ICE IN THE TREATMENT OF CROUPOUS 
PNEUMONIA. 
BY 
is 
THOMAS J. MAYS, M.D., 
PROFESSOR OF DISEASES OF THE CHEST IN THE PHILADELPHIA POLY- 
CLINIC, AND VISITING PHYSICIAN TO THE RUSH HOSPITAL 
FOR CONSUMPTION. 
FROM 
THE MEDICAL NEWS, 
January 21, 1893. [Reprinted from The MEDICAL News, January 21, 1893.] 
ICE IN THE TREATMENT OF CROUPOUS PNEU- 
MONIA. 
By THOMAS J. MAYS, M.D., 
PROFESSOR OF DISEASES OF THE CHEST IN THE PHILADELPHIA POLY 
CLINIC, AND VISITING PHYSICIAN TO THE RUSH HOSPITAL 
FOR CONSUMPTION. 
Under the title, “ Can Croupous Pneumonia be 
Aborted ? ” I contributed a paper to The Medical 
News of September 24, 1892, in which are given the 
histories of two cases of pneumonia treated princi- 
pally with applications of ice to the chest. Since that 
time I have used the same method of treatment in a 
number of other cases, with equal success, and have 
considered the subject of sufficient importance to 
institute a collective investigation on a small scale by 
sending 500 circulars of inquiry1 to as many mem- 
bers of the profession, so as to ascertain whether 
my experience with ice in this disease has been or 
may be disproved or confirmed. I have already 
received a number of responses to my circulars, 
which I shall prepare for publication in due time; 
but before doing so, and in order to make my col- 
lective report as full and as conclusive as possible, I 
am anxious to correct, so far as I am able, the false 
and unreasonble prejudice that exists against the 
1 I shall be glad to send circulars to any wjia, want or have 
not received them. 2 
application of cold in pneumonia—a feeling that 
I shared myself until I gave the plan a trial—and 
shall herewith communicate a history of one of my 
recent cases, the treatment of which has just closed, 
and which, on account of its interesting course 
and termination, will, I trust, aid in removing this 
serious obstacle to the more general use of what I 
conceive to be a most valuable remedy. 
R., male, aged forty-five, was admitted to the 
Polyclinic Hospital on December 15, 1892, with the 
following history: He was taken ill with a pain in 
his left side five days previously. On admission his 
temperature was 102.6°, his pulse was no, and his 
respiration 30; the countenance was flushed; he was 
restless and delirious; the sputum was rusty and 
bloody; he had a dry, black coated tongue, a pulse 
intermittent every fourth beat, and the chlorids were 
absent from his urine. He had been a hard drinker 
for twenty years. Physical examination showed 
dulness extending from the apex to the base of the 
left lung anteriorly, laterally, and posteriorly. The 
dulness in the upper anterior half of the lung partook 
of the nature of flatness. The right lung was normal. 
Anteriorly there was complete suppression of respira- 
atory murmur in the upper half, and crepitation and 
partial suppression of respiratory murmur in the 
lower half; posteriorly in the upper half there were 
a few moist rales, and in the lower half, bronchial 
breathing. 
His whole left chest was enveloped in ice-bags 
wrapped in dry towels, and ice was applied to his 
head on the afternoon of the first day of admission. 
He was ordered of a grain of strychnine every 
three hours, and of a grain of the same drug hypo- 
dermatically morning and evening, ten drops of the 3 
tincture of digitalis every four hours, and three 
ounces of fresh beef-juice alternately with a glass of 
milk containing a tablespoonful of whiskey every 
hour. 
On the 17th, two days arter admission,the intensity 
of the flatness of the upper half of the lung had mark- 
edly diminished, and the respiratory murmur and 
very moist crepitation were now heard in this area; 
the crepitation and bronchial breathing in the lower 
half not materially changed. 
On the 20th dulness had disappeared almost en- 
tirely from the lower half, and had diminished very 
much in the upper half. The last area was now freely 
permeable to air, and moist crepitant and subcrepi- 
tant rales could be heard all over it. 
On the 24th the physical signs, except impaired 
percussion resonance in the upper half anteriorly, 
had disappeared, and the ice was discontinued. 
The digitalis by the mouth, and the strychnine 
hypodermatically, were also stopped, but of a 
grain of strychnine by the mouth was kept up 
three times a day. The beef-juice, milk, and whiskey 
were continued at longer intervals. 
The temperature began to fall on the 16th, the 
day following the application of the ice, and on the 
morning of the 18th it was reduced to the normal 
point, where it practically remained. The sputum 
continued rusty, bloody, and copious for one week, 
but the pain and cough subsided soon after the ice 
was applied. The breathing also became much 
easier. 
