Smelling salts.

I was delving into some reference material recently, trying to track down details of early treatment of mild head injury, and I was struck by the repeated mention of smelling salts as a folk remedy for this problem. But just what are smelling salts? Do they work and can they cause injury? Although smelling salts have recently undergone a resurgence of interest by athletes as a pre-game stimulant or as a ‘‘pick me up’’ when performance is flagging, it appears that little is really known or understood about these agents. Over time they have tended to remain a traditional part of the trainer’s kit (along with the ubiquitous sponge and cold sprays) rather than in the medical bag. In the setting of sporting head injury, there are still many individuals and organisations that recommend the use of smelling salts to try and revive the injured athlete. Most recent sports medicine textbooks, however, emphatically state that smelling salts are contraindicated as they cause a withdrawal reaction, with the potential to cause or exacerbate spine injury. Take, for example, this early guideline for the management of unconscious patients from The treatment to restore natural breathing and circulation published in 1878 by Dr Peter Shepherd, Surgeon Major, Army Medical Department and an Associate of the Order of St John of Jerusalem. His approach was fairly dogmatic: