Encyclopaedia Homeopathica

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. In homoeopathic prescribing your endeavour is to find a drug which will cover not only the actual pathological picture but also the reaction of the individual patient to that disease. Suppose you consider an acute illness, you want a drug which will cover the symptoms that are produced by the infective organism, that is to say, the ordinary symptoms on which you found your diagnosis. The patient is infected, say, with pneumococcus, and has the symptoms of pneumonia, so you want a drug which will cover the pneumonic symptom complex. Well, so far there is no difference from what is done in ordinary medicine. -But, in addition to that, in homoeopathic prescribing you endeavour to find out in what way any one patient A infected with a 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 is to choose from that group the individual drug which covers not only the pneumococcal symptoms but also the manner in which the patient A reacts to his pneumococcal infection. The drug which covers the combined picture is the one you want 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 is infected. It is your ability to recognize differences in identical diseases which determines your success, and that is why the experienced clinican is a far more successful homoeopathic prescriber than the inexperienced; he knows what a pneumonia should do, how it should behave, what are its constant symptoms, and he comes to a case and says, "Hello, this man is a little different". It is on that difference that he founds his prescription, and it is because he recognizes that difference that he is successful. So do not imagine that the practice of Homoeopathy is going to make your clinical medicine of less use to you; on the contrary, it is going to take advantage of every atom of knowledge and experience that you have, and the greater your clinical experience the more successful you are going to be. We are always hearing that we homoeopaths are symptom hunters, that we prescribe on symptoms alone. We do nothing of the kind. The only successful homoeopathic prescribers I have known have been most observant clinicans. Instead of tending to neglect one's clincal work one pays more and more attention to it and it steadily improves, and it is on that that successful homoeopathic prescribing depends. -From what I have said, you will see the significance of the statement that you must cover the totality of your symptoms, in other words, the symptoms of the disease and all the other symptoms as well. In practice you select the drugs which you known have an affinity to the symptoms of the disease you are treating possibly a dozen or so drugs and you can then neglect these diagnostic symptoms, as you know these drugs all have them, and concentrate on finding symptoms which from 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, rapid respiration, 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 generally evenly coated tongue, whether he has a dry mouth or a moist one, whether he is thirsty or thirstless, whether he is more comfortable 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 very definitely want to know; it is on that sort of thing you prescribe; but you only take it into account after you have decided that the drugs you are considering have the constant features on which you have made your diagnosis. It is not a question of neglecting your clinical side; it is a question of knowing which drugs have the clinical picture, and adding to that the Copyright 2000, Archibel S.A.

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points 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 this vexed 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 difficult where 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 maintained that 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 normal course, with a slightly lowered temperature; he would have a perfectly good, well-sustained pulse; there would be no signs of a flagging heart; the crisis would be very much more of a lysis than a crisis, but it would not occur before the normal period 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, your mortality 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 its normal 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 starting treatment, 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 weakness developing. But you have precipitated a crisis, and a crisis is always attended by a certain amount of stress, possibly a certain amount of risk although this is not so likely when the crisis occurs early in the disease as when it occurs after seven 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 higher potencies. Where you are using the higher potencies you must get a very accurate correspondence between the symptoms 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 are prescribing the higher potencies you have to get a much more accurate matching. I am quite sure that anyone who has tried the two systems, and has had a bad case and seen the crisis in twelve hours, never rests satisfied with merely making the patient safe and comfortable over ten days; once you have experienced the power of the one you will never go back to the other. One is more difficult, but it is much better; the other is easier, and is better than treating cases on orthodox lines. One requires more detailed drug knowledge than the other, but I think it is worth while acquiring that knowledge 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 first drug modifies the picture and you then get indications for a second prescription, and possibly a third, before the crisis takes place. -Where you are using the higher potencies, it is advisable to continue the administration of the selected drug until the temperature 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 of medicine, possibly the same but possibly different, say, twenty-four hours later, whereas if you have kept up your Copyright 2000, Archibel S.A.

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administration 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 quite sufficient to give the drug about once in four hours; and, as far as I can see, there is no particular advantage in giving it more frequently. As far as the high potencies are concerned, I think it is wiser to give the drug every two hours, the reason being that you want a number of stimuli in a comparatively short period of time in order to obtain the crisis within twelve 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 find the patient more comfortable, without much change in temperature. In another twenty-four hours the temperature should be coming down, the patient obviously doing well, and all anxiety disappearing; possibly by then a fresh prescription 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, or twenty-four hours. In six hours you ought to find the temperature coming down; in twelve hours it will probably be down to 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, and then as you gain greater knowledge heighten the potency and shorten the interval, so that eventually you are treating all your cases with medium or high potency. Possibly it is a wise way to do. Personally, I think it is better to go out for the best right from the start, do the extra work required in order to get moe accurate matching, and aim for an early 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 general similarity. Most of the drugs which are used exclusively in low potencies have not been fully proved; we have no knowledge of their finer differentiating points, we only have a knowledge of their cruder effects. So when you use one of these drugs in a higher potency you cannot accurately match the finer differentiating symptoms of the case. The higher 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 is worth while noting the finer points of the case and seeing if they crop up in the next case in which you think of giving that drug. -In the average case of penumonia that you meet with there are three stages in the disease. There is first of all the stage of congestion, or invasion, in other words, the incipient stage in which you are in doubt whether you are going to tackle a pneumonia at all. Then there is the stage of frank consolidation, in which the patient is running a good temperature, and has 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 three stages from the ordinary clinical standpoint the picture the patient presents is quite different in each stage, and for that reason your drug selection in each stage will be different, so from the homoeopathic prescribing point of view one tends to group pneumonias under the various stages. Firstly, one takes the group of drugs which would apply to the incipient pneumonia. Secondly, one takes the group of drugs which would apply to the frankly developed pneumonia in a strong healthy person. Thirdly, one considers the pneumonias which is either of a more septic type or a straight pneumonia 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 pneumonia which is not clearing up properly. So from the prescribing point of view you link up your drugs according to the clinical picture.

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 Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica 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, rapidly developing condition. You are much more likely to meet with it in the strong, healthy, robust patient. As a rule you will find 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 and tingling 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 whether the 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 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 in the 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 distinguishing point comes in; the Aconite patient with definite early involvement of the left side of the chest is aggravated by lying on the 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 with bright 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 these Aconite indications, but if it has gone on beyond thirty-six hours at the outside you will not get your response from Aconite. Nor will you get Aconite indications. If it has gone beyond the Aconite stage there will be definite patches of consolidation in the affected lung and you will get no response to Aconite, you will have to go on to one of the drugs for the later stages of pneumonia. -That is the typical Aconite onset. And here I think it might be worth while discussing dosage and repetition in these incipient 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 of Aconite you will modify the temperature, you will modify the distress, you will modify the anxiety, and you will modify the pain. But you will not arrest the progress of the Subdivision and when you go back and see the patient next day you will be 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 you will think you have probably made a mistake in your diagnosis and it was merely a common or garden chill and was never going 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 the effects. -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 of Aconite in any potency will stop it. But if the patient is heading for a pneumonia Aconite 6 will not do it. I have seen it tried. -If you are using potencies above a 30, I think you are wise to repeat your medicine at not longer intervals than one hour for the thirst four hours, and after that keep up your administration at two hourly intervals over a period of twelve hours in all. If you do that, and your prescribing is accurate, you will see case after case in which you have obvious physical signs starting, which from your experience you know would be a commencing pneumonia, but which in twenty-four hours 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 Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica up the administration longer. At the end of twelve hours you will not be satisfied that the patient is well; he will be obviously 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 before the following morning. And you may get Ferrum phos. running on to about the third day of Subdivision, until you have definite, obvious consolidation. -The first distinguishing feature between the Ferrum phos. patient and the Aconite is the appearance. Instead of the very brightly 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, if the patient is coughing, is disturbed, or has to talk, he very rapidly flushes up a bright red flush, but when he rests that flush tends to ebb away and leave just the malar flush on a rather palish background. -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 patients are 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 of wanting 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 Ferrum phos. it gives the impression of being somewhat swollen. At the commencement it is usually red, although it may have a faint 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 are definitely 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 all unusual for a definite pleuritic rub to develop within forty-eight hours of the onset, and with that pleuritic rub you are liable to get the development of very sharp pleuritic pains, which, of course, are aggravated by motion. Apart from their pleurisies your Ferrum phos. patients are often restless, but once they have developed a pleurisy any movement hurts them. -A further point which sometimes helps you is that the time of aggravation in Ferrum phos. tends to be in the early morning, 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 are liable to get a bright red streaked sputum, rather than the rusty sputum of the later pneumonia drugs, in other words Ferrum phos. is indicated in the early stage of consolidation. The Phosphorus sputum on the other hand is beginning to turn rusty, it is a darker red and there is more blood in contrast to the streaky sputum in Ferrum phos.

Belladonna
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-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 intense excitement of the heart, and a pulse which feels as if it would almost burst through the vessels. The patient is always extremely excited, and I have seen these Belladonna cases, particularly in children, in which the patients have been practically 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 surface burning 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 for this 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 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, because some of the other drugs have a similar condition in delirium, but they hate to be in the dark and want the room lighted as otherwise 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 that Belladonna is intensely thirsty, but I have seen quite a number of Belladonna pneumonias in which there was very little thirst at all; the patients complained of the mouth being very dry, hot, and burning, and yet they were not particularly thirsty. So do not be put off Belladonna because the patient is not as thirsty as one would expect from the statements in the textbooks. -In the pneumonias you do not get the typical strawberry tongue that is described in Belladonna; you are much more likely to 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 left side. 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 scanty indeed. -These patients always have a very intense, congestive throbbing headache, which is worse if they are lying with the head at 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 acute hyperaesthesia of the chest wall over the affected area. The chest wall becomes astonishingly sensitive to touch, and is horribly painful on coughing. And, because of this hyperaesthesia of the chest wall the patients are unable to lie on the affected 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 very nearly true, with the result that many of these children with a commencing pneumonia, or possible even more commonly with 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 does not find clear-cut indications for it under about twenty-four hours. The story you are given is that the child has been seedy 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 typical Ipecac. child usually tends to be flushed. It is rather a dusky flush, and the child has a hot, sweaty face. The temperature in Ipecac. is usually not so high as in the other drugs it is round about 103 and the pulse is not quite so bounding. -Always in these Ipecac. children the thing that strikes you is the amount of mucus in the chest; there is mostly a diffuse, Copyright 2000, Archibel S.A.

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generalized rattle. And invariably the patients have very suffocative paroxysms of coughing. The point that makes you think of Ipecac. is that these suffocative attacks of coughing very often go on to definite retching and the child brings up a quantity of stringy, difficult, blood-stained sputume. One has to distinguish these attacks from those found in some of the later drugs. In some of the Resolution pneumonias you find similar suffocative coughs, which again go on practically to vomiting, but in them the patients bring up quantities of dark, offensive blood, whereas the blood in the Ipecac. 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 disappears and you get the typical pallid, whitish, pale-lipped Ipecac. patient. You get the impression, after these attacks, that the patients are very tired, very wearied, and during that stage they are awfully difficult to please. They feel rotten, they feel sick, they do not want to be fussed, and they may ask for something, but they do not really want it and will refuse it if 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 attacks of 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 of tongue in these cases. -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 about them. -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. You may 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 of four drugs : Bryonia, Phosphorus, Veratrum viride, or Chelidonium. These, I think are much the commonest drugs for the simple, uncomplicated, straight-going lobar pneumonias. It is a little difficult to say whether Bryonia or Phosphorus is more common, and it varies a good deal with the season of the year. In the milder weather probably you come across more Bryonia, and in the colder weather more Phosphoruses, so over the years you will probably see as many Bryonia pneumonias as Phosphorus ones. As regards the other drugs, there wille be a year, or an epidermic, in which you will see quite a number of Veratrum viride pneumonias, and then there may probably be two or three years in which you see comparatively few it seems to run in definite strains of pneumonic infection. The Chelidonium pneumonias are a little less common, 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 woke feeling 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-looking patient. -The face is somewhat dusky in colour. The patient feels hot, and usually has a hot, damp sweat. It is not a profuse perspiration but the skin is hot and damp. Twelve to twenty-four hours later you very often get a dusky appearance of the extremities. About the same time you find the lips are beginning to turn dusky in colour, and they very soon tend to become dry and to crack. They have a somewhat swollen appearance. Copyright 2000, Archibel S.A.

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-The patient very often complains of a rather intense frontal headache which settles down over the eyes. Often it is much more a feeling of weight than of actual pain, but it becomes painful on any movement or exertion, such as talking or sitting up. Another thing you can link on to this aggravation of the headache from sitting up is that these Bryonia patients 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 the patient 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 is that if you let them drink as much cold water as they want it is bad for them and very often makes them feel sick. So when dealing with a Bryonia patient it is wise to regulate the quantity of water they take, especially at any one time, and not 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, and talking upsets them and makes them worse. They are very short tempered and they are difficult to satisfy. They often ask for something and refuse it when it is brought to them, they are thoroughly cross-grained. They easily become 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 increase of pain. So, again from the nursing point of view, you are very wise to prohibit visitors to your Bryonia patients. This is sometimes a little difficult to do, because the Bryonia patients rather tend to harp on their business affairs, they think about them, they talk about them, they often worry about them, and very often they ask to be allowed to see somebody from the office. If you do allow it, they are most likely to be annoyed at what the people in the office are doing, and this annoyance is very bad for them. So, from the practical point of view, never allow any possibility of such a thing happening in the cas of a Bryonia patient. -As far as the actual physical condition is concerned, in Bryonia you are much more likely to kind the right lung involved than the left. If the Subdivision is more extensive, you find the right lung involved to a greater degree than the left. But do not rule out Bryonia altogether because you have a left-sided pneumonia; I have seen several pneumonias now which were confined to the left side but in which Bryonia was indicated and worked very well indeed. So do not say, "well, this is a left-sided pneumonia, it cannot be a Bryonia " it can. Much more commonly you find the right side involved, but the fact that it is left-sided does not rule Bryonia out. -In these Bryonia cases you are very liable to get a pleur-pneumonia, rather than a straight pneumonia, with very sharp, intense, pleuritic pain. And there are one or two points about that pain which are sometimes helpful. First of all, it is very much aggravated by any movement on the patient's part. Secondly, it is usually mainly on the right side. Thirdly, the patient likes to lie on the side that is affected; if it is a right-sided pneumonia you find him turning over on to the right side as that is the most easy position, and if it is a left-sided pneumonia you find him turning over on to the left side. -When the patient coughs which he does a great deal he has intense pain in the chest, and it is then that you see the Bryonia picture of the patient sitting up in bed trying to hold the chest with his hands to keep it quiet while he is coughing. And, again from the clinical point de view, you do give your Bryonia patients great help by strapping up the affected side of the chest; either adhesive plaster or a tight binder gives great relief. You know the modern custom is to put antiphlogistine on the pneumonia paient; well, it does help the Bryonia case, but it is the splinting of the chest that helps, more than the antiphlogistine itself. -The breathing of the Bryonia patient is always very sort. He takes short, panting breaths, keeping the breathing as shallow as possible because any movement of the chest wall hurts. So you see the patient sitting firmly propped up, breathing short, panting breaths. -Usually in these Bryonia pneumonias there is a certain amount of irritation in the throat, and the patients mostly have a rather hoarse voice. -There are one or two other points if the pneumonia has gone on a little further and run into the fourth, fifth, or sixth day. These patients then become more toxic, more drugged looking, rather heavier, and they are liable to develop a low type of muttering, wandering delirium; it is never a very violent one. In their delirium they are very often uncertain as to where they are, for instance, if they are at home they do not recognize it and they say they want to go home. They are also very apt to develop that old Bryonia symptom of worrying about their business; they think they are still at work, they have a deuce of a lot to do, and they keep on talking about it and imagining they are still back at the office. -Then occasionally but not so commonly you find one of these Bryonia patients becoming acutely anxious, and when this anxiety state develops you will quite often get him becoming restless. That is a little apt to confuse you because you have Copyright 2000, Archibel S.A.

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it firmly imprinted in your mind that Bryonia is very much aggravated by any movement. But if you go into the question he will tell you that, although any movement increases his discomfort and his pain, he just cannot lie still even though moving hurts him. It is never the extreme restlessness that you get in some of the other drugs, and if it is associated with that nervous anxiety do not rule out Bryonia on the fact that the patient is restless. -Another Bryonia distinguishing point is that the patients are hot blooded. They feel hot, and they are uncomfortable in a hot atmosphere. -If the room is too warm it will aggravate their cough, and they very much prefer a cold room and a current of air. -Well, that is the commonest type of pneumonia, at least in this country. -Possibly, as I say, it is rather commoner in the spring than in the real cold, wintry weather, and you will find that Bryonia will cover the majority of the cases you see of that type.

Phosphorus
-The next commonest drug in pneumonia is Phosphorus. -As a rule the Phosphorus pneumonia develops rather more quickly than the Bryonia one. The kind of story I have come to associate with a Phosphorus pneumonia is that the patient had been feeling very tired for possibly twelve or twenty-four hours, and then he probably went out into a cold atmosphere and on going out felt an acute sense of oppression or tightness in the chest. Usually the same night he left hot and developed a dry cough. Possibly there was also a little hoarseness, or even actual loss of voice, and the feeling of tightness and oppression in the chest very much increased. Next he developed a sort of catchy respiration, a slight embarrassement on inspiration, and the breathing became rather difficult. -In appearance you will find the Phosphorus pneumonias have a brighter red flush than the Bryonias they are not quite so dusky. Although they have a flush, when they are peaceful it tends to die down a bit, and you do not get the same degree of cyanosis of the lips. The skin surface is hot, and it is moist, but not so moist as in Bryonia. Though the patients are obviously tired they do not give you the same impression of sleepiness as the Bryonias do; they are more awake, they are more worried, and they are more anxious. -One seeing these patients you are immediately impressed by the fact that their respiration is seriously embarrassed. Their breathing is obviously difficult, and they say they cannot get enough air; Very early in the Subdivision there are signs of the accessory respiratory mechanism coming into play, the chest wall is heaving a bit, the nose is flapping, and the patient is obviously having difficulty. In these earlier stages the difficulty is out of proportion to the actual physical signs to be found in the chest. -Next you notice that the patient tends to be rather tremulous. The hands are a little shaky, the facial muscles are twitching, and there may also be irregular twitching of the alae nasi. -Always in these Phosphorus pneumonias there is a very trying, tormenting, irritating cough. And that cough is very often accompanied by a feeling of rawness, or burning in the chest. -In the earlier stages, I think, the Phosphorus tongue tends to be dry and reddish, and it gives you the appearance of being a little swollen. -But by the third or fourth day there is a certain amount of light, dry, white or whitish-yellow coating; These Phosphorus patients are always intensely thirsty, and their desire in pneumonia, as always, is for cold drinks. Phosphorus patients, no matter what their ailments, always want cold drinks, but in pneumonia, with their very dry mouth, they very often ask for something juicy or sour rather than plain cold water. -There is another point that sometimes helps you in the diagnosis of your Phosphorus pneumonias, and that is the position which the patients find most comfortable. They want to be propped up, which is not surprising when you consider the feeling of oppression in the chest, but in addition to that you often see them with the chin tilted up and the head thrown well back, which they say very considerably helps their difficult breathing. -That is a useful point, because it distinguishes Phosphorus from some of the other drugs which take up a position leaning forward with the elbows on the knees. There are not many drugs which adopt the Phosphorus attitude, and it is always very suggestive when you see it. -Another point which ought to help you is that they are chilly patienths; they feel the cold, and any draught of cold air is liable to excite an attack of coughing. -A further helpuf point is that in their pneumonias, with their state of anxiety and distress, Phosphorus patients very much dislike being left alone. They become scared if they are alone, and they feel very much more peaceful and comforted if they have someone about, particularly if they are in actual contact with them. It is not enough merely to sit by the bed of a Phosphorus patient, he wants you to hold his hand, and the actual physical contact gives him a sense of great relief. Copyright 2000, Archibel S.A.

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-There is one point I missed in both these drugs, and that is the character of the sputum. In the Phosphorus patient in the earlier stages there is a very tormenting, dry cough, with very little sputum indeed. -By about the third day that sputum tends to increase, and there is a rather bright, red strak through the mucous sputum. By the fourth day that red streak is becoming darker, and very soon afterwards the typical rusty sputum appears. -In the Bryonia case the sputum is much darker in colour right from the beginning; even before it reaches the actual rusty stage of consolidation the blood in the sputum is darker than that of Phosphorus. -And the sputum in Bryonia is, I think, more sticky, more difficult to expel, and rather tends to hang about the mouth. The Phosphorus sputum is liable to be a little more watery, and although scanty it is easier to get up. -As regards the temperature and the pulse rate in Bryonia and Phosphorus than it does in Bryonia, and possibly the pulse is a little fuller, but they both run a temperature round about 103, and they both tend to have quite a full, strong pulse.

Veratrum viride
-The third of these frank pneumonia drugs is Veratrum viride, and here you have a very clear-cut picture indeed. -The onset is very similar to that in a Phosphorus case. It develops at much the same rate, but is not attended by the same degree of oppression of the chest. In Veratrum viride there is a very much more rapid rise of temperature, and there is apt to be a much higher fever, probably running up to 105. There is a difference in the colour of the Veratrum viride patient and the Phosphorus patient. It is a little difficult to put into words, though if you could only see the two patients it would be quite easy to point out the difference. Although both are congested, and oth have red faces, yet I think the Veratrum viride patient gives you the impression of being a little more livid than the Phosphorus one; I think that is the nearest one can get to it. -The Veratrum viride patient always complains of a feeling of intese pulstion, he feels as if his heart were simly pounding out through the chest wall. The pulse is full and bounding, and with that you very often get the impression that the Veratrum viride patient's face is rather bloated and swollen looking. -There is always marked excitement in these pneumonias. Very violent delirium may develop quite early, and the patients are liable to have all sorts of obsessions that they see faces and figures on the wall. -It is always something terrifying that they see, and with that state of intense excitement, in Veratrum viride you will always find widely dilated pupils. -You will realize that this is almost word for word a repetition of the description of the picture you meet with in Belladonna, but it is impossible to confound the two. Belladonna has an intense flush and a burning dry skin; whereas Veratrum viride is lived and covered with beads of sweat. -In spite of the high temperature, and without any fall in temperature, there is always profuse perspiration in the Veratrum viride patients. -I have seen them in pneumonia with a temperature of 105, the sweat standing out in beads all over, and in spite of that profuse sweat there was no drop in temperature at all. -These Veratrum viride patients are always intensely thirsty, and very often with their thirst there is a feeling of slight nausea. There is one point, a clinical one, that I want to give you about their thirst. -I have never come across it in any of the Materia Medicas, but clinically I have had it verified quite frequently and it is that the Veratrum viride patients often complain of everything they take tasting abominably sweet. For instance, I remember the first child I saw with a Veratrum viride pneumonia, and one of his bitterest complaints was that everything he took, plain water, fruit drinks, anything in fact, tasted abominably sweet. -We had an awful hunt to try and match it up with a drug, and finally it was on his general indications, not on his sweet taste, that he got his Veratrum viride, and he promptly cleared up. Since that time I have had the symptom verified at least half a dozen times. You do not always get it, but when you do it is a useful lead towards the possibility of Veratrum viride. -There is another point which is almost diagnostic of Veratrum viride when you meet it, and it concerne the tongue. You get two types of tongue in Veratrum viride. One has a thick, yellowish coating, and it is not uncommon. But the one that you look for, and hope for, is a tongue with a thick coating and a bright red streak down the centre. -If you have a pneumonia with a high temperature, full bounding pulse, generalized sweat, thirst, and that red streak down the centre of the tongue, you need not bother your head any further; that is Veratrum viride, and will clear up on it every time. I remember one year we had six Veratrum viride pneumonias in the hospital during the winter; they all had Veratrum viride, and every one of them had their crisis the same night. So if you have these legs to stand on you are perfectly safe to push in Veratrum viride, and you will get your results every time. -There is one other point that I have had verified. You know the Bryonia patients have an aggravation from having to sit up, Copyright 2000, Archibel S.A.

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it makes them giddy and they very often resent having to move. -In Veratrum viride, also, there is an aggravation from sitting up, but it is different; the patients do not become giddy, but they complain that their vision becomes dim. I have verified that clinically on several occasions. You can tack on to that another Veratrum viride sympyom on which is not uncommon, I think, in the drugs with widely dilated pupils and that is that you always find a certain amount of photophobia in the Veratrum viride patients. -The sputum in Veratrum viride comes in about midway between the Phosphorus and the Bryonia ones; it is not quite so bright as the Phosphorus and not quite so dusky as the Bryonia. It is a little difficult to expel, it is a little sticky, and there is always a certain amount of chest pain while coughing and trying to bring it up, but there is not the acute, stabbing pain of Bryonia, or the raw burning of Phosphorus.

Chelidonium majus
-I think most of the pneumonias in which you give Bryonia without success are cases in which you have missed Chelidonium. The two are very alike in appearance, and they are very alike in the character of their pains. They are also very similar in onset. The Chelidonium patients are usually rather out of sorts, and you very commonly find that they have had a loss of appetite and general discomfort preceding the onset of their pneumonias. -In Chelidonium the appearance is somewhat dusky. It is rather similar to the Bryonia duskiness, but, instead of the bluish look that you find in Bryonia, there is a slightly yellowish tinge in Chelidonium. -On this yellowish base there is liable to be a rather localized, deeper, malar flush, and quite often that flush is one sided. Very commonly it is the right side which is more flushed than the left. -As far as mentality is concerned, these two drugs are very similar, or at least they appear to be so at first sight. The Chelidonium patients are lethargic, they do not want to be disturbed, they do not want to make any effort, they are as much aggravated by movement as the Bryonia patients, and they are definitely irritable. But their irritability, when you get down to it, is rather different. -Bryonia patients are absorbed in their own worries, and say "for heaven's sake leave me alone", whereas Chelidonium patients are much more spiteful any snappy. For instance, you may be cross-questioning them and going along quite nicely, and suddenly they spit out at you in the most surprising and uncivil way that is the typical Chelidonium reaction. -Then always in Chelidonium at least in every Chelidonium case I have seen the involvement is on the right side. Bryonia also has the involvement on the right side, and yet it is just here that you get distinguishing points. In the Bryonia case as a rule the pains in the chest are much more round towards the axilla, or round towards the back. In Chelidonium the pains tend to be more towards the front, and go right through to the scapular region. Instead of the sharp, stabbing pains being in the side, you get them more in the front of the chest and going right through to the back. -As regards the appearance of the tongue in the two drugs, the Bryonia one tends to be whitish, and the Chelidonium one tends to be yellow. As far as the sputum is concerned I think there is more profuse expectoration in Chelidonium, it is not so difficult to get up, and it is not quite so dusky as the Bryonia sputum. -Then you get your outstanding distinction. In Bryonia you have an intense thirst for cold drinks. In Chelidonium you have a desire for hot things. So there the two drugs at once part company. -As a rule the position taken up by the two patients is different. The Bryonia patient tends to turn over on to the affected side. -The Chelidonium patient likes to sit up and lean forward. Both keep as still as they possibly can. -By the way, there is one point I have missed in all the drugs, and that is their period of aggravation. In Bryonia it tends to be round about 9 o'clock in the evening. Chelidonium has two periods of aggravation, it has one about 4 o'clock in the afternoon, and another about 4 o'clock in the morning, so there is a double periodicity in the twenty-four hours. As far as Phosphorus and Veratrum viride are concerned, there is no definite hour of maximum intensity, but both tend to become worse in the evening just before nightfall, when there is a period of increased excitement, increased nervousness, and increased apprehension. -Well, these are the main drugs for your ordinary, frankly developed pneumonias. Dosage in Developed Pneumonias -Where you are dealing with any of these typical lobar pneumonias I think the question of dosage is really quite simple. -There was a good deal of difference of opinion, and I think there is possibly some difference still, as to the optimum potency in these frank pneumonias, but having watched it here over the last twenty years I have no doubt myself as to what gives the best results. -When I came here first almost everyone in the hospital was using low potencies in these cases. Later some of the men started using medium potencies usually a 30, and with great courage a 200. In America I had been taught to use much Copyright 2000, Archibel S.A.

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higher potencies, and of later years this practice has been more and more adopted here. Now we are using all potencies up to the very highest, and I am convinced that, where the prescribing is accurate, the best restults are obtained by the use of the very hightest potencies. I should say that in my own practice, in the average case, I would prescribe a 10m, though where the indications were very clear my preference would always be to go higher provided there were no contraindications. I give cm's in preference to 10m's if I am perfectly certain that I have the right drug. -Then as regards repetition. Watching the results again, the average case of pneumonia, when it is frankly developed, will require at least six doses of the medicine; it may require more. One finds that the average length of action of each dose is round about two hours; That is to say, one gives a dose, and in two hours time one will find the patient needs a repetition. So in practice what one does is to order six doses of whatever potency one chooses, in the average case probably a 10m, and have it repeated every two hours. -In the great majority of cases you find that is all the medicine that is required; in the frank, straight case, one prescription will be sufficient, you will get a crisis, and you will not have to repeat. In a minority of the cases you will find that you have to keep up your administration after the twelve hours, but if you do I think you will find that you do not have to repeat so frequently, you will probably have to give another three doses in all, at four-hourly intervals.

Complicated pneumonias (mixed infection or alcoholic patient) (groupe iii)

-We now come to the much more difficult problem of firstly, the complicated pneumonia complicated either by the fact that the patient has a mixed infection, or by the fact that he is a very unhealthy patient to start with and secondly, the creeping type of pneumonia or the frank broncho-pneumonia. These are the types of case that are much more difficult to handle. It is more difficult to decide what your dosage should be, and what your repetition should be, and it is the type of case which seldom responds to one prescription. Mostly your first drug improves matters and the patient becomes very much better, the symptoms change, and you then have to give a second prescription to clear up the case. -When you are getting on to the later stages of a pneumonia it is a little difficult to choose your right potency. Suppose you are called in to a pneumonia that has been running five, six, or seven days, and the patient is obviously flagging; it requires a considerable amount of judgment to give the right potency, because you can over do it, you can give too high, to which they cannot respond, and so do them harm; on the other hand you can miss the chance of clearing up the whole thing by giving too low and not setting up enough response. It is certainly difficult to choose right potencies for these cases. -In a certain type of mixed infection mixed influenzal pneumococcal infection. I think there is a grave danger in giving too high a potency. -It is difficult to find a happy medium. In some of these bad cases if you give too high a potency you kill the patients, if too low they do not respond, and it varies in different patients even in the same epidemic. What they found in America was that in cases of that sort their best potency was a Im, which seemed to be high but not dangerous, and eventually they always gave a Im in these severe cases, with very good results. -Where you are dealing with the frankly alcoholic patient with a pneumococcal infection, I think you are quite safe with the higher potencies. -So, in practice, what I have come to is that in these unpleasant, mixed infections, I tend to give a Im rather than a 1 o m, because it seems to produce less disturbance and yet produces a very definite reaction; and I repeat at about the same intervals as for an ordinary, straight pneumonia. But where I am dealing with a frankly alcoholic patient I tend to give higher potencies, probably a 10m, possibly a cm. And, incidentally, I find that in the majority of these alcoholic patients one is wise to give some alcoholic stimulus during the time of their acute crisis they do better when they have it, it steadies them, and they are less liable to become delirious. -Then as regards the drugs which you may require for these complicated pneumonias, it is a little difficult to differentiate between those required for a case of mixed infection and those for an alcoholic case, because although the cause may be different in the two cases the symptm picture one sees in the bed is very similar whether one is dealing with a bad mixed infection or with an alcoholic patient, so one has to group these drugs together. I think some of them possibly apply more commonly to the alcoholic type, but they may equally be required in the more septic type without an alcoholic history. To cover this type of case one has to consider about half a dozen drugs, which group themselves pretty well together; they are Baptisia, Mercury, Rhus, Pyrogen, Hepar, and Lachesis. -I find it very difficult to give you a key drug of this group. -At one time I used to consider that Mercury was the outstanding one for the alcoholic type of pneumonia; now I think one more commonly gets indications for Lachesis in this type; occasionally one gets indications for Baptisia. Again in the so-called septic type, I used to look on Baptisia as the key drug, but nowadays I see as many Pyrogen and Lachesis cases Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica in these septic pneumonias; they run very close together.

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Baptisia tinctoria
-Taking the ordinary case of rather virulent pneumonia in which there are indications for Baptisia, there is usually a history of a fairly slow onset of the Subdivision. Occasionally in the course of a very virulent epidemic you will find Baptisia cases developing with astonishing rapidity, even in a few hours, but in the majority of cases, in an average winter, the onset is much slower. -The first outstanding characteristic of Baptisia pneumonias is the befogged mental confusion. The patients are dull mentally, they find it difficult to think, they find it difficult to answer your questions, and you will probably have difficulty in taking the case as very often they do not remember the details of their illness. -Their speech is rather slow, and often you will find them becoming middly delirious quite early in the course of the Subdivision. It is a gentle, wandering delirium, with again a good deal of confusion as to where they are and what they feel like. Very often you will find them droswsy; you can wake them up, but if you do you will get an incomplete answer and they they will drowse off again. -Another Baptisia symptom is that in spite of their drowsy state these patients are restless. They have generalized aching pain, they complain of their bed being had, it hurts them to lie, and you will find them moving about to get a more comfortable position. Sometimes that restlessness is associated with their inabilit to locate what is happening to them, they feel their arms or legs are uncomfortable and they move about to make sure where they are, or what is happening to them. -Another point is that these Baptisia patients are always cyanosed. -They have rather a puffy, cyanotic appearance, their eyes look heavy, usually half closed, their lips are cyanosed, and there is a lot of sordes about the mouth. The mouth itself is always offensive, and very, very dry indeed. The tongue usually has a brown coat down the centre; it may be yellow to begin with, but it usually very rapidly becomes brown. -The tongue itself is very dry to touch. But, in spite of this intense dryness of the tongue, you do not get excessive thirst in the Baptisias. -They will take a sip of water, but that is all they want; for one thing they cannot be bothered, and for another the thirst is not excessive. -The skin surface of the Baptisia patient is always hot and damp, and the patients often complain of very unpleasant waves of heat all over. Always with their damp sweat they develop a very heavy, unpleasant odour. -The main complaint is a feeling of intense oppression in the chest, and with this sensation they are rather afraid to lie down because lying seems to increase it and makes them feel as if they are going to suffocate. -Very often they will tell you that the feeling of compression is not so much a sensation of the chest wall being tight as of the lungs inside being compressed, and this at once distinguishes it from the ordinary tightness of the chest which you find in so many of the other drugs. -Another characteristic about these patients is that they have a rather scanty sputum, which is very sticky and difficult to expel, in spite of the fact that there is often a good deal of rale in the chest. -In appearance the patient is not unlike a very much more toxic Bryonia patient.

Pyrogenium
-The Pyrogen pneumonias are usually much more rapid in their onset than the Baptisias. Mentally the patients are quite different. You will always get a certain amount of loquacity in your Pyrogen patients. -They are rather impatient, they talk fast, they talk a good deal, and they are liable to be rather irritable. -In appearance the Pyrogen patients tend to have a brighter flush, they are not quite so cyanotic as the Baptisias. On any exertion, coughing, or anything of that sort, they tend to flush up much more, and they then become definitely dusky. After a paroxysm of coughing the colour tends to ebb, and they may become definitely pale. -The temperature tends to be definitely higher than in the average Baptisia case, running up to 104 or 105, and it is always accompanied by very considerable hot sweat. -The tongue in Pyrogen and Baptisia cases is ometimes very difficult to distinguish as you will get Pyrogen patients with one that is almost as dry as it is in Baptisia, and with the same kind of brown, dry coating. But occasionally you will come across a Pyrogen patient with a much redder tongue with less coating on it, and which is very dry and accompanied by a good deal of thirst. -Both these patients suffer from waves of heat, but in Pyrogen they are always followed by waves of shivering they are Copyright 2000, Archibel S.A.

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alternate hot and cold waves. It is almost as if the patient suddenly blushed from his toes to his head, exactly the same thing as would be described as "hot flushes". -In both the Baptisias and the Pyrogen there is exactly the same complaint of general soreness, which is described in the same way; they say the bed is too hard and they move about to try to get an easy position, which makes them restless. They give exactly the same description of not knowing where their arms and legs are, and they both say they are moving about in order to bring their sensation back to normal. You cannot distinguish the one from the other in this respect. -There is one point you can tack on to these aching pains, and that is that in pyrogen cases you quite commonly hear the statement that the illness started as an aching in the legs which gradually spread up. -It is a quite frequent story. -In contrast to the chest symptms in Baptisia, the Pyrogen case suffers much more from a sense of general oppression of the chest, with a good deal of aching soreness actually on the chest wall. And the respirations in the Pyrogen case are always very rapid and very shallow, which is frequently the case in Baptisia also. -The sputum in the Pyrogen case tends to be more profuse, it is somewhat pussy, and it is always offensive. -Then there is one other point which at once distinguishes the Pyrogen pneumonia from that of any other drug in the Materia Medica, and that is that there is always a discrepancy between the pulse and the temperature. That discrepancy may be a very rapid pulse with a comparatively low temperature; or equally commonly it may be a high temperature and a comparatively slow pulse. It may go either way, but it is the discrepancy between the pulse and the temperature that really matters.

Lachesis mutus
-Lachesis is very similar to Baptisia and Pyrogen. I think in the majority of cases you will find your Lachesis pneumonias cropping up later in the winter or in the early spring; You very often find them cropping up just at the end of a cold spell when the weather is beginning to get warmer. In these pneumonias you have to acquire an entirely fresh picture of Lachesis from the one you associate with Lachesis in the chronic patient. For instance, you know your chronic Lachesis patient simply talks your head off, but in the pneumonias where Lachesis is indicated you are much more likely to get the extremely toxic, fuddled, maudlin, drunken sort of patient. They are rather heavy looking, with a mottled, cyanotic appearance, a very puffy-looking face, and puffy, swollen-looking, cyanotic lips. Their speech is thick, they have difficulty in articulating, and they are liable to drop half their words. They stumble over what they are saying, and frequently they leave a sentence half finished. -Another point that is sometimes helpful in spotting your Lachesis patient is that their very cyanotic, swollen-looking lips tend to become incredibly sensitive to touch. -Quite frequently these people go on to a frank delirium tremens, with all sorts of delusions. They hear voices, they imagine all sorts of things, they become suspicious, they think they are being poisoned, and they refuse to take their medicine. -As far as the appearance of the tongue is concerned, it is always a very dry, swollen, dark red tongue. And in spite of that dry tongue you will get a good deal of very sticky, stringy saliva in the mouth. These Lachesis patients have great difficulty in coughing, they have a horrible feeling of suffocation, they have great difficulty in breathing, and they are simply terrified to lie down. They hate to go to sleep because of this sense of suffocation, and it they do drowse off they are almost certain to wake up with a sense of suffocation and a most distressing attack of coughing. -There are one or two definite Lachesis symptoms which are useful. -These patients mostly get a very violent, surging headache with their cough. It feels as if all the blood in their body is forced into their head. Their head is hot and bursting and yet at the same time they often complain that their legs, feet, and very often their hands, too, are feeling icy cold. -Then with their chest involvement they always have a horrible feeling of fullness in the chest, which may be just behind the sternum, or it may be in either side. More commonly the main involvement is on the left side in Lachesis pneumonias. -There are two very typical Lachesis symptoms. One is that with their respiratory distress these patients always have a horrible choking sensation, a feeling of tightness round their throat, and they cannot bear to have the blankets up round their neck as they feel they would strangle if they did. The other is that although they get acute stabbing pains in the chest, very often on the left side of the chest, they cannot bear any pressure on the chest at all. This distinguishes Lachesis from so many of the other drugs with stabbing pains which are relieved by firm pressure on the chest. -As regards the sputum, in Lachesis it is usually scanty. The patient feels as if he had a lump in the chest and as if he could shift it a certain distance but when it got half way it stuck. You can hear the rattle in the chest, and yet the patient cannot expel anything. -Occasionally you come across an apparent contradiction in that sort of muddled, besotted patient. These Lachesis patients Copyright 2000, Archibel S.A.

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sometimes develop a hyperaesthesia over the the affected area of the chest, which is exceedingly sensitive to touch. They may develop a hyperaesthesia to noise. They may become very sensitive to light. And they are often hyperaesthesia to smell; for instance, you notice that during the period when smoking is allowed in the wards the Lachesis patient is enormously distressed, quite out of all proportion to the actual odour.

Mercurius solubilis
-I think you are liable to meet with Mercury pneumonias about the the same time of the year as Lachesis ones, that is in the later part of the winter. In their pneumonias at first sight it is awfully difficult to distinguish your Mercury mentality from the Lachesis mentality, but in appearance I think there is a certain amount of difference. -Like the the Lachesis patient, the Mercury patient tends to have a very puffy face, but it is rather more livid in colour and gives you the impression of being more sickly looking, the patient looks more ill somehow. I think the Mercury patient is a little more sweaty, and the skin looks a little more greasy. -As regards mentality, you get very much the same sort of D.T. 's developing in the Mercury patients as in the Lachesis, and they become just about as suspicious. Their speech is almost as difficult, it is rather hurried, and they tend to fall over their words; but it is much more a case of stammering than of failing to finish a sentence in the way Lachesis patients do. I think the Mercury patients are rather more irritable, and they are definitely more anxious and more restless. -The next thing which helps you is that in the Mercury patients there is very marked, generalized tremor, tremor of the hands, tremor of the tongue, tremor of the facial muscles. -Then in Mercury there is much more commonly a tendency to ulceration of the corners of the mouth, and a much more profuse, watery salivation; it is not so stringy as in Lachesis. -Quite often you will find definite aphthous patches in the mouth, on the insides of the cheek, or on the tongue, and these usually sting and burn on touch. -The appearance of the two tongues is dissimilar. In Mercury it is a rather swollen, flabby, pale, greasy looking tongue. But if the patient has developed definite D.T. 's you will find it becoming more coated and tending to be rather drier. The patients usually complain of an unpleasant, sweetish, offensive taste. -In these Mercury patients there is always a pretty profuse, generalized sweat. As a rule there is a swinging temperature, and you can link on to that the general Mercury instability to heat, they are either far too hot or far too cold. The Lachesis patients, of cour, are always hot, they cannot stand heat. And incidentally your Lachesis patients are thirsty, they want cold drinks, and they very often get a horrible choking sensation if they attempt to take anything hot; it very much aggravates their distress and aggravates their embarrassment in breathing. The Mercury patients tend to be much more thirsty than the Lachesis ones, and they have an incessant desire for ice-cold drinks. -The cough in Mercury tends to be rather different. It is usually a dry, racking cough. And here you will very frequently get a typical Mercury indication, which is that the cough tends to come in double paroxysms. The patient has a violent paroxysm, then a pause, then another paroxysm, and then a period of peace. -Another distinction is that as a rule you get your main involvement on the right side in Mercury, rather than on the left side as in Lachesis. -Very often it is the right lower lobe which is affected, and there are sharp stabbing pains going right through to the back. -As far as the sensation in the chest is concerned, it is not unlike the Lachesis feeling that the chest is full, and with their paroxysms of coughing the patients often tell you they feel as if their chest would simply burst. -Finally, the sputum in Mercury is, I think, rather more profuse than in Lachesis; it is rather more liquid, it is usually pretty dark in colour, and it is always offensive. -In discussing these complicated pneumonias you will notice I have taken all the rather hot, congested, muttering types together. There are two other drugs which I ought to mention for the same conditions, and the distinguishing point about them is that they are both definitely chilly, in other words, the patients are sensitive to cold, which immediately differentiates them from the four drugs we have already taken. These two are Hepar sulph. and Rhus tox.

Sulphur
-Where you are dealing with a Hepar pneumonia you always have a septic type to contend with, and you get the impression that the patient is very ill. As a rule Hepar patients are palish in appearance, although they may have a somewhat hectic flush. -The skin surface is usually moist, with a rather sour-smelling sweat. -The first thing that will strike you about these patients is their extreme sensitiveness to cold. Your Hepar patients are Copyright 2000, Archibel S.A.

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very chilly, they want their blankets right up to their necks, they want their room as hot as they can have it, they hate to have any draught in the neighbourhood at all. -Mentally, they are very difficult. They have a horrible, discontented, dissatisfied, critical outlook. They have a marvellous faculty of remembering any unpleasant occurrence that they have had. They will probably tell you they have seen another doctor the day before and he did not do them any good; or else they will tell you that the nurse did not carry out your instructions. -They always have a complaint of some kind. -These Hepar patients are definitely over-sensitive. They are disturbed by their surroundings, they are disturbed by any noise in their neighbourhood, and they very often react unpleasantly to particular people, for instance you will find they take a dislike to one particular nurse in the ward, and nothing she can do is any good. -Their speech is always hasty, the words simply tumble out of them in a gush, and it is usually a complaint of some kind that they have to talk about. -They tend to develop a definite labial herpetic eruption, or a crack at the corner of the mouth. The upper lip tends to be rather swollen, thickened, and very often reddened. Quite often in these Hepar pneumonias there is a deep split in the centre of the lower lip. -The tongue is always very sensitive. Very often they complain of a hot, burning tongue, or of a burning tip to the tongue, and you often find aphthous patches scattered about the mouth, either on the sides of the tongue, or on the lips, and they are always horribly sensitive. These patients usually complain of a rather bitter taste. -One point which always strikes me as a contradiction in the Hepar patients, is that, in spite of their very sensitive mouth, they like rather highly tasting drinks and food, something with a bit of a bite about it. -These patients have two main physical complaints. One is a sense of extreme weakness in the chest. The other and this is much more common is acute stabbing pains in the chest. These pains are accompanied by a definite aggravation from lying on the affected side. You will find as we go along that the position taken up by the patient in pneumonia is constantly cropping up as a differentiating point; one could almost split the drugs into two groups, those in which the patient is ameliorated by lying on the affected side and those in which the patient is aggravated by it. -As regards the cough, in Hepar it is always a very choking, strangling, spasmodic cough It comes in quite frequent paroxysms, and is accompanied by acute dyspnoea. In these paroxysms you will find the patient sitting up in bed with the head tilted well back, and in their pneumonias the cough is accompanied by a very profuse, usually purulent, blood- stained sputum. A striking thing about the cough is that it is appallingly easily produced by any cold, for instance, you merely have to wave anything in the neighbourhood of a typical Hepar patient to produce one of these spasms, and if the patient even puts a hand out of the blankets a paroxysm will be started if the hand gets chilled. -As a rule the temperature in these Hepar cases is a rather swinging, septic type of temperature. It is accompanied by very profuse sweating, and yet in spite of the sweating there is not a definite drop in temperature and the patient feels if anything more uncomfortable for it. -Any slight effort on the patient's part will produce one of these violent sweats. -These Hepar cases always feel very much worse after they have been asleep. You expect your pneumonias to wake up feeling better if they have a decent sleep, but the Hepar always feel much worse. Their sleep is unrestful and they have very distressing dreams, very often they are dreams of fire. -There are two periods at which you get marked aggravation in Hepar. -One is round about 6 or 7 o'clock in the evening, when the patients very often have a rise of temperature. The other is about 2 o'clock in the morning. At this time the patients very often have an acute paroxysm of coughing. They are liable to become very exhausted by this and may settle down afterwards and fall asleep, and if so you will get your post-sleep aggravation later in the morning.

