Chapter 7 - Diseases of the Chest
Consumption
Consumption - First Stage
Consumption - Second Stage
Consumption - Third Stage
Causes of Consumption
Bacterial Invasion
Classes of Bacteria
Exciting Causes of Consumption
Treatment of Consumption
Diet in Consurnption
Acute Bronchitis
Chronic Bronchitis
Emphysema
Swelling of the Lungs
Pulmonary Apoplexy
Air in the Chest
Water in the Chest
Pleurisy
Lungs and Their Diseases - Diagram
Charts of Various Lung Diseases - Diagram
Pneumonia
Typhoid Pneumonia
Broncho Pneumonia
Other Forms of Lung Inflammation
Asthma
Hay Fever
Thyroid Gland

7.21 Pneumonia

Lung Fever. Pneumonia.

This disease, by common usage, has been called a fever; but by physicians it is reckoned as one of the inflammations. It is inflammation of the lungs or lights; and whatever fever there may be results entirely from this local inflammation.
For the purpose of more clearly~ describing this complaint, it is found convenient to divide it into three stages, or degrees of progress.

First Stage. This is called the stage of engorgement. The lungs during this stage are engorged or crowded with blood. If we could inspect them, we should find the inflamed portion redder, thicker, and heavier than usual. We should find them weaker, that is, more easily torn than in the natural state; with less air in them, and consequently crackling less upon pressure, yet not entirely destitute of air and crackling, and not so heavy as to sink in water. Rapping upon the chest at this period gives out a flatter, duller, or less hollow sound than usual. On applying the stethoscope, we hear less of the natural rustling sound of health; and, either mingling with, or overcoming it, we hear a minute crackling sound, as the air passes in and out in breathing.
This crackling has been compared to that produced by fine salt thrown upon red hot coals; or by that of rubbing a lock of fine hair between the thumb and finger near the ear. It is caused by small bubbles of air being forced along the moist and sticky sides of the small tubes and air cells. It is heard only while the breath is being drawn in.

Second Stage. If the inflammation advances to the second stage, the swelling of the diseased lung increases so as to force out the air entirely, and it becomes solid, and wholly useless for the purpose of breathing. In solidity and general appearance, it resembles a piece of liver. Hence it is said to be hepatized, or liverized; and this is p called the stage of hepatization.
As the lung grows more solid, its vitality and strength diminish; it is not near as strong as a piece of healthy liver, though it looks like it; it is soft and easily broken; indeed it seems to be in a state of commencing decay or rottenness. Hence some writers, in order to be more precisely correct, call this the stage of red softening.
With increased solidity, there is of course increased dullness on percussion. When the stethoscope is applied to the chest, we hear no sound of air passing into and out of the diseased lung; no natural rustling, or minute crackling; but in their stead, we have a kind of whistling, produced by the air passing back and forth in the windpipe and its branches, but finding no entrance into the solidified air cells. The breathing sometimes sounds Eke a sort of puff, owing to the column of air rebounding when refused admission to the closed up cells.
The general symptoms now increase in severity. There is greater difficulty of breathing; the phlegm is more gluey; perhaps some delirium shows itself; and the patient grows weaker.

Third Stage. At this period, the lung changes from red hepatization or red softening to gray hepatization or gray softening, and matter is now found diffused through its whole substance. The percussion sounds are much the same as in the second stage. On listening, we hear more of the rattling sound produced by disturbed phlegm. The matter raised is thinner, more like liquid; and looks like prune juice. The symptoms generally indicate that the patient is sinking. Patients may recover from the first and second stages, but rarely from the third.

Symptoms. For several days before the disease is pronounced enough to make the patient appear very sick there is a general discomfort of the principal air passages, especially the nose ,and throat, in fact, a great many cases of pneumonia follow a so called cold, which has been present f or two or three weeks. In others, and in this disease perhaps the first symptom to be noticed is a chill, mild or severe, which has no influence upon the severity of the disease that is to follow. Following this chill comes the fever and usually the so called pluritic pain over some portion of either lung, many times it appears to be over the nipple of the side affected, or it may appear m the lower chest or even in the back. Shortness of breath caused by the pain when a deep inhalation is attempted then appears, and though the pain in the chest may diminish, which is frequently the case, fever and shortness of breath continues; the appetite leaves, thirst appears to a greater or less extent, the bowels are usually sluggish, the flush shows on the cheeks and a distressed, hacking cough, suppressed if causing too much pain, and the raising of a scanty, dark reddish phlegm, which, when expectorated into a vessel has a tendency to stick to the sides, and does not flow freely like saliva. The disease rapidly assumes a severe condition, and in favorable cases remains about the same for five to eight days. During these days mentioned, the so called crisis occurs, which is the sudden dropping of the temperature from 102 to 104 at which height it has been, down to the normal, which is 981 degrees. The respiration during these time. is rapid and short. The sickness of the patient progressively increases the pulse which is around 100 to 130. The mind is many times clouded especially in children or those addicted to liquor.

Treatment, It is well to understand that in this most serious disease the best care and maintenance of strength is absolutely required. There are a certain number of cases that will die in spite of the best treatment that can be obtained, another number will get web if not given the wrong treatment or neglected, but a large middle class between these two extremes will need careful treatment to carry them through to recovery. There can be no absolute routine treatment in pneumonia, as the condition of the patient will demand how much stimulation is needed and what degree of lung tissue is affected. In the early stages of pneumonia, some depressant to the increased circulation which will be seen by the rapid beat of the pulse, is needed, a tincture of aconite or of veratum viride in one drop doses repeated every half hour until five or eight doses have been given. Although the temperature will be increased at this time, a hot mustard foot bath will help the aconite in its action and relieve temporarily the congestion of the lung. If violent pain in the chest, due to pleurisy is present, small doses of Dover's powder which may be obtained at drug stores and which consists of ipecac which is a sweat producer, and morphine which is a pain quieter, and the combination of these two, act most happily upon the system in this condition. Thus 5 to 10 grains of Dover's powders repeated it the pain continues, every three or four hours will often give great relief. This remedy must be used only during the first two or three days, as later on they will only tend to further depress the heart ' which may by this time be showing the effect of the disease. It will now be necessary to see that the eliminating organs of the body, such as the bowels, the kidneys and the lungs are kept in a state of active work, an expectorant such as the prescription recommended under bronchitis consisting of chloride of ammonia, citrate of potash and licorice mixture will enable, the patient to raise the phlegm and the citrate of potash will exert a favorable action of the kidneys. It then remains for us to keep the heart in as good condition as possible, care being taken not to over stimulate as the chances are good for all the stimulants we possess to be needed before the patient is through the crisis. This is done by the use of strychnia, the most favorable and digitalis and alcohol in the form of whiskey and brandy in the order named. Strychnia may be given on the second and third days, or if not needed then, when the acceleration of the pulse to above 110 renders it necessary. The dosage may be at first 1 60 Of a grain four times a day, when this dose ceases to hold the pulse at 110 the dose may be increased to 1 40 of a grain every four hours, and even later again increased to 1 30 or even 1 20 of a grain, but of course, these later doses only on the advice of the physician who has taken charge of the case. Whiskey or brandy in tablespoon doses for adult every four to six hours will be of temporary service in tiding the patient over attacks of heart failure. Digitalis in the form of tincture given in doses of 10 drops three, four or five times during twenty four hours may be needed after the third, fourth or fifth, days. The fever will of ten rise to 103 or 104 degrees and remain at this point, but as the disease will turn sometime between the fifth and eighth or ninth days we do not have to use strenuous measures to reduce the fever unless the patient is very nervous or delirious. In this latter case tepid or cool water sponging will often relieve the nervous troubles by reducing the fever and enabling the patient to sleep without artificial aid. A jacket made of sheet wadding and kept about the chest is a good precaution if constant care of a nurse is not given. This will often tend to reduce congestion and surely keeps the chest from exposure to changes in temperature, should the patient throw off the clothes. In emergencies which may occur at any time during the course of the disease and to be watched for especially at the crisis or turn of the disease, the aromatic spirits of ammonia in half teaspoonful doses diluted with water may be given every hour for the stimulating effect. Oxygen is often of value though many times used without effect. It will quiet labored breathing to some extent and supply the blood with a necessary article which the consolidation in the lung is withholding from it. As soon as possible withdraw what unnecessary stimulation is being given and through the convalescence give the expectorant mixture and nourish well with eggs, broth, milk and light but concentrated articles of diet.

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