Clinical observations on pneumonia in children / by William Stephenson.

  • Stephenson, William, 1837-1919.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: Clinical observations on pneumonia in children / by William Stephenson. Source: Wellcome Collection.

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    present, the whole body may be placed in a warm “pack.” No means is more conducive to the comfort of the patient; the general uneasiness and sense of fulness of the system is allayed, and natural sleep induced. At the same time, it must be remarked, I have never observed any decided change in the temperature or pulse from the use of the pack, but nevertheless the quiet and comfort afforded thereby is very evident. Where further means are necessary to reduce tension, we have the selection of three valuable remedies — aconite, antimony, or ipecacuan ; but the good to be got from these is only within the first thirty-six or forty-eight hours. They should not be continued longer, and never, for any theoretical action upon the lung lesion, should they be given when the pulse is relatively high for the tem¬ perature. The large majority of cases, indeed, may be best treated by ipecacuan or aconite, and acetate of ammonia. The value of aconite in acute inflammatory disease may be denied if we judge of it by its power of lowering pulse and temperature, or cutting short the disease. Looking for its action in these quarters, I long disbelieved in its good effects, but have lately had my confidence in it renewed by observing the increased comfort of the patient, and the lowering of the tension where high, under its use. I have not yet, however, been able to record a definite action in the clinical chart to change mere opinion into conviction. In case 5 (John Gill), where aconite was given throughout the febrile attack, it is worthy of note how the convalescence was prolonged by recurring high temperatures. Without assigning this to the effect of the unnecessarily prolonged use of the remedy, the circumstance must be noted at present in connexion with it. In a few rare cases, in healthy children, where the onset of the disease is associated with considerable dyspnoea, bloodletting by leeches between the scapulas may be employed with undoubted effect; also, when pain in the chest is very severe and preventing rest, a single leech to the seat of pain will afford great relief. Where the pulse is high in relation to the temperature, quite an opposite line of treatment must be followed. Here quinine, iron, and digitalis, singly or in varying combination, are the remedies indicated. In pneumonia occurring amidst the sequelae of scarlet fever, I have seen good results also from belladonna. The selection must turn upon the due recognition of the constitutional state giving rise to the inordinate pulse. Various conditions may so act—the effect of the high temperature upon the nervous system, the amount of blood deterioration, a general cachectic state, or simple atony of the muscular vascular system. Several remedies may likewise be employed to minister to the comfort of the patient. I would specially mention morphia and spirit of chloroform. Salines may be given from the first, in combination with the other medicines enumerated, and their use may be continued with