Rhus toxicodendron
-The other chilly drug for this mixed type of infection is Rhus tox. -I think in the majority of cases the Rhus tox. pneumonias develop somewhat slowly, and you will very often get a history that the onset of the pneumonia was caused by the patient's being out and getting soaked damp in particular is the exciting cause of Rhus pneumonias, and especially cold damp. -In appearance these Rhus patients are always somewhat cyanotic, they are rather dusky in colour, and they have a moist skin, very often they have a profuse sweat. The lips are very cyanotic, and extensive herpetic eruptions are developed quite early in the Subdivision. I think in Rhus the herpes tends to appear first of all on the lower lip, but mostly by the time you see the patients they have pretty generalized, extensive herpetic eruptions about the mouth. Copyright 2000, Archibel S.A.

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-In their pneumonic attacks these Rhus patients are horribly distressed, they feel ill, they are anxious, and they are dredfully restless, they cannot get peace at all. They are very depressed, and have a general feeling of discouragement. They will very often tell you that they feel so horribly uncomfortable that they think they would be better if you could only let them out of bed, they say that if they could only move about a little more it would help them. -In their anxiety, particularly if they are becoming a bit muddled, they are very liable to get an obsession that they may be poisoned. Quite frequently in these cases you will find the patients becoming middly delirious. It is a low, restless, muttering delirium, and it is always accompanied by extreme physical restlessness as well. -In addition to general restlessness, in these Rhus cases you will usually get a complaint of pretty generalized aching pains, and the patients say these aching pains are easier if they keep on the move. -The tongue in Rhus is fairly suggestive. In the earlier stages, certainly in the stages before the patients become delirious, you get a typical Rhus tongue, which is a white-coated tongue with a red margin, or a red triangular tip. But by the time the muttering delirious state has developed the tongue will have tended to become brown, and intensely dry. The patients often complain of a horrible metallic sort of taste; they may call it coppery, or something of that sort, but in any case it is a very unpleasant , metallic taste. There is always very marked, constant thirst. -The patients complain of the mouth and throat feeling appallingly dry, almost as if burnt, and they have incessant thirst, with a preference for cold drinks. -The cough is always a very troublesome one. It is a constant, tormenting cough, and the patients will usually tell you that they have a feeling of intense irritation in the middle of the chest, somewhere behind the sternum. -The respirations are always very shallow, short, hurried, and difficult. -These Rhus patients are just about as sensitive to cold as are the Hepar patients, and the attack of coughing will be brought on by any cold draught, or any exposure to cold. In both cases when examining your patients you have to be very careful not to uncover them too much or you will precipitate one of these violent paroxysms of coughing. -There is always a certain amount of laryngeal involvement in these Rhus cases, and it may be very troublesome indeed. Short of this, there is always at least a degree of hoarseness. -The sputum in the Rhus case is usually fairly profuse, rather liquid, dark in colour, and definitely blood-stained. The temperature tends to be of the swinging type, but it does not have the same degree of swing as you find in Hepar. As a rule there is rahter a full pulse, which is fast and not well sustained. -There are two other points which sometimes help you in your Rhus diagnosis. -One is that after a paroxysm of coughing, when the patient has apparently got very hot, he immediately gets a horribly chilly sensation, sweats profusely, feels horribly cold, and wants to be covered up. And the other point, which you can link on to that, is that, although they are intensely thirsty, if they drink too much cold water they are apt to feel very chilly, and it is very likely to precipitate another paroxysm of coughing. -As a rule in these Rhus cases the times of maximum aggravation occur dring the night rather than during the day. The patients become more restless, more worried, and more inclined to get out of bed, during the night.

Complicated pneumonias (broncho-pneumonia) (groupe iii)

-There is another class of drugs which I always look on as useful in either the creeping type of pneumonia, or in definite broncho-pneumonia in the adult. You know the type of unpleasant case that starts as a frank lobar pneumonia, and probably twenty-four hours later a patch appears somewhere in the uninvolved lung, and the next day there is another patch somewhere else, possibly without much clearing up of the old area; That is the type of case in which these drugs are indicated, and I think you can cover it pretty well with four. On particular indications you may require any of the drugs I have already described, but I think you are more likely to need, Pulsatilla, Natrum sulph., Senega, or Lobelia for these cases. They all have certain points of similarity, of course, but they all have their own individualizing symptoms. I think possibly Natrum sulph. is more typical of these than any of the others, so I will start with it.

Natrium sulphuricum
-As a rule in the Natrum sulph. pneumonias, or broncho-pneumonias, you get a history of a fairly gradual onset. You find physical signs in one area, probably quite a small area, and the condition is steadily spreading. The patients are usually definitely cyanotic, and not infrequently in Natrum sulph. there is a sort of yellowish tinge, there may even be a definite jaundice. It is a quite frequently indicated drug in post-operative pneumonias pneumonia following an acute appendix, pneumonia following a gall bladder operation, etc. -The outstanding characteristic of the Natrum sulph. patient, apart from the type of pneumonia, is the mentality. Natrum Copyright 2000, Archibel S.A.

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sulph. patients are always extremely depressed. It is not a weepy depression at all, but they feel horribly gloomy and flat, they do not want to be disturbed, they do not want to be interfered with, they are quite liale to turn their back on you, they do not want to be questioned, and they do not want to have to think. They are quite liable to say "For heaven's sake leave me alone". Very often they display a certain amount of irritability if they have to talk to you, and they are strangely sensitive to noise and often acutely irritated by it. They are always sensitive to heat, they cannot bear a stuffy room at all, and they always have a got, sticky skin surface. -The tongue in Natrum sulph. is very suggestive. It has a pretty general greyish-green coating. At times you may find a yellowish tongue with a definitely brown base, or a whitish tongue with a yellow base. -But that greyish-green tongue is the one characteristic of Natrum sulph. -The patients always complain of a good deal of acute pain in the chest, and it is a pretty acute stabbing pain accompanied by a feeling of general soreness in the chest wall. That stabbing pain is very much aggravated by coughing, and while coughing you will find these Natrum sulph. patients sitting up supporting the side of the chest to keep it as quiet as possible. -There is always a degree of physical restlessness in Natrum sulph. -patients, they feel jolly uncomfortable, they are forced to change their position, but their movement does not give them any sense of relief at all. -Then all the Natrum sulph. pneumonias I have seen have complained very bitterly of an intensely troublesome occipital headache. -There is usually a rather bitter taste in the mouth, but the thirst is not extreme. -Another symptom which is sometimes very distressing is a feeling of intense heat in the legs, from about the knees downwards. -You know the ordinary Natrum sulph. time of aggravation is taken to be about 5 o'clock in the morning, well, in their pneumonias that is not the time of maximum aggravation, it is much earlier, it is between 3 and 4 o'clock in the morning. You are liable to get a very bad spell in these Natrum sulph. pneumonias about 3 or 4 o'clock in the morning, definitely earlier than the 5 o'clock aggravation that you expect in Natrum sulph.. -As regards the sputum, quite frequently in these Natrum sulph. cases it is definitely greenish, and it may even be definitely bile-stained. -One winter we had quite a number of cases with frankly bile-stained sputum in their pneumonias. And with that greenish, or yellowish, sputum there is a good deal of rusty material intermingled. There is a fair quantity of sputum, and as a rule it comes up without undue difficulty. -In spite of the fact that you have this creeping type of pneumonia, you will always get the maximum involvement on the left side, usually, I think, the left lower lobe.

Pulsatilla pratensis
-I think the next most common of these drugs is Pulsatilla. In the average Pulsatilla pneumonia, or broncho-pneumonia, I think you usually get a history of the patient's having had a frank cold, a catarrhal condition, which has spread down into the chest. It is in the slowly advancing, progressive pneumonia that you most commonly get your indications for Pulsatilla. -In appearance the Pulsatilla pneumonia patients are always definitely dusky; it is a red colour, but it is a dusky red; The patients give you the impression of being rather bloated and puffy-looking; They also give you the impression of not having a great deal of bite about them, they are of the rather mild, gentle, yielding type, and they do not stand up against their infection well, the Subdivision seems to be gradually spreading and snowing them under. They become definitely anxious about themselves, worried, afraid that they are not going to get better, and they very definitely hate being left alone. They want somebody about, and they want attention. -In their pneumonias Pulsatilla patients get very marked dyspnoea; it is very extreme. It is accompanied by a feeling of intense tightness in the chest, or a feeling of horrible fullness in the chest, with a very acute air hunger; they want to have the doors and windows open, and they love a draught of air about. -This dyspnoea tends to get worse as the evening progresses; They have a pretty violent, gagging, choking cough, and in their paroxysms of coughing they are liable to become acutely cyanosed. -Quite frequently you will get the statement by these Pulsatilla patients that after one of these violent choking coughs it feels as if something were torn loose in the chest and the whole chest left raw. -After one of these paroxysms there is always a complaint of extreme soreness in the chest wall, which feels as if all the muscles were strained. -These Pulsatilla patients in their pneumonias complain of a very dry mouth and throat, and the tongue usually has a thick, Copyright 2000, Archibel S.A.

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sticky, whitish coat. But in spite of this dryness of their mouth and throat the patients are not thirsty. They may like a little sourish drink to relieve the dryness, but there is no real thirst in the Pulsatilla pneumonias. -As regards position, these patients are rather more uncomfortable lying on the side which is mainly involved. Their most comfortable position is lying on the back, propped up a bit, and particularly with the arms raised out from the sides; you may even find them pushing their arms up above the head. -All these Pulsatilla patients are, of course, sensitive to heat, and, as you would expect, they often complain of a feeling of generalized hotness. But occasionally you will come across a Pulsatilla patient who says that intermingled with this generalized heat they have patchy areas of chilliness. -The sputum in Pulsatilla is always a difficult one. it is very tenacious indeed, and the patient almost chokes in the effort to expel it. It is usually yellowish in colour, and, of course, definitely blood-stained.

Senega
-The third of these drugs is Senega. In many ways it is not unlike the other two drugs we have taken. There is much the same kind of pathological state, but I think there is rather more bronchitis surrounding the patch of consolidation than there is in the two previous drugs. In other words, there are more rales coarse rales which are pretty generalized in the chest, and amongst them you will pick up definite patches of consolidation. -You usually meet your Senega case after the patient has been ill for some days. And most of those I have seen have given me the impression that had one seen them earlier they would probably have been Bryonia a missed Bryonia might quite well run on to a Senega. -In appearance the Senega patients are very flushed. It is not a very bright flush but it is pretty general, and the patients give you the impression of being puffy and rather bloated looking. They have a hot sweaty skin, and they always have very intense respiratory embarrassment. Their main complaint is always a feeling of intense oppression in the chest, very often they say it feels as if they had a ton weight sitting on the chest, and they just cannot breathe. -The impression these patients give you is that they are intensely tired; they are weary, and phlegmatic, and just tired out. Yet underneath that tiredness there is definite anxiety. I remember seeing one patient exceedingly ill with an influenzal pneumonia who had a small daughter ill at the same time, with the same condition, and it was astonishing how little interest the mother took in the illness of her daughter. She never even asked how the child was. -She was very definitely anxious about her own state and as to whether she was going to get better because she had so many responsabilities about the house, and yet the fact that her child was seriously ill at the moment made no impression at all. It is a weird mixture of a mental state, and it is pretty typical of Senega. -The Senega cough is awfully troublesome. It is a practically constant, violent cough, and it produces a strange sort of hyperaesthesia of the walls of the chest. Very often in these cases with a generalized bronchitis, when you are percussing the chest you will get on to an area of hyperaesthesia, and you will always find it is over a consolidated area. -With this generalized aching in the chest wall which accompanies the violent coughing there is always a certain amount of restlessness; the patients say they are rather more comfortable and the aching pain is rather easier if they move about a bit. -With the paroxysms of coughing they become frightfully hot, very red in the face, and covered with a hot sweat. And with this profuse sweating there is apt to be a good deal of sudaminous rash. -These Senega patients say they feel too hot and that they like air, but in spite of that they start coughing at once if you open the windows. Though the patients feel far too hot, and they are sweating and want to push off their blankets, yet an actual current of air will start them coughing. -Mostly in their pneumonias there is a certain amount of hoarseness, and I have seen several Senega pneumonias now in which there was complete loss of voice. -As a rule the condition is more extensive on the right side, but it tends to spread from the right side over to the left. Every Senega case I have seen has had peculiarly loud, harsh, breathing with their respiratory distress. There is liable to be a certain amount of cyanosis of the extremities. The patients frequently have a very high temperature, and they are liable to develop signs of a failing heart early in the Subdivision; the right side of the heart begins to dilate, and a definite generalized oedema of the lungs is very likely to develop. -The most striking cases of Senega pneumonia which I have seen have been in middle-aged women, about 45 or so, always rather heavy, over-weight, and rather short necked, just the bronchial type. You will get indications for Senega in senile patients suffering from coughs, but that is in cases of chronic bronchitis, which present quite a different picture.

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Lobelia inflata
-You will find that Lobelia is not very often indicated, but it does cover a very definite picture, and it has one or two very striking symptoms which, I think, are not covered by any other drug. -The impression you get of Lobelia patients is that they are pretty ill. -They look rather pale, and they have a rather sweaty skin surface. They always complain of a feeling of horrible oppression and of a very marked sense of fullness in the chest, which they say they cannot shift at all. -They have a very spasmodic, dry cough, which seems to do them no good and which is always attended by nausea. They want to keep as still as they possibly can, and any movement, any exertion, very much increases their sense of respiratory embarrassment, and also the nausea. -The nausea which accompanies the coughing is, like most nausea cases, associated with a good deal of salivation. But there is one definite characteristic about the Lobelia nausea and that is that it is very greatly relieved by eating or drinking. -Accompanying the nausea the patients have a very distressing feeling of emptiness in the epigastrium. -Another characteristic Lobelia symptom is that the patients are very liable to develop intensely irritating urticarial patches, accompanied by a generalized tingling of the skin surface. Alternatively, they sometimes develop a localized oedema of the chest wall. I remember seeing one patient with a Lobelia pneumonia whose chest wall on one side was a great, solid, oedematous mass. -And as a rule you find that that localized oedema is over the affected area. -Another thing you find quite frequently in the Lobelia patients is that after a violent paroxysm of coughing they are liable to develop localized patches of ecchymosis. -In these cases there is always a rather fast pulse, which is soft and thready. And, as I mentioned before, there is a very mrked aversion to movement of any kind; it increases their respiratory distress, and it also increases their nausea. You will always find a certain amount of air hunger; the patients are more comfortable if there is fresh, circulating air, although they do not like a definite draught. -Mentally, the Lobelia patients tend to be rather depressed; they want to be left quiet, they do not want to be disturbed. -There is one other Lobelia symptm which sometimes crops up, and that is that in these pneumonic attacks the patients quite frequently complain of very violent sacral pains. They have a good deal of respiratory distress, and one's tendency is to prop them up a bit, but if one does one often finds they complain bitterly of this sacral pain and extreme sacral tenderness. -You will see that here you have a very definite symptom picture which is difficult to cover without Lobelia, so although it is comparatively rarely indicated you do want to know it.

Late pneumonia (group iv)

-We now come to the consideration of drugs for the later stages of pneumonia, either a pneumonia you have not seen in the earlier stages, or one that is not resolving well, not clearing up satsifactorily, and in which you want to clear the chest up finally. -For that type of case there are about half-a-dozen drugs which you have to know fairly well Antimony tart., Carbo veg., kali carb., Arsenic, Lycopodium and Sulphur. When I have covered these drugs you ought to be quite prepared to go and tackle a pneumonia epidemic and expect to get a 100 per cent. recoveries, which is rather better than they are getting with their newest pneumonia preparations they are still getting 23 per cent. deaths. -I think the best way to take up these drugs is in the order in which I have given them to you.

Antimonium tartaricum
-In the adult you expect to find the symptom of Antimony tart. cropping up late in a pneumonia, you do not usually get them in the early stages, and by the time the patients have gone on to an Antimony tart. state they are seriously ill. The appearance of these patients is suggestive, they are pale, they have a pincked look, rather a bluish coloration of the skin, and they are covered with a cold sweat. The nose looks rather pointed, pinched in, and very often it has a somewhat sooty colour. -Owing to the extensive chest involvement you will find the alae nasi flapping and with the obvious effort to get as much air in as possible all the muscles down the side of the neck are standing out and the patient is struggling for breath. The lips Copyright 2000, Archibel S.A.

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in typical Antimony tart. -cases are rather livid, although if the patients are running towards a collapse, as they sometimes do in Antimony tart., the lips may tend to become paler, and in any case they are usually very dry. -The impression you get of these patients is one of extreme suffering; They are intensely distressed, and their main reaction is one of wanting to be left alone "For heaven's sake don't disturb me". They do not want to speak, they do not want to be spoken to, and very often they do not even want to be looked at. The patients themselves are very miserable, and you often find them lying panting for breath and moaning. -As a rule there is a very thick coating to the tongue; it is a horrible, pasty, white coating, and the tongue looks just as if it had been painted with white enamel. In a few cases you may find a somewhat brown coat, which is very dry, but that is exceptional. The outstanding point is that, in spite of the dryness of the lips and tongue, these Antimony tart. patients are completely thirstless. -Another practical point to remember is that these Antimony tart. cases have a loathing of food of any kind, and in particular any attempt to feed them on milk will produce an acute nausea the Antimony tart. -patients have an acute intolerance of milk. -As far as the actual chest condition is concerned, there is invariably an excessive secretion of mucus; standing by the bed you can hear the moist bubble in the chest. There is a very rattling cough, and yet, in spite of the rattle, there is very little sputum expelled. With the effort to expel that sputum the Antimony tart. patients usually suffer from pretty acute nausea, and they may actually vomit. -With their violent cough these patients suffer from a great sense of oppression in the chest, and very often there is great soreness of the chest wall. They cannot bear any weight on the chest at all, they want to push the blankets off, they want to get them away from their neck, and any suggestion of weight, even a single blanket, will embarrass them. -These patients are very sensitive to any stuffy atmosphere. They have an acute air hunger, and a warm room makes them veyr much more uncomfortable. -And an important point is that they are particularly aggravated by any radiant heat. -With the extensive chest involvement, the hands and fingers, feet and lower extremities, are very liable to become bluish, cyanotic, also the patients become very tremulous and, in spite of their general heat and aggravation from warmth, they very often complain of a feeling of coldness from about the knees downwards. -As you would expect in a case of this kind; it is impossible for the patient to lie down flat; the only thing that gives him any comfort at all is to be propped up in bed, at the same time avoiding any suggestion of constriction of the chest. -I do not think there is any particular preference for either side of the chest in Antimony tart.; I have seen as many cases involving the left side as the right. -Another point is that in these Antimony tart. cases there is always a tendency to heart failure, the circulation is giving out, the pulse tends to become irregular, and the heart tends to dilate. -Well, that is the kind of case that we meet here from about the fifth day of Subdivision onwards. We quite frequently see patients coming in in that state. But we do not expect a patient ever to get into that state once he is in the hospital.

Carbo vegetabilis
-In Antimony tart. we have just discussed one type of very serious case. -The next one, which is just about as serious, is Carbo veg., and at first sight it is a little difficult to distiguish between it and the Antimony tart. case. However, there are certain distinguishing points. -In appearance, as you first see these patients, there is very little to distinguish the two, the Carbo veg. looks just as ill, he has the same sort of pinched appearance, the same respiratory embrassment, the same kind of flapping nose, and the same bluish colour. I think, in the majority of cases, the Carbo veg. patient is a little more blue, and the Antimony tart. patient a little more livid. As a rule in the Carbo veg. case there is less cyanosis of the extremities, which are more likely to be pale and covered with an icy, cold sweat. -Both these drugs are covered with a cold sweat, I think it is about equally marked in the two. They both have an intense air hunger, but here you find your first distinguishing point. -Your Carbo veg. patients say that they have an intense air hunger, and yet they feel frightfully cold, whereas there is none of that feeling of frightful coldness in the Antimony tart. patients. -As a rule, instead of the rather dry, bluish lips of Antimony tart. -the lips of Carbo veg. tend to be purplish and somewhat swollen. -And instead of the white coating on the tongue which is so typical of Antimony tart. you are very much more liable to get a dirty, yellowish-brown, very dry tongue. Again as a distinguishing point between the two, in Carbo veg. you will get Copyright 2000, Archibel S.A.

