Case IV.—Cold and Hoarseness—Warning about Asthma.

One of my earliest trials of the sulphur fumes was made upon a gentle- page 19 man of wealth and high position in society, residing in one of the mansion-houses in our district. The case is hardly worth recording, but for the lesson it teaches, or warning rather; a warning which Dr. Dewar's own pamphlet rather ignores. I had been attending one of his girls for a cold of long continuance, and had been giving the ordinary medicines, ipecacuanha wine, etc., with little benefit. One morning I received a message that the gentleman himself was affected with cold, and in bed; I had better call to see him. I found that he had been ailing for a week, was rather hoarse, but had scarcely, if at all, any cough. The proper treatment should have been by spray or an inhaler, but as yet I had not received the instruments. I suggested and explained to him the sulphur cure, to which he consented, though his lady consented with great reluctance. It so happened that a stranger gentleman and his wife were on a visit at the time, and great curiosity being excited to witness this strange medical innovation, this stranger gentleman said to me, 'I am anxious to witness the performance too, but dare not. I am a great martyr to asthma, and am almost certain it will bring on an attack. At present I am perfectly well, and won't risk it.' I assured him that it was recommended as the best cure for asthma yet discovered; that in Kirkcaldy it was a regular domestic institution, practised by all and sundry to preserve health, as well as cure disease; that as a tonic it was there superseding steel and cod-liver oil; and that even the scholars in the various schools were fumigated several times a day (according to Dr. Dewar), with the happy result of both improving their health and sharpening their intellects, by keeping the air always fresh and pure. Induced by my advice, the gentleman remained to witness the process.

While the room was filled with fumes, I caused my patient in bed (for lack of a suitable inhaler) to inhale now and then the steam of hot water from a jug. The steam and sulphurous acid fumes uniting caused a sort of artificial spray, identical in chemical composition with the spray of the instrument. Very soon the asthmatic gentleman rushed out, saying, 'I have had enough of it.' Shortly after, the two ladies. The children began to rush out too, but I hold by force my young patient, little Miss. I kept the room filled for half an hour or so, with nobody present but the patient, Miss, and myself. And in reflecting on it now, I think probably more sulphur was used than there was any occasion for. On leaving, I said, 'I positively think, Mr.——, you are speaking better already.' I then told him, and he promised, to repeat the process at night. 'I will call again tomorrow morning,' said I, 'not that you are so bad as to require a visit, but simply that I would like to see how you are.' On my next visit, I found Mr.——going about the house apparently well, and little Miss's cough better than it had been for weeks. But they had not repeated the process at night. I asked the reason. 'My wife,' said he, 'would not hear of it on any account. Besides, I was better at night, either with the medicine or fumes, or both together, and did not need it.' 'But for the sake of little Miss,' said I, 'you should have done it.' I then asked to see his lady, and recommended another dose to Miss. The only answer was, 'Oh! those nasty fumes, I won't submit to another trial.'

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It struck me as rather odd that a lady, who always appeared to have the utmost confidence in her medical adviser, and had obeyed his advice most implicitly before, should prove refractory after seeing the good results of a single trial. But there was a reason for it all, an enigma that I got explained only yesterday (10th October). The occasion was this :—Yesterday morning I was called to see the gamekeeper of this family by the lady's orders. Understanding that it was a case of sore throat, I took my spray-producer with me. The gamekeeper had been ill with ulcerated sore throat for several days (the effect of cold and bile), but by good treatment, such as mustard-poultices, blue pills, etc., he was greatly better, and probably would have been quite well to-day without any more ado. All that remained was a slight degree of tenderness of throat and difficulty of swallowing,—to relieve which, I gave him a few whiffs, with the view of hastening his cure twenty-four hours or thereby. The man immediately said, 'My throat is perfectly right; I have neither pain nor difficulty of swallowing.' This was rather too good not to let the lady know all about it, by way of retaliation for her former sneers against the sulphur cure. So of course I called just by the bye; I knew the lady would be anxious to know about the gamekeeper. In answer to the question, 'How is the gamekeeper?' 'Oh! quite well,' said I. 'One minute before I called he was complaining a good deal of his throat; the next minute I had it all right.' 'Indeed!' said she. 'How did you manage it so quickly as that?' A. 'By the sulphur cure, to be sure, which you despise so much.' In uttering these words, there possibly might be the slightest approach to a twinkle of triumph, not easily avoided. It could not, however, amount to rudeness; for she immediately told me with the greatest kindness and good-humour what was her objection to the sulphur fumes. 'I am perfectly conscious,' said she, 'that my husband was the better of them, and Missie too,'—'Yes, I was,' cried Missie,—'but do you know. Doctor, they brought on the stranger gentleman such an attack of asthma, perhaps the worst he ever had in his life. He got no relief till the afternoon, nor complete relief even for several days. I would not for the world have allowed a puff of them again while he was with us.' After recovering somewhat from the mingled feelings of sorrow, shame, contrition, and surprise with which this announcement overwhelmed me, I asked, 'Why did you not tell me this before?' A. 'I tell you it even now only from a sense of duty to put you on your guard. The gentleman was so satisfied that you acted from kindness, and to the best of your judgment, that he begged of me not to reveal it lest it might hurt your feelings.' After thanking her most cordially for such an act of kindness, I begged that she might allow me to make use of this case as a warning to others—a favour which she allowed very reluctantly, and only on my telling her that I was collecting notes about this cure, and putting it on its trial. 'As an honest man,' said I, 'I wish to probe it to the bottom, and find its flaws as well as merits. Hitherto, the only fault I have ever detected about it is, that it does not invariably come up to expectations. But this is a very serious matter.'

Remarks on this Case.—Though I have never yet tried the page 21 sulphur cure in asthma, this case appears to me a striking demonstration (so far as mere reasoning can prove it without trial), that in asthmatic attacks mild sulphur fumes will operate like a charm.¹ How so? Because, wherever the seat of asthma may be, sulphur fumes act on that seat, and therefore must stimulate it when in a state of disease. For an inflamed eye, one never would apply a lotion to the nose, but to the eye itself; and the lotion, to be effectual, must be of such a strength, that, dropped into a healthy eye needing no stimulation, it would raise inflammation in it. In like manner, for the cure of liver complaint, nothing can be expected from any medicine that acts solely on the kidneys, but from something that acts directly on the liver itself—calomel, for example. Yet a huge dose of calomel in a healthy person would infallibly induce a species of artificial liver disease, just as this gentleman had inadvertently raised in him what we may call an artificial asthma. This is the sole secret of the maxim similia similibus curantur, just a plain common-sense truth, on which so much nonsense and quackery have been raised.

Practical Conclusion.—Persons of weak chests, if quite healthy at the time, should not needlessly expose themselves to fumes unduly strong; and from reasoning alone, I confidently predict that patients with a cough will stand a stronger dose of them without coughing being excited, than people in health with no cough at all. 2d Lesson.—As a curative measure, long continuance to mild fumes is safer and infinitely better in every way than a shorter exposure to stronger fumes.