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The Treatment of Some of the
More Common Symptoms of
Pulmonary Tuberculosis
a gas, as wells M. E.
PHILADELPHIA, PA.
Lecturer On clinical Medicine in the Hahnemann Medical College and
- Hospital of Philadelphia
- (Read before the Schuylkill County Homoeopathic Medical Society,
- July 30, 1908.)
Reprinted from “The Hahnemannian Monthly,” August, isos.







THE TREATMENT OF SOME OF THE MORE COMMON SYMPTOMS
OF PULMONARY TUBERCULOSIS.
BY
G. HARLAN WELLS, M. D., PHILADELPHIA, PA.
Lecturer on Clinical Medicine in the Hahnemann Medical College and Hospital of
Philadelphia.
(Read before the Schuylkill County Homoeopathic Medical Society, July 30, 1908.)
THE Object of the modern treatment of pulmonary tuber-
culosis is to so improve the nutritive powers of the infected
individual that the body will be able to retard the activities of
and to destroy the tubercle bacilli. In order that this result
may be accomplished there are certain fundamental therapeutic
principles that must always be adhered to. The old method of
treating pulmonary tuberculosis by attempting to suppress cer-
tain prominent symptoms of the disease by the administration
of large doses of Opium, coal tar products, etc., has been SO
utterly abandoned by every therapeutist who has had any ex-
tensive experience with these cases, that I am surprised to find
homoeopathic physicians occasionally falling in the very pit-
falls from which our allopathic brethren are trying so hard to
escape. Too much emphasis, let me repeat, cannot be laid upon
the importance of adhering as closely as possible to those thera-
peutic procedures that tend to stimulate the protective powers
of the human organism and thus render the tissues of the in-
fected individual an unsuitable culture medium for the tubercle
bacilli, and we should be very slow in departing from this
course merely for the purpose of suppressing a symptom or
group of symptoms. We all recognize, however, that in the
treatment of tuberculosis it often happens that a certain symp-
tom will become of paramount or even of vital importance,
and unless Special therapeutic measures are instituted for its
control the result will be disastrous to the patient.
Time does not not permit me to discuss the therapeutic man-
agement of all the symptoms and complications of this protean
disease, so that I shall confine my remarks to those that are
most commonly met with in medical practice, namely:
I. Debility and loss of weight.
2. Digestive disorders.
Cough.
Haemoptysis.
Fever.
Night sweats.
Diarrhoea.
Debility and Loss of Weight.—One or both of these con-
ditions are invariably met with in pulmonary tuberculosis and
very frequently are among its earliest manifestations. They
are due to the action of the toxins, generated by the infect-
ing organisms upon the metabolic functions of the body. Their
treatment may be conveniently considered together.
The most effective method of combating the debility and
malnutrition of phthisis is life in the open air. When these
patients are kept in the open air all or a large part of the
twenty-four hours, we soon find an increase in the ability to
assimilate food, an improvement in the anemia, and under fav-
orable conditions, an increase in weight which may be very
rapid. Next in importance to fresh air is the selection of a
proper diet. Inasmuch as I have discussed the subject of diet
in detail in a recent article,” I shall at present simply state that
the diet should be as abundant as the patient can comfortably
digest, and should contain a large proportion of proteids, fats
and fresh fruits and vegetables. Three meals and three lunches
should be given daily. .
Next to life in the open air and a proper diet, in the average
case rest is the most valuable means of overcoming the de-
bility and loss of weight. I make it a rule to begin the treat-
ment of all active cases of phthisis by a month's rest in bed or
on a couch. In chronic and very mild cases such complete
rest is not so essential, but the danger of overexertion, especial-
ly in the early part of the treatment, must be carefully guarded
against. In discussing the treatment of fever I will consider
the indications and contraindications for rest in detail.
& If the measures indicated above are properly carried out, the
use of any special remedy for overcoming the debility and loss
of weight will rarely be necessary. The homoeopathic method
of selecting a remedy for the totality of symptoms presented
by the individual case is the most scientific and satisfactory way
of employing drugs in the treatment of phthisis. There are
a few cases, however, where physiological medication is ren-
dered advisable by the onset of symptoms that are likely to
i
*The Modern Treatment of Pulmonary Tuberculosis. THE HAHNE-
MANNIAN MONTHLY, January, Igo&. g
2
prove rapidly fatal or by the lack of improvement after the
careful and persistent use of homoeopathic remedies. Not that
it is at all certain that physiological medication will be effec-
tive in those cases where homoeopathic remedies have failed,
but because the patient is entitled to every possible aid that
medical science affords.
I shall not attempt to give detailed indications for all the
remedies that may be of assistance in overcoming the debility
and malnutrition in phthisis. In my experience I find the most
generally useful are: Ars. iod., 2x; nux vom., 2x ; Strych.
phos., 3x ; china; ferr. iOd., 2x ; iodine, 3x.
Cod liver oil, which has been the mainstay of the old school
for many years, can hardly be considered a remedy at all in
the sense in which we usually employ the term. It is primarily
a food and has no advantage over the more palatable oils and
fats, such as olive oil, butter, etc. In fact on account of its
tendency to nauseate the patient and destroy the appetite, it
frequently does more harm than good. Its place in the therapy
of phthisis is very limited. In the form of an inunction it is
Often beneficial in children, but Latham attributes its thera-
peutic value, when used in this manner, as being largely due
to the stimulating effect of the massage. Nux vomica and its
alkaloid, Strychnia, are very useful drugs in cases where the
appetite is poor and an atonic condition of the stomach exists.
Its best effect on digestion is obtained by giving ten or fifteen
drops of the tincture in water fifteen minutes before meals,
three times a day. In some cases the sulphate of Strychnia
seems to work better. I first try giving I-200 gr, three times
a day before meals. If this fails I increase the dose to I-IOO
or I-50 gr. Quinine in doses of two grains three times a day
is sometimes valuable in improving the appetite and toning up
the system. Iron in the form of Blaud’s mass may be given
alone or combined with the quinine in some cases, where the
anemia is marked. Unfortunately, however, iron does not pro-
duce the brilliant results in the anemia of phthisis that it does
in ordinary chlorosis. It should not be given where there is a
tendency to gastric catarrh, constipation or pulmonary hamor-
rhage. Arsenic is a remedy which physicians of all schools
admit to be very valuable in the malnutrition of phthisis, and
some even go so far as to claim that it is a specific. It is by no
means a specific and probably produces its good results by its
profound action on nutrition. Physiologically it is employed
in the form of Fowler solution, three to five drops in an ounce
3
of water after meals three times a day. Personally, I have
had much better results from the use of arsenic in smaller
doses on the homoeopathic indication. Many excellent Ob-
servers have reported good results from the use of arsenic
hypodermically in the form of one-fourth grain of sodium
cacodylate two or three times a day.
The hypophosphites, the glycerophosphites and iodine in var-
ious forms have been widely employed for their tonic effects.
While valuable in selected cases they have no specific curative
action.
2. Digestive Disorders.-Almost every case of pulmonary
tuberculosis presents some form of digestive disturbance. This
most commonly manifests itself in the form of anorexia, nausea
and vomiting and distention by gas. As the stomach plays
such an important part in the cure of phthisis, any disturbance
of its function should receive immediate and careful attention.
In every case of gastric disturbance or loss of appetite, the
mouth and teeth should receive careful attention. If the tongue
is heavily coated in the morning the mouth should be washed
out with a I to 3 solution of hydrogen peroxide in water, fol-
lowed by a mouth wash of listerine or the following:
B. Alcohol,
Glycerine,
Water, aa fäi;
Essence peppermint, gtts. iii.
During the remainder of the day the patient should clean
the mouth with listerine or the alcohol and glycerine wash
above mentioned after each meal.
For loss of appetite fresh air is the best tonic. In many
instances a change of diet may be necessary. This is especially
true when the patient has been taking a large quantity of milk
and eggs for several weeks or months, as this not uncommonly
causes dilatation of the stomach. We must always be on the
watch for this condition when a patient is on a forced diet.
The indications of its onset are coated tongue, loss of appetite,
, nausea and vomiting, and enlargement of the area of gastric
tympany on percussion. It should be treated by the immediate
withdrawal of liquid food and the substitution of a concen-
trated dry diet. Solid food should be resumed gradually after
three or four weeks, but in a smaller quantity than before the
dilatation occurred. The addition of fresh fruits or fruit juices
is often an important aid to the appetite and digestion. Pine-
apple juice, orange juice or grape juice are all acceptable. A
4

small quantity of wine or champagne taken at meals sometimes
produces the desired effect.
Nausea and vomiting frequently result from the same causes
that impair the appetite, and the treatment above outlined will
apply to both conditions. For the distressing cough and vomit-
ing following the administration of food, some form of coun-
ter-irritation over the epigastrium, such as a small blister or
painting the skin with tincture of iodine may prove effective.
