Case V.—Very serious Case of Inflamed or Ulcerated Windpipe and Pharynx.

I am detailing these cases not at all in chronological order. Beginning with trifles, we come now to something of a more serious nature, and possibly may get to consumption by-and-by. When this case occurred, I had only as yet tried the sulphur fumes; but intending to operate a little on human windpipes, I had sent a few days before for a Spray-producer. Knowing well that human windpipes, throats, and lungs were tender, delicate, and sacred things, I regretted much that, with the sole exception of Dr. Halliday Douglas, there was no doctor, so far as I knew, to whom I could apply for guidance and instruction, and with Dr. Douglas himself I was not personally acquainted. But reasonably enough concluding, that if the physician of Chalmers' Hospital was like the other principal Edinburgh physicians, he was not likely to think it any breach of etiquette for an unknown country doctor to ask a few important questions, I wrote a letter, being sure of a civil answer at any rate. The answer was couched in not only civil and polite, but kind, almost affectionate, terms; its purport being an encouragement to proceed with my experiments; and though not yet in a position to give a decided answer in regard to consumption, with other diseases of throat, chest, and windpipe, 'like yourself I anticipate good results,' etc.

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The instrument arrived twelve hours earlier than the letter; and, curiously enough, it was not ten minutes in my possession till the following case, as if sent by Providence on purpose to test it, afforded a striking proof of its power :—On Friday morning, the 4th October, while (in consequence of a midwifery case during the night) I was still in bed, an urgent message came to my house for me to visit immediately a gentleman holding a Government situation not far from here, said to be bad with a sore throat. Either through some neglect the message was not delivered to me as urgent, or, in consequence of my own sleepy brain, I did not hear it as such. Taking a nap first, I soon rose and set off to the country, quite forgetting the poor patient altogether. On returning at noon, another message came, conveying great amazement that I had never called, and a request that I would go at once, for he was in great distress. I found him in bed, looking miserable, and complaining greatly of pain in his throat. He had a fly-blister on a large swelling below the chin, painful to the touch, which I took to be a swollen gland, arising from the internal irritation, and likely to suppurate. On looking into the throat, I could see nothing wrong with it. He then pointed to the windpipe and pharynx as the seat of pain. The history was this : the internal irritation had begun two months ago, probably in consequence of his business; one part of his duty being to spend two hours every morning in an open gig between a railway station and his office, viz., from five to seven; and two hours every night similarly exposed, from six to eight—the morning hours, especially at this season of the year, being decidedly the worst in all the twenty-four for windpipes even in a healthy state. Though slight at first, the pain and difficulty of swallowing had gradually increased, and become greatly worse for the last two days. Soon after the internal irritation began, a little swelling like a bean showed itself under the chin, which, keeping pace with the inward disorder, was, at the time of my visit, the size of an ordinary apple, but not so round. 'My difficulty of swallowing,' said he, 'is so great, I have never tasted a drop of water the whole night, nor tasted food this whole day; I cannot get over even a drop of tea.' I told him that his whole windpipe and throat would need to be washed out with an astringent gargle, and forthwith sent off for my newly-arrived instrument, fondly hoping it would 'make its début with great éclat.' Before injecting the spray I asked him to try one teaspoonful of cold water, which, with great difficulty and many grimaces, he succeeded in swallowing. I then gave him some twelve or fifteen whiffs of the spray, and immediately afterwards asked, 'How do you feel?'—A. 'I can swallow my spittle much easier at any rate.' I then put a teacupful of water in his hand. To my own astonishment, as well as that of his wife and himself, he gulped down several mouthfuls with the greatest ease! told me that the pain was almost if not entirely gone! and immediately added, 'Away, gudewife, and prepare some food; I 'm tremendous hungry!' I then told him to keep quiet in bed, and I would call at night to repeat the operation. On calling at night and looking into the bed, the bird had flown; he was engaged in his office, sorting some letters! I then asked his wife if his swallowing powers had page 23 managed a little arrow-root, or anything similar, since my last visit. Arrow-root! he had enjoyed two good hearty meals; one of them a minced collops dinner as usual. [Note.—Rev. Sir, in case you think me writing a sensation novel, please call at the office when that way, and ascertain for yourself that all this is strictly true. Were I writing a novel, I would never think of anything so extravagant.]

Next morning he was so decidedly better, I did not think it necessary to repeat the operation; told him all he would need was care and a dose of medicine. Even the size of the swelling had much declined, the internal irritation which had occasioned it being nearly removed. The weather being frosty at the time, and intensely cold, most unfortunately I carelessly neglected charging him to keep within doors; probably for the same reason as one might neglect to charge a fractured limb newly bandaged up, on no account to get up and dance a reel! This was all on Saturday morning. The next sight I saw of him was on that same evening, just at six o'clock, while beginning to get dark. On coming up from the 'Cadger Brig,' and walking fast to keep myself in heat (the night being bitterly and intensely cold), the Government gig goes whirring past me; and unless there was some great ocular delusion, to my great horror and amazement who was within it, but somebody (well wrapped up indeed, as the night and an open running blister on the throat required) as like my patient himself as could possibly be! In vain did I hold up my fist, and shake it in his face in a threatening manner, as the most eloquent and telling mode of crying, 'Madman! do you mean to kill yourself?' Her Majesty's mail was not to be interrupted by any such foolish menaces. Nor is this the worst. That was defiance to frosty air the second. Unaware of the danger, and conscientiously desirous to do his duty to Government, he had, unknown to me, risked the same exploit in the morning between five and six. Observe, Reverend Sir, the astonishing nature of this exploit. On Friday at noon, an inflamed or ulcerated windpipe or pharynx, of two months' duration, had come to the climax already described. In exactly seventeen hours thereafter he begins his usual open-air occupation at five o'clock on a cold frosty morning, because (as he afterwards told me by way of apology) he thought he was almost completely belter! a feat of daring, though conscientious, performance of duty, compared to which such paltry tricks as eating fire, or swallowing a huge naked sword (that used to make us stare so much of old) are perfect baubles. The fact that he ever thought of such a thing, says a great deal in favour of calling the Spray-producer a magical machine; and the additional fact of his coming home alive, shows that human windpipes may not be such delicate tender things as medical men declare. But you will not, I am sure, be surprised to learn that a serious and much more tedious relapse was the inevitable consequence.

Relapse.—Next morning (Sunday), a message came down for me to see the gentleman again, 'He was worse than ever!' But when that message came to my house I was beyond his reach, being on the borders of Tweedsmuir, engaged with a case of a different character. On returning at night I immediately called. He was indeed worse in every respect except one, the difficulty of swallowing being not quite page 24 so great as on the first visit. But he was hoarse, constantly hacking up immense quantities of phlegm and mucus; tongue remarkably foul; skin hot; pulse very feverish; the gland below the chin now a huge swelling from ear to car; the whole face also swollen, especially beneath the eyes; great difficulty of speaking at intervals; and though the difficulty of swallowing was not quite so great, it was very considerable. The patient had been waiting eagerly for my visit, expressed great joy at seeing me, and hoped I would give him the same relief as formerly. Conscientiously believing that if some patients must be starved into health, others fattened into it, etc., this one would need to be frightened into it in the first place, I determined to inflict on him such a lecture as he was not likely to forget in a hurry. 'My dear hearer!' I began, 'this playing at windpipe-curing being rather a ticklish game, and this being Sunday night at any rate, you cannot be the worse of a serious sermon suitable for the occasion. I choose for my text those pithy words of the sixth commandment, "Thou shalt not kill." And before attempting to cure you a second time, would beg to preach from it a short discourse on the ordinary way of curing your disease when of two months' standing, etc., etc.' I then detailed in their order the leeching, fomenting, blistering, antimonials, and expectorants, confinement to a room the whole winter, reducing the system, then cod oil and iron to get it up again, the sighing for genial weather, cursing of east winds, etc.; to complete the cure, the change of scene, the disappointment, the medical consultation with some eminent professor, the professor's regret that after the very judicious treatment already adopted he can only suggest, etc. etc., and then the patient's coming home to die. I then concluded, 'This being the usual way of cure, I have to tell you, candidly and seriously, that not only may it possibly be your own, but for my part I see not the slightest hope of averting it, unless you co-operate with your medical adviser, and in right earnest begin to take care of yourself. Under any treatment whatever you must be confined to the house for a length of time. As for driving out in a gig at live o'clock in the morning, I tell you frankly that though you were well tomorrow, you won't be allowed to go into your garden except during the heat of the day, for the whole ensuing winter, without a respirator at any rate.' The patient being duly and deeply impressed with such an unexpected theological exposition, only mused a little without a remark, and then said, 'But what is to become of the Government work?' 'That,' said I, 'is a problem I have nothing to do with. Though all the governments of the world go to wreck, my mind is made up : either implicit obedience, or I walk out with my spray-box in hand, without administering another dose. For observe, my dear sir, paltry and insignificant as you seem to think your own life, not so in my estimation is the success or failure of my machine. You have been honoured by being made the subject of its first experiment, and it must have fair-play. The issue is momentous to me and my patients. Because if it can cure you, the rational conclusion is that it may cure others made of the same flesh and blood.'

