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The Pamphlet Collection of Sir Robert Stout: Volume 33

Case VIII.—Case of threatened or incipient Consumption

Case VIII.—Case of threatened or incipient Consumption.

On Friday, the 2d October 1867, my much esteemed and skilful friend, Dr. Crawford of Peebles, sent a letter to me, accompanied by a patient (who was a relative of my own), requesting that I would carefully examine him, and report if I could 'suggest anything further in the way of treatment.' A growing lad, age nineteen, rather badly page 30 formed chest, had contracted a cough in early spring; had tried change of air for it repeatedly, cod-liver oil, quinine and sulphuric acid, croton oil to chest, etc. The uvula, tonsils, and back of the pharynx covered extensively with granulations, which were coated with yellow muco-purulent matter. Dr. C. had sponged over these parts with caustic twice a week. But matters were gradually getting rather worse, besides cold weather setting in. The expectoration of muco-purulent matter was very abundant, and tinged with blood; a good deal of wheezing in various parts of the chest, especially under the left clavicle; sound on percussion pretty clear, except in the lower part of left side in front. Dr. C. hoped phthisis had not yet begun, but evidently threatened.

On the patient entering my house, a great cough at the door brought up a considerable amount of brownish purulent matter tinged with blood. After careful examination, I wrote as follows:—

'Biggar, 3d October 1867.

'My Dear Doctor,—I wish I could be as thoroughly satisfied with the condition of——as I certainly am with your treatment of him. You appear to me to have tried all ordinary means applicable in similar cases. But, notwithstanding your judicious treatment, I fear he runs a great risk of falling into phthisis, if not indeed beyond the borders of it already, unless something can be done to check that great discharge of purulent matter tinged with blood. In addition to his ago, duration of the cough, etc., this discharge appears the most alarming symptom. Where does it come from? A great deal certainly from the granular mucous membrane of the pharynx; some, probably, from the same membrane of the bronchial tubes down to their most minute ramifications (from the râles of the chest this is likely). None, it is to be hoped, from any burst tubercles or lung cavities. Come from where it may, we must, I think, apply some astringent lotion (as it were), in vapour, of course, to the very parts affected,' etc. I then detailed the process of sulphur fumigation, suggested an hour of such fumes morning and evening, and requested him to procure Dr. Dewar's pamphlet and judge for himself. Both of us agreed that a viper was hatching, if not already hatched, though it had not yet, we fondly hoped, firmly laid hold on, or eaten any holes into, the poor boy's lungs.

On yesterday, the 12th, I wrote the following letter :—

'Biggar, 12th Oct. 1867.

'My Dear Doctor,—Now that——has had a week's trial of the fumes, please tell me how he keeps, by giving short and clear answers to the following :—1. Any diminution of the cough? 2. Of the purulent expectoration? 3. Any difference in the appearance of pharynx? 4. Still any trace of blood in sputa? 5. Any improvement, or the reverse, in the general health?

'I am jotting down a few notes of cases at present, or putting the Sulphur Cure on its trial. What do you think of putting the patient on Hyposulphites or sulphites of soda or magnesia instead of cod-liver oil? The sulphurous acid of such sulphites is supposed to enter the blood, and attack the enemy at its fountain-head (see page 31 Medical Journal for this month—Art. Jamaica, Yellow Fever).——should take care to have his evening fumes in his own bedroom, and not expose himself to cold after them. Dr. H. Douglas approves of long exposure to weak fumes, instead of such strong suffocating ones as to make people cough much.—I am, my dear Sir, yours most sincerely,

R. Pairman.'

'Dr. Crawford, Peebles'

Note.—This case is detailed up to this date, without hearing any accounts of the patient's condition. I mention this to show the honesty of my trial.