drug every two hours, and you go back in six, twelve, ortwenty-four hours. In six hours you ought to find the temperature coming down; in twelve hours it will probably be downto normal, and in twenty-four it certainly ought to be.

-That is the difference of the two systems, but they are both effective.-Many people advocate that at the start it is wiser to use low potencies until you acquire confidence in your drug selection,


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and then as you gain greater knowledge heighten the potency and shorten the interval, so that eventually you aretreating all your cases with medium or high potency. Possibly it is a wise way to do. Personally, I think it is better to goout for the best right from the start, do the extra work required in order to get moe accurate matching, and aim for anearly crisis in every case.

-It is sometimes said that certain drugs are effective in high, potency and certain drugs only effective in low. I do not think

this is so.-The reason certain medicines have been found effective more commonly in low potency turns on the point of generalsimilarity. Most of the drugs which are used exclusively in low potencies have not been fully proved; we have noknowledge of their finer differentiating points, we only have a knowledge of their cruder effects. So when you use oneof these drugs in a higher potency you cannot accurately match the finer differentiating symptoms of the case. Thehigher you go, the more accurate the prescribing must be; in low potency a general similarity is enough to give an effect.Suppose you get a marked effect from a low potency, and later go high you will certainly get an effect. In that case it isworth while noting the finer points of the case and seeing if they crop up in the next case in which you think of givingthat drug.

-In the average case of penumonia that you meet with there are three stages in the disease. There is first of all the stageof congestion, or invasion, in other words, the incipient stage in which you are in doubt whether you are going to tackle apneumonia at all. Then there is the stage of frank consolidation, in which the patient is running a good temperature, andhas obvious physical signs in the chest.

-And later there is thes tage of resolution, in which the condition is beginning to clear up. If our consider these threestages from the ordinary clinical standpoint the picture the patient presents is quite different in each stage, and forthat reason your drug selection in each stage will be different, so from the homoeopathic prescribing point of view onetends to group pneumonias under the various stages. Firstly, one takes the group of drugs which would apply to theincipient pneumonia. Secondly, one takes the group of drugs which would apply to the frankly developed pneumonia in astrong healthy person. Thirdly, one considers the pneumonias which is either of a more septic type or a straightpneumonia in a bad soil, such as an alcoholic, or again a creeping type of pneumonia or a frank broncho-pneumonia.

-Fourthly, one takes the group of drugs which would apply to the resolution stage of pneumonia, or the unresolved pneumoniawhich is not clearing up properly. So from the prescribing point of view you link up your drugs according to the clinicalpicture.

Pneumonias

Pneumonias

Incipient stage (group i)-In the incipient pneumonia stage there are four drugs which are commonly indicated, and I think the simplest way is to

take these up in order. There are Aconite, Belladonna, Ferrum phos. and Ipecac .

Aconitum napellus-In the Aconite pneumonias you will always get a history of a very sudden onset. Usually the story is that the patient has

been out and exposed to cold, and the same evening he comes down with a temperature it is a very acute, rapidlydeveloping condition. You are much more likely to meet with it in the strong, healthy, robust patient. As a rule you willfind a high temperature, very marked excitement, restlessness, and pretty acute anxiety. The patient has a full,bounding pulse, a very flushed face, and a hot, dry skin. Usually he complains of a very dry mouth which feels hot andtingling and is accompanied by intense thirst. The desire is almost always for cold drinks.

-Well, that is the picture as you see it. And, of course, on that you cannot make your diagnosis; you cannot decide whetherthe patient has an ordinary chill which will subside in no time, or whethr it is going on to a definite Subdivisiond condition.

-Then to take up the points that lead one to prescribe Aconite .-With this intense excitement, restlessness and anxiety, in your Aconite patient you find you have contracted pupils. That

is the first point you have to fix on from the prescribing point of view. The next point is that, in spite of the extremely


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hot, flushed face and hot skin, your Aconite patients complain of coldness of the extremities.-Another point which is an Aconite indication is that the patients very quickly develop a constant, dry, short cough, which

they say is due to the dryness of their throat. Very early they begin to have pains, pretty acute stabbing ones, usually inthe left side of the chest.

