Treating Phthisis With Antimony (Antimonium, Stibium)

In the earlier stages of this disease, when there is evidence of local lung-congestion, with pain and oppression, and in the later stages when acute general symptoms are not urgent, I have known it serviceable. Dr. Hogg recommended its application on plaster, sprinkling about 4 gr. of finely powdered tartar emetic upon the surface of an ordinary warm "pitch-plaster:" in the course of a few days this produced much irritation and a crop of pustules. It seems rather severe treatment, but is sometimes beneficial (British and Foreign Review, ii., 1860, p. 382).

Treating Phthisis With Arsenic (Arsenicum)

For the employment of arsenic in chest diseases we may go back as far as Dioscorides, who states that "sandarach" (probably the sulphuret) "is given to patients suffering with lung-suppuration, and mixed with resin is inhaled in vapor for obstinate cough." Dr. Bed-does used it early in this century, and recently the value of the drug in certain stages of tubercular phthisis has attracted renewed attention. Herard and Moutard-Martin have especially recorded good results from it in relieving the lung-congestion and the general pyrexia of early stages; at the same time the latter physician observes that it is most efficacious when phthisis assumes a slow torpid course, acute tuberculosis not being modified by it. "It has a reconstituting action, and modifies secondarily the pulmonary lesion" in suitable cases (Lancet, i., 1868).

Before suppuration of tubercular deposits has taken place, I have found arsenical solution in 2 or3-min. doses, three times daily, give particularly good results; it is well to combine it with a course of cod-liver oil and change of climate, and it should be continued for weeks or even months if possible. I agree with the account given by Isnard (which is still more favorable), for he found it relieve profuse sweatings, improve appetite, and promote in some favorable cases not only healing of cavities but absorption of tubercle (Bulletin de Therapeutique, t. lxxvii.). It controls diarrhoea in these cases in a very marked way.

Cersoy traces to arsenic an effect which has been also attributed to it in bronchitis, and which really accords with what we know of its physiological action - viz., the lessening of congestion both in the bronchial mucous membrane and in peritubercular lung-tissue; thus he finds that it benefits haemoptysis (Gazette des Hopitaux, 1869). Prof. Stille thinks it probable that any benefit conferred in phthisis is due to an influence upon the accompanying bronchitis.

Massart is almost alone in his recommendation of an arseniate of gold, which, in doses of 1/10 to 1/3 gr., he found useful even in advanced cases (Revue de Therapeutique, 1860, p. 21). The general opinion of French observers, however, would restrict the value of arsenic to early stages, or to the relief of certain symptoms: thus Nouat agrees as to the good results of 1/70 to 1/30-gr. doses given early in the malady, and finds that in later stages, especially in the cases mostly seen in hospital practice, benefit is exceptional (Lancet, i., 1870); and Trousseau, while recording improvement as to diarrhoea, hectic, expectoration, and cough, does not speak of cures, but of the gradual development of the malady and the formation of fresh tubercle. He prescribed cigarettes containing arseniate of soda, and pilules of arsenious acid.

I do not find many English observations on this subject, nor has this medication for phthisis been generally adopted among us. Dr. Williams says, "I have tried it only to a limited extent.....It has only seemed to be useful in chronic cases with asthmatic or cutaneous complication, but well deserves further investigation" ("Pulmonary Consumption," p. 362). Dr. Ringer suggests that allowance must be made for a natural improvement in some forms of phthisis, but has himself seen instances of recovery under its use "in children with general tuberculosis," and "in adults suffering from subacute and chronic forms." He corroborates also, to some extent, the statement that it will reduce temperature (Handbook). Dr. Sanger reports, from the convalescent hospital at Seaford, favorable results in a large number of phthisical patients to whom he gave 5-min. doses of Fowler's solution, but he generally combined it with iron or hyposulphites (Lancet, i., 1869). Dr. Leared based a favorable opinion upon observation of nine cases, but finds the remedy "trying to the digestive system" (Medical Times, i., 1863), and this I believe to be a very common result owing to the dose prescribed being too large. Dr. Bartholow, without offering detailed evidence, affirms that "we have no single drug of equal utility in the chronic forms of phthisis, but it is not" serviceable in caseous pneumonia .... neither is it beneficial when much hectic is present with rapid disintegration of pulmonary tissues."

