The powerful compounds of Arsenic and Mercury have been extensively employed, upon the theory of destroying the bacillus in the blood and tissues. There is no doubt that small doses of Arsenic, as pointed out by Brunton, are beneficial in the early stages of phthisis, probably by their power in rapidly breaking up the diseased epithelial products in the alveoli, but there is no evidence to justify the assumption that in safe doses the drug has any action on the bacilli. Hence the employment of the Cacodylates and the more toxic new arsenical preparations as Soamin, Arsamin, or Atoxyl are unjustifiable.
Mercury has been reinstalled as an antituberculous agent, and were it not for the serious objections which maintain against the drug after its long use it would be a good routine. The writer believes that mercury is not borne by the phthisical patient in the same manner as by the syphilitic, in which latter case the metal seems to form a harmless com pound with the toxins of the spirochetes. B. L. Wright maintains that excellent results are obtainable by deep muscular injections of gr. Succinimide of Mercury into the buttock region every second day till symptoms of mild salivation appear, after which the dose is lessened and longer intervals between the injections permitted. The treatment extends with occasional breaks over a year.
Iodine and Iodoform have already been referred to incidentally in connection with injections of Guaiacol; there is no evidence that any bactericidal action can be produced in this manner. The writer has seen phthisis supervene under enormous dosage by Iodides in Tufnell's treat ment of aneurism, and also sometimes in tertiary syphilis where the drugs had been employed in very large doses.
The drenching of the patient with large doses of Tannin, Verbascum Thapsus, and the host of inert vegetable substances gave way to the routine administration of coal tar products, such as Methylene Blue, which in their turn have proved useless.
The Hypophosphites still enjoy a considerable amount of popularity; probably the various compound syrups owe any virtue which they possess to the calcium salt contained in them which increases the coagulability of the blood and still is believed by some to favour calcareous degeneration in caseated tuberculous products.
Electricity.—This agent has been pressed into the service in numerous ways; thus the X rays have been utilised in the diagnosis of phthisis in its earliest stage, and some also attribute a curative power to them when applied over small localised apical deposits. The rays certainly have a marked influence for good in the various forms of cutaneous tuberculosis.
The high-frequency current has been extolled as an antituberculous agent in phthisis, and is employed by those who believe that it powerfully excites phagocytosis, weakens the virulence of the toxins, promotes oxidation and hastens elimination.
Surgical Treatment.—This has been tried, and the results of pneumon ectomy or removal of a portion of lung injured by tubercle have been almost invariably disastrous. Pneumonotomy or incision of the lung with the knife or thermo-cautery in order to evacuate cavities and establish drainage has so frequently been followed by fatal results that the opera tion has passed into discredit and should seldom if ever be attempted.
As recovery after a spontaneous pneumothorax in phthisis has several times been observed, various attempts have been made to put the diseased lung at complete rest by producing pneumothorax. Thus Forlanini opens the pleural cavity and injects into it without injuring the lung a quantity of compressed nitrogen gas till complete collapse is effected, injections being usually required. When skilfully performed there is but little risk, and the reports are more favourable than after other surgical procedures.
Multiple rib resection and Chondrotamy of the first and second ribs have been several times performed with the view of mobilising the upper portion of the thoracic wall in apical phthisis and permitting the contraction of cavities by slow cicatrisation.
The injection of antiseptics through a fine needle inserted into the seat of the lesion in the lung has been recommended and practised, but the method has been abandoned.
Symptomatic Treatment—Though the open-air, overfeeding, tuberculin, creosote and other methods mentioned should constitute the main routine treatment of pulmonary tuberculosis, various symptoms usually arise demanding the discriminating skill and experience of the physician.
Cough is the most common of these symptomatic phenomena, and often its unscientific treatment lends to disastrous results. The cough necessary to bring up the purulent or muco-purulent secretion should never be inter fered with. The practice of drenching phthisical patients with nauseating expectorants like tartar emetic, squill, hippo, senega, &c., is most repre hensible, especially when there is no general bronchitis present. These drugs cannot alter the contents of the suppurating pulmonary cavities, but they have the power of arresting the digestive function and of destroy ing the appetite.