Pneumonia - Victorian Health and Medicine

PNEUMONIA. - This disease is an acute inflammation of the substance of the lungs, and so far different from Pleurisy, as that in the inflammation of the bag or membrane that contains the lungs, and lines at the same time the whole cavity of the chest.

The symptoms that indicate inflammation of these organs, are pain in the chest, extending to the shoulders and back, and becoming more acute as the disease advances, a constant and anxious difficulty of breathing, augmented by a recumbent, and relieved, or less severe, when the body is placed in an erect position, attended with a sense of distension and fulness of the lungs, which nature attempts to relieve by a frequent and abortive cough; the face becomes tumid, and the lips livid; the pulse being quick, full, and round in pneumonia, and quick, hard, and sharp in pleurisy. The pain may be either under the breastbone or at either side, or in all places at once; there is much thirst, great anxiety, and a tongue either dry and rough, or moist and white. The other organs suffer sympathetically, such as the head and skin, when the former is the case, and there is much congestion, as indicated by throbbing in the temples, heat, and pain; the prognosis of the disease is unfavourable, as delirium may supervene, always a serious symptom. But as respects the skin, which is nothing more than an extended surface-lung, it always suffers to a greater or less degree in this disease; and as all affections of the skin reciprocally affect the lungs, the cuticle, in pneumonia, becomes dry, rough, and extremely sensitive to cold.

Inflammation of the lungs may exist without pain, as in the peripneumonia notha of old age; but in youth and adult periods, this is rare.

The treatment of this disease demands great judgment; that bleeding is often necessary, no one will deny who bears in mind the vital function of the organ; but it should not be carried too far, or if possible, be repeated. When the great object of the treatment is borne in mind, the mode of after-management will be more intelligible, viz., that the chief and foremost consideration is to relieve the overcharged lungs of the excess of blood accumulated in their vessels; which, by pressure on the nerves of the organ, causes not only the pain, and by obstructing the air passages, impedes respiration, inducing difficulty of breathing, but preventing the blood from circulating through the structure of the lungs.

When it is remembered that the skin is only another kind of lung, and that in this disease it is cold, rough, and dry, indicating the absence of its natural blood, drawn off from the surface to flood the lungs ; it will then easily be comprehended that a hot bath, by bringing back the circulation to the surface, must unload the lungs, and by equalizing the powers, afford immediate relief from pain, and the general amelioration of all the other oppressive symptoms. Very great is the benefit produced by the hot bath, in relieving the oppressed organ, and throwing the superabundance of blood on the skin, where it can in turn be got rid of in the form of perspiration, and by a sharp action on the bowels, as a purgative, be removed from the system before its accumulation in the cuticle could produce any hurtful consequences, or reciprocally re-act on the lungs.

So great indeed is the benefit of the bath, that if the effect could be continued long enough, no other mode of treatment than a hot bath and a purgative would be needed to cure this dangerous disease. Still, it must be understood that this means is one of the first remedies to be adopted, and if immediately employed after bleeding, when that measure is rendered necessary by the urgency of the symptoms, two of the most important moves in the system of treatment will have been adopted. The bath should be used for five or seven minutes, and the temperature of the water kept, up to the last moment, to the same heat as when first used. The patient should be folded in a blanket undried and placed in bed, that perspiration may be induced; the subjoined pills, and a dose of the accompanying mixture, being given before he is left in repose. Take of

Extract of colocynth . 12 grains
Calomel...... 8 grains
Croton oil ..... 1 drop

Make into a mass with extract of henbane, and divide into 4 pills, two of which are to be given for a dose, and repeated the following day if required. Take of

Powdered nitre . . . . 30 grains
Tartar emetic . . . . 4 grains

Dissolve in:-

Camphor water. . . . 5 1/2 ounces
Laudanum . . . . l drachm
Syrup of saffron . . . 1/2 ounce

Mix, and give two tablespoonfuls after the pills, and one tablespoonful every two hours afterwards. The feet should be kept constantly hot; and if, after a few hours, the pain in the chest continues, from six to twelve leeches should be applied to the part over each lung; or a blister may be substituted for the leeches. The thirst is to be mitigated by effervescing draughts, made by dissolving twenty grains of the .carbonate of potass in half a tumbler of water, and adding fifteen grains of powdered citric acid, or the same quantities of carbonate of soda and tartaric acid. In cases where the pain and inflammatory symptoms are strong, and the physical state of the patient too weak to admit of excessive depletion with safety, one of the following pills may be given every four hours in addition to the mixture and dose of purgative pills. Take of

Calomel ....... 12
Opium, powdered . . . 5 grains

Extract of henbane, enough to make into a mass, which is to be divided into six pills, which are to be discontinued as soon as the urgency of the symptoms is subdued. To recapitulate: the treatment of pneumonia should commence with bleeding to the extent of from twelve, fifteen, or twenty ounces, the hot bath, the purgative pills, and the saline fever mixture; in extreme cases, using in addition the calomel and opium pills, and leeches, or a blister on the chest; but in all cases allaying the thirst with cooling drinks and effervescing draughts. During the whole treatment the patient should be kept in bed, remarkably quiet, and on the thinnest and least exciting diet; the skin, as much as the lungs, being guarded against exposure to damp or cold; and as this disease is very prone to recur, every precaution must be taken during convalescence, not to let the patient be exposed to causes that might renew so serious a complaint.

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