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.
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 pneumonias 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 disease 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 wants 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, sticky, whitish coat. But in spite 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 responsibilities 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 conditions 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 disease; 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.
Lobelia.
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 thinks, 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 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.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.