Wistar Institute of Anatomy and Biology.

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of capillary blood vessels through which the whole volume
of blood in the body is driven about three times each
minute, we can understand why it is such a frequent and
formidable disease.

Many good physicians consider pneumonia among the



*Read before the SUte Eclectic Medical Society of Missouri,
May 19, 1909.



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262 THE AMERICAN MEDICAL JOURNAL-



infectious diseases while other equally as good observers
take a different view and regard it a simple inflammation
arising trom cold, a sudden chilling of the surface, or
injuries or other causes operating to depress the system and
bring it below par.

Personally, I am not inclined to accept the idea that any
specific germ — pneumococcus or diplococcus — is causitive
of pneumonia, but there is no doubt in mv mind that auto-
intoxication with a natural pre disposition is more often
responsible for pneumonia than any other cause.

We can readily understand that one long exposed to
cold, driving the circulation from the skin, congesting
internal organs, producing stasis, will result in the blood
being laden with toxines. We can as readily understand
how a debauch — excessive indulgence in alcoholics, indes-
cretions in eating, producing profound disturbance of the
system will result in the same condition. Now, with a
hereditary tendency to pneumonia an attack is almost sure
to supervene.

There are probably few physicians who have not also
seen pneumonia grafted onto puerperal septicaemia, menin-
gitis, erysipelas or other infectious diseases.

This disease does not seem to be confined to any age,

sex or climate. In the aged it is especially frequent and

pernicious, due no doubt to a lack of elasticity in the pul-

* monary capillaries which favors stasis of blood in the lungs.

In the new born, especially those of premature birth,
when subjected to a prolonged bath before the circulation
has become properly established in the lungs are apt to
suffer from pneumonia.

Usually the onset of pneumonia is attended with a well
marked chill of greater or less severity and duration, though
frequently a few days of symptoms of cold — tightness in
chest, sharp dry cough, pinched expression of tissues, chill-
iness, headache and nausea — will precede the initial chill.

After the chill, especially in the young and robust, we



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AMERICAN MEDICAL JOURNAL. 263



find a rapid rise of the temperature reaching from 104^ to
lOS"^, pulse full and bounding with a rate of from 110 to 140
per minute, respiration hurried — from 30 to 60 per minute,
the cough is more harassing with a slight glary expectora-
tion, cheeks are splotched and a drawn anxious expression
about the face, the feeling of weight and constriction in the
chest is increased and soon results in an agonizing pain in
the involved portion of the lungs.

In the aged, or alcoholics, the temperature is not high
and the condition generally is more adynamic. The spu-
tum now rapidly becomes rusty — brick dust or brightly
streaked and is exceedingly tenacious.

In this disease we usually find a marked disturbance in
the pulse and respiratory ratio, especially in the earlier
stages. The hurried respirations in the earlier stages is
due to high tem))erature, pain or extensive involvement of
lung tissue, but this symptom in the latter stages is almost
certainly due to a failure of resolution to take place exten-
sive and severe involvement and great destruction of lung
tissue is imminent.

Pathologists from the earliest period have recognized
three distinct stages in this disease, that of engorgement,
red and gray hepatization.

In the stage of engorgement we find in the portion of
the lung involved a great distension of the capillary vessels
and very sluggish movement of the blood in them, the epi-
thelial lining of the avioli is oedematous. In fact, the en-
tire involved portion of the lung is oedematous and some
blood is found in the air cells.

In the second stage, that of red hepatization, we find a
solidified condition of the involved tissue — no air entering
it and the surface of the lung presents a granular appear-
ance.

The third stage, that of gray hepatization, is usually
the first step in the process of resolution; the exudate is
softened and the cell elements are undergoing disintegra-



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264 THB AMB&ICAM MBDICAl^ JOUNUAL.



tion, and absorption is beginning to take place.

If the engorgement has been extreme and the lung tis-
sue has broken down a purulency obtains and numerous
small abscesses sometimes coalescitig and forming an ab-
scess cavity of considerable dimensions results.

Red and gray hepatization may exist simultaneously —
resolution taking place in portions of the lung only.

During the stage of engorgement we find upon in-
spection of movement of the a£fected side, especially if the
lower lobe of the lung is involved. The limitation becomes
marked during hepatization if the involvement is consider-
able and measurement will show increase in size. The in-
tercostal spaces are not obliterated. Palpation also detects
loss of motion and the textile fremitus is frequently distinct.

The percussion note is not materially changed during
the stage of engorgement, but in the other stages we find it
varying from a tympanitic note to absolute dullness.

We may find the tympanitic note at the circumference
of the hepatized area. We do not find the wooden flatness
or resistance that attends effusions into the pleural cavity.

Auscultation during engorgement reveals a soft sup-
pressed murmur, and when a deep inspiration is taken a
sub crepitant rale which seems to be close to the ear is
elicited. In auscultation at this stage no garments should
be interposed between the skin and the auscultating instru-
ment, as the friction between the fibers of cloth would
closely simulate the crepitant rales. There seems to be a
difference of opinion as to whether these rales are produced
by air entering the small bronchi or friction between the
surfaces of the plurae. Personally, I am inclined to the
opinion they are due to air entering the cells partially filled
with the e£fusioi).

During the stage of red hepatization no murmur or
crepitation is heard, but instead a harsh bronchia] sound
very similar to one breathing from the mouth direct into the
ear. This is produced by the sound being transmitted from



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THK AMKKleAN MKlUCAl^ JUUKWAL. 265



the larger bronchi through the solidified tissue and chest
walls to the ear. The voice of the patient heard through
the auscultating instrument is as if spoken direct into the
ear.

With the advent of gray hepatization and air again be-
gins to eiiter the small bronchi and air cells we will at
first detect the small mucous rales and as resolution pro-
ceeds they will grow larger and the percussion note will
rise. The cough is not now so harassing, the expectoration
is more free and gradually fades from a dark prune juice
color to a semi-purulency, growing less and less until the
long tissue is freed from all effused material and regains its
normal function.

I feel that physicians can not be too careful in defi-
nitely loosing the area and degree of involvement of lung
tissue early in the attack, as upon this our prognosis would
be to some extent ipfluenced and I am of the opinion that
surgical interference by reason of large abscess formations
is more often required than practiced.

Observers claim to note in this disease a crisis occur-
ring from the eighth to tenth day marking the termination
of the attack abruptly in a great majority of instances.
Others claim that the disease more often terminates by ly-
sis or resolution. All seem to agree that we occasionally
have a delayed resolution lasting often for weeks.

Personally, I have rarely observed a well marked crisis
in this disease, but on the contrary, I usually observe it
pursuing the most typical course of inflammatory processes.

Among complications which may arise in pneumonia
we will notice first pericarditis. This is not so frequently
encountered as some others, but suflSciently so to challenge
our attention It is most frequently found in children, or
in pleuro pneumonia, pneumonia affecting the left lung or
in double pneumonia.

The pericardial inflammation is usually of the plastic
variety and recovery is to be expected. We sometimes,



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266 THK AMERICAN MKDICAI. JOURNAL.



however, find effusion taking place and the pericardium be-
coming greatly distended and the effusion becoming puru-
lent.

Pain in region of heart of varying intensity, irregular
fever, rapid pulse should call the physician's attention to
the possibility of heart involvement. Upon auscultation we
would likely find a friction sound due to contact of inflam-
ed pericardial surfaces. This sound is heard with systole
and diastole but is not synchronous with the heart sounds.
The percussion note would not likely be changed prior to
effusion, neither would the friction sound i>e heard after
effusion. No other symptoms will likely be noted in the
plastic variety, but with pericardial effusion which may
rapidly follow we will find the pain and fever intensified in
addition to a troublesome dyspnoea with a dusky face, a
dullness under percussion as the effusion increases. When
the effusion is extreme we may have dvsphagia and aphonia
may result from pressure of the recurrent laryngeal nerve
as it crosses the aorta. The heart sounds are muffled and
grow weaker as effusion proceeds. The pulse grows more
rapid and we will often notice that with inspiration it is es-
pecially feeble and frequently cannot be felt.

The symptoms of pericarditis are not always clearly
defined and while it is presumed that physicians would
recognize it, it may be that when it arises as a complication
in pneumonia we would be inclineti to consider it a case of
delayed resolution or an unfavorable turn in the pneumo-
nia and fail to adopt the necessary means of relief.

