Case II. is of the same nature, and occurred in a gentleman of 24, who had had good health till twelve months before, when he noticed for the first time wheezing, and afterwards cough, traceable partly to the dusty nature of his business, partly to wearing damp clothes. The chest symptoms continued so bad as to confine him to the house for three or four months; afterwards, he seemed gradually to recover under the use of tonics and cod oil, and the influence of a warmer climate, and when he came to me in January 1869 for the first time, he looked well; however, he complained of debility, of constant dyspnœa on exertion, and of exaggerated attacks of it occurring suddenly at times, of some cough and of glutinous expectoration; if he attempted to live well, as he had been told to do—meaning especially the taking of wine—he usually got an attack of epistaxis.
Physical examination revealed a sibilus at the end of inspiration, and a rhonchus with expiration over all the right lung, except the apex; the chest was very fully developed and abnormally resonant.
I prescribed for him inhalations of oxygen in the proportion of 12 pints to 60 of air, and he took these twice in the week for five weeks; after each one he expressed himself in much the same manner as the last patient, was conscious of a general feeling of renewed health, of a greater power of breathing, and of facility of expectoration; great improvement took place in his condition, and I think it must be credited principally to the gas; for, although I ordered him 10 to 20 drops of tinct. lobeliæ at night-time, and later on tinct. fer. acetatis and frictions with the linim. tereb. acet., yet it is to be borne in mind that he had previously had a fair trial of expectorants, tonics, and even change of air, without anything like equivalent relief.
Case III. Phthisis pulmonalis.—Mrs. W——, æt. 31, who had lost her father and sisters of consumption, consulted me in Dec. 1867. For the last six months had had cough, for the last three had emaciated, and at this time had the prostration, night sweats, diarrhœa, and hectic of the third stage of phthisis; hæmoptysis had occurred several times: the expectoration was generally purulent. There were violent pains, especially over left chest, and examination revealed a fine crepitus at apex of left lung. The patient was treated with ordinary medicines, and improved gradually. Opium in the form of an atomized spray was found to be the best medicine for relieving cough, and procuring sleep; tincture of steel and carbolic acid used in the same manner relieved, to a certain extent, the profuse expectoration; and although the case became complicated with a peri-uterine hæmatocele, in February 1868 she rallied from this also.
It was July 1868 before she could walk as far as my house. Her principal symptoms then were debility, pains in the chest, cough, and copious muco-purulent sputum. At this time she began inhalations of oxygen in the proportion of 6 pints to 60 of air, increasing by degrees to 12 pints. She took eight inhalations at intervals of two days, and then found the above symptoms so much relieved as to be able to omit all treatment for a time. She herself attributed great benefit to the gas, and was taking no other special medicine at the time. Since then she has borne fairly well the cares of a large family. She has gained flesh, and though there is still a frequent cough, and sputum, and a mucous râle about the left apex (I examined the chest two days ago), the progress of the disease is arrested for a time at least.
Case IV. points precisely in the same direction. In May 1868 I was consulted by a gentleman of 19, whose father died of phthisis. He had been steward on board a packet plying between Liverpool and New York; got wet through on his last voyage, lung symptoms soon set in, and he considers that his present ones date from three months ago. He has constant cough, for which he can get no relief, profuse sweatings, hectic, and extreme emaciation; in short, all the ordinary signs of softening tubercle in the right apex, and had been sent home by medical men in Liverpool to Handsworth,—just to die. However, he too rallied under careful nursing, and with the help of ordinary medicinal agents, and by July was able to walk to my house, and begin inhalations of oxygen in proportion of 6 pints to 60. At this time the above-named symptoms were all better, and his principal complaint was of difficulty of breathing, and of pain in the side of the chest, and these did not yield to medicines or to liniments. He continued to inhale twice a week for two months, and at the end of that time was sufficiently recovered to seek for a situation. He is now in the employ of the London and North-Western Railway Company, has gained two stone, he says, and is 6 ft. 4 in. in height. I had an opportunity of examining his chest last week, and detected only dry and interrupted respiration in one apex. I should add that he continued the tinct. fer. perchlor. and cod oil during and after his treatment by gas; but he distinguished relief to the dyspnœa from the gas alone.
Case V.—Rev. W. M——, aged 34, lost father, brothers, and sisters from phthisis. In February 1868, when I first saw him, the prominent symptoms had lasted six months—the dyspepsia, the tight cough, the loss of voice, and the emaciation.
In March the physical signs of phthisis were evident in the left apex, as was ascertained by Dr. Russell, who saw the patient with me at that time. I need not detail symptoms or treatment, as they did not differ from what is usual; suffice it to say that improvement took place, but was temporary, and in April we recommended him to visit Jersey. He was there for three months (being considerably longer than I had intended), and at that time he thought that he found benefit from the sulphurous acid spray. However, he returned as bad, if not worse, than when he went, with night sweats, extreme prostration, cough, difficulty of breathing, and purulent expectoration. It was in this condition, and when he had had a trial of almost every other remedy, including a prolonged course of cod oil, that I proposed oxygen to him, and he began it July 24, 1868, in proportion of 6 pints to 60, increasing gradually up to 10 to 60, and taking this two or three times a week up to October 8, a period of 2½ months; during the whole course of the time, he had expressed himself as much relieved, both as to breathing power, cough, character of expectoration, appetite, and strength. He had gained weight, and the malady was quiescent. He had been accustomed to come from the country by train, and to ride back in a cab. On one unfortunate day (October 8), which was cold and very wet, he got into a cab the window of which was broken, drove six miles in the night air, in the course of that night got a sudden pain in the side, and dyspnœa, and when I saw him next day pneumonia had attacked the right lung, and he was desperately ill.
Now the point of the case is this. It has been said that the inhalation of oxygen is liable to cause inflammation of the lung. Did it do so in this patient? That must be a question to be decided on the evidence, but I cannot think that it did. The dilution of the gas was great; the same quantity had been inhaled for weeks before without any injury, and the other exciting cause was such a probable one. At the end of a month’s time he was convalescent, and urgently requested the resumption of his inhalations. I consented, and he again expressed relief from them, especially as to the dyspnœa; but effusion in the right pleura came on gradually, but too surely; for some time we saw the end approaching, and he died last month. Almost to the last he expressed benefit from the gas, and he certainly suffered less than any consumptive patient whom I have ever seen.[[10]]
Case VI.—I adduce as an instance of another variety of dyspnœa a warehouse woman of 27, who had also lost several brothers and sisters of phthisis. Had been much depressed by nursing the last one through a long and painful illness; she came to me in June 1868, with symptoms of dyspepsia and history of attacks of urgent difficulty of breathing coming on generally at a fixed hour of 9 or 10 in the morning; occasionally after later meals; she kept constantly sighing deeply, and had various symptoms of hysterical temperament; had also cough and viscid expectoration; but a physical examination revealed nothing very definite—perhaps puerile respiration in one lung and diminished vesicular murmur in the other.