Homœopathic treatment of pneumonia in adults

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HOM(EOPATHIC TREATMENT OF PNEUMONIA IN ADULTS* By T. F. STEWART, M.B., Ch.B.(Glas.), F.R.F.P.S.G., F.F.Hom. INTRODUCTION

This paper on pneumonia describes four patients treated in general practice and makes an analysis of eighty consecutive unselected cases of pneumonia in the Glasgow Homceopathic Hospital from 1946 to 1956. Homceopathic remedies and potencies used and frequency of repetition are discussed. Reasons for failure of homceopathic treatment and the use of antibiotics or combined treatment are considered. When I selected pneumonia as the subject of m y presidential address, I thought that I only had to look up past Hospital records to find the necessary material but after a great m a n y hours of reading ease-sheets and attempting to analyse methods and results there appeared to be no conclusion to m y labours. My investigation did not reveal a n y original observations and the discussion only revises what all experienced homceopaths already know, but it m a y be of some use to less experienced embryo homceopaths because it shows the methods used and indicates t h a t most cases of pneumonia, even the severe complicated types which reach hospital, can usually be treated by the more common homceopathic remedies. HOMEEOPATHIC TREATMENT OF PNEUMONIA IN GENERAL PRACTICE

The following is an account of four cases of pneumonia in general practice which m a y help to illustrate the response to homceopathic treatment usually expected in this condition: 1. Girl aged 8; shivering on previous night, unwell in morning but went to school because of examinations, couldn't manage them, developed pain right side of back and cough 7 p.m. 2/12/52. Unable to contact own panel doctor who was out paying calls so mother asked if I could come. I saw the patient at about midnight. She was a blonde girl with bright flushed face, dilated pupils, flushed dry hot skill just like scarlet fever, pulse 144, temperature 104 ~ and right-sided middle lobe pneumonia, all symptoms crying out for Belladonna. I told the mother that the orthodox treatment for her girl was penicillin although I was certain her case would respond effectively to Homceopathy but perhaps I had better give penicillin since I was acting for her own doctor. She said she had cancelled the call for her own doctor and would prefer me to carry on as I thought best. So I gave her six powders of Belladonna 30, one to be taken hourly if awake. Her own panel doctor, a conscientious man, called after midnight even though the call had been cancelled. He confirmed pneumonia and said to the mother, "This is pneumonia and you're taking a risk not giving her penicillin." The mother (noble woman!) replied, "Dr. Stewart was very decent in coming round here about midnight and I ' d like to leave his treatment till tomorrow." During the night the child was delirious, seeing horrible things on television and telling her mother to turn it off. In the morning when I arrived she had scoffed a good breakfast and looked well, pulse 100, temperature 98.4, but she still had signs of consolidation in her right chest. Her own doctor anxiously called to see what had happened, and said wheu he saw the result, " I thought M. & B. and penicillin had pneumonia beaten but it is not more effective than this." I 'phoned the doctor and asked him to carry on since I had only attended in the emergency. The doctor gave her Belladonna most of that day four-hourly in water. On the following day the doctor's assist a n t confirmed the physical signs of pneumonia and, although the child was well in all other respects, he thought she should have penicillin b y mouth, but the * A P~per read a t t h e Scottish B r a n c h of the F a c u l t y of Homceopathy.

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6(~

senior doctor stopped it next day. The reason why I record this case is because the presence of pneumonie signs was confirmed b y three doctors, so the clinical diagnosis was not in doubt although the fever dropped from 104 ~ to normal it~ about 8 hours. 2. Female aged 67; also seen as an emergency late at night. She had a history of shivering in the morning, later too hot, vomiting after lunch and later twice vomited bile. She complained of a horrible taste in her m o u t h and slight headache. Examination showed flushed face especially left cheek, pulse 92, temperature 103 ~ respiration 30, enlarged glands in left axilla and right inguinal region, impaired percussion note, diminished vocal resonance and fine rs in the left and back indicating a left lower lobe pneumonia. There was also a grossly enlarged spleen reaching down to umbilical level. Ignoring the spleen and glands (presumed due to chronic myeloid leuk~emia which was subsequently confirmed), her mental depression, left basal pneumonia and green bile-vomiting called for Natrum sulph, which was given in the 30th potency two-hourly. Next morning the patient reported she had slept poorly and had a slight headache but no more vomiting; the temperature was normal but crepitations and dullness were still present in the left base. The medicine was continued four-hourly in water for a further 24 hours and b y the seventh day the chest was apparently clear on physical examination. 3. Female aged 81; on 6/2/56 cough for a week, fell and injured back this morning, restless and groaning. Since then very anxious and excited. Drycoated tongue. Pulse 120, temperature 102 ~ Given Aconite lm/1 for shock and fright, then Arsenic lm hourly for four doses. In evening, comatose, had gone to sleep on bed-pan, having partly expelled a small dark motion. Attempt at examination showed pulse 90, temperature 100.5~ Cheyne-Stokes respiration, dry tongue with red tip, groaning respiration, r~les heard in right base. Daughterin-law reported t h a t she had been drowsy all afternoon, lying on her right side, very thirsty and wanting somebody beside her. Right basal pneumonia with these symptoms shouts for Phosphorus, so she was given l m and admitted to hospital where Phosphorus l m was continued for two days. X-ray confirmed pneumonia. Her daughter, an unbeliever, who thought pneumonia in a lady of 81 would take several weeks to get better was very much surprised when the patient was discharged well after only 7 days in hospital. 4. Male aged 56 with gross lower thoracic scoliosis and a history of chronic cough, angina of effort and breathlessness on slight exertion, became desperately fll on the day after exposure to a fog, had tightness like an iron band round his chest and was exhausted with coughing; he was so ill t h a t it seemed that a sedative might finish his life. On the previous history of a left basal pneumonia and his recent exposure to a d a m p fog, his nausea and mental depression, Natrum sulph. 30 was given in water hourly. Next day he reported a very restless night due to aches and pains in his body and legs which compelled him to move every few seconds. Rhus tox. 30 was then given two-hourly, but later in the day the restlessness was not much improved and the patient had become extremely anxious and feared he might die so Arsenic album l m was given twohourly. That night he slept soundly for six hours and felt very much happier the next day although he still had restlessness of his limbs, more of a physical restlessness indicating Rhus tox. which was given in the 30th potency three times a day for a couple of days. On the third day his sputum report arrived indicating t h a t the organisms were mainly pneumococci sensitive to penicillin but b y that time he had practically recovered so there was no necessity for antibiotics. There are two points of interest here. First of all, the severe aches and paim~ in the limbs are not common in pneumococcal pneumonia and secondly recovery from infection with that organism is usually very rapid under antibiotic o~ homoeopathie treatment, but after the acute phase his progress seemed to lag~ he did not feel very strong and so ten days after the Rhus tox. he had hi~

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c o n s t i t u t i o n a l r e m e d y Lycopodium 30/3 a f t e r which he r a p i d l y progressed a n d was b a c k t o work t h r e e weeks after t h e onset o f his illness. T h e e x p l a n a t i o n of t h e aches a n d t h e d e l a y in r e c o v e r y was f o u n d when t h e results of t h e blood samples t a k e n on t h e first d a y a n d e i g h t h d a y of his illness i n d i c a t e d a rising t i t r e of influenza A virus. This d e b i l i t a t e d p a t i e n t definitely h a d t h e severe t ) ~ c of influenza infection from which he m a d e quite a quick recovery, which m i g h t n o t h a v e h a p p e n e d h a d he been given penicillin to e l i m i n a t e t h e pneumococci a n d o t h e r n o n - p a t h o g e n i c organisms in t h e u p p e r r e s p i r a t o r y t r a c t so leaving t h e tissues e x p o s e d to an u n a d u l t e r a t e d influenzal infection. PNEUMONIA IN HOSPITAL The following s t a t e m e n t a t t e m p t s to a n a l y s e t h e facts a b o u t 80 consecutive unselected cases labelled p n e u m o n i a , which were a d m i t t e d to t h e Glasgow H o m ( e o p a t h i c H o s p i t a l b e t w e e n 1946 a n d 1956: T a b l e I illustrates t h e n u m b e r of p a t i e n t s in each age group decade a n d shows t h a t 41 cases were l o b a r p n e u m o n i a , 39 b r o n c h o - p n e u m o n i a , 33 p a t i e n t s (40 per cent.) h a d antibiotics, a n d 7 died. TABLE I. I N C I D E N C E OF T Y P E S OF : P N E u m O N I A , P E N I C I L L I N T H E R A P Y AND MORTALITY

Age distribution

! } ! 13-19 I 20-19 ! 30-39 40-49 i 50-59 60-69 70-79 80-89 I'otMs -I+

- - I

i

Lobar pneumonia .. Cases having an antibiotic Mortality .... .

3

Broncho-pneumonia 99I Cases having an antibiotic Mortality ....

5 1

!

I '

~

5 2

3

1

41 17 2

3 2

39 16 5

9

5

I

:12

2

6

1

2

Ji

I

i

r

~ 9

3 2 m

X - r a y confirmation was carried o u t in 69 p a t i e n t s (86 p e r cent.) 12 cases showed p l e u r a l effusion; o u t o f these p a t i e n t s , 8 h a d l o b a r p n e u m o n i a a n d two of t h e m s u b s e q u e n t l y d e v e l o p e d e m p y e m a . T a b l e I I , which excludes t h e seven cases who died, shows t h e d u r a t i o n of fever m e a s u r e d in days. I t also m a k e s t h e division into l o b a r a n d b r o n c h o - p n e u m o n i a a n d indicates w h e t h e r an a n t i b i o t i c -was given or not. TABLE II. DUlCATION OF :PYREXlA At0TEI~ A D m i S S I O N

2

Number of days pyrexia L o b a r p n e u m o n i a .. Cases h a v i n g a n a n t i b i o t i c

10 6

Broncho-pneumonia Cases h a v i n g a n a n t i b i o t i c

12 9

t

t

3

t 2

3

2 l

5

] 6-,0 i 0ver 10

2

i

i 1

I

1

3

1

2

l 2

I t will be n o t e d t h a t t h e r e t u r n to n o r m a l t e m p e r a t u r e in these cases a p p e a r s to t a k e r a t h e r longer t h a n one would e x p e c t w i t h t h e correct a n t i b i o t i c in unc o m p l i c a t e d p n e u m o n i a , however, it m u s t be a p p r e c i a t e d t h a t these were n o t all simple cases b u t u s u a l l y t h o s e which h a d failed to r e s p o n d a t h o m e or h a d some complicating factor. I t is w o r t h noting t h a t a frail elderly person m a y die of p n e u m o n i a w i t h o u t producing a n y fever, a n d t h a t such a p a t i e n t m a y begin to i m p r o v e as soon as t h e t e m p e r a t u r e rises due to s t i m u l a t i o n of reaction b y a homceopathic ,'emedy or t h e correct antibiotic.

