§ 134. The chief remedies in pneumonia are: Aconite, Bryon., Puls., Lauroc, Mercur., Canthar., Phosphor., Rhus t., Tart, stib., Bellad., Am., Lyc, Seneg., Cann., Nux v., etc.

If the fever should have a synochal character, if the pulse should be hard, quick and full, the face red, the chilliness or heat excessive, the pains in the chest violent, and the respiration oppressed and accompanied with anxiety, Aconite should be given in repeated doses. Bryonia is an excellent remedy when the inflammation was occasioned by exposure to dry and cold weather, by straining, or other violent muscular exertions; when it is not entirely developed or not violent. This remedy is principally indicated when the fever and pains are moderate, the sputa white, slimy and streaked with blood, the cough loose and the oppression not excessive, attended with constant desire to draw breath. Rheumatic or bruising pains in the muscles of the chest or extremities are an additional indication for Bryonia.

Next to Bryonia we mention Pulsatilla, which is particularly indicated when the pneumonia has a rheu-matic-catarrhal character, when the expectoration is 3 copious and not bloody, when the pain is more external and is increased by pressure on the thorax, and when the breathing is rattling. Rheumatic pains in different parts of the body are an additional indication for Pulsatilla. It is particularly suitable when the above-mentioned symptoms occur in a female patient with pale face, blue eyes, blond hair, when they occur in consequence of fright or chagrin, and are accompanied with gastric symptoms. Belladonna will be found suitable when there is great congestion of blood to the brain, when the face is bloated and very red, the lips and tongue are cracked and dry, when there is delirium, and the disease threatens to assume a typhoid character. Belladonna is frequently useful after Aconite; it corresponds to the synochal as well as the erethic fever, to a strong, full and quick, as well as to a small and quick pulse, to stitches in the chest as well as to pressure attended with heavy, short, anxious and quick breathing. It should always be used if Aconite should prove unavailing to moderate the fever.

Tartarus emet. is recommended as the principal remedy in the second stage of pneumonia, and is, according to Dr. CI. Muller indicated by the following symptoms: little or no stinging pain, great oppression and difficulty of breathing; loose cough with mucous rattling and alleviation of the oppression by the expectoration, which is very profuse; the sputa contains little or no blood, but a quantity of mucus; a portion of the lungs is hepatized (stage of spleniza-tion as well as red hepatization). The percussion-sound over a larger or smaller portion of the thorax is dull, with increased resistance; the portion of the thoracic walls adjoining the afore-mentioned region has either a tympanitic or the normal sound. Auscultation reveals bronchophony, bronchial respiration and consonant rattle. In bilious pneumonia, Tartar, emet. is indicated by the following symptoms: slight bilious tinge of the skin, of the albuginea, alae nasi and corners of the mouth, yellow-brownish coating of the tongue, bitter taste, disposition to vomit or actual vomiting, brown saffron-coloured urine; stinging pain under the right false ribs, or pain in the pit of the stomach with distention of the pit, frequent eructations and hiccough; violent aching, boring pain in the frontal region, sometimes increasing to furious delirium towards evening; the cough is frequently attended with vomiting, with scanty expectoration of a somewhat blood-streaked, frothy, saffron-coloured mucus. Nux v., Mercur., Senega, Digit., China, Sulph., are likewise suitable in that kind of pneumonia.

Nux vom. is indicated in pneumonia by a difficult, tenacious, sanguineous expectoration with much cough: the expectoration affords momentary relief: the patient complains of pressure and a feeling of anxiety in the chest; the pulse is not very strong, the patient is uneasy and restless. In pneumonia, with bilious symptoms, Nux v. deserves great attention.

In violent pneumonia, when the sticking pains in the chest are excited or aggravated by coughing or breathing (also in pleuro-pneumonia), when they are very violent and extend over a large surface, when a large portion of the lungs is inflamed with dyspnoea, when the cough is dry and the sputa rust-coloured (a characteristic symptom), Phosphorus is then in many cases the only remedy, affording relief in 8 or 12 hours. We should give two or three drops of the third or fourth attenuation every two or three hours. Sometimes, when the attack is very violent from the commencement. Phosphorus has to be given in alternation with Aconite or Belladonna, agreeably to the symptoms. This alternation may be necessary in the second stage of pneumonia, when the percussion-sound over the affected portion of the lungs is dull, and bronchophony or bronchial respiration or perhaps consonant rattle is heard. Phosphorus is likewise indicated when the inflammation threatens to assume a typhoid character, the physical symptoms remaining nearly unaltered, or when symptoms of approaching paralysis of the lungs denote the passage of the inflammation into the stage of gray hepatization or purulent infiltration of the pulmonary parenchyma, attended with remarkable depression of the mental faculties, bland delirium and grasping at flocks, subsultus tendinum, rapid prostration, cold, viscid sweats, small, frequent, feeble pulse, dim eyes, sunken countenance, dry lips and tongue, short and difficult breathing, oppression and anguish, difficult cough and respiration, etc.*

Mercurius is indicated by a crampy-tensive pain in the left side of the chest, with violent oppression of breathing, which is sometimes increased by a burning, lancinating pain; this is attended with a cough which is at first dry, and afterwards accompanied with bloody expectoration; the pulse is hurried, full; much thirst; the fever is attended with a general nervous irritation, great heat, profuse, fetid sweats, nightly delirium, violent pains in the limbs, violent vertigo, dry mouth and throat, and particularly with great sensitiveness and painfulness of the region of the liver and epigastrium and of the pit of the stomach.