Inhalation in the treatment of disease; its therapeutics and practice. A treatise on the inhalation of gases, vapors, fumes, compressed and rarefied air, nebulized fluids, and powders

Front matter

MEDICAL TEXT-BOOKS

PUBLISHED BY

LINDSAY & BLAKISTON, PHILADELPHIA.

Preface To The Second Edition

The author's treatise on Inhalation having been some time out of print, and a new edition called for, the text has been subjected to revision, and such additions and alterations have been made as seemed requisite to present the subject from the standpoint of the day. It has not been deemed advisable to add to the number of cases recorded in the first edition, as this would have incumbered the volume without serving any adequate purpose; indeed, a number of cases, previously recorded, are omitted in the present edition as superfluous.

The article on Compressed and Rarefied Air has been much enlarged, to render it commensurate with the amount of attention bestowed on pneumatic therapeutics, abroad, in the treatment of certain affections of the lungs and heart.

Additional illustrations have been introduced where they have been thought likely to add to the value of the work. For several of these we are gratefully indebted to Codman & Shurtleff, of Boston, Tiemann & Co. and J. Reynders & Co., of New York, and Gemrig, of Philadelphia.

1431 Walnut Street, Philadelphia, January, 1876.

Preface To The First Edition

Inhalation, especially by the method of nebulization, is at present attracting favorable attention from the profession.

At the annual meeting of the American Medical Association, held in Baltimore, in 1866, a committee, of which the writer was chairman, was appointed to prepare for the meeting of 1867 a report on the Therapeutics of Inhalation. In the preparation of this report, the writer accumulated a quantity of material much too voluminous for that purpose, and determined to incorporate the most valuable portions in book-form, presenting in some detail the historical record of experiments, pathological studies, etc., from which conclusions were drawn for the report. The principal literature on the subject is foreign — for the most part German — the most elaborate work being (Die Inhalations- Therapie) by Dr. George Lewin, of Berlin, from which much has been drawn in the preparation of the present volume, besides which, as will be seen, many other authors have been consulted, as also an extensive file of foreign and American journals; while the private experience of several practitioners in this country has been laid under contribution.

Philadelphia, October 1st, 1867.

INTEODUCTION.

In examining the literature upon our subject, we find that from the earliest ages inhalation has been employed in Greece, in Rome, in Arabia, and thence, with the extension of medical knowledge, everywhere. Again and again has the method been extensively resorted to, and subsequently fallen into disuse, perhaps into abuse, for at each resumption it has seemed necessary to advance specious reasons to account for its previous neglect.

From time to time fresh discoveries in pneumatics have given renewed impulse to further investigation of the subject; and at each period with some permanent beneficial result.

Thus the discovery of oxygen by Priestley and Scheele in the middle of the last century, led to experiments upon the economy with " different kinds of air ;" and atmospheres noxious and innocuous became pressed into the service of therapeutics.

Then, early in the present century, the discovery of the peculiar properties of chlorine and iodine, led anew to examination of the physical properties of volatile substances ; and the inhalations of resinous materials, of narcotics, etc., were again brought into medical requisition.

Again, the observed effects of compressed air in cer-

Vlll INTRODUCTION.

tain of the mechanical employments, attracted experiment as to its value as a therapeutic agent.

Finally, the more recent device of a method of subdividing a liquid into a spray-cloud or nebula, and thus utilizing it in this attenuated form to the purposes of inhalation, and enlarging at once its sphere of usefulness, gave a fresh impetus to the study of the Therapeutics of Inhalation, which has resulted in the acquisition of new and valuable methods for at least affording grateful relief in certain pulmonary affections, to the cure of which medicine is, unfortunately, inadequate.

The personal attention necessary to insure proper inhalation, even of the most volatile substances, has no doubt debarred many physicians from a resort to the method, in preference to the much easier plan of advising a patient to swallow a draught or a pill ; and this, perhaps, is the reason why it has so long been found principally in use by a class of practitioners, " who," to use the language of the author of one of our best works on Therapeutics, " inhabit the debatable region between medicine and quackery.' 7 Dr. Rogers, in a note to Elliotson's Practice, Philadelphia Edition, 1844, p. 804, says: "A medical man, when he orders a patient to inhale vapors, must give his personal attention to the manner in which it is performed, if he wishes to have his intentions efficiently carried out. On one occasion, in a large hospital, when a patient with ulcerated sore throat had been ordered to inhale steam, I found him with a tin inhaler comfortably tucked under the bedclothes with a cork stuffed into the air-tube. The consequence of this was that the patient was obliged to remove his mouth from the instrument after every inspiration, and after all his laborious efforts the supply of

INTRODUCTION. IX

steam was very inefficient. The nurse (in every respect an excellent one), on being questioned as to the use of the cork, very naturally replied that it was ' to keep in the steam ;' and added, that she had been in the hospital eleven years and never saw an inhaler used in any other way. There is nothing surprising in all this. Xurses are not expected to understand the principles of pneumatics. On instituting an inspection of the other inhalers in the hospital, every one of them was found duly provided with a cork/'

The material collected in the following pages will show that inhalation has at all times possessed the confidence of men in good professional repute. Our various works on Therapeutics and Materia Medica, Copland's Dictionary, and the works on Practice issued in the earlier portion of the present century, give historical lists, more or less complete, of the various authorities who have at times employed inhalations and recommended them, as well as lists of the remedies resorted to. To have presented a complete list in the present volume would have occupied many -pages that are devoted to matter more practical, and the writer has been unwilling to furnish an incomplete record. Instead of an extended display of authorities, therefore, reference is made in each appropriate place to those individuals to whom the profession is indebted for having first prominently placed before them the merits of the inhalations of various remedies in certain diseases ; and with regard to the new method of inhaling nebulized fluids, the authorities cited are, as far as possible, authenticated, and credit given to the sources from which information has been derived.

The subject is still incomplete ; the observations re-

X INTRODUCTION.

corded at various times are not yet sufficiently numerous, accurate, or corroborative of each other for the deduction of positive conclusions ; and it is to be regretted that the value of a faithful record of unfavorable results has not attracted a sufficient share of attention from those who have hitherto written on the subject.

Such observations and records of authors, abroad and at home, as have seemed to the writer most valuable from the mass of matter which has accumulated on his hands, are laid before the reader that he may form his own estimate of their value. The writer has endeavored to present the subject as impartially as a decided bias in favor of inhalations would permit.

It may not be amiss here to answer an objection that will often be heard urged against inhalation. It is this : Inhalation being defended on the ground that affected structures are thus subjected to local treatment ; and, at the same time, it being impossible to limit the local action to the diseased structures ; where, then, the great benefit? We see, however, that the objection holds good in a measure, with regard to medicines given by the stomach ; they affect more or less the entire system, though their action may predominate in some one direction ; but there is a class of therapeutists who teach that it is by sustaining those portions of organs still healthy, and protecting them against the extension of morbific processes, which have already imperilled the integrity of part of their substance, or at any rate temporarily impaired their natural functions, that we are able to extend the restorative influence by continuance of molecular action into the very structures diseased, and thus excite them, as far as they are not disorganized or changed, to a return of normal function. Healthy tis-

INTRODUCTION. XI

sues, too, resist the effect of medicines, local or general ; thus we can rarely restrict the action of a lotion or a caustic to the diseased structures, and the parts in immediate contiguity often receive a full benefit from the application; still, they recover from it, so that even an accidental occurrence of the kind affords no valid argument against the use of such local treatment.

It seems plausible, too, that even when remedies act systemically, we should anticipate better results by impressing first the particular organs designed to be acted upon with any remedy by its passage through the system, than by impressing the system primarily and the affected organ secondarily, by the passage through it of medicated blood-plasma, or modified nerve-force; besides which, the systemic exhalants are more actively called upon for their emunctorial duties than are the systemic absorbents for the impression of some special organ ; added to which, the changes which may occur during the progress of the digestion of a medicine may alter its primary effect ; and if any difference has been detected in the effect of any remedy as administered by inhalation or deglutition, it is not illogical to trace the cause, in a great measure, to the digestive process to which it is subjected in the stomach, where the remedies undergo preparation for absorption. We administer remedies for the production of effects known to occur after exposure to the digestive process, and it may be possible that their action would be different were they not thus digested ; at any rate, we act upon such premises, for we diminish the quantity of medicine to be introduced by direct absorption into the body for a certain effect, whether by the skin or by the bronchial mucous membrane ; and therefore, in resorting to inhalatory

Xll INTRODUCTION.

therapeutics, we must carefully watch the effect of remedies; for much judgment may be required in the selection of a special materia medica. One advantage is, that remedies exhibited for inhalation are usually presented in a simply medicinal form, deprived in great measure of the original (resinous, woody, or other) connecting medium, which is more apt to be preserved as usually administered ; and another is that the misfortunes and errors of the elaborate prescriptions of polypharmacists are less apt to be endured by the patient.

As has again and again been proven by actual experiment on the lower animals, and on man, the mucous membrane of the respiratory organs has a much greater capacity for absorption than that of the stomach, than which it is much more delicate; and for articles not desirable to be exposed to the solvent principle of the gastric juice, inhalation is at least as advantageous a mode, in many instances, for the administration of appropriate remedies, as the skin or connective tissue. The material inhaled comes directly in close juxtaposition to the blood while in its most vital state, and is thus more promptly and more thoroughly absorbed into the tide of the circulation than when it traverses part of the venous circuit before exposure to the inspiratory effort. It is often advantageous, too, that nothing shall interfere directly with the digestive functions.

The promptness with which the respiratory mucous membrane absorbs is well shown in the action of general anaesthetics, and he who is skeptical as regards the facility with which other articles of the materia medica are absorbed, can perform upon himself the experiment of taking a certain amount of a narcotic by the stomach, and at another time, under similar conditions of body as

INTRODUCTION. Xlll

well as may be, inhaling a similar amount of the same narcotic in solution, by some of the methods described in the pages of this volume ; and, unless he be the subject of some idiosyncrasy, the truth of the matter may safely rest upon his own verdict as to the resulting sensations.

Introduction, vii

Table of Contents, xv

List of Illustrations, xix

Part I

The Inhalation of Airs, Gases, Vapors, and Eumes, . 13 Inhalers, . . . . . . . . . . .19

Atmospheric Air, 33

Condensed and Rarefied Air, ....... 37

Oxygen, 61

Ozone, 79

Nitrous Oxide, 80

Nitrous Acid, 81

Hydrogen, 82

Sulphuretted Hydrogen, ....... 83

Carbonic Acid, 83

Carburetted Hydrogen, 87

Chlorine, 91

Iodine, 96

Iodoform, 110

Sulphur, Ill

Chloride of Ammonium, . . . ... . . 115

Ether, 121

Nitrite of Amyl, 131

Balsamic Vapors, ......... 133

Resinous Vapors of the Coniferae, 136

XVI

CONTENTS,

Tar,

Oil of Turpentine, .

Oils of Pine, .

Other Essential Oils,

Oxygenated Essences

Creasote,

Carbolic Acid,

Opium and other Narcot

Nitrate of Potassium,

Camphor,

Lime,

Arsenic, .

Mercury,

Chloride of Copper

Hot Water, .

Part II Page 139

Inhalation of Nebulized Fluids, or Sprays, . . 184 Nebulized Medicaments and the Apparatus for their Production, 184

Experiments upon Men and Animals as to the Penetration

of Nebulized Fluids into the Respiratory Passages, . . 213

Experiments with Negative Results, ..... 214

Experiments with Positive Kesults, 224

Keport on the foregoing Experiments to the Parisian Academy of Medicine, 230

Further Experiments in Germany and elsewhere, . . . 233

The Proportion of Nebula Inhaled, . . . • . .247

Immediate Effects of the Inhalation of Nebulized Fluids, . 250

Manner of Conducting the Inhalation of Nebulized Fluids, . 251

Number, Strength, and Duration of Inhalations, etc., . . 257

Articles of the Materia Medica suitable for Nebulization, . 259

PART III. The Inhalation of Powders, 336

The Insufflation or Inhalation of Powders in Affections of

the Eespiratory Organs, ....... 336

CONTENTS. XV11

PAGE

Experiments on Men and Animals proving the Penetration of Powders into the Respiratory Tracts, .... 345

Pathological Proofs of the Penetration of Powders into the Lung Tissue, 350

Articles of the Materia Medica employed by Inhalation or Insufflation in Powder, ....... 363