INHALATION 
 
 ITS THERAPEUTICS AND PRACTICE. 
 
 A TEBATISE 
 
 INHALATION OF GASES, VAPOKS, NEBULIZED 
 FLUIDS, AND POWDEKS, 
 
 INCLUDING 
 
 A DESCRIPTION OF THE APPARATUS EMPLOYED, AND A RECORD 
 
 OF NUMEROUS EXPERIMENTS, PHYSIOLOGICAL AND 
 
 PATHOLOGICAL ; WITH CASES. 
 
 V 
 
 By J. SOLIS COHEN, M.D. 
 
 c ^ofCo^ 
 
 lllnstrata 1SS7 
 
 *' of Washing 
 
 PHILADELPHIA: 
 LINDSAY & BLAKISTON. 
 
 1867. 
 
^ 
 
 N <^ 
 
 
 Entered according to Act of Congress, in the year 1867, 
 
 By LINDSAY & BLAKISTON, 
 
 In the Clerk's Office of the District Court of the United States for 
 Eastern District of Pennsylvania. 
 
 PHILADELPHIA: 
 CAXTON PRESS OP SHERMAN & CO. 
 
CONTENTS. 
 
 PAGE 
 
 Preface, v 
 
 Introduction, vii 
 
 Part L 
 Inhalation of Nebulized Fluids. 
 
 CHAPTER I. 
 
 Nebulized Medicaments and the Apparatus for their Pro- 
 duction, 13 
 
 CHAPTER II. 
 
 Experiments upon Men and Animals, with Pathological 
 Proof of the Entrance of Nebulized Eluids into the Respi- 
 ratory Passages, 39 
 
 CHAPTER III, 
 
 Manner of Conducting Inhalation of Nebulized Fluids ; their 
 Immediate Effects; their Number, Strength, and Dura- 
 tion, &c, .,,<«,.... 75 
 
 CHAPTER IT, 
 
 Articles of the Materia Medica suitable for Nebulization, . 88 
 
 CHAPTER V. 
 
 Diseases to the Treatment of which this Method is Appli- 
 cable, 99 
 
IV CONTENTS. 
 
 Part II. 
 
 PAGR 
 
 Inhalation of Medicated Airs, Gases, and Yapors, . 175 
 
 Part III. 
 Inhalation of Powders. 
 
 CHAPTER I. 
 
 Inhalation or Insufflation of Powders in Affections of the 
 Respiratory Organs, . 270 
 
 CHAPTER II. 
 
 Experiments Proving their Penetration into the Respiratory 
 Tract, 277 
 
 CHAPTER III. 
 
 Pathological Proofs of the Penetration of Powders into the 
 Pulmonary Tissue, ........ 282 
 
 Index, > 295 
 
 * 
 
 ERRATA. 
 
 Page 32, 6th line from top, for 1865 read 1866. 
 " 175, 7th " bottom, for employed read described. 
 " 225, 3d " " " adapted read adopted. 
 
PREFACE. 
 
 Inhalation, especially by the method of nebuliza- 
 tion, is at present attracting favorable attention from 
 the profession. 
 
 At the annual meeting of the American Medical As- 
 sociation, held in Baltimore, in 1866, a committee, of 
 which the writer was chairman, was appointed to pre- 
 pare for the meeting of 1867 a report on the Therapeu- 
 tics of Inhalation. In the preparation of this report, 
 the writer accumulated a quantity of material much too 
 voluminous for that purpose, and determined to incor- 
 porate the most valuable portions in book-form, present- 
 ing in some detail the historical record of experiments, 
 pathological studies, &c, 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 
 
VI PREFACE. 
 
 which, as will be seen, many other authors have been 
 consulted, as also an extensive file of foreign and Ameri- 
 can journals ; while the private experience of several 
 practitioners in this country has been laid under contri- 
 bution. 
 
 Philadelphia, No. 127 South Tenth Street, 
 October 1, 1867. 
 
INTRODUCTION. 
 
 In examining the literature upon our subject, we find 
 that inhalation has been employed from the earliest ages 
 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 ad- 
 vance specious reasons accounting for its previous neg- 
 lect. 
 
 Of late, new discoveries in pneumatics have at various 
 periods given an impulse to further investigation of the 
 subject, and at each time with some permanent benefi- 
 cial result. 
 
 Thus the discovery of oxygen by Priestly 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 were 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, &c, were again brought into medical 
 requisition. 
 
 Again, the observed effects of compressed air in cer- 
 tain of the mechanical employments, attracted experi- 
 ment as to its value as a therapeutic agent. 
 
 Finally, the recent discovery of a method of subdivid- 
 ing liquids into a cloud or nebula, and thus utilizing 
 
Vlll INTRODUCTION. 
 
 them to the purposes of inhalation, and enlarging at 
 once its sphere of usefulness, has given a fresh impetus 
 to the study of the Therapeutics of Inhalation, which 
 bids fair to result in the acquisition of new and valua- 
 ble methods for at least affording grateful relief in those 
 pulmonary affections, to the cure of which, medicine is, 
 unfortunately, inadequate. 
 
 The personal attention necessary to insure proper in- 
 halation, 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 advis- 
 ing a patient to swallow a draught or a pill ; and this, 
 perhaps, is the reason why it has heretofore 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." Dr. Rogers, in a note to 
 Elliotson's Practice, Philadelphia Edition, 1844, p. 804, 
 says : " A medical man, when he orders a patient to in- 
 hale 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 bed- 
 clothes with a cork stuffed into the air-tube. The con- 
 sequence of this was that the patient was obliged to re- 
 move his mouth from the instrument after every inspi- 
 ration, and after all his laborious efforts the supply of 
 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 Ho keep in 
 the steam ;' and added, that she had been in the hos- 
 
INTRODUCTION. IX 
 
 pital eleven years and never saw an inhaler used in any 
 other way. There is nothing surprising in all this. 
 Nurses 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 con- 
 fidence of men in good professional repute. Our va- 
 rious works on Therapeutics and Materia Medica, Cop- 
 land's Dictionary, and the works on Practice issued 
 in the earlier portion of the present century, give his- 
 torical lists, more or less complete, of the various au- 
 thorities who have at times employed inhalations and 
 recommended them, as well as lists of the remedies re- 
 sorted to. To have presented a complete list in the pres- 
 ent volume would have occupied many pages that are 
 devoted to matter more practical, and the writer has 
 been unwilling to furnish an incomplete record. In- 
 stead of an extended display of authorities, therefore, 
 reference is made in each appropriate place to those in- 
 dividuals 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, au- 
 thenticated, and credit given to the sources from which 
 information has been derived. 
 
 The subject is necessarily incomplete ; the observa- 
 tions made in various directions are not yet sufficiently 
 numerous or corroborative of each other for the deduc- 
 tion of positive conclusions ; and it is to be regretted 
 that the value of a faithful record of unfavorable results 
 
X INTRODUCTION. 
 
 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 af- 
 fected 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 direc- 
 tior. ' r 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 ex- 
 tend the restorative influence by continuance of molecu- 
 lar 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- 
 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, the parts immediately 
 adjacent often receive a full benefit from the applica- 
 
INTRODUCTION. XI 
 
 tion ; still, that 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 ; be- 
 sides 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 inha- 
 latory therapeutics, we must carefully watch the effect 
 of remedies, for it may require much judgment in the 
 selection of a special materia inedica. One advantage 
 is, that remedies exhibited for inhalation are usually 
 presented in a simply medicinal form, deprived in great 
 
XU INTRODUCTION. 
 
 measure of the original (resinous, woody, or other) con- 
 necting medium, which is more apt to be preserved as 
 usually administered, while the misfortunes and errors 
 of the elaborate prescriptions of polypharmacists are 
 less apt to be endured by the patient. 
 
 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 prin- 
 ciple of the gastric juice, inhalation is at least as ad- 
 vantageous a mode, in many instances, for the adminis- 
 tration of appropriate remedies, as the skin or connective 
 cellular 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 
 performs part of the venous circuit before exposure to 
 the inspiratory effort. It is often, too, advantageous 
 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 
 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 sub- 
 ject of some idiosyncrasy, the truth of the matter may 
 safely rest upon his own verdict as to the resulting 
 sensations. 
 
ON INHALATION. 
 
 PART I. 
 
 INHALATION OF NEBULIZED FLUIDS. 
 
 CHAPTER I. 
 
 NEBULIZED MEDICAMENTS AND THE APPARATUS FOR 
 THEIR PRODUCTION. 
 
 Every one who has seen a waterfall strike upon the 
 rocks below it, knows how portions of the stream are 
 broken by the concussion into a coarser or finer spray 
 which remains for a time suspended in the atmosphere. 
 A stream of water forced through a narrow tube against 
 a firm resistance will produce the same effect, as we 
 sometimes see in the more remote particles of the water 
 as it is dashed from a building against which an engine 
 is playing. These remote particles are no longer in 
 contact, but are separate molecules, which, as soon as 
 they alight, are condensed into drops. 
 
 On this principle, it occurred to Auphan, at Euzet- 
 les-Bains, in 1849, to break up the mineral water of 
 that watering-place into a fine spray, for purposes of 
 inhalation, by forcing a delicate stream to impinge 
 against the walls of the apartment. The same system 
 was adopted shortly after at Jjamotte-les- Bains ; and 
 subsequently Sales-Girons, in conjunction with M. de 
 
 2 
 
14 NEBULIZED MEDICAMENTS 
 
 Flube, proprietor of the baths at Pierrefonds, a water- 
 ing-place near Compeigne, and who first suggested the 
 idea of pulverizing liquids without employing a blast 
 of air, constructed an apparatus for converting these 
 mineral waters into the finest possible spray, with 
 the idea of more thoroughly preparing them for the 
 treatment of diseases of the respiratory organs. Sales- 
 Gtirons read a paper entitled, u Memoir e sur la Chambre 
 de Respiration nouvelle de Pierrefonds" before the Hy- 
 drological Academy of Paris, on December 8th, 1856 ; 
 in which he described his inhalatorium, and contended 
 that the spray penetrated deeply into the respiratory 
 tract. Doubts were expressed by many of the members 
 as to the fact of such penetrations, and shortly after, 
 experiments were instituted at the different spas to solve 
 the mooted question. 
 
 Sales-Girons' inhalatorium was a chamber seven me- 
 tres long, four and a half metres wide, and three metres 
 high, in which it was intended that several patients, 
 from one to fifteen, should take inhalations together. 
 During the inhalations the window of the apartment 
 was kept open, and the condensed fluid which accumu- 
 lated upon the floor was carried off by a waste pipe. 
 The patients were prevented from being wet through 
 by appropriate coverings. A suction pump outside of 
 the chamber drew the mineral water up into a tube, 
 which passed through a water-bath heated to the de- 
 sired temperature, and then passed into the chamber, 
 where it terminated in a vertical cylinder to the end of 
 which was attached the pulverizer or apparatus for pro- 
 ducing the spray. Six fine grooves in the cylinder, 
 controlled by a stop-cock, gave exit to as many strongly 
 compressed streams of mineral water, which, striking 
 with great force against a metallic plate at short range, 
 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 15 
 
 were thence distributed in the atmosphere jn the form 
 of a fine spray. (Therapeutique Respiratoire ; Traite 
 Theorique et Pratique des Salles de Respiration Nou- 
 velles a Veau Minerale Pulverisee, pour le traitement des 
 Maladies de Poitrine. Par le Docteur Sales-Girons, 
 Medicin-Inspecteur des Eaux Sulfureuses de Pierre- 
 fonds, 1858.) 
 
 MM. Patissier and Ossian Henry visited the inhala- 
 torium at Pierrefonds, and reported to the Academy of 
 Paris that they were satisfied that the sprays produced 
 at that establishment contained all the elements of the 
 original mineral water. Sales-Girons received a silver 
 medal from the Academy as a recognition of his val- 
 uable addition to our therapeutic resources. 
 
 Subsequently, Sales-Girons devised a portable ap- 
 paratus, a pulverisateur poi'tatif des liquides medica- 
 rnenteux, which can be used in any apartment, and 
 through which any medicated liquid can be broken up 
 into spray as fine as that produced in his inhalatorium. 
 A committee consisting of MM. Gavarret, Patissier, 0. 
 Henry, and Poiseuille, presented a favorable report on 
 this apparatus to the Parisian Academy of Medicine. 
 
 The convenience of such an instrument at once com- 
 mended itself to those desirous of employing the new 
 method of medication, and gave an excellent opportu- 
 nity to its adherents and opponents for experiment at 
 their convenience as to the penetration of the spray 
 into the respiratory tract. This apparatus (Fig. 1) was 
 manufactured by Charriere, of Paris, and is known as 
 the first model of Charriere. It consists of a metallic 
 vessel of the capacity of from eighteen to twenty 
 ounces, which is to be filled two-thirds with the liquid 
 intended to be pulverized. In the neck of this vessel 
 
16 
 
 NEBULIZED MEDICAMENTS 
 
 there screws a compression pump (condensing syringe), 
 which, by compressing the air above the liquid, drives 
 the latter through a capillary tube against a convex 
 button, in close proximity, with such force that it is 
 from that point deflected off in a fine spray. A man- 
 ometer attached to the instrument shows the amount of 
 
 Fig. 1 .* 
 
 Sales-Girons' Pulverisateur Portatif. (From Lewin.) 
 
 * a, compression pump ; b, reservoir ; c, stream of fluid about 
 to strike the button which is concealed within the drum ; d, tube 
 with stop-cock ; /, drum or cylinder in which the excess of spray 
 is condensed ; g, waste tube to carry off the condensed fluid ; h, 
 manometer. 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 17 
 
 pressure employed, the usual pressure being a force of 
 from three to five atmospheres. 
 
 The second model of Charriere differs from the first 
 in the reservoir being made of glass, and the glass tube 
 through which the stream of fluid is forced, dipping 
 down into the fluid. 
 
 In the third model of Charriere, water pressure is 
 used instead of compressed air ; but the pressure soon 
 giving out, it requires to be kept in motion more fre- 
 quently. 
 
 Later, M. Matthieu (de la Drome) constructed a 
 portable spray producer according to a principle sug- 
 gested by H. Tirman, and which consists in the forcible 
 extrusion of air and fluid at the same time. The prin- 
 ciple will be recognized by taking an ordinary syringe 
 after it has just been discharged of its contents, drawing 
 back the piston, and then projecting it forward with 
 force. The fluid remaining in the nozzle will be for- 
 cibly ejected with the escaping air, and will be con- 
 verted into spray ; and it may be mentioned in passing 
 that a syringe thus handled, or the little gum-ball 
 douches, now used for nasal, aural, and urethral injec- 
 tions, — taking up but a drop or so of liquid and then 
 propelling it out with great force, affords an excellent 
 method of medicating locally the fauces, tonsils, pha- 
 rynx, &c. The smaller the opening of the nozzle of 
 the syringe, the finer will be the spray. 
 
 Matthieu' s apparatus was exhibited to the Parisian 
 Academy of Medicine on the 9th of May, 1859 {Gazette 
 des Hdpitaux, 1859, p. 297), and is called by him a 
 Ne'phogene, or, as we have anglicized it, a nebulizer, 
 which is a more correct name for these instruments 
 than pulverizer or atomizer, for the liquid is not pul- 
 
 2* 
 
18 
 
 NEBULIZED MEDICAMENTS 
 
 verized nor atomized, but simply broken up into a cloud 
 or nebula. This instrument (Fig. 2) consists of a 
 Heron's ball, in which the air is compressed. After the 
 
 Fig 
 
 Matthieu's Nephogene. (From Lewin.) 
 
 necessary pressure has been produced, on opening the 
 vent, which is controlled by a stop-cock, this com- 
 pressed air rushes out with great force, and, in escap- 
 ing, drives before it and with it a small quantity of the 
 desired fluid, which is allowed to drip into the exit 
 tube from a glass globe above ; and as it leaves the cap- 
 illary opening at the extremity, it emerges to all sides 
 in a fine spray ; a lamp warms the spray as it escapes. 
 There are several objections to the employment of 
 this apparatus for inhalatory purposes. A large quan- 
 tity of compressed air is forced out, and the liquid is 
 driven into the mouth in a straight line, and with such 
 
 * a, compression pump ; b, glass globe containing the fluid to 
 be nebulized; c, exit tube; d, flexible tube conveying the con- 
 densed air from the reservoir to the exit tube ; /, air reservoir. 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 19 
 
 force that the ordinary strength of an inspiratory effort 
 cannot deflect it into the air-passages, and the greater 
 part of it condenses upon the pharynx and soft palate, 
 and sometimes strikes these parts with such force (ac- 
 cording to Lewin) as to cause spasmodic closure of the 
 glottis and excite spasms of coughing. It is but fair to 
 mention that this instrument was originally intended 
 for administering a spray bath to any individual por- 
 tion of the body. {See Gaz. Hebdom., May 4, 1860, and 
 \_Matthieus tetter] May 11, 1860.) 
 
 Lambron, Velpeau, and others have constructed sim- 
 ilar instruments on the same principle. {Lewin.) 
 
 Sales-Girons also constructed a third instrument, in 
 which the spray is produced by the agency of bristles 
 attached to the circumference of a wheel. As the wheel 
 is rapidly turned, the brushes dip into the fluid to be 
 nebulized, and as they emerge from it strike with force 
 against a ledge, and thence the fluid is disseminated as 
 a fine spray. {Fieber.) 
 
 Lewin, of Berlin, has constructed an apparatus with 
 an ordinary suction pump (syringe) which forces the 
 liquid into a reservoir, the air within which is thus com- 
 pressed, and in its turn becomes a propelling force 
 driving the fluid, by the opening of a valve, out of a 
 very fine aperture, whence it impinges on a convex 
 button, and is thus broken into spray. This apparatus 
 once set in action will continue to work for a consider- 
 able time without further pumping. 
 
 Waldenburg {Die Inhalationen der zerstdubten 
 Fliissigkeiten, &c, von Dr. L. Waldenburg, Berlin, 
 1864), has constructed an apparatus with a suction and 
 forcing pump (the same sort of pump that is furnished 
 with Mayer's uterus douche), which draws the liquid 
 
20 NEBULIZED MEDICAMENTS 
 
 from a second vessel, and then drives it out, through a 
 capillary opening, against a cylindrical drum with a 
 concave plate of metal (a la Sales-Girons). A tube at- 
 tached to the drum conveys the condensed excess of 
 spray back to the reservoir, so that the same liquid can 
 be used again and again for some time. Waldenburg 
 also conceived the idea of suspending the nebulized 
 spray in connection with the vapor of water ; and he 
 adjusted a flask in which the water or desired decoction 
 was made to boil, so that the steam passed through the 
 cylindrical drum of his nebulizer and thus mingled with 
 the spray. 
 
 Subsequently he constructed, after a plan suggested 
 to him by Reichenheim, a chemist, an apparatus in 
 which the steam and the nebulized fluid was produced 
 at the same time. A convenient vessel was tightly 
 closed by a cork. Through an opening in the cork 
 dipped a wide tube nearly to the bottom of the vessel. 
 The tube gradually narrowing terminated at its bent 
 extremity outside of the vessel in a capillary opening. 
 The vessel, filled nearly full of a watery fluid, being 
 heated, a portion of the fluid is converted into vapor, 
 and, as it cannot escape through the cork, it presses 
 more and more by its continued evolution upon the 
 upper surface of the fluid, and in its escape drives out 
 some of the fluid before it through the exposed extrem- 
 ity of the tube dipping into the vessel. Then by direct- 
 ing the escaping stream against some appropriate resist- 
 ance, as a convex metallic lens, the simultaneous pro- 
 duction of steam and spray may be kept up for a con- 
 siderable time. 
 
 Dr. J. Schnitzler ( Wiener Medicinhalle, 1862, No. 
 29, Fieber, Lewin et al.) has constructed an apparatus. 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 21 
 
 This consists of a stout cylinder of glass, with an air- 
 tight metallic cap and base: the air in the vessel which 
 contains the fluid is compressed by a screw instead of a 
 vertical piston, and when the cock is opened, after a 
 few rapid turns of the screw have produced the desired 
 pressure, the stream rushes out through a capillary 
 tube, and impinges against a lens in close proximity. 
 With this apparatus the lens against which the fluid is 
 nebulized can be held in the mouth of the patient so as 
 to prevent too great a loss of fluid. 
 
 Fournie {Gazette des Hopitaux, July, 1861) has 
 constructed an apparatus composed of a compression 
 pump, and a reservoir with a stop-cock ; a glass cylin- 
 der with a tube ending in a capillary opening and made 
 of platinum ; beneath the capillary extremity of the 
 tube a lens on which the impinging stream is nebulized. 
 In this apparatus also, the lens can be inserted within 
 the mouth and the nebulization take place there. 
 
 The most convenient apparatus working by pressure, 
 next to that of Lewin, to be described presently, and 
 for promoting deep inhalations of any fluid which will 
 not be acted upon by metal, is the modification of 
 Sales- Girons, figured on the next page, and manu- 
 factured by L. Mathieu (cutler), of Paris. It is 
 readily managed, and produces a more minute spray 
 than any other instrument I have seen employed. An 
 idea of the appearance of the nebula produced may be 
 inferred from the exclamation of a boilermaker of this 
 city, for a friend of whom I was employing an opiate 
 solution at ordinary temperature. He saw me take the 
 cold water from a drinking pitcher and add it to the 
 medicated solution, and, after watching the play of the 
 spray for a few seconds, he burst out, " Well, Doctor, 
 
22 
 
 NEBULIZED MEDICAMENTS 
 
 I'll be hanged! that's the first time I ever saw any one 
 get up steam out of cold water !" 
 
 Fig. 3.* 
 
 This apparatus (Fig. 3) is composed of a glass re- 
 servoir c, in which the liquid to be employed is poured 
 through the little funnel G. On compressing the air 
 in the pump B, by motion of the lever A, the fluid is 
 forced through a small groove in one of the plates 
 
 * A, lever; B, condensing syringe; C, glass reservoir; D, joint 
 in which there is a groove through which the stream escapes ; E, 
 metallic drum, against the concave surface of which the stream 
 becomes nebulized ; F, waste pipe ; (x, funnel for entrance of 
 fluid ; H, screw regulating the delicacy of the escaping current of 
 fluid. 
 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 23 
 
 forming the joint D, and, by turning the screw H, the. 
 smooth plate is more or less compressed against the 
 groove, thus regulating the fineness of the stream. A 
 stream as fine as the finest hair can be thus secured if 
 the instrument be properly constructed. This stream 
 strikes against the upper portion of the cylindrical me- 
 tallic drum E, whence it is diffused in a very fine spray. 
 A waste-pipe F, conveys the excess of fluid back into 
 the reservoir. The force with which this little appa- 
 ratus works can be seen by removing the drum, when 
 the stream will be projected up for several feet, then 
 falling like a fountain. It is said that at a few inches 
 distance the stream can be projected into the skin, thus 
 forming a mode of endermic medication. 
 
 All these apparatuses are composed entirely, or in 
 great part, of metal, which limits their ^employment to 
 such articles as will not chemically react upon them. 
 
 This objection is overcome by the very admirable 
 apparatus of Lewin, of Berlin (Fig. 4), which combines 
 the Sales-Girons' principle of the suddenly-arrested 
 stream, and the Nathanson principle of the distributing 
 current of air. It consists of a strong glass reservoir 
 of the capacity of one-fourth gallon, and graduated in 
 ounces. It is covered by a strong metal cap, in which 
 there are three openings : one for the introduction of the 
 liquid and the subsequent attachment of the condensing 
 syringe ; one affords exit to the capillary extremity of 
 a slender tube which reaches to the bottom of the glass ; 
 and the third is covered by a spring safety-valve, through 
 which the compressed air may escape after a certain 
 pressure has been produced. The finger is placed upon 
 the capillary extremity of the exit tube until the air in 
 the reservoir has been sufficiently compressed by a few 
 
24 
 
 NEBULIZED MEDICAMENTS 
 
 strokes of the piston, when the finger is removed, and 
 the fluid rushes out with great force and breaks upon a 
 gilded metallic convex button secured in a glass drum, 
 
 Fig. 4.* 
 
 Lewin's Glass Nebulizer. (From Lewin.) 
 
 perforated to admit the stream, and attached by a sup- 
 port to the side of the instrument. The drum is not 
 furnished with a waste-pipe, but is so inclined that the 
 excess of fluid will flow over its edge into any con- 
 venient receptacle. 
 
 The advantages of this instrument are, that the medi- 
 cinal solution comes in contact only with glass, or with 
 the gilded button, and therefore any substance desired 
 can be nebulized with it ; that the amount of fluid 
 nebulized, as well as the quantity remaining, can be 
 
 * a, condensing syringe ; b, reservoir; c, exit tube; d, drum. 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 25 
 
 accurately measured ; that twelve or fifteen strokes of 
 the piston is sufficient to secure the escape of fluid for 
 several minutes, thus avoiding the labor of frequent 
 pumping during inhalation. 
 
 The great objection to the apparatus is its extrav- 
 agance with the liquid. Where economy is no object, 
 it is the most convenient instrument for office use. 
 If there be allowed to remain in the reservoir any solu- 
 tion which may undergo change, or in which a precipi- 
 tate may form, the capillary tube may become clogged 
 up, and thus either stop the exit of the fluid entirely, 
 or deflect the stream so that it will not impinge upon 
 the lens. The exercise of care is necessary, therefore, 
 to keep the instrument clean, and to avoid following its 
 use with one medicine, by the use of another which may 
 cause a precipitate. 
 
 In 1862, Dr. Bergson constructed a nebulizing ap- 
 paratus according to a suggestion of Dr. Nathanson 
 [Deutsche KtiniJc, 1863, No. 7), which depends upon a 
 physical principle similar to that of Matthieu. This 
 principle is, that a strong transverse current passing 
 over a perpendicular tube will rarefy the air in the top 
 of that tube, and thus draw up any liquid in which the 
 tube may be immersed, the liquid, as it meets the cur- 
 rent, being broken into spray. This principle was for- 
 merly applied to the cleansing of chimney flues, and 
 quite recently has been employed for pumping bilge- 
 water ' from the holds of vessels, for distributing the 
 water from fire engines, and for superheating steam by 
 the prompt evaporation of a watery spray forced within 
 a boiler. It has of late years become familiar to every 
 one in our larger cities in the perfume distributors used 
 by the ladies to odorize their handkerchiefs or any other 
 
 3 
 
26 
 
 NEBULIZED MEDICAMENTS 
 
 portion of their attire ; and has been introduced into 
 parlors and public places of amusement for the purpose 
 of perfuming the atmosphere. It is also an excellent 
 mode of distributing a disinfecting solution in the at- 
 mosphere of a sick-chamber, or the wards of a hospital. 
 The apparatus, as constructed by Bergson, consists 
 of two tubes at right angles, placed with their extrem- 
 ities together, and so joined that the extremity of the 
 perpendicular tube should stand in front of the axis of 
 the horizontal tube, as seen in the accompanying di- 
 agram. 
 
 Fig. 5. 
 
 The Bergson Tubes. 
 
 If two tubes are thus arranged, and the vertical tube 
 placed in a vessel containing a liquid, and then a current 
 of air be blown from the mouth through the horizontal 
 tube, the transverse current will carry over with it, as 
 it were, the top of the column of air in the vertical 
 tube, which, of course, will force up a current of the 
 liquid to occupy the space of the air ; and this continu- 
 ing, the liquid will at length reach the top, and be blown 
 by the transverse current into a coarser or finer spray. 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 27 
 
 The fineness of the spray, and, consequently, its facility 
 of ingress into the respiratory tract, will depend upon 
 the minuteness of the extremities of the tubes, princi- 
 pally upon that of the tube dipping into the liquid. If 
 the fluid is to be nebulized by the breath alone, the 
 opening of the horizontal tube must not be too small, 
 otherwise force enough cannot be produced. If the cur- 
 
 Fig. 6.* 
 
 Bergson's Apparatus with the Foot Bellows. (From Lewin. 
 
 * a, reservoir for fluid ; b, waiter ; c, vertical tube ; d, horizon- 
 tal tube ; /, flexible tubiug ; g, air reservoir ; h, rubber bellows to 
 be compressed by the foot ; i, joint connecting the Bergson tubes ; 
 A, nebula or spray; I, rim or cap of reservoir to which the nebu- 
 lizing tubes are attached. 
 
28 NEBULIZED MEDICAMENTS 
 
 rent is produced by means of a bellows, as the Davison's 
 injecting syringe, the opening of the horizontal tube can 
 be smaller. 
 
 For the production of a continuous stream, an air 
 reservoir must be attached to the syringe, and, for 
 this purpose, Dr. Bergson adopted the arrangement 
 of a rubber bellows worked with the foot, connected to 
 the horizontal tube by rubber tubing, in the continuity 
 of which is placed a globular elastic ball as an air res- 
 ervoir. (Fig. 6.) 
 
 Later, Dr. Andrew Clarke, of London, adopted 
 smaller bulbs, so that they can be compressed by the 
 hand. It seems to me that the main advantage of the 
 double bulb is, that pumping is thus rendered less labo- 
 rious, for I do not conceive that there is anything to be 
 gained for purposes of inhalation by the production of 
 a continuous stream ; at times, indeed, rather the re- 
 verse, for the expiratory current regularly interrupts 
 the inhalation necessarily, and may thus cause a waste 
 of fluid. 
 
 These tubes can be formed of metal, glass, or hard 
 rubber. Glass tubes can usually be cleansed by an acid 
 bath, or by nebulizing through them a dilute mixture 
 of sulphuric or muriatic acid and water, and then soak- 
 ing them in pure water. If they become clogged, the 
 best way to free them is by suction with the mouth at 
 the larger end, so as to draw the obstructing matter 
 back from the small end of the tube. If this does not 
 suffice, or they become clogged while in use, a camel's- 
 hair pencil, or a bristle, or a fine metallic wire, may be 
 employed. A needle will be apt to break off" the fine 
 points. The tubes may be formed by drawing out glass 
 tubing over the flame of a spirit or gas light, and then 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 29 
 
 separating them by a scratch with the blade of a knife ; 
 and if they are so joined that the points bear the rela- 
 tion to each other shown in Fig. 5, they will work all 
 right. If the end of the perpendicular tube be below 
 the axis of the horizontal tube, the current will pass 
 over it without impinging sufficiently to take the head 
 off of the air in the vertical tube ; and if it be too high, 
 the current will pass to the side, or perhaps pass down 
 the vertical tube, and cause the fluid to bubble up in the 
 vessel. If the perpendicular tube be bent so as to run 
 under the horizontal tube before dipping down into the 
 liquid (see Fig. 9), the tubes can be nicely adjusted by 
 cord or small sections of gum tubing. I was in the 
 habit of forming tubes in this manner for some time 
 before I was aware that the modification had already 
 been adopted by Prof. Winterich, of Berlin, and for 
 the same purpose, that of gaining readier access within 
 the cavity of the mouth. Indeed, the idea soon sug- 
 gested itself to everybody of turning these tubes after 
 properly adjusting their points, so as to gain access to 
 any desired point; and they have been curved into 
 douches for the nares, anterior and posterior, the lar- 
 ynx, the bladder, the uterus, &c. 
 
 Dr. Lewin has constructed a very convenient pocket 
 nebulizer after the pattern of Bergson. The rectangu- 
 lar tubes are made of metal or of vulcanized rubber, 
 and joined by a hinge, so that when not in use the two 
 tubes fold one upon the other, and take up but very 
 little space. This is intended for use, as occasion may 
 require, by blowing through the horizontal tube with 
 the breath ; but such a method is rather applicable to 
 other purposes than those of inhalation, for the idea of 
 another's breath being blown into one's mouth is dis- 
 
 3* 
 
30 
 
 NEBULIZED MEDICAMENTS 
 
 agreeable. To those who care to employ this method, 
 I would suggest the attaching of a few inches of rubber 
 tubing to the horizontal tube, so as to avoid close con- 
 tact with the face of a patient, and to render the neces- 
 sary effort less laborious. 
 
 Dr. Mans {Deutsche Klinik, June 16, 1866, p. 224) 
 has made an improvement on the construction of these 
 tubes of Bergson, which I have found to give at each 
 compression of the pump an amount of spray almost 
 incredible to one who has not seen it, and with very 
 little effort, which, though not more advantageous than 
 the original tubes for purposes of inhalation, inasmuch 
 as these latter produce spray enough, I have found ex- 
 tremely useful in cases of pharyngitis where I wished 
 to employ the spray as a substitute for the gargle ; and 
 this especially in the throat troubles of young children, 
 where the instrument which will do the most service in 
 the shortest space of time is quite a desideratum. 
 
 In this modification, the apparatus is made out of 
 three tubes instead of two. The third tube communi- 
 cates with the horizontal tube, and runs down behind 
 the perpendicular tube the depth of a cork, in which 
 the two vertical tubes run. Now, when the medicine 
 vial is tightly corked, part of the transverse current 
 presses on the surface of the liquid, and forces it up 
 the perpendicular tube which dips into it, and thus the 
 force that in the original tube is exhausted in producing 
 the vacuum in the vertical tube, is reserved for the pro- 
 duction of spray. I have had instruments thus ar- 
 ranged, duck-billed, after the manner of Winterich, 
 and then curved so as to point to any desired portion 
 of the pharynx, the whole of which, if desired, can be 
 douched by a single pressure of the bulb. 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 31 
 
 The spray producer of Dr. Richardson, of London, 
 introduced for purposes of local anaesthesia, is con- 
 structed upon the same principle as Mans' modification 
 of Bergson's tubes, but upon a different model. In 
 both Mans' and Richardson's instrument the pressure 
 continues for some moments after each compression of 
 the bulb, which is not the case in the Bergson tube. 
 
 Bergson has named his apparatus a Hydrokomion, 
 the same name applied in 1829 by Schneider and 
 Rudolf Walz to a sort of shower-bath apparatus, con- 
 sisting of a reservoir containing water, the air over 
 which was compressed by a pump, and the fluid was 
 driven out through many fine openings. This last-men- 
 tioned apparatus, however, was never intended for res- 
 piratory purposes. 
 
 The nebulized current from the Bergson apparatus is 
 more powerful than that from apparatus on the Sales- 
 Girons principle, and it can be at once directed into 
 the mouth. It is therefore most suitable to diseases of 
 the fauces, pharynx, base of tongue, and lingual surface 
 of the epiglottis. For the deeper structures, the other 
 instruments, the spray from which merely hangs sus- 
 pended in the air, are more suitable, as they are less 
 likely to elude the current of inspiration. 
 
 Lewin, in conjunction with Bergson, constructed an 
 attachment to his apparatus already described, by which 
 the same instrument could be employed on the Berg- 
 son principle, and thus answer every indication. The 
 drum and lens is removed from the apparatus (Fig. 4), 
 and a rod and rings attached, supporting a gradu- 
 ated glass tube terminating below in a very fine open- 
 ing, placed directly in front of the capillary opening of 
 the tube dipping into the reservoir. The glass tube is 
 
32 
 
 NEBULIZED MEDICAMENTS 
 
 filled with the solution to be nebulized, and drips by- 
 gravity in front of the other opening. The reservoir 
 contains nothing but air, and as this is compressed the 
 current escapes, and the nebulization is thus produced. 
 It is really Bergson's tubes upside down. 
 
 In May, 1865, I exhibited to the Surgical Section of 
 the American Medical Association a portable instrument 
 (Fig. 7), in which I had turned the Bergson tubes as 
 modified by Winterich upside down, and screwed a little 
 reservoir on to the large extremity of the perpendicular 
 tube, so as to make use of the same principle of gravity. 
 
 Pig. 7. 
 
 Bergson's Tubes reversed, with the reservoir on top. 
 
 Where glass tubes are employed, the extremity of the 
 perpendicular tube is blown out into a reservoir (see 
 Fig. 9). If the fluid drips down too fast, and that it 
 will drip is an objection to the instrument, rendering its 
 employment inelegant at certain times, it can be regu- 
 lated by the insertion of some porous material, or in 
 the metallic reservoir by diminishing the size of the 
 opening through which the fluid drops into the tube. 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 33 
 
 This instrument is very useful in many cases. Patients 
 can manage it themselves ; if of glass can readily ad- 
 just the extremities of the tubes so they will work ; 
 and in applying nebulized fluids to the pharynx, &c, 
 the vessel containing the fluid does not obstruct the 
 view into the mouth. 
 
 In all these apparatuses thus described, with the 
 exception of the Eeichenheim-Waldenburg instrument, 
 the spray, as it emerges, is too cold for general use in 
 acute affections, unless the fluid employed is first 
 warmed, or the spray produced and passed over a spirit- 
 lamp, as in the apparatus of Matthieu, Fig. 2. 
 
 It was, therefore, a happy idea of Dr. Siegle, of 
 Stuttgart, to employ steam as the motive power with 
 the Bergson tubes, instead of compressed air, thus 
 saving to the patient the necessity of an assistant, or 
 the labor of frequent pumping, and securing a more 
 constant nebulizing force than can be produced by the 
 pump, from which the force gradually diminishes unless 
 renewed. 
 
 Siegle attaches the horizontal tube to a small boiler 
 in which water is placed, and as the steam evolved 
 escapes through the tube, it creates the transverse cur- 
 rent necessary to draw T the fluid from the reservoir up 
 the perpendicular tube, and then nebulizes it in the 
 manner already described. The only possible objection 
 to steam as a motive power is that the nebulized fluid 
 is always mixed with a certain amount of steam, which 
 it is possible, but hardly probable, might sometimes 
 prove objectionable. The largest portion of the steam 
 escapes in the surrounding atmosphere ; very little is 
 mixed with the spray ; too little to prove objectionable. 
 How small this quantity is will be shown hereafter. 
 
34 NEBULIZED MEDICAMENTS 
 
 Another motive power which has been applied to this 
 purpose during the past year, is the evolution of car- 
 bonic acid gas from a mixture placed in a vessel to 
 which the horizontal tube is attached. This is the idea 
 of a young French physician, whose name I cannot re- 
 call. 
 
 Dr. G. J. Arnold, of Roxbury, describes {Boston 
 Med. $ Surg. Jour., Dec. 27th, 1866, p. 434) an appa- 
 ratus in which he employs hydrostatic pressure as the 
 propelling power. The horizontal tube of a Bergson 
 apparatus is connected with the upper portion of an air 
 reservoir by means of a stop-cock and rubber tubing ; 
 at a higher elevation is placed another reservoir filled 
 with water ; as the water from the latter flows into the 
 lower portion of the air reservoir, the air within it is 
 compressed, and when sufficient pressure has been ob- 
 tained, the stop-cock is opened, and the compressed air 
 escaping through the horizontal tube, produces the 
 nebulization. 
 
 Siegle's boilers are made either of metal or of glass, 
 and each one, before it leaves the manufacturer, is tested 
 to bear a pressure of two atmospheres. The boiler is 
 furnished with a safety valve to avoid explosion, and 
 with one of Collardeau's thermo-barometers, gauged to 
 two atmospheres, in order to designate the pressure, 
 which is regulated by raising or lowering the flame of 
 the lamp by means of a screw acting on the wick. A 
 stand sliding on the outside of the apparatus sustains 
 the reservoir of the fluid to be nebulized by it ; and 
 below this another stand supports a small spirit-lamp, 
 in order to raise the temperature of the liquid in 
 the vessel above if necessary. For office use the appa- 
 ratus may be furnished with a gas lamp, which is more 
 
AND THE APPARATUS FOR THEIR PRODUCTION. 35 
 
 convenient and less expensive, and a large boiler can 
 be made to receive several sets of the Bergson tubes, 
 so that separate tubes may be employed for nebulizing 
 such solutions, as of tannin, chloride of iron, &c, which 
 are likely to form precipitates with other solutions. 
 
 The most convenient form of Siegle's apparatus is that 
 figured in the accompanying cut (Fig. 8) ; the whole in- 
 
 Fig. 8. 
 
 Siegle's Steam Nebulizer. 
 
 closed in a metallic case, which still further lessens the 
 danger of bad results from an explosion. The hori- 
 zontal tube passes down by an elbow into the boiler 
 through a tightly fitting rubber stopper ; and the cork 
 stopper in the opening through which the water is intro- 
 duced does away with the necessity of any further safety 
 valve. The thermo-barometer is gauged to two atmos- 
 
36 NEBULIZED MEDICAMENTS 
 
 pheres, but the apparatus will be set in action with a 
 pressure of one-half atmosphere. The stronger the 
 pressure the more rapid the escape of steam, and the 
 more rapid the nebulization, and the stronger the pro- 
 pulsion of the spray. The desired pressure can, there- 
 fore, be readily maintained by controlling the height of 
 the flame beneath the boiler. 
 
 Various modifications of Siegle's Steam Hydroko- 
 mion have been made by Lewin, Fieber, Beigel, and 
 many others, but they are all on the same principle, 
 and possess no advantage over his. 
 
 In all these forms in which the horizontal tube is bent 
 so as to dip down into the boiler, every now and then, 
 especially soon after the apparatus is set in action, the 
 steam condenses at the curve, and as this is driven out 
 by the steam behind, it spurts out hot water, which is 
 sometimes projected into the face or eyes of the patient 
 with very unpleasant results, and sometimes renders 
 them unwilling to continue the inhalation. This can be 
 in great measure avoided by passing the horizontal tube 
 directly into the boiler at the side close to the top, and 
 thus avoiding the curve where the steam condenses. 
 This is the form of instrument that I am in the habit 
 of employing, with the duck-bill form tubes, ^vhich per- 
 mit of their being introduced within a mouth speculum, 
 and thus avoiding considerable loss of spray. No safety 
 valve is considered necessary, inasmuch as too much 
 steam would force out the cork and thus escape without 
 explosion. With this modification the apparatus, as 
 figured in the following cut (Fig. 9), is essentially the 
 Siegle apparatus, having his original arrangement of a 
 lamp with a screw for raising or lowering the wick. A 
 vaginal speculum introduced well into the mouth pro- 
 
AND THE APPARATUS FOE, THEIR PRODUCTION. 37 
 
 tects the teeth, tongue, roof of the mouth, &c. ; and the 
 tubes entering the funnel-end of the speculum, the face 
 
 Modified form of Siegle's Steam Nebulizer, with Duck-bill Tubes. 
 
 and clothing are thus protected, a very desirable pre- 
 caution in the inhalation of solutions of the nitrate of 
 silver, &c. The condensed liquid, as it flows over the 
 funnel extremity of the speculum, is directed into an 
 appropriate receptacle, so as to protect the clothing and 
 furniture. The instrument, with all its appurtenances, 
 can be obtained of Mr. Gemrig, the well-known surgi- 
 cal instrument maker, of this city. 
 
 Some of these funnels have a tube below to which a 
 piece of tubing can be attached, and thus act as a 
 waste-pipe to direct the excess. A very convenient 
 combination of this kind with the funnel or face pro- 
 tector attached to the apparatus, has been constructed 
 by Dr. William Read, of Boston, which, as seen in 
 
 4 
 
38 
 
 NEBULIZED MEDICAMENTS. 
 
 the accompanying figure (Fig. 10), is very compact, and 
 can be readily carried about securely packed in the tin 
 box employed as a stand when the instrument is in use. 
 
 Fig. 10. 
 
 Dr. Beigle, of London, also has constructed a very 
 useful face protector, a sort of concave plate with a cen- 
 tral aperture through which the spray passes, placed 
 in front of. the mouth of the patient. 
 
 Dr. Beigle has also devised an admirable little 
 pocket steam apparatus suitable for travellers who de- 
 sire to continue this method of medication. 
 
 Lewin and some others prefer the horizontal tube to 
 be of metal, with a holder in which slides the glass tube 
 intended to dip into the medicated fluid. This is an 
 improvement, as the risk of breaking the horizontal 
 tube is avoided ; and if the glass tube become broken 
 it can be readily replaced by another, and easily ad- 
 justed. 
 
CHAPTER II. 
 
 EXPERIMENTS UPON MEN AND ANIMALS AS TO THE PENE- 
 TRATION OF NEBULIZED FLUIDS INTO THE RESPIRA- 
 TORY PASSAGES. 
 
 The report of Sales-Girons to the Academy of 
 Medicine of Paris, as to the results obtained in his 
 inhalatorium, caused a great sensation among the medi- 
 cal profession; and numerous experiments were insti- 
 tuted under different auspices, and with certain predi- 
 lections in favor of the new method or against it r to 
 determine whether the nebulized fluids really pene- 
 trated into the respiratory tract, and if so, to what 
 extent. 
 
 At first the number of these investigations was 
 limited because the experiments had to be carried on 
 at the establishments where the method was being em- 
 ployed; but as soon as Sales-Girons invented his 
 portable instruments, investigation was further stimu- 
 lated, and being rendered more convenient of execu- 
 tion, a great number of observers became engaged in 
 the pursuit. The results of these experiments were 
 duly published in the leading French journals, and as 
 the subject spread outside of France, in other Euro- 
 pean journals. They have been recorded with more or 
 less detail in the works of Waldenburg [Die Inhala- 
 tionen der zerstaubten Miissigkeiten, so wie der Dampfe 
 
40 EXPERIMENTS AS TO PENETRATION 
 
 und Gase, &c, von Dr. L. Waldenburg, Berlin, 1864), 
 Fieber (Die Inhalation Medicamentbser Flussigkeiten, 
 &c, von Dr. Friedrich Fieber, Wien, 1865), Lewin 
 (Die Inhalations- Therapie, &c, von Dr. Georg Lewin, 
 Berlin, 1865), and others, and alluded to by every one 
 who has written on this subject. As they are interest- 
 ing and instructive, some account of them will be given 
 here. 
 
 Experiments with Negative Results. 
 
 Prominent among observers reporting negative re- 
 sults, was Prosper de Pietra-Santa, physician at 
 Eaux-Bonnes, whose experiments were performed, partly 
 in the presence of Poggiale, who had been appointed 
 by the Academy to prepare a report on the subject, 
 in an inhalatorium arranged at Eaux-Bonnes, according 
 to the principles of Sales-Girons. 
 
 He experimented upon a goat, upon three rabbits, 
 and upon himself and another observer (L' Union Medi- 
 cate, 1861, Nos. 43, 44, and 59 ; Gazette Medicate de 
 Paris, 1861, Nos. 14 and 15). 
 
 He caused a young goat to breathe, for a quarter of 
 an hour, an atmosphere loaded with the nebulized 
 mineral water of Eaux-Bonnes, to which a small quan- 
 tity of common salt had been added. The animal was 
 then killed, and a solution of nitrate of silver applied 
 to the larynx and bronchi, but without evincing any 
 reaction. 
 
 He caused a rabbit to breathe a nebulized solution 
 of sulphate of iron from the Sales-Girons apparatus, 
 for a period of twenty minutes. The application of a 
 test of cyanide of potassium failed to detect any iron 
 in the lungs or in the larynx; but succeeded in the 
 isthmus of the fauces, on the soft palate, and in one 
 
OF NEBULIZED FLUIDS. 41 
 
 portion of the oesophagus ; the latter probably because 
 the animal had swallowed some of the fluid. 
 
 He held two rabbits within a short distance of the 
 spot where the fluid was nebulized in the inhalatorium 
 of Eaux-Bonnes. The animals were killed, and the 
 test applied with nitrate of silver and with acetate of 
 lead, but without evincing the slightest trace of reac- 
 tion in the respiratory organs. 
 
 M. Prosper de Pietra-Santa read his memoir before 
 the Academy of Medicine, October 8, 1861 (Gazette 
 Hebdomadaire, 1861, p. 659), coming among other 
 conclusions, as the result of his clinical observations 
 and experiments, to the following : — that the nebulized 
 mineral waters do not penetrate into the bronchi ; that 
 a considerable depression of temperature is produced 
 at the moment of nebulization ; that a very consider- 
 able desulphurization takes place in the nebulization 
 of these mineral waters ; and that the temporary alle- 
 viations observed, are due to the inspiration of the dis- 
 engaged hydro-sulphuric acid gas. 
 
 Rene Briau, physician at Eaux-Bonnes (Gazette 
 Hebdomadaire* 1861, No. 15), at the laboratory of 
 the College of France, placed at his disposition by 
 Prof. Claude Bernard, on 31st January, caused a rab- 
 bit to breathe for twenty-two minutes close to the drum 
 of a Sales-Girons apparatus, the nebulized spray of 
 two litres (a litre is 1.0567 quarts) of a solution of cy- 
 anide of potassium, the animal remaining tranquil and 
 breathing the whole of the liquid. Immediately after, 
 the animal was killed by section of the spinal cord. 
 The test of a solution of the sesquichloride of iron was 
 applied, and detected the presence of the cyanide salt 
 in the larynx, in the trachea, and in the larger and 
 
 4* 
 
42 EXPERIMENTS AS TO PENETRATION 
 
 smaller bronchi. Prof. Claude Bernard, who, with MM. 
 Vella and Leconte, witnessed this experiment, raised 
 the objection that the substance employed is very 
 readily and very rapidly absorbed into the blood, and 
 that this fact could account for its presence in the 
 respiratory tract; and, at his suggestion, the urine, 
 ureters, and kidneys were also tested, and the same re- 
 action took place. Briau, therefore, did not consider 
 the experiment conclusive. Lewin (op. cit., p. 163), in 
 commenting upon this experiment, very judiciously ob- 
 serves that the absorption into the system might have 
 taken place through the delicate mucous membrane of 
 the respiratory organ. 
 
 Then reversing his experiment, Briau caused a rabbit 
 to inhale a solution of the chloride of iron (a salt ab- 
 sorbed with difficulty by the animal tissues) during 
 twenty-six minutes ; and the reaction gave again a posi- 
 tive result. 
 
 The 6th of February following, a small dog was held 
 close to the drum and breathed tranquilly, for twenty- 
 five minutes, an atmosphere in which two litres of the 
 solution of the perchloride of iron was nebulized. In 
 this case the test could detect no trace of the salt ex- 
 cept in the mouth, the nostrils, and the pharynx. He 
 then performed the same experiment with another dog, 
 employing the solution of the cyanide of potassium by 
 inhalation, and the iron salt as the test. Surprised at 
 the different results on two species of animals so closely 
 related, he immediately repeated his experiments upon 
 another rabbit, and on applying the test, in a few 
 minutes the characteristic reaction occurred in the 
 whole extent of the bronchial tree. 
 
 Finally, Prof. H. Bouley (d'Alfort) placed at his 
 
OF NEBULIZED FLUIDS. 43 
 
 disposal a horse, who had a carcinomatous tumor of the 
 stomach; and on the 18th of February, with the assist- 
 ance of M. Raoux, he experimented on this animal at 
 the veterinary college. The horse, whose respiratory 
 organs were intact, was placed horizontally with his 
 head on the same plane as the rest of his*body. The 
 experiment lasted an hour and a quarter, forty-five 
 minutes being consumed in the inhalation of four litres 
 of a solution of the sesquichloride of iron. After the 
 animal was killed by section of the spinal marrow, the 
 fluid which had been inhaled was detected in the nos- 
 trils, but there was no evidence of its having penetrated 
 into the bronchi, the trachea, or the larynx. Briau 
 concludes that he can account for the success with the 
 rabbits on account of the proximity of their glottis to 
 the mouth, and that the fluid in condensing on the pos- 
 terior walls of the pharynx flows down into the larynx 
 and trachea. In this view he is sustained by Prof. 
 Claude Bernard. 
 
 Champouillon (Gazette des Hopitaux, 1861, No. 66) 
 directed an invalid to breathe, for half an hour, a solu- 
 tion of the chloride of iron. After the mouth had been 
 thoroughly rinsed, the sputa were tested with cyanide 
 of potassium, but no reaction was produced. 
 
 Delore (Gazette Medicate de Lyon, 1861, September 
 1st and 1 6th) caused several individuals to inhale neb- 
 ulized solutions containing iodide of potassium, and 
 tincture of iodine: but found no trace of iodine either 
 in their urine or in their saliva. 
 
 Armand Rey (L' Union Medicate, 1861, No. 139) 
 desired to employ an atmosphere more profusely loaded 
 with spray or nebula than could be produced by the 
 apparatus of Sales-Girons, and he constructed an ap- 
 
44 EXPERIMENTS AS TO PENETRATION 
 
 paratus by means of which the capillary jets of water, 
 projected by a vertical pressure of fifteen metres, were 
 received perpendicularly upon the palettes of a hori- 
 zontal turbine, very rapidly rotated in the direction 
 opposite to that of the jets. He thus produced a very 
 dense spray, but the whole of the water did not nebu- 
 lize, a portion of it spurted about unpleasantly. To 
 control this dashing he inclosed the apparatus in a wide- 
 meshed net, but to his astonishment it caught the whole 
 amount of the spray, which it condensed, and did not 
 permit the slightest particle to pass through. Then he 
 employed pasteboard, in which he made openings of the 
 size and form of the human glottis, and again the whole 
 of the spray was caught and condensed. 
 
 Then he instituted some experiments upon animals, 
 the results of which were negative. 
 
 The cause of these obstructions he attributed to the 
 circumstance that these sprays are merely suspended 
 in the air, and that therefore, as soon as any impedi- 
 ment interfered with their slight impulse, the nebulized 
 particles immediately collected and condensed into 
 drops. Thus the inner surface of the cheeks, the roof 
 of the mouth, palate, &c, being such impediments, they 
 detain the spray, which falls in drops without gaining 
 entrance into the larynx. But, as Lewin observes (p. 
 177), he seems to have overlooked the fact that in in- 
 halation the inspiratory current as it passes into the 
 lungs will deflect these light particles as they play in 
 the atmosphere, and direct them towards the middle 
 line of the open glottis, so that they will describe a sort 
 of curve in their passage. 
 
 Edouard Fournie was the most persistent opponent 
 to the new method, and exercised a remarkable degree 
 
OF NEBULIZED FLUIDS. 45 
 
 of ingenuity in devising crucial experiments to put to 
 the utmost test the theory that the nebulized medica- 
 ments penetrated into the air-passages. [Proceedings of 
 Academie des Sciences, 1861 ; Gazette Hebdomadaire, 
 1861, p. 626 ; Gazette des Hopitaux, 1862, No. 9.) 
 
 At a stance of the Academie des Sciences, held Sep- 
 tember 16th, 1861, he read extracts from a work of 
 his, entitled, " Memoire sur la penetration des corps 
 pulverulents, volatils, gazeux, solides et liquides, dans 
 les voies respiratoires au point de veu de l'hygiene et 
 de la therapeutique," in which he details his various 
 experiments. 
 
 In order to test the mechanical feasibility of such 
 penetration, Fournie constructed an artificial respira- 
 tory apparatus. He bent at right angles a tube twenty- 
 five centimetres long and two centimetres in diameter, 
 and placed it through one of two openings in a flask, so 
 that it dipped into a solution of sulphate of iron, with 
 which the vessel was half filled. The free extremity of 
 this tube terminated in a wide mouth-piece, which might 
 represent the oral cavity. The other opening commu- 
 nicated, by means of rubber tubing, with the nozzle of 
 an exhausting syringe furnished with a delicate valve 
 which would open as soon as the force exceeded that of 
 the inspiratory force of the lungs of a strong healthy 
 man. He filled a Sales-Girons apparatus with a solu- 
 tion of the cyanide of potassium, and placed it at ten 
 centimetres distance from the mouth-piece of the appa- 
 ratus ; and at the same time that the nebulizer was put 
 in action, the exhausting syringe was placed in action 
 rhythmical^with the duration and strength of ordinary 
 human inspiration. 
 
 Although the fluid was thoroughly nebulized, the 
 
46 EXPERIMENTS AS TO PENETRATION 
 
 solution of sulphate of iron did not change color in the 
 least. From this experiment Fournie came to the con- 
 clusion that he had demonstrated that the solution of 
 the cyanide of potassium could not be made to enter the 
 flask. 
 
 At a later date he instituted a different experiment. 
 Having detached from a recent cadaver, a human larynx 
 with the tongue, epiglottis, and pharynx, he attached 
 to this a glass tube of the diameter of the trachea. Ar- 
 tificial inspiration was produced by placing in the mouth 
 of the experimenter a tube of rubber attached to the 
 lower end of the artificial windpipe ; and during the in- 
 spiration, the glottis was held open by means of serres- 
 fines attached to the posterior crico-arytenoid muscles, 
 while the watery spray from the pulverisateur was di- 
 rected towards the larynx. It was seen in this experi- 
 ment that the larger portion of the nebulized fluid struck 
 on the pharynx, and was then and there condensed. 
 Another smaller portion fell down upon the epiglottis, 
 which protected the opening of the glottis like a regular 
 roof, and thence glided in great drops along the aryteno- 
 epiglottic folds to gain entrance into the larynx. Not 
 the slightest trace of the nebulized water could be seen 
 upon the walls of the tube. 
 
 This experiment was repeated with solutions sensitive 
 to the most delicate chemical tests, and with similar 
 negative results. 
 
 Then Fournie experimented on himself. He took it 
 for granted that if the nebulized fluids penetrated into 
 the trachea and the bronchi, he ought to be able to de- 
 tect their presence in the sputa expectorated immedi- 
 ately after an inhalation. Suffering at the time from 
 an acute attack of bronchitis, he inhaled a solution of 
 
OF NEBULIZED FLUIDS. 47 
 
 arsenious acid, five grammes to five hundred grammes 
 of water. He selected this material because it is less 
 readily absorbed through the tissues than others, and at 
 the same time can be detected by reagents when present 
 in the minutest quantity. 
 
 He placed himself within five centimetres distance 
 from the opening of the apparatus, and inhaled, to the 
 best of his ability, with widely opened mouth, the en- 
 tire solution of five hundred grammes. The material 
 expectorated during the few minutes next succeeding, 
 and amounting to four grammes, were dried upon a 
 platinum capsule, incinerated with nitrate of potassa, 
 and the product of combustion placed in contact with 
 water acidulated with sulphuric acid, according to the 
 process of Marsh ; but without producing any of the 
 metallic arsenical rings on the porcelain. The reaction 
 ensued, however, as soon as one drop of the arsenical 
 solution was added. 
 
 A similar experiment, performed upon a young man 
 laboring under a profuse specific bronchorrhoea, afforded 
 the same negative result. 
 
 On another occasion a concentrated solution of ni- 
 trate of silver was inhaled through a glass tube of three 
 centimetres diameter, employed in order to protect the 
 mouth from discoloration. Laryngoscopic inspection, 
 immediately after the inhalation, showed the posterior 
 wall of the pharynx tinged with the nitrate, but the 
 interior of the larynx retained its natural color. The 
 sputa expectorated immediately after, showed no evi- 
 dence of the inhalation. 
 
 A young man, twenty-four years of age, who had 
 worn a canula for several years, in consequence of a 
 fracture of the larynx, the result of an accident, was 
 
48 EXPERIMENTS AS TO PENETRATION 
 
 selected for an experiment. The condition of the young 
 man's organs, as seen by the laryngoscope, was as fol- 
 lows : — Above the vocal cords, everything appeared nor- 
 mal ; the cords themselves were colored red, having lost 
 their brilliant mother-of-pearly tint ; toward the poste- 
 rior inferior third of the left vocal cord a small nodule 
 was perceived, having much the appearance of a carti- 
 lage. The lesion had not interfered with inspiration, 
 for the arytenoid cartilages separated properly and the 
 laryngeal cavity expanded in the usual manner; but 
 expiration was so difficult that for its performance the 
 tracheal opening was indispensable ; the closure of the 
 larynx daring expiration seemed to be effected by the 
 lesion in the cricoid cartilage, which had been the seat 
 of fracture, as a result of which the crico-thyroid and 
 posterior-crico-arytenoid muscles had become paralyzed. 
 A bunch of raw cotton attached to a thread was intro- 
 duced into the trachea, and the pulverisateur set in ac- 
 tion. During the inhalation the canula was closed by 
 the finger of the patient, which was slightly raised 
 during expiration ; and the solution employed was of 
 iodide of potassium five grammes to five hundred 
 grammes of water. After the inhalation, the cotton 
 was withdrawn and tested with starch and with sul- 
 phuric acid, but afforded no reaction. 
 
 A similar experiment was performed upon one of the 
 female nurses of the Hospital Beaujon, who also wore 
 a canula in her trachea, and with the same negative 
 result. 
 
 From these experiments, Fournie' offered the follow- 
 ing reasons to account for the non-penetration of the 
 nebulized liquids : — 
 
OF NEBULIZED FLUIDS. 49 
 
 1st. The divergence of the watery particles in issuing 
 from the apparatus. 
 
 2d. The propulsion of the current from the apparatus 
 in a straight line. 
 
 3d. The curve of the trachea. 
 
 4th. The proximity of the soft palate to the base of 
 the tongue. 
 
 5th. The involuntary contraction of the glottis. 
 
 6th. The irritability of the larynx. 
 
 Finally, he draws the following conclusions : — 
 
 1st. It is nevertheless possible, by this method, to 
 induce a toxic effect upon the larynx, but one of short 
 duration only. 
 
 2d. The fluid can certainly penetrate into the air- 
 passages, but not with facility, nor in sufficient quan- 
 tity; and this only when the inhalation is performed 
 with peculiar care, such as opening the mouth well, sep- 
 arating the base of the tongue from the soft palate, with 
 the head inclined backwards to destroy as much as pos- 
 sible the rectangular curve that the windpipe makes 
 with the oral cavity. 
 
 In contradistinction to the difficulty or impossibility 
 of inhaling fluids into the air-passages, he calls atten- 
 tion to the facility with which solid powders can be 
 drawn by inspiration even into the remotest bronchi, in 
 proof of which he cites the various experiments in which 
 he demonstrated that such powders will pass completely 
 through a tube twenty-five centimetres in length and 
 two centimetres in diameter, and bent at a right angle ; 
 and he says that while the watery particles condense 
 upon the sides of the tube, solid particles are propelled 
 by successive ricochetting to the very end of the tube. 
 
 Fournie believed the sulpho-hydrogen gas, disengaged 
 5 
 
50 EXPERIMENTS AS TO PENETRATION 
 
 from the therm o-sulphurous waters, to be, by its direct 
 contact with the seat of lesion, one of the principal 
 agents in the curation of diseases of the chest. 
 
 Lewin (op. tit., p. 174), in commenting upon these 
 experiments, calls attention to the circumstance that 
 Fournie seems to have overlooked the important fact 
 that the trachea and the bronchi, instead of being dry 
 and smooth like the glass tubes used for experiment, 
 are constantly moist, and more or less covered with 
 mucus ; and that the pulverulent particles must possess 
 a peculiar strength if they can ricochet over this moist 
 mucus until they reach the bronchi. 
 
 If powders penetrate into the bronchi they must be 
 projected in a continuous line, for as soon as they alight 
 on the moist surface they must become entangled and 
 remain there. 
 
 As Lewin says, in ignoring as conclusive Fournie"s 
 experiment with the exsected larynx, in which the epi- 
 glottis is placed " like a regular roof over the entrance 
 of the glottis," the epiglottis does not retain this posi- 
 tion during deep inspiration, as can be demonstrated by 
 laryngoscopic observation ; it becomes more erect. It 
 is absolutely impossible to place the larynx of a cadaver 
 with its pharynx, soft palate, tongue, &c, in the posi- 
 tion which they assume during life in deep and volun- 
 tary inspiration. 
 
 Experiments with Positive Results. 
 
 The most extensive series of experiments were per- 
 formed by Demarquay, surgeon to the Maison Munici- 
 pale de Saute, and these it is, principally, upon which is 
 based the favorable report to the Academie de Me'de- 
 cine (Gazette Medicate de Paris, 1861, p. 616). 
 
OF NEBULIZED FLUIDS. 51 
 
 These experiments were performed at the Maison 
 Municipale de Sante in the presence of Profs. Poggiale, 
 Re'veil, Gobley, and Trousseau, MM. Mialhe, See, 
 Pietra-Santa, Giraud-Teulon, and the students of the 
 institution ; and with the assistance of M. Leconte 
 {Bulletin de V Academie, September 24, 1861 ; Gazette 
 Rebdomadaire, September 27, 1861, p. 627). 
 
 Demarquay experimented upon some eighty rabbits, 
 upon a number of dogs, and upon the same female nurse 
 at the Hospital Beaujon, who was made the subject of 
 one of the experiments of Fournie\ 
 
 The rabbits were caused to breathe an atmosphere 
 loaded with the nebulized spray of a solution containing 
 one gramme of the perchloride of iron to one hundred 
 grammes of distilled water, the apparatus employed 
 being that of Mathieu (and Tirman). The snouts of the 
 rabbits were held forcibly open by a suitable dilator. 
 The experiments continued five minutes, with a few mo- 
 mentary intervals of rest. The animals had all been 
 lively before the experiment ; a number of them were 
 killed immediately upon the conclusion of the experi- 
 ment, and the remainder were saved. Upon testing the 
 respiratory organs of the slaughtered animals with a 
 solution of cyanide of potassium, the presence of iron 
 in a greater or less degree, and in various degrees as 
 respected the individual portions of the apparatus, was 
 demonstrated in the entire respiratory tract, even in 
 the parenchymatous tissue of the lungs ; and, upon the 
 addition of acetic acid, the blue tinging became still 
 more apparent. In order that it might not be objected 
 that the fluid ran down the tracts, the experiment was 
 commenced at the bronchial tubes and continued up 
 into the larynx. In some cases the entire bronchial 
 
52 EXPERIMENTS AS TO PENETRATION 
 
 tree became blue, in others some portions of the mi- 
 nutest bronchi remained uncolored. The chloride of 
 iron was detected in the oesophagus and in the stomach 
 in consequence of the swallowing of some of the fluid. 
 Immediately after the death of the animals, and at in- 
 tervals during twenty-four or forty-eight hours, sec- 
 tions of lung were placed in contact with a watery 
 solution of cyanide of potassium to which acetic acid 
 had been added, which demonstrated the existence of 
 the iron salt in the very cells of the lung. 
 
 The animals which had not been killed were attacked 
 with broncho-pneumonia, and some of them with regular 
 circumscribed pneumonia, within a period of from twelve 
 to twenty-four hours ; — a further proof of the penetra- 
 tion of the fluid. 
 
 Similar experiments were repeated upon dogs, and 
 with similar results, except that the nebulized fluid 
 was not found in the parenchyma of the lungs. 
 
 Upon one of these dogs Demarquay performed the 
 operation of tracheotomy, and then caused it to inhale 
 a solution containing one per cent, of tannin. The 
 wound was tightly closed during the inhalation, which 
 continued several minutes, and at its close he passed 
 into the trachea a piece of paper which had been moist- 
 ened in a solution of chloride of iron and then dried; 
 and the inky reaction soon appeared. 
 
 In these experiments with the dogs, not only were 
 their snouts kept forcibly dilated, but their tongues 
 were drawn forwards by means of threads passed 
 through the organ, to prevent any impediment to the 
 entrance of the fluid by contact of the tongue against 
 the soft palate. 
 
 Demarquay experimented upon a female nurse in the 
 
OF NEBULIZED FLUIDS. 53 
 
 Hospital Beaujon, who was compelled to wear a canula 
 in her trachea. This is the same case upon whom 
 Fournie' experimented with negative results. The laryn- 
 geal structures were very much contracted, and the 
 patient could bear the withdrawal of the canula only 
 for a brief period at a time. This female inhaled as 
 best she could, a weak solution containing one per cent, 
 of tannin. During the inhalation the tracheal opening 
 was closed by a strip of paper which had been moist- 
 ened with a solution of the sesquichloride of iron, the 
 paper being confined by adhesive strips, and the whole 
 covered by a napkin. The mouth was placed at a dis- 
 tance of twenty-five centimetres from the distributing 
 tube of a Matthieu's apparatus. 
 
 The difficulties in this case were very great from the 
 condition of the glottis, the position of the wound with 
 considerable depression of tissue at that point, and the 
 prominence of the sterno-cleido mastoid muscles. Twice 
 the experiment failed on account of the yielding of the 
 paper and the adhesive plaster, and their partial de- 
 tachment from the canula; but, on the third attempt, 
 Demarquay kept his finger applied over the opening, 
 and the strip of paper was withdrawn colored black in 
 considerable extent. 
 
 Demarquay lays great stress on the result of this 
 experiment as being prominently favorable (Gazette 
 Hebdomadaire, 1862, p. 391), for if a larynx so altered 
 from its normal condition, as to be unequal without 
 artificial aid to the admission of sufficient air to sustain 
 life, would permit enough of the fluid to pass it, to be 
 detected by chemical reaction, it is hard to conceive 
 why a larynx in a normal condition would not afford 
 much greater facility of penetration. 
 
54 EXPERIMENTS AS TO PENETRATION 
 
 At the seance of the Acade*mie de Medecine of Paris, 
 April 29, 1862, Prof. Trousseau exhibited several sec- 
 tions of the lungs of Demarquay's rabbits in which the 
 penetration of the chloride of iron could be demon- 
 strated even to the minutest ramifications of the bronchi. 
 Tavernier {Experiences sur la penetration dans les 
 poumons des pousieres liquides tenant en dissolution des 
 reactifs cliniques ou des medicaments. — G-azette Medicale 
 de Paris, 1861, p. 808) experimented on himself with 
 a solution of sesquichloride of iron, and cyanide of potas- 
 sium. He employed the pulverisateur of Sales-Girons 
 and took in long and deep breaths. First, he inhaled 
 the solution of tannin, and then, that of the cyanide of 
 potassium ; with each he experienced a sensation of 
 cold in the chest, with some feeling of constriction, and 
 a disposition to cough. After the inhalation, an ex- 
 amination with the laryngoscope revealed that the 
 larynx over and below the vocal cords, and the vocal 
 cords themselves to a greater extent, were covered with 
 a sombre layer, which was nothing else than Prussian 
 blue. Then he rinsed out his mouth again and again 
 until the water contained no more trace of the Prussian 
 blue ; . and after that he endeavored, by hawking and 
 coughing, to bring up some mucus from the trachea or 
 larynx ; this, at first strongly though irregularly col- 
 ored, was afterwards followed by uniformly colored 
 mucus, which he had not the slightest doubt, had been 
 brought up from the minute bronchi, in contact with 
 the pulmonary cells. 
 
 Prof. Gratiolet, shortly after, repeated Tavernier's 
 experiments upon himself, and reported similar results 
 [G-azette Hebdomadaire, 1861, p. 822). 
 
 Bataille took advantage of a chronic inflammation 
 
OF NEBULIZED FLUIDS. 55 
 
 of the mucous membrane of the respiratory organs 
 under which he was laboring, and while endeavoring to 
 cure this experimented on himself (Gazette Hebdoma- 
 daire, 1862, p. 390). He inhaled for a time a solution 
 of the extract of rhatany, and then examined the parts 
 with the laryngoscope. He found the mucous mem- 
 brane of the larynx and trachea colored red. After 
 a few hours this color had disappeared ; nevertheless, 
 during the entire day he expectorated reddish sputa. 
 Bataille concluded that the medicated fluid had pene- 
 trated into the bronchi, for his reddish expectorations 
 were of the character designated as "bronchiques." 
 
 Moura-Bourouillou (Gazette des Hopitaux, 1861), 
 experimented on himself, and on patients, with a black 
 fluid. Examination with the laryngoscope discovered 
 the traces of the fluid in the larynx and in the trachea. 
 His experiments upon himself he repeated in the pres- 
 ence of Poggiale. Not only did he demonstrate the 
 presence of the pulverized particles in the trachea, but 
 also their actual entrance and passage through the 
 glottis during inhalation as observed with the laryngo- 
 scope (La Revue Medicate, December 15, 1861). 
 
 Auphan experimented to discover how far liquids 
 could be made to penetrate into the respiratory tract. 
 With this view he injected into the trachea of a rabbit 
 four drachms of a solution containing one per cent, of 
 iodide of potassium. No cough was produced. In ten 
 minutes the animal was killed, and he tested the trachea, 
 the bronchi, and the parenchyma of the lungs without 
 producing any reaction with starch. In another ex- 
 periment he killed the animal immediately after its 
 conclusion, and there ensued a slight reaction. Auphan 
 does not doubt the penetration of fluids into the respi- 
 
56 EXPERIMENTS AS TO PENETRATION 
 
 ratory tract, which, he thinks, absorbs the material em- 
 ployed very promptly (G-azette Medicate de Paris, 
 1861, p. 315). 
 
 Sales-Girons performed some experiments with an 
 artificial respiratory apparatus which he constructed 
 out of gutta percha, with a mouth, a soft palate raised 
 up, a tongue depressed so as to expose a portion of the 
 posterior wall of a pharynx which was bent at an 
 obtuse angle, and below it, horizontally, at a distance 
 of three centimetres, was a glottis, and below the larynx, 
 a glass tube represented the trachea. When this ap- 
 paratus was placed before a pulverisateur and inspira- 
 tion was drawn through the trachea, the liquid pene- 
 trated into that tube ; but if the tube was bent into an 
 angle the spray was arrested at the first angle, and fell 
 below in drops of water. 
 
 Report on the foregoing Experiments to the Parisian 
 Academy of Medicine. 
 
 On January 7th, 1862, Poggiale, as chairman of the 
 committee appointed to investigate this question, made 
 an extensive and very interesting report to the Aca- 
 demic Imperial de Medecine of Paris, in which he re- 
 viewed the whole subject critically, and in which, in an- 
 swering affirmatively the question, " Do the pulverized 
 liquids penetrate into the respiratory tract?" he based 
 his conclusions chiefly upon the experiments upon rab- 
 bits, made by himself and others, principally Demar- 
 quay. He even drew positive conclusions from the ex- 
 periments reported as evincing negative results ; show- 
 ing that in Briau's cases the fluids were clearly proved 
 to have reached the air-passages, although the animals 
 
OF NEBULIZED FLUIDS. 57 
 
 had been allowed to breathe through the nose. He 
 referred to the many causes of error in such experi- 
 ments, arising sometimes on the part of the experimenter 
 himself, who might lack the necessary chemical, physi- 
 cal, or anatomical knowledge necessary for accurate 
 observation; or from want of intelligence or skill of the 
 assistants ; or from the nature of the apparatus em- 
 ployed ; or, finally, from the manner of managing the ani- 
 mals, their want of co-operation, their struggles, &c, &c. 
 In alluding to the negative result from Fournie"s ex- 
 periment upon the nurse at Beaujon, he showed how 
 the error in that case must have arisen from imperfect 
 closure of the opening of the trachea during the ex- 
 periment ; for Demarquay, in his experiment with the 
 very same individual, had failed twice from such a 
 cause ; and not until the third attempt did the experi- 
 ment succeed. Finally, he believed that the experi- 
 ments of Fournie himself upon the penetration of pow- 
 dered substances into the air-passages proved the 
 possibility of the entrance of pulverized fluids. 
 
 Four months later, in the discussion before the Aca- 
 demy, held April 29th, Durand-Fardel, who had been 
 one of the first to doubt the penetration of these fluids, 
 objected to a portion of Poggiale's views, and for him- 
 self came to the following conclusions : — that the fluids 
 penetrated to a considerable extent in the subglottic 
 region and in the trachea, but that such penetration as 
 far as the bronchi had not been proved; for everything 
 went to show that the traces were feebler as the parts 
 were more distant from the glottis ; and that, if they 
 did pass beyond the trachea, it was in such small pro- 
 portion as to deprive them of «their therapeutic value 
 
58 EXPERIMENTS AS TO PENETRATION 
 
 {Bull, de I'AcadSmie de Med., 1862, vol. xxvii, p. 
 752). 
 
 The discussion was continued on May 6th (idem), 
 when Trousseau declared himself warmly in favor of 
 the method, expressing some degree of surprise that a 
 doubt as to the penetration of these liquids could be 
 entertained, since the penetration of coal and other 
 materials w T as a fact beyond dispute ; and upon an ob- 
 servation being made by an opponent that the larynx 
 is a vigilant sentinel, denying entrance to foreign 
 bodies, Trousseau replied, "It is a vigilant sentinel, per- 
 haps so, but one that can be taken by surprise. When 
 it cries out, ' Who goes there?' it is already too late ; — 
 in other words, when cough occurs, it is because the 
 liquid has already penetrated into the larynx !" As 
 further proof, he exhibited the lungs of a rabbit which 
 had inhaled but five minutes, and in which not only 
 could the penetration of the solution of the iron salt be 
 demonstrated to have reached the parenchyma of the 
 lungs, but further, to have left traces of the existence 
 of a pneumonia excited by means of this inhaled fluid. 
 " Why," said he, " the fluids may penetrate too much, 
 and it is therefore a method of treatment demanding 
 caution." 
 
 Poggiale, in reply to Fournie"s objections to his 
 report, replied, that the experiments on men and ani- 
 mals leave no doubt as to the penetration of pulverized 
 substances. The experiments of Fournie prove noth- 
 ing, if compared with the results of those of Moura- 
 Bourouillou. He did not object to Fournie" s results 
 with his various artificial contrivances ; but contended 
 that, as we have to deal with men and animals, it is with 
 
 
OF NEBULIZED FLUIDS. 59 
 
 men and animals that we should experiment, and not 
 with tubes and vessels which have not the elasticity 
 nor pliability of organic tissues. In regard to Durand- 
 Fardel's objection that it had not been demonstrated 
 that the liquids penetrated into the bronchial tubes, he 
 brought forward the cases in which its presence had 
 been detected in the lung tissue ; and Demarquay's 
 rabbits, in whom it had produced pulmonary inflamma- 
 tion, for which reasons " the penetration into the bron- 
 chial ramifications is an incontestable fact." 
 
 Poggiale's report also included the questions as to 
 the change of temperature in the pulverized fluids in 
 issuing from the instrument, the chemical alteration of 
 the sulphuretted waters by the process of nebulization, 
 and the probable value of therapeutical results. 
 
 The mineral waters of the various spas do undergo 
 some change, but not so with artificial solutions. 
 
 The result of the discussion was an almost unanimous 
 acquiescence with the able report of Poggiale. 
 
 Further Experiments in Germany and elsewhere. 
 
 The widely disseminated results of the French ex- 
 perimenters, to which reference is made in the pre- 
 ceding pages, soon stimulated similar investigation in 
 other portions of the continent, and we have recorded 
 the researches of various observers in Russia, in Ger- 
 many, and in Spain. 
 
 Dr. Friedbjch Fieber, of Vienna, was the first to 
 introduce the new method into Germany, and with the 
 assistance of his brother, Dr. Carl Fieber, he repeated 
 Demarquay's experiments on rabbits and upon an in- 
 dividual with a tracheal fistule. These experiments 
 
60 EXPERIMENTS AS TO PENETRATION 
 
 were repeated before Prof. Schroff, and confirmed the 
 results of the French observer. 
 
 His experiment upon the individual who had under- 
 gone tracheotomy differed somewhat from that of De- 
 marquay upon the nurse at the Beaujon Hospital [Die 
 Inhalation Medieamentbser FliissigJceiten, <Jn?., p. 44). 
 This patient was a shoemaker, aged twenty-two years, 
 of strong frame and healthy lungs, who had been re- 
 ceived on September 11th, 1861, in the wards of Herrn 
 Primarius Kolisko, and who was under treatment for 
 typhus. 
 
 October 3d, he was seized with dyspnoea, which, 
 within a few days, increased to such an extent that on 
 the 9th instant he was transferred to the surgical wards, 
 where, on the 11th, the operation of laryngotomy was 
 performed. The patient recovered gradually, but was 
 not able to dispense with the canula. 
 
 Some three weeks after the performance of the opera- 
 tion, an attempt was made to withdraw the canula for a 
 few moments, but it had to be promptly returned, and 
 even an experiment made to see how long he could bear 
 a closure of the fistule could not be endured longer than 
 from twenty to thirty seconds. 
 
 On the 1st day of January, 1862, Fieber undertook 
 to repeat upon this man the experiment of Demarquay, 
 and the effort was attended with difficulties fully as 
 great as those of his Parisian prototype. In the present 
 instance the difficulty lay less in a contracted glottis, 
 and a strongly projecting sterno-cleido-mastoid, than in 
 the want of intelligence on the part of the patient, who, 
 in addition, was excessively timid, and could not make 
 up his mind to submit to the inhalation until Fieber had 
 
OF NEBULIZED FLUIDS. 61 
 
 himself inhaled before him. Even then he breathed 
 with so much dread that the first two attempts re- 
 mained fruitless ; but the third attempt, at which he 
 was rather more skilful, gave a positive result, though not 
 to a very satisfactory extent. At the fourth trial, how- 
 ever, the result was more or less similar to that obtained 
 by Demarquay. Fieber employed one of Charriere's 
 apparatus instead of one of Matthieu's, as Demarquay 
 had done, and the solution experimented with contained 
 two per cent, of tannin. He did not place within the 
 opening a piece of paper as a test, but saturated a strip 
 of linen with the solution of the perchloride of iron, and 
 the finger alone was sufficient to close up the opening. 
 Fieber regrets very much that, on account of the many 
 difficulties with which it was attended, he was compelled 
 to forego a laryngoscopic examination at the conclu- 
 sion of the experiment. 
 
 Tobold {Deutsche Klinik, 1862, p. 211) exhibited at 
 the meeting of the Berliner Medizinischen Gesellschaft 
 the lungs of rabbits upon which he had repeated the ex- 
 periments of Demarquay, and with similar positive re- 
 sults. 
 
 Schnitzler and Stork ( Wiener Medicinalhalle, 
 1862, No. 46; Fieber, p. 50; and Wochenblatt der 
 aesellschaft der Aerzte, 1862, No. 45; Lewin, p. 183) 
 experimented upon the servant of Dr. Stork, with 6ol- 
 o-red solutions, of rhatany, Campeachy-wood, saffron, 
 &c. ; and upon laryngoscopic examination, to which the 
 individual was thoroughly accustomed, the coloring 
 could be detected far down the larynx, and in one in- 
 stance could be followed. into the trachea. 
 
 These gentlemen also repeated the often-cited exper- 
 iment of Demarquay, upon an individual who had under- 
 
 6 
 
62 EXPERIMENTS AS TO PENETRATION 
 
 gone tracheotomy some eighteen months previously, on 
 account of the presence of some syphilitic tumors. The 
 method of experiment was that already detailed in con- 
 nection with Fieber's case. The first two trials failed, 
 but the third, fourth, and fifth succeeded, the patient 
 inhaling more quietly and deeply, and the strength of 
 the solution being increased from one grain to five to 
 the ounce. 
 
 The same experiment was then repeated with a dilute 
 solution of iodine, only the linen was not placed imme- 
 diately in the tracheal opening, but was fastened to a 
 probe and introduced concealed within a thin tube, so 
 that having been pushed forward and brought in con- 
 tact with the tracheal mucus, it could be removed again 
 concealed within the tube; the fragment then placed in 
 a strong solution of starch assumed the light blue color. 
 Twice the experiment succeeded; a third time it failed. 
 These gentlemen also repeated Sales-Girons' experi- 
 ments with an artificial respiratory apparatus, and with 
 confirmatory results. (Fieber, p. 50.) 
 
 Lewin (Die Inhalation s-Therapie, Berlin, 1865, p. 
 183) contributes five experiments; the first two of which 
 were performed in the presence of Prof. Virchow. 
 
 1. A middle-sized dog, bound in a towel, was held by 
 one servant, and while another servant held the snout 
 open, the animal was made to breathe the spray of a 
 solution (1 : 100) of the perchloride of iron from a 
 Mathieu Nephogene, great difficulty being encountered 
 in holding the animal so that the spray could be kept 
 directed into his mouth, for he would forcibly turn his 
 head sideways so as to keep his muzzle out of the line 
 of the current. After the nebulization of twelve ounces 
 of the fluid, the animal, whose eyes had become quite 
 
OF NEBULIZED FLUIDS. bZ 
 
 bloodshot in his efforts to free himself, was killed by 
 section of the spinal cord. 
 
 The peculiar black reaction with tannin could be dis- 
 tinguished on the soft palate, the posterior pharyngeal 
 wall, the posterior surface of the epiglottis, and at 
 various spots in the trachea, principally on the lateral 
 walls ; but not at all in the bronchi or in the paren- 
 chyma of the lungs. 
 
 2. A more powerful animal was selected this time, 
 and the following device was pursued to manage more 
 easily the head and snout of the animal, and to secure 
 a more favorable position for the experiment : One side 
 of a chest was so cut out that when closed over the 
 neck of the animal it was completely encircled, the head 
 within the box ; in the opposite side of the box the 
 delivery tube of the apparatus was admitted through a 
 suitable opening, and through another small aperture, 
 Lewin watched the effect. The interior of the chest 
 was soon filled with the nebulized spray, but the dog 
 forced his snout downwards to such a degree that the 
 penetrating particles of the fluid were principally re- 
 ceived upon his nose and the upper part of his muzzle, 
 and here condensed without at all entering the mouth. 
 The examination, upon killing the animal directly after 
 the experiment, gave a negative result in the larynx 
 and in the trachea. 
 
 3. A powerful rabbit was made to inhale six ounces of 
 a solution of chloride of iron (2 : 100) at a distance of 
 one foot from the apparatus, the muzzle being forcibly 
 dilated. This animal also was very restless, as were all 
 the animals with which Lewin experimented. The 
 tongue was allowed to remain quietly in the mouth, 
 and it was observed to lay with its base so much in 
 
64 EXPERIMENTS AS TO PENETRATION 
 
 contact with the posterior wall of the pharynx as to 
 occlude the entrance into the larynx. 
 
 On examining the slaughtered animal, the fluid em- 
 ployed was chemically detected upon the upper surface 
 of the epiglottis, on the lateral borders of the lower 
 surface, and upon the protrusion at the thyroidal at- 
 tachment of the epiglottis ; but not in the trachea. 
 
 4. The same experiment was repeated with another 
 strong rabbit, the nostrils being compressed and the 
 muzzle held open, and with the same result. 
 
 5. The same experiment was performed upon a fee- 
 ble rabbit, which could be so held that the hands did 
 not compress the abdomen and thus impede the respi- 
 ratory process, as was the case with the other animals. 
 
 In this case, the fluid could be detected beyond the 
 bifurcation of the trachea, but not far, and only with 
 slight traces. 
 
 In all his examinations upon the cadavers of these 
 animals, Lewin took the precaution to open the bronchi 
 first and proceed towards the larynx, so that no parti- 
 cles of fluid might flow from above downwards. 
 
 Lewin, in commenting upon these results, acknowl- 
 edges that experiments upon animals cannot definitely 
 settle the question of the penetration of these fluids 
 into the respiratory tract. There is a great difference 
 between the voluntary well-directed inhalations of a 
 patient, and the restless, uneasy, unnatural breathing 
 of an animal being experimented upon, to say nothing 
 of the effect of position of the head, tongue, epiglottis, 
 soft palate, &c. He also calls attention to the fact, 
 that the bronchi absorb readily, and that results may 
 take place during life which cannot be demonstrated 
 after death. 
 
OF NEBULIZED FLUIDS. 65 
 
 Lewin's views are very similar to those of Durand- 
 Fardel. 
 
 Pathological Proofs of Penetration. 
 
 Lewin also details {pp. cit., p. 190) a most instructive 
 pathological case, in which, with Dr. Schulz, chemical 
 assistant to Professor Frerichs, he found free iron in 
 the interior of a cavity in the lung of a patient who, 
 shortly before his death, had inhaled a solution of the 
 sesquichloride of iron. This case is as follows : — 
 
 A carriage-driver, Muller by name, get. 48, whose 
 mother had died with tuberculosis, had suffered from 
 dropsy as early as his seventh year, whether ensuing 
 upon an attack of scarlet fever or not, could not be de- 
 termined. After recovery from this illness, he asserts 
 that he had remained perfectly well until shortly be- 
 fore Christmas, 1861. About this time, during rather 
 a cold spell, he fell asleep upon his box, and on awak- 
 ening became conscious of a strong drawing pain in the 
 upper thoracic region of the right side. This pain 
 gradually diminished without medical interference, and 
 eventually subsided entirely. Shortly before Easter 
 (April 20th) the patient contracted a fresh cold, attrib- 
 uted to exposure in frosty weather. Since that time 
 he had been expectorating a profusion of sputa, un- 
 pleasant to the taste, and producing scraping sensations 
 in the throat. 
 
 After some medicinal treatment, the amount of ex- 
 pectoration became moderated during the daytime, so 
 that only after night, and particularly early in the 
 mornings, the patient expelled the sputa, which re- 
 tained their unpleasant taste and odor, but with less 
 production of the scraping. 
 
 6* 
 
66 EXPERIMENTS AS TO PENETRATION 
 
 The patient sought admittance in the Charite, and on 
 May 14th, his present condition was noted down as 
 follows : 
 
 Patient rather strongly built, with moderately devel- 
 oped but rigid muscles. Color of skin normal ; enlarged 
 and congested bloodvessels to be seen upon the cheeks. 
 Mucous membranes moderately congested. Can assume 
 any position in bed, but feels too weak to remain up. 
 
 Throat well proportioned ; its muscles slightly em- 
 ployed in costo-abdominal respiration. A swollen 
 lymphatic gland, rather painful upon pressure, upon 
 the scalenus muscle of the right side. The voice some- 
 what hoarse. No pain in the larynx. 
 
 Thorax, in general, well formed, with a slight de- 
 pression in the region of the seventh rib, right side. 
 The angle of Louis marked, the clavicular furrow deep- 
 ened, and more so on the right side than on the left. 
 Elevation of thorax tolerably normal, no difference to 
 be detected between the two sides. 
 
 Percussion produces a tolerably high, lightly tympan- 
 itic sound at the sixth rib of the right side, in the mam- 
 millary line ; and so, also, in the right supra-clavicular 
 fossa. Behind, upon both sides, healthy resonance 
 clear beyond the attachment of the twelfth ribs. All 
 over the left side, resonance clear, rather higher over 
 the upper lobe than over the lower one. On the right 
 side, a tolerably intense dull sound, outwards from the 
 eighth spinous process. Stronger fremitus over the 
 whole of the right side than upon the left side, and 
 especially over the region of dulness. 
 
 Auscultation: left and behind, vesicular murmur 
 with some sonorousness and sibilance ; over the entire 
 right side, very loud moist rattling and scanty rales 
 
OF NEBULIZED FLUIDS. 67 
 
 masking the vesicular murmur. In front, very loud 
 vesicular murmur on the left side, sharp bronchial-like 
 respiration upon the right ; expiration rather long ; 
 less rattling and whistling than behind. 
 
 The patient did not cough very much during the ex- 
 amination. The cough is much greater at night than 
 during the daytime, and is principally induced by 
 change of position. Expectoration easy, with a small 
 quantity of sputum brought up by each paroxysm of 
 cough. There are no long-continued paroxysms of 
 cough with expulsion of large masses of sputum. The 
 sputum is of a grayish-green color, distinctly translu- 
 cent, only here and there a few mucous shreds extend 
 from its upper mucous stratum, through a watery mid- 
 dle stratum, to its tolerably homogeneous sediment. 
 
 The impulse of the apex of the heart could not be 
 felt ; the systolic heaving was diffuse. Cardiac dulness, 
 normal. Sounds clear, the second sound somewhat 
 flapping at the pulmonary orifice. 
 
 The radial artery, somewhat serpentine in its course, 
 of rather strong outline, weak beat, and slight tension. 
 
 Tongue with a thick gray covering, especially in its 
 central portion. 
 
 Laryngeal mucous membrane congested, somewhat 
 swollen, and covered with viscid, adherent secretion. 
 
 Abdomen soft and rather flat ; a large scrotal hernia 
 on the right side. 
 
 Spleen and liver of normal outline. 
 
 Appetite rather active ; thirst frequent. Alvine 
 evacuations at intervals of two days. Urine cloudy, 
 but without containing albumen. 
 
 Temperature 39.5 (C), pulse 96, respiration 36. 
 
 17th. Morning. Sleeplessness, moderate sweats, se- 
 
68 EXPERIMENTS AS TO PENETRATION 
 
 vere paroxysm of cough the night previous. Ordered, 
 Decoct, cinchonce (5ij) with Acid, phosphor. 
 
 Evening. Temperature 40, pulse 104, respiration, 
 28. 
 
 18th. Morning. Temperature 38.5, pulse 96, respi- 
 ration 40. 
 
 Patient prefers to retain the semi-recumbent posture, 
 but without fear of dyspnoea. Thorax rather strongly 
 and actively expanded. Expression of countenance 
 quiet. Quantity of expectoration some eight ounces, 
 slimy, grayish-green in color, and covered with froth 
 in profusion. 
 
 19th. Morning. Temperature 38, pulse 96, respira- 
 tion 44. 
 
 Yesterday evening, after an attack of dyspnoea, 
 coughed up a good deal of blood, which has afforded 
 considerable relief. The sputa during the day, again 
 about eight ounces, of triple consistence as before ; only 
 the fluid middle portion is a brownish-red, instead of a 
 grayish-green. Ify. Plumb, acet. grs. ij, dos. vj. 
 
 20th. Blood coughed up again, but the quantity can- 
 not be determined. Towards noon deep inspiration 
 produces a stitch in the right side, in the region of the 
 right nipple, and extending up to the axillary region. 
 Percussion sound in the line of the right axilla, appears 
 somewhat shorter than before. Ordered, 10 dry cups 
 over the affected region. 
 
 21st. Temperature 38, pulse 128, respiration 44. 
 Has again coughed up blood to the amount of four 
 ounces. The stitch in the side and the dyspnoea have 
 subsided. Ordered, Plumb, acet. gr. ss., every three 
 hours. 
 
OF NEBULIZED FLUIDS. 69 
 
 22d. Temperature 39.4, pulse 120, respiration 44. 
 Again has coughed up about four ounces of blood. 
 
 23d. Temperature 38.5, pulse 136, respiration 60. 
 Profuse sweats, great dyspnoea, intensive cough. Strong 
 haemoptysis to the amount of about ten ounces. Treat- 
 ment : — Inhalation from Mathieu's nepiiogexe of 
 Liquor f err i sesquichlorati, at noon and towards even- 
 ing, each time thirty drops in six ounces of aqua destill. 
 Patient rather short-winded, and so weak that it re- 
 quired great effort to make the inhalation ; still after 
 the inhalation he asserted that he felt much more com- 
 fortable than he had done before it. He did not cough 
 as much as before by a great deal ; the dyspnoea de- 
 creased; the amount of expectoration diminished in 
 quantity and less sanguinolent ; the patient's counten- 
 ance fresher and livelier; the speech clearer and stronger 
 than before. Towards evening, temperature 32, pulse 
 118, respiration 40. 
 
 24th. Sleepless throughout the night previous, with 
 severer sweat and cough. Expectoration much more 
 difficult. Although respiration appeared performed in 
 great part by the employment of the accessory muscles, 
 there was no feeling of want of breath. The sputum 
 amounted to three ounces, was translucent, the middle 
 stratum dark brown, without any trace of pure blood 
 discoverable in it. Death at 2 p.m. 
 
 Autopsy, May 26th. — Marked decrease of subdermoid 
 areolar tissue ; the cartilages of the ribs to a consider- 
 able extent ossified. On raising up the sternum there 
 was exposed to view, underneath the first rib, a cavity 
 from which flowed out a black fluid with blackish shreds 
 of tissue. Both lungs strongly inflated ; the left one 
 totally adherent; the right one less so. From the 
 
70 EXPERIMENTS AS TO PENETRATION 
 
 bronchus of the left lung there gushed forth a muddy- 
 brown fluid ; the lung itself large, loose, pervious 
 throughout, only in the posterior portion strongly oeclem- 
 atous and hypersemic, moderately strongly pigmented. 
 The bronchi very narrow, even the larger trunks. 
 The muddy liquid distributed pretty fully in the lower 
 lobe. Mucous membrane moderately injected. 
 
 Upon the right side the adhesion was produced 
 principally by thick fibrinous masses, under which the 
 pleura appeared strongly injected. The lower por- 
 tion OF THE UPPER LOBE WAS CONVERTED INTO A SAC, 
 WITH THIN WALLS FIRMLY ADHERENT TO THE THORACIC 
 PARIETES, IN WHICH WAS FOUND THE SHREDS AND THE 
 BLACK FLUID ABOVE MENTIONED, BESIDE SOME BLACK- 
 ISH-RED lumps (blood clots). The lower lobe rather 
 adherent. Upon its cut surface were seen numerous 
 prominent grayish-white infiltrations ; the remaining 
 tissue was void of air, and on pressure allowed the escape 
 of some of the muddy fluid. The middle lobe and the 
 lower portion of the upper lobe showed broncho-pneu- 
 monic infiltration, surrounded by oedematous tissue. 
 The bronchi moderately large, and mostly filled with a 
 brownish muddy-looking fluid. The vessels of the lungs 
 free from adhesions, their inner walls strongly discol- 
 ored. In the first rib, between the bone and the car- 
 tilage, there was a small space which did not appear to 
 have been made artificially. These extremities of the 
 rib appeared a somewhat muddy, gray, partly carti- 
 laginous and partly striated tissue. Outside of it, com- 
 municating with the space, lay a small cavity, which 
 was covered with reddish excrescences. The adhesions 
 right at the first rib were rather strong, thick, and, in 
 addition, somewhat slanting. 
 
OF NEBULIZED FLUIDS. 71 
 
 In the larynx and in the trachea, but little of the 
 muddy fluid. The mucous membrane discolored. 
 
 In the heart, much fatty blood. The right cavity 
 rather large in comparison with the left. Valves normal. 
 The pulmonary and aortic valves somewhat glazed. 
 The aorta somewhat dilated above the semilunar valves. 
 
 On the border of the anterior sinus of Valsalva of 
 the semilunar valve of the pulmonary artery, and to- 
 wards the left, was discovered a small opening leading 
 to a bloodvessel, which formed a small sac on the outer 
 side of the aorta, and from which several branches 
 coursed over the aorta ; one of the largest of these 
 communicated, by a free vessel at the base of the left 
 ventricle, with a small artery which arose, with a calibre 
 of about a line from the aorta, close to the posterior 
 coronary artery. Close to the opening of the posterior 
 coronary artery there was a still smaller aperture, from 
 out of which air could be fo*rced by blowing into the 
 network of vessels described as originating from the 
 pulmonary artery. At the commencement of the aorta 
 there were a great many adhesions, chiefly rounded 
 superficially. 
 
 The black-colored liquid found in the protected 
 cavity in the lower portion of the upper lobe 
 
 WAS EXAMINED BY THE CHEMICAL ASSISTANT, Dr. 
 SCHULZ, IMMEDIATELY AFTER THE AUTOPSY, AND 
 SHOWED THE PRESENCE OF FREE IRON, AS ALSO DID THE 
 BLACKISH CLOTS — OF COURSE BUT IN SMALL PROPOR- 
 TION. Here we have the strongest possible evidence 
 of the penetration into the lung of inhaled nebulized 
 fluids. 
 
 In a somewhat similar case related by Prof. Zdek- 
 auer, of St. Petersburg ( Wiener Med. Wochenschrift, 
 
72 EXPERIMENTS AS TO PENETRATION 
 
 No. 30, 1861 ; Fieber, op. cit., p. 42 ; and Lewin, op. 
 cit., p. 240; et al.), a patient died from debility shortly 
 after the restraint of a profuse haemoptysis by inhala- 
 tions of a strong solution of the chloride of iron. Dr. 
 Holm discovered everywhere in the tissue of the lung 
 iron in greater quantity than could be due to the blood. 
 As Fieber mentions in a foot-note, this case proves the 
 penetration of the fluid into the minutest ramification 
 of the bronchi. 
 
 Waldenburg (op. cit., pp. 111-165) instituted a 
 great number of ingenious experiments upon men and 
 animals, not so much to prove the entrance of the ma- 
 terial into the respiratory tract, of which ability he had 
 no doubt, as to determine the quantity or proportion 
 that thus penetrated, and also in w T hat form they reached 
 the parts, whether still as spray or condensed into 
 drops ; but, for reasons that are obvious, he was unable 
 to come to any satisfactofy conclusion. 
 
 Prof. Gerhardt, of Jena (Inhalation medikamen- 
 toser Flilssigkeiten. Fin Beitrag zur Localtherapie 
 respiratorischer Erhranhungen. Von Rudolf Wede- 
 mann, Jena, 1862 ; quoted by Fieber, op. cit., p. 49), 
 repeated a number of experiments upon men. He 
 caused several invalids to inhale a chloride of iron solu- 
 tion, and shortly after, by the aid of the laryngoscope, 
 he pencilled the larynx with a solution of tannin. The 
 laryngeal image showed the inky reaction on the apices 
 of the arytenoid cartilages, and on the posterior surface 
 of the epiglottis ; in one case, several dark spots could 
 be seen upon the true vocal cords. In one patient, with 
 a fistule between the hyoid bone and the thyroid car- 
 tilage, a paper which had been dipped into a solution of 
 tannin was held in the fistule after a few inhalations of 
 
OF NEBULIZED FLUIDS. 73 
 
 a solution of the chloride of iron had been taken, and 
 the usual reaction of these salts ensued. 
 
 Wedemann (op. cit., pp. 30-43) records many clin- 
 ical observations confirmative of the question discussed. 
 
 Semeleder (Wochenblatt der Zeitschrift d. k. k. 
 Gfesellsch. der Aertzte in Wien, 1864, No. 1, quoted by 
 Fieber, op. cit., p. 51) found that after the inhalation 
 of astringent solutions, the secretions collected at sev- 
 eral places in the larynx as whitish floccules, with a re- 
 duction of the capillary injection attendant on inflam- 
 mation of the true and false vocal cords. 
 
 Prof. Niemeyer, in the latest (6th) edition of his 
 Manual of Special Pathology and Therapeutics (1865), 
 states that the fact of the entrance of these sprays ad- 
 mits of no doubt. He had treated with markedly satis- 
 factory results, chronic laryngeal catarrh, follicular 
 laryngitis, and pharyngitis, &c, employing solutions of 
 alum, tannin, and nitrate of silver. 
 
 Dr. Morell Mackenzie, of London (Med. Times 
 and Grazette, 1865, No. 765, p. 213), stated at a meet- 
 ing of the Royal Medical and Chirurgical Society, of 
 London, Feb. 14th, 1865, that, in conjunction with 
 Dr. Duchesne, of Woodford, he had performed some 
 experiments upon pigs and dogs, and with positive re- 
 sults ; and Dr. Gibb expressed his conviction, based 
 upon his own observations, that the fluids penetrated 
 into the minutest bronchi. 
 
 Besides the experiments above detailed, many others 
 were instituted by different observers in various parts 
 of Germany, in Russia, Spain, Great Britain, &c, but 
 the results do not differ from those already recorded. 
 The entrance of the nebula, upon voluntary inspira- 
 tion, into the larynx, can easily be demonstrated by 
 
 7 
 

 74 
 
 causing an individual to inhale a colored solution, as of 
 indigo, aniline, &c, under circumstances favorable for 
 penetration, and then examining the parts by aid of the 
 laryngoscope. 
 
 In these experiments it is desirable to secure as finely 
 divided a nebula as possible, and its delicacy can be 
 tested by using a colored solution, as of indigo, and 
 allowing the spray to strike against a piece of unglazed 
 paper, which will become more or less completely cov- 
 ered, showing the degree of tenuity of the drops; a plan 
 first employed by Siegle, who binds up in his work a 
 page on which is pasted two strips of paper thus sub- 
 jected to two apparatuses, his own having produced a 
 spray so fine that the paper looks as if it had been 
 dipped in the solution, so evenly is it colored. Another 
 method of testing the degree of subdivision, and which 
 is applicable to any solution, is to allow the nebula, as 
 it is produced, to strike against a pane of window glass, 
 and notice the minuteness of the condensing particles. 
 
 Thus, in despite of the experiments with negative re- 
 sults, we are led to the conclusion that nebulized fluids 
 can be inhaled deeply into the respiratory tract ; and 
 that when failure occurs it is due to unfavorable posi- 
 tion of the glottis, or an improper method of inhalation. 
 
CHAPTER III. 
 
 the inhalation of nebulized fluids ; the propor- 
 tion of nebula inhaled ; immediate effects of 
 inhalation; manner of conducting inhalations; 
 the number, strength, and duration of inha- 
 lations, etc. 
 
 From what has already been narrated it is evident 
 that the inhalation of nebulized fluids can be utilized 
 for the alleviation and cure of disease, and that the 
 method at once enlarges our resources in local treat- 
 ment ; presents us with a means of affecting the sys- 
 tem by absorption without compromising the digest- 
 ive powers of the alimentary canal, or interfering with 
 them ; for the mucous membrane of the air-passages is 
 much quicker to absorb than that of the stomach, be- 
 sides which, the attenuated form in which the remedy is 
 presented secures a subdivision of labor, as it were, on 
 the part of the absorbent vessels, so that an effect more 
 prompt and sustained may be produced, than w r hen the 
 remedy is presented in bulk and thus subjected to 
 gradual ingestion ; while the absence of a digestive 
 process secures the absorption of the remedy in the 
 chemical form in which it is exhibited. 
 
 It will be seen that the powers of absorption of the 
 pulmonary mucous membrane have been employed for 
 systemic medication, where idiosyncrasy or disease has 
 
76 THE INHALATION OF NEBULIZED FLUIDS. 
 
 prevented the administration of remedies in the usual 
 way. 
 
 How much of the Spray reaches the Larynx, Trachea, 
 and Lungs ? 
 
 This is a question that every skeptic puts, and it is a 
 difficult one to answer. 
 
 Beigel reports the following results obtained by him 
 with Siegle's apparatus : 
 
 "If the boiler, which contains about eight ounces, is 
 half filled, viz., with four ounces of water, and the lamp 
 beneath lighted, the evolution of steam begins in about 
 ten minutes. One ounce of fluid is then, between 
 twenty-five to thirty minutes, turned into spray and in- 
 haled. The quantity of condensed fluid, after the in- 
 halation obtained through the tube of my screen, is 
 about four drachms, the loss in the boiler one ounce. 
 Half an ounce of medicated spray was, therefore, 
 mixed with one ounce of steam. About half of that 
 quantity recoils from the screen into the air, while 
 the other half reaches the mouth. Here, again, about 
 half the quantity remains, to be either swallowed or 
 spit away, whilst the other half, viz., about three drachms 
 of mixture of steam and medicated fluid passes the glot- 
 tis and penetrates into the respiratory tract. In re- 
 spect to that mixture, the conclusion may fairly be 
 drawn that it contains a far greater quantity of atom- 
 ized fluid than vapor. Not only because it can be as- 
 sumed, a priori, that the heavier particles of the fluid 
 are driven by the force of the blast into the mouth, 
 whilst the lighter steam mixes very readily with the 
 atmosphere, but because an analysis of the fluid, ob- 
 tained by condensation, shows that the original strength 
 
THE PROPORTION OF NEBULA INHALED. 77 
 
 of the solution is diminished but little ; at least, it was 
 so in solutions of common salt, which I have tested. 
 The experiment, to show that the steam dissolves into 
 the air, while the atomized clouds rush forth, can easily 
 be made with my screen. The opening through which 
 the patient inhales is closed, the apparatus put into ac- 
 tion, and the condensed fluid gathered. If steam merely 
 escapes, we find that after one ounce of water has been 
 turned into steam, about twenty minims only have been 
 condensed and gathered in the vessel, while it contains 
 about six drachms, when atomization has taken place at 
 the same time. The conclusion is, therefore, obvious, 
 that the strength of the medicated fluid is altered but 
 very little through its mixture with the steam." (Beigel, 
 pp. 49, 50, 51.) 
 
 The probabilities are, that from one-sixth to one- 
 twelfth of the fluid nebulized reaches the respiratory 
 tract ; but we must allow for the absorption by the 
 buccal mucous membranes of much that reaches the 
 mouth and is there condensed ; and as the proportion 
 differs much according to the manner of inhaling, the 
 doses to be employed will vary according to the propor- 
 tion apparently actually inhaled in any given case ; in 
 determining which, the physician will have to depend 
 upon his own judgment after witnessing his patient's 
 manner of inhaling. 
 
 Dr. James Collins, of this city, has furnished me 
 with the following result of some experiments instituted 
 by him to ascertain the probable amount of nebula re- 
 ceived into the system. 
 
78 
 
 THE INHALATION OF NEBULIZED FLUIDS. 
 
 A steam apparatus was used with the Bergson tubes. 
 The amount of drippings collected were carefully evap- 
 orated, and the residue weighed : 
 
 Ferro-ferricyanide of potassium, g 
 were dissolved in 2 ounces 
 Eesidue from drippings, 
 
 Loss, .... 
 
 rammes 2 
 of water 
 
 grammes 1.445 
 .555 
 
 Sulphate of copper. 
 
 Residue in drippings, 
 
 grammes 2 
 
 1.181 
 
 Loss, .... 
 
 .819 
 
 Bicarbonate of potassa, . 
 
 Residue from drippings, 
 
 grammes 2 
 
 1.545 
 
 Loss, .... 
 
 .455 
 
 Nitrate of potassa, 
 
 Residue from drippings, 
 
 grammes 2 
 
 1.285 
 
 Loss, .... 
 
 .715 
 
 Muriate of ammonia, 
 
 Residue in drippings, 
 
 Loss, 
 
 grammes 2 
 
 1.845 
 
 .155 
 
 An analysis of the residue of fluid, containing chlor- 
 ate of potassa 20 grains to the ounce, and deposited on 
 the sides of a mouth speculum which had been used in 
 inhaling, resulted as follows : 
 
 On speculum, ..... grammes .058 
 
 Residue of 4 ounces of fluid, . . 2.755 
 
 Total residue, 2.813 
 
 Original contents, 80 grains, . . grammes 5.183 
 
 Loss, 2.370 
 
IMMEDIATE EFFECTS OF INHALATION. 79 
 
 Immediate Effects of the Inhalation of Nebulized 
 Fluids. 
 
 If the nebula really penetrates beyond the glottis, a 
 peculiar sensation will immediately be felt in the tra- 
 chea and upper sternal part of the chest, according to 
 the depth of the inhalation and the amount of permea- 
 tion by the fluid. As facility of inhalation is acquired, 
 this feeling will be produced over a greater extent of 
 surface. If the fluid nebulized be at the ordinary tem- 
 perature, a sense of cold will be felt in the parts; and 
 if ice-water be inhaled the sense of cold will be very 
 distinct. Sometimes a sense of oppression, and occa- 
 sionally of real soreness, is experienced, especially when 
 at a first attempt at inhalation, a strong solution as of 
 an astringent or caustic is employed ; hence it will be 
 found desirable as a rule to cause a patient to inhale 
 some bland fluid at his first attempt until he becomes 
 accustomed to the method, unless it be a case of haem- 
 optysis, when it is better to proceed at once with the 
 astringent. Haemoptysis has occasionally been induced 
 by inhalation, having, as will "be seen in the following 
 pages, occurred under the observation of Fieber. Dr. 
 Da Costa [Essay on Inhalation, p. 20) states that on 
 two occasions he has seen from the inhalation of a strong 
 solution of alum, asthmatic, wheezing breathing very 
 speedily produced, with loud dry raies discernible at 
 various parts of the chest; the attack lasting from eight 
 to ten minutes. Dr. Collins tells me that he has wit- 
 nessed the same effect. 
 
 If discomfort arise during an inhalation, the proce.ss 
 should be suspended, and the parts gradually accus- 
 tomed to the procedure ; and if the effect should follow 
 invariably, the method should be discontinued. 
 
80 THE INHALATION OF NEBULIZED FLUIDS. 
 
 Usually, the sensation is not disagreeable ; the first 
 few inhalations induce titillation of the glottis provoca- 
 tive of cough ; but this soon ceases, and at subsequent 
 inhalations cough is not produced ; and, indeed, in some 
 instances, the inhalation does not produce any cough. 
 As a general rule, there is cough at the conclusion of 
 each inhalation, or shortly after it, with freedom and 
 increased facility of expectoration. 
 
 If there is inflammation of the upper air-passages 
 with pain and soreness, the inhalation almost invaria- 
 bly affords an immediate feeling of relief, probably by 
 supplying moisture to the parts, and of course as a 
 topical effect also of the narcotic or sedative which 
 may be employed. 
 
 Manner of Conducting the Inhalation of Nebulized 
 Fluids. 
 
 The patient should sit at ease in front of the appa- 
 ratus, tlje distributing tube from which should be on a 
 level with his mouth. Siegle recommends that the pa- 
 tient lean the chest forward with the elbows or arms 
 resting upon the edge of a table. This position will, 
 I think, be found the most suitable and convenient, un- 
 less in exceptional cases. Waldenburg recommends 
 that the patients should, when strong enough, stand up 
 and take their inhalations; but this position does not 
 permit of as free an expansion of the chest, and calls 
 off part of the muscular force of the auxiliary muscles 
 of respiration for the maintenance of the erect posture, 
 and, necessitating frequent respiration, the inspirations 
 are, of course, less deep. Lewin prefers that the back 
 should be supported, instead of permitting the patients 
 to lean forward. 
 
MANNER OF CONDUCTING INHALATIONS. 81 
 
 As soon as the apparatus is in action, which, with the 
 steam apparatus, will usually be in from three to five 
 minutes after the application of the flame, — and sooner 
 if the precaution be taken to pour hot water into the 
 boiler, thereby saving time and alcohol, — the patient 
 should be directed to incline his head a little backwards, 
 thus bringing the oral and laryngeal cavities more to- 
 wards a direct line, and the spray, with or without the 
 intervention of a funnel or face protector, allowed to 
 pass into the mouth of the patient, who should make 
 deep and regular inspirations and expirations. 
 
 It is impossible to give precise rules as to the distance 
 from the apparatus at which the patient's mouth should 
 be maintained, or the time that shall be occupied in each 
 inhalation. Differences suitable to each case, dependent 
 on irritability of structures, facility of inhalation, &c, 
 will occur with every individual. Usually a rather 
 warm spray is more pleasantly endured at a first inha- 
 lation, and therefore it is well at the beginning of each 
 inhalation to place the delivery tube at a distance of but 
 from four to six inches from the mouth of the patient, 
 and then gradually increase the distance to from twelve 
 to twenty-four inches, as may be most suitable. If the 
 laryngeal structures are very irritable, the first sitting 
 should not occupy more than five minutes, and the in- 
 halation should not be repeated the same day. As the 
 parts become accustomed to the irritation, and the fa- 
 cility of inhalation increases, the time of each inhala- 
 tion may be increased to ten or fifteen minutes, and be 
 repeated from two to ten times a day, according to the 
 indications. 
 
 It will be found a better plan to designate a certain 
 quantity to be inhaled as a dose, and gradually increase 
 
82 THE INHALATION OF NEBULIZED FLUIDS. 
 
 the amount, than to prescribe a certain number of in- 
 halatory efforts, or a certain duration of time; as regard 
 to either of these particulars distracts the attention of 
 the patient. 
 
 The temperature of the spray lessens with the in- 
 crease of its distance from the apparatus, and the force 
 of the current is also affected in like manner but in a 
 less degree, this depending rather upon the rapidity 
 with which the steam is formed and heat regulated by 
 controlling the size of the flame with the screw attached 
 to the wick. 
 
 The following are the rules laid down by Siegle to be 
 observed with his apparatus, having the thermo-barom- 
 eter to designate the steam pressure. 
 
 •{ 
 
 •{ 
 
 Stream strong. Temperature high. 
 
 Thermo-barometer 2°. Distance 2-6 inches. 
 
 e.g., In Laryngitis Crouposa. 
 
 Stream strong. Temperature low. 
 
 Thermo-barometer 2°. Distance 1-2 feet. 
 
 e.g., In Pharyngitis Chronica. 
 
 Stream weak. Temperature high. 
 
 Thermo-barometer 1°. Distance 2-6 inches. 
 
 e.g., In Tuberculosis of Lungs and Larynx. 
 
 i ( Stream weak. Temperature low. 
 
 t Thermo-barometer 1°. Distance 1-2 feet. 
 
 e.g., In Hemoptysis. 
 
 In the apparatus of Sales-Girons and others working 
 by pressure, the temperature can be increased by placing 
 a flame behind the drum ; the current of the nebula 
 creates a vacuum directly behind the point on which 
 the spray strikes, and this draws the flame inwards and 
 heats the spray. 
 
 It is difficult to lay down special rules which shall be 
 
MANNER OF CONDUCTING INHALATIONS. 83 
 
 applicable to every case, and every physician employ- 
 ing this method will soon learn by practice to regulate 
 the manner of inhalation so as to suit his cases. Prac- 
 tice soon enables the patients to inhale properly, and 
 also to overcome the disposition to cough, which is some- 
 times very great in their earlier efforts. Where diffi- 
 culty is anticipated, or where patients manifest consider- 
 able concern, it will be best at first that they should 
 merely be allowed to inhale the steam issuing from the 
 apparatus, or plain water, and then the medicated fluid 
 can be added gradually. For the same reason the pres- 
 sure of the steam at the commencement of a sitting 
 may be moderated, gradually rising to a higher degree 
 of the therm o-barometer by increasing the size of the 
 flame. 
 
 Where the patients are more intelligent, but at the 
 same time nervous, a somewhat similar management 
 may become necessary. Such patients can sit at first 
 a little sideways, so that the current streams past 
 the face ; then, as they become accustomed to it, they 
 can bend forward from time to time so as to get the 
 open mouth in the passing current, and then take in a 
 deep breath of the spray from the side. 
 
 With small children and bed-ridden patients, the ap- 
 paratus can very readily be so placed that the current 
 can be directed into the mouth of the patient while lying 
 upon his side. The pillows and adjacent bed coverings 
 must be covered with some suitable material before the 
 inhalation is begun, in order to protect the bed from 
 moisture. 
 
 Larger children are most conveniently managed by 
 taking them upon the lap in order to remove their 
 anxiety, and showing them the movements of inhala- 
 
84 THE INHALATION OF NEBULIZED FLUIDS. 
 
 tion. In this manner children of three years of age 
 soon learn to inhale with real enjoyment or childish de- 
 light in the process. 
 
 Moura-Bourrouillou recommends holding the nostrils 
 closed by means of the finger or some special contriv- 
 ance, in order the better to secure penetration of the 
 spray into the air-passages. Traube recommends that 
 the patient should extend the tongue well out of the 
 mouth. Siegle holds both of these directions unneces- 
 sary ; on the contrary, if the tongue is very fleshy and 
 seems to be much in the way, lessening the oral orifice, 
 he directs the patient to keep it depressed himself with 
 a knee-shaped spatula. The mouth speculum subserves 
 the purpose of a tongue-depressor. 
 
 The physician must by no means neglect to watch 
 the first inhalations of his patient ; otherwise, after a few 
 moments, the tongue will be allowed to raise so that its 
 base will press back upon the soft palate instead of 
 being flatly applied to the floor of the mouth, with the 
 tip behind the lower incisor teeth ; or the head will 
 have assumed an unfavorable position, the mouth be no 
 longer properly opened, the inspirations become less 
 energetic, or too frequent, &c. &c. 
 
 Siegle also recommends that, in the beginning, the 
 patient take an inspiration as if he were going to gape, 
 or inspire after a quiet prolonged articulation of the 
 diphthong sound ce. 
 
 At the close of the inhalation, the patient should 
 cleanse the mouth and pharynx by gargling with fresh 
 water. If, however, the inhalation has been taken for 
 an affection of the mouth or pharynx, this gargling can 
 be dispensed with, that the medication may secure a 
 longer local effect. 
 
MANNER OF CONDUCTING INHALATIONS. 85 
 
 In concluding, Siegle cannot call too much the atten- 
 tion of physician and patient to the following rules : 
 
 1st. Take care that the temperature of the spray and 
 the strength of its propulsion remain constant during 
 the entire continuance of the sitting. This has ref- 
 erence to the patient's distance from the instrument, 
 as well as the pressure as indicated by the thermo- 
 barometer. 
 
 2d. Never permit an inhalation to be taken after 
 bodily exercise or mental excitement, so long as the 
 temperature of the skin remains elevated, or the pulse 
 or respiration disturbed. 
 
 3d. Several hours must elapse between a hearty meal 
 and the inhalation. 
 
 4th. In affections of the phalanx the respiratory 
 efforts of the patient need not exceed those of his ordi- 
 nary breathing. In affections of the larynx, the wind- 
 pipe, the bronchi, and the lungs, the force of the inspi- 
 ration must be greater in proportion to the distance of 
 the affected structures from the mouth ; the deepest in- 
 spirations being necessary in affections of the lungs. 
 
 5th. Let the patient rest awhile from time to time 
 during the inhalation; and under no circumstances must 
 the length of a sitting exceed a period not justified by 
 the strength of the patient. 
 
 6th. The excess of spray condensing in the mouth 
 and accumulating, especially when not composed of 
 harmless substances, such as mere water, common salt, 
 &c, must be expectorated into some conveniently placed 
 receptacle. 
 
 7th. Children and infants should not be out of view 
 for a single moment during the inhalation. 
 
 8th. After the inhalation let the patient, who will 
 
86 THE INHALATION OF NEBULIZED FLUIDS. 
 
 then begin to cough more than usual, remain quiet for 
 a quarter of an hour before he leaves the apartment. 
 
 9th. During the inhalation the patient should not be 
 allowed to speak, nor should any conversation be held 
 with him. His entire attention should be directed upon 
 the inhalation. 
 
 Before proceeding with a medicinal solution it is 
 often well, especially with nervous patients, to begin 
 with pure water, and gradually add the medicated solu- 
 tion drop by drop. In some cases, where even water 
 could not be inhaled, Beigel has found advantage from 
 employing milk, after the inhalation of which for some 
 time, he has been able to proceed with the desired 
 remedy. 
 
 With some children Hauk succeeded by forming his 
 solution into an emulsion, so that it was mistaken for 
 milk, and thus inhaled more readily than if the subter- 
 fuge had not been resorted to. 
 
 Number, Strength, and Duration of Inhalations, $c. 
 
 The time which shall be devoted to taking an inhala- 
 tion will depend upon the quantity of the medicament 
 which is desired to be introduced at each sitting, and 
 upon the special apparatus employed, the minuteness 
 of the particles of the spray, and considerations of a 
 similar character. The glass apparatus of Lewin has 
 been so constructed as to nebulize two ounces of fluid 
 in one minute by from forty-eight to fifty-two strokes 
 of the pump ; and as he has found the most convenient 
 quantity for each inhalation to be forty-eight ounces, 
 it will require twenty-four minutes to reduce this 
 amount into spray. This will be found rather a tire- 
 
MANNER OF CONDUCTING INHALATIONS. 87 
 
 some sitting for most patients, and also very wasteful 
 of the fluid, for his own experiments show that of the 
 forty-eight ounces nebulized, but three ounces find 
 entrance into the mouth of the patient ; and therefore 
 the strength of the solution must be so graduated as to 
 contain in three ounces as much of the substance dis- 
 solved as is desired to be brought in contact with the 
 mucous membrane of the pharynx, larynx, bronchi, &c. 
 
 With the apparatus of Bergson, eight ounces are 
 required to be nebulized to introduce three ounces of 
 spray into the mouth, which will take from twelve to 
 fourteen minutes, and require about forty-eight com- 
 pressions of the bellows or bag. With Mathieu's ndph- 
 ogene six ounces are required, consuming from ten to 
 twelve minutes. With Lewin's steam hydrokomion, 
 four ounces, and twenty minutes. It is difficult to say 
 how much of this goes beyond the larynx or into it. 
 With most of the steam apparatuses it takes from ten 
 .to fifteen minutes to nebulize an ounce — the usual 
 amount employed for one inhalation ; but by increasing 
 the force of the steam, and enlarging the size of the cap- 
 illary openings of the tube, it can be accomplished in 
 from four to seven minutes. 
 
 For acute diseases, usually three and four inhalations 
 daily will be sufficient. More frequent inhalation will 
 be requisite in croup and diphtheria. In chronic affec- 
 tions one or two a day will suffice. 
 
CHAPTER IV. 
 
 ARTICLES OF THE MATERIA MEDICA SUITABLE FOR 
 NEBULIZATION. 
 
 Any article of the materia medica soluble in water 
 or in weak alcohol, is suitable for submission to the 
 method of nebulization. Oils, and solutions in glycer- 
 ine, have also been employed ; but a fine spray cannot 
 be produced with them, inasmuch as the aperture from 
 which the fluid escapes must be larger than for watery 
 and spirituous solutions ; though for applications ante- 
 rior to the larynx they are much better adapted than 
 ordinary pencillings or garglings, because, by the minute 
 subdivision of particles, more complete contact is se- 
 cured, as well as a more continuous effect. 
 
 The sulphurous waters are decomposed by this pro- 
 cess, giving off their hydrosulphuric acid ; but the ex- 
 temporaneous solutions usually employed are not thus 
 altered. 
 
 The materials employed should be chemically pure, 
 and the solutions well filtered before using, in order 
 that no sediment may accumulate to clog up the aper- 
 ture through which the fine stream of fluid is forced. 
 
 Simple pharmacy is more necessary to be observed 
 here, than in the administration of remedies by the 
 stomach ; and it is best always to begin with as weak 
 a solution as will suit the case, the substance employed 
 
ARTICLES OF THE MATERIA MEDICA, ETC. 89 
 
 to be selected with reference to a physiological and 
 therapeutical influence upon the constitution, as well 
 as for its local effect. 
 
 The absorptive power of the mucous membrane of 
 the respiratory organs being much greater than that of 
 the stomach, poisonous substances must be employed 
 with great caution, and the doses be augmented very 
 gradually. 
 
 The strength of any solution to be employed will 
 depend upon the individuality of the patient, his dis- 
 tance from the instrument, the length of the sitting, 
 and similar considerations. 
 
 List of Medicines hitherto Nebulized for Inhalation; 
 with the Doses, §c. 
 
 The following list comprises, to the best of the writer's 
 knowledge, all the principal remedies hitherto used for 
 purposes of inhalation by the process of nebulization, 
 with the doses in which they have been employed, the 
 diseases for which they are recommended, and, as far 
 as could be ascertained, the authorities by whom they 
 were first introduced : 
 
 1. Water. 
 
 a. Cold "Water. — First recommended by Fieber in haemop- 
 tysis, at a temperature of 8°-10° R. 
 
 A very grateful application to the burning heat of certain 
 pharyngeal affections. 
 
 b. Warm Water. — Extensively employed to promote secre- 
 tion, to dilute mucus and facilitate its detachment from the mucous 
 membrane of the air-passages. Valuable in laryngeal angina and 
 laryngeal croup (Siegle). Applicable to local relief in diphtheria. 
 A grateful application in all forms of inflammation of the pharyn- 
 geal and laryngeal and tracheal mucous membranes. Promotes 
 expectoration in croup by supplying watery material and retard- 
 ing evaporation in the formation of false membrane. Useful to 
 
 8* 
 
90 ARTICLES OF THE MATERIA MEDICA 
 
 relieve the pain of ulcerative processes and keep the parts cleansed. 
 Used in asthma and bronchitis. » 
 
 2. Potass^: Peemangams. 
 
 Used by Reveil {Arch. Gen. de Med.) as a disinfectant to purify 
 the atmosphere, nebulizing in the room a solution containing one 
 large teaspoonful to two and three-quarters pounds of water. Also 
 20-30 drops per day in pharyngeal diphtheria. 
 
 I have found it valuable as a detergent and astringent in ulcer- 
 ative tonsillitis and other suppurative affections of the throat. 
 
 3. Liquor Ferri Sesquichloratis. 
 
 Dose: 5-30 drops to the ounce of distilled water. In much 
 stronger solution as a styptic in chronic pharyngitis and chronic 
 laryngitis. 
 
 Diseases. — In haemoptysis (Hillairet, Zdekauer, Lingen, Lewin, 
 Waldenburg, Siegle, Wedemann, Leiblinger, Fieber, $c.) ; to repel 
 excessive secretions from the air-passages ; in pulmonary catarrh ; 
 in atonic affections of the respiratory organs. In whooping-cough 
 (Siegle). In the earlier stages of phthisis, and as a weak inhala- 
 tion in hysterical aphonia (Da Costa). In diphtheria (Lewin). 
 
 According to Lewin, contraindicated in phthisis of delicate 
 females, accompanied with fever and irritability of the mucous 
 membrane. 
 
 Care must be taken that the teeth are not blackened by this 
 solution, and it is therefore desirable to pass a mouth speculum 
 some distance beyond the teeth to protect them. 
 
 Unless prepared at the moment required, the solution should 
 be kept in a dark place, to prevent precipitation of the salt. 
 
 Accumulations of sediment upon the glass tubes are best re- 
 moved by baths of sulphuric acid. 
 
 4. Ferri Subsulphas (MonseVs Salt). 
 
 Dose : Grs. J-10 to the ounce of water. 
 Diseases. — Same as other salts of iron. 
 
 5. Alumen. 
 
 Dose: 5-30 grains to the ounce of water, or some aromatic in- 
 fusion. 
 
 Diseases. — Inflammation, especially catarrhal, of the pharynx 
 and upper air-passages. Excessive secretion (Niemeyer). In 
 
SUITABLE FOR NEBULIZATION. 91 
 
 haemoptysis (Tobold, Polansky, Schlesinger, Siegle), where it seems 
 to produce a more prolonged effect than the chloride of iron. Diph- 
 theritis (Lewin). Laryngeal excrescences (Siegle). In combina- 
 tion with tar-water in phthisis (Waldenbitrg). 
 
 In a coarse spray, an excellent substitute for the gargle in in- 
 flammatory conditions of fauces, tonsils, &c. With the duck-bill 
 tubes, and Clarke's bellows, it can be accurately applied. 
 
 In acute tonsillitis, and acute inflammations of the adjacent 
 structures generally. 
 
 6. Acidum Tannicum. 
 
 Dose: 1-20 grains to the ounce of water. 
 
 Diseases. — The same as alum ; but seems more applicable than 
 alum where the affections have attained some chronicity. Diph- 
 theria, pulmonary gangrene (Trousseau). Croup of the larynx 
 (Barthez, Lewin, Fieber). (Edema of the glottis (Trousseau). 
 Chronic catarrhs ; chronic affections of fauces, pharynx, larynx, 
 &c. Hypersecretion. Haemoptysis : ^j — 3 SS - to Aq. fl. fjj (Po- 
 lansky, Fieber). Polypoid excrescences (Fieber, Siegle). Paraly- 
 sis of vocal muscles (Klimbacher). As an antiseptic. 
 
 Begin ordinarily with small doses, and desist if it produce too 
 much dryness or sensation of heat. 
 
 7. EXTRACTUM RhATANIjE. 
 
 Employed by Bataille in chronic inflammation of the mucous 
 membranes of the air-passages. 
 
 8. Argenti Nitras. 
 
 Dose: ^-10 grains to the ounce of water. 
 
 Diseases. — Granular pharyngitis (Lewin, Waldeman). Inflam- 
 mations and ulcerations of pharynx and larynx. Moist growths. 
 Dipththeritis (Lewin). Chronic laryngeal and pharyngeal catarrhs 
 (Niemeyer). 
 
 Care must be taken that too deep inspirations are not taken 
 when employed for affections of the upper passages. 
 
 The mouth speculum, a face protector, or a mask, should be 
 used to prevent discoloration of the face. 
 
 The solution should be kept in the dark, and refiftered before 
 being used. 
 
 9. Aluminium Nitricum. 
 
 Dose : Grains 2-5 to the ounce of water. 
 
92 ARTICLES OF THE MATERIA MEDICA 
 
 First used by Beigel, who prepares it from a simple solution of 
 the metal in nitric acid ; agitating the crystals in distilled water 
 repeatedly, condensing the solution by evaporation, and recrystal- 
 lizing. Eendered great service, not only in inflammation, but 
 also in nervous affections of the larynx and trachea. 
 
 10. Sodii Chloridum. 
 
 Dose: Grains 1-drachms 4, to the ounce of water. 
 
 Useful in catarrhs of the air-passages. 
 
 Waldenburg uses it in doses of 1-10 grains to the ounce, and at- 
 tributes to it all the good effects produced by the inhalation of the 
 various mineral waters. 
 
 Beigel sets the apparatus in different parts of the room so as to 
 get up a sort of artificial sea air in the atmosphere for a time ; and 
 he recommends it as giving great relief in all stages of consump- 
 tion. 
 
 Lewin employs it in small doses to relieve cough and promote 
 expectoration. 
 
 Liebig recommends it in combination with tannin in chronic 
 catarrhs with difficult expectoration. 
 
 11. Liquor Sode Chlorinate. 
 
 Dose: f^ss-f^j. 
 
 Diseases. — In bronchitis with offensive and copious expectora- 
 tion. In phthisis. As a disinfectant to purify the atmosphere. 
 
 12. Potass^e Chloras. 
 Dose : Grains i-xx to the ounce of water. 
 
 Diseases. — Diphtheria (Fieber, Lewin). Aphthse of children 
 (Siegle). Pharyngitis {Lewin). 
 
 13. POTASSII IODIDUM. 
 
 Dose: Grains ij-xx to the ounce of water. 
 
 Diseases. — Granular inflammations of larynx and pharynx. 
 Induration and chronic thickenings of laryngeal structures 
 (Lewin). In glandular complications. Chronic bronchitis with 
 emphysema? 
 
 14. Potassii Bromidum. 
 
 Dose: Grain i-x to the ounce of water. 
 Diseases. — Laryngeal croup (Schnitzler). 
 
SUITABLE FOR NEBULIZATION. 93 
 
 15. TlNCTURA IODINII. 
 
 Dose: Gtt. j-xx to the ounce of water. 
 
 Diseases. — Follicular inflammations of larynx and pharynx. 
 Pharyngitis sicca. All affections of the throat where there has 
 been implication of the glandular structures. Granular pharyn- 
 gitis (Siegle). 
 
 16. Ammonia Murias. 
 
 Dose: Grains ij-£ij to the ounce of water. 
 
 Diseases. — Kecent laryngeal and bronchial catarrh, where it 
 promotes expectoration (Lewin). Emphysema ; catarrh ; simple 
 bronchitis (Gerhardt, of Jena). In combination with salt, in 
 phthisis (Gerhardt, of Jena). Pneumonia, croup, chronic bron- 
 chitis, chronic pneumonia. In early forming stage of bronchitis. 
 
 17. Potass^e Carbonas. 
 
 Dose : Grains x-3ij to the ounce of water. 
 
 Diseases. — Same as muriate of ammonia, especially in certain 
 forms of follicular pharyngitis (Siegle). Follicular pharyngeal 
 catarrh {Lewin). Substitute for a gargle; also, for a very dilute 
 solution of caustic potassa. Pseudo-membranous croup ; whoop- 
 ing cough ; pneumonia. 
 
 18. Plumbi Acetas. 
 
 Dose : Grains iij-x to the ounce of water. 
 
 Diseases. — In obstinate, troublesome colds, not yielding to other 
 medicament (Beigel). Also, by Waldenburg. In acute catarrhs 
 of larynx and bronchi (Fieber). 
 
 19. Zinci Sulphas. 
 
 Dose: Grains v-xx to the ounce of water. 
 
 Diseases. — As a gargle in chronic inflammations. In excessive 
 secretions (Siegle, Fieber, Lieblinger). 
 
 20. Cupri Sulphas. 
 
 Dose : Grains j-xx to the ounce of water. 
 
 Diseases. — Chronic inflammations. Pharyngitis and laryngitis 
 (Vogler). Ulcerative tonsillitis. Ulcerations of fauces and phar- 
 ynx. Pulmonary gangrene (Trousseau). 
 
94 ARTICLES OF THE MATERIA MEDICA 
 
 21. Liquor Potass^: Arsenitis. 
 
 Dose: G-tt. j-xx to the ounce of water. 
 
 Diseases. — Nervous asthma (Trousseau, Wistinghausen, Lewiri) 
 
 22. Sod^] Chloras. 
 Disease. — Asthma. 
 
 23. Liquor, Iodinii Compositus. 
 
 Dose: Gtt. ij-xv. 
 
 Disease. — Chronic bronchitis [Da Costa). 
 
 Pot. iod. ^j-gss. ; iodinii pur. grs. j-ij ; aqu. dest. ft)ij. In syph- 
 ilitic laryngitis ( Waldenburg). 
 
 24. Argentum Iodidum. 
 
 Used by Gibb in phthisis in the second stage with profuse ex- 
 pectoration, and with laryngeal affections at the same time. 
 
 25. Hydrargyri Bichloridum. 
 
 Dose: Gr. ss.-ij to the ounce of water. 
 
 Diseases. — Syphilitic affections of pharynx and larynx (Lewin, 
 Schnitzler, Waldenburg, Demarquay, $c). In syphilitic excres- 
 cences (Siegle). The inspirations must not be too deep. 
 
 26. Aqua Picis Liquids. 
 
 Dose : f^j-ij of officinal solution. 
 
 Diseases. — Putrid bronchorrhoea without fever (Lewin, Walden- 
 burg). Colliquative sweats, and purulent secretion of phthisis 
 (Lewin). Pulmonary gangrene. Dilated bronchi with emphy- 
 sema ( Waldenburg). Vesicular emphysema. 
 
 Siegle calls it an antiseptic, par excellence. 
 
 27. Aqua Calcis. 
 
 Dose : 1 part lime to 100 of water. 
 
 Diseases. — Diphtheria ; pseudo-membranous croup (Biermer). 
 
 28 Aqua AssAFCETiDiE. 
 
 Used, by Lewin, in asthma with emphysema, in combination 
 with aq. menth. pip. and aq. castorei. 
 
SUITABLE FOR NEBULIZATION. 95 
 
 29. Aqua Amtgdalaej; Amar^;. 
 
 A good menstruum for chloride of iron and other irritant arti- 
 cles (Lewiri). A sedative in painful affections of the larynx and 
 upper air-passages. Excessive paroxysmal cough (Siec/le). 
 
 30. Tinctura Opii Simplex. 
 
 Dose : Gtt. v-xx to the ounce of water. 
 
 Diseases. — Suitable to troublesome coughs in any affection where 
 opium is not contraindicated. Suitable to painful inflammations, 
 as in angina tonsillaris, &c. As an addition to other solutions. 
 
 31. Extractum Opii. 
 
 Dose: Gr. j-v to the ounce of water. 
 
 In this largest dose I have used it to avert a severe tonsillitis, 
 producing all the physiological effects of the drug much more 
 promptly than by ordinary administration. 
 
 In doses of gr. \ to gr. £, Dr. Da Costa uses it in irritative 
 'coughs, and as an adjunct to allay irritation. 
 
 32. MoRPHI/E ACETAS. 
 
 Dose : jL— | gr. to the ounce of water. 
 Diseases.-^S&me as preparations of opium. 
 
 33. Extractum Hyoscyami Alcoholicum. 
 Dose: Gr. ^-2 to the ounce of water ; of fluid extract, gtt. iii-x. 
 Diseases. — Spasmodic coughs. "Whooping cough, intense bron- 
 chitis, bronchial catarrh with spasm [Fieber). Phthisis (Leiblinger, 
 Lewin). 
 
 34. Extractum Cannabis Indicum. 
 Dose : Gr. \-\ to the ounce of water. 
 Diseases. — Spasmodic cough of phthisis (Leiblinger). 
 
 35. Tinctura Cannabis Indica. 
 Dose : Gtt. v-x to the ounce of water. 
 Diseases. — Spasmodic coughs. Irritative coughs. 
 
 36. Extractum Conii. 
 Dose: Gr. j-vj to ounce of water; of fluid extract gtt. iij-viij. 
 In very painful irritations in larynx [Lewin) ; in hypersesthe- 
 
96 ARTICLES OP THE MATERIA MEDICA 
 
 sia of larynx ( Waldenburg). In irritative coughs. In asthma 
 (Da Costa). 
 
 37. Tinct. Belladonna. 
 In nightly irritative coughs of children (Sales-Cfirons, Blache). 
 
 38. Atropine Sulphas. 
 
 Dose : J gr. to 20 ounces of water. 
 
 According to Fieber, unnecessary and dangerous. 
 
 39. Tinct. Stramonii. 
 
 Diseases. — Asthma. Same as other narcotics (Lcwiri). 
 
 40. Tinct. Digitalis. 
 Diseases. — Same as other sedatives (Lewin). 
 
 41. Tinct. Lobelia Inflata. 
 Diseases. — Asthma. Same diseases as other sedatives (Lewin). 
 
 42. Tinct. Opii Camphorata. 
 Diseases. — Irritable coughs ; as a sedative in painful affections 
 of upper air-passages. ♦ 
 
 43. Glycerina. 
 
 Diseases. — In inflammation of bronchi. In pertussis (Fieber). 
 In dry cough of phthisis (Leiblinger). 
 
 "With tannin (1 pt. tannin, 50 parts glycerine, 100 parts water) 
 to soothe irritation from inflammation of the pharynx, particu- 
 larly if applied in the first stage (Demarquay). Its antiseptic 
 qualities destroy the fetid odor frequently exhaled by patients 
 laboring under certain diseases of the pharynx and palate. 
 
 In laryngitis and tracheitis, associated with hoarseness and loss 
 of voice (Scott Alison). 
 
 44. Oleum Terebinthina Kectif. 
 
 Dose : Gtt. j-ij to ounce of warm water. 
 
 In the chronic catarrh of emphysema (Leiblinger). Chronic 
 bronchitis with offensive secretions. Bronchorrhcea. Gangrene 
 of lungs. 
 
SUITABLE FOR NEBULIZATION. 97 
 
 45. Oleum Cadinum. 
 
 Dose : Gtt. j-ij to ounce of warm water. 
 Chronic catarrh of emphysema (Leiblinger). 
 
 46. Ol. Cubebs. 
 
 In the same affections as the oil of turpentine ( Trousseau), 
 
 47. Ol. Copaiba. 
 
 In the same affections as the oil of turpentine [Trousseau). 
 
 48. Oleum Oliv,e. 
 
 In an oleaginous mixture with gum arabic in dry cough, in bron- 
 chitis, and in whooping cough (Fieber, Leiblinger). 
 
 49. Oleum Morrhute. 
 
 This has been used in phthisis, &c. Makes the room smell too 
 unpleasantly to be much used in private practice. 
 
 50. Oleum Pint. 
 
 This has been used in alcohol by Lewin as excitant in aphonia, 
 but without material result. 
 
 51. Camphora. 
 With mucilage of gum Arabic in the putrid expectoration of 
 phthisis [Fieber) ; but must be discontinued on the appearance of 
 congestion or irritation. 
 
 52. Quinine Sulphas. 
 
 Dose : \-1 to the ounce of water. 
 
 Used by Pieber in a regularly returning paroxysmal cough in 
 a consumptive female. Quin. sulph., grs. ij ; tr. opii, gtt. vij ; alu- 
 menis, grs. v; aq. font. f^j. On the same day in which it was 
 given haemoptysis ensued, but whether the result of pulmonary 
 congestion due to the quinia is uncertain. 
 
 Used in intermittent fever by Ancelon [La Rev. Medicale, t. 4, 
 pp. 598-601). 
 
 Used in intermittent fever by Sales-Girons (Gazette Medicale, 
 Sept. 8th, 1866). In tuberculosis [Sales-Girons). 
 
 9 
 
98 
 
 53. Acidum Carbolicum. 
 
 Dose: Gtt. iii-x to ounce of water. 
 
 In all stages of phthisis ( Wolfe, Lange). 
 
 54. Mineral Waters 
 
 At "Wistinghausen. In laryngitis and pharyngitis with viscid 
 secretion and troublesome expectoration. First stage of phthisis 
 (Auphari). 
 
 Sulphurous Waters: In hoarseness. Granular pharyngitis. An- 
 gina tonsillaris. Granular laryngitis and pharyngitis. Aphonia. 
 Spasm of the glottis. Bronchial catarrh. Asthma. Phthisis 
 [Sales- Girons). 
 
 Spengler thinks these mineral waters restore the functions of 
 the ciliary epithelium. 
 
 
CHAPTER V. 
 
 DISEASES TO THE TREATMENT OF WHICH INHALATIONS 
 OF NEBULIZED SOLUTIONS ARE APPLICABLE. 
 
 Sales-Girons considers inhalations in this form in- 
 dicated in acute and chronic diseases of the pharynx, 
 larynx, trachea, bronchi, and lungs ; in nasal catarrh, 
 in asthma, in tuberculosis; also in acute tonsillitis, 
 pharyngitis, bronchitis, pneumonia, simple and pseudo- 
 membranous angina, and croup. At first he employed 
 the method in chronic affections only, and the earlier 
 remedies resorted to were the sulphurous waters of Eaux- 
 Bonnes, Pierrefonds, de Labassere, &c. ; and inasmuch 
 as the treatment was pursued at these various watering- 
 places, the plan was that the patients should drink one 
 glass of the mineral water every morning upon the 
 empty stomach, and afterwards inhale a certain quan- 
 tity broken up into spray by the pulverisateur. 
 
 Subsequently he added to his materia medica tar 
 water, salt and water, and solutions containing iodine 
 and chlorine, and finally he added the emollients, sed- 
 atives, and antiseptics, the chloride of iron in cases 
 of haemoptysis, and quinine as antiseptic in the last 
 stages of tuberculosis. The duration of the inhalation 
 depended on the condition of the patient, the stage of 
 the disease, and the nature of the remedy. In chronic 
 affections of the respiratory organs, where sulphurous 
 
100 DISEASES TO WHICH NEBULIZED 
 
 waters, tar-water, and emollient remedies were em- 
 ployed, the sitting continued some twenty minutes, — the 
 time ordinarily consumed in nebulizing a glass of the 
 mineral water. The inhalations were given twice a day, 
 the first one in the morning before meals, and the second 
 towards evening. When deemed advisable, and well 
 borne by the patient, a third inhalation was permitted 
 in the afternoon. 
 
 Briau (Gazette Hebdomad aire, 1861, No. xv, p. 229) 
 gives the results arrived at by himself in 49 cases, in all 
 of which he employed the apparatus of Sales-Girons, 
 the patient being seated in close proximity to the spray 
 as it left the point of nebulization, and breathing it in 
 slowly and deeply. In no instance was cough or other 
 irritation induced. Some of the cases experienced a 
 sense of tickling referred to the region of the base of 
 the epiglottis. With the exception of one young lady 
 who felt unwell for a few minutes without assignable 
 cause, they all bore the inhalations well. 
 
 All other treatment was abandoned for the time, save 
 drinking th'e mineral waters of the resort. 
 
 Of the 49 cases there were 
 
 28 of simple or granular pharyngitis. 
 
 2 of syphilitic plaques, with pulmonary tuberculosis. 
 
 2 of simple ulceration of the larynx. 
 
 2 of nervous aphonia. 
 
 6 of chronic bronchitis. 
 
 4 of pulmonary tuberculosis with pharyngitis. 
 
 2 of uncomplicated pulmonary tuberculosis. 
 
 3 of haemoptysis without discoverable pulmonary le- 
 sion. 
 
 Positive results were observed only in the two syph- 
 ilitic cases, but without amelioration of their pulmonary 
 
INHALATIONS ARE APPLICABLE. 101 
 
 symptoms. Both patients had drunk the mineral waters 
 for fourteen days without the slightest beneficial effect 
 upon the local affection ; but after the fifth inhalation 
 the inflammation began to diminish, and soon subsided 
 entirely. One of the cases, however, was at the same 
 time under the use of the protiodide of mercury. 
 
 In the other cases of pharyngeal and laryngeal dis- 
 ease, Briau acknowledges no other effect than that 
 which could be attributed to an ordinary gargle, the 
 better for being a running water gargle, and of very 
 long duration. 
 
 He noticed no effect whatever in the cases of pul- 
 monary disease which he could attribute to the new 
 method. 
 
 The majority of the patients took one inhalation daily 
 of from fifteen to forty-five minutes' duration. Three of 
 the cases of laryngeal disease took two inhalations daily. 
 One of these was a case of ulceration from impaction 
 in the left ventricle of a husk of corn, minute portions 
 of which were coughed out at intervals. This patient 
 had fifty-three stances in one month. Another was a 
 case of functional aphonia, in which forty-two stances 
 were tried ; and the third was hoarseness from a non- 
 specific ulcer on one of the true vocal cords. 
 
 These patients were made to inhale with the head 
 inclined forwards, although the observer admits that 
 the spray might have had better access to the larynx 
 had their heads been inclined backwards. 
 
 In valuing these observations of Briau it is to be re- 
 membered that he was opposed to the method. (See 
 page 41.) 
 
 9* 
 
102 DISEASES TO WHICH NEBULIZED 
 
 Coryza. 
 
 By closing the mouth and giving the head the proper 
 inclination, the nebulized spray can be readily inspired 
 into the nostrils. 
 
 Waldenburg reports favorable results with solutions 
 of common salt, and of muriate of ammonia, in that form 
 of coryza known as the dry snuffles. 
 
 The profuse secretion of coryza can be diminished by 
 inhalations of alum, which, by its antiseptic properties, 
 will destroy fetor when present. 
 
 Acute Inflammation of the Fauces and Pharynx. 
 
 Local applications by means of gargles have long 
 been employed in these aifections ; but independent of 
 the pain which frequently follows attempts to gargle 
 under such circumstances, it is impossible to gargle in 
 such a manner that the fluid shall come in contact with 
 the posterior pharyngeal wall, without a voluntary at- 
 tempt to swallow, which produces but imperfect con- 
 tact. One can prove this by gargling with any colored 
 solution, such as indigo or aniline, and then examining 
 the parts before a mirror. He will find the roof of the 
 mouth, tongue, and soft palate covered with the color 
 employed, while the deeper parts of the throat are not 
 discolored. 
 
 Hence, in the expressive language of Dr. Da Costa, 
 " for really valuable purposes the day of the gargle has 
 passed," for by means of this new method we can direct 
 the spray to any desired point, and secure its contact 
 without any other co-operation on the part of the pa- 
 tient than that of simply opening his mouth to permit 
 ingress. 
 
INHALATIONS ARE APPLICABLE. 103 
 
 The articles principally employed in these affections 
 are tannin and alum. I prefer the latter in acute in- 
 flammations generally, independent of its less unpleas- 
 ant taste. The solution may be of the strength of from 
 five to twenty grains to the ounce of water, and the in- 
 halations should be frequently renewed, say an ounce 
 of such a solution should be nebulized five or six times 
 a day, and the patient inhale as much of it as possible. 
 Better effects usually follow at a low temperature, but 
 the solution can be warmed if desirable. If there is a 
 great deal of pain the extract of opium, grs. J to gr. j, 
 can be advantageously added to the solution ; and in- 
 deed, in some cases, an opiate inhalation of itself will 
 be of great value. 
 
 In a severe case of angina tonsillaris in a lady of this 
 city who is subject to ulcerative attacks of tonsillitis, 
 and several members of whose family I was attending 
 during the epidemic of influenza of last year, I suc- 
 ceeded in aborting the disease by strong inhalations of 
 opium, employing a solution of five grains of the watery 
 extract to the ounce of distilled water, and repeating 
 half the quantity at intervals of two hours. The re- 
 lief to the pain, difficulty of breathing, &c, was very 
 prompt, narcotism soon ensued, and after a sound sleep 
 deglutition was again practicable, and inhalations of 
 warm water simply were substituted for the opiate in- 
 halations, of which she had taken but three, containing 
 ten grains of the extract of opium ; but it must be re- 
 membered in connection, that the patient was in bed, 
 took the inhalations from the side, and the probability 
 is that not more than three grains at the utmost gained 
 access to the parts, some of it being diffused in the air, 
 
104 DISEASES TO WHICH NEBULIZED 
 
 and a good deal that entered the mouth being driven 
 out again in expiration. 
 
 In the milder cases of acute angina, inhalations of 
 lukewarm water, or milk and water, will often suffice. 
 
 In inhalations for diseases of the pharynx the inspir- 
 ations should be very light, and for those of the fauces 
 hardly any inspiratory effort is necessary, the natural 
 movement of inspiration being sufficient. 
 
 Prof. Seitz has seen the best results in angina tonsil- 
 laris from nebulized ice-water (Fieber, op. cit., p. 106). 
 
 I have frequently been able to reduce recent inflam- 
 mation of the tonsils very promptly, in those subject to 
 tonsillitis, by the inhalation of a solution of alum, five 
 to ten grains to the ounce, repeated every hour or two 
 hours until the desired effect had been produced. I have 
 also succeeded with solutions of sulphate of copper three 
 or four times daily. Of course, if a purge was neces- 
 sary, it was directed to be taken. 
 
 In these inflammatory cases I like to direct the spray 
 by means of properly curved nebulizers. 
 
 Chronic Inflammations of the Fauces and Pharynx. 
 
 For these affections as ordinarily met with, I rather 
 prefer the effects of a solution of tannin in the propor- 
 tion of gr. j — x to the ounce of distilled water. It is 
 better to make the solution as it is required, to prevent 
 change into gallic acid, and to filter the solution before 
 using it. In my own hands, tannin has given better 
 satisfaction than alum, though by many they are used 
 indifferently. I think tannin produces a more chronic 
 effect than alum, and this is what is desired. Here the 
 inhalations need not exceed two a day, for the disease 
 
INHALATIONS ARE APPLICABLE. 105 
 
 will require more or less time for removal, and hence 
 the superiority of the effect of tannin. 
 
 In very obstinate cases, with alteration, thickening 
 of the mucous membrane, I have seen good results 
 from morning and evening inhalations of a weak solu- 
 tion of the sulphate of zinc, a grain or two, to two, 
 three, or four ounces of distilled water. In obstinate 
 cases, which have resisted these measures, I have some- 
 times employed a solution of iodine with advantage. 
 In the dry variety of the disease, pharyngitis sicca, I 
 can testify to good results from a solution of muriate 
 of ammonia; though in one instance, of long standing, 
 in a baker, where the sal-ammoniac failed, daily inha- 
 lations of a solution of iodine, ten drops of the tincture 
 to the ounce of water, morning and evening, accom- 
 plished the result ; and the man was ab]e to resume his 
 employment after having been compelled to abandon it 
 for more than two years. 
 
 I have seen several cases of pharyngitis sicca in shop- 
 keepers, which have been promptly relieved by inha- 
 lations of sal-ammoniac. In these cases, I have ad- 
 vised the inhalations to be taken at the place of business, 
 and three times a day, — before opening the store, at 
 noon, and before closing. 
 
 Wherever there has been ulceration, I have employed 
 local applications of nitrate of silver or other protective 
 to the ulcerated spots, for such applications are much 
 more effectual than the spray. 
 
 I have met with one or two cases of chronic inflam- 
 mation of the fauces and pharynx in stokers, exposed 
 for several hours at a time to a hot fire ; and have found 
 the inhalation of the spray of warm water, or warmed 
 infusion of wild cherry bark, answer an admirable pur- 
 
106 DISEASES TO WHICH NEBULIZED 
 
 pose in relieving the dryness of throat and frequent 
 disposition to cough, to which they were subject. 
 
 I have, however, had one case under treatment for 
 many months, of chronic pharyngitis with a relaxed 
 state of the mucous membrane of several years' stand- 
 ing, in a brick mason, which has resisted all the treat- 
 ment detailed, as well as the employment in the same 
 manner of the bromides of potassium and ammonium 
 separately and together, alone and in combination with 
 iodide of potassium, and almost the entire range of seda- 
 tives and alteratives ; with and without systemic treat- 
 ment. Temporary amelioration has occasionally fol- 
 lowed the employment of a new remedy ; but the great- 
 est advantage has been experienced during the healing 
 of a blister on the outside of the neck produced by the 
 inunction of Croton oil. 
 
 It will be often found desirable to ring the changes 
 on various astringent and alterant applications, as the 
 parts become accustomed to their influence one after 
 the other. 
 
 Inhalations of a weak solution of the nitrate of sil- 
 ver have been employed with success in cases of ob- 
 stinate chronic pharyngitis. I have had no experience 
 with the article in that form for this affection, except 
 when an accompaniment of laryngeal phthisis. 
 
 Hypertr opined Tonsils. 
 
 Inhalations of tannin, tincture of the chloride of iron, 
 &c, come in play very well after excision of these 
 glands, as astringents and as haemostatics to arrest 
 profuse hemorrhage after the operation. 
 
INHALATIONS ARE APPLICABLE. 107 
 
 Syphilitic Angina. 
 
 This affection has been treated with good effects by 
 Briau, Demarquay, Schnitzler, Waldenburg, and Lew- 
 in, by inhalations of a solution of corrosive sublimate, 
 one or two grains to the ounce of distilled water. 
 
 Granular Pharyngitis. 
 
 Demarquay found great benefit in a dozen of cases 
 from the inhalation of tannin, 1 part to 100 of water, 
 with the use of the waters of Eaux-Bonnes, where the 
 treatment was instituted. 
 
 In general, the condition of the patients improved 
 under the influence of three to four nebulizations a day. 
 Sometimes improvement began in a single day. In from 
 twenty to twenty-five days, he cured a young lawyer, 
 whose voice lost its power on moderate exercise, of a 
 dryness of the throat, with slight but long-continued 
 cough and bloody sputa. Examination of the phar- 
 ynx showed a chronic inflammation of the entire 
 region, with a normal development of the pharyngeal 
 glands. Trousseau witnessed this case. 
 
 Demarquay, however, does not consider this treat- 
 ment a radical cure for granular pharyngitis, the cause 
 of which he considers to exist deeper in the organism. 
 
 Pharyngo- Laryngitis. 
 
 Dr. Johann Schnitzler reports {Wiener Medicinal- 
 Halle, 1862, No. 48, p. 442) one case in an individual 
 about 30 years of age. Marked improvement ensued 
 in a few days from inhalations of tannin, five grains to 
 the ounce of water. This was not considered a curable 
 
108 DISEASES TO WHICH NEBULIZED 
 
 case, inasmuch as the patient would not give up the 
 abuse of spirituous drinks, to which his catarrh was 
 partly attributable. [Lewin, op. eit, p. 259.) 
 
 I have repeatedly verified the experience of Schnitz- 
 ler, Waldeman, Fieber, Lewin, and others, as to the 
 effect of astringent inhalations in these affections ; and, 
 occasionally, the result has been so prompt as to stag- 
 ger credence ; and the like of which, certainly, has not 
 attended other treatment. A couple of cases from my 
 note-book in illustration : 
 
 C. F. H n, a stout, hearty driver of an express 
 
 wagon, contracted an intense laryngitis and pharyn- 
 gitis from exposure incident to his employment. When 
 he was sent to me, April 6th, 1866, after the disease 
 had existed three or four days, his voice was very 
 hoarse, and he complained of great pain in swallowing. 
 Laryngoscopy revealed intense congestion of the laryn- 
 geal mucous membrane, including that covering the 
 vocal cords. He inhaled a nebulized solution of alum 
 during fifteen minutes with great relief, and the follow- 
 ing day the pain and dysphagia had left him, the voice 
 was almost natural, and the parts had assumed their 
 normal appearance. 
 
 Mrs. E S n, came to me on Saturday night, 
 
 April 14th, 1866. Two nights previously, this lady 
 had taken cold. There was great oppression of breath- 
 ing, and on examination I found her to be suffering 
 from general faucitis, submucous laryngitis, with sub- 
 mucous infiltration of the aryteno-epiglottic folds. 
 
 I projected some spray of ether upon the fauces ; and 
 shortly after caused her to inhale from the steam- 
 nebulizer, one ounce of a saturated solution of chlorate 
 of potassa. The following morning she returned ; 
 
INHALATIONS ARE APPLICABLE. 109 
 
 there was still a little hoarseness, but the other symp- 
 toms were gone, so that, to all intents and purposes, 
 she was well. I applied within the larynx a douche of 
 sulphate of zinc, 15 grs. to f Sj, to stimulate the mu- 
 cous membrane ; and after that the patient did not 
 return. 
 
 Mrs. F n, of this city, applied to me May 1, 
 
 1866, recommended by the express driver, whose case 
 has been mentioned. She had been suifering from sore 
 throat for several days. I found infiltration of the 
 aryteno-epiglottic folds and of the mucous membrane 
 covering the cartilages of Santorini. Inhalations of 
 alum water were administered, and she was directed to 
 take three comp. cath. pills at bedtime. The next day 
 she returned much the better for her purge and her 
 inhalation. The inhalation of alum was repeated in 
 the evening, and the day following she was sufficiently 
 well to resume her domestic employments and dispense 
 with professional services. 
 
 I might mention in this place an unusual case of 
 faucitis which occurred in a young lady of this city 
 under my care, in which the disease was confined to one 
 side, cut off short at the mesial line, so much so that 
 the uvula presented a forked-like appearance, and in- 
 deed was mistaken by me for a bifid uvula on account 
 of the inflammation and swelling on that side, and 
 dragging the other side down without implicating it in 
 the inflammation. During the treatment, I showed this 
 case to several professional gentlemen, to whom it was 
 as novel as to myself. Nitrate of silver gr. xx ad f^j, 
 was projected on the parts from a Bergson's apparatus, 
 and in ten days the parts began to heal rapidly, the 
 
 10 
 
110 DISEASES TO WHICH NEBULIZED 
 
 general health improved, and the emaciated patient re- 
 gained her embonpoint. 
 
 Follicular Pharyngo- Laryngitis. 
 
 In this form of sore throat, to which clergymen and 
 other public speakers are subject, I have found great 
 benefit from the continued use of inhalations of tannin 
 in weak solution. Sometimes it will be necessary to 
 make a change in the remedy, and employ some other 
 astringent for a time, and then resort again to tan- 
 nin. Good results have followed the inhalation of 
 a weak solution of opium or hyoscyamus, at a some- 
 what elevated temperature, just before employment of 
 the voice. I have found this advice of value to lawyers 
 and public performers subject to this and kindred affec- 
 tions. The permanent cure of this affection necessitates 
 the withdrawal for a time from exposure to the causes 
 which produced the trouble in the first instance. I 
 cannot affirm that I know of a single case in which a 
 permanent cure has been effected, though I have treated 
 several ; all of whom report greater relief from the 
 inhalations than from any previous treatment, and 
 resort to their apparatus as they find they have occa- 
 sion for it. 
 
 Acute Laryngeal Catarrh. 
 Siegle reports (op. cit. 52) that he employed in many 
 cases inhalations of tannin and alum, but not with much 
 benefit, unless he dieted the patients and kept them 
 abed. When the severer symptoms had diminished, 
 and the main object was to lessen the difficult expecto- 
 ration, he found the greatest advantage from a solution 
 of sal ammoniac, 4 grs. to the ounce of distilled water, 
 
INHALATIONS ARE APPLICABLE. Ill 
 
 several times daily, in close proximity to the appar- 
 atus. 
 
 Waldenburg found the best result from a solution of 
 common salt, 4 to 10 grs. to the ounce of water. 
 
 Fieber reports prompt success from sulphate of zinc 
 with the addition of laudanum. The inhalation of alum 
 water, to which a little narcotic may be added, will usu- 
 ally induce a great deal of comfort. Inhalations of 
 warm water often afford a feeling of relief. 
 
 Biegel reports several cases cured by inhalation of 
 solutions of alum. 
 
 Chronic Laryngitis. 
 
 Dr. Johann Schnitzler ( Wiener Medicin. Halle, 
 1862, No. 48) reports five cases. Three were treated 
 with inhalations of alum, two with tannin ; rapid and 
 marked improvement in all. Improved appearances 
 noted with the laryngoscope ; the mucous membrane 
 appeared paler shortly after each inhalation than be- 
 fore. In one case of chronic hoarseness, before inhala- 
 tion, the vocal cords were covered with accumulations 
 of mucus, and after inhalation they were cleaned off, 
 and the voice had become clearer likewise. 
 
 Tannin, the salts of iron, and chlorate of potassa, 
 are the remedies most frequently recommended for in- 
 halation in this form of disease, and may be adequate 
 to a cure when there is no constitutional implication. 
 
 Laryngeal Phthisis. 
 
 Demarquay reports great improvement from an in- 
 halation of tannin, 1 part to 100 of water, in a case of 
 laryngeal phthisis, in which deglutition was very pain- 
 ful and almost impossible. 
 
 In one case of laryngeal phthisis which terminated 
 
112 DISEASES TO WHICH NEBULIZED 
 
 fatally under my own care, as indeed have all the cases 
 which I have attended to their termination, great tem- 
 porary relief followed for a long time inhalations of ni- 
 trate of silver, a grain to the ounce of distilled water. 
 
 For the dysphagia so constant an attendant upon 
 these cases, I have found considerable relief from in- 
 halations containing opium or some other narcotic. 
 
 In some cases, where violent fits of coughing follow 
 almost every attempt to swallow, I have seen relief 
 from inhalations of this kind, ringing the changes upon 
 the astringent and narcotic preparations, as the system 
 became less influenced by the article under employ- 
 ment. 
 
 In one case of laryngeal phthisis, in a glass grinder, 
 under the care of Dr. William H. Pancoast, of this 
 city, which I had the opportunity of observing fre- 
 quently, considerable temporary benefit accrued from 
 the inhalation at different times of astringents, narco- 
 tics, and of lime water. This case also, terminated 
 fatally. 
 
 Lewin has recommended in these affections, the in- 
 halation of a nebulized solution of nitrate of silver, gr. 
 1-2 to the ounce of distilled water. I have once or 
 twice resorted to them, but the beneficial effect did not 
 compare to that of local medication by the probang, 
 with a strong solution of the salt. 
 
 Inhalations of Solutions of Nitrate of Silver in Chronic 
 Diseases of the Air-Passages. 
 
 Dr. Ludwig Joseph, of Breslau, reports (Deutsche 
 KliniJc, May 26th, 1866) that he has employed inhala- 
 tions of nebulized fluids in chronic affections of the 
 larynx, bronchi, and lungs, the medicament principally 
 
INHALATIONS ARE APPLICABLE. 113 
 
 used being solutions of nitrate of silver of various 
 strengths. With Tobold he has experienced more 
 benefit from them in affections of the bronchi and of 
 the lungs, than in affections of the larynx, where topical 
 treatment can be better carried out, and with more 
 benefit. The effect of the nebulized fluids in laryn- 
 geal complaints is too weak, and not sufficiently ener- 
 getic. Their mild influence is more applicable to af- 
 fections of the bronchial tubes, and of the air-cells, 
 where powerful effects are not required. 
 
 In chronic bronchial catarrh, with profuse secretion 
 from the bronchial mucous membrane, and in bronchi- 
 ectasie, he found the inhalation of nitrate of silver of 
 incontestable value. He found it lessen the abnormal 
 secretion from the mucous membrane, stimulate the 
 membrane by its slight irritation, and thus gradually 
 assist the resumption of its normal functions. It seems 
 also to tone up the bronchial mucous membrane. The 
 effect is not equal in all constitutions, but is best in 
 slow, sleepy, torpid, scrofulous individuals. It is well 
 borne in well-founded cases of suspected tuberculosis. 
 Dr. Joseph has treated several cases of frank tubercu- 
 losis, demonstrable by physical exploration, in this 
 manner, with the result of diminishing the amount of 
 ulcerative processes, and promoting general improve- 
 ment. In these cases the general condition of the pa- 
 tients was favorable. 
 
 Among others, the following case of chronic bron- 
 chial catarrh, with suspicion of tubercle, is of great 
 interest: 
 
 P K , of Bremen, get. 29, a merchant, small 
 
 in build, of delicate frame, well nurtured, came under 
 treatment September, 1864, having failed to obtain re- 
 
 10* 
 
114 DISEASES TO WHICH NEBULIZED 
 
 lief from his disease, from various remedies that had 
 been judiciously employed. He was made to inhale a 
 solution of nitrate of silver, five grains to the ounce of 
 water; and within three weeks the expectoration ceased 
 entirely, and at the date of writing, twenty months after, 
 there was not a trace of cough or of expectoration. 
 
 Dr. Joseph has never seen any direct injury from 
 the inhalations of these solutions of nitrate of silver. 
 At the first sittings, the patients feel an irritation along 
 the course of the trachea, continued sometimes as far 
 as the xiphoid process of the sternum, — a feeling of 
 rawness. Immediately after the inhalation, a quantity 
 of thick tenacious secretion is often expectorated with 
 ease. 
 
 He reports a case of bronchiectasie (dilatation of the 
 minuter bronchi) in which the most remarkable im- 
 provement followed the inhalation, for six weeks, of 
 solutions of nitrate of silver, gradually increased in 
 strength to a scruple of the salt to the ounce of dis- 
 tilled water. 
 
 He has used, with good results, in painful affections, 
 a solution of the acetate of morphia in bitter almond 
 and fennel-seed water, as recommended by Fieber and 
 others. 
 
 Croup. 
 
 Dr. Johann Schnitzler {op. cit.) reports two cases 
 of croup, treated with inhalations of a solution of brom- 
 ide of potassium ; one of which terminated fatally, the 
 other resulting favorably. 
 
 1st case. This was a three-year-old boy, a sister of 
 whom had recently died of croup. The Doctor saw 
 the child on the third day of the disease. It was then 
 
 
INHALATIONS ARE APPLICABLE. 115 
 
 lying in a state of apathy upon its mother's arms, th« 
 countenance pale, the eyelids half closed, the hands 
 hanging by the side. Suddenly the child became un- 
 easy, put its hands up to its throat, and began to cry 
 and to cough, but both cough and voice were toneless ; 
 the child could be seen to cry and to cough, but it could 
 hardly be heard to do so. The breathing was difficult, 
 and marked by the peculiar rales of croup ; the pulse 
 was small, barely to be counted, and gliding from under 
 the finger. Examining the fauces, large white patches 
 [plaques) covered the tonsils and the entire posterior pha- 
 ryngeal wall. During the examination, the breathing 
 became more difficult, and the child hurriedly but 
 vainly gasped for air. An emetic had no effect. In 
 spite of the unfavorable prognosis, an attempt was 
 made to save the patient, and an inhalation of a solu- 
 tion of bromide of potassium, five grains to the ounce, 
 was instituted. As a large proportion of the fluid 
 struck the pharynx, it detached much of the patches, 
 which was spat out. For two hours the child felt 
 better, but soon the threatening symptoms recurred 
 again, and in spite of five repetitions of the inhalation, 
 the child died that night with symptoms of suffocation. 
 2d ease. This was a well-developed child, six months 
 old, with pseudo-membranous croup. Inhalations of 
 bromide of potassium, ten grains to the ounce of water, 
 were administered. After fifty to sixty inspirations, 
 instead of the rales, a flapping respiration ensued, as 
 from the air passing and repassing a membrane par- 
 tially detached. Soon there was so much improvement, 
 that the cough was less frequent and the voice less 
 hoarse. This improvement continued four or five hours, 
 when the previous symptoms returned. Another inhala- 
 
116 DISEASES TO WHICH NEBULIZED 
 
 fcion produced the same relief, which continued through- 
 out the entire night. The following morning, the child's 
 appearance was quieter, the pulse had gone down from 
 130 in the minute to 100, and voice and cough were 
 somewhat hoarser, but the cough no longer so severe. 
 Another inhalation produced again the same effect as 
 before, but to a greater extent ; another inhalation was 
 given in the evening ; followed by quieter sleep. Pulse 
 in the morning 96-100 ; two inhalations during the day. 
 The next morning, the fourth of the treatment, after 
 the child had in all taken six inhalations, two ounces 
 each time, the breathing had become quiet, pulse not 
 accelerated, voice nearly as clear as natural, and the 
 cough almost entirely gone. 
 
 Prof. Biermer, of Berne, relates (Schweizerische 
 Zeitungfilr Heilkunde, 1864, p. 157, Lewin, op. cit. p. 
 287 ; et al.) the following interesting case of laryngeal 
 croup in the adult, cured by inhalations of warm watery 
 vapor and of lime-water, 
 
 A young girl of eighteen years of age, was treated 
 in the beginning of March, 1864, for what appeared 
 to be a simple laryngitis. During breakfast on the 
 morning of March 13th, there suddenly ensued an in- 
 tense paroxysm of cough, with appearance of asphyxia, 
 cyanosis, cool extremities, loss of consciousness, and 
 complete insensibility. The physician who was called 
 in the emergency, recognized the necessity of imme- 
 diate resort to some powerful restorative, and applied 
 a hot hammer upon the breast; but without exciting 
 any reaction. Under continued severe irritation of the 
 skin, and the use of liq. ammon. anisati, the patient 
 gradually came to, and eventually coughed up a con- 
 siderable quantity of croup membrane; after which the 
 
INHALATIONS ARE APPLICABLE. 117 
 
 respiration became easier. After this attack, the 
 breathing remained stenotic, rattling, and whistling. 
 On her reception into the hospital, the morning of the 
 same day, the countenance was still very livid, the eyes 
 dull, the pulse very feeble and small, the nose and ex- 
 tremities cool, and the crowing respiration accompanied 
 by paroxysms of cough, during which, pseudo-mem- 
 brane was expectorated. One patch was ring-shaped, 
 having received the impression from one of the rings 
 of the trachea. External irritation, and calomel, suc- 
 ceeded in diminishing the dyspnoea. t The next morn- 
 ing, intense dyspnoea again set in, accompanied with 
 the ordinary croupal long-drawn inspiration, with the 
 employment of all the auxiliary muscles, and marked 
 inspiratory incurbation of the scrobiculus cordis. In 
 spite of the vomiting induced by an emetic, the orthop- 
 noetic symptoms increased, with lividity of the counte- 
 nance and great distress, during the continuance of the 
 cough. Under these circumstances, in order to moisten 
 the dry mucous membrane of the air-passages, the in- 
 halation of warm water, broken up by the pulverisa- 
 teur, was employed. This agreed with the patient so 
 well, that finally boiling water was permitted to be 
 nebulized through the apparatus, for the patient de- 
 clared that the warmest steam possible afforded her the 
 greatest relief. She inhaled the warm steam for an 
 hour with great eagerness, and expectorated to a con- 
 siderable extent, while the dryness and difficulty of 
 breathing gradually lessened. Then a stormy suffoca- 
 tive paroxysm of cough came on, during which a con- 
 siderable quantity of mucus and pieces of croupal mem- 
 brane were expelled. The patient then breathed much 
 more freely, and felt greatly relieved. From this time 
 
118 DISEASES TO WHICH NEBULIZED 
 
 on, she inhaled every two hours warm lime-water, in 
 the proportion of one part to thirty, each inhalation 
 continuing a quarter of an hour. From this time 
 forward, the symptoms of croup declined more and 
 more, and with a profuse expectoration of thick, 
 crumby, yellow, purulent masses ; the fever abated, 
 and convalescence began the following day ; the apho- 
 nia, however, continuing until the 9th of April, when 
 it also began to disappear. 
 
 M. Biermer, and all those who watched the progress 
 of this case, wer« convinced {Brit. $ For. Med.-Ohir. 
 Review, July, 1865, from Bui. Gen. de Therap., 
 April 15, 1865) that the inhalations had a solvent 
 effect upon the false membrane ; but the Professor 
 does not recommend an exclusive adoption of this local 
 treatment, which softens and detaches the exudations, 
 but does not reach the cause of the disease, which must 
 be combated by constitutional remedies, calomel being 
 considered the chief. 
 
 Prof. Biermer was aware of the case of croup re- 
 ported by Siegle, as cured by inhalation of nebulized 
 water, very warm, and he attributes the happy result 
 chiefly to the high temperature, especially when lime : 
 water is added to it. 
 
 Prof. Biermer was led to the employment of lime- 
 water from the statement of M. Kuchenmeister, of 
 Dresden, that diphtheritic membranes are rapidly dis- 
 solved in lime-water. This was confirmed by Forster, 
 of Dresden, and also by Prof. Biermer, who repeated 
 Kuchenmeister' s experiments before the students of his 
 clinical lectures in the University of Berne, placing 
 some pseudo-membranous exudations in a small glass 
 of lime-water ; and they disappeared before the eyes 
 
INHALATIONS ARE APPLICABLE. 119 
 
 of the students in from ten to fifteen minutes, leaving 
 only a slight sediment in the bottom of the glass. 
 
 Dr. Brauser, of Ratisbon, has also lately published 
 (quoted in Brit. $> For. Med.-Chir. Rev., July, 1865) 
 a case of croup in a child of four and a half years old, 
 treated in the same manner, a perfect cure. M. Brau- 
 ser insists on the necessity of using the inhalations 
 hot. 
 
 Siegle (op. cit., p. 60) reports a very severe case 
 of membranous croup with impending death, in a child 
 two years of age, for whom he had tried all the usual 
 remedies in vain. He was about instituting inhala- 
 tions of nitrate of silver or tannin, when the rapidly 
 threatening symptoms of want of air seemed to him to 
 be less due to obstruction by croupal membrane, than 
 to ineifectual attempts to detach the accumulating mu- 
 cus ; to assist these, he administered inhalations of 
 warm steam, and very soon the patient began to spit 
 out portions of the membrane. After an inhalation of 
 a quarter of an hour, the child breathed more freely, 
 and after twenty-four hours, during which it was more 
 or less kept up day and night, the child bringing 
 up a good deal of mucus, and shreds of croup mem- 
 brane, which the mother removed from its mouth with 
 her finger, the life of the little patient was saved. 
 
 Siegle also reports another case of croup in a little 
 boy of five years of age, in which several inhalations 
 of tannin were taken daily by the little patient, who 
 quietly submitted to the new method ; but in spite of 
 the amendment of some of the most desperate symp- 
 toms, the patient died. 
 
 Barthez (Traitement des ang. diphth. par la pulv., 
 Paris, 1861, Lewin, op. cit. p. 224-235) details four 
 
120 DISEASES TO WHICH NEBULIZED 
 
 cases of croup, treated by him at the Hopital des En- 
 fants, St. Eugenie, with inhalations of tannin, 5-10 
 parts to 100 parts of water, from eight to twenty times 
 a day, fifteen to twenty minutes at a time ; in which he 
 observed the excellent effect of the remedy upon the 
 membranous exudation. Respiration became freer, 
 the dyspnoea diminished, and the suffocative paroxysms 
 disappeared. Two of the cases terminated fatally, in 
 consequence of the systemic poisoning, for in one of 
 the cases where the presence of the membrane had 
 been diagnosed, no trace of it could be found upon 
 post-mortem examination. 
 
 The first case, a girl set. 4 J, was one of general diph- 
 theritis, with pseudo-membranous exudation in the nos- 
 trils, upon the lips, in the mouth, larynx, and doubtless 
 in the bronchi. Death occurred on the sixth day after 
 commencing treatment, and the twelfth of the disease. 
 At the autopsy there was no relic of pseudo-membrane 
 anywhere on the tonsils, pharynx, larynx, trachea, or 
 bronchi. 
 , This case showed us, remarks Barthez : 
 
 1st. A modification of the local appearances after 24 
 hours, under the influence of the nebulized solution of 
 tannin. 
 
 2d. The local improvement the greater, the more the 
 pseudo-membrane came in contact with the nebula. 
 
 3d. The corresponding diminution of the general 
 symptoms of diphtheritic intoxication, with the diminu- 
 tion of the local symptoms. 
 
 The second case, a boy set. 5J, was diphtheritis of the 
 pharynx, larynx, and nostrils. Internal treatment with 
 large doses of sesquichloride of iron, and inhalations of 
 a tannin solution ; immediate and permanent benefit by 
 
INHALATIONS ARE APPLICABLE. 121 
 
 the inhalation of tannin ; improvement in the croupal 
 symptoms while the systemic poisoning rapidly increased, 
 and the child died on the twelfth day of the disease, and 
 tenth of the treatment. 
 
 The third case, a boy set. 3, was one of angina mem- 
 branacea — croup in the second stage. Treatment by in- 
 halation began on the fourth day, with repeated inha- 
 lations of a nebulized solution of tannin. For three days 
 the disease remained stationary; then improvement rap- 
 idly ensued, with recovery on the ninth day. 
 
 The fourth case, a girl get. 3J, was one of croup in 
 the first stage, with pseudo-membranous exudation upon 
 the tonsils, the soft palate, and the uvula. Prompt 
 recovery on the fourth day of treatment by inhalation 
 of a solution of tannin. 
 
 Fieber [op. cit., p. 114), who, having translated Bar- 
 thez' cases, treated fifteen cases of his own in the same 
 manner, reports two-thirds of them cured, the remaining 
 third having terminated fatally. He combats Barthez 
 opinion as to the mechanical effect of the tannin, which, 
 according to that observer, is to pucker the membrane, 
 so that its edges roll over, and it thus becomes gradually 
 detached ; and states that he has never seen this effect, 
 but that the membrane appears to him to become, as it 
 were, dissolved under the influence of the tannin. 
 
 Dr. Da Costa [Essay on Inhalations, New York, 1867, 
 p. 30) in commenting upon these* cases, remarks that 
 when we look at the length of the treatment, it does not 
 look as if the remedy had any marked solvent power, 
 for dipththeritic membranes are not permanent struct- 
 ures, but are very apt to disappear from the circumfer- 
 ence to the centre within a week after their appearance ; 
 and hence, if we accord any value to the treatment — 
 
 11 
 
122 DISEASES TO WHICH NEBULIZED 
 
 which, bearing in mind the usually fatal character of 
 laryngeal diphtheria and the grave character of pseudo- 
 membranous croup, we cannot totally refuse to do — we 
 must also admit that the action is not rapid, and not 
 what we might expect from a solvent ; nor can we over- 
 look the effect of the water in the combination as a 
 cleansing agent, and as tending to aid in removing and 
 in expectorating the breaking-down textures, for in 
 Siegle's hands the inhalation of pulverized warm water 
 alone produced the greatest relief in an apparently hope- 
 less case. 
 
 My own experience with inhalation in croup is limited 
 to a single severe case of catarrhal croup, in which the 
 relief of very distressing symptoms repeatedly followed 
 inhalation of lime-water. 
 
 Dr. James Collins, of this city, furnished me with 
 the following record of his experience with inhalations in 
 croup : 
 
 Pseudo-membranous Croup. — Mary E , set. 11 
 
 months. Was called to the case November 18, 1866. 
 Patient apparently beyond recovery. Lime inhalations 
 employed with little or no effect, and the patient died. 
 
 A. B , aet. 3 years. A robust, healthy child. 
 
 Had been unwell for a few days, suffering from cough, 
 neglecting its play, and becoming somewhat peevish ; 
 but had shown no alarming symptoms until the previous 
 night, when the cough became more brazen and spas- 
 modic. I found the child with marked fever, dyspnoea, 
 husky voice, distressing and spasmodic cough. On ex- 
 amination I found the fauces lined w T ith an albuminous 
 deposit. Lime-water inhalations were at once instituted, 
 and a mustard bath, while one of the family was des- 
 patched for an emetic ; but by the time it was procured 
 
INHALATIONS ARE APPLICABLE. 123 
 
 the symptoms had abated so much that it was not deemed 
 necessary to administer it. The cough loosened, and 
 tough albuminous material was coughed up in large 
 irregular masses, which readily spread out into flakes 
 on being spat into water. The inhalations were con- 
 tinued every two hours that night, and three times the 
 following day, after which I found no other topical ap- 
 plication necessary. The inhalations were continued 
 from time to time, a mild purge administered, and tur- 
 pentine sfupes applied to the back of the neck and the 
 breast. The child steadily improved and recovered. 
 
 Dr. Collins informs me that he has tried lime-water 
 inhalations in several cases of simple spasmodic croup, 
 with success in every instance. 
 
 Diphtheria. 
 
 Lewin records in detail [op. cit. 466-499) eighteen 
 cases of diphtheria treated by him, in part with inhala- 
 tions, of which number fifteen recovered. These results 
 being remarkable, I consider it well worth while to in- 
 sert a synopsis of the cases, their treatment, and the 
 result. 
 
 Case I. Margaret H., set. 4. Treatment began on 
 the tenth day of the disease, when the symptoms were 
 as follows : April 14— evening. Pulse, 120 ; respiration 
 30 ; urine somewhat albuminous ; sleep good ; voice a 
 little hoarse ; deglutition somewhat impeded ; cough 
 trifling ; lymphatics of the neck on the right side swollen ; 
 right tonsil covered with a deeply penetrating pseudo- 
 membrane ; larynx copper-colored ; epiglottis swollen. 
 Treatment : internally, chlorate of potassa 5j to f§v of 
 water; locally, chromic acid 5jss. to fSj applied to the 
 deposit ; by inhalation, chlorate of potash 5j to f§vj. 
 
124 DISEASES TO WHICH NEBULIZED 
 
 Under this treatment the condition gradually improved, 
 and the child was about to be discharged from observa- 
 tion, when, on the fifth day of the treatment, she was 
 attacked with rigors in the evening, followed by fever ; 
 the next morning a deeply penetrating white exudation 
 was observed on the left tonsil, which seemed to be 
 drawn more deeply towards the larynx. The same 
 treatment was reinstituted, and after a few days the 
 child recovered entirely. 
 
 Case II. Hannah F , set. 5, the sister of two 
 
 boys recently dead of diphtheria. She was seen on the 
 third day of the disease, when, May 29, her condition 
 was as follows : pulse 120 ; respiration 28 ; urine 
 slightly turbid ; sleep good ; voice and deglutition nor- 
 mal ; no cough ; lymphatics on right side swollen ; 
 grayish-white exudation on the right arch of the palate 
 and upon the right tonsil, dipping down deep to its 
 lower surface ; larynx copper-red ; the mucous membrane, 
 especially upon the upper surface of the epiglottis, 
 somewhat swollen. Treatment : internally, chlorate of 
 potassa 5j to fgiv — a tablespoonful every hour ; locally, 
 chromic acid 5ij to foj ; by inhalation, chlorate of potassa 
 5ij to f§viij. By the 3d of June all the phenomena of 
 disease had disappeared ; but on the 7th of June an 
 alteration of the voice was noticed, and a difficulty in 
 deglutition, fluids returning by the nose, owing to a par- 
 tial paralysis of the soft palate, of which there was, 
 under the use of iron, gradual restoration in four weeks. 
 
 Case III Otto F., set. 3., brother of Case II. On 
 the second day of the disease, May 29, he presented the 
 following condition : pulse 112 ; respiration 26 ; sleep 
 good ; voice normal ; deglutition somewhat impaired ; 
 some cough ; lymphatics of neck swollen on both sides ; 
 
INHALATIONS ARE APPLICABLE. 125 
 
 exudation on both sides of the pharynx, on the left side 
 extending further towards the entrance into the larynx ; 
 larynx somewhat congested, grayish-yellow slimy exu- 
 dation on the free border of the epiglottis. Treatment : 
 internally, Potas. chlor. 5j to f§iv, a papspoonful 
 every two hours ; locally, cauterization with chromic 
 acid 5ij to fSj ; by inhalation, potass, chlor. 5\j to fSviij. 
 Recovery prompt. 
 
 Case IV. Alfred B., set. 8. On the third day after 
 having been taken with fever he began to cough ; this 
 increased and assumed a barking tone. Tonsils covered 
 with whitish-gray matter. Improvement followed an 
 emetic and the application of leeches ; but on the next 
 day the fever increased, the cough increased, hoarseness 
 came on, and the medical attendant administered an 
 emetic, again applied leeches, and gave two grains of 
 calomel every other hour until twelve grains had been 
 taken. June 12, the fifth day of the disease, the con- 
 dition was as follows : pulse 126 ; respiration 34 ; no 
 albumen in urine ; sleep broken by a barking cough ; 
 some dysphagia ; lymphatics swollen on both sides of 
 neck; the velum on the right side, from the attachment 
 of the uvula over to the lower end of the tonsil, covered 
 with gray-white pseudo-membrane ; left tonsil slightly 
 affected ; the entire larynx, as far as could be seen, 
 highly reddened, the upper surfaces of the arytenoid 
 cartilages covered with thin gray-white exudations ; the 
 vocal cords could not be seen. Treatment : internally, 
 Potass, chloras. Sjss. to f§iv, — a papspoonful every two 
 hours ; locally, cauterization with chromic acid 5\j to 
 fSj ; by inhalation, potass, chloras. 5ij to foviij, two 
 ounces every two hours. On the 15th the child was 
 pronounced well. 
 
 11* 
 
126 DISEASES TO WHICH NEBULIZED 
 
 Case V. Hannah ]£., set. 3J, very delicate. Con- 
 dition July 10th as follows : pulse 96 ; resp. 24 ; some 
 albumen in urine ; sleep tolerable ; considerable hoarse- 
 ness ; a moderate degree of dysphagia ; frequent cough ; 
 lymphatics somewhat swollen ; considerable and deeply 
 penetrating exudation upon both tonsils and arches ; 
 mucous membrane of entire larynx and commencement 
 of trachea, bright red ; epiglottis somewhat swollen. 
 Treatment : internally, potass, chlor. 5\j to f§v ; locally, 
 cauterization with chromic acid 5\j to f§j ; by inhala- 
 tion, alumen 5\j to fSviij. The next day the voice 
 had improved, the epiglottis was more swollen and in- 
 flamed, but showed no exudation ; internal treatment 
 and inhalation as on the day previous ; the epiglottis 
 and arytenoid cartilages were touched with nitric acid, 
 5ss. to f§j. By the 13th every function was in order. 
 Recovery complete. 
 
 Case VI. Hulda H., set. 5. Second day of disease, 
 Aug. 24, condition as follows : pulse 140 ; resp. 32 ; 
 no albumen in urine; sleep disturbed; voice hoarse; 
 considerable dysphagia ; cough frequent and hoarse ; 
 lymphatics much swollen on both sides and painful upon 
 pressure ; both tonsils, the uvula, and a portion of the 
 arches much swollen, and covered with thick leathery 
 pseudo-membrane; epiglottis swollen, considerable white- 
 gray deposit on its upper surface, receding on the right 
 side toward the ary teno-epiglottic ligament. Treatment : 
 internally, potass, chlor. oij to fgvj, a tablespoonful 
 every second hour ; locally, cauterization with acid 
 chrom. 5\j to f§j ; by inhalation, alum 5ss. to f§vj, 
 two ounces every second hour. On the 28th the con- 
 dition had become as follows : pulse 120 ; resp. 28 ; 
 much albumen in urine ; lymphatic swellings less pain- 
 
INHALATIONS ARE APPLICABLE. 127 
 
 ful on pressure ; right tonsil almost entirely clean, left? 
 still covered ; epiglottis clean. Treatment : internally, 
 liq. ferri sesquichl. 5 drops every third hour ; locally, 
 touching with arg. nit. 3j to f.5j ; by inhalation, alum 
 as before. By the 30th, convalescence was established, 
 and the case went on to complete recovery. 
 
 Case VII. August M., set. 10, living in a dirty un- 
 healthy cellar ; rather delicate, but had always been 
 well. Aug. 26, took cold running about the streets, 
 felt unwell, with loss of appetite. Dysphagia began 
 early on 27th. Aug. 30, condition as follows : pulse 
 140 ; resp. 36 ; no albumen in urine ; sleep restless ; 
 voice hoarse ; considerable dysphagia, with pain in the 
 right ear on eating ; lymphatics on both sides swollen 
 and painful to pressure ; the uvula lengthened and thick- 
 ened, and as if covered with kid ; pseudo-membrane 
 upon both tonsils and palatine arches, and sharply de- 
 fined from the sound tissue; epiglottis much swollen, 
 and on the right side of its free border, covered with 
 pseudo-membrane ; vocal cords normal ; nostrils much 
 inflamed. Treatment: internally, potass, chlor. 5ij to 
 f§vj, a tablespoonful every two hours; locally, cauter- 
 ization with chromic acid 5\j to fSj. Inhalations of 
 alum 5ss. to fgvj, 1J-2 oz. every two hours. On the 
 2d of September, 5 drops of liq. ferri. sesquichlor. every 
 3 hours was substituted for the chlorate of potassa. 
 Recovery prompt. 
 
 Case VIII. Helen M., set. 8, sister of Case VII. 
 Dec. 1, condition as follows: pulse 132; resp. normal; 
 sleep uneasy ; considerable dysphagia ; lymphatics on 
 both sides swollen, and painful on pressure ; tonsils and 
 arches covered with pseudo-membrane ; epiglottis some- 
 
128 DISEASES TO WHICH NEBULIZED 
 
 what inflamed. Treatment : internally, potass, chlor. ; 
 inhalation ; locally, chromic acid. Complete recovery. 
 
 Case IX. Louise M., set. 3J, sister of Nos. VII and 
 VIII. Tonsils not inflamed, but swollen, and upon 
 them isolated spots of pseudo-membrane. The spots 
 were touched with chromic acid ; a solution of alum 
 was inhaled, and the next day all the local symptoms 
 vanished. No general treatment required in this case. 
 
 Case X. Mary P., get. 15. Jan. 25, fourth day of 
 the disease, condition as follows : pulse 128 ; resp. 
 38 ; urine slightly albuminous ; sleep poor ; voice hoarse ; 
 severe dysphagia ; moderate cough ; lymphatics on both 
 sides swollen ; on the right tonsil, and right soft palate, 
 white matters, but as in this case nitrate of silver had 
 been applied locally the day before, it is impossible to 
 determine whether the appearance denoted diphtheritic 
 exudation, or the escharotic effect of the nitrate of sil- 
 ver ; larynx perfectly clear, not even injected. This 
 case was treated with chlorate of potassa internally, cau- 
 terization with chromic acid after the exudation had 
 spread somewhat, and inhalation of a solution of alum. 
 Recovery was prompt in a few days. 
 
 Case XI. Bertha E., set. 4. Dec. 24, appeared pale, 
 lost appetite, and complained of pain in swallowing. 
 Examination showed pseudo-membrane on both tonsils, 
 on velum, and on posterior wall of pharynx. Treatment 
 was immediately instituted by local cauterization with 
 chromic acid, and the administration of chlorate of 
 potassa internally. Dec. 28, condition as follows : pulse 
 104 ; resp. 24 ; urine contained considerable urates, no 
 albumen ; sleep good ; voice somewhat hoarse ; trifling 
 dysphagia ; trifling cough ; lymphatics very much swollen 
 and painful ; posterior wall of pharynx, uvula, both 
 
INHALATIONS ARE APPLICABLE. 129 
 
 arches, and tonsils, fully covered with pseudo-mem- 
 brane ; larynx very much inflamed, as also epiglottis 
 and false vocal cords ; true cords free. Treatment : in- 
 ternally, liq. ferri sesquichlor. 5 drops every two hours ; 
 locally, cauterization with chromic acid ; by inhalation, 
 alum. Condition gradually improved, and on Jan. 1st, 
 1864, pulse 100, resp. 16 ; lymphatics still swollen and 
 painful. Treatment : internally, decoct, cinch. (5ij to 
 fgiv), acid hydrochl. f5ss., and Tokay wine ; inhalations 
 of chlorate of potassa 5j to f^vij. Jan. 2d, pulse 140 ; 
 resp. 28 and stridulous ; voice very hoarse ; pseudo- 
 membrane on lower surface of epiglottis, and on aryt- 
 enoid cartilages. Treatment : internally, liq. ferri ses- 
 quichl. and Tokay wine; cauterization with chromic acid, 
 3j to fgj. Three paroxysms of marked dyspnoea at 
 night. Jan. 3d, pulse 136 ; resp. 24, and freer ; some 
 albumen in urine, and a good deal of urates ; cough in- 
 creased but dry ; lymphatics still swollen ; local ap- 
 pearances unchanged. Treatment : internally, potass, 
 nit., potass, bicarb, aa 5j, to f§iv of Tokay wine ; cau- 
 terization as before, followed by an hour's vomiting of 
 slime. Coughed up in the night thick yellow-reddish 
 membranes, tinged with blood on their internal sur- 
 faces, and which from their form must have come from 
 the trachea. Jan. 4th, pseudo-membrane also upon the 
 false vocal cords. Treatment: internally, liq. ferri 
 sesquichl. ; by inhalation, potass, chlor. A short par- 
 oxysm of dyspnoea at night. Jan. 5th and 6th, pulse 135 ; 
 resp. 32 : aphonia ; pharynx almost clean ; pseudo- 
 membrane only on epiglottis. Treatment : the same. 
 Similar dyspnoea at night. Jan. 9th, pulse 160 ; resp. 
 40; marked stridor; urine scanty, more albumen; 
 cough severe and whistling ; vocal cords covered with 
 
130 DISEASES TO WHICH NEBULIZED 
 
 diphtheritic deposits ; pharynx entirely clear ; circum- 
 scribed pneumonia on right side with rusty sputa. 
 Treatment : the same. Jan. 10th, pulse 130 ; resp. 32 ; 
 no stridor ; urine containing much albumen, filling half 
 the test-tube. Treatment : internally, sodse nit., carb. 
 nit. aa 5j to f§iv; otherwise the same. Very little 
 rusty sputa. After two days further, improvement 
 began and continued to complete recovery. 
 
 Case XII. C. D., laborer, set. 46. June 7th, 1864, 
 condition as follows : pale, feeble, and emaciated ; diph- 
 theritic chancre on foreskin and glans penis, both of 
 which are half destroyed ; diphtheritic pharyno-laryn- 
 gitis. Posterior wall of pharynx, soft palate, uvula, 
 both arches, covered with membrane so adherent that 
 an attempt to remove it with the forceps produced 
 hemorrhage ; the middle portion of both lips in great 
 extent partly covered with diphtheritic deposit, partly 
 with adherent sanguinolent effusion ; lymphatics at 
 angle of lower jaw, both sides, much swollen. Epiglottis 
 swollen to three or four times its natural thickness, 
 covered on both faces with thick pseudo-membrane ; so 
 also, but more thinly, the false vocal cords and the aryt- 
 eno-epiglottic ligaments. True vocal cords reddened, 
 a yellowish-white exudation at the lower attachment of 
 the left cord. No albumen in urine ; voice hoarse ; a 
 good deal of hoarse cough ; temperature 38.4 R. ; pulse 
 80, resp. 24. Treatment : locally, acid chr. 5ss. to fgj. 
 aq. dest., detaching a piece of leathery membrane an 
 inch in length and almost the same size in breadth ; in- 
 halations of potass, chlor. gr. x to f5ij, by the steam 
 nebulizer. Internally, decoct, cinch. (5ij to fSiij), with 
 vin. rubri. foiij, seth. spts. nit. gtt. x, acid phosp. 5j, 
 elseos. citri f§ss. ; a tablespoonful every two hours. 
 
INHALATIONS ARE APPLICABLE. 131 
 
 Spirits of camphor locally to the chancres. July 16th, 
 recovered. 
 
 Case XIII. Marie J., set. 13. Taken with diph- 
 theria on Christmas eve, 1863 ; diphtheritic membrane 
 on both tonsils, and the right posterior palatine arch, 
 from which a small diphtheritic ulceration reached to 
 the anterior border of the epiglottis. The parts were 
 touched twice a day with chromic acid 5ij to foj, and 
 on the fourteenth day, had improved enough to pass 
 from observation. January 19th, she returned under 
 treatment for difficulty in swallowing solids, and altera- 
 tion in voice ; she remained under treatment until 
 March 17th, and eventually recovered completely. 
 
 Case XIV. Hugo L., set. 9, had some exudation on 
 the tonsils, and some specks on the uvula. These were 
 touched with chlorate of potassa in glycerine, and sul- 
 phate of copper was given as an emetic. Suffocation 
 set in, and tracheotomy was thought necessary. Laryn- 
 goscopy revealed trifling exudation upon the vocal cords, 
 and inflammation of the posterior wall of the larynx, 
 but there was no mechanical obstruction to respiration. 
 Inhalation of the watery vapor from emollient decoc- 
 tions were employed, and subsequently inhalations of 
 oxygen gas, with good results; and eventually the 
 child recovered. 
 
 Case XV. Mrs. W., set. 23, had some alteration of 
 voice following an attack of diphtheria. This was 
 found to depend on a small warty excrescence situated 
 near the attachment of the right vocal cord. The 
 cords were somewhat thickened, and the general mucous 
 membrane injected. The topical treatment consisted 
 in touching the excrescence with iodine in glycerine, 
 tannin, and nitrate of silver, and inhalations of a solu- 
 
132 DISEASES TO WHICH NEBULIZED 
 
 tion of tannin, and later of ol. pini pumelion. The ex- 
 crescence diminished, and the voice regained its timbre, 
 but at last accounts was still incompetent for the pur- 
 poses of vocal music. 
 
 The three following cases terminated fatally. In 
 none of them was the local treatment instituted until 
 after the diphtheritic process had already extended 
 more or less into the larynx, or at least over the upper 
 surface of the epiglottis. 
 
 Case XVI. F. J., boy, set. 8|. Christmas, 1862, 
 was attacked with tonsillitis, which was cured by local 
 treatment in fourteen days. February 26th following, 
 was attacked with severe coryza, with parotitis, swell- 
 ing of the lymphatics, and severe fever. Deglutition 
 becoming painful, an examination of the fauces showed 
 the velum swollen, dark-colored, and covered here and 
 there with grayish spots. The pseudo-membrane soon 
 extended towards the posterior pharyngeal wall, and from 
 the attendant dyspnoea and croupal cough sound, seemed 
 to have penetrated into the larynx. An emetic of anti- 
 mony and ipecac' afforded relief, with the expulsion of a 
 fragment of membrane ; but the disease soon assumed a 
 typhic character, when acid hydrochl. (5ss. to f 5x) was 
 administered inwardly, and a topical application of the 
 muriatic acid was made by the pencil. 
 
 March 1st, the condition was as follows : pulse, 176, 
 small and weak ; respiration, 60, inspiration rough and 
 rattling, expiration shorter and less stridulous ; coun- 
 tenance pale ; lips, clear red, with some spots less 
 red ; belly, tumid ; parotids and lymphatics, swollen 
 and painful; mucous rales over the chest ; velum, ton- 
 sils, arches, posterior pharyngeal wall covered with 
 
 
INHALATIONS ARE APPLICABLE. 133 
 
 adherent exudation, exposing bloody spots when re- 
 moved ; epiglottis swollen to the size of the middle finger, 
 leaving but a small slit sideways for the passage of air ; 
 in the middle of its anterior border, an excoriated spot 
 reaching to the lower surface, partly bloody and partly 
 covered with gray-white exudation ; a great deal of 
 albumen in urine. Treatment : internally, Liq. ferri 
 sesquichl., 3j to f§x ; locally, cauterization with chro- 
 mic acid, the retching produced by which ejected some 
 slimy whitish-gray masses, tinged with blood ; by in- 
 halation, argent, nitr., gr. ss. to f5j, an ounce every 
 hour through Bergson's apparatus. In the night of 
 March 1-2, there was severe dyspnoea, with marked 
 stridor attendant upon both acts of respiration ; pulse, 
 206 ; respiration, 30 ; strong cardiac impulse ; ex- 
 tremities cool ; intelligence disturbed ; a great deal of 
 albumen in urine. Now, half a drachm of unguent, hy- 
 drarg. cinereum was rubbed in every two hours. In the 
 evening, the dyspnoea had somewhat reduced, and the 
 child was more comfortable ; skin dry, but not hot ; 
 epiglottis free from membrane, but more swollen ; from 
 between the epiglottis and posterior wall of phar- 
 ynx, a loose piece of membrane was removed by the 
 finger. An attempt to induce retching by mechanical 
 irritation, so as to expel some more of the membrane, 
 failed, a little thick slime only being expectorated. At 
 eleven clock at night, the difficulty of respiration 
 became much increased ; pulse rose to 212, and great 
 weakness ensued; and at two o'clock the patient died 
 comatose. 
 
 Case XVII. Fritz M., set. 8, whose two sisters had 
 contracted diphtheria a few days previous, was attacked 
 with the disease, the local process destroying the ton- 
 
 12 
 
134 DISEASES TO WHICH NEBULIZED 
 
 sils by ulceration, and attacking the glotto-epiglottic liga- 
 ment. The swollen epiglottis was attacked on its laryn- 
 geal surface by the diphtheritic process, as were also 
 the ary-epiglottic ligaments. The disease progressed, 
 and the child died. The treatment consisted in the ad- 
 ministration of chlorate of potassa ; cauterization with 
 chromic acid ; and the inhalation at first of tannin, and 
 subsequently of sesquichloride of iron, at which time 
 the same remedy was substituted internally also. 
 
 Case XVIII. Anna M., set. 14, with diphtheritic 
 exudation upon pharynx, laryngeal face of epiglottis, 
 and arytenoid cartilages ; urine loaded with albumen. 
 Improvement. On the twenty-second day, inflamma- 
 tion (diphtheritic ?) of the stomach ; urine scanty, with 
 a good deal of albumen ; paralysis of velum, and later 
 of oesophagus ; nourishment by the stomach-tube ; hy- 
 drothorax ; hydropericardium. Death on thirty-third 
 day. 
 
 This case was treated at first with sesquichloride of 
 iron internally ; cauterization with nitrate of silver and 
 chromic acid ; and inhalation* of a solution of tannin, 
 to which after a few days conium was added, about a 
 drop and a half to the ounce, while sulphate of quinine 
 was added to the iron treatment. Various other treat- 
 ment, such as the administration of digitalis, nitrate 
 of potassa, &c, and the inunction of a mercurial oint- 
 ment, was employed to meet certain indications. 
 
 Lewin mentions that the local application of the 
 chromic acid in all these cases, produced retching, often 
 violent and sometimes continuing for some time. It is 
 probable that this mechanical effect contributed towards 
 a good result. The inhalations seem to have answered 
 
INHALATIONS ARE APPLICABLE. 135 
 
 a good purpose ; probably by keeping up a supply of 
 watery matter, and thus assisting in the expectoration 
 of the exudation before its coagulation into membrane. 
 At the same time it will be perceived that systemic med- 
 ication was not neglected, although much stress cannot 
 be laid on the chlorate of potassa, which was the remedy 
 most frequently employed internally, for in this country 
 its internal administration has not proved adequate 
 to resist the systemic poisoning, or even produce much 
 effect upon the local trouble. 
 
 The cases are worth recording, on account of the re- 
 markable result — a cure in fifteen cases out of eighteen 
 — the three fatal cases being all of them more unfavora- 
 ble from the outset than the others, and farther ad- 
 vanced in progress before the institution of treatment, 
 leaving the inference that even these cases might have 
 terminated differently had they been placed under this 
 routine earlier. 
 
 I hardly think the cases of diphtheria, as met with in 
 this country, would be amenable to the same treatment, 
 unless at the same time the system were continuously 
 supported by ordinary stimulants. 
 
 M. Kuchenmeister, of Dresden, has published a 
 case of diphtheritic pharyngo-laryngitis in a child of 
 three years and a half old, treated with inhalations of 
 lime-water with complete success (Brit. $- For. Med-Chir. 
 Rev., July 1865). 
 
 Dr. Da Costa, of Philadelphia (op. cit., p. 32), has 
 watched, in two cases of diphtheria, the action of lime- 
 water on the visible deposits. 
 
 In the first case, that of a lady, seen in consultation 
 
136 DISEASES TO WHICH NEBULIZED 
 
 with her physician on the fifth day of her confinement, 
 the deposit covered the roof of the mouth, the half 
 arches, and part of the wall of the pharynx. There was 
 also — and indeed the progress of the case placed the 
 matter beyond doubt — reason to believe that nasal diph- 
 theria existed. She was taking chloride of iron, full 
 nourishment, and stimulants. A stream of pulverized 
 lime-water, about eight times stronger than that offici- 
 nal in our Pharmacopoeia — the liquor calcis saccharatus 
 of the British Pharmacopoeia — was directed upon the 
 affected part by means of an excellent hand-ball atomi- 
 zer for three or four minutes at a time. The treatment 
 was carried on every few hours, but no perceptible in- 
 fluence on the membrane could be detected. The appli- 
 cation was cleansing and very grateful, particularly so 
 when thrown up the nostrils. The case terminated 
 fatally, the membranes in the mouth remaining in a very 
 thick layer. 
 
 The second case was that of a gentleman thirty-five 
 years of age. Here there was no nasal diphtheria, nor 
 were the constitutional symptoms by any means so 
 grave ; and after the disappearance of the membranes, 
 which took place in about nine days, convalescence was 
 rapid. As local treatment, early in the affection, a 
 strong solution of sulphate of copper was employed. 
 But both at the time, and afterwards, Dr. Da Costa 
 made use of atomized solutions of lime, in the same 
 manner as in the preceding case, and not hot. The 
 remedy was again very grateful and cleansing ; yet, 
 though the same spot in the left half arch was repeat- 
 edly selected on which to throw the solution, no percep- 
 tible effect in thinning the deposit could be noticed from 
 its influence. 
 
INHALATIONS ARE APPLICABLE. 137 
 
 It will be remembered that inhalation of lime-water 
 has been proposed in cases of diphtheria, on account of 
 its supposed solvent powers upon the diphtheritic mem- 
 brane in situ. 
 
 Dr. James Collins, of this city, has furnished me 
 with the following notes of a case of diphtheria, in 
 which lime-water inhalations were administered, under 
 his treatment : 
 
 Wm. M , set. 3. When called to this little 
 
 patient, September 24, 1866, I found him pallid, strug- 
 gling for breath, with cold extremities, pulse 120 and 
 feeble, and marked diphtheritic deposit lining the fauces 
 and covering the tonsils. According to the mother's 
 statement, the child had been " sickish-like" for ten days, 
 but not sick enough to cause her to send for the doc- 
 tor. I removed several large flakes of diphtheritic 
 membrane with the finger very readily, gave injections 
 of quinia and beef tea, ordered wine and water, and ad- 
 ministered lime-water inhalations. The effect of the lo- 
 cal treatment seemed to be quite marked. The difficulty 
 of breathing was greatly relieved ; the pulse became less 
 frequent and fuller ; the skin became warmer, and for a 
 time the child seemed to be relieved. During the night 
 he again became worse and died. 
 
 (Edema of the Glottis. 
 
 Trousseau (Clinique Medicate de V Hotel Dieu, Paris, 
 1861, p. 475) records a severe case of oedema of the 
 glottis promptly relieved by inhalations of tannin. A 
 woman, set. 21, who had recovered from puerperal per- 
 itonitis six weeks previously, was admitted into the 
 hospital with great pain in the throat, swollen tonsils, 
 
 12* 
 
138 DISEASES TO WHICH NEBULIZED 
 
 and difficulty in swallowing. The angina, already of ten 
 days' duration, increased rapidly in severity, at times 
 impeding respiration to such an extent as to threaten 
 life. Inspiration was accompanied by laryngotracheal 
 r&les, although respiration was free, and the voice re- 
 tained its natural tone. The countenance of the patient 
 was like that of one threatened with asphyxia ; the pulse 
 extremely small ; the submaxillary region tumid and 
 painful. The pharyngeal mucous membrane was very 
 much inflamed, and examination with the finger re- 
 vealed an oedematous swelling of the epiglottis and the 
 aryteno-epiglottic folds. The diagnosis was, of course, 
 oedema of the glottis. 
 
 Inhalations of a strong solution of tannin from the 
 apparatus of Mathieu were at once instituted and re- 
 peated hourly ; under the influence of which, the attack 
 moderated, and on the following day there was marked 
 improvement, — but a single suffocative paroxysm ensu- 
 ing, and that of less intensity, — with greater freedom of 
 respiration, and disappearance of the rales. The swelling 
 of the epiglottis and of the aryteno-epiglottic folds had 
 markedly diminished likewise. The respiration soon 
 became normal, and only a single suffocative paroxysm 
 occurred in twenty-four hours ; and in four days the 
 patient left the hospital advanced in convalescence. 
 
 Trousseau also reported to the Academy of Medicine 
 another case of oedema of the glottis likewise cured by 
 inhalations of a solution of tannin. 
 
 I have myself treated two cases of oedema of the 
 larynx. One w r as the case of a lady in this city, who 
 was carried out insensible from the upper story of a 
 house on fire, in which very combustible materials, as 
 soaps, oils, &c, were burning. The dense hot smoke 
 
INHALATIONS ARE- APPLICABLE. 139 
 
 from these substances had been inhaled, and produced an 
 intense laryngitis with complete aphonia. I was called 
 to the patient a few hours after the occurrence, and 
 found her exhausted, in great distress from dyspnoea, 
 and threatened with death from suffocation. A solu- 
 tion of the watery extract of opium was immediately 
 procured, and an ounce administered warm by inhala- 
 tion, with relief to the suffering, and, to some extent, 
 to the dyspnoetic paroxysms. The inhalations were 
 repeated every half hour, for four or five times, until 
 respiration had become markedly relieved, when they 
 were given in a more diluted form every two hours. I 
 paid the patient five visits within seven hours, and at 
 each visit administered the inhalations myself, so as to 
 insure the proper administration of some of them. The 
 expressions of gratitude for relief were such as to leave 
 no doubt as to their good result, and the patient would 
 not have parted with the apparatus under any con- 
 sideration. The opium inhalations were continued 
 three or four times a day for a week, when the acute 
 symptoms of laryngitis having subsided, tannin was 
 substituted, with the result of return of voice. 
 
 The second case, that of a widow in this city, was 
 sent to me by my friend and colaborer, Dr. D. D. 
 Richardson. The laryngitis in this instance was 
 very painful, and complete aphonia had existed for five 
 days. There was very great dyspnoea, so that the 
 patient gasped for breath as she entered my apartment. 
 She said that, several times, while coming to visit me, 
 she felt as though she would not be able to breathe any 
 longer. I made a laryngoscopic examination, and 
 found the aryteno-epiglottic folds very much swollen 
 and inflamed, and the false vocal cords so oedematous, 
 
140 DISEASES TO WHICH NEBULIZED 
 
 as to entirely cut off a view of the true cords. This 
 appearance was recognized by Dr. Henry V. Gray, of 
 Petersburg, Va., who happened to be in my office at 
 the moment, a gentleman who was at that time, him- 
 self familiar to some extent with the use of the laryn- 
 goscope. In Order to relieve the intense distress of 
 the patient, I placed her before an apparatus from 
 which a patient but a few minutes before had been in- 
 haling a warm solution containing of laudanum f 5j to 
 f Sj ; and set the pump going, while I was getting out 
 my scarificator, with the intention of scarifying the swol- 
 len structures. She could not have taken above half a 
 dozen inspirations, when she heaved a long sigh of 
 relief, followed by a prolonged oh ! and, continuing the 
 inhalation, in a few minutes the dyspnoea had vanished, 
 and the voice had returned, rendering scarification un- 
 necessary ; for on a second laryngoscopic examination, 
 the tumefaction was so much reduced as to forbid sur- 
 gical interference. The result was unanticipated by 
 myself, and Dr. Gray exclaimed, " Why, Doctor, that 
 is magic !" 
 
 A dose of sulphate of magnesia was ordered for the 
 patient, and she was directed to use embrocations of 
 the oil of turpentine externally for a few days. The 
 trouble rapidly subsided after the single inhalation, so 
 that its repetition was not requisite. 
 
 Stricture of the Glottis. 
 
 Dr. Semeleder, of Vienna, relates (Wochenblatt der 
 Zeitschrift der K. K. Gresellsch. d. Aerzte in Wien., 
 No. 1, 1864, Lewin, op. cit., p. 289) a case of stenosis 
 of the larynx, supervening during the healing of an 
 
INHALATIONS ARE APPLICABLE. 141 
 
 incised wound, completely relieved by inhalations of a 
 solution of alum. 
 
 A woman, set. 46, endeavoring to commit suicide, 
 cut her throat, with a razor, about the position of the 
 upper border of the thyroid cartilage. The larynx 
 w r as opened close under the epiglottis, and thence the 
 wound communicated directly with the pharynx. The 
 voice was low and difficult, swallowing painful, and on 
 an attempt to drink, some drops would flow down be- 
 tween the arytenoids upon the vocal cords, and thence 
 out of the wound. 
 
 On the fourth day, an elastic catheter, and over this 
 a double canula of hard rubber, was placed within the 
 glottis through the wound, with relief to respiration 
 and expectoration. After the condition of the patient 
 had gradually improved to a remarkable degree, sud- 
 denly, on the forty-ninth day, she was seized with diffi- 
 culty of breathing, following exposure to cold, ac- 
 companied with swelling of the vocal cords, true and 
 false, and the production of a stenosis of the larynx. 
 To relieve this, the inhalation of a nebulized solution 
 of alum in water was employed, beginning with 5j to 
 Sbj of water, and later increased to 5ij, with the addi- 
 tion of a few drops of.tr. opii, in order to secure the 
 astringent effect of the inhalations. 
 
 The patient inhaled, once, daily, six to eight minutes, 
 the canula being closed. She improved so much that 
 the swelling and congestion of the whole laryngeal 
 structures, as well as the epiglottis, gradually became 
 reduced. Immediately after each inhalation, the voice 
 was much louder than it had been before. After three 
 weeks of these inhalations, the glottis had again be- 
 come so movable, that the canula was withdrawn from 
 
142 DISEASES TO WHICH NEBULIZED 
 
 the wound. The patient breathed freely without the 
 canula, and the voice gradually improved. 
 
 Aphonia. 
 
 Dr. Johann Schnitzler reports (op. cit.) a case of 
 complete aphonia cured by inhalations of alum. For 
 two years the patient had been subject to recurrent 
 hoarseness, until, some six or eight months before treat- 
 ment by inhalation, the voice suddenly left, and the 
 aphonia remained constant. The laryngoscope showed 
 marked swelling of the vocal cords, and of the mucous 
 membrane of the larynx generally. Nothing abnormal 
 was detected in the lungs. This physical condition was 
 confirmed by Semeleder. Inhalations of a solution of 
 alum were instituted, and on the second day the voice 
 was louder ; and in eight or nine days the patient had 
 recovered a pretty good voice, though hoarse, which be- 
 came clearer and louder every day. The gradual dim- 
 inution of the catarrhal swelling of the vocal cords 
 was watched with the laryngoscope. 
 
 WaldenburGt (op. cit., p. 332) reports the loss of 
 voice in a case of laryngitis and tuberculosis, in which 
 the aphonia was improved under the inhalation of a 
 solution of common salt, gr. ij to the ounce. 
 
 Fieber (op. cit., p. 119) reports a case of laryngo- 
 tracheal catarrh, with almost complete aphonia, in which 
 the voice soon returned, under the inhalation of a solu- 
 tion of tr. opii gtt. vj, zinci. sulph. grs. vj, to the ounce 
 of water. 
 
 In aphonia from paralysis of the vocal cords, now 
 usually treated by the local application of electricity, 
 Dr. Klimbacher employed with success in addition (Fie- 
 ber, op. cit,, p. 119) inhalations of a solution of tannin. 
 
 
INHALATIONS ARE APPLICABLE. 143 
 
 LEWiNalso employed in addition to the Faradization, 
 inhalation of a solution of the sesquichloride of iron, 
 with good result in a case of pharyngo-laryngitis, with 
 occasional hysterical aphonia. 
 
 Siegle (op. cit., p. 70) employed inhalation of a 
 strong solution of alum for three days, with partial 
 return of the voice, in a case of hysterical aphonia, of 
 several years' duration, the cure being subsequently 
 rendered permanent by local Faradization. 
 
 Siegle (pp. cit., p. 71) also relates a case of rheumatic 
 aphonia in a student, whose voice improved day by day 
 under several inhalations daily of hot vapor of water, 
 so as to leave nothing more to be desired on the eighth 
 day ; and he mentions a similar case reported by Lewin, 
 which had not improved under Faradization of three or 
 four weeks' continuance, and in which prompt and per- 
 manent relief followed the hypodermic use of strychnia 
 in doses gradually increased to half a grain. 
 
 Where aphonia is a result of acute or chronic inflam- 
 mation of the vocal cords, with swelling or iifduration 
 of their structures, the remedies applicable to the local 
 condition of the parts will cure the aphonia. 
 
 I treated a case of aphonia of several months' dura- 
 tion, the past winter, in a young lady who, after failure 
 of the ordinary methods, had been treated by inhala- 
 tions of tannin daily for ten weeks, without result, and 
 who was sent to me as a case of nervous aphonia. I 
 tried for a day or two, inhalations of a watery solution 
 of iodine, from Mathieu's (cutler) apparatus on the Sales- 
 Girons principle, with a slight improvement of the 
 voice, but seeing on examination with the laryngoscope, 
 that the aphonia was not nervous, but due to chronic 
 inflammation of the vocal cords, with thickening, I re- 
 
144 DISEASES TO WHICH NEBULIZED 
 
 sorted to local applications of a strong solution of nitrate 
 of silver, applied by the probang, and this being in- 
 effectual, after two or three trials, I applied a solution 
 of the corrosive sublimate, 60 grains to the ounce, with 
 restoration of the voice, which, under the continuance 
 of the treatment, gradually improved in timbre, and 
 with final relief from all the nervous symptoms which 
 had ensued under fears of consumption, and the mental 
 dread of an incurable affection. ♦ 
 
 In one case of aphonia from the inhalation of hot 
 smoke and flame during exposure in a house on fire, after 
 the more acute symptoms of laryngitis had subsided, I 
 employed inhalations of tannin for the laryngeal trou- 
 ble, and during their employment, the patient recovered 
 her voice. 
 
 In several other cases contracted under the same cir- 
 cumstances, which, under my own observation, were 
 treated by Dr. W. W. Keen of this city, the same re- 
 sult followed the same treatment. In these cases, how- 
 ever, the relief of the local trouble causing the loss of 
 voice in the first instance, naturally relieved the aphonia. 
 
 I have in this way relieved several incidental apho- 
 nias dependent on laryngitis, bronchitis, &c. 
 
 Whooping- Cough. 
 
 Dr. Wedemann, of Jena, assistant in the clinic of 
 Prof. Gerhardt (quoted by Fieber, Siegle, and Lewin, 
 op. cit. p. 278-85), reports a number of cases treated 
 by inhalations of nebulized medicaments, and among 
 them a case of whooping-cough in a child seven years 
 of age, in whom the intensity of the spasms of cough 
 began to diminish after the very first inhalation of a 
 
INHALATIONS ARE APPLICABLE. 145 
 
 solution of sesquichloride of iron, gtt. iij to the ounce 
 (Wedemann, op. cit. p. 42). 
 
 Fieber (op. cit. p. 116) reports the case of a child four 
 years of age, in whom the paroxysms threatened suffo- 
 cation, and in which the disproportion between the ob- 
 jective symptoms and the subjective phenomena lead- 
 ing him to consider the affection a disease of the par 
 vagum, rather than of the minute bronchi and air cells," 
 he resolved to employ inhalations of the following mix- 
 ture : Ext. hyoscyami sem. alcoh. gr. vj, ol. olivse, 
 f Sj, pulv. gummi arab. §ss., aq. font. Ifoij. After 
 eight days' use, the disease had become so mild that 
 further attendance was unnecessary. The emulsion was 
 very well nebulized. Treatment began April 23d, 380 
 inhalations (inspirations) readily taken ; no cough, nar- 
 cotic effect produced. 24th, same treatment; four spells 
 at night, no blood in sputa; next night two paroxysms 
 of cough. The cough worse in daytime while the child 
 is moving about. 25th, 380 inhalations. 26th, one spell 
 during the night, less intense than before ; 380 inhala- 
 tions. 27th, child slept all night, 380 inhalations. This 
 treatment was kept up until the 30th, with cessation of 
 all the disagreeable symptoms. 
 
 Siegle (op. cit. p. 73) reports the cases of two sisters, 
 aged respectively three and five years, in whom the dis- 
 ease Jiad lasted for five days. He employed inhalations of 
 a solution of alum, a drachm to six ounces of water, twice 
 daily, ten minutes at a time. By the night of the very 
 first day, the paroxysms had abated in violence, and 
 the cases were completely cured ; the younger on the 
 eighth day of treatment, and the other a few days later. 
 
 Dr. Rohn, of Hanau ( Wien. Med. Wochenschrift, xvi, 
 52, 53, 1866), was led to the employment of inhalations 
 
 13 
 
146 DISEASES TO WHICH NEBULIZED 
 
 of a solution of nitrate of silver in whooping-cough, in 
 consequence of the result of several laryngoscopic ex- 
 aminations of adults and larger children, while suffering 
 with this affection. He found the mucous membrane, 
 covering the anterior wall of the lower portion of the 
 laryngeal cavity and the commencement of the trachea, 
 hyperaemic in a marked degree, the vocal cords spark- 
 ling white and in marked contrast to the intense red of 
 the subglottic region. He therefore considers that the 
 lower laryngeal space, and the commencement of the 
 trachea and the upper portion of the trachea, is the seat 
 of catarrhal inflammation during the spasmodic stage of 
 whooping-cough; and he is confirmed in this view by 
 the uniform statements of adults and larger children, 
 that a peculiar severe irrita-tion about the upper part of 
 the windpipe precedes the spasm of cough which it ex- 
 cites. Dr. Rohn inquires whether the existence of the 
 catarrh at this point is not the true cause of the peculiar 
 paroxysms of cough ; and if the irritation of the in- 
 ferior laryngeal nerve, which is composed of sensory 
 fibres, will produce the same result with irritation of 
 the internal filaments of the superior laryngeal nerve. 
 Concluding, therefore, that the commencement of the 
 spasmodic affection might also be due to a catarrhal 
 condition of the mucous membrane of the central and 
 smaller bronchi, he resorted to the therapeutical effect of 
 inhalations, in order to reduce the inflammatory process 
 by a local caustic action. He has convinced himself 
 that such treatment resulted favorably in the cases of 
 six children over four years of age, and in two grown 
 persons. The medicament was a solution of the nitrate 
 of silver, gr. J-l to the ounce of distilled water, ac- 
 cording to the age of the patient, and the severity of 
 
INHALATIONS ARE APPLICABLE. 147 
 
 the affection. About half an ounce of the solution was 
 inhaled once daily. All these cases were of from three 
 to five weeks' duration, and either in the beginning of 
 the convulsive stage, or at its maximum. Dr. Rohn 
 states that after the first two, and at the furthest, after 
 the first three inhalations, the cough became markedly 
 diminished in violence and duration, and in all of them 
 with an immediate abatement of the vomiting ; that 
 after the fourth and sixth inhalation, the general char- 
 acteristic whooping-cough symptoms disappeared ; leav- 
 ing behind, at the most, but a slight simple catarrh. A 
 still further experience convinces the investigator that at 
 least with children over four years of age, who can be 
 very well made to take the inhalations, other febrile 
 complications of the respiratory organs do not contra- 
 indicate the inhalatory treatment. [Schmidt's Jahr- 
 biicher, Nov. 1866, p. 57.) 
 
 Further on this subject see Schmidt's Jahrbiicher, 
 July, 1866, p. 62, on the treatment of whooping-cough 
 by inhalations of nebulized solutions of tannin, by 
 vapors of turpentine, and, p. 63, by air breathed in 
 the apartments for purifying illuminating gas. 
 
 Acute or Catarrhal Bronchitis. 
 
 To be treated on the same principles as catarrhal 
 laryngitis, only the inhalations should be increased in 
 number, in strength of solution, and in duration ; while 
 the inspirations are to be made more slowly and deeply, 
 so as to draw the fluid particles into the bronchial 
 tubes. 
 
 Nebulized warm water often affords considerable re- 
 lief and increases the facility of expectoration. In the 
 
148 DISEASES TO WHICH NEBULIZED 
 
 forming stage of acute bronchitis, sal ammoniac is an 
 excellent addition to the warm water. 
 
 For the relief of pain, narcotic and mucilaginous 
 solutions should be employed ; to reduce secretion, as- 
 tringents. 
 
 In putrid bronchorrhoea, in addition to astringent 
 remedies, the balsams serve a useful purpose. Walden- 
 burg and Lewin recommend particularly the tar-water 
 in these cases, when there is no fever. Siegle recom- 
 mends tannin, on account of its antiseptic qualities. 
 Others recommend alum. Fieber speaks highly of the 
 sulphate of zinc under these circumstances. 
 
 Chronic Bronchitis. 
 
 In this affection particularly, inhalations have been 
 highly recommended. In the ordinary form of the 
 disease weak solutions of tannin, of alum, and of iron, 
 appear to be the favorite remedies. Wedemann recom- 
 mends very highly, a solution of tannin; two grains to 
 the ounce, with the addition of one-twentieth of a grain 
 of morphia. Siegle prefers the action of *the tincture 
 of the chloride of iron. 
 
 Da Costa (op. cit. p. 34) narrates a severe case cured 
 mainly by inhalations of alum, eight grains to the 
 ounce, with the addition of six drops of the fluid extract 
 of conium, the alum being gradually increased to the 
 proportion of twenty grains to the ounce. 
 
 Beigel (p. 121) details a case in which inhalations, 
 night and morning, of a solution containing two grains 
 of alum and ten minims of laudanum to the ounce of 
 distilled water, proved successful after the failure of 
 many other remedies. He also details a severe case 
 (p. 124) which he relieved by inhalations of tannin grs. 
 
INHALATIONS ARE APPLICABLE. 149 
 
 iij, ext. hyoscyami. grs. ij, aq. dest. f§j, night and morn- 
 ing, subsequently changed, on account of the taste, to 
 sulphate of iron, four grains to the ounce; and also a 
 case of chronic bronchitis, occurring after small-pox, 
 which succumbed to inhalations three times a day, of 
 alum, one grain to the ounce, with the addition of ten 
 minims of laudanum. 
 
 Fieber reports a case, of the variety simulating 
 consumption, of twenty-five years' standing, which im- 
 proved in a marked degree under the inhalation of a 
 solution of sulphate of zinc, five grains to the ounce. 
 In the dry variety of the disease, Fieber recommends 
 his oleaginous mixture. 
 
 In this dry variety, the inhalation of warm water will 
 often subserve a useful purpose by supplying moisture ; 
 and if it does not facilitate expectoration sufficiently, 
 a little common salt, sal ammoniac, or chlorate or car- 
 bonate of potassa, may be dissolved in it. Inhalations 
 of iodized water are often recommended in this affec- 
 tion, as are also weak solutions of the nitrate of silver. 
 
 Good effects occasionally ensue from the liq. iodinii 
 compositus, ten to forty drops to the ounce of water, 
 two and three times a day. If there coexist pain, of 
 course the narcotics and sedatives may be added to the 
 inhalation, but preferably in minute quantity. In- 
 halations, however, should be accompanied by external 
 revulsion, and attention to diet, social and domestic 
 habits, &c. 
 
 Ecemoptysis. 
 
 The principal articles employed to restrain hemor- 
 rhages from the air-passages have been cold water, ses- 
 quichloride of iron, subsulphate of iron, tannin, alum, 
 and ergot. 
 
150 DISEASES TO WHICH NEBULIZED 
 
 Cold water was first recommended by Fieber (Allg. 
 Wien. Med. Zeit., 1862, No. 16), who says that where 
 it can be borne, the inhalation of cold water at a tem- 
 perature of from 8° to 10° R., suffices in slight cases of 
 haemoptysis, and in cases of bloody sputa. 
 
 The solution of the sesquichloride of iron, is the rem- 
 edy most frequently resorted to in haemoptysis, on ac- 
 count of its well-known haemostatic agency, coagulating 
 the albumen of the blood into an insoluble clot, and thus 
 preventing further escape of the blood. It is also ab- 
 sorbed by the bronchial mucous membrane, and is thus 
 to be used in cases of anaemia, with an ulterior view as 
 to its ordinary therapeutical effect. It is to be resorted 
 to in threatening cases, but is contraindicated in the 
 febrile states of phthisis, and in delicate individuals 
 with great sensitiveness and irritability of the mucous 
 membrane. Lewin mentions the case [op. cit., p. 348) 
 of a lady in whom the inhalation of a solution of the 
 sesquichloride of iron employed for a profuse bronchor- 
 rhoea always induced a slight haemoptysis, even when in 
 the proportion of but half a drop of liq. ferri sesqui- 
 chlorid. to the ounce of water. 
 
 In using these ferruginous inhalations, care must be 
 taken to protect the teeth. 
 
 Lewin suggests the possibility of the iron exciting a 
 plastic exudation in a pulmonary cavity, the same as 
 when injected into the sac of a hydrocele, &c. 
 
 The strength of the solution used for the purpose of 
 arresting haemoptysis varies considerably with various 
 authorities. From two to five grains to the ounce is am- 
 ple, for a small proportion of iron will coagulate a large 
 quantity of blood. Prof. Zclekauer employed a drachm 
 to six ounces of water, half of which quantity was in- 
 
 
INHALATIONS ARE APPLICABLE. 151 
 
 haled at each sitting by means of Mathieu's instrument. 
 And by the way, the instrument of Mathieu, if at hand, 
 or the insufflator of Bergson with the double bulb, on 
 account of the low temperature of the spray they pro- 
 duce, is preferable in these cases to the steam apparatus. 
 In cases of great danger, where the patient's strength 
 must be economized to the utmost, the proportion of 
 iron in the solution can be increased, in order to diminish 
 the time of inhalation. 
 
 Tannic acid also, coagulates the blood, is an astrin- 
 gent, and diminishes secretion. It is said to be less apt 
 to excite inflammation than iron, and its influence is 
 probably more continuous. It is indicated in the milder 
 cases of haemoptysis, the so-called passive hemorrhages, 
 and when inflammation is present ; also in cases where 
 it may not be desirable to introduce iron into the blood ; 
 in the bloody sputa of bronchorrhoea, where it comes in 
 play as an antiseptic. It can be administered in larger 
 doses than the iron, — say from ten to twenty grains to 
 the ounce. 
 
 Alum coagulates the blood, and is like tannin, — as- 
 tringent and antiseptic. It is more suitable than tan- 
 nin in acute inflammatory conditions ; and not being 
 absorbed by the mucous membrane, is indicated in cases 
 where it is not desirable to impress the organism. 
 
 Other astringents, metallic and vegetable, have been 
 employed in haemoptysis, and serve a useful purpose, 
 though they can hardly replace iron, tannin, and alum. 
 
 It must not be forgotten that many pulmonary hem- 
 orrhages cease promptly without the introduction of a 
 haemostatic ; which fact renders it difficult, in ordinary 
 cases, to judge of the exact value of the inhalations. 
 
 That ferruginous inhalations have often saved life by 
 
152 DISEASES TO WHICH NEBULIZED 
 
 promptly arresting haemoptysis and keeping up contrac- 
 tion of the bloodvessels, is abundantly attested by the 
 records of many hundred cases from the pens of the 
 various observers. 
 
 One or two striking examples are introduced in illus- 
 tration : 
 
 Fieber (op. cit. p. 141) relates a remarkable case in a 
 man whose whole family were predisposed to affections of 
 the respiratory organs, and several of whom were suffer- 
 ing from pulmonary and tracheal troubles. About fifteen 
 years previous, the patient, at that time twenty years old, 
 while journeying in winter, was attacked with haemoptysis 
 and pneumonia. Various treatment had been employed 
 for the cough, &c, without success. Dr. Wagner be- 
 came acquainted with the patient in 1860. At that 
 time he had an exceedingly severe cough, with profuse, 
 bloody expectoration. The apices of both lungs were 
 infiltrated with tubercles, the right one to a very great 
 degree. The sound on percussion was dull, and the res- 
 piratory murmur almost entirely bronchial. The region 
 under the right clavicle became more and more sunken 
 in, slight pains in the right thorax and under the right 
 shoulder-blade were complained of, and the patient 
 emaciated greatly. Whey, cod-liver oil, and mild 
 narcotics with quinine, were of benefit, so that after a 
 while the patient felt like travelling and resuming his 
 employments, but desisted from so doing on account of 
 his catarrh and slight attacks of haemoptysis. In the 
 year 1861, the patient complained of a sense of weight 
 in the right loin and the right testicle, which latter organ 
 was enlarged, hard, uneven, and painful on pressure. 
 This was attributed to strain at stool. All the emol- 
 lient, soothing remedies, in connection with rest, &c, 
 
 
INHALATIONS ARE APPLICABLE. 153 
 
 produced no effect. The diagnosis pointed to tubercu- 
 lous infiltration. A suspensory had to be worn. The 
 patient's appetite was always moderate ; bowels consti- 
 pated, requiring laxatives. He would lose flesh and 
 regain it and lose it again. Continued speaking and 
 physical fatigue were very well borne. Early in De- 
 cember the bronchial catarrh exacerbated and increased 
 to a very great degree. At the same time he became 
 subject to attacks of haemoptysis of such vehemence that 
 his life was in constant danger. This condition had re- 
 mained, in spite of all remedies, for more than five 
 weeks, when, on the 9th of January, inquiry was made 
 of Dr. Fieber whether it would be possible by means of in- 
 halations to keep the patient alive for three or four days 
 to see his brother, whose arrival was expected at that 
 time. Fieber found the patient in a state of great helpless- 
 ness, hardly able to move himself, and barely able to con- 
 verse. A thorough examination — which would have been 
 superfluous — was impossible. All sorts of remedies had 
 been so ineffectual that the patient had discarded medicine 
 and contented himself by sucking enormous quantities 
 of small pieces of ice. On the day, on the evening of 
 which the inhalatory treatment began, four pints (seitel) 
 of blood were expectorated. With little hope of good 
 result, the inhalation was begun that 9th of January, the 
 greatest care being necessary for fear of exciting even 
 a moderate paroxysm of cough, which would have re- 
 sulted in a hemorrhage which might have proved fatal. 
 A solution of the sesquichloride of iron (which, by the 
 way, had been given by the stomach with no better effect 
 than anything else), two scruples to two pounds of spring- 
 water, was placed in the second model of Charriere's ap- 
 paratus, and only such pressure exercised as absolutely 
 
154 DISEASES TO WHICH NEBULIZED 
 
 necessary to nebulize the fluid. The patient was per- 
 mitted to inhale this so cautiously that a quarter of an 
 hour's rest was allowed after every fifth inspiration. 
 Three such sets of inspirations were given in the forenoon 
 and the like number in the afternoon, so that he took, 
 daily, thirty inspirations. The number was subsequently 
 increased to forty-eight, and the proportion of the iron 
 increased to a drachm. The result was a happy one. 
 On the 10th of January the patient expectorated only 
 one pint of blood. The sputa remained bloody until 
 the 14th, and after that, they continued free from tinge. 
 The patient was of a very irritable temperament, and 
 every irritation induced congestion to the lungs. This 
 was the reason that later, after any considerable emo- 
 tion, the sputa became tinged with blood, though this 
 would quickly disappear. On the first day of February, 
 a narcotic solution was substituted for the ferruginous 
 one, in order to diminish the catarrhal phenomena. At 
 the end of April the inhalations were discontinued. 
 The strength of the patient, meanwhile, had so increased 
 that he was subsequently able in the beginning of June 
 to travel to Roznan for the purpose of undergoing the 
 whey-cure; and there Dr. Polansky resumed the inhala- 
 tions, employing tannin. Dr. Fieber saw the patient 
 again at Vienna, in August ; he had improved very 
 much in appearance, and was about departing for Berlin 
 to rejoin his relatives. 
 
 Zdekauer reported (Wien. Med. Woch., 1861) a re- 
 markable case of arrested hemorrhage, in which the 
 presence of iron in the lung was demonstrated after 
 death. This case is detailed byLewin (op. cit. p. 240), 
 and is as follows : 
 
 J. B , an invalid soldier, was sick with Bright's 
 
INHALATIONS ARE APPLICABLE. 155 
 
 disease, with albuminuria and consecutive dropsy. Close 
 examination revealed the existence, at the same time, of 
 hypertrophy of the heart, and either insufficiency of the 
 mitral valve, or atheromatous excrescences in the aorta. 
 The diagnosis was difficult on account of the pressing 
 upwards of the diaphragm by ascites; and the short, but 
 rough respiratory murmur was so loud and difficult to 
 restrain, that only an occasional systolic murmur could 
 be heard ; while percussion elicited the existence of an 
 enlargement of the heart. 
 
 Milk, diuretics, nitrate of potassa, and other remedies, 
 were all ineffectual. The dropsical exudation and effu- 
 sion increased rapidly ; the patient could only breathe 
 when sitting in an arm-chair. One day he was attacked 
 with suffocation, followed by a terrific hemorrhage, 
 which seemed to have no disposition to cease. 
 
 The apparatus of Mathieu happened to be at hand, 
 as well as a solution of the chloride of iron, so that 
 the resort to inhalation was made immediately. The 
 poor patient just about breathed, or rather gasped for 
 breath, and in two minutes he had fainted. He was 
 soon restored to consciousness by sprinkling cold water 
 upon his face, and he was made to inhale the solution 
 for two minutes, when the hemorrhage ceased as if cut 
 off short ; but it had exhausted the remaining strength 
 of the patient, who died two days after with suffocative 
 phenomena. 
 
 Autopsy. Bloody serous exudation in the right pleu- 
 ral cavity floating the lung. In the right lung several 
 insulated blood clots, of very dense consistence, and not 
 bloody when cut into. In the left lung, similar blood- 
 clots, but much smaller. The heart hypertrophied and 
 covered with fat. Atheromatous deposit in the ascend- 
 
156 DISEASES TO WHICH NEBULIZED 
 
 ing aorta ; insufficiency of the mitral valve. The left 
 kidney much degenerated, the right one less so. Serous 
 infiltration and effusion everywhere. 
 
 Dr. Holm examined the blood clots, and found in all 
 parts of the lung-structure iron in much larger quanti- 
 ties than could be attributed to the iron of the blood. 
 
 It is an important fact, that this very hemorrhage, 
 which arose from great stagnation of the blood and 
 regurgitation into the vessels of the lungs, was arrested 
 by the inhalation of a watery spray containing chloride 
 of iron, and that on the corpse could be demonstrated 
 the deep penetration of the solution into the very bleed- 
 ing tissue of the lung. 
 
 Phthisis JPulmonalis. 
 
 Fieber reports (Lewin, op. cit. p. 244) in detail a 
 remarkable case of inferred phthisis in a married 
 woman set. 38, with exacerbating paroxysm of cough 
 and vomiting every night about three o'clock A. M. 
 Her general condition was improved by tonics — bark 
 and quinine — but without any impression upon the se- 
 verity of the cough, or the amount of the sputa. Nar- 
 cotics and demulcents were of no avail. Then, aban- 
 doning all remedies except tr. cinchonge, he instituted 
 inhalations with the pulverisateur. Within twenty days 
 the patient took, in all, 3635 inhalations {inspirations) ; 
 the smallest number in any one day being 40, the largest, 
 300, the average, 240. This treatment began Septem- 
 ber 12, 1861, with 40 inhalations of the spray of pure 
 water. September 14th, 80 inhalations, consuming five 
 minutes, of a solution of tr. opii simplex gtt. iij ad aq. 
 dest. fgj. The soothing effect being trifling, he increased 
 the proportion to five drops, and on the 16th she took 80 
 
INHALATIONS ARE APPLICABLE. 157 
 
 inhalations, and the soothing effect was greater; 17th, 
 100 inhalations in five minutes ; 18th, 5 grains of alum 
 was added to prevent too great a degree of somnolence, 
 which showed itself particularly towards evening; and 
 of this, 75 inhalations in four and one-half minutes ; 19th, 
 160 inhalations in ten minutes ; 20th, 21st, 22d, each 
 day 240 inhalations in fifteen minutes. Now she coughed 
 verp little during the day, and the expectoration had 
 decreased. The nightly paroxysms of cough had lost 
 nothing of their intensity. He then determined to make 
 an experiment with an antiperiodic mixture, and on 
 the 23d, the patient took 200 inspirations of a fluid con- 
 taining to the ounce of water, 2 grs. quin. sulph. (of 
 which 0.64 grs. dissolved, the rest remaining suspended) 
 tr. opii gtt. vij, alumen gr. v. Nothing peculiar was 
 noticed during the inhalation, but haemoptysis occurred 
 on that day, and also on the succeeding day, in all 
 together to the amount of about four teaspoonfuls of 
 blood, alkaline in reaction ; and there was increase of 
 the catarrhal symptoms. The patient complained of 
 the benumbing sensation produced by the alum, and of 
 its taste ; and on the following day, September 25th, she 
 took 120 inhalations, in seven and one-half minutes, of 
 a mixture of 5 drops of tr. opii, 7J grs. tannin, and one 
 ounce of water. This solution was retained to the end 
 of the treatment. The catarrh decreased ; the sputa 
 showed less blood. September 26th, no blood in sputa ; 
 catarrh trifling. The nightly paroxysm suspended for 
 an hour, appeared at four A. M., and was less intense 
 than heretofore. Patient complaining of weariness ; no 
 inhalation ; 27th, 240 inhalations in fifteen minutes, 
 paroxysm again at four A. M.; 28th and 29th, same 
 treatment, paroxysm came on at five A. M., and for the 
 
 14 
 
158 DISEASES TO WHICH NEBULIZED 
 
 first time so modified that the patient did not vomit 
 towards the last of it, as had been the case since June ; 
 on the 29th, the patient thought that she had overslept 
 her paroxysm, but it came on, however, at six A. M.; 
 30th, no inhalation ; paroxysm came on at seven A. M., 
 and still weaker. October 1st, no paroxysm, 240 inha- 
 lations. Patient can now inhale without producing the 
 least disposition to cough, which had always been*the 
 case, more or less, until this day. She has been sleepier 
 than usual for several days, owing to the effect of the 
 opium inhaled. October 2d, 250 inhalations ; 3d, no 
 inhalations ; 4th, 5th, and 6th, each day 240 inhala- 
 tions. At this point the treatment was discontinued, 
 as there had been no paroxysm for several days, but 
 little cough, and very trifling secretion. The percus- 
 sion was the same as at the beginning of the treatment, 
 but of the catarrhal r&les, there remained only some 
 rude respiration on the left side. 
 
 Another case from the same source. Tuberculosis 
 of left lung, haemoptysis, intense cough, marked improve- 
 ment under inhalations of opium and alum. Patient, 
 a man set. 28, feeble, emaciated, tuberculous infiltration 
 of left upper lobe, cough intense and painful, expec- 
 toration easy but very profuse, pulse 120. Treatment 
 began May 10th, with inhalations of tr. opii f5ij, aq. 
 dest. lbij, 20 inhalations in the morning and 10 in the 
 evening, increased by the third day to 30 in the morn- 
 ing and 20 in the evening, with decrease in the fre- 
 quency of the cough and in its intensity, decrease of 
 moist rales, and reduction of pulse to 108. Now, alum 
 5ij was added to the opiate solution; expectoration de- 
 creased, strength increased. June 17th, 40 inhalations 
 in the morning, 30 in the evening. July 1st, 50 in- 
 
INHALATIONS ARE APPLICABLE. 159 
 
 halations morning, 40 evening. July 2d, 50 inhala- 
 tions morning and evening. Three grains of quinine 
 were now added daily. Then the strength of the patient 
 increased in a marked degree. After several nightly 
 excesses, on July 9th a slight haemoptysis, not followed 
 by any injurious results. Early in August the catarrh 
 was reduced to a minimum, and the patient returned to 
 his own residence. 
 
 Lewin (op. cit. p. 45) closes his own record of cases 
 of phthisis treated by the new method of inhalation, 
 with the following, in which the result promised a per- 
 manent cure. 
 
 Tuberculosis Laryngis et Pulmonum. — Judge K., of 
 Bromberg, get. 39, of slender build, feeble constitution, 
 and phthisical diathesis, is the offspring of healthy, 
 sturdy parents, still living. His mother, however, suf- 
 fers from cough. He has three sisters, and they are 
 healthy. Of the exanthemata, he has had only scarlet 
 fever in his seventh year. 
 
 In 1841, after great exertion and exposure to cold, 
 he contracted a " gastric nervous fever," from which he 
 recovered after a period of six weeks, but of which he 
 soon had a relapse which lasted another six weeks. 
 Since this time he has remained weak and feeble. 
 
 His present illness is attributed to an overheating 
 followed by a cold, during an exhausting official sitting 
 in 1855. The disease set in with chill, heat, fever, 
 considerable cough, and subsequent emaciation. He 
 then sought recuperation at Reinerz, where by the use 
 of its tepid springs, with the use of whey, he became 
 tolerably well again. While travelling, in the following 
 year, 1856, the cough returned, and has since remained 
 permanent without alteration. 
 
160 DISEASES TO WHICH NEBULIZED 
 
 . In the summer of 1862 the patient sought the min- 
 eral springs at Ems, and not without some. benefit; but 
 fourteen days after the treatment at that place had 
 been discontinued, there set in a hoarseness with occa- 
 sional small, lumpy, bloody expectorations. 
 
 Soon after this he began to experience great difficulty 
 in swallowing his food, so as to render the process very 
 uncomfortable, and " he sate himself to his meals very 
 reluctantly." The pain was felt principally during the 
 first and third portions of the process of deglutition, 
 and also by the passage of the bolus over the ulcerated 
 epiglottis on one side, and the inflamed arytenoid car- 
 tilages on the other. 
 
 Present condition, June 2d, 1863 : The pitch of the 
 voice is high, attenuated, and weak. The soft palate 
 is redder in color than is normal. On the right side 
 are many relaxed veins extending as far as the uvula. 
 
 The circumvallate papillae are much enlarged, and 
 project in a button-like manner. On the right side of 
 the root of the tongue is a thread-like vein with lateral 
 varicosed branches, extending almost to the anterior 
 attachment of the epiglottis. 
 
 The follicular glands are more swollen on the right 
 side, less prominent on the left. Two very full glands, 
 superficially ulcerated, are seen upon the glotto-epi- 
 glottic ligament. 
 
 On the anterior border of the epiglottis, particularly 
 the left side extending beyond the middle line, is a loss 
 of substance with tuberculous characteristics. The bor- 
 der of this defect of the epiglottis shows a small swelling 
 on its free extremity where it approaches the sound por- 
 tion of the left side, and, rather more upon the inferior 
 surface, a button-like excrescence. The inferior sur- 
 
INHALATIONS ARE APPLICABLE. 161 
 
 face of the epiglottis in the neighborhood of this defect 
 is yellowish and cicatrized, and the protuberance of the 
 epiglottis can scarcely be seen. 
 
 The ary-epiglottic folds are more swollen on the 
 right side, and there is a small cicatrix upon the left. 
 The mucous membrane of the arytenoid cartilages is so 
 cedematous from infiltration that it cuts off almost com- 
 pletely the view of the vocal cords, permitting only 
 their anterior attachments to be seen, at which point 
 their color is reddishly livid. 
 
 The false vocal cords are dark red in color and very 
 much swollen, and on the right one there is a superficial 
 erosion. 
 
 The anterior wall of the trachea, as far as can be 
 seen, is colored as from a recently contracted catarrh. 
 
 The larynx is painful to pressure. The neck is 
 small, thin, and long. The contour of the thorax is 
 flat, depressed, and paralytic. On the right side, be- 
 neath the attachment of the clavicle to the sternum, is 
 a longish depression, and the whole region beneath the 
 right clavicle is sunken in. Inspiratory elevation but 
 slight. The panniculus adiposus gone. 
 
 Percussion in the right supra-clavicular region elicits 
 a dull, empty sound ; on the left side, normal. In the 
 internal supra-clavicular region of both sides, the sound 
 on percussion is alike and normal ; externally, on the 
 contrary, it is clearer upon the right side than on the 
 left. 
 
 In the intrascapular region the sound on percussion 
 is dull on the right side ; otherwise everything is normal. 
 
 Cardiac dulness rather increased. 
 
 Auscultation reveals anteriorly in the left supra- 
 clavicular region, undoubted sonorous rales in the apex 
 
 14* 
 
162 DISEASES TO WHICH NEBULIZED 
 
 of the lung. On the right side, undetermined respira- 
 tion. Vocal vibration and fremitus stronger over the 
 right thorax than over the left. 
 
 Puerile respiratory murmur posteriorly, but much 
 weaker on the right side than on the left. 
 
 The patient inhaled, during six weeks, at first com- 
 mon salt alone ; later with the addition of the bicarbon- 
 ate of soda, both in the same proportion, gradually in- 
 creased to §ss. to 24 oz. of water, to which at times a 
 little tincture of opium was added. The beneficial 
 effect was not temporary only, it was continuous ; and 
 to-day (reported in 1865) the patient still remains com- 
 paratively well, and pursues his laborious avocation in 
 K . 
 
 In this case the positively beneficial result was re- 
 markable, for the tuberculous process in the lungs took 
 on a retrograde movement. 
 
 I have had the opportunity of watching the effects of 
 inhalations of nebulized solutions in a number of cases 
 of phthisis, seven of which continued under my observa- 
 tion until their fatal termination. One of these was the 
 most intimate friend I ever had. The inhalation of tar- 
 water, of an infusion of wild cherry bark, of slightly 
 narcotic solutions, afforded a great deal of relief to his 
 cough and his dyspnoea ; and when he left the city, 
 about a year before his death, to try again the effects 
 of a warmer climate, during a residence in which, from 
 some ten years previous until shortly anterior to the 
 commencement of the late war, he had been compara- 
 tively well, — that is, well enough to attend to business 
 at all seasons, — he took his Siegle's apparatus with him, 
 and from time to time employed it as he found it neces- 
 sary to resort to its palliative influence. 
 
INHALATIONS ARE APPLICABLE. 163 
 
 In another case, that of a medical friend and former 
 schoolmate, the relief to the dyspnoea from these inha- 
 lations was far greater than had been procured by any 
 other method. This gentleman preferred the tincture 
 of hyoscyamus, ten drops to the ouncO of water, or of 
 infusion of wild cherry bark, and often told me that 
 the inhalation of half this quantity was sufficient to 
 place him perceptibly under the narcotic influence of 
 the hyoscyamus. 
 
 I have chiefly employed hyoscyamus and infusion of 
 wild cherry, with an occasional astringent when the 
 expe'ctoration was profuse and exhausting ; and tar- 
 water as an antiseptic. The inhalation of warm water 
 alone will facilitate expectoration'. All of these cases 
 experienced great relief from the topical effect of the 
 inhalations. I have not had an opportunity of observ- 
 ing the constitutional effect of inhalations in the early 
 stage of the tuberculous deposit, but since the report of 
 Mr. Broadbent's success with the injection of acetic 
 acid in cancerous and other tumors, I have been anxious 
 to try its effect by inhalation upon tubercle. 
 
 Dr. J. R. Wolfe, of Aberdeen (Med. Times and 
 Gazette, Nov. 25, 1865 ; Brit, and For. Med. Chir. 
 Rev., Oct. 1866, p. 538), writes : Prof. Longet lately 
 made some experiments on himself with phenic (car- 
 bolic) acid for an attack of haemoptysis and tuberculo- 
 sis, and was so much relieved that the substance is now 
 largely employed by several French physicians. Dr. 
 Labort, of Yincennes, informed Dr. Wolfe that he had 
 administered it to between two hundred and three 
 hundred patients in different stages of phthisis with 
 marked benefit. The mode of administration was the 
 following : Fifteen drops of the pure acid were dissolved 
 
164 DISEASES TO WHICH NEBULIZED 
 
 in two ounces of spirit, and the solution mixed with 
 thirty-two ounces of water, and this quantity was ad- 
 ministered daily, partly by the stomach, and partly by 
 the inhalation of the fluid in a pulverized state, by some 
 of the instruments now in use for reducing fluids to fine 
 molecules- It is remarked by Dr. Wolfe that as an 
 adjunct to cod-liver oil, the phenic acid is beneficial in 
 all stages of phthisis, but he considers it eminently useful 
 in suppressing hemorrhage from the lungs, in allaying 
 irritation, and arresting profuse secretion. 
 
 The inhalation of carbolic acid has been tried in 
 the Pennsylvania Hospital, and in private practice by 
 Dr. J. Forsyth Meigs, of this city, who finds it of 
 value as a palliative in phthisis. 
 
 Pulmonary G-angrene. 
 
 In relation to this affection Dr. Beigel states (op. 
 cit. p. 190) that when he was physician to the Spa of 
 Reinerz, he remembers some cases who had visited that 
 resort in the hope of procuring relief from the fetid 
 odor of their breath ; and he relates the case of a 
 young Russian, set. 21, who had been subject to phthisis 
 for years, and in both of whose lungs there were signs 
 of large cavities. The breath of this patient was so 
 fetid that he found great difficulty in securing apart- 
 ments. He was made to inhale a solution of chloride 
 of lime (one drachm to the ounce), which did not cause 
 any cough ; and though its effect was unmistakable, 
 liquor chlori. (one part to six parts of water) was sub- 
 stituted, which made the patient's condition much more 
 tolerable. He inhaled nearly every hour, and almost 
 from the first inhalation, the improvement was so 
 
INHALATIONS ARE APPLICABLE. 165 
 
 marked that one could remain with him a quarter of an 
 hour or more, which before had been impossible. 
 
 Trousseau speaks of the value of tannin, extract of 
 rhatany, sulphate of copper, corrosive sublimate, and 
 arsenate of potassa in this affection when administered 
 by inhalation, the doses at first to be very small, and 
 increased gradually as the organism becomes accustomed 
 ^to their influence (Clinique Medicate de V Hotel Dieu, 
 Paris, 1861, p. 583). 
 
 Pulmonary Emphysema. Asthma. 
 
 Wistinghausen (Peter sburger Med. Zeitschrift, 
 1862, xvii, p. 137, quoted by Lewin, op. cit. p. 242) 
 reports the following case cured by inhalations of Fow- 
 ler's solution of arsenic. A young girl, set. 15, whose 
 mother had died of tuberculosis, had suffered from child- 
 hood with laryngeal and bronchial catarrh, eventuating 
 in emphysema of both lungs with asthmatic paroxysms. 
 After the employment of a great variety of remedies, 
 external and internal ; after a residence during three 
 summers at Wielbach and Ems, at Salzbrunn ; and the 
 resort to local gymnastics during two winters — all 
 without beneficial result — she was, at the suggestion of 
 Prof. Eck, placed under the treatment by inhalation 
 of solut. arsen. Fowleri gtt. x-xv-xx, pro aq. destil. 
 f§j, once or twice a day. The same remedy had been 
 administered inwardly without advantage, as had also 
 ss t0 i g r - °f nitrate of silver, four times a day. After 
 ten days of inhalation (ten minutes each day) the asthma 
 ceased entirely, and, the inhalations being continued, 
 did not return during the severe and cold w T inter and 
 the variable spring of 1861. The patient could expose 
 herself in all weathers without using the respirator, 
 
166 DISEASES TO WHICH NEBULIZED 
 
 with which until then she had been unable to dispense, 
 even during a short promenade. She could also join 
 in the dance until late at night without any trace of 
 shortness of breath, though before this treatment, the 
 very excitement of receiving an invitation to a company 
 would bring on a severe attack of asthma. The aus- 
 cultatory phenomena had not altered much, the mucous 
 sibilant rales having subsided only in the right scapu- 
 lary region. 
 
 The patient had inhaled in all four ounces of the 
 Fowler's solution, without any symptoms of arsenical 
 poisoning. After this, she inhaled tannin, gr. x ad 
 f§j, and after a time, ext. Turion. pini in the same 
 strength, thirty drops at each time. Sales-Girons' ap- 
 paratus was employed. Mathieu's instrument was em- 
 ployed once, but was uncomfortably cold. 
 
 Lewin also recommends the use of Fowler's solution 
 of arsenic, from half a scruple to half a drachm, to 
 twelve ounces of water. He relates (op. cit., 442-446) 
 several cases in detail which he subjected to this treat- 
 ment with benefit. Sometimes he added to the solution 
 some common salt. He also, and occasionally with 
 benefit, used the oleo-balsamic mixture, 5j to half the 
 ounce of aqua castoreii. 
 
 Waldenburg (op. cit., 277-294) reports good results 
 from solutions of common salt, tincture of opium, and 
 oleum pini. 
 
 Siegle (op. cit., p. 82) reports favorably on the effect 
 of common salt. 
 
 Leibllnger recommends, in emphysema, the inhala- 
 tion of the ol. terebinth, gtt. j to the fluid ounce of warm 
 water, and also the ol. cadini, gtt. ij to the ounce. 
 
 I have seen a good deal of benefit from inhalations of 
 
INHALATIONS ARE APPLICABLE. 167 
 
 a weak solution of iodine, with and without combination 
 of iodide of potassium, in a single instance of emphy- 
 sema from chronic bronchitis, which has come under my 
 own observation. 
 
 Syphilitic Ulcerations. 
 
 Dr. Johann Schnitzler (op. cit.) reports two cases 
 of syphilitic ulcerations of the naso-pharyngeal space, 
 and of the larynx, very quickly cured by inhalations of 
 a solution of corrosive sublimate, a grain to the ounce. 
 The cleansing of the ulcerated surfaces could be demon- 
 strated with the laryngoscope after each inhalation. 
 
 Demarquay (op. cit. Lewin, p. 223) found rapid im- 
 provement in syphilitic affections of the soft palate, the 
 pharynx, and the larynx, under the influence of nebu- 
 lized solutions of corrosive sublimate, 25 centigrammes 
 to 500 grammes of water, which he found the best of 
 all topical remedies in connection with internal treat- 
 ment. The inhalations were taken three to four times, 
 and each time from five to six minutes in duration. 
 
 In several cases he saw very circumscribed mucous 
 patches of these parts disappear rapidly. He remarked 
 this particularly in an old man who suffered with great 
 hoarseness, and on whose palatum molle there were such 
 mucous patches. A general treatment previously in- 
 stituted had afforded no relief, but he improved promptly 
 under the new method. 
 
 The Sore Throats accompanying the Exanthemata. 
 
 The management of the sore throat in cases of scar- 
 latina and other exanthems, is often a matter of great 
 difficulty, especially in young children, w T ho cannot be 
 coaxed into co-operation for the relief of the local symp- 
 
168 DISEASES TO WHICH NEBULIZED 
 
 toms. Where the patient is too young to gargle, or 
 too feeble to do so, there is often great trouble experi- 
 enced in making local applications by the mop or the 
 syringe, to say nothing of the inefficiency of the method, 
 and the eifect of struggling on the constitution of the 
 patient. With the nebulizer, especially if the duck-bill 
 tubes are used, we have a means of making local appli- 
 cations at once agreeable and efficient, and can, there- 
 fore, to a certain extent, control the local inflammation. 
 In one very bad case of anginose scarlatina in my own 
 family, in which my friend Dr. Alfred Slocum of this 
 city was called to my assistance, we had ample proof 
 of the value of this treatment. The case was a very 
 severe one in every particular, and considered danger- 
 ous from the very onset, and both physicians predicted 
 an unfavorable termination. When the little fellow, 
 a boy of seven years of age, could not by any means be 
 induced to take a drop of medicine or nourishment, he 
 never, after the first application of the nebulized spray, 
 refused its repetition, but opened his little mouth, as 
 far as the swelling would permit, to receive the grateful 
 shower, and he often made motions asking for its use. 
 It would have been impossible for this child to have 
 gargled ; he resisted with all his force, the application 
 of a mop for the extraction of the profuse secretion from 
 his swollen tonsils, and I firmly believe that but for the 
 relief to the anginose symptoms, the patient would have 
 died. We used the apparatus of Dr. Andrew Clarke. 
 The case was the most threatening one I ever saw re- 
 cover, and the patient was confined to his bed for six 
 weeks, the disease being followed by nasal and aural 
 catarrh, dropsy, intermittent action of the heart, long- 
 continued swellings of the lymphatics of the neck, &c. 
 
INHALATIONS ARE APPLICABLE. 169 
 
 The material used in this instance was chiefly a solu- 
 tion of the permanganate of potassa, just strong enough 
 to give the water a decidedly pink tinge ; and occasion- 
 ally, as the symptoms were more acute, a weak solution 
 of alum water. These inhalations were administered 
 hot, by placing the apparatus, for a few moments before 
 using it, in a vessel containing hot water. When the 
 patient called for the application at other times than 
 when regularly ordered, the instructions were to employ 
 hot water simply. 
 
 My friend, Dr. James Collins, of this city, commu- 
 nicates the following case : Scarlatina anginosa. B , 
 
 set. 6 years. Called January 25, 1867. After an infu- 
 sion of capsicum and a saturated solution of chlorate 
 of potassa had been used topically without apparent 
 benefit, inhalations of creasote water gtt. vj to f§j, were 
 begun on the third day of the disease, and administered 
 at first every hour, and subsequently every second hour. 
 The anginose symptoms were at once greatly relieved, 
 and the child fell asleep breathing much better than 
 she had done before. 
 
 The symptoms in this case were threatening from the 
 beginning, and it terminated fatally on the sixth day. 
 
 There is no doubt as to the local benefit of the inha- 
 lations ; they were evidently very soothing, and the pa- 
 tient was more comfortable from the time they were 
 employed. 
 
 Supporting treatment was instituted, in conjunction 
 wifh chlorate of potassa and tincture of belladonna. 
 
 Some observations on the sore throat of small-pox, 
 and its extension as far as the trachea, have been made 
 by Naumann and Semeleder, the symptoms of the 
 ulceration being much those of severe catarrh. Astrin- 
 
 15 
 
170 DISEASES TO WHICH NEBULIZED 
 
 gent and narcotic inhalations had considerable influence 
 
 in lessening the laryngeal complications (Baumgartner 
 
 op. cit., p. 90). 
 
 In the catarrh accompanying typhus fever, Ruhle 
 
 observed favorable results from the antiseptic influence 
 
 of inhalations of tannin (Baumgartner, op. cit., p. 91). 
 
 • 
 Pneumonia. 
 
 But few observations have been made in the treat- 
 ment of pneumonia by inhalation" of nebulized fluids. 
 Siegle remarks (op. cit. p. 85) that Auphan recom- 
 mended the use of nebulized water at Euzet-les-Bains 
 in hepatization of recent or of non-recent standing, 
 though at the same time he considers inhalations con- 
 traindicated in coexisting inflammatory fever. 
 
 Diseases Other than those Affecting the Respiratory 
 Organs. 
 
 Sales-Girons has suggested (G-azette Medicate, Sep- 
 tember 8, 1866) the employment of nebulized solutions 
 by inhalation in certain stages of cholera, where absorp- 
 tion having become impossible by the digestive tube, the 
 lungs offer opportunity for the absorption of medicines 
 into the system. 
 
 The same idea occurred to Dr. Wittmeyer, of Nord- 
 hausen (Deutsche Klinik, October 13, 1866), who pro- 
 poses the inhalation of nebulized water to convey that 
 fluid promptly to the thickened blood in the stage of 
 asphyxia, and thus enable it to circulate more freely. 
 
 Sales-Girons (G-azette Medicale, Sept. 8, 1866) and 
 Ancelon (La Rev. Med., vol. 4, p. 598) have employed 
 inhalations of the sulphate of quinine successfully in 
 the treatment of intermittent fever. 
 
INHALATIONS ARE APPLICABLE. 171 
 
 Anaemia, dyspepsia, and other affections, have been 
 treated by the inhalation of nebulized fluids, with the 
 view of affecting the system more promptly than by the 
 usual method, especially in cases where the digestion 
 has been impaired. The observations recorded are few 
 and scattered, and, as yet, of too undecided value to 
 justify a positive opinion as to their efficacy. 
 
 Quite recently, Sales-Girons has presented a memoir 
 on respiratory therapeutics, upon which M. Beclard has 
 made a report to the Parisian Academy of Medicine 
 (G-azette Hebdomadaire, No. 10, 1867). It is claimed 
 that these inhalations may be safely resorted to in a 
 great variety of diseases, for the purpose of producing 
 constitutional effects, because the mucous membrane of 
 the respiratory organs exceeds all other mucous mem- 
 branes, including that of the small intestines as well as 
 the stomach, in its powers of absorption, as a consequence 
 of the rapid passage of the entire mass of the blood 
 through the lungs, exposing, within the space of less 
 than half a minute, almost every globule of that fluid to 
 the action of any remedy, through the endosmotic action 
 of an extremely attenuated membrane of great absorp- 
 tive power. In proof of this capability of absorption, 
 it is stated that twenty-five litres of water may be in- 
 jected into the bronchi of a horse within six hours, and 
 become at once absorbed without occasioning any sensi- 
 ble injury to the animal. 
 
 There may, therefore, be good grounds for Dr. Witt- 
 meyer's idea of conveying water to the blood promptly 
 in states of asphyxia, by means of its inhalation in the 
 form of nebula. 
 
 In cases of infectious and contagious diseases, and 
 under other circumstances where it is desirable to pre- 
 
172 DISEASES TO WHICH NEBULIZED 
 
 vent contamination of the atmosphere with the emana- 
 tions from a patient or his discharges, or when it is de- 
 sirable to disinfect an atmosphere already so tainted, 
 we have a ready means of diffusing this purifying agent 
 through the atmosphere of an apartment, by resorting 
 to the process of nebulization, so as to divide it in the 
 most minute manner possible. In this manner, one or 
 more instruments can be placed in action in different 
 portions of the room, and kept up sufficiently to main- 
 tain a comparatively pure atmosphere. 
 
 Upon this point, Dr. Da Costa writes me : " Having 
 had a good deal of facial erysipelas brought into the 
 wards at the Pennsylvania Hospital, and two cases sub- 
 sequently developing themselves there, I used chlorin- 
 ated soda. In a few minutes the whole ward was filled 
 with the odor of chlorine, and during the whole day 
 and evening the particles of soda burn flickeringly in 
 the lighter gas with their characteristic yellow flame, 
 a good proof of diffusion. Surely, to disinfect rooms, 
 &c, there is nothing better." 
 
 Then, also, in cases of disease where we wish to medi- 
 cate the atmosphere with which the patient is sur- 
 rounded, as with a terebinthinate or other impregnation, 
 or simply to supply moisture, or to create an artificial 
 sea-air, as was done in a more imperfect manner in 1845 
 by Hirzel, of Zurich, who sprinkled an artificial sea- 
 water from a small fountain, in the apartments of con- 
 sumptive patients ; we can place one or more instru- 
 ments in convenient localities and keep up such a medi- 
 cation as is required, or renew it at proper intervals. 
 So, too, in cases where patients are too feeble to make 
 any effort at inhalation, and where it is impossible or 
 imprudent to call their attention to the process, an in- 
 
INHALATIONS ARE APPLICABLE. 173 
 
 strument may be set going in close proximity to them, 
 in such a manner that a portion of the air they inspire 
 shall contain more or less of the nebula. 
 
 Summary. 
 
 In reviewing the entire subject, as portrayed in the 
 preceding pages, we may conclude that the employment 
 of remedies in this form is by no means to be ignored or 
 underestimated, as far, at least, as regards diseases of 
 the respiratory passages ; that these inhalations are 
 not to be used carelessly, for the reduction of tension 
 in the air inhaled while loaded with nebula may induce 
 congestion, which may prove detrimental, as in the case 
 related by Fieber, in which haemoptysis was induced, 
 and in the case related by Trousseau, in which fatal 
 pneumonia was induced by the too-frequent inhalation 
 of an astringent ; and as shown in the experiments of 
 Demarquay upon rabbits, in whom the inhalations pro- 
 duced pleuro-pneumonia ; that there is indubitable evi- 
 dence of their great value in certain forms of sore throat, 
 and particularly so in children ; that they can be resorted 
 to with confidence to restrain hemorrhage, to subdue 
 irritation and inflammations, to relieve dyspnoea, to re- 
 press excessive secretion, to resolve exudation, — in fact, 
 to do all for the respiratory mucous membrane that can 
 be accomplished for other structures by the application 
 of moisture, simple and medicated ; that under favorable 
 conditions of system, apart from constitutional implica- 
 tion, they are directly adequate to the cure of chronic 
 affections of the respiratory organs that are at all cura- 
 ble ; perhaps, in part, by inducing exercise of the parts 
 as an essential element of the process, and thereby ex- 
 citing restorative nutrition leading to resumption of 
 
 15* 
 
174 NEBULIZED INHALATIONS IN DISEASE. 
 
 normal function ; but that they are not, in themselves 
 and by themselves, adequate to the cure of disease, in- 
 dependent of general treatment ; that they are less ap- 
 plicable to acute affections than to chronic, except in so 
 far as they palliate special symptoms or relieve them ; 
 that they are less efficient than local applications by the 
 mop or sponge, in cases of thickening, or ulceration, or 
 other evident change of structure in parts within reach 
 of the probang ; and that, therefore, though not specific 
 in the usual sense of the term, they are to be regarded 
 as an invaluable addition to our approved methods of 
 administering remedial agents, and as such entitled to 
 our favorable consideration. 
 
ON INHALATION, 
 
 PART II. 
 
 THE INHALATION OF MEDICATED AIES, GASES, 
 AND VAPOKS. 
 
 Inhalations of oxygen, nitrous oxide, sulphuretted 
 hydrogen, and other gases, can be administered at ordi- 
 nary temperatures ; as also the vapors from chlorine, 
 iodine, creasote, camphor, acetine, ether, chloroform, 
 and, as highly recommended by Lewin, of muriate of 
 ammonia in statu nascente. At an increase of temper- 
 ature there can be employed in the same manner, the 
 volatile ethereal oils, and the vapors from water and 
 from decoctions of aromatic, resinous, and narcotic 
 plants. 
 
 Vapors may be inhaled, diffused through the atmos- 
 phere of an apartment, or they may be conveyed directly 
 to the respiratory organs by means of some of the appa- 
 ratus to be employed. • 
 
 The proper method of inhaling even gases and vapors 
 from an inhaler must be acquired by the patient, other- 
 wise the vapor will merely enter the mouth and reach 
 the pharynx, or if it mixes with the air in the lungs, 
 will do so by diffusion ; but with some effort the manner 
 of effecting penetration into the lungs can be readily 
 
176 THE INHALATION OF MEDICATED 
 
 acquired. That it is no easy matter to inhale a vapor, 
 and that consequently, when vapors of stramonium, &c, 
 are smoked, instead of being carried into the lungs by 
 the inspiratory current, they impress the system sym- 
 pathetically or otherwise by their effect upon the mucous 
 membrane or nervous distribution of the pharynx, can 
 be made evident by attempting to inhale the smoke from 
 an ordinary cigar. As usually smoked, none of the 
 smoke passes the glottis, and when the attempt to in- 
 hale is made, it will be found to require considerable 
 effort, and induce a paroxysm of cough with disagree- 
 able sensations, even in the persons of inveterate smok- 
 ers. A volume of smoke can be retained in the mouth 
 without embarrassing respiration for a considerable 
 time, which is proof positive that inhalation is being 
 carried on behind the velum through the nares. Closing 
 the nostrils the effect is different. 
 
 The importance, then, of seeing that patients inhale 
 properly is self-evident, for if they are merely directed 
 to inhale, in many instances the attempt will be futile, 
 and the method of course fall into disrepute. 
 
 One great mistake often made is in having the water 
 from which the vapor rises too hot. Usually a temper- 
 ature of from 110° to 120° is all that will be requisite 
 to disengage the vapor of vegetable substances, and the 
 greater the volatility of the substance to be used the 
 less th^ degree of heat that will be required. 
 
 Dr. John Harwood, of London (On the Practical Use 
 of Inhalations, $c, London, 1839), endeavored by ex- 
 periment to determine the best temperature for inhala- 
 tion, as also the temperature of the water necessary to 
 produce the desired temperature of inhalation. This he 
 did by retaining the bulb of a delicate thermometer in 
 
AIRS, GASES, AND VAPORS. 177 
 
 the vapor within the inhaler, and successively passing a 
 volume of twenty cubic inches of atmospheric air at a 
 given temperature through the instrument, this volume 
 of air being similar to that which is received by the 
 lungs during diminished or impaired respiration ; and 
 the passage of the current through the inhaler was con- 
 ducted in the succession of the inspirations of breathing. 
 It was thus ascertained that atmospheric air of 57°, 
 when combined in its passage through the inhaler, with 
 the vapor arising from 
 
 Water at 100° 
 
 afforded 
 
 an 
 
 inhalation of 79° 
 
 " it no° 
 
 
 It 
 
 It 
 
 " 84° 
 
 u u 120° 
 
 
 a 
 
 " 
 
 " 88° 
 
 « (( 13QO 
 
 
 it 
 
 tt 
 
 " 93° 
 
 " 0< 140° 
 
 
 tt 
 
 it 
 
 « 99° 
 
 « <<150° 
 
 
 (< 
 
 tt 
 
 « 104°. 
 
 Dr. Harwood recommends water at from 110° to 135° 
 as the best scale for ordinary purposes, 130° being the 
 most suitable temperature. 
 
 Inhalers for Vapors, Airs, $c. 
 
 Mudge's inhaler is a vessel with a tight cover, through 
 which pass two tubes, one extending externally from 
 the upper surface of the cover to within half an inch of 
 the bottom of the vessel, the other extending from the 
 lower surface of the cover some six or more inches. 
 The external tube is furnished with a mouthpiece, 
 through which inspiration is to be made, expiration 
 being performed through the nostrils. The desired 
 fluid being placed in the inhaler, inhalation is effected 
 by drawing into the lungs through the external tube, 
 the air contained in the inhaler over the surface of the 
 fluid ; the air is then resupplied from the atmosphere 
 
178 THE INHALATION OF MEDICATED 
 
 by the inner tube, and passing through the medicinal 
 fluid becomes impregnated with its active principle. 
 
 Sm Charles Scudamore's apparatus is substan- 
 tially the same. He employed a glass vessel with a 
 double neck ; though a wide-mouthed bottle with two 
 perforations through the closely-fitting cork will answer 
 the same purpose. He directs that the water in the 
 inhaler should be about an inch in depth, and to this 
 the mixture to be inhaled must be added. He deems it 
 important that the bottle should be large and the tubes 
 capacious. The tube issuing from the bottle should be 
 upright, passing gradually into a slight curve, so that 
 the vapor should not be much cooled during its egress. 
 The ingress tube should dip very near ^o the bottom of 
 the vessel, that all the air introduced may become im- 
 pregnated. The patient should be desired to inhale by 
 a combination of a suction effort and a pretty deep in- 
 spiration ; then to drop the under lip from the mouth- 
 piece and make a free expiration, and thus continue 
 the process, pausing occasionally to avoid fatigue, which 
 would more certainly ensue by breathing quickly, or 
 using an inhaler with small tubes, or containing too 
 large a quantity of water. 
 
 Most of the inhalers in use are modifications of 
 Mudge's. In using these, the tongue can be placed 
 against the end of the tube in the mouth during expira- 
 tion, so that the expired air passes out through the 
 nostrils, or otherwise the mouth must be removed from 
 the instrument at each expiration, in order that the 
 expired air shall not pass into the inhaler. By using 
 a mouthpiece provided with a valve, as in the admirable 
 apparatus of Beigel, described and depicted further on, 
 
AIRS, GASES, AND VAPORS. 179 
 
 in the section on the inhalation of oxygen, this incon- 
 venience is avoided. 
 
 A different sort of inhaler was introduced by Prof. 
 Max Langenbeck {Deutsche Klinik, 1861, p. 129), 
 consisting of a flattened globe varying in diameter from 
 three-quarters of an inch to an inch and a half, formed 
 of two halves which screw together, after the medicated 
 cotton, wool, or sponge has been placed in the interior ; 
 a number of holes pn each side permitting the passage 
 of the air. The instrument is placed partially within 
 the mouth, the lips of which compress the projecting 
 portion. 
 
 An instrument virtually the same has been contrived 
 by Dr. M. S. Buttles of New York {Med. Record, 
 1866, p. 44), to which a rubber tube may be attached, 
 so that the instrument may be entirely concealed within 
 the mouth, the tube remaining outside to permit access 
 of atmospheric air. These instruments can be modified 
 for insertion into the nasal passages in treating nasal, 
 or naso-pharyngeal affections. 
 
 Dr. Pomeroy of New York {Med. Record, 1866, p. 
 44), has modified this instrument, and Dr. A. P. Mer- 
 ril, of the same city, has recently devised a very elegant 
 affair on the same principle, much of the shape of a 
 lead pencil, designed especially for inhalations through 
 the nostrils. An ordinary % tobacco pipe answers the 
 purpose fully. This method is adapted only for sub- 
 stances volatile at ordinary temperatures. 
 
 Dr. John Snow, of London, contrived an inhaler 
 chiefly adapted for the inhalation of opium, but also ap- 
 plicable to many other medicines. It is made chiefly of 
 tin, and consists of a cylindrical chamber, between four 
 and five inches in diameter, and three or four inches deep, 
 
180 THE INHALATION OF MEDICATED 
 
 under the centre of which a spirit-lamp is placed. The 
 bottom of the inhaler consists of a thin piece of talc, on 
 which is placed a small capsule of Berlin ware, for the 
 purpose of holding the extract of opium. A porcelain 
 funnel-holder, which is placed on the talc, keeps the cap- 
 sule exactly over the flame of the lamp. The talc 
 allows sufficient heat to be transmitted to the opium, 
 without conducting it to the sides of the inhaler, and, 
 consequently, the air which is inhajed is not unduly 
 heated. The lid of the inhaler is movable, and it is 
 provided with a delicately balanced valve for the ad- 
 mission of air, and is connected to a face-piece by means 
 of an elastic tube of wide calibre. This face-piece 
 covers the mouth and nostrils, and is a modification of 
 that of Hawksley. It is flexible, the sides and margin 
 consisting of thin sheet lead, lined with oiled silk and 
 covered with leather, with an expiratory valve which 
 can be moved more or less to one side from the opening 
 it covers, so as to admit unmedicated air whenever the 
 vapor feels too pungent. 
 
 Forced Inhalation of Atmospheric Air. 
 
 We know of the benefits derived by residents in 
 mountainous regions, and by the pedestrian tours and 
 other gymnastic exercises to which pugilists are sub- 
 jected during training, which, developing their respira- 
 tory capacity, increases their strength and powers of 
 endurance. 
 
 In individuals with weak lungs, in those of sedentary 
 habits, whose pulmonary organs are rarely properly 
 aerated, the habitual employment of a number of forced 
 inspirations of fresh air at stated hours, will soon exert 
 a beneficial influence. The result will be facilitated by 
 
AIRS, GASES, AND VAPORS. 181 
 
 forcibly straightening out the shoulders, either volun- 
 tarily or with the aid of an assistant, during the inspi- 
 ration, which should be slow and through a small oval 
 aperture, or through a quill, round which the lips are 
 closed ; and the position of the arms being maintained 
 during the expiration. 
 
 r 
 
 Forced Expiration and Inspiration for the Relief of 
 Spasmodic Asthma. 
 
 Dr. J. S. Monell, of New York, writes to the editor 
 of The Medical Record of that city (see No. for Aug. 
 15, 1866), that in December, 1865, about nine o'clock 
 one evening, he was having a severe attack of asthma, 
 to which he has been subject for fifteen years. He 
 placed himself standing at the foot of his bed, with his 
 arms folded upon the foot-board for a pillow, the fore- 
 head resting upon the folded arms, and the feet placed 
 at a sufficient distance to make a partial semicircle of 
 the body. While laboring severely for air, the thought 
 occurred to him to cease breathing for a few seconds. 
 He did so, and after several trials experienced some 
 relief. He then expired all the air that it was possible 
 for him to do, after which he determined not to inspire 
 again until he found it absolutely necessary. He suc- 
 ceeded in waiting several seconds, then inspiration was 
 carried to its fullest capacity, and retained with great 
 effort for many seconds. This act of forced expiration, 
 waiting, thorough inspiration, and again waiting, was 
 continued for some fifteen minutes, and to his delight, 
 the spasm was perfectly relieved. He has since relieved 
 several similar attacks by the same method, in less than 
 two minutes. He has advised this course for many 
 others, and their testimony has been uniformly satis- 
 
 16 
 
182 THE INHALATION OF MEDICATED 
 
 factory, except in one instance, that of an aged lady 
 with heart disease. It requires a great effort on the 
 part of the patient to perform this act. The first at- 
 tempt at retaining the inspired air during the asthmatic 
 attack, will cause the patient to think he cannot con- 
 tinue it, but perseverance will soon delight him with 
 relief from the spasm. 
 
 The Inhalation of Compressed Air, 
 
 In the latter part of the last century, the attention 
 of scientific men was directed to the influence of con- 
 densed air upon animal and vegetable life ; and the re- 
 sult of certain experiments upon animals led to the 
 suggestion that the respiration of compressed air might 
 be beneficial in certain cases of disease. 
 
 E. Tabakie, Dec. 7th, 1832, made a communication 
 upon the subject to the Acade*mie des Sciences, and in 
 August, 1835, M. Junod reported to the same body the 
 result of his own experiments upon the human subject. 
 Later, under the directions of M. Tabarie, the method 
 was employed in the treatment of disease by Bertin of 
 Montpellier, Pravaz, Milliet, of Lyons, — who reported 
 some cases of phthisis apparently benefited in the first 
 and second stages, — and others. Milliet's work, Be 
 V Air Comprime comme agent Therapeutique, Lyons, 
 1854, contains (Lewin, op. cit., p. 5, note) the record of 
 twenty-two cases, including asthma, pulmonary conges- 
 tion, emphysema, hepatization, phthisis, bronchial ca- 
 tarrh, chlorosis, whooping-cough, laryngo-tracheitis, 
 broncho-tracheitis, bronchitis, and chronic pneumonia. 
 Bertin' s work, Etude Clinique de Vemploi et des Effets 
 du bain d' 'Air Comprime dans le Traitement de Diver ses 
 Maladies, Paris, 1855, contains (Lewin, op. cit., p. 5, 
 
AIRS, GASES, AND VAPORS. 183 
 
 note) thirty-five observations in bronchitis, acute and 
 chronic, chronic angina with aphonia, chronic pharyn- 
 gitis, aphonia, bronchial catarrh, pulmonary oedema, 
 emphysema, asthma, haemoptysis, chronic pneumonia, 
 and phthisis. 
 
 Sandahl (Om Verhningarne of ' for tat ad Luft, Stock- 
 holm, 1862 ; see Lewin, op. cit., p. 6, note) reports the 
 statistical observations of three hundred and fifty-three 
 cases, of which there were one hundred and forty of dis- 
 eases of the larynx and trachea, seven of pneumonia, 
 twenty-two of asthma with emphysema, thirty-one of 
 tuberculosis, five of organic valvular insufficiency of the 
 heart, ten of anaemia, and thirty-five of aural catarrh. 
 
 Tabarie's apparatus consisted of a wrought iron 
 spherical chamber, capable of accommodating from one 
 to a dozen patients ; air under a pressure of from J to 
 | atmosphere, was forced into the chamber by a pump 
 worked by steam. An arrangement attached to the 
 apparatus afforded egress to the air expired by the 
 patients. Each sitting lasted two hours, the requisite 
 pressure was produced gradually during the first half 
 hour, and after being continued for an hour, was gradu- 
 ally withdrawn during the last half hour. 
 
 Inhalation of Oxygen Gas. 
 
 Dr. Bricuetau (Bulletin Generate de Therapeutique 
 Feb. 25, 1866 ; also, Brit, and For. Med. Chir. Rev., 
 Oct. 1866, p. 532) relates some of his experience with 
 the inhalation of oxygen gas. He uses an India-rubber 
 bag furnished with a mouth-piece, which is controlled 
 by a stop-cock ; and the patient taking a deep breath 
 out of the bag, the quantity of the gas inhaled may be 
 approximative gauged by the extent to which the bag 
 
184 THE INHALATION OF MEDICATED 
 
 collapses at each inspiration. This apparatus must be 
 similar to the one so much in vogue bj the dentists 
 of this country for the administration of the nitrous 
 oxide gas for anaesthetic purposes. To prevent the air 
 of expiration from entering the bag, and thus mingling 
 with the pure gas and diluting it with its products, it is 
 directed that the patient close his lips, and pass the 
 expiratory current through his nostrils ; or what is to 
 be preferred, the India-rubber tubing may be compressed 
 near the mouth-piece during the process of expiration. 
 
 M. Brichetau considers inhalations of oxygen adapted 
 to phthisical cases only under special conditions, ad- 
 mitting that in diseases attended with the febrile move- 
 ment, it may even act injuriously ; but that its employ- 
 ment may be of service in the earlier stages of phthisis 
 in patients of scrofulous or lymphatic habit, where the 
 local symptoms are not well marked, and where there 
 is progressive emaciation with persistent dyspepsia, a 
 condition looked upon as favorable to the formation of 
 pulmonary tubercles. 
 
 Oxygen has also produced amelioration of the symp- 
 toms in some cases of asthma. Its value in anaemia is 
 incontestable. 
 
 M. Demarquay (Gazette Medicate de Paris, April 
 14, 1866), who has devoted much attention to the use 
 of oxygen inhalations in medicine, says, in speaking of 
 its therapeutic indications, that in the early stages of 
 phthisis, when there is no fever, and no fear of exciting 
 local action, when the patient is becoming emaciated, 
 and the emaciation is increased by persistent dyspepsia, 
 oxygen may have a salutary influence in modifying the 
 state of constitution, and sustaining the organism. 
 Asthenia is the disease in which oxygen has been given 
 

 AIRS, GASES, AND VAPORS. 185 
 
 by preference. Of twenty-two patients treated by 
 Beddoes, ten were cured, and nine relieved. But the 
 employment of oxygen in asthenia meets with numer- 
 ous contraindications. Oxygen renders indisputable 
 service in essential anaemia. It is specially indicated 
 in that form of chlorosis of young girls which is char- 
 acterized by obstinate anorexia ; in the anaemia of con- 
 valescence, and in the anaemia, often severe, of newly- 
 delivered females. The inhalation of oxygen is also 
 successful in anaemia arising from hemorrhage or from 
 fatigue, and is also a very energetic remedy in the 
 debility produced by prolonged suppuration ; it stimu- 
 lates the appetite, sustains the powers of the patient, 
 and enables him to recover. In diabetes, under the in- 
 fluence of oxygen inhalations, the quantity of sugar 
 contained in the urine is remarkably diminished. 
 
 In surgery, oxygen stimulates weak and ill-con- 
 ditioned ulcers, and accelerates the production of granu- 
 lations in cicatrizing wounds. In senile gangrene, as 
 long as the circulation continues in the artery of the 
 foot, oxygen is, according to the observations of MM. 
 Laugier, Demarquay, and Maurice Raymond, the only 
 remedy which, in advanced cases, affords a chance of 
 recovery." (Ranking' 's Abstract, Jan. 1867, p. 200.) 
 
 According to Demarquay's observations, oxygen when 
 respired to the extent of twenty-nine or thirty quarts, 
 produces little effect. Various invalids derived benefit 
 from such a dose repeated daily. They observed some- 
 times, a little heat in the pharynx, and a little confu- 
 sion in the head, or headache ; the pulse usually rose a 
 little in frequency and force, but sometimes fell ; the 
 appetite improved, and there was a general sense of 
 comfort and of increased energy. It does not appear to 
 
 16* 
 
186 THE INHALATION OF MEDICATED 
 
 be suited to those greatly exhausted by suppurating 
 wounds, nor those in the later stages of phthisis. 
 
 I reproduce in this place, an interesting chapter on 
 this subject from Beigel [On Inhalation as a Means 
 of Local Treatment of the Organs of Respiration by 
 Atomized Fluids and Grases. By Hermann Beigel, 
 M.D., L.R.C.P.S., &c, London, 1866, p. 69). 
 
 " Their efficacy can be explained if applied to the 
 proper cases. In all diseases in which dyspnoea forms 
 one of the most dangerous consequences, no doubt can 
 exist of the manner in which oxygen acts, as in dis- 
 eases of the heart, for instance, in bronchitis, in asthma, 
 emphysema, and more especially in phthisis. Here a 
 part or parts of the lungs are impermeable to the air. 
 But the body requires a certain amount of oxygen (an 
 adult about 23,000 cubic centimetres, or 34 grammes, 
 per hour) for the purpose of decarbonization of the 
 blood, without which its existence is either impossible 
 or very much disturbed. The diseased lungs are, there- 
 fore, forced to counterbalance by the number of respira- 
 tions what, in a healthy state, they would have done by 
 the greater capacity of the same. Hence, respiration 
 in individuals laboring from a disease which impairs 
 healthy breathing, becomes irregular, difficult, frequent, 
 which frequency in lung diseases is in close relationship 
 to the area of the lungs that became impermeable. 
 Now if we assist the lungs in their unnatural labor, by 
 giving them either pure oxygen, or such an atmosphere 
 as contains a greater amount of that gas than usual, 
 or, in other words, if we assist the decarbonization of 
 the blood in a manner which does not force the lungs 
 to perform such an exhausting exercise, we place the 
 patient in the best possible position. In diseases of the 
 
 
AIRS, GASES, AND VAPORS. 187 
 
 heart the same takes place, with the difference that im- 
 perfect circulation of the blood is the cause of its being 
 insufficiently decarbonized. 
 
 "After Priestley had detected oxygen, and Beddoes 
 and Davy had begun to treat patients by means of that 
 gas, the fate of oxygen was the same as it is of all medi- 
 caments which were considered to possess such proper- 
 ties as to cure almost every disease. Medicaments of 
 that kind do not exist and cannot exist, and disappoint- 
 ment has always been the result of such assumptions ; 
 but then the fault is generally made in the other ex- 
 treme direction, namely: the conclusion is then drawn, 
 that because the respective medicament did not cure all 
 diseases, it does not possess healing properties at all. 
 
 " Neither of those ways is the path science studies, sep- 
 arately and minutely examining every action and prop- 
 erty of a body, accepting that which is found to be 
 useful, and rejecting that which has proved useless. 
 
 "From this point of view we must admit that inhala- 
 tions of oxygen, pure or mixed with air, are an agent 
 highly valuable in diseases, in which imperfect decar- 
 bonization of the blood takes place, — be it by imper- 
 meability of some parts of the lungs, be it by imperfect 
 circulation of the blood, by closure of the glottis, by 
 admixture of poisonous substances to the blood, or other 
 causes. 
 
 " It is not long since the application of compressed air 
 in certain diseases of the chest has been recommended, 
 and Berton, Junod, Tabarie', and Pravaz have endeav- 
 ored to show it to be the most effective remedy in such 
 affections. Now, Dr. Lange has gathered all facts hith- 
 erto known in connection with the subject, and maintains 
 that the efficacy of the compressed air principally rests 
 
188 THE INHALATION OF MEDICATED 
 
 upon the blood being more richly supplied with oxygen, 
 and that a healthier nutrition is the immediate conse- 
 quence of it. He proves that by the application of 
 compressed air, a considerable increase of the negative 
 pressure of inspiration and of the positive pressure of 
 expiration takes place, whereby the power of the muscles 
 of inspiration becomes greater, the pressure of the blood 
 in the aortic system is lowered, and the frequency of 
 the heart's pulsation diminished. The animal heat 
 lowers likewise after the application of a compressed air 
 bath, the organs of digestion are placed in a better posi- 
 tion, whilst the appetite increases, and the functions of 
 the bowels are performed with greater ease. Increase 
 in secretion of the urine has been observed in most of 
 the cases. 
 
 " It has generally been thought that pure oxygen can- 
 not be inhaled without injury to health ; but Demarquay 
 and Leconte have shown that they, as well as their 
 friends, could readily inhale from twenty to thirty litres* 
 without suffering any injury, and Ducroy has stated in 
 the Academy of Paris, that pure oxygen, contrary to 
 the general belief, can be inhaled for several hours with- 
 out being detrimental to health ; that its action is an- 
 tagonistic to that of chloroform ; that it is a powerful 
 remedy for the disagreeable accidents arising from chlo- 
 roform and other anaesthetics ; and that in asphyxia from 
 poisonous gases — as, for instance, from carbonic acid — 
 it exercises likewise a beneficial influence. Ducroy, there- 
 fore, proposed to make every patient, awakening from 
 a chloroform-narcosis, inhale oxygen, in order to rid him 
 of headache and other inconveniences following the ad- 
 
 * A litre is 1.0567 quarts. 
 

 
 189 
 
 ministration of that anaesthetic. According to the re- 
 ports of different authors, it should be a rule, whenever 
 chloroform is administered to have the oxygen-inhaler 
 ready for use. 
 
 "In compliance with the foregoing remarks, Mr. Erich- 
 sen, in his ' Monograph on Asphyxia,' says : 'In a 
 considerable number of experiments that I have per- 
 formed on this subject, I have never succeeded in re-ex- 
 citing the contractions of the ventricles by means of the 
 inflation of the lungs with common air, provided they 
 had fairly ceased to act before artificial respiration was 
 set up.' He was then led to try oxygen, and in several 
 instances was successful in restoring the action of the 
 ventricles after the entire cessation of the heart's action. 
 
 " Most interesting are the experiments made by Bed- 
 does, whereby it was clearly shown that animals drowned 
 and kept in water till death had apparently occurred, 
 soon recovered in the free air, when, previous to their 
 being drowned, they had inhaled oxygen ; while others 
 which had not, died. The same result was obtained 
 with animals put into mixtures which produce a very 
 low temperature. Those which had previously inhaled 
 oxygen could for a long time remain in such mixtures, 
 whilst others were frozen to death ; others, again, were 
 exposed to an atmosphere of hydrogen, and kept therein 
 until entire cessation of respiration. Those treated 
 previously by oxygen soon recovered when brought into 
 the air, whilst animation could not be restored in the 
 others. 
 
 " But to return to our theme, viz., the application of 
 oxygen, it has proved to be of great value in cases in 
 which insufficient oxidation, or an abnormal composition 
 of the blood, forms a prominent symptom; as in asthma, 
 
190 THE INHALATION OF MEDICATED 
 
 in the more advanced stages of consumption, in chronic 
 bronchitis, anaemia, Bright's disease, chlorosis, and 
 other similar affections. Inflammatory stages of phthi- 
 sis, inflammatory conditions of the respiratory organs 
 in general, contraindicate the application of oxygen. 
 It need not be mentioned that an alternately-combined 
 treatment of oxygen and atomized fluids sometimes will 
 render better services than either of them exclusively 
 applied, as will be seen in many cases to be reported on 
 in the second part of this treatise. 
 
 " It remains now for me to make a few remarks on the 
 apparatus I use for the administration of oxygen gas, as 
 well as for the inhalation of volatiles, &c. It differs 
 from the inhalers hitherto constructed, not only in shape 
 and finish, forming a fine ornamental vase, but tends 
 also to remedy some inconveniences connected with other 
 similar apparatus. The patient was hitherto, after each 
 inspiration, either obliged to turn his face from the ap- 
 paratus, in order to perform the expiration, or to expire 
 into the apparatus, whereby the oxygen became mixed 
 with the expired air. 
 
 " The only apparatus which tried to avoid this incon- 
 venience is that of Dr. Richardson. But the mouth- 
 piece of his apparatus, covering very inconveniently the 
 patient's mouth and nose, is not only rather clumsy, but 
 the valves which were intended to regulate the inspira- 
 tion and expiration, soon became rolled up and never 
 acted, or in a very insufficient manner only. 
 
 "The following section of the mouthpiece of my inhaler 
 (Fig. 11) sufficiently explains its construction. The two 
 valves (A and B) are made of vulcanite, and, acting ex- 
 tremely easily, close and open with great precision. It 
 is obvious that the inhalation of the oxygen with each 
 
191 
 
 inspiration — during which the valve B gets closed — 
 takes place in the direction of the arrow at A ; while, 
 
 during expiration, A closes, and the expired air escapes 
 in the direction of the arrow at B. 
 
 " In respect to the production of oxygen gas, it is now 
 quite cheap enough as to be used by almost every patient. 
 Hitherto, Messrs. Robbins & Co.'s oxygenesis has been 
 frequently used. But though a quantity of the gas 
 could readily be obtained by it in a short period, two 
 things prevented the preparation from being generally 
 applied, namely : its price, and the necessity of placing 
 into the patient's hand a quantity of sulphuric acid. 
 But these impediments do no longer exist, since Messrs. 
 Robbins & Co., recently manufacture another prepara- 
 tion, which is distinguished by its cheapness and by the 
 large amount of oxygen which can be produced by it, 
 as well as by the great ease and simplicity with which 
 the evolution of the gas can be carried on by the patient, 
 it being only necessary to put the powder into the in- 
 haler and to pour hot water over it ; the gas then imme- 
 diately escapes, and can be inhaled through the mouth- 
 piece. Thus no obstacle to the general application of 
 oxygen in appropriate cases any longer exists." 
 
 Early last year I procured from London one of Dr. 
 
192 THE INHALATION OF MEDICATED 
 
 Beigel's inhalers and a quantity of Robbins & Co.'s 
 oxy generator, as the powder furnished by them is called. 
 Inasmuch as its importation into this country makes it 
 rather expensive, I requested the importers to ask for 
 the formula for its manufacture, but this courtesy was 
 refused by the manufacturers. I think it is composed 
 of chloride of lime, with a small quantity of the peroxide 
 of cobalt, the reaction upon the application of heat being 
 the same as that of nitric acid in the formation of sul- 
 phuric acid. I have seen it mentioned somewhere, that 
 a solution of the chloride of lime, with a trace of the re- 
 cently-prepared peroxide of any metal, will give off oxy- 
 gen upon the application of heat, leaving, after the reac- 
 tion, nothing but chloride of calcium and water. A 
 portion of this powder was examined by Prof. R. E. 
 Rogers and Prof. Rand, of this city, who confirmed the 
 statement of Dr. Beigel as to the prompt evolution of 
 oxygen gas, and my supposition as to the constituents 
 of the powder. The amount of gas given off is about 
 equal in volume to that procured from chlorate of po- 
 tassa by the ordinary method of heating in a retort. 
 Drs. Barton and Leffman, chemical assistants in Jeffer- 
 son College Laboratory, examined a specimen of this 
 powder, and found it to contain oxide of cobalt in small 
 quantities, and unequally distributed throughout the 
 mass. 
 
 It would certainly be desirable if some enterprising 
 chemists would manufacture the compound in this coun- 
 try, so that it would be cheap enough to come into gen- 
 eral use. Oxygen inhalations could then be resorted to 
 as readily as inhalation of any of the volatile articles of 
 the materia medica, the evolution of the gas ensuing im- 
 mediately upon the addition of boiling water. 
 
AIRS, GASES, AND VAPORS. 193 
 
 A rough method of impregnating the atmosphere with 
 oxygen gas extemporaneously, is to throw some chlorate 
 of potassa upon live coals ; but of course this method is 
 much inferior to one by which the gas can be collected. 
 
 My own experience with oxygen gas as a therapeutic 
 agent has been thus far exceedingly limited. I have 
 employed it in a number of cases of imperfect aeration 
 of the air-cells of the lungs from deficient inspiration, 
 and with decided benefit, but I am not prepared to 
 state the benefit was not entirely due, — as it was in 
 great measure due, certainly, — to the mechanical effect 
 of the inhalation expanding the air-cells by forced in- 
 spiration, for in the fine weather of spring and summer 
 I have seen results fully as satisfactory from regular 
 deep inspirations of fresh air ; the patient seated in the 
 open atmosphere, or before an open window, and tak- 
 ing deep inspirations slowly, while an attendant forces 
 the shoulders backwards so as to assist the expansion 
 of the chest during the effort of inspiration. From four 
 to eight such efforts are sufficient at a time to begin 
 with, and may be repeated twice a day. In cases 
 where there is a sense of oppression in the upper por- 
 tions of the chest from inefficient expansion, the relief 
 given by these movements is prompt and decisive. 
 
 I feel free to record that in one case of undoubted 
 incipient phthisis, by which I mean a case of impaired 
 respiration, in which the general symptoms and the 
 family history strongly pointed to the onset of pulmo- 
 nary tuberculosis, but in which there were as yet no 
 positive physical signs of the disease other than im- 
 paired respiration, and extreme dyspnoea at the first 
 institution of the mechanical exercises above mentioned, 
 the inhalation of oxygen gas, has certainly, for a time 
 
 17 
 
194 THE INHALATION OF MEDICATED 
 
 at any rate, warded off the threatened disease, and 
 given the patient renewed vigor, as evinced by increase 
 in nutrition, renewal of vital buoyancy, and restored 
 powers of physical endurance. Of course, it is impossi- 
 ble to say determinately that this case would have been 
 one of phthisis, for when any threatened disease is early 
 arrested, or aborted, the pathological evidences of cor- 
 rect diagnosis are lost. 
 
 The inhalation of oxygen has been tried in Europe 
 for scarlet fever, but I am unable to do more than men- 
 tion the fact. 
 
 Dr. Wittmeyer, of Nordhausen {Deutsche Klinik, 
 Oct. 13, 1866, p. 866), has suggested the inhalation of 
 oxygen, and of the vapor of water in the stage of 
 asphyxia in cholera. He is led to the employment of 
 these inhalations because the functional activity and 
 absorbent powers of the alimentary canal being im- 
 paired, and hypodermic injection having failed, there 
 remains open to us but the respiratory tract by which 
 to convey remedies to the system at large. He con- 
 siders two indications highly important in this stage of 
 cholera ; the first being to convey water to the thick- 
 ened blood ; for which purpose he proposes that the 
 patient shall inhale steam and hot water nebulized from 
 one of Siegle's apparatus, the temperature of the nebu- 
 lized water being kept sufficiently warm by a flame 
 under the medicine-glass ; then, he contends that as 
 the thickening of the blood impedes the interchange of 
 the gases in the lungs, the second indication is to con- 
 vey oxygen to the blood, which is best accomplished by 
 inhalation of the pure gas, which he maintains would 
 have a more promptly excitant action upon the heart 
 than any ordinary medicine which could be adminis- 
 
AIRS, GASES, AND VAPORS. 195 
 
 tered in another method ; and as a result, the blood 
 would be enabled to circulate through the vessels more 
 rapidly, and become better and better prepared to imbibe 
 the desired amount of vapor of water and of oxygen. 
 
 Dr. Jutte, of Stettin (Deutsche Klinik, Dec. 1st, 
 1866, p. 436), commenting on the article of Dr. Witt- 
 meyer, says that he had made the experiment of ad- 
 ministering oxygen by inhalation to four adult patients 
 during the short and severe epidemic which prevailed 
 in and about Stettin in the year 1856; and that the ad- 
 ministration had been conducted with great care, and 
 with sufficient frequency ; but that all of his patients 
 died without evincing the least sign of even temporary 
 improvement, and he was so disappointed with the re- 
 sult that he did not pursue the experiment any further. 
 
 This idea of Dr. Wittmeyer is, however, not entirely 
 new, at least as far as regards oxygen inhalations in 
 cholera, though, as far as I know, the suggestion of the 
 inhalation of the vapor of water under such circum- 
 stances, is entirely original. 
 
 In the " Reports on Asiatic Cholera in the Madras 
 Army, from 1828 to 1844, by Samuel Rogers. London, 
 1848," the inhalation of oxygen is spoken of favorably. 
 
 The inhalation of Oxygen as an antidote in narcosis 
 has received recommendation from other sources than 
 those already mentioned incidentally. 
 
 Thus (Ranking* s Abstract, vol. 5, 1847, p. 332), under 
 the impression that the specific effects of ether vapor 
 upon the system are due to its power of producing a 
 state analagous to asphyxia, it has been suggested by Dr. 
 Jackson, and subsequently by Mr. Richardson, that 
 oxygen should be kept ready to be inhaled in case of 
 the occurrence of formidable symptoms, and Mr. Hooper, 
 
196 THE INHALATION OF MEDICATED 
 
 acting on the suggestion, has supplied his inhaler with 
 the means of furnishing oxygen at pleasure. 
 
 The following case is related {Ranking s Abstract, 
 vol. 17, p. 118, from the Canada Medical Journal, 
 Jan. 1853) in support of the idea that the inhalation of 
 oxygen might be very beneficial in the asphyxia caused 
 by chloroform and carbonic acid, or by drowning. " A 
 young man attached to the laboratory of the New York 
 Medical College," writes the late Dr. Simeon Abra- 
 hams, "became asphyxiated from the inhalation of the 
 vapor of chloroform ; and so far had its effects been 
 carried, that he became pulseless, and all hopes of his 
 resuscitation abandoned; and as all the usually recom- 
 mended remedies had been tried without success, noth- 
 ing but the death of the young man was looked for, 
 when I proposed, as a dernier ressort, the application of 
 pure oxygen gas as the only chance by which resuscita- 
 tion could be brought about ; but, at the time, the pro- 
 posal met with opposition from the medical men present, 
 who were anxiously watching what seemed to be the 
 expiring efforts of the poor boy, expecting each moment 
 to be his last. Having, however, consented, the gas 
 had not been more than a few seconds applied to his 
 nostrils, when he who was apparently beyond the help 
 of human aid, and absolutely in articulo mortis, arose 
 and placed himself upon a chair, proving most conclu- 
 sively how correct I was in proposing the application of 
 oxygen gas as a remedy against the deleterious effects 
 of chloroform as an anaesthetic." 
 
 Dr. Beigel (op. cit., p. 104) considers the adminis- 
 tration of oxygen gas particularly applicable to the 
 suffocative paroxysms of croup, not for the purpose of 
 curing the disease by the inhalation of oxygen, but to 
 
AIRS, GASES, AND VAPORS. 197 
 
 guard the patient from the consequences of such attacks, 
 which frequently prove fatal, and to place him in such 
 a position as to enable us to apply other remedies ; 
 oxygen, under such circumstances, having in some meas- 
 ure the same effect as tracheotomy, whereby we intend 
 to evade a particular part of the respiratory tract, in 
 order to gain time till we possibly master the inflam- 
 mation, as well as the formation of the pathological 
 products represented by the croupal membranes. 
 
 As an illustration of this fact, Dr. Beigel reproduces 
 (p. 105) the following' case, reported by Miquel (Cor- 
 respondence Blatt des Vereins filr Gemeinschaftliche 
 Arbeiter, 1862) : 
 
 " Severe case of croup; application of the usual medi- 
 caments without benefit. Immediate alleviation after 
 oxygen had been inhaled. — The patient was a boy 
 twenty-one months old, hitherto perfectly healthy. 
 On February 21, 1862, Miquel was summoned, and 
 found the child in the following condition : Breath- 
 ing, noisy and whistling, short, some fifty respirations 
 in the minute, but irregular, as well in respect to 
 the rhythm as to duration ; pulse small, very fre- 
 quent, impossible to be counted ; countenance pale, 
 lips livid ; all muscles are active during breathing, 
 and the regular movements of the levatores alse nasi, 
 of the muscles of the throat, &c, were combined with 
 irregular spasmodic movements, which now and then 
 agitated the face. The little patient frequently bent 
 his head quite backwards, the expression of his counte- 
 nance being very anxious, and seized his throat convul- 
 sively with his hands. His face was moist and cold. 
 The child very seldom yet made efforts to cough ; when 
 coughing, the voice appeared barking, hoarse, sup- 
 
 17* 
 
198 THE INHALATION OF MEDICATED 
 
 pressed. According to the report of the house doctor, 
 nine days ago the child was seized with symptoms of 
 croup, which at first decreased by emetics, leeches, and 
 other remedies, but three days ago have recurred with 
 great intensity. The usual remedies were applied again, 
 but failed to do any good, and a newly administered 
 emetic was to the same effect ; involution of the legs in 
 mustard powder, and inhalations of hot steam, were 
 vainly resorted to. At half-past ten, inhalations of 
 oxygen were tried. One cubic foot of that gas, one 
 volume of pure oxygen mixed with a smaller portion of 
 atmospheric air in a gasometer, was brought to the 
 patient's residence. The amount of respiration might 
 have been about five cubic inches, the quantity of gas 
 (1728 cubic inches) was, therefore, sufficient for 350 
 inspirations, which might have been performed in about 
 nine or ten minutes, yet the procedure lasted about fifteen 
 to twenty minutes. The child's condition after the in- 
 halation was the following : pulse perceptible, less fre- 
 quent, number of respirations about the same. The ap- 
 pearance of the child was, according to the judgment of 
 all persons around him, more quiet, less anxious ; patient 
 became more reactive to the impediment to respiration, 
 so that he coughs frequently, though with the peculiar 
 croup sound ; once such a cough spontaneously pro- 
 duced vomiting. The spasmodic movements of the 
 muscles of the face, as well as of other regions of the 
 body, ceased, and at one o'clock in the morning the 
 parents came to me to report that the child had slept 
 very quietly, and that the spasm and anxiety had dis- 
 appeared. They added that on no previous night the 
 suffocating seizures and the expression of the counte- 
 nance were so alarming ; but that on none of the four 
 

 199 
 
 previous nights was the patient so quiet as he is to- 
 night. On the following morning the child was found 
 to be still better, and though the oppression recurred 
 on the following evening in a slight degree, yet all the 
 remainder vanished by medicaments applied for the 
 disease itself, and the patient recovered entirely." 
 
 Beigel relates the details of several cases under his 
 own care, treated by alternate inhalations of oxygen 
 and of nebulized fluids. 
 
 One of these (op. cit., p. 114) was advanced diph- 
 theria in a child six years of age, which was cured by 
 the inhalation of oxygen gas, one gallon morning and 
 evening, and the inhalation of a solution of the tincture 
 of the chloride of iron, ten minims to the fluid ounce of 
 water ; a remarkable alteration in the patient's condi- 
 tion being perceptible after the first inhalation of oxy- 
 gen. Also (op. cit., p. 116) a very severe case of diph- 
 theria after small-pox, with exudation lining the whole 
 pharynx, laryngeal implication, suffocative paroxysms, 
 &c. The patient, a boy ten years of age, was seen by 
 Dr. Beigel on the fourteenth day of the illness, after 
 the administration of calomel for six days had afforded 
 no relief. This case was treated by inhalations of the 
 spray of hot water, afterwards of lime-water, and sub- 
 sequently of tannin ; oxygen being administered to re- 
 lieve the suffocative attack with complete success, and 
 being continued twice a day as long as requisite ; the 
 combined treatment resulting in a cure. 
 
 It will be remembered that in Lewin's fourteenth 
 case of diphtheria (see p. 131), oxygen inhalations were 
 resorted to in addition to the other treatment. 
 
 Beigel also relates (op. cit., p. 133) a severe case of 
 asthma, in which the suffocating attacks were sup- 
 
200 THE INHALATION OF MEDICATED 
 
 pressed by inhalations of oxygen ; this case and several 
 others, detailed in succession, having been cured by the 
 alternate inhalations of oxygen and of Fowler's solu- 
 tion of arsenic. He also details a case of emphysema, 
 and one of chronic laryngitis with suffocative parox- 
 ysms, in which oxygen inhalations were productive of 
 great benefit. 
 
 Beigel believes that in children predisposed to phthisis, 
 the inhalation of oxygen gas would delay, or even pre- 
 vent the outbreak of the disease ; and that even after 
 the development of the affection, inhalations of oxygen 
 gas sometimes render astonishing services. In proof of 
 this he details a case (op. cit., p. 182) in which an en- 
 gineer, twenty-three years of age, of scrofulous diathe- 
 sis, with tuberculous infiltration of the left apex, and 
 bronchial catarrh of the right lung, with haemoptysis, 
 colliquative perspirations and rapid loss of flesh, was so 
 much improved by the inhalation of a gallon of oxygen 
 twice a day, and of a solution of the sesquichloride of 
 iron twice a day, that in a little less than five months, at 
 which time the treatment was discontinued, the patient 
 could hardly be recognized as the same man ; he had 
 grown strong and muscular, and but that dulness re- 
 mained at the left apex, he could be considered perfectly 
 healthy. He was seen a year afterwards by Dr. Beigel, 
 whom he assured that he had enjoyed very good health 
 during the whole of that period. 
 
 Inhalation of Nitrous-Oxide Gas. 
 
 The inhalation of nitrous-oxide (laughing-gas) has 
 been employed pure, for the purpose of supplying the 
 system with a large amount of the oxygen it contains, 
 and in the same affections for which oxygen has been 
 

 AIRS, GASES, AND VAPORS. 201 
 
 recommended, such as anaemia, incipient phthisis, &c; 
 and, it appears, equally applicably. It is now prepared 
 extensively in all our large cities as an anaesthetic for 
 dental purposes, and can thus be readily procured by 
 those who wish to try its efficacy. 
 
 Surgeon George G. Shumman, United States Volun- 
 teers, reports (Am. Med. Times, 1863, pp. 28 and 38) 
 a number of cases (14) of typhoid fever, also two of 
 measles, and one of 'erysipelas, in which inhalations of 
 the nitrous-oxide gas were administered at the stage of 
 prostration for the purpose of supplying oxygen to the 
 system, with beneficial results in all cases ; even in some 
 which proved fatal, for life had been apparently prolonged 
 many hours by this means, although insufficient to stimu- 
 late to the point of recuperation. Some of these cases 
 which recovered, had been pronounced hopeless, and all 
 of the patients are reported as having expressed them- 
 selves as feeling much the better for the inhalations. 
 Attention is called to the resort to this method in the 
 prostrated stages of cholera and other affections. 
 
 Whether it acts by supplying oxygen is a question. 
 Other compounds of oxygen and nitrogen containing 
 a much larger proportion of oxygen, are, as* is well 
 known, extremely deleterious when inhaled. It is 
 quite probable that the nitrous oxide has an influence 
 as such; because we know that the action of chemical 
 compounds is often different to what would be inferred 
 from a knowledge of the effects of their constituents. 
 
 Inhalation of Vapors of Chlorine. 
 
 Chlorine may be inhaled by adding water to chloride 
 of lime in a Wolfe's bottle or other inhaler. 
 
 It has been asserted that paper-makers, though ex- 
 
202 THE INHALATION OF MEDICATED 
 
 posed to the fine dust from the rags, &c, are, as a class, 
 peculiarly exempt from phthisis, and on account of their 
 exposure to the fumes of chlorine ; and it is probable 
 that this circumstance gave origin to its suggestion as a 
 remedial agent by inhalation. 
 
 Gannal, observing that workmen in a bleaching es- 
 tablishment, who suffered under diseases of the chest, 
 were visibly improved, ascribed the amelioration to the 
 inhalation of air containing this gas, and was led to in- 
 stitute experiments upon consumptives, with good re- 
 sults. Sir James Murray is reported [Dub. Jour. Med. 
 Set., March, 1839), to state that a friend had observed 
 similar beneficial effects among his workmen from ex- 
 posure to the inhalation of a watery vapor strongly im- 
 pregnated with this gas. 
 
 Louis reported that in a number of experiments on 
 consumptive patients at LaPitie', L'Hotel Dieu, &c, he 
 had not obtained any successful result from the inhala- 
 tions of chlorine gas; though he has elsewhere admitted, 
 with M. Cottereau, that singular advantage may be ob- 
 tained from chloruretted inhalations in certain cases of 
 chronic bronchitis, even where the general symptoms 
 closely resemble those of phthisis. 
 
 Dr. Stokes found these inhalations prejudicial in 
 phthisis, being too provocative of irritation, though he 
 found them beneficial in correcting fetor in gangrene of 
 the lungs. Dr. Elliotson found them secure greater ame- 
 lioration than narcotics or any other means then em- 
 ployed ; and many others have confirmed this result. 
 
 Dr. A. T. Thompson considered chlorine (Dungli- 
 son's New Remedies, 7th edit., p. 200) the best topical 
 expectorant, and the most salutary excitant to the mu- 
 cous membrane that had yet been inhaled. 
 
AIRS, GASES, AND VAPORS. 203 
 
 Sir Chas. Scudamore tried chlorine in several in- 
 stances of phthisis, but found it inferior to iodine. 
 
 Dr. 'Elliotsox (Lancet, 1830-1, vol. 11, p. 198) found 
 great mitigation from inhalation of chlorine in two cases 
 of phthisis. 
 
 " A remarkable case of consumption, of the worst 
 kind, cured by inhalation of chlorine," is reported by 
 Dr. Cottereau (Lancet, 1830-31, vol. 11, p. 169, from 
 the Journal Hebdomadaire), in which, some two years 
 after being cured of his consumption, the patient died 
 from acute inflammation of the mucous membrane of 
 the stomach and small intestines, without any derange- 
 ment of the respiratory system ; and the post-mortem 
 examination showed the old cicatrices, and some crude 
 tuberculous granulations. Twelve more cases, in which 
 all the physical signs were decisive of phthisis, and in 
 which recovery ensued under inhalations of chlorine, are 
 recorded by Dr. Cottereau in Arch. Gen. de Med., ^No- 
 vember, 1830. 
 
 In cases of poisoning by hydrocyanic acid, as well as 
 by sulphuretted hydrogen, the inhalation of chlorine is 
 a most efficient agent. Chlorinated lime may be used 
 for this purpose. (Dunglisoii s New Remedies, 7th ed., 
 p. 202.) 
 
 Prof. Dunglison considers the inhalation of chlorine 
 adapted only to cases of disease in which the pathologi- 
 cal condition of . the bronchial mucous membrane or 
 neighboring parts, requires the exhibition of an excitant. 
 In this way it may be occasionally serviceable in chronic 
 bronchitis. (Materia Medica, 4th ed., p. 257.) 
 
 The gas, in proper dilution for inhalation, may be 
 evolved by mixing one or two drachms of the chlorine- 
 water with a couple of ounces of hot water, and placing 
 the vessel in a hot bath, or over a flame. 
 
204 THE INHALATION OF MEDICATED 
 
 Dr. Corrigan (Bunglisons New Remedies, 7th ed., 
 p. 201, with figure) devised an apparatus for this pur- 
 pose, fulfilling the following requisites : Firstly, That 
 the apparatus should be simple in its construction and 
 easily kept in order ; Secondly, That it should be capa- 
 ble of keeping up a supply of vapor for any length of 
 time, and that the evolution of the vapor should be 
 steady and easily regulated ; Thirdly, that it should 
 also furnish a sufficient supply of aqueous vapor, to pre- 
 vent any irritation of the larynx, or lining membrane 
 of the air-tubes ; and, Fourthly, and most important of 
 all, that its employment should entail neither trouble 
 nor fatigue on the invalid. This apparatus consists of 
 a light, open, iron-wire frame, about eighteen inches 
 high, at the bottom of which is a spirit-lamp ; at the 
 proper height above this is an evaporating porcelain 
 dish, about six inches in diameter ; and above this is a 
 glass globe, with its neck downwards. In the neck of 
 the globe is a cork, bored, and through the opening is 
 drawn, moderately tight, a short plug of cotton wick, 
 such as is used in a spirit-lamp ; in the glass globe, 
 opposite the neck, a pin-hole is drilled, to allow air to 
 pass in, according as the fluid within drops out through 
 the neck. To use it, the porcelain dish is filled with 
 hot water, the spirit-lamp is lighted, and as soon as the 
 water in the dish has begun to boil, the glass globe con- 
 taining chlorinated lime (if this be the substance used), 
 is placed in position. The rate at which the fluid in 
 the globe shall percolate the cotton wick and drop into 
 the hot water beneath, is easily regulated. If it should 
 not drop with sufficient rapidity, one or two of the 
 threads of cotton may be removed. Should it drop too 
 rapidly, this is corrected by pressing in the cork more 
 
205 
 
 tightly, or introducing one or two additional threads of 
 wick. 
 
 Eight ounces of a saturated solution of chlorinated 
 lime may be poured into the glass globe ; and into the 
 water of the porcelain dish, two ounces of the diluted 
 sulphuric acid of the Pharmacopoeia. As the solution 
 drops, the acid seizes on the lime, and the chlorine is 
 evolved in connection with aqueous vapor. 
 
 Prof. Jos. Pancoast, of Philadelphia, reports ( Trans. 
 Am. Med. Ass'n, 1850, vol. iii, p. 135) the cure of a 
 particular form of aphonia by means of the inhalation 
 of the vapor of chlorine. The form of aphonia is that 
 inferred to be due to partial paralysis of the intrinsic 
 muscles of the larynx. 
 
 As an inhaling apparatus, Dr. Pancoast used the 
 ordinary tubulated glass retort of the chemist, with a 
 glass funnel having some filtering paper at the bottom. 
 In the bowl of the retort he placed a solution of the 
 chloride of soda, or lime. Into the glass funnel was 
 put a weak solution of muriatic acid in water. As the 
 dilute acid fell drop by drop into the bowl of the retort, 
 chlorine was very gradually liberated and breathed 
 from the end of the instrument. 
 
 In using this apparatus, some care is required that 
 the acid solution should not be allowed to drop too 
 freely on the salt in the bowl of the retort, so as to de- 
 velop the gas too freely. But the patient has the means 
 of protecting himself against too strong an impression 
 of the chlorine on the glottis, by diluting it with air 
 drawn in through the nostrils, a measure to which he 
 would instinctively resort. 
 
 The first case in which this method was employed, 
 was a healthy young country girl, who had contracted 
 
 IS 
 
206 THE INHALATION OF MEDICATED 
 
 a severe cold by remaining in a damp spring-house. 
 The aphonia had lasted for six months, resisting every 
 sort of treatment. 
 
 She was placed upon the inhalation of chlorine, con- 
 tinued for some minutes, and repeated two or three times 
 a day, according to the degree of irritation it produced 
 in the throat and larynx. From the first trial, the pa- 
 tient's voice improved, and in three days had become 
 very nearly as strong as ever. A couple of months 
 after her return to the country, another cold was fol- 
 lowed by a similar case of aphonia. The patient again 
 breathed the dilute chlorine vapor for a few times, and 
 had her voice restored. 
 
 The second case was that of a well-known practi- 
 tioner whose voice had been lost for about seven months, 
 so that he was unable to practice his profession. Besides 
 exhausting the more ordinary means resorted to in these 
 cases, he had made, without any good effect, repeated 
 trials of a strong lunar caustic solution, applied with a 
 sponge to the glottis. 
 
 His voice began to improve from the first trial of the 
 chlorine. The improvement was steady, but more slow 
 than in the case above detailed, a week or ten days 
 elapsing before his voice was restored to its natural 
 strength. 
 
 Dr. Pancoast considers that the chlorine acts merely 
 as a local stimulant, and that iodine, or any other excit- 
 ing vapor would effect similar results. 
 
 Inhalation of Vapors of Iodine. 
 
 The close resemblance between tuberculosis and 
 scrofulosis, and the well-known alterative effects of 
 iodine upon diseases of the latter character, especially 
 
 
AIRS, GASES, AND VAPORS. 207 
 
 as they affect the lymphatics and other glands, readily 
 led to the employment of the same remedy in pulmo- 
 nary consumption ; and the volatile nature of iodine 
 suggested its employment by inhalation, for the treat- 
 ment of affections of the respiratory organs. This 
 vapor has been found of decided efficacy in confirmed 
 phthisis, and in certain forms of catarrh, by Berton, 
 Sir James Murray, Baudelocque, Huette, Chartroulle, 
 Lugol, Chomel, Laennec, Piorry, Dechambre, Corri- 
 gan, Scudamore, and many other well-known authori- 
 ties. 
 
 Piorry read a paper on the subject of the treat- 
 ment of phthisis by iodine inhalations, before the 
 Acaddmie de Me'decine (Comptes Rendus, Jan. 24, 
 1854, see Ranking s Abstract, vol. 20, p. 70) [Archives 
 Generates de Me'decine, March, 1854, p. 361), in which 
 he treats of it in very high terms. M. Piorry, after 
 mentioning the circumstances inducing him to employ 
 inhalations of iodine in the treatment of phthisis, says 
 that the results of the experiments, instituted by him- 
 self in conjunction with M. Deyne, an interne of his 
 service, were very satisfactory. A striking ameliora- 
 tion took place in many of their patients, which amelio- 
 ration was permanent, inasmuch as several patients, 
 mentioned in his work on Practical Medicine, were 
 still in the enjoyment of good health. 
 
 The successful treatment of hydrocele and tubercu- 
 lous diseases of the testicle, by injections of solutions 
 of iodine, led to the inference of obtaining similar bene- 
 fit in pulmonary excavations, but the difficulty, not to 
 mention the temerity, of attempting the injection of 
 tincture of iodine into a pulmonary cavity, or into the 
 air-passages, led to the plan of employing the vapor of 
 
208 THE INHALATION OF MEDICATED 
 
 iodine. Sometimes the crystals of iodine were em- 
 ployed to evolve the vapor, and sometimes the tincture 
 of iodine was used. In the former instance, two or 
 three scruples of iodine were placed in a wide-mouthed 
 quart jar, from which the vapor would be disengaged 
 spontaneously with greater or less rapidity, according 
 to the temperature and humidity of the atmosphere. 
 
 In other cases, one to three ounces of the tincture of 
 iodine were poured into the jar, which was then heated 
 until the vapors of iodine and alcohol were given off. 
 The patients breathed the vapors, taking one deep 
 sighing inspiration at a time, and repeated the effort 
 from one to two hundred times daily, at appropriate 
 intervals, several successive inspirations producing pain 
 in the larynx and bronchi) with cough, although the 
 single inspirations did not produce much irritation. 
 
 With Laennec, who surrounded the bed of his con- 
 sumptive patients with the varec, in order to procure 
 the iodinized vapor, Piorry, too, employed inhalations 
 of iodine during sleep. He placed several saucers con- 
 taining iodine about the patient's pillow, or attached a 
 number of vials of iodine to the bedposts, so as to satu- 
 rate the air with iodine, which is given off in sufficient 
 quantity to blue any starched curtains that may be 
 about the bed. 
 
 Piorry calls attention to the circumstance, that if a 
 moist starched paper is interposed between the vessel 
 from which the vapor is being liberated, and the pa- 
 tient's mouth, as he takes an inspiration, it turns blue, 
 while the same air breathed upon the paper, after 
 having traversed the lungs, causes no change; from 
 which fact he infers, that the iodine which enters the 
 lungs is absorbed there. 
 
 
AIRS, GASES, AND VAPORS. 209 
 
 The treatment of Piorry's cases was not confined to 
 the iodine inhalations. Most of them took from twenty 
 to sixty grains of the iodide of potassium by the stom- 
 ach daily. In cases of supposed adhesions, frictions 
 were resorted to with tincture of iodine, one part to 
 nineteen parts of water. Other remedies, as astrin- 
 gents, opiates, and other narcotics, quinine, &c, were 
 given to fulfil various indications ; while a nutritious 
 and reparative diet was employed, to which regimen 
 Piorry gives a preference over all the remedies em- 
 ployed, except the iodine. 
 
 Thirty-one patients were thus treated during a period 
 of two years, all presenting in different degrees un- 
 mistakable signs of phthisis, with the characteristic 
 sputa, and positive plessimetric and stethoscopic evi- 
 dences of the disease. 
 
 In order to determine with precision the effects of 
 the iodine, some charts were prepared, upon which were 
 marked exact delineations of the parts diseased, and rep- 
 resentations of the variations in sound upon percussion, 
 which occurred from day to day. After periods varying 
 from four, six, or twenty days, to from six weeks to 
 four months of the iodine treatment, there was in al- 
 most every case a diminution of the extent of the sur- 
 face over which there was at first feebleness of respi- 
 ration, dulness, resistance, &c, while at the same time, 
 auscultation indicated an amelioration in the condition 
 of the condensed portions of the lung. Numerous 
 patients with cavities in the lungs were apparently 
 cured. 
 
 The ultimate results were : decided amelioration in 
 the symptoms and anatomical characters in twenty 
 cases ; disappearance of the anatomical characters and 
 
 18* 
 
210 THE INHALATION OP MEDICATED 
 
 of most of the symptoms in seven cases ; death with or 
 without amelioration in four cases. 
 
 M. Piorry's conclusions are as follows : 
 
 1st. The inhalation of the vapor and tincture of iodine 
 is useful in the cure of phthisis. 
 
 2d. In many cases, such inhalation is followed by a 
 diminution in the extent of the indurated parts sur- 
 rounding tuberculous deposits, and an amelioration in 
 the general symptoms. 
 
 3d. It is probable that tubercle itself disappears 
 under the influence of iodine inhalations. 
 
 4th. That inhalations of the tincture of iodine may 
 promote the cure of tuberculous cavities. 
 
 5th. That after the softening of tubercles, the result- 
 ing cavities may cicatrize spontaneously. 
 
 6th. That compression of the thorax over the points 
 of disease indicated by percussion and auscultation, may 
 contribute to the cure of the local lesion, and to the 
 prevention of pyaemia. 
 
 7th. That iodide of potassium administered internally, 
 and frictions with diluted tincture of iodine over adhe- 
 rent portions of the lung, are also of great utility. 
 
 Sir Chas. Scudamoke found the irritating qualities of 
 the gas subdued by the addition of a little tincture of 
 conium at the time of employing the inhalation, a higher 
 heat being necessary to liberate the vapors from the 
 conium than is necessary with iodine alone. 
 
 Sir Chas. Scudamore (London Med. Gazette, February, 
 1840), after ten years' experience with iodine inhala- 
 tions, had acquired increased confidence in their efficacy. 
 His formula at this time was 6 grs. each of iodine and 
 iodide of potassium, with 2 drachms of alcohol, to 5 
 ounces of distilled water, adding a little tincture of 
 
211 
 
 conium at the time of mixing the solution of iodine with 
 the water for inhalation. He began with a drachm or 
 so of the iodine mixture, two or three times a day, in- 
 creasing the dose, if necessary. 
 
 The vapor of iodine may be inhaled from a solution 
 of the tincture in water, by means of a Wolfe's bottle, 
 or other inhaler, no artificial heat being necessary. 
 
 Dr. Berton's method consisted in placing into a flask 
 with two openings, some dilute sulphuric acid, to which is 
 added a quarter or half a grain of the hydriodate of 
 potash ; the iodine vapors are promptly disengaged, and 
 are inhaled by the patient from one of the tubes from 
 the flask, the process of inhalation occupying four or 
 five minutes, and being repeated as often as desirable, 
 even to the number of ten times a day. 
 
 Dr. Pereira's experience in phthisis, as well as other 
 chronic pulmonary complaints, has not been favorable. 
 
 M. Simon relates {Brit. $> For. Med.-Cldr. Rev., July 
 1861, from X' Union Medicale, March 16, 1861) the re- 
 sults of a number of cases of phthisis pulmonalis treated 
 by M. Chartroulle with inhalations of iodine, a prac- 
 tice very frequent in Belgium. Under his directions, 
 twenty-eight patients in the hospital were treated by the 
 inhalation of the vapor of pure iodine, and of this num- 
 ber only eleven could be said to have derived no benefit 
 from the treatment. In these unsuccessful cases the pul- 
 monary lesions were not modified, but still, the symptoms 
 were not aggravated in any case. In opposition to the 
 statement that iodine vapor produces haemoptysis, it was 
 found that pulmonary hemorrhage ceased more rapidly 
 under this kind of treatment than under other plans 
 which are more generally employed. Seventeen pa- 
 tients derived positive benefit from the iodine treatment, 
 
212 THE INHALATION OF MEDICATED 
 
 and this improvement was observed not only in relation 
 to the general symptoms, but also to the pulmonary 
 lesion itself, as was proved by percussion and ausculta- 
 tion. Out of the seventeen patients but four might be con- 
 sidered as actually cured. One of these cases of cure is 
 the following : A youth 16 years of age, entered the 
 hospital in such an alarming condition that at first the 
 physicians hesitated to submit him to the iodine inhala- 
 tions. He was in a state of great emaciation, and his 
 skin was almost constantly covered with profuse perspi- 
 ration ; he had diarrhoea, which had lasted for two 
 months, and he had repeatedly suffered from haemopty- 
 sis. There were very extensive indurations in the lungs, 
 and at the apex of the right lung there was a cavity of 
 some size, as was shown by very obvious gargouillement. 
 The expectoration also was characteristic. After rest- 
 ing a few days, this young man was subjected to the 
 iodine inhalations, and all the symptoms which had ap- 
 peared so serious were soon modified in a most remark- 
 able manner. The general symptoms disappeared first, 
 and the body recovered its plumpness with great rapid- 
 ity. The perspiration, diarrhoea, fever, cough, and ex- 
 pectoration, were soon relieved or removed, and six 
 weeks after admission into the hospital the patient went 
 out quite well. 
 
 Several other cases of the same nature are recorded 
 from both the public and private practice of M. Char- 
 troulle, and in all of them the beneficial results of iodine 
 inhalations are remarkably exhibited. Dr. Simon, who 
 relates the cases, attributes a great part of the efficacy 
 of the treatment to the apparatus employed for inhala- 
 tion, which, however, is not described in the paper. By 
 this apparatus, it appears, a degree of precision is given 
 
 
AIRS, GASES, AND VAPORS. 213 
 
 to the treatment which consequently becomes the more 
 efficacious, for a close of the vapor may be estimated 
 with exactness, and the remedy may be made propor- 
 tionate to the severity of the disease and the strength 
 of the patient. 
 
 Lewin (op. cit., p. 202) had employed vapor of iodine 
 in phthisis several times without any favorable results, 
 but all his cases were in the advanced stage. 
 
 The inhalation of iodine vapor has been employed in 
 coryza. An army surgeon, M. Luc, seized with very 
 bad coryza, attended by fever, severe cephalalgia, and 
 excessive secretion, determined upon trying the effect of 
 the inhalation of iodine vapor. The coryza first ap- 
 peared at 9 A. M., and the inhalations were commenced 
 at 3 P. M., being repeated every three minutes during 
 an hour, each lasting about a minute. The headache 
 was first relieved, the sneezing then occurring less fre- 
 quently, the amount of secretion diminishing, and by 6 
 P. M., all traces of the coryza had disappeared, except 
 a little burning sensation in the throat. Several of the 
 officers have since tried the means with the same re- 
 sults. The inhalation is effected by placing a bottle of 
 tincture under the nose, the hand supplying warmth 
 enough to vaporize the iodine. (Rev. Med., August 31 ; 
 Med. Times and Gazette, November 11, 1865 ; The Med. 
 Record, March 1, 1866.) 
 
 Dr. A. P. Merrill, of New York, formerly Professor 
 of Materia Medica in the Memphis Medical College, and 
 editor of the Memphis Medical Recorder, has for a num- 
 ber of years made extensive use of the inhalation of the 
 valors of iodine in mucous inflammations of the trachea 
 and bronchi, led to the treatment by the happy results 
 previously obtained in his own case and that of others, 
 
214 THE INHALATION OP MEDICATED 
 
 by its local application in a convenient form, in cases 
 of chronic pharyngitis and laryngitis. These cases are 
 reported in the Memphis Medical Record, vol. i, 1852- 
 3, pp. 8, 21, 113 ; vol. iii, 1854-5, pp. 133, 18T, 228, 
 285 ; vol. iv, 1856, pp. 252, 377. 
 
 Dr. Merrill employs the vapor disengaged directly 
 from the crystals of iodine, which are sufficiently volatile 
 in a current of cold air to afford all the strength of 
 vapor that can be conveniently borne by the patient. I 
 make a few extracts from some communications on this 
 subject, kindly furnished me by that gentleman. " In 
 a case of such inflammation beyond the reach of the 
 brush, I found a patient inhaling the vapor of gum cam- 
 phor through a common quill, but without much effect. 
 I added a few grains of iodine to the camphor, and then 
 the relief obtained was more decided ; but in applying 
 this combination to other cases, I met with a difficulty 
 in the liquefaction of the mixture, and then determined 
 to use each remedy separately, by placing it within a 
 small cane tube, with a little coarse wool in each end 
 to prevent the escape of the medicine. I nave used 
 tubes of glass, also, but found them to hold the reme- 
 dies less securely. The cane tubes have answered an 
 excellent purpose, whether employed through the medi- 
 um of the mouth or the nasal passages, but more re- 
 cently I have substituted tubes made of hard rubber, 
 so rounded at the ends as to prevent irritation, and the 
 vapor escapes through several perforations at the ex- 
 tremity. With these tubes, which unscrew at the middle 
 for the introduction of the iodine, the teeth, tongue, &c, 
 are protected from any disagreeable effects of the vapor, 
 and the current may be made to impinge in any desired 
 direction. 
 
 
215 
 
 " Great benefit is derived from iodine inhalations in 
 the more acute affections of the nasal membranes, such 
 as coryza, hemorrhage, and catarrh. They relieve the 
 habitual catarrh of old people, and are advantageous to 
 public speakers and singers, whose vocal organs have 
 become debilitated from excessive exercise in their voca- 
 tions, and which sometimes show a tendency to oedema 
 of the glottis, and terminate in aphonia." 
 
 Dr. Merrill details (Am. Jour. Med. Sci., Jan. 1866) 
 an interesting case of symptomatic bronchial irritation, 
 in which the iodine inhalations were very beneficial. 
 These were made with tubes of cane in the manner pre- 
 viously described. He considers that the iodine acts 
 in chronic cases by exciting a watery secretion which 
 disengages the viscid mucus which frequently induces 
 coughing by its titillation, and that it relieves hyper- 
 emia and hypertrophy. He has found benefit from in- 
 halations of iodine vapor, in croup, in oedema of the glot- 
 tis, and aphonia. 
 
 In cases of children, and people unwilling or unable 
 to inhale properly, he attaches a gum hand-bellows by 
 a rubber tubing to the tubes, and thus forces the vapor 
 into the nasal or laryngeal passages. 
 
 Dr. Merrill has kindly furnished me with the follow- 
 ing notes of a case of profuse bronchorrhoea, which 
 was suppressed by inhalations of iodine. 
 
 "Mrs. McL., aged 70 years, had suffered for several 
 months with cough, constipation, and oedema of the feet 
 and legs, with incontinence of urine. She complained 
 especially of excessive expectoration, which had re- 
 duced her almost to a skeleton, and it was with diffi- 
 culty she could walk across the room. I did not see 
 the matter expectorated, which was so offensive that she 
 
216 THE INHALATION OF MEDICATED 
 
 declined saving it, but both she and her daughter esti- 
 mated the quantity latterly at a pint to a pint and a 
 half every morning, for it was only in the morning that 
 her cough troubled her. Beginning at three to four 
 o'clock, it continued several hours, during which time 
 the expectoration was free and profuse, and she often 
 passed the remainder of the day without coughing at 
 all. 
 
 "I gave her an inhaling-tube, charged with iodine, to 
 be used frequently during the day and night, and di- 
 rected her to take one-tenth of a grain of arsenious 
 acid three times a day, together with half a grain of 
 calomel at night. This course was continued twenty 
 days with progressive improvement, when (June, 1867) 
 she was entirely relieved of the bronchial disease, and 
 the iodine inhalations were suspended." 
 
 Inhalation of Nitrous Gas in Whooping-cough. 
 
 Dr. Thomas records (Am. Med. Recorder, 1822, p. 
 660) a case of pertussis of nearly three weeks' duration, 
 which was cured within ten days by the inhalation of 
 nitrous gas. The patient was his own son, aged be- 
 tween four and five months, and he was led to the use 
 of the remedy from the perusal of some cases treated 
 by this gas by Mr. Patterson, in J. Carmichael Smith's 
 work on Nitrous Vapor, to which his attention was 
 called for the purpose by a professional friend. He 
 closed every aperture of the apartment occupied by 
 the little patient, which might afford exit to the gas ; 
 he then placed a teacup in a sand-bath, poured half an 
 ounce of sulphuric acid into the cup, to which he gradu- 
 ally added half an ounce of pulverized nitrate of pot- 
 assa, so as to occupy an hour each night in the disen- 
 
217 
 
 gagement of the vapor. The application did not provoke 
 cough, and the child usually fell asleep at an early hour. 
 The treatment began on the night of July 30th, and 
 after that of August 1st, there was no more whooping, 
 and in ten days the child was well. Dr. Thomas con- 
 cludes thus : " In the foregoing case it appears evident 
 to me, and I trust it will to all those who read it,- that 
 the vis medicatrix naturae had no agency in relieving 
 the patient. I am willing at all times to pay due hom- 
 age to that power, but not at the expense of truth and 
 justice ; let us, therefore, ' render unto Caesar that which 
 belongs to Caesar,' and not ascribe merit where none is 
 due." 
 
 Inhalation of Sulphurous Vapors. 
 
 The inhalation of sulphurous vapors has been em- 
 ployed from very early times. Galen, it is known, rec- 
 ommended patients with various affections of the re- 
 spiratory organs to frequent the neighborhood of Mount 
 Vesuvius, to respire the air loaded with its sulphurous 
 emanations. They were also employed by Celsus. 
 
 Recently (Lewin, p. 4) sulphurous vapors have been 
 much employed in chronic bronchitis by the French ' 
 physicians, principally Pujade, of Amelie les Bains. 
 
 Dr. Jas. Dewar (Dublin Medical Press and Circu- 
 lar) speaks highly of the benefit of using the sulphur- 
 ous acid fumes in the treatment of typhoid, ephemeral, 
 and scarlet fevers ; in diphtheria, gout, and rheuma- 
 tism. He saturates the atmosphere of the patient's 
 room with the vapor. (The Medical Record, vol. 1, p. 
 395.) 
 
 The manufacture of sulphuric acid, it is asserted 
 19 
 
218 THE INHALATION OF MEDICATED 
 
 bf M. Baumes (Dictionnaire des Sciences Medicates) 
 protects those employed against phthisis, even restor- 
 ing to health those that seem to have been predisposed 
 to the disease. (Coxe, On Medical Inhalation, Phila., 
 1845.) 
 
 Inhalation of Carbonic Acid in Phthisis. 
 
 The statement of M. Gutllot {Archives G-enerales 
 de Med., Jan., Feb., and March, 1845 ; Banking's Ab- 
 stract, 1845, vol. i, p. 211) that the dark- colored mat- 
 ter found in the lungs under certain circumstances, and 
 which, according to Dr. Cakswell, is a physiological 
 carbonaceous deposit due to stagnation of the blood in 
 the pulmonary tissues, possesses the remarkable power 
 of inducing a modification in tuberculous deposits, led 
 to experiments as to the power of arresting phthisis by 
 instituting inhalations of carbonic acid gas as a reme- 
 dial agent. Certain Russian physicians reported favor- 
 able results a few years subsequently, but the subject 
 does not seem to have attracted much attention outside 
 of their own country, and has most likely fallen into 
 disuse there. 
 
 The Inhalation of Illuminating Gas. 
 
 The vapors of illuminating gas have been employed 
 in cases of whooping-cough. Early in 1864, at Amster- 
 dam, children with this affection were sent to the place 
 of manufacture of the burning gas, and allowed to 
 breathe the gaseous atmosphere for a certain period, 
 with very satisfactory results, many cases having been 
 considered to have been cured in this manner, and 
 without injurious results in any one instance. 
 
 The same method was employed at Calais in the 
 
 
219 
 
 winter of 1864, during an epidemic of pertussis, a num- 
 ber of children thus affected being sent to the gas-house 
 to breathe the vapor at the moment of escape after sub- 
 jection to the purifying process. As soon as the chil- 
 dren breathed this air they began to improve, and 
 thorough cures resulted. Two or three visits sufficed 
 to put an end to the paroxysm of cough. 
 
 Other investigations were made in this direction 
 about the same period. Thus we see (Am. Jour. Med. 
 Sci., April, 1865, p. 487, from Brit. Med. Jour., Nov. 
 5, 1864) M. Commerge presented to the Imperial 
 Academy of Medicine, a report on this subject drawn 
 up from the observations of the effects produced on one 
 hundred and forty-two children affected with whooping- 
 cough, and who had been brought under the action of 
 the gases in the gas-works at St. Maude. His conclu- 
 sions are to the effect that the treatment produces ex- 
 cellent results, and at all periods of the disorder. In 
 general, twelve stances are required for the cure, and 
 each seance should be of two hours' duration. However 
 young the patients, no danger results from the exposure 
 to the gases. Then again, we have Dr. Bertholles, 
 who informs the French Academy of Medicine of the 
 effects observed to result from the inhalation of the 
 vapors disengaged from the remains of the materials 
 used in the purification of gas, by children having 
 whooping-cough. The register of the coal works at 
 Ternes show that, during the past six months, nine 
 hundred and one patients have been subjected to this 
 vapor treatment, and that of these, two hundred and 
 nineteen were cured, and one hundred and twenty-two 
 relieved. The favorable results are probably due to the 
 ammoniacal gases and the tar vapor associated with it. 
 
220 THE INHALATION OF MEDICATED 
 
 See more recently on the same subject Schmidt's 
 Jahrhiicher, July, 1866, p. 63. 
 
 In this connection it will be interesting to record here 
 the results of some experiments performed upon cases 
 of whooping-cough, at the St. Annen Children's Hospi- 
 tal, of Vienna, with the view of determining the effect 
 of the inhalation of various gases in the treatment of 
 this affection. 
 
 These results are summed up as follows : 
 
 1st. Inhalation of pure oxygen gas did not, in any 
 instance, produce paroxysms of cough. 
 
 2d. Inhalation of nitrous oxide gas, or of a mixture 
 of oxygen and atmospheric air in equal parts, did not 
 produce a single paroxysm of cough, even when the in- 
 halation was continued for a considerable period. The 
 children inhaled it with eagerness for from five to ten 
 minutes, and would have continued to do so longer, had 
 permission been allowed. 
 
 3d. Inhalation of pure nitrogen and hydrogen was 
 attempted only on a single occasion ; the children 
 breathed it very unwillingly, and only for a very short 
 period. In two cases, the inhalation of nitrogen was 
 interrupted by paroxysms of cough. Inhalation of 
 hydrogen produced disposition to cough in one case. 
 
 4th. The inhalation of carbonic acid gas always pro- 
 duced a very heavy fit of coughing at the first deep 
 inspiration, even when the experiment was continued 
 for a very short time. An experiment was made with 
 a mixture of one volume of carbonic acid gas with 
 fifteen volumes of ordinary air, which always produced 
 a fit of coughing, either immediately or within two or 
 three minutes. With further dilution the result was 
 not constant, but fits of coughing followed much more 
 
AIRS, GASES, AND VAPORS. 221 
 
 frequently than from the inhalation of pure atmos- 
 pheric air. 
 
 5th. A very slight proportion of ammoniacal vapor, 
 so slight that it could not be detected by the sense of 
 smell, in the limited number of cases in which it was 
 tried, was followed by constant severe paroxysms of 
 cough. 
 
 Dr. Hauke, in summing up the practical results of 
 these experiments, and arguing from the fact that car- 
 bonic acid gas is the gas most obnoxious to whooping- 
 cough, on the ground that there is some arrest of the 
 separation of carbonic acid gas in the lungs, puts the 
 following question : Does this arrest or hindrance to 
 the separation of carbonic acid gas from the lungs of 
 children laboring under whooping-cough, throw any 
 light upon the cause of the peculiar fits of coughing ? 
 His anatomical and clinical experience assures him that 
 such is the case, and although his investigations have 
 not furnished any specific remedy against whooping- 
 cough, some valuable assistance has been gained in de- 
 cs " O 
 
 creasing the number and severity of the paroxysms of 
 cough. 
 
 These investigations appear to substantiate the old 
 advice to permit whooping-cough patients, free from 
 fever, to be out in the open air as much as possible on 
 still, sunny, summer days. In the confined space of a 
 sick-room, the air loaded with carbonic acid gas, and 
 the volatile ammoniacal particles of the various excre- 
 tions, is in itself sufficient to induce cough. Out in the 
 open air, on the contrary, where nature furnishes in 
 every leaf an apparatus for the generation of oxygen, 
 not only is such injurious effect prevented, but the 
 greater liberation of carbonic acid gas, by promoting 
 
 19* 
 
222 THE INHALATION OP MEDICATED 
 
 the respiratory process, will have a calmative effect 
 upon the paroxysm. When the state of the weather is 
 such as to prevent the egress of the child into the open 
 air, it is advisable on the same grounds, to place in the 
 chamber many-leaved, blossomless plants, meagre in 
 perfume, so as to increase the proportion of oxygen in 
 the atmosphere of the apartment, particularly for a few 
 hours after a meal, because at this time the production 
 of carbonic acid in the organism reaches its maximum. 
 For similar reasons such articles of nutrition should be 
 selected as are least productive of carbonic acid gas, 
 and which by their high oxidation, require but a small 
 quantity of oxygen for their combustion in the system. 
 Therefore the diet most appropriate under such circum- 
 stances, are materials rich in fatty constituents, such 
 as milk, sugar, and starches. On the same principles, 
 great attention should be paid to the condition of the 
 skin, by the use of frequent ablutions, baths, &c. 
 (Jahrb. fur Kinderheilkunde, 1862 ; Med. Neuigh. fur 
 Aertzter, Erlangen, 1862, ISTo. 22 ; Lewin, p. 202.) 
 
 The inconvenience often attendant upon sending 
 children with whooping-cough to the gas-works, a prac- 
 tice which he had pursued with good effect in 1864, led 
 Dr. Lochner (Gazette Medicale, Oct. 20th, 1866) to 
 the attempt to employ at home, in the case of his- own 
 son, one of the substances contained in the purifying 
 chambers of the gas-works, and he selected benzine, 
 with the vapor of which he kept the room impregnated 
 by pouring a few drops upon the bed of the patient. In 
 the case of his own child, in whom the paroxysms were 
 very violent, though only numbering five or six in the 
 twenty-four hours, the disease lasted but six days. He 
 also employed the benzine internally, ten or fifteen 
 
223 
 
 drops daily in a little water ; and when the child was 
 sleeping, sprinkled a few drops upon the bed. 
 
 Inhalation of Chloroform. 
 
 The inhalation of chloroform has been recommended 
 in whooping-cough by Dr. Fleetwood Churchill as 
 controlling the disposition to cough, the whoop, &c. (See 
 Braitheivaite, 1853, p. 93.) 
 
 Mr. Gr. H. Heath, of Newcastle-on-Tyne, reports 
 that in cholera, cases where the vomiting is excessive 
 will sometimes be controlled by inhalations of chloro- 
 form, when nothing else will do so ; and life may in 
 this way be saved. (Lancet, Oct. 15th, 1853.) 
 
 The inhalation of chloroform has been recommended 
 in asthma, also in spasmodic croup, in order to over- 
 come the spasm. It is also employed for a similar 
 purpose in angina pectoris, colic, and other painful 
 affections, without pushing the administration to the 
 abolition of sensation or consciousness. 
 
 Its uses as an anaesthetic do not come under con- 
 sideration in this volume. 
 
 Inhalation of Sulphuric Ether. 
 
 Inhalations of sulphurous ether have been recom- 
 mended as almost an abortive in pneumonia. Skoda 
 states that he has never seen it exercise any modifying 
 influence, even in the earliest stages. 
 
 They have been highly recommended in whooping- 
 cough, spasmodic asthma, and in chronic affections of 
 the air-passages generally, and it is not unlikely that 
 much of the benefit arising from the inhalation of 
 ethereal solutions of the balsams is due to the sulphuric 
 ether. 
 
224 THE INHALATION OF MEDICATED 
 
 Inhalations of " naphtha vitrioli" (sulphuric ether), 
 were recommended by Joerdans {Copland's Diet.) in 
 certain affections of the respiratory organs. 
 
 Ether, impregnated with musk, camphor, assafoetida, 
 opium, &c, is sometimes preferable to pure ether. 
 
 Inhalations of sulphuric ether, alone or combined with 
 the vapor from preparations of conium, were advised by 
 Dr. Richard Pearson in cases of phthisis, as an agent 
 in abating the hectic, checking the sweats, relieving the 
 dyspnoea, and deodorizing the sputa. He does not rec- 
 ommend them as curative, but as affording very grate- 
 ful relief to such patients, who will not willingly dis- 
 continue their employment, after having once expe- 
 rienced their benefits. 
 
 Inhalations of ether, impregnated with squill by the 
 addition of the tincture, are recommended in asthma by 
 the same authority. (Coxe,On Medical Inhalation, Phil- 
 adelphia, 1845.) 
 
 Scudamore employed inhalations of ether in spas- 
 modic asthma. 
 
 Dr. Eberle recommended the inhalation of ethereal 
 vapors in pulmonary affections. He considered them 
 of very great value in relieving dyspnoea. (Coxe, op. cit.) 
 
 In the dyspnoea dependent on chronic bronchitis, 
 Prof. Wood considers the inhalation of ether doubly 
 useful, if carefully managed, both by relieving the dis- 
 tressing sensation, and favoring mucous secretion. 
 ( Wood's Therapeutics, 2d edit., vol. ii, p. 697.) 
 
 Dr. Physick, of Philadelphia, was in the habit of 
 employing the vapor from equal parts of Hoffman's 
 anodyne and laudanum, in cases of recent catarrhs, in 
 coryza, and obstinate hoarseness; and its value in these 
 
 
AIRS, GASES, AND VAPORS. 225 
 
 cases is attested by Dr. Chapman in his work on Ther- 
 apeutics. 
 
 Dr. W. Y. GrADBERRY, of Lexington, Kentucky, re- 
 cords in the Nashville Journal of Medicine and Surgery, 
 October, 1866, some cases of capillary bronchitis treated 
 effectually with inhalations of ether. 
 
 The same gentleman has furnished me with the fol- 
 lowing notes of the effect of the same treatment in a 
 case of acute bronchitis : " Early in the winter of 1866-7, 
 the Rev. Mr. B n left Lexington, Miss., for Cincin- 
 nati, Ohio, suffering with catarrh, and returned in ten 
 days with a violent attack of bronchitis and diarrhoea. 
 During the first week his fever was high, with a pulse 
 ranging from 110 to 130. He complained of oppression 
 of the chest, dyspnoea, and loss of sleep. After a week's 
 trial with the remedies usually adopted in such cases, I 
 became alarmed for the safety of my patient, and de- 
 termined to use inhalations of sulphuric ether. By it 
 the dyspnoea was immediately relieved, sleep became 
 natural and refreshing, his harassing cough gradually 
 subsided, and he soon recovered. He took it at inter- 
 vals, pro re nata." Dr. Gadberry informs me that he 
 had recently asked this patient his opinion of the effi- 
 cacy of the ether in his case, and he assured him that it 
 had given decided and permanent relief. 
 
 In a letter to Dr. Gadberry, from Dr. W. H. Wil- 
 liams, of Lexington, Kentucky, the latter gentleman 
 writes under date of April 15, 1867 : " During the 
 spring of 1866, I was the subject of severe bronchial 
 catarrh, which persisted for many weeks, resisting the 
 ordinary course of treatment prescribed by adapted au- 
 thorities, when, at your suggestion, I began the use of 
 ethereal inhalations, the disease at this time having as- 
 
226 THE INHALATION OF MEDICATED 
 
 sumed a gravity well calculated to arouse my suspicion 
 of approaching tuberculosis. I first used sulphuric 
 ether, and it served well the purpose of relieving the 
 frequent paroxysms of dyspnoea, which, though not se- 
 vere, were extremely annoying. Subsequently I adopted 
 the use of equal parts of ether and tar, and with more 
 gratifying results than I had experienced from the use 
 of ether alone. 
 
 "The combination seems to promote a free and easy, 
 yet not a copious expectoration, but on the contrary ex- 
 hibits a decided tendency to overcome the hypersecre- 
 tion. This, perhaps, is due to a sedative and antiphlo- 
 gistic influence exerted by the tar-vapor upon the in- 
 flamed mucous membrane. I pursued this course for 
 some weeks, to my entire relief." 
 
 Dr. Samuel W. Francis, of Newport, Rhode Island, 
 writes me that he has employed inhalations of ether for 
 a bad sore throat, to which he is subject, and feels con- 
 fident that the inhalation not only alleviated the symp- 
 toms but cured the sore throat ; and he has formed the 
 opinion that we have a valuable remedy by this means, 
 in the treatment of bronchitis. 
 
 The inhalation of sulphuric ether has been recom- 
 mended from various sources as a valuable remedy in 
 cases of hysterical or nervous aphonia. I have myself 
 on several occasions, been able to restore the voice in 
 cases of aphonia in this way, but all of my cases occurred 
 in* military practice during the late civil war, and I 
 have no reason to believe that they were not those of 
 malingering in every instance. It was curious to notice 
 in some of the cases, after the subjects had learned the 
 object of placing them under an anaesthetic influence, 
 how well they could control themselves while going under 
 
AIRS, GASES, AND VAPORS. 227 
 
 the influence of the ether, not a sound escaping them 
 until the moment of unconsciousness; but, oblivion hav- 
 ing once ensued, the effect in coming-to was not antici- 
 pated, or if anticipated, was forgotten under the an- 
 aesthetic state, and the intoxication would be evinced by 
 the usual clamors, when a sudden restoration of con- 
 sciousness would announce to them, with a moral shock, 
 the cure of their aphonia. 
 
 I have, however, succeeded in restoring the voice in 
 cases of so-called nervous aphonia, by the injection of 
 sulphuric ether into the larynx, but here the result was 
 due to the local stimulus, rather than to the thera- 
 peutic effect of the ether. 
 
 Dr. F. D. Lente, of Cold Springs, New York, re- 
 cords (Am. Med. Times, April 6, 1861, p. 224) a case 
 of hysterical aphonia cured by the inhalation of sul- 
 phuric ether. This was an unmarried female, set. 40, 
 who had been an invalid for several years. Early in 
 1860 she lost her voice so that she could not articulate 
 above a whisper. In December of that year she was 
 placed under the influence of sulphuric ether for the re- 
 duction of a strangulated femoral hernia, and twice, on 
 recovering from the anaesthetic influence, the patient ex- 
 pressed her belief that she articulated with less effort, 
 although she still spoke in whispers. Brought a third 
 time under the influence of the ether, preparatory to 
 the operation, certain attendant circumstances kept 
 her under the influence of the ether for two hours, and 
 as soon as she had fully recovered from its effect she 
 exclaimed aloud — " Doctor, I can speak !" and her 
 voice remained permanent up to the date of the report. 
 
 Dr. Lente instances a case reported a short time pre- 
 viously, in which a carman of London recovered the use 
 
228 THE INHALATION OF MEDICATED 
 
 of his voice after a deprivation of eight months, while 
 under the influence of chloroform, for the purpose of 
 overcoming some rigidity about the muscles of his jaw. 
 
 Dr. L. Nordmann, of this city, writes me under date 
 of April 6th, 1867, that at Haddington U. S. A. Gen- 
 eral Hospital, he had under his charge, in 1864, three 
 cases of complete aphonia in United States soldiers, 
 young men otherwise healthy. These men were not 
 considered malingerers by himself nor by his colleagues. 
 They each had made a similar statement, that loss of 
 voice followed a severe cough contracted during pro- 
 longed exposure to wet and cold while on duty, some 
 three months previous to his seeing them. Having 
 heard of a case of aphonia successfully treated in Balti- 
 more by inhalations of sulphuric ether, Dr. Nordmann 
 determined tQ try the eifect of the inhalation of ether 
 on these cases, and as the effects of the anaesthetic 
 passed off, each, to his great surprise, had recovered 
 the proper use of his voice. 
 
 Dr. James H. Hutchinson, of this city, reports 
 (Am. Jour. Med. Sci., April, 1864, p. 412), a case of 
 loss (hysterical) of speech and hearing successfully 
 treated by the inhalation of ether. C. C, a German 
 girl, aet. 20, was admitted to the Episcopal Hospital, 
 September 22d, on account of entire loss of speech, 
 which had occurred ten days previously. Complete 
 deafness supervened two weeks after her admission. 
 
 The history of the case is as follows : She had always 
 enjoyed good health up to two and a half years previous, 
 when she was about to leave Germany for this country. 
 At that time she had a violent quarrel with her fellow- 
 travellers, which gave rise to a hemorrhage from the 
 lungs. During the voyage she had several convulsions, 
 
AIRS, GASES, AND VAPORS. 229 
 
 but upon her arrival in this country she was sufficiently 
 woll to take the place of cook in a private family, and 
 she continued in good health, with short interruptions, 
 up to September of 1863. Dr. Hutchinson found her 
 in the wards of the hospital when he took charge of 
 them at the beginning of the year. He learned that 
 she had had but few convulsions while in the hospital, 
 and that the usual remedies had been tried without re- 
 lieving her condition. Electricity, the various tonics, 
 nux vomica, and lastly, sulphate of aniline, had all 
 been resorted to without benefit. During all this time, 
 her only means of communication with others was by 
 means of a slate. Dr. H. was anxious to discover 
 whether the loss of speech and of hearing was in any 
 degree feigned, and with that view the resident physi- 
 cian was directed to administer ether to her by inhala- 
 tion, in the belief that if such were the case, she would 
 find words as she came under the influence of the an- 
 aesthetic. The result, however, was different from what 
 had been expected. The ether threw her into a slight 
 convulsion, from which she soon recovered, having en- 
 tirely regained her hearing. The experiment was 
 directed to be repeated twice subsequently. Upon re- 
 covering her consciousness she was able to say ma?nma, 
 and to make various inarticulate sounds. She was a 
 third time (three days later) placed under the influence 
 of ether, with the following curious result, — that of re- 
 covery of speech and loss of hearing. A fourth ether- 
 iz-ation produced no immediate result ; but in the course 
 of a few days after, she was able first to hear loud noises, 
 and later, to understand what was said when spoken in a 
 loud tone of voice. The improvement after this was 
 very rapid, and by the middle of January her recovery 
 
 20 
 
230 THE INHALATION OF MEDICATED 
 
 was complete. She was retained in the hospital for 
 observation until the beginning of February ; but as 
 she continued quite well, she was discharged at this 
 time at her own request. Her joy at her recovery may 
 well be imagined, as all hope had been abandoned by 
 herself and friends, by whom application had been 
 made to the managers of the Deaf and Dumb Asylum, 
 for her admission to that institution. 
 
 The Montreal G-azette Medicate publishes from LA- 
 beille Medicate, the report of two cases of diphtheritic 
 angina, or false membranous croup, treated with suc- 
 cess by inhalations of ether, under charge of Dr. M. 
 Besson. 
 
 The first patient was a girl six years of age, who 
 presented the. following symptoms : Swelling of the sub- 
 maxillary glands, puffed face, pulse slightly accelerated, 
 pain in the throat, difficulty in swallowing, mucous mem- 
 brane of fauces engorged and reddened, tonsils strongly 
 tumefied, and presenting several patches of the pellicu- 
 lar exudation which characterizes diphtheritic angina. 
 Voice gone; cough dry, choking, and croupy. Respi- 
 ration short, accelerated, and labored. The patient was 
 at first treated in the usual manner, — by vomits of tar- 
 tar-emetic and ipecacuanha, &c, chlorate of potassa, 
 mercurial frictions around the neck, — ^with no effect, how- 
 ever, except the expulsion of some membranous shreds 
 and patches. As a dernier ressort, Dr. B. thinking it 
 unadvisable to resort to tracheotomy, inhalations of 
 ether were employed. The effect was an attack of suf- 
 focation, accompanied by a violent respiratory struggle, 
 lasting nearly a minute, during which a false membrane, 
 over six centimetre's in length, and three millimetres in 
 thickness, very dense, like a piece of parchment, was 
 
AIRS, GASES, AND VAPORS. 231 
 
 expelled. The effects of this paroxysm gradually sub- 
 sided, and the patient soon went into a calm sleep. 
 After about eight hours the symptoms recurred, and 
 again recourse was had to the ether fumigations, result- 
 ing in further expulsion of false membranous exudation. 
 Calm and sleep again supervened, the croupy symptoms 
 yielded, and in a few days complete recovery had taken 
 place. 
 
 The second patient was a little boy, five years of age, 
 who was attacked with diphtheritic angina. Vomits of 
 sulphate of copper, &c, had been used, followed by the 
 expulsion of some false membrane, but still the symp- 
 toms became aggravated. There was complete aphonia, 
 tonsils tumefied, and covered with whitish patches ; cough 
 insonorous and choking ; successive dyspnoea ; convul- 
 sive movements of the expiratory muscles ; quick, sibi- 
 lant inspiration ; face congested ; eyes injected ; jugu- 
 lars distended ; extreme anxiety, convulsive agitation, 
 and intense fever. In short, the patient was in the 
 midst of these terrible paroxysms, which have hardly 
 any remission, and which announce that the final symp- 
 toms of asphyxia are near at hand. In this condition 
 the patient was made to inhale, in the space of several 
 minutes, about five drachms of vaporized ether, and 
 soon afterwards, in the midst of the violent efforts of 
 a veritable strangulation, he expelled, enveloped in 
 thready mucosities, a false membrane, seven to eight 
 centimetres long, two centimetres in its greatest circum- 
 ference, and very dense. In half an hour the symp- 
 toms of amelioration had become so decided, that the 
 disease was thought to be broken, and during the fore- 
 part of the night the little patient rested quietly. 
 
