Oct. 12.—Head bad, but not so bad as usual. On 15th, menstruation came on, and aggravated symptoms somewhat.
I directed inhalations to be increased in strength every day, until I reached equal proportions of air and oxygen—as much as 30 pints of each.
On October 21 had an attack of prostration to a more extreme degree than ever known before; she seemed, in fact, at the point of death from sheer exhaustion. And here again we are met by the important question—Was this due to oxygen? for experience recorded of its effects seems to warrant this apparent paradox, that although in many cases a stimulant, in some it is a depressant; that although it will increase the vital powers when only moderately depressed, it will tend to lower them when they are already very much lowered.[[11]] Or, again, was the prostration due to the bromide of potassium?
Candidly, I do not think that it was due to these causes, partly because she had had no inhalation for two days before, and no medicine for three days, and partly because a depression similar, though less in degree, has followed menstruation on other occasions, and this had been more profuse than usual.
For the time I gave her quinine and brandy and a little morphia, and on the 23d permitted her to resume inhalation, beginning at 12 to 60; she again gradually increased the dose to 30 pints in the day. For the bromide of potassium I substituted small doses of strychnia. The administration of the gas in varying doses was persevered with till November 4—a full month altogether—then I recommended her to discontinue it. The effect was certainly not marked; if there was any, it might be in relieving the sense of suffocation, which was not so bad during that month as it had been before and since; but on the whole the gas must be considered to have failed in this case. However, it will be remembered that many other remedies had failed also, and the further progress of the case has convinced me of the presence of serious organic disease; it is in fact two months since I have ceased to entertain or give any hope whatever of this lady’s recovery.
Case XII. was one of general debility with irritable heart. A gentleman of 35, who had lost several brothers by phthisis, and had been subject to unusual harass and exertion, began to lose appetite, to grow thin, and to suffer from lassitude, dyspnœa, and palpitation. When he came to me in May 1868, the symptoms had lasted for two or three months, but I could detect no physical signs of disease. For some weeks he took quinine, aconite, and cod oil, and applied belladonna; still he did not improve much.
On June 21, he inhaled 4 pints mixed with 30 of air, and felt a “greater lightness”—no increase of palpitation. After four days of treatment, he got an opportunity of spending a fortnight in the Highlands, and I recommended him to try the breathing of oxygen there. He returned home, however, in July, not so much improved as we had hoped, and still complaining much of soreness about the chest, and oppressed breathing. From this time to September he took an inhalation every third or fourth day, and with perceptible benefit. It is true that he took, for some weeks of the time, the hypophosphate of lime and cod oil, but still the effect of the inhalation in improving breathing power, and appetite especially, was immediate enough to convince us that it had a large share in his recovery. He has remained fairly well since.
To resume: 12 cases are here related; 2 of the 12 are of organic, and in all probability incurable disease, and these 2 derived little or no benefit from the inhalation of oxygen; the other 10 found benefit as recorded, some more, some less, but all of a kind which I have not seen given by medicine alone. It remains to ask—Is there any common character by which we may connect together this series of cases, and which may enable us to say, oxygen is good for such and such a class of cases, as we say iodide of potassium or quinine is good for such and such a class?
I think that we may find some such common character in the presence of congestion, especially venous congestion, whether of the liver, the lungs, or the uterus: more than this I will not say at present; the classification of carefully-observed cases, and a rational theory of this “modus medendi,” are points that require special study, and cannot be dogmatised upon until we have a wider basis of facts.