=The Lungs and Bronchial Tubes=
_Meaning of Bronchitis--Symptoms and Treatment--Remedies for
Infants--Pneumonia--Consumption the Great Destroyer--Asthma--La
Grippe._
=COUGH= (_occurring in Bronchitis, Pneumonia, Consumption or
Tuberculosis, Asthma, and Influenza or Grippe_).--Cough is a symptom
of many disorders. It may be caused by irritation of any part of the
breathing apparatus, as the nose, throat, windpipe, bronchial tubes,
and (in pleurisy and pneumonia) covering membrane of the lung. The
irritation which produces cough is commonly due either to congestion
of the mucous membrane lining the air passages (in early stage of
inflammation of these tissues), or to secretion of mucus or pus
blocking them, which occurs in the later stages.
Cough is caused by a sudden, violent expulsion of air from the chest
following the drawing in of a deep breath. A loose cough is to be
encouraged, as by its means mucus and other discharge is expelled from
the air passages.
A dry cough is seen in the early stages of various respiratory
diseases, as bronchitis, pneumonia, pleurisy, consumption, whooping
cough, and with irritation from enlarged tonsils and adenoids (see p.
61) occurring in children.
Irritation produced by inhaling dust, or any irritation existing in
the nose, ear, or throat may lead to this variety of cough. The dry
cough accomplishes no good, and if continuous and excessive may do
harm, and demands medicinal relief.
=Bronchitis.=--Cough following or accompanying cold in the head and
sore throat generally means bronchitis.
The larynx or lower part of the throat ends just below the "Adam's
apple" in the windpipe. The windpipe is about four and a half inches
long and three-quarters to an inch in diameter, and terminates by
dividing into the two bronchial tubes in the upper part of the chest.
Each bronchial tube divides and subdivides in turn like the branches
of a tree, the branches growing more numerous and smaller and smaller
until they finally end in the microscopic air sacs or air cells of the
lungs. The bronchial tubes convey air to the air cells, and in the
latter the oxygen is absorbed into the blood, and carbonic acid is
given up. Bronchitis is an inflammation of the mucous membrane lining
these tubes. In cough of an ordinary cold only the mucous membrane of
the windpipe and, perhaps, of the larger tubes is inflamed. This is a
very mild disorder compared to inflammation of the smaller and more
numerous tubes.
In bronchitis, besides the ordinary symptoms of a severe cold in the
head, as sneezing, running of mucus from the nose, sore throat and
some hoarseness perhaps, and languor and soreness in the muscles,
there is at first a feeling of tightness, pressure, and rawness in the
region of the breastbone, with a harsh, dry cough. The coughing causes
a strain of the diaphragm (the muscle which forms the floor of the
chest), so that there are often pain and soreness along the lower
borders of the chest where the diaphragm is attached to the inside of
the ribs. After a few days the cough becomes looser, greatly to the
patient's comfort, and a mixture of mucus and pus is expectorated. In
a healthy adult such a cough is usually not in itself a serious
affair, and apart from the discomfort of the first day or two, there
is not sufficient disturbance of the general health to interfere with
the ordinary pursuits. The temperature is the best guide in such
cases; if it is above normal (98-3/5 deg. F.) the patient should stay
indoors. In infants, young children, enfeebled or elderly people,
bronchitis may be a serious matter, and may be followed by pneumonia
by extension of the inflammation from the small bronchial tubes into
the air sacs of the lungs, and infection with the pneumonia germ. The
principal signs of severe attacks of bronchitis are rapid breathing,
fever, and rapid pulse.
The normal rate of breathing in adults is seventeen a minute, that is,
seventeen inbreaths and seventeen outbreaths. In children of one to
five years the normal rate is about twenty-six breathing movements a
minute. In serious cases of bronchitis the rate may be twenty-five to
forty in adults, or forty to sixty in children, per minute.
Of course the only exact way of learning the nature of a chest trouble
is thorough, careful examination by a physician, for cough, fever,
rapid breathing and rapid pulse occur in many other diseases besides
bronchitis, particularly pneumonia.
Pneumonia begins suddenly, often with a severe chill, headache, and
general pains like _grippe_. In a few hours cough begins, short and
dry, with violent, stabbing pain in one side of the chest, generally
near the nipple. The breathing is rapid, with expanding nostrils, the
face is anxious and often flushed. The matter coughed up at first is
often streaked with blood, and is thick and like jelly. The
temperature is often 104 deg.-105 deg. F.
If the disease proceeds favorably, at the end of five, seven, or ten
days the temperature, breathing, and pulse become normal suddenly, and
the patient rapidly emerges from a state of danger and distress to one
of comfort and safety. The sudden onset of pneumonia with chill,
agonizing pain in side, rapid breathing, and often delirium with later
bloody or rusty-colored, gelatinous expectoration, will then usually
serve to distinguish it from bronchitis, but not always.
Whenever, with cough, rapid and difficult breathing occur with rise of
temperature (as shown by the thermometer) and rapid pulse, the case
is serious, and medical advice is urgently demanded.
=Treatment of Acute Cough and Bronchitis.=--In the case of healthy
adults with a cough accompanying an ordinary cold, the treatment is
very simple, when there is little fever or disturbance of the general
health. The remedies recommended for cold in the head (p. 55) should
be taken at first. It is also particularly desirable for the patient
to stay in the house, or better in bed, for the first day or two, or
until the temperature is normal.
The feeling of tightness and distress in the chest may be relieved by
applying a mild mustard paper over the breastbone, or a poultice
containing mustard, one part, and flour, three parts, mixed with warm
water into a paste and spread between two single thicknesses of cotton
cloth about eight inches square. The tincture of iodine painted twice
over a similar area forms another convenient application instead of
the mustard. If the cough is excessive and troublesome at night the
tablets of "ammonium chloride compound with codeine" are convenient.
One may be taken every hour or two by an adult, till relieved.
Children suffering from a recent cough and fever should be kept in bed
while the temperature is above normal. It is well to give infants at
the start a grain of calomel or half a teaspoonful of castor oil, and
to children of five to eight years double the dose.
The chest should be rubbed with a liniment composed of one part of
turpentine and two parts of camphorated oil. It is well also to apply
a jacket made of sheet cotton over the whole chest. It is essential to
keep the room at a temperature of about 70 deg. F. and well ventilated,
not permitting babies to crawl on the floor when able to be up, or to
pass from a warm to a cold room. Sweet spirit of niter is a
serviceable remedy to use at the beginning: five to fifteen drops
every two hours in water for a child from one to ten years of age, for
the first day or two.
If the cough is harsh, hard, or croupy (see p. 83), give syrup of
ipecac every two hours: ten drops to an infant of one year or under,
thirty drops to a child of ten years, unless it causes nausea or
vomiting, when the dose may be reduced one-half. If children become
"stuffed up" with secretion so that the breathing is difficult and
noisy, give a teaspoonful of the syrup of ipecac to make them vomit,
for until they are six or seven years old children cannot expectorate,
and mucus which is coughed up into the mouth is swallowed by them.
Vomiting not only gets rid of that secretion which has been swallowed,
but expels it from the bronchial tubes. This treatment may be repeated
if the condition recurs.
In infants under a year of age medicine is to be avoided as much as
possible. A teaspoonful of sweet oil and molasses, equal parts, may be
given occasionally to loosen the cough in mild cases. In other cases
use the cough tablet for infants described on p. 91. A paste
consisting of mustard, one part, and flour, twenty parts, is very
useful when spread on a cloth and applied all about the chest, front
and back. The diet should be only milk for young children during the
first day or two, and older patients should not have much more than
this, except toast and soups. In feeble babies with bronchitis it is
wise to give five or ten drops of brandy or whisky in water every two
hours, to relieve difficulty in breathing.
Children who are subject to frequent colds, or those in whom cough is
persistent, should receive Peter Moeller's cod-liver oil, one-half to
one teaspoonful, according to age, three times daily after eating. One
of the emulsions may be used instead if the pure oil is unpalatable.
Adenoids and enlarged tonsils are a fruitful source of constant colds
and sore throat, and their removal is advisable (see p. 61). Hardening
of the skin by daily sponge baths with cold salt water, while the
child stands or sits in warm water, is effective as a preventive of
colds, as is also an out-of-door life with proper attention to
clothing and foot gear.
=Treatment of Pneumonia.=--Patients developing the symptoms described
as suggestive of pneumonia need the immediate attention of a
physician. If a person is unfortunate enough to have the care of such
a case, when it is impossible to secure a physician, it may afford
some comfort to know that good nursing is really the prime requisite
in aiding recovery, while skillful treatment is of most value if
complications arise.
One in every ten cases of pneumonia in ordinarily healthy people
proves fatal. In specially selected young men, as soldiers, the death
rate from pneumonia is only one in twenty-five cases. On the other
hand, pneumonia is the common cause of death in old age; about seventy
out of every hundred patients who die from pneumonia are between sixty
and eighty years of age. Infants under a year old, and persons
enfeebled with disease or suffering from excesses, particularly
alcoholism, are also likely to die if stricken with the disease.
The patient should go to bed in a large, well-ventilated, and sunny
room. The temperature of the room should be about 70 deg. F., and the
patient must not be covered so warmly with clothing as to cause
perspiration. A flannel jacket may be made to surround the chest, and
should open down the whole front. The nightshirt is worn over this;
nothing more. Daily sponging of the patient with tepid water (85 deg. to
90 deg. F.) should be practiced. The body is not to be all exposed at
once, but each limb and the trunk are to be separately sponged and
dried. If the fever is high (104 deg. F.) the water should be cold (77 deg. to
72 deg. F.), and the sponging done every three hours in the case of a
strong patient. Visitors must be absolutely forbidden. No more than
one or two persons are to be allowed in the sick room at once.
The diet should consist chiefly of milk, a glass every two hours,
varied with milk mixed with thin cooked cereal or eggnog. It is wise
to give at the beginning of the disease a cathartic, such as five
grains of calomel followed in twelve hours by a Seidlitz powder, if
the bowels do not act freely before that time. To relieve the pain in
the side, if excruciating, give one-quarter grain morphine
sulphate,[4] and repeat once, if necessary, in two hours. The
application of an ice bag to the painful side frequently stops the
pain, and, moreover, is excellent treatment throughout the course of
the disease. The seat of pain usually indicates that the lung on that
side is the inflamed one, so that the ice bag should be allowed to
rest against that portion of the chest. Water should be freely
supplied, and should be given as well as milk even if the patient is
delirious.
The bowels are to be moved daily by glycerin suppositories or
injection of warm water. Dover's powder in doses of five grains is
useful to assuage cough. It may be repeated once, after two hours'
interval if desirable, but must not be employed at the same time as
morphine. After the first two or three days are passed, or sooner in
weak subjects, give strychnine sulphate, one-thirtieth grain, every
six hours in pill or tablet form. The strychnine is to be continued
until the temperature becomes normal, and then reduced about one-half
in amount for a week or ten days while the patient remains in bed, as
he must for some time after the temperature, pulse, and breathing have
become normal.
=CONSUMPTION; TUBERCULOSIS OF THE LUNGS; PHTHISIS.=--This disease
demands especial attention, not only because it is above all others
the great destroyer of human life, causing one-seventh of all deaths,
but because, so far from being a surely fatal disease as popularly
believed, it is an eminently curable disorder if recognized in its
earliest stage. The most careful laboratory examinations of bodies
dead from other causes, show that very many people have had
tuberculosis at some time, and to some extent, during life. The reason
why the disease fails to progress in most persons is that the system
is strong enough to resist the inroads of the disease. The process
becomes arrested by the germs being surrounded by a barrier of healthy
tissue, and so perishing in their walled-in position. These facts
prove that so far from being incurable, recovery from consumption
frequently occurs without even our knowledge of the disease. It is
only those cases which become so far advanced as to be easily
recognized that are likely to result fatally. Many more cases of
consumption are now cured than formerly, because exact methods have
been discovered which enable us to determine the existence of the
disease at an early stage of its development.
Consumption is due to the growth of a special germ in the lungs. The
disease is contagious, that is, it is capable of being communicated
from a consumptive to a healthy person by means of the germs present
in the sputum (expectoration) of the patient. The danger of thus
acquiring the disease directly from a consumptive is slight, if one
take simple precautions which will be mentioned later, except in the
case of a husband, wife, or child of the patient who come in close
personal contact, as in kissing, etc. This is proved by the fact that
attendants in hospitals for consumptives, who devote their lives to
the care of these patients, are rarely affected with consumption. The
chief source of danger to persons at large is dust containing the
germs derived from the expectoration of human patients, and thus
finding entrance into the lungs.
Consumption is said to be inherited. This is not the case, as only
most rarely is an infant born actually bearing the living germs of the
disease in its body. A tendency to the disease is seen in certain
families, and this tendency may be inherited in the sense that the
lung tissue of these persons possesses less resistance to the growth
of the germ of consumption. It may well be, however, that the children
of consumptive parents, as has been suggested, are more resistant to
the disease through inherited immunity (as is seen in the offspring of
parents who have had other contagious diseases), and that the reason
that they more often acquire tuberculosis is because they are
constantly exposed to contact with the germ of consumption in their
everyday home life.
It is known that there are certain occupations and diseases which
render the individual more susceptible to consumption. Thus, stone
cutters, knife grinders and polishers, on account of inhaling the
irritating dust, are more liable to the disease than any other class.
Plasterers, cigar makers, and upholsterers are next in order of
susceptibility for the same reason; while out-of-door workers, as
farmers, are less likely to contract consumption than any other body
of workers except bankers and brokers. Among diseases predisposing to
consumption, ordinary colds and bronchitis, influenza, pneumonia,
measles, nasal obstruction causing mouth-breathing, and scarlet fever
are the most important.
No age is exempt, from the cradle to the grave, although the liability
to the disease diminishes markedly after the age of forty.
About one-third more women than men recover from consumption, probably
because it is more practicable for them to alter their mode of life to
suit the requirements of treatment.
It is, then, the neglected cold and cough (bronchitis) which offers a
field most commonly favorable for the growth of the germs in the lungs
which cause consumption. And it is essential to discover the existence
of the disease at its beginning, what is called the incipient stage,
in order to have the best chance of recovery. It becomes important,
therefore, that each individual know the signs and symptoms which
suggest beginning consumption.
Cough is the most constant early symptom, dry and hacking at first,
and most troublesome at night and in the early morning. Expectoration
comes later. Loss of weight, of strength, and of appetite are also
important early symptoms. Dyspepsia with cough and loss of weight and
strength form a common group of symptoms. The patient is pale, has
nausea, vomiting, or heartburn, and there is rise of temperature in
the afternoon, together with general weakness; and, in women, absence
of monthly periods. Slight daily rise of temperature, usually as much
as a half to one degree, is a very suspicious feature in connection
with chronic cough and loss of weight. To test the condition, the
temperature should be taken once in two hours, and will commonly be
found at its highest about 4 P.M., daily. The pulse is also increased
in frequency. Night sweats are common in consumption, but not as a
rule in the first stage; they occur more often in the early morning
hours.
Chills, fever, and sweating are sometimes the first symptoms of
consumption, and in a malarial region would very probably lead to
error, since these symptoms may appear at about the same intervals as
in ague. But the chills and fever are not arrested by quinine, as in
malaria, and there are also present cough and loss of weight, not
commonly prominent in malaria. Persistently enlarged glands, which may
be felt as lumps beneath the skin along the sides of the neck, or in
the armpits, should be looked upon with suspicion as generally
tuberculous, containing the germ of consumption. They certainly demand
the attention of early removal by a surgeon.
The spitting of bright-red blood is one of the most certain signs of
consumption, and occurs in about eighty per cent of all cases, but
rarely appears as an early warning. The pupils of the eyes may be
constantly large at the onset of the disease, but this is a sign of
general weakness. Pain is also a frequent but not constant early
symptom in the form of "stitch in the side," or pain between or
beneath the shoulder blades, or in the region of the breastbone. This
pain is due to pleurisy accompanying the tuberculosis. Shortness of
breath on exertion is present when consumption is well established,
but is not so common as an early symptom. The voice is often somewhat
hoarse or husky at the onset of consumption, owing to tuberculous
laryngitis.
To sum up then, one should always suspect tuberculosis in a person
afflicted with chronic cough who is losing weight and strength,
especially if there is fever at some time during the day and any
additional symptoms, such as those described. Such a one should
immediately apply to a physician for examination of the chest, lungs,
and sputum (expectoration). If the germs of tuberculosis are found on
microscopical inspection of the sputum, the existence of consumption
is absolutely established. Failure to find the germs in this way does
not on the other hand prove that the patient is free from the
disease, except after repeated examinations at different times,
together with the inability to discover any signs by examination of
the chest. This examination in some instances produces no positive
results, and it may be impossible for the physician to discover
anything wrong in the lungs at the commencement of consumption. But,
generally, examination either of the lungs or of the sputum will
decide the matter, one or both giving positive information.
The use of the X-rays in the hands of some experts sometimes reveals
the presence of consumption before it is possible to detect it by any
other method. There is also a substance called tuberculin, which, when
injected under the skin in suspected cases of consumption causes a
rise of temperature in persons suffering from the disease, but has no
effect on the healthy. This method is that commonly applied in testing
cattle for tuberculosis. As the results of tuberculin injection in the
consumptive are something like an attack of _grippe_, and as
tuberculin is not wholly devoid of danger to these patients, this test
should be reserved to the last, and is only to be used by a physician.
=Treatment.=--There is no special remedy at our disposal which will
destroy or even hinder the growth of the germs of tuberculosis in the
lungs. Our endeavors must consist in improving the patient's strength,
weight, and vital resistance to the germs by proper feeding, and by
means of a constant out-of-door life. The ideal conditions for
out-of-door existence are pure air and the largest number of sunshiny
days in the year. Dryness and an even temperature, and an elevation of
from 2,000 to 3,000 feet, are often serviceable, but not necessarily
successful.
When it is impossible for the patient to leave his home he should
remain out of doors all hours of bright days, ten to twelve hours
daily in summer, six to eight hours in winter without regard to
temperature, and should sleep on a porch or on the roof, if possible.
In the Adirondacks, patients sit on verandas with perfect comfort
while the thermometer is at ten degrees below zero. A patient (a
physician) in a Massachusetts sanitarium has arranged a shelf,
protected at the sides, along the outside of a window, on which his
pillow rests at night, while he sleeps with his head out of doors and
his body in bed in a room inside. If it becomes stormy he retires
within and closes the window. If the temperature ranges above 100 deg. F.
patients should rest in bed or on a couch in the open air, but, if
below this, patients may exercise. A steamer chair set inside of a
padded, wicker bath chair, from which the seat has been removed, makes
a convenient protected arrangement in which a consumptive can pass his
time out of doors. If the patient is quite weak and feverish he may
remain in bed, or on a couch, placed on a veranda or balcony during
the day, and in a room in which all the windows are open at night.
Screens may be used to protect from direct draughts.
No degree of cold, nor any of the common symptoms, as night sweats,
fever, cough, or spitting of blood, should be allowed to interfere
with this fresh-air treatment. The treatment may seem heroic, but is
most successful. The patient must be warmly clothed or covered with
blankets, and protected from strong winds, rain, and snow. During
clear weather patients may sleep out of doors on piazzas, balconies,
or in tents.
Nutritious food is of equal value with the open-air life. A liberal
diet of milk and cream, eggs, meat and vegetables is indicated. Raw
eggs swallowed whole with a little sherry, or pepper and salt on them,
may be taken between meals, beginning with one and increasing the
number till three are taken at a time, or nine daily. If the appetite
is very poor it is best that a glass of milk be taken every two hours,
varied by white of egg and water and meat juice. Drug treatment
depends on individual symptoms, and can, therefore, only be given
under a physician's care. Sanitarium treatment is the most successful,
because patients are under the absolute control of experts and usually
in an ideal climate. Change of climate is often useful, but patients
should not leave their homes without the advice of a competent
physician, as there are many questions to consider in taking such a
step.[5] There is a growing tendency among physicians to give
consumptives out-of-door treatment at their homes, if living out of
cities, as careful personal supervision gives much better results than
a random life in a popular climatic resort.
=Prevention.=--Weakly children and those born of consumptives must
receive a generous diet of milk, eggs, meat, and vegetables, and spend
most of their time in the open air. Their milk should be heated for
fifteen minutes to a temperature of 160 deg. F., in order to kill any
germs of tuberculosis, unless the cows have been tested for this
disease. The patient must have a separate sleeping room, and refrain
from kissing or caressing other members of the family.
The care of the sputum (expectoration) is, however, the essential
means of preventing contagion. Out of doors, it should be deposited in
a bottle which is cleaned by rinsing in boiling water. Indoors, paper
bags or paper boxes made for the purpose are used to receive the
sputum, and burned before they become dry. The use of rags,
handkerchiefs, and paper napkins is dirty, and apt to cause soiling of
the hands and clothes and lead to contagion. Plenty of sunlight in the
sick room will cause destruction of the germs of consumption, besides
proving beneficial to the patient. No dusting is to be done in the
invalid's room; only moist cleansing. All dishes used by a consumptive
must be boiled before they are again employed.
=ASTHMA.=--This is a disorder caused by sudden narrowing of the
smaller air tubes in the lungs. This narrowing is produced by
swelling of the mucous membrane lining them, or is due to contraction
of the tubes through reflex nervous influences. It may accompany
bronchitis, or may be uncomplicated. It may be a manifestation of
gout.
The sufferers from asthma are usually apparently well in the period
between the attacks. The attack often comes on suddenly in the night;
the patient wakening with a feeling of suffocation. The difficulty in
breathing soon becomes so great that he has to sit up, and often goes
to a window and throws it open in the attempt to get his breath. The
breathing is very labored and panting. There is little difficulty in
drawing the breath, but expiration is very difficult, and usually
accompanied by wheezing or whistling sounds. The patient appears to be
on the brink of suffocation; the eyeballs protrude; the face is
anxious and pale; the muscles of the neck stand out; the lips may be
blue; a cold sweat covers the body; the hands and feet are cold, and
talking becomes impossible. Altogether, a case of asthma presents a
most alarming appearance to the bystander, and the patient seems to be
on the verge of dying, yet death has probably never occurred during an
attack of this disease. The attacks last from one-half to one or
several hours, if not stopped by treatment, and they often return on
several successive nights, and then disappear, not to recur for months
or years.
Attacks are brought on by the most curious and diverse means.
Atmospheric conditions are most important. Emanations from plants, or
animals, are common exciting agencies. Fright or emotion of any kind;
certain articles of diet; dust and nasal obstruction are also frequent
causes. Patients may be free from the disease in cities and attacked
on going into the country. Men are subject to asthma more than women,
and the victims belong to families subject to nervous troubles of
various kinds. The attack frequently subsides suddenly, just when the
patient seems to be on the point of suffocation. There is often
coughing and spitting of little yellowish, semitransparent balls of
mucus floating in a thinner secretion.
Asthma is not likely to be mistaken for other diseases. The
temperature is normal during an attack, and this will enable us to
exclude other chest disorders, as bronchitis and pneumonia.
Occasionally asthma is a symptom of heart and kidney disease. In the
former it occurs after exercise; in the latter the attack continues
for a considerable time without relief. But, as in all other serious
diseases, a physician's services are essential, and it is our object
to supply only such information as would be desirable in emergencies
when it is impossible to obtain one.
=Treatment.=--An attack of asthma is most successfully cut short by
means of one-quarter of a grain of morphine sulphate[6] with 1/20 of a
grain of atropine sulphate, taken in a glass of hot water containing a
tablespoonful of whisky or brandy. Ten drops of laudanum,[7] or a
tablespoonful of paregoric, may be used instead of the morphine if the
latter is not at hand. Sometimes the inhalation of tobacco smoke from
a cigar or pipe will stop an attack in those unaccustomed to its use.
In the absence of morphine, or opium in the form of laudanum or
paregoric, fifteen drops of chloroform or half a teaspoonful of ether
may be swallowed on sugar.
A useful application for use on the outside of the chest consists of
mustard, one part, and flour, three parts, mixed into a paste with
warm water and placed between single thicknesses of cotton cloth.
Various cigarettes and pastilles, usually containing stramonium and
saltpeter, are sold by druggists for the use of asthmatic patients.
They are often efficient in arresting an attack of asthma, but it is
impossible to recommend any one kind, as one brand may agree with one
patient better than another. Amyl nitrite is sold in "pearls" or
small, glass bulbs, each containing three or four drops, one of which
is to be broken in and inhaled from a handkerchief during an attack of
asthma. This often affords temporary relief.
To avoid the continuance of the disease it is emphatically advisable
to consult a physician who may be able to discover and remove the
cause. The diet should consist chiefly of eggs, fish, milk, and
vegetables (with the exception of beans, large quantities of potatoes,
and roots, as parsnips, beets, turnips, etc.). Meat should be eaten
but sparingly, and also pastries, sugar, and starches (as cereals,
potato, and bread). The evening meal ought to be light, dinner being
served at midday. Any change of climate may stop asthmatic seizures
for a time, but the relief is apt to be temporary. Climatic conditions
affect different patients differently. Warm, moist air in places
destitute of much vegetation (as Florida, Southern California, and the
shore of Cape Cod and the Island of Nantucket, in summer) enjoy
popularity with many asthmatics, while a dry, high altitude influences
others much more favorably.
=INFLUENZA; LA GRIPPE.=--Influenza is an acute, highly contagious
disease due to a special germ, and tending to spread with amazing
rapidity over vast areas. It has occurred as a world-wide epidemic at
various times in history, and during four periods in the last century.
A pandemic of influenza began in the winter of 1889-90, and continued
in the form of local epidemics till 1904, the disease suddenly
appearing in a community and, after a prevalence of about six weeks,
disappearing again. One attack, it is, perhaps, unnecessary to state,
does not protect against another. The mortality is about 1 death to
400 cases. The feeble and aged are those who are apt to succumb.
Fatalities usually result from complications or sequels, such as
pneumonia or tuberculosis; neurasthenia or insanity may follow.
=Symptoms.=--There are commonly four important symptoms characteristic
of _grippe_: fever; pain, catarrh; and depression, mental and
physical. _Grippe_ attacks the patient with great suddenness. While in
perfect health and engaged in ordinary work, one is often seized with
a severe chill followed by general depression, pain in the head, back,
and limbs, soreness of the muscles, and fever. The temperature varies
from 100 deg. to 104 deg. F. The catarrh attacks the eyes, nose, throat, and
larger tubes in the lungs. The eyes become reddened and sensitive to
light, and movements of the eyeballs cause pain. Sneezing comes on
early, and, after a day or two, is followed by discharge from the
nose. The throat is often sore and reddened. There may be a feeling of
weight and tightness in the chest accompanied by a harsh, dry cough,
which, after a few days, becomes looser and expectoration occurs.
