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Impaired Health Its Cause And Cure by J. H Tilden, M.D.

PNEUMONIA

   Definition.--An infectious disease of the lungs, which usually terminates by a crisis in seven or eight days.

   Etiology.--Children are very liable to have pneumonia. The predisposition of children up to six years of age is to take the disease. Then there is a diminution of attacks in children up to fifteen. From this time on there is an increase. Anything that has a tendency to enervate renders the subject of a scrofulous diathesis liable to take this disease. Without question it is a disease that originates in the intestine. It is really a disease caused by toxins. An enervated state, followed by unusually heavy eating or a change in diet--eating in an unaccustomed way--may be the exciting cause. It is thought to come from a cold. Nearly all diseases start with a cold, for nearly all diseases are caused by toxin absorption from the bowels; and when we become better acquainted with the real cause of disease, we shall know that, at the base and foundation, all diseases are alike--that is, they begin with toxin poisoning. Just why in one person it locates in the lungs, in another in the membranes of the brain and spinal cord, and in another causes infantile paralysis, are questions for the laws of heredity and nutrition to solve--germs will not solve them. An injury may sometimes be given as the cause, but the real cause lies back in nutrition.

   Climate and seasons do not appear to have a controlling influence, for the disease is found in every month in the year. Winter, however, is probably the season showing the largest proportion of pneumonia cases.

   Conditions Favoring Infection.--According to Dr. Osler, the majority of people harbor the germs in the mouth, nose, and throat. This is said of all infectious diseases. But Osler also says that some individuals are less resistant. If we are resistant at one time and not resistant at another, what is the reason? If it is possible to be resistant at one time and not at another, is it not possible to put the health in such a condition that it will be resistant all the time? This, I believe, is true as regards man's relationship to all diseases. There is a serum which is used to immunize, but it is doubtful if it has been more successful than any other immunizing on this order. There are supposed to be forty different varieties of pneumonia. This is a delusion of the profession. If the stomach and bowels have no decomposition in them there will never be any pneumonia developed.

   A really good state of health is the proper immunizer against this disease, the same as against all others.

   Symptoms.--Pneumonia usually starts with symptoms of a cold, which may last two or three days. In other cases there are symptoms of a slight cold, with coughing and soreness in the chest. In the majority of cases the disease begins with a chill. Cough is annoying from the very start. The disease has the appearance of an acute fever, with pains and aching throughout the body. In a certain percentage of cases the pain in the chest is very severe. This is especially true where there is a pleuritic complication. If one lung is affected, the face is usually flushed on that side. Where both lungs are affected, both cheeks will carry a flush. The breathing is short and hurried, often running forty at the doctor's first call.

   The expression of the eyes is that of anxiety, caused by precordial oppression. The expectoration is often tinged with blood during the first twenty-four hours. Then again it will be white and frothy, and the blood tinging does not appear for forty-eight to, sometimes, seventy-two hours. This would indicate that the seat of the trouble is low down in the lungs. Where it is located high, the expectoration becomes diagnostic earlier in the disease. The temperature varies from 102 to 106 F--usually from 101 to 102 in the morning and 104 in the evening. In severe types of the disease it will reach 106, and even 107. The distress from coughing and oppression in breathing is persistent until about the seventh day. This is called the crisis in the case. Then the temperature drops down, and the breathing becomes easier. From this point on the convalescence should run along rapidly. In those whose general condition is bad, and whose nursing and treatment have not been exactly what they should be, there may develop a typhoid condition at this stage. Where this is true, the temperature goes up rather than down, and all symptoms increase, typhoid symptoms develop, and death is liable to occur. This disease is very severe on old people; and it is pretty generally understood that drunkards, or those who have the drinking habit, never get over an attack.

   The crisis comes on the seventh day--this is the average time. In slight cases the crisis often develops on the third day, and there are other cases that are prolonged to the tenth; but in those that reach the crisis on the third day it is just barely possible that there has been a pneumonic state existing in a light form for several days before sufficient attention was given to determine that it was pneumonia.

   Cough.--The cough at first is dry and persistent, causing pain and discomfort. Patients will clamor for relief; but it is a very great mistake to give anything in the line of opiates to relieve. They should be encouraged to wait until the expectoration stage appears, which it will do on about the third or fourth day, provided they have been handled carefully with respect to nursing, etc. After the stage of expectoration is reached, the secretion lubricates and relieves the friction caused by the cough. From this time on the patient should be fairly comfortable. At first the expectoration is mucus. Then it becomes tinged with a little blood. Later on the blood tinge imparts a rusty appearance to the sputum, and it loses its stickiness or tenaciousness, which makes it difficult to raise.

   Where there is liver derangement, the sputum may take on a yellowish appearance from bile. As the fever declines--which it generally does after the expectoration is fully established--the expectoration becomes lighter, until it entirely disappears.

   There is an unusual type of pneumonia, affecting the apices of both lungs. I have never seen a case of this character get well. When the secretion or expectoration stage is reached, the amount of material thrown off is so great and so tenacious that the patient is unable to throw it out of the lungs, and he dies drowned in his own secretions.

   Condition of Digestive Organs.--The tongue is usually furred. Where the contents of the intestinal canal are in a state of decomposition, and the absorption of the toxins is very pronounced, the tongue will be very greatly furred, the breath bad, and some cases will vomit profusely the first few days, The patient has no appetite. The bowels are more commonly constipated than otherwise.

   Skin.--ln this condition herpes frequently occurs on different parts of the body. This in itself is often a source of a great deal of discomfort. The cutaneous derangement affects the lips more than any other part of the body, and more in pneumonia than in any other disease. There is a superstition that where this occurs patients will get well. There is just a possibility that this idea is based more on facts than on fiction; for in cases where herpes manifests it would indicate that the disease is not so profoundly established in the lungs. In other words, where herpes appears on the surface, on the principle that two diseases cannot exist in activity at the same time, the pneumonia must not be so profound a type as to center all the morbid process on the lungs.

   Cerebral Symptoms--Children frequently have convulsions, headache, backache, and become extremely nervous in the evening. There is always more or less precordial oppression, (difficult breathing) but worse as the evening comes on. Delirium is very common in pneumonia where there is great oppression in breathing. There is a tendency on the part of the patient to leave the bed in a semi-delirium; or it would be better described as a halfsleep--just too sleepy to be awake, and yet too distressed in breathing to permit a complete loss of consciousness. Where the drowsiness is profound, the struggle for life is very great; for life depends upon breath, and many times the breathing is so oppressed that it is necessary for the patient to stay awake to breathe.

   Treatment.--All diseases are self-limited; but if one would find types to correspond with text-book descriptions, the diseases must be treated according to the textbooks. It is easy for one to understand that the influence of a dinner may be said to be self-limited. The influence of a cup of coffee is self-limited. The influence of one acute attack of toxin poisoning is self-limited. Pneumonia, or other so-called infectious diseases, represent a state of toxemia, and if nothing is added--if no more toxin be turned loose in the system after the disease is once established--it is self-evident that the poison must be self-limited, and the limitation must always be the same; but if more toxin poisoning is added after treatment is begun, it is obvious that it would be impossible to have any disease originating in this way ending in any kind of regularity, unless it were in death. Pneumonia is a disease that is brought on from toxin poisoning, but the subject must be prepared by weeks and months of improper life--tilling the soil, so to speak, and cultivating it for the propagation of disease. After it is once started, to bring it to as hasty a termination as possible, food must be stopped absolutely. All the water desired should be given. Wash the bowels frequently--at least once every day--with warm water.

   If there is a tendency for cold feet and hands, warm applications should be put to the feet. If the temperature is running high, a hot bath should be given every three hours, if necessary to bring comfort and reduce the temperature. If the patient is fairly comfortable, he may be given a bath every evening. Have the water quite hot--100 or perhaps 102--and allow the patient to remain in the tub long enough to become relaxed and comfortable. A half-hour is not too long, if that length of time is required to bring the desired results. While the patient is in the bath, hot water should be added to keep the bath temperature up to 100 or 102. If there is a great deal of difficult breathing, hot cloths wrung through a wringer should be put on the chest. Fresh air must be procured, but the patient must not be in a draft. The temperature of the room should be from 50 to 60 F. when the temperature runs up, if the patient becomes nervous, and cough is annoying, use the hot bath every three hours, if necessary, to bring full relief. Sheet cotton oiled with olive oil, placed on the chest and held on by a roll bandage, often gives relief. If there is pain in the abdomen at any time, put the towel wrung out of hot water over the point of pain. The patient should not be annoyed through the night. The lights should be put out; the nurse should stay within hearing distance, so as to be ready to meet any needs of the patient; but the patient should not know that she is close by. In other words, the patient should not be encouraged to wish much attendance at night. Patients treated in this way will get along very nicely as soon as the expectorating stage, such as I have described, has been established.

   All pneumonia patients possessing a fair constitution should be convalescing nicely in from seven to eight days. When the temperature and pulse are normal, the feeding may be the same as described under typhoid fever.

   The treatment suggested above presupposes that it is begun at the time the patient is taken ill. If, however, a case is taken charge of after it has been badly managed for a week or ten days, and typhoid symptoms are presenting and the patient is delirious, with engorgement of the lungs and precordial oppression pronounced, the treatment should not vary materially from that which has been suggested above. There should be heat to the feet, and a mustard plaster to the chest. After relief comes the mustard plaster may be removed and antiphlogistine substituted, being renewed about twice in twenty-four hours.

   Such cases have undoubtedly been medicated and fed, or they would not develop such desperate symptoms, The bowels should be cleared out. Two enemas should be given each day, if necessary--at least one each night.

   The first day's bathing, washing-out of bowels, and suspension of all food should make a change in the patient. On the second day, two hot baths will be all the bathing that is necessary. When the temperature has gone to normal, and all the symptoms have subsided, then feed as recommended for convalescing in other fevers.

   Morphine, or any other preparation of opium, is very dangerous in pneumonia, as it causes a filling-up of the lungs and an inability to expectorate, and the patient will frequently die from lack of power to free the lungs. One of the worst symptoms following the use of opiates is the semi-delirium. Patients are made sleepy because of the drug, and on account of difficult breathing they struggle to stay awake. This makes a case look very desperate, when no doubt the symptoms would all be very light if it were not for the peculiar influence of the drug. Pneumonia is a disease that will surrender to kind nursing and complete absence of anything in the drug line. In those cases where there is double pneumonia, and the disease is located in the apices, the mortality is one hundred per cent. The mortality in ordinary pneumonia should be almost nil.

 

DIPHTHERIA

   Definition.--An infectious disease characterized by an exudation thrown out on the mucous membrane of the pharynx, tonsils, larynx, and sometimes in the trachea and bronchial tubes. By believers in bacteriology it is declared that there is a diphtheritic bacillus or germ which is diagnostic, and that without this particular germ the disease is not diphtheria. But this germ is frequently found in the throats of people who have not had the disease!

   Etiology.--This disease has been epidemic, endemic, and sporadic. For the last twenty-five years it has gradually been declining in severity.

   Children who are overfed, who have developed in the intestinal tract a state of decomposition or putrescence, running on for some time, and who have broken down their resistance, will develop a state of toxemia which will cause them to be susceptible to the prevailing influences, atmospheric and otherwise.

   Children who are fed too frequently or fed improperly, and who are troubled with constipation and the passing of undigested food with the bowel movements, are made susceptible not only to diphtheria, but also to scarlet fever, measles, whooping-cough, etc. Indeed, it can be proved that normal, healthy children--children who have bowels that are regular, and who are not troubled with intestinal indigestion--cannot be made to take any of these diseases.

   Symptoms.--The pharyngeal type starts very much as tonsilitis. There are symptoms of cold, and if these conditions develop, the throat becomes sensitive, painful, and swollen. Diphtheria is located on the tonsils and in the pharynx when these locations are inflamed.

   Children usually complain of slight discomfort. If the parents look into the throat, they will see a little redness and swelling, and perhaps two or three white specks about the size of a wheat-grain. If the disease is light, these specks may coalesce, the inflammation will not extend very far down, and the child will complain of difficult swallowing for a few days; but within a week the throat will be well without any special treatment, except to inhibit eating.

   Where the infection is intense, the temperature will run to 102 and 103, the tonsils will become very much enlarged, and the diphtheritic membrane will form over these parts, sometimes extending pretty well up on the soft palate. In such cases swallowing is almost impossible. The disease may even extend into the nostrils. If such patients are fed, brain complications may develop, and the patients die in the course of ten days to two weeks. The glands in the neck become very much swollen, due to infection. The membrane that forms will at first have a grayish-white color, then change into a dirty gray or brown, sometimes a yellowish white; it is firmly adherent, and, if loosened and thrown off, leaves the surface completely denuded and decidedly irritated, but it is soon covered with another exudate.

True Croup or Laryngo-Tracheal Diphtheria

   Where the larynx and trachea are involved, the symptoms at first are those of ordinary croup. Children will begin by coughing with a croupy sound. In the majority of cases they do not appear to be very ill; in fact, they win entertain and amuse themselves with their playthings and playmates, sometimes for two days; and again I have known cases to run on for three days, the cough becoming a little more croupy each afternoon and evening, but this symptom passing off more or less in the fore part of the night and the forenoon. Parents seldom are uneasy, because the croup is not severe; it does not affect the breathing very materially, and the child usually has an appetite, and will eat its regular meals where it is permitted to do so. If examined by the trained ear, there will be evidence of a deposit taking place in the bronchial tubes.

   Years ago, when 1 was doing a general practice, it was my misfortune to meet with a great many of these cases. In those days it was not uncommon for me to be called to prescribe for a child with a slight attack of croup. All that the parents seemed to think would be necessary for me to do was to give the patient a little croup medicine, so insignificant were the symptoms. To strengthen this belief, when I called to make the examination, I would often find the child playing with other children. On looking into the throat, perhaps I would see a little redness of the pharynx. Then, on placing my ear between the shoulder-blades, I would hear a mucous rale, which not only diagnosed the case, but also prognosed it. I never knew a case to get well. Where this disease is located in the pharynx, and passes down only a very short distance into the trachea, sometimes the membrane is thrown off and the child recovers; but this is so rare that I have heard of only a few cases.

   Many people will confuse diphtheritic croup, or diphtheria, with catarrhal croup. This is a very great mistake; for children should invariably recover from catarrhal croup, while in diphtheritic croup, or true croup, where the membrane extends, down to the bronchial tubes, the mortality is one hundred per cent.

   Treatment.--The entire profession is enlisted on the side of antitoxin as the proper remedy. I have no faith in it, do not believe in the theory, hence have not recommended it--nor shall I. The claims that there has been a tremendous reduction in the amount of diphtheria, and especially in the mortality of the disease, because of the use of serum, I am not prepared to accept. Scarlet fever is just as formidable a disease, just as contagious, and just as dangerous to life as diphtheria has ever been. It keeps pace with diphtheria in growing less severe in type and in having fewer epidemics. Indeed, mortality statistics show that there is a larger percentage of fatal cases in diphtheria than in scarlet fever, and the profession does not claim to know anything at all about the specific cause of scarlet fever; so, until the subject is illuminated to my entire satisfaction, I shall use the decline in severity of scarlet fever to prove that there is nothing in the contention of the bacteriologists that diphtheria has been controlled by antitoxin. The severity of all so-called contagions has declined in the last twenty years, and so has murderous treatment.

   The proper treatment is to wash out the bowels two or three times a day, when the child is first taken sick, using as large enemas as can be put into the bowels.

   See that the child has nothing at all to eat. It should not be encouraged to drink, nor to swallow anything. It should be encouraged to wash its mouth and spit out rather than to swallow. Thirst must be controlled by small water enemas.

   The child should be placed on its right side, leaning well forward, with its face rather down, so that the saliva will drain from the mouth on a cloth. These cloths should be burned. The child should not be allowed to lie in such a position that the secretion will run down the throat into the stomach.

   A small towel may be wet in tepid salt water, pressed snugly against the throat, and held there by pinning a dry towel around the neck. The towel may be wet every three or four hours. No sprays or washes of any kind should be used. it is to be hoped that the old-fashioned gargling has passed into oblivion. Gargling, or spraying the throat, only aggravates the disease and encourages swallowing. The disease must be confined to the throat as much as possible, and the child must be allowed to lie in a position where everything will drain well out of the mouth. This is to prevent further infection. When the child is tired of lying on one side, it may be changed to the other side, but kept in the same position--lying on the side, inclining well forward, with either the left or right leg, whichever is uppermost, bent at a right angle with the body, so as to prevent the child from rolling over on its face.

   If the temperature is above 103 F., the child should have a hot bath once or twice a day. After being in the hot water about five minutes, cold water may be added to reduce the temperature of the water from 100 to 60. If the child's temperature is not above 102, simply a warm bath morning and night is enough. When the child is showing great restlessness, it may have an extra bath, and the water may be extra warm to bring on relaxation and relief. The child should have its spine rubbed at least once a day before bedtime. This is to relieve any aching and tire. The rubbing should be very gentle, and should be continued until the child is quieted down and asleep. Children with this disease should be left as much alone as possible. Certainly there are to be no questions asked, and curious people should not be permitted in the room. Of course, where quarantine is thoroughly carried out, no one except the nurse will be permitted to see a sick child.

   No feeding, nor swallowing even of water, is to be indulged in until the disease is thoroughly under control. No drugs are necessary.

   The above are my suggestions for pharyngeal or nasal diphtheria. I have no treatment to offer for laryngeal croup or diphtheritic croup, or what is commonly called true croup, where the membrane extends to the bronchial tubes. This type of the disease is necessarily fatal.

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