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A MANUAL 
 
 Inhalers, Inhalations and Inhalants 
 
 AND 
 GUIDE TO 
 -THEIR DISCRIMINATING USE- 
 IN THE TREATMENT 
 OF 
 
 COMMON CATARRHAL DISEASES 
 
 OF THE 
 
 RESPIRATORY TRACT. 
 
 BEVERLEY ROBINSON, M. D., 
 
 M 
 Clinical Professor of Medicine at the Bellevue Hospital 
 Medical College, New York. 
 
 Second Edition. 
 
 1888. 
 GEORGE S. DAVIS, 
 
 DETROIT. MICH. 
 
Copyrighted by 
 GEORGE S. DAVIS. 
 
 ■Hftnuv tmpitf 
 
 BIOLOGY 
 
 UBRARY 
 

 INTRODUCTION. 
 
 I am convinced that a small book on inhalers, 
 inhalations, and inhalants, is needed by general prac- 
 titioners of medicine. First, because the text-books 
 for sale are somewhat out of date. Second, because 
 those obtainable do not answer actual requirements, 
 owing to their size and completeness. By this criti- 
 cism, I mean particularly that many inhalers are 
 described in detail, which are no longer employed at 
 all — and, indeed, never were used, except perhaps by 
 the inventors — and views are related at length, which 
 were formerly debatable, but now are settled definitely. 
 I am of the opinion, also, that books of this sort are 
 useful only when based upon personal experience, and 
 also provided they express individual convictions, and 
 not simply the opinions of others. 
 
 M51409 
 
CHAPTER I. 
 
 MEDICATED SPRAYS. 
 
 The kinds of atomizers in ordinary use are 
 numerous. 
 
 Some throw a very coarse spray, like Leffert's 
 (fig. i), and are mainly useful as instruments for 
 
 Fig. i. — Leffert's Nasal Spray Apparatus. 
 
 cleansing purposes in diseases of the nose and throat; 
 others project a medium coarse spray (fig. 2) or a 
 quite fine spray (fig. 3), and with proper limitations, 
 are serviceable as a means of local medication. 
 
 All hand atomizers are worked by means of either 
 a single or by two rubber bulbs. Two bulbs produce 
 a continuous spray, as the middle bulb, or the one 
 next the bottle of the atomizer, acts as a receiver for 
 
.:;:•>;'; — 6 — 
 
 compressed air. A single bulb causes an interrupted 
 spray,, which is almost continuous whenever the bulb 
 is pressed repeatedly and rapidly with the hand. If a 
 continous spray is in use, the end bulb must not be 
 pressed upon previous to withdrawal of the nozzle, 
 during the time the middle bulb is emptying itself of 
 
 Fig. 2. — Goodyear Flexible Tube Atomizer. 
 
 the compressed air. Otherwise the spray will continue 
 to be formed, and, whenever the nozzle of the atomizer 
 is removed from the nares, or mouth, will wet and soil 
 the patient's face and clothing. It can be appreciated 
 how annoying this occurrence is, both to the patient 
 and physician, and particularly, if a staining fluid like 
 nitrate of silver, or iron, is used. 
 
 If the bottle of the atomizer contains a non-stain- 
 
— 7 — 
 ing liquid, the resulting damage, or disagreeable effect, 
 is not so great. 
 
 The advantage of the single bulb lies in the fact 
 that when the pressure with the hand ceases the effect 
 passes away within a few seconds, and the spray 
 stops, and in withdrawing the instrument, there is 
 little, or no risk of wetting the patient with the atom- 
 ized fluid. 
 
 p IG 3 — Davidson Hard rubber Atomizer, 
 
 CONTINUOUS SPRAY (WITH TWO TIPS). 
 
 In the Goodyear Atomizer (fig. 2), the tubes 
 being made of fine metal, may be bent at will, and 
 the volume of the spray can be regulated by straight- 
 ening the tube, and then turning the inner tube to 
 right or left. Do this before using the tube, thus 
 assuring such a spray as may be desired. The inner 
 tube may be unscrewed and removed for facility of 
 cleaning it if it should become clogged. The sim- 
 
plicity of its construction, and its adjustability to 
 
 most cases, render this a very desirable instrument.* 
 
 The most improved form of atomizing tubes are 
 
 those known as Sass' spray tubes (fig. 4). They were 
 
 Fig. 4. — Sass' Hard-rubber Spray Tubes. 
 
 originally made of glass. They are now made of 
 metal and hard rubber. The latter tubes are less 
 liable to break than the former, Neither do they sepa- 
 rate from each other, since the two tubes, horizontal 
 and vertical, are not cemented together, but are joined 
 firmly by solder, or rubber. The tube of Sass, in 
 order to be effectually used, must be employed 
 
 *The description here given is taken from the Goodyear 
 Company's circular, and only changed so far as to be, in my 
 opinion, entirely accurate. 
 
— 9 
 
 by means of compressed air from a suitable air- 
 receiver which contains air under a pressure of at 
 least 20 to 30 pounds to the square inch (fig. 5). It 
 
 Fig. 5.— Compressed-air Spray Apparatus. 
 
 is manifest that no such pressure can, be kept up for 
 any length of time with the ordinary hand bulb, as the 
 fatigue of working it would soon become too consid- 
 erable for anyone of moderate strength. Further, it 
 is probable that the bulbs, or bulb, would soon give 
 way, or lose their elasticity, and thus become inoper- 
 ative. 
 
 Many of the hand-ball atomizers, as well as the 
 spray-producers of Sass, work upon the same prin- 
 ciple. The cold medicated fluid is contained in a 
 small bottle of suitable shape and size. Into this 
 
bottle, and to within a few lines of its bottom, passes 
 the lower portion of the vertical spray-tube. Ordinar- 
 ily — although this is not an absolute requirement for 
 use — this spray-tube is held tightly at the neck of the 
 bottle by a perforated stopper in rubber or cork, 
 through which it passes. A small triangular wedge is 
 cut on the margin of the stopper and through its en- 
 tire length, so as to allow the air-pressure to exert it- 
 self upon the surface of the fluid in the bottle. 
 
 To the proximal extremity of the upper tube of 
 the atomizer, the rubber tubing, connected with the 
 rubber bulb, or bulbs, is attached. When pressure is 
 made with the single bulb, the air from it is driven 
 with more or less force directly along the horizontal 
 tube of the spray tube. Of course when two bulbs 
 are used the air passes first into the middle bulