By W.L.Gross, M.D., New Brighton, Penna.
Many of the cases of typical pneumonia need no special active treatment when the disease takes a favorable course. Most cases that get well do so under, or, I may say, in spite of any treatment.
From the now absolute method of treatment by large bleedings and from the use of certain drugs, as Veratrum, Tartar emetic, coal tar derivatives, etc, which are even now used by professing Homoeopaths, we should expect harm, rather than good.
We do not know of any means certainly to influence favorably the pneumonic process.
Whether we are yet to learn of some specific mode of treatment, perhaps by means of some serum, yet to be perfected, I cannot say. Until now my experience with the sera on the market has been very unsatisfactory. We are at present obliged to rely upon purely symptomatic and constitutional treatment. The symptoms which are usually prominent in pneumonia even in the milder cases and of which the patient is especially desirous to be relieved are the pain in the side, the troublesome cough, and the difficulty and distress in breathing.
Since the respiratory symptoms are partly due to the pain, as this improves the patient’s breathing often undergoes a decided improvement.
For the pain we have a number of local application to the skin of the affected side. An ice bag sometimes gives marked relief. Many patients cannot bear this, but prefer warm poultices or cold wet compresses.
The application of mustard plasters or dry cups is sometimes of advantage.
Hypodermic injections of Morphia are, however, the most efficacious.
There is no good reason why we should not use this remedy, with care and in moderate doses, for the relief of the pain and, as the disease is of short duration, there is little danger of inducing the Morphin habit.
Local blood-letting is a remedy the action of which cannot be explained physiologically and yet experience has shown that it is of undoubted advantage.
The tepid or cold bath serves as the most effective means of improving the respiration, of aiding expectoration and of stimulating and refreshing the whole system.
It is useless if not injurious to give a patient baths if the disease is progressing favorably, for almost every kind of bath has some disagreeable feature.
These disadvantages, however, are always less in severe cases than the benefit and improvement which baths give the patient and which most patients recognize with gratitude.
The main point is that the patient should make no physical exertion while in the bath.
He should be lifted into it, held and supported while in and lifted into bed again after it.
Since the baths are given primarily no on account of the fever, but to improve the respiration, and because of their favorable influence on the nervous system, their temperature need not be especially low.
The temperature may be from 770 to 860. Somewhat warmer with weak and sensitive people and colder for the strong and robust with very high fever or severe nervous symptoms.
Not more than two baths day are needed in most cases.
The favorable action of the baths is seen in the great relief and refreshment that the patient feels. The respiration is quieter and slower, but deeper. Patient often falls into a quiet sleep after the bath. The wet pack can be used instead of the bath with advantage in some cases. It seems to irritate the patient less and gives the same or even greater relief.
It is hardly necessary to mention that the patient’s strength must be kept up, as far as possible, with nourishing foods, liquid in character, as milk broths, etc. Alcohol, in the form of brandy or whiskey, may be used in a critical turn to bridge over danger of collapse, but my experience with it has not been very encouraging.
A great deal has been said on the open air treatment of pneumonias, and while my experience has not been as great as might be yet it has been demonstrated to my satisfaction that the open air treatment in cold weather has harmed more of my patients than it benefited.
Plenty of fresh, cool air is necessary, but the method of putting a pneumonia patient in an open room in winter does not appeal to me as the correct method of procedure.
As to remedies, our homoeopathic drugs occupy a prominent position in the treatment of pneumonia, the progress of the disease being materially shortened and the severity of the symptoms being diminished by their employment.
The remedy most frequently indicated in the first stage of a typical case of pneumonia is Ferrum phos. Its administration is only contra-indicated by marked bronchial obstruction, manifested by dyspnoea, moderate fever, impaired surface circulation and heart feebleness and cyanosis. When these symptoms are present Tartar emetic is preferable. Phosphorus is probably given more frequently than any other remedy by the majority of prescribers and it is certainly a valuable remedy. It is more suitable, however, to broncho-pneumonia occurring in degenerate adults; those suffering from fatty degenerations, Bright’s disease, diabetes, pulmonary phthisis, etc. The febrile symptoms are generally less marked than in the Ferr. Phos. case. Bryonia is particularly suitable to those cases complicated with pleurisy, which is not common. When the symptoms of capillary involvement are not prominent and there is much complaint of pain and soreness in the sub-sternal region when coughing, children being inclined to hold the chest when coughing, Bryonia gives good results.
The indications for Squilla are almost the same as for Bryonia. It is often given if Bryonia fails or after it has done its work. There is more irritability of the mucous membranes and more spasmodicity under Squills than under Bryonia.
Sulphur is useful after any of the preceding medicines and is the better indicated the more the pulmonary consolidation predominates over bronchitic and pleuritic symptoms.
Aconite or Gelsemium may be needed for the febrile symptoms in the early stages and Iodide of Antimony when the bronchial element is pre-eminent.
This Iodide of Antimony is of first importance in those cases of broncho-pneumonia occurring in the course of some case of pulmonary tuberculosis.
The Arsenite of antimony is an important remedy in the broncho-pneumonias of the aged with long rales and feeble heart action.
Especial care should be exercised during convalescence from broncho-pneumonia to secure perfect resolution of the inflamed lung, as neglected cases often develop tuberculosis. The patient should be kept under observation until all traces of consolidation have disappeared.
In order to aid resolution, careful hygienic and dietetic measures, together with change of air, cod liver oil and respiratory gymnastics, may be advised.