THE THERAPEUTIC MANAGEMENT OF PNEUMONIA


The therapeutic management of pneumonia is first of all a game. It is often a quick and sharp game, giving an opportunity to stand up and put ones nerve, principles and wits into buoyant use. For this reason it is always best to play the game alone. It is my own rule to refuse consultation and to this rule only three exceptions can be called.


You may be sure that I did not come here to tell you how to manage your cases of pneumonia. I realize that individual experience teaches each practitioner to develop a form of his own in accord with his own temperament and the interactions of his circle of influence. If, therefore, some of my assertions have the sonorous ring of authoritative pronouncement, know that they are authoritative only for me and that they are here spread out only for your criticism, your approval or disapproval.

Three elementary principles are to be considered in the therapeutic management of pneumonia, or of any other acute malady of critical pace and strong invasion. These are:.

1. The materia medica.

2. The vital dynamics.

3. The personal domination.

Not much need be said at this time about the materia medica. Certainly every homoeopath has his own repertoire of remedies, the result of his study and experience. It goes without saying that the more complete this mental collection, the less the danger of falling into routine, and the better the footing at every step, because the good effect of the remedy extends through the entire environment, be it home or hospital. It is to the interest and satisfaction of every doctor, who is homoeopathically inclined, not only to expand his personal conceptions of a remedy, but to round out the number of remedy acquaintances. In relation to pneumonia this has been fairly well done and explains the recognized homoeopathic success in its handling.

In addition to ones own quota of familiar and dependable symptomatology and to more than a century of recorded homoeopathic experience with pneumonia, there is the great literature of practical data, the general materia medica, to draw upon when needed; and we have repertorial and other means to mould it to its uses. The possibilities of selection are from A to Z and the process of selection involves close observation of and attentiveness to the impressions and expressions of the patient, and the transmutation of the symptomatic findings into the suitable remedy. No more pleasant or profitable medical art could be imagined. I recall having used such apparent exotics to pneumonia as Natr. mur., AEthusa, Pertussin and Curare. Provings of Radium bromide, though it has symptoms often found in cases of pneumonia is not often used, I suspect, though it deserves consideration. It has served me well several times.

Because pneumonia is a disease which tends to rapid development of acute pathology, because it is concentrated more or less in its anatomical extent, because it is in intimate relation to the great thoracic and abdominal plexa or centers, because it is rather limited with respect to certain seasonal influences in its etiology, the remedy picture usually stands out clearly. There are important exceptions to be mentioned later but this is generally true of the first call for a remedy.

The first remedy, especially if it proves to be the only one needed, is likely to be one of our old friends not much disguised. But this very fact makes it the more needful to be watchful for the unfamiliar identity as such, even if it is not recognized by name and located in the books at the moment. It should be as soon afterwards as possible.

As to particular remedies, I have not much to say. A remedy which has held sway for several years in routine fashion within certain limits, is Phosphorus. This is used mostly during the first weeks of the cold season, and for long, slender, pale children, the nordic blondes usually, brought up on sugary and starchy fodder. Besides the type and the season the symptoms are of the well known Phosphorus characteristics. One dose and two visits are all that is necessary. The cases have interest for humane reasons only. Routine is not interesting.

The interest of the materia medica lies in the problems that it offers, the ever varying applications, the finding of new remedy patterns. As hinted already, one dose not need to be armed with a great collection of remedies to handle pneumonia successfully, but it is essential to anticipate and recognize new developments and new adaptations. The interest in prescribing for pneumonia is not so much in materia medica as in playing the game; and the real game is the game of vital dynamics. It is my conviction that our materia medica is adequate for virtually all the needs of pneumonia.

I cannot, with good grace, conclude the subject of materia medica without a word of recommendation of that remarkable little reference monograph of the Pulfords, Leaders in Pneumonia.

Dynamics is another story. Homoeopaths are not the ones who are writing the death certificates yet dynamics is not altogether a question of mortality, as William Templeton in the British Homoeopathic Journal for October, 1931, shows. There are times when the mortality rate is low and times when the worst treatment may be followed by a rather long succession of recoveries.

The immediate effect, that which shows promptly after the administration of the remedy, is the real demonstration of virtue. In the enthusiasm of early Homoeopathic practice I kept pneumonia charts tracing the temperature, pulse and respiration, from the beginning to the end of each case, the data being noted frequently so as to record the effects of remedies in black and white. There is a considerable collection of these charts some- where in the attic yet, and it is indeed a spectacular demonstration to see the invariable pulse cadence and usually the defervescence begin immediately or very soon after administering a remedy.

Treatment is undoubtedly related to mortality, but the more practical question is that of getting the patient well quickly, with health not only intact but more vigorous than before. The pneumonia patient usually has good inherent vitality. Pneumonia is often the eruption of constitutional dyscrasiae and when the outburst is past, if the patients reactions have been well manipulated, with remedies, he will have a new lease of vital energy, good for many years.

To execute this art the prime essential is, of course, the perception of what is similar, judgment as to what symptomatic basis is the most thoroughly reactable, and judgment in administration; in short, recognition of the dynamic factors in each problem.

