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Un laniar anoteli Di recli, Propagano ei Ministerul Sanalalii Publice
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QUININE REATMENT IN LOBAR PNEUMONIA 173 SUBCUTANEOUS INTRAMUSCULAR QUIN INETREATMENT IN LOBAR PNEUMONIA LYDER NICOLAYSEN CHRISTIANIA
Ero the VIII Medicat ward of the Ullevaal Hospitat.
THE reaiment of pneumonia by quinin is of old standins it
was Brs recommende in the eventies of last century amons
interva and the object was to ac o the laver Quinin therapycnme to occup a Some hat different position after Rufrech had introduce iis subculaneous use, as it seems that the effect differs materiali accordininto hether the quinine is administered subcutan-
Austechi maintains that quinine has a specific effectin pneumonia an his te is that by consistentis of quinineae has lowere the
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l7 QUIN INSTREATMENT IN LOBAR PNEUMONIA
more persistent concentrationis quinin in the blood is secured than by absorption rom the intestine Aster Severat injections cumulation occurs in the lood Furthermore the quinine accumulates in theorsans and cante demonstrated therein longer than in the blood. The pneumonic infiitrated tuns qdaysafter an injection, stili containsquinin in a concentration hic is hisher than is ever ound in theblood. neumonia sufferer eliminate quinine for a long time throughthe sputum. Boecher examined the constants of quinin in the luns and expectorate in consumptives and Mund a Strihingly large content of quinine in the luns and sputum Test on suinea pis also Seem to Sho that the quinin is concentraled in the lunss. In a lensthy furvey in l922. Cahn-Bronne collected ali observations and relevant literature M.John recommend quinin treaimentaster havin tried i formix years on l97 cases his mortali cis never-thelem stili hish, amely more than i per cent. a compared with 28. in cases treated oulside the Hospital As the Hospital moreoverreceived the severest cases the difference possibinis greater than the figures appea to hoW. The mortalit Dom neumonia both in and ut of the Hospitalvaries considerably It is throughout greater in omen than in men, and ascis ellanown increaSe with age.
Accordin to the investigations o Thiis'. during the decade 1895to 190q. the mortalit in the roh0stollen and Ullevaal Hospital as28 per cent of 260 cases durin 10 years is childre unde linyearso age are included he obtaine a mortalit os 2 per cent. in menl8.3 per cent. and women 27. 5 per cent. as,omen formed four fifthsos his materiai thei percentas of mortalitri ill determine the resulisas a hole. The mortalit in hiis materiat was unde 30 yearsabout 10 per cent. 304,q0 years, 23.5 per cent. OVer 60jectrS, morethan 50 per cent. In the ear 1916-l9l in the three medicat ward of the Ullevaal Hospital l 86 pneumonia cases were trealed wit 25 per cent morinlity of theseri 26 were men it 2 per centi, and 60 were omen withra per cent mortality Iudsinifrom his it ould appea that the pneumonia mortalit in the Hospita in Christiani has remainediatri uniform durin therias decade. Since ut 19l have reate allisneumonia cases in the VIIIward wit quinine. In orde to form an de of the effect of this reat-ment, I for purposes of controi tried to compare the resulta fineumonia treaiment,ithout quinin in the VII and Ι wards wit thequinine reaiment in the VIII. O in to the kindnes of the chies
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QUININETREATMENT IN LOBAR PNEUMONIA 175
physicians Schee 6 Figenscha u. was permitte to so throus hthe ista of their ards Admission into the three medica ward os Ullevaal is uranted by the Medicat Committee. hicli distributes thepatient accordin asted are vallabie. The neumonia cases maythere oreae assume tot throushout of the famelind in the different ward at a sive time. I furthermore the distribution o ages an sexe is the fame in the three wards the conditions for judsinu the resulti quinine reaiment,ouldae provided, namely uniformmateriai and a sussicien is contro cases. The diagnosis an of courseae made illi tesSe or renter certainty. Generali ho ever, it ma be assume that the diasnosis oflobar neumonia is made withireat certaint an presumabi equalcertain ty in the dfferent wards Aloini,hich may be of some importanc further, is hether an equali stiar distinctio is madebet een obar an catarrhalineumonia, soras to exclude the alter form. For his an some ther reason it,ould o the whole, bedifficultu secure absolutet homogeneou materint.
The ear 19l and 9l wer no made se of in view of the influenetalineumonia then prevalent whicli judsins iso the literature is no influencedi quinine and the differentia diagnosis of whichfrom iobar may occasio difficulty The pneumonia cases here trealed
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As ill e een the individua froups in his table are very malland a coupte more deallis in both instances Would make a rapid change in the ratio. From the statistica potnt of vie 'hereiare it is hardlyreliable an oni compile it in orde to how the distributionbetween exes and ages It is only the principat figures hicli cante used and which sho that durins the period in the VI and IKwardsthere ere realed 37 pneumonia patienis it 17. per cent mortalio an in the VIII 95 pneumonia patient Wit 9. per cent. mortality. Is eury to distribute the materia it ma perhapsi permissible. An in an case notininteresting. to layiown a dividius line at theasse of 50 is his is done the folio in vie resulis:
I there is an benefit obtainable rom quinin tremiment it appenrs likel to mali itfel manifes in pneumonia patient under 50 yearso age. As stated these statistic have been prepared accordininto the lista in orde to create the mos uniform possibi conditions the Start
sun the quinine reaiment an consequently I have realed with quinine a number Dother cases besides hos indicate above. Is deduci the death within therars twenty-Mur hour an also Ome instances in hic the risis followe almos immediatel aster the injectionis quinine and a Couple os cases whicli received no quinine.
pneumonia patient With 9 death 6. per cent Thi should there- fore sive a Some ha adequale expressionis the mortalit in neu-
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QUIN INSTREATMENT IN LOBAR PNEUMONIA 177
monia unde quinine reaiment hen the materia is sisted. Phere like ise, a dividin line is ut at 50 w obtain: 0-50 ears. 99 pneumonia patients with deallis per centi 50-80 3 cases with 5 deallis Q per cent. It mistit eis interest to examine the individua cases in hiclideati supervened, andra there re describe them it the ulmost
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l78 QUIN INE REATMENT IN LOBAR PNEUMONIA
the remainde howeve could possibi have been avexi a specific
empyema appeared Thessive ove fift years of age were throughout Severe HSes fineumonia hicli in cases 5 an 6 and possibi 8. came under reaiment ather late. But case cilio S a medium un- complicate pneumonia hich was reate on therandiay. In his Case a specificor edicine hould have manifeste iis action. In any event it is no possibie from the individua cases of death. to mahean deductions hic ma servem a basi fors e Statisti S. In contrast to Cahn-Bronne Lwas unable to observe any reliable influenceo the ever curve or it duration Theclast mentioned writer belleved himself able o prove statisticali that the crisis, Wit quinine reat-ment, Occur earlier than other ise. In orde to Setti Such a questionho ever both his figures and mine are too fe . o eliminate possibie elements of chanc much bisse figures out be needed. O theother han a patient' senera condition appear in e appreciablyimpro Uedandit wasour impression that the clinical picture is throughout more satisfacto durins quinin treaiment Omihi potnt themajorityos riter appea tot Asreed. There,as sed Austechfs formula:
In his form quinine an e sive in a relativel concentraled
solution hicli canine boiled Should a litile quinineae precipitaledout it illis readit dissolved by heatin the liquid The injectionis made intramusculari in the nates o the thisti. Onlyci a se uare cases a there an infit tration o any duration or Stistit necrosis Forthe est e a no injurious effeci. The patienis ere siVen ne injectio Straistit a on admission o the folio ins da and after-ward ever Second day but as a ule no more than injections. Tosether it this reaiment the received amplior per OS Or
I the quinin acts then it stand to reaso that the result williebelle the Soone the diseas comes unde treaiment but it should beemphasieted that it appears to have a beneficia effect in an Stase of the liness. It is no easy on the basis of the materiali hand to judsethe benefitis quinine reaiment, just as,in the whole, it S Xceed-inui difficulto determine the effect os a sive agent in a diseASehavin s relatiVely good a prognosis as obar neumonia Evenlarge figures might leave doub here But takin into consideration
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the faci that we have nothin much belle to ς by Phave found theresult so encourasin that I feel myself Strongly impellesto continue this reaiment unti someletter ne come Uyon the cene. BIBLIOGRAPHY
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180 MODERN METHODS OSTREATING PNEUMONIA MODERN METHODS OF TREATIN LOBARPNEUMONIA
REA A THE ANNUA MEETINGOP THE MEDICA AND CHIRURGICA FACULT O MARYLAND. APRI 26. 1923
T confine one' entire attention to the ne e method ostreat initoba pneumonia ould heu neglect the stili mos important aspects of the therapy of the disease. It is ni necessaryto loo hac ove the almos counties lis o discarde therapeutic mensure t convince urseives of the wisdom of the remar madeb Derpensen, Nature cures, and the ni dut of the physicia isto maintain liferanti this cur is effected . O late ear the increas in no lege of the etiological asenis responsibi for obarsneumonia has led to an increased activit Amons therapeutista to develo specific form os reaiment. Specific sera, vaccine and chemicat ali ave thei advocates an it is to thesemeasures that we hali retur after atrie considerationis the most important senera methods. Genera regimen in the care of pneumonia The toxemia os obar
it os bullding up theiodntissues is not an important one we musido nothin to intersere illi elimination by toppin up the bo eis :other is we ma laedlas, like On the other hanesit is essentialto increas every formo elimination possibi an to this en fluid force to xt 4000 cc datly allows the kidneys. bowel and shin tofunction est in his respect Should vomitin or delirium interfere wit the fluid intake subculaneous injections os sal solutioni Mur- phylaxips may be resorte to. The severit of the toxemia is frequently revealed by a fallingmyocardium. e must par no effore t relieve the hear musciesrom the very onset of the disease of reat importance in this respect