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CASE MANAGEMENT Necessity of further Diagnostics prior to Start of the Treatment Where can and/or should Therapy and Observation take place? Prognostic Factors and Criteria for Admission to Hospital Homeopathic Case-Analysis and first Prescription On Potency Dosage and Administration Which auxiliary therapies and/or measures are reasonable and/or necessary? Who should assess the course of the disease-/therapy-progress at what point and in which form? Recommendations on Case-Assessment in Pneumonia When should the homeopathic Remedy be changed? How long should Patients be treated in Pneumonia? General recommendations in homeopathic Case Management CASE MANAGEMENT In chronlogical order: 1) Necessity of further diagnostics? 1) Where can and/or should therapy and observation take place? 1) Prognostic factors and criteria for admission to hospital 1) Homeopathic case-analysis and first prescription 1) On Potency 1) Dosage and Administration 1) Which auxiliary therapies and/or measures are reasonable and/or necessary? 2) Who should assess the course of the disease-/therapy-progress in what form and when? 3) Recommendations on case-assessment in pneumonia 4) When should the homeopathic remedy be changed? 5) How long should patients be treated in pneumonia 6) Frequent mistakes in homeopathic case management Necessity of further Diagnostics prior to Start of the Treatment After taking the case incl. physical examination you should consider if you need and/or can arrange further diagnostic steps such as X-ray, blood-tests, CT-scans, etc. If you find it necessary and possible for clarity with the given case, do so! Possibly you might want or need further diagnostics in the course of the disease - in order to expand your understanding of the case, as a measurement for therapy-progress or for other reasons. Where can and/or should Therapy and Observation take place? According to where the case-taking took place - at the patient's home, in your practice, or in hospital - you have to assess where the start of the therapy can be managed, so that the patient is safe and has what she or he needs given the circumstances. For this see the next chapter "Prognostic factors and criteria for hospital admission". Prognostic Factors and Criteria for Admission to Hospital In Children glt1,glt2,2023 Risk-groups Children under 3 years of age, History of (semi-)severe Asthma, cachexia, malnutrition and other severe chronic conditions or diseases.
Scaling for Air-Obstruction in children glt2
Homeopathic specifics for broncho-pneumonia pew1,1904 In infancy, during old age or cases in which the patient is in an enfeebled condition the outlook is not favorable. The prognosis is affected by co-existing circumstances. Bad nutrition, unhygienic surroundings, rachitic children, chronic nephritis or cardiac complications render it unfavorable. The probable outcome is less encouraging when the pneumonia complicates whooping cough, than when associated with measles. The height of the temperature, the extent of the bronchitis and the amount of consolidation are most important factors. A temperature of 104°F/40°C to 105°F/40,6°C is unfavorable. The ultimate prognosis in cases not going on to complete resolution is unfavorable, as such areas of consolidation form foci for tubercular infection or abscesses. Blackwood bwax,1902: The unfavorable symptoms are a high temperature, continuous dyspnea, Cheyne-Stokes respiration, convulsions, delirium, especially if the disease has existed for some time and has an extensive inflammatory process. Gatchell gccx,1902: The younger the child [esp. younger than 3 years glt2,2023] the more grave the prognosis. In older children with secondary broncho-pneumonia the prognosis is more favorable. The prognosis must always be guarded, for sudden extension of the disease to previously unaffected portions of the lung may at any time change the aspect of the case in a few hours. In Adults Risk groups Patients with chronic diseases such as COPD, heart- and/or kidney-insufficiency, diabetes, cerebro-vascular diseases, cancer, immunosuppression, addiction to alcohol, or health care insecurity. Homeopathic specifics for lobar pneumonia Paige pew1,1904: Complications exert a grave influence, especially meningitis and endocarditis. Death is due to cardiac failure, general toxemia or asphyxia. The temperature is a significant omen. A temperature of 104°F/40°C is favorable, but if it continues to rise after the fourth day it is unfavorable. A low temperature range, if the pulse and respiration correspond, is favorable. A pulse of 120/min or over, especially if it is thready, compressible or intermittent is of grave account. Offensive expectoration or if "prune juice" in character, shows deterioration of blood and tissues, or possibly gangrene. Tracheal rales, especially with inability to expectorate, usually portend death and indicate pulmonary edema. Cases beginning with severe gastro-intestinal symptoms show double the mortality of those beginning with chill. Rapid development of consolidation, a large amount of frothy expectoration, respiration rate over fifty, increased rapidity of pulse and rise of temperature after the seventh day, delirium throughout the twenty-four hours, are each and all unfavorable signs. [Symptoms denoting an unfavorable result are as follows: frequency and feebleness of the pulse, quick and labored respiration, blueness of the face, bloody dark colored sputa, low muttering delirium and great prostration. These symptoms forbode speedy dissolution.] dicx,1893 [1915: Recently it has been stated that if the blood pressure in millimeters falls below the number of pulse beats per minute, during the height of the disease, the outlook is unfavorable. If the endocardium becomes involved the pulse becomes irregular and the heart sounds become vague and obscure. The rhythm is disturbed. These are dangerous symptoms. .] milx,1915 [1875: The most valuable symptom of approaching death was the up and down movement of the trachea; ... in pneumonia this symptom is of especial value, anticipating, as it does, alarming changes in pulse and temperature. Shrady, J., Moribund condition, Medical Record, New York, 1875, Vol.X, p.238] Criteria for Hospitalisation 1. CRB-65 Index
Each criterion receives one point; this results in three risk classes with corresponding management recommendations
Extended version for patients in hospital = CRUB 65 U Blood UREA Blood urea > 7 mmol/l Source: Lorenz, Joachim, Community Acquired Pneumonia, Kompetenznetz Ambulant erworbene Pneumonie, Published by the German Ministery for Education and Research, 2003 2. Pneumonia Severity Index (PSI) Clinically relevant symptoms of crisis 1997
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Further important Features: - Signs of septicemia - Hypotonia (in adults < 90/60mmHg) - More than one area of lung involved - Temperature lower than 35°C/95°F or higher than 40°C/104°F - Oxygenisation lower than 90% with pulse > 125/min Source - Fine MJ et al., A prediction rule to identify low-risk-patients with community acquired pneumonia, NEJM 1997; 336:243 3. NEWS 2 In clinical settings in Europe the NEWS 2-score is a broadly used one to decide whether a patient can be treated at home, in hospital or even in intensive-care-units. A NEWS-score of 5 points or more indicates an urgent clinical alert and response
