J.G. Thornley
1878 The Lancet  
SIR,-The use of stimulants in certain cases of pneumonia, as recommended by the late Dr. Anstie, though unsuccessful in the case about to be related, has many points worthy of the most careful consideration. 1. M-, a married woman, aged thirty-eight years, the mother of three children, had some time previously been under my treatment for prolapsus uteri and leucocrheea. She was a tall, delicate, anaemic woman, subject to chronic bronchitis in the winter months, and was therefore a bad subject
more » ... ore a bad subject for pneumonia. On October 1st of last year I was sent for, and found her suffering from cough, rusty sputum, quick pulse, pain in the left side, and the symptoms of pneumonia generally. There was well-marked dulness over the base of the right lung, and comparative dulness, with crepitation and bronchial breathing, over the base of the left. The temperature in the axilla was 101 2° F. The cough was troublesome, and the face flushed ; the pulse 136, and the respiration 38 per minute. Wunderlich lays it down as a rule that a case of pneumonia must be considered severe when the temperature records 104° F., the pulse more than 120, and the respiration more than 40 per minute ; slight if below these numbers. Not wishing to burden this case with details, I may state that at the height of the disease the pulse ranged from 140 to 160 per minute, the respiration was 48 per minute, and the highest temperature recorded was 1038° F. According to Wunderlich's rule, the case was severe as regards the number of the pulse-beats and respirations, but was not severe as far as temperature was concerned. The consolidation of both lower lobes of the lungs increased, the lips and cheeks became of a deep purple from defective aeration of the blood, and the patient died on the ninth day. The treatment adopted from the first was supporting and stimulating ; 8 oz. of whisky in divided doses every three hours was given ; this amount was increased to 20 oz. on the fifth day, and was given in divided doses during the twentyfour hours; Liebig's extract of meat and milk-and-water formed the chief part of the nourishment ; counter-irritation was tried to the chest in the form of turpentine fomentations, and afterwards linseed-meal and mustard poultices. On the sixth day of the disease there was an entire absence of the chlorides in the urine, although a considerable amount of chloride of sodium had been taken in well-salted beeftea. On the seventh day of the disease there was a trace of albumen, and for several days previously there was a large quantity of urates, the specific gravity of the urine being above the normal-1023 to 1026. The treatment of pneumonia has been one of the most discordant topics in the science of medicine. About fifty years ago bloodletting was the practice, but Laennec soon became dissatisfied with this practice, and believed that it was often injurious. At a later date antimony in large doses was introduced by Rasori, but the Rasorian method soon became unsatisfactory, as on one occasion Laennec lost five e patients thus treated out of sixteen, and on another occasion twelve out of thirty cases were lost. Andral states-' I have not seen pneumonia ameliorated by large doses of this medicine (tartar emetic), for neither has it appeared to do good when borne by the stomach, nor when it has excited distressing nausea and vomiting." The late Dr. Anstie mentions one case of a man, aged twenty-four years, who took twenty-four ounces of brandy in the twenty-four hours, and who recovered; and another case of a child, aged fourteen months, who took six ounces of wine in the twenty-four hours, and who also recovered. I During my residence as house-surgeon in a large provincial hospital I saw a considerable number of cases of pneumonia thus treated, and the majority successfully, and I believe . that it is the more rational treatment, especially in the aged, in the inhabitants of large towns, and in those in whom vitality is low or defective. Yours &c. some interest to your numerous readers. On March 21st, 1878, Kallapuanth, a free coolie boy (bon in the colony), aged nine years, was bitten by a dog supposed to be rabid. On admission to hospital the wounds were found to be slight and situated on the scalp. I had thE scalp shaved, and the wounds well sucked. After this strong nitric acid was applied, and the wounds dressed with ordinary carbolic oil. The patient being placed in bed, half an ounce of sulphate of magnesia was given ; extreme quietness to be observed. Next day the boy was free from pain, and wound: healthy. On the 25th of the same month the patient was discharged, the wounds being entirely healed. During this time the patient did not exhibit the least unfavourable symptom. On April 4th his father brouaht him to hospital suffering from intermittent fever. The dispenser of the hospital gave him five grains of sulphate of quinine, which relieved him, and next day the boy was perfectly well. On April 6th I received a message in the morning to go immediately to the hospital. I went at once, and found this boy with all the symptoms of hydrophobia. I tried to give him a dose of a concentrated solution of bromide of potassium and chloral hydrate (half an ounce altogether), but failed, as he could not bear the sight or sound of fluid. I then tried giving it by enema, but failed for a similar reason. Not having any hypodermic solutions at hand at the time, I determined on trying the wourali poison/it having a powerful sedative action. Having some arrows tipped with the poison, I introduced one in middle of cervical vertebrse and another in middle of lumbar vertebrae. No visible effect was produced within an hour. I then inserted a third arrow for a moment, close by the first one. The effect was instantaneous and visible to those around. The boy became quiet, and took nourishment as well as water. He then fell into a quiet sleep, and, awaking in four hours, asked for food. Having obtained it, he lay quiet for an hour ; then, turning on his side, with a deep sigh, expired. From the time of insertion of the third arrow he was entirely free from pain and spasm. This makes the twelfth case of hydrophobia I have met with since beginning my medical career, and the symptoms presented in it the worst. In conclusion, I may say that if it were possible to obtain the wourali poison in a fluid form, and use it by means of the hypodermic syringe, so as to be able to determine exactly the amount necessary to produce a sedative effect, we should solve that difficult and contested question of finding an antidote to the terrible scourge, livrlrri-nhn'hin, a.
doi:10.1016/s0140-6736(02)42961-3 fatcat:7lsm62df3zgsnlpxgxxeogx7yi