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 pneumonias, 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 pneumococcus 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 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 homoeopathic 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 clinician 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 clinicians. Instead of tending to neglect one’s clinical 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 know 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 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 point 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 were 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. They 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 pneumonia 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 the 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 sign 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 continuous 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 prescriptions, 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 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 more 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 pneumonia 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 the stage of resolution, in which the condition is beginning to clear up. If you 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 pneumonia 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.