The Thymol Treatment.—Bozzolo introduced this drug in the treatment of hookworm disease in 1879. Thymol has an aromatic, thyme-like odor and a pungent taste and, while soluble in about an equal amount of alcohol, is only soluble in water in the proportion of 1 to 1100.
It is usual to prescribe the drug in 5-grain capsules or preferably in cachets, one part of thymol being triturated with an equal amount of sugar of milk. If the cachet is moistened with a little water it may be swallowed like a raw oyster.
Stiles prefers giving the treatment on Sunday so that the working days of the patient may not be lessened. By giving the patient bicarbonate of soda for a few days before the treatment it is thought that the mucus lining of the jejunum is cleared away so that the worms are more readily affected by the drug. At any rate one should give about 1 or 2 ounces of a 50% solution of Epsom salts on Saturday evening. Sodium sulphate is preferred by some.
The following morning at 6 A.M. the patient takes one-half the dose of thymol proper for his age and at 8 A.M. he takes the remaining half of the dose. At 10 A.M. he takes another dose of Epsom salts. The reason for dividing the dose of thymol is that should untoward symptoms occur after the first portion of the dose we do not give the second. Stiles now prefers to divide his dose into three portions, one to be given at 6 A.M., one at 7 A.M. and the remaining third portion at 8 A.M., followed by salts at 10 A.M. The patient should lie on the right side while taking the treatment to facilitate the passage of the drug from the often dilated stomach.
The patient should remain in bed until 12 o’clock when he may take some coffee, without milk, and crackers.
Patients must be warned to avoid anything containing fats or alcohol while undergoing treatment as fats and alcohol dissolve the thymol and tend to cause poisoning. Under no circumstances should castor oil be used. People are apt to forget that butter, milk, etc., contain the dangerous fats.
Seidell has shown that about one-third of the thymol dosage is excreted in the urine and very little by faeces. This shows absorption of the drug. It is thought some of the drug may be excreted by the lungs. Congestion of the lungs has been reported in fatal cases of thymol poisoning.
Mild symptoms of poisoning are burning in the pit of the stomach and tingling sensations of the body. More severe symptoms are those associated with cardiac weakness and respiratory distress. Coffee and strychnine are the usual remedies for thymol poisoning. Inhalation, but not swallowing, of aromatic spirits of ammonia is often of value.
The thymol dosage recommended according to the age, or rather the apparent age of the patient, is: