ABORTIVE TREATMENT OF PHI, 
BY W. Y. GADBURY. M. D., 
OF YAZOO CITY, MISSISSIPPI. 
READ BEFORE THE STATE MEDICAL ASSOCIATION OF MISSISSIPPI. Abortive Treatment of Pneumonia, 
W, Y. GADBURY, M. D,, OF YAZOO CITY, MISS, 
I desire to introduce to this body for discussion a sub- 
ject that may properly be designated as the Abortive 
Treatment of Pneumonia. I have hesitated to do so, be- 
cause some of our best authors have recently adopted the 
theory that the disease is of constitutional origin—that it 
is a fever with a local manifestation. I am not yet pre- 
pared to concur in opinion with those who advocate this 
doctrine, but as the question can only be settled by ex- 
tended observation and research, I will confine myself to a 
brief recital of the reasons which induce me to believe 
that the disease is of a phlegmonous character, entirely 
independent of any previous constitutional taint. It would 
be a strange doctrine to declare that plasticity of the blood 
and exudation of lymph within the cells of an injured 
organ, whether, the result of traumatism or not, should be 
considered a constitutional disease. This reserve power of 
the blood, ever present in healthy organisms, is essential to 
life and may be called forth at any moment to preserve the 
integrity of animal tissue. A scratch or a wound imme- 
diately receives this benign gift. Perhaps in every stage 
of life, it is demanded to repair damage in hidden parts of 
the body, which, if left unsealed, would greatly shorten the 
duration of human life. 2 
Abortive Treatment of Pneumonia. 
We have all witnessed the origin of local lesions at- 
tended by the exudation of fibrinous products, resulting in 
fever of several days duration. We have seen this mate- 
ria] poured forth on the tlaps of amputated limbs in cases 
when it was impossible that it could have proceeded 
from a blood poison. There is no reason why it should 
not occur in the lungs from causes which determine other 
local lesions. The attenuated and porous nature of the 
lung tissue, the complexity of the pulmonary circulation, 
its tortuous and distended capilliaries exposed to the con- 
tact of air of dilferent density and temperature, all con- 
spire to form a nidus for the arrest and reception of any 
material that may be floating in the blood. It is there- 
fore not surprising that any sudden influx of blood ren- 
dered adhesive by the development of fibrin should close 
the cells and delicate network of the lungs. Thus clogged 
and rendered unfit for duty, exudation or degeneration 
must take place. There is no density of tissue to limit the 
quantity, and the whole substance of a lung may be filled 
with this product if it is not arrested. It is not denied 
that pneumonia may be cotemporaneous in its origin with 
zymotic fever, and we all know that it is often intercurrent 
in the progress of fevers and surgical injuries. This much 
of the pathology and history of the disease comes within 
the province of this paper, which is designed to show that 
the disease is not of constitutional origin or strictly self- 
limited in its nature, but that it may be aborted in its course. 
There are four objective points in the treatment of this 
disease, which should at all times be kept in view. First, 
to give rest to the injured organ by paralyzing the respira- 
tory nerve centers so as to reduce the respiratory move- 
ments nearly to the normal standard. Second, to arrest 
the congestion and exudation. Third, to reduce the tem- 
perature and pulse. Fourth, to support the system. All 
of these must be constantly in the mind of the attending 
physician, from the onset to the termination of the case. 
The following extracts, taken from Fothergill’s Hand- 
book of Treatment, illustrates in forcible language the 
opinions which have exercised a controlling influence over Abof,tive Treatment of Pneumonia. 
my mind for many years. On page 205 the author says: 
“Under all circumstances it is very necessary that rest as 
far as possible be given to the diseased viscus. In all in- 
flammatory conditions rest is clearly indicated. Quiet- 
permits of the reduction of the hyperaunia, which is the 
initial step of the inflammatory process, whether, simple 
or tuberculous. It is the impossibility of securing perfect- 
rest that renders the presence of tubercle in the lungs and 
bowels so much graver than is its appearance in an ordi- 
nary gland. The constant movements of the lungs and of 
the bowels cause a further development of connective tissue, 
just as does the movement of a broken limb call out callus ; 
and this new formation takes on in its turn, tuberculous de- 
generation. If rest could be secured the secondary forma- 
tion could be avoided.” 
Again, on page 391, he condemns without qualification 
the use of opium in thoracic diseases on account of its 
paralyzing influence over the heart and respiratory nerve 
centers. His condemnation of this grand and heroic rem- 
edy from a theoretical stand-point is unsustained by prac- 
tice, and few practitioners in this country will admit the 
correctness of the author's opinions. The paralytic and 
antagonistic influence of remedial agents deserve more 
consideration than they receive from medical teachers, and 
the day is not far distant when much of the mysterious 
operation of medicines, will be explained through their 
influence directly upon the nervous system. It is unfor- 
tunate that Dr. Fothergill did not point out clearly the in- 
dications which forbid the use of opium in thoracic aflec 
tions. His simple declaration that it paralyzes the heart 
and respiratory nerve centers, does not- prove its lethal ten- 
dency when properly used. We all believe that we can 
determine when it is indicated, but it is extremely difficult 
to know the stopping point. A remedy of such power over 
the heart and lungs could not be otherwise than dangerous 
if misapplied or used in excess. 
The precept taught in this extract is universally accept- 
ed as true by the profession, and if he had not attempted 
3 4 
Abortive Treatment of Pneumonia. 
to cast odium upon the only reliable remedy we have to 
secure the desired rest, we would have no cause of quarrel 
with the author. He then proceeds to declare that opium is 
a dangerous remedy. 
If timely and judiciously applied, there is no remedy 
known to me which exerts so much control over this dis- 
ease as opium. Its use is attended with some hazard, as its 
paralytic influence is not confined to the thoracic organs 
alone, but involves the vascular system, and all the secer- 
nant organs except the skin. 
While it arrests the congestion and exudation, it renders 
torpid the liver, kidneys and alimentary canal. Vigilance 
is therefore necessary to guard against suppression of 
urine and torpor of all the digestive organs. Enemata and 
diuretics may be demanded to correct these evils. As a 
general rule, opium, or some of its preparations, may 
be given boldly in the early stages of pneumonia, with a 
view to the rapid reduction of the respiratory movement, 
but when the forces begin to flag, quinine and alcoholic 
stimulants must be combined with it, to counteract its gen 
eral sedative effect upon the system. Its local influence 
over the thoracic organs once acquired, may be sustained 
without narcotism. In some persons great mental distress 
results from its use, but even in these cases its sedative 
influence may be secured by a judicious combination with 
other agents. Sometimes it is better borne when given by 
enema, or under the skin. When one form disagrees 
some other should be selected, or the opiate may be com- 
bined or alternated with chloral or the bromides, aconite, 
ox. cerium, ammoniated valerian, veratrum, or ipecac. Al- 
coholic stimulants sometimes render the system more tol- 
erant of opium. When rest has been given to the injured 
organ and fever is subdued, the remedy may be gradually 
lessened in quantity, but in no case withdrawn under two 
or three days, unless deep narcotism should supervene. In 
this latter event, the usual antidote must be given until 
stupor passes off. At this period, we often find alcoholic 
stimulants demanded on account of the prostration of the Abortive Treatment ok Pneumonia. 
5 
vital powers, and their continuance with morphia and 
quinine may sustain the paralytic influence already ac- 
quired over the nerve centres. They are by no means an- 
tagonistic in their operation in this disease. 
If exhaustion does not require the use of stimulants, it 
is better to withhold them until the respiration and febrile 
movement have been reduced and sustained for several 
days. The quinine, in my judgment, has more sustaining 
powers than any evanescent stimulant, but both may be 
required to sustain the system. If, after using the sedat- 
ives and anti-pyretics, the disease is held in abeyance for 
two or three days, it is well to offer some acce})table form 
of alcohol, and if it is relished by the patient, and he rests 
quietly after using it, then it may be allowed freely in 
doses sufficient to satisfy the demands of the case. This 
agent is also a respiratory depressant and hypnotic, as 
well as a sustainer of the vital forces in some con- 
ditions of the system, but as a general rule, its therapeutic 
value is more easily determined by the patient than the 
physician. If it is agreeable and comforting to the patient, 
his judgment as to quality and quantity maybe trusted 
in pneumonic cases, provided his perceptive faculties re- 
main intact, otherwise the attending physician must decide 
when and how much must be administered. The tempera- 
ture of the sick room must be kept uniform. 
Alimentation, digestion, assimilation and nutrition 
should receive due attention in the advanced stage of the 
disease. Having stated the outlines, I will now briefly 
give some of the details of treatment. 
The first and most important indication in the treatment 
of pneumonia is to give rest to the respiratory movements 
by paralyzing the respiratory nerve centres, and for this 
purpose, I prepare the following combination, altered to 
suit the age, condition and idiosyncracy of the patient, viz : 
R. Calomel. 
Bicarb, soda, a a grs. xii. 
Quinine, drachm, j. 
Acetate Morphia, grs., iv. 
Mix and make 12 powders. 6 
Abortive Treatment of Pneumonia. 