Treating Phthisis With Iron (Ferrum)

A great deal of fear has been expressed about the use of iron in this malady, and it has been said by eminent observers to hasten and aggravate its course, especially when given in full doses and in the early stages (Trousseau, Millet: Bulletin de Therapeutique, 1862, etc.). If there be acute pyrexia and evidence of pulmonary congestion, leading to florid haemoptysis, then I think that iron is better avoided, because it can increase blood-pressure and congestion, and stimulates blood-formation, and in any case it should be given with much caution during the early stages of the malady, and special attention should be directed to supplying at the same time any deficiency of fatty food, and to securing a due supply of oxygen (Dobell: British Medical Journal, i., 1867). Iodide of iron is one of the best preparations to use, especially in "scrofulous phthisis," and it should be combined, if possible, with cod-liver or other oils. In later stages of phthisis, all are agreed as to the value of iron in relieving many of the most distressing symptoms and much assisting any measure of recovery that can be obtained: the astringent preparations control purulent formations and discharges of various kinds, such as expectoration and passive haemoptysis, diarrhoea, and profuse perspiration, and they often improve the strength and the appetite. Bonorden used the sulphate in a number of cases, giving from 2 to 4 gr. every two hours for several days at a time: the dose seems large, but he obtained very good results (Schmidts Jahrb., May, 1852). Dr. Thompson employed chiefly the perchloride at the Brompton Consumption Hospital, and calculated the effects of iron medication in more than 1,500 cases, - 54.6 per cent. were found "improved," 23 per cent. much improved, and only 21 per cent. not improved. He does not give the details of any cases, nor does he mention the stages of the disease when iron was used, but states generally that the patients grew stronger, and were able to eat better, and suffered less from flatulence, diarrhoea, night-sweats, and haemoptysis: he considers that iron is clearly required in the treatment of phthisis, because "it improves the condition of the blood," and he advocates its continued but moderate use "as a food" (Practitioner, vol. i.). Others have written special treatises in favor of this medication. Dr. Cotton obtained favorable results from the iodide and ammonio-citrate (Medical Times, i., 1860), and Sir Thomas Watson recommends iron in non-inflammatory forms of phthisis, "and finds the mist. ferri comp. very useful when it is well borne:" if sweating be profuse, he uses the perchloride. Dr. Cameron recommends the basic iodate of iron as better than the iodide: it contains 51 per cent. iodine and 11 per cent. iron (Dublin Quarterly, May, 1869).

Treating Phthisis With Kalium (Potassium)

The value of chlorate of potash in phthisis has been much disputed: by some it has been esteemed a specific, and though it really cannot be called so, it has the power of relieving at least some of the symptoms. Dr. Fountain introduced it with the hypothesis that it gave up oxygen to the blood (v. Physiological Action), and seems to have found benefit from the salt, not only in consumption, but in various disorders with impeded respiration (Medical Times, ii., 1859, American Journal, I860).1 Dr. Harkin records that in the first or second stages of phthisis doses of 5 to 20 gr. improved color and strength, and diminished cough and diarrhoea (Dublin Quarterly, November, 1861). Dr. Symonds considered it of service in promoting the healing of vomicae (British Medical Journal, i., 1868), and Spender, pointing out that full doses may readily be given, because of its great solubility in boiling water, "regrets that its value in phthisis is not better known" (British and Foreign Re-view, i., 1872). On the other hand, Dr. Flint's observations satisfied him of benefit from the drug in only one out of fourteen cases, mostly advanced (American Quarterly Review and Medical Times, ii., 1861). Dr. Cotton could trace no definite effects to it, though it seemed to improve the vigor of cachectic individuals generally. I have myself known the carbonate as well as the chlorate relieve pleuritic stitches, diminish profuse purulent expectoration, and check copious perspiration.