(1) A survey of l00 cases and critical exposition
of the literature has been undertaken.
(2) Improvement was noted in 63.3% of cases of which
30% were slightly improved and 14.4% much improved.
( 3) Indications, contraindications', prophylaxis and
the ultimate difficulties of the treatment have
been discussed:
(a) Crisalbine may be given to cases pyrexial
or apyrexial, not improving or stationary
with sputum still positive for Koch's bacillus
and undergoing routine Sanatorium
treatment.
(b) it is useful in conjunction with collapse
therapy, where an artificial pneumothorax
is contemplated or has been induced to control
disease in the contralateral lung.
(c) it may be used in both the exudative and
productive type of case.
(d) it may be used where other treatment has
proved unavailing; and where the time or
economic factor is important.
(4) It is not a "cure" but is of value as an adjuvant
in the treatment of Pulmonary Tuberculosis;
its limitations and dangers must be
recognised.
(a) It produces evidences of Toxicity in 57.8%
of cases.
(b) It is contraindicated in associated cardiac,
renal or hepatic disease.
(c) Good results are not generally obtained in
advanced cases of pulmonary tuberculosis.
(d) It will not replace other tried methods of
treatment and is generally not required
where other methods are satisfactory, but
may be used in conjunction with these.
(5) It is of limited value; a few selected cases show
good results; a fair percentage are slightly improved
and life prolonged, and no case of death
was directly attributable to Crisalbine. It will
not save life.
There is little, if any, value in the drug
in uncollapsed cavities.
Each case must be judged on its own merits:
the dose should be small (0.05 gm.) ; gradually
increased; reactions should be carefully studied.
(6) There is no proved experimental basis for its use
in Pulmonary Tuberculosis.
Its precise action in the human body is
unknown: it is more a Stimulation Therapy than a
true Chemotherapy.
(7) Its value from a public health standpoint has
been discussed: the bacillary loss of sputum is
not generally permanent. It must still have a
limited sphere and cannot be generally employed
by all.
(8) Results are based on clinical values; immediate
and remote results are difficult to judge and
often prove rather disappointing.
(9) It is possible that remote reactions caused by
gold may have a wider effect than is at present
generally realised: there is also evidence that
examination of the blood cells may afford a
standard for the assessment of its value in this
disease.
(10) It is still a highly controversial subject; there
is hope that a substance related to this gold
compound, having a minimal effect on the human
body, may yet be forthcoming.
It should not be withdrawn from clinical
use, and should be employed with due regard to
the resistance and reactions of the patient in
certain selected cases. It should have a place
in the armamentaria of the Physician in his fight
against Tuberculosis
