Pneumonia in Indiana.

Editor MEDICAL WORLD:-I am in pretty full accord with Dr. Benedict's article in that "often just when we think we are sure we are right, we find that we are not so certain." There are, however, two forms of disease very fatal in their character, and these I think I can cure, besides some that are not so serious. One is membranous croup (which is as distinct from laryngeal diphtheria as a corn is from a cancer), and the other is pneumonia. The diagnostic indications of pneumonia are so well set out in the editorial pages of the December WORLD that little is left to be said on that subject. But I have never seen in any journal, not even in THE WORLD, a treatment for pneumonia that I would adopt.

In the treatment of pneumonia, the essential thing is to equalize and sustain the circulation. Do this by administering a pure relaxant, associated with a pure stimulant. The agents selected must be sanative, for in many cases they must be continued and given in full quantities. Begin the treatment of a case in an adult with the following:

Powd. fresh capsicum an.

Powd. fresh lobelia seed. ãā grs.j M. Sig: Give in small capsule each hour.

After a few hours gradually increase the dose until the surface becomes moist. If the capsicum burns the stomach, follow each dose with a few drops of pure, cold, sweet cream. If excessive nausea arises, give the medicine at shorter intervals and in smaller doses for a time, but give as freely as the stomach will tolerate. I often give it in four or five-grain doses each hour, or two hours, for days together with no complaint from the patient, except slight burning of the stomach or occasional emesis. If the patient should vomit occasionally no harm will come of it, but on the contrary much good, for in the act of vomiting the lungs are subjected to pressure while the residual air is confined, forming a cushion against which the blood vessels are compresst, driving the blood into the general circulation, thus relieving the lungs of engorgement. The capsicum sustains the heart as no other agent will do, and the lobelia relaxes the general system favoring the distribution of the blood to the capillaries of the systemic circulation.

This in brief is the foundation of a treat

ment for pneumonia that excels anything I ever saw. If you try it thoroly you will be convinced. I say nothing about meeting such complications and incidental indications as may arise in any case, such as treatment of malarial condition, keeping the bowels free, the liver active, and nourishing the patient, etc. But the sheet anchor must not be omitted. The physician

will be surprised at the remarkable free

dom from nausea under this treatment while the lungs are congested.

Under this treatment I have lost two cases of pneumonia in the last eighteen years, one an old man, another a very feeble woman. Young children cannot take this treatment so well. For them I substitute xanthoxylum and asclepias for the capsicum and lobelia, and give it in infusion.

Notwithstanding the criticism that I know such a statement will provoke, I unqualifiedly assert that the mortality in pneumonia will not exceed five per cent. under a thoro vigorous treatment in which lobelia inflata and capsicum an. are given freely. The skilful practioner can without difficulty easily determine when to increase or diminish the one or the other of the above-mentioned drugs that constitute the sheet anchor in my treatment of pneumonia. W. A. SPURGEON, M. D.

Muncie, Ind.

[Eclectics have long claimed superiority of results in the treatment of pneumonia, and as medicine is a broad science, not a collection of sectarian beliefs, it would be well to pay a little closer attention to the methods they use, in order that the general good may be advanced.-ED.]

Pneumonia, Points on Treatment. Editor MEDICAL WORLD:-In a case of croupous pneumonia the patient should be placed in a large, well-ventilated room, for he must have pure air, and get his quota of oxygen, with the necessary moisture by water evaporation. The temperature of the room should be kept steadily night and day at from 65° to 70° F. Have the bed elevated at the head and require the patient to repose at such an angle, elevated as high as possible so as not to be uncomfortable, in order to get the benefit of the law of gravity. A gown is sufficient for clothing, with light and warm bed covering. Order the feet to be kept warm and the head cool. This accomplisht, order calomel 1-6 grain at intervals, until the

bowels move, aided if necessary at the proper time with castor oil or a seidlitz powder, or such other laxative as you may elect.

Apply an adhesive plaster to the chestwalls anteriorly. Properly medicated, linseed oil with beeswax and camphor well sprinkled with capsicum, is good.

You will observe the reciprocal action of heart and lungs is diverted, and is laboring to restore their normal relations, resulting in rapid exhaustion, unless the physician relieves the difficulty. Now is the proper time to restore the lost art blood-letting, which clears the way for veratrum and other heart sedatives. Codein should be administered to quiet cough and restlessness-lemonade, hot or cold, for drink as expedient.

Someone may know what to use to dissolve the tenacious sputa; I don't. I wish I did. Expectorants may be used, but beware and not upset the stomach, remembering the patient must be nourisht.

Give liquid foods every four hours, night and day, milk and fruit-juices as a basis. Control the temperature and you control the disease and husband the vitality, and see that all eliminating organs perform their functions.

Antipyretics should be given if fever runs high, guarding the welfare of the heart with its appropriate supports. Phenacetin in small doses, supplemented with other drugs suited to the condition, is excellent.

A mustard sponge bath should be given as occasion demands. A daily action of bowels should be required, and if offensive, disinfect liberally, using sulfocarbolates.

If in a malarial district quinin should be used ab initio. Also at the crisis a solution of quinin in alcohol should be applied externally, with strychnin and quinin internally. Here the famous eggnogg asserts its rights. In the suppurative stages sanguinarin, calcium iodid and such builders as the case may demand should be appropriated.

All company should be rigidly excluded and the patient enjoined not to talk if possible, and no exposure or exertion permitted. They are always detrimental in pneumonia. Every case should be treated on its own merits and environment, for there are no two precisely alike. There is no iron rule. Different localities require different treatment, and an effort should always be made to abort if possible.

Just a few clinical thoughts, omitting details (for it is hard to condense) on the

croupous type. Control this type and you will master the other (catarrhal).

Now if his Satanic Majesty the Tarantula -Devil-Grip (for he must be a Bug too), allies himself with the Pneumococcus they are dangerous forces, and march under the "Black Flag." Fortify and remain there until they are exhausted and capitulate. San Saba, Texas. DR. N. KETCHUM.

Treatment of Acute Pneumonia.

Editor MEDICAL WORLD:-Mrs. A., aged nineteen, was attackt December 1 with pneumonia, which involved the lower lobe of the right lung. The temperature was 1054°; pulse, 140 per minute. She had headache; dry skin; harsh, dry cough; with pain in right side; tongue dry and coated. I gave fifteen grains of acetanilid, placed hot irons around her and covered her with blankets. Within two hours she was in free perspiration. The temperature fell to 101°; the pulse became soft and regular at 80, and the headache was relieved. I then gave her:

gr. v

M. Ft. Capsules No. xv.
Sig. One capsule every four hours.

On the following day she began to expectorate in large quantity. The temperature gradually fell, and on the fifth day from the inception of the attack, she was able to sit up.

Capt. L., aged thirty-five, strong and robust, from exposure, contracted pneumonia, involving the lower lobe of the left lung. left lung. The attack was complicated with pleurisy. The temperature was 104°, with excruciating pain in the left side, and dry cough. To relieve pain, I gave hypodermic of morphia, one-quarter of a grain, with atropiæ sulfate, one-seventyfifth of a grain, and applied dry cups over seat of pain. After the patient was somewhat relieved, I gave fifteen grains of antikamnia, and covered him with blankets and placed hot irons and bottles filled with hot water around him. Within

two hours he was covered with profuse perspiration, and the temperature was reduced to 100°, while the pulse was soft and regular. I then gave him the cough mixture mentioned in the first case. His temperature never afterward reached higher than 102°. He began to expectorate in large quantity, and made a good tho protracted recovery.

I might mention many other cases similar in detail.

I do not know of a better way to relieve the congestion in the lungs than by giving medicine to produce free diaphoresis. Some advocate blisters over the seat of the congestion or consolidation, but I cannot understand what good they can do—unless there is a complication with pleurisy, and even in this case it would only tend to relieve the congestion on the pleural surface.

Would I bleed a patient in acute pneumonia? I have bled several, but cannot say that I have seen any great advantage derived from it. It will, of course, bring down the pulse and relieve somewhat the distresst breathing, but the symptoms soon return, and I think the loss of blood is no advantage to the vital forces. admit that in exceptional cases, it may prove advantageous. Still, such cases are extremely rare.

Yet I

I look upon aconite as a very strong sedative. When the pulse is lowered by it, it is at the expense of the nervous force. In fact, it will require large doses of aconite to bring down the pulse in acute pneumonia, and if it is given by tincture, it leaves a very disagreeable feeling in the fauces, caused thru its paralyzing the soft palate. Aconite lessens the pulsebeat by its tendency to paralyze the motor functions of the heart. If we lessen the pulse-beat, we do not necessarily relieve the congestion in the lung-but if we can give a remedy that will dilate the capillaries of the skin and allow the blood to find the surface, and by osmosis get rid of the pent-up material that should be excreted, then we relieve the system of the overstrain and relieve the lung of its congestion -not absolutely, but in part and place that organ in a fair way to resolution. In my experience I have found no remedies that act better, when properly administered, than the coal-tar derivativesthat is, in the incipient stage of pneumonia and in robust subjects.

They relieve the headache, produce diaphoresis, take the strain from the heart

and lungs, reduce the pulse, and act as an anodyne. But here their usefulness may end, for, if continued, they may do harm. Should the fever not rise higher than 100° or 101°, they are contraindicated, unless given in small doses of one or two grains, at intervals of four or six hours.

Milton, Del. R. B. HOPKINS, M. D.

Treatment of Pneumonia.

Editor MEDICAL WORLD:-In treating pneumonia I do not use alteratives like Dr, Benedict, but think I use common sense. Of course, we all know that routine work will not do here in all cases. Age, conditions of heart and stomach and nervous system are first carefully lookt into in prescribing for this disease. Given a babe of one year in the first twenty-four hours of an attack of lobular pneumonia, I first of all seek to allay the pain and lessen the fever, which usually runs pretty high for twenty-four hours after the invasion. Then open the bowels gently yet freely. The first is done by an opiate, and if cough is severe I use something like the following:

Syr. scillae comp.
Ammon, mur.

Ext. ipecac
Tr. opii camph.

. grs. xxv. fl.gtts. x to xv. 3iv.

Yerbazine (Lilly), q.s. ad 3ij. M. S.-Twenty to three gtts. pro re nata.

The second indication is usually met with acetanilid and caffein citrate, half grain of former to one-eighth grain of latter, and hot baths.

The bowels are then opened by tablets of calomel and ipecac, one-quarter grain each, one hour apart, until four are taken, followed by that nauseous castor oil, if the child can bear it (and it usually does). A flannel cloth is saturated with equal parts turpentine, coal oil and camphor, and applied over the side where pain is situated. I only blister an infant as a forlorn hope, for the blister usually causes the child more annoyance than the disease. After the bowels are well opened I put child upon :

R

nating. Nurse carefully, watch heart, and give a toddy and strychnin as needed. But if the child rests quietly at night,that is, sleeps well,-I do not have it disturbed unless the pulse runs low and weak. Plenty of milk and liquids are given thruout.

Now take a stout, robust man or woman, of twenty to forty years old. At first I usually give the patient one-quarter grain morphin sulfate, with atropia sulfate 150 grains hypodermically, if I find him in great pain upon first visit. Then the next thing I put on a mustard plaster, and let it stay over the seat of pain until the skin is slightly pimpled. Then purge freely with calomel, one-half to one grain every hour until three to four grains are taken. If very sick at stomach, I put a mustard plaster over the epigastrium until it is very red. I then start the patient out upon the following:

With

Should fever run very high I give acetanilid or phenacetin or antikamnia five grains, and caffein citrate one grain every two hours until he sweats freely. this treatment he generally keeps drowsy and sweating. Should the heart show signs of weakening I give strychnin and whisky until he is tided over.

I feed him on any light diet he may like, but principally insist upon a milk diet, changed when he tires to soups or sour milk, or put whisky in milk. I have given a patient 1-40 grain of strychnin sulfate every three hours for four or five days, and have seen only beneficial results. Should the stomach rebel against so much ammonia, I let him have lemonade, and hold up on the ammonia and give elix ginseng (a Chinaman, you will say,) until the stomach is all right. But let me say right here, that in my own practise I have had but one or two cases, in a period of

nine years, who could not take the treatment I have outlined above.

First, last and all the time, I keep watch upon the heart, knowing that it is the principal organ to keep well toned up.

I would like to say to Dr. Benedict that in a practice covering a period of nine years, I have lost two patients only from pneumonia where I have been called in during the first forty-eight hours. It may have been pure luck that I didn't lose more, but I am strongly inclined to believe it is in the treatment. Neither are there serious complications or relapses. And knowing this to be the past record of this treatment, when I often hear other men speak of losing five, ten, or even fifteen per cent. of their pneumonia patients, I am loath to part with it. I carefully avoid blistering in the extremes of age, because experience has taught me to not do so, unless it is a last resort or death.

La grippe is upon us now with all its terrors, aching heads, back and muscles, much pneumonia will follow its wake, no doubt. For the acute stages of this dreaded terror, quinin bisulfate and acetanilid, five grains each for a stout man every two or three hours will relieve that bone-breaking, muscle bruised feeling quicker than anything it has ever been my lot to try. course, many cannot take either, then I use phenacetin and salicin.

Of

I hope Dr. Waugh has regained his "equilabraham," as Mrs. Malaprop (I believe it is) would say, and answer the heading of his article in January WORLD, "Why Do We Die?"

