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MODERN METHODS OSTREATING PNEUMONIA 18 l
is the reventionis an movementi the par of the patient This. in m opinion, is the mOS Valuabie contributio that an e made by the traine nurse. The patient mustae liste wheneverae evens much a turn in bed. Ianow of four patienis,ho have die&while. or immediatel aster usin a bedpan. The physician hould mahethis clear not ni to the nurse ut also to the patient cor heinsused, of course notu Alar the atteris necessarily. At form ostreaiment hic require exertio on the par of the patient must,
therefore, e modihed. Recent studies by Moy have hown that thedigitaliete hear does no dilate a readit durin pneumonia a theundisitalized controis This ould seem to e ound argument forthe early administrationis digitalis Certaincit is however, that digitalis in some form is urgenti indicate at therars sis of myocardialinsufficiency. The powdered eaves may be used by mouit but a more rapid an certain methodis administratio is disitatin or disifoline hypodermicatly Sudden ear fallure ma require in addition theus of morphine and atropine or even venefection. Cassein Sodio benetoate an camplior in il are stimulant to berased hen necessar after the fuit amount of digitalis has been sive o when additiona stimulation is required. The toxemia may also mahe iselffeltin the periphera circulation in the formis vasomotor paralyses and this is best combated orantherbest re vented by hydrotherapy in the formis col sponsinsevery three o four liours As cautionediefore it is ili advised to moveth patient an so the spongins may be confine to the anterior sursace of theiod and the extremittes Movin the patient into tu is absolutet contra-indicated Epineptiri or pituitri Hre Some times helpsu in raisin the lood-pressure by action o the periphera Vesset an strychnine ma acti stimulatins the medulla
Perhap the commones result of the severe toxemia is abdominat distentio due o paralysis of the intestina musculature Fe HSeSrun the Ourse flobar pneumonia without at some time beins disturbed by tympanitis an it hout be anticipate an treaiment instituted A the earlies moment. Turpentine stupes are osten sufficient torelieVeralisti degrees of distention hol turpentine stupes tot applied for twent minutes and the replaced by hot ater stupes O twentyminutes and then the proces repeated especiali is a recta iube einserted. ore markedi persistent distentio ma require turpentineenemata turpentine lyc to l000 ccis ater o glyceri enemctin
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182 MODERN METHODS OSTREATING PNEUMONIA
contain very litile residue. Pain is ne of the very troublesome symptom in Some cases It is
produce by the pleurisy whicli accompanies the pneumonitis and sine cause for the rapi an Shallo ireathin s osten Seen in theearly Stases of the disesse Morphine is osten require to quiet hispain but it is advisable to seras mali a dos a possibi on account of the paralyzin action hicli morphine exeris o the intestinat wall.
in logenses containins heroin, gr. in. Delirium must be controited antis morphine alone fatis Schlesinperis Solutio ma exert a quietin effect Occasionali iis effect is ust the
ID anosis and dyspne hecome prominent symptom great relies may ometimes e had rom the administrationis oxygen This is best done in a vitable Oxysen chamber but quite satisfactor resulis canae obtained by bulbin the oxysen throus a mater a and into Soft-rubber catheter hicli has been introduced through the nos toa potnt where iis timis ust visibi back of the ost palate This methodis les disturbin to the patient than the lanne and is also more eastly performe by the attendant. Fresti coo at is most comfortins to the patient an Aid in reducitis an restiessness. Exposure hould beavoided.
Doctos orders. Absolute est sive delatis . Fore fluid to 3000 cc.
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MODERN METHODS OSTREATING PNEUMONIA 183
Convalescent human serum Stenuetj.
pneum coccus Serum developed by the Rockefelle Institute orkersis the only one that has received nough of a tria to warrant analytical discuSSion. Ges chichen serum prepared by further immunietin the atready immune chichen to the various types fineumo occus has been used in Chicago in the Cook CountsHospital and also triedit Camp Grant. The statistic relative to the case mortalit are suggestive a reduction om 5. 3 per cent to 20. per cent in the Cook ounty Hospital anda mortalit of . per cent in 322 reate cases a Cam Grant butthe reactions follo insciis us coupled illi otheraeasons testo modifications andes have seen no further statiStics. An attemptu use therapeuticatly the immune serum obtained Domconvalescent neumonia patients by bleedin them oon after their
crisis inas made in Philadelphia by r. Stenge and reported last year. This method is notini attended by urea technical difficulties but is
also ope to many theoretica objections. The chie objection is that Serum rom convalescent patient is neve found to e a rich in specific antibodies ascis the serum producedi animal immunietation,
and treaiment wit this alter formos serum has atready been discardedas useles in ali types excepi Typed. I aliud of course tomerum homanimal immunire t Types II. III and IV pneumococcus. Prophylacti vaccination it kille cultures of Typera. II. III. Pneumo Occu was performed by Austin and Cecilin 12.5 19 soldiersat Cam Upton. Durins a comparatively shori periodis observation
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18 MODERN METHODS OSTREATING PNEUMONIA
cent This method has not et it senera acceptance and it hasno been sive a sufficient test so that, must passcit by with a mere
of the druus hic from time to time have been advocated quinine has recently returnestio prominencem a specific in pneumonia. any Vectr as it was used ver frequently AS an antipyretic and there ore osten in pneumonia. In l9ll, Momenroth and Leo announce thedis over of a quinin sali hicli the calle optochin In the testtube his rus a found to have an almos unbellevabie power tokill the pneumococcus No Ver extensive therapeutic tests were madein his counirnas it was oon learne that occasiona toxic manifes tations ere accompanted by lesion in the optic nerve. In Germany,hΟwever, a basi sal has recently been prepared hichus sal to beharmies an a the fame time ver efficacious in the reaiment ofloba pneumonia This substanc is known a numoquin It is broughtto Your attention no iecause the writer belleves that when sufficient knowledge bout iis se is obtained, shali have a mos valvabie adjuncto our armamentarium Unti that time however, manifdestred, Salal turn to quinine hic is sal by ome writers Gahn-Bronner to surpas opto hin. Painful loca reactions usuali folio the hypodermic injectionis quinine so that: his dilution is necessary. One satisfactor preparation hicli a b obtaine at an drus
Athaline reaiment has been advocated by many clinicians but themost thorous stud of this phase of the condition made by Meansi has demonstrate that not every case suffers rom an acidosis MeanSpoinis ut that the productionis an athalosis nolint ma readilyoccur ut also is quite anserous. O void his it is necessar tomahe frequent observations o the alveolarii and thealood Og. This fac complicates the procedure to suci, an extent a tomahe itinapplicabie or senera routine Se. The formos specific therapnwith whicli the writer has lia most experiene is Typera antipneumo occus serum Durin the war hewas stationed for three monilis at the Rockefelle Institute Hospitaland rom here sent to tam Meade to reat the pneumoni CHSeS.
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MODERN METHODS OSTREATING PNEUMONIA 185
though operate o by mistake or a suspecte empyema eforebein See by ur Service, as apparenti cured of the pneumonia oni to die te day later rom a meninsitis. In the realediroupthere eremo complications other thanuhose mentionestabove There a unfortunatet no contro GrouP. Two ears later hil resident at the Boston Cit Hospital the writer supervised the reaiment of 75 cases of Ypeclineumonia it serum obtaine Dom the Massachusetts Board of Health. The Se compriSed me and women Dali ases and varieties of physicalcondition admitted many of them late in the disease. The mortali rate in his rou os cases as 17. per cent of these cases 56 cases which ere realed durin the irst,ee of the diseas only died sivin a mortalit of 2.5 per cent. During the ext two ears, unde Dr. E. A. Locias direction, eVer Serum reate case a controited by a Simila unirealed case. The controis ere made to compare clinicali a nearly a possibie
Number Number Mortality, cases deallis Per cent.
In a recent addres delivere before New or Academ os Medicine Dr. Locis arefuit analyzed the serum reaiment of pneumonia an brought ut, mons an interestin potnta, the fac that he veras mortalit obtaine in civilia hospital in
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186 MODERN METHODS OF TREATING PNEUMONIA
Boston, New or and Baltimore vias l9.3 per cent. From l Base Hospital in the various arm camps, however, H HVerctge moriniit of 9. 5 per cent was obtain ed. and the Rockefelle Institute Hospital figures how 95 cases treates illi a mortalit of 9.2 percent. ThesestBtiStic Seem to ho that, although serum reaiment of Ype Ιlobar neumonia is os definite value in reducin the case mortality, it is a procedure hicli requires exceptiona facilities and the service of his lily traine specialiStS.Ceci a the Bellevue Hospital and Connor at the New or Hospital, have for the past is years sive a thorough tria tora ne formis reaiment This consist of the administrationis a polyvalentantibod extraci prepared by Hunmon of the Mulford Laboratories hom hors serum hicli has been histit immuniete against the fixe types of pneumococcus Types I, II and III). his prepara tion is a protein-fre suspensionis specific antibodies in sali solution. The resulis hom reaiment it this preparatio obtaine at the Bellevue Hospital are summariete in Table III. Dr. Cecit, ho has very kindi loaned the writer ome of his lanter stides, asks that ita made clea that the intravenous injectiono this substanc late in the diseas is attente by many Severe renctions hich, in a se instances have terminate fatally. For this rectSon Subculaneous injectio os large amounts is no iein triedand the resulta ill soon e announced. Bothir Ceci and Dr. Conno lae encourased to so on it this or on account of the ver definite indicatio of the value of the method. Is circumstancesare favorabie his preparation,il soonae avallabie or seneralise. Table III. - Comparisonis dealh-rate in realed and contro series
30.0Summary. q. e mus neve lose sish of the importance of senera therapeutic measures in the reaiment of lobar neumonia. 2. of the specia measures Yperi antipneumococcus Serum is the
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only one hic has sive Satisfactor resulta in a large enough seriesto arrant ita further Se . 3. Quinin therapy seem ver promisins n ma Subsequently prove tot ostrea value.
