The solutions of these and other volatile antiseptics in oily liquids for use by the atomiser or nebuliser are much preferable to aqueous or spirit uous solutions. They are of very decided utility in laryngeal phthisis (see p. 492). Continuous inhalation of Chloride of ammonium, Eucalyp tus Oil, Chlorine, Formalin, Ozone, and a host of volatile substances has been extolled from time to time.
Somewhat allied to the preceding methods of combating the bacilli in the lung by the administration of volatile antiseptics is the plan of intratracheal injection. This has been already described under Laryngeal Tuberculosis. This method must not, however, be confounded with that of inhalations, sprays, &c., the intention being that the intratracheal injection after its slow absorption from the bronchial and tracheal mucosa will enter the blood and exercise its beneficial action in this fluid.
Tuberculin.—P.T.R. Tuberculin (bovine type) is the vaccine to be selected for injection; it is, however, now only used by a few and at most sanatoria its use has been abandoned. Incipient cases of apical phthisis without fever are perhaps the only suitable examples for this method of treatment. The initial dose should not exceed what corresponds to mgm. of the dried substance.
Cod-Liver Oil has long maintained a high reputation in all forms of chronic tuberculosis, but by common consent it is (though still prized) to be regarded as possessing no specific action. Its great value depends upon its being an easily assimilated form of food which by supplying fat enables the patient to resist the emaciating actions of the toxins of the bacillus. It moreover assists the assimilation of other foods which would not be absorbed except in its presence, as the increase in body weight is often more than the amount of oil consumed would account for. It is hest administered in combination with Malt Extract soon after meals, but its use should be suspended during pyrexia.
The excellent and sometimes surprising results obtained by abdominal inunction in mesenteric gland disease have been mentioned on p. 569.
Creosole.---Of the host of antiseptic drugs employed from time to time in the treatment of phthisis none have stood the test of experience so firmly as pure beechwood creosote. Guttmann found that the tubercle
bacillus grows but feebly in a r in 4,00o culture with creosote, and he calculated by giving 15 mins. daily the blood would he so charged with the drug that the growth of the bacillus would be inhibited. Clinicians have constantly observed how the temperature falls, sweating ceases, cough lessens, sputum diminishes, and the appetite improves during a course of the drug. All these effects are, however, probably due not to any bactericidal action, but to the drug neutralising the evil effects of the tubercle toxins on the different organs. It has been frequently noticed that though weight increases and nearly every symptom improves, the number of bacilli in the sputum may remain undiminished, but ultimately by the cessation of fever and the increase of appetite the protective mechanism of the body is strengthened.
The antiseptic action of creosote is more remarkable in the living body than in vitro: this may be seen m its sterilising power over the urinary secretion, but such effects can only be obtained by full dosage—zo to 15 mins. daily. The drug is best given in capsule form 3 mins. 3 to 5 times a day, and some physicians recommend up to 6o mins. as the daily dosage of pure beechwood creosote, which is rich in guaiacol. Pinewood creosote contains a large amount of Creosol and is not so suitable for internal administration.
Creosote may be given by the mouth, alone in capsular form or in combination with cod-liver oil; it has been injected hypodermically when mixed with oil or vaseline. It is very advantageously administered by the rectum; 20 to 3o mins. mixed with t oz. cod-liver oil and the yolk of one egg, 2 oz. whiskey and 4 oz. water may be injected once or twice daily.
in to of oil may be freely rubbed into the skin, and inhalations or sprays may beemployed at the same time, the latter methods exercising a marked sedative action on the tracheal and bronchial surfaces. All the above mentioned routes may be employed in a single case—a plan advocated by Bourget under the title of the " intensive method," by which as much as r fluid drachm of the drug may be daily introduced into the blood.