These dynamic factors pertain, first, to the medicine; second, to the patient. Those of the medicine are:

1. Dosage

2. Potency

3. Reaction.

Concerning dosage, I would pronounce emphatically in favor of the single dose and that for dynamic reasons. The single dose will do all and more than repetition can do. It produces a more steady, clean-cut and thorough reaction. When the reaction subsides, if another remedy is needed, the new remedy picture is more clear and the latent, if not the most superficially apparent aspects of the patient are better. Precious time in deciding for the next remedy is saved and the liability to wrong selection is lessened.

Anyone who gives the single dose a trial, with the remedy selected on the basis of pertinent symptoms, will never return to the soup-bowl excesses of repetition. Repetition is desirable at times in conditions of mechanical obstruction or in overwhelming infections in people of inherently feeble vitality, since such infections (like tetanus or general dropsy) are equivalent to the persistence of mechanical obstruction. But in ordinary acute disease it is a relic of quantity prescribing and a symptom of thoughtless custom or of timidity.

After reaction, repetition is properly indicated only when there are clear-cut signs for the same remedy (which is unusual) or for another remedy. Even when the renewed onset is alarming the only chance of survival may be lost by not perceiving or not waiting for positive reactable symptoms. I refer to the characteristics of the sick person.

As to the potency, if one is not a repetitionist the 1M and higher is altogether the best, though with feeble old people the 200th may be the best. Potency should be judged by that indefinable quality, latent vitality, not on the outward aspects of disease, however desperate in appearance. If the prescriber can settle with his judgment and practice single dosage, he will have less trouble in selecting the potency. A favorite practice in acute conditions is to hit a good smash with a very high potency at the outset.

As to reactions, much applies that has been said concerning correct repetition. Reactions from mineral remedies such as Phosphorus and Antimonium tart. are likely to show an aggravation following twelve to twenty-four hours of improvement. These aggravations should not be mistaken for relapses. It is better not to prescribe over the telephone in such cases, but to go and see what impressions are to be gained.

Even a first prescription should never be made until the remedy is definitely seen. A good first prescription breaks the back of the enemy so that even if relapses should occur most patients would be able to struggle through in time without more medicine.

Dynamic factors pertaining especially to the patient are chiefly these:.

1. The genius of the present infection, or epidemic, if any. This may suggest the remedy when the personal distinctions are lacking.

2. The history of the causal incidents or surroundings.

3. the miasms; to be observed after the primary infection is antidoted and progress comes to a stop or when the duration is protracted by the quickening of a latent or chronic constitutional state, such as psora, syphilis or sycosis.

4. Chronic or constitutional states of the same infection (the Tuberculinums should especially be considered).

5. The effects of drugging, such as dosing with aspirin or the effects of an old quinine-malarial combination.

6. Mental shock or fear.

7. Pure nervous shock from carrying the load, the Lecithins or Scopalamine states, for instance (fatigue remedies).

It all sounds rather complicated but it really is simple because one does not meet many of the dynamic factors of the patient at one time, and it should not be difficult to see which factors are most peculiar, characteristic and striking, for they stand out prominently in most cases.

There is, however, one important exception, the eruption of sublimated (even through former generations) miasmatic states. If after the primary infection is antidoted progress comes to a stop, or the duration is protracted, or even when, as sometimes happens, characteristic symptoms fail to point the way to favorable reactions, a latent constitutional state such as psora, syphilis or sycosis has become quickened. Now if one is guided by the laboratory man who says that the syphilitic taint is not found in pneumonia, some cases will be lost that would otherwise make brilliant recoveries.

In this situation the laboratory is useless because influences deeper than the present laboratory findings are at work. The syphilitic miasm in such instances is especially vicious and sudden. The thing to do is to search for the finer characteristic that may have crept into the case almost unnoticed; search especially for the most persistent, individual and recent ones. These will be found to be reactable and a quick recovery will result.

Finally, a word on personal domination. By this is meant no priestly domination, nor pretty oversight of attendants and surroundings, but domination through the positive effects of prescribing, felt keenly by the patient and apparent to all.

The therapeutic management of pneumonia is first of all a game. It is often a quick and sharp game, giving an opportunity to stand up and put ones nerve, principles and wits into buoyant use. For this reason it is always best to play the game alone. It is my own rule to refuse consultation and to this rule only three exceptions can be called. It is absolutely necessary to keep the vision of the game clear and the grip on the patient undisturbed. Effective prescribing convinces all that it is primarily a game of medicine and if its management is not left to the prescriber, he has no place in the line-up.

As to the patient, there is a mental coup which I have used in rare circumstances, and I cannot do better than to quote from a former article:.

As a rule I care not whether a patient has any faith in medicine or in his doctor so long as his remedy is in sight. But sometimes a situation arises in which the patient is struggling along but is either indifferent to life or needs a decisive outlook and resolution of spirit which remedies have not given. I then make the request to speak with him alone and I ask him how he feels about his case and how he feels as to the prospects of recovery. Whatever his answer I then tell him that he is very sick and that I cannot promise life, but that he has a goodly store of latent vitality, plenty to carry him through if he will but resolve to hold on a while longer. This has invariably a good effect. By being directed to envision the issue, the patient chooses, as it were, the right direction.

WATERBURY, CONN.

Royal E S Hayes