Pneumonia.

HORACE R. POWELL, M.D., POUGHKEEPSIE, NEW YORK

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With considerable interest I have read the articles in the February number of the THERAPEUTIST, especially with reference to the use of echinacea to combat blood dyscrasia.

Considering the high rate of mortality in this condition, it must ever be a subject of considerable interest to the general practitioner.

So far as the use of remedies is concerned, I am an optimist from experience. The first point I desire to make is, treat the individual according to existing conditions.

I am satisfied that pneumonia can often be jugulated, and when this fails, that cases can often be carried to a successful termination.

In every case I have the feet soaked in hot mustard water, after which the patient is put to bed in a well ventilated room.

I advise that he be sponged with a hot solution of magnesium sulphate, two teaspoonfuls to two quarts of water, at intervals to be determined by the condition of the skin.

The gastro-intestinal canal is then cleared out with calomel and podophyllin in small, doses, frequently repeated to effect, when magnesium sulphate is given in hot solution. Throughout the case the latter is given early in the morning when necessary to keep the bowels relaxed, not purged.

In addition, in order to prevent auto-intoxication, I invariably administer 5-grain doses of sodium sulphocarbolate every two, three or four hours, as is necessary to keep the tongue moist and the stools free from disagreeable odor.

When the gastro-intestinal canal is not kept in proper condition, sepsis adds materially to the danger.

My favorite defervescent in sthenic cases is a combination of veratrin, aconitin and digitalin from one-half to two hours, until the pulse comes down to about 80. The pulse should be kept soft and compressible throughout the disease.

I believe veratrum to be one of the best single eliminants, acting upon the skin, kidneys and bowels. Properly fortified and carefully used I believe with it we best meet the condition as to circulation.

I do not favor the administration of strychnia and digitalis early in sthenic cases, and never as a routine prescription. Lessen the supply of blood to the congested areas by the use of veratrum, and the heart will usually need nothing but cactus grandiflorus to level up the circulation and bring about its physiological equilibrium.

As an expectorant, in the early part of a case I prefer apomorphine muriate, about 1/40 grain from one to three hours, while later I like a tablet of muriate of ammonia and apomorphine.

As a local application I like antiphlogistine or some other similar paste applied hot and covered with absorbent cotton and oiled silk. This should encircle the thorax and be so applied as not to materially interfere with the respiratory movements.

As soon as expectoration is well established, I prefer turpentine and sweet oil or lard applied hot, in the proportion of one part. of the former to two or three of the latter, and covered in the same manner. This should be watched in order to prevent blistering. As soon as deep redness of the parts is established, I lessen the proportion of turpentine and later discontinue its use.

The patient should be allowed a fair quantity of pure water, fruit juices, etc.

The diet should be liquid throughout the febrile stage, and milk should be so prepared as to avoid if possible the formation of indigestible curds, which surely adds to the chances for intestinal sepsis. Butter milk is an ideal food and an excellent diuretic.

That prepared by the use of lactone tablets is an eligible preparation. Malted milk, junket, etc., are frequently taken with relish and benefit. As a semi-solid food I like baked apple. So far as echinacea is concerned, I have never used it, but from my experience with it in other septic conditions, I believe it should merit our serious consideration.

I believe, however, that there will be but little use for it, providing the gastro-intestinal canal be kept in good condition by the use of sodium sulphocarbolate, and equilibrium of the circulation be maintained by the proper use of veratrum.

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