Pneumonia, or inflammation of the lungs, is one of the most serious diseases of the winter season. The largest number of cases occur in the months of December, January, February and March. If, however, the winter is mild, the high peak of incidence may be put off until March and April.
This relation to cold, damp weather, exposure, etc., cannot be underestimated in concluding exactly what factors operate in producing pneumonia in any given case. True, the actual cause of pneumonia is a germ which invades the tissues of the lungs. But simply to say this, does not by any means explain how pneumonia attacks the body.
Our noses are breeding places for many germs which may be dangerous and yet, curiously enough, these germs may apparently stay in the nose or throat without interfering with a perfect state of health. We have heard recently from Dr. Flexner that the germ of infantile paralysis apparently invades the brain by way of the nerves of smell. In other words, the germ locates itself in the nose, and advances into the central nervous system along the exposed nerve ends of the olfactory membrane, directly into the citadel of life itself.
The germ of pneumonia apparently acts in the same manner. It may be present in healthy noses and throats. But what are the factors which cause it to set up activity in the lungs?
There are only two possible answers. One is that we become immune to our own germs, and it is only when a pneumococcus from another nose or throat is sprayed upon us by coughing or spit into the street so that we breathe it in, that we become stricken. Or the other explanation is that our resistance becomes lowered due to the factors of exposure to bad weather, moisture, cold, etc., mentioned above.
We can provide very largely against both possibilities. There is great virtue in the old ideas of bundling up in the winter time, wearing rubbers and galoshes, keeping the feet from getting cold and wet, and changing damp clothing as soon as one gets home. Avoidance of crowds, at least unnecessarily repeated exposure among crowds in theaters, etc., so as not to catch your neighbor’s pneumococcus, will take care of the first factor mentioned.
Most important of all is to treat all chilly, feverish symptoms, the feeling that one has caught cold or has caught infection, with respect, and go to bed for three or four days and allow the body’s recuperative powers to overcome the invader.
There are many reports to the effect that pneumonia begins in the form of colds or bronchitis. To my mind this means that pneumonia was present all the time, and was simply ascribed to a cold in the early stages, and should have been treated properly at that time.
How FRESH Air Now Is USED IN TREATMENT of PNEUMONIA
I said above that the most important element in the treatment of pneumonia is to go to bed as soon as there are any intimations that it has taken hold. There is nothing that is so likely to break down resistance in the face of an infection in the lungs as the attempt some people make to walk it off or wear it out by working. It is particularly the successful type of business man, who has always been able to impose his will on an entire organization, who thinks he can also bluff Nature, and who often does it to his cost.
Perhaps the most important improvement in our treatment of pneumonia over the method used by our grandfathers is that of the use of fresh air. It took a long time for man to learn that fresh air was a tonic to the lungs and not a detriment. Even if the air is cold, even if the day is snowy and rainy, it is better to have plenty of fresh air than to be shut up tight in a warm room. In fact, I am inclined to believe that the lowering of the incidence of pneumonia is due to the fact that we ventilate our rooms better than we used to, and to the new science of air conditioning.
It was an English practitioner, George Bodington, who shocked all of his neighbors and patients and his colleagues by suggesting that people with lung disease should get out in the open air. So great was the opposition to his ideas that he was compelled to desist treating such patients and take up institutional work. But about the turn of the century his doctrines were revived by Dr. Northrup, children’s specialist, in New York, who put his babies with pneumonia out on the roof, no matter what the weather.
“Why compel a person to take five breaths when three breaths will do?” was the question he asked all critics of his method.
We find today that pneumonia patients certainly get enough fresh air. The sick room of the pneumonia patient, instead of being the stuffy, airtight apartment that it used to be, today discloses the patient with a sweater on, the nurse with a sweater and coat and gloves and a woolen cap. Sometimes I think we rather overdo it, and that with sick and feeble patients it is not necessary to be quite so strenuous. Certainly when the patient’s body must be exposed in order to change the bedclothes and for other purposes, the room should be warmed up to the point of comfort. But under any circumstances, fresh air is a great improvement over the old suffocation treatment.
A modification, and perhaps an improvement on the use of fresh air, is the oxygen tent which increases the number of atmospheres of oxygen which the patient is breathing. Where an oxygen room or an oxygen tent is available, it should be put in use before the patient is in extreme danger.
In the matter of drugs we have nothing that can be called extremely effective. The heart and circulatory system is the most vulnerable point in pneumonia, and when the time comes it must be supported. Every physician has his favorite drug in pneumonia, and the fact that he believes in it so implicitly is probably good medicine, as his confidence is communicated to the patient and the family.