The foregoing is a general outline of the treatment of pneumonia practiced by me for several years past. Under it, the mortality of this disease has been much less than under the excessive depletory treatment, which I practiced some years ago. Out of eighty-eight cases treated by myself and my son, in the winter and spring of 1869, there were three deaths, a mortality of a fraction less than 3.53 per cent. The cause of death in the fatal cases was as follows: Case first, infant, ten months old, bilateral pneumonia, complicated with pertussis, died on the sixth day in a paroxysm of suffocative dyspnoea. Case second, male, aged sixty-five, broncho-pneumonia, ninth attack, dismissed convalescent on the twelfth day; eight days afterward, after imprudent exposure, took a heavy chill, and died in forty-eight hours of congestion of the brain, without appreciable pulmonary trouble. Case third, child, one year old, bilateral pneumonia. The parents would enforce no treatment that promised a rational hope of success, and the case was abandoned. It died on the eighth day. Of the recoveries many cases were complicated with pertussis, and the general type of the disease was severe. Any general plan of treatment must of course be greatly modified, to meet the exigencies of individual cases. In drunkards, and very old and feeble subjects, and sometimes where the pneumonia occurs as an intercurrent disease in typus and typhoid fever, we must, from the beginning, resort to the plan of sustaining treatment. We need not fear to do this, for the great object we have in view is to nourish the patient, and sustain his vital powers. Further, we must bear in mind that the investigations of Brown-Sequard and Claude Bernard, have pretty conclusively established the fact, that the velocity of the current of blood is not increased during the prevalence of inflammatory action. The increased action of the heart is due to debility, which always accompanies high animal temperature, and the increase in the number of pulsations is simply a compensation for the loss of power in the contractile force of the heart. The truth of the above proposition is probably best illustrated by the great success of what is called the restora tive treatment of pneumonia in hospital practice. The patients there treated have usually been poorly nourished, and oftener still are far advanced in the disease when received. In such subjects the restorative is the only plan of treatment that is rationally adapted to the case. When a pneumonia results in abscess, or purulent infiltration, or gangrene, I know of no treatment that promises a rational hope of success. When we have prolonged the life of the patient to the last possible hour, and given him all the bodily stimulants that the resources of our art suggest, I believe we have done our whole duty. Although I have never seen it, I do not deny that such cases do sometimes recover, but I believe such recoveries always take place under sustaining treatment. I have prolonged this paper much beyond the limits originally intended, and have also given it a more elementary cast than I had at first proposed. But I found that I must somewhat change my first plan, if I would render intelligible to every one what I had to say. I have purposely omitted any remarks on the anatomical characters of this disease, because in the few autopsies that I have witnessed, I have seen no appearances that are not fully described in any systematic work on the subject. 13 |