Critical Analysis of Borland's Pneumonia

Author: DOUGLAS M. BORLAND M.B., Ch.B. (Glas.) FFHom. (1885 - 1960)

Year of Publication: 1939.

Edition/Publication: 2003 Reprint Edition / B. Jain Publishers Pvt Ltd.

About the Author: Dr Borland qualified MB, ChB at Glasgow University in 1909. After various hospital posts he went to Chicago to study under Dr Kent, going as an open-minded sceptic and returning as an astonished and convinced homoeopath. He then took an appointment at the London Homoeopathic Hospital, followed by active service during World War I with the Royal Army Medical Corps. After the war he established a consultant practice in London and returned to the staff of the London Homoeopathic Hospital, where he subsequently became senior consultant physician and chairman of the staff. He was respected for his presence as a doctor and his willingness to assist his colleagues.
Borland was a pupil of Kent in 1908, he was one of those who brought Kentian philosophy to his motherland.
Borland wrote several popular books. These include:
Influenzas (1939)
Pneumonias (1939)
Children's Types (1939)
Some Emergencies of General Practice (1946)
Homeopathy for Mother and Infant (1950)
Digestive Drugs
Homeopathy in Practice
Homeopathy in Theory and Practice
Treatment of Certain Heart Conditions

 Borland died November 29, 1960.

 About the Repertory: This book is part of shorthand notes of Postgraduate Lectures delivered by Dr. Borland at the London Homoeopathic Hospital (Reprinted from Homoeopathy). This lecture is a result of author's extensive experience on the subject. It contains not only the detailed therapeutics of Pneumonia but also a detailed discussion on the potency to be used and repetition of doses is given.

 Aim of the Book: The aim of this book is to present in a concise manner the detailed knowledge of therapeutics and prescription of Pneumonias. This is a short booklet on the subject which helps the reader to deal with the case of Pneumonia and provide cure. Dr. Borland expected that when treating a pneumonia epidemic homeopathically there would be a 100% recovery rate.

 Source of the Repertory: This book is part of shorthand notes of Postgraduate Lectures delivered by Dr. Borland at the London Homoeopathic Hospital (Reprinted from Homoeopathy).

 Macroconstuction: The book is divided into two parts:

Part I: Understanding Pneumonia with remedies and their Indications.

Part II: Repertory

 Contents with page number

Pneumonias 1-6
Group 1 - Incipient Stage 7-14
Group 2 - Frankly Developed Pneumonia 15-25
Group 3 - Complicated Pneumonia 26-44
Group 4 - Late Pneumonia 45-59
Index 61-74

 Part I: The first part of the book aims at knowing Pneumonia from homoeopathic view.  The salient features which Dr. Borland has tried to deal with in the first part are:

• Prescription should be based on Totality of symptoms covering the disease picture as well as the patient picture.
• To recognize difference between pathognomic and non pathognomic symptoms. Prescription should always be based on non pathognomic symptoms and not on pathognomic symptoms which Borland called as diagnostic symptoms.
• For a perfect cure, physician should choose: Right medicine; Right strength of drug i.e. potency and Right repetition of drug.
• Role of potencies
  In Acute disease if you restrict your prescription to low potencies you avoided the complications of the disease, you made your patients more comfortable and you reduced your mortality rate. But by this method you do not reduce the duration of disease.
  By the administration of higher potencies, - something above 30 you will find that you abort the disease. It does not run its normal course; the duration of the illness is very much shortened and you have an anticipated crisis.
• For Repetition of doses
  When you are using low potencies, you have to keep up your drug administration right throughout the course of the disease.
  When you are using the higher potencies, it is advisable to continue the administration of the selected drug until the temperature has reached normal and has remained normal for at least 6 hours.
  In average case where you are using a low potency it is quite sufficient to give the drug about once in four hours.
  As far as the high potencies are concerned, I think it is wiser to give the drug every 2 hours, the reason being that you want a number of stimuli in a comparatively short period of time in order to obtain the crisis within 12-24 hours.

 Dr. Borland also advocates that 'Many people advocate that at the start it is wiser to use low potencies until you acquire confidence in your selection and then as you gain greater knowledge heighten the potency and shorten the interval, so that eventually you are treating all your crisis with medium or high potency.

Personally, I think it is better to go out for the best right from the start'

• Understanding the Stages of Disease and group of the Homeopathic drugs which would cover each stage.
  
  Associating drugs according to symptoms presented in clinical practice.
  
  Group I Incipient Stage
  
  (Aconite, Belladona, Ferrrum-phos, Ipecac)
  
  In each drug, description of picture of patient during onset, attack is given. Like peculiarities of Aconite patient in Incipient stage, Choice of potency, action of potency and the changes it produces is explained.
  
  Group II Frankly developed Pneumonia
  
  After the first 24 hours consider Bryonia, Phosphorus, Veratrum-viride and Chelidonium. Bryonia is consider in milder weather while Phosphorus in colder weather.
  
  In the first part description of each drug is given in detail and in the second part the Directions for choosing Dosage is given.
  
  Developed Pneumonia: Use of high potencies CM, 10M.
  
  Frankly developed Pneumonia: At least 6 doses of medicine. One finds that the average length of action of action of each dose is around 2 hours; 6 doses of whatever potency probably a 10M and repeat every 2 hours.
  
  Group III       -Complicated Pneumonia - Mixed patient or unhealthy patient
                     -Creeping type of Pneumonia or Frank Broncho-pneumonia.
  
  A)     Mixed patient or Alcoholic patient: Baptisia, Mercurius, Rhus-tox, Pyrogen, Hepar-sulph, Lachesis (Lachesis is the most commonly used drug at this stage): Picture of patient is given.
  B)     Creeping type of Pneumonia, or Definite Bronchopneumonia in Adult: Pulsatilla, Natrum-sulph, Senega and Lobelia. Picture of patient is given.
  
  The best potency at this stage was a 1M, which seemed to be high but not dangerous. In Frankly alcoholic patient with pneumococcal infection give high potency.
  
  Group IV  Late Pneumonia:  One that is not resolving well, not clearing up satisfactorily. Antim-tart, Carbo-veg, Kali-carb, Ars-alb, Lycopodium, Sulph.
  
  Picture of the patient along with choice of potency is given. For example:
  
  Carbo-veg: CM's every 10 or 15 minute.
  
  Lycopodium: 10M's 2 hourly.
  
  Sulphur CM's 2 hourly.

Part II: Therapeutic Symptom Index

This part contains a symptom index of the first part of the book.

Microconstuction

1. The second part is divided into 21 sections or chapters consisting of:

General.

Mentals

Head and Vertigo

Face and Lips

Mouth

Tongue

Eyes

Nose

Throat

Stomach

Abdomen

Rectum

Chest

Cough

Sputum

Heart

Pulse

Temperature

Extremities

Skin

Sleep

Chapters are arranged following Hahnemann's schema. The first chapter is  

   General (containing stages, onset, temperature reactions, weather)

2. The Rubrics are written in Roman case arranged alphabetically.

3. Subrubrics- are written in Italic case starting with an indent and also arranged   

    alphabetically.

4. Medicines are listed in each rubric, subrubric alphabetically followed by the  

 page number where it is mentioned.

5. Cross reference are mentioned in (brackets, after See.)

Total number of Medicines: 24.

How to use the Repertory: Dr. Borland explained the implementation of his therapeutic index in the first part:

"Suppose you take a case of pneumonia; it does not interest you that the patient has a temperature, a rapid pulse, rapid respiration, rusty sputum, because all the drugs you consider for the treatment of a pneumonia have these symptoms and you do not need to bother about them at all.

"But it does matter to you whether the individual patient has a generally evenly coated tongue, whether he has a dry mouth or a moist one, whether he is thirsty or thirstless, whether he is more comfortable lying on the affected side or on the opposite one, whether he is drugged and toxic or delirious and excited, whether he is more at peace with somebody by his bed or prefers to be left alone.

"All that sort of thing you very definitely want to know; it is on that sort of thing you prescribe; but you only take it into account after you have decided that the drugs you are considering have the constant features on which you have made your diagnosis.

"It is not a question of neglecting your clinical side; it is a question of knowing which drugs have the clinical picture, and adding to that the points on which you are going to prescribe."

ADVANTAGES:

1. In some symptoms i.e. those related to Pneumonia, care has been taken to   form a complete symptom for example

          Chapter: Chest

                   Rubric: Pain

                             Area affected:

                             Aggravated by:

                             Ameliorated by:

          Chapter: Cough

                   Rubric: Aggravated by:

                             Ameliorated by:

2. Rubric describing the physical type of patient is also given, under Generals

    (Type physical) which helps in forming the totality.

3. Pathological rubrics like consolidation, Pain: pleuritic have been included.

4. A special rubric for deciding the thermal reaction of patiens is  

    given. Rubric: Temperature reaction to:

        Sensitive to cold (for Chilly); Sensitive to heat (for Hot); Sensitive to heat and cold (for Ambithermal).

5. Special rubrics related to mind have been included like:

        Desires hand being held, Dislike of particular person, Interference resents, Unpleasant occurences relates.

6. Handy and concise.

7. Contains rubrics related to Pneumonia with concomitants at one place.

8. Quick prescription in case of pneumonia at any stage.

DISADVANTAGES:

1. Limited number of rubrics.

2. NO GRADATION OF REMEDIES

3. Number of remedies is very less.

Comments: 'Borland's Pneumonia' is more of a treatise on the subject than a repertory. No doubt it has long been known for its repertorial part, but it is more of an Index than a repertory. In the first chapter of General we have rubrics for potency, repetition of doses which is unusual considering it as repertory on Pneumonia. Also there is no gradation of remedies, so the book serves for quick prescription instead of proper repertorisation.

Dr. Borland is famous for his booklets wherein he extensively described the indications of medicines in the condition, ending the booklet with a short alphabetic index. Even his book on 'Influenzas' deals with the medicines indicated followed by an index. Though in this book the description of index is elaborate but it lacks precision if compared to other regional repertories.

So 'Borland's Pneumonia' can be thought of as a treatise on Pneumonia identifying stages of disease, its symptoms, related medicines, potency to be prescribed and repetition needed.