The patient having come under all due submission, I then administered the spray, with the immediate effect of relieving at once pain, page 25 difficulty of swallowing and of speaking. The effect was not so striking as at first, partly because expected, and partly because the power of swallowing was not entirely lost. But the patient, of course, continued feverish and unwell in many respects, and was altogether or nearly confined to bed for several days. On Monday morning I found that all the throat symptoms still existed, though not so badly, and that the spray immediately again gave relief; but his general condition in no respect improved. I ordered warm poultices to the throat, and medicine for the bowels, and intended to apply the spray more frequently, say three or four times every day. Alas! for the uncertainty and mistiming of a country doctor's life! I never gave the spray again till Wednesday night, a whirl of business of different kinds preventing. I never once saw him on Tuesday at all, nor Biggar either, being tied the whole of that day to a bedpost at Castle Craig, and spending the time (for want of anything better to do) in beginning and nearly finishing this letter to you. A country doctor is the worst person in the world for such a work as I have taken in hand. Never did I more eagerly wish for a week of quiet and reflection to conduct these experiments, and write the result in peace and calmness, after due thought and consideration. Instead of that, the whole week has been a whirl of excitement with midwifery cases, spray injecting, writing letters to Edinburgh, Glasgow, Kirkcaldy, and I know not where; ploughmen half killed with their horses; sulphur burning, etc., etc. All this time attempting to reflect and philosophize, beginning this letter to you on Tuesday last at Castle Craig, writing snatches of it here, there, in all ends of the county, or at home, as I could find leisure, and taking great care amid all this excitement neither to diverge one iota from the truth, nor raise palpitation in my own person. Really, reverend sir, you must excuse many errors in writing, and offences against good taste, that would be very unpardonable in such a finished composition as usually emanates from your own study.

But to return to the patient. On Wednesday night I found his state not materially changed, and that for want of the spray he had taken my advice, and occasionally indulged in the inhalation of sulphur fumes conjoined with steam as a substitute. On Wednesday evening I put him into the hands of another doctor, seeing that this irregular visiting of mine would never give himself or my instrument a chance. This doctor, or rather young aspirant to the honour of M.D., not yet quite fledged, was my own son; who, being very proud of a first patient, was most attentive to his duties; and promised to administer a dose of spray four times daily, as duly directed. From that time till now progress has been forward, and on the whole satisfactory. I now write on Saturday at half-past two; so that he has now been under this treatment for three days. I stop for the purpose of visiting the office and giving the latest report.

Saturday, 12th Oct. 1867, 3 P.M.—Greatly improved in many respects. Pulse weak, but not so feverish; tongue clean; appetite a little better; complains of a stitch in the back; feels weak and sickly, partly from medicine in stomach which has not yet operated. Very depressed in spirits, because his throat is not so much better as he ex- page 26 pected; great hacking of phlegm; still some difficulty of swallowing and speaking occasionally, which are always relieved after the spray. External swelling not above a third of its former size. I ordered for him light meals frequently repeated, half a glass of sherry three or four times daily, a large fly-blister over the larynx, and to continue the spray. My opinion is that the case is hopeful; but there being evidence (as I think) of ulceration in the larynx or pharynx, the case will probably be tedious. I leave a space in this letter to tell the result.

Monday, 14th Oct.—Ordered him yesterday to discontinue the spray, and keep a constant mild taint of sulphur fumes in his bedroom instead. To-day much improved in every way.

Wednesday, 16th Oct.—Since last report progress forward and satisfactory. To-day greatly better in every respect. Still the slightest degree of internal irritation and difficulty of swallowing. Still hacking up a little phlegm, which contains some streaks of blood (only seen today), confirming my notion of the existence of ulceration.

Friday, 18th Oct.—So nearly well that I may almost dismiss the case as cured. There may be some slight tenderness, and need to guard against relapse during the whole winter. But already we are talking of a respirator to let him out soon. Note.—I jotted down all particulars of this case from the beginning, resolved to tell the result, and expecting that result to be failure. My candid opinion is (after an experience of twenty-eight years) that this gentleman under all ordinary treatment would certainly have died; and that, should his recovery prove permanent (as it promises), he owes his life, under God, to Dr. Dewar of Kirkcaldy. Note 2.—Lest any reader may think this case detailed in a style too merry for the patient's feelings, I beg to observe that his own sanction has permitted me to tell his foolish exposure, Sunday lecture and everything. After all, how many of us endure needless relapses without such a good excuse as a strict attachment to duty, and eagerness to return to it at the earliest moment we think ourselves fit?

Note for Third Edition.—Nov. 13.—Continued gradually to improve. The external gland suppurated after all. Keeps quite well, and out in all weathers for the last fortnight, protected by a respirator.

Note for Seventh Edition.—Dec. 4.—Apparently quite well; has resumed his open air work at night: sometimes with a respirator, sometimes without.