American Durna of the Medicat Sciences Philadelphia. 166um. 6, Decemberi 923, p. 877-883ὶ
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188 PNEUMONIA MODERN APHORISMS ROM THE INTERNA CLINIC.wRITTEN FOR THE PRACTISING PHYSICIAN
THE IMPORTANT DISEASES HIC ARE OF AIL OCCURRENCE
INTRAMUSCULAR injections os quinin may have a very taVourable effect on obarsneumonict. To se a patient playins draushis in the ward o the Murth day of his pneumoniacis Striking. I necessar the injectio ma be repeate on the folio ins day. Quinine per os Seem to do nothing. The it appears rapidi in the blood but is out again speedily. Henc a depositi quinine eem to beaeiter. Ont pneumoco calineumonias are accessibi to this treaiment. The patients are as a ule much more speedi alabrile. Even an entire arres of the itines may be observed. The improvement in the genera condition is strikins. The oor patient is aved a great dea of sufferin in this way. Al the birthiainst optochine misit have been SAVed. Fe are refractor to quinine. Quinin is reatly one of the mos powerfui os druss. One eed only thin os malaria, angina, neumonia, uriculctrfibrilitatio an Meniere' diseASe. In addition it is a stomachic, toni and Bntipyretic. Quinine houldae injected early in ioba pneumonict. Furthermore se e complications seem to occur in thi treaiment.
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DISEASES OF THEMEAR AN CIRCULATION a 89 THE DEVELOPMENT DURING THE LASTIS EARS. O OUR VIEwS CONCERNIN DISEASES O THEHEAR AND CIRCULATION
IN his lecture sive at the festivaliathering of the ederiandsche
ns B cardia agent the author said a follows: It is atready possibi now to combine many of the various formsoLarrhythmia into froups, hic may be ascribed omne and the fame cause, ni differing in form an constellation Thus, in his depart-ment, hic, as S much splitiminio mali sections the broad lineos a simple classification againiecomes visibie. The practica aduantases of this are makin themselves manifest. It has no been convincingly shown that irregularities of the rhythmo the hear are reali no the signis a serious diseas of the heart.but are functional derangemenis hic ma even occurri otherwisesound an stron hearis. Thei clinica importance lies in the factthat, o in to thei deviatins mechanism the very unpleasantly
affect the patient destro his laetin os et hein and continuallydisquiet iman fili him illi anxiet as a memento mori ' at thesam time the distur the pumpins actionis the heari and may evenresul in considerable deransement of the circulation Only lowly, with the ripenins o ou knowledse, have e succeede in findinsne means for eliminatins his undestrabie symptom. Digitalis is even no considere as effective, notin a means forstrensilienins the heari but asin damper for amover-stimulated heari: an instea os res physica wor is frequently the est means toexpe extrasystole and even conductive disturbances The nervina disappotntedis the are effective at mos for a moment Here Gninit is the old asenis,hich. illi more correct And sharpe indication,
can e fruitiali applied strychnine an quinine, hic no again annot e sufficienti pratsed The sirs asent formerly used iniq
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190 DISEASES OF THEMEART AND CIRCULATION
Quinin was so much in honour atine timerus a cardia agent that the Viennes clinicis Oppolae rechon it, alons it rest an digitalis. AS ur three mos powerfui therapeuti means in diseases of the heart. Stokois in his text- book potnis to the fac that quinine, o in totis dampin os an excessive digitali action, may, in Bn reSpectS,
be calle an antasonis of digitalis. De always ave diuitatis and quinin tosether. ecause e found that this mixture ad a betteressectin his patient than digitalis alone. myself refuse to sive quinine n the strensili os scientificconsiderations, ecause a a matter o fact, reali an finalty it paralyses the heart. How thoroughlyd was in the wrons was Shownto me by the folio in happening one da a patient came to me, by chance or possibi noti chance a Dutchman who old me that he had a means forsettingetid of the so intractibie perpetuat arrhythmia Dom hic he suffered He furnished proos by appearinibefore meo the followin da with a regula pulse Asci threatene that Ιwould not et him ut os, room alive is helaidio communicate his trich cio me heincknowledsed that in suci cases h too a gramo quinine Gone a m supposed scientific argument, but, hat ane prospecti Soon quinin was found - thoughini exceptionalty satisfactor in casei complete Arrhythmia, tot an unsurpassed agent for the cur os ali hos irregularities hic are due, o toweaknes of the heari but to excessive or of the heari, hyperkinesis of the eari in extrasystole, by injectio into the lood in attack of precipitation in exophthalmic solire and in the so obstinate tachycardia in Ouns persons M. Frey showed that quinidine acts more o erfuit especiali in arrhythmia perpetua than quinin and there remo tu se irregularities hich, cannot overcome bythes means. ut at the Same time e know that where there is true eaknes of the heari, these paralysin agent musti used illi theuimoSt care, as ther is the do more harm than good So here again e re ac to ha ha been stio ni clinica experienceformertrax holesome and curative, butima hisher plane milli beller