SEMISPECIFICS AND ANTISEPTICS. The profession is still searching for a specific for this disease. Iodine, men thol, cinnamic acid, oil of cloves, cod liver-oil, peanut-oil, nitrate of silver hypodermically and externally, iodide of potassium, europhen, formalin, creasote, guaiacol, ichthyol, kalagua, tuberculin, antitubercle serum, various forms of cold and hot inhalations, and, finally, climate have all been strongly advocated by dif ferent observers as exerting a marked in hibitory influence on the progress of the disease.
Probably too much has been expected, or perhaps those attempting to apply the principles advocated by the originators of the several so-called semispccifics, have not sufficiently individualized their patients; hence the disappointment in many instances.
Creasote and its various derivatives are extensively used by the profession; it is best administered in doses not ex ceeding 15 drops of Merck's preparation or 5 to 20 drops of creosotal or five to 15 grains of guaiacol three times a day after meals. The liquid form of creasote and its derivatives may be administered in milk, but preferably in capsules of subnitrate of bismuth, 5 drops in each capsule. Creasote may also be adminis tered in capsules containing codliver-oil.
Creasote should not be given to a pa tient with fever or signs of congestion (inflammation), nor with wasting, loss of appetite, nor long-continued hectic. It may be given when there is no fever, or only the slight fever of suppuration, as during the formation of cavities. It should not be given also when there is repeated humoptysis. E. Lemoine (Le Nord Mdd., Sept. 15, '97).
In Detlweiler's sanitarium, at Falken stein, creasote has been given a thor ough trial, and has now been completely abandoned, along with tuberculin and all other specific remedies. General dietetic and hygienic influences are the only rem edies relied on. St. Clair Thomson (Lancet, Oct. 30, '97).
Cinnamic acid and oil of cloves are also used; the latter is administered in doses of from 5 to 40 drops, the amount being increased daily until the limit is reached or until the patient becomes so thoroughly saturated with the drug that the odor is apparent when he enters the physician's office. Cinnamic acid is a
favorite drug of some physicians, but it is not so well tolerated by the stomach as the oil of cloves.
Ichthyol is, perhaps, the most valu able drug we possess in treating all cases of pulmonary tuberculosis presenting mixed infection. The best results are obtained from the administration of large doses, and if the drug is given in such form as to pass the stomach undis solved, amounts of 30 grains, three times a day, are easily borne and untoward effects are few. An occasional diarrhea or an attack of vomiting which is pre ceded by the taste of ichthyol may occur. These symptoms quickly subside upon the withdrawal of the drug, and with its resumption the dose which caused the above symptoms can usually be given without further trouble.
The improvement is rapid, and within one month, in individual cases, where other beneficial factors are eliminated, there may be a gain in weight of eight or ten pounds, and in those patients whose weight had, previously, and under different surroundings, remained sta tionary for long periods of time. There is improvement in general nutrition, as evidenced in females by return of men struation. The fever, sweats, and cough diminish, the sputum is more easily brought up, is smaller in quantity, and is changed in character. In some in stances expectoration is too quickly re duced, and patients experience difficulty in raising the sputa. In cases far ad vanced, those having a cavity, with ex cessive expectoration when ichthyol acts well, the effect is striking, and it is more suggestive of the important part played by secondary infection in tubercular processes.
Ichthyol changes the character from the fetid, decomposed, purulent sputum into that which is mucoid and frothy, ameliorates the symptoms of fever, chills, sweats, and general failure of nu trition dependent upon the absorption of pus-products, so that it may be said that in such cases ichthyol practically accom plishes drainage, and, what is more im portant, tends to convert the function of the pyogenic membrane into one which secretes mucus instead of pus. The de bilitating effect of pus-absorption is put aside, and there is general improvement noted.