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the rate of mortality is much less. Go back twenty-five or fifty years, and the plan of treatment was almost if not quite a oneideaed plan, and every one was treated just alike, because he or she, as the case might be, had pneumonia.
The plan of treatment then was strickly anti-phlogistic, venesection, antimony, calomel, and blisters. Later on down the line, vènesection was almost, if not quite, discarded. The danger of antimony was soon brought to notice, by Dr. Boling, of Montgomery, Ala., in 1851. He describes the fatality of this drug from gastro-intestinal irritation; and it, like venesection, was laid aside.
The next remedy brought to bear upon the minils of the profession was veratrum viride. This proposed and did take the place of venesection and antimony, acting as a reliable arterial sedative. Again, in 1866, Austin Flint discarded all arterial sedatious and depressing remedies, and advocated the liberal use of opium or its salts, alcohol, supporting treatment, and time for the disease to run its course; and, in mild uncomplicated cases, little or no treatment at all. Later in life he came to a different conclusion, and in his last edition of Practice of Medicine, advises a more active plan of treatment: recommends quinine in heroic doses, and also adınits the use of arterial sedatives. Quinine, to subdue high temperature; opium, to allay pain and give rest; and alcohol.
Prof. Loomis, of New York, our next teacher and author, condemns all depressing remedies, such as arterial or cardiac sedatives, but admits quinine to control high temperature, and opium to relieve pain, and alcohol to prevent heart failure. He regards pneumonia as a self-limited disease, and the best thing to do is to support the powers of life, and be guided by the patient's. general condition, and not by the physical changes in the lung, and does not admit the idea of aborting the disease.
Now, in regard to the treatment of pneumonia, I think there can be no specified rule laid down. I think when we are called in to see a patient with pneumonia that we should, first and foremost, take in all of the surroundings connected with the patient and fully ascertain what kind of a patient we have to treat. If I was called to see a robust, healthy young man of full habits, suddenly struck down with a violent attack of pneumonia, with
great pain in the side, and full, bounding pulse, and flushed face, I would not hesitate one moment to resort to venesection in such a case. On the other hand, if the patient is not robust, and rather weakly constituted, I would first give him from nine to ten grains of calomel, and follow it with oil or salts in eight or ten hours, if it did not act before that time, and get from four to six good actions from the bowels. Next, I would give opium and use hot poultices over the lung to relieve pain. After moving the bowels well, if the temperature was still very high, pulse full and bounding, I would then give him veratrum in small doses, seeing that the patient was in the hands of a careful and experienced nurse; but I think it is too dangerous and depressing a remedy to leave in the hands of an inexperienced
I think, in a large proportion of patients, that we get more bad effects from the use of veratrum than we do good ones. Nine out of ten times I never use it at all with my patients, but rely principally upon the use of opium, morphine or Dover's powder, one or the other, giving just enough to allay pain and give rest. I also give quinine to reduce the temperature, alcocol in the form of eggnog as a nourishing stimulant and heart tonic. In the event that this does not keep up the action of the heart sufficiently, I then give tincture of digitalis, and under every and all circumstances I give my patients good, nourishing diet, such as milk, animal soups, and so on, to hold them up and support the powers of life till the disease has time to run its
In a word, I treat my patients and not the disease. Where the lung is badly hepatized, I have often observed happy effects from a blister, followed by hot poultices to the side.
At the incipency of the attack, I most always give calomel enough to move the bowels well, after that I seldom ever resort to purgatives again. To adults, I frequently give from two to five drops of turpentine two or three times a day until I get the kidneys to acting well, and if I have good reason to think my patient is infected with malaria, I always give quinine early in the disease. If an adult, I give from four to six grains every five hours until fully under its influence, after that from two to three grains every six hours. Alcohol as a stimulant heart tonic, and plenty of good, nourishing diet to support life, and, as before stated, I treat my patients and not the disease.
PAPOID IN DYSPEPTIC STATES.-Dr. Woodbury has given an extended analysis of the physiological action of carica papaya. To his results certain cases recently coming under my observation lend clinical corroboration. It has been of especial value in all states where the digestive functions are feeble, inoperative, and seriously impaired from catarrhal complications, or from any other cause, since it is most emphatically indicated when the digestive fluids are unequal to the task of converting the ingesta to a condition preparatory to assimilation.
Case I., Young lady, æt 19. Symptoms: The patient was pale, languid, and debilitated; loss of appetite; pulse feeble, compressible, and small in volume; troubled with insoronia, and extremely nervous. The food that she took was not digestedit was simply decomposed, attended by persistent and annoying eructations of gas, acid in character; she complained of a great pain in her head, distress after meals, constipation, and irregular
I prescribed the following:
Ex. colocynth, co.......
Having relieved the constipation, I prescribed papoid, bismuth and strychnine as follows: R. Papoid.....
..gr. xy. Bismuth sub nit,
gr. Xxx. Strychnin ..... M. Div. in ch. No. x. S.: Take one powder before breakfast and one before dinner. The first powder to be preceded by a coffee-cupful of hot water, taken as hot as can be borne.
This case represents a very numerous class, which are exceedingly common, instantly recognized, and are successfully treated when papoid is the remedial agent used. In one week this pa
..gr. xii. ..gr. vi. ..gr. iii. ..gr. xii. .gr. ii.
tient reported herself immensely relieved. She said that after the second day the eructations ceased, the acid condition was changed, the distress in her stomach was relieved, the sensation of fullness in her throat disappeared, her appetite improved, the insomnia gave way to restful sleep, and, to use her own forcible phrase, she had escaped from the horrors of dyspepsia and the intensified horrors of insomnia."
Case II. A gentlenian of 35—a remarkably active, clear, in. tellectual man of tireless energy, and a great sufferer from nasal catarrh, which he had had for fifteen years; it had utterly destroyed the sense of smell; the olfactory had ceased to respond to any appeal, and the catarrhal condition had extended to the stomach and duodenum. He complained of complete loss of appetite, pain in his head, with a furred tongue, constipation, sleepless nights, aversion to exercise, owing to his physical prostration, and a general feeling of fatigue. He had considerable palpitation of the heart, and was deeply imbued with a perpetual apprehension of the recent discovery of heart failure, from which he expected to die at any moment. Having allayed his fears of heart failure and convinced him that his palpitation was directly attributable to indigestion, I ordered him to take a coffeecupful of water as hot as he could sip it, half an hour before breakfast, and then take one pill ten minutes before.
In addition, I prescribed hydrastin and eucalyptus an hour af. ter each moal, and a laxative at bedtime. The hot water was continued for ten days; then I abandoned it, and placed him upon
..f 3 ii. Aq. menth. p.. q. s. ad....
.f 3 ii. M. S.: Shake the bottle and give a teaspoonful before each meal.
The catarrhal condition of his stomach, nasal passages and upper bowels proved a most formidable obstacle, and sustained a very obstinate set of symptoms to combat.
He had devoted several weeks, under the professional care of an excellent specialist in laryngology, to the treatment of his catarrh-spraying and insufflation, etc.—which only afforded him temporary relief in this humid atmosphere and changing temperature. I ordered him to continue this course of treatment for six weeks, which he did, during my absence from the city. Upon my return he presented himself at my office, and reported such a radical change in his symptoms towards complete restoration of his health-which his appearance fully sustained and vindicated that the same line of medication was adhered to for a short time longer, and, within two months from the commencement of his case, he was discharged cured.
It must be remembered that he had been treated by several excellent physicians, who had in every way met every indication and symptom that presented in his case with a host of remedies -scientifically and intelligently prescribed—aided by a long list of dietary articles of the very best quality-peptonoids, pepsin, pancreatin, beef extracts, maltine, with its numerous and valuable additions. He had tried the grape cure, the skimmed-milk delusion, and various other good remedies for certain conditions. Within a week from commencing the administration of that wonderful remedy his symptoms changed. His headache left him; the great distress in his stomach, which tortured him for hours after meals, ceased; his tongue became perfectly clean, bowels regular, appetite excellent, complexion clear, spirits revived, and a general appearance of returning health and rejoicing.
The ruling remedy in this case was the papoid; he having been carefully and scientifically treated for months upon the old plan of remedial agents that I have named without any perceptible relief, and changing directly to a new course of treatment, in which papoid was the chief factor, there is but one logical conclusion to arrive at as to the remedy that wrought the change.
Case III. This patient, who had complained for several years of catarrh of the bladder, following an aggravated attack of cystitis, applied to me for advice and treatment for his urinary