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complications quinine should be given. I agree with Dr. Paschal, that every case is a law unto itself, but I believe the routine practice of giving quinine and opium should be condemned.
DR. BETHEL NOWLIN, Jonah: I believe I can tell you how to treat pneumonia in a few words. I have a treatment of my own for pneumonia (and I have a very high opinion of my judgment in the management of this disease). Put the patient to bed at the earliest possible time, in a good comfortable bed, and in a good, warm, well-ventilated room; open bowels with some mild purgative; keep him quiet, but let him rest. Feed him a light liquid diet; give him what water he wants. That we can not abort pneumonia is generally conceded; it is a self-limited disease. Give him comfort and support him, and keep drugs out of his stomach, and he has the best chance to get well. I am strongly opposed to putting ice on pneumonia patients to control high temperature. Last winter a year ago there was appalling mortality in Texas from pneumonia, and I believe if the treatment was known, the large majority would be found having died with the ice bag on their chest.
DR. J. T. ORR, Terrell: The truth is we do not know anything about pneumonia ; everybody has a different treatment, and the proof that one remedy is to be preferred and is specific has not lessened the death rate any. A great deal has been written as to aborting pneumonia. A few months ago I was taken with a rigor in the afternoon, followed by high temperature, with a very rapid pulse and rather painful cough, followed immediately by rust-colored sputum, expectoration free, pupil dilated, nausea, restless expression on face. I took an eighth of a grain of morphine and sent for my colleague and he said that I would be several days in bed with pneumonia ; that there was considerable dullness over the entire lower portion of the right lung. About one o'clock I had a profuse perspiration, no rusty expectoration, and the next morning I was entirely well. Was it a case of pneumonia aborted ?
DR. JAMES H. Evans, Palestine, in closing, said: I think the gentlemen who have spoken misunderstood me to a certain extent—that the disease is due to the pneumococcus; that is the concensus of opinion. No matter what you do we will have epidemics and our patients will die. What to give and what not to give is what I dwell on mostly. I believe we lose sight of the great good to be derived from the older remedies. Pioneer physicians got along with veratrum all right, and I do not believe that we possess a better drug than veratrum for pneumonia today. I do not give it in every case of pneumonia; in the strong and robust and in the sthenic stage only. Suppose you have a case with a full bounding pulse, temperature running up to 104 or 105, and oftentimes attended with delirium; in this form there is nothing better than veratrum. As to digitalis, it is a heart stimulant, no one will doubt; but I believe that it contracts the arterioles and throws more work on the heart—it may be compared to a tired horse. I claim that in congestion of the lungs, as in pneumonia, digitalis is contraindicated. Alcohol, I believe, is the best remedy we possess; we know that it does not contract the arterioles, it stimulates the heart and dilates the blood-vessels. I believe we do more harm than good in the treatment of pneumonia. If we will only treat the patient and not the disease we will get the best results in pneumonia. As to the diagnosis, one gentleman claimed that he could distinguish between bronchitis and catarrhal pneumonia. We first have a bronchitis preceding pneumonia. Capillary bronchitis and catarrhal pneumonia are identical. I claim we can not tell when one is just merging into the other.
SOME OBSERVATIONS ON THE TREATMENT OF PUL
MONARY PHTHISIS IN PRIVATE PRACTICE.
H. J. CHAPMAN, M. D.,
SAN ANTONIO, TEXAS.
The problem that confronts one in the treatment of these cases in private practice is a somewhat different one than the care of same in sanatoria. With my increase of experience, I am the more impressed with the great necessity of a complete supervision of habits without which many, if not most, cases will not do well, no matter what treatment is used or to what climate they are sent. Speaking broadly, all cases that show a temperature of over 100 degrees should be kept at rest at least during the hours of fever, and better still, one hour before the expected rise. The old advice to live out of doors and take all the exercise possible has been vastly overdone, and too often literally followed. An out-of-door life is one of the great essestials, but it should be so regulated as not to exhaust the patient in his search for sunshine and fresh air.