Clinical criteria for homeopathic assessment glt2,2023 - Insecure care (especially nightly surveillance!) - At least one person should continuously observe the patient. - Deterioration of consciousness (like stupor, inability to wake the patient up, ...) and confusion of mind. - Breathing frequency over > 45 - 50/min in children or 30-35/min in adults - Irregular breathing, interrupted breathing (more than 15 sec.) independent from coughing - PO2 % < 90% - Blood pressure decrease to 90/60mmHg and lower - nightly bradycardia! - Pulse: > 130/min in children, >110/min in adults - Signs of Exsiccosis, bloated abdomen without peristalsis - Marked fear of parents - should always lead to hospital administration! Any deterioration of these criteria should lead to immediate hospital administration! (You should tell parents: "If you go too late, your child may die!") Finally the decision when a patient should better be watched and treated in hospital or at home also depends on various factors such as: How far away is the next hospital? How can the transport be managed? What equipment does the hospital have? How much clinical experience does the treating homeopath have? How good are the care-takers' skills in observing the patient? etc. Ed. Homeopathic Case-Analysis and first Prescription Ed.: To identify what the homeopathical characteristics of the patient's disease-picture are at the moment of assessment, is sometimes easy and sometimes not. We recommend you write down your case-hypothesis, so that you can check later if your assumption was correct or if not, where you were wrong. This way you can continually improve your percentage of correct prescriptions. We further recommend that you analyze the case before you start repertorisation. Too early repertorisation may likely lead you to certain remedy-ideas familiar to you, but not necessarily the best fit regarding the disease-picture at this point! Be aware that so called "smaller remedies" (remedies not used so often under a certain condition, e.g. Ant-ars.) are only included in specific rubrics, whereas "big remedies" are found in many rubrics! So you should pick your rubrics carefully, as a "smaller remedy" might just be the most appropriate for the case at hand! If a symptom is extremely prominent in a case which also contains small remedies in the rubric, then check the Materia Medica, to see if this remedy corresponds to the case. Also perform a thorough differential diagnostic of remedies deduced from your repertorisation in the Materia medica. Analyzing paper-cases and studying the rubrics in which smaller remedies are noted can help improve your judgment! Saine snex: As a rule it is better to also know the chronic case or remedy of te patient, as in about 50% of the cases the acute remedy is the same as the chronic remedy of the person. For patients with difficult cases, the advent of pneumonia tends to be an excellent way to make a breakthrough in their chronic case and can offer help to find their chronic remedy. Recommendations for the approach in highly acute cases glt2,2023 Editors.: This recommendations by Galic - should only be applied where all other - especially also all orthodox medical help has already been given or is not available! Step 1 Self-Management of the homeopath The aim is to stay/become as clearheaded and mindful as possible for the case at hand. Free yourself of fear as much as possible. Confront yourself with the worst-case-scenario. Step 2 Repertorize the symptoms you already have and see if you can achieve a reasonable repertorial result. Don't look for a numeric fit between case and remedies. Try to find out what really fits the case in this state. The remedy should perfectly fit the disease-condition AT THE GIVEN MOMENT! Step 3 In life-threatening cases familiar individualizing symptoms are frequently missing. Keep your eyes open also for "small/unfamiliar" symptoms and seldomly used remedies. Step 4 Search the primary Materia medica and case-publications of the 19th century for descriptions and compare with the case-condition you see right now. Step 5 If the beginning of a treatment succeeds with a small specific remedy, the reactive power of the individual increases and further, new symptoms emerge. At the same time the patient stabilizes. With new symptoms the possible following remedy can be differentiated. Step 6 Avoid being overhasty, euphoric, or overconfident, if a given remedy helped the patient! For if the condition deteriorates again, your self-esteem might cave in! Step 7 If your case-hypothesis does not work with a prescribed remedy, search for a new hypothesis and remedy. Have the courage to develop new ideas and approaches to help the patient! Homeopathic characteristics of life-threatening cases You will only seldomly find general keynote-symptoms, thus be careful not to ask for symptoms/generals which are not relevant at this point. A small therapeutic window for prescriptions dictates that the remedy must fit exactly for the patient's state at that moment. Conclusion: 'Don't look for what you know, but look for what is there! If the pathological state is the quintessential criterium, start there! Don't' change the remedy during transient changes of the disease-course! On Potency This chapter was added by us editors, because we found valuable information on this important topic scattered throughout the scanned literature, potentially helpful for successful homeopathic practice. Hence we decided to gather this data in one chapter, where general advice is given in chronological order of publication. We also found many pointers suggesting that that specific information referred to a certain remedy (often in combination with a certain state of the patient). These notes we inserted in the Materia Medica-Chapter of this book at the corresponding remedies. The Viennese Pneumonia-Potency-Study 1852-1862* The Austrian Drs. Wurmb and Kasper, later supplemented by Dr. Eidherr were working as homeopathic physicians in charge at Leopoldstadt-hospital in Vienna in the 1850ies. At that time it was a frequently discussed question of homeopaths in what potencies homeopathic remedies give the best results. In order to contribute to answering that question these homeopaths decided to give for 3 continuing years every patient with the diagnosis pneumonia the C30 potency of each chosen remedy. Afterwards for 3 years C 6 and then for another 3 years only C15. Here are some of their results: Group I C30 Potency - 55 cases - Duration of hospital-treatment average 11,3 days Physical signs of exudation vanished in 12,3 days Group II C6 Potency - 31 cases - Duration of hospital-treatment average 19,5 days Physical signs of exudation vanished in 20,5 days Group III C15 Potency - 54 cases - Duration of hospital-treatment average 14,6 days Physical signs of exudation vanished in 18,1 days We are absolutely clear that this sort of study is not sufficient for modern scientific research. Still this data - together with the statement from other authorities - makes clear that the choice of potency does significantly make a difference in terms of duration of the diseases and seems to give some hint on were the best paths about the right potencies in the treatment of pneumonia might be. *Cited from Carrol Dunham - Homeopathy, The Science of Therapeutics, Francis Hart and Co., New York, 1877, p. 240-246, Editors: This study shows that the given potency does matter in terms of duration of pneumonia and hospital-treatment. Later homeopathic experiences (esp. by homeopaths like CM Boger, D. Borland) - with much higher potencies (like CM, MM, etc.) and given with different dosology - show even much quicker response and much shorter duration of disease! Therefore the best posology is of very high importance for treatment of patients with pneumonia - and for many other diseases! Nicol nicx,1885 [Ed. Under Ant-t. - On dosage in lobar pneumonia in children:] Usually, I dissolve a powder of the third decimal trituration in six teaspoonfuls of water and give a teaspoonful every hour or more often; if the child is unwilling to take water, I place a very small quantity of the 4th decimal trituration on the tongue every hour. In very young children, I have seen good results from the 12th decimal trituration. Nash nh6,1909 Chapter Kali-i.: On Potency - At begin of my practice I gave the pure substance in water. A few years ago I tried the 200th potency with the same quick curative effect. Since that I frequently use the remedies in such high potencies. Chapter Lyc.: In the use of these remedies (Sulph., Calc. and Lyc.) I never use at this stage anything below the 30th potency, and often use much higher. Sulph. 