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the preacher with a smile subsequently, and the preacher said, "Have you seen sister?" "No, sir. I began to think about it seriously, and decided she did not do me such a wrong." After all, gentlemen, it is a good deal of imagination.
Dr. Clark (in closing): I thank you for your kind reception of my paper. I am anxious to see in the reorganization of the Medical Association of Georgia more than the combining of the county medical societies; I am anxious to see a reorganization of the physicians of Georgia as a band of colleagues and brothers, working together for the benefit of mankind, and if what I have said will help a little bit toward the attainment of that end, I shall feel well repaid. (Applause.)
THE TREATMENT OF BRONCHO-PNEUMONIA.
BY SAMUEL A. VISANSKA, M.D., ATLANTA.
As the season is still upon us when the physicians will be called to treat numbers of such cases, would it not be well to discuss the very best methods of reducing the death rate of this dreadful disease, carrying off thousands of children each year, and which, next to the summer diarrheas, is most fatal? It might be termed the winter disease of infants. There are scarcely any two physicians. who treat the disease alike; and this being the case, would it not be more beneficial to both patient and physician, if we could get together, and bring down the treatment to a practical, and not a theoretical basis? The theory of medicine is one thing; the practice another; blessed is the doctor who is practical.
Taking nature as the best physician, there is no disease which requires more intelligent assistance than that of broncho-pneumonia. The two vital organs are affected from the beginning, the lungs and heart, and often a severe enteritis occurs. The age of the child and its surroundings will have to be considered also. The first requisite to treat a case successfully is, as little as you think of it, to get the confidence of the family. Unless you do, there will be all kinds of suggestions from them as to the internal and external treatment. A good neighbor comes over with the very thing that cured her child, and the parents, intelligent ones, too, are willing to try it.
If you use one form of external application and the baby is not doing well, the mother is told of something a doctor used across the street, that patient happened to get well and you will often be influenced to use it. The textbooks do not take up these points I mention, but experience, especially my first experience, has brought this to my mind: This meddlesome interference on the part of grandmother, parent and the neighbor has caused the death of many a little patient. My advice to every physician is to be master of the situation or step down and out. We all should realize that broncho-pneumonia is, in a great majority of cases, a secondary disease, and as a rule bronchitis is the primary cause. This may be either a simple bronchitis, or that which occurs as a part of infectious diseases, among which are measles, whoopingcough, diphtheria and membranous croup, influenza and possibly typhoid fever. Of course the specific cause of the inflammation is probably the pneumococcus of Frankel, but the staphylococcus and streptococcus pyogenes, the bacillus of Friedlander, or, as has been demonstrated, the tubercle bacillus may be the exciting cause. Of the predisposing causes of catarrhal pneumonia, age is the most important, and in children under three years of age it is the lobular form of pneumonia, which is found in a great majority of cases. It is especially most fatal in cases occurring under two years of age. With a knowledge of the morbid anatomy and symptoms in our minds, the question might be asked by what method can we lower the death rate?
1. We should be able to make a diagnosis and tell the dividing line between the pre-existing bronchial trouble and the extension into the terminal tubes and peribronchial tissue, as a number of errors of diagnosis have been made.
2. The predisposing cause should be borne in mind. My experience has taught me that pneumonia. complicating whooping-cough requires the most active treatment, and for convenience we will divide the treatment into hygienic, external, and internal.
Hygienic. The room should be large and have at least two windows and one with a fireplace is preferable. The temperature of the room should be kept at from 68 degrees to 70 degrees. The windows should be opened from above and below so as to allow plenty of fresh air into the room, as in mild cases that is our method of administering oxygen.
It is almost criminal to have your patient in a stuffy room with a big fire and every window and door closed. You need not allow a current of air to strike the child, as screens can be used. See that the bed of your little patient is made comfortable, and keep your patient on it most of the time, but the position of the child should be changed occasionally.
External. By the external treatment, I mean the various applications which have been applied to the chest to bring about resolution. This external treatment has been and is yet as great a puzzle to me, as when I treated my first case. I wish I knew positively if they do good and which application is most beneficial, and I would be extremely grateful, if my fellow physicians could enlighten me on this subject. Many things, from the sweetscented onion poultice to mother earth, has been used and the man who gets the cure with one preparation or the other naturally advises its use, but is it in any way due to the external application? One will use a mustard plaster, the flaxseed poultice, a combination of turpentine, lard and camphor, or fifty other combinations, and all claim good results, yet the death rate remains extremely high.
We often forget what the disease really is, and the changes which have taken place. In consultation, is where you will find in most cases the absurdity of the external application; by that I mean that if you are using one application, the consultant will often advise another, and yet there is no more reason for it than the first. The theory of the external treatment is to attract the blood from the lungs to the surface of the body. To do that you must use a method to attract the blood equally and not just over the area of the chest wall. Nothing has served me so well as the mustard, hot mustard bath, or mustard pack, and the child should remain in the bath until there is a pink glow over the body. It should then be wrapped in a blanket and placed in bed, where as a rule, it falls into a peaceful sleep; at the same time the high nervous tension is relieved, the child breathes easier, the pulse is not so rapid, the capillaries dilate, and the little patient often breaks out in a copious perspiration, carrying off the toxines, thereby throwing less work on the heart, kidneys and intestinal canal. These baths should be repeated as often as necessary. Returning to the applications used (manufactured or home-made), I believe they do little good unless there is a pleuritic con'dition, and the child is made more comfortable. I prefer then, the hot camphorated oil with mustard, applied anteriorly and posteriorly over the lung area by gentle massage; children enjoy being rubbed, and will often go to sleep while the rubbing is going on. If you wish a quick counter-irritant the mustard plaster will suffice, then if you like, a close fitting flannel undershirt, lined with cotton material, can be worn next to the skin. Nothing heavy should be allowed over the chest, as nature often brings into play all the auxiliary muscles of respiration so as to convey oxygen to the system. Then again, if you have