A further point which sometimes helps you is that the time of aggravation in Ferrum phos. tends to be in the early morning, usually between 4 o’clock and 6 o’ clock, whereas the Aconite time of aggravation is late in the evening, sometime up to midnight.
The character of the sputum is a help, though not so much in distinguishing between Ferrum phos. and the other acute drugs as between Ferrum phos. and Phosphorus with which it may easily be confused. In the Ferrum phos. cases you are liable to get a bright red streaked sputum, rather than the rusty sputum of the later pneumonia drugs, in other words Ferrum phos. is indicated in the early stage of consolidation. The Phosphorus sputum on the other hand is beginning to turn rusty, it is a darker red and there is more blood in contrast to the streaky sputum in Ferrum phos.
Belladonna.
Here again you have a very clear cut, definite picture. The onset of the Belladonna attack is just about as acute as that of Aconite. You often find a Belladonna case developing the same evening as the patient has been subjected to exposure. The attack is always very severe. It is attended by a violent temperature, running up to 105 degree or over, with intense excitement of the heart, and a pulse which feels as if it would almost burst through the vessels. The patient is always extremely excited, and I have seen these Belladonna cases, particularly in children, in which the patients have been practically delirious within twelve hours of the onset of the disease, with the temperature running up to 106 degree. They always have a bright red face, and very often you will find a generalized blush over the whole skin and the surface burning hot to touch.
If the patients go on to the delirious state-or possibly even short of that-you always find intense excitement in Belladonna It is not the extreme anxiety and fear of impending death which you get in Aconite. It is a question of excitement; and in the adult the Belladonna case is the type which comes into hospital and Sister reports: “I will have to get a special for this patient, I cannot keep him in bed, he is restless, excited and crying out, and almost impossible to control.”
The next thing which distinguishes these patients is the state of the pupils, which in Belladonna are always widely dilated. You can tack on to that the Belladonna photophobia, which is intense; these patients are invariably sensitive to light. If you are nursing a Belladonna pneumonia you are tempted to keep a light in the room as the patient appears to be terrifies of all sorts of things, but, if you do, for goodness sake do not let it shine on your patient. They seem to see strange things in shadowy corners, and one feels one must keep the light on to let them see what is there, but it is absolutely essential that it should not shine on them. This is a very useful distinguishing point, because some of the other drugs have a similar condition in delirium, but they hate to be in the dark and want the room lighted as otherwise they imagine all sorts of things in dark corners. Belladonna patients always prefer to have the room darkened because of their photophobia which outweighs all else.
Then as regards the thirst, Belladonna patients always have a dry mouth. It is always laid down in the textbooks that Belladonna is intensely thirsty, but I have seen quite a number of Belladonna pneumonias in which there was very little thirst at all; the patients complained of the mouth being very dry, hot, and burning, and yet they were not particularly thirsty. So do not be put off Belladonna because the patient is not as thirsty as one would expect from the statements in the textbooks.
In the pneumonias you do not get the typical strawberry tongue that is described in Belladonna; you are much more likely to find a congested, dry, dark red tongue.
I think a right-sided pneumonia is more common in Belladonna, but I have seen cases with the main involvement on the left side. The thing that is constant about them is that any movement of any kind is liable to bring on an attack of coughing. In the early stages, the Belladonna cough is a very dry, painful, tearing cough, and the sputum is usually very scanty indeed.
These patients always have a very intense, congestive throbbing headache, which is worse if they are lying with the head at all low, and is frightfully sensitive to any movement.
Another symptom of Belladonna which is sometimes helpful is that the patients are very liable to develop an acute hyperaesthesia of the chest wall over the affected area. The chest wall becomes astonishingly sensitive to touch, and is horribly painful on coughing. And, because of this hyperaesthesia of the chest wall the patients are unable to lie on the affected side.
Ipecacuanha.
The fourth of these drugs for the acute stage of pneumonia is Ipecac. and it applies much more to children than it does to adults. I do not know if you were taught, as we were that 80 percent. of children’s ailments start with an attack of vomiting, no matter what the child is going to develop. I think it is very nearly true, with the results that many of these children with a commencing pneumonia, or possible even more commonly with a commencing broncho-pneumonia, show very definite indications for Ipecac.
In my experience the onset of the Ipecac. pneumonia is a little slower than it is in the other three drugs. One usually does not find clear-cut indications for it under about twenty-four hours. The story you are given is that the child has been seedy the previous day, off its food, possibly feeling rather sickish, or it may actually have vomited. And I think Ipecac. is more commonly indicated in the milder weather than in the intensely cold weather.
In a pneumonia attack the typical Ipecac. child usually tends to be flushed. It is rather a dusky flush, and the child has a hot sweaty face. The temperature in Ipecac. is usually not so high as in the other drugs-it is round about 103 degree-and the pulse is not quite so bounding.
Always in these Ipecac. children the thing strikes you is the amount of mucus in the chest; there is mostly a diffuse, generalized rattle. And invariably the patients have very suffocative paroxysms of coughing. The point that makes you think of Ipecac. is that these suffocative attacks of coughing very often go on to definite retching and the child brings up a quantity of stringy difficult, blood-stained sputum. One has to distinguish these attacks from those found in some of the later drugs. In some of the Resolution pneumonias you find similar suffocative coughs, which again go on practically to vomiting, but in them the patients bring up quantities of dark, offensive blood, whereas the blood in the Ipecac. sputum is always the bright red of a commencing pneumonia.
After these paroxysms of coughing you often find the Ipecac. patients very exhausted, and then their flush disappears and you get the typical pallid, whitish, pale-lipped Ipecac. patient. You get the impression, after these attacks, that the patients are very tired, very wearied, and during that stage they are awfully difficult to please. They feel rotten, they feel sick, they do not want to be fussed, and they may ask for something, but they do not really want it and will refuse it if they get it, they are just miserable.
In their pneumonic attacks these Ipecac. patients always have a good deal of nasal irritation, with pretty violent of sneezing. I have never seen an Ipecac. pneumonia yet which did not have these sneezing attacks.
The appearance of the mouth is somewhat suggestive. It is usually rather sticky, and I have seen two different types of tongue in these cases. In a straight-going lobar pneumonia I think more commonly the Ipecac tongue is clean. But in a broncho- pneumonia, where there is probably a good deal of nausea apart from that caused by the actual attacks of coughing, I have seen an Ipecac. tongue which was pretty heavily coated. As a rule these Ipecac. patients are completely thirstless.
Another thing that is constant about Ipecac. patients is that they are always very sensitive to a stuffy atmosphere; it brings on their cough, and it increases their distress, so you find that they always like to have a current of air about them.
Well, that covers your incipient pneumonias, and you ought to be able to abort any of these cases in twelve to twenty-four hours. If you do not see the case early enough for that you will probably have to consider one of your other drugs. You may be lucky and get a Ferrum phos. which has persisted, or you may possibly get an Ipecac. which has persisted, but you are unlikely to get an Aconite after the first twenty-four hours, or a Belladonna after the first thirty-six hours.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.