A system of practical medicine. By American authors. Vol. 3

by Unknown

Camphor and musk have been highly recommended as cardiac stimulants, but they are inferior to alcohol.

Digitalis of late years has been extensively used to counteract heart-insufficiency, but it is very uncertain in its action in the heart-insufficiency of pneumonia, and has seemed to me more frequently to do harm than good. The nervous element of the heart-failure contraindicates its use.

The second important indication in the treatment of croupous pneumonia is to lower the temperature. The plan of applying cold compresses to the chest in pneumonia, though far from being a new one, still has its strongest advocates in the modern school of therapeutics. It is proposed to apply thick compresses wet in ice-water over the seat of the inflammation, changed every five minutes. Some use the Esmarch ice-bag for the same purpose. Patients who were moribund have, it is said, been revived by immersion in a cold bath. The advocates of this treatment claim that the temperature is lowered; that the patient experiences a feeling of relief during the bath; that the pain, dyspnoea, pulse-rate, restlessness, and severity of the attack are all ameliorated; and that the duration of the disease has been cut short by the continued use of cold baths or cold packs.⁵¹

⁵¹ Rules for the employment of cold as an antipyretic in pneumonia:

Cold Bath.—As soon as the axillary temperature in the evening rises above 103° F., place the patient at full length in a bath with a temperature of 70° F. or 80° F. Gradually lower the temperature of the bath by the addition of cold water or ice until the temperature of the patient begins to fall. It may be necessary to lower the temperature of the bath to 60° F. before the temperature of the patient is affected. After the temperature begins to fall, thermometrical observations must be taken every two or three minutes; the rectal temperature only can be relied upon. If the temperature falls rapidly—that is, two or three degrees in five or six minutes—as soon as the fall reaches 102° F. the patient should be removed from the bath; if it falls slowly, as soon as it reaches 101° F. he should be removed and immediately placed in bed. The patient should never be kept in the bath until the temperature reaches the normal, for it continues to fall for some time after his removal from the bath, and he may pass from a condition of fever into a state of collapse. The duration of the bath should rarely exceed fifteen minutes. While the patient is in the bath cold should be applied to the head by means of a sponge or by an ice-bag.

In the young, the feeble, and the aged the duration of the bath should never exceed five minutes. Once commenced, the baths must be persisted in until the crisis is reached.

Cold Pack.—This is much less effective than the bath, but if the patient is too feeble to be moved it may be employed. The patient should be wrapped in a sheet wrung out of tepid water, and over this a sheet should be applied wrung out of ice-cold water; the latter may be removed as often as it becomes warm. Its application and removal may be continued until the desired fall in temperature shall be obtained.

Cold Compresses.—The method of applying cold compresses in pneumonia is as follows: A cloth of some thickness is to be wrung from ice-cold water and applied every five minutes to the affected side, or an ice-bag is employed instead of the compresses. It is claimed for this method that it not only relieves the local symptoms, but lowers the temperature and hastens the day of crisis.

If cold is to be applied to the chest, either moist or dry, all the disadvantages arising from repeated exposure and frequent changes of temperature can be avoided by the use of the rubber coil, and it should always be employed in preference to wet compresses.

The experience of American practitioners, so far as I have learned, is against this plan of treatment. It is found that under it pneumonia is more liable to extend; that the shock of the cold to the surface causes a nervous depression from which the old and feeble do not rally; that although a reduction of temperature may be effected, heart-insufficiency is more rapidly reached and is more difficult to overcome. Besides, the statistical results of this plan of treatment are decidedly against its use. The above statements do not prohibit cold sponging of the limbs and face if it is grateful to the patient.