On the afternoon of the 18th the low muttering 
delirium and picking at the bed-clothes, symptoms 
which were strongly marked in this case, gave way 
to a most violent attack of delirium tremens. This 
became so active that it was necessary to strap the 
man in bed for twenty-four hours, and under the 4 
liberal appliance of morphine, potassium bromide, 
sulfonal, and whiskey the attack was subdued in 
about forty-eight hours, and after this he made an 
uninterrupted recovery. 
The accompanying chart illustrates the tempera- 
ture, pulse, and respiration rate of the case. 
This case presents several features upon which I 
shall in conclusion take the liberty of making a few 
brief comments. 
i. Prognosis. Without claiming too much it may 
be said that this was unfavorable. Every-day ex- 5 
perience teaches that the alcohol-habit creates a pre- 
disposition to pneumonia, and that alcoholism is one 
of the gravest complications of the latter disease. 
When this condition is taken in connection with 
the delirium and the picking at the bedclothes it 
is quite certain that the prognosis was not reassuring 
in this case. 
2. The resolving power of the ice on the pneumonic 
exudation. It is of course well known that cold has 
the power of contracting the bloodvessels, and with 
this view of its action it is clear how ice is capable 
of dissipating an engorged state of the circulation 
such as is found in the early stage of pneumonia; 
but when it resolves an inflamed area which, from 
the absence of the respiratory murmur and the 
presence of the flat percussion-note, it is quite cer- 
tain had passed beyond the stage of engorgement 
and into that of exudation, we are more or less 
at a loss to account for the mode of its opera- 
tion. I must confess that the lateness of the time 
at which the ice was first applied made me very 
doubtful whether it would have the least influ- 
ence on this (upper) portion of the lung, and I 
therefore relied chiefly on its power to check the 
extension of the disease in the remainder of this 
organ. That it had this action was well evidenced 
two days after it had been used, when moist crepita- 
tion and the respiratory murmur appeared, showing 
clearly that the air vesicles were freeing themselves 
of exuded material and that air again had access to 
them. 
3. Influence on the symptoms. In most of the cases 
that have come under my observation, the pain, diffi- 6 
cult respiration, cough, and expectoration so con- 
stantly associated with pneumonia were all notably 
relieved in a short time after the ice was applied. This 
alleviation was very pronounced in the case under 
consideration. Very oftea it is this feature of the 
treatment that makes it acceptable to those patients 
who yield to it at first under strong protest. 
4. Value of strychnine. The value of strychnine 
in the treatment of pneumonia has been well de- 
monstrated by Brunton and others, but its efficacy 
lies only in the administration of large doses and 
in its being pushed to the point of its physiologic 
action. When given in this way it is infinitely bet- 
ter than digitalis—in fact, I think the usefulness of 
the latter drug in pneumonia is greatly over-esti- 
mated, and its supposed benefit is founded on a 
spurious pathology. By the mouth and hypoder- 
matically this patient received nearly half a grain 
(i7?) strychnine daily for five days with good 
results. It is needless to say, however, that if he 
had not been a chronic alcoholic the physiologic 
limit of the action of the drug could have been 
reached by giving smaller doses—say from to 
of a grain every three or four hours, with an extra 
daily injection of -fo of a grain. 
Details of treatment. Surround the affected area, 
front, side, and back, with rubber ice-bags well 
wrapped in towels, continuously. Care must be ex- 
ercised to prevent the ice-bags from leaking, and 
from moving away from the chest. Place an ice bag 
on the head. Give from to of a grain of strych- 
nine, by the mouth, every three or four hours, and 
an injection of of a grain of the same drug once 7 
a day until its physiologic action becomes ap- 
parent in restlessness, which may, perhaps, be first 
observed in the lower extremities, the reflexes of 
which are usually enhanced. Give morphine hypo- 
dermatically to produce sleep, and three ounces of 
freshly expressed beef-juice1 alternately with a glass- 
ful of milk with whiskey every two hours. If the 
stomach is rebellious give the beef-juice, milk, and 
whiskey by the rectum. A tablespoonful of beef-pow- 
der in chocolate or coffee is a most valuable food in 
these cases when given every three hours. In the 
convalescent stage I have found the following for- 
mula very serviceable: 
R.—Strychninae sulph. . . . gr. I yi. 
Syr. acidi hydriodici 
Syr. hypophosph. 
aa f^ij.—M. 
S.—One teaspoonful four times daily. 
1 The Osborne Beef Press, No. i or No. 2, may be used to ex- 
press the juice of fresh beef. The Medical News. 
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