55m, Fincke, and Lyc. 6m., Jenichen, are favorites with me. Chapter Iod.: "My observation is that it does better low, say, the 2nd [Ed. - D2 potency] trituration, than higher." Editors: See for his further suggestions under the specific drugs. Drs. Pulford pfa3,1928 "DON'T give too low potencies*." (Preface) Ed.: We could not find any clear statement from Pulford which potencies are high "enough". We found only one case of pneumonia from A. Pulford in which he startet with C30 ("was all we had with us") and then continued with C 10.000. Maybe further published cases by Pulfords themselves can be found to clear the question which potencies they found high enough in cases with Pneumonia! Underhill 1936 "The potency range suggested is from the 30th to the 1000th centesimal. Below the 30th, repetition is more often required. The very high potencies may unnecessarily aggravate sensitive patients and in case an emergency should require a stepping up of the remedy a still higher potency might not be quickly available. A very satisfactory medium potency is the 200th centesimal or the 2C, as it is sometimes called. In all acute conditions, if the remedy fails to hold after satisfactory initial action, it is well, after checking the symptoms, to repeat in a higher potency, as for example following the 200th with the 1000th or as is often termed the 1M. potency. A single dose of the 200th potency of the similimum will cure the vast majority of acute illnesses, pneumonia not excepted. If more than two doses of medicine in ascending potency are required, rest assured the remedy selection was in error." [Source: Homoeopathic treatment of pneumonia (E. Underhill), The Homoeopathic Recorder, 1936, Presented before the Hahnemannian Round Table, Philadelphia.] Borland bl4,1939 [Ed. taken from the introduction] Then there is another difficulty which, from the purely practical standpoint, I want to make very clear, and that is this vexed question of what strength of drug, i.e. potency, you are going to use and what repetition you are going to give. Where you are dealing with acute disease your choice of potency is very much simplified. It is very much more difficult where you are dealing with chronic disease. You will find from experience that where you are dealing with acute disease there are two attitudes of mind you can adopt. One is "play for safety", and this was advocated by some of the senior men when I first came here. There maintained that in acute disease if you restricted 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 your duration of disease. Suppose you were dealing with the average case of pneumonia in which you expected your crisis from the seventh to the tenth day. By prescribing low potencies you would relieve the patient's distress, you would diminish the severity of the attack, you would avoid complications such as a developing pleural effusion and possibly empyema; the patient would run a normal course, with a slightly lowered temperature; he would have a perfectly good, well-sustained pulse; there would be no signs of a flagging heart; the crisis would be very much more of a lysis than a crisis, but it would not occur before the normal period of seven to ten days. The patient would never cause a moment's anxiety, he would just steadily get better. That you can do. I have seen it done repeatedly, and it is a course of action which was strongly advocated in this hospital. They said the mortality rate under that line of treatment was enormously better than the mortality under the orthodox treatment, whether it was the expectant treatment or the active treatment of pneumonia; and I think that is true, your mortality rate will be better. The second method of treating these acute conditions is by the administration of higher potencies something above a thirty. You will find that by the administration of these higher potencies 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. Instead of getting the crisis from the seventh to tenth day you get it from twelve to forty-eight hours after starting treatment, irrespective of the day of disease. The relative advantages of the two methods of treatment are obvious. If you can cut short the duration of an acute illness of that sort you are still further diminishing your complications, you are still further diminishing the stress your patient has to endure, and you are less liable to get any signs of weakness developing. But you have precipitated a crisis, and a crisis is always attended by a certain amount of stress, possibly a certain amount of risk although this is not so likely when the crisis occurs early in the disease as when it occurs after seven to ten days of continuous fever. The temperature crashes over a few hours, but you do not get a collapse because you have a perfectly healthy patient to start with instead of one whose vitality is impaired by long toxemia. Another point of contrast in the two systems is this. By using the lower potencies your matching of the drug symptoms with the symptoms of the patient does not require to be quite so accurate as it does when you are using the higher potencies. Where you are using the higher potencies you must get a very accurate correspondence between the symptoms of your patient and the symptoms of your drug. If you are using the lower potencies you can produce a modifying effect without necessarily covering the whole case, so your work is less difficult. It is easier to prescribe the lower potencies and get a general similarity, whereas if you are prescribing the higher potencies you have to get a much more accurate matching. I am quite sure that anyone who has tried the two systems, and has had a bad case and seen the crisis in twelve hours, never rests satisfied with merely making the patient safe and comfortable over ten days; once you have experienced the power of the one you will never go back to the other. One is more difficult, but it is much better; the other is easier, and is better than treating cases on orthodox lines. One requires more detailed drug knowledge than the other, but I think it is worth while acquiring that knowledge in order to obtain the better results. That is the difference of the two systems, but they are both effective. Many people advocate that at the start it is wiser to use low potencies until you acquire confidence in your drug selection, and then as you gain greater knowledge heighten the potency and shorten the interval, so that eventually you are treating all your cases with medium or high potency. Possibly it is a wise way to do. Personally, I think it is better to go out for the best right from the start, do the extra work required in order to get more accurate matching, and aim for an early crisis in every case. It is sometimes said that certain drugs are effective in high potency and certain drugs only effective in low. I do not think this is so. The reason certain medicines have been found effective more commonly in low potency turns on the point of general similarity. Most of the drugs which are used exclusively in low potencies have not been fully proved; we have no knowledge of their finer differentiating points, we only have a knowledge of their cruder effects. So when you use one of these drugs in a higher potency you cannot accurately match the finer differentiating symptoms of the case. The higher you go, the more accurate the prescribing must be; in low potency a general similarity is enough to give an effect. Suppose you get a marked effect from a low potency, and later go high you will certainly get an effect. In that case it is worth while noting the finer points of the case and seeing if they crop up in the next case in which you think of giving that drug. On dosage and Repetition in incipient pneumonias bl4,1939 [Ed. taken from the the chapter on Acon.] And here I think it might be worth while discussing dosage and repetition in these incipient pneumonias, because the same applies to all four drugs [Ed. Acon., Bell., Ferr-p., Ip.]