During this early stage of cases attended with marked gastro-intestinal irritation it may be desirable to use remedies to allay high fever, for which purpose fractional doses of tincture of aconite by the mouth and quinia by enema or suppository are efficient, while avoiding all risk of injuring the stomach. The diet at first should be carefully restricted: it is not at this time that prostration is to be feared, while by a thorough allaying of gastric irritation and by the establishment of fair digestion an ally of immense value for the later and more dangerous stages is secured. But at all periods of this disease the occurrence of vomiting or of diarrhoea should be the signal for instant revision of the diet and for the omission of any remedy, no matter how strongly indicated on other grounds, which could be regarded as the cause of the disturbance.
Milk, skimmed or whole; gruel, light broths, or beef-tea; junket, arrowroot, or similar light yet nourishing articles, are most suitable. Stimulants are frequently indicated on account of the tendency to failure of the respiration and heart, and owing to the typhoid nervous symptoms. They are required at all ages, especially by young children and by the aged. Children in particular bear relatively large amounts, and respond to their use well and promptly. The form and strength of the stimulant must be adapted to the state of the stomach. Wine-whey and weak milk-punch are often serviceable. Many children will take brandy or whiskey in water, but will refuse the former preparations. Dry champagne has proved highly valuable in many serious cases, especially in older persons, for young children will rarely take it.
Other important indications are to favor expectoration and to stimulate the respiratory forces. These are closely associated, and are of prime importance, since in catarrhal pneumonia the principal danger to life undoubtedly comes from the progressive diminution of the pulmonary area open to respiration, and from the increasing failure of the respiratory muscles to overcome the obstruction to full inflation. It is through this agency that pulmonary collapse extends, that heart failure subsequently occurs, and that carbonic acid poisoning, with its attendant nervous symptoms, is finally developed.
The preparations of ammonia seem to be the most valuable remedies to meet these indications. In adults, where the disease is attended with high fever, the following may be ordered:
| Rx. | Ammonii chloridi, | gr. lxxx; |
| Syr. scillæ vel syr. senegæ, | fluidrachm iij; | |
| Liq. ammoniæ acetatis, q. s. ad | fluidounce iv. |
Ft. sol. S. A dessertspoonful in water every three hours. To this may be added one or two drops of tincture of aconite in each dose, watching carefully for the appearance of its effects; or small doses of morphia or of deodorized tincture of opium may be added, according to the severity of cough or of nervous restlessness. But to children in nearly all cases, and frequently to adults, it is best to give carbonate of ammonia at once, as follows:
| Rx. | Ammoniæ carbonatis, | gr. xlviij; |
| Pulv. acaciæ et sacchari, | aa q. s. | |
| Sp. lavandulæ comp. | fluidrachm ij; | |
| Aquæ, q. s. ad | fluidounce iv. |
Ft. mist. S. One teaspoonful in water every two or three hours for a child five years old.
It may occasionally be necessary, owing to the abundance and the viscidity of the bronchial secretions, to administer an emetic, but this should be avoided if possible. If required, choice should be made of one which will act promptly and decisively without subsequent nausea or relaxation. Such is a combination of alum and ipecacuanha, or of sulphate of zinc and ipecacuanha, which have proved very satisfactory in my hands. Jürgensen recommends apomorphine, administered hypodermically, as the agent which he has found most efficient. The dose of this substance is about gr. 1/12 for an adult, whilst for a child of five years it should not be more than gr. 1/30 or gr. 1/25. The dose may be repeated in 15 or 30 minutes if no emetic action is secured.
I attach great importance to the use of strychnia in catarrhal pneumonia after symptoms of respiratory failure appear. Its value as a stimulus to the muscles of respiration, and possibly directly to the respiratory nervous centre, is established. It may be given alternating with the ammonia mixture, thus: