Still more serious is the mistake of administering respiratory sedatives morphia and opiates when there is profuse secretion, as it is astonishing how small is the dose of these sufficient to stop the necessary cough and produce a fatal asphyxiation during the later stage of the disease. It is, however, otherwise in the very early stage of phthisis before softening has set in, when the patient may be harassed by a dry incessant hacking cough which keeps the lungs in a state of unrest, and tends to produce a degree of pyrexia and prevents sleep. Here Morphia or Heroin is clearly indicated in small and repeated doses sufficient to slightly influence the respiratory or coughing centre, and the following combination will he found to be a valuable one: It . Liquor. Al orphina: Bintecon. 5j.
Potassii Bicarbonatis 3v j.
Aquee Lanrocerasi 5ij.
Aqua: Deslillala: cn6 T5N 11j. Misce.
Ft. mist. Cpl. 5j. cant ;`;S. succi Limonis quartis //anis.
Heroin Hydrochloride may advantageously he employed when there is a moderate amount of secretion and a cough much beyond what is neces sary to clear the bronchial tubes, as it may be given in doses gr.) sufficient to soothe the cough centre without rendering the secretion more adhesive.
Laryngeal cough may often he relieved by the r in roo Carbolic spray or by a 5 per cent. solution of Menthol in Liquid Paraffin employed by the nebuliser. In some cases inhalations of Creosote, Friar's Balsam or Conium may be advantageously employed. Cough which resists all drugs sometimes yields speedily on the establishment of the open-air treatment.
Dyspncea also generally is cut short by resort to the open-air method, and its presence is a clear indication for the suspension of morphia or other narcotic. Rarely will oxygen inhalation be required: when clue to an accumulation of pus in the tubes from the overflow of a large cavity, an occasional emetic may be required, and Ammonium Carbonate is the safest of these. By the administration of teaspoonful doses of Sal Volatile in an ounce of water to which a tablespoonful of fresh lemon juice has been added, as recommended in former editions of this work, the bronchial tubes may be relieved and the cardiac depression combated in the advanced stages of phthisis. Partial asphyxia may be relieved promptly in some cases by dose of Picrutoxin. which acts by stimulating the respiratory centre: Hantoptysis should be promptly met by the various methods described in the article under this heading. The former plans of drugging with tannin, ergot and the mineral astringents should never be resorted to, the only reliable procedure being to saturate ihe blood with Calcium Salts.
Insomnia is often due to incessant coughing, and when this symptom is caused by unnecessary stimulation of the respiratory or cough centre, in the absence of abundant secretion, one dose of Morphia, Codeine, Heroin or Dionin may he safely administered at bed-time. Simple insomnia may be met by zo-gr. doses of Trional.
Pain is often due to localised pleurisy or to pleurodynia induced by incessant coughing; in the absence of free secretion it may be relieved by Morphia. Local applications are usually sufficient. and Chloroform Liniment on lint under oiled silk is a reliable routine. Belladonna Lini ment should never be employed in this manner owing to the danger of absorption, since phthisical patients are very susceptible to the action of atropine. A small cantharides blister, which was the former routine treatment of localised tuberculous lesions in the chest. may he often employed with advantage. In thin subjects this acts like Bier's method and relieves underlying congestion; moreover. after absorption minute quantities of cantharidin appear to possess some specific action, as maintained by Liebreich, who injected the drug with the view of causing exudation of scrum from the capillaries in the vicinity of the tubercles.
Severe thoracic pain in phthisis can always be markedly relieved by strapping the chest with adhesive rubber plaster.
Pyrexia —The treatment of this symptom has undergone many changes, as its causation has become better understood. Speaking generally, the most reliable of all agents is absolute rest of the body as the patient lies in the horizontal position in the open air. The fever is the result of auto inoculation with the toxins elaborated by the bacillus, and may be regarded as a phenomenon in most if not all respects identical with the reaction which occurs after a dose of tuberculin. The influx of the toxins is usually due to physical exercise or mental excitement, and Wright has quoted instances where the opsonic index has fallen from over r to o•r2 after moderate exercise.
Sometimes the increased flow of lymph through the infected areas in the lung may be accounted for by the persistent coughing which floods the blood with the tuberculous toxin, and hence the importance of minimising all unnecessary cough, especially in pyrexial cases. By absolute rest of body and mind the auto-inoculations are stopped and the case is brought back to the condition of purely localised infection, and Wright maintains that this desideratum is hastened by the administration of Calcium Salts to increase the coagulability of the blood.