Pneumonia, like the poor, is ever with us; it stalks through the land and strikes with unerring dart the rich and poor alike, respecting neither the vagrant nor the millionaire. It is found in all portions of the country and to some extent in all seasons. Sometimes its approach is quiet, unobserved and apparently without visible cause and again the onset is quick and violent and its attacks easily traced to some unusually sudden or protracted exposure of the victim.
Whatever its cause, its course, if unchecked, is rapid, its transition from one stage to another certain, and the results speedily fatal. It cuts down almost, if not quite as many, as the great white plague.
Age, sex, social condition, occupation, nor manner of living hinder its attack and it is the consensus of opinion of most authors that modern medicine does not effect a favorable influence in its treatment.
For the purpose of this paper we confine our remarks to the commoner form or what is known as lobar or croupous pneumonia and I shall not burden you with a technical description of the lesions, further than as they appear in discussing the treatment. Suffice to say that the three stages represent three distinct pathological states and the treatment in each must differ. If Homoeopathy had done no more than give to the world a rational plan of treatment for this disease it had done much, it had accomplished a good work; “modern medicine” is uncertain, unreliable and disappointing, but Homoeopathy is accomplishing the same results in pneumonia to-day as it did in the beginning and the remedies are as potent now as then.
At the same time we must demonstrate that this is true; we must “make good” if we would have our theory accepted, and be recognized as healers of the people. The average individual cares little for the means by which he is cured, but in the time of distress grasps for help even as a drowning man grasps at a straw.
It behooves us, therefore, to make our work plain, our statements clear and declare to the patient and his friends the malady that besets him.
Therefore, we should and must make a careful
This presupposes that the Homoeopath is versed in the classification of disease, that he knows how to determine the kind, extent and severity of the trouble he is called to treat, and that he is able also in some degree to measure or, at least, estimate the vital force and resistance of the patient.
In short, he should be able to recognize the severity of the case; if but a mild engorgement of a small area of lung tissue is present it augurs more favorably for a cure than if in a similar invasion we have a great engorgement of a large area.
In short, it is of great value to the physician if he is well versed in the art of physical examination and is a good, not to say expert, diagnostician. He may search for the bacillus of Friedlander if he will; its demonstration may be a satisfaction to him and positive proof of the presence of pneumonia but it aids him little, if any, in the treatment. On the contrary, however, the pulse rate, frequency of respiration, temperature and urinary tests do much to help him in the selection of his remedy.
Having diagnosed our diseases we have done a good work, but have not benefitted the patient; our chief aim is to cure and in our effort to accomplish this we must institute and continue an appropriate regime or treatment.
This must be carried out along well defined lines; it is not enough to push this very important problem to one side and dispose of it by that stereotyped phrase, “Give the indicated remedy.”
How shall we choose this? How shall it be used? How shall we demonstrate before men the manner in which we select and administer drugs for the cure of this or any other disease? It may be summed up all in one phrase, “Meet the indications as they arise.” In pneumonia more than in any disease we may paraphrase an old sentence and say, “He who anticipates is lost.”
Stimulate the heart in the beginning and it is goaded to exhaustion; force down or keep down the temperature by antipyretics and toxaemia will end the disease and the patient in short order. Deplete the system unduly and we have fatal exhaustion follow. Coal tar products, Digitalis, ice packs and Morphine have no place in the homoeopathic treatment of pneumonia.
Better, a thousand times better, give nothing, rather than those above mentioned. Unilateral, uncomplicated pneumonia, should and, as a rule, will run its course and limit its own action; in short, be cured without treatment if the sufferer be afforded reasonably good nursing; but experience and practice teach us that this disease may be cut short or modified by appropriate remedies at any stage and that medicine, properly directed, aborts many cases.
Materia medica teaches us that certain remedies and certain classes of remedies have an affinity for, or elective action upon, certain organs or tissues of the body; for example, Belladonna upon the eye, or Ipecac upon the stomach, and clinical demonstrations have convinced us that medicine applied to a body afflicted with certain clearly defined pathologic states, induces or accelerates a cure, hence in pneumonia we turn to a group of remedies whose action is upon mucous and serous tissue, quick, intense and of short duration; this corresponds to the “first stage.” Hence we look to such medicines as Aconite, Verat. vir., Ferrum phos., Bryonia, Gelsemium and so on. Not that the prescriber should be confined to these, but that the moment he recognizes a certain set of symptoms it calls to his mind a certain group of remedies whose known and proven action, confirmed by clinical experience, stamps them as polychrests for this condition.
But you say, “Do not the Allopath and Eclectic even so?” My answer is, “Yes,” in many instances, and by way of comment add that unto such as do, comes success far above their fellows. Those who eschew coal tar products, Morphine and heart irritants in the early stages of the disease, have learned an important lesson, be they known by whatever name.
But our case is progressing; the red mass is beginning to turn gray, the respiratory apparatus is still crippled, the circulation is burdened and the fearful toxaemia that is inevitable, poisons the system; blood, nerves, kidneys and liver are burdened as never before; the crisis is upon us. What shall we do? What can we do to avert disaster and speedy death? Once again, “Let us meet the indications.”
If our work in the beginning was well done the crisis will not be severe, the system will have, in a large measure, prepared antitoxin and our case will recover.
If this has not been accomplished we can, for the conditions described, seek aid from such remedies as Kali mur., Ammonia mur., Mercurius vivus, Arsenicum album, Kali phos., Strychnine, Kali iodide, Sulph., Hepar, etc.
We must sustain and help the system until the struggle passes, coach the heart, prod it if need be, encourage elimination, increase the opsonins. In short, we must make the organism avail itself of every resource possible, not by the use of remedies that act as a lash, but by the agency of such as soothe, strengthen and control.
It is at this time the patient must be kept quiet, the anxious friends kept in another room and strangers positively excluded. It is at this time the nurse, quiet, prudent, alert and watchful (and we have many such), observes the drop in the temperature and acts accordingly, applying heat, stimulation or drugs as the physician directs; it is she who watches the unsteady pulse and guards against extreme exertion, gives nourishment in small and repeated doses, and, in short, relieves the sufferer of even thinking of himself or his comfort. During this period a little stimulation has saved many lives, while a change unto, and prompt application of a new remedy has often turned the tide and the patient survives. This period is short, often but a few hours, yet, it is a critical time, it requires tact and prudence.
What now of the so-called third stage or convalescence? It is, if wrongly managed, the starting point for asthma, chronic bronchitis, incomplete resolution, abscess of the lung and tuberculosis.
While a patient may appear well at the end of fourteen days, as a rule, he needs attention for a longer period; rest, quiet, regular diet and gentle exercise do much in this stage, but the main thing is to give Nature a chance, to keep away that which will be harmful, to allow the organism to rid itself of waste products; nor should our vigilance be relaxed until the last sign of fever has gone and the last trace of consolidation and cough disappeared.
Many a case of pneumonia has ended as consumption for no reason save an abridged convalescence.
Aside from medicine, our patient should have good care and a comfortable bed in a warm room; this I say, well knowing the attitude of the profession on the question of fresh air, but pure air does not mean cold air and ample ventilation does not mean a draught.
In hospitals these matters are easily managed but in private houses it may be and is, many times a hard problem. When possible it is better to have some kind of ventilating apparatus, if only a window box, or have the air pass through a second, unoccupied, room to the invalid.
Draughts should be avoided and a constant temperature of 70° F. is the one to maintain, a variation of five degrees either way, is all that should be allowed. The body should be well protected and an abundance of pure water given, taking care not to “waterlog” the stomach. Sponging frequently with 40 per cent. or 50 per cent. Alcohol is beneficial and agreeable. If constipation is annoying or persistent, copious saline enemas should be given, as occasion may require; these not only act in a mechanical way but the absorption of a goodly portion of the saline fluid stimulates the elimination and in no small degree dilutes the heavily laden blood current.
Whiskey, so much lauded by many physicians in the treatment of pneumonia, is an agent of little or no value save for external use, though it may be administered with good effect at the time of the crisis. Moderate drinkers do better if their accustomed amount of whiskey is allowed and hard drinkers furnish the largest number of fatal pneumonias.
There has been much said and written on this question and good, honest practitioners have declared in favor of all sorts of agents, from simple Alcohol sponging to the flax seed, onion or mustard poultice, some even resorting to the fly blister and cupping.
It is, I believe, true that heat and moisture properly combined and applied, exercise a beneficial effect upon the capillary circulation, and there is none of my hearers who will reject the idea that such an application on the chest wall will influence the underlying lung tissue to a greater or less extent, or that any considerable change in the external temperature of the chest has a marked influence on the deeper structures. Theoretically, therefore, their use should be of some value, but again we find objection made because of their odor, the difficulty of their application, their unsanitary composition and the fact that the patient’s clothing and bedding become wet and chilled. In short, their nastiness.
These objections are, however, no longer tenable. To-day we have easily accessible, local applications of marked anti-phlogistic action that are clean and sanitary, are easily applied and withal preserve an even temperature; especially is this true if a hot water bag is used conjunctively; such an application markedly decreases the pain, renders the patient more comfortable and promotes capillary activity – a thing greatly to be desired.
There can be no possible objection to their use and clinical experience has demonstrated their value many times, indeed.
They should, therefore, be used without hesitation.
It may be that this paper has, to some extent, digressed from the title; that in discussing pneumonia, we have taken it in its entirety more than from the standpoint of therapeutics alone; that in some instances we have based our reasoning upon pathological conditions – not symptoms; but if such criticism appears, our answer is that symptoms are but expressions of pathological conditions, and in the selection of a remedy and auxiliary measures we should not lose sight of this fact.
Our sole aim is to cure the patient and to this end we should observe carefully, prescribe according to conditions as presented, nurse faithfully and patiently, and withal use our greatest measure of skill.
Fred’k F. Netherton, Clinton, Mo.: I do not think that as well written a paper as that should go begging for a discussant. One criticism – I do not take it that old school medicine is modern medicine, from the fact that the vast majority of the old school still cling to antiquated methods.
As to the treatment of pneumonia, I quite agree that there are a great many cases in which the patient would be better off without their treatment, and that the crises would pass without any of those sequelae. I have been practicing eighteen years, and last spring I lost my first case. I think that is something that most of my old school neighbors who have been practicing that long cannot say. I think if we only follow the indicated remedy, we would not have to depend upon the coal tar products or ice packs. The patient will oftentimes recover far more rapidly, without the depressing effect of the ice pack, and if he can stand the ice pack at all, he will recover more quickly without it. The ice pack is contrary to all scientific reasoning, as by its use the heat is driven in and radiation prevented. Try half cooking two eggs in the shell, then place one of them in a dish of ice water till cooled, break open and what have we The chilled one is cooked in the centre, the yolk hardened, while the one not subjected to the ice bath is still soft, uncooked. More than this, with the patient with fever, we have a system of capillary circulation, pores for the escape of perspiration, nature’s method for regulating heat; with these all contracted the harm done is very damaging to the vital forces, and the patient has become the victim of the doctor instead of being permitted to recover as he might if he but had a chance.
W. H. Pulford, M. D., Delaware, O.: There are many complications, often in cases of pneumonia, which call for our careful consideration; for instance, the constitutional defects of infancy, the disturbances at puberty, the chronic bronchial catarrh and disturbances of females coming up at the menopause. My policy is to study the patient and symptoms objectively and subjectively, and carefully prescribe the indicated remedy.
Anna D. Varner, M. D., Wilkinsburg, Pa.: Since I did not hear the paper nor the previous discussion, you will pardon me if I repeat what has already been said. The best possible aid to the indicated remedy in pneumonia is plenty of fresh air. I keep the patients comfortably warm, open wide the windows in the coldest months in winter, and have had the most gratifying results even in very young infants.
J. C. Fahnestock, M. D., Piqua, O.: The author of this paper tells us that pneumonia comes next to the great white plague. He has told us a great many good things in his paper.
We will have to go back to Hahnemann’s time. We ought to have learned a long time ago that we are treating sick patients, and not diseases. We are treating sick individuals suffering from pneumonia. We must take into consideration all the conditions of a patient, who was sick before he had pneumonia. I do not believe any of you have seen a child with pneumonia but who was sick before he had pneumonia. I never have in twenty-five years. I agree with you in thinking of your pathology in pneumonia only as a diagnosis. We want to know the diagnosis. The symptoms will tell you of the pathology and everything that you can know of the patient. If you make a microscopical examination of the urine or the blood that is symptomatology. You will get the whole condition of that individual, and the picture of that individual is the picture that we must take into consideration when we prescribe the remedy. If I myself had pneumonia I would dislike very much to have anyone throw open the windows and doors and have me covered up. I could not stand that when I am well.
The doctor in his paper said something about alcoholics, and that he feared those who were diseased with alcohol, as it were. He had a deranged condition before he took pneumonia. He was very careful to say something about that, but he did not say anything about the other chronic diseases.
I believe that if the indicated homoeopathic remedy is properly applied. pneumonia if seen in the beginning, is not a dangerous disease. I have not lost a patient with pneumonia for years, and I have wondered why others lose them. Possibly they were worse than any cases I have had. They die for them and get well for me, but I use the indicated homoeopathic remedy. I never use stimulants, and I do not use applications of ice, but keep them warm. I do not believe you would want to treat croup by opening up the windows when it is 30 degrees below zero.
I congratulate the doctor upon his most excellent paper.
Dr. Richardson: I would like to tell you of two or three things I do in pneumonia. One is that I almost invariably clear out the intestinal tract the very first thing. You can do so much more with your patient if you clear out the intestinal tract. I have a little oxygen which I use in my pneumonia cases from the beginning – five or ten minutes every two hours I think it aborts it much quicker. Another thing that I do with my babies is to have them lie in the sunshine all the time, and keep them warm. I have seen babies get well in a temperature from 75 to 80, and I have seen them get well in a temperature of 60. I do not know which is better to take. In hospital experience we keep the temperature low, but in my private practice they say that it will surely kill a child, and they get along just as well under homoeopathic treatment in one case as the other.
H. H. Baxter, M. D. Cleveland, O.: The statement was made in the paper and afterwards referred to that pneumonia is almost as fatal as the great white plague. I want to take issue upon that point with the author, but would suggest that you eliminate cases of pneumonia occurring in the extremely aged. If you consider only those in the adult period of life you will find that the percentage of mortality, especially under homoeopathic treatment, is extremely small.
Pneumonia is pneumonia, whether it be broncho-pneumonia or whatever form it may take, whether the patient be an infant, or an old person enfeebled by age, though that makes all the difference in the world. I believe if we could eliminate those cases it would show that under good homoeopathic treatment the mortality would be very small, and very much greater in our favor than it is at present.
I want to suggest another thing, and that is, that the treatment of pneumonia, as well as all other diseases, resolves itself into two phases of treatment – the medical and the hygienic. The management of the patient as to hygienic surroundings, includes good air, good food, cleanliness and all other things that go to make up hygienic conditions. The other phase is that of medication. Of course, the homoeopathic profession has had such an extended treatment of pneumonia that we have settled down to a routine treatment, but this is somewhat misleading to some of the younger members of the profession and they think that the most important thing is the hygienic treatment, but I want to assure them that the medication is the most important part.
I want to emphasize the fact that cold air is not necessarily pure air.