192 DISEASES OF THE PARENCHYMA OF THE LUNG. 



and inhalation of chloroform. By means of each of these agents, the 

 action of the heart and the temperature can be reduced, and the fever 

 moderated; but they have no immediate local influence. The use 

 of tartar-emetic has of late fallen somewhat into discredit. My re- 

 cent experiments with quinine show that, in cases of danger from exces- 

 sive fever, quinine should be given in two-grain doses every two hours ; 

 or, what is better, in two or three ten-grain doses at short intervals. 



According to Biermer, veratrin (a remedy spoken of by Vogt as a 

 very effective antipyretic) is one of the surest means of diminishing 

 the pulse-rate, and reducing the temperature in pneumonia. Indeed, 

 JBiermer, Kocher, and others, claim for it a direct influence upon the 

 pneumonic process itself, and maintain that, in certain recent cases, 

 the disease has been eradicated by its use. Veratrin has this advantage 

 over digitalis, that it operates more promptly, both upon pulse and 

 temperature, and is less apt to act cumulatively. But, on the other 

 hand, reduction of the temperature and lowering of the pulse can only 

 be brought about by the exhibition of doses so large as to cause symp- 

 toms of poisoning, vomiting, purging, and great prostration. Of pure 

 veratrin, the twentieth of a grain may be given for a dose of the 

 resin, veratri viridis, one-sixth of a grain. Of the tincture, from four 

 to eight drops may be taken every three hours in a mucilaginous ve- 

 hicle. Modern experience fully warrants its use in recent cases and 

 robust subjects. 11 



In most cases of pneumonia all the above-named measures are su- 

 perfluous, and the patient will soon improve under cold compresses 

 and a placebo of gum-water ; still, the better we remember the indi- 

 cation for active treatment, the greater our success will be. 



As the disease advances, the symptoms often demand measures the 

 physiological operation of which is exactly the opposite of all those 

 hitherto described. We have seen that an excessive exudation, a pro- 

 traction of the pneumonic fever, or, independently of either of these, 

 a debilitated state of constitution prior to the attack, may give rise 

 to a state of the most complete adynamia ; and, indeed, it is to this ex- 

 haustion that most people succumb who die of pneumonia. The feeble 

 contractions of the heart tend to produce new dangers from passive 

 oedema of the lung, and commencing palsy of the bronchial muscles 

 embarrasses the evacuation of the bronchi. Stimulants must now be 

 administered; the heart is to be excited into energetic action; tho 

 contractile power of the bronchial muscles must be raised. Fruitless as 

 their extensive employment often is in other diseases, from the transi- 

 tory character of their action, yet stimulants may produce very gratify- 

 ing results if given in cases where symptoms of exhaustion arise while 

 the pneumonic process is still incomplete. By giving large doses 



