Treatment of Pneumonia.

T. JENSEN, M. D., SPRING GROVE, MINNESOTA

In every living being there exists a certain force that opposes disease. For convenience's sake you may call it formative, or vital force. This force does not exist in every individual in an equal degree. In some persons it is very strong and has great power for life. In others it is feeble, and consequently disease and even death may result. This formative or vital force is a regular and co-ordinate action of all the organs of the body.

While we have no positive means of determining whether an individual has sufficient force to oppose disease, there are methods by which we are enabled to give a pretty good opinion. The development of the individual organs in all directions is an important element in this calculation.

During my college course, we were taught by our professor of pathology that the basilary portion of the brain has direct relation to the longevity of an individual's tenacity for life. He claimed he could determine a person's tenacity of life, by measuring the depth of the brain.

The measurement is made by drawing a line from the occipital protuberance to the suture between the malar bone and the external angular process of the osfrontis, then measuring the distance from this line to the external meatus. If the distance is above three-quarters of an inch, the person has a vital force to reach the average; but below half an inch, we find the tenacity for life very feeble and the prognoses have to be guarded, especially in pneumonia.

If above an inch, the person has vitality to live to an extreme old age. As a rule, a person with a deep life line generally has a very good appetite and sleeps well. Another fact, a person with a deep life line is less liable to prostatic trouble, and catheterization is seldom required.

Another fact, the superficial and tortuous blood vessels of the forehead and temple are rarely seen unless the person has previously led an intemperate life, and an apoplectic stroke generally ends the life.

I have made use of the above tests during my practice and have found them reliable. In fact, they have helped me in forming my prognosis in many hopeless cases, and the final outcome has been according to the tests obtained.

The past thirty years I have had my share of cases of pneumonia. When I first began to practice, I had from twenty to thirty cases of pneumonia every year. Physicians were not so numerous then, so it taxed my ability and bodily strength to attend them all.

In my first years of practice I was left to my own resources and judgment. I had to experiment with different forms of treatment. The principal medicines I used in pneumonia were aconite, veratrum viride, digitalis, quinin, aqua camphor and calomel. If there was cyanosis present, I used sulphuric ether.

I depended very much upon stimulants. My success was uniformly good—even more so than with some of my neighboring brothers at that time. I have seen pneumonia in all its forms, as it is met with in this latitude: Double pneumonia, and pneumonia complicated with pleurisy, meningitis, emphysema, abscess of the lung, and typhoid pneumonia.

I consider pneumonia a septic disease like typhoid and scarlet fever. Hence, an antiseptic treatment is just as well applicable in pneumonia as in the above named diseases.

When called to a case of pneumonia, say about twenty-four or thirty-six hours after the initial chill, the temperature 104°F., tongue heavily coated, I invariably give large doses of castor oil and repeat if necessary. If this is not sufficient, I flush the colon with a saline solution, using a rectal tube. Sometimes lavage of the stomach is beneficial.

By this I have often brought the temperature down to 102°F. Now I select the proper antiseptic for the alimentary canal. The tongue is my guide or index. If the tongue is clean and its papillae are visible, then one of the sulphocarbolates is sufficient in preserving the asepsis of the alimentary canal.

If the tongue becomes very dry and sleek, and has the appearance and color of cicatricial tissue, or is of a purplish yellow hue, I employ diluted nitric acid in ten or fifteen drop doses every three hours.

If the tongue appears bright red and narrow at the apex and slightly coated at the base, I use diluted muriatic acid. If the tongue is large, broad and sticky, and indentation of the teeth is shown on its edges; or if it appears as if some white powder had been sprinkled on it, I have found sulphite of soda very good. I have found the above antiseptics very useful in all forms of sepsis as typhoid, scarlet fever as well as in pneumonia.

The diet must be considered. Milk, as a rule, I have found contraindicated in many cases. It is often apt to carry fuel to the already existing sepsis. I generally feed my patients on beef broth and bread which is free from starch. My aim is to bring my patient over the critical period as pleasantly as possible. When resolution takes place I resume more substantial diet.

Our professor of practice of medicine used to tell us that uncomplicated pneumonia is a self-limited disease. If not complicated with other disease it ought not to last more than nine days. For the last five years, my aim has been to use antiseptic treatment according to its indications, and try to undermine the foundation of the disease by properly selected means, so as to convey it in its own channel until resolution takes place.

In uncomplicated pneumonia in my hands and with my mode of treatment, the mortality has been nil with all patients except young infants or aged persons with heart lesion, or persons who have previously led an intemperate life.

For the pneumonic toxins I have obtained much benefit from echinacea angustifolia and creosote carbonate. If the temperature is very high and the skin dry, I advise creosote carbonate in from twenty to thirty drop doses three times a day. If the temperature is moderate, say 103°F., and the skin moist, then I give echinacea in fifteen to twenty drop doses every three hours.

I have found both of these remedies to be of immense benefit in pneumonia. They have often brought the temperature down to 100° in a day or two, but one or the other of these remedies would have to be continued until resolution takes place. Also the antiseptic for the alimentary canal.

With acute, infectious pneumonia in the aged, especially if the patient has led an intemperate life, and the whole lung on the affected side is involved, the person is very apt to have heart weakness and pulmonary hypostasis. In such cases, free stimulants are necessary. The patient should be rolled from side to side several times a day in order to overcome the hypostasis.

In such a case I invariably employ diffusible stimulants, as aqua camphor or the ammonia mixture. I am very much afraid of strychnin in old persons, as over stimulation will readily occur and the danger of dilatation of the heart's right ventricle on account of obstruction of the pulmonary circulation is great. Sulphuric ether or trinitrin are preferable in old persons, and I would rather be on the safe side.

I have been using the ammonia mixture as follows: Ammonium chlorid, soda, four drams each; tincture ammonia anisate, extract of licorice; one ounce each. Water to make one pint. Of this I give a tablespoonful every three hours. The ammonium chlorid is converted into carbonate in the above mixture, by the addition of soda, and when mixed with licorice it is more palatable than the carbonate. The above stimulants are used if there is cyanosis, heart failure and, perhaps, delirium, with old persons. Strychnin is applicable if indicated, with younger persons. For pleuritic pains I do not use narcotics in any form, but depend on turpentine and sweet oil inunction of equal parts. Then I apply warm cloths to the affected parts.

Often we are not called until the fifth or sixth day after the initial chill, when cyanosis is far advanced, expectoration arrested, and perhaps there is an atheromatous condition of the blood vessels. In an elderly person or perhaps one who has led an intemperate life previously, the usual outcome of such a case is fatal, but a young person will recover if properly treated.

I remember a case to which I was called twenty-eight years ago. The patient, aged forty, had a temperature of 104°F. He was very delirious. I gave him the usual remedies. I saw him two days later. The expectoration was entirely arrested and I was very much surprised in finding typhoid eruptions on his chest. The delirium increased and the case puzzled me very much. I saw him every day, and on the twenty-first day the fever declined and he commenced to expectorate rusty sputum. This continued until the thirtieth day, when resolution became complete.

Sixteen years ago I was called to Mr. O. S., age seventy. Saw him the fourth day after the initial chill. The following conditions were present: cyanosis well marked, temperature 104°F., muttering delirium. Fortunately his life line was very good, the basilary portion of the brain was very deep. It measured over one inch. My prognosis of the case was more favorable than it otherwise would have been.

I remember I treated him with whisky, nitroglycerin and aqua camphor. I prescribed whisky in this case because he had led an intemperate life as long as I had known him. Then stimulants were more directly indicated than anything else.

The old man lived to be eighty-six years of age. Ten years later, he had the misfortune to fracture his femur. The fracture was of the intracapsular variety. He was laid up for four months, but still he got up and around again with the aid of a cane. The most remarkable feature of this case was that he did not develop bed-sores or any difficulty of urination during his four months' stay in bed.

I have frequently seen pneumonia complicated with effusion and abscess of the lungs, but as soon as resolution took place, the effusion disappeared. Several of my patients who survived pneumonia, died in later years from tuberculosis. I have only seen one case of meningitis as a complication, but it proved fatal.

If, after ten or fifteen days, the lungs from delayed resolution do not clear up, we must ascertain the cause. If due to sepsis, echinacea should be continued. If the temperature is below 101° F., I have seen syrup of hydriodic acid very useful, or ammonium iodide in combination with the chloride of ammonia mixture I stated above.