If this fails we can usually control it by the use of a sympto-
matically indicated remedy such as ipecac, antin. crudum, nux
vomica or creasote.
Sometimes when other measures fail we will get good re-
Sults by administering 20 grains of Subgallate of bismuth in a
glass of soda or Vichy water. As a last resort in obstimate
cases it is necessary to pass the stomach tube and wash the
stomach out with a I per cent. Solution of bicarbonate of soda
and pour in through the tube the following mixture:
Milk, one pint; one egg, and three ounces of finely powdered
meat. This may have to be repeated three times a day.
Distention can usually be relieved by a properly selected diet,
eliminating sugar and sweets as far as possible and by the selec-
tion of the homoeopathic remedy. .
Of the remedies for the gastric disturbances of phthisis, I
believe nux vomica is the most important. Often the second
decimal trituration is very efficient. In other cases with märk-
ed anorexia, the best results are obtained by giving the tincture
as mentioned previously in this paper. Hydrastis, either in
potency or in drop doses of the tincture, is also valuable. Ar-
senic, china, creasote and arg. nitricum are often of service.
3. Cough.--To the mind of the average patient this is the
most important symptom of phthisis and he is easily persuaded
into the belief that any medicine that ameliorates his cough is
doing him a great deal of good. Nothing could be further
from the truth, and I am satisfied that more persons have been
lured to their death by means of the cough soothing opium
containing mixtures that are so widely exploited by the manu-
facturers of “patent medicines” than by any other single
agency. The cough of a consumptive is rarely of any special
prognostic value and in some cases assists rather than retards
the cure. It is a symptom which should always be carefully
studied in relation to its cause before we attempt to prescribe
for it and opium and its derivatives should be the last, rather
than the first remedy to be thought of.
5
As I stated above, it is important to seek for the cause of
the cough before attempting to treat it. In a large number of
cases the cough arises from conditions entirely outside of the
tuberculous process itself. Latham gives the following classi-
fication of the causes of cough in tuberculous patients which
is useful for clinical purposes. (I) Reflex irritation, espe-
cially from Sources other than the air passages, without any
need for expectoration; (2) the necessity for removing accu-
mulated secretion; (3) causes other than, though often de-
pendent upon, the original disease.
(I) Reflex Coughs.-AS examples of this form of cough I
may mention exposure to sudden changes of temperature, such
as going from a warm room into the cold air or getting into
bed between cold sheets; exertion from walking too fast or
climbing stairs too rapidly; pleuritic irritation, which not infre-
quently is the cause of a dry persistent cough; cough following
the taking of food due either to the irritation of the pharynx
or to reflex irritation of the vagus nerve.
The removal of the cause as far as possible naturally sug-
gests itself as the best method of controlling these various
forms of cough. Thus sudden changes of temperature should
be guarded against. Very frequently distressing night coughs
will be markedly relieved by giving the patient a glass of
warm milk and having the sheets warmed before he retires
to bed. The patient should be warned against overexertion
where this factor seems to act unfavorably. The dry, hack-
ing pleuritic cough can usually be promptly relieved by ap-
plying adhesive straps to the affected side, where the irri-
tation is in the lateral or basal regions. If the pleurisy is
apical; counter-irritation by means of tincture of iodine or
*blister is often effectual. Where the cough is caused
by the taking of food, cleansing of the throat with a mild
antiseptic wash prior to eating or the administration of the
sº 5gallate of bismuth in soda or Vichy water a short time
before eating is often helpful. It goes without saying that
only bland and unirritating food should be administered in
such cases.
(2) Coughs dependent upon the presence of accumulated
secretions.—The ordinary examples of coughs of this char-
acter are the morning cough resulting from the accumulation
of sputum during the night or, in the later stage, the cough
brought on by efforts to empty cavities in the lungs. This lat-
ter form is especially likely to occur when the patient lies in
f

6
certain positions. The important point to remember about
coughs due to the presence of secretions, is that they are bene-
ficial to the patient and should never be checked by sedatives.
If weakening to the patient a little mild stimulant, such as a
teaspoonful of whiskey in hot milk or thirty drops of aromatic
Spirits of ammonia in water may be given.
The most useful remedies for this form of cough are antim.
iod., hepar Sulph., Stannum and phos. Where the sputum is
tenacious and offensive, the use of the carbonate of creasote in
doses of fifteen drops t. i. d. is decidedly useful in rendering
expectoration less difficult and in inhibiting bacterial decom-
position in the bronchi.
(3) Coughs from causes other than, though dependent upon,
the original disease.—The most important conditions giving
rise to this type of cough are chronic catarrh of the pharynx,
laryngitis and bronchitis. Chronic catarrh of the pharynx is
by far the most common cause of cough in the earlier stages
of tuberculosis, and proper attention to the throat will render
the administration of anodynes entirely unnecessary in many
cases. Where the throat is filled with tough mucous, the use
of an alkaline spray or gargle three times a day, followed by
the application of the following solution once daily by the nurse
or physician is beneficial:
B. Phenal, m, v; *
Iodine, gr. x; - #
Pot. iodide, gr. xx;
Glycerine, fji. M.
Sig.—Paint on the pharynx Once daily.
Where the throat is dry and glazed, I employ the alkaline
spray or gargle and have the patient dissolve a marshmallow
or slippery elm lozenge in the mouth. In severe cases of this
type, the use of a codeine and menthol lozenge for a time is
advisable. - *
Cough resulting from bronchitis is best treated by means of
inhalations. Yeo's zinc respirator is a cheap and effective
means of employing this method. The substance to be inhaled
is placed on the respirator, which is worn by the patient from
one to three hours, three times a day. The most efficient com-
bination for this purpose in my observation is the following:
*.
B. Beechwood creasote,
Oil of eucalyptus,
Chloroform,
Alcohol, aa 3i.
7 > *
Sig.—Use fifteen drops every fifteen minutes for one hour
three times a day. -
In some instances where the mucous is very tenacious, the
inhalation of steam from a pint of boiling water to which a
drachm of comp. tincture of benzoin has been added is very
valuable. This should be employed three or four times daily.
Remedies useful in this type of cough are aconite, bryonia,
ferr. phos., hepar, Sulph., kali bich., phos., droSera, Stannum,
sang., rumex. Palliatives may be necessary where the cough is
weakening to the patient, causes continued loss of sleep or
brings on attacks of haemoptysis. Codeine in doses of one-
quarter to one-half grain every three or four hours, in the pref-
erable palliative. Heroin, I-16 or I-I2 grain and dionin, M
grain are also useful. The best results from palliatives are ob-
tained by changing from one to the other occasionally and dis-
continuing their use as soon as possible.
In closing my remarks on the cough of phthisis, let me say
that, speaking generally, fresh air is by far the most effective
single agent in relieving this symptom. Many persons lose
their cough entirely after a few weeks' treatment in the fresh
air, and the percentage of cases where the cough cannot be
satisfactorily controlled by the combined action of fresh air
and the indicated homoeopathic remedy is very small indeed.
Where we cannot treat the patient under ideal conditions the
adjuvant measures mentioned above will have to be more fre-
quently employed. The two points I wish to impress upon
your mind are the uselessness, nay, even the harmfulness of
administering opiates to every tuberculous patient with a cough
and the supreme value of fresh air in controlling or amelior-
ating this symptom.
4. Hamoptysis.--This symptom constitutes one of the most
alărming and one of the most rapidly fatal complications that
Wé meet with in pulmonary tuberculosis. Intelligent treatment
gepends upon our recognizing the cause of the haemorrhage
*with which we are dealing. There are two forms of haemor-
rhage met with in phthisis: (a) Haemorrhage due to conges-
tion or hyperemia, and (b) haemorrhage due to rupture of a
large vessel into a cavity.
(a) Haºmorrhage as the result of congestion or hyperemia
may occur either in the early or late stages of the disease.
The amount of blood lost is usually small and the prognosis
under proper treatment almost invariably good. If the sputum
is simply blood-tinged, it is only necessary to keep the patient
S

from overexertion for a few days. If the amount of blood is
larger, the patient should be put to bed and kept at absolute
rest. He should not be allowed to speak except in a whisper
and percussion of the chest should be carefully avoided. An
ice bag should be applied to the chest if we are able to deter-
mine the side affected. The diet should be liquid and the
quantity moderate. Whiskey or coffee and tea should be
avoided unless symptoms of collapse are present. The most
efficient drug for controlling haemorrhages of this type is amyl
nitrate, three or four drops by inhalation. This remedy has
received the most thorough trial during the recent years and in
the congestive form of haemorrhage acts almost as a specific.
Following the amyl nitrate we should administer one minim
of glonoine every half to one hour until the haemorrhage is en-
tirely controlled. It is usually my custom, in addition, to place
ten drops of aconite Ix in half a glass of water and give one
teaspoonful every fifteen minutes. This remedy controls the
anxiety and restlessness usually met with in these cases and
probably influences the haemorrhage itself favorably. If the
haemorrhage is accompanied by constant coughing and the pa-
tient is highly excited, we should inject at once 94 gr. of mor-
phine. In persistent small haemorrhages the use of glonoine
and a restricted diet is advisable. Calcium lactate, gr. xxº
t. i. d. is also useful. . r
Aside from aconite, other valuable homoeopathic remedies
are: Hamamelis, ferr. phos., geranium, ipecac, hydrastinine
hydrochlorate and erigeron.
(b) Haºmorrhage into a cavity due to rupture of a large
vessel.-This form of haemorrhage occurs only in the advanced
stages of phthisis. Haemorrhages of this character are fre-
quently fatal in spite of all our therapeutic efforts. Absolute
rest, preferably in a semi-recumbent position, is essential. If
the source of the haemorrhage can be located, the patient should
be placed on the affected side to prevent the blood from flowing
into the opposite lung. No food should be given for several
hours, unless the patient is in a state of collapse, when a mild
stimulant will be advisable. The only drug is physiological
doses that is of any value in these cases is morphine and this
must be employed with extreme caution in large haemorrhages,
as its effect in diminishing the sensibility of the bronchial mu-
cous membrane may result in the blood accumulating in the
lungs and the patient will be asphyxiated by his own blood.
If its use seems advisable, 94 gr. should be given hypodermic-
Q

ally. If the patient survives the attack he should be kept at
absolute rest for one week after all signs of the haemorrhage
have subsided. -
Blackwood recommends millefolium as being indicated ho-
moeopathically in many cases of pulmonary hamorrhage with
cavity formation.
6. Fever.—Rest in the open air is by far the most effective
way of reducing the fever in phthisis. In fact, as long as pa-
tients with a febrile temperature persist in walking about or in
engaging in his usual Occupation, a reduction of the fever is
almost impossible. Every patient whose maximum daily tem-
perature is IOO. F. or over should be kept in bed, in the open
air, if possible, and not allowed to get up until his maximum
daily temperature does not exceed 99 F. He should then very
cautiously be allowed to sit up daily for gradually increasing
periods if his temperature is not elevated. It is important to
start some mild form of exercise as soon as possible, but this
must never be sufficient to cause an elevation of temperature
above 99° F. From four to eight weeks are required to re-
duce the temperature to normal in cases of moderate severity.
As regards diet, the patient should take as much solid food as
possible in addition to the regular quantity of milk and eggs.
As an adjuvant the patient should be sponged daily with water
at about 70° F. Acetanalid, phenacetin and other coal tar
products are always useless and frequently harmful. I have
seen some cases in which quinine in doses of two grains three
times a day was remarkably efficient in reducing the temper-
ature. There are several homoeopathic remedies of value in
this condition. The ones I have most generally employed are
aconite, bryonia, gelsemium, baptisia, china, echinacea and
arsegicum.
g; Night Sweats—This annoying symptom is due to the
toxemia or to extreme weakness. It usually disappears under
the open air treatment without the use of drugs. Patients who
are subject to night sweats should wear a woolen night robe.
If weakness is the cause of the sweating, the administration of
two or three teaspoonfuls of whiskey in a glass of hot milk at
bedtime will usually control the condition. In other cases
sponging of the body with one ounce of vinegar in a pint of
water is effective. Among the homoeopathic remedies of value
are jaborandi, tabacum and phos. acid.
The most effective physiological remedy is atropine in doses
of I-IOO or I-50 of a grain at bedtime. Camphoric acid, 12

IO
grains at bedtime, may be used where atropine is objectionable.
8. Diarrhaea.—This symptom may arise either from ordi-
nary causes or may be due to tuberculous ulceration of the
bowels. The latter condition is not as common in adults as is
commonly supposed. When it occurs it is a very serious com-
plication and renders the prognosis grave.
When a tuberculous patient develops an attack of diarrhoea
I invariably administer calomel in 94 grain doses until a grain
is taken, and put him on a diet consisting of milk and farinac-
eous foods. This, with whatever remedy is symtomatically
indicated, will cut short the vast majority of simple cases in
two or three days. It is a mistake to give astringents in the
beginning of such attacks. In tuberculous diarrhoea a diet of
milk and raw eggs is advisable. Flushing the colon daily with
a quart of normal salt solution is sometimes helpful. Merc.
corr. and arsenicum are the most generally useful remedies.
In many cases we are compelled to resort to astringents.
Personally, I employ the subgallate of bismuth or tannigen in
ten or fifteen grain powders every three hours. Morphine,
I-12 or I-16 gr. may be added to either of these if the pain is
distressing.
II
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