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 sometimes develop a hyperaesthesia over 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 hyperaesthetic 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.
I think you are liable to meet with Mercury pneumonias about 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 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 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 course, 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 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.
Hepar sulph
Where you are dealing with, a Hepar pneumonia you always have a septic type to extend with, and you get the impression that the patient is very ill. As a rule Hepar patients 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 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 a 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 reddened. Quite often in these Hepar pneumonias there is a deep spilt 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 tongues, 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 spilt 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 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 Hepars always feel much worse. Their sleep is unrestful and they have very distressing dreams, very often they are dreams of fire.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.