- Douglas M.Borland.

FROM the digestive angle, Aesculus is indicated usually in the rather older patient, the oldish man, who is beginning to break down a little. He is always rather heavy and dull, and there is a good deal of generous venous congestion, slightly congested veins, very often slightly dilated capillaries which are very obvious, and the patient is dull, heavy, and rather depressed. In most instances you will get a history that the patient has been quite a good liver; he has done himself pretty well and his digestion is beginning to give out. The Aesculus patient usually complains a good deal of heartburn, with troublesome acid eructation. And the eructation is fairly typical; it is a very nasty, bitter, greasy type of eructation. He also tells you that very often after a decent meal, with that eructation he begins to gulp up little mouthfuls of sourish food. Then, always you will get a complaint of fullness and discomfort immediately after a meal, sometimes amounting to actual pain usually of a burning character, and this discomfort often continues right along to the second meal, which for a time gives him some relief. On occasion you will get the story of this fullness and eructation going on to actual vomiting, the patient gulping up small quantities, mouthfuls, of food, which are sour or bitter, and of his going on doing this till his stomach is empty, when he feels very much more comfortable. The next thing about this Aesculus patient is that with this general venous state, and with the general feeling of fullness in the abdomen, on examination you will always find a certain amount of hepatic enlargement. Associated with this, they often complain of backache, an aching pain in the back with a good deal of stiffness, and particularly they complain of difficulty in getting up out of a chair. You have seen the congested old man in the club very often, a typical picture sitting back in an easy chair, and you have seen him struggling up out of his chair and holding his back-that is typical of Aesculus. As a rule, the appetite is not good. They complain of a general lack of appetite, but usually, there is considerable thirst. These patients always suffer from constipation, and they are liable to get attacks of very painful haemorrhoids, a feeling as if the rectum were full of sharp little sticks; and extreme pain on attempting to defecate. They are always sensitive to pressure on the abdomen, or to tight clothing, and they always feel at their worst in the mornings when they wake. If they have an after-lunch nap, they wake feeling more bloated, more congested, and they have more eructation. They are also always sensitive to hot, stuffy atmospheres. It is most important to get a knowledge of your drug as a whole and not to prescribe on a few well-known characteristics. For instance, the Lachesis patient has very much the same sort of temperature reactions as the Aesculus patient, very much the same venous congestion, very much the same distension, and also the marked aggravation after sleep; and yet mentally the two are poles apart. Aesculus patients have the dull lethargy of the venous patient, who is just heavy, and sluggish, and wants to sit back in his chair; while Lachesis has all the mental activity, acute loquacity, and suspicion which immediately make you realise that you are dealing with a different type altogether. Aesculus is the picture one tends to associate with the man who has done himself very well all his life; he is getting on in years, towards the seventies, and is beginning to go to pieces. Very often you will get a history that, during latter years, he has had very troublesome rheumatic pains, which tend to wander about from one place to another, and they are pretty sharp in character. He is the type of patient who normally gets a dose of Sulphur from most of us, and we are rather worried and disappointed because he does not respond as a Sulphur patient should do. It is not really the patient's fault : it is ours.


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