Endocarditis more often complicates pneumonia than
pericarditis, and is far more fatal in its tendencies.

In this complication we find the simple and the malig-
nant or ulcerative varieties. When we consider the mor-
bid anatomy of endocarditis, especially the ulcerative form,
our chief concern will be the possibility of the disengage-
ment of necrotic tissue forming emboli, and perforation of
the heart walls.



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VHH AMKRICAN MHUiC\L, JOURNAL. 267



If the embolism proceeds from the left heart an in-
farction of the vessels of the brain, liver, spleen, kidneys or
in fact anywhere in the body supplied by the aorta or its
branches. If from the right heart an infarction of the pul-
monary vessels will likely occur. When the vessels of the
brain are involved we may have all the symptoms of appo-
plexy developing or a meningitis. While endocarditis and
cerebral complications seem to be often associated we have
brain or meningeal complications in pneumonia arising from
other causes. I saw one case in analcoholic die, with all
the symptoms of delirium tremens, when in fact, he had
not been under the influence of alcohol for quite a time.
Osier reports a case diagnosed as acute mania, and pneu-
monia was not suspected until the autopsy revealed it.

We find bloody urine in pneumonia when Ihe renal
vessels are blocked, an intractable jaundice in hepatic
trouble a splenitis is sometimes encountered in pneumonia
and is doubtless due to infarction of the spleenic vessels.
Pulmonary abscess would likely result from emboli pro-
ceeding from the right heart.

Other complications may arise in the course of pneu-
monia, such as croupous inflammation oi the alimentary
tract, herpetic eruptions, etc., but probably the most im-
portant have been mentioned.

The successful treatment of pneumonia consists largely
in good nursing. A light, airy, clean room, kept at a
proper temperature, clean bed and surroundings generally,
excluding unnecessary callers and other nuisances and the
the majority of pneumonia cases will recover with very lit-
tle medicine. If there are evidences of accumulations of
effete material in the alimentary tract, good judgmeot
would diclate its prompt removal, but by no means should
catharsis be pushed to depletion. If the temperature is
high, the circulation strong and active, pain in lung severe,
we think of veratrum, gelsemium and bryonia in combina-
tion in proper doses as the remedies. In children we usu-
ally substitute aconite for veratrum.



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268 TUB AMERICAN MKDICAL JOUKWAL

In elderly patients, or alcoholics, lacopus, digitalis,
er^ot, nux vomica and cactns are among the ramedies. In
elderly patients, or alcoholics, it is important to make use
of hot applications to the extremities.

The real value of externalapplication to the chest is a
mooted question, with the advantage of the argument prob-
ably on the side of the skeptics. I am inclined to the
opinion, however, that, at least, the psychic effect upon the
patient and friends may be salutary, if not to them, to the
physician. Complications should be met as they arise — if
pus-cavities can be located they should be invaded by the
surgeon's knife and their contents evacuated. If extensive
efiusions in the pericardium are evident and rapid absorp
tion is not taking place the life of our patient depends upon
its evacuation.



ARE THE PEOPLE TO BE UNKNOWINGLY
DRUGGED*



By Paul Pierce, M. D. ,

Editor The National Food Magazine.

The average individual is usually careful in selecting
his physician, and the average physician is safe to be skill-
ful in selecting his drugs. But the some individual, with-
out the exercise of unceasing care is compelled uncon-
sciously to take into his system daily many doses of drugs
which have been incorporated into various more or less san-
itarily prepared foods.

The idea of using embalming substances to preserve
articles of daily diet is not attractive, althopgh some com-
mercial interests insist that they are necessary and harm-
less, an4 as this question of using chemical preservatives in
food products is exciting such universal iuterest at thepres-



♦Read before the State Rclectic Medical Society of Missouri,
May 19, 1909.



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TUB AMERICAN MBDICAL JOURNAL. 269



ent time, there is a load call for the opinion of the Medical
Fraternity on the snbject.

The reactionary food manufacturing interests are now
clamoring for a return to the practice of using artificial pre-
servatives without restraint of the food control authorities.
But there is another element of manufacturers who declare
that chemicals are not necessary to preserve good food ma-
terial, when perfect sanitation prevails. They class artifi-
cial preservatives as drugs, fit only for medical purposes, to
be administered only bv competent physicians, and it is the
physician — the man who makes a study of disease and its
cause — who can tell us more authoritatively than any one
else, about the real effects of foods preserved with chemi-
cals.