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marked thirst, whereas in Antimony tart. the patient is thirstless. -The typical Carbo veg. patient wants sips of cold water, and very often complains of a very unpleasant, foul taste in the mouth. -As far as the actual chest condition in Carbo veg. is concerned, you are more liable to get definite extensive areas of consolidation, and rather less generalized bubbling in the chest. -There is usually far more acute rawness in the chest in Carbo veg. -than in Antimony tart. And in the Carbo veg. patient you mostly find that the sputum is just about as difficult as it is in Antimony tart.; the patient will tell you it comes up so far and then they just cannot get it out. But instead of that effort to expectorate producing the vomiting that you meet with in Antimony tart. in Carbo veg. it is very much more likely to produce an attack of extreme exhaustion, the patient lying back simply gasping for breath. -Incidentally, these Carbo veg. patients respond astonishingly well to the administration of oxygen. -Both Carbo veg. and Antimony tart. have that horrible sense of a load on the chest. It is a feeling of dreadful oppression, which the patients describe either as an absolute weight sitting on the chest, or as the chest being full almost to bursting. -Another distinguishing point is that in Carbo veg. there is always marked abdominal discomfort, a feeling of distension, fullness and flatulence, instead of the intense nausea of Antimony tart.. -As far as the position taken up by the two patients is concerned there is very little to distinguish them. They both want to be propped up, and they both want to avoid any constriction of the chest or round the neck, but the Carbo veg. will allow you to put a single blanket up to keep them warm, whereas the Antimony tart. simply cannot tolerate it. -Another point about Carbo veg. patients is that they always tend to sleep into an aggravation; they doze off and then wake up simply gasping for breath. -In the Carbo veg. patient, as in the Antimony tart. patient, you have a definitely failing heart. -I think as a rule the temperature tends to be less high in the Carbo veg. -case than it does in the Antimony tart., and I think you are most likely to meet your Carbo veg. case just immediately before, or just immediately after, a pneumonic crisis. -As far as relief from your drug is concerned, you should get this almost immediately in an Antimony tart. case, and the Carbo veg. patient should be comfortable in about six hours. It is astonishing how quickly they respond. It is usually a question of acute heart failure, and either the patients respond at once or else you should give one of the other heart failure drugs. I should expect one of these Carbo veg. patients with critical collpase to be out of danger in twelve hours. But they are exactly the type one used to dash at with all sorts of diffusible stimulants and they mostly died, whereas now one expects them to recover. -If you want to cur these cases, however, do not give them stimulants. -I have seen cases of that sort in which there was obvious heart failure and the physician had pushed in Coramin and Carbo veg. did no good at all afterwards, it simply did not have any effect. Nowadays I would neer employ any stimulant in a case of that sort; I am sure one gets better results without. The only exception I would make would be strong coffee in the case of Carbo veg., as these patients sometimes do respond astonishingly well do it. They have a desire for it, even a craving for it, and it oftens eems to do them good. But that is the only exception I would make. -As regards potency, in Carbo veg. one is dealing with an acute collapse, there is a dilating heart and a heart failure, and one must obtain an effect fairly quickly, so my personal preference is to go high and give frequently until I get a definite response. I would give cm's every ten or fifteen minutes until I got a definite response. The kind of response one gets is that the patient begins to feel warmer. Instead of the icy coldness they begin to feel less cold, they look less cold, they are less cold to touch, and the sweat begins to disappear. I would then space the drug out and give it every half hour, until there were definite signs that the heart was taking up again, in other words, until the pulse was fuller, the distress getting less, and the cyanosis beginning to fade. As a rule you get the patient through the crisis in twelve hours. -But to do that you must give frequent repetition to begin with and you must keep up your action for some hours, given cm's all the time. I have tried low potencies in cases of this kind and the patients did not respond at all; I have then jumped up to a cm and the drug has had immediate effect. -So much is this so that up in the private wards, where one quite frequently sees these cases, the Sister does not want anything but cm's for them that is how experienced Sisters come to look on it, they always want the highest potency you will order as they say the other is a waste of time. -That is practical experience, it is not a desire for any particular potency. -Antimony tart. cases are not so acute, in them you are dealing with a water-logged chest rather than a sudden cardiac failure. It is slower in onset, and you have more time to play with. In these cses 10m's hourly at first and later two-hourly will be sufficient. Copyright 2000, Archibel S.A.

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Kalium carbonicum
-I think Kali carb. tends to be indicated from about the fifth day of Subdivision onwards, although you may get indications for it earlier. It is a very serious case, but it is a case that you see before the really critical stage comes along. Very often it is a case which has responded to a certain extent to one of your previous drugs, but you are not satisfied with its progress, the patient is still running a temperature and, although more comfortable, is not clearing up. It is in that type of case that you find your Kali carb. indications. -The appearance is always that of a patient who has been pretty exhausted by their attack. He looks rather pale, flabby, and washed out, and has a sort of haggard, exhausted appearance. Very often in Kali carb. -there is a puffy look about the face. The patient always has an anxious, worried, rather frightened expression. And with that there is very often a good deal of tremor of the facial muscles, and twitching of the hands and fingers; he picks at the fingers, and picks at the bedclothes. -These patients dislike being left alone, they get more worried, more scared. They are definitely sensitive, they are very easily annoyed, very easily irritated, and they are particularly sensitive to any noise in their immediate neighbourhood. -The lips tend to be cyanotic, dry, and cracked. As regards the tongue, I think most commonly Kali carb., patients complain that it fells as if it had been scalded; it is dry and red and has this burnt feeling. -But you will quite frequently meet with a case in which the tongue has a dirty, greyish-white coat. As a rule these Kali carb. patients are not markedly thirsty; their mouth is dry, and they may want a little sip of water, but they are not markedly thirsty. -The cough tends to be very dry, and suffocative in type. And with an attack of coughing you will find these patients breaking out into a profuse sweat. The sputum is always scanty, difficult to expel, and very often it only comes up into the back of the throat and is swallowed. -There are two very definite Kali carb. indications. The first is that these Kali carb. patients are frightfully sensitive to any draught of air, it produces a violent attack of coughing, a regular paroxysm, and it also produces a horrible sense of chilliness. The other characteristic point is the position taken up by Kali carb. patients in their respiratory distress. They always want to sit upright, and, unlike the other drugs we have considered, they lean forward and support themselves with their elbows on their knees, or they like a bed table across the bed and they lean forward on that. -Always in these Kali carb. pneumonic cases the patients have violent chest pains with their cough. The kind of pains they get are the stitches right through the chest, or acute stabbing pains in chest. -The pains are very much aggravated by any motion, and, of course, they are produced by any of these violent spasmodic coughs. I think as a rule the maximum involvement is on the left side of the chest rather than on the right, and, whichever side it is, it tends to involve the lower lobes rather than the upper. -You do not tend to get the same degree of cardiac failure in Kali carb. -as you do in the two preceding drugs. You get a weak pulse without a great deal of tone in it, but you do not tend to get the acute dilation of the heart that you do in the others. You get a weak, running pulse, but not acute heart failure. -There is one other useful diagnostic point, and that is the time of maximum aggravation. It is in the early hours of the morning, between 2 and 4 o'clock. You may meet with it at any time during that interval, but you are most likely to get your worst period about 3 o'clock in the morning. Quite frequently you will find your Kali carb. patients sitting up in the typical position, gasping for breath, about 3 o'clock in the morning, with a horrible feeling of oppression and tightness in the chest and acute stabbing pains. -There is one point which sometimes tends to make you confuse your Kali carb.'s, and that is that in their pneumonias these Kali carb. -patients do get a good deal of flatulence, a good deal of abdominal discomfort, and a good deal of abdominal distension. -When considering the question of potency you may have to be a little careful in dealing with old people in Kali carb. cases. Where you have indications for Kali carb. you are not dealing with an acute emergency, and in consequence you do not need your highest potencies. I would give 1 m's to older Kali carb.'s for choice. The average case responds well to 10m's repeated in the usual way.

Lycopodium clavatum
-Of the last three drugs I thought of looking at I think Lycopodium probably follows the Kali picture more closely than any of the other drugs; it is very similar in many ways. -In the majority of cases you do not get indications for Lycopodium before the second half of the course of the average Copyright 2000, Archibel S.A.

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pneumonia, in other words, it is not usually indicated until after the fourth day. As a rule, you will get a history that at the beginning of their illness these patients were mentally fairly active, and that they are now becoming very tired, very weary, rather worried about their condition, and not a little frightened. -In appearance, they give you the impression of being anxious; they have rather a worried look, and a practically perpetual frown. They are rather sallow in colour, a sort of yellow-ash-grey appearance, and they have obvious acute respiratory distress. The lips tend to be somewhat cyanosed, very often they are definitely cyanosed, and there may be a somewhat dusky appearance generally. If you see these patients latish in the Subdivision, about the fourth or fifth day, you will find them becoming definitely weak, and rather torpid and sluggish. -The mentality of the typical Lycopodium pneumonia patients is a little difficult to get hold of because although they are anxious, worried about themselves, wanting attention, wanting somebody about, yet they are peevish and irritable with those trying to help them. They are rather domineering, they are definitely exacting in their demands on their attendants, and yet that is coupled up with the desire to get as much attention as they possibly can. After they have been asleep they are very liable to wake up in a very cross-tempered mood. -Associated with the respiratory distress, there is a somewhat pinched appearance of the nose which is not unlike the Antimonium tart. -appearance, and there is a good deal of flapping of the nostrils. -But there is more general twitching of the facial muscles in Lycopodium, and the nose gives the impression of being dusky, rather than sooty as in Antimonium tart. -Another point about the Lycopodium patients is that they always tend to have a very noticeable yellow discoloration of the teeth. Very often they complain of a sour taste in the mouth, and the tongue tends to be coated white. In addition to this coat, there are often definitely sensitive spots along the margin of the tongue, and the patient often complains that if feels stiff and swollen. Lycopodium patients are rather variable as regards thirst. Sometimes you will get a Lycopodium patient who is definitely thirsty, but again you may get a patient who is not thirsty at all. If they are thirsty they prefer warm drinks to cold. And if they have much to drink it is very apt to produce a sensation of fullness and flatulence; it may actually produce a sense of nausea. -The respiration in the Lycopodium case is always very difficult, short, panting, laboured breathing. The patients usually complain of a feeling of tightness in the chest, or even of an actual sensation of constriction. -The cough is always a very difficult, paroxysmal; violent, spasmodic cough. Very often the patient complains of intense rawness in the chest after coughing. -The sputum is always scanty, tough, and very difficult to get up. -It is very often a yellowish-grey, blood-stained sputum, and not infrequently the patients tell you that it tastes definitely salty. -As a rule the patients complain of feeling chilly. They are sensitive to cold, but they dislike a stuffy room. Usually there is very little sweating, the skin may be slightly moist but there is no definite sweat. In most of these cases you will find your maximum involvement on the right side of the chest rather than the left. And you will always get a complaint of a good deal of abdominal flatulence, particularly is this so after taking anything in the way of food; the patient feels absolutely bloated on any attempt to eat. -As a rule these Lycopodium patients are very uncomfortable if they are lying on the back, their breathing becomes more laboured, and they are more distressed. They are very much better sitting up. -Another small point is that you will very often see these patients sleeping with their eyes half open. Not infrequently they have a very restless kind of sleep, and they often dream of fatal accidents. -In the Lycopodium case there is one very constant period during which there is a general aggravation of the patient's distress, and that is between the hours of 4 and 8 o'clock in the evening. During this time you will get an increase of temperature, increased respiratory distress, and very often increased cough. Very often the temperature swings up about 4 o'clock, stays up until about 8 o'clock, and then begins to drop. -As regards the temperature in Lycopodium, commonly it is a medium high one, ranging round about 103. The pulse tends to be rather compressible, soft and rapid. -Lycopodium cases respond well to 10m's repeated 2 hourly.

Arsenicum album
-Arsenicum is one of the drugs which you will require only in the collapsed stage of a pneumonic crisis; you seldom get indications for it during the active stage of a pneumonia. -The picture presented by the Arsenicum patient is very typical. There is always intense mental and physical restlessness. Copyright 2000, Archibel S.A.

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In the earlier stages of the collapse you will see the patient constantly tossing about, never still for a moment, and as the collapse goes on he gets weaker and weaker until he is hardly able to move, and even then his eyes keep it up to the very last. -Right throughout the whole picture there is exactly the same sort of mental state extreme mental anxiety, extreme fear, the patient is certain he is going to die, he wants attention, wants somebody there, is afraid of being left alone, and wishes to goodness you would get on and do something for him. -The appearance of these patients is somewhat suggestive. As a rule they are pale, and rather livid looking, or they may be somewhat cyanotic, and the surface is covered with a cold, clammy, sweat. The lips are usually cyanotic; they may be rather full, but very often you will see them looking rather shrunken, shrivelled looking, and actually bluish. -The patients themselves are always intensely chilly. Very often there is almost a rigor; the patients keep shivering with cold, they want to be covered up, and they cannot bear any draught about. -They are always intensely thirsty, their mouths are parched and dry, and there is a constant desire for sips of water. The strange thing is that, in spite of their general chilliness, they want their water as cold as they can get it. -The charactristic thing about the tongue in the Arsenicum case is its dryness. It may be red, or it may be brown, but it is always dry, dry to the touch, and the patient often complains of the mouth feeling burning hot. -Then as regards the cough in these Arsenicum cases, you will very often find the patients hardly coughing at all, they do not seem to have sufficient strength to cough. Any cough that there is is very useless and brings up no sputum at all. If the patients are not quite so ill as that, they have a very violent, suffocative cough which makes them sit up in bed feeling as if they were going to strangle. -They always complain of intense compression in the chest; it feels horribly tight, as if they could not breathe at all. And after coughing, or even when they are lying still, they often complain of burning pain in the chest. After one of these paroxysms of coughing they very often have violent pain round their lower ribs, and very often pain in the epigastrium, too. -The sputum in Arsenicum is always scanty, because, as I mentioned before, the patients do not seem to have the strength to get it up. -Very often they cough it up into the back of the throat and just swallow it. -In these Arsenicum cases you are very apt to get a falling temperature; you may get an actual collapse temperature, with a running pulse and possibly a fibrillating heart. And the patients often complain of a horrible feeling of tremendous weakness in the chest. -The collapse in Arsenicum cases is very liable to take place in the early hours of the morning, it is usually sometime between 1 o'clock and 3 o'clock and is most likely between 1 o'clock and 2 o'clock. -Well, that is the picture as you see it. And here I want to put in a word of warning. If you have a case of that sort, with definite Arsenicum indications, and you prescribe Arsenicum and get a reaction taking place, unless you follow that Arsenicum up with another drug within the next twelve hours you will find your collapse recurring; then you will find that your patient does not respond to a repetition of your Arsenicum and that patient will die. -The kind of response you get to Arsenicum is that the intense, mental anxiety begins to subside, the intense chilliness subsides, the patient begins to feel warmer and more at peace. The intense sweating stops, the temperature begins to rise a little, and the pulse begins to steady down. Well that is the stage at which you must follow up with your next drug. -You may require any drug in the Materia Medica to follow up that reactive stage, but the two which are very much the most commonly indicated are Phosphorus and Sulphur. If you get your patient becoming warmer, the anxiety going, the pulse improving, the temperature rising, and instead of the white, livid appearance the patient becoming rather flushed, and still remaining thirsty, then the probability is that he is going on to a Phosphorus reaction. If, on the other hand, the response is not quite so complete, the patient is becoming a little warmer and then having cold waves, the anxiety is not quite so great but he is feeling frightfully tired out, he is still a bit sweaty, possibly the legs and feet are a little cold and the upper part a little hot, or possibly the legs and feet are a little hot and the upper part cold, he is intermittently hot then cold and chilly, then the patient is going on to Sulphur. And, as I already said, you will find that in the majority of cases Phosphorus or Sulphur is the drug with which you have to follow up your Arsenical response, and you will find a Im your most useful potency repeated 2 hourly.

Sulphur
-The last of these drugs I want to touch on in detail is Sulphur. -There is practically no Subdivision from which humanity suffers in which you may not find Sulphur indicated, and there are various occasions in pneumonia in which you may want Sulphur. It may be indicated in any stage of the Subdivision from Copyright 2000, Archibel S.A.

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the second day onwards. You may want to prescribe Sulphur in one of these difficult cases which is not clearing, one in which you have had indications for a drug which has done a certain amount of good, then you have had indications for another drug which again has done some good, and finally you cannot get clear indications for anything and the patient is not yet well. An intercurrent dose of Sulphur will set up a response. You may get indications for Sulphur in a case in which the patient has done quite well up to a point, the temperature has come down, either by crisis or by lysis, and yet the physical signs are not improving to your satisfaction; a dose of Sulphur will very often clear up the whole thing, start your resolution, or clear up remaining patches in the lung. But these are not the cases I want to cover in the description of the straight Sulphur pneumonia. -I think the appearance of the patient is the first thing that makes you consider Sulphur in a pneumonia, and the second is the patient's complaint. -In appearance the Sulphur pneumonic patient always gives you the impression of being very dusky and dirty looking. All the orifices tend to be red, the lips are red, the nose gives the impression of being red, the ears are red, very often there is a mild blepharities, the eyes look congested and red, and the patient gives you the impression of being dirty and undity. -As far as the complaint of these patients is concerned, their main one is a feeling of intense weariness. They feel deadly ill, they are very low spirited, and they are definitely complaining. They always suffer from a feeling of intense oppression of the chest, which they say feels as if it had a ton weight sitting on it. -Then in these Sulphur cases there is a strange mixture in their temperature sensations. You tend to look on your Sulphur patients as burning hot, with burning hot feet which they want to sick out of bed. -Well, you do at times find that state in your Sulphur pneumonia patients, but much more commonly you find they have alternating waves of heat and cold. You will very often find they have hot patches and cold patches, for instance, a hot head, or hot hands and feet, associated with chilliness in the back. it is that irregular distribution of heat and cold which is typical of the Sulphur pneumonic patient. -Another thing that strikes you about the Sulphur pneumonias is that they are definitely going to the bad. They are very ill, and they are not reacting properly to their Subdivision. -In their pneumonias the Sulphur patients develop a very worring cough. -It never seems to leave them at peace at all, and it simply wears them out; they get frightfully tired of it and they are apt to get irritable with it. -The sputum is very scanty, and the cough is always associated with pretty acute pains in the chest, which usually stick right through to the back. -I think as a rule in these Sulphur cases you are liable to have a more extensive involvement of the left side of the chest, rather than the right. -You will very often see a case in which there are the typical pains one associates with Chelidonium pains in the front of the chest going right through to the scapula. But a differentiating point is that you are more likely to get them on the right of the chest in Chelidonium, whereas in Sulphur they are more frequently on the left side. Occasionally, however, you do come across a Sulphur case with the typical Chelidonium pain on the right side of the chest. -These Sulphur patients always complain of a horribly dry mouth, which is very often offensive. The tongue is usually thickly coated, rather dirty, and there is always intense thirst. -Then there are one or two typical Sulphur symptoms. One is that these patients are very liable to have their worst paroxysms of coughing after they have been asleep. Another is that very often after being asleep they wake with a horrible feeling of pulsation in the chest, accompanied by pretty acute anxiety and a feeling that they are going to die. There is one odd thing in these Sulphur pneumonias, and that is that in spite of the fact that they often wake up in this acute distress they quite frequently tell you that while they are asleep they have singularly pleasant, peaceful dreams. It is about the only drug in the Materia Medica that I know which has that peaceful dream in a distressful condition like a pneumonia. -Another point about these patients is that, as they are very tired and very exhausted, they tend to slip down in the bed, and if they do get low it very much increase their respiratory distress. You will find that these Sulphur pneumonia patients all have a pretty acute air hunger; they want as much air about them as they can get, and they are very embarrassed if the room becomes at all close. -There are two periods in which you are liable to get trouble. The first is about 5 o'clock in the morning. At the time the patients are apt to wake up with the horrible feeling in their chests, and extreme exhaustion. They feel there is something deadly wrong and are sure that they are going to die. And quite frequently about that time in the morning they have an attack of diarrhoea; The other period in which your Sulphur pneumonia feels very bad is about 11 o'clock in the morning, between 11 and 12. At that time they get into the horrible Sulphur sinking, depressed, low, miserable state. -These Sulphur patients are always sweaty, and it is usually a hot, heavy-smelling sweat. And, speaking of this, when you are Copyright 2000, Archibel S.A.

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nursing a Sulphur pneumonia do be careful not to allow the nurse to give the patient a blanket bath, because although he has that horrid, offensive sweat you will find if you do allow him to have a blanket bath he will get a rise of temperature the same evening for a certainty. Another thing worth remembering from the practical point of view is that Sulphur patients do not stand talking well. This is not quite so marked as it is in Bryonia (incidentally quite a number of your Bryonia cases will run on to Sulphur ), but the Sulphur patient is very definitely aggravated by having to talk. He feels completely exhausted and tired out by it, and it does him definite harm. So do not allow your Sulphur patients to have visitors. -In the acute stage Sulphur patients respond remarkably well to the very highest potencies; cm's repeated 2 hourly; but in the stage of exhaustion it is wiser to administer 1 m's instead at the same intervals.

BORLAND D. M., Some Emergencies of General Practice (bl8)

BORLAND Douglas M.

Some emergencies of general practice *

It would seem that for most of us life comes in phases. For our generation there was the period before the First World War, then the phase of the war, followed by the period between the wars, and then the phase of the Second World War. These are common to all, but there are also phases peculiar to each of us. I am now looking back over the period when I was actively engaged in the work of the Hospital and the teaching carried on there. Thinking of my early days and the difficulties then confronting me I wondered if in any way I could help those starting out on the same road. As a result, I am tempted to offer you this paper on some of the emergencies confronting the beginner in homoeopathic general practice. I think emergencies are one of one's greatest difficulties when beginning to practice Homoeopathy. In an acute emergency one has to do something immediately; we cannot spend time hunting for a drug. All these emergency cases fall roughly into two main groups - the patient who is dying, and the patient who is in great pain. You sometimes get the two combined. There is a third problem - Is the case medical or surgical? - and that is always at the back of one's mind. Here it is your general medical skill that comes in; in the other two types it is a question of homoeopathic knowledge. So it is the dangerous case and the case of acute pain that I want to consider here. In the first instance you will find that the matching of acute pain is much the more difficult; the cases of acute danger are much easier to tackle. The dangerous cases usually resolve themselves into a question of cardiac failure in one form or another, I think from the homoeopathic standpoint one can tackle these cases of incipient cardiac failure very satisfactorily. The simplest way to group the dangerous cases from a drug point of view is to look on them under three headings : 1, the cases with acute cardiac failure ; 2, the case in which there is a gradual cardiac failure with a tendency to dilatation; and 3, the case of acute cardiac attack of the anginous type.

Acute cardiac failure

For the acute cardiac failures I think you will find that most of your cases require one of four drugs; Arsenic, Antimony tart., Carbo veg., and Oxalic acid. There are various points about these individual drugs which help you in your selection, and you will find that very soon you begin to select your drug almost as quickly as you spot your pathological condition, and by the time you have overhauled your patient you know what to give. In the Arsenic case you have the typical Arsenic mental distress, with extreme fear, extreme anxiety, mental and physical restlessness, and with a constant thirst, a desire for small sips of ice-cold water. So far as the actual local symptoms are concerned the main complaint is of a feeling of extreme cardiac pressure, a sensation of great weight on, or constriction of, the chest, as if the patient cannot get enough breath in, and a fear that he is just going to die. Copyright 2000, Archibel S.A.

