Late Pneumonia



As regards potency, in Carbo veg. one is dealing with an acute collapse, there is a dilating heart and a heart failure, and one must obtain an effect fairly quickly, so my personal preference is to go high and give frequently until I get a definite response. I would give cm’s every ten or fifteen minutes until I got a definite response. The kind of response one gets is that the patient begins to feel warmer. Instead of the icy coldness they begin to feel less cold, they look less cold, they are less cold to touch, and the sweat begins to disappear. I would then space the drug out and give it every half hour, until there were definite signs that the heart was taking up again, in other words, until the pulse was fuller, the distress getting less, and the cyanosis beginning to fade. As a rule you get the patient through the crisis in twelve hours. But to do that you must give frequent repetition to begin with, and you must keep up your action for some hours, giving cm’s all the time. I have tried low potencies in cases of this kind and the patients did not respond at all; I have then jumped up to a cm and the drug has had immediate effect. So much is this so that up in the private wards, where one quite frequently sees these cases, the Sister does not want anything but cm’s for them-that is how experienced Sisters come to look on it, they always want the highest potency you will order as they say the other is a waste of time. That is practical experience, it is not a desire for any particular potency.

Antimony tart. cases are not so acute, in them you are dealing with a water-logged chest rather than a sudden cardiac failure. It is slower in onset, and you have more time to play with. In these cases 10 m’s hourly at first and later two-hourly will be sufficient.

Kali carb.

I think Kali carb. tends to be indicated from about the fifth day of disease onwards, although you may get indications for it earlier. It is a very serious case, but it is a case that you see before the really critical stage comes along. Very often it is a case which has responded to a certain extent to one of your previous drugs, but you are not satisfised with its progress, the patient is still running a temperature and, although more comfortable, is not clearing up. It is in that type of case that you find your Kali carb. indications.

The appearance is always that of a patient who has been pretty exhausted by their attack. He looks rather pale, flabby, and washed out, and has a sort of haggard, exhausted appearance. Very often in Kali carb. there is a puffy look about the face. The patient always has an anxious, worried, rather frightened expression. And with that there is very often a good deal of tremor of the facial muscles, and twitching of the hands and fingers; he picks at the fingers, and picks at the bedclothes.

These patients dislike being left alone, they get more worried, more scared. They are definitely sensitive, they are very easily annoyed, very easily irritated, and they are particularly sensitive to any noise in their immediate neighbourhood.

The lips tend to be cyanotic, dry and cracked. As regards the tongue, I think most commonly Kali carb, patients complain that it feels as if it had been scalded; it is dry and red and has this burnt feeling. But you will quite frequently meet with a case in which the tongue has a dirty, greyish-white coat. As a rule these Kali carb. patients are not markedly thirsty; their mouth is dry, and they may want a little sip of water, but they are not markedly thirsty.

The cough tends to be very dry, and suffocative in type. And with an attack of coughing you will find these patients breaking out into a profuse sweat. The sputum is always scanty, difficult to expel, and very often it only comes up into back of the throat and is swallowed.

There are two very definite Kali carb. indications. The first is that these Kali carb. patients are frightfully sensitive to any draught of air, it produces a violent attack of coughing, a regular paroxysm, and it also produces a horrible sense of chilliness. The other characteristic point is the position taken up by Kali carb. patients in their respiratory distress. They always want to sit upright, and, unlike the other drugs we have considered, they lean forward and support themselves with their elbows on their knees, or they like a bed table across the bed and they lean forward on that.

Always in these Kali carb. pneumonic cases the patients have violent chest pains with their cough. The kind of pains they get are the stitches right through the chest, or acute stabbing pains in chest. The pains are very much aggravated by any motion, and, of course, they are produced by any of these violent spasmodic coughs. I think as a rule the maximum involvement is on the left side of the chest rather than on the right, and whichever side it is, it tends to involve the lower lobes rather than the upper.

You do not tend to get the same degree of cardiac failure in Kali carb. as you do in the two preceding drugs. You get a weak pulse without a great deal of tone in it, but you do not tend to get the acute dilation of the heart that you do in the others. You get a weak, running pulse, but not acute heart failure.

There is one other useful diagnostic point, and that is the time of maximum aggravation. It is in the early hours of the morning, between 2 and 4 o’clock. You may meet with it at any time during that interval, but you are most likely to get your worst period about 3 o’clock in the morning. Quite frequently you will find your Kali carb. patients sitting up in the typical position, gasping for breath, about 3 o’clock in the morning, with a horrible feeling of oppression and tightness in the chest and acute stabbing pains.

There is one point which sometimes tends to make you confuse your Kali carb.’s with your Carbo veg.’s and that is that in their pneumonias these Kali carb. patients do get a good deal of flatulence, a good deal of abdominal discomfort, and a good deal of abdominal distension.

When considering the question of potency you may have to be a little careful in dealing with old people in Kali carb. cases. Where you have indications for Kali carb. you are not dealing with an acute emergency, and in consequence you do not need your highest potencies. I would give Im’s to older Kali carb.’s for choice. The average case responds well to 10 M’s repeated in the usual way.

Lycopodium.

Of the last three drugs I thought of looking at I think Lycopodium probably follows the kali picture more closely than any of the other drugs; it is very similar in many ways.

In the majority of cases you do not get indications for Lycopodium before the second half of the course of the average pneumonia, in other words, it is not usually indicated until after the fourth day. As a rule, you will get a history that at the beginning of their illness these patients were mentally fairly active, and that they are now becoming very tired, very weary, rather worried about their condition, and not a little frightened.

In appearance, they give you the impression of being anxious; they have rather a worried look, and a practically perpetual frown. They are rather sallow in colour, a sort of yellow-ash-grey appearance, and they have obvious acute respiratory distress. The lips tend to be somewhat cyanosed, very often they are definitely cyanosed, and there may be a somewhat dusky appearance generally. If you see these patients latish in the disease, about the fourth or fifth day, you will find them becoming definitely weak, and rather torpid and sluggish.

The mentality of the typical Lycopodium pneumonia patients is a little difficult to get hold of because although they are anxious, worried about themselves, wanting attention, wanting somebody about, yet they are peevish and irritable with those trying to help them. They are rather domineering, they are definitely exacting in their demands on their attendants, and yet that is coupled up with the desire to get as much attention as they possibly can. After they have been asleep they are very liable to wake up in a very cross-tempered mood.

Associated with the respiratory distress, there is a somewhat pinched appearance of the nose which is not unlike the Antimonium tart. appearance, and there is a good deal of flapping of the nostrils. But there is more general twitching of the facial muscles in Lycopodium, and the nose gives the impression of being dusky, rather than sooty as in Antimonium tart.

Another point about the Lycopodium patients is that they always tend to have a very noticeable yellow discoloration of the teeth. Very often they complain of a sour taste in the mouth, and the tongue tends to be coated white. In addition to this coat there are often definitely sensitive spots along the margin of the tongue, and the patient often complains that it feels stiff and swollen. Lycopodium patient are rather variable as regards thirst. Sometimes you will get a Lycopodium patient who is definitely thirsty, but again you may get a patient who is not thirsty at all. If they are thirsty they prefer warm drinks to cold. And if they have much to drink it is very apt to produce a sensation of fullness and flatulence; it may actually produce a sense of nausea.

Douglas Borland
Douglas Borland M.D. was a leading British homeopath in the early 1900s. In 1908, he studied with Kent in Chicago, and was known to be one of those from England who brought Kentian homeopathy back to his motherland.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.