PNEUMONIA. lowering his resistance on account of its specific. Intravenous alcohol has been used by various

Transcription

1 Dec., 1935] INTRAVENOUS ALCOHOL IN PNEUMONIA : BAKHSH & ANDREABEN 673 lowering his resistnce on ccount its specific TREATMENT OF LOBAR PNEUction on liver cells. MONIA WITH INTRAVENOUS INJECV/ Intrvenous lcohol hs been used by vrious V TIONS OF ALCOHOL Europen physicins in vriety diseses, m.r.c.p. (Lond.) such s cncer lungs, puerperl sepsis, By ILAHI BAKHSH, m.d. (Lond.), but it ws Lu, CAPTAIN, I.M.S. subcute endocrditis, Buer (1931) who first used it in Fejgin A. T. ANDREASEN, m.r.c.s. (Eng.) pulmonry suppurtions. Their ory ws CAPTAIN, I.M.S. intrvenous lcohol, insted being tken Punjb tht Jhclum, Indin Militry Hospitl, ef ill up by liver cells dexicted, s in orl The tretment dministrtion, went stright right side lobr pneumoni Still remins difficult problem in hert from whence it ws tken by pulspite hordes reserch workers circultion lungs. The curtive monry iling devotedly in this field ll over world. effect lcohol in ir cses post-pneuso fr, sheet-nchor monic pulmonry suppurtion ws due, in ir pneumonic ptient hs been good opinion, selective ffinity lcohol for nursing rest, drugs reticulo-endolil cells in pulmonry hving persistently filed us. It is grtifying* know tht tissue, where it exerted its bctericidl power. digitlis is so little used nowdys by modern physicin combt hert They gve smll doses insulin protect filure in pneumoni. from ny dmge which might be done is still gretliver Morphi friend physicin but must be usedby n overflow lcohol from pulmonry cutiously; its dministrtion fter thirdcircultion. or fourth dy disese is surest mens AVe first tried this tretment on cse hstening ftl issue. pulmonry bscess complicting pneumoni, Oxygen rpy hs been dvocted for result ws so stisfcry tht we were relief cynosis, vrious methods curious know wht effect intrvenous lcohol hve on n uncomplicted cse lobr dministrtion, including elborte oxygen would j tents, hve been invented, but one doubts its pneumoni. We believe tht this is n experij mteril benefit once cynosis is mrked. ment hir untried by ny or workers. Even its erly dministrtion, when cynosis Technique injections is very slight, lis not reduced mortlity pprecibly in our experience. Those who hve We employed, in cses quoted, solution in sterile norml ny experience in pneumoni know how futile 20 per cent lcohol sline. The dose used vried from 20 c.cm. ll se mesures prove once ptient strts 25 c.cm. per dy, in verge-sized ptient. going down hill. Anti-pneumococcl serum hs not given AVe lter found tht strength solution could be incresed 33 per cent without good results t one time expected it, expense entiled in its preprtion forbids its cusing ny more rection thn previously. In only one cse did we hve give two injections generl use. Recent work by Sutcliff Finl 12 c.cm. 10 c.cm. (1934) shows ppliction per dy on ccount specific serum rpy pneumoni be even more limited constnt rigors which single doses 20 c.cm. In ll or cses rection thn ws previously supposed. These uthors produced. injection ws slight, limited stte tht serum cn be employed only ny purpose in one out ten cses suspected feeling chilliness bout 20 minutes threequrters n hour fter injection. pneumoni. Subcutneous infiltrtion due Modern reserch hs refore utterly filed fulty in puncturing vein produced solve this difficult technique give problem, physicin wepon wherewith combt this momentry pin running up rm. Slight indurtion without suppurtion t site dreded disese. For most us issue depends upon good nursing hope tht injection ws only sequel we observed when no by mischnce needle eir slipped out compliction will occur. vein or trnsfixed it. The orl dministrtion lcohol in tretment pneumoni hs been prctised since Cse records time immemoril. Medicl still differ opinions Cse 1.?G. H., recruit, ged 18, dmitted for pin s its in right chest, cough fever one dy's durtion. efficcy. While we do not hesitte give smll doses bry or chmpgne on Condition dmission.?temperture?101?f., cse pulse?102, respirtion?24, generl condition good, l? filing hert we believe tht routine nsi working. Cynosis?nil. Lungs?impired percusdministrtion lcohol in pneumoni, sion note over bck right lower lobe with lthough rendering restless ptient momenpleuritic rub over eighth rib in right mid-xillry trily peceful, does more hrm thn good by line, with diminished ir entry, broncho-vesiculr * brething sub-crepitnt rles. Sputum?tencious [Note.?At risk dispp Ullltuig burs we feel tht we must point out tht, despite rusty. recent criticism use digitlis in pneumoni, Tretment.?Sline perient, Dover's powder t night re re still mny excellent physicins who still use for first three dys. Ctplsm chest sedtive expecrnt mixture. digitlis in pneumoni consider it gret vlue. Edir, /. M. G.]

2 674 THE INDIAN MEDICAL GAZETTE [Dec., th Februry, 1935.?Crisis occurred. Temperture remined norml until 21st Februry, when it rose 102.4?F. The white blood count ws 20, nd Februry. Temperture?104?F., complined pin in right chest. Exmintion reveled dullness on percussion with diminished vocl fremitus distnt breth voice sounds loclized over right lower chest. Hert not displced. The ptient looked very ill. The white blood cells hd risen 23,000. Lter in evening he hd severe fit coughing brought up li pints greenish evil-smelling mteril, mostly pus. The condition ws, refore, one pulmonry bscess pressing on right lower bronchus, thus ccounting for peculir signs found. 23rd Februry. Temperture?100.2?F., gret improvement in generl condition; white blood cells? 16, th Februry. Temperture gin rose 103?F. 2nd Mrch. In intervl temperture hd been irregulr; in morning, ptient hd nor fit coughing six ounces pus ws coughed up. The temperture went down 99?F. sme evening but rose 101?F. next dy. 9th Mrch. It ws decided try intrvenous lcohol. The mn's condition ws now very poor, he hving hd irregulr tempertures up 104?F. two rigors in intervl since 3rd Mrch. Fifteen minutes fter injection lcohol, ptient complined feeling cold. Seen n hour lter, he ws very comfortble sid he felt much better. He hd no cough. 10th Mrch. Injection repeted. 11th Mrch. Temperture hs cesed swing since first injection lcohol, hs stedily dropped until it is now norml. From this dte ptient mde rpid uneventful recovery. Cse 2.?M. A., Sepoy, ged 23, dmitted on 21st Mrch, 1935, with pin in right chest, cough fever one dy's durtion. Temperture?99.5?F., Cse 2, Sepoy, M. A. Admitted 21st Mrch, Lobr pneumoni rt. right lower lobe pleuritic rub over ninth tenth rib in right mid-xillry line. White blood cells?s,500 (poly. 76 per cent, Iynipho. 22 per cent, 1. mono. 2 per cent, eosin. 0). Treted with ctplsm over right lower chest, Dover's powder fluids d lib. 23rd Mrch. Temperture?104.8?F. with ll signs consolidtion, rusty sputum increse in chest pin. 25th Mrch. White blood cells?10,500. Tretment.?Twenty-two cubic centimetres 20 per cent lcohol solution were given intrvenously t 10.m. Slight coughing during injection feeling chilliness 30 minutes lter. The temperture cme down 101.5?F. sme evening with gret relief in sense oppression distress. 25th Mrch. Alcohol injection given. Slept well tht night. White blood cells?12, th Mrch. Temperture cme down norml sme night. Resolution ws completed within next two dys. Dischrged fit on 6th April. Cse 3.?H. M., cook, ged 30. Acute onset with pin in right chest?cough fever on 5th April, Generl condition poor; snic type; he nsi Cse 3, cook, H. M. Admitted 6th April, Lobr pneumoni rt. ' Z II 12 Respirtion s. I S9/0///2 Temperture Temperiin pulse?88, respirtion?22, generl condition?good, cynosis?nil; dyspnoe slight; sputum semi-viscid scnty but not rusty. Pneumococci present in lrge numbers. Signs erly pneumonic congestion in working; cynosis slight; dyspnoe moderte; diminished respirry movements with impired percussion note over right lower lobe. Air entrjr diminished, breth sounds broncho-vesiculr, some subcrepitnt rles udible over front bck this re; sputum scnty frothy; pneumococci in lrge numbers. Accentution second pulmonry hert sound, orwise norml. White blood cells?13,600 (poly. 78 per cent, lympho. 20 per cent, 1. mono. 2 per cent, eosin. 0). Blood slide for mlri prsites negtive. Tretment.?6th April. Twenty-two cubic centimetres 20 per cent lcohol injected intrvenously. There ws mild fit, coughing during injection; threequrters n hour lter slight rigor which ws relieved by hot wter bottles. The temperture rose 103?F. but pin in - chest disppered. The ptient very soon fell sleep. Dover's powder, grins 10, given t nieht.

3 Dec., 1935] INTRAVENOUS ALCOHOL IN PNEUMONIA : BAKHSH & ANDREASEN 075 7th April. Twenty-two cubic centimetres 20 per cent lcohol repeted gin followed by slight rigor with subsequent improvement in generl condition mrked decrese in chest pin. Physicl signs in lungs, however, remined unchnged. Sputum hd by now become thin cler. Injections lcohol were given dily with progressive improvement in, generl condition subjective sympms, but without much effect on temperture. 9th April. White blood cells?12,000, without ny chnge in proportions different cells. 12th April (sixth dy disese). Temperture? 100.8?F., pulse?78, regulr good volume; respirtion?24, no distress. Physicl signs still remin those erly congestion. It ws difficult believe tht cse ws one pneumoni on sixth dy. 12th April. White blood cells?12, th April. Crisis occurred in fternoon, temperture dropping norml within twelve hours, remined norml. The ptient mde rpid uneventful recovery. Resolution lung condition ws complete by 16th April. Cse 4.?K. K., Sepoy, ged 30. Sudden onset^ on 10th April, 1935, with pinful cough, pin in right side fever. Cse 4, 4, Sepoy, K. K. K. K. Admitted 11th 11th April, Lobr pneumoni rt. rt. neurotic type with low threshold for pin, but ho ws emphtic bout beneficil effect injections, when it ws proposed sp tretment on ccount rection produced, it ws he who sked us continue t ny cost. Although temperture ws not much ffected, re ws moderte reduction in pulse respirtion rtes. The process consolidtion ws rrested except for ptch 2 inches by 3 inches on bck right lower lobe. 15th April. The bove-mentioned ptch consolidtion ppered for first time during course disese. The sputum, however, ws now thin cler pin in chest hd been bsent for three dys. White blood cells?12, th April. The ptient hd bd night with slight delirium. 17th April. The pin reppered on bck lower prt involved lobe but physicl signs were entirely negtive. 18th April. The temperture begn drop slowly with furr meliortion in generl sympms disppernce delirium. White blood cells?8, th April. Crisis occurred shortly fter lst his two dily injections. From this point on ptient rpidly recovered. Cse 5? G. M., Sepoy, ged 22. Sudden onset with severe bdominl pin on morning 29th April, Temperture?102?F., pulse?100, respirtion? 30. Abdomen showed no distension nor ny rigidity. Cse 5, Sepoy, G. M. Admitted 29th April, Lobr pneumoni rt. 2/\ 5 4 5? /O // /g /3 Resplriiorts 11th April. Admitted with moderte dyspnoe; no cynosis, ctive l; nsi herpes lbilis. The signs in lungs were those pneumonic congestion with udible pleuritic rub. Sputum ws thick, scnty, rusty; pneumococci present in lrge numbers. There ws ccentution redupliction second pulmonry hert sound. Or systems norml. The white blood cell count ws 16,000 (poly. 76 per cent, lympho. 22 per cent, 1. mono. 1 per cent, eosin. 1 per cent). 11th April. Tretment with lcohol commenced. It ws found tht fter his dily injection 22 c.cm. he hd rigor with rise temperture complined pin long rm during injection. This pin disppered immeditely on cesstion injection. Lter, on ccount persistent rigors, dose ws divided in two injections 12 c.cm. 10 c.cm. respectively, given one in morning, one in evening on ech dy. By this mens full dose ws given without ny rection. The ptient ws Pin chiefly in left upper qudrnt where slight locl tenderness hyperessi were elicited; slight impirment, over bck left lower lobe lungs, percussion note ir entry; no or physicl signs. Enem produced good result, hot wter bottle for bdomen relieved pin. 30th April. The ptient developed vomiting with dirrhoe. The sols contined no blood or mucus. Atropine 1/100 gr. morphi 1/6 gr. given. The vomiting dirrhoe cesed. The lungs now showed definite signs consolidtion over smll re,

