PNEUMONIA.
The patient should be put to bed at the earliest moment in a large and thoroughly ventilated room. A real advance in the treatment of the disease (hiring late years has been the wider acceptance of the necessity of a supply of pure air, as the danger of draughts and chills has become recognised as a bogey. The windows of the sleeping apartment should be kept as widely open as in the treatment of a case of phthisis by the open air method. By this means the degree of toxaemia may be minimised within certain limits, and it is somewhat surprising to observe that whilst some authorities extol Oxygen inhalations for this purpose, they overlook the importance of the freest possible supply of pure air. In the pneumonia of children this fresh air method of treatment has been abused by some physicians, who insist upon the patient being continuously kept in a draught of cold air.
The bed-clothing should be light, and there is no objection to a moderate degree of warmth from an open fireplace, which aids ventilation. By causing the patient's bed to be surrounded at the distance of a few feet by screens covered with coarse muslin, doors, windows and ventilators may he left constantly open. The crowding of the sick-room by the patient's relatives should be strictly forbidden, and it is a good rule when the apartment is small to prohibit a third person from being constantly present.
By limiting the amount of bed-clothing, cold sponging may be rendered unnecessary save when the degree of fever is high. Constant rinsing of the mouth by a weak Permanganate solution is a wise procedure, by which further toxaemia from swallowing the infected sputum is prevented.
The diet should be such as is indicated in most febrile conditions, small quantities of liquid nourishment being administered at short intervals. Milk answers all requirements, but this should not be poured in as is often done in amounts beyond the patient's assimilative powers. Rarely should the limit of 3 or 4 pints of milk daily be exceeded. There is a temptation to overfeed, owing to the anticipation of weakness of the heart supervening at a later stage, but as this cardiac asthenia is mainly due to it may be precipitated by large amounts of food. There is also
a special reason why milk in unlimited quantity should be avoided. since its richness in lime salts increases the coagulability of the blood, which is generally at a high point in the disease. In some cases where calcium salts are indicated milk may be pressed, but as a rule it will be wiser to restrict its administration to 2 pints daily, and give small quantities of clear soup or chicken jelly at intervals, and to dilute the milk with effervescing potash or soda water or with barley water. Ice and pure water may be permitted in moderate amount to allay thirst. Lemon-juice is indicated theoretically as tending to minimise the coagulability of the blood; when it is added to the dietary the milk may be administered in the form of whey. Alcohol should never be employed as a routine, hut kept in reserve for the treat ment of later symptoms.
Blood-letting, formerly employed as a routine with the view of lessening the amount of toxins in the body, is now not resorted to unless in the presence of certain serious symptoms which will he dealt with later on.
Drug Treatment.—The less heroic this is the better, but the practice of absolutely abstaining from the administration of drugs in pneumonia is a weak practice, usually having its basis in ignorance or scepticism of the scientific action of many remedial agents. and it is quite as reprehensible as was the polypharmacy and wholesale drugging of former years.
Toxemia may be diminished within certain restricted limits by the judicious administration in the early stages of an occasional saline purgative following a moderate dose of Calomel. By the employment of mild diuretics and diaphoretics elimination of injurious products can be assisted through the kidneys and skin, and the pyrexia may be sensibly reduced without risk of harm being done. Though such agents are probably useless in severe cases showing a high degree of pyrexia or (these may be accepted in pneumonia as synonyms), nevertheless in other cases they may be able to turn the scale in favour of recovery. The following combination therefore may be employed usually with advantage: R. spt. .Ether. Nitrosi Liq. Ammon. Acet. 3ij.