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67

I f pyrexia is an indication of reaction to illness and a part of nature's healing process, a homoeopath should not he unduly concerned if the fever is a little prolonged so long as the patient is feeling better in himself. PATIENTS W H O D I E D

1. Case 290. Male aged 76; lobar pneumonia both bases, some effusion in left side where he had previously had pleuritie pain. He improved and felt comfortable although there was little change in the physical signs. On the fourth night after admission he had an attack of dyspnoea (? cardiac asthma) and next morning had tremor of his tongue and hands, also oedema of his legs, and died of heart failure. 2. Case 260. Female aged 74: broncho-pneumonia with a history of severe asthma for a half century and chronic bronchitis which was so severe t h a t ten years previously operation for prolapse was considered impossible, so t h a t she had had to wear a cup and stem pessary. She had been ailing for years and her heart was failing when admitted. She died six days later, X - r a y confirming signs of chronic bronchitis, enlarged heart and bilateral pneumonia but no effusion. 3. Case 170. Female aged 72: broncho-pneumonia with an old history of rheumatic fever and recent history of hyperpiesia followed by failing myocardium and auricular fibrillation, also a small cerebral thrombosis with paresis of left leg. On admission she had extreme dyspnoea and persistent cough in both bases, poor heart sounds, enlarged liver and oedema of legs and sacrum. X - r a y confirmed consolidation of both bases. This patient's fever subsided but her pulse rate remained high and she died of exhaustion on the eighth d a y after admission. 4. Case 304. Female aged 65: broncho-pneumonia with a history of chronic bronchitis, also jaundice three years previously since when she had had dyspepsia with flatulence and vomiting so that she was unable to eat solid food or meat and had thus lost much weight. Two days before admission, she had suddenly become pale and shocked, which m a y have been due to a "silent" myocardial infarction because after admission she was found to have a low blood pressure, and in relation to her fever her pulse rate was slow, perhaps due to heart block. She was desperately ill on admission, however after two days of intermittent delirium she appeared to improve and was more rational, but the physical signs in her chest remained. She failed to respond to Baptisia and Pyrogenand died on the fifth day. 5. Case 285. Male aged 56: broncho-pneumonia with a history of heavy drinking for m a n y years, also never being well since he lost his job three months previously. Although his fever had subsided and he appeared to be improving on the day after admission, he got up suddenly and after going back to bed, immediately died presumably from a myocardial infarction. 6. Case 161. Male aged 50; broncho-pneumonia with a historyof pulmonary tuberculosis and years of chronic bronchitis in addition to a fibrosed lung. His symptoms also appeared to improve but his pulse rate remained high; he developed pink frothy sputum and died within 24 hours of admission. 7. Case 217. Female aged 46; lobar pneumonia with effusion which failed to respond to 500,000 units of penicillin four-hourly for some days followed by chloromycetin. For a week before admission she had complained of malaise, aches all over the epigastrium and severe left pleuritic pain, and on admission she had bloody sputum (not rusty) with nausea and vomiting after coughing and her menses had begun on the day after her illness. After admission her cyanosis and sanguineous sputum remained. Later she had diarrhoea and her fever fell but her respiration and pulse rate rose and she developed a whistling apical murmur. Ten days after admission she collapsed during stool and died 15 minutes later. Straw coloured fluid from her chest contained numerous epithelial cells and polymorphs but no bacteria, so it was concluded t h a t she had 3

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died from a virulent virus infection. The cyanosis, persistent blood in the sputum and gastro-intestinal symptoms suggest that this was a case of influenza A. Unfortunately there is no record of her previous medical history.

Mortality Rate At first sight the mortality rate appears disappointing but it must be pointed out that this is not the figure for simple acute pneumonia occurring in healthy persons. Such cases treated homoeopathically are usually afebrile by 24-48 hours and well in a few days and thus never reach hospital. Patients admitted tend to be complicated cases, terminal pneumonias or acute pneumonias occurring in debilitated or elderly p~tients. From consideration of Table II it will be seen that (30 cases) 37-5 per cent. of the patients were over 60 years of age. Of the patients who died, the seventy-six year old cardiovascular system of Case 1 found double pneumonia too much for it. Cases 2, 3 and 4 died of terminal pneumonia secondary to other conditions rather than acute pneumonia. Case 5 died of a myocardial infarct within 24 hours of ~dmission and m a y have been moribund on admission; even so, we have all seen patients rescued from the jaws of death by our favourite "corpse reviver", Carbo veg. in high potency. Case 7 was apparently a case of influenz~ A, but there was some cardiac complication. HOM(EOPATHIC REMEDIES USED

It was thought that it would be of some interest to discuss the remedies used, so the following tables show the order of frequency of prescription and the frequency of use of remedies grouped according to Borland's (1) classification of pneumonia: TABLE I I I .

FREQUENCY OF USE OF DIFFERENT REMEDIES

Order of Frequency Bryonia

..........

Sulphur . . . . . . . . . . Phosphorus . . . . . . . . Natrum tour ....... Carbo veg ........... Arsenic alb . . . . . . . . . Lachesis .......... Lyvopodium ........

45 43 25 20 18 ]7

12 11

Tubereulinum ...... Kali carb ......... Antimony tart ..... Mercurius ........ Pulsatilla ...... Opium .......... Arnica .......... Causticum ........

TABLE FREQUENCY

I. II. IIIA.

IIIB. I V.

11

10 9 9 9 7 6 6

Bacillinum ........ Baptisia .......... BeUadonna ........ Ferrum phos ....... Chelidonium ...... Rhus tox ......... Natrum tour ....... Thuja ............

IV.

OF USE OF I:~EMEDIES IN BORLAND~S CLASSIFICATION OF PNEUMONIA

Incipient stage

Aconite

Frankly developed

Bryonia

45

Phosphorus

Mixed infection

Baptisia

5

Pyrogen

1

Ferrum

phos 5

25

2

Belladonna

Ipecavua~ha

0

Veratrum vir. 1 Chelidonium

4

Lachesis

or Alcoholic p a t i e n t ] t i e r c u r i u s 9

Hepar sulph. 0

Rhus tox.

Creeping type or B-Pneumonia

Pulsatilla

Senega 0

Late pneumonia

5 5 5 5 4 4 3 "~

N a t . s u l p h . 20

9

A n t i m o n y tart. 9 C a r b o r e g . 18 Lycopodium 11 A r s . alb. 17

5

12

Kali carb. Sulphur 43

4

Lobelia 0

10

Foubister (2) found that Phosphoruswas the commonest remedy for pneumonia in children, Sulphur and Pulsatillatook second place and Bryonia thh'd. In

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69

P:NEUMONIA

Glasgow in the treatment of adults Bryonia was the commonest remedy by far. Sulphur appears to come a close second but when considering the first prescription after admission to hospital, Sulphur and Phosphorus were prescribed with similar frequency, although in the later stages Sulphur was commonly prescribed when recovery was slow and there was no obvious indication for prescribing a remedy. I t is not surprising t h a t Natrum sulph, is the next remedy in frequency when we consider its relation to damp conditions such as are prevalent in the Glasgow climate. The remedies which Borland (3) recommended for incipient pneumonia-Aconite, Ferrum phos., Belladonna and Ipecacuanha--were seldom prescribed but that was to be expected because the cases admitted to hospital were mainly in the later stages. Ipecacuanha, which Tyler (4) and Borland labelled "especially the infant's friend, commonly indicated in bronchitis of infancy", was never prescribed at all. And in Borland's groups there are three other remedies which were not prescribed: Hepar sulph., Senega and Lobelia. From consideration of the frequency of different remedies used it will be noted that nearly all treatment was carried out with our well-tried common remedies. This should encourage the beginner in Homceopathy to appreciate that he will be able to get good results in 90 per cent. of cases if he becomes really familiar with a few well-known remedies. POTENCY

I n venturing to discuss potency I appreciate that I am "rushing in where angels fear to tread", so please regard these remarks as bait for argument after the paper. The following tables give the frequency with which different potencies were used (Table V) and the potency used in the first prescription after admission to hospital (Table VI). TABLE V. ~REQUENCY OF U S E OF DIFFERENT POTENCIES

i .9 3

4

6

9

Frequency . .__ 5

19

3

6

Potency

' 30

Low Potency

High potency

12 Total i 30 2

Percentage.. I

~-

" 200

lm

10m

59

50

47

~

50m Total 1

157

10% 46~o i

44%

TABLE VI. POTENCY OF FII~ST PRESCRIPTION AFTER ADMISSION TO HOSPITAL

Potency

..

Frequency

..

% of f r e q u e n c y

Low potency

30

30

30

6 7.5

High potency 200

im

1Om

30

16

16

12

37.5

20

20

15

f

55%

High Potencies The first analysis (Table V) suggests that the potencies used were lower than those favoured by Borland (5) who recommended~'high potencies (lm and 10m) repeated two-hourly to abort a pneumonia in 12-24 hours. He was referring

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to new cases of pneumonia but as mentioned previously most of those patients a~lmitted to hospital had either not responded to their original treatment or had some complicating factor. Even in spite of this, Table VI shows t h a t the 55 per cent. of the first prescriptions given in hospital were in the higher potencies (200-10m). The absence of very high potencies (with the exception of the single 50m given) m a y be related to the late Dr. W. Boyd's opinion t h a t the 200, and perhaps t h e . l m potencies were the most powerful potencies and further increase in the potency did not increase their effectiveness.

30 Potency This potency was b y far the most frequently p r e s c r i b e d . . . 46 per cent. of the total. I t was commonly given in the later stages of the illness when, although the patient was improved, a change of remedy was required or when reaction was lagging and a nosode or "intercurrent" remedy was used to stimulate reaction. This m a y be considered to be in keeping with Borland's (6) reference to the later stages of pneumonia or the more complicated case where he stated it required a considerable amount of judgment to give the right potency, because you can overdo it, you can give too high, to which the patient cannot respond and so do him harm; on the other hand, you can miss the chance of clearing up the whole thing by giving too low and not setting up enough response.

