My Experience with Large Doses of Creosote in Tuberculosis-A Report of Cases

BY E. S. RAY, M. D., HAMDEN JUNCTION

From the earliest dawn of medical history down through the centuries to the present time, tuberculosis has been and is now humanity's greatest scourge. It has respect for no station of life, but invades alike the homes of wealth and the hovels of the poor. Like Hamlet's Specter, it walks - the earth not unrebuked, but nevertheless unscathed. Its army of annual victims numbers nearly one-third the total for all diseases. Until the dawn of the nineteenth century comparatively little was done to check its onward march. But the achievements of such men as Addison, Laennec, Virchow and Koch during the last three-quarters of a century promise to very materially reduce the mortality if they do not lead up to the total extinction of this greatest foe of mankind. During the early part of the period mentioned, Addison, Laennec, and later, Virchow, wrestled with the pathology of the tubercle and solved some of the great questions then before the medical world; but it remained for Koch to discover the bacillus tuberculosis and reveal in his after-investigations some of the brightest gems of modern pathologic thought.

Since Koch's discovery the profession all over the world has labored hard in the therapeutic field, both in laboratory and in active practice, to determine the conditions under which the cause or causes of tuberculosis cannot live; and I think I may say that the profession has been at least partially successful. Will you permit me today to add my mite to the wonderful volume of literary contributions on this theme?

The limits of this paper will not permit me to discuss the various forms of tubercular disease both with reference to its pathology and the organs involved. Nor will the same conditions permit me to dwell upon the oft-times pathetic

experiences of the active practician as he goes his rounds ministering to adult and child, to the pulmonary form in the mother and possibly the last tetanic agony of the meningeal form in her child; or the articular or osseous form in the son, and the intestinal in the father. These are familiar pictures to you and however much pleasure or profit we might derive from these discussions, the field is too broad for this particular theme.

Before passing to the reports of cases, I wish to say that during the last seven years I have treated all cases of tuberculosis coming under my care with large doses of beechwood creosote; indeed I have pushed the administration of the drug to the extreme limit of tolerance; while I have done this I have not failed to prescribe those helps in the way of out-door exercise, proper diet, and any other treatment which individual cases required. While I believe in large doses of creosote, and believe the large doses to be more effective than the usual small doses employed, I do not rely upon it alone, so that the special object of this paper will have been attained if I succeed in bringing to your attention the fact, demonstrated by my experience, that the human organism will, after a variable length of time during which the dose is gradually increased, develop a tolerance for beechwood creosote which is indeed remarkable. I have frequently had patients take from 400 to 600 drops of the drug daily for months without the slightest inconvenience. It occasionally happens that a transient dizziness will be felt after each dose, and one patient complained of backache only after he had reached the enormous daily dose of 850 drops. Sometimes the patient will reach the limit of tolerance for the stomach with much smaller quantities than those mentioned; but if the dose be diminished for a time. then the patient may go on to double or three times the amount first rejected by the stomach.

I have almost invariably given creosote in capsules, ing the patient follow each dose with a drink of milk, ving in quantity as the dose of the drug increased. I

have usually given the dose three times a day after meals, but sometimes it is better to give the dose oftener and not so much at a time when the daily quantity taken is above 300 drops. The patient begins with three drops the first day and increases the dose one drop each day; but occasionally in urgent cases I have had the dose increased three to five drops each day. I have the dose increased in this way until dizziness or backache is complained of, indicating saturation, or until the stomach rejects it. This point will be found somewhere between 100 and 600 drops in the great majority of cases. When the point of extreme toleration is reached the patient continues that quantity as long as it is deemed necessary to administer the drug. If the patient improves and ultimate recovery takes place, it will be found in many cases that as improvement goes on the patient can bear less and less of the drug until ultimately only small quantities can be borne, i. e., the point of toleration expressed in drops of the drug gradually diminishes as the patient improves. Observing this in many of my cases has brought the thought to my mind that possibly we may yet be able to demonstrate that a definite relationship exists between the amount of tubercular infection and the quantity of creosote required to counteract it. But this remains to be seen.