232 THE INHALATION OF MEDICATED 
 
 Towards midnight, the dyspnoea and the paroxysms 
 became again urgent and violent, so that the patient 
 himself cried for the use of the ether. This second 
 fumigation produced the expulsion of several pieces of 
 false membrane, rolled upon themselves, but smaller 
 than the previous one. Again, subsidence of the croupy 
 symptoms, and their occasional re-occurrence during the 
 next two days, when the ether was again applied. 
 
 The patient finally recovered. 
 
 The evaporation of the ether in these cases was ac- 
 complished by very simple means, placing a bottle con- 
 taining the ether, and terminating in an extemporized 
 tube, into a bowl of water of 40° Cent., the ether fumes 
 were thus carried from the tube with the air of inspira- 
 tion into the air-passages. [Med. and Surg. Reporter, 
 Philada,, April 25th, 1866.) 
 
 Dr. E. R. Livingston, of Plattsmouth, Nebraska, 
 communicates to the Am. Jour. Med. Sci., April, 1867, 
 p. 376, the particulars of a case of laryngitis with ex- 
 udation of lymph, treated with inhalations of sulphuric 
 ether. On the 4th of January, Dr. L. was called to a 
 little girl set. two, the messenger informing him that 
 the patient had croup, and was dying. Previous to his 
 arrival, the mother had administered a full dose of 
 syrup of squills, and he found the patient vomiting and 
 purging freely. Pulse 150 ; tongue slightly coated, 
 somewhat swollen, and red ; fauces red, with an engorged 
 appearance ; tonsils slightly swollen ; considerable ten- 
 derness over the larynx; eyes watery; breathing slightly 
 stridulous, the mother stating that previous to emesis it 
 was very labored, or, as she expressed it, " the child was 
 choking;" countenance expressive of great anxiety ; and 
 
233 
 
 though no coughing occurred at the time of the doctor's 
 visit, he was informed that she had coughed repeatedly 
 with a ringing, croupy cough. 
 
 Inhalations of lime-water were directed, as hot as 
 could be borne by the child ; also one of the following 
 powders every two hours, viz. : 1^. hyd. chlor. mit., gr. 
 x. ; antim. et pot. tart., gr. j. ; ammoniae hydrochlor., 
 5j ; M. ft. chart. No. xii. The mother of the child was 
 instructed to keep a large open kettle of water boiling 
 on the stove, for the purpose of moistening the atmos- 
 phere. 
 
 About midnight Dr. L. received a most urgent request 
 to visit the child immediately, as she was suffocating. 
 Before entering the chamber of the invalid, he was 
 struck with the loud wheezing noise of her respiration, 
 and the peculiar loud, ringing cough. There was 
 great dyspnoea ; respiration performed with difficulty ; 
 nostrils dilated ; muscles of chest and neck violently 
 exerted ; lips livid, and head thrown backwards, with 
 great restlessness, and a slightly cyanosed appearance 
 of the countenance. On inquiry, he was informed that 
 the lime-water inhalations had afforded temporary relief, 
 but that each time they were left off the difficulty of 
 breathing recurred in a short time. 
 
 The parents were informed of the perilous condition 
 of their child, for whose recovery tracheotomy appeared 
 to offer the only hope, though with very little encour- 
 agement. At this moment, remembering the suggestion 
 of Dr. Black and Dr. Gadberry, he proceeded to ad- 
 minister some of Squibb's ether by inhalation, according 
 to the directions of Dr. Lente, as reported by Dr. 
 Packard in the Am. Jour. Med. Sci., for Jan. 1866, 
 premising the inhalation by the internal administration 
 
 20* 
 
234 THE INHALATION OF MEDICATED 
 
 of half a teaspoonful, which, as anticipated, was swal- 
 lowed with difficulty, and caused a severe paroxysm of 
 coughing. 
 
 In precisely eight minutes from the time the patient 
 commenced the inhalation, the abnormal muscular exer- 
 tion ceased ; a general relaxation took place ; the pulse 
 fell to 100, and the peculiar "flip" sound of partially 
 detached membrane was distinctly heard during expira- 
 tion ; the loud wheezing noise of the breathing abated, 
 and in thirteen minutes the child was sleeping in com- 
 parative ease. In about ten minutes more she coughed, 
 not with the loud, ringing, metallic sound so peculiar 
 to this affection, but with the moist rale which every 
 practitioner hails as the harbinger of success in the 
 treatment of this dreadful malady. The coughing was 
 followed by efforts at vomiting, and numerous portions 
 of membrane were discharged, the edges having a whit- 
 ish, and the centres a grayish appearance; they were 
 oblong in shape, from an eighth to three-fourths of an 
 inch in length, and from half a line to a line in thick- 
 ness. A few times more, at short intervals, coughing 
 occurred, followed by emesis and the expulsion of ad- 
 ditional portions of membrane. The vomiting now 
 ceased, and the child slept almost naturally, the respira- 
 tion being normal. Her sleep was frequently disturbed 
 by short fits of coughing ; but the intervals of rest in- 
 creased in duration, and no more membrane was expelled, 
 though it was evident that she occasionally swallowed 
 portions without completely awakening. At 4 o'clock 
 the child was *out of danger ; at 10 A. M. awake and 
 playful. The recovery was entire. 
 
 In commenting on this case Dr. Livingston acknowl- 
 edges that the previous exhibition of the powders, and 
 
235 
 
 the inhalations of the nebulized lime-water, may render 
 it doubtful if the recovery was entirely due to the inha- 
 lation of the ether ; and suggesting that the spray of the 
 lime-water is in great measure carbonated by inhala- 
 tion, and thus rendered inoperative, he attributes the 
 temporary relief afforded by its administration to the 
 warm moisture of the water. But as there was no evi- 
 dence of permanent relief until the administration of 
 ether by inhalation, and the favorable effect of the latter 
 was rapidly produced under his direct observation, he 
 has no hesitancy whatever in ascribing the recovery to 
 the ether. 
 
 Dr. W. Y. Gadberry, of Yazoo City, Mississippi, 
 has furnished me the following notes of a case of croup 
 treated by inhalations of sulphuric ether : 
 
 " On the night of the 15th of April, 1867, I was 
 called, in the absence of the attending physician, to see 
 a child of Mr. M , get. eight months. When I ar- 
 rived the child was in imminent danger of dying from 
 non-plastic croup. It had been relieved on the night 
 previous with emetics of alum and lobelia, and cold ap- 
 plications to the throat. The fever, however, continued 
 up to the time of my visit. I ordered an alum emetic, 
 which acted promptly ; applied turpentine and hot 
 flannels to the throat, and a snuff plaster to the chest. 
 In the course of half an hour the symptoms improved 
 some little, but not enough to justify my departure, or 
 any assurance of permanent relief. I then resorted to 
 inhalations of sulphuric ether, which gave complete 
 relief in five minutes to all the difficulty of respiration; 
 nor did it return any more. To relieve the febrile ex- 
 citement I directed hyd. cum creta, to be repeated 
 until it acted on the bowels." 
 
236 THE INHALATION OF MEDICATED 
 
 The anaesthetic virtues of ether do not come under 
 consideration in this volume. 
 
 Inhalation of Balsamic Vapors. 
 
 The custom of sending patients with pulmonary com- 
 plaints to localities where they might constantly breathe 
 the balsamic atmosphere produced by the vegetation of 
 aromatic plants, is of very ancient origin. 
 
 In the middle of the seventeenth century, Dr. Bennet 
 of London employed an artificial atmosphere of this 
 kind, by the fumigations of frankincense, styrax, and 
 turpentine, with coltsfoot, cinnamon, &c, in powder, 
 or made into troches and burned upon coals. He also 
 employed the vapors from mixtures of herbs over which 
 boiling water had been poured. [Copland's Diet.) 
 
 They were much used by Mead and others, and are 
 recommended among other inhalations by Dr. Tweedie, 
 in his treatise on Diseases of the Respiratory Organs, 
 as promotive of secretion. 
 
 Balsamic inhalations at one time attracted a great 
 deal of attention in continental Europe ; they were rec- 
 ommended by Delpit, Rullier, Maygrier, and others, 
 and very strongly by Trousseau and Pidoux in the 
 treatment of chronic pulmonary catarrhs, and obstinate 
 cases of chronic laryngitis, especially when connected 
 with ulceration. 
 
 The plan advised by Trousseau and Pidoux is to 
 throw some of the balsam upon live coals, which they 
 consider preferable to the method of pouring boiling 
 water upon some of the material in an inhaler, because 
 after their method, the apartment becomes filled with 
 the vapor, and the patient can remain for whole days 
 in an atmosphere thus impregnated. They state that 
 
237 
 
 chronic catarrhs have been cured in this manner after 
 failure with the same remedies used internally. 
 
 These inhalations were found valuable in phthisis, as a 
 means of preserving strength, and thus prolonging life. 
 The balsams most constantly employed were benzoin, 
 and, more frequently, balsam of Tolu ; and the balsam 
 of Peru was also occasionally employed in the same 
 way. 
 
 Inhalation of an ethereal solution of Tolu has been 
 successfully employed by M. Roziere in cases of bron- 
 chial catarrh, loss of voice, and chronic affections of the 
 chest generally. His plan is to mix 20 grammes of the 
 balsam with 60 grammes of sulphuric ether ; the mix- 
 ture to be placed in a wide-mouthed bottle which the 
 patient holds, uncorked, to his nose for two or three 
 miuutes every half hour. 
 
 As, however, the inhalation of sulphuric ether alone, 
 as mentioned previously, is very highly recommended 
 in these very affections, it is not improbable that much 
 of the beneficial effect of the ethereal solution of Tolu 
 is attributable to the menstruum. 
 
 To employ the balsams with the ordinary inhaler, 
 boiling water may be poured upon one or two drachms 
 of the drug. 
 
 The balsam of copaiba has been much used in inha- 
 lation by Dr. Edward J. Coxe, of Baltimore, in the 
 treatment of chronic laryngeal and bronchial affections. 
 
 Inhalations of Vapors of Turpentine. 
 
 Professor Skoda has treated gangrene of the lung 
 successfully by turpentine inhalations. His plan is as 
 follows : The essence of turpentine is poured upon boil- 
 ing water and the patient is directed to inhale the vapor 
 
238 THE INHALATION OF MEDICATED 
 
 arising therefrom for fifteen minutes every two hours. 
 Sulphate of quinia is also administered in the usual 
 doses. Four cases are reported (Medical Times and 
 Grazette, April 15, 1853 ; and Zeitschr. filr K. K., 
 G-eselsch. der Aerzte zu Wien., 1853, t. ix, p. 445). 
 The first case was that of a servant affected with limited 
 gangrene of the superior lobe of the right lung. After 
 six weeks of this treatment, it became impossible to de- 
 tect either infiltration or gangrene of the organ. On 
 the contrary, the respiratory murmur had returned over 
 the whole region. Three months afterwards the patient 
 was seen in good health. 
 
 In the second case, an innkeeper, of mature age and 
 strong constitution, became the subject of a gangrenous 
 cavity in the lower lobe of the right lung, consequent 
 upon disease commencing March 11, 1852. On March 
 21st, the patient began with the inhalations of the 
 vapor of turpentine ; he continued, without repugnance, 
 for five or ten minutes every two hours, taking, at the 
 same time, the usual doses of quinia. At the end of 
 three weeks, the expectoration, which had been extremely 
 abundant (a pint and a half daily), became reduced to 
 a quarter of a pint. The inspirations had been em- 
 ployed four times a day. At the end of six weeks the 
 patient could quit his bed. His strength was returning, 
 the appetite was improving, and his general aspect 
 favorable ; but the expectoration continued to be fetid 
 from time to time, and was always sanious. The right 
 side of the chest was painful, and respiration labored, 
 but the air entered the circumference of the lower lobe ; 
 the respiration being uncertain and accompanied by 
 feeble rales and sibilance. The patient went into the 
 country, where he continued the turpentine inspirations 
 
AIRS, GASES, AND VAPORS. 239 
 
 twice a day up to the middle of July, when both cough 
 and expectoration had entirely disappeared. In the 
 month of December, 1852, he came to M. Skoda for a 
 certificate of health. There was no pain, nor oppres- 
 sion, nor cough. He had recovered his embonpoint and 
 his strength ; there was no retraction of the thorax ; 
 vesicular respiration everywhere. 
 
 In the third case it was not in the Professor's power 
 to persist in the plan. 
 
 The fourth case was still under treatment. A butcher, 
 of strong constitution, had a gangrenous cavity in the 
 inferior lobe of the left lung. He fell ill about the end 
 of May, 1852. The inspirations of turpentine were 
 commenced June 4th. At the end of a week, the fetid 
 expectoration, which daily equalled two pints, had en- 
 tirely disappeared, and the patient considered himself 
 well, because the pain and the oppression in breath- 
 ing had diminished, the appetite had returned, and the 
 sleep was tranquil. He therefore left off inhaling the 
 turpentine, which was extremely disagreeable to him. 
 On June 19th there came on a severe shivering fit, with 
 cough and dyspnoea, and during the following night the 
 patient expectorated several pints of extremely fetid 
 sanies of dirty brown color. The inspirations were rec- 
 ommended, but the patient used them as little as possi- 
 ble, on account of the irritation which they produced in 
 the air-passages. In eight days the quantity of matter 
 brought up had greatly diminished, and the pulse was 
 normal, but there was pain in the chest. The patient 
 lay immovable upon his back in a state of great weak- 
 ness and prostration; there was no appetite. The lower 
 lobe of the left lung was impervious to air. The inspira- 
 
240 THE INHALATION OF MEDICATED 
 
 tions were again suspended, but again recommenced on 
 account of recurrence of the bad symptoms, the disa- 
 greeable odor of the turpentine being partly rectified by 
 a few drops of the essence of rose. About the middle 
 of October he was able to go into the country, having 
 recovered strength sufficient to leave his bed ; neverthe- 
 less, there remained a sense of oppression and pain 
 under the left scapula. At the end of January he con- 
 sidered himself well. There was a sudden expectora- 
 tion of two ounces of blood, after a slight fit of cough- 
 ing, on February 10th, probably proceeding from the 
 callous walls of a former gangrenous cavity ; but there 
 are no signs of further infiltration, and the case seems 
 likely to terminate well {Banking's Abstract, 1854, 
 vol. 19, p. 69). 
 
 The inhalation of the vapors of turpentine has also 
 been recommended as a remedy in whooping-cough 
 (Schmidt's Jahrbilcher, 1866 ; Band 130, p. 63). 
 
 The oil of turpentine may be inhaled by putting 20- 
 60 drops in an ounce of water and applying heat. 
 
 Inhalation of the Vapors of Tar. 
 
 Sir Alexander Crichton published, in 1817, " An 
 account of some experiments made with the vapor of 
 boiling tar in the cure of pulmonary consumption," in 
 which he explains that accident led him to the discovery 
 of this potent remedy, which he placed before the notice 
 of the profession. 
 
 Drs. Bluhm and Von Roos, reporting upon the value 
 of these inhalations, state, as the result of the study of 
 many cases, that the tar fumigations produce a very 
 prompt and salutary effect upon the cough, the expec- 
 
AIRS, GASES, AND VAPORS. 241 
 
 toration, and the respiration ; and that the sleep be- 
 comes more tranquil, continuous, and restorative ; and 
 that the patient thus regains strength. (Ctfxe, op. cit.) 
 
 The tar recommended by Sir Alexander Crichton is 
 that used for the cordage of ships, to every pound of 
 which he added half an ounce of the subcarbonate of 
 potassa, in order to neutralize the pyroligneous acid. 
 
 He placed the vessel containing the tar over a spirit- 
 lamp, taking care that it should boil slowly and not 
 burn ; the tar being renewed every three hours, so as to 
 keep the apartment impregnated with the vapor night 
 and day. The vessel must be cleansed daily to prevent 
 the incineration and decomposition of the residuum, 
 which is irritating. 
 
 These fumigations were not employed alone, other 
 remedies being employed as deemed advisable. 
 
 Dr. Mackintosh {Practice of Physic) recommends 
 the inhalation of the vapors of tar in chronic uncom- 
 plicated bronchitis. 
 
 Dr. Eberle recommends the fumes of tar in whoop- 
 ing-cough. 
 
 Dr. M. Baillie, of London, attests the value of inhala- 
 tions of vapors of boiling tar and vinegar, in tonsillitis, 
 and similar affections. 
 
 Dr. Morton, of Philadelphia, employed inhalation of 
 tar vapor extensively as a palliative in consumption, 
 and preferred it to any other method of treating chronic 
 catarrh. 
 
 Prof. Wood (Therapeutics, &c, 2d ed., vol. i, p. 78) 
 has witnessed the happiest effects from the vapors of tar, 
 when continued for months, in very threatening chronic 
 pulmonary disease. 
 
 I have frequently seen benefit from the vapors of tar 
 21 
 
242 THE INHALATION OF MEDICATED 
 
 in cases of advanced phthisis, and in chronic bronchitis, 
 where, if it has no other local influence, it at least re- 
 duces the irritability of the mucous membrane, checks 
 hypersecretion to some extent, and facilitates expecto- 
 ration, thus conserving the powers of the patient. In 
 recent inflammations, and in the hectic fever of phthisis, 
 its use requires caution, as it has been said to induce 
 congestion, and may thus give rise to hemorrhage or 
 severe inflammation. 
 
 Prof. Chapman found benefit from the fumes of con- 
 centrated pyroligneous acid in foul ulcerations of the 
 throat and nostrils [Therapeutics, vol. ii, p. 36). 
 
 Inhalation of Vapors of Creasote. 
 
 Creasote may be inhaled in the proportion of three 
 to fifteen drops to the ounce of water, heat being 
 applied; or it may be employed alone at ordinary tem- 
 peratures. It may be inhaled from any of the inhalers ; 
 or very simply, by pouring boiling water over a few 
 drops of creasote in the bottom of a teapot, and inhal- 
 ing through the spout. 
 
 Creasote inhalations will, it is said, often relieve the 
 irritating cough of phthisis, after the failure of opiates 
 and like remedies, allaying the irritation, checking the 
 secretion, assisting expectoration, and thus acting ben- 
 eficially by conserving the patient's strength, prevent- 
 ing exhaustion from paroxysms of severe cough, &c, 
 even if it has no specific remedial agency. 
 
 Inhalations of vapors of creasote are reported to 
 agree usually very well from the first ; but in irritable 
 constitutions, where they are not so readily tolerated, 
 it has been recommended to subdue the irritability of 
 the mucous membrane, by a previously instituted inha- 
 
AIRS, GASES, AND VAPORS. 243 
 
 lation of the vapor from coniutn ; and where there is 
 any tendency to spasm, to add a few drops of the liquor 
 potassse at the moment of employing the inhalation. 
 
 Dr. Elliotson [Med. Chir. Trans., vol. xix, p. 217) 
 records that in phthisis, he has, in many instances, 
 caused patients to breathe for four or five minutes at a 
 time, and four or five times a day, a mixture of creasote 
 with mucilage and water, but without any decided result. 
 He has found such inhalations useful, however, in cases 
 of bronchitis with profuse discharge, those designated 
 as bronchorrhoea ; he has also found them useful in 
 asthma; and so also in chronic affections of the larynx, 
 trachea, and bronchi generally, he has found them of 
 great advantage, both when used alone, and when con- 
 joined with other medications ; and he has not known 
 any inconvenience to have resulted from their employ- 
 ment in a single instance. 
 
 MM. Serres and Andral, in their report read at 
 the seance of the Academie des Sciences, Nov. 30th, 
 1857 {Gazette Hebdomadaire, Dec. 11th, 1857), upon 
 fumigations of acetic acid and creasote in the treatment 
 of chronic bronchitis, recommended by M. L. Mandl, 
 state that the varieties of bronchitis for which this treat- 
 ment is recommended are, the dry catarrh of Laennec ; 
 chronic bronchitis with unilateral subcrepitant rale ; 
 and the bronchitis of pleurisy. These three varieties 
 form a group which is designated by Mandl under the 
 name of bronchite seche, characterized by the paucity of 
 symptoms furnished by auscultation and percussion. 
 The treatment consisted simply in the employment of 
 warm fumigations by means of an apparatus composed 
 of a glass globe with double tubulure, furnished with a 
 rubber tubing, and placed upon a copper stand. Into 
 
244 THE INHALATION OF MEDICATED 
 
 the vessel is introduced 60 grammes of water, and 5 
 grammes of a solution composed of 5 grammes of crea- 
 sote, 50 grammes of acetic acid, and 500 grammes of 
 water. The liquid is then heated, and the fumes that 
 arise are inspired by the patient. The strength of the 
 mixture is to be gradually increased, according to the 
 duration of the malady, the susceptibility of the larynx, 
 and bronchi, &c. Chronic mucous catarrh will not 
 yield to the acid fumigations as readily as the dry 
 bronchitis. In such cases he employs the emetics in 
 addition, repeated whenever indicated by the abun- 
 dance of rales. In the pituitous catarrh, properly so 
 called, so frequently connected with an affection of the 
 heart, and which in all cases, especially when it has 
 existed several years, denotes a considerable degree of 
 alteration of the mucous membrane of the bronchi, the 
 acidulated fumigations, if well supported, will amelio- 
 rate the condition of these tubes, but will not cure them. 
 
 Inhalation of Vapors of Oleum Pini Pumelion. 
 
 Lewin (op. cit, p. 207) speaks of the use of the ol. 
 pini pumelion, with a few drops of which he saturates 
 a small piece of cotton, which is then placed in the bowl 
 of a small smoking-pipe, through which the patient in- 
 spires for several hours at a time. This oil, he states, 
 contains less resin than the ol. terebinth., and is not 
 unpleasant to the taste. The breath and urine soon 
 acquire its peculiar odor, proving its absorption. It 
 seems partly to induce contractility of the sluggish and 
 relaxed vessels, and partly to act as an excitant and 
 expectorant to the mucous membranes. More than 
 from three to five drops are not to be given in a single 
 day, because a larger quantity may become too stimu- 
 
AIRS, GASES, AND VAPORS. 245 
 
 lating. Dr. Lewin has employed such inhalations with 
 success in chronic pulmonary catarrhs, and in pulmonic 
 blennorrhea ; and Dr. Boer recommends its loosening 
 effect from the relief experienced by himself in a tight 
 catarrh. It was at a much earlier date employed by 
 Copland in bronchitis, and recommended by him. 
 
 Inhalation of Vapors of Oleum Pini Sylvestris. 
 
 Quite recently (Lewin, op. cit., p. 208), Prof. Ger- 
 HARDT, of Jena, has made some investigations into the 
 action of the ol. pini sylvest., in chronic affections of 
 the respiratory organs. Into a basinful of hot water 
 he drops from six drops to two teaspoonfuls of the oil, 
 and the patient breathes, through a tube, the vapor that 
 is given off, from half an hour to two hours daily. The 
 effect of this inhalation is found to be very similar to 
 that produced by the oil of turpentine, only that the 
 latter is rather more antiseptic, and the former more 
 astringent 'and sorbefacient. The best results were ob- 
 tained in chronic catarrh of the larynx or bronchi, and 
 also in dilatation of the minuter bronchi, one case of 
 which was so far relieved after four weeks' inhalation, 
 that the lessening of the calibre of the bronchi was 
 noticeable, and the expectoration, which previously had 
 been profuse, decreased in quantity, and eventually 
 ceased ; while an inhalation of sal-ammoniac instituted 
 earlier had been followed by hardly any result. 
 
 The inhalations of the oleum pini were not always 
 well borne, but in the majority of cases, soon produced 
 a decreasing effect upon the amount of expectoration. 
 
 21* 
 
246 THE INHALATION OF MEDICATED 
 
 Inhalation of the Resinous Vapors of the Conifers. 
 
 Dr. W. W. Ireland [Edinburgh Medical Journal, 
 Feb. 1864 ; British and Foreign Med. Chir. Review, 
 July, 1864, p. 250) had already made the observation 
 that in pine forests, the quantity of ozone in the air 
 was increased by their resinous emanations, which con- 
 tained, if not ozone itself, at least a substance possess- 
 ing many of its properties. He records some practical 
 observations made at a little town called Die, in the 
 south of France, on the therapeutic effect of resinous 
 vapors. This kind of treatment was in popular use 
 among the mountains of Dauphind for more than a 
 century, and was discovered by accident. Some la- 
 borers were cutting wood for preparing pitch, when one 
 of them was suddenly seized with acute rheumatism in 
 the legs, which disabled him from the more active work, 
 but allowed him to arrange the cut wood in the furnace. 
 After working a little time at this employment, which 
 exposed him to the resinous vapors from the wood, he 
 felt his complaint gradually disappearing; and the 
 cure thus effected became known among the peasantry, 
 and subsequently attracted more particular attention. 
 
 Dr. Chevandier, finding that the peasants suffering 
 from rheumatism exposed themselves to the vapors of a 
 pitch furnace, and thus became cured of their complaints, 
 examined the subject in a scientific manner. He found 
 that the peasants had been in the habit of sitting in the 
 furnace at a heat of nearly 190° Fahrenheit, and his 
 own experience showed that in an atmosphere saturated 
 with turpentine vapors, that very high temperature was 
 not only tolerable but pleasant, and he himself entered 
 the furnace to study its physiological effects. He 
 
AIRS, GASES, AND VAPORS. 247 
 
 found that the skin perspired freely, the pulse rose, 
 and his sensations were agreeable. 
 
 Since these experiments were made, some baths have 
 been used at Die, on the same principle as the pitch 
 furnace. They resemble a large baking-oven, the fire 
 being below ; and the resinous layers of pine wood are 
 strewed upon the floor, and the patient sits upon a 
 bench, wrapped in a porous covering of wool. 
 
 The temperature to which the patients are exposed is 
 generally from 140° to 158° Fahr., and they remain 
 from fifteen to twenty minutes. The sensations of the 
 patients are agreeable, and the perspiration is abundant, 
 the pulse rising from twelve to fifteen beats, and at first 
 the respiration is accelerated. After the proper period 
 has expired, the patient goes to bed, where he remains 
 an hour or two. 
 
 The diseases treated by this plan are rheumatism in 
 all its forms ; inflammation of mucous surfaces, as 
 chronic bronchitis and laryngitis ; neuralgia ; glandular 
 enlargements ; and constitutional syphilis. Nine-tenths 
 of the patients who come to Die suffer from rheumatism, 
 the muscular form yielding more readily than any other, 
 but articular rheumatism yields more slowly. After 
 rheumatism, chronic bronchitis appears to be most ben- 
 efited by this treatment, probably from the effects of 
 the vapor on the diseased mucous membrane. Five 
 cases of phthisis are also said to have been successfully 
 treated by courses of twenty baths, but most of the 
 cases were in the first stage. 
 
 Pectoral complaints never occur among those who 
 work in turpentine, and in the south of France it is 
 known that these maladies and rheumatism are compar- 
 atively rare among the inhabitants of districts covered 
 
 
248 THE INHALATION OF MEDICATED 
 
 by pine forests ; and hence it would appear that the res- 
 inous vapors possess some important therapeutic prop- 
 erties in these diseases. 
 
 Dr. Ireland suggests that the beneficial effects may 
 be due to the influence of ozone or antozone upon the 
 blood. Hence, fumigations of the resinous layers of 
 fresh pine wood, or of oil of turpentine, may be benefi- 
 cial in phthisis, or the patient may live in a room or 
 conservatory filled with saplings of pine. 
 
 Baths, like those used at Die, have been attempted 
 in other places, as at Grenoble, Valence, and near Vau- 
 cluse, but the wood the inhabitants employ is said not 
 to be the same; and Dr. Ireland recommends patients 
 laboring under obstinate rheumatism or bronchitis to go 
 to Die, which is reached by a diligence, starting from 
 the railway station at Valence. Die is a small town, 
 situated in a beautiful valley among the Alps of Dau- 
 phin 4, the lofty peaks of which guard it from the mis- 
 tral, and its elevated situation saves it from the scorch- 
 ing heat of the summer of the South. 
 
 Inhalations of the vapors of resin have been employed 
 under the same circumstances as the vapors of tar, tur- 
 pentine, creasote, &c, and the well-known effect of 
 such inhalations has prompted the practice, which is 
 of very ancient origin, of sending patients affected with 
 phthisis and other chronic pulmonary affections, for 
 temporary or permanent residence, to regions in which 
 pine forests abound. 
 
 Also the fumes from burning undressed wool have 
 been recommended in cases of chronic laryngitis and 
 bronchitis, and they have also been said to prove ad- 
 vantageous in phthisis. 
 
 It may be remarked in connection, that the assertion 
 
AIRS, GASES, AND VAPORS. 249 
 
 has been made that young persons employed in wool- 
 factories are exempt from phthisis, in consequence of 
 the constant exposure to the inhalation of oil, which is 
 used in large quantities in such factories. 
 
 Inhalation of Permanganate of Potassa with Vapor of 
 Water. 
 Staff- Surgeon Dr. Thalwitzer, of the Prussian army, 
 during the recent war with Denmark, employed inhala- 
 tions of permanganate of potassa with vapor of water 
 in two cases of severe dyspnoea, consequent on gun- 
 shot wound of the chest. Five grains of the permangan- 
 ate of potash were added to the water inhaled at each sit- 
 ting. The instrument employed consisted of a tightly- 
 closed cylinder with a funnel-shaped cover, the tube of 
 which, after rising for a foot, was bent at an angle and 
 then continued horizontally for another foot in length. 
 In both cases the expectoration became decreased, and 
 in one case, in which pulmonary gangrene had ensued, 
 the foul odor was markedly reduced. Both patients 
 liked the inhalation, which relieved the difficulty of 
 expectoration and improved their general condition. 
 {Schmidt's Jahrbucher, 1866 ; Band, 130, p. 140.) 
 
 Inhalation of the Vapors of Nitrate of Potassa. 
 
 Inhalation of the fumes from burning nitrate of potash 
 have been much lauded in cases of asthma. Pieces of 
 bibulous paper are soaked in a saturated solution of the 
 nitrate and then dried. When used, the paper is set on 
 fire in a convenient vessel and the patient inhales the 
 fumes as they are given off, or merely breathes the air 
 of the apartment. Sometimes they are smoked in a pipe 
 in the same way as ordinary tobacco. They have also 
 
250 THE INHALATION OF MEDICATED 
 
 been employed in whooping-cough and in the spasmodic 
 coughs attendant upon other affections. Recently they 
 have been much recommended by Dr. Hyde Salter, in 
 the treatment of asthma. 
 
 Sal Ammoniac — Muriate of Ammonia. 
 
 This substance has been recognized as a beneficial 
 agent in the treatment of affections of the throat and 
 respiratory organs, from the very earliest periods in the 
 records of medicine. 
 
 It was first employed by inhalation, according to 
 Lewin, by a pupil of the famous Prof. Schonlein, Prof. 
 Fuchs, of Gottingen. In the published report of the 
 Gottingen Clinics for 1838 and 1839, it is recorded that 
 Prof. Fuchs employed the inhalation of the vapors from 
 sal ammoniac in the treatment of chronic catarrhs of the 
 respiratory organs, placing the material upon a heated 
 porcelain plate, and directing the patient to breathe the 
 fumes. Lasseque, more recently, resorted to the same 
 means, in France, with satisfactory results. Later, in 
 1855, the fumes from sal ammoniac were highly recom- 
 mended by Dr. Gieseler in chronic pulmonary catarrh, 
 and his method of administration is as follows : Two or 
 three teaspoonfuls of the salt are placed in a Hessian 
 crucible and heated over a Berzelius lamp, the patient 
 sitting in front of the apparatus and inhaling the vapor ; 
 the chamber soon becomes filled with the fumes of sal 
 ammoniac, and for some time after their disengagement 
 has been discontinued, the invalid remains in the 
 strongly-impregnated atmosphere. 
 
 Direct inhalations give better results than breathing 
 the strongly-impregnated atmosphere of a room in which 
 the fumes are being disengaged. Paroxysms of cough, 
 
 
251 
 
 with profuse expectoration, ensue only during the earlier 
 sittings ; later, there results merely a sensation of 
 warmth in the air-passages. 
 
 Lewin, of Berlin, devised a chemical process for pro- 
 curing the vapors of sal ammoniac in a nascent state 
 without the employment of heat or fire, which latter 
 method, besides being inconvenient, evolves the fumes 
 too rapidly and too profusely, thereby filling the cham- 
 ber with the fumes, and often provoking cough, &c. 
 
 Fig. 12.* 
 
 Lewin's apparatus for the inhalation of vapors of sal ammoniac. (From Lewin.) 
 
 This apparatus (Fig. 12) consists of a series of three 
 Wolfe's bottles. One of these contains liq. ammonias 
 caustici, another pure muriatic acid, and the third bottle, 
 
 * a, glass vessel containing strong aqua ammonia? ; &, glass ves- 
 sel containing muriatic acid ; c, glass vessel containing distilled 
 water, slightly acidulated ; d, rubber tubing, to which is attached 
 the mouth-piece ; e, /, connecting glass tubes ; g, h, glass tubes for 
 admittance of atmospheric air. 
 
252 THE INHALATION OF MEDICATED 
 
 which is filled with water, receives a tube from each of the 
 other bottles, these tubes reaching to the bottom of the 
 water, while from a third opening in the cork the vapor 
 extrudes through an exit tube, to which a mouth-piece 
 is attached by India-rubber tubing. Now, as the effort 
 of inspiration draws the liquids from the first two bottles 
 into the third bottle, their ingredients combine to form 
 the sal ammoniac vapor, which, during its passage 
 through the water, becomes cleansed of impurities. If 
 it is desired to medicate the nascent sal ammoniac with 
 creasote, or an oleo-balsamic mixture, or bitter almond 
 water, &c, all that will be necessary, will be to add 
 it to the water in the third bottle. 
 
 Dr. Pasch (Preuss. Vereinzeitung, 1862, 19, quoted 
 by Lewin, p. 200) places a drachm of liq. ammon. caustici 
 in a saucer, in which he places a watch-glass containing 
 3j — 5ss of pure muriatic acid. White fumes of sal am- 
 moniac are immediately evolved, and, as in other cases, 
 may be inhaled with or without the use of a funnel, to 
 direct them into the mouth. A great excess of ammo- 
 nia is produced by this method, but it is not considered 
 injurious. There always remains a quantity of carbonic 
 acid gas in the lungs of catarrhal patients which is not 
 exhaled, and which, remaining in the minutest bronchi, 
 becomes converted into carbonate of ammonia as the sal 
 ammoniac reaches it. 
 
 I have often instructed patients merely to place a 
 pinch of the salt upon an iron spoon and hold it over 
 the flame of a gas or spirit-lamp ; the fumes are evolved 
 in a few moments, and the spoon can be removed and 
 the fumes inhaled until evaporation ceases, when the 
 process is to be renewed until the required amount has 
 been employed. 
 
AIRS, GASES, AND VAPORS. 253 
 
 I can testify to the extreme value of these inhala- 
 tions in cases of dryness of the fauces, even when of 
 several years' standing, as met with in salesmen and 
 others, whose mouths are more or less frequently open, 
 and who, by the nature of their employment, are ex- 
 posed to variations of temperature ; also in the dryness 
 of the fauces of cooks, bakers, and others who are con- 
 stantly breathing a heated atmosphere ; also in chronic 
 pharyngitis; in the commencing stage of bronchitis, to 
 induce free secretion ; in snuffles, naso-pharyngeal ca- 
 tarrhs, &c. 
 
 Inhalation of Vapors from Opium, and other narcotics. 
 
 Opium, as is well known, is extensively inhaled in 
 the East for sensual purposes. The Chinese place a 
 portion of the extract, the size of a pea, into the bowl 
 of a pipe, which is heated over a flame for a time, and 
 then the opium is set on fire and the smoke forcibly in- 
 haled. 
 
 Dr. Snow's method is to place the required quantity 
 of the extract, in the form of a pill, upon the capsule 
 of his inhaler, described on pages 179 and 180, and 
 then the spirit-lamp is lighted beneath ; the patient be- 
 ginning to inhale immediately, and continuing to do so 
 until volatilization ceases, the process usually lasting 
 about ten minutes, and leaving as residue a porous car- 
 bonized mass. 
 
 Morphia, in doses of half a grain, may be used for 
 inhalation in preference to opium, than which it is said 
 to be pleasanter, inasmuch as the extract of opium sup- 
 plies some smoke in addition to its active principles. 
 The morphia is mixed with dry plaster of Paris to in- 
 crease its bulk. 
 
 22 
 
254 THE INHALATION OF MEDICATED 
 
 Extract of stramonium has been used by inhalation 
 in the same manner as extract of opium, in cases of 
 asthma, and with asserted relief. 
 
 Inhalation of vapors of stramonium was first intro- 
 duced by Ziegler, and has been highly extolled by Mar- 
 tin Solon, Andral, Trousseau, and many other Conti- 
 nental authorities. It has been employed a good deal 
 in this country, though not much positive information 
 has been recorded. These vapors are also said to give 
 relief in the exhausting cough and impeded respiration 
 of phthisis ; and in dyspnoea from any cause. 
 
 The dried leaves, or the fibres of the root may be 
 smoked, alone, or with tobacco if the patient is accus- 
 tomed to tobacco, either in a pipe, or a cigarette ; or 
 cigars may be steeped in a strong decoction ot stramo- 
 nium and then dried until fit for smoking. 
 . As ordinarily smoked, it is doubtful whether the 
 remedy gains access into the lungs, but if the smoke, as 
 it issues from the mouth after the puff of the smoker, is 
 inspired, it will then be drawn into the lungs and the 
 effect will be more prompt ; otherwise it does not enter 
 the larynx, and the effect is due to absorption by the 
 mucous membrane of the mouth and pharynx. 
 
 Belladonna, employed in a similar manner, has been 
 recommended by many of the same authorities for the 
 cure of spasmodic asthma ; it is sometimes mixed with 
 tobacco and smoked, and sometimes the vapor from an 
 infusion in water is inhaled. 
 
 Other narcotics have also occasionally been employed 
 by inhalation for similar purposes. 
 
 Inhalation of Camphor. 
 This substance was probably first employed by inha- 
 
AIRS, GASES, AND VAPORS. 255 
 
 lation by the Arabian physician Avicenna. In the form 
 of vapor, camphor is sometimes inhaled in asthma, croup, 
 spasmodic coughs, and chronic catarrhal affections ; and 
 there is no doubt that its constitutional impression may 
 be obtained in the same way. It may be inhaled by 
 means of an ordinary inhaler, placed in water more or v 
 less heated, to favor the volatilization of the camphor. 
 
 M. Raspail recommends that a small tube, a quill, 
 for example, should be filled with the coarsely-powdered 
 medicine, and loosely closed at each end, so as to admit 
 the passage of air, and that this should be used in the 
 same manner as a cigar, but without burning. In the 
 inhalation of camphor, care must be taken to arrest the 
 process when signs are exhibited of its acting on the 
 brain. 
 
 A piece of camphor held before the nostrils, so that 
 its vapor may be snuffed up into the nasal passages, is 
 sometimes beneficial in coryza. Powdered camphor has 
 been recommended to be used in the same way, and for 
 the same purpose, as well as for the relief of various 
 spasmodic or catarrhal affections of the air-passages. 
 ( Wood's Therapeutics and Pharmacology, Phila., 1860, 
 vol. i, p. 714.) 
 
 A drachm or more of the tincture of camphor may 
 be placed in an ounce of water, and inhaled with the 
 watery vapor evolved by a. spirit-lamp. 
 
 Inhalations of the vapor of camphor were much em- 
 ployed by Dr. Bodtcher of Copenhagen. 
 
 The inhalation of vapors of camphor with those of 
 iodine have been used successfully by Prof. A. P. 
 Merril, now of New York. [Memphis Medical Re- 
 corder, March, 1855, p. 228.) 
 
256 THE INHALATION OF MEDICATED 
 
 Inhalation of Tobacco Smoke. 
 
 In those who by habit have not lost their suscepti- 
 bility to the effect of this plant, the inhalation of the 
 smoke from tobacco will often serve a good purpose in 
 nervous affections of the respiratory organs. It has 
 thus been recommended in ordinary spasmodic cough, 
 in asthma, in phthisis, and also in spasmodic croup. 
 
 Lime Inhalations. 
 
 Dr. A. Geiger, of Dayton, Ohio, administers lime- 
 water by inhalation, — or rather vapor of water containing 
 small particles of lime in suspension, — by pouring hot 
 water upon small pieces of unslacked lime ; the ebullition 
 is such in the process that a profusion of minute par- 
 ticles of the lime becomes detached and forced up with 
 the steam arising from the vessel in which the slacking 
 is going on, and remain with it in suspension, so that 
 the compound can be readily inspired. 
 
 Dr. Geiger, after narrating a very interesting case of 
 diphtheritic croup in which large portions of membrane 
 retaining the cast of the entire trachea were coughed 
 up, and a portion of which he found to become dissolved 
 in lime-water (Med. and Surg. Reporter, Phila., March 
 24th, 1866), continues : "I determined to try the effects 
 of the lime in the next case of diphtheria, or pseudo- 
 membranous croup, occurring in my practice. The first 
 case that presented itself was one of croup, in a boy 
 about four years of age (son of Irish parents), residing 
 some two miles from the city. The boy had already 
 been sick two days before my visit. When called, I 
 ordered the father to take out with him some unslacked 
 lime, which he did. Upon my arrival at the house, I 
 
AIRS, GASES, AND VAPORS. 257 
 
 found the patient sitting up in bed ; severe and distress- 
 ing dyspnoea ; the face and body covered with perspi- 
 ration from his efforts to get his breath. The usual 
 harsh, dry cough, and the symptoms all indicating the 
 last stages of pseudo-membranous croup, I determined 
 to try alone the effects of the lime, as I saw no hope in 
 any other treatment. But in what way could I bring 
 it in contact with the membranous formation to dissolve 
 it ? I hit upon the following expedient : I placed some 
 unslacked lime in a saucer, and then, after throwing a 
 cloth over his head, held the saucer under, so that he 
 was compelled to breathe the fumes arising from the lime 
 in the process of slacking. I retained it for a few 
 minutes and then removed it. The breathing was some 
 easier, and directly he expectorated a large quantity of 
 tough mucus and phlegm, and was very much relieved. 
 In this process, the steam arising from the lime in slack- 
 ing, contains in it particles of lime which are thus, by 
 inhalation, brought in contact with the membrane in 
 the windpipe. I ordered lime-water and milk to be 
 given internally, and the inhalations to be repeated in 
 the same way, whenever the symptoms of suffocation 
 w T ere severe, and that the father should report to me 
 in the morning the boy's condition. 
 
 " He came in the following morning, said i he was 
 much better ; that the night before, after again inhaling 
 the fumes of the lime, he had vomited up a lot of tough 
 stuff, and got better right away.' I prescribed a ca- 
 thartic to be given him, and the fumes of the lime, if 
 he choked up again. I saw the patient no more. The 
 father reported from day to day that he was getting bet- 
 ter, and finally, that he could ' eat as much as ever.' ' 
 
 Dr. Geiger, in the same communication, reports 
 22* 
 
258 THE INHALATION OF MEDICATED 
 
 another case of a fleshy little boy, three or four years 
 of age, attacked two days previous to his visit. There 
 was hard breathing, stridulous cough, with evidence of 
 the formation of membrane, though to less extent than 
 the case above. A purge was ordered, and directions 
 given how to employ the lime inhalations. Visiting 
 the child again in a few hours, he found the difficulty in 
 breathing quite relieved ; the mother reporting that 
 the lime had acted like a " miracle ;" that after breath- 
 ing the fumes for a few minutes, he vomited freely and 
 was at once relieved. On the day following, the child 
 was so well that further medication was unnecessary. 
 
 Dr. Geiger also states that Dr. 0. Crook, of the 
 same city, reported six cases of diphtheria and mem- 
 branous croup, in which the fumes of lime and lime- 
 water were used, five of which recovered. 
 
 Dr. Geiger reports another successful case in the 
 same journal for March 10th, 1866. 
 
 Dr. Alexander J. C. Skene, of Brooklyn, N. Y., 
 reports {Med. and Surg. Rep., Dec. 22d, 1866, p. 527) 
 that he has tried the inhalation of lime-water broken up 
 into spray by Richardson's Spray Producer, in several 
 cases of croup, and believes that he has observed marked 
 advantage derived thereby. 
 
 Dr. Thomas Byrnes, of Walcott, Iowa {Med. and 
 Surg. Reporter, Philadelphia, July, 1866, p. 26), reports 
 a case of diphtheria in a child seven years of age, in 
 which, when he was called to the case, the tonsils were 
 large, and the mucous membrane of a bright red color, 
 a small patch of membrane covering the left tonsil. The 
 constitutional symptoms were very slight. He swabbed 
 the throat with tr. ferri chloridi, and administered five 
 
AIRS, GASES, AND VAPORS. 259 
 
 drops internally every hour. The following morning 
 the tonsils were covered with false membrane, which 
 had ascended to the palatine arches. Small patches 
 were visible on the uvula also. The cervical and sub- 
 maxillary glands had become very much swollen, and 
 painful to the touch. The lime was prepared for inha- 
 lation, as directed by Dr. Geiger, and it soon exerted 
 its beneficial effect. Small patches that covered the 
 uvula were entirely dissolved, and those on the tonsils 
 were diminished in size. The inhalations were continued 
 at intervals of four hours. Towards evening, the false 
 membrane had entirely disappeared, but returned again 
 the next day and was again removed by lime inhala- 
 tions. The systemic affection in this case was combated 
 by supporting measures and the internal administration 
 of iron. 
 
 Dr. C. V. Moore, of Stillwater, New Jersey, writes 
 to the Med. and Surg. Reporter, of Philadelphia, Sep- 
 tember 5, 1866, p. 224, as follows : " I have recently 
 had two severe cases of diphtheria. In one the disease 
 had invaded the larynx, causing loss of voice, croupy 
 cough, and paroxysmal attacks of suffocation and res- 
 piration. Both cases were promptly relieved, and cured 
 simply by the internal administration of small and oft- 
 repeated doses of permanganate of potassa, and the in- 
 halation of vapor of slacking lime. The relief from the 
 inhalation was very marked, and the result was gratify- 
 ing, both to the little sufferer, the friends, and most as- 
 suredly to the attending physician." 
 
 These cases were sporadic. Internal treatment, milk, 
 and beef tea. 
 
 Acting Assistant Surgeon Henry McElderry, Uni- 
 ted States Army (Phila. Med. and Surg. Reporter, 
 
280 THE INHALATION OF MEDICATED 
 
 April 28, 1866), reports a case of diphtheria, in which, 
 in addition to supporting systemic treatment, the inha- 
 lation of lime with steam, from the action of hot water 
 on unslacked lime, was employed with the successful re- 
 moval of rapidly-spreading diphtheritic deposit on the 
 left tonsil and on the arches of the palate on that side. 
 He writes that the instantaneous relief given by the in- 
 halations, when he has seen so many remedies signally 
 fail in diphtheria, has led him to attribute the very for- 
 tunate and successful issue in this case entirely to their 
 influence. He has never seen any remedy act with 
 more promptness or satisfaction than the lime inhala- 
 tions did in this case. 
 
 Many other cases have been reported subsequently, 
 confirming the statements and experiments of Dr. 
 Geiger. 
 
 Inhalation of Arsenical Vapors. 
 
 The vapors from arsenic are known to produce cer- 
 tain poisonous effects upon those unaccustomed to them. 
 They were formerly used in the East for medicinal pur- 
 poses, and their employment has recently been revived 
 by Trousseau, who employed cigarettes made from bib- 
 ulous paper saturated in a watery solution of arsenite 
 of soda, 5ss-j to the ounce, in the treatment of chronic 
 bronchial affections, and in phthisis. 
 
 Inhalation of Mercurial Vapors. 
 
 The inhalation of mercurial vapors has been em- 
 ployed for ages in Arabia and in India for the produc- 
 tion of salivation. 
 
 Fracastori tells us [Copland, on Bronchitis, 1866, 
 p. 133) that inhalations of vapors from cinnabar were 
 
261 
 
 used at a very early date in the treatment of constitu- 
 tional syphilis. 
 
 The vapors from mercurial cigarettes have been used 
 with advantage (Stille's Therap., vol. ii, p. 694) in 
 cases of chronic thickening of the vocal cords, ozsena, 
 nasal polypus, and catarrh of the Eustachian tube ; the 
 cigarettes for which purpose may be made according to 
 the following directions, originally suggested by Trous- 
 seau : Take nitrate of mercury and strong nitric acid, 
 of each fifteen grains, distilled water a sufficient quan- 
 tity ; mix the acid and water, add the nitrate of mer- 
 cury, and dissolve by a gentle heat ; saturate with the 
 liquid a sheet of thick white blotting-paper, six inches 
 by eight in size, and dry it ; before it is entirely dry 
 cut the paper into suitable strips for making tubes about 
 one-eighth of an inch in diameter, and secure with gum ; 
 the interior of the tube may be stuffed with tobacco for 
 those who are accustomed to smoking, but this addition 
 it is better to dispense with ; the paper, when dry, will 
 burn steadily, and its smoke, on being drawn into the 
 mouth, should be directed upon the seat of the disease. 
 
 Dr. Polak (Wiener Medic. Woehenschrift,1860,l$o. 
 36) writes of the mercurial inhalations employed in the 
 Orient for the treatment of syphilis. He says that in 
 Persia the readiest method of curing syphilitic affections 
 is by means of inhalation. There is added to the moist- 
 ened narghile-tombac, a trochiscus of cinnabar, and a 
 pipe thus prepared is smoked by the patient once or 
 twice a day. 
 
 The ordinary formula for the pastille is as follows : 
 Cinnabar, 2 muskals(lmuskalis equal to 66 grs. apothe- 
 caries' weight) ; catechu, 2 muskals ; borax, J muskal ; 
 Lawsonia 2 muskals ; china nodosa, 3 muskals ; com- 
 
262 THE INHALATION OF MEDICATED 
 
 bined with mucilage of gum arabic, and formed into 12 
 troches. Another formula is cinnabar 2 M., mercury 2 
 M., leaves of cannabis indica 3 M'., made with mucilage 
 into 14 troches. 
 
 One or two of these pastilles is to be smoked daily, 
 and in the following manner : The smoke is inhaled into 
 the lungs, retained there for a few moments, and then 
 expired either through the mouth alone or through the 
 mouth and nose together. Generally, a moderate mer- 
 curial stomatitis ensues after the eighth or tenth inha- 
 lation, which is a sign for discontinuing the process. 
 During the treatment the patient must rinse out the 
 mouth frequently, and be careful to observe great clean- 
 liness. The diet consists of milk with sugar, rice and 
 milk with sugar, also sheeps-feet jelly. Salt food, acids 
 and fruits are interdicted. The mercurial stomatitis is 
 treated with powdered sumac, with catechu, or the 
 tabaschis (bambus magnesia) with gulnar (full flowers of 
 the pomegranate). According to these investigations 
 of Dr. Polak, no other method is comparable with that 
 of these inhalations for the prompt treatment of syphil- 
 itic affections of the throat. 
 
 Inhalation of the Vapor of Chloride of Copper. 
 
 Dr. Th. Clemens, of Frankfort-on-the-Main, has 
 communicated several articles to the Deutsche Klinik, 
 1865-6, on the use of the vapor from a chloride of cop- 
 per by inhalation, and as a disinfectant. He asserts 
 that it is an established fact, supported by experience, 
 that workers in copper mines and in copper fabrics 
 remain protected against the cholera poison. This led 
 him to the employment of these vapors in the treatment 
 of cholera, in connection with the internal and external 
 
AIRS, GASES, AND VAPORS. 263 
 
 use of the remedy. The vapor is produced by heating 
 a solution of the chloride of copper, a drachm to the 
 pound of alcohol, with the addition of two drachms 
 of chloroform. He has used it successfully as a disin- 
 fectant in crowded hospitals, and it has proved effectual 
 in epidemics of measles and scarlet fever. He has used 
 the vapor by inhalation successfully in one case of pul- 
 monary gangrene, and in two cases of pulmonary tu- 
 berculosis. 
 
 Inhalations as pursued by the Persians. 
 
 Lewin (p. 209) copies from the Allg. Med. Central 
 Zeitung, 1863, ISTo. 23, an interesting account of the 
 method of inhalation pursued by the Persians, as nar- 
 rated by Dr. Polak. This consists in smoking the 
 fumes of certain medicinal agents through their nar- 
 ghile, a smoking apparatus, by means of which the 
 smoke passes through a vessel containing cold water, 
 before it reaches the mouth. The material to be em- 
 ployed medicinally is mixed with their smoking tobacco, 
 which is made into moistened masses and inserted into 
 the plaster bowl of the narghile, and then burning coals 
 are laid upon it. The material is slowly consumed, and 
 the smoke in passing through the cold water receptacle, 
 is not only cooled, but also deprived of a portion of its 
 narcotic or other properties. Dr. Polak found that the 
 inhalation of cinnabar was very well borne, even by 
 young children ; that six to eight strong pulls produced 
 a slight sensation of approaching syncope, continuing, 
 however, only for a short time, and allowing the opera- 
 tion to be repeated by the next day. 
 
 In cases of chronic catarrh and bronchitis, Dr. Polak 
 employed gum ammoniac, gum galbanum, &c ; in spas- 
 
264 THE INHALATION OF MEDICATED 
 
 modic and hysterical affections, assafoetida ; in ischias, 
 turpentine with pistacia lentiscus, or mastic, with good 
 results, or at least without injurious effect. In addition 
 they could employ quinine, salicine, even narcotine and 
 digitalis ; and many mineral substances, as borax, sal 
 ammoniac, &c. 
 
 By smoking the tobacco, a condition of relaxation 
 can be induced, advantage of which may be taken, the 
 same as the narcosis from chloroform, for the reduction 
 of luxations, the reposition of hernias, &c. The plant 
 tombak, employed by the Orientals, is one of the Ni- 
 cotians, and very similar to our own tobacco ; it has a 
 red leaf, grows favorably in sandy soils, &c, &c. 
 
 Inhalations of the Vapor of Hot Water. 
 
 Inhalations of the vapor from hot water are very 
 serviceable in many states of laryngeal inflammation, 
 especially in cases of croup, where the supply of watery 
 vapor perhaps prevents the congelation of pseudo-mem- 
 brane, and keeps the exudation in a fluid state, and thus 
 more readily expectorated. 
 
 It is not improbable that all the benefit from the 
 inhalation of warm lime-water in croup acts in this way, 
 affording moisture to the exuded matters, which in their 
 congelation must part with some of their watery con- 
 stituents. 
 
 After the performance of the operation of trache- 
 otomy, it has been found serviceable to maintain a warm 
 and moist atmosphere about the patient. ' 
 
 It is well known that in many pulmonary complaints, 
 accompanied with more or less distress in breathing, 
 advantage will follow the warming and moistening of 
 the air by keeping a current of steam rising from a 
 
265 
 
 vessel of water kept boiling for that purpose. The 
 warm moisture inhaled acts upon the irritated mem- 
 branes with the same soothing influence exerted upon 
 external inflammations by warm fomentations, and thus 
 the disposition to cough is lessened, expectoration is 
 facilitated, &c. 
 
 Warm steam, with camomile flowers and a little ether 
 has been recommended in asthma by Dr. Eberle, and 
 also the inhalation of vapor of warm water and vine- 
 gar, in cynanche tonsillaris, and tracheitis. 
 
 Dr. Mackintosh recommends the inhalation of hot 
 vapor in croup, and in scarlet fever. 
 
 The vapor of medicated waters may be employed 
 medicinally by inhalation ; thus, Boerhaave employed 
 the vapor of water distilled over elder flowers, as a 
 remedy in pulmonary catarrh. 
 
 The vapor from vinegar thrown upon hot water, 
 facilitates dislodgement of mucus, which can then be 
 more easily expectorated. The vapor of vinegar with 
 boiling tar, was employed at one time by Dr. M. 
 Baillie, of London, in chronic pulmonary complaints. 
 Dr. Pringle (E. J. Coxe, Treatise on Inhalation, Phil., 
 1845) attested the good effects he had observed in pleu- 
 ritis and pneumonia from causing his patients to breathe 
 over the steam of hot water, a practice recommended 
 by Boerhaaye and Van Swieten, and confirmed in 
 repeated trials by Dr. Huck, who found it more bene- 
 ficial when the phlegm was viscid, as also more grate- 
 ful to the patient by adding a small portion of vinegar ; 
 and Dr. Rush, in editing Dr. Pringle's work, says 
 that too much cannot be said in favor of this simple 
 and powerful remedy, for he has seen patients snatched 
 from the jaws of death by it. 
 
 23 
 
266 THE INHALATION OF MEDICATED 
 
 Dr. Tweedie (Dis. of Resp. Organs) says the inha- 
 lation of steam in some cases rendered slightly stimu- 
 lant and alterative by the addition of camphor, turpen- 
 tine, or the balsams, has been found useful in promoting 
 secretion from the diseased membrane. He recommends 
 also, the use of sedatives, and antispasmodics, as bella- 
 donna, camphor, ether, and opium, by inhalation in 
 chronic laryngitis. 
 
 Dr. Eberle recommends warm steam, with camo- 
 mile flowers and a little ether, in asthma ; warm water 
 and vinegar in cynanche tonsillaris and trachealis. 
 
 Winteringhausen, though disapproving of fumiga- 
 tions as advised by Bennet, Mead, and others, acknowl- 
 edges the advantages derived from the inhalation of the 
 steam of hot water, medicated vinegar of squills, &c. 
 
 The value of inhalations of steam in cases of poison- 
 ing by corrosive vapors is submitted to the profession by 
 Samuel P. Duffield, Ph.D., who in the Detroit Re- 
 view of Medicine and Surgery, gives the following suc- 
 cessful treatment of poisoning by bromine inhalation : 
 The corrosive action of the bromine was such that the 
 glottis had closed with a spasm, and did not yield will- 
 ingly. The patient was brotfght near to a steam-pipe, 
 the mouth held open, and the steam thrown from some 
 distance, so as not to burn him, into his mouth and 
 over his face. It had the desired eifect, and the patient 
 was subsequently sent home. The steam inhalations 
 were continued for some time, and the patient re- 
 covered. [The Medical Record, ~New York, Sept. 16th, 
 186T, p. 323.) 
 
 Medicated Atmospheres. 
 In addition to the methods of direct inhalation, in- 
 
AIRS, GASES, AND VAPORS. 267 
 
 direct inhalations have often been employed, by medi- 
 cating the atmosphere in which a patient usually re- 
 sides, as has been alluded to incidentally. The method 
 has been at several times resorted to as a regular cura- 
 tive process in the treatment of chronic pulmonary af- 
 fections. Bartolinus endeavored in this way to keep 
 sitting apartments medicated with vapors, as substitutes 
 for voyages to special climates, for those unable to 
 leave their homes. 
 
 Thomas Beddoes recommended that the apartments 
 usually occupied by consumptives should communicate 
 with cow-houses, stables, &c, so that the atmosphere 
 should be continually impregnated with the warm am- 
 moniacal emanations; and this plan of treatment was 
 at one time considered highly successful, but it soon 
 fell into disrepute, and subsequently into disuse. Thus, 
 also, residences near tanneries, have at various times 
 been recommended for the purpose of supplying an at- 
 mosphere more or less constantly impregnated with va- 
 pors which have been considered remedies of great 
 value in the treatment of pulmonary affections. 
 
 While this work was in press, I received, too late for 
 incorporation in a more appropriate place, a letter from 
 Dr. S. Waterman, Surgeon to the Metropolitan Police, 
 New York, in which he speaks very highly of aromatic 
 alcoholic inhalations. He says : "I have been in the 
 habit for many years of making use of aromatic alco- 
 holic inhalations, and I have no hesitation in saying 
 that they are of the most signal service when properly 
 employed. I have used for this purpose the best c eau 
 de cologne,' that of Maria Farina, which I mix in tea- 
 spoonful quantities with boiling water on the stove in 
 winter, and on a gas-stove in summer. It creates an 
 atmosphere highly impregnated with the aroma of the 
 
268 RESPIRATORY DIET. 
 
 volatile oil contained in the preparation, and is willingly 
 inhaled by the patient. I have used these inhalations, 
 
 " 1st. In the more advanced stages of croup, when 
 from the imperfect decarbonization of the blood the 
 nervous powers begin to fail, and paralysis of the nerves 
 of the lungs is to be feared. In this state the inhala- 
 tions act as a local stimulant, invigorating the nervous 
 power, and often overcoming that dangerous state when 
 no other remedy would do so. That these inhalations 
 exert, also, a beneficial effect upon the nervous distri- 
 butions of the entire mucous membrane of the fauces, 
 larynx, trachea, and bronchi, in these cases, I now en- 
 tertain no matter of doubt. 
 
 " 2d. In bronchial disorders dependent upon a relaxed 
 state of the mucous membrane, these inhalations have 
 often proved highly useful. For adults they may be 
 continued for days and weeks. They sometimes cause 
 violent cough ; but it is just in such cases, where they 
 exert a stimulating effect upon the mucous surfaces, 
 that their effects will be found salutary." 
 
 Respiratory Diet. 
 
