Fortunately, in a Casualty Clearing Station like this we shall not see the later cases, the people who have gone badly septic. There you may require any of the acutely septic drugs, such as the Snake Poisons, Hepar, Silica, Pyrogen; any of these may be required in the later stages. But as we shall not have to deal with them here I shall not attempt to give you the indications.
Then, to take up the question of pure nervous trauma, the terrified patients. I think you have to concentrate on the fact that the nervous element is fear, and you will have to give our terrified drugs. In the immediate onset the drug that is going to stand you in greatest stead is Aconite. There has been a tendency in considering these cases to advocate the administration of Ignatia. The patients come in weeping, terrified, and shaking giving quite an Ignatia picture, but I am perfectly certain that Ignatia will not work.
Ignatia patients are shocked patients, but they are not shocked from the same cause, they have not been terrified out of their wits; and Ignatia will let you down in most of these cases. Whereas, if you get patients coming in jittering as some of them will do, unable to keep still, simply terrified out of their wits, jumping at every sound, that is the typical Aconite picture; and Aconite is going to quieten them down more quickly than anything else, and with far less harm to them and a far more speedy recovery than by putting them on to sedatives.
We are advised by the consulting neurologist than any badly shocked case should be put on to two to four drachms of Paraldehyde right away, in order to induce from four to eight hours sleep, and that at the end of that time the patient will be perfectly all right. But I am quite sure you will get much better results by giving Aconite, and the patients will get up feeling much better than they would after Paraldehyde. I would give a 200 every fifteen minutes.
Then as regards the treatment of the worst cases of shock, where the patients go on to loss of speech, twitching and convulsions. They are a little more difficult to cover, and the two drugs that I think you will find most useful are Hyoscyamus and Stramonium. Certain of these cases are definitely violent, and in these more violent cases you will want Stramonium. It is an absolute picture of the condition which you will meet, and it has the fear element as marked as in Aconite, and Stramonium will help you out with these violent cases.
But where the patients suffer from loss of memory, not knowing where they are, unable to remember their names, general hebetude, Hyoscyamus is going to help more than any other drug in the Materia Medica. It, again, has the fear element in it, and again, the peculiar dissociation that we meet with in the case of shell shock patients. It is rather interesting to notice that the orthodox do recommend giving Hyoscyamus rather than Paraldehyde in some of these cases; they say they get better results.
In cases of pure scare, as from an air raid warning, Aconite will often quieten the patients. Very often they are suffering from anticipation, not fear, and then they will run to Ignatia, Phosphoric acid, Argentum nit., or Gelsemium. And, incidentally, Gels. is one of our great standbys for the patient who is alternately hot and cold, shivering, trembling, and in a constant state of anticipation. Argentum nit. gets an acute sick feeling, with a sensation of “tummy turning” or with diarrhoea. Your Ignatia is just shaky, trembling, weepy, wanting to be comforted and told they are all right.
Then the other type of casualty we may have to deal with in these air raids is the gas casualty. And it is very difficult to say exactly what is going to be our greatest help in these gas cases. I think the most helpful way to look at the problem is to take the two types of gas with which we are most likely to meet. I think we are almost certain to be up against Mustard Gas or a gas of that type, but we may also have some of the lachrymatory gases to cope with. Mustard Gas is the deadly type. And with Mustard Gas the problem differs to the tissue attacked.
The actual danger to the eyes will have been tackled to a large extend by the mechanical measures taken to wash them out, so when you see them after they have been decontaminated you will get very little indication on which to prescribe. We have a potency of Mustard Gas made, and failing, any other indication, personally I should give every one of these cases whose eyes had been attacked by Mustard Gas a dose of potentized Mustard Gas, purely as a prophylactic measure.
You may get no immediate eye symptoms at all, or very slight ones which may subside after the eyes have been cleaned out and yet at anytime up to twenty-five years afterwards to least you may get a degenerative condition of the epithelial covering of the cornea, which simply dies. It is a very insidious thing; it may develop at any time even years after; and if we can get a prophylactic to stop it, it is worth trying. I cannot tell you that potentized Mustard Gas works, as we hadnt it in the last war, but I think it will work, and it certainly ought to be tried as a prophylactic. There are still cases of corneal ulceration developing, due to exposure to gas in the last war twenty-five years ago.
So far as the acuter stages are concerned, we have to rely mainly on mechanical measures of washing out the irritant. As regards treating any remaining acute conjunctivitis, it is very difficult to know what will be our most useful medicine. There are dozens of drugs which have acute inflammatory conditions of the eyes and one cannot know in advance which is going to be most useful.
Another effect produced by Mustard Gas is an intense burning irritation of the skin, which is a slowly developing, acute dermatitis. Clinically, the outstanding characteristic is the fact that the irritation develops long before there is any sign of acute inflammation in the skin. The first thing the soldier used to complain about in the last war was the irritation; he could not see anything, but it got steadily worse. The drug in the Materia Medica which behaves like that is Mezereum, which starts as an acute irritation in the skin, blowing up into an acute dermatitis; and it is quite possible that Mezereum may be helpful in these skin conditions.
I think the probability is that we shall have to use other drugs as well, and the kind of drugs and I would expect to be indicated are those drugs and produce an acute dermatitis from a surface irritation, such as Poison ivy, Croton oil, and so on; possibly Petroleum, which, again produces a slowly developing, very acute dermatitis, but more probably Anacardium, Clematis, Croton tig, Rhus tox, Ranunculus, that group of drugs. They all produce a somewhat similar kind of dermatitis, but of the lot Mezereum produces the irritation most marked before the dermatitis develops.
Once vesication of the skin has developed, I think Croton tig. is going to help you more than anything, but Nitric acid and Carbolic acid, which both have the horrible, corrosive irritation, may also be useful, and possible Apis.
The most serious lesion produced by this Mustard Gas is acute pulmonary oedema; and that was the deadly factor during the last war. The men used to come in with their lungs simply bubbling from top to bottom, coughing incessantly, and spitting up a little blood-stained, watery fluid, the lungs rapidly became completely waterlogged, and they simply died like flies.
Well, there are certain drugs which have a very definite similarity to the picture that one sees in these cases. In the last war the least severe cases presented a picture which is almost identical with Ipecac. They were hot, and miserable, and felt deadly ill, they were very often sick with the attempt to cough, and they had a very rapid pulse. They were covered with a hot, clammy sweat, and, of course they were cyanosed. And that picture does respond to Ipecac.
In the next stage, a little beyond the Ipecac picture, they were rather more cyanosed, there was rather more blood in the sputum, it was rather darker in colour, and there was rather more blood in the sputum, it was rather darker in colour, and there was more definite evidence of heart failure, and they went on to Laurocerasus.
There was another stage, very similar to the last, with rather less coughing, possibly less fluid in the chest, with the feeling that their chests were absolutely bursting, rather more definite cyanosis, more obvious heart failure, and extreme air hunger; and they responded to Lachesis.
There were others, again who were very hot, very sweaty, very offensive with very offensive mouth, and who were coughing up a somewhat purulent, bloody, frothy sputum. They were horribly restless, shaky, tremulous, and either burning hot or sweaty and cold. And they responded to Mercury.
And then, lastly, there was another type; the patients were paler, completely thirstless, with more bubbles in their chests, though less able to get up any sputum at all, getting rather cold, beginning to collapse. And they ran either to antimony tart. or to Arsenic.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.