| Rx. | Quiniæ sulph. | gr. xxiv; |
| Strychniæ, | gr. ¼; | |
| Acid. muriatici diluti, | gtt. xvj; | |
| Glycerinæ, | fluidrachm iij; | |
| Liq. pepsinæ, q. s. ad | fluidounce iv. |
Ft. sol. S. Teaspoonful in water every three or four hours, for a child of five years of age.
But when urgent symptoms arise it may be given in much larger doses and hypodermically, so as to ensure its full absorption and effect. I have thus given in many severe cases, and at times with unquestionably good results, as much to an adult as gr. 1/24 every four hours, day and night, for seventy-two or ninety-six hours.
The fever in catarrhal pneumonia does not demand special treatment nearly so often as in the croupous form. Though the evening maxima may be quite high, yet the occurrence of the morning remissions brings some relief and obviates the necessity for vigorous antipyretic treatment. The nervous system and the heart do not therefore suffer severely and constantly from this cause in this disease. Still, there are not a few cases when hyperpyrexia occurs and demands prompt treatment. If the nervous symptoms are not threatening, and if the respirations are still fairly well performed, it will be proper to try the effect of a few full doses of quinia, or, if that fails, of antipyrine. But if, despite these remedies, or in the event of the stomach rejecting them, or, finally, if more urgent symptoms of nervous and respiratory failure are impending, recourse should be had to cold effusion, particularly if the highly laudatory statements of Bartels, Ziemssen, and Jürgensen be confirmed by further observation. I have not found it necessary, or may have failed to appreciate the necessity, to resort to the external use of cold in catarrhal pneumonia; but the remarks of Jürgensen as to the remarkable influence of cold water dashed upon the surface of the chest or directed against the cervical spine in stimulating deep respirations accord with general observation, and suggest this mode of treatment, especially in cases of sustained high temperature with rapid, shallow, imperfect respirations and defective aëration of the blood.
The nervous symptoms frequently are so severe as to require the administration of sedatives. Remedies of this class must, however, be used cautiously and sparingly. It were unwise to give those which depress the heart and respiration, or, on the other hand, to administer opium in such doses as would blunt perception and lessen cough to an injurious degree. By the use of small doses of opium from the beginning of the attack, however, combined with strict attention to the other details of treatment, it is often possible to prevent the development of severe nervous symptoms which would require powerful sedatives. In cases of extreme restlessness and sleeplessness benefit may be found from the use of such a suppository as the following:
| Rx. | Pulv. assafoetidæ, | drachm j; |
| Quiniæ sulph. | gr. xxx; | |
| Ol. theobromæ, | q. s. |
To be made into twelve suppositories of small size, suitable for a child of five years of age, one of which may be used and repeated in three or four hours.
Enemas of chloral hydrate, from five grains for a child of five years to twenty grains for an adult, may be used without fear of depressing the heart or checking the secretions, and with great relief to the nervous symptoms, especially if tending toward convulsions. In cases of extremely active and restless delirium, where prompt sedative action is demanded, and yet where the use of opiates is forbidden, the hypodermic use of hyoscyamia in doses of gr. 1/80 to 1/100 for an adult may give gratifying results.
In cases which pass into a subacute form a continuance is demanded of every precaution as to the diet, the hygiene of the sick-room, and the use of general tonic remedies. Advantage may then be found from the use of oil of turpentine, which has seemed to me the most valuable alterative and stimulating expectorant under such circumstances.
As the case progresses into the chronic form it becomes necessary to gradually substitute for the more strict and special method of treatment previously employed one in which the maintenance of the general health shall be the prime object. The regulation of the diet, care in dress, the cautious resumption of gentle exercise, and the use of carefully-regulated pulmonary gymnastics so as to favor the full inflation of the lungs and the invigoration of the respiratory muscles, are to be closely attended to.