Si#-—One powder every 2, 3 or 4 hours, until the res- 
pirations are reduced nearly to the normal standard, or 
profound narcotism ensues. The nurses are instructed to 
make a record often of the pulse, respirations and temper- 
ture, and to watch for narcotism. If the patient does not 
arouse from sleep easily, the intervals are increased. 
Warm turpentine stupes are applied over the affected organ 
and continued until the surface is deeply reddened. Over 
this is applied cotton wadding and a flannel bandage. 
If this fails as a counter-irritant, croton oil is added. If 
the fever is not high, it is well to apply a blister at once, 
guarding against extensive vesication by the early use of 
emollient poultices. If the patient complains of the bad 
effects of the opiate, 5 grains oxalate cerium and 3 drops 
of tine, aconite root given with each powder, will soothe the 
patient if his bowels are opep. Tine, veratrum may be of 
service to reduce the fever, but repeated doses often dis- 
turbs the stomach and depresses the system. A good con- 
dition of the stomach contributes much to the successful 
management of this disease. During the active stages the 
bowels should be moved by enemata every 24 hours, to re- 
duce the fever and divert from the brain. When the fever 
has been subdued, and indications of exhaustion are evi- 
dent, the mercury should be discontinued. My experience 
induces me to believe that when the respirations are re- 
duced nearly to the normal standard, and held down for 
2 or 3 days, the congestion and exudation will be arrested. 
If the skin becomes cool and relaxed, opium should be 
substituted for the morphia, and the patient may be in- 
vited to try stimulants. When the skin is dry and harsh, 
and the stomach is in good condition, dovers powders may 
keep down the thoracic movements and relax the surface. 
This is an excellent preparation for children when it does 
not disturb the stomach. When it is rejected, I prefer 
the following formula, which makes the safest and best 
liquid preparation of this class I have ever used, viz: 
R. Acetate morphia grs. ij. 
Bicarb, soda, drachms ij. 
Mint water, oz. iv. 
Mix and iilter carefully. Abortive Treatment of Pneumonia. 
Dose for adults, a tablespoonful; for children, one-htilf 
to one teaspoonful as often as required. I introduced this 
preparation during the late war under the name of ano- 
dyne mixture, and it became a favorite with physicians, 
druggists and familes where it is known. It is an excel- 
lent substitute for paregoric, over which it possesses many 
advantages—efficient and comparatively harmless, and es- 
pecially adapted for the diseases of children when opiates 
are demanded. 
To impress upon you the benefits as well as the dangers 
of this plan of treatment, 1 will cite a case which occurred 
in the family of Dr. J. P. Moore, a prominent member of 
this Association. His son, aged 20 years, was seized with 
pneumonia, involving both lungs. The doctor requested 
me to see the case, and after consultation we agreed to try 
the abortive plan. The combination of calomel, quinine, 
soda and morphine was pressed upon the patient for fifteen 
hours, when he suddenly became deeply narcotized from 
the effects of two and a half grains of morphia. This 
condition was promptly met by the usual antidotes, and 
he rallied in a few hours to find himself convalescent with 
some hepatization of the inferior lobe of the left lung 
He was directed to continue the quinine and take stimu 
lants, which soon restored him. This young man was 
delicate and impressible, and had been taking brain seda- 
tives previous to the attack, which I think accounts for the 
sudden access of narcotism, a result that I never witnessed 
from so small a quantity of morphia before. Many cases 
will take double this quantity for days without narcotism, 
while others yield promptly to its influence. This diversity 
of impressibility is difficult to explain, and we have no 
data which will enable us to determine the maximum dose 
that can be borne. Mr. Moore’s case was exceptional, and 
cannot be considered a criterion. Some of my cases have 
taken a grain of morphine every three hours, combined 
with other agents, during the first twenty-four hours, with 
the happiest results. 
I have made no distinction between lobar and lobulai 
7 8 
Abortive Treatment ok Pneumonia. 
pneumonia, because 1 believe this treatment applicable to 
both forms of the disease. Nor do I consider it neces- 
sary to enter into minute details. Since I have adopted 
this plan my mind has often reverted back over a broad 
iield of professional life, checkered with marks of devo- 
tion to every system that lias prevailed for the last thirty 
years, with a view to determine their relative merits, and 
on each comparison my judgment was strengthened in the 
the conviction that the one 1 now suggest has yielded 
more favorable results in my hands than any other. Mod- 
ification of treatment maybe demanded, but the principles 
which I have endeavored to inculcate in this paper I be- 
lieve will bear the scrutiny which awaits every innovation 
on the fashions of the day, and trust you will all give it a 
fair trial.