I think it hardly fair for Dr. Matthews, of Corsicana, Tex., to excite our curiosity by telling us of his wonderful result in curing a brother M. D. of his morphincocain habit, and never tell us one bit of his methods, as he does in the January WORLD. Surely such wonderful results, in all its details, should be in the hands and minds, too, of every physician in the land, that we all of us could free those poor helpless mortals who are bound body and mind to this terrible habit or disease. He would confer a great favor to some of us to "detail" a while.

Pilot Oak, Ky.

BERRY BOWEN, M. D.

Do not forget special offer of WORLD for four years for $3. Hope you will join our large and happy "family." It is a family of mutual helpers.

THE WORLD is of great value to me. The editorials are worth many times the price of the journal and it also contains articles that are like clear-toned bugle blasts above the din of the mediocre.-J. H. CALLBREATH, M. D, Waterbury Ct.

An Unusual Case.

Editor MEDICAL WORLD: We have seven volumes of the MEDICAL WORLD, bound. One of these bound annuals is more valuable to the busy doctor than a regular high-priced medical book. Come to think of it, these medical books are feloniously high, and the State should come in and fix an honest price for them.

A strange case came to me two years ago. A father came to me from the country and reported that his adult girl had swallowed a hairpin. I gave him advice, from time to time, for several days, and the pin remained in the bowels and did not move. I did not see the case, and a brother physician passing that way called and removed the instrument from the fundus of the uterus. He charged $100, which the father refused to pay, and a suit followed. Three doctors at the trial swore the fee was reasonable. The attending physician, on oath, told how the pin was adherent and how he removed it, and gave the impression that it had pierced the bowel and uterus, and was nearly thru the wall of the womb, when he found it, at least that was my impression, and is my present memory of his description of his services. I was witness, but swore that the case was so unusual that I was unable to fix the value of his services. The court found for the doctor. Remarks are invited about the case. Long live THE MEDICAL WORLD.

Oswego, Kan.

W. S. NEWLON, M. D.

Potassium Permanganate and Opium
Poisoning.

Editor MEDICAL WORLD:-With reference to the above subject in the January MEDICAL WORLD, would refer Dr. McCampbell to a paper read by me before the section on materia medica of the American Medical Association in 1894, at San Francisco; also would refer him to an able article by Dr. Moss, in the Medical Record of February, 1894. In the Medical News of May 5, 1894, a physician of Pittsburg, Pa., reports a case where a patient had taken two ounces and a half of laudanum of unknown strength three hours before admission into the hospital. In addition to the usual treatment, including coffee, hypodermic injections of atropin, artificial respiration, and so on, and when the case seemed hopeless repeated injections of a half saturated solution in doses of eight grains were administered at inter

vals of half an hour. After the fifth injection the patient recovered.

Morphin is rapidly oxidized by the permanganate, even in the presence of peptones and albumen. Dr. Moss gives .60 to .90 dissolved in half pint of water, repeated at intervals of thirty minutes. It is also employed hypodermically. San Francisco, Cal. H. I. JONES, M. D.

General Considerations About the Bowel.

Editor MEDICAL WORLD: Pain with stools may be due to several different causes. Thus, there may be the cutting pain of piles; that due to anal fissure; that caused by inflammation of, or about, the rectum; that resulting from rectal stenosis, from carcinoma, or from syphilis; also the pain and straining (tenesmus), aptly designated nausea of the rectum, that is characteristic of dysentery. Then there are the distinctive discharges of cholera, looking like water containing grains of boiled rice.

Green stools indicate intestinal fermentation, especially in children, but it must not be forgotten that many stools are normal in color when passed, but get green after exposure to the air. Greenish, golden-yellow, or even reddish stools are due to the presence of an excess of bile, which, when very profuse, may cause watery stools. All light colored stools signify a deficiency of bile. A mucous stool is a fair index of the comparative height in the bowel at which trouble exists. Thus, mucus-covered hard fecal matter means that the trouble is low down, say in the colon, while a softer stool would signify trouble higher up, say in the ileum, and when the feces are well mixed with the mucus it means that the disease is still higher up, say in the jejunum, where the admixture takes place before the feces are at all formed.

In the same way bloody stools may be used as an index of the relative height of the seat of the trouble. The nearer to the anus is the point at which the blood is poured out, the redder it looks, whereas it becomes darker the further it has to traverse the gut before making its exit. When it is exuded very high up, it emerges almost black. An exception is in typhoid fever, in which disease blood is apt to come out quite red from any part of the gut. The reason for this probably is that in this disease the usual active chemic changes of the gut are in abeyance. Gastric and duodenal blood is often passed tarry-black.

Sometimes foreign bodies are lodged in