Case I: D. N., aged 40, came under my care August 13, 1895, and presented the usual physical signs and subjective symptoms of incipient hip-joint disease. This patient. was presented by me at a clinic before the Jackson County Medical Society twice and there was no dissenting voice as to the diagnosis, so I deem it unnecessary to enter into his symptoms in detail. Suffice it to say that his temperature was above normal persistently for six months; percussion over the greater trochanter elicited pain; there was limited flexion of the thigh upon the abdomen, lameness, and pain in the joint. Later on during the following winter a small area of consolidation appeared in the left lung in front at the apex. This patient was under treatment about one year when he was deemed well enough to work as no symptoms had been present for two months; but upon tak

ing up his work again on his farm he relapsed and was again placed upon the same treatment for eight months with final complete cure, there being only slight limitation of flexion of the thigh upon the abdomen. The treatment consisted of rest to the joint-I put him on crutches, not wishing to lose the beneficial influence of open air exerciseand for three months I gave him tonic and alterative treatment alternately with no result. I then conceived the idea of trying creosote in large doses with this patient. The train of thought which led me to do so was about as follows: I had to contend with a disease which cripples for life all or nearly all of its victims and this man has a wife and family dependent upon his labor. I believe creosote to be the only drug able to counteract the tubercular process in that joint; but to get enough of the drug into the joint structures to do this by the blood channels will require the administration of large quantities. I explained the situation to the patient and he readily consented to do as I wished. He began with the usual small dose and persisted bravely according to my directions, and his reward is that of having established a principle in therapeutics and being able to support his family without aid from anyone. This patient found his limit of tolerance at 850 drops of creosote daily. At this enormous dose he developed backache and was ordered to take only 600 drops daily, which he did, and the backache disappeared. This dose was continued some months until he was well. This is my only experience with large doses of creosote in tubercular arthritis.

Case II: E. N., aged 39, was a maiden sister of the case reported above. She came under my care in January, 1900, with a well-marked case of pulmonary tuberculosis of the fibroid form. She had been more or less indisposed for two years or more and after taking various patent medicines came finally under my care. I ordered her to spend much of her time in the open air and climb the hills adjacent to her home every day in order that every air cell might be put to work and the fibroid tissue kept from contracting. In addition to these measures she was ordered to take creosote in increasing dosage. I have every reason to believe she followed directions in every particular. I saw her, myself, take several 200-drop doses of the creosote when I made my calls. She steadily improved under this management until the following June. One day during that month

the dogs broke into the field where the sheep were grazing and attacked the flock. She ran about half a mile to the rescue of the sheep; returning home she was seized with a chill which proved to be the onset of pleurisy, from which she never recovered. This patient took 600 drops of creosote daily for many weeks, but after the attack of pleurisy her stomach would not bear large doses of the drug and in December following she died of the disease. My experience with fibroid phthisis is limited to two other cases than the one reported and although large doses of creosote were prescribed in all the benefit was only temporary, all ultimately dying of the disease. Still the benefit derived in the case just reported, although of two years standing when she came under my care, warrants the hope that even this form might be successfully treated early in the disease.

Case III: A. T., a married woman, aged 34 when she came under my care in March, 1897, was a typical case of pulmonary tuberculosis of the catarrhal form, her father and two sisters having died of the disease. Her temperature was 102° F., and the pulse was 120. She was greatly emaciated by exhausting night sweats. The apex of the left lung was crepitating and there were numerous coarse râles over both sides of the chest. Under the usual outdoor exercise, after the fever was reduced by creosote and rest in bed, and increasing dosage of creosote together with tonic treatment, this patient improved more rapidly than I had told her to expect. By the middle of June she was in excellent health, all symptoms having completely subsided; and a substantial gain in weight indicated that recovery was complete. I ordered her to take creosote all summer in order to forestall if possible the relighting up of the disease when winter came on. The winter of 1897-98, however, passed without incident, but in the fall of 1898 she contracted influenza and for a time the old trouble seemed to threaten her. She again took large doses of creosote and the result was most gratifying. This patient found her maximum of toleration at 250 drops, but since the attack in the fall of 1898 she has remained perfectly well, having borne two children, the last one in January of this year.

Case IV: This case, a woman, Mrs N., aged 24, came under my observation in May, 1898. Both parents died of consumption. She gave a history of having been in poor health for four years, catches cold easily and always coughs