The general public probably does not note, but scien*
tific people surely must have marked, the significance of
the fact that, based upon, the opinion of a Special Govern-
ment Commission, appointed by the insistence of the class
of manufacturing interests first referred to — the authorities
at Washington have issued a ruling under the National
Pood Law, permitting the unlimited use of Benzoate of
Soda, generally agreed, we believe, to be a dangerous coal-
tar drug when taken for an indefinite period in prepared
foods.

Employed in foods where it cannot be detected by
taste or smell, we learn that its p.incipal use is to permit
the cheap preservation of inferior raw mateiials and
products carelessly prepared in indifferently clean sur-
roundings.

Leaving out of consideration, however, the fact that
the presence of Benzoate of Soda usually indicate the kind
of food one would not care to eat who saw it made and
know what it was made of — the question of greatest import-
ance, of course, is the possible injurious effect of this drag
upon the health of the people. Under this point, there is
admittedly a conflict of opinion among scientists; and the
opinion against its wholesomeness are so numerous and



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270 THB AMHRiCAN MEDICAL JOURNAA.

come from sources so eminent as to constitute at least a
doubt too grave in character, we tbink, to be ignored or
lightly passed over.

It is a self evident proposition that drugs are not foods,
and should not be administered indiscriminately to sick and
well, infants and adults, without the sanction of a
physician.

To their everlasting credit, some food manufacturers
stand strongly for this principle and have formed a power-
ful organization to fight for strict food purity and against
the use of chemical preservatives, which they have proved
by their own experience, to be unnecessary, if fresh, clean
materials are emploved, under satisfactory conditions

Many reforms have been brought about.

Artificial colors have been driven out. Food labeling
has been improved to make it more honest, but many abuses
remain.

However, the eminent Commission, appointed, un-
fortunately, at the behest of the reactionary food manufac-
turers, to consider the harmlessness or otherwise of Benzoate
of Soda, seems to have dwelt with the matter from a chem-
ical standpoint only, and was anticipated at the outset, and
their decision has been taken advantage of to perpetuate
some of the gravest abuses of the past.

To-day, by the action of the Government Officials at
Washington, that Section of the National Pood Law which
aimed to secure freedom from adulteration and fraudulent
cheapening, is practically nullified by the free admission
into all foods of Benzoate of Soda as a preservative; and so
far as the National Government is concerned, this drug
may now be used in any quantity in meat, fish, milk,
butter, cheese, vegetables, fruits and condimental foods; in
fact, the entire list of our prepared food supplies.

It is admitted generally, and confirmed by Dr. Bitting
of the Department of Agriculture, in Government Bulletin,
No. 119, of January 9rh, 1909. that the principal use of
Benzoate of Soda is to permit the employment of refuse and



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THB AMKRICAN MKDiCAA. JOUI^J<IAL. 271

waste material. This material is the garbage of the can-
ning factory, more often than otherwise hall rotten, sour
and offensive at the outset; old, spoiled and vermin-infested
evaporated apples and other fruits, preserved and manufac-
tured into attractive looking foods; and its manner of using
in this way has been more fully and graphically described
than it can be related here.

These are grave — not to s^y criminal — abuses, and the
work of improving such condition seems worthy of the
attention of all public spirited professional men.

Many of the leading pathologists and chemists of the
country have demurred from the decision of the Govern-
ment Commission, either on the ground that it was not
warranted by any facts ascertained during the investigation,
or by the fact that the inquity was not broad enough to be
practical, in that it failed to cover the usual purpose of
artificial preservatives in foods, or both.

England, Germany, Prance, Italy, Austria and Spain
all have Pood Laws condemning and restricting chemical
preservatives in food products. The World's Pure Pood
Congress, recexitly held at Geneva, Switzerland, condemned
chemical preservatives. Dr. W. H. Wiley, Chief of the
United States Bureau of Chemistry, has submitted official
reports denouncing them as extremely injurious. Similar
action has been taken bv the Association of State and
National Dairy and Pood Departments.

