Suggestions in the Treatment of Pneumonia.
It may be a matter of supererogation to present to many of our readers the cardinal features essential in the successful treatment of pneumonia; but while we frequently refer to them, they are always practical, and this presentation may be convenient to someone who has not previously practiced a similar, direct method.
To begin with, harsh measures are never justifiable in this condition. Mild methods persisted in are in every way superior, and if administered with confidence, will produce immediate results.
Let every case be treated according to its own symptomatology, and think not at all of the possible microbic origin of the disease. Discard the use of antiseptics as exercising any abortive or preventive treatment in pneumonia. If intestinal antiseptics are plainly indicated in the later stages of the disease, administer them according to their indications.
Combat any excess of temperature in this disease from its first appearance. Let the theory that fever is conservative have no place, whatever, in your mind. It is always to be dreaded and its influence is persistently detrimental.
Remember that cold applications encourage the precise conditions which are present at the beginning of the preliminary congestion from which these cases proceed. It encourages the advancement of this congestion; while heat antagonizes the congestion, unloads the preliminary engorgement, imparts strength and tone to the capillaries, strengthens the vital processes, and, in fact, antagonizes every pathological condition upon which the disease depends. To stimulate the removal of morbific products and encourage a free, normal supply of healthy blood, always apply heat.
Conserve in every way the strength of the patient, but use no stimulants until the indications for their use in general failure, or in failure of the heart, or weakness of the nervous system are plainly apparent. This is imperative.
Strychnin and digitalis, given in the sthenic stage of this fever have, in many cases in which I have observed their action, brought about an early collapse and a fatal result which, I am sure, would not have occurred had they been withheld. I believe heart failure is oftener the result of the treatment than of the disease.
Use no active physics in this disease, or other reducing agents; and laxatives only as indicated.
In sthenic patients with high temperature, large, round, full, soft pulse, dark discoloration of the face with full tissues, give veratrum in from one-half to one and one-half drop doses every hour, closely observing its influence until the pulse is reduced and the temperature abates.
If the skin is hot and dry with increasing temperature, with a small, hard, rapid pulse, give aconite. If with these symptoms there is chilliness with local soreness and evidences of preliminary congestion, add belladonna to the aconite and give the two remedies conjointly in small doses frequently repeated. If the chilliness is extreme, increase the quantity of belladonna from one-half drop of the tincture at a dose to one drop. These remedies will work most harmoniously together.
Where there is local soreness, or where from pleuritic involvement there are short, cutting pains with dry, hacking cough, bryonia is the indicated remedy. This agent, I consider, meets the general pathological indications as fully as any other one remedy.
My experience has confirmed its beneficial influence in many cases. It may be given in conjunction with, or instead of aconite, and its influence upon the temperature is occasionally all sufficient, especially if there is persistent pain in the chest. If the pain is positively pleuritic in character it works exceedinglv well in conjunction with asclepias.
I have observed that this remedy, and in fact any remedy used in the treatment of pneumonia of the infant or of the aged, will do very much better if given in small doses at intervals of twenty or thirty minutes. The smaller dose, frequently repeated, has accomplished results for me that the same remedy in large doses at long intervals has failed to accomplish. The adjustment of other measures to the patient are very important.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.