On the Treatment of Pneumonia
Boston Medical and Surgical Journal
I shall devote this lecture to the treatment of pneumonia. The history of the therapeutics of pulmonary diseases comprehends no subject of greater interest than this. Just as we have seen Huxley in England give a whole treatise of physiology while writing about the cray fish, so in describing the various treatments of pneumonia wliich have at different times prevailed, and the discussions which have arisen therefrom, one would go over about the entire history of the treatment of disease in
... of disease in general. Permit me, then, as briefly as possible, to sum up the history of the therapeutics of pneumonia. The suddenness and gravity of the invasion, the intensity of the febrile phenomena, the profound disturbance of the respiration, all conspire to render pneumonia one of the most serious diseases of the economy. Hence the ancients, not having for their guide auscultation and percussion, made of this affection the type of phlegmasias. They directed against this disease, which they regarded as one of the most dangerous, a treatment proportional to the evil to be overcome, and drew from the arsenal of therapeutics the most energetic remedies. We must triumph over the disease, said Sydenham, and this pernicious doctrine has for a long time directed the entire therapeutics of pneumonia. It was forgotten that in this contest between the physician and the disease there exists a patient ; more than all, the true Hippocratic doctrine was lost sight of, and the definition which Hippocrates gave to the disease. The father of medicine regarded the morbid phenomena as symptoms of the struggle by which nature was attempting to effect a removal of the disease ; it was of importance, then, not to disturb (without very strong reasons) this spontaneous tendency of nature toward restoration. During long years, then, treatments of the most heroic kind were instituted against pneumonia, and what served to perpetuate the error, was the fact that pneumonia was seen to disappear and patients to get well under these treatments. Only, -the period of convalescence was long, and it was the custom to attribute this enfeeblement not to the medication, but rather to the pulmonary affection itself. In the eighteenth century we observe several tentatives made in good earnest to establish a hygienic treatment of pneumonia, but these attempts on the part of Van Swieten and Boerhaave were soon forgotten, and the profession came back, more determined than ever, to modes of treatment the most violent and heroic. But this entire scaffolding, for ages based on tradition, was destined to fall to the ground under the destructive influence of two methods of investigation which came to be applied to the study of diseases ; statistics 011 the one part, and the observation of temperature on the other. The doctrine of Broussais, which had pushed to its extreme limits the diabolical methods which it had , Valleix rallied around a banner which had for device, Numerandoe et perpendendoe observationes. Then the school of Vienna followed the school of Paris in its new departure, and Skoda and his pupil, Dielt, showed us all the advantages which one might derive from statistics in the study of the treatment of disease. What did statistics show when applied to the examination of the different treatments of pneumonia? That the absence of all medication gave better results than medication of a very active kind. Here was a fact of prime importance which destroyed at one blow the therapeutic rule which had heretofore prevailed, namely, that it is necessary to treat a severe disease by severe remedies. But statistics alone can never settle a disputed point in therapeutics. The statistical method of demonstration has certainly a high value in the other sciences; it does not, however, iu medicine, and especially in therapeutics, give all the results which might be expected of it. Therefore, without going quite as far as Forget, who regards statistics (la statistique) as " an obliging maid who gives herself to the first comer," we may properly affirm that the medical products which are the offspring of this method of observation are incongruous and of little vitality. In fact, in medicine, and particularly in therapeutics, observations are seldom or never proper subjects of comparison. Individual conditions, and the type of the disease more especially, may at each instant modify the results, and this it is that explains the popularity aud the decadence of therapeutic agents. A remedy which at one time has wrought wonderful cures, at another time is employed with no success at all, and this difference results from the circumstance that in the one set of cases the disease appeared in a mild form, while in the other cases it was grave.