4. The weak pulse, want of reaction, non-disappearance of the pneumonic consolidation, or its appearance during the progress of exhaustive diseases, are the unfavourable signs of pneumonia.
5. Continued exercise or work after the attack; low diet, large blood-lettings; depressants, such as tartar emetic and sedatives; expectorants, such as squills and ipecacuanha; mercury and violent purgatives, are opposed to the restorative treatment of the disease, and when not fatal, tend to prolong its duration.
6. Small blood-lettings of from six to eight ounces may be used in extreme cases, more especially of double pneumonia or of broncho-pneumonia, as a palliative to relieve tension of the bloodvessels and congestion of the right heart and lungs.
7. Local pain is best relieved by large warm poultices.
8. The true disease, that is, the exudation which has infiltrated itself through the pulmonary tissues and been coagulated, constituting hepatization, can only be removed, first, by its transformation into pus cells; second, by the molecular degeneration and liquefaction of these; third, by absorption into the blood; and fourth, by excretion of the exuded matter in a chemically altered form through the evacuations.
9. These processes are favoured by supporting the vital powers: first, by rest in bed immediately after the attack; second, by beef-tea and milk during the febrile period, with a moderate amount of wine, if the pulse be feeble; third, by beefsteaks and solid food as soon as they can be taken, with more wine or a little spirits, if the pulse falter; fourth, by mild diuretics on the seventh or eighth day, to favour excretion by the kidneys.
10. The same pathology and principles of treatment apply to all simple cases of pneumonia, whether single or double—the latter being only modified by the weakness of the patient, when more restoratives and stimulants are required.
11. In complicated cases other treatment may be required, according to the circumstances of the case; the pneumonia, however, being always influenced in the manner previously detailed.
12. Since I commenced the treatment of pneumonia by restoratives on the principles just detailed, in 1848, 153 cases of the acute form of the disease have entered my clinical wards in the Royal Infirmary. Of these 129 were simple, and 24 complicated cases. They have been recorded by my clinical clerks, and the progress of each case superintended by my house physician. The whole investigation and the results have been arrived at in public, before successive large clinical classes. Of the 129 simple or uncomplicated cases, of which 35 were double, all recovered, notwithstanding many of them presented the most apparently alarming symptoms. Among the 24 complicated cases were five deaths—1 from ulcerated intestines, 2 from cerebral meningitis, and 2 from uræmia following Bright’s disease. Of the whole series, the deaths were 1 in 30⅗ cases. Among the simple cases, single or double, the mortality was nil.