Sometimes I have, found Fowler's solution of arsenic useful. If anemia is present, I have found a solution of ferro-albuminate with nux vomica very useful. The main factor is to nourish the patient with good, nourishing and digestible food, and stimulants only as the case may demand.

The above treatment for pneumonia I have followed for the past five years and the success has been very favorable. If I should see a patient during the initial chill, I would give him a solution of sulphate of quinin in teaspoonful doses every four hours.

I have had an experience on my own person to that effect. In the spring of 1898 I attended a young man who had double pneumonia. I saw him twice a day for ten days, when he recovered. On my last visit I took some of his sputa for microscopic examination. I was probably not careful in handling the specimen, and two days later I developed a severe chill. I knew at the moment that I was infected with the pneumonic infection.

I went to bed immediately and took a heaping teaspoonful of sulphate of quinin, and repeated it every four hours, but I did not get the physiological action of the quinin until the third day, when I discovered I was deaf. I had all the symptoms of pneumonia, and a rusty expectoration. I was afraid to call in my nearest doctor, as I feared he would treat me differently, so I decided to be my own doctor.

The temperature varied from 102° to 103°F., no higher. The seventh day resolution took place. I found after I got well I had lost twenty-five pounds during my sickness.

I treated thirteen cases of pneumonia during 1907. From these I will select three cases which might be of interest.

Case 1. Was called February 1 to Mr. J. L., a habitual drunkard, aged fifty-six. Had been drunk continually for several weeks and was drunk when he had the initial chill. The following conditions were present: cyanosis, well marked; atheromatous condition of the superficial blood vessels of the neck and forehead; the left lung solid from the clavicle to the nipple anteriorly and posteriorly from the neck to the last rib; the aortic valve of the heart was also involved. A hopeless case, indeed. Died the following day.

Case 2. Also a habitual drunkard, age thirty. Had initial chill when intoxicated. I saw him on March 4 and saw him three or four times a day during his illness. He developed pleurisy and abscess of the lungs. Also had terrible hemorrhages and coughed and raised an immense amount of pus.

The treatment I prescribed from the beginning was aromatic sulphuric acid in water every three hours, tincture echinacea in half teaspoonful doses four times a day until the fever declined. When there was no more hemorrhage the acid was omitted and creosote was used. in its place.

This commenced with three drops and gradually increased one drop every second day, continuing until twenty drops were reached. Echinacea was continued in alternation with creosote. Finally the echinacea was omitted and Fowler's solution of arsenic was substituted in alternation with creosote. After six weeks' struggle he recovered.

Case 3. September 24, 1907, Mr. J. E. L., age 45. On the third day after the initial chill the following condition was found: temperature, 105°F.; oppressed breathing; no expectoration; considerable cyanosis; the left lung solid from the clavicle to the nipple. I cleaned the primae vim and gave him, as an antiseptic for the alimentary canal, sulphocarbonate of zinc, and echinacea for the pneumonic toxins.

There was also a great deal of hypostasis. The patient had to be moved from side to side several times a day. The next day the temperature was 103° and the cyanosis less. He had commenced to expectorate a little and continued this until the seventh day, when the temperature dropped to 100°, and on the ninth day resolution took place.

I attributed my success in this case to the antiseptic treatment of the alimentary canal and echinacea for the pneumonic toxins as no other medicine was used. I did not use creosote carbonate, as the indication was plainly for echinacea.

COMMENT.—The argument at the present day is that from twenty-five to forty per cent of pneumonia patients must die. I have stated and repeated on the pages of this journal, that I believe that strychnin and digitalis, or a course of stimulation through the entire course of the disease, are to blame for more deaths, than the disease.

In the above article, a course of treatment is outlined which is widely different from that of our school, and just as widely different from that of the majority of regular physicians, in that the Doctor absolutely refuses to over-stimulate the heart; he refuses to give stimulants until they are indicated; he uses no depressing measures whatever; he meets the separate indications by a remedy which has been proved to him to be specific, and he conserves from the first the strength and vitality of his patient.

I have argued at other times that there was more than one successful method of treating pneumonia. There may be found to be many successful courses, and the day is almost at hand when any physician who claims that pneumonia is essentially a fatal disease, will lay himself liable to censure, as not being informed in some one of the successful methods of cure.

(Comment continued in Echinacea)

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.