. - In these acute conditions, if you want to abort the attack altogether it is no use prescribing under a [C] 30. If you give [C] 3 of Aconite you will modify the temperature, you will modify the distress, you will modify the anxiety, and you will modify the pain. But you will not arrest the progress of the Subdivision and when you go back and see the patient next day you will be able to make out definite physical signs in the chest. If you give potencies above the [C] 30, when you go back next day you will find that the temperature has fallen and all the symptoms are subsiding. The whole thing just fades out and you will think you have probably made a mistake in your diagnosis and it was merely a common or garden chill and was never going to be a pneumonia at all. - If you have simply an Aconite-chill, which has not yet developed a raging temperature, Aconite low will do away with the effects." - "But a [C] 6, for instance, will only do it if you get in very early. Once your raging temperature has developed you must give a high potency if you want to abort pneumonia. If you have simply an irritation from exposure to cold Aconite wipes it out; say the patient has a temperature of 99°, a dose of Aconite in any potency will stop it. But if the patient is heading for a pneumonia Aconite 6 will not do it. I have seen it tried. - If you are using potencies above a [C] 30, I think you are wise to repeat your medicine at not longer intervals than one hour for the first four hours, and after that keep up your administration at two hourly intervals over a period of twelve hours in all. If you do that, and your prescribing is accurate, you will see case after case in which you have obvious physical signs starting, which from your experience you know would be a commencing pneumonia, but which in twenty-four hours is perfectly well you simply abort the whole thing. This applies to all four drugs for incipient pneumonias. - The administration must be kept up until the temperature is right down, otherwise it is very liable to swing again. - The [C] 30 also works but it works more slowly; you will abort these cases with it, but not in twelve hours, you will have to keep up the administration longer. At the end of twelve hours you will not be satisfied that the patient is well; he will be obviously on the way to recovery, but you will have to keep up the administration for at least another twelve hours." Dosage in Developed Pneumonias Where you are dealing with any of these typical lobar pneumonias I think the question of dosage is really quite simple. - There was a good deal of difference of opinion, and I think there is possibly some difference still, as to the optimum potency in these frank pneumonias, but having watched it here over the last twenty years I have no doubt myself as to what gives the best results. - When I came here first almost everyone in the hospital was using low potencies in these cases. Later some of the men started using medium potencies usually a 30 [C], and with great courage a 200 [C]. - In America I had been taught to use much higher potencies, and of later years this practice has been more and more adopted here. Now we are using all potencies up to the very highest, and I am convinced that, where the prescribing is accurate, the best results are obtained by the use of the very highest potencies. I should say that in my own practice, in the average case, I would prescribe a 10m [10.000 C], though where the indications were very clear my preference would always be to go higher provided there were no contra- indications. I give CM's [100.000 C] in preference to 10 M's [10.000 C] if I am perfectly certain that I have the right drug. - Then as regards repetition. Watching the results again, the average case of pneumonia, when it is frankly developed, will require at least six doses of the medicine; it may require more. One finds that the average length of action of each dose is round about two hours; That is to say, one gives a dose, and in two hours' time one will find the patient needs a repetition. So in practice what one does is to order six doses of whatever potency one chooses, in the average case probably a 10 M, and have it repeated every two hours. - In the great majority of cases you find that is all the medicine that is required; in the frank, straight case, one prescription will be sufficient, you will get a crisis, and you will not have to repeat. In a minority of the cases you will find that you have to keep up your administration after the twelve hours, but if you do I think you will find that you do not have to repeat so frequently, you will probably have to give another three doses in all, at four-hourly intervals. [Ed.: Further information on Borland''s ideas on the fitting potency for special indications you find under: Ars., Carb-v., Kali-c., Lyc. and Sulph. - see here below:] Chapter Ars.: ... you will find a 1M [Ann. 1000 C] your most useful potency repeated 2 hourly. Chapter Carb-v.: - As regards potency, in Carb-v. one is dealing with an acute collapse, there is a dilating heart and a heart failure, and one must obtain an effect fairly quickly, so my personal preference is to go high and give frequently until I get a definite response. I would give CM's [100 000 C] every ten or fifteen minutes until I got a definite response. The kind of response one gets is that the patient begins to feel warmer. Instead of the icy coldness they begin to feel less cold, they look less cold, they are less cold to touch, and the sweat begins to disappear. I would then space the drug out and give it every half hour, until there were definite signs that the heart was taking up again, in other words, until the pulse was fuller, the distress getting less, and the cyanosis beginning to fade. As a rule you get the patient through the crisis in twelve hours. - But to do that you must give frequent repetition to begin with and you must keep up your action for some hours, given CM's all the time. I have tried low potencies in cases of this kind and the patients did not respond at all; I have then jumped up to a CM and the drug has had immediate effect. So much is this so that up in the private wards, where one quite frequently sees these cases, the Sister does not want anything but CM's [100 000 C] for them that is how experienced Sisters come to look on it, they always want the highest potency you will order as they say the other is a waste of time. That is practical experience, it is not a desire for any particular potency. - Ant-t.-cases are not so acute, in them you are dealing with a water-logged chest rather than a sudden cardiac failure. It is slower in onset, and you have more time to play with. In these cases 10 M's [10.000 C] hourly at first and later two-hourly will be sufficient. Chapter Kali-c.: When considering the question of potency you may have to be a little careful in dealing with old people in Kali-c.