Creasote used in neEtrly four hundred eases, including not only the pulmonary form, but tubercular disease of the peri toneum, the joints, the bones, the glands, and the larynx. Great care is demanded, both as to the method of administration and the quality of the drug. A conven ient way of prescribing it is in capsules containing 2 or 4 minims of creasote mixed with codliver-oil; and these shou'Al always be given immediately after eat ing and never on an empty stomach. After several days complete tolerance is established, and within four or five days the dose can be gradually increased, until finally the stomach improves in every way, and all irritation with the accom panying indigestion has been relieved. In regard to the method of increasing the dose, tbe fodowing rule will be found to work well: Begin with 2-minint doses three times a day; in acute cases in crease the dose by 2 minims every fourth day until 12 minims are given at one time; then observe the results of the largest dose for several weeks, and, if the improvement is not satisfactory, care fully add 2 minims more every eight or nine days until a 20-minim dose has been reached; then persist with this quantity until the symptoms warrant a diminution of the amount. The highest dose has frequently been used for four or five months at a time before decreasing it, with the most .satisfaetory results. Tbe chronic cases do not, as a rule, require so large a dose, or to have it so rapidly increased. ln average chronic cases the patients use 12 minims three times a day, beginning with 2 minims, increas ing by 2 minims every six days to minims, then every second week to 12 minims, according to the effect. During the first week or ten days there are troublesome eructa_tions of gas flavored with ereasote, but not a single instance has been seen where this did uot entirely subside after the cremote had corrected the fermentation caused by old indiges tion. Conway (N. Y. ,N1ed. Jour., June 1, '95).
Before giving the patient with phthisis creasote he should be placed in the con ditions favorable to his recovery by sub mitting him to the air-cure. For really successful treatment large doses of crea sote are required; the greater the quan tity of the medicament which the pa tient can sustain, the more chance there is for recovery. It may be given in the mouth, the rectum, the trachea (by means of injection), and the skin. The most convenient forms in which to ad minister creasote by the mouth are pills and solution in codliver-oil, and in either of these the dose may be as much as 30 grains or even more per day. In many eases, however, doses of not more than 3 grains cause indigestion, and a tuberculous patient should, above all else, be kept free from disturbance of his digestive functions. The rectum is less able to tolerate the remedy than the stomach, and after a very few days the patient loses control of the bowel and is frequently attacked by colic and diar rhcea. E. Chaumier (Lancet, Jan. 22, '98).
When tuberculosis of the larynx com plicates the pulmonary trouble, creasote should be employed locally as well. The fact should be borne in. mind, however, that the benefit observed will mainly de pend upon the internal administration of the remedy, though the local applica tions greatly assist the curative process.
Creasote is quite as efficient in laryn geal tuberculosis as it is in the pul monary form, but should be used both internally and topically. For the latter an oily solution is preferred, such as n Beech-wood creasote, 2 drachms. Oil of \vintergreen, 2 drachms. Hydrocarbon oil, 1 drachm. Castor-oil, 3 drachms.
The oil of wintergreen and castor-oil should first be mixed together, then the hydrocarbon oil added, and, lastly, the creasote. Sterilizing the solution by dry heat gives it a much clearer appearance; besides it is very fluid and non-irritating, of pleasant odor and taste. It may be used as a spray, or applied with a laryngeal applicator or as a submucous injection. Topical application alone may be relied on for the successful relief of the symptoms of primary tubercular de posits with infiltration and hypertrophy of the mucous membrane, provided the temperature is not high and the general condition is good. If, on the other hand,
the evening temperature is high and the case seemingly progressing to active ul ceration, a few submucous injections should be used as adjuncts to local treat ment. The cough, laryngeal soreness, and moderate dysphagia of primary cases are quickly relieved by sprays of creasote, but resolution of their infiltrations and hypertrophies is not so rapid. In several patients laryng,eal distress was relieved after a few applications, but the infiltra tion continued for months.
The interior of the larynx should be thoronghly cleansed before any treat ment is undertaken. Applications may be made by means of down sprays, of the laryngeal syringe, or by absorbent cotton on an applicator; but the latter occasionally produces an undesirable amount of coughing. An 8- or 10-per cent. solution of cocaine should first be carefully applied to the larynx, and, after it has had time to produce moderate ancesthesia, the spray of creasote (2 drachms to the ounce) is used. After the spray the pyriform sinuses may be filled with creasote solution, and also some of it allowed to drop into the trachea through the opening of a gum-elastic tip drawn over the cannula of the syr inge. This kceps the laryngeal surfaces bathed in creasote for a considerable period, and the patient should, if possible, be kept perfectly quiet and not allowed to talk or swallow for half an hour after ward. The stronger solution of creasote niay be used every third or fourth day and the weaker ones every day or so, depending entirely- on the amount of stimulation it produces; the laryngeal membrane becomes very red and consid erably swelled from too-frequent applica tions. In the ulcerative stages of laryn geal tuberculosis spray-s of a drachm of creasote to the ounce may be used daily with advantage; but if there is no ulcer ative process a personal experience of each must decide the frequency of the applications. A slight burning sensa, tion follows, but it only lasts a few min utes; and the disagreeable taste is very effectually covered by the wintergreen oil. Where there is ulcerations, both topical applications and submucous in jections are advisable, as they hasten the separa.tion of sloughing tissue, stimulate healthy granulation, and at the same time arrest progress. The injection should be a.s superficial as possible, as the primary tubercular deposit is immedi ately beneath the epithelial layer. Weak solutions of cocaine may be sufficient in some cases, but complete aniesthesia is usually necessary-, and 20-per-cent. solu tions are generally the most satisfactory, administered on an applicator,—although it may be safe to employ the spray if the physician is well acquainted with his patient. Little pain or reaction follows the injection of oily solutions, but pure creasote causes a burning sensation and considerable soreness, which lasts a vari able time. Much depends on the locality of the injection; the posterior surface of the arytenoids seems to be specially sensi tive. There is little or no luemorthage after the needle is removed, and on the following day the mucous membrane is more tense and possibly somewhat red der. This condition subsides in the eourse of a few days, leaving the tissues in a wrinkled condition, as if the mucous membrane were too large for the sub jacent pasts. This is most noticeable around the arytenoids. Careful judg ment is required to determine how often the injections should he given, but, as a rule, it should be once in five or six days. If ulceration is praceeding rapidly, one injection may be given daily until three or four have been administered. After several injections it is well to wait ' for a time and see if the circle of resolu tion will not spread from the point of in jection to the neighboring tissues.