However, we know that a large num ber of cases of tuberculosis is due, pri marily, to lack of assimilation, and it is not strange that we find quite a percent age of patients with chronic gastritis and dilated stomachs. Most cases of this nature can be relieved by siphon irriga tion of the stomach three times a week, and, if dilatation be present, Einhorn's electrode may be introduced and Lama dization practiced.
Milk or cream, meat, eggs, vegetables, and game are all staples that should be liberally provided. When patients first come under treatment, owing to a gen erally depreciated vitality, it may be ad visable to allow a cup of broth or bouil lon or a glass of milk between meals; but as early as possible this extra diet should be dispensed with. Occasionally, even in incipient cases, the digestive functions are so impaired as to make it imperative to select a special diet, until, by the use of electricity and lavage, they have been restored; the following is a good selection for most cases: 7 A.m. Two soft-boiled eggs. Two slices of buttered toast. One cup of coffee with milk, cream, and sugar.
9.30 A.M. IiOUnIss (10 ounces) and two slices of bread and butter.
12.00 M. Lamb-chops, steak, or chicken. Mashed or baked potatoes. Boiled rice in milk. Toasted bread and butter. Weak tea with milk and sugar.
3.00 P.M. Same as 9.30 A.M.
5.30 P.M. Meat-soup with farina or the like in it. Squab or other meat. Spinach, asparagus, green peas. thick ened rice, or some pudding (custard).
8.30 P.M. Koumiss, crackers and butter, or oysters, ale and crackers, or a sandwich and stout.
Individual Medicinal Treatment. There is too great a tendency among the profession to depend mainly upon one line of treatment in this disease. Either the patient remains at home and becomes the recipient of medicinal treat ment or is sent away with the instruc tion to depend upon climatic influences for the arrestment of his trouble. Clini cians of experience among the tubercu lous in various health resorts all recog nize that good results can generally be looked for only when climatic influences are supplemented by judicious symp tomatic treatment.
Only a few years ago the recognized treatment of phthisis was to administer sedative cough-mixtures and deliver the hopeless patient over to the kind and cheerful ministrations of priest and neighbor. Then came the era of dosing, and codliver-oil and ereasote followed. Now climate, hygiene, and dietetics very properly form the basis of all intelligent treatment of tuberculosis. The remark ably encouraging results attained at sanitariums in America and abroad have aroused the profession from a lethargy born of hopelessness.
The public is at last beginning to understand, not only that tuberculosis is infectious, but that it is, in a large majority of cases, susceptible of cure. Recognizing this fact, the various health resorts of the country have been, for the past year. more than ever crowded with victims of this dread disease. Unfortu nately, very many are imbued with the idea that climatic influence alone is all that is needed to restore them to health.
No general line of treatment can be laid down for even a small percentage of tuberculous patients. We must not ex pect to treat successfully pulmonary tuberculosis in the abstract, but every case must. in justice, be treated in ac cordance with its individual manifesta tions of disease, idiosyncrasies, and com plications.
Probably it is this individualizing of patients that is largely responsible for the comparatively flattering results ob tained among sanitarium patients over those attainable in private practice in the same climate.
In very incipient cases, in those of the pretubercular stage, climate and out-of door life are generally all that is neces sary to insure but, unfortu nately, the percentage of such cases is small when the disease is recognized. The general run of so-called incipient cases all present complications of one sort or another demanding treatment in order to remove conditions which, if al lowed to remain, will, to say the least, severely handicap the patient in his fight for life and restoration to health.
Symptomatic treatment and indi vidualizing of patients are exceedingly important in all cases. Almost invari ably anemia is present and must be re moved. This is most readily accom plished by administering iron and static electricity. Among various forms of iron the following are preferable: pep to-mangan, tr. citro-ferri chloride, and Bland's pills. Static electricity should be given for one hour daily, the patient being charged through the negative pole except in decided neurotics, in whom the current should be reversed. Func tional cardiac disorders should be con trolled by strychnine, digitalis, strophan thus, or glonoin. Strychnine in mild cases should be given in doses of/ 100 grain three times a day; in more ad vanced cases larger closes should be used. Bitter tonics are indicated from time to time; a happy combination in the ma jority of cases may be:— It Tr. nux vomica, gtt. v-x. Tr. gentian co., 1 drachm. Fl. ext. condurango, gtt. v-x.
M. Sig.: Three times a day.
Syrup of hydriodic acid combined with syrup of hypophosphites is also an excellent tonic.
Coughing is best controlled by codeine sulphate, to grain; or heroin, V„ to '/, grain, given according to circum stances every three or four hours or at bed-time. All forms of cough-mixtures and syrups are mischievous.
Night-sweals are controlled by atro pine in most patients; hypodermic in jections of nitrate of silver are reported to be of value in obstinate eases; cam phor is at times advantageous.
In night-sweats camphoric acid acts more powerfully than either atropine or agaricin. The tendency to excessive sweating seems to disappear. Thirty grains should be given at night two or three hours before the sweating begins, or in two doses at short intervals, in powder, capsules, or cachets. Ralph Stockman (Edinburgh Med. Jour., Jan., '97).
The night-sweats of phthisis may be controlled by giving an hypodermic in jection of V„ grain of atropine sulphate at bed-time. After three or four nights it may be suspended, and it may not be necessary to revert to it for a week or more. Picrotoxinc, in doses of grain at bed-time, is also of value. William Murrell (Med. Brief, Jan., '98).
Sodium tellurate, first used by Neusser, of Vienna, given to 51 patients in doses of about 3 grains; it controlled the sweats without exciting any untoward effects. It is a white powder, soluble in water and alcohol, and is eliminated by the kidneys and lungs, and imparts to the breath a garlicky odor: the only drawback to its use. In severe cases two doses of 4 grains ouch may be given in pill form. Thule (Jour. des Prat., Feb. 17, 1900).