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The patients as a rule are cold, they feel cold, but they may complain of some burning pain in the chest. In appearance they always look extremely anxious and are grey, their lips rather pale, may be a little cyanotic, and they give you the impression of being very dangerously ill. They often have a peculiar pinched, wrinkled, grey appearance. As a rule in these cases you will get the history that the attack has developed quite suddenly, and the response to Arsenic should be equally quick. If you do not get a response to Arsenic within a quarter of an hour the patient is not an Arsenic one. The first response that you ought to get is a diminution of the patient's mental anxiety and extreme fear; the restlessness beginning to subside, and he begins to feel a little warmer. In these cases my experience has been that you are wise to administer the highest potency of Arsenic you have with you, and as I now carry all remedies up to the cm. I always give cms. of Arsenic. But whatever potency you have with you, use the highest, because this is the kind of case that will die very rapidly and you gain more by giving whatever potency you have than by wasting time going home to get a higher one. The Arsenic seems to act very much like a temporary cardiac stimulant, and I find that in the majority of these cases you have to repeat the dose, certainly to begin with, about every 15 minutes. The next thing is that very often one sees a case of that sort which responds perfectly well, the patient is better, everyone feels he is getting over it, and then in three, or four, or six hours the symptoms begin to come back, the patient no longer responds to Arsenic, collapses and dies. That was my experience at one time. Then it began to dawn on me that I had given another drug during the reactive period I could have carried these cases on. I found that when this was done the patients did not get the secondary collapse and were thus saved. To achieve this result you have to give your secondary drug within four to six hours of the primary collapse while the patient is still responding to the Arsenic, otherwise you are in great danger of having a secondary collapse which you cannot combat. So remember that this is one of the very few instances in which one appears to ride right across the dictum that so long as the patient is improving one carries on with the same drug. In these acute cases if you have set up a reaction at all you have got to take advantage of it, otherwise the patient will sink again. The drugs which as a rule I have found these Arsenic cases go on to in the reactive stage are Phosphorus or Sulphur, but that is by no means constant. You can quite see that grey, pinched, anxious Arsenic patient responding, getting a little warmer, less pinched and drawn, not so anxious or restless, with a little more colour, and becoming a typical Phosphorous type. Equally you can see them going to the other extreme, where they are too hot, with irregular waves of heat and cold, rather tending to push the blankets off, still with air hunger and going on to Sulphur. These are the two commonest drugs you will need, but whatever the response is you ought to be able to follow up immediately you get the action well under way. The Antimony tart. patients have very much the same sort of condition, but mentally they are quite different. In Antimony tart. there is a more definite tendency towards cyanosis than in Arsenic, you never see a patient needing Antimony tart., without very definite cyanosis signs in the finger nails, often extending over the whole of the hands, and the feet may be involved as well. We do not get the same degree of mental anxiety in Antimony tart. as in Arsenic. The patients are more down and out, much more hopeless and depressed. They are never quite so restless nor so pale. Again, there is none of the thirst you meet with in Arsenic, in fact anything to drink seems to increase the feeling of distress. Another contrast is that the Antimony tart. patient is very much aggravated by heat, and especially by any stuffiness in the atmosphere. But there is one point to remember here as a contrast between Antimony tart. and Carbo veg. : the Antimony tart. patients do not like a stream of air circulating round them; they want the room fresh, but they like it still. In most Antimony tart. patients there is a very early tendency to oedema of the lower extremities. Another point which helps in your Antimony tart. diagnosis is that practically all these patients have a very thickly coated tongue --it is a thick white coat - and a rather sticky, uncomfortable mouth. They have a feeling of fullness in the chest much more than the sensation of acute pressure found in Arsenic. An you are likely to find pretty generalised, diffuse rales in the lower parts of the chest on both sides. In contrast to Arsenic. the collapse is similar to that after a pneumonic crisis, and if the patient responds to Antimony tart. it will carry him through. You do not have to be on your guard to find the follow-up drug as you have to be in an Arsenic case. The Carbo veg. case gives the classical picture of the patient with all the symptoms of collapse. They have the cold sweaty skin, are mentally dull, rather foggy in their outlook with not a very clear idea of where they are or what is going to happen to them. There is intense air hunger, and, in spite of their cold, clammy extremities, they want the air blowing on Copyright 2000, Archibel S.A.

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them; they cannot bear the bedclothes around the neck and they do definitely benefit from the exhibition of oxygen. They are very much paler than the Antimony tart. patients, the lips tend to be pale rather than cyanotic, and there is none of the underlying blueness one associates with Antimony tart. The next point is that they always have a feeling of great distension, not so much in the chest as in the upper abdomen, and the cardiac distress is always associated with a good deal of flatulence. Like the Antimony tart. patients, any attempt to eat or drink tends to increase the distress, and they have none of the Arsenic thirst. Another apparent contradiction you come across in Carbo veg. is that, in spite of the desire to be uncovered and the intolerance of the blankets around the upper part of the neck or chest, these patients complain of icy-cold extremities, as if the legs were just lumps of lead, and they cannot get them warm at all. I think in Carbo veg. you have to be careful as to how long you are going to keep up your drug administration when you get the patient responding --sweating less, the surface becoming warmer, and the distress less acute. You are wise then to be thinking of a second drug, because some Carbo veg. patients do relapse although many of them make quite a straight recovery on that remedy. You do have to be careful. If you find the patient has responded up to a point on Carbo veg. do not imagine that a higher potency of Carbo veg. is necessarily going to carry on the improvement. As a rule it does not, and it is much better to look round for a fresh drug to keep up the reaction. In the majority of these cases the drug that follows best has been Sulphur, although Kali carb. should always be considered. The last of the drugs which I commonly think of for these collapsed conditions is Oxalic acid. Oxalic acid has one or two very outstanding symptoms which are a great help in the selection of that drug. The first is that the patients always complain of a feeling of the most intense exhaustion, very often associated with a sensation of numbness. They frequently state that their legs and feet numb and paralysed, as if they had no legs at all. The skin surface is just about as cold and clammy as it is in Carbo veg., but there is a peculiar mottled cyanosis in Oxalic acid which you do not get in the other drugs. The finger tips and finger nails and toe nails will be definitely cyanotic, but in addition there is a peculiar mottled appearance of the hands and feet which is quite distinctive of Oxalic acid. There is a somewhat similar mottled, cyanotic appearance in the face, especially over the malar bones. These patients, in contrast to the Arsenic type, want to keep absolutely still, and movement of any kind greatly increases their distress. In addition to the general distress, most of these Oxalic acid patients complain of very definite sharp praecordial pains. These pains are not like the typical anginous stab, but more of sharp pricking sort of pain which usually comes through from the back and may run up the left side of the sternum towards the clavicle, or down the left side of sternum into the epigastrium. The most starting cases giving this picture that I have seen have been in the critical stage of an influenzial pneumonia where the patient was just fading out, having lost all strength, and the heart failing rapidly. I think all the patients of that type that I have seen have been left basal pneumonias. I remember seeing two or three patients who apparently were doing quite well on Natrum sulph.. react beautifully to oxalic acid. But one does get indications for its use in chronic cardiac cases as well.

Gradual cardiac failure with tendency to dilation

In these cases the heart is just gradually giving out, beginning to dilate a little, becoming slightly irregular, while the patients are going down hill. If the condition is not so acute as to call for one of the four drugs we have been discussing there are another three or four which you may find very helpful. That is quite apart from your ordinary prescribing. You find that in many of these cases in which there is a tendency to cardiac failure, the heart picks up and the tendency to dilation disappears on your ordinary prescribing, and you do not need to prescribe on the cardiac symptoms particularly, that is to say, the patient responds to the drug for their general symptoms. For instance, quite frequently in pneumonia, a bad case, with the patient pretty worn out with indications for Lycopodium there is a tendency to a failing heart, with dilation, but after the administration of Lycopodium the heart picks up, the pulse steadies, and the tendency to dilation disappears. You find the same in all acute illness where the patient is responding to the particular drug indicated. But you also get cases in which the patient is doing quite well but there is a tendency to cardiac failure which is not responding to the apparently indicated remedy, then you have to consider the drugs for cardiac failure in addition.

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For these cases the most common drugs are the Snake Poisons, especially Lachesis and Naja. And less commonly Lycopus and Laurocerasus. It is very difficult to distinguish one Snake Poison from another in such conditions. In appearance they are all very similar, but much the most common remedies for these conditions are Lachesis and Naja. The Lachesis picture I think is pretty typical of all, and there are just a few indications which make one choose Naja in preference to Lachesis. In all these cases indicating the Snake Poison you get a rather purplish, bloated appearance. They suffer from a feeling of tightness or constriction in the chest, more commonly in the upper part of the chest, and they are intolerant of any weight or pressure of the bedclothes, or any tight clothing round the upper part of the chest, or neck. All are sensitive to heat; they feel hot and they dislike a hot stuffy room. They have a marked aggravation after sleep; they get acute suffocative attacks when they all fall asleep and they wake up in increased distress. All these Snake Poison patients in their cardiac distress have a marked aggravation from being turned over on to the left side. They have a very marked tremor, and their hands are shaky. And most of them as they tend to get worse become mentally fogged, confused, and very often become difficult and suspicious. If there were nothing more than that, one would give Lachesis. But in a certain number of these cases you get rather acute stitching pains which go right through the chest from the precordium to the region of the scapula, associated with very marked numbness, particularly in the left arm and hand. Where the numbness is pronounced one would give Naja in preference to Lachesis. If the pain - stitching in character - is more marked one tends to give Naja, but if the feeling of constriction is predominant then Lachesis is the remedy. But the general symptoms are identical. I think possibly Naja is a little less red, less bloated looking, a little paler than Lachesis, but that is not very striking. Apart from the Snake Poison there are two other drugs which you will find very useful in these conditions. The first of these is Lycopus. You get indications for Lycopus in a case in which the heart is just starting to fail; it is beginning to dilate a little, and the pulse is tending to become a little irregular. The patients are pale rather than cyanotic, and are always restless. The outstanding symptom of the Lycopus case is that the patients complain of a horrible tumultuous sensation in the cardiac region. They very often tell you it feels as if their heart had suddenly run away and was just going mad. This is accompanied by a feeling of intense throbbing extending up into the neck and right into the head. The other Lycopus symptom which helps is that accompanying his tumult in the chest there is a very marked tendency to cough. It feels as if the heart just tuns away, it sets up an acute irritation, and they cough. Another Lycopus distinguishing symptom is that the distress is vastly increased by turning over on the right side - a contrast with the Snake Poisons which are worse turning over on the left side. Lastly, these Lycopus patients have an intense dislike of any food, and particularly of the smell of food. The last of these drugs I want to touch on is Laurocerasus. The Laurocerasus picture is very definite, and I think the easiest way to remember it is to picture for yourself the appearance presented by a congenital heart in a patient 16 to 18 years of age. You know the peculiar bluish-red appearance of the congenital heart, somewhat clubbed fingers, which again are rather congested, and the bluish appearance - almost like ripe grapes - of the lips. That is the underlying colour you get in Laurocerasus. These patients always suffer from extreme dyspnoea, very nearly Cheyne-Stokes in character. They take a sudden gasp for breath, followed by two or three long breaths, then the breathing gets gradually shallower, next a pause, then two or three gasps, and so it goes on. Another feature is that the respiratory dyspnoea gets very much worse when the patient sits up; they are better in a semi-prone position. A point which is an apparent contradiction is that with this extreme cyanosis you get a very early tendency to the development of hypo-static pneumonia at the bases, and when it has developed the cough is very much more troublesome unless they are reasonably propped up. When lying down the cough is worse, yet if they sit up the feeling of constriction is increased, so they have to get a position midway between. These patients are always chilly. They want to be kept warm, and they feel cold to touch. And of course, as you would expect in a condition of that sort, any movement or exertion aggravates them acutely.

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Anginous attacks
Let us look now at the cases with definite anginous attacks. For these cases you must give the patient relief very speedily. It is a little difficult to pick out of the Materia Medica the most commonly indicated drug for it, but I think one can limit the choice to about one of half a dozen - Aconite, Cactus, Arsenic, Iodine, Spongia, Spigelia and Lilium tig. The outstanding characteristic of the majority of these cases in their first attack is an absolutely overwhelming fear. The patient is certain he is going to die, and that very speedily, and he is terrified. He is quite unable to keep still, and yet any movement seems to aggravate his distress. Here a dose of Aconite in high potency will give relief almost instantaneously. I have seen a case of that sort and put a dose of Aconite on the tongue and almost before the remedy could be swallowed that patient was feeling better. I usually carried 10m as my highest potency in general practice and I gave Aconite 10m. The man had a similar attack at a later date, and the anxiety, the distress, and the fear were nothing like so marked because he had come through one attack before, and Aconite had no effect at all. That has been my experience. Where you are dealing with the first attack and the patient is quite certain he is going to die, Aconite does relieve him right away, but does not act in a second or later attack. So if you get a man with his first attack, give a dose of Aconite and you will probably find in no time he is feeling more comfortable. But if he has had a previous attack Aconite will not be helpful. For the patient who is having a subsequent attack much the most likely drug to help is Cactus. Cactus has a good deal of anxiety and fear, but it is quite different from that of Aconite. It is not a fear that the immediate attack will be fatal, it is more a conviction that he has an absolutely incurable condition which will eventually kill him. That is one point about the Cactus indications. Another is the type of the actual distress of which the patient complains. He feels as if he had a tight band around the chest which was gradually becoming tighter and tighter and that if this constriction did not let up soon the heart would be unable to function. It is that feeling of increasing tension which gives you the Cactus indication. In addition you may get stabbing; radiating pains from the precordium, but they are not so characteristic of Cactus as the intense constricting feeling, which is, of course, just exactly how the majority of your anginous patients describe it. In these acute conditions I always give the drug in high potency because it acts much more quickly and one wants instant relief. Then you will get an occasional patient having an anginous attack with very similar constricting feelings, not quite so intense but a definite feeling of constriction. The patient has been ailing for some time, is rather anxious and worried, very chilly, and accompanying this feeling of constriction there is an acute, distressing, burning sensation in the chest. These anginous patients respond very well to a dose of Arsenic. I have never seen Arsenic do anything in an anginous attack except in the rather broken down, ill-looking, very definitely anxious, fearful, with that sense of constriction accompanied by the burning discomfort in the chest. And Arsenic does relieve these cases quickly. There is another type of case which is very similar to that; with very much the same sensation, but the feeling of constriction, the feeling of tension, is described as being actually in the heart itself rather than involving the whole of the side of the chest. The patients are just about as anxious as the Arsenicum patients - in fact all these anginous patients are anxious - but instead of the intense chilliness of the Arsenic they are uncomfortable in heat and in a stuffy atmosphere. They are just about as restless, but instead of the pale, drawn appearance which you get in Arsenic, they tend to be rather flushed, and as a rule they are dark-haired, dark-complexioned people. They are rather underweight, in spite of the fact that they have always been pretty good livers and very often have an appetite above the average although they have not been putting on weight. These cases respond exceedingly well to Iodine. Then there is yet another type of case in which instead of the complaint being of constriction it is of a progressive sensation of swelling in the heart region. It feels as if the heart gets bigger and bigger until it would finally burst, and this sensation of fullness spreads up into the neck. This sensation of fullness and swelling is very much aggravated by lying down, when the patient feels as if he would nearly choke and it is accompanied by very acute pain. The patients themselves are chilly and any draught of air increases their distress. Copyright 2000, Archibel S.A.

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In addition to the feeling of distension, they usually complain of more or less marked numbness, particularly of the left arm and hand, though very frequently there is numbness of the hand only without any involvement of the arm, and not infrequently they complain of numbness of the lower extremities too. As a rule the face and neck give you the impression of being some what congested; they do not have the pale, drawn, wrinkled Arsenicum appearance. And these cases respond well to Spongia. Another drug which you will find useful in a condition which is somewhat similar, though not an angina at all, but which you meet with in hysterical women. You will fail to find any cardiac lesion, but they will produce a symptom picture difficult to distinguish from a true anginous attack. They have the very marked stabbing, radiating pains, and often an intense hyperaesthesia of the chest wall. They are very depressed, frightened, and intensely irritable. They are sensitive to heat, and their distress is aggravated by any movement. In addition to the stabbing pains they have the anginous sense of constriction, tightness, of the chest wall. These cases are usually associated with some kind of pelvic lesion, or a history of having had some gynaecological illness. I have seen quite a number of these cases now in which an electro-cardiogram shows no lesion at all. And all the symptoms have cleared up entirely with Lilium tig. So you seen when you are confronted with one of these very distressing conditions where you have to make a quick decision, it is fairly easy to individualize and get something which will give almost instantaneous relief.

Pain killers
The next problem I want to touch on is the patient suffering from acute pain. Pain killers are a little difficult to systematize, and I thought probably the most helpful way would be to consider the cases of acute pain which one meets with in general practice, and these I think one can classify to a certain extent. One gets acute neuralgias, acute inflammation of one of the serous membranes, and acute colic. I think that more or less covers the ordinary conditions one meets with in general practice. To tackle these from the homoeopathic standpoint is not very difficult. If one considers the acute neuralgias from the prescribing point of view one takes the character of the pain and the circumstances which make it better or worse, and to a lesser extent it s situation. It is on these that one mainly prescribes : in other words, on the character of the pain and the modalities. It is exactly the same as regards serous inflammations; again it is partly on the situation but much more on the character of the pain and the circumstances which modify it that one prescribes. With colic equally; and it does not matter whether it be gallstone, intestinal or renal colic, one pays a little attention to the situation but very much more to the character of the pain and what modifies it. Working on these lines it is possible to take up the three groups and give the indications for the leading drugs which you must have at your finger ends. But before taking these up in detail I should like to touch on another very painful condition commonly met with in general practice, namely ACUTE EARACHE.

Acute earache
If you go to a patient who is suffering from violent earache, acute stabbing pains in the the ear, and tenderness over the mastoid region, when you first look t it from the homoeopathic standpoint you are completely lost. After a little experience you find that these cases are very satisfactory, you get your relief astonishingly quickly, and often a case which you expect would require incision of the membrane within the next few hours quickly subsides ad the patient is comfortable when you go back in the evening. That is the sort of thing you should be able to do in these acute conditions. In cases of acute otitis with violent pains all round the the mastoid region there are three or four drugs I want to consider. Supposing you take the the case which has come on very suddenly, with a history of the patient having been out in a very cold north-east wind, he is intensely restless, the pains are very violent, usually burning in character. He is irritable, a bit scared, with all the signs of a rising temperature, and extreme tenderness to touch. With that history after a few doses of Aconite the acute inflammatory process which is just starting will have entirely disappeared. That is the type that one hopes for, and which one sees very often in winter. You will get another case - usually in children - where there is not the same definite history of chill, although that may be Copyright 2000, Archibel S.A.

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present, but where the pain is even more intense and where the patient is practically beside himself with pain, will not stay still, is as cross and as irritable as can be, again with extreme tenderness, and you get the impression that nothing that the friends do satisfies him. You give him a few doses of Chamomilla and again the whole inflammatory process will rapidly subside. The next case has gone a little further; there is much more tenderness over the mastoid region, possibly a little bulging, and the ear begins to look a little more prominent on the affected side. The external ear is very red, often much redder than on the opposite side. There are very acute stabbing pains running into the ear, the condition is a little comforted by hot applications, and the patient is extremely sorry for himself, miserable, wanting to be comforted, probably a little tearful, but without the irritability of Chamomilla, and Capsicum almost always clears it up. In addition to the three drugs which I have considered, one always has in mind the possibility of a Pulsatilla child requiring a dose of Pulsatilla for the condition. And also one not infrequently sees a case giving indications for Mercury or Hepar sulph., but these I have no time to do more than mention. Then to go on to typical acute neuralgias, facial neuralgias, or acute sciaticas, or things of that sort where, you want to get immediate relief. Again you can use pretty well routine methods for relieving these cases. Let is consider the acute facial neuralgias, for instance acute trigeminal neuralgia; there are two outstanding drugs for these conditions. It does not really matter which branch of the nerve is involved, you take a case like that, with violent pain coming in sharp stabs, or twinges of pain running up the course of the nerve, coming on from any movement of the muscles of the face, very much aggravated by any draught of air, with extreme superficial tenderness over the affected nerve, which is much more comfortable from warmth, applied warmth, and also from firm supporting pressure. That case, particularly when it involves the right side, almost always responds to Mag. Phos. - nine out of ten will so respond. Incidentally this does not apply to dental neuralgia, these are much more different and they run to quite a number of different drugs. If you have the same condition, with practically the same symptoms, the same modalities, affecting the left side, it generally responds to Colocynth. The side usually determines the choice, but occasionally either drug may relieve neuralgias involving the opposite side. Where you get an orbital neuralgia, with much more sharp stinging pains, "as if a red hot needle were stuck into it" is a very common description in these cases, and the pains tending to radiate out over the course of the nerve, in the majority of cases you get relief from Spigelia. There is one very useful point about Spigelia; and that is that you sometimes get the statement that, in spite of the burning character of the pain, after it has been touched there is a strange cold sensation in the affected area. That is Spigelia and Spigelia alone. These are the three drugs which I find much the most useful in a routine way for facial neuralgias. As a rule I use high potencies, but I do not like to go too high because sometimes in these very painful conditions the very high potency aggravates the pain for the time being, for ten minutes or so, and thus causes unnecessary suffering, so in th these cases with acute pain I seldom go higher than a 30 potency.

Post-herpetic neuralgias
There is another group of conditions of the same type, the post-herpetic neuralgias, which are sometimes very troublesome. You know the ordinary shingles neuralgia where the patient comes with acute burning pain along the course of the intercostal nerve and gives a history that he has had a small crop of shingles, very often so light that he paid little or no attention to it. Well, if you can get the same modalities as you got in the facial neuralgias under Mag. Phos., that remedy will often relieve. Much more commonly you find that these post-herpetic cases respond to Ranunculus. The particular features for this drug are the history of herpes, the very sharp shooting pains extending along the course of the intercostal nerve, that the painful area is very sensitive to touch, that the pain is induced or aggravated by it, and you may get the statement that the patient is extremely conscious of any weather change because it will cause a return of the neuralgia again. Well, that type of case responds in almost every instance to Ranunculus. You will get a few of these cases which have not responded to Ranunculus, with much the same distribution of pain, and the same modalities, but without the marked aggravation in wet weather, where the affected area is extremely sensitive to any cold draught, particularly sensitive to any bathing with cold water, and where the pains are likely to be very troublesome at night, and with a marked hyperaesthesia over the affected area. And these cases usually respond to Copyright 2000, Archibel S.A.

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Mezereum.

Sciatica
Then you get another type of neuralgia - the sciaticas. And there again you can get helpful leads. In cases of sciatica, in which I can get no indications at all but the ordinary classical symptoms of sciatica, that is to say, acute pain down the sciatic nerve, which is aggravated by any movement, is very sensitive to cold, more comfortable if kept quiet and warm, then it depends which leg is involved what drug I give. If it is a right sided sciatica I give Mag. Phos., but if it is a left sided I give Colocynth. And you would be astonished how often one gets almost immediate relief from either Mag. Phos. or Colocynth. Some sciatica patients are frightfully uncomfortable the longer they keep still, they have got to start moving, and there are two drugs which seem to cover the majority of these cases. If the patient is warm-blooded, and the sciatic pains tend to be more troublesome when warm, particularly warmth of bed, and rather better when moving about, in the majority of instances one gets relief from Kali Iod. If, on the other hand, you have very much the same modalities with a chilly patient, particularly if he is sensitive to damp as well as cold, and again more comfortable when moving about, Rhus will clear the majority of such cases. Then there are one or two odd indications which sometimes help you in a sciatica where you can get no other distinguishing symptoms. For instance, if you get a sciatica which has, associated with the acute sciatic pain, marked numbness, there are two drugs which cover most of your cases. One is Gnaphalium, which has this sensation of numbness associated with pain and tenderness over the sciatic nerve more marked than any other drug in the Materia Medica. The second drug which has this numbness associated with pain and tenderness of the sciatic nerve is Plumbum, and the main indication which suggests this remedy is that. I have never seen a sciatica giving indications for Plumbum which was not associated with extreme constipation as well as the pain and numbness.

Acute colic
In case of acute colic, renal, hepatic, or intestinal one can give quick relief by fairly snapshot prescribing. When you go to such a case and know that morphia and atropine will relieve the spasm, it is very tempting to use them. If you cannot get your homoeopathic drug in a snapshot way I think you are bound to give the patient relief with your hypodermic. To my mind the disadvantages of this procedure are twofold. First, there is the disadvantage that after such relief it is necessary to begin to treat the case now masked, if not actually complicated, by the action of the morphia. Secondly, there is always the danger that in an acute case of this kind the morphia may conceal the development of a surgical emergency which in consequence may be missed. Suppose you have a hepatic colic, it is quite likely to be use to a stone pressing down into the bile ducts, which may perforate. If morphia has been used it is quite possible - one has seen it happen - that owing to the sedative, indications of the perforation are not detected for hours afterwards. The clinical picture is masked, and you are exposing the patient to a very grave risk. So if there is a method of dealing with these colics apart from morphia I think it is wise to use it. But, as I say, you are only justified in using it if you are getting relief; the patient need not suffer merely because you would prefer using a homoeopathic drug to a sedative. Fortunately the indications in these colics are usually pretty definite. If you have a case of a first attack of colic, whether it be hepatic or renal it is a very devastating experience for the patient and he is usually terrified. The pains are usually extreme and nearly drive the patient crazy, and if, in addition, the patient feels frightfully cold, very anxious, faint whenever he sits up or sands up, and yet cannot bear the room being hot, Aconite will usually give relief within a couple of minutes. You will seldom get indication for Aconite in repeated attacks. The patients somehow begin to realise that although the condition is frightfully painful it is not moral, so the mental anxiety necessary for the administration of Aconite is not present, and without that mental anxiety Aconite does not seem to act. Another case having repeated attacks, each short in duration, developing quite suddenly, stopping as suddenly, associated with a feeling of fullness in the epigastrium, and where the attacks are induced, or very much aggravated, by any fluids, and accompanied by flushing of the face dilated pupils and a full bounding pulse, Belladonna relieves them almost immediately. Copyright 2000, Archibel S.A.

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Consider another patient who has had liver symptoms for some time, just vague discomfort, slight fullness in the right hypochondrium, a good deal of flatulence, intolerance of fats, and who is losing condition becoming sallow and slightly yellow. He develops an acute hepatic colic, with violent shoots of pain going right through to the back, particularly to the angle of the right scapula, which subside and leave a constant ache in the hepatic region, and then he gets another violent colicky attack. These attacks are relieved by very hot applications, or the drinking of water as hot as it can be swallowed. Chelidonium relieves these attacks in the most astonishing way. In these cases, X-rays usually reveal a number of gallstones. And, in contrast with what happens with morphia and atropine treatment, subsequent X-rays after Chelidonium has been given frequently show that one or more of these gallstones have passed almost painlessly. So with Chelidonium you are well under way with your treatment of the gallstones, whereas with morphia and atropine you merely relieve the acute attack of pain. In other words, you have already taken a long step in the treatment of that patient towards clearing the condition altogether. That is one point to be said in favour of your homoeopathic treatment rather than the merely sedative relief. There are quite a number of other drugs for these colics, some of them hepatic, some renal, and some intestinal, and they all have their own individual points which are very easy to pick up at the bedside. If one memorizes them in this way it is astonishing the ease of your work in acute cases. You see I am not giving you the full description of these drugs, I am picking out only the points which apply too this type of case. That is how you have to do it in practice, but you must remember that these drugs I am giving you for these conditions are the common ones, and that every now and then you meet a case which appears to call for one of these drugs and yet the patient does not respond. There are certain homoeopathic physicians who sometimes call me out in consultation for acute cases and I know perfectly well before I leave my room that it is no use my thinking of these drugs as they will already have been given; and what I have to get is something that is not common but out of the way. I remember seeing a case of gallstones colic with one of our very good physicians. It was an elderly woman, and she had that typical Chelidonium picture. Of course she had had Chelidonium already, but without benefit. The doctor said, "I don't understand this case at all; I think she must have a malignant lever." I asked why, and he said, "Because she has all the Chelidonium indications and she does not respond." This is the sort of old case you will meet with, so if that should happen to be your first one do not think therefore that Homoeopathy does not work; you will find that as time goes on you get more and more cases that do work and the exceptions are fewer and fewer. As a matter of fact that particular case responded to a dose of one of the Snake Poisons, but I have never seen another case that had a Snake Poison for that condition, and one gave it purely because she had already had her Chelidonium; had I seen the case in the first instance I should certainly have given Chelidonium. In spite of the old cases it is worth while getting these ordinary drugs at your finger ends so that when cases crop up you can prescribe easily on the few indications of the acute condition as presented to you. There are one or two other drugs that I can touch on which you will find very helpful in these colics. For instance, Berberis, which is extremely useful in colics whether renal or gallstone. The outstanding point about the Berberis colic, no matter its situation, is that from one centre the pain radiates in all directions. Suppose you have a renal colic - and when Berberis is indicated I think it is more commonly on the left side than the right - you will find that where you get indications for Berberis the colicky pain starting in the renal region, or in the course of the ureter, there is one centre of acute pain, and from that centre the pain radiates in all directions. If you have a hepatic colic you get the centre of acute intensity in the gall-bladder, and from there that pain radiates in all directions, it goes through to the back, into the chest, into the abdomen. That is the outstanding point about these Berberis colics. In addition to that, where you are dealing with a renal colic you almost always get an acute urging to urinate, and a good deal of pain on urination. Where you are dealing with a biliary colic, it is usually accompanied by a very marked aggravation from any movement; this is present to a slight extent in the renal colics, but it is not so marked; and in both the patient is very distressed, and has a pale, earthy looking complexion. The pallor, I think, is more marked in the renal cases, and where there has been a previous gallstone colic you may get a jaundiced tinge in the hepatic cases. It is a very useful drug, and I do not know any other which has the extent of radiation of pain that you get in Berberis. It is surprising how widespread the area of tenderness can be which is associated with a Berberis colic, so much so that in gallstone attacks you get so much tenderness and resistance that you are very afraid of a perforated gall-bladder you get such a resistant right upper rectus, and you may be very suspicious of a peri-renal abscess in the renal cases, again because of the extreme resistance of the muscles on the side of the abdomen. In a Berberis renal case the urine is as rule rather suggestive. More commonly it is not bloodstained, but contains a quantity Copyright 2000, Archibel S.A.

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of greyish-white deposit which may be pure pus, but mostly contains pus and a quantity of amorphous material usually phosphates, sometimes urates. Although it is a very dirty looking urine it is surprisingly inoffensive. There are two drugs which one always thinks of for colics of any kind, and they are Colocynth. and Mag. Phos. It does not matter where the colic is; when you have an acute abdominal colic of any kind one always thinks of the possibility of either Colocynth. or Mag. Phos. Both remedies are often useful for colic in any area, uterine, intestinal, bile ducts, or renal - it does not matter which it is. The point about these drugs is that they are almost identical, that always in their colics the pain is very extreme, and the patients are doubled up with pain. In both cases the pains are relieved by external pressure, and by heat. In Mag. Phos. there is rather more relief from rubbing than there is in Colocynth., which prefers steady, hard pressure. The next thing about them is that their colics are intermitting. The patients get spasms of pain which come up to head and then subside. There are one or two distinguishing points which help you to choose between Colocynth. and Mag. Phos. With Colocynth. in the attacks of colic you always find the patient intensely irritable. He is frightfully impatient, wants something done at once, wants immediate relief, and is liable to be violently angry if the relief is not forthcoming. In Mag. Phos. there is not the same degree of irritability, and the patient is distraught because of the intensity of the pain rather than violently angry. Another point that sometimes helps in your selection is that Colocynth. tends to have a slightly coated tongue, particularly if it is the digestive tract that is upset, whereas when Mag. Phos. is indicated it usually is clean. Both these drugs have a marked aggravation from cold, a little more marked in Mag. Phos. than in Colocynth. For instance, Mag. Phos. is exceedingly sensitive to a draught on the area, whereas Colocynth, though it likes hot applications, is not so extremely sensitive to cold air in its neighbourhood. Another distinguishing point between the two is that in Colocynth. there is apt to be a tendency to giddiness, particularly on turning more especially to the left, but this is not present in Mag. Phos. Where you have a report that the colic - and I think this applies much more commonly to uterine than to intestinal colic has followed on an attack of anger it is almost of anger it is almost certainly Colocynth. you require. If the colic is the result of over-indulgence in cheese it is Colocynth. that is indicated, not Mag. Phos. If the pain is the result of exposure to cold, either a dysmenorrhoea or an abdominal colic, it is much more likely to be Mag. Phos. than Colocynth. These are two of the most useful drugs in the Materia Medica for colics, and it is surprising the relief you can get, even in cases of intestinal obstruction, from the administration of Colocynth. or Mag. Phos. I have seen cases of intestinal carcinoma with partial obstruction in which the patients were suffering from intense recurring colicky pains coming to a head and then subsiding. Mag. Phos. has given the most astonishing relief. Less commonly in such cases where there has been marked irritability in addition to the local symptoms, Colocynth. has also done wonders. Very often one or other of these drugs has kept a patient in a surprising degree of comfort till death supervened. In these malignant colics I never th go high; a 30 potency is sufficient. In an ordinary acute colic, say dysmenorrhoea, I give a 10M and the relief is almost immediate, and the same applies to intestinal colics. There is another drug which is very useful as a contrast to these two, and it has very much the same sort of pain, a very violent, spasmodic colic coming on quite suddenly, rising up to head, then subsiding, and that is Dioscorea. Dioscorea has the same relief from applied heat, and it is sometimes more comfortable for him pressure, but, in contradistinction to the other two drugs, instead of the patients being doubled up with pain they are hyper-extended; you find them bending back as far as possible. And the only drug I know which has that violent abdominal colic which does get relief from extreme extension is Dioscorea. I have seen it useful in gall-bladder attacks, in a few intestinal colics, and in a case of violent dysmenorrhoea. I have never tried it in renal case. Where you get that extreme extension of the spine you can give Dioscorea every time without asking any further questions. There is one other drug I want to mention because one tends to forget it as a colic medicine, and that is Ipecacuanha. Ipecac. is one of the most useful colic drugs we haven and the indications for it are very clear and definite. The character of the pain described in Ipecac. is much more cutting than the acute spasmodic pain occurring in most other drugs. But the outstanding feature of Ipecac. is the feeling of intense nausea which develops with each spasm of pain. Accompanying that nausea is the other Ipecac. characteristic that in spite of that feeling of deathly sickness the patient has a clean tongue. You will see quite a number of adolescent girls who get most violent dysmenorrhoea, they are rather warm-blood people, and with the spasm of pain - they very often describe is as cutting pain in the lower abdomen Copyright 2000, Archibel S.A.

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they get hot and sweaty and deadly sick so that they cannot stand up and any movement makes them worse. They have a perfectly clean tongue and a normal temperature, and very often Ipecac. will stop the attack, and even the tendency to dysmenorrhoea altogether. It is one of the very useful drugs and, as I say, one of the ones one tends to overlook. I have seen several cases of renal colic, associated with the same intense nausea, which have responded to Ipecac., but I think that is more rare; it is more commonly in uterine cases that you get indications for it. There are three drugs I always tend to associate in my own mind for colics : Lycopodium, Raphanus and Opium, the reason being that in all three the colic is accompanied by violent abdominal flatulence. It Is always an intestinal colic in which I expect to find indications for one or other of these drugs. It may be associated with a gall-bladder disturbance, and if so it is much more likely to be Lycopodium than either of the other two. In all three there is a tendency for the flatulence to be stuck in various pockets in the abdomen, that is to say, you get irregular areas of distension. In all three you are likely to get indications in post-operative abdominal distensions, semi-paralytic conditions of the bowel. Where you have definite paralytic conditions like a paralytic ileus following abdominal section you are more likely to get indications for Raphanus and Opium than for Lycopodium, but if the paralytic condition happens to be more in the region of the caecum the indications are probably for Lycopodium rather than for the other two. That is the general picture, and there are one or two distinguishing points which help you. For instance, in Lycopodium the colicky pain is likely to start on the right side of the abdomen, down towards the right iliac fossa, and spread over to the left side, whereas in the other two it remains more or less localised in the one definite area. In Lycopodium you are very liable to get a late afternoon period of extreme distress, the ordinary 4 to 8 p.m. aggravation of Lycopodium. There is likely to be very much more rumbling and gurgling in the abdomen in Lycopodium, and there is more tendency to eructation, whereas in the other two the patient does not seem to get the wind up to the same extent. Where there is eructation the patients usually complain of a very sour taste in Lycopodium cases. In Lycopodium you usually have a somewhat emaciated patient with a rather sallow, pale complexion. There are one or two points that lead you to Opium instead of the other two. In Opium, as I said, there is apt to be a definite area of distension, and the patient may say that he gets a feeling as if everything simply churned up to one point and could not get past it, or as if something were trying to squeeze the intestinal contents past some obstructing band, or as if something were being forced through a very narrow opening. Another point that leads to the selection of Opium is that which these attacks of colic the Opium patient tends to become very flushed and hot, feels the bed abominably hot, wants to push the blankets off, and after the spasm has subsided tends to become very pale, limp, and often stuporose. The area of distension in Opium is likely to be in the centre of the abdomen rather than in the right iliac fossa, and it is one of the most commonly indicated drugs in a paralytic ileus. Another point that sometimes puts you on to Opium is that when the pains are developing and coming up to a head the Opium patients develop an extreme hyperaesthesia to noise. I remember one patient who had a paralytic ileus after an abdominal section and as he was working up to another attack of vomiting he had that hyperaesthesia to noise more marked than I have ever seen it. If the nurse in the room happened to jangle the basin into which he was going to be sick he nearly went off his head and he turned and fairly cursed her. That hyperaesthesia to noise made me think of Opium, and it completely controlled his attack and the whole condition subsided. This hyperaesthesia is worth remembering as it is so different from the sluggish condition induced by the administration of Opium in material doses. The Raphanus type of post-operative colic is again slightly different. Instead of getting the right side of the abdomen distended as in Lycopodium, or the swelling up in the middle as in Opium, in Raphanus you get pockets of wind, a small area coming up in one place, getting quite hard, and then subsiding, followed by fresh areas doing exactly the same. These pockets of wind may be in any part of the abdomen. In acute attacks of pain the patients tend to get a little flushed, but not so flushed as the Opium patients, and they do not have the tendency to eructation that one associates with Lycopodium, in fact they do not seem to be able to get rid of their wind at all either upwards or downwards. But it is these small isolated pockets coming up in irregular areas throughout the abdomen which give you your main lead in Raphanus cases, and I have seen quite a number of them now, post-operative cases, and it is astonishing how quickly after a dose of this remedy the disturbance subsides and the patient begins to pass flatulence quite comfortably. th In post-operative cases I usually give Lycopodium in 200 potency. In Raphanus I always use the 200 s; having found this potency worked I have stuck to it. In Opium, I usually give a higher potency because these cases are pretty extreme. Copyright 2000, Archibel S.A.

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There are, of course, endless other drugs which have colic, but I am trying to pick out those most useful in emergencies. There is one other which you ought to know Podophyllum. Podophyllum you will find useful in hepatic colics mainly. It is helpful in intestinal colics associated with diarrhoea, I mean with acute diarrhoea, but then you prescribe it much more on the diarrhoea symptoms than on those of the colic. But you do get indications for it in hepatic colics purely on the local symptoms. I think in these cases where you have Podophyllum indicated in hepatic colic you always have a degree of infection of the gall-bladder, and one of the first things that makes you think of the possibility of Podophyllum is the fact that the maximum temperature is in the morning and not in the evening. It has a 7 o'clock in the morning peak temperature. In addition to that, the Podophyllum patients are very miserable and depressed, almost disgusted with life. There is always a degree of jaundice in the gall-bladder cases, and it may be pretty marked. In the majority of these cases the pain is not definitely localized in the gall-bladder area, it is more in the epigastrium as a whole, and tends to spread across from the middle of the epigastrium towards the liver region. The pains are twisting in character, and they are much aggravated by taking food. In these Podophyllum cases when the acute pain has subsided there is a horrible feeling of soreness in the liver region, and you find these patients lying stroking the liver, which gives a great sense of comfort. When I see an infected gall-bladder with a morning temperature instead of an evening one I immediately think of Podophyllum. It is astonishing how often one gets this indication, and then you generally see the patient lying in bed stroking the liver region. In every case where the morning temperature and that relief from stroking have put me on to Podophyllum I have found that the other symptoms fitted in.

Discussion
Dr. mcCrae thought the paper was a masterpiece. There was nothing in it to criticize, there were details of valuable help to everybody which were like the artist sharpening his pencil to produce some line of particular splendour which would make the picture complete. Most had pencils but they were blunt, and the homoeopath would always be grateful for these amazingly useful hints. He hoped Dr. Borland would soon return so that the members could thank him personally. He also thanked the President for the way in which he had read the paper. Dr. John Paterson said that they had listened to a real clinical paper. There was not much which one could criticize, but one might add a little. With regard to the cardiac cases, Arsenic and Sulphur his experience was that Arsenic was often the acute of Sulphur and on the mental side they were the exact opposite. One found that a Sulphur patient swung in an acute condition to Arsenic and Dr. Borland had brought out that point. He was interested in the question of Aconite acting in the first attack but not in the second. There had been many discussions about covering the totality of the symptoms and here was evidence that the homoeopathic remedy could be prescribed on the mental symptoms which worked in the first instance but it did not cover the whole of the case. It was possible to prescribe homoeopathically without covering the whole of the case, only covering a phase because obviously on the next occasion the pain was present but not the fear, the Aconite had removed one phase of the case - mental fear. Aconite came out very strongly in the air raids. Another remedy was Natrum Mur. He wondered if any orthodox practitioners were surprised that there was no mention of Digitalis but Digitalis was quite useful in these slightly relaxing hearts in homoeopathic doses, not in the massive doses given in allopathic medicine. With regard to renal colic, in examining the stools of patients the Bacillus Morgan came out very frequently and he associated Lycopodium with it. Lycopodium had always been considered to be a right-sided remedy but the peculiar point about a case in which it had proved successful was that the pain had been left-sided and when the case had been X-rayed it had been found that the right kidney was more involved than the left, so that it looked as if the actual renal colic condition started in the left kidney but gave no trouble. It was only when the right kidney was involved that the first symptom developed, so that even with a left-sided renal colic Lycopodium should not be excluded. Dr. Stonham said that the paper was excellent and the sort of paper which would appeal to the general practitioner, who was always coming up against acute cases. To have such cases so plainly stated with the drug indications for them was very valuable. There were one or two points he would like to mention with regard to Aconite which, as Dr. Borland had said, was very useful in many cases. The case which he did not mention was the acute pulmonary oedema. He had given Aconite 30 in such cases and it quickly calmed the patient in that distressing and somewhat dangerous condition and he had found it valuable not only in the first case but also in cases when the attack has been repeated. Dr. Borland said he gave Laurocerasus in acute heart complaints. He had had an acute case with Cheyne-Stokes respiration, it looked as if Copyright 2000, Archibel S.A.

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the patient would die, he gave Hydrocyanic Acid and he recovered very nicely. Many people would substantiate the value of Dr. Borland's paper. Dr. G. R. Mitchell said that a clinical paper was most useful. He wanted to criticize something Dr. Paterson said when he took the Aconite example as not prescribing on the totality. He would have thought it was an example of prescribing on that procedure because in the first case, on all the manifestations, Aconite was the drug, and it worked and on the second occasion there was a different totality, and the Aconite did not work. That was the way he would regarded the matter. Dr. hardy added her grateful thanks to Dr. Borland for his paper. With regard to medicines for heart complaints she agreed with Dr. Paterson that Digitalis 200, one dose, was very effective in the semi-chronic or chronic case of the right sided congestion, blue face and blue nails, but not in the acute patient. She also used mother tincture Crataegus for heart patients because it was specific for the cardiac muscle. Another drug which was used in Russia was Adonis mother tincture, five drops to a dose. There was a remark which she did not like about Chelidonium - that the patient did not respond and that it must therefore be cancer. The case was Lachesis to start with and that did not exclude the possibility of cancer. She had a very bad case of cancer which was cured by Lachesis, a liver case with constant pain. In her personal experience Raphanus was indicated in the hepatic lesions, and Momordica in splenic lesions. Dr. Le Hunte Cooper did not think too much could be said about the work which had been put into this paper and the wonderful collection of details on which indications had been given and which were of the greatest possible value. The paper would require a great deal of study, so that these indications could be taken for future use. He was rather in favour of trying to keep the remedies which were very definitely specific for particular conditions because in cases where there was an emergency, there was no time to seek for all the exact indications which might help, but he was rather surprised that Dr. Borland did not make more use of the Snake Poisons in heart cases because he must admit he would not be without Lachesis. If there was any suggestion of heart failure he would give Lachesis and would be surprised if it did not answer. There was one rather interesting point from the homoeopathic point of view with regard to Snake Poisons and that was to think of the first thing which an individual felt when he was bitten by a snake, which was death, and when death threatened the patient the prescriber should think of the Snake Poisons. He mentioned this in a paper he read on Snake Poisons in Berlin just before the war and it attracted the attention of reporters who were present. In the Berliner Tageblatte there appeared in headlines, "When death threatens, think of the Snake Poisons." Another point was that he thought a little more might have been made of Pulsatilla for the ear. His experience was that a pain in the ear was met by Pulsatilla irrespective of the indications of the Pulsatilla patient. One liked to have something at the back of one's mind which could help immediately without having to think too completely of other remedies. If one had too many remedies they came in afterwards, but at first one might fall between two stools. Dr. Alva Benjamin said that with regard to the collapse cases one would have thought that Dr. Borland would have mentioned Veratrum Album for cases of great coldness and excessive sweating. With regard to heart cases he had had a lot of help from Chamomilla, particularly when the pain was very severe. With regard to ear cases he was surprised Dr. Borland did not mention Bryonia for inflammatory conditions; he had found It admirable. In one case the child was developing mastoid. He asked Dr. Cunningham to come to see the case, meantime giving the child Bryonia 10M, and almost immediately there was no need for him to attend. He had had other cases in which he found Bryonia 10M extremely valuable. Dr. Hardy added that Bryonia was very useful. In one case she gave a dose of Bryonia where the patient was lying on the painful side and did not want to move, which cleared up in ten minutes. Dr. Fraser Kerr said that the Aconite cases had interested him; he thought that the mental aspects were not so much mental as characteristic of the whole case. In one of his own cases of a child of 11 or 12 with asthma who was in a dreadful state he gave Aconite and within a few moments she was relatively easy. The mental aspects characterized the whole case. Dr. Ghai said that during the last four or five years he could not remember a case where he had used morphia in a very large panel and private practice. He could recall three or four cases of children with earache, flushed, dilated pupils with the pain coming and going constantly, for which he gave Belladonna 30 and the next day the child was better. Pulsatilla was very useful but usually in the Pulsatilla patient the pain did not come and go constantly. Dr. C. E. Wheeler thought that as all the members felt the same about Dr. Borland's paper a special message should be sent to him from the meeting. Dr. Borland would be gratified to know that his paper had been enjoyed so much. From the earlier years that he knew Dr. Borland he had always realized that he had the gift of classifying his experience to himself and getting the maximum value of it and that was why he could express himself clearly. He had managed to get Copyright 2000, Archibel S.A.

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what he wanted to say into a succinct space, although the paper was long there was no over-elaboration of detail. His principal feeling as he listened was certainly one of enjoyment but also of regret that he had not been able to sit under Dr. Borland. He must have made it easier for beginners by his ability to get into the other person's mind the essentials of a very wide experience. It was not merely one or two cases, he had watched these things and had been able to classify them. It was not that the drugs Dr. Borland had mentioned were unfamiliar, although the speaker would admit that he had never given Oxalic Acid in heart emergencies, and would like to see the next case which came along; in this way they were classified. There were one or two points which he would mention. The first was the relation drawn between Mag. Phos. and Colocynth. He personally had never been able to decide whether Colocynth. was a left sided drug; he had given it for left-side neuralgia. The most prominent ingredient in tincture of Colocynth. was Mag. Phos. so that in prescribing Colocynth. one was giving Mag. Phos., which raised an interesting point, and he made it because it was the general observation which enabled one to see whether the point had substance and one which should be studied. It had been in his mind since he realized that tinctures were mixtures; Lycopodium contained a lot of Silica and so on, so did Belladonna and the balsam compounds. He did not think atropine was a pain reliever, it was a relaxer. That was the point in his mind, whether the drug which presumably was responsible for the relief of a group of symptoms would be just as effective if it were given alone. The Colocynth. was chosen on the whole symptomatology which was all in Mag. Phos. - the pain, etc. Did Mag. Phos. indicate Colocynth.? Was it not probable that the vehicle was important and that it would not be so effective if the Mag. Phos. had not been given? I there was to be research he would suggest that this was a suitable subject. A far more detailed knowledge of the proportions of mineral ingredients in the vegetable tinctures was needed. Such research might throw a great deal of light on some symptoms when they would be associated in that way. There were potassium salts in Pulsatilla and it was the potassium salt which stood out in a particular tincture. With regard to dysmenorrhoeal pain where there was excessive periods and nausea, he would have thought of Ipecac. and Verat. Alb. In Podophyllum the one outstanding symptom was that there was normally a gastro-colic reflex-taking food into the stomach stimulated the movement of the colon and there had to be a motion after every meal; that would be a strong indication to him. He would suggest that a definite expression of pleasure for his paper should be sent to Dr. Borland. Dr. W. lees Templeton said that most of them felt that they had been back at school and he felt not only humbled but humiliated, for the must admit that he did not get such good results, possibly because one did not always get the symptoms. Most of the emergencies he saw were unable to give symptoms and one had to judge on appearances. He was glad, therefore, that Dr. Borland had elaborated on the appearance of the patient, because that was important. With regard to drugs, he did not find Ant. Tart. was useful in heart cases because he believed the pathology was different. He thought Ant. Tart. had a pulmonary pathology, not cardiac. Carbo veg. had a great and justifiable reputation as the "corpse reviver" and it did work when the appropriate symptoms were present. Cold sweat he looked upon as a guiding symptom for Verat. Alb. and he had verified its value in collapse. He was sorry that Dr. Borland was not more specific in his diagnoses, e.g. if pain was due to coronary thrombosis he doubted if the high potency alone should ease this particular pain in a matter of minutes. The wait with the patient for four or five hours for the second presentation was a serious matter when one was called out in the middle of the night, and like confinements many of these emergencies did occur at night. Why was this, he wondered. With regard to otitis media he felt that the success obtained depended on the stage at which the doctor was called in. If he got in early and there were good indications the result could be very good, but how rarely one did get to it early! Beyond that stage it was not so easy, and people talked as if a mastoid arose suddenly; it did not, it was not a question of an earache today and a mastoid tomorrow. He had seen Capsicum successful where there was tenderness and swelling of the mastoid, but with otitis media and a purulent discharge he would not delay in seeking the advice of the aurist. Pulsatilla and Silica were the great polychrests in otitis media with discharge. Belladonna and Chamomilla to abort and avoid discharge. Again with fifth nerve neuralgia it was question of stage at which the doctor saw the patient. If it was a chronic case the treatment was not easy. Supra-orbital neuralgia after sinus trouble was interesting, and frequently he found that China Sulph. was indicated and proved efficacious. Post-herpetic pain was another difficult condition to influence. If there was scar tissue present in the posterior root it would take more than one dose of Ranunculus to remove it. Many of these Copyright 2000, Archibel S.A.

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cases had already received Ranunculus in the acute condition. The drug he found most useful in the acute condition was Arsenic where the eruption was widespread, and Arsenic covered the pathology of the condition as well. Sciatica was rarely easy. The typical Colocynth. case where the pain was better for lying on the painful side was often quoted, but how often did one get it? Kali Iod. was the drug where the patient would not SIT DOWN in the consulting room; Rhus had to be considered in the fibrositic conditions. This was not a true sciatica, as shown by the improvement from exercise; a true sciatica rarely was. With reference to the colics he was glad Dr. Borland mentioned the symptoms of Dioscorea where the patient rolled about and did not know what to do - a very useful indication. Here the amelioration of Dioscorea was rarely obtained, but Clarke stresses the symptom "moves all over the place to get relief". As well as giving the homoeopathic remedy in these colic cases he confessed he often left something more palliative, but he was frequently surprised how rarely this was required. One useful indication for Lycopodium in renal colic was pain in the back better on passing urine. Some might say that it was a mechanical relief, but he doubted if this was so. He would like to stress again the importance of the objective description of the symptoms in these emergencies - the appearance of the patient, his colour, position and movements were usually all one had to prescribe on. In painful conditions so much depended on circumstances. If of short duration and there was little pathological change, speedy results could be obtained; but if the condition was chronic he feared that to claim too much would only lead to disappointment. No that results could not be obtained, but only as a result of a serious study of the whole case. In his clinic he advised that if local modalities were good, to prescribe in the first instance one these alone, and only when this failed to take the whole case, but he emphasized this method only where the local symptoms were good. Dr. A. Moncrieff added her thanks to Dr. Borland whom she considered our most brilliant prescriber in acute conditions, and what success she had in acute prescribing she felt was due to his teaching. In her children's clinic she had a great number of cases of otitis media and most of them came not necessarily in the very acute stage when probably Belladonna might be indicated, but with a history of acute earache for one or two nights. On examination of the drums there would be redness and possibly bulging, and she had found Pulsatilla so often indicated if the condition affected the right ear that she almost tended to use it as a routine remedy. If the left ear was affected she often found Silica useful, and Hepar Sulph. if the child was so hypersensitive to pain that he or she cried before being touched. Most of her ear cases either cleared up or discharged, the exception being the very tough drums which she occasionally had to refer to Dr. Cunningham. With regard to colics, she agreed with Dr. Wheeler that Verat. Alb. was very useful in dysmenorrhoea accompanied with vomiting, and had found Dr. Tyler's experiences of Tuberculinum also most effective in this condition. The President said that a message would be sent to Dr. Borland. He had found great pleasure in reading the paper. He would not say very much about the drugs, but Arnica for a tired heart was useful. Very often there were no indications on which o prescribe at all. He did not agree with Dr. Cooper. He saw two boys, brothers, the other day : John sat on the chair, Kit sat on his mother's knee but John would not do so, although he would do anything for his mother. He was typical Bryonia case and the other child was a typical Pulsatilla. With regard to Dr. Ghai's remarks on Belladonna in earaches, there was no drug for any one complaint, it often depended on the season of the year. There were remedies suitable for summer, autumn, winter and spring; just then with the high cold winds it was Belladonna. With regard to dysmenorrhoea very often Mag. Phos. would help in the acute attack, and the remedy which had helped him the most was Tuberculinum 6, and it very often eliminated the need for Mag. Phos. They all knew that Carbo veg. was a "corpse reviver"; with regard to Veratrum Alb. he had a very severe diarrhoea one day, with a cold clammy sweat. He took a dose of Veratrum Alb. and in twenty minutes was relieved. A patient came to him with neuralgia in the face, he got her X-rayed and found a black speck in one of her teeth. For two years she had amalgam in that tooth and she had to have it removed. One had to be careful that there was not some such cause for pain in the face.

BORLAND D. M., The Treatment of Certain Heart Conditions (bl2)

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BORLAND Douglas M.

Acute heart failure

Arsenicum album
-There will be the typical Arsenic mental distress, with extreme fear, extreme anxiety, mental and physical restlessness, with constant thirst and desire for small sips of ice-cold waster. -So far as the actual local symptoms are concerned, the main complaint is of a feeling of extreme cardiac pressure, a feeling of great weight or constriction of the chest. Associated with this the patients feel as if they cannot get enough air into the lungs, and feel that they are just going to die. -The patients as a rule are cold, they feel cold, though they may complain of some burning pain in the chest. -In appearance, they always look extremely anxious. They are grey, their lips are rather pale, may be a little cyanotic, and they give you the impression of being very dangerously ill. They very often have a peculiar pinched, wrinkled, grey appearance. -As a rule in these cases one gets a history that the attack has developed quite suddenly, and the response to Arsenic should be equally quick. In a case of that sort, if one does not get a response to Arsenic within a quarter of an hour the patient is not an Arsenic patient. The first response that one ought to get is a diminution of the patient's mental anxiety and extreme fear, the restlessness beginning to subside, and the patient beginning to feel a little warmer. -In a case of that sort my experience has been that one is wise to administer the highest potency of Arsenic available, because this is the kind of case that will die very rapidly and no time should be wasted on low potencies. The Arsenic seems to act very much like a temporary cardiac stimulant, and I find that in the majority of these cases one has to repeat the dose, certainly to begin with, about every 15 minutes. -There is a very important practical point in connection with these cases, namely, that one very often sees a case of this sort which responds perfectly well, the patient is better, everyone feels he is getting over it, and then in 3, or 4, or 6 hours the symptoms begin to come back, the patient no longer responds to Arsenic and collapses and dies. That was my experience at one time. -Then it began to dawn on me that had I cut in with another drug during the reactive period I could have carried these patients on. -I found that when I did this they did not get the secondary collapse, and one saved them. But to that one has to get in the secondary drug within 4 to 6 hours of the primary collapse while the patient is responding to the Arsenic, otherwise there is great danger of a secondary collapse which one cannot combat. -This seems to be one of the very few instances in which one appears to ride right across the dictum that so long as the patient is improving one carries on with the same drug. In these acute Arsenic cases if one has set up a reaction at all one has to take advantage of the reaction, and if one does not do so the patient will sink. -The drugs which, as a rule, I have found these Arsenic cases go on to in the reactive stage are Phosphorus or Sulphur, but that is by no means constant, I am merely throwing it out as a help. -One can easily picture that grey, pinched, anxious Arsenic patient responding, getting a little warmer, a little less grey, a little less pinched, a little less drawn, a little less anxious, a little more color, and going on to a typical Phosphorous. Equally one can see them going to the other extreme where they are too hot, with irregular waves of heat and cold, rather tending to push the blankets off, still with air- hunger, and going on to Sulphur. -These are the two commonest drugs, but whatever the response is one ought to be able to follow it up immediately the reaction is well under way.

Antimonium tartaricum
-The Antimony tart. patients present a somewhat similar picture, but there are clear points of difference. -In Antimony tart. there is more a definite tendency towards cyanosis than in Arsenic, one never sees an Antimony tart. patient without very definite signs of cyanosis. This may involve the whole extremities or may be confined to the finger and toe nails. -One never sees the same kind of mental anxiety in Antimony tart. The patients are more down and out, much more hopeless, more depressed. They are never quite so restless and never quite so pale. Copyright 2000, Archibel S.A.

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-Again, there is none of the thirst one meets with in Arsenic, in fact anything to drink seems to increase the patient's distress. -Another contrast is that the Antimony tart. patient is very much aggravated by heat, and especially by any stuffiness in the atmosphere. There is one point worth nothing here as a contrast between Antimony tart. and Carbo veg., Antimony tart. patients do not like a stream of air circulating round them, they want the room fresh, but they like it still. -In most of these Antimony tart. patients there is a very early tendency to oedema of the lower extremities. -Another point which helps you in your Antimony tart. selection is that practically all these patients have a very thickly coated tongue a white coat with a rather sticky, uncomfortable mouth. -They have a feeling of fullness in the chest rather than the feeling of acute pressure found in Arsenic. And one usually finds pretty generalized, diffuse rales in the lower parts of the chest on both sides. -In contrast to Arsenic, if one has a case of this type it is the kind of collapse one meets with after a pneumonic crisis if the patient responds to Antimony tart. it will carry him through. -One does not have to be on the jump to find the follow-up drug as one has to be in the Arsenic case.

Carbo vegetabilis
-presents the classical picture of patients with all the symptoms of collapse. They have the cold sweaty skin, they are mentally dull, rather foggy in their outlook, have not a very clear idea of where they are or what is going to happen to them. They have the most intense air hunger, an, in spite of their cold clammy extremities, they want the air blowing on them, they cannot bear to have the bedclothes round their necks, and they do definitely benefit from the administration of oxygen. -They are very much paler than the Antimony tart. patients, the lips tend to be pale rather than cyanotic, and there is none of the underlying blueness one associates with Antimony tart. -The next point is that they always have a feeling of horrible distension. It is very often complained of not so much in the chest as in the upper abdomen, and their cardiac distress is always associated with a good deal of flatulence. -Like the Antimony tart. patients, any attempt to eat or drink tends very much to increase their distress, and they have none of the Arsenic thirst. Another apparent contradiction you come across in Carbo veg. is that, in spite of their desire to be uncovered, and the intolerance of the blankets round the upper part of the neck or chest, these Carbo veg. patients complain of ice-cold extremities, they feel as if the legs are just lumps of lead, and they cannot get them warm at all. -I think in Carbo veg. one has to be careful as to how long one is to keep up the administration once the patient is responding, sweating less, the surface becoming warmer, and the distress less acute. It is wise then to hunt round for a second drug in case of need, because some Carbo veg. patients do relapse, although many of them make quite a straight recovery on Carbo veg. One does have to be careful. If one finds a patient who has responded up to a point on Carbo veg. it does not follow that a higher potency of Carbo veg. is going to carry on the good work. As a rule it does not, and it is much better to hunt round for a fresh drug to keep up the reaction. Often when the patient has responded only up to a point to the administration of Carbo veg. the follow-up drug will be found to be Sulphur, but Kali carb. should always be considered.

Oxalicum acidum
-has one or two very outstanding symptoms which are often met with in cases of collapse, and which are a great help in the selection of the drug. -First, the patients always complain of a feeling of the most intense exhaustion. Associated with that exhaustion there is usually a sense of numbness. The patients very often they say they don't feel as if they had any legs at all. -The skin surface is just about as cold and clammy as it is in Carbo veg., but there is a peculiar mottled cyanosis in Oxalic acid which one does not get in the other drugs. The finger tips and finger nails and toe nails will be definitely cyanotic, but in addition to that there is a peculiar mottled appearance of the hands and feet which is quite distinctive of Oxalic acid. There is a somewhat similar mottled, cyanotic appearance in the face, very often over the malar bones. -The patients, in contrast to the Arsenic patients, want to keep absolutely dead still, movement of any kind vastly increases their distress. -In addition to their general distress, most of these Oxalic acid patients complain of peculiar, very definite, sharp, precordial pains. -The pain is not like the typical angina's pain, it is a sharp pricking sort of pain which usually comes through from the back Copyright 2000, Archibel S.A.

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and may run up the left side of the sternum towards the clavicle, or down the left side of the sternum into the epigastrium. -The most startling cases giving this picture that I have seen have been in the critical stage of an influenzal pneumonia where the patient was just petering out, seemed to have lost all strength, was dead beat, and the heart was just giving out. All the patients of that type that I have seen have had left basal pneumonias. I remember seeing two or three cases which apparently were doing quite well on Natrum sulph. and collapsed, and they reacted beautifully to Oxalic acid. But one does get indications for it in chronic cardiac cases as well.

Chronic heart failure

Lachesis mutus
-In all these cases indicating the Snake Poisons there is a rather purplish bloated appearance. They all suffer from a feeling of tightness or constriction in the chest, more commonly in the upper part of the chest, and they are all intolerant of any weight or pressure of the bedclothes, or any tight clothing round the upper part of the chest or the neck. All are sensitive to heat; they feel hot, and they dislike a hot stuffy room. They all have a marked aggravation after sleep. They get acute suffocative attacks when they fall asleep, and they wake up in increased distress. -All these Snake Poison patients in their cardiac distresses have a marked aggravation from being turned over on the left side. -All of them have a very marked tremor, their hands are shaky. -And most of them, as they tend to get worse, become difficult and suspicious. If there were nothing more than that one would give them Lachesis. But in a certain number of these cases there are rather acute stitching pains which go right through the the chest from the precordium to the region of the scapula, associated with very marked numbness, particularly in the left arm and hand. And where that numbness is pronounced one tends to give Naja in preference to Lachesis. -If the the pain, stitching pain, is more marked, one tends to give Naja. If the feeling of constriction is more marked, one tends to give Lachesis. But their general symptoms are identical. I think possibly Naja is a little less red, less bloated looking, a little paler than Lachesis, but that is not very striking. -To my mind the the choice of one of the other Shake Poisons as distinct from Lachesis and Naja in such cases is always governed by the general symptom picture rather than by the purely cardiac picture. For example, one may require Crotalus horridus in a case of failing heart associated with acute sepsis, but one would be guided to the choice by the septic state rather than by the cardiac symptoms per se.

Lycopodium clavatum
-One gets indications for Lycopus in a case in which the heart is just beginning to fail; it is beginning to dilate a little, and the pulse is tending to become a little irregular. -The patients tend to be pale rather than cyanotic, and they are always restless. The outstanding symptom of the Lycopus case is that the patients complain of a horrible tumultuous sensation in the cardiac region. They very often tell one it feels as if their heart had suddenly run away and was just going mad. This is accompanied by a feeling of intense throbbing extending up into the neck and right into the head. -The other Lycopus symptom which helps one is that accompanying thus tumult taking place in the chest there is a very marked tendency to cough. It feels as if the heart just runs away, it sets up an acute irritation, and they cough. Another Lycopus distinguishing symptom is that their distress is vastly increased by turning over on the right side a contrast with the Snake Poisons which are worse turning over on the left side. -Lastly, these Lycopus patients have an intense dislike of any food, particularly the smell of food.

Laurocerasus
-The Laurocerasus picture is very definite, and I find the easiest way to remember it is to picture to oneself the appearance presented by a congenital heart of about 16 to 18 years of age. You know the peculiar bluish red appearance of the congenital heart, somewhat clubbed fingers, which, again, are rather congested, and the peculiar bluish Copyright 2000, Archibel S.A.

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appearance almost like ripe grapes of the lips. That is the sort of underlying color one associates with Laurocerasus. -These patients always suffer from extreme dyspnoea, and the type of dyspnoea is very nearly Cheyne Stokes in character. They take a sudden gust for breath, then two or three long breaths, then the breathing gets gradually shallower, then a pause, then two or three gasps, and so it goes on. -Another feature is that the respiratory dyspnoea gets very much worse if they are sat up; they are better in a semi-prone position. -There is a marked tendency to the early development of hypostatic pneumonia in such cases, and once this has appeared the patient's cough is more troublesome unless they are reasonably propped up. When lying the cough is worse. Sitting bolt upright produces a feeling of extreme constriction of the chest. Semi-prone is the position of choice.

Angina and pseudoangina

Aconitum napellus
-If one thinks for a moment of any cases of the kind one has seen one finds, I think, that the outstanding characteristic of the majority of these cases in their first attack is an absolutely overwhelming fear. The patient is certain he is going to die, and that he is going to die very speedily, and he is terrified. He is quite unable to keep still, and yet any movement seems to aggravate his distress. In a case of that sort a dose of Aconite high will give relief almost instantaneously. I have seen such a case and put a dose of Aconite on the patient's tongue, and before the medicine could be swallowed the patient was feeling better. It is almost instantaneous. I usually carried 10 m. as my highest potency in general practice, and I gave Aconite 10 m. -That man had a similar attack at a later date, and the anxiety, the distress, and the fear were nothing like so marked because he had come through one attack before, and Aconite had no effect at all. That has been my experience. Where one is dealing with the first attack and the patient is quite certain he is going to die, Aconite does relieve him right away, but it does not act in a second or later attack. So if one gets a man in his first attack a dose of Aconite will probably help and in no time he will be feeling more comfortable. If he has had a previous attack, however, Aconite is unlikely to help him.

Cactus grandiflorus
-If you have a patient who is having a later attack much the most likely drug to help is Cactus. Cactus has a good deal of anxiety and fear, but it is quite different from that of Aconite. It is not a fear that the immediate attack will kill him, it is more a conviction that he has an absolutely incurable condition which will eventually wipe him out. -That is one point about the Cactus indications. Another point is the type of the actual distress of which the patient complains. -He feels as if he had a tight band round the chest which was gradually becoming tighter and tighter and that if this tightness does not let up soon the heart will be unable to function. -It is that feeling of increasing tension which gives the Cactus indication. -In addition to the constriction there may be stabbing radiating pains from the precordium, but they are not so characteristic of Cactus as the intense constricting feeling, which is, of course, just exactly how the majority of angina's patients describe their feeling. -In these acute conditions I always give my drug high, because it acts much more quickly, and one must get relief as quickly as possible.

Arsenicum album
-Occasionally one comes across a patient having an anginous attack with very similar constricting feelings, not quite so intense as in Cactus where it seems to dominate the whole picture, but still a definite feeling of constriction. The patient has been ailing for some time, is rather anxious and worried, very chilly, and accompanying the feeling of constriction there is a pretty acute, distressing, burning sensation in the chest. These anginous patients respond very well to a dose of Arsenic. I have never seen Arsenic do anything in an anginous attack except in the rather broken down, ill-looking patient, who is a bit pale, rather withered looking, very definitely anxious, fearful, with that sense of Copyright 2000, Archibel S.A.

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Iodium
-There is another type of case which is very similar to that, with very much the same sensation, but the feeling of constriction, the feeling of tension, is described as being actually in the heart itself rather than involving the whole of the side of the chest. The patients are just about as anxious as the Arsenicum patients in fact all these anginous patients are anxious but instead of the intense chilliness of the Arsenic they are uncomfortable in heat and in a stuffy atmosphere. They are just about as restless, but, instead of the pale, drawn appearances which you get in Arsenic they tend to be rather more flushed, and, as a rule, they are dark-haired, dark complexioned people. They are usually rather underweight, in spite of the fact that one gets a report that they have always been pretty good livers, and they very often have an appetite above the average, although they have not been putting on weight. These cases respond exceedingly well to Iodine.

Spongia tosta
-There is yet another type of case in which instead of the complaint being of constriction it is of a sensation of progressive swelling in the heart region. It feels as if the heart gets bigger and bigger until it would finally burst, and this sensation of fullness spreads up into the neck. -This sensation of fullness and swelling is very much aggravated by lying down, when the patient feels as if he would nearly choke, and it is accompanied by pretty acute pain. The patients themselves are chilly, and any draught of air increases their distress. -In addition to their feeling of distension, they usually complain of more or less marked numbness, particularly of the left arm and hand, though very frequently there is numbness of the hand without any involvement of the arm, and not infrequently they complain of numbness of the lower extremities, too. -As a rule, the face and neck give you the impression of being somewhat congested, they do not have the pale, drawn, wrinkled Arsenicum appearance. -These cases respond well to Spongia.

Spigelia anthelmia
-There is another drug which is useful in the case which has not got the typical anginous constriction, but has much more the pseudoanginous stabbing, radiating pains charp, stabbing pains starting in the precordium, spreading up into the neck, may be across into the right side, or may be more or less numbness involving the whole affected area, and as a rule the pain that they stress is a little eased by turning over on the right side. -Accompanying the stabbing pains there is always more or less marked hyperesthesia over the precordium. If you attempt to percuss out the area of cardiac dullness the patient resents it extremely. Any movement aggravates the pain, or brings on a violent attack. These cases respond very well indeed to doses of Spigelia.

Lilium tigrinum
-There is a condition which is not an angina at all, but which one meets with in hysterical women. One fails to find any cardiac lesion, but the patients will produce a symptom- picture which one finds difficult to distinguish from a true anginous attack. That is to say, they have very marked stabbing, radiating pains, and they very often have an intense hyperaesthesia of the chest wall. They are very depressed, they are very frightened, and they are intensely irritable. They are sensitive to heat, and they distress is aggravated by any movement. -In addition to their stabbing pains they have the anginous sense of constriction, tightness, of the chest wall. -These cases are usually associated with some kind of pelvic lesion, or a history of having had some gynecological illness. -I have seen quite a number of these cases now in which I have had an electrocardiogram done which showed no lesion at all. -And all the symptoms have cleared up entirely on doses of Lilium tig. -They are two other medicines which are of great value in treating heart conditions, namely, Cratoegus Oxyacantha and Lactrodectus mactans.

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Heart conditions in general

Crataegus oxyacantha
-The condition in which I have found Crataegus of the greatest value is the myocardial degeneration with a steadily failing heart. -In such a condition there will be the usual accompanying symptoms, steadily increasing pulse rate, signs of pulmonary congestion, a certain amount of oedema, slight cyanosis, and aggravation from any exertion. -In such a condition Crataegus in low potency has in my experience produced the most dramatic effects and an astonishing amount of recovery in the apparently irreparably demaged heart. -I am in the habit of giving Crataegus 3x every 3 to 4 hours for several weeks.

Latrodectus mactans
-The indications for Lactodectus are again in cases of cardiac failure. The type of case in which Y have found it most useful is in a case of heart failure accompanied by, or dependent on, a definite valvular lesion. -As in Cactus, there are the usual physical signs of a failing heart, but, in addition, in Lactrodectus there is always very marked irritability, and the patients always complain of numbness of the left hand and arm, and they usually have precordial pain, which may be of any degree of severity. -In such a case I have found great help from the administration of Lactrodectus 12 or 30 , given at short intervals, say 2 to 4 hours, for a matter of 24 hours, and then repeated only when necessary.

BOUKO LEVY M., Homeopathic and Drainage Repertory (bkl1)

BOUKO LEVY

Preface
FOREWORD This family book can be used everyday by mothers, therapists, and doctors. With this book, the most effective and least toxic medication can be found to treat diseases occurring in the family. Of course, there is no replacement for a doctor trained in homeopathic medicine. However, this book can be of great assistance when there is an emergency or if a doctor is not available. Once a physician is consulted, the information obtained by using this book to analyze a critical situation will be of great help. This book can also be used at the beginning of the homeopathic medical student's training to obtain good results. These successes will allow the student to gain self confidence and appreciate how homeopathic reasoning takes into account the individual reactions of a patient. By using the information in this book on drainage techniques, practitioners who are already familiar with homeopathic prescribing will add tremendously to their successes. In the past one hundred years, environmental, nutritional, and chemical stresses have changed and the sensitivity of the patient has increased while the strength of their immune system has declined. Therefore, it is essential that the practitioner help the patient regain and maintain their health as quickly as possible by draining or detoxifying the organs and balancing their functions through biotherapeutics. Many homeopaths combine the new biotherapeutics of phytotherapy, phytogemmotherapy, organotherapy, trace elements, and satellite drainage remedies, with classical homeopathic prescribing. These biotherapeutics, which have their roots in the old healing philosophies, will help a patient reach and maintain their optimum health. Copyright 2000, Archibel S.A.

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Most of the chemicals physicians have on their therapeutic palette can bring on very unpleasant side effects and sometimes these side effects are very dangerous. Allopathic drugs may also stop certain symptoms of a chronic disease, but this does not mean they can cure the patient. Homeopathy, however, is a family medicine. It acts well on acute diseases such as infections, colds, headaches, athletic injuries, cystitis, etc., as well as on chronic diseases such as allergies, arthritis, asthma, eczema, colitis, mastitis, etc.. Overall, it is a complete system of medicine related to the other branches of the Healing Arts. Many patients will derive a great benefit from combining homeopathic techniques with diet, acupuncture, chiropractic and osteopathy.

Homeopathic medicine and cybernetics

"We shall never gain complete control of nature; our organism, which is itself an element of nature, will always be perishable and limited in its power to adapt, just as in the amplitude of its functions. But noticing this must not paralyze us; on the contrary, it indicates to our being the direction to follow." - Sigmund Freud -

Discomfort in the Civilization - 1929.

Our solar system is known as a cybernetic system in which the planet earth and other planets interact and function as a whole system. Our [body's systems also obey the same general laws as the rest of the universe: each organ, cell, hormone, vitamin, etc., all interact and react with each other in order for the body to function within its own organization. The planetary system contains all the elements necessary to maintain life. Homeopathic medicines are elements taken from this system, either from the plant, animal, or mineral kingdom. When they are prepared according to homeopathic procedures, these medications become powerful natural remedies, without dangerous side effects. Homeopathy is a natural system of medicine based on the experimental scientific method. It is also a cybernetic system in which the totality of the organization is interdependent on the dynamics of communications between subunits, i.e. cell to cell, organ to organ, hormone to hormone, etc. The ecosystem is a loop or feedback system, defining a group in equilibrium by its entries and exits. A homeopathic remedy acts with the very precise coded information that it gets more precise with increasing potencies. Most of the natural elements circulating in our body such as hormones, vitamins, trace elements, D.N. A., etc., are found in very small quantities and are naturally succussed or shaken about 80 times a minute by the force of the heart beat. Homeopathic remedies which are prepared by dilution and dynamization contain the same type of coded information that exists in these naturally occurring diluted and dynamized bodily elements. Also, the information contained in a homeopathic remedy comes from the three kingdoms of nature and is more accessible and penetrating to the systems of the body than any synthetic drug. This natural analogy is the basis of homeopathic reasoning and explains why homeopathic remedies are more effective than synthetic drugs at correcting disorders in the body's systems. In other words, homeopathic medicine helps the individual to adapt to the general laws of the planetary system where they live and follow its evolution.

The new biotherapeutic remedies Drainage

The disorders that the patient presents to the homeopath are superficial expressions reflected from their deep reactive mode. Each person is made of various layers and the homeopath must take them off carefully, one by one, to penetrate deep into the mechanisms of the patient. As the homeopath removes each layer, the body needs assistance in detoxifying and tonifying the affected organs. It needs drainage of the essential emunctories. It usually takes many years to become a good homeopath. The materia medica evolves all the time and the repertories are very large. Copyright 2000, Archibel S.A.

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So, how can we quickly get good results in chronic diseases? An easy way to penetrate the homeopathic world, is to use the techniques of drainage. This is the perfect field of action for the new biotherapeutics which have been prepared from the three everpresent kingdoms of nature, i.e. the plant, animal, and mineral kingdoms. These new biotherapeutics are excellent for all ages. They are particularly effective for all chronic diseases such as allergies, ear, nose, and throat pathologies, woman's health, rheumatisms, digestive disorders, overabundance diseases, stress management, and general ageing functions. In most cases, the patient needs to stimulate the organs affected by a chronic disease. The body's cleaning and fortifying abilities are naturally maintained by the wheel of emunctories. Two courses of emunctories treat and eliminate the stream of toxins along this wheel. The first course goes from the skin to the digestive system and then to the respiratory system. The second course evolves from the urinary system, then goes to the osteo-articular system and finally to the cardio-vascular system. All of the emunctories are govemed by the endocrine and nervous system and must be considered at each stage of treatment. Our individual wheel of emunctories turns according to our own constitution, reactive mode, and line of life. In the evolution of a chronic disease, the order in which the different organs are affected shows the exact treatment strategy to follow and the type of drainage the patient needs. The key to chronic disease treatment is good detoxification. Drainage regulates the activity of the blocked or deficient organs and improves the quality of the essential emunctories. This is the first condition necessary for a quick and complete healing. Drainage and hygiene of the body are always necessary to correct and maintain health.

Techniques of drainage
phytotherapy: plant extracts, in mother tincture (M.T. ) and phytogemmotherapy: bud extracts, in first decimal ( lX) Plants are the basic elements to use for the drainage of all chronic diseases. They must be used for prolonged courses of treatment, usually for a minimum of 2 months each. It is important to alternate the different plants according to the rhythm of seasons: vascular plants should be given in the Summer and rheumatic plants in the Winter, liver detoxifying plants in the Spring and kidney detoxifying plants in the Fall.

Organotherapy
Organotherapeutic remedies are healthy organ extracts or organ secretions prepared according to the general rules of homeopathic remedies. The most commonly used potency is the 4C.

Action of the remedy according to its potency

4C stimulates the organ 7C regulates the function 9C suppresses the activity All diseases evolve to a cellular destruction of the system. Organotherapy will help to slow down the natural and pathological deterioration of the organ and its function. Organs must work in harmony with the body so that each organ can assimilate the proper nutrition from the body as well as help to maintain the health of the body. Organotherapy represents a vital support for over stressed organs and must be started in all lesional pathologies. Along with, or after, prolonged allopathic treatments, organotherapy will support the organs and help them to recover their natural functioning.

Trace elements
Trace elements are metals and metalloids present inside the human body, in minute quantities, necessary for normal Copyright 2000, Archibel S.A.

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metabolic functioning. As biotherapeutic remedies they can be used in either liquid or pill form and are known as oligotherapeutic remedies. They should be used when the patient has a functional pathology. A functional pathology means that the patient does not have any deep organ lesions, rather, the disorders are due to the difficulty of the person to adapt to stressful conditions. There are many cases where oligotherapy is an essential part of the treatment. For example, in arthritis it is a major complementary therapeutic; during viral infections it stimulates the immune system and facilitates a quick and complete healing.

Satellite remedies
Satellite remedies facilitate the action of polychrests by improving the function of the affected emunctories. In acute and chronic pathologies they aid in the drainage of the patient. Some have a very sharp action such as lemna minor, the satellite of thuya and calcarea carbonica, acting on the nose mucosa. Others have a wide emunctorial field of action such as chelidonium, the satellite of several polychrests, acting on many emunctories. They should be used before the polychrest or nosode and during the entire chronic treatment, in 4C to 7C potencies, 1 to 6 times a day or less, or as needed. They will help to prevent the aggravations that are produced by a deep acting remedy and permit the stabilization of a chronic disease. Drainage is the easiest and most natural way to safely practice preventive medicine.

The four constitutions and four reactive modes

The four constitutions describe the patient's framework, they determine the predisposition and sensitivity to develop specific pathologies. The four reactive modes direct the evolution of the chronic diseases, they show the development of the body and it's functions. The human edifice is a mosaic made of the four constitutions and four reactive modes. However, each person is characterized by 1 or 2 constitutions and reactive modes which evolve naturally throughout their life. Some patients present one constitution that is very closely related to one reactive mode. For example, carbonic can be very closely related to psoric, phosphoric to tuberculinic.

The four constitutions

The carbonic constitutional type develops broadly. The skeleton is thick and resistant, the hands and teeth are strong and square, the joints are stiff. They are punctual, obstinate, like discipline and respect the law. They have a tendency to congestions, obesity and sclerosis. The phosphoric constitutional type grows thin. The skeleton is long, fragile, and very flexible. Their teeth make the dentist's day. They are creative, artistic, and suffer from being oversensitive with wide mood swings. They have a tendency to decalcification, a sluggish lymphatic system, chronic suppurations and organ degeneration. The natrum constitutional type grows in a vague diamond shape. All of the tissues are bloated by water retention. The walk is slow and disturbed by an ineffective anxious restlessness and all kinds of tics. They are suspicious, introverted, secretive and obsessional. Their tendency is to develop chronic infections, and in particular warts and tumours in the genital system. The fluoric constitutional type has a twisted growth. The skeleton presents with varied malformations and asymmetries with marked flexibility and hyperlaxity of the joints. They walk as though they are on a tight-rope. Intuitive or insensible, fast or slow, genius or retarded, their nervous system is always involved. Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica They will develop vascular disorders and ulcerative processes.

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The four reactive modes

The psoric (earth) reactive mode has centrifugal reactions. They are improved by eliminations, which reestablishes their balance. The pathologies alternate periodically with arthritis, parasitosis, allergies, increased IgE, urticaria and hay-fever, eczema and asthma, psoriasis and piles, skin and intestinal diseases, etc.. The eliminations, natural and pathological, are ill-smelling and cause itching. Between the periods of elimination they feel well, but with functional ageing they develop temperature regulation disorders, fatigue, and abnormal hunger. Sedentary life, overabundance, lack of physical exercise and allopathic suppression of their attempt to eliminate will progressively break down the psoric. Their reactive mode is to balance. The tuberculinic (air) reactive mode evolves by sudden paroxysmal attacks according to their extreme sensitivity. Some tuberculinics present with allergies while others present with anergy. Some present with no specific defenses and others present with increased IgG. The Lymphatic, venous, hepatic, and respiratory systems are predominantly affected with a general exhaustion syndrome and nervous hypersensitivity. Their endocrine disorders are dominated by a hyperexcitability of the thyroid gland. They have a mineralization defect that is particularly aggravated during the growth periods of childhood and adolescence, and in old age it is associated with the luetic reactive mode. Mentally and physically, this person is bounced up and down by cyclothymic rhythms (alternating moods of elation and mild depression); The eliminations exhaust the patient. The chronic disease state evolves quickly into a condition of cellular degeneration and necrosis, such as hepatitis or pneumonia. Their reactive mode is to over-react. The sycotic (water) reactive mode drags into conditions of progressive degeneration. Toxins, germs, vaccinations, and prolonged allopathic treatments aggravate the deceleration of their metabolic functions and the intoxication of their reticuloendothelial tissue by water retention. All of the symptoms are aggravated by dampness. They are like a garbage can that is maladjusted to their environment and cannot get rid of the toxic wastes that they accumulate. They usually develop persistent chronic infections, especially E.N. T. and genito-urinary infections, obsessive ideas, and tumours that are the result of a failure of their normal immune system function. The body is progressively invaded by overabundance diseases. The patient repeats the same action, the same behaviors and physical tics, over and over. Their reactive mode is no reaction. The luetic (fire) reactive mode presents with a physical and mental disharmony that leads the patient to ulcerative and sclerotic processes. The target organs are the vascular walls, elastic tissue, bones, skin, mucous membranes, throat, and neuroendocrine system. They manifests entire system imbalances and as a result of being dominated by the speed of life, pathologies related to environment stress. They also develop cyclothymic instabilities, spasmodic disorders with insecurity syndromes, and growth disorders that in the extreme result in being either a midget or a giant. Restlessness and fears are aggravated during the night. These paradoxical behaviors and cellular mutations drive their life of anarchy. They evolve with infection and necrosis, induration and sclerosis, exostosis, decalcification spots and ptosis. Their reactive mode is to live in unbalance.

Treatment of the reactive modes

Treatment of the chronic patient consists of aiding the affected organs in regaining their strength and reestablishing a balance between the function of the body and the affected organs. Drainage of each reactive mode is essential to slow down the natural ageing process. The psoric is always overloading themselves with food, drink and activity. Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica They need prolonged digestive drainage and a good diet with daily physical exercise. The tuberculinic must always receive mineral salts and intense periodical drainage to activate the venous, Lymphatic, hepatic and pancreatic systems. Drainage of their nervous system is essential. The sycotic must unblock their emunctories and stimulate their immune system, especially with organotherapeutics. They need prolonged digestive and urinary drainage. The luetic needs drainage of the arteries, veins, and capillaries, as well as, regulation of the nervous system. They might need mineral salts and endocrine drainage during periods of growth and in old age.

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The line of life

In order to correctly analyze the patient's case, the practitioner must be able to perfectly draw the patient's individual line of life. It's course shows the evolution of the reactive modes and the logic in the appearance of the different diseases that occurred during their life. From birth, all individuals will evolve by 7 cycles, just as they contain 7 lives in the planetary system. Each organ and function corresponds to a particular planet: the brain to the Moon, the liver to Jupiter, the kidneys to Venus, the lungs to Mercury, the gallbladder to Mars, the spleen to Saturn, and the heart to the Sun. The 4 reactive modes also follow a natural evolution during our life, just as our growth and our maturity follow natural cycles until death. The first cycle corresponds to intra-uterine life. From birth, the line of life can be divided into 6 essential cycles: birth until 7 years, 7 to 14 years, 14 to 21 years, 21 years until the menopausal or andropausal period begins, the period of menopause or andropause, and finally old age.

The first cycle intra-uterine life

O1 corresponds to the first moment of birth, when the two germinal cells meet and combine producing the first embryonic cell ,which develops into a fetus in total darkness for 9 months. This is the first program that encodes hereditary information about the immune functions. O2 corresponds to the second birth, the discovery of oxygen and light. O1 to O2 contains the essential mystery of creation. Embryonic and foetal studies give very precious information to the doctor about the human body; for example, the same type of cells produce the skin and nervous systems, another type of cell produces both the genital and urinary systems. All of the changes that take place in the mother during the pregnancy are extremely important for understanding the future health of the mother and her child.

The second cycle the first seven years

The second program is encoded from O to 7 years and will determine many of the disease patterns for the rest of a person's life. During the first cycle of 7 years, there is a natural evolution of the four reactive modes along the line of life which marks the development of any healthy child. The infant is a psoric, they remove stresses by skin eruptions and digestive disorders. When these two emunctories are surpassed, respiratory system pathologies appear. The depth of the hereditary psora can be precisely evaluated from these first moments of the child's life. When the child starts walking and talking, they express their luetic reactive mode. They experiment with their center of gravity and the power of language, eventually becoming self-sufficient. This is the time for night fears and restlessness. When the child discovers cleanliness, between the ages of 18 and 36 months, they become sycotic. They can repeat the same nose or ear infections over and over, never becoming completely healthy. Their behaviors are obsessional, not only mentally but also physically, with a lack of immune system response. During growth accelerations, they are tuberculinic. They have sudden and violent pathologies, such as fevers, bronchitis, parasitosis, arthritis, colics, etc., with or Copyright 2000, Archibel S.A.

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superimposed on chronic fatigue and decalcification. At this period the child must always recieve mineral salts, such as Schuessler salts. During the first seven years of life, this natural movement of the reactive modes can be disturbed by many factors such as infectious diseases, epidemics, vaccinations, pollutions, stresses, etc. The line of life often shows the patient's individual sensitivity with one or two reactive modes dominating their history. The evolution of this second cycle corresponds to the visible maturation of their immune system and will express itself through similar pathologies all the rest life of their life.

The other cycles

Seven years of age corresponds to the beginning of the Oedipus cycle. This period of time is dominated by the luetic reactive mode, just as when the child learned to walk they needed the same luetic energy. During the third cycle, from ages 7 to 14 years, the child develops into puberty. The endocrine glands are stimulated and develop beginning with suprarenal, then the thyroid. When the genital glands mature puberty is established. In the fourth cycle, from ages l4 to 21 years, these natural endocrine changes will orient the reactions of the person to the tuberculino-sycotic mode which can remain with them their entire life and provoke tumoral pathologies when their fertility declines. After 21 years of age, during the fifth cycle of mature age, the different methods of adaptation turn around and show which of the 4 reactive modes the patient is operating in for that particular period of time. Usually the pathologies of the first two cycles return. The sixth cycle, the period of menopause or andropause, is a particularly luetic period. The seventh cycle is dominated by elderly emunctories which are worn out with deep lesions of the vascular and osseous systems. This patient should be given a prolonged drainage of their emunctorial system. Respect the hierarchy of the the natural wheel. The individual line of life indicates the dominant reactive modes of the patient and shows the correct order to follow with the homeopathic therapy. The treatment strategy of chronic diseases lies in the precise analysis of the two first cycles, which point out the dominant general modalities of the patient. The natural evolution of the second and third cycle of the line of life

Symptoms and remedies Symptoms

The value of a symptom is proportional to: ( I ) the importance the patient gives to it, (2) its precision, described by sensations and modalities, (3) its peculiarity, symptoms which are unusual from the norm. In this repertory, the symptoms are described in two degrees; Ist degree symptoms are capitalized and 2nd degree symptoms are in lower case. However, all of the remedies are important inside each rubric. Etiological symptoms, when they are the real cause, are first in the hierarchy. General and mental symptoms are next and local symptoms have the least value. Above this hierarchy, the general reactive mode which can be recognized as accidents on the line of life, take a strong etiological and general value. One must be careful with the so called "etiological" symptoms. Most of the time they are a general modality and not the real beginning of the pathology. When the disease is not neuro-psychiatric any mental symptoms will have the most importance. In acute cases, mental symptoms that stand out will lead directly to the remedy. In neuro-psychiatric cases, the easiest and most useful symptoms are the general symptoms, i.e. , the general reactive mode, general modality, periodicity, side, temperature, climate, pain, sensory organs, sensations, appetite, aversions, Copyright 2000, Archibel S.A.

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desires, thirst, sweat, sleep, dreams, and sexuality. The local symptoms are at the bottom of the hierarchy. They can take a general value when they are recurring during the line of life or present in at least 3 organs as a particular reactive mode of the patient.

Copyright 2000, Archibel S.A.