Each case must be separately studied; the amount and kind of exercise prescribed, bearing in mind the strength of the individual, his previous habits, his fever, and the effect of exercise on the heart.
An old rule that I am apt to give patients is this: Do not do anything that exhausts you or causes shortness of breath.
Another problem, that is hard to solve, constantly presents itself. That is the matter of diet. It is easy to tell your patients to eat all the easily digested and nutritious food possible, but that is not sufficient. One must individualize and study the needs of each patient and ascertain if directions are intelligently followed; guarding against the errors of stuffing on the one hand, and lack of good food on the other. Forced feeding is often of great value,
but must have the supervision of the physician, or the digestive organs will rebel, and we will lose more than we have gained.
Ventilation is another item that demands attention. Most lung patients are especially afraid of fresh air, and have to be strictly instructed to be in the open during every hour of daylight, and in this climate should accustom themselves to sleep on porches, or at least in rooms with
open. Climate is a most valuable adjunct, but it has been demonstrated many times that a large per cent of early-stage cases will recover if placed under hygienic conditions, and made to live rightly. The results in some of the sanatoria located within a few miles of some of the large cities afford ample proof of this assertion. And right here I wish to call attention to one fact, which, while hardly germane to the subject, is of great importance, and that is the educational value of sanatoria. This is not confied to the patients themselves, but makes its influence felt from many centers by means of the recovered cases. Germany is foremost in this movement, and has proved that it is much more economical to the State to assist in the recovery of early cases than to allow them to progress and become a menace to others. I trust the day is not distant when our National government will do as well.
In conclusion, I wish to say a few words on treatment. In the search for a specific for tuberculosis, we have expected too much. We have too often sought for a remedy that, given to the poor consumptive, and lo! he is well. We have a very complex problem to solve, and must realize the limitation of remedies in this as we do in other diseases. One would hardly expect quinine to cure an abscess of the liver or spleen, complicating a case of malaria. Nor would we condemn the remedy if the patient should die of septicæmia, while he was also suffering from malaria.
During the last eight years I have used nearly all the specific remedies in this disease, including the old tuberculin, antiphthisin, purified tuberculin, oxytuberculin (Hirschfelder), watery extract (von Ruck), and several serums. Of these I regard the watery extract as the safest and best. It is certainly a great aid in the
successful treatment of tuberculosis, and gives results which, from present indications, will, in many cases, prove permanent. A few words as to its value and limitations may not be amiss. There is no doubt that it has a positive specific action on living tubercle, and I have often seen partly consolidated lung areas, which showed decidedly dull percussion note with bronchial respiration, return to normal under its use. It must, however, be remembered that these cases were under good climatic and hygienic conditions during the administration of the specific remedy. On the other hand, cases which improved under care and climate the so-called climatic cure, more properly speaking, "latencies”—are very prone to recur. The active manifestations are gone, but the infiltrations are still present, ready to spring into activity if favorable conditions are supplied. Specific remedies can have no action on dead tubercle, and it is the difficulty in differentiating between living and dead tubercle that makes prognosis so difficult. It is often a matter of months to be able to determine whether a given infiltration would be reorganized, or would break down and be expectorated.
During the time of liquifaction of tubercle and formation of cavities, we have to deal with essentially a case of septicæmia, and it is only by attention to hygiene, by careful feeding, and the use of tonics, can we support the patient during this trying period. Specific remedies can not modify the course of this process. It can, however, bring about an artificial immunity which, in addition to the natural immunity of the individual, will prevent further extension of the disease, and with this increased immunity we often note the disappearance of tubercle, which otherwise would have broken down. In other words, this remedy has enabled me to bring about a recovery in cases which, in my opinion, would otherwise have proved fatal. Creosote and its derivatives have enjoyed considerable reputation as a remedy against tuberculosis, but I think they are chiefly of value in the treatment of the symptoms. Being partly excreted by the lungs, they modify the secretion, prevent putrefaction, and assist in expectoration. They have the