Now I have little doubt, and the cases I have recorded prove, that if this robust man had been well supported from the first he would have recovered much sooner, and that the quinine was altogether unnecessary.
Case II.—A healthy man, æt. 22, admitted on the seventh day with double pneumonia at the bases, but to what extent is not stated: had marked dyspnœa, and other apparently urgent symptoms. He was bled by venesection to six ounces, and an acetate of ammonia mixture ordered, containing 1
12 gr. of antim. tart. for a dose, to be taken every three hours. On the following day there was great relief, and the disease was “knocked down,” although it is stated that dulness over the bases continued. He was dismissed cured “a few days” afterwards.
We have here the dyspnœa so commonly present in cases of double pneumonia on the sixth or seventh day, which readily disappears by itself, and is relieved by a warm poultice. It is supposed, however, that a small bleeding of six ounces “knocked down,” or, as some call it, jugulated or strangled the pneumonia. What really happened, however, was that the dyspnœa and apparently urgent symptoms disappeared on the eighth day, which is the usual occurrence. It is distinctly stated that the lungs remained consolidated, so that no impression was made on the disease. What is meant by being dismissed “in a few days” it is of course impossible to tell.
Case III.—A girl æt. 15, admitted on the eighth day, with double pneumonia—the left side more affected than the right, but the extent on neither side stated. She was ordered mist. ammon. acet. with small quantities (?) of morphia. Two days afterwards articular rheumatism appeared. On the following day six leeches were applied to the left side with marked benefit, and a small quantity (?) of antimony was added to the mixture. Dismissed cured on the thirty-second day.
Here was a case of double pneumonia and acute rheumatism running their natural course in a weak subject. Is it to be supposed that six leeches to one side modified the one, or that the “small quantities” of morphia and other treatment influenced the other? Would not the course of both have been shortened by a restorative treatment?
Case IV.—A labourer, æt. 23, admitted on the eighth day, with pneumonia below the fourth rib, anteriorly on the right side. “Six leeches with saline mixture, containing 1
12 gr. of antim. tart., followed by a blister, appeared (!) to give temporary relief.” On the twelfth day typhoid fever declared itself, with bronchitis. Brandy, stimulants, and poultices were then ordered. Dismissed cured on the thirty-fifth day.
Dr. Sieveking says of this case that probably the patient might have done equally well without the leeches and tartar emetic. Of this there can be no doubt. The progress of broncho-pneumonia is always more tedious than that of simple pneumonia, and the recovery was further delayed by the complication of typhoid fever. Can the treatment be defended?
How is it shown in these four cases that the pneumonia in all of them was not precisely the same, that it varied in type, or required a different treatment? That it may be complicated with various diseases, and be associated with strength or weakness of the individual attacked, is no proof of any specific change in the disease itself. In this respect it is in no way different at present from what it has ever been. Then, as to treatment, can it be seriously maintained that the low diet in the first case, that the loss of six ounces of blood in the second, or the six leeches and other treatment in the two others, benefited the pneumonia and hastened its resolution? Of this there is no proof whatever. Unquestionably they tended to an opposite result, as would at once be made apparent if Dr. Sieveking, instead of lecturing on four cases, would tabulate one hundred cases so treated, and let us count what follows. I submit, therefore, that the principles laid down by Dr. Sieveking are in no way supported by his own facts; and, as they are directly opposed to the conclusions derived from more extensive data, they offer no evidence in favour of that mixed treatment which seems so reasonable, and is so popular with many members of the profession.[[5]]
The question of blood-letting as a point of scientific practice has again been raised by Dr. Richardson,[[6]] who, appealing to that love of authority so powerful among medical men, asks—“Is it possible that twenty centuries were grossly abused by the infliction of what in the present state of feeling, was, on occasions, akin to crime? I believe not.” He then proceeds to discuss ten propositions—or, as he calls them, discoveries made by the ancients; and asks with regard to each of them how far the application of them is sound and judicious practice. His conclusion is, that blood-letting is still useful in some stages of typhus fever; in cases where there is sudden tension of blood, of which sunstroke is an example; in cases of chronic congestion of brain; in cases of acute pain from serous membrane; in some classes of spasmodic pain; in cases of sudden arrest of circulation from concussion; in cases of congestion of the right heart; and, it may be, in extreme cases of hæmorrhage. Above all, he says, “I claim for it a first place in the treatment of simple uræmic coma.”
It is impossible to discuss at length, in this paper, all the important practical points referred to by Dr. Richardson. But I shall refer to two great principles in modern as distinguished from ancient medicine, which I think must vitiate the most of his conclusions.