-If you see your Aconite patient after the first twelve hours you can usually make out early signs at the left apex that is

where you get your first definite clinical indication that the patient is starting a consolidation. And here a distinguishingpoint comes in; the Aconite patient with definite early involvement of the left side of the chest is aggravated by lying onthe affected side, he is more uncomfortable turned over on the left. The most comfortable position is well propped up,lying on the back.

-Very early, if the patient is developing pneumonia, he begins to bring up small quantities of sputum which is streaked withbright blood, and with the effort of coughing he feels as if his chest were being cut.

-If you see the patient within the first twenty-four hours, or possibly within the first thirty-six hours, you will find theseAconite indications, but if it has gone on beyond thirty-six hours at the outside you will not get your response fromAconite . Nor will you get Aconite indications. If it has gone beyond the Aconite stage there will be definite patches ofconsolidation in the affected lung and you will get no response to Aconite , you will have to go on to one of the drugs forthe later stages of pneumonia.

-That is the typical Aconite onset. And here I think it might be worth while discussing dosage and repetition in theseincipient pneumonias, because the same applies to all four drugs.

-In these acute conditions, if you want to abort the attack altogether it is no use prescribing under a 30. If you give 3x ofAconite you will modify the temperature, you will modify the distress, you will modify the anxiety, and you will modify thepain. But you will not arrest the progress of the Subdivision and when you go back and see the patient next day you willbe able to make out definite physical signs in the chest. If you give potencies above the 30, when you go back next day

you will find that the temperature has fallen and all the symptoms are subsiding. The whole thing just fades out and youwill think you have probably made a mistake in your diagnosis and it was merely a common or garden chill and was nevergoing to be a pneumonia at all.

-If you have simply an Aconite chill, which has not yet developed a raging temperature, Aconite low will do away with theeffects.

-But a 6, for instance, will only do it if you get in very early.-Once your raging temperature has developed you must give a high potency if you want to abort pneumonia. If you have

simply an irritation from exposure to cold Aconite wipes it out; say the patient has a temperature of 99, a dose ofAconite in any potency will stop it. But if the patient is heading for a pneumonia Aconite 6 will not do it. I have seen ittried.

-If you are using potencies above a 30, I think you are wise to repeat your medicine at not longer intervals than one hourfor the thirst four hours, and after that keep up your administration at two hourly intervals over a period of twelvehours in all. If you do that, and your prescribing is accurate, you will see case after case in which you have obviousphysical signs starting, which from your experience you know would be a commencing pneumonia, but which in twenty-fourhours is perfectly well you simply abort the whole thing. This applies to all four drugs for incipient pneumonias.

-The administration must be kept up until the temperature is right down, otherwise it is very liable to swing again.-The 30 also works but it works more slowly; you will abort these cases with it, but not in twelve hours, you will have to keep

up the administration longer. At the end of twelve hours you will not be satisfied that the patient is well; he will beobviously on the way to recovery, but you will have to keep up the administration for at least another twelve hours.

Ferrum phosphoricum-The next most common of these early drugs is Ferrum phos. The Ferrum phos. picture also is fairly definite. As a rule,

the pneumonia takes a little longer to develop than in Aconite .-For instance, if you get an exposure one afternoon your are unlikely to find the Ferrum phos. picture developing beforethe following morning. And you may getFerrum phos. running on to about the third day of Subdivision, until you havedefinite, obvious consolidation.

-The first distinguishing feature between the Ferrum phos. patient and the Aconite is the appearance. Instead of the verybrightly flushed face and hot, dry skin of the Aconite , in Ferrum phos.

-you usually find either a localized flush over the malar regions, or else a very variable state of redness, that is to say, ifthe patient is coughing, is disturbed, or has to talk, he very rapidly flushes up a bright red flush, but when he rests thatflush tends to ebb away and leave just the malar flush on a rather palish background.


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-Also in Ferrum phos. you often find a very suggestive pallor round the mouth.-The next thing about Ferrum phos. is that you do not find the same degree of excitement and terror as there is in

Aconite .-The patients are more tired, they are very indisposed to talk, they are very sensitive to any disturbance round about them,

any noise, any loud speaking seems to distress them, and they want to be left quiet. They are very much more at peace if

they are quiet and if no one interferes with them which is exactly the reverse of the Aconite state in which the patientsare terrified, want someone to be about all the time, are sure they are going to die, and are afraid to be left alone.-As regards temperature and pulse rate, it is very difficult to distinguish between Aconite and Ferrum phos. Both run a

high temperature, and both have a rapid, bounding pulse.-Where thirst is concerned there is very little to it also. They are both very thirsty, and both want quantities of cold

water. But occasionally you come across Ferrum phos. patients who complain of rather a sweetish taste, and instead ofwanting cold water they prefer something rather sour to counteract this sweet taste.

