The Purvis Oration ON THE DIAGNOSIS OF ORGANIC FROM FUNCTIONAL AFFECTIONS OF THE NERVOUS SYSTEM: Delivered before the West Kent Medico-Chirurgical Society
Authors: J. S. R. Russell
Journal: BMJ (1908)

MLRcCH.4, 1909&I-can only run -over -these matters briefly, and cannot touch all the points, The patient has something the matter with his lungs, and therefore it is often thought that the first thing to do is to give expectorants.What do we mean by expectorants, and what is their action?We! mean either that expeotorants assist the patient to cough up the secretions In their tubes-to " loosen " it, as they say-Dr ..that the expectorant produces a secretion In the tubes.O course we do not want to produce any secre- tion, In the tubes in pneumonia, and there is not any- thing except in the pneumonic parts to bring up.So expectorants,are contraindicated, and clinically they are found not to do good.,The patient has a cough.What is the use of that cough to him?It is intended.to help him to get rid of the little secretion in his tubes, and therefore It is a thing to encourage and not to stop.And where the cough is not verytroublesome you need n,ot worry about it.This raites another question: Shall you give anything like that very favourite remedy, Dover'a.powder ?That contains opium.What.wlll be the effect of giving opium?You cheek the patient's sensibility and-he will not get rid of the stuff out of his tubes.Remember that opium is a drug whtchmust be employed with verygreat care in pneumonia.Sleeplessness is another most important symptom to treat n --pneumonia.Many patients sleep brokenly, but still they -sleep.Other patients cannot close their eyes, they long fox sleep but cannot get it, and they lie awake day and-night, If you do not procure them sleep some- how, they will die of sheer exhaustion.Another point is, that not only are -the patients sometimes sleepless1 but they,are actually delirlous and wild, and are cinstantly getting out of.bed,-or trying to.And drinkers get delirium tremens under these circumstances, and it they are allowed, they run all about the room, seeing things.These patients frequently die.But if there is no delirium tremens, no drink,but, an ordinary case of pneumonia with nervous iymptoms, in a patient who has been working the brain very actively, in such patients pneu- monia takes on the nervous type; they are often found to be unable to obtatn sleep, and they become actively delirious. .The other day I went to see a gentleman who had had -no sleep for at least forty-eight hourE, and yet his temperature had fallen and apparently hls pneumonia was resolving, or at any rate had come to an end.He was incessantly talking and fidgeting, and tryIng to get out of-bed and Jumn about.What shall you do for such a case as that?You must get him to sleep, and at once.How shall you do It?You cannot give large doses of' chloral, because of.the action which that exerts on the heart.It is no good playing with sulphonal and paral- dehyde and things of that sort, which may or may not affect him, but will take some hours to do 0o In any case.It is no good, giving potasium bromide, and you cannot give chloroform in such a case, and so it comes to this, can you give a subcutaneous injection of morphine ?You must.The only contraindication to giving morphine in any chest complaint is a large amount,.ofsecretion in the tubes, because It prevents the desire to cough so as to get rid of-it.But in a number of theEe cases there is nothing obviously wrong in tbe other parts of the lunggs-only In the' part which is inflamed-and if one lung is free of -disease you -may give some opium.Bat you must be prepared for frights after you have given it.-Youmay -glve an adult pattent one-third of a grain of morphine, and if he does not sleeo as a result of that, you may give him another.With that dose of two thirds of .agratn he may go to sleep, and then you find after a time that you cannot awaken him, and you ORiAI AN FTCIALNROS FETOS.a6