While I could identify the airflow obstruction and inflammation, I was at a loss as to how best to treat it. In medical school, I had read Baillie’s The Morbid Anatomy of Some of the Most Important Parts of the Human Body, which described and illustrated hyperinflated lungs with enlarged airspaces. Often autopsies of those who died revealed that the lungs did not collapse as they usually do when the air is admitted but remained distended, as if they had lost their power of contracting. I had also read Laënnec’s A Treatise on the Diseases of the Chest - Laënnec had coined the term emphysema - and A Treatise on the Diseases of the Chest by William Stokes of Dublin, Ireland, which included a chapter on emphysema in it. I’d also read all the recently published lectures on emphysema by another doctor, Thomas Hodgkin, a morbid anatomist at Guy’s Hospital.
Now, as I examined each patient, I summoned every tidbit I’d learned from Uncle Ormond and everything I’d ever read. The symptoms of bronchitis were cough and expectoration, but what I saw in my patients was the almost complete obstruction of the bronchi, which could become suffocative. Most of my patients complained of dyspnea and in some, the skin had a blue tinge, so I knew they were not getting enough oxygen. The average age for someone who died ‘naturally’ of bronchitis or emphysema was sixty years. I’d treated patients in my office as young as ten months.
Trying to recall all the suggested remedies in these and other medical texts, I set about my task.
I asked a man in his forties, who said he ran a coffee-stall on Whitechapel Road, what brought him to my office. He said, “One of them boys told me about yer.” It could only be Wiggins or one of his little friends, Ollie or Rattle, all errand-boys for Sherlock. He told me that he felt a tightness across his chest, accompanied with a feeling of rawness or soreness and that these feelings were aggravated by every act of coughing. He had a slight fever and a dry cough with very little mucus being expectorated. But during and especially at the end of each act of coughing, he said he felt a painful sensation under the breast bone. He also felt it when breathing in cold air or upon drawing a long breath.
“What remedies have you tried, sir?” I asked.
“At bedtime, a hot foot-bath, a glass of hot toddy and ten grains of Dover’s powder.”
Dover’s was an old preparation comprised of powder of ipecacuanha, a homeopathic medicine, an ingredient in syrup of ipecac used to induce vomiting, powdered opium and potassium sulfate. People also used it to induce sweating, allegedly in advance of a cold and at the beginning of an attack of fever.
Another patient had the same symptoms initially, but then his cough became looser, less painful but more profuse, and it was frothy and streaked with blood. A few days later, the expectoration became thick and yellow, and the cough became more frequent and violent. He had tried using a mustard-plaster to relieve pain and soreness in his chest, and he’d taken to consuming a half-teaspoonful of the syrup of squills every two hours. When he became nauseous, he tried tartar emetic, wild cherry syrup, and water and drank that every two hours. Yet another patient, a man in his fifties who walked very stiffly, had tried nitrate of potash, tincture of digitalis, and syrup of squills mixed with six ounces of water. He said he sipped it every fifteen minutes, but it had done no good.
My roomful of patients had tried many home remedies: garlic, pepper, cinnamon, turpentine, bromides and iodides. I’d had good luck with Kimball White Pine and Tar Cough Syrup, which consisted of four minims of chloroform, so I dispensed this freely. I was concerned, though, because the chloroform could cause fatal cardiac or respiratory arrest, so cautioned my patients about proper dosage.
On the patients with the most advanced symptoms, I tried something that Uncle was employing at the hospital, a vibratory inhibitor administered with a hard-ball applicator. I used short, rapid strokes with medium pressure for about forty seconds to the posterior spinal nerve roots from the seventh cervical to the eighth dorsal.
My last patient of the day was a lovely, young woman with blond ringlets and deep and haunting blue eyes. She was in her mid-twenties and she was dressed in a modest beige blouse and skirt and a dark coat. I guessed that she might be a milliner or seamstress. She presented with symptoms of dyspnea, cough and expectoration and weak breath sounds.
I asked her name.
“Penelope. Penelope Potash. I have a little girl, Miss,” she said. “I need to get well to take care of her.”
She was skin and bones and also mentioned that her monthly periods had stopped. I’d heard that vibration gave good results for this malady, but I was skeptical about any of these treatments, and particularly this one for absent periods.
“Remove your blouse, please.”
As she did so, a strand of sunlight filtered in through the half window, illuminating the dusty desk and creeping across the room. When she turned around, it shone directly on her back. I was aghast at huge bruises, cuts and red welts. I was not sure what instrument of violence was used to beat her, but it would not have surprised me if she also had broken bones or ribs.
I put my hands on her shoulders and turned her round to face me. “What has happened to you? Who did this to you?”
She shrugged off my hands, lowered her eyes and said, “I had a disagreement with someone.”
“A disagreement! You have welts all over your back. This was not just a disagreement. Who did this to you? We must go to the authorities.”
She pulled at her blouse and started to button it.
“No, please. Don’t. I’m just trying to help.”
She dropped her hands to her sides and
