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Symptoms.-In the large majority of cases pneumonia begins with a pronounced chill; this attack is usually abrupt, without any premonitory symptoms, and often occurs during the night. At the same time, there occurs a sharp pain, which is usually referred to a point near the nipple of the affected side; this is one of the early signs distinguishing pneumonia from pleurisy. This pain may be very severe, causing the patient to " catch his breath" at every attempt to inspire; on the other hand, cases occur in which the pain is comparatively trifling.
Immediately following the chill, there occurs a fever, usually of great intensity, all the usual symptoms-thirst, intense heat of the skin, constipation, pain in the head and in the limbs - indi cating severe constitutional disturbance, are noted. The face is flushed, though not usually uniformly so, for there is apt to be an intense circumscribed redness of one or both cheeks, while the sur rounding skin may be of rather dusky appearance.
An early feature of the disease is a cough, which occasions the patient much pain and annoyance, since every act of coughing is accompanied by great pain. The matter expectorated is at first scanty and transparent, but later becomes more profuse and acquires a reddish brown tint, like that of iron rust. This tint is due to the admixture of a small amount of blood from the lungs. At times this amount may be much increased, so as to give the expectorated matter bright red color. Cases occur, however, in which there is no expectoration until late in the disease. The breathing is usually hurried and labored, and the patient frequently complains of extreme pain in every breath.
Such are the symptoms when the inflammation is limited to a portion of one lung, as is usually the case. If a greater amount of the lung tissue be involved, the symptoms are correspondingly more severe. At times the entire lung on one side becomes inflamed, or what is more frequently the case, a portion of each lung is subject to the disease. In this case, the embarrassment of breathing becomes greater, the blueness of the skin is more marked, the fever is higher, and the patient's prostration is much greater. Then again, it may happen that but a part of the lung is involved at first in the inflammation, and that during the patient's conva lescence the disease spreads to the rest of the same lung. This complication is indicated by the occurrence of another chill, or by a sudden and rapid increase in the intensity of the fever.
After the symptoms of the disease have remained at their height for several days, signs of improvement appear; the fever diminishes, the cough and expectoration are decreased ; the breathing becomes easier and less frequent; in short, the patient is evidently conva lescing. For several days the patient remains extremely weak and prostrated ; there is a marked difference in this respect between the profound exhaustion following pneumonia, and the comparatively slight debility after pleurisy. If the disease progress without complication, the patient's restoration to health is usually completed in two or three weeks. There are, however, several unfortunate terminations, which may either protract the disease indefinitely, or may finally exhaust the patient's strength ; one of these termina tions is the so-called abscess of the lung. In this case the lung does not gradually resume its natural condition, but a certain amount of it becomes converted into pus, so that an abscess is produced. Then again, it happens that the patient's convalescence stops at a certain point, he does not recover his health entirely, remains weak, pale and feeble ; begins to have a little fever in the afternoon, perhaps pro fuse perspiration at night ; suffers from an occasional shivering sen sation at night, and is found upon examination to be suffering from "galloping consumption."
Pneumonia occurs frequently as a complication of other dis eases, such as typhoid fever and measles. Yet the majority of cases occur spontaneously. Many times the disease seems to be induced by exposure to cold, and there can be no doubt that such exposure does at least promote the development of this affection. It seems however probable that there is some especial cause behind, without which the exposure to cold is not sufficient to induce this disease. Pneumonia may occur at any period of life, and is more common among males than among females. It occurs over the entire United States, oftener in the Southern and Middle, than in the Northern States ; it is more frequently met with during the winter and spring months than at other times in the year.
The patient's chances for life depend largely upon the amount of lung-tissue involved in the inflammation. If the patient be in fair health, and but a portion of one lung become inflamed, recov ery is the rule, to which there are but very few exceptions. If, however, the extent of diseased lung be much greater, or other complications occur, the disease is followed by a considerable percentage of mortality. The treatment must be regulated by the condition of the patient, since it must ever be borne in mind that the object is to support the patient through the disease. The great danger in this disease occurs from the failure of the heart's action, although we might suppose, from the blueness of the patient's skin, that there is danger of gradual suffocation ; yet the difficulty is to be remedied not by any efforts addressed to the lungs, but by supporting the heart, so as to keep the blood circu lated through the lung. If the patient be in robust health, there is but little danger that his heart will flag, unless, indeed, an exces sive amount of the lung be inflamed. If but a portion of one lung be diseased, it will not be necessary to employ very active measures of treatment, since recovery is practically assured. For these favorable cases it suffices to diminish the pain and to reduce the intensity of the fever. The pain will be best controlled by a large, soft linseed poultice, made to cover the affected side, bound tightly on and covered with oiled silk. This poultice should be changed at least every three hours. Opium, in some form (best, perhaps, as ten grains of Dover's powder), will also diminish the pain and the tendency to a distressing cough. The temperature of the body may be reduced by frequent sponging with lukewarm water, or by the hot bath, or the wet pack. These measures are, however, rarely necessary, except in the complicated cases. Free evacuations of the bowels should be secured, for which, perhaps, the best means are twenty grains of the cream of tartar or the citrate of magnesia.
If, however, the previous health of the patient have been unsatisfactory; if he have been weak and debilitated, and from the onset of the disease shows plainly its depressing effects, an entirely different line of treatment is required. These are the cases in which the power of the heart must be stimulated to prevent a fatal result. For this purpose whisky or brandy must be freely used, preferably in the shape of milk punch. Quinine, too, is required in these cases - two grains every four hours in a tablespoonful of brandy. It is rarely beneficial to give any medicines for the relief of the cough, since with opium we diminish the tendency to cough and accomplish the desired object. The greatest attention should be paid to the diet, since food is of course an absolute necessity in sustaining the patient's strength - milk, broths, eggs, all liberally supplied with alcoholic stimulants.
The supporting measures arc usually called for also in the cases marked by delirium, since this syn otom is usually an indication of debility. After convalescence from an attack of pneumonia, the lung will be for some time unusually susceptible to changes of tern perature. It is, therefore, important to take especial pains not to " take cold." Flannel should be worn next to the skin for a con siderable time after convalescence.
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