As a rule, the press of the country has espoused the
cause of the consumer as against that of the food adulterator
and the corrupt politician, but no one not at the heart of the
situation can realize the extent of the outrages perpetrated
on the human stomach bv a certain type of food manu-
facturers.

The gravity of the situation demands expert and con-
scientious workers, and it is hoped that the medical fratern-
ity of the country will seize upon this as a labor worthy



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272 THH AMBRICAW MHDICAL JOUNMAL.

of their atteotion, and rise up aad stamp oat this menace
to human health and normal living.

The writer has sent oat some 6,000 letters to prom-
inent physicians, asking their opinions upon the use of
chemicals as food preservatives, with regard to the health
of a commanity. Already the answers are coming in, in
large numbers, condemning in no uncertain terms, the use
of chemicals, as unnatural and deleterious as articles of
diet. Up to date, not one physician has written commend-
ing, or even condoning the process.



SPEAKING OF HOGS, HOWS THIS?
The Arkansas Hog.

Arkansas has a greater variety of hogs and less pork
and lard than any State in the Union. An average hog in
Arkansas weighs about fourteen pounds dressed, with its
head on, and about six and one-half pounds with its head
off. It can outrun a greyhound, jump a rail fence, climb
like a parrot and live on grass, roots and rabbit- tracks. It
hasn't much tail or bristle, but plenty of gall. It will lick
a wolf or bear in a fair fight. It is called razorback because
it is shaped like a sunfish.

In hunting razorbacks they are always shot at side-
ways, for there is not a ghost of a show to hit them other-
wise, any more than to shoot at a split shirigle. It can
drink milk out of a quart jar on account of its thin head.
This type of razorbacks is known as the stone hog, because
its head is so heavy and its nose so long that it balances up
behind. The owner of this type of hogs usually ties a stone
to its tail to keep it from overbalancing and breaking its
neck while running. If the stone is too heavy it will pull
the skin over its eyes and it will go blind. — The Arkansan.



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THE AMtfKiCAW MtfUICAL JOURNAL* 273

SOME LITTLE THINGS PERTAINING TO OFFICE
PRACTICE AND OFFICE PHARMACY.*



By D. S. Talbot, M. D.

Every man, whatever his avocatioo in life may be, ev-
idently displays ia some measure, a disiiactive individaali-
ty; that is, he differs from all others, in his manner or
method of doing things of like character. These'differences
are perhaps, as sharply defined, and stand out as clearly in
the medical profession, as in that of any other profession or
calling. Whether these individual characteristics have
been brought about by natural causes, varied opportunities,
different educational facilities, or different environments, it
matters not; it behooves us as members of a worthy pro-
fession to mingle with each other, and try to profit by a
social interchange of ideas. Therefore, gentlemen of the
Eclectic Medical Society of Missouri, I am glad that I am
permitted to be with you to-day. Not that I expect to
teach you but very little,— perhaps not anything — but if I
only succeed in getting some of the rust rubbed off of me
and can absorb some new ideas from you, then I will have
been more than paid for writing this little article.

Now, I have no intention of entering into the details of
a general office practice, but merely to tell you our way of
doing a few little things in the office.

We carry an average of from 60 to 70 different specific
medicines, and on these we place our chief reliance. We
prescribe in accordance with specific indications as neatly
as we can determine them. Very of tea we use a single
remedy, yet quite frequently, we see cause to use two to
four medicines in the same prescription. Call this poly-
pharmacia, shotgun prescribing, or what not; we claim to
get good results many times from these compound mixtures,
although we will not deny the fact, as Prof. Howe used to



*Read before the State Eclectic Medical ^Society of Missouri,
May 19, 1909.



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274 THB AMBRICAN MBDICAI, JOURNAL.

express it, that we do occasionally send a patient to heaven;
yet we are not aware that we even killed anyone out-
right.

Usually in the preparation of a compound we select
only one medicine for each special indication, but some-
times we use more than one for some special purpose which
act as congeners. For example, take a case of irregular or
intermittent action of the heart so frequently met with.
^, Spec, cactus, 5ss;spec. Crataegus 3^1 arom. spts. am-



Online LibraryWistar Institute of Anatomy and BiologyThe American medical journal → online text (page 21 of 41)