Chelidonium.
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 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 and 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 learn 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 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 results are obtained by the use of the very highest potencies. I should say that in my own practice, in the average case, I would prescribe a 10 m, though where the indications were very clear my preference would always be to go higher provided there were no contra-indications. I give cm’s in preference to 10 m’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.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.