-The tongue in Aconite and Ferrum phos. is different. In Aconite it is usually dry, and not particularly coated. In Ferrumphos. it gives the impression of being somewhat swollen. At the commencement it is usually red, although it may have afaint white coating; by the third day it will have developed a definite coat.

-But in the earlier stages it is a rather darkish red, swollen looking tongue.-The Ferrum phos. patient has a pretty incessant, tormenting cough, but, instead of being induced by a sensation of

dryness in the throat as in Aconite , it is excited by a sense of irritation lower down behind the sternum. Very frequently you get a history that if the patient has a violent bout of coughing it is very liable to bring on an attack of epistaxis.

-There is another constant point about the Ferrum phos. patients, and that is that in their febrile attacks they aredefinitely chilly.

-They are sensitive to cold, and their cough is liable to be excited by a draught of cold air.-Another point that distinguishes Ferrum phos. from Aconite is that the right side of the chest is much more likely to be

involved than the left. You very often find pleuritic signs on the right side quite early in the Subdivision, it is not at allunusual for a definite pleuritic rub to develop within forty-eight hours of the onset, and with that pleuritic rub you areliable to get the development of very sharp pleuritic pains, which, of course, are aggravated by motion. Apart from theirpleurisies your Ferrum phos. patients are often restless, but once they have developed a pleurisy any movement hurtsthem.

-A further point which sometimes helps you is that the time of aggravation in Ferrum phos. tends to be in the earlymorning, usually between 4 o'clock and 6 o'clock, whereas the Aconite time of aggravation is late in the evening,sometimes up to midnight.

-The character of the sputum is a help, though not so much in distinguishing between Ferrum phos. and the other acute

drugs as between Ferrum phos. and Phosphorus with which it may easily be confused. In the Ferrum phos. cases you areliable to get a bright red streaked sputum, rather than the rusty sputum of the later pneumonia drugs, in other wordsFerrum phos. is indicated in the early stage of consolidation. The Phosphorus sputum on the other hand is beginning toturn rusty, it is a darker red and there is more blood in contrast to the streaky sputum in Ferrum phos.

Belladonna-Here again you have a very clear cut, definite picture. The onset of the Belladonna attack is just about as acute as that of

Aconite . You often find a Belladonna case developing the same evening as the patient has been subjected to exposure.The attack is always very severe. It is attended by a violent temperature, running up to 105 or over, with intenseexcitement of the heart, and a pulse which feels as if it would almost burst through the vessels. The patient is alwaysextremely excited, and I have seen these Belladonna cases, particularly in children, in which the patients have beenpractically delirious within twelve hours of the onset of the Subdivision, with the temperature running up to 106. They

always have a bright red face, and very often you will find a generalized blush over the whole skin and the surfaceburning hot to touch.-If the patients go on to the delirious state or possibly even short of that you always find intense excitement in Belladonna.-It is not the extreme anxiety and fear of impending death which you get in Aconite . It is a question of excitement; and in

the adult the Belladonna case is the type which comes into hospital and Sister reports : "I will have to get a special forthis patient, I cannot keep him in bed, he is restless, excited and crying out, and almost impossible to control".

-The next thing which distinguishes these patients is the state of the pupils, which in Belladonna are always widely dilated.You can tak on to that the Belladonna photophobia, which is intense; these patients are invariably sensitive to light. If

you are nursing a Belladonna pneumonia you are tempted to keep a light in the room as the patient appears to be terrified


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of all sorts of things, but, if you do, for goodness sake do not let it shine on your patient.-They seem to see strange things in shadowy corners, and one feels one must keep the light on to let them see what is

there, but it is absolutely essential that it should not shine on them. This is a very useful distinguishing point, becausesome of the other drugs have a similar condition in delirium, but they hate to be in the dark and want the room lighted asotherwise they imagine all sorts of things in dark corners.

