Antimonium tart.
In the adult you expect to find the symptoms of Antimony tart. cropping up late in a pneumonia, you do not usually get them in the early stages, and by the time the patients have gone on to an Antimony tart. state they are seriously ill. The appearance of these patients is suggestive, they are pale, they have a pinched look, rather a bluish coloration of the skin, and they are covered with a cold sweat. The nose looks rather pointed, pinched in, and very often it has a somewhat sooty colour. Owing to the extensive chest involvement you will find the alae nasi flapping and with the obvious effort to get as much air in as possible all the muscles down the side of the neck are standing out and the patient is struggling for breath. The lips in typical Antimony tart. cases are rather livid, although if the patients are running towards a collapse, as they sometimes do in Antimony tart., the lips may tend to become paler, and in any case they are usually very dry.
The impression you get of these patients is one of extreme suffering. They are intensely distressed, and their main reaction is one of wanting to be left alone-“For heaven’s sake don’t disturb me.” They do not want to speak, they do not want to speak they do not want to be spoken to, and very often they do not even want to be looked at. The patients themselves are very miserable, and you often find them lying panting for breath and moaning.
As a rule there is a very thick coating to the tongue; it is a horrible, pasty, white coating, and the tongue looks just as if it had been painted with white enamel. in few cases you may find a somewhat brown coat, which is very dry, but that is exceptional. The outstanding point is that, in spite of the dryness of the lips and tongue, these Antimony tart. patients are completely thirstless.
Another practical point to remember is that these Antimony tart. cases have a loathing of food of any kind, and in particular any attempt to feed them on milk will produce an acute nausea-the Antimony tart. patients have an acute intolerance of milk.
As far as the actual chest condition is concerned, there is invariably an excessive secretion of mucus; standing by the bed you can hear the moist bubble in the chest. There is a very rattling cough, and yet, in spite of the rattle, there is very little sputum expelled. With the effort to expel that sputum the Antimony tart. patients usually suffer from pretty acute nausea, and they may actually vomit.
With their violent cough these patients suffer from a great sense of oppression in the chest, and very often there is great soreness of the chest wall. They cannot bear any weight on the chest at all, they want to push the blankets off, they want to get them away from their neck, and any suggestion of weight, even a single blanket, will embarrass them.
These patients are very sensitive to any stuffy atmosphere. They have an acute air hunger, and a warm room makes them very much more uncomfortable. And an important point is that they are particularly aggravated by any radiant heat.
With the extensive chest involvement, the hands and fingers, feet and lower extremities, are very liable to become bluish, cyanotic, also the patients become very tremulous and, in spite of their general heat and aggravation from warmth, they very often complain of a feeling of coldness from about the knees downwards. As you would expect in a case of this kind, it is impossible for the patient to lie down flat; the only thing that gives him any comfort at all is to be propped up in bed, at the same time avoiding any suggestion of constriction of the chest.
I do not think there is any particular preference for either side of the chest in Antimony tart; I have seen as many cases involving the left side as the right.
Another point is that in these Antimony tart. cases there is always a tendency to heart failure, the circulation is giving out, the pulse tends to become irregular, and the heart tends to dilate.
Well, that is the kind of case that we meet here from about the fifth day of disease onwards. We quite frequently see patients coming in in that state. But we do not expect a patient ever to get into that state once he is in the hospital.
Carbo veg.
In Antimony tart. we have just discussed one type of very serious case. The next one, which is just about as serious, is Carbo veg., and at first sight it is a little difficult to distinguish between it and the Antimony tart. case. However, there are certain distinguishing points.
In appearance, as you first see these patients, there is very little to distinguish the two, the Carbo veg. looks just as ill he has the same sort of pinched appearance, the same respiratory embarrassment, the same kind of flapping nose, and the same bluish colour. I think, in the majority of cases, the Carbo veg. patient is a little more blue, and the Antimony tart. patient a little more livid. As a rule in the Carbo veg. case there is less cyanosis of the extremities, which are more likely to be pale and covered with an icy, cold sweat.
Both these drugs are covered with a cold sweat, I think it is about equally marked in the two. They both have an intense air hunger, but here you find your first distinguishing point. Your Carbo. veg patients say that they have an intense air hunger, and yet they feel frightfully cold, whereas there is none of that feeling of frightful coldness in the Antimony tart. patients.
As a rule, instead of the rather dry, bluish lips of Antimony tart. the lips of Carbo veg. tend to be purplish and somewhat swollen. And instead of the white coating on the tongue which is so typical of Antimony tart. you are very much more liable to get a dirty, yellowish-brown, very dry tongue. Again as a distinguishing point between the two, in Carbo veg. you will get marked thirst, whereas in Antimony tart. the patient is thirstless. The typical Carbo veg. patient wants sips of cold water, and very often complains of a very unpleasant, foul taste in the mouth.
As far as the actual chest condition in Carbo veg. is concerned, you are more liable to get definite extensive areas of consolidation, and rather less generalized bubbling in the chest.
There is usually far more acute rawness in the chest in Carbo veg. than in Antimony tart. And in the Carbo veg. patient you mostly find that the sputum is just about as difficult as it is in Antimony tart.; the patient will tell you it comes up so far and then they just cannot get it out. But instead of that effort to expectorate producing the vomiting that you meet with in Antimony tart., in Carbo veg. it is very much more likely to produce an attack of extreme exhaustion, the patient lying back simply gasping for breath. Incidentally, these Carbo veg. patients respond astonishingly well to the administration of oxygen.
Both Carbo veg. and Antimony tart. have that horrible sense of a load on the chest. It is a feeling of dreadful oppression, which the patients describe either as an absolute weight sitting on the chest, or as the chest being full almost to bursting.
Another distinguishing point is that in Carbo veg. there is always marked abdominal discomfort, a feeling of distension, fullness and flatulence, instead of the intense nausea of Antimony tart.
As far as the position taken up by the two patients is concerned there is very little to distinguish them. They both want to be propped up, and they both want to avoid any constriction of the chest or round the neck, but the Carbo veg. will allow you to put a single blanket up to keep them warm, whereas the Antimony tart. simply cannot tolerate it. Another point about Carbo veg. patients is that they always tend to sleep into an aggravation; they doze off and then wake up simply gasping for breath.
In the Carbo veg. patient, as in the Antimony tart. patient, you have a definitely failing heart.
I think as a rule the temperature tends to be less high in the Carbo veg. case than it does in the Antimony tart. and I think you are most likely to meet your Carbo veg. case just immediately before, or just immediately after, a pneumonic crisis.
As far as relief from your drug is concerned, you should get this almost immediately in an Antimony tart. case, and the Carbo veg. patient should be comfortable in about six hours. It is astonishing how quickly they respond. It is usually a question of acute heart failure, and either the patients respond at once or else you should give one of the other heart failure drugs. I should expect one of these Carbo veg. patients with critical collapse to be out of danger in twelve hours. But they are exactly the type one used to dash at with all sorts of diffusible stimulants. and they mostly died, whereas now one expects them to recover. If you want to cure these cases, however, do not give them stimulants. I have seen cases of that sort in which there was obvious heart failure and the physician had pushed in Coramin and Carbo veg. did no good at all afterwards, it simply did not have any effect. Nowadays I would never employ any stimulant in a case of that sort; I am sure one gets better results without. The only exception I would make would be strong coffee in the case of Carbo veg., as these patients sometimes do respond astonishingly well to it. They have a desire for it, even a craving for it, and it often seems to do them good. But that is the only exception. I would make.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.