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.
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
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.
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
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
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
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.
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
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.
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