A. Alexander Howell
1914 American Journal of the Medical Sciences  
The emphasis in the therapeutic use of pituitery extract in pneumonia has, thus far, been chiefly laid on its marked stimulating effect on the circulation and in the enthusiasm engendered by this discovery, other effects favorable in certain emergencies of pneu¬ monia have been overlooked or remained unmentioned. With our present knowledge as to the significance of the bloodpressure in pneumonia every factor bearing on this phase of the question deserves close attention. While it is true that
more » ... l depres¬ sion of blood-pressure in pneumonia can be traced to the effect of the pneumonic toxin directly or indirectly on the circulation, yet much can be gained from an analysis of the way in which various factors affecting the course of the disease in this way act. As examples of factors acting unfavorably in a general way, lack of fresh air, improper or insufficient nourishment, excessive cough, pain, loss of sleep, etc., may be mentioned. Without minimizing the importance of such factors, should, however, factors present themselves which in addition to their general capacity for harm manifest a specific action on the circulation, our interest should be doubly aroused. It is to two such conditions at times associated with pneumonia, tympanitic distention and diarrhea, that we desire to call attention. Tympanitic distention presents a comparatively simple problem. The circulation is hampered in a twofold way. The diaphragm is forced upward so that not only does the capacity of the chest at rest suffer, but its active capacity is curtailed through inability of the diaphragm to descend freely on inspiration. This results in impaired oxygenation of the blood, a lack which is magnified by the added demands of the increased effort in. breathing. The heart, in turn, nourished by this oxygen-poor blood, is less able to perform its task and is further hindered by the crowding and change of position to which it is subjected. The cause of the distention is a more or less complete paresis of the intestine, toxic in origin, and directly dependent on the pneumonic poison. How remedy this state of affairs? The course which suggests itself-reduce the dose of poison by eliminationcannot practically be followed as a first step. The reason for this is obvious, the organs to which we must turn, the lungs, the skin, the bowels, and the kidneys, are already seriously handicapped or their use contra-indicated. In the lungs hampered, as described
doi:10.1097/00000441-191410000-00010 fatcat:cbukplk5d5a7vmkfvsy3prkrqy