4 THE INDIAN MEDICAL GAZETTE 676 2J inches by 14 inches over bck left, lower lobe. Pinful cough hd developed with rusty sputum contining numbers pneumococci. Alse nsi working with slight dyspnoe; no cynosis; white blood cell count (poly. 78 per cent, lympho. 18 per cent, I. mono. 3 per cent, eosin. 1 per cent). Tretment.?Twenty-one cubic centimetres 20 per cent lcohol solution injected intrvenously. Some coughing occurred during dministrtion lcohol, but few minutes lter ptient sid tht pin hd gone from his chest he ws feeling sleepy. On wking n hour lter, ptient hd no pin in eir bdomen or chest, his cough ws mrkedly less irritting. The ptient slept well tht 23vd My. ment, in 24th My. [Dec., Crisis occurred with generl condition. furr 1935 improve- Urine cler lbumin. Cse 6, Sepoy, R. S. Admitted 16th My, Lobr pneumoni rt. night. 1st My. Twenty-two cubic centimetres 33 per cent lcohol solution dministered. A slight rigor ok plce 20 minutes lter. The ptient hd n excellent night. Lung signs remined unchnged, without re consolidtion previously injection lcohol (33 per cent) ws repeted. The rigor ws this time very slight. The physicl signs diminishing; previous ptch consolidtion is now occupied entirely by rles, breth sounds re becoming vesiculr. 3rd My. The ptient himself sked for his injection this morning, stting tht he wished injections continued s he felt so much better fter previous one. The injection ws repeted. 4th My. The condition much improved, dyspnoe hs disppered. The signs consolidtion rles hve now completely disppered. There is no cough or sputum. Injections continued dily with furr improvement in generl condition. White blood cells?10,400. 6th My. The temperture rose only 99?F. 8th My. The temperture norml. The ptient sitting up with no signs in chest or bdomen. A rpid uneventful convlescence followed. Cse 6.?R. S., Sepoy, ged IS. Admitted on 16th My, Sudden onset pin in right chest twelve hours previously with cough fever. Temperture? 104?F.. pulse?120, respirtion?30. Generl condition good. Dyspnoe moderte; no cynosis; signs erly pneumonic congestion in right lower lobe lung; cough dry pinful without sputum. No pprent bnormlity in hert. Urine:?cid, specific grvity lbumin + + deposit contining few white blood corpuscles red blood corpuscles with some grnulr csts; no sugr or or bnormlity present. Blood slide for mlril prsites negtive. While blood cells?27,000 (poly. 75 per cent, lympho. 20 per 2nd My. ny increse in mentioned. The. cent, 1. mono. 3 per cent, eosin. 2 per cent). Totl red blood cells 4,287,500, hemoglobin 80 per cent, colour index 0.9. Sympmtic tretment ws instituted. 18th My. Condition sme. Sputum rusty, thick tencious. 19th My. Chest pin worse, cynosis evident, signs consolidtion hve ppered over bck right lung; chrcter urine unchnged. Tretment.?Injection lcohol (20 c.cm. 33 per cent) commenced. Slight coughing occurred during injection but no rigor. The effect ws drmtic, pin in chest disppering ptient flling soundly sleep within two hours injection. He hd peceful night with good del less dyspnoe. 21st My. Cough sputum prcticlly negligible. Urine tl quntity 29 ounces, lkline, specific grvity 1031, lbumin nil, csts few, number very much decresed. No red blood nor white blood corpuscles. Injections lcohol continued dily without ny rection such s rigors or coughing. 22nd My. Sleeping well feeling well with very little cough. Lung signs remined unchnged. White blood cells?12,400. The lbumin reppered in urine in very slight quntity, but no or bnorml content. 25th My. A slight rising temperture 99.4?F. Init progress orwise very stisfcry. 26th My. Resolution is rpidly tking plce. From this dte on no more injections were given, convlescence ws rpid uneventful. Discussion The first cse, one pulmonry bscess, is included in this pper becuse it ws our first cse in which intrvenous lcohol ws tried. The results were so encourging in cse which ws cliniclly in very bd condition tht we were opinion tht perhps, by erly institution lcohol tretment in ll cses pneumoni, we might void mny complictions this disese. In connection with subject lcohol intrvenously dministered in pneumoni, one us (A.) clls mind cse double pneumoni, treted lst yer. The ptient hd rrived t its eleventh dy with consolidtion present in both lungs with bubbling rles, temperture?104?f., pulse?130, irregulr low tension, respirtion?55, cynosis mrked with cold sweting extremities, with no signs crisis or resolution by lysis being bout tke plce. All signs impending dissolution were present; ptient ws severely xic, delirium hd been present for three dys. The urgent question treting ptient hd

