Symptoms

Pneumonia is an infectious inflammatory disease of the lungs, accompanied by grave constitutional disturbances, such as fever and rapid and enfeebled heart action. The mortality at some seasons of the year, and especially among debilitated or alcoholic patients, is very great, and since no known remedy can limit the disease, it is exceedingly important to maintain the strength of the patient through the few days during which the fever lasts, or until the crisis by which it terminates has been reached. All danger, however, is not then over, and convalescence in all cases, and especially in aged persons, must be promoted by careful dietetic treatment. The onset of the disease is acute, and the fever is often high, reaching 1040 or 1050 or more on the first day. The duration of the fever varies from five to seven or nine days on the average, when it subsides by a sudden fall. The rate of respiration is greatly accelerated, with or without subjective dyspnoea. More or less cough accompanies the fever, and there is frequently delirium.

Dietetic Treatment

The indications for treatment are to give a light diet, which will not excite the cough in swallowing or increase dyspnoea by distention of the stomach, or augment the en-feeblement of the heart action by overtaxing the digestive powers. Vomiting should be especially guarded against, and if nausea exists, efforts should be made at once to control it. It is not necessary to keep the patient upon a rigid milk diet, but if milk is well borne, it is advisable to give nothing else while the acute symptoms last; otherwise, whey, meat juice, broths, and egg albumin may be allowed. Starchy and saccharine food must be withheld. Cold drinks are both acceptable and beneficial to the patient, and water, plain or aerated, such as Apollinaris or soda water, may be drunk in considerable quantity. It is believed by some authorities that the activity of the kidneys may be thus promoted, and that the poison which occasions the constitutional symptoms of the disease may be better eliminated. There are cases, however, among persons with robust circulation in which the onset is very sudden and violent. The pulse is full and bounding, and the heart is greatly overworked by the effort to propel a large volume of imperfectly aerated blood.

In such instances the addition of large quantities of fluid to the circulation, besides what is actually required for nutrition, may have the effect of still further straining the heart.

It is stated that carbonated waters reduce the viscidity of the sputum, which is often very tenacious.

The diet should be kept fluid until defervescence has occurred, with a normal temperature and commencing disappearance of the exudation - in fact, it is well to prolong the fluid diet for three or four days after the temperature has become normal, in order to make sure that a relapse of the fever is not likely to follow. In those cases in which resolution is postponed and the patient becomes more and more feeble, although the temperature may be nearly or quite normal, it may be desirable to give a little properly prepared solid food somewhat earlier, and scraped beef, milk toast, or a soft cooked egg may be added to the milk diet.

During the entire period of convalescence the diet must be very nourishing and of easy digestion; milk may still be given, and after slowly returning to the regulation three meals a day (see Convalescent Diet, p. 441) patients do well to take milk punch, or egg-nog, or a glass of wine and a biscuit three or four times a day in the intervals.

Alcohol is exceptionally well borne, and it undoubtedly serves both as a food and as a support to the overworked heart. The fact that it is thoroughly oxidised in the circulation or tissues is demonstrated by the large quantities which patients can often digest and absorb without toxic symptoms. Doses may be thus tolerated which in health would ordinarily produce drunkenness. In alcoholic subjects who have been drinking up to the time of the onset of the disease it is indispensable to continue the use of alcohol, for the sudden withdrawal of its stimulating effect on the organism may give rise to rapid collapse. In aged and constitutionally weak persons it is also important that its use should be begun early in considerable quantities.

In extreme cases as much as an ounce every two hours, or twelve ounces in the day, may be given with benefit, but ordinarily from six to eight ounces will suffice. There are other cases found among robust subjects who do not need such stimulation, and possibly may not require alcohol at all. The custom now in vogue of prescribing other forms of cardiac stimulants, such as strychnine, and vasodilators, like nitroglycerin, makes the employment of excessive doses of alcohol less imperative. It should always be remembered that it is undesirable to produce toxic symptoms of alcoholism in pneumonia as well as in any other disease. So long as the pulse is slowed and its force strengthened the use of alcohol may be regarded as beneficial; but if delirium is increased and the odour of whisky or brandy is strong in the breath an hour or two after it has been given, it is an indication that the patient is receiving more than is desirable, and the dosage should be reduced. From its serving as a fuel, and thereby saving tissue waste in the muscles, the free use of alcohol in pneumonia undoubtedly saves many lives.