Late Pneumonia



The respiration in the Lycopodium case is always very difficult, short, panting, laboured breathing. The patients usually complain of a feeling of tightness in the chest, or even of an actual sensation of constriction.

The cough is always a very difficult, paroxysmal, violent, spasmodic cough. Very often the patient complains of intense rawness in the chest after coughing.

The sputum is always scanty, tough, and very difficult to get up. It is very often a yellowish-grey, blood-stained sputum, and not infrequently the patients tell you that it tastes definitely salty.

As a rule the patients complain of feeling chilly. They are sensitive to cold, but they dislike a stuffy room. Usually there is very little sweating, the skin may be slightly moist but there is no definite sweat. In most of these cases you will find your maximum involvement on the right side of the chest rather than the left. And you will always get a complaint of a good deal of abdominal flatulence, particularly is this so after taking anything in the way of food; the patient feels absolutely bloated on any attempt to eat.

As a rule these Lycopodium patients are very uncomfortable if they are lying on the back, their breathing becomes more laboured, and they are more distressed. They are very much better sitting up.

Another small point is that you will very often see these patients sleeping with their eyes half open, Not infrequently they have a very restless kind of sleep, and they often dream of fatal accidents.

In the Lycopodium case there is one very constant period during which there is a general aggravation of the patient’s – -distress, and that is between the hours of 4 and 8 o’clock in the evening. During this time you will get an increase of temperature, increased respiratory distress, and very often increased cough. Very often the temperature swings up about 4 o’clock, stays up until about 8 o’clock, and then begins to drop.

As regards the temperature in Lycopodium, commonly it is a medium high one, ranging round about 103 degree. The pulse tends to be rather compressible, soft and rapid.

Lycopodium cases respond well to 1om’s repeated 2 hourly.

Arsenicum.

Arsenicum is one of the drugs which you will require only in the collapsed stage of a pneumonic crisis; you seldom get indications for it during the active stage of a pneumonia.

The picture presented by the Arsenicum patient is very typical. There is always intense mental and physical restlessness. In the earlier stages of the collapse you will see the patient constantly tossing about, never still for a moment, and as the collapse goes on he gets weaker and weaker until he is hardly able to move, and even then his eyes keep it up to the very last.

Right throughout the whole picture there is exactly the same sort of mental state-extreme mental anxiety, extreme fear, The patient is certain he is going to die, he wants attention, wants somebody there, is afraid of being left alone, and wishes to goodness you would get on and do something for him.

The appearance of these patients is somewhat suggestive. As a rule they are pale, and rather livid looking, or they may be somewhat cyanotic, and the surface is covered with a cold, clammy, sweat. The lips are usually cyanotic; they may be rather full, but very often you will see them looking rather shrunken, shrivelled looking, and actually bluish.

The patients themselves are always intensely chilly. Very often there is almost a rigor; the patients keep shivering with cold, they want to be covered up, and they cannot bear any draught about.

They are always intensely thirsty, their mouths are parched and dry, and there is a constant desire for sips of water. The strange thing is that in spite of their general chilliness, they want their water as cold as they can get it.

The characteristic thing about the tongue in the Arsenicum case is its dryness. It may be red, or it may be brown, but it is always dry, dry to the touch, and the patient often complains of the mouth feeling burning hot.

Then as regards the cough in these Arsenicum cases, you will very often find the patients hardly coughing at all, they do not seem to have sufficient strength to cough. Any cough that there is is very useless and brings up no sputum at all. If the patients are not quite so ill as that, they have a very violent, suffocative cough which makes them sit up in bed feeling as if they were going to strangle.

They always complain of intense compression in the chest; it feels horribly tight, as if they could not breathe at all. And after coughing, or even when they are lying still, they often complain of burning pain in the chest. After one of these paroxysms of coughing they very often have violent pain round their lower ribs, and very often pain in the epigastrium, too.

The sputum in Arsenicum is always scanty, because, as I mentioned before, the patients do not seem to have the strength to get it up. Very often they cough it up into the back of the throat and just swallow it.

In these Arsenicum cases you are very apt to get a falling temperature; you may get an actual collapse temperature, with a running pulse and possibly a fibrillating heart. And the patients often complain of a horrible feeling of tremendous weakness in the chest.

The collapse in Arsenicum cases is very liable to take place in the early hours of the morning, it is usually sometime between 1 o’clock and 3 o’clock and is most likely between 1 o’clock and 2 o’clock.

Well, that is the picture as you see it. And here I want to put in a word of warning. If you have a case of that sort, with definite Arsenicum indications, and you prescribe Arsenicum and get a reaction taking place, unless you follow that Arsenicum up with another drug within the next twelve hours you will find your collapse recurring; then you will find that your patient does not respond to a repetition of your Arsenicum and that patient will die. The kind of response you get to Arsenicum is that the intense mental anxiety begins to subside, the intense chilliness subsides, the patient begins to feel warmer and more at peace. The intense sweating stops, the temperature begins to rise a little, and the pulse begins to steady down. Well that is the stage at which you must follow up with your next drug.

You may require any drug in the Materia Medica to follow up that reactive stage, but the two which are very much the most commonly indicated are Phosphorus and Sulphur. If you get your patient becoming warmer, the anxiety going, the pulse improving, the temperature rising, and instead of the white, livid appearance the patient becoming rather flushed, and still remaining thirsty, then the probability is that he is going on to a Phosphorus reaction. If, one the other hand, the response is not quite so complete, the patient is becoming a little warmer and then having cold waves, the anxiety is not quite so great but he is feeling frightfully tired out, he is still a bit sweaty, possibly the legs and feet are a little cold and the upper part a little hot, or possibly the legs and feet are a little hot and the upper part cold, he is intermittently hot then cold and chilly, then the patient is going on to Sulphur. And, as I already said, you will find that in the majority of cases Phosphorus or Sulphur is the drug with which you have to follow up your Arsenical response, and you will find a IM your most useful potency repeated 2 hourly.

Sulphur.

The last of these drugs I want to touch on in detail is Sulphur. There is practically no disease from which humanity suffers in which you may not find Sulphur indicated, and there are various occasions in pneumonia in which you may want Sulphur. It may be indicated in any stage of the disease from the second day onwards. You may want to prescribe Sulphur in one of these difficult cases which is not clearing, one in which you have had indications for a drug which has done a certain amount of good, then you have had indications for another drug which again has done some good, and finally you cannot get clear indications for anything and the patient is not yet well. An intercurrent dose of Sulphur will set up a response. You may get indications for Sulphur in a case in which the patient has done quite well up to a point, the temperature has come down, either by crisis or by lysis, and yet the physical signs are not improving to your satisfaction; a dose of Sulphur will very often clear up the whole thing, start your resolution, or clear up remaining patches in the lung. But these are not the cases I want to cover in the description of the straight Sulphur pneumonia.

I think the appearance of the patient is the first thing that makes you consider Sulphur in a pneumonia, and the second is the patient’s complaint.

In appearance the Sulphur pneumonic patient always gives you the impression of being very dusky and dirty looking. All the orifices tend to be red, the lips are red, the nose gives the impression of being red, the ears are red, very often there is a mild blepharitis, the eyes look congested and red, and the patient gives you the impression of being dirty and untidy.

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.