5 ALCOHOL Dec., 1935] INTRAVENOUS IN injection intrvenous fced. An hlf n ounce glucose 10 per cent bry ws in bout 50 c.cm. sterile norml sline once dy, eleventh twice given during The effect, on twelfth thirteenth dys. food vlue which we t tht time scribed The ptient injection, ws drmtic. ws becme quiet, respirry distress temperrelieved, fter slight rigor, fll until ture begn fll, continued it reched norml on thirteenth morning. his The ptient hd, by this time, quite regined mde on n norml mentl stte from be good recovery. We now think, in view six bove, quoted injection cses tht beneficil effect not in this pprently hopeless cse ws due specific s food vlue so much ction lcohol. We think following points worthy on note. Some se re difficult describe tht y pper but were so striking cliniclly must be recorded. injection, () Pin.?Within n hour decrese in sufficient ws in every cse, re llow chest intensity pin in comhd It ptient " sleep comfortbly hours within pletely disppered first injection. during (b) Cough.?After slight stimultion ws stedy re injection in some cses, ccom- decrese in pnied by coughing. This ws chnge in chrcter mount decrese in from thick, rusty, pneumonic mtter within sputum cler non-viscid wtery In two three dys first injection. before begun ws those cses where injection sputum hd become rusty, it never developed but very soon becme wtery this sputum. There ws chnge chrcter, eject. (c) Dyspnoe cynosis.?cynosis mined entirely insignificnt throughout where esy re- disese in those cses first or injections were commenced from mjority cses, second dy disese. In lowered respirtion rte ws dyspnoe much reduced. ws slightly {d) Pulse rte.?the pulse rte lowered, in cse 3, it remined surprisingly rising low considering temperture, rrely In cse 102?F. bove 88 for temperture cute nephritis 6, which ws complicted by not com tretment with lcohol ws remined pulse menced until fifth dy, tht dy. well below 110 level fter rise tem(e) Temperture.?There ws ech injection, perture more or less, fter ptient's condis rise being less less however, remrkble, ws It tion improved. until tht temperture remined rised ninth dy, just crisis occurred t eighth or lthough s in n untreted cse pneumoni, temperture* perhps generl height course PNEUMONIA ws not so : BAKHSH & ANDREASEN 677 high s it would hve been or- wise. (/) Consolidtion.?Arrest process consolidtion in those cses treted from strt disese ws most remrkble outsting feture. The congestive stge grdully regressed, so tht by time crisis occurred involved lobe ws lmost free from ny signs pneumoni. In cses 2 6, where lcohol ws not commenced until fifth dy disese where consolidtion hd lredy set in, rpid resolution ws noteworthy. Resolution in non-lcoholtreted cse tkes from dys be completed, wheres in se cses it ws complete before second dy fter crisis. (g) The leucocyte count.?except in cse 2, where count rose from 8,500 12,800 fter first injection, re ws grdul decrese running prllel with regression lung signs improvement in generl condition ptient. (h) Course disese.?in cses 2 6, where injection ws given on fifth dy disese, crisis occurred on eighth ninth dys, respectively. In cses 3, 4 5, injections were commenced on second dy disese crisis occurred on 8th, 9th 8th dys, respectively. Thus course disese, from rise temperture on first dy fll on eighth or ninth dy by crisis, ws with lcohol, in those sme in cses treted in those not with treted lcohol, prtilly treted t ll by lcohol. The complictions, i.e., lung bscess cute nephritis, were beneficilly ffected by lcohol. (i) The subjective condition ptient ws immeditely chnged from tht cute distress pneumonic ptient one ese sleep. The ptients mselves so felt benefit injections tht y mselves sked for ir injections, looking forwrd relief which lwys followed ech injection which incresed from dy dy. Although no conclusion cn be drwn or hyposes fered we feel tht we hve h new method for tretment pneumoni worthy furr investigtion tril. As cses occur so we re continuing our investigtions hope tht in ner future we shll hve vilble necessry rrngements in order tht certin collterl lborry investigtions my be undertken. The bove tretment is now being pplied by one us post-nestic post-opertive lung complictions. Summry method tretment for pneumoni is put forwrd, six cses re described, effect intrvenous lcohol, s observed in se cses, is discussed. A new (Continued, t foot next pge)

6 (Continued from previous pge) The min effects re :? Pin cough re immeditely relieved. The consolidtion is rrested regresses, The ptient's distress vnishes he sleeps well, The ' defences' body re pprently not interfered with. References Lu, A., Feigin, M., Buer, J. (1931). Presse Med., Vol. XXXIX, p Sutcliff, W. D., Finl, M. (1934). New Engl Journ. Med., Vol. CCX, p. 237.