-cases. Where you have indications for Kali-c. you are not dealing with an acute emergency, and in consequence you do not need your highest potencies. I would give 1 M's [1000 C] to older Kali-c.'s for choice. The average case responds well to 10 M's [10.000 C] repeated in the usual way. Chapter Lyc.: Lycopodium cases respond well to 10 M's repeated 2 hourly. Bauer 1966 On administration of the i n d i c a t e d homeopathic remedy in M or XM potency, in 2-hourly repetition, results in every state of pneumonia regularly the fever to come down within 12 to 24 hours. (Source - Zeitschrift für Klassische Homöopathie (Journal for classical homeopathy), 1966/2, p. 79) Galic gtl2,2023 Experiences following Borland bl4: Potencies up to 30C - Modify the course but do not shorten it - Remedy-Diagnosis can be more imprecise - Frequent doses are needed Potencies higher than 200C - Shorten the course of the disease, but give more crisis at the beginning - Have to fit more precisely to give reaction Own experiences - In Lobar pneumonia give XMK [10.000 C Korsakow (K)] (Small children, infants 50 MK [50.000 C K]) - In Broncho-pneumonia MK [1000 C K] Dosage According to clinical findings, as dilution in water, until crisis is over then wait and see (cp. Constantin Hering, The Homeopathic domestic physician, Boericke & Tafel, New York, 1872). Saine snex,2023 The more intense the pneumonia and the higher the fever, the higher you go with your potency. So if you think about giving a 200 or a 10.000 -> go with the 10.000 -> You will have a much clearer reaction and know much earlier if it is the right remedy or not. You usually do not need to change the potency. E.g. start with 10M and finish with 10M. But if you start with a C 30 I advise you to go higher if it is the right remedy. If Lippe says he dealt with pneumonia in one dose: he means of the CM and in water repeated every two hours! And if he says he had to use two doses, it means he had to go to the MM. So if you don't understand this little historical subtlety you are lost! Campora camx,2025 The most important criterion regarding the selection of potencies is that: the greater the intensity of the symptoms (dyspnea, pain, weakness, fever, etc), the greater the potency needed; therefore, in cases with intense symptoms, it should be preferred to start with potencies of 10M, 50M or 100M. I use both dry doses (globules) and liquid forms (drops) and I have not seen remarkable differences in my results with one or the other. The truly key factor is to select the correct remedy, in a sufficiently high potency, which, as I have explained, must be in accordance with the intensity of the symptoms of the case. I wish to make it clear that with the use of these high potencies there is no need to fear symptomatic aggravations in these patients with very intense symptoms; if they occur, they are of very short duration and are followed by a quick and lasting improvement. In my experience, it is important to repeat the dose, more or less frequently, according to the patient's answer. I prescribe its repetition considering: 1) the patient's subjective feeling of well-being 2) the control of his respiratory and heart rate and oxygen saturation. Conclusions from the Editors 2023 In sources from early homeopathic practice (app. 1830 -1860) mainly lower potencies (Mother-tinctures up to C 15) were used and recommended. From approximately 1860 onward homeopaths more frequently prescribed higher potencies (C30 to C 200) and then - as technology for higher potentiation of remedies advanced - they tested and then recommended even higher potencies, up to DMM [10 000 000 C]. It still remains unclear to us, in how far the various parameters (e.g. State of the patient, used remedy, sort of pneumonia, etc.) should lead the choice of potency. The statements given on that above seem similar in some aspects and contradictory in others, even in the small field of pneumonia-treatment. In how far should the specific drug that has been chosen be considered parallel to the patient's current state (see e.g. Carb-v., Ferr-p., Iod.)? In our opinion the ideal cure remains: Rapid, gentle and permanent restoration of health with the minimum dose! (cp. S. Hahnemann, Organon 6th Edition, § II) These still remain open scientific questions to be answered. Maybe analysis of different published cases will shed more light on the topic. We are convinced that the recommendations by Borland, Boger, Galic, Saine, and the Viennese study provide important hints. Dosage and Administration [Ed. see also Chapter Posology above] Nicol nicx,1885: [Ed. Under Ant-t. - On dosage in lobar pneumonia in children:] Usually, I dissolve a powder of the third decimal trituration in six teaspoonful's of water and give a teaspoonful every hour or even oftener; if the child is unwilling to take water, I place a very small quantity of the 4th decimal trituration on the tongue every hour. Borland bl4,1939: Then as far as repetition is concerned. Where you are using low potencies you have to keep up your drug administration right throughout the course of the disease. ... Where 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 six hours. Otherwise you will find the patient tends to get a further rise of temperature and will require a second course of medicine, possibly the same but possibly different, say, twenty-four hours later, whereas if you have kept up your administration for six hours after the temperature has become normal you do not, as a rule, get any relapse at all. As regards the frequency of administration of the drug, in the average case, where you are using a low potency it is quite sufficient to give the drug about once in four hours; and, as far as I can see, there is no particular advantage in giving it more frequently. As far as the high potencies are concerned, I think it is wiser to give the drug every two 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 twelve to twenty-four hours. So in ordinary practice if giving a low potency, one repeats four-hourly and is perfectly happy to go back in twenty-four hours, not expecting to have to change the drug or the potency, and expecting to find the patient more comfortable, without much change in temperature. In another twenty-four hours the temperature should be coming down, the patient obviously doing well, and all anxiety disappearing; possibly by then a fresh prescription will be required, but there will be nothing dramatic, and no reason to hurry. Where you are using a high potency, you start off giving the drug every two hours, and you go back in six, twelve, or twenty-four hours. In six hours you ought to find the temperature coming down; in twelve hours it will probably be down to normal, and in twenty-four it certainly ought to be. On dosage in incipient pneumonias: If you are using potencies above a 30 [C], I think you are wise to repeat your medicine at no longer intervals than one hour for the first four hours, and after that keep up your administration at two hourly intervals over a period of twelve hours in all. If you do that, and your prescribing is accurate, you will see case after case in which you have obvious physical signs starting, which from your experience you know would be a commencing pneumonia, but which in twenty-four hours is perfectly well you simply abort the whole thing. This applies to all four drugs [Ed. Acon., Bell., Ferr-p., Ip.] for incipient pneumonias. The administration must be kept up until the temperature is right down, otherwise it is very liable to swing again. The 30 [C] also works but it works more slowly; you will abort these cases with it, but not in twelve hours, you will have to keep up the administration longer. At the end of twelve hours you will not be satisfied that the patient is well; he will be obviously on the way to recovery, but you will have to keep up the administration for at least another twelve hours." On dosage in developed pneumonias: Then as regards to repetition. Watching the results again, the average case of pneumonia, when it is frankly developed, will require at least six doses of the medicine; it may require more. One finds that the average length of action of each dose is round about two hours; That is to say, one gives a dose, and in two hours' time one will find the patient needs a repetition. So in practice what one does is to order six