Low Potency Only 10 per cent. of the prescriptions were given in the low potency, usually in the later stages of illness. The two 12c prescriptions were the nosodes, Bacillinum and Tuberculinum, given as intercurrents. On a number of occasions a low potency was given and then p r o m p t l y followed by the 30 or higher potency of the same remedy. Presumably having used the low tentatively and found it beneficial it was considered that the high would be more dramatic, or perhaps the low had no effect, but, being certain t h a t the drug was indicated, it was decided that the potency had not been correct and the higher would act. Occasionally, when a remedy had been effective in high potency and had been stopped a low potency of the same remedy was given a few days later. I presume this is related to Dr. W. Boyd's conception that, when the violence of acute illness has been overcome by a high potency, but there is a very slight return of symptoms, repetition of the high potency will cause an undesirable aggravation, whereas to give a dose of the same medicine in low potency will give just enough stimulus to overcome the last kick of the illness. In some cases low potency was apparently prescribed because there were gross irreversible pathological changes which might have been aggravated b y a higher potency. On six occasions, a low potency was given as the first prescription. I n some cases the reason for this was not clear, but m a y have been because the prescriber did not know what the patient had had before admission and since there was improvement, it was not advisable to give a high potency which might have upset the reaction, whereas some treatment was required and it was considered t h a t a low potency might continue to help without upsetting the original stimulus. In other cases, as Close (7) recommended, in "disease of a malignant character and rapid progress. I n the beginning when torpor and collapse indicate a dangerously low vitality and deficient reaction, a few doses of a low potency m a y be required until reaction comes about, after which the potency should be changed to a higher one if it is necessary to repeat the remedy".

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FREQUENCY OF REPETITION OF DOSES

Remedies were usually given at first as a dry powder and then in water two-hourly until the patient improved, then four-hourly still in water and continued for some hours after fever had subsided. Later in the illness homceopathic medicines were usually given as a single dose of a nosode or "intercurrent", but sometimes three or six doses of the indicated remedy were given four-hourly. REASONS W H Y HOMCEOPATHY MAY FAIL

A. Absence of Symptoms on which to prescribe m a y be caused by: 1. Inability of the patient to describe his symptoms due to lack of intelligence and experience in answering questions asked b y homceopathic doctors. 2. The patient concealing his symptoms because embarrassed or thinking t h a t mentioning them would make the doctor think he was daft, e.g. the Baptisia symptoms of the body feeling scattered about and tossing around trying to get the pieces together. Mitchell (8) 1950. 3. No symptoms on which to prescribe because of absence of reaction on the part of the patient due to extreme old age or a severely debilitated state before infection occurred. 4. No symptoms because resistance m a y be complete|y overwhelmed b y a virulent organism or massive dose of infection.

B. The Remedy May Fail to Act because: 1. The wrong remedy is given, or perhaps one or two wrong remedies have already been given, thus obscuring the drug picture on which to prescribe, or causing a drug complex which appears to block the activity of homceopathic remedies. 2. The action of the remedy m a y be inhibited b y camphor in camphorated oil on chest, sheets or clothes, or moth-balls or some other application or inhalant or even drug-taking b y the patient without the doctor's knowledge. 3. The remedy m a y be contaminated. 4. The indicated remedy m a y fail to work because the original cause of illhealth m a y be still acting, so t h a t the patient requires a so-called "intercurrent" dose of some nosode or remedy related to the original cause of disease. 5. The wrong potency m a y be given. Borland (5) recommended very high potencies in the treatment of pneumonia but Mitchell (9) has suggested t h a t some patients m a y be sensitive to only a limited range of potency and low potencies (3x) m a y be dramatic in acute illness and low potencies m a y be used to follow the initial high potency; alternatively, high potencies m a y work where low have failed. 6. The patient m a y be insensitive to homceopathic remedies. This is very rare and in most cases is probably due to some factor which has been overlooked. Although Close (10) mentions t h a t "people who are accustomed to long and severe labour out of doors, who sleep little and whose food is coarse, are less susceptible, also persons exposed to continual influence of drugs such as tobacco workers and dealers, distillers and brewers and all connected with the liquor and tobacco trade, druggists, perfumiers, chemical workers etc., often possess little susceptibility to medicines and usually require low potencies in illnesses, except where their illness is directly caused b y some particular drug influence, when a high potency of the same or similar drug m a y have the best antidote. Idiots, imbeciles and the deaf and dumb have a low degree of susceptibility as a rule". Lastly a patient m a y not respond to homoeopathic t r e a t m e n t because surgery is required, e.g. if there is an empyema requiring drainage, but Hahnem a n n (11) laid down t h a t the ideal physician should appreciate what is curable by medicine and K e n t (12) further explained t h a t one should not a t t e m p t to cure b y medicine illnesses t h a t require the surgeon, the dentist or the priest.