Bodily weakness and depression of spirits are usually prominent and
form often the most persistent and distressing symptoms.
After three or four days the pains decrease, the temperature falls,
and the cough and oppression in the chest lessen, and recovery usually
takes place within a week, or ten days, in serious cases. The patient
should go to bed at once, and should not leave it until the
temperature is normal (98-3/5 deg. F.). For some time afterwards general
weakness, associated with heart weakness, causes the patient to sweat
easily, and to get out of breath and have a rapid pulse on slight
exertion.
Such is the picture of a typical case, but it often happens that some
of the symptoms are absent, while others are exaggerated so that
different types of _grippe_ are often described. Thus the pain in the
back and head may be so intense as to resemble that of meningitis.
Occasionally the stomach and bowels are attacked so that violent
vomiting and diarrhea occur, while other members of the same family
present the ordinary form of influenza. There is a form that attacks
principally the nervous system, the nasal and bronchial tracts
escaping altogether. Continual fever is the only symptom in some
cases. _Grippe_ may last for weeks. Whenever doubt exists as to the
nature of the disorder, a microscopic examination of the expectoration
or of the mucus from the throat by a competent physician will
definitely determine the existence of influenza, if the special germs
of that disease are found. It is the prevailing and erroneous fashion
for a person to call any cold in the head the _grippe_; and there are,
indeed, many cases in which it becomes difficult for a physician to
distinguish between _grippe_ and a severe cold with muscular soreness
and fever, except by the microscopic test. Influenza becomes dangerous
chiefly through its complications, as pneumonia, inflammation of the
middle ear, of the eyes, or of the kidneys, and through its
depressing effect upon the heart.
These complications can often be prevented by avoiding the slightest
imprudence or exposure during convalescence. Elderly and feeble
persons should be protected from contact with the disease in every
way. Whole prisons have been exempt from _grippe_ during epidemics,
owing to the enforced seclusion of the inmates. The one absolutely
essential feature in treatment is that the patient stay in bed while
the fever lasts and in the house afterwards, except as his strength
will permit him to go out of doors for a time each sunny day until
recovery is fully established.
=Treatment.=--The medicinal treatment consists at first in combating
the toxin of the disease and assuaging pain, and later in promoting
strength. Hot lemonade and whisky may be given during the chilly
period and a single six- to ten-grain dose of quinine. Pain is
combated by phenacetin,[8] three grains repeated every three hours
till relieved. At night a most useful medicine to afford comfort when
pain and sleeplessness are troublesome, is Dover's powder, ten grains
(or codeine, one grain), with thirty grains of sodium bromide
dissolved in water. After the first day it is usually advisable to
give a two-grain quinine pill together with a tablet containing
one-thirtieth of a grain of strychnine three times a day after meals
for a week or two as a tonic (adult). Only mild cathartics are
suitable to keep the bowels regular as a Seidlitz powder in the
morning before breakfast. The diet should be liquid while the fever
lasts--as milk, cocoa, soups, eggnog, one of these each two hours. A
tablespoonful of whisky, rum, or brandy may be added to the milk three
times daily if there is much weakness.
The germ causing _grippe_ lives only two days, but successive crops of
spores are raised in a proper medium. Neglected mucus in nose or
throat affords an inviting field for the germ. Therefore it is
essential to keep the nostrils free and open by means of spraying with
the Seiler's tablet solution (p. 49), and then always breathing
through the nostrils.
FOOTNOTES:
[4] Caution. Dangerous. Use only on physician's order.
[5] Arizona, New Mexico, Colorado, and the Adirondacks contain the
most favorable climatic resorts in this country.
[6] Caution. Dangerous. Use only on physician's order.
[7] This dose is only suitable for strong, healthy adults of average
weight and those who are not affected peculiarly by opium. Delicate
women and others not coming under the above head should take but half
the dose and repeat in an hour if necessary.
[8] Caution. A powerful medicine.