doses of whatever potency one chooses, in the average case probably a 10m, and have it repeated every two hours. ... In the great majority of cases you find that is all the medicine that is required; in the frank, straight case, one prescription will be sufficient, you will get a crisis, and you will not have to repeat. In a minority of the cases you will find that you have to keep up your administration after the twelve hours, but if you do I think you will find that you do not have to repeat so frequently, you will probably have to give another three doses in all, at four-hourly intervals. [Ed. In Chapter Carb-v.:] As regards potency, in Carb-v. one is dealing with an acute collapse, there is a dilating heart and a heart failure, and one must obtain an effect fairly quickly, so my personal preference is to go high and give frequently until I get a definite response. I would give CM's [100 000 C] every ten or fifteen minutes until I got a definite response. The kind of response one gets is that the patient begins to feel warmer. Instead of the icy coldness they begin to feel less cold, they look less cold, they are less cold to touch, and the sweat begins to disappear. I would then space the drug out and give it every half hour, until there were definite signs that the heart was taking up again, in other words, until the pulse was fuller, the distress getting less, and the cyanosis beginning to fade. As a rule, you get the patient through the crisis in twelve hours. Saine snex,2023: The first dose of a remedy should be given dry, the second in water - e.g. 30 - 120 minutes later - i.e. put one pellet in half a glas of water, stir about 30 times violently and take a teaspoon. It does not matter what kind of water or what kind of spoon. I continue to give the remedy (e.g. every half hour or every hour or every two hours) until the patient improves greatly. If he is just improving a bit, continue the remedy! When they have improved greatly you stop and wait until the situation has stabilized, then repeat the remedy. If you feel the patient is mentally or emotionally not capable of knowing when to do that, just tell them routinely to go ahead. E.g. The pulse was 130/min, I say take remedy and repeat in water in an hour and call me in 2 hours. After two hours the pulse is 105. I say monitor your pulse, and as long as it is going down you are doing well, but if it stabilizes e.g. at 90 it means you have to take another dose. Always give a dose of the remedy before the person goes to sleep at night and one dose first thing in the morning. First follow-up should be after 2-4 hours or the next day - until that the patient should take the remedy every 2 hours. Vithoulkas and Kent etc. all give the impression that you only give one single dose of the remedy. E.g. I would give Bell. in pneumonia, they were well, but the next day they were much worse. I realized that there was a relapse in sleep, so I started to give a dose before sleep and also gave it more often in general. And Borland who was a student of Kent also said in his book: I had the impression I just ought to give the remedy once, but patients had relapse, so I decided to give the remedy more often until the fever was down. And since I do this, he says, I got almost uniform excellent results. And I mentioned this at a conference and somebody said: Oh, Margret Tyler also says this (she was also a student of Kent). If Lippe says he dealt with pneumonia in one dose: he means of the CM and in water repeated every two hours! And if he says he had to use two doses, it means he had to go to the MM. So if you don't understand this little historical subtlety you are lost! To clarify this here is a case by [Ed. Adolphus] Lippe of a woman from Europe. She had a very severe pneumonia. She was an aristocratic person, always has been treated with allopathy. People who were visiting her were patients of Lippe and recommended him. She said she did not believe in homeopathy, but she was dying so she finally agreed. Lippe gave her a remedy every two hours and went to visit her next day and she was improving, but Lippe decided to continue the remedy because he said in her belief if we discontinue the remedy she will probably get worse. So he continued to repeat every 2 hours for 24 hours, and nothing (disadvantageous) happened and she recovered very well. Galic glt2,2023: According to clinical findings, I give the remedy as a dilution in water, until crisis is over. Then I wait and see. I use a solution with two globules size nr. 3 in 200 ml of water. I recommend to take teaspoonfuls every 5 minutes to 1 hour, depending on the clinical state, until clinical improvement or obvious change of the symptoms, which again require a differential diagnosis. Stir the solution rigorously with a spoon between the individual takings. My practical experience: Patients often do not follow the physicians' instructions exactly. In my practice patients have used plastic, steel or wooden spoons. Sometimes they even stirred the glass with their fingers. If the remedy was fitting, the results were evident. The advice (from some homeopaths) to only use plastic spoons correlates with a standard procedure aiming to avoid a possible disruption of the action of the given remedy. This does not correspond with my practical experience. Ed.: In our clinical experience of 15 years we never witnessed problems when patients used metal or wooden spoons or also regular glasses, neither in acute or in chronic cases. A problem with disturbance of action of homeopathic remedies to us seem to be only silver-spoons. Recommended special administration of homeopathic remedies glt2,2023 Infants in incubators - Give drops - from the above described dilution - into the conjunctivae with a dropper. Breastfed Infants - In case the mother also suffers from pneumonia in a similar homeopathic condition, the breastfeeding mother primarily takes the remedy, not the child. If only the child is sick, only the child receives the remedy, not the mother. Children and adults - see above Patients in intensive care-units, esp. with artificial respiration and/or unconscious patients - Here I have used dosage and administration analogous to that for children in incubators. Which auxiliary therapies and/or measures are reasonable and/or necessary? Apart from choosing the curative homeopathic remedies, there are various other measures to consider which might be necessary and/or helpful for the healing process. We have collected all we could find in chapter -"Further recommendations for treatment" (p. XXX). Especially fluid-intake needs, potential need for oxygen-supplementation, and care-measures we regard as very important. Who should assess the course of the disease-/therapy-progress at what point and in which form? Saine snex,2023: First follow-up should be after 2-4 hours or the next day - until that the patient should take the remedy every 2 hours. You may have to repeat the remedy before you can assess the case. So give the first dose dry in the mouth and the second dose e.g. half an hour later in water and then call after an hour. Or give the second dose in 1 hour and call me in 2 hours. Or: take second dose in 2 hours and call me in 4 hours. Or: Take it every 2 hours until tomorrow. (Telephone-)Checklist for observing parents glt2,2023 In the treatment of children parents should have a comprehensive, written down, - list of exact criteria for observation and for hospital administration. Advice: Let the parents read to you what criteria and steps to take they have written down! Continuous observation is mandatory, also during the night!! Breathing regularity, breathing rate, breathing excursion Breathing sounds: weak or missing breathing sounds can be signs of atelectasis! Duration of exspirium (the longer the more dramatic) Increase of paradox breathing Diagnosis of pulsus paradoxus - as sign of respiratory-distress-syndrome Severity level of delirium: Reaction on being talked to. How many wake periods per day? Changes of breathing during delirium. Signs of intracranial pressure: No eye-reflexes, fixed eyes staring downwards, open mouth, drooping of jaws, loss of muscular tonicity, Missing urination, Lack of fluid-uptake Bradycardia at night? - Extremely important symptom! Recommendations on Case-Assessment in Pneumonia Ed.: Efficient assessment of the therapeutic process is not always easy. We have observed quite a few case-reports where it seemed to us, that the homeopathic remedies did not decidingly change the course and/or duration of the disease, although the attending physician believed otherwise. You need various information in order to attain a clear result showing as to what extent your remedy-choice, administration and other measures have been decidedly helpful and/or if alterations are necessary. 1. General course and duration of the disease (cp. Chapt. "Pathognomonic symptoms") 2. Knowledge of the disease course and duration with curative remedies - under the given 'patients' condition. To gain this insight you can study all kinds of cases and conditions and thus be prepared for what can be expected. We have collected several hundred cases of people with pneumonia under homeopathic treatment, which can be shared! 3. Knowledge of the deciding parameters and their expectable changes within the given time (see below). General important Parameters for Assessment of therapeutic Effects in Patients with Pneumonia Editors: These parameters must be checked continually in patients with pneumonia in order to be sure that they are continually improving: - Pulse [It is the most sensitive parameter! snex,2023] - Respiratory rate and rhythm [Any variation could mean that the condition is getting better or worse. glt2,2023] - Dyspnea/Oxygenisation of blood - State of consciousness - Temperature (see Galic and Saine below) - Energy of the patient/Mobility of the patient - Quality and amount of sleep - Intensity of pain - esp. in chest - Skin colour (e.g. cyanosis) - Thirst - Cough - Expectoration - Any further particular symptom of the patient, such as anxiety, disposition, etc. snex Favourable remedy-reactions in children glt2,2023 Rise of temperature at the beginning, then: - Prolonged time awake (Caution: Don't confuse this with excited delirium!). - Normalization of breathing and pulse - Increase of mobility - Decrease of temperature - Sound (night) sleep (with recollection of dreams) - Increase and normalization of excretions (urine, stool, etc.) - Coughing up sputum without exhaustion from coughing - Increase of appetite Galic glt2,2023: A positive reaction to a curative homeopathic remedy is stabilization of vital functions - without marked primal reaction (meaning - aggravation or shift of symptoms). In acute lobar pneumonia usually every stage of the disease needs another remedy. Deciding for homeopathic diagnostics is the change from one state of the disease to the next. If one state is over, yet another crisis can arise in the next stage, even with accurate homeopathic treatment! Aggravation in a new phase affords a new remedy in most cases. Especially after administration of anti-pyretics the fever may rise after a curative homeopathic remedy! Stabilization of vital parameters (such as easier breathing, less pain, better sleep, etc.), even during the rise of temperature, show a curative action of a homeopathic remedy, (esp. in the mentioned case). Fever should not be observed as an isolated progression parameter but in context with other parameters, especially breathing, pulse and general condition! It is often observed that after administration of a curative remedy the fever rises, but the general condition and breathing improve. Fast amelioration of dyspnea after a remedy does not automatically mean remission of infiltration, but only an amelioration of breathing inhibition (Hering-Breuer-reflex)! Saine snex,2023: After the first or second dose you should have a good idea if you are on the right track. This means that the cough will be better, the patient is more at ease with breathing, temperature dropped, etc. But the temperature may not drop until an hour or more: Because if you give the remedy at a time when the temperature is increasing. So e.g. when you give the remedy the temp. is 103.7°F/39,8°C and two hours later it is 103.9°F/39,9°C; but if you hadn't given the remedy it would have been 104.4°F/40,3°C! So it may still go up a bit first. But if the remedy is right the patient will say he feels better, the cough is less etc. But if the temperature is not ascending naturally, e.g. in the second stage, then you expect the temperature to go down right away, after about 2 hours. The pulse parallels the fever. But often the pulse is more accurate to measure the difference. Teach people how to read the temperature: Shake the thermometer down, then stick it under arm, wait 3 minutes, look at the temperature, then put it back for another minute, if it went up, then put it back again for a minute -> until it does not go up anymore, and this will be the temperature. Bauer 1966: On adminsitration of the i n d i c a t e d homeopathic remedy in M or XM potency, in 2-hourly repetition, results in every state of pneumonia regularly the fever to come down within 12 to 24 hours. Editors: See also Borland in chapter "On Potency". When should the homeopathic Remedy be changed? Pulford pfa3,1928: [From the Introduction:] Remember that the SIMILIMUM will cut short any disease at any time and will act at once and rarely needs repetition. If it does need repetition it is NOT the similimum. The farther away you are from the similimum, the oftener you will have to repeat. Whenever a disease must run its, or a given, course it is a sign that you have at no time had the similimum and that the patient would have been fully as well off, if not better, had he had no medical interference whatever. Galic glt2,2023: If lobar-pneumonia is effectively treated before hepatization can set in, the course of the disease can be shortened by homeopathic therapy. If the case has advanced to hepatization, the disease will go through all stages even with best homeopathic treatment. [Ed.: Compare Pulfords, Borland and Bauer] It is important to wait until clear symptoms of the new stage show up, and not to change the remedy too early. Remedy-changes should be based upon stable, clear symptoms. Until these mature, you should stay patient and perform your diagnostic observation carefully! 'Again: Do not change the remedy too early! With clear symptoms high potencies act quicker and more comprehensively. If you have gathered the specific symptoms of the exact condition (3 symptoms are many in such a case - often you find only 1-2 symptoms), Mind: Wait until the symptoms are distinct and do not further inquire about irrelevant symptoms in regard to this acute situation! How long should Patients be treated in Pneumonia? Tyler tl3,1934: [Ed.: Found under Bapt. and Tub.:] It is only in the earlier stages of pneumonia in patients previously healthy, that the first prescription may be expected to finish the case. You may need to retake the symptoms and prescribe again. At the end of pneumonias and broncho-pneumonias, treat afterwards, so as not to get further attacks. In pneumonia medicine should be continued, but less frequently till temperature not only comes down but remains down for 24 hours. Farrington fr2,1901: The treatment of the sequalae of pneumonia may be dispensed with in a few words. The evacuation of a large collection of pus in the pleural cavity may be necessary. The diet, exercise and other hygienic measures may require attention, but in all cases the homeopathic remedy that fits the totality of the symptoms is the only hope of entirely relieving the patient of the burden which, from avoidable or perhaps unavoidable causes, has been placed upon him. Paige pew1,1902: During the important and critical period of convalescence the patient should receive most careful attention to avoid relapse and to ensure complete recovery. Respiratory exercises, diet, physical exercise, clothing, hygiene, etc., should be carefully supervised. Cod liver oil, mixed fats, malt preparations, fresh air and change of scene with appropriate remedies constitute the treatment for this stage. General recommendations in homeopathic Case Management A good error culture and error management are valuable tools in all parts of life, but especially in the medical field. Many single experiences and studies show that in the long run, a mindful and positive ("No Blame") culture delivers better results than ignoring mistakes altogether. If we learn from our own and other physicians' failures, we are on the fastest track to improve our own medical care for people. If we publish our failures, this can even benefit the entire homeopathic profession and the entire medical field. Therefor we found it valuable to add a chapter on important sources describing failures in the treatment of people suffering pneumonia. 1. Thorough homeopathic Case-Taking Already the founder of homeopathy, Dr. Samuel Hahnemann, stated that sketching the totality of the symptoms accurately is "the most difficult part of the task [Ed. ... of successful homeopathic prescribing]". (ORG 6, §104). This includes the sum of all important features AND at the same time to line out the more important features of the case at the present moment. Furthermore we found that certain diseases or disease-states have certain aspects which are especially important to be accurately observed (such as diagnostic findings on the tongue or in the urine in patients with pneumonia). This is why we included a chapter on case-taking in this book to help homeopathic physicians identify all important components of the total sum of symptoms within their pneumonia-patients. It seems to us that case-taking (including thorough state-of-the-art clinical examination) is a very neglected element of homeopathic training, practice, culture of failure, and science, in still many regions. For some reason this process is often neglected even though there is little justification for such a presumptuous approach. The poorer the "painting" of the disease-picture the harder the similar/curative remedy-picture can be found. In various homeopathic supervision-settings we discovered that the most frequent reason, why a homeopath had not been able to help a patient, was because he had missed some important details of the patient's symptoms! 2. Avoid Repertorisation of Symptoms before thorough Case-Analysis Repertorizing symptoms during case-taking/before thorough case-analysis is another major source of error. The danger in this approach is that you may be led to certain ideas of what might be a curative remedy for the patient before the disease-picture is fully and clearly drawn and analyzed. This can also cause a serious problem in finding a curative remedy. We recommend: First focus on accurate case taking. Second, take time to thoroughly analyze what the most important features of the case are. We recommend that you write your analysis down. And only then, as a third step, consult the repertory and look up what you stated in your analysis. Writing down your case-hypothesis also helps to continuously reflect and improve your capability of prescribing. 3. On Case Analysis and Repertorisation This is another very neglected element within homeopathic research, practice, and teaching. A high-quality case-analysis requires investigation of various aspects, which are by far not self-evident: - A clear picture of the pathognomonic signs and symptoms as well as the course of the disease (e.g. Bronchiolitis in a nursling). This is necessary primarily to be able to differentiate the individualising aspects of the given case. - Identification of the most important symptoms at the given point. Maybe these are the currently most prominent ones. But possibly the actual state of the patient (e.g. paralysis of the lungs) or also the individual symptoms of e.g. the whooping cough, which was the precursor of this certain pneumonia, are more important right then. - Analyzing published cases, especially cases solved with less prominent remedies for the treatment of pneumonia, can assist learning which repertory-rubrics help identify the curative remedy. Therefore we also collected published case-reports (so far 500 cases) as a useful training-tool. - Use the repertory AFTER thorough case-analysis - and start with the symptom/state/rubric which seems most important to you! 4. Recognition of "smaller"/ less familiar Remedies and Symptoms/Characteristics Remedies, which have fewer entries in the repertory and/or with which you are less familiar, are often overseen. During repertorisation it can help to consider remedies you are not familiar with (for treating pneumonia) and read their Materia medica even if you only find them in one repertory-rubric. And here again studying successfully treated case-reports can help. By routinely using the same well known repertory-rubrics, homeopaths often end up with the same (familiar) remedies for differential diagnostic and often with poorer curative success as could have been possible. 5. Pay attention to further important Features There is an abundant amount of documented experience and knowledge available on homeopathic diagnostics, prescription, Materia medica and case management - including findings of modern orthodox medicine and/or other medical methods from the past 200 years. We collected and compiled all of this regarding the field of pneumonia- and pleurisy-treatment the best we could. Especially further measures, apart from homeopathic remedy-prescription, are very important features to consider in order to cure patients of pneumonia in "the shortest, most reliable, and most harmless way, ..." (ORG §2)! Yet all this knowledge is only fruitful if it is thoroughly studied, trained, and then put to practice. For every tool is only as good as its usage! 6. Assessment of Case Development Have my prescription and other interventions really decidedly ameliorated the case so far at all, and in the best way possible? This assessment of the effect of my treatment is often not as easy as it might seem. For detailed information read the chapter "Recommendations for case-assessment". We found many published homeopathic case-reports, in which the author was very convinced that he had treated the patient efficiently. To us, having knowledge of natural course and truly successful homeopathic treatment, the homeopathic treatment in these cases seemed not to have affected the course of the disease at all. So to us the question arises: Had valuable, explanatory information about the severity of the disease got lost in the case description or did the author have a blind spot when assessing the course of the disease? We recommend you study the natural course of the treated disease thoroughly and also learn from reports of successfully treated cases with all stages and disease-states! 7. Treatment until the Patient's Condition is stable In the treatment of patients with pneumonia it is very important to treat until the curative process is stable. Furthermore it is recommended to have checks with patient if the curative process has continued until the pneumonia and/or pleurisy is really cured or if there have remained remaining symptoms which need to be treated (e.g. dyspnea, cough, pain, weakness, etc.) For information on this see the chapter "How long should patients with pneumonia be treated". ◄ GUIDELINES FOR COMPREHENSIVE HOMEOPATHIC CASE-TAKING IN PNEUMONIA AND/OR PLEURISY | ▲ | FURTHER RECOMMENDATIONS ON PNEUMONIA TREATMENT ► |