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ANTIBIOTICS Many people are inclined to think t h a t antibiotics are the complete answer to all acute infections, but homceopaths consider that our method is better because it stimulates the vis medicatrix naturae and works regardless of the type of organism associated with the illness. Apart from using an antibiotic to which the organism is insensitive, like all other orthodox remedies, these preparations have their drawbacks, their socalled side-effects and occasional risks, so that they must be used with care, should be properly selected and given in correct dosage. I used the term "occasional risk" because homceopaths see the majority of bad results of antibiotic treatment and are inclined perhaps to get a prejudiced view about the frequency of allergy or toxicity and forget how m a n y lives have been saved by them. At the same time our orthodox colleagues are very conscious of the dangers as indicated b y the following quotations: Cullinan (13) (1953) . . . " I t is becoming more and more clear that antibiotics are dangerous weapons only to be handled with understanding and discretion." Tunbridge (14) (1956) . . . "The greatest problem with antibiotics is their misuse". One American estimate (Jawetz (1954)) rates the proportion of antibiotics misused as high as 95 per cent. The misuse has led to an increasing prevalence of resistant strains of bacteria, particularly in hospitals . . . . The list of toxic manifestations is growing and is formidable: glossitis, stomatitis, nausea, vomiting, diarrhoea, urticarial skin rashes, arthralgia, vestibular and auditory disturbances. Sensitivity to penicillin is becoming more and more c o m m o n . . , arthralgie symptoms often persisting for several weeks or months, and the sudden onset of severe shock presumably due to an allergic reaction which occasionally has proved fatal. Aplastic anaemia has followed prescribing ehloramphenicol for long periods. Tetraeyclines (aureomycin, achromycin) as well as being liver poisons, cause nausea and diarrhoea, and b y altering the bowel flora cause vitamin deficiency and m a y render the bowel susceptible to fungal growths or the dreaded staphylococcal enteritis. The high incidence of toxic reactions to tetracyclines has caused a marked reduction in their use. Ehrlieh Faber and Goodman (15) (1955) discussing status asthmaticus in childhood mention t h a t "infection is almost invariably present, often due to bacteria which are ordinarily considered non-pathogenic in adults". Possibly the prevalent use of antibiotics, by altering the type of organism in the respiratory tract, m a y allow non-sensitive bacteria to thrive and become pathogenic. This might account for the recent increase in the mortality from status asthmaticus, from negligible figures to 1,500 per year, which Foubister (16) suggested might be due to modern drugs. Antibiotics in Pneumonia Having discussed some of the disadvantages of antibiotics, it is only fair to say something in defence of their use in pneumonia, especially as 40 per cent. of the hospital cases had an antibiotic. Garrod (17) (1955) has classified the indications for antibiotic therapy into one group where there is an unchangeable indication for their use. This group includes lobar pneumonia. His second group, where the effect of antibiotics is unpredictable either (1) where bacterial sensitivity varies (staphylococcal infections) or (2) where the bacterial cause varies (this sub-group includes broncho-pneumonia). Coupe and Sutton (18) (1956) state: "Penicillin by general experience remains a very satisfactory antibiotic in the treatment of pneumococcal pneumonia, at least the equal of any other antibiotic and superior to most, according to the M.R.C. Trial of 1951. They state t h a t there is a one-in-ten

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chance t h a t a pneumococcal infection will fail to respond to penicillin. Incidentally their suggested dose is 3-500,000 units thrice daily reducing the dose with improvement but continuing penicillin for at least five days. They further state t h a t "the majority of patients respond promptly in 24-28 hours, but failure to improve calls for patience and the intensity of the penicillin treatment should be increased if progress is unsatisfactory, and unless there is definite deterioration rather than failure to improve continue the penicillin for another 24-48 hours by which time sputum bacterial observations m a y guide. For suspected lung abscess they suggest a dose of 1,000,000 units four-hourly until improvement, or change in therapy. For those patients who have a strong objection to injections it is worth noting that oral penicillin is effe ctive. Anderson and Landsman (19) (1947) using much smaller doses, when investigating the relative effectiveness of intramuscular and oral penicillin, found t h a t the average duration of fever in uncomplicated cases of pneumonia, in the intramuscular group was 1.9 days and in the oral group 1.4 days. Tablets of calcium penicillin with 0.5 gm. sodium citrate were used three-hourly for three days. I n order to enhance absorption and maintain effective blood levels the tablets were given along with 1-2 oz. of milk (28-56 mls.) and the daily fluid intake reduced to 2 pints (1.136 litres). From these results it was clear t h a t oral penicillin is a satisfactory method of treatment of pneumonia. The newer buffered penicillin preparations can now be used more easily without so much attention to gastric acidity and fluid restriction. Although penicillin is effective in pneumoeoccal pneumonia its effect in broncho-pneumonia is unpredictable e.g. Wood (2) (1956) described a school outbreak of virus pneumonia (primary atypical pneumonia) where the symptoms were not so mild as usually portrayed in text-books. In the epidemic the onset was abrupt with a sudden fever of 101~ ~ 103 ~ in several cases and 104 ~ in one. The first case developed consolidation in the right base suggesting lobar pneumonia. I t was observed that the duration of physical signs in the early cases treated with penicillin and sulphonamides was considerable and localized rs were still audible in several cases between the second and third weeks of the illness and furthermore some of the cases relapsed. The later cases were treated with chlortetracycline which appeared to be extremely effective, provided it was given early in the disease, although the author mentions t h a t Snyder etal. {1952) in a similar outbreak in America found no obvious response to several antibiotics including chlortetracyeline. Wood from his experience has suggested that if the diagnosis of virus broncho-pneumonia (primary atypical pneumonia) is firmly suspected "it is N O T advisable to t r y the effect of penicillin or sulphonamides first as the illness will be prolonged". COMBII~ED TREATMENT Having enumerated reasons for failure of homceopathic treatment, the uninitiated might say, " W h y not start at once with antibiotics?" A possible reply is t h a t it might not be the correct antibiotic and so might do more harm than good. Furthermore, in another five years or so antibiotics m a y be not quite so fashionable and much less commonly used, partly because of allergy and their toxic effects, but perhaps also because pathogenic organisms m a y become highly skilled in mutation and thus resisting the known antibiotics. I n addition, early administration of antibiotics in an illness m a y interfere with the patient's development of antibodies and other defenee mechanisms and so leave him improperly cured or liable to relapse. In the days before chemotherapy, if a patient survived and recovered from lobar pneumonia, it was common for him to feel better than he had felt for y e a r s - - t h e natural illness appeared to have cleared the bad out of his s y s t e m - - b u t nowadays it is not infrequent for us to

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find people who have never been well since treatment of an acute illness by antibiotics, but before jumping to conclusions about the ill effect being due to antibiotics let us consider these points: would the patient have died without the antibiotic? Was the organism sensitive to it? Was the treatment given in the correct dosage for the right duration? Homceopaths consider that the most effective way of curing the patient is by stimulating his natural reaction to disease and they can see little sense in giving an antibiotic without knowing for certain that it will be effective, especially when they are accustomed to good results with Homceopathy alone, e.g. Foubister (21) quoted figures from the 1919 pandemic influenza in U.S.A., when 17,000 patients treated by Homceopathy had a death rate of 0.3 per cent. compared with 20 per cent. in those treated by allopathic methods, i.e. homceopathically treated cases had a mortality rate 1/66th of the rate of those treated allopathically. On the other hand, there are a few patients whose capability of reacting is greatly reduced by a massive dose of infection or a particularly virulent organism especially ff occurring in a person already debilitated by environmental circumstances, old age or chronic ill health. In such patients irreversible pathological changes may occur quickly before the reaction can be induced by Homceopathy, and since medical research has proved that antibiotics act by killing and inhibiting the growth of bacteria there can be little justification for withholding an antibiotic ff it is known t h a t the infecting organism is sensitive to it. Such a line of treatment appears to be quite in keeping with paragraph 2 of Organon (22}. "The highest ideal of cure is rapid, gentle and permanent restoration of the health, or removal and annihilation of the disease in its whole extent, in the shortest, most reliable and most harmless way, on easily comprehensible principles." In general practice treatment of acute infections, such as pneumonia, more especially if occurring in debilitated patients, it is worth while sending a sputum specimen to the Public Health laboratories requesting type of organism and antibiotic sensitivity, so that by two days the infecting organism is known and the effective antibiotic can be used promptly and effectively if the patient has failed to react to previous treatment. Antibiotics were used in 33 (40 per cent.) of the patients admitted to hospital. It must be appreciated that most of these were difficult cases which had some complication or had not responded to the apparently indicated remedy before admission. Penicillin was usually used in doses of 500,000 units intramuscularly two or three times a day but more commonly daily for l, 2 or 3 days by which time the patient was able to react and complete the recovery by his own natural forces. SUMMARY Three eases of pneumonia in patients aged 6, 67 and 81 are described indicating prompt response to Homo~opathy in each. The case of the grossly scoliotie man of 56 with angina and breathlessness on slight exertion is mentioned; he was seriously ill for two days and although his sputum contained pneumococci, he did not respond as quickly as expected; this was subsequently explained by the fact that he actually had an influenzal A infection. There is an analysis of 80 unseleeted consecutive cases labelled pneumonia which were admitted to Glasgow Homceopathie Hospital between 1946 and 1956. Forty-one were lobar and 39 broncho-pneumonia. Thirty-three patients had antibiotics in addition to Homceopathy. Details of seven eases who died are given. Bryonia was most frequently prescribed (45 times); Sulphur comes a close second (43); then Phosphorus (25) and next Natrum sulph. (20), the latter being perhaps related to the damp climate of the West of Scotland. Higher potencies (200-10m) were often prescribed. The probable reason for

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using different potencies are discussed along with the frequency of repetition. Reasons w h y H o m c e o p a t h y m a y fail are discussed. Antibiotics and combined t r e a t m e n t are mentioned and it is suggested that, if the e m b r y o homceopath feels apprehensive about treating pneumonia without antibiotics, he m a y satisfy his conscience b y p r o m p t l y sending sputa for typing and antibiotic sensitivity, so t h a t should the patient fail to respond b y 48 hours he will know which is the correct antibiotic to use, whereas if he h a d given the wrong antibiotic at the onset it might have aggravated the patient's condition. REFERENCES (1) BOI~LAND, D. M. Pneumonias, Brit. Horn. Ass.

(2) FOVBISTE~,D. M. (1956) Brit. Horn. J., 45, 68. (3) BORLA~D,D. l~. Pneumonias, Brit. Hom. Ass., 7. (4) TYLE]~and BO~LAND.Pointers to Common Remedies, No. l, 32. (5) BORLAi~D, D. l~. Pneumonias, Brit. Horn. Ass., 3. (6) - Ibid., 26. (7) CLose, S. (1924) Leer. Horn. Phil., Boerieke & Tafel, Philadelphia, 200. (8) MITCHELL,G. R. (1950) Brit. Horn. J., 40, 141. (9) MIWCHELL,G. R. Ibid., 136. (10) CLOSE,S. (1924) Leer. Horn. Phil., Boerieke & Tafel, 199. (11) HAH~.MAN~, S. Organon, 6th edition, translated WiUiarn Boericke, Boericke & Tafel, Philadelphia, 92. (12) KENT, J. T. (1937) Leer. on Horn. Phil., Horn. Pub. Co., 44. (13) CULLINAN,E. R. (1955) Medical Progress, Butterworth, London, 4. (14) T~B~IDGE, R. E. (1956) Ibid., 5. (15) Em~LIC~,E. E. et at. (1955) A n n . Allergy, 13, 280. (16) FOVBISTER,D. M. (1956) Brit. Horn. J., 45, 66. (17) GA~ROD,L.P. (1955) Brit. med. J., li, 757. (18) COWeEand SUTTON(1956) Ibid., l, 286 (19) A~D~RSONand LA~DSMA~(1947) Ibid., li, 950. (20) WOOD,P. (1956) Ibid., l, 712-3. (21) FOUBISTER,D. M. (1956) Brit. Horn. J., 45, 67. (22) HAHN~.MANN, S. Organon, sixth edition, translated William Boericke, Boerieke & Tale1, Philadelphia, 92. DISCUSSION DR. T. D. ROSS t h a n k e d Dr. Stewart for his interesting a n d frank paper. Although the figures were n o t v e r y impressive he felt t h a t knowing m a n y of the eases which h a d been in the hospital it was a wonder so m a n y h a d been saved, particularly the severe influenzal pneumonias. H e stated t h a t it was usual in t h e hospital to give the patient a few days with remedies before giving a n y antibiotic, if this should be required, and to continue the r e m e d y for a d a y or two after the temperature returned to normal. Potencies used were generally 10m or l m in v e r y ill patients. H e stressed t h a t diagnosis is n o t always easy and referred to some cases of bronchial carcinoma and two cases of deep venous thrombosis of the legs with embolic lesions in the lungs which h a d presented as acute chests. DR. G. G. ROBERTSON stated t h a t in general practice he was finding t h a t measles and scarlet fever etc., were much less severe and complications were few. There h a d been a change in the severity in m a n y of these conditions with the a d v e n t of sulphonamides a n d antibiotics. He had, however, heard recently o f difficulty with resistance of t h e tubercle bacilli to streptomycin. His impression was t h a t convalescence and t e n d e n c y to recurrence of illness was not worse with antibiotics t h a n with homceopathic treatment. DR. T. ROBERTSON stated t h a t he usually used lower potencies, mainly 4c, and his feeling was that, provided the r e m e d y was correct, the p o t e n c y was not nearly so important. D~. DUTHI~ t h a n k e d Dr. Stewart for his interesting p a p e r and for the immense a m o u n t of work which it had entailed. He wondered whether the sex of the patient h a d a n y bearing on sensitivity to homceopathie remedies. Referring to Dr. Stewart's mention of Dr. Borland, he t h o u g h t t h a t Dr. Borland

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had dealt more with early or youthful cases, and, therefore, had used more acute remedies in the use of which he was an expert. The selection of potencies, he thought, depended on one's confidence in a particular potency. DR. T. D. Ross asked whether any members had used some of the more rare remedies for chest conditions. He remembered a case of an elderly lady with pneumonia who had cleared up very well with Digitalis in potency. DR. BOYD quoted a case of a child with a severe cough which had been greatly helped by Lobelia, the chief feature being the spasmodic cough and profuse salivation. DR. A. C. G. Ross thanked Dr. Stewart for his interesting paper and mentioned a recent article in one of the medical journals in which a professor had stressed his extreme respect of the toxic effects of antibiotics, particularly the development of enteritis as a result of drug treatment. DR. T. ROBERTSONasked whether members thought the antibiotics had an adverse effect on the remedies. DR. T. D. Ross replied that he thought probably penicillin had no such adverse effect. Chloromycetin and sulphonamides might make prescribing difficult. There was some discussion on whether Camphor had an antidotal effect on remedies. No one was quite definite about this and thought that possibly only certain remedies were affected by Camphor. DR. C~PBELL thought that Veratrum vir. might be used more, particularly in the early stages. DR. Ross agreed with this and stated t h a t Veratrura vir. was sometimes like Belladonna but with giddiness on sitting up, a red streak on the centre of the tongue, a sweet taste and bloody sputum. DR. G. L. WILSO~ stated that he felt that one of the first cases he lost should have had Veratrum vir. which he did not give. This was a man with fever 105 ~ F., profuse sweating, a pulse that shook the bed and a feeling that he would die if he went to sleep. He did in fact die when he went to sleep. I t was afterwards when discussing the case with Dr. Patrick he decided that he might have saved the case with Veratrum vir. He also felt that unusual symptoms should be used more in selection of remedies, e.g. hunger plus fever--Phos. He had seen this work like magic. He, himself, always used potencies of 30c. DR. E. PATERSONthanked Dr. Stewart for his paper and mentioned Hellehorus, as a remedy with hunger plus fever and an aggravation at 4 to 8 p.m. DR. ROXBURGH stated that Professor McNee used to recommend that penicillin was not given to young people with pneumonia as it tended to delay resolution, and that another antibiotic was more favourable. This concluded the discussion.