Suggestions in the Treatment of Phthisis.

F. A. PINELES-MONTAGU, M. D., DRUEY, N. D.

No disease at the present time is attracting so much attention as pulmonary tuberculosis. It is not the intention of the writer to go fully into the causes or character of this serious disease but to state some simply practical facts concerning its treatment.

Much could be said concerning the causes. Suffice it to say that it occasionally follows croupous pneumonia, especially if that disease affects the apex of the lung, or if that disease terminates in abscess or in gangrene. It may also sometimes follow a protracted case of bronchitis. At other times the disease appears during an otherwise apparently favorable convalescence from some other prolonged inflammatory disease.

Sedentary habits, masturbation, sexual excesses, intemperance, want of proper ventilation and fresh air, breathing impure air, materially assist in the production of phthisis. Dampness of the soil, a sudden change of climate from heat to cold, excessive moisture in the atmosphere, are predisposing causes to phthisis. Severe mental depression from worry, grief, anxiety or over-studying predispose to phthisis. Phthisis may follow pernicious anemia in girls, and it also may be caused by diabetes, or drinking the milk of animals affected with tubercle.

The constitutional symptoms of phthisis pulmonialis are persistent, although often there is but slight elevation of the temperature, anorexia, with general emaciation, indigestion, chills and in severe cases night sweats.

In any form of phthisis a most generous nutritious diet should be given. When fat is introduced into the stomach it is sent to the liver in a state of emulsion, and from there to the lungs, usually proves beneficial in supporting the action of the lungs. The best fats that I have found in this disease are cream in abundance, pure olive oil and pure unadulterated cod liver oil, and to the first two it is often beneficial to give in conjunction liquor arsenicalis.

With reference to cod liver oil, see that you obtain it pure. It should not fail to stand the undermentioned test.

Test: This is a reliable test that I have used for many years. Other liver oils would be almost impossible to detect; when, however, other oils of other than hepatic origin are present, they either will not yield with ac. sulphuric purif. C. P. the violet or red colors; or, these colors instantly become mingled with or obscured by a dark brown substance, the oil becoming charred. These results take place when whale oil and seal oil, or where olive oil and other vegetable oils are present. I have prescribed the following formulas for many years with excellent success in these cases for general medication:

Sig.: One dram three, four or five times each day.

The above formula will reduce the temperature, keeping it near normal, will prevent palpitation and reduce the frequency of the pulse, which if feeble will become stronger under its use, will prevent hemorrhage and keep the bowels regular and will lessen and relieve the cough, especially in incipient phthisis.

Make an emulsion.

This emulsion must be mixed in a mortar with a pestle thoroughly, otherwise it is useless, and one drug at a time must be mixed taking two or three minutes for each, otherwise it will not emulsify properly and therefore will not benefit your patient.

The above formula will relieve the cough, remove indigestion that is so prevalent in phthisis, cure night sweats and build up the system. The patient puts on flesh, becomes brighter and more cheerful and if taken for a very long period in a great many cases destroys the germs and helps to fill up the cavities. It is both a food and a germicide. It may be given in dram doses.

With reference to diet I have found the following of great benefit:

8 a. m. breakfast. Two large cups of coca, bread and butter and a lightly boiled egg.

At 11 a. m. The yolk of an egg beaten up in one-half pint of milk, one teaspoonful of good brandy or a little sugar to suit the taste.

12:30 p. m. dinner. Chicken broth with bread, boiled, not roasted, chicken with vegetables, rice, sago, tapioca, custard or boiled custard with plenty of milk or cream.

At 3 p. m. The same as 11 a. m.

5. p.m. tea. The same as breakfast with the addition of a little jam, sweet not sour, and a couple of large cups of weak tea with cream instead of cocoa.

At 8 p.m. The same as 3 p. m.

The patient should take walks in the sunshine in pleasant company or alone, and if it is impossible through weakness he should be kept out in the open air as much as possible.

The patient should wear flannel next to his skin the year round, and in addition a lung protector back and front, woolen stockings, and thick boots not shoes.

If emaciation, is extreme, 6 to 12 ounces of port wine or brandy is of great service given between meals. Beer, whisky and tobacco must be prohibited.

Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.