 In 1848, Sales-Girons suggested the regularly sup- 
 plying diseased lungs with a respiratory pabulum, suit- 
 able to their condition, on similar grounds to those 
 defining suitable diet in diseases of the digestive organs, 
 and this he called a respiratory diet. A piece of resin 
 or balsam, or whatever was intended to medicate the air, 
 was placed within a respirator, to be worn in front of 
 the patient's mouth, thus keeping him in the same at- 
 mosphere all day long, and enabling him to attend to 
 his business without exposure to the unmitigated oxygen 
 of the atmosphere, often prejudicial in many diseases of 
 the pulmonary organs. 
 
RESPIRATORY DIET. 269 
 
 He maintains [Gazette Hebdomadaire, February 17, 
 1860, p. 108) that respiration is susceptible of diet as 
 easily as digestion ; and for the purpose of supplying 
 this diet, he employs various substances, placed in a 
 little apparatus, which the patiervt carries about him 
 the greater part of the day, applied above the mouth 
 and nostrils, to modify the atmosphere before it gains 
 access to the respiratory tract. He contends that the 
 respiratory diet is in accordance with a theory of rela- 
 tions between the living organism and the atmosphere, 
 or the theory of relations of the lungs with oxygen. 
 
 In the discussion which ensued upon Bouillaud's 
 report upon the work of Sales-Girons [Gazette Hebdoma- 
 daire, January 4, 1861), M. Fontan put the query 
 whether there was not in this production of Sales- 
 Girons, the germ of a grand discovery, that of a third 
 state of oxygen, oxygen negatively electric, or sub- 
 oxygen, in contradistinction to oxygen positively elec- 
 tric, ozone or sur-oxygen, and ordinary oxygen, or 
 neutral oxygen. 
 
 Prof. Dickson {Elements of Medicine, 1855, p. 624) 
 says we would anticipate some soothing influence from 
 the inspiration of air made to contain a less quantity of 
 oxygen, which is generally regarded as a stimulant. He 
 refers, however, to atmospheric mixtures with nitrogen 
 and hydrogen, and with carbonic oxide or carbonic acid ; 
 and accounts in a similar way for the advantages said to 
 have been derived by some consumptives, from residing 
 in stables with cattle, so much in vogue in England in 
 the time of Darwin and Beddoes. 
 
 This method of keeping up a peculiarly medicated 
 atmosphere is much the same as Sales-Girons' respira- 
 tory diet. 
 
 23* 
 
ON INHALATION. 
 
 PART III. 
 
 THE INHALATION OF POWDERS. 
 
 CHAPTER I. 
 
 THE INSUFFLATION OR INHALATION OF POWDERS IN 
 AFFECTIONS OF THE RESPIRATORY ORGANS. 
 
 The earliest employment of powders by insufflation, 
 in the treatment of diseases of the air-passages, has been 
 ascribed to iEscuLAPius, who, according to Galen, was 
 accustomed in cases of angina to blow an astringent 
 powder into the larynx by means of a bent reed. 
 
 Aretjeus, who flourished in Cappadocia in the latter 
 part of the first century, is said to have used a similar 
 instrument and for the same purpose, especially in the 
 laryngeal complaints of children ; while in our own 
 days, the method has been reintroduced into practice 
 by Bretonneau, Trousseau, and Belloc, followed by 
 many others, who have devised instruments of various 
 form and mechanism for the propulsion of such powders. 
 Trousseau's instrument consists of a glass tube of con- 
 
ETC. 271 
 
 venient size, within one aperture of which is to be in- 
 serted from three to four grains of the powder to be 
 used ; the other end is placed as far as possible within 
 the mouth of the patient, who closes his lips upon it 
 and takes an inspiration through the tube. Trousseau 
 recommends the medicinal powders to be rubbed up 
 with sugar of milk, to give them sufficient body. His 
 formulae are, for bismuth, 1 part to 1, 2, or more of 
 the sugar of milk ; for alum, 1 part to 2 ; for acetate 
 of lead, 1 to 7 ; for calomel, 1 to 12 ; for red precipi- 
 tate, sulphate of zinc, and sulphate of copper, 1 to 36 ; 
 for nitrate of silver, 1 to 24—72. He employed the alum 
 and bismuth in relaxed conditions of the mucous mem- 
 brane, unattended with marked inflammation ; the salts 
 of lead and copper, in cases of considerable inflamma- 
 tion ; nitrate of silver, in cases of known or inferred 
 ulceration ; the mercurial preparations, in syphilitic 
 cases, and also in non-specific ulcerations. The insuf- 
 flations were made daily, or every other day. 
 
 Prof. Burow, of Koningsburg (Deutsche Klinik, 
 1853, No. 21) was in the habit of employing in this 
 manner, nitrate of silver, three grains to the drachm 
 of sugar of milk, in chronic laryngitis ; and reported a 
 number of cases of several years' standing, with almost 
 complete aphonia, which were cured in a few weeks, 
 with restoration of the voice even to purposes of vocal 
 music. Finding with many of his patients an inability 
 to inhale the powder by the methods previously recom- 
 mended, and that in some cases the powder was actually 
 blown out of the tube in expiration, he devised a special 
 contrivance, composed of two parallel tubes, one fur- 
 nished with a valve, so that the powder could not be 
 blown out by expiration, but was compulsorily inhaled 
 
272 INSUFFLATION OF POWDERS 
 
 in inspiration. The quantity of the powder employed 
 by him was as much as could be put in the nib of an 
 ordinary steel pen ; and this amount was used daily. 
 
 Pserhofer, of Vienna, treated not only laryngeal, 
 but also bronchial and pulmonary troubles in this way, 
 and also employed the respiratory tract for the intro- 
 duction of medicines in the treatment of affections of 
 other organs (Schmidt's Jahrb., 1856). 
 
 Ebert, of Berlin, placed the powder in a steel pen, 
 which he placed half-way within a quill open at both 
 ends, and inserted the quill within the mouth in such 
 manner that the pen should lie over the root of the 
 tongue, when the patient, closing his lips over the quill 
 and compressing his nostrils, inhaled suddenly and 
 strongly. He found the patients' first attempt usually 
 unsuccessful, the powder only getting upon the base of 
 the tongue and about the pharynx, so that when nitrate 
 of silver was used, the peculiar metallic taste was per- 
 ceived in these parts ; but generally after the second 
 or third attempt, the powder was more or less thor- 
 oughly inhaled, as evinced by spasm of cough, burn- 
 ing sensation in the larynx, &c. A number of cases of 
 laryngitis are narrated, some in young and delicate 
 females, in which satisfactory beneficial results followed 
 this treatment. For details of twelve cases, see Lewin, 
 op. cit., p. 126 to 136. 
 
 Lewin, of Berlin, uses a small tubulated retort for 
 the inhalation of powders, a small tube passing through 
 the stopper to the bottom of the retort in which the 
 powder is placed, the patient inspiring forcibly through 
 the beak of the apparatus. 
 
 The most convenient insufflator that I know of is 
 that of Rauchfuss, which consists of a properly shaped 
 
IN DISEASES OF RESPIRATORY ORGANS. 273 
 
 tube, with a gum ball for the purpose of propelling the 
 powder forwards ; the powder is inserted into a slot in 
 the tube, over which a smaller tube slides after the intro- 
 duction of the medicine, which can be propelled in any 
 direction desired, by arranging the apertures of exit at 
 the distal extremity of the tube. 
 
 Chambers, Fournie', and many others, have devised 
 instruments for this purpose. 
 
 Dr. T. K. Chambers, of London {Lancet, 1848), 
 recommends the inhalation of a light innocuous pow- 
 der, with which the required medicinal agent may be 
 mingled. He found most suited to his purpose the pollen 
 of the lycopodium (club-moss), first allowed to imbibe 
 as much as it would take up of a saturated solution of 
 the substance to be employed (in the cases narrated, 
 nitrate of silver and sulphate of copper, or a combina- 
 tion of the two), and then carefully dried, and after- 
 wards reduced to an impalpable powder. The plan rec- 
 ommended for the inhalation is, that the patient should 
 introduce into his mouth, as far as may be without 
 choking, the tube of a well-dried glass funnel, and draw 
 in his breath strongly at the same moment that an at- 
 tendant, or himself if able, dusts the powder into the 
 funnel from a nursery puff-ball. To obviate the neces- 
 sity for withdrawing the funnel during expiration, and 
 to prevent the powder from floating about the room, an 
 apparatus with a double valve, and a closed powder-box 
 allowing the powder to pass only from without inwards, 
 may be employed instead of the funnel. 
 
 Prof. Dickson {Elements of Medicine, 1855, p. 624) 
 thinks he has seen inhalation of the finely-levigated 
 powders of cinchona, and the acetate of lead, useful in 
 restraining profuse expectoration. 
 
274 INSUFFLATION OF POWDERS 
 
 Prof. R. H. Thomas, of Baltimore, recommends 
 {Transactions of the American Medical Association, 
 1855, vol. viii, p. 591, with cut) to the notice of the 
 profession the following simple and easy method of ap- 
 plying nitrate of silver to the air-passages, contrived 
 and adopted by his brother, Dr. John Chew Thomas, 
 of Baltimore. 
 
 Let a fine grindstone or emery-wheel be caused to 
 revolve with great velocity, while a stick of the caustic 
 is lightly held in contact with it. The effect will be to 
 convert the caustic into an impalpable powder, which 
 may be inhaled freely by the patient, who sits before 
 the stone at a convenient distance ; from three to six or 
 eight inhalations may be taken at a sitting, according 
 to the effects, but it is recommended to desist after much 
 cough is created, and the operation may be repeated 
 every two or three days, according to the influence it 
 exerts on the disease. 
 
 It has been found, in Dr. Thomas's experience, to be 
 well adapted to chronic inflammation of the larynx, 
 trachea, and bronchi, rarely causing any more than a 
 temporary irritation. He has also used it with good 
 effect in recent hoarseness and slight inflammation of 
 the fauces and throat. In established acute inflamma- 
 tion, depletion and general treatment should precede its 
 employment. 
 
 Dr. Thomas refers to a number of instances of slight 
 but persistent affections of the larynx and trachea, 
 which were accompanied with weakness of voice, hoarse- 
 ness, inability to speak or read for any length of time, 
 which were entirely cured by the use of this means ; also 
 cases of chronic bronchitis, which had proved very obsti- 
 nate, yielding perfectly to the steady use of the same 
 
IN DISEASES OF RESPIRATORY ORGANS. 275 
 
 agency. He does not claim that it can supersede the 
 use of the sponge and caustic solution, but that in many 
 of the slighter affections of the throat, it may enable us 
 to dispense with the disagreeable necessity of using the 
 mop, and that it is applicable to some cases to which 
 the former method is not. 
 
 Prof. Chas. Matthews describes and depicts (Am. 
 Med. Times, November 24, 1860, p. 365) an instrument 
 of his invention, intended to facilitate the inhala- 
 tion of the smoke of powders in a state of ignition. It 
 consists of two tubes of paper, to the outer of which is 
 attached the mouth-piece, the powder being confined 
 w T ithin the inner tube, upon lighting which the smoke is 
 conveyed to the mouth through the interspace between 
 the two tubes. Cubebs is preferred as the vehicle to 
 give sufficient volume to the powder when employed in 
 this manner, for cases where a gentle stimulus is de- 
 sired; though decayed wood, pine bark, &c, may be 
 employed for the purpose. 
 
 An important point to be determined, says Lewin (op. 
 cit., p. 122), in this connection, is whether the powder in- 
 spired remains in the respiratory tract, and is not again 
 extruded by the waving outwards of the ciliary epithe- 
 lium. That this latter occurrence is generally the case, 
 continues Lewin, we know very well. A large quantity 
 of minute dust is continually floating in the atmosphere, 
 especially in crowded cities. Now, if all this were in- 
 haled, and remained in the pulmonary organs, it would 
 eventually produce fatal consequences, because the bron- 
 chial tubes would become more or less clogged up. Such 
 a result, however, is avoided by our natural instinct of 
 breathing through the nostrils, the tortuous sinuosities 
 (from the shape of the turbinated bones) of which 
 
276 INSUFFLATION OF POWDERS. 
 
 cavities, are provided with small hairs ; these hairs and 
 the turbinated prominences catch the particles of dust 
 inhaled through the nostrils, which particles are subse- 
 quently ejected from time to time by a very familiar 
 process. But after a certain number of nasal inspira- 
 tions, we find it necessary to gape or take a deeper in- 
 spiration than ordinary, for which purpose the mouth is 
 more or less widely opened ; usually it is not very widely 
 opened, and the soft palate not being raised very much, 
 the dust taken in with the inspiration strikes the velum, 
 and becoming entangled in its mucus, it is thrown upon 
 the moist mucous membrane of the tongue, half arches, 
 and pharynx ; the dust that has proceeded farther, is 
 arrested by the epiglottis, the ary-epiglottic folds, and 
 the ventricular bands or false vocal cords. If, notwith- 
 standing these hindrances, some of the dust reaches the 
 larynx or trachea, it is detained by the moist mucous 
 membrane, and is expectorated by hawking or coughing, 
 or is gradually removed by the waving of the cilia. 
 
 This is much less the case, and in some instances not 
 at all the case, when the materials inhaled are soluble, 
 and dissolve in the bronchial mucus before the cilia 
 can extrude them; or when the matters are specifically 
 too heavy to be moved by them; or when too great a 
 quantity has been inhaled; or when the mucous mem- 
 brane does not possess its full strength and capabilities. 
 
 On these grounds, concludes Lewin, it would appear 
 that the inhalation of powders can be employed for the 
 purposes of local therapeutics. 
 
CHAPTER II. 
 
 EXPERIMENTS ON MEN AND ANIMALS, PROVING THE 
 PENETRATION OF POWDERS INTO THE RESPIRATORY 
 TRACTS. 
 
 Any one can convince himself that powders can be 
 voluntarily drawn at least into the upper air-passages, 
 by directing the dust of some colored substance, as char- 
 coal, for instance, across his mouth, and suddenly tak- 
 ing a deep inspiration. The irritation produced, and the 
 spasm of cough accompanying it, will be proof positive 
 that some of the suspended particles have been drawn 
 beyond the glottis, while an examination with the laryn- 
 goscope will show that some particles of the dust have 
 lodged upon the vocal cords, true and false, the greater 
 proportion being spread on the anterior wall of the tra- 
 chea, and very little reaching the posterior walls of the 
 larynx. A large portion of the powder will, of course, 
 have remained in the mouth, principally detained about 
 the base of the tongue, and upon the soft palate just 
 over the attachment of the uvula. 
 
 A great many experiments have been made upon ani- 
 mals who were forced to inhale powders, and in whom, 
 after section, the presence of the powders has been de- 
 monstrated in the respiratory organs. 
 
 The principal experimenter in this direction has been 
 Fournie, and his reports have excited a good deal of 
 attention among those interested in the question. 
 
 24 
 
278 EXPERIMENTS PROVING PENETRATION 
 
 In the British $> Foreign Medico-Chirurgical Review, 
 July, 1863, p. 241, we read : " Dr. Edouard Fournie 
 (_Z7 Union Medicale, February 5, 1863) has clearly as- 
 certained that the dust of charcoal, flint, starch, &c, 
 penetrates into the bronchi, and he has endeavored to 
 render the fact available in the treatment of disease. 
 In order to obviate any disagreeable sensation on the 
 part of the patient, he recommends the medicinal powder 
 to be breathed in a special contrivance which he de- 
 scribes. It consists of an oval wooden box, fitted with 
 two tubes, so arranged that the patient breathes the air 
 in the box mingled with the medicinal powder. Laryn- 
 goscopy examination, and the black expectoration after 
 the use of the apparatus, when charcoal-dust has been 
 employed, proves that the dust has entered the respira- 
 tory passages. The same apparatus is available for the 
 inspiration of volatilized iodine, and Dr. Fournie has 
 also thus employed for medicinal purposes, starch, alum, 
 tannin, subacetate of lead, and nitrate of silver. The 
 diseases which he has successfully treated have been 
 cases of catarrh, bronchitis, and some of well-marked 
 phthisis." 
 
 Fournie inclosed the head of a coal-heaver, whose 
 nostrils were first compressed by forceps (pince-nez), 
 in a sack filled with a quantity of coal-dust, and then the 
 sack was shaken over his head with a good deal of force. 
 The man coughed and coughed, and seemed to feel very 
 uncomfortable. After being allowed to breathe this at- 
 mosphere for three minutes, the sack was removed and 
 an examination by the laryngoscope gave the following 
 result : The tongue, soft palate, tonsils, and pharynx, 
 were fully covered with a thick layer of coal-dust ; the 
 epiglottis, aryteno-epiglottic ligaments, and the aryte- 
 
OF POWDERS INTO THE RESPIRATORY TRACTS. 279 
 
 noid cartilages, were marked with coal streaks at sev- 
 eral places, and were very much reddened; there was 
 only a thin black streak over the right vocal cord. An 
 examination with the laryngoscope before the experi- 
 ment, had shown the parts to be normal. This clean- 
 ness of the mucous membrane of the larynx contrasted 
 very strongly with the condition of the trachea, the mu- 
 cous membrane of which, particularly on its posterior 
 wall, was almost entirely covered with coal-dust. This 
 experiment was repeated by Fournie upon himself and 
 others, with similar results. (Lewin, op. cit., p. 121.) 
 
 Quite recently, Dr. Moritz Rosenthal, of Vienna, 
 has published the records of a series of experiments 
 which he instituted upon rabbits to determine the extent 
 to which pulverulent substances could be made to pene- 
 trate into the respiratory organs [Schmidt's Jahrbucher, 
 November, 1866, from Wien. Zeitschrift, 1866, No. 1). 
 Some very finely-pulverized charcoal, sifted through a 
 cloth, was placed in a double linen bag, in which a mod- 
 erately-sized rabbit was confined, and the bag, with its 
 contents, was then whirled round for from fifteen to 
 twenty minutes, after which the animal was killed by 
 section of the spinal cord, and the respiratory tract 
 examined from below upwards, to avoid the conveyance 
 by the shears of any of the material from above down- 
 wards. The coal was found in the ventricles of the larynx, 
 on the walls of the trachea, and on those of the larger 
 bronchi. By the aid of a lens, it was detected in the in- 
 terstitial lung-tissue, where it became still more evident 
 upon microscopical examination. Sufficient reasons are 
 adduced to prove that the appearances were not due to 
 the pigment matter normally found in the lung-tissue 
 of such animals. An animal which had been permitted 
 
280 EXPERIMENTS PROVING PENETRATION 
 
 to live for several days after having been similarly ex- 
 posed to an atmosphere loaded with the charcoal-dust, 
 was examined, but not a particle of coal was found. in 
 the larynx or trachea, although such particles were dis- 
 covered under the microscope in various portions of the 
 lung, and also imbedded in the muscular structure of 
 the right ventricle of the heart, into which they had 
 bored their way ; not, however, in that of the left ven- 
 tricle. Another rabbit was compelled to breathe a mix- 
 ture of coal and starch powder, for fifteen minutes, im- 
 mediately after which it was killed, but afforded no 
 evidence of starch, microscopically or chemically, in 
 the lungs or in any other organ ; the starch had been 
 detained in the mucus of the upper part of the air-pas- 
 sages. A large rabbit was made to breathe for twenty 
 minutes an atmosphere in which was suspended six 
 ounces of carbonate of lead. Evidences of the lead 
 were found in the larynx, trachea, and main bronchi; 
 and the lung-tissue, when dried under the microscope, 
 showed irregular masses of crystals, identical with those 
 of the carbonate of lead. 
 
 Dr. Rosenthal found that in foundries, where the 
 models are sprinkled all over with graphite before being 
 cast, the sputa of the workmen were black-colored and 
 somewhat greasy. On laryngoscopic examination, he 
 found stripes of grayish-black dust collected upon the 
 posterior pharyngeal wall, and also upon the epiglottis 
 and the vocal cords, the mucous membrane covering 
 which structures was greatly reddened. These work- 
 men are well nourished as a general rule, not liable 
 to pulmonary affections particularly, and tuberculosis 
 among them is rare. The irritation from the inhaled 
 graphite seems principally confined to the pharynx, 
 
OF POWDERS INTO THE RESPIRATORY TRACTS. 281 
 
 larynx, and upper portion of the trachea. The writer 
 then goes on to recount the effect of various occupa- 
 tions, where the atmosphere of the workroom is filled 
 with dust, as those of bakers, grinders, apothecaries, 
 &c. ; he believes that very often such substances in- 
 haled, by keeping up a continued irritation of the bron- 
 chial mucous membrane, &c, affect the distributions of 
 the vagus, recurrent, and hypoglossal nerves ; at times, 
 even to the extent of producing paralysis. 
 
 The investigation into the diseases to which workers 
 in stone, glass, tobacco, coal, &c, are subjected, by 
 Traube, Cohnheim, Leuthold, Kussman, Degen, Zen- 
 ker, Selbman, Koschlakoff, Felbz, and many other Teu- 
 tonic physicians who have given the subject great atten- 
 tion, prove, beyond the possibility of a doubt, that fine 
 particles of dust gain entrance into the air-passages, 
 inducing severe and often fatal affections. 
 
 24* 
 
CHAPTER III. 
 
 PATHOLOGICAL PROOFS OF THE PENETRATION OF 
 POWDERS INTO THE LUNG-TISSUE. 
 
 A case proving the penetration of particles of coal 
 into the lung-tissue, from inhaling an atmosphere loaded 
 with the substance, is reported in detail by Prof. Traube 
 {Deutsche Klinik, 1860, Nos. 49 and 50, pp. 2 to 3|). 
 This case was a charcoal carrier, set. 54, who had worked 
 at his employment for twelve years, and in whose 
 lungs, after death, particles of charcoal were detected 
 (Schmidt's Jahrbucher, vol. 110, p. 299). For twenty 
 years he had had a cough, and of late years had 
 suffered with shortness of breath. For twelve years, 
 and to within the last three months of his life, he had 
 been almost constantly exposed to the dust of charcoal, 
 and had often observed that his sputa were black. In 
 his expectoration were found numerous free black par- 
 ticles, of very irregular, angular shape, and sometimes 
 of large size. Some of these presented structural pecu- 
 liarities identifying them with the wood of the Pinus 
 sylvestris. Three months before his death he was 
 attacked with pericarditis, and subsequently, double 
 pleuritis, and finally, gangrenous erysipelas. At the 
 autopsy, the lungs were found free from structural 
 lesion, but almost everywhere of a dark black color. A 
 copious amount of dark serous fluid exuded on pressure, 
 staining the fingers black like India-ink, and exhibiting 
 
PATHOLOGICAL PROOFS OF PENETRATION, ETC. 283 
 
 under the microscope black and red particles similar to 
 those which had been found in the sputa. Some of 
 these particles were firmly imbedded in the pulmonary 
 cells, to which they had bored their way. Prof. Traube 
 believes that derangement of the ciliary action of the 
 bronchial mucous membrane is essential to the accumu- 
 lation of carbonaceous matter in the lungs, inasmuch 
 as many persons continually inhale fine dust in simi- 
 larly loaded atmospheres without apparent suffering. 
 
 A similar case occurring in Prof. Traube's Klinik is re- 
 ported by Dr. Leuthold, in the Berlin en Klinik Woch- 
 ensehrift, iii, 3, 1866 (Schmidt's Jahrbiicher, Band 
 132, 1866, p. 163), in which, during life, the particles 
 of the coal were detected in the sputa upon microscopi- 
 cal examination ; and at the autopsy, Dr. Cohnheim 
 detected similar particles in the very stroma of the 
 lungs, and in the bronchial glands, proving that they 
 had penetrated into the air-cells and had bored their 
 w r ay through the walls of the alveola. 
 
 Dr. Peacock reports [Brit, and For. Medico-CMr- 
 urgical Review, vol. xxv, 1860) the results of a post- 
 mortem examination of a patient who died of millstone- 
 makers' phthisis, at the age of thirty-seven, having com- 
 menced work at that trade in his twentieth year. Por- 
 tions of the indurated pulmonary tissue, and of the dis- 
 eased bronchial glands, were obligingly examined by Dr. 
 Bristowe, who furnished the reporter with the follow- 
 ing notes : " The diseased portions of lung were much 
 indurated, having generally an opaque whitish hue, but 
 being thickly studded with a black pigment. Under 
 the microscope little or no trace of original lung-struc- 
 ture was visible, but the diseased masses appear to be 
 made up of dense, closely-arranged, fibroid tissue, 
 
284 PATHOLOGICAL PROOFS OF PENETRATION 
 
 studded here and therewith numerous irregular groups 
 of black pigment, and generally with an abundance of 
 transparent granules and globules of various sizes. The 
 tissues were rendered comparatively transparent under 
 the influence of strong acetic acid, the fibroid tissue 
 becoming a little expanded, and many of the granules 
 and globules disappearing. The bronchial gland pre- 
 sented characters identical with those of the diseased 
 lung." 
 
 Dr. Peacock subjected portions of the indurated lung- 
 tissue to ignition in the flame of a spirit-lamp. The 
 white ash which remained, dissolved to a great extent 
 in hydrochloric acid, and partly with effervescence ; but 
 a portion was left which was seen under the microscope 
 to consist of small angular transparent granules, exactly 
 resembling the finer portions of the silicious dust col- 
 lected from one of the workshops. Dr. Moldenhauer, 
 assistant in the chemical laboratory at St. Thomas' 
 Hospital, also subjected portions of the indurated lung 
 to the action of fire and nitric acid, and found that a 
 considerable quantity of gritty matter remained, which 
 had an amorphous aspect under the microscope, and 
 was inferred to be silicious. The bronchial gland did 
 not contain any similar material. 
 
 At a meeting of the Pathological Society of London, 
 held May 16th, 1865, Dr. Greenhow exhibited two 
 morbid pathological specimens, one being a specimen of 
 diseased lungs from a case of grinders' asthma, and the 
 other a specimen of coal-miners' black lung. To copy 
 the account from the Transactions of the Society : 
 
 "Specimen of diseased lung from a case of grinders' 
 asthma. — The specimen has been in my possession for 
 some years. It was taken from the body of a razor- 
 
OF POWDERS INTO LUNG-TISSUE. 285 
 
 grinder, who had long suffered from grinders' pulmonary 
 disease, but had died from an intercurrent attack of 
 pneumonia. The portion of lung shown is from the 
 upper lobe, near the apex ; it is consolidated, but some 
 parts are harder than others, and it is intersected by a 
 firm white band, apparently produced by the thicken- 
 ing of interlobular tissue. It is now of a dark bluish- 
 gray color, but is paler than when fresh. On exami- 
 nation of a thin slice under the microscope, a few small, 
 apparently crystalline bodies, * irregular in size and 
 shape, were seen embedded in the tissue, which also 
 contained numerous small, well-defined, black masses 
 of various sizes, which gave the lung its peculiar dark 
 color. On the supposition that these latter might be 
 at least due to the presence of oxidized iron, a very 
 thin slice of the lung was taken and immersed for some 
 time in hydrochloric acid ; but on examination under 
 the microscope, it was found still to present appear- 
 ances identical with those already described. In order 
 to determine the nature of the apparently crystalline 
 bodies, a small portion of the lung was carefully incin- 
 erated in a porcelain crucible ; it left a bright red ash 
 which partially dissolved in boiling hydrochloric acid, 
 leaving a small residue that gravitated to the bottom of 
 the vessel. On examination of this residue under the 
 microscope, it was found to consist partly of an amor- 
 phous deposit, partly of small angular masses which 
 reflected light powerfully, and polarized light trans- 
 mitted through them. A portion of the residue being, 
 at the suggestion of my friend, Mr. Heisch, lecturer 
 on chemistry at the Middlesex Hospital, exposed in a 
 shallow platinum vessel to the fumes of hydrofluoric 
 acid, was entirely dissipated, proving it to be silica. A 
 
286 PATHOLOGICAL PROOFS OF PENETRATION 
 
 comparative experiment was tried with a portion of 
 ordinary lung (from a patient who had died in the 
 Middlesex Hospital) which, when incinerated, left an 
 ash not quite so red as that from the grinder's lung, 
 and altogether soluble in boiling hydrochloric acid. 
 The solution of the ash from both lungs gave faint in- 
 dications of the existence of iron, about equal in both 
 cases ; but the absence of free particles of iron in the 
 grinder's lung was determined by bringing every part 
 of the specimen into proximity with a delicate magnetic 
 needle without causing any sensible disturbance. 
 
 " The disease from which the patient had suffered ap- 
 pears to have been chronic, or, as Rokitansky terms it, 
 interstitial pneumonia, and its cause was doubtless the 
 inhalation of finely pulverized grit, given doff from the 
 revolving grindstone while the man was at work, and 
 which, as we have seen, was found in the lung after 
 death, in the form of small angular particles of silica. 
 
 u Specimen of coal-miners black lung. — This speci- 
 men, like the former, has been in my possession for some 
 time. It was obtained from the body of a collier who 
 had worked in the shallow and ill-ventilated coal mines 
 near Wolverhampton, and was taken from the free mar- 
 gin of the upper lobe. The general color of the mass 
 is dark blue, almost black ; but it was quite black when 
 fresh, at which time a black juice could readily be 
 expressed from its substance. The pleura is thickened, 
 and the lung is traversed by some firm white bands, 
 apparently formed by the thickening of the interlobular 
 tissue. The lung cuts toughly, and is very firm and 
 solid, but not uniformly so, some ill-defined harder por- 
 tions being felt in the substance when handled. Under 
 the microscope, the lung was seen to be studded with 
 
OF POWDERS INTO LUNG-TISSUE. 287 
 
 small black deposits, apparently irregular, both in shape 
 and size, but the examination was not made until it had 
 been for some time immersed in spirit. On boiling a 
 small slice in strong hydrochloric acid, the black deposit 
 was not affected. A portion of the lung when incin- 
 erated, left a red ash, closely resembling the ash left 
 from burnt coal. When boiled in hydrochloric acid, 
 this ash was partially dissolved, leaving a white or 
 grayish amorphous residue, which did not polarize light, 
 but evidently consisted of silica, for it was dissipated 
 on being exposed to the fumes of hydrofluoric acid. 
 
 "This case appears to have been assimilated in its 
 pathological characters to that of the razor-grinder. 
 The lung was similarly consolidated, and traversed by 
 white bands. Whatever doubt may sometimes be enter- 
 tained regarding the origin of the black deposit in the 
 lungs of colliers, it appears quite certain that in this in- 
 stance it arose mainly from the inhalation of finely -pul- 
 verized coal; for on no other supposition can we explain 
 the presence of the very large amount of amorphous silica 
 obtained from the incinerated lung. 
 
 " Remarks. — The result of the examination of these 
 specimens of lung accords with the history of the symp- 
 toms from which the several classes of operatives ex- 
 posed to inhale grit, or other heavy dust, are practically 
 found to suffer. The earlier symptoms are those of 
 bronchial irritation, namely: slight dyspnoea, cough, 
 and scanty expectoration colored with the material in- 
 haled. This ailment often proceeds so slowly and in- 
 sidiously that the sufferer is scarcely aware of its exist- 
 ence until it becomes aggravated by some attack of ca- 
 tarrh, and more or less disables him from working. 
 Hence, overlooking the previous indisposition, he, for 
 
288 PATHOLOGICAL PROOFS OF PENETRATION 
 
 the most part, dates the commencement of his illness 
 from the occurrence of a cold. In a great many in- 
 stances, and especially those in which the dust inhaled 
 is of a light description, the disease often remains bron- 
 chial throughout, and presents only the ordinary char- 
 acters of chronic bronchitis, with or without emphysema. 
 But in other cases, and especially in those in which a 
 heavy dust, such as that given off in the processes of 
 razor-grinding or china-scouring, has been inhaled, 
 chronic pneumonia supervenes after a time, and fre- 
 quently proves fatal, either in consequence of an inter- 
 current attack of acute pneumonia, or after a long 
 chronic course with symptoms resembling those of very 
 chronic phthisis. Dyspnoea is always a very marked 
 feature of such cases, and is sometimes so extreme as 
 to prevent active locomotion, even while the patient 
 is still able to continue his occupation. The physical 
 signs are also out of all proportion to the amount of dis- 
 turbance of the general health, which, in constitutionally 
 sound subjects, is much less than in those who are the 
 subjects of pulmonary disease arising from constitutional 
 cachexia. Sometimes, even when the complaint appears 
 to be far advanced, the discontinuance of exposure to 
 the determined cause, viz., the inhalation of dust, is fol- 
 lowed by a most marked improvement in health." 
 
 Prof, Zenker relates in detail (Deutseh. Arch, fur 
 Klinik Med., 1866, vol. 11, p. 116) a case of an oper- 
 ative, aet. 31, who had been employed during life in pre- 
 paring the paper books for the gold-leaf fabric, and who 
 died in 1864, after an illness of eight weeks. The powder 
 employed is that known as English red, a compound of 
 iron, which is used in the form of a dry impalpable pow- 
 der, and rubbed into the paper with felt. The atmos- 
 
OF POWDERS INTO LUNG-TISSUE. 289 
 
 phere of the workroom becomes so filled with the dust 
 as, in a few minutes, to dry the fauces of strangers unac- 
 customed to the atmosphere. The lung of this patient 
 had a red color; and on chemical examination, Prof, von 
 GoruP-Besanez found oxide of iron in large quantities 
 as fine molecules in the air-passages, and to a greater ex- 
 tent in the lung-tissue itself; besides, also, in the bron- 
 chial glands ; and still further, showing that the par- 
 ticles, after penetrating the interstitial tissue, had been 
 carried onwards by the lymphatic system. 
 
 A solution, in hydrochloric acid, of 55 grammes of the 
 incinerated ash of this lung-tissue, was found to contain 
 0.828 grammes of oxide of iron ; therefore, 14.5 
 grammes, or about half an ounce to 1000 grammes; 
 or in the proportion of three-fourths of an ounce in the 
 entire lungs, which, in the present instance, weighed 
 1500 grammes, the left lung weighing 720, and the 
 right 780 grammes ; much in excess of the normal 
 weight of the female lungs, which, according to Krause, 
 is 1050, according to Dieberg, 1073 grammes. 
 
 In order to determine the specific gravity, a compar- 
 ative experiment was made with the healthy lung of a 
 robust man of forty years of age, who died of another 
 affection, and with the compressed lung of an old man, 
 who died of pleuritic exudation, care being taken to re- 
 move by frequent washing, &c, all sources of error 
 which might invalidate the experiment. The result is 
 shown in the following table : 
 
 A portion of the Of the Of the 
 
 oxidized lung; sound lung; compressed lung; 
 
 Weighed in air, 7.210 gr. 8.810 gr. 12.02 gr. 
 
 Weighed in water, 0.440 0.130 0.03 
 
 Loss of weight in water, . . 6.770 8.680 11.99 
 
 Thesp. gr. being 1.065 1.015 1.0025 
 
 25 
 
290 PATHOLOGICAL PROOFS OF PENETRATION 
 
 To demonstrate more clearly the increased weight, 
 equal portions were taken from the above specimens, and 
 also from the sound lung of a boy of fifteen years of age, 
 which were allowed to drop to the bottom of a glass cyl- 
 inder, filled with water to the height of forty-five cen- 
 timetres ; when it was found that the oxidized lung fell 
 in thirteen seconds, upon a first, second, and third trial; 
 that the piece of sound lung from the robust man aged 
 forty, fell in twenty-six seconds on the first trial, in 
 twenty-five seconds on the second trial, and in twenty- 
 six seconds on the third trial ; the piece of sound lung 
 from the boy aged fifteen, fell in thirty seconds on the 
 first and second trials ; and the specimen of compressed 
 lung from an aged man fell in thirty-one seconds on the 
 first trial, in thirty-two seconds on the second trial, and 
 in thirty-two seconds on the third trial. 
 
 A second case is related w T ith similar results as to the 
 detection of oxide of iron in the air-passages and lung- 
 tissue, in a patient who had been employed backing glass 
 mirrors, the English red being used for the purpose of 
 rendering the metal adherent. 
 
 The sputa of a similar operative, examined twelve 
 hours after leaving off work, were found to contain the 
 oxide of iron upon chemical and microscopical investi- 
 gation. 
 
 The results of many other post-mortem examinations 
 have given the same results. Thus may be mentioned 
 the cases recorded by Erdmann, Lowe, Brockman, 
 Pearson, Bichat, Trousseau, Laennec, and many 
 others. 
 
 Dr. L. Petrenz (Lewin, op. cit., p. 11) found stony 
 concretions the size of a hazel-nut in purulent pulmonary 
 cavities. 
 
OF POWDERS INTO LUNG-TISSUE. 291 
 
 With regard to the black pigmentary matters found 
 in the lungs of deceased coal-miners, and others who 
 have worked in atmospheres loaded with coal-dust, some 
 authors deny altogether their penetration into the pul- 
 monary organs ; others contend that they may be in- 
 haled, but, being insoluble, are expectorated ; others 
 not only admit their penetration, but are of opinion 
 that they accumulate, act deleteriously, and produce al- 
 teration of structure. 
 
 Virchow is one of those who contend that these ap- 
 pearances are not due to the inhalation of particles of 
 coal-dust; which, according to him, if inhaled, would be 
 extruded with the bronchial mucus. He considers the 
 affection pigmentary, and due principally to obstruction 
 of the mitral valve dependent upon a chronic hypere- 
 mia of the lungs, the result of a detention of the blood 
 in the pulmonary veins. 
 
 Bayle recorded two cases which he attributed to a 
 circumscribed melanosis; and Laennec, in commenting 
 upon this view, rather refers the black deposit, as at 
 least in part due, to inhalation from the smoke of the 
 lamp or other products of illumination in general use, as 
 it was sometimes discovered in the lungs of nurses ac- 
 customed to sit up at night with the sick. 
 
 It is also found in the lungs of other miners, not 
 colliers, who work with lamps suspended over their 
 heads. 
 
 Others, again, are of opinion that the carbonaceous 
 material or lampblack thus inhaled, accumulating, 
 forms a nidus for the attraction of further carbonaceous 
 matter from the blood. This view seems to be worthy 
 of a good deal of consideration, for it has been found 
 that by washing the lungs containing such deposits, two 
 
292 PATHOLOGICAL PROOFS OF PENETRATION 
 
 materials are secured — one a vegetable carbon not acted 
 upon by the solvents which will readily dissolve the 
 other or organic pigmentary matter. 
 
 While it is true that much of the matters inhaled 
 would be thrown out of the system with the bronchial 
 secretions, it must be remembered that some portions 
 will be too heavy to be cast out against gravity, by the 
 mere motion of the bronchial cilia, while other minute 
 sharp-pointed particles, will bore their way through the 
 epithelium, and thus eventually become embedded into 
 the very pulmonary tissue, as indeed appears to have 
 been the case in the examples cited, similar evidence to 
 which can be readily increased by adducing further 
 records. 
 
 We know, too, that workmen who remain long at a 
 time in apartments filled with fine dust, — for instance, 
 bakers, weavers, chimney-sweepers, artificers in stone, 
 &c, — are peculiarly liable to diseases of the lungs. Thus 
 Dr. Peacock, calling attention {Brit. $- 'For. Med.-Chir. 
 Rev., vol. xxv, 1860, p. 215) to the form of phthisis to 
 which the French millstone-makers are subject, explains 
 how it is contracted. The rough working of the stone is 
 effected by a steel chisel, " the pritchel," which is struck 
 by a metal hammer, and the surfaces are finished by 
 picking with a double-pointed steel instrument fixed in 
 a wooden handle — the "bill and thrift." As the burr 
 is extremely hard (it is the " French burr," situated in 
 the Paris basin above the gypsum containing bones, and 
 in strata of sand and sandstone, and is harder to work 
 than gun-flint), every stroke of the chisel is attended by 
 a flash of light and a cloud of dust, and larger or smaller 
 particles of stone, forming a sharp grit, are thrown off. 
 Portions of the stone and of iron from the chisel not in- 
 
OF POWDERS INTO LUNG-TISSUE. 293 
 
 frequently become embedded in the hands of the work- 
 men, so that the backs of the hands of those who have 
 been long at the trade are studded with small bluish 
 spots ; and occasionally the men sustain serious injury 
 to their eyes. The mortality of these workmen is very 
 great, so that of fifty workmen, about twenty will die 
 of pulmonary disease within a few years, and they seldom 
 live beyond forty years of age, especially if they begin 
 to work at the trade in early life before their full physi- 
 cal development has been acquired. Dr. Peacock found 
 in four workshops forty-one workmen, of whom the 
 eldest was but thirty-eight years of age, and those next 
 oldest twenty-nine and twenty-eight respectively. Most 
 of them had before them, on an average, but eight or 
 nine years more of labor. It is a remarkable fact that 
 these workmen, knowing their condition and the result 
 of a continuance at their avocation, seem thoroughly 
 satisfied with it. Their wages are high (5s. per day), 
 their dwellings and workshops are healthy, and they 
 are well clothed. They drink freely of ardent spirits, 
 which is said to preserve their strength and enable them 
 to exist longer. 
 
 Prof. Dickson, in his lectures last winter in Jefferson 
 Medical College, Philadelphia, teaching the causation of 
 disease, drew the attention of his class to the fact that 
 many diseases are necessary results of the occupations 
 of civilized life, and instanced the wet and dry grin- 
 ders in England, who have long been doomed to prema- 
 ture old age and death, from the wearing away of the 
 stone in "foam-like surges," which fill the lungs and 
 thus induce fatal disease ; for a dry grinder rarely 
 reaches thirty-five, or a wet grinder forty-five years of 
 age; quoting the following lines from Elliot's Corn-Law 
 
 25* 
 
294 
 
 ETC. 
 
 Rhymes, showing how these grinders, like the millstone- 
 makers, continue at their trade on account of its high 
 wages and opportunity for affording the means of alco- 
 holic stimulation : 
 
 " There draws the grinder his laborious breath ; 
 
 There, coughing, at his deadly trade he bends; 
 Born to die young, he fears nor man nor death ; 
 
 Despair and riot are his bosom friends. 
 Bid science on his cheek prolong the bloom ! 
 
 He wilt not live — he seems in haste to gain 
 The undisturbed asylum of the tomb ; 
 
 And, old at two-and- thirty, meets his doom." 
 
 As a pathological proof of the penetrability of fine 
 powders into the respiratory passages, I may instance a 
 number of cases occurring in a family in this city living 
 over a perfumery store which caught fire. The family 
 breathed the stifling smoke, and ten of them who came 
 under the care of Dr. W. W. Keen, Jr., and myself, were 
 attacked with severe bronchitis, with aphonia ; and for 
 several days subsequent to the accident they expecto- 
 rated large quantities of black sputa, which were 
 nothing more nor less than the carbonaceous matters 
 they were forced to inhale during the conflagration be- 
 fore they could be rescued. 
 
 Dr. Da Costa, of this city, in a foot-note to the re- 
 print of his lately-published essay on Inhalation, states 
 that quite recently his attention had been called by Dr. 
 Fleming, of Pittsburg, to the rapidity with which men 
 repairing copper work which had been used for steam, 
 water, &c, become affected by the impalpable oxide of 
 copper therein formed. Dr. Fleming himself, having 
 been exposed for a few minutes to the same influence, 
 and the quantity breathed having been very minute, was 
 astonished at the great effect experienced ; constriction 
 about the chest, most active salivation, &c. 
 
INDEX. 
 
 Academy of Paris (Hyclrological), 14. 
 
 (Imperial, of Medicine), 15. 
 report to, on Sales-Girons' inhalatorium, 15. 
 on Sales-Girons' portable nebulizer, 15. 
 of Poggiale to, on the inhalation of nebulized fluids, 56. 
 discussion before, on Poggiale's report, 57. 
 Acidum carbolicum, 98. 
 
 tannicum, 91. 
 Alumen, 90. 
 
 Aluminium nitricum, 91. 
 Ammonia murias, 93. 
 
 inhalation of vapors of, 250. 
 Le win's inhaler for vapors of, 251. 
 Angina diphtheritica, 230. 
 tonsillaris, 103. 
 syphilitica, 107. 
 Aphonia, 142, 205, 226. 
 Aqua amygdalarse amarte, 95. 
 assafoetidae, 94. 
 calcis, 94. 
 picis liquids, 94. 
 Argenti nitras, 91. 
 Argentum iodidum, 94. 
 Arnold, Dr. G-. J., apparatus of, 34. 
 Aromatic alcoholic inhalations, 267. 
 Arsenical vapors, inhalation of, 260. 
 Asphyxia, 194, 196. 
 Asthma, 165, 181, 249. 
 
 * of grinders, case of, 284. 
 Atmospheres, medicated, 267. 
 Atmospheric air, forced inhalation of, 180-1. 
 compressed, inhalation of, 182. 
 
296 INDEX. 
 
 Atropine sulphas, 96. 
 Axtphan, experiments of, 55. 
 inhalatorium of, 13. 
 
 Balsamic vapors, inhalation of, 236. 
 Bataille, experiments of, 55. . 
 Beigel, face protector of, 38. 
 
 oxygen, inhaler of, 191. 
 
 pocket steam nebulizer of, 38. 
 Belladonna, inhalation of vapors of, 254. 
 Belladonnas tinctura, 96. 
 Benzine, inhalation of, 222. 
 Bergson, nebulizer of, 25-8. 
 
 Bernard, Prof. Claude, experiments witnessed by, 41. 
 Briau Bene, experiments of, 41. 
 
 treatment of cases by, 100. 
 Bronchial catarrh, 113. 
 Bronchitis, acute, 147, 225. 
 
 chronic, 148, 243. 
 Bronchorrhcea, 148, 215. 
 
 Cadinum oleum, 97. 
 Camphor, 97. 
 
 inhalation of vapors of, 255. 
 
 Raspail's inhalers for, 255. 
 Cannabis indicum extractum, 95. 
 
 tinctura, 95. 
 Carbolic acid, 98, 163. 
 
 Carbonaceous matters found in miners' lungs, 291. 
 Carbonic acid gas as a nebulizing force, 34. 
 
 inhalation of, 218. 
 Cases of angina tonsillaris, 103. 
 
 aphonia, 142-4, 205, 227, 228. 
 
 asphyxia, 196. 
 
 asthma, 165, 181, 199. 
 
 bronchiectasie, 114. 
 
 bronchitis, acute, 225. 
 
 chronic, 113, 148-9, 225. 
 
 bronchorrhcea, 215. 
 
 coal-miners' black lung, 286. 
 
 coryza, 213. 
 
INDEX. 297 
 
 Cases of croup, 114-122, 197, 232, 235, 256. 
 
 diphtheria, 123-137, 199, 230, 258-260. 
 
 emphysema, 165. 
 
 faucitis, 109. 
 . grinders' asthma, 284. 
 
 haemoptysis, 152-6. 
 
 laryngeal phthisis, 111. 
 
 loss of speech and hearing, 228. 
 
 millstone-makers' phthisis, 283. 
 
 oedema of the glottis, 137-9. 
 
 penetration of charcoal dust into the pulmonary tissue, 282. 
 
 penetration of " English red" into the pulmonary tissue, 288- 
 290. 
 
 pharyngitis, chronic, 106. 
 granular, 107. 
 
 pharyngo-laryngitis, 108-9. 
 
 phthisis pulmonalis, 156, 158, 159, 162, 163, 193, 203, 209, 211. 
 
 pulmonary gangrene, 164, 238, 239. 
 
 scarlatina anginosa, 168-9. 
 
 stricture of the glottis, 140. 
 
 tuberculosis with pathological proofs of the penetration of 
 nebulized fluids into the lungs, 65, 72. 
 
 whooping-cough, 144-7, 216. 
 Catarrh of typhus fever, 170. 
 Champouillon, experiments of, 43. 
 Charriere, apparatus of, 15, 17. 
 Chlorine, inhalation of, 201. 
 Chloroform, inhalation of, 223. 
 Cholera, 170, 194-5. 
 
 Clarke, Dr. Andrew, apparatus of, 28. 
 Cohen, apparatus of, 32, 37. 
 
 Comparative merits of apparatus of Sales-Girons and of Berg- 
 son, 31. 
 Compressed air, inhalation of, 182. 
 
 Tabarie's apparatus for inhalation of, 183. 
 Conii extractum, 95. 
 
 Corrigan's apparatus for inhalation of chlorine, &c, 204. 
 Coryza, 102, 213. 
 Copaiba, oil of, 97. 
 Copper, inhalation of vapors of chloride of, 262. 
 
 inhalation of oxide of, 294. 
 
298 INDEX. 
 
 Creasote vapors, inhalation of, 242. 
 Croup, 114, 232, 235, 256. 
 
 Delore, experiments of, 43. 
 
 Demarquay, experiments of, 50. 
 
 his cases of granular pharyngitis, 107. 
 
 Diet, respiratory, 268. 
 
 Digitalis, tincture of, 96. 
 
 Diphtheria, 123, 230, 258. 
 
 Discussion on Poggiale's report to the Imperial Academy of Medi- 
 cine, 57. 
 
 Disinfection, 172. 
 
 Diseases to the treatment of which nebulized fluids are appli- 
 cable, 99. 
 
 Ditrand-Eardel, his conclusions, 57. 
 
 Emphysema, 165. 
 Ether, inhalation of, 223. 
 Exanthemata, sore throats of, 167. 
 
 Experiments on men and animals as to the penetration of nebu- 
 lized fluids, 39. 
 
 proving the penetration of powders into, the respiratory 
 tracts, 277. 
 
 Of Auphaa, 55. 
 
 Battaille, 55. 
 
 Briau, 41. 
 
 Champouillon, 43. 
 
 Delore, 43. 
 
 Demarquay, 50. 
 
 Eieber, 60. 
 
 Fournie, 44, 278. 
 
 Gerhardt, 72. 
 
 Gibb, 73. 
 
 Gratiolet, 54. 
 
 Lewin, 62. 
 
 Mackenzie, 73. 
 
 Moura-Bourouillou, 55. 
 
 Pietra-Santa, 40. 
 
 Key, 43. 
 
 Sales-Girons, 56. 
 
INDEX. 299 
 
 Experiments of Schnitzler and Stork, 61. 
 
 Semeleder, 73. 
 
 Tavernier, 54. 
 
 Tobold, 61. 
 
 with artificial respiratory apparatus, 45, 56. 
 
 with negative results, 40. 
 
 with positive results, 50. 
 Extract of cannabis indicum, 95. 
 
 conium, 95. 
 
 hyoscyamus (alcoholic), 95. 
 
 opium, 95. 
 
 rhatany, 91. 
 
 Fauces, acute inflammation of, 102. 
 
 chronic inflammation of, 104. 
 Ferri sesquichloridi, 90. 
 
 subsulphas, 90. 
 Fieber, experiments of, 60. 
 Fotjrnie, apparatus of, 21. 
 
 conclusions of, 49. 
 
 experiments of, 44, 278. 
 
 work of, 45. 
 
 Gases, inhalation of, 175. 
 Gibb, experiments of, 73. 
 Glottis, oedema of, 137. 
 
 stricture of, 140. 
 Gratiolet, experiments of, 54. 
 
 Haemoptysis, 149. 
 Hydrargyri bichloridum, 94. 
 Hydrokomion of Bergson, 31. 
 
 of Schneider and Walz, 31. 
 Hydrological Academy of Paris, 14. 
 Hydrostatic pressure as a nebulizing force, 34. 
 
 Illuminating gas, inhalation of, 218. 
 Inhalers for gases, vapors, &c, 177, 214. 
 Inhalation employed for systemic medication, 75 
 
 of gases, vapors, &c, 175. 
 
 nebulized fluids, 75. 
 
300 INDEX. 
 
 Inhalation of nebulized fluids, articles suitable for, 88. 
 
 immediate effects of, 79. 
 
 list of medicines applicable to, 89. 
 
 manner of conducting, 80. 
 
 number, strength, and duration of, 86. 
 
 Siegle's rules for, 85. 
 Inhalatorium at Euzet-les-Bains, 13. 
 Lamotte-les-Bains, 13. 
 Pierrefonds, 14. 
 Intermittent fever, 170. 
 . Introduction, vii. 
 Iodine, inhalation of, 206. 
 
 methods for, 207. 
 
 Berton's method, 211. 
 
 Merrill's method, 214. 
 
 results of in Piorry's thirty-one cases of phthisis, 209. 
 
 Scudamore's formula for, 210. 
 Iodinii compositus liquor, 94. 
 
 tinctura, 93. 
 Iron, sesquichloride of, 90. 
 subsulphate of, 90. 
 
 Lambron, apparatus of, 19. 
 Lamotte-les-Bains, inhalatorium at, 13: 
 Langenbkck, inhaler of, 179. 
 Laryngeal phthisis, 111. 
 Laryngitis, acute, 110. 
 
 chronic, 111. 
 Laughing gas, inhalation of, 200. 
 Lewust, apparatus of, 19, 23, 29, 31, 251. 
 
 experiments of, 62. 
 
 his glass nebulizer, advantages of, 24. 
 objections to, 25. 
 
 his objections to Key's conclusions, 44. 
 
 his strictures on FourniS's experiments, 50. 
 Lime, inhalation of vapors from, 256. 
 
 water, inhalation of, in croup and diphtheria, 116-123. 
 Liquor ferri sesquichloridi, 90. 
 
 potassse arsenitis, 94. 
 Lobelia inflata, tincture of, 96. 
 
INDEX. 301 
 
 Mackenzie, experiments of, 73. 
 
 Mans, his modification of Bergen's apparatus, 30. 
 
 Mathieu (cutler), nebulizer of, 22. 
 
 Matthietj (de la Drome), nebulizer of, 17. 
 
 Medicated atmospheres, 266. 
 
 Mercurial vapors, inhalation of, 260. 
 
 Millstone-makers' phthisis, 283, 292. 
 
 Morphiae acetas, 95. 
 
 Morrhuae oleum, 97. 
 
 Mottra-Bourouillou, experiments of, 55. 
 
 Mudge, inhaler of, 177. 
 
 Narcotic vapors, inhalation of, 253. 
 Nebulized sprays as disinfectants, 172. 
 Nebulizer of Arnold, 34. 
 
 Author, 32, 37. 
 
 Bergson, 26-7. 
 
 Fournie, 21. 
 
 Lewin, 24, 29. 
 
 Mathieu, 22. 
 
 Bead, 38. 
 
 Sales-Grirons, 15, 16, 17, 19. 
 
 Schnitzler, 21. 
 
 Siegle, 34-5. 
 
 Waldenburg, 19. 
 Ne"phogene of Matthieu, 18. 
 Niemeyer, observations of, 73. 
 Nitrate of potassa, inhalation of fumes of, 249. 
 
 of silver, inhalation of, in chronic affections, 112. 
 Nitrous gas, inhalation of, 216. 
 Nitrous oxide gas, inhalation of, 200. 
 
 Objections to nebulizer of Lewin, 25. 
 
 Matthieu, 18. 
 Oleum cadinum, 97. 
 
 copaibae, 97. 
 
 cubebae, 97. 
 
 morrhuaa, 97. 
 
 olivae, 97. 
 
 pini, 97. 
 
 inhalation of vapors of, 244-5 
 
 26 
 
302 INDEX. 
 
 Oleum terebinthinse, 96. 
 Opii extractum, 95. 
 
 tinctura camphorata, 96. 
 simplex, 95. 
 Opium, inhalation of vapors of, 253. 
 Oxygen, inhalation of, 183. 
 Oxy-generator, 192. 
 
 Pathological proofs of the penetration of fluids into the respiratory 
 organs, 55, 65-73. 
 
 powders into the lung-tissue, 282. 
 Persians, inhalations as practised by the, 263. 
 Pharyngitis, acute, 102. 
 
 chronic, 104. 
 
 granulosa, 107. 
 
 sicca, 105. 
 Pharyngo-laryngitis, 107, 110. 
 Phthisis laryngea, 111. 
 
 pulmonalis, 156, 158, 193, 203, 209, 211, 218, 224, 240. 
 Pierrefonds, inhalatorium at, 14. 
 Pietra-Santa, Prosper de, experiments of, 40. 
 
 views of, 41. 
 Pigmentary matters found in miners' lungs, 291. 
 Pine, inhalation of vapors of oils of, 244-5. 
 Plumbi acetas, 93. 
 Pneumonia, 170. 
 Pocket nebulizer of Lewin, 29. 
 
 Poggiale, his report to the Imperial Academy of Medicine, 56. 
 Pomeroy, inhaler of, 179. 
 Potassae arsenitis liquor, 94. 
 
 carbonas, 93. 
 
 chloras, 92. 
 
 nitras, 249. 
 
 permanganas, 90, 249. 
 Potassi bromidum, 92. 
 
 iodidum, 92. 
 Proportion of nebulized spray entering the larynx during inhala- 
 tion, 76-8. 
 Prunus Yirginiana, inhalation of infusion of, 162-3. 
 Pulmonary gangrene, 164, 237. 
 Pulverizateur portatif of Sales-G-irons, 15, 16. 
 
INDEX. I 
 
 Pyroligneous acid fumes, inhalation of, 242. 
 
 Quiniae sulphas, 97. 
 
 Head, steam nebulizer of, 38. 
 Key Armand, apparatus of, 44. 
 
 experiments of, 44. 
 Eeport of Poggiale to the Imperial Academy of Medicine, 56. 
 Kesinous vapors, inhalation of, 246. 
 Respiratory diet, 268. 
 
 therapeutics, 171. 
 Richardson, spray producer of, 31. 
 
 Sal ammoniac, inhalation of vapors of, 250. 
 Sales-Gtrons, experiments of, 56. 
 
 his inhalatorium at Pierrefonds, 14. 
 
 his method of treatment, 99. 
 
 his portable nebulizer, 15. 
 Scarlatina, 168, 194. 
 
 Schneider and Walz, hydrokomion of, 31. 
 Schnitzler, apparatus of, 21. 
 
 cases of, 107. 
 
 and Stork, experiments of, 61. 
 Scudamore, inhaler of, 178. 
 Semeleder, experiments of, 73. 
 Siegle, apparatus of, 33-5. 
 
 use of steam by, 33. 
 Small-pox, sore throat of, 169. 
 Smoke, inhalation of, 294. 
 Snow, inhaler of, 179. 
 Sodae chloras, 94. 
 
 liquor chlorinata, 92. 
 Sodii chloridum, 92. 
 Sore throats of exanthemata, 167. 
 Steam as a nebulizing force, 20. 33. 
 
 inhalation of, 264. 
 Stramonium, inhalation of vapors of, 254. 
 
 tincture of, 96. 
 Sulphur vapors, inhalation of, 217. 
 Sulphuric ether, inhalation of, 223. 
 
 comp., inhalation of, 224. 
 
304 INDEX. 
 
 Summary of views as to the inhalation of nebulized fluids, 173. 
 Syphilitic ulcerations, 167. 
 
 Tabarie, apparatus of, for inhalation of compressed air, 183. 
 
 Tannin, 91. 
 
 Tar vapors, inhalation of, 240. 
 
 Ta vernier, experiments of, 54. 
 
 Tincture of belladonna, 96. 
 
 digitalis, 96. 
 
 lobelia inflata, 96. 
 
 opium, 95. 
 
 (camphorated), 96. 
 
 stramonium, 96. 
 Tobacco smoke, inhalation of, 256. 
 Tobold, experiments of, 61. 
 Tonsillitis, 104. 
 Tonsils, hypertrophied, 106. 
 Trousseau, his demonstration of Demarquay's rabbits, 54. 
 
 his remarks before the Parisian Academy of Medicine, 58. 
 Tubes of Bergson, 26. 
 
 as modified by author, 32. 
 Mans, 30. 
 Winterich and others, 29. 
 
 how made, kept clean, &c, 28-9. 
 Turpentine, oil of, 96. 
 
 vapors, inhalation of, 237. 
 Typhoid fever, 201. 
 
 Vapors, inhaler for, 177, 251. 
 
 inhalation of, 175. 
 
 proper temperature for inhalation, 177. 
 Velpeau, apparatus of, 19. 
 
 Waldenburg, apparatus of, 19. 
 Water, cold, 89. 
 
 warm, 89. 
 
 mineral, 98. 
 
 inhalation of hot vapor of, 264. 
 medicated vapors of, 265. 
 Wedemann, clinical observations of, 73. 
 Whooping-cough, 144, 216, 218, 220, 222, 240. 
 
INDEX. 305 
 
 Wild cherry bark infusion, inhalation of, 162-3. 
 Winterich, his modification of Bergson's tubes, 29. 
 Wool, inhalation of fumes from, 248. 
 
 Zdekauer, case of detection in lung-tissue of fluid inhaled before 
 
 death, 72. 
 Zinci sulphas, 93. 
 
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 Stokes on Diseases of the Heart and Aorta. Octavo, . 
 Skoda on Auscultation and Percussion. 12mo., 
 Tanner's Practice of Medicine. Eoyal octavo, . 
 Tanner on Diseases of Children. Octavo, . 
 Tanner's Index of Diseases. Octavo, .... 
 
 Tanner's Memoranda of Poisons. 32mo., . 
 Trousseau's Clinical Medicine. Octavo. Price per part, 
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 Thompson on Pulmonary Consumption. Octavo. Illustrated 
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 Taylor's Movement Cure. 12mo. Illustrated,. 
 Virchow's Cellular Pathology. Octavo, . 
 Virchow on Morbid Tumors, ..... 
 
 Walker on Intermarriage. 12mo. Illustrated, 
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 Waring's Practical Therapeutics. Eoyal octavo, 
 Walton's Operative Ophthalmic Surgery. Octavo. Illus 
 
 trated, 
 
 Watson's Practice of Medicine. Abridged. 12mo. Flexi 
 
 ble cloth, 
 
 Wright on Headaches. 
 
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 12mo., . 
 
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