-Belladonna patients always prefer to have the room darkened because of their photophobia which outweights all else.-Then as regards the thirst, Belladonna patients always have a dry mouth. It is always laid down in the textbooks thatBelladonna is intensely thirsty, but I have seen quite a number of Belladonna pneumonias in which there was very littlethirst at all; the patients complained of the mouth being very dry, hot, and burning, and yet they were not particularlythirsty. So do not be put off Belladonna because the patient is not as thirsty as one would expect from the statementsin the textbooks.

-In the pneumonias you do not get the typical strawberry tongue that is described in Belladonna; you are much more likelyto find a congested, dry, dark red tongue.

-I think a right-sided pneumonia is more common in Belladonna, but I have seen cases with the main involvement on the leftside. The thing that is constant about them is that any movement of any kind is liable to bring on an attack of coughing.In the early stages, the Belladonna cough is a very dry, painful, tearing cough, and the sputum is usually very scantyindeed.

-These patients always have a very intense, congestive throbbing headache, which is worse if they are lying with the headat all low, and is frightfully sensitive to any movement.

-Another symptom of Belladonna which is sometimes helpful is that the patients are very liable to develop an acutehyperaesthesia of the chest wall over the affected area. The chest wall becomes astonishingly sensitive to touch, and ishorribly painful on coughing. And, because of this hyperaesthesia of the chest wall the patients are unable to lie on theaffected side.

Ipecacuanha-The fourth of these drugs for the acute stage of pneumonia is Ipecac.-and it applies much more to children than it does to adults. I do not know if you were taught, as we were, that 80 per cent.

of children's ailments start with an attack of vomiting, no matter what the child is going to develop. I think it is verynearly true, with the result that many of these children with a commencing pneumonia, or possible even more commonlywith a commencing broncho-pneumonia, show very definite indications for Ipecac. .

-In my experience the onset of the Ipecac. pneumonia is a little slower than it is in the other three drugs. One usually doesnot find clear-cut indications for it under about twenty-four hours. The story you are given is that the child has beenseedy the previous day, off its food, possibly feeling rather sickish, or it may actually have vomited. And I think Ipecac.is more commonly indicated in the milder weather than in the intensely cold weather In a pneumonic attack the typicalIpecac. child usually tends to be flushed. It is rather a dusky flush, and the child has a hot, sweaty face. Thetemperature in Ipecac. is usually not so high as in the other drugs it is round about 103 and the pulse is not quite sobounding.

-Always in these Ipecac. children the thing that strikes you is the amount of mucus in the chest; there is mostly a diffuse,generalized rattle. And invariably the patients have very suffocative paroxysms of coughing. The point that makes youthink of Ipecac. is that these suffocative attacks of coughing very often go on to definite retching and the child bringsup a quantity of stringy, difficult, blood-stained sputume. One has to distinguish these attacks from those found in someof the later drugs. In some of the Resolution pneumonias you find similar suffocative coughs, which again go onpractically to vomiting, but in them the patients bring up quantities of dark, offensive blood, whereas the blood in theIpecac. sputum is always the bright red of a commencing pneumonia.

-After these paroxysms of coughing you often find the Ipecac. patients very exhausted, and then their flush disappearsand you get the typical pallid, whitish, pale-lipped Ipecac. patient. You get the impression, after these attacks, that thepatients are very tired, very wearied, and during that stage they are awfully difficult to please. They feel rotten, theyfeel sick, they do not want to be fussed, and they may ask for something, but they do not really want it and will refuse itif they get it, they are just miserable.

-In their pneumonic attacks these Ipecac. patients always have a good deal of nasal irritation, with pretty violent attacksof sneezing. I have never seen an Ipecac. pneumonia yet which did not have these sneezing attacks.

-The appearance of the mouth is somewhat suggestive. It is usually rather sticky, and I have seen two different types oftongue in these cases.


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-In a straight-going lobar pneumonia I think more commonly the Ipecac.-tongue is clean. But in a broncho-pneumonia, where there is probably a good deal of nausea apart from that caused by the

actual attacks of coughing, I have seen an Ipecac. tongue which was pretty heavily coated. As a rule these Ipecac.patients are completely thirstless.

-Another thing that is constant about Ipecac. patients is that they are always very sensitive to a stuffy atmosphere; it

brings on their cough, and it increases their distress, so you find that they always like to have a current of air aboutthem.-Well, that covers your incipient pneumonias, and you ought to be able to abort any of these cases in twelve to twenty-four

hours. If you do not see the case early enough for that you will probably have to consider one of your other drugs. Youmay be lucky and get a Ferrum phos. which has persisted, or you may possibly get an Ipecac. which has persisted, but

you are unlikely to get an Aconite after the first twenty-four hours, or a Belladonna after the first thirty-six hours.

Frankly developed pneumonia (groupe ii)-For the average case of frankly developed pneumonia, when you are quite satisfied that you can make your diagnosis on the

physical signs, that is to say, the case you see after the first twenty-four hours, commonly you have to consider one offour drugs : Bryonia, Phosphorus, Veratrum viride , or Chelidonium. These, I think are much the commonest drugs forthe simple, uncomplicated, straight-going lobar pneumonias. It is a little difficult to say whether Bryonia or Phosphorus ismore common, and it varies a good deal with the season of the year. In the milder weather probably you come acrossmore Bryonia, and in the colder weather more Phosphoruses , so over the years you will probably see as many Bryoniapneumonias as Phosphorus ones. As regards the other drugs, there wille be a year, or an epidermic, in which you will seequite a number of Veratrum viride pneumonias, and then there may probably be two or three years in which you seecomparatively few it seems to run in definite strains of pneumonic infection. The Chelidonium pneumonias are a little lesscommon, and I think they also tend to come more in the milder weather than in the sharp, cold weather.

Bryonia alba-In the Bryonia pneumonias there is usually a history of a fairly gradual onset. The kind of story you get is that the patient

has been out of sorts for a day or two, complaining of indefinite feelings of malaise, and then that one morning he wokefeeling thoroughly ill, very often with an attack of sneezing and a feeling of blocking in the head.

-During the morning he felt shivery, he may have had an actual rigor, and by the afternoon he had a good going temperature.The probaility is that these people have been running a slight temperature for the previous twelve to twenty-four hours,though they have not consulted you for it; they have certainly been off colour.

-When you see a Bryonia pneumonia the impression you get is of a definitely congested, heavy-looking, sleepy-lookingpatient.

-The face is somewhat dusky in colour. The patient feels hot, and usually has a hot, damp sweat. It is not a profuseperspiration but the skin is hot and damp. Twelve to twenty-four hours later you very often get a dusky appearance ofthe extremities. About the same time you find the lips are beginning to turn dusky in colour, and they very soon tend tobecome dry and to crack. They have a somewhat swollen appearance.

-The patient very often complains of a rather intense frontal headache which settles down over the eyes. Often it is muchmore a feeling of weight than of actual pain, but it becomes painful on any movement or exertion, such as talking orsitting up. Another thing you can link on to this aggravation of the headache from sitting up is that these Bryoniapatients very often feel generally extremely ill on sitting up, they become giddy and somewhat faint.

-In these Bryonia pneumonias you always find a heavy thick, white coating on a dry tongue; the mouth feels dry, and thepatient is very thirsty. Very often there is a bitter taste in the mouth, and the main desire is for large quantities of cold

water. In this connection there is one point that is worth remembering about the nursing of these patients, and that isthat if you let them drink as much cold water as they want it is bad for them and very often makes them feel sick. Sowhen dealing with a Bryonia patient it is wise to regulate the quantity of water they take, especially at any one time, andnot to allow them to have all they would like.

-The next thing to consider is the mental reaction of Bryonia patients.-Bryonia patients, as I said before, look heavy and dull, and they very definitely dislike being disturbed at all. They resent

having to do anything, for instance, having to move, or having to turn over to be examined. They dislike having to talk, andtalking upsets them and makes them worse. They are very short tempered and they are difficult to satisfy. They oftenask for something and refuse it when it is brought to them, they are thoroughly cross-grained. They easily become


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annoyed, and if they are annoyed it always aggravates their physical condition.-I have often seen a Bryonia pneumonia who was doing quite well until he had visitors in who annoyed him and promptly he

had a rise of a degree or a degree and a half of temperature in a couple of hours, with increase of physical distress,increase of cough, and very often marked incr

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