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 disease. 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 mildly delirious quite early in the course of the disease. 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 drowsy; you can wake them up, but if you do you will get an incomplete answer and then 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 hard, 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 inability 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 complain 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.
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 Baptisia. 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 degree or 105 degree, and it is always accompanied by very considerable hot sweat.
The tongue in Pyrogen and Baptisia cases is sometimes 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 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 Pyrogens 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 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 symptoms 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 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 sentences 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 breathing, and they are simply terrified to lie down. They hate to go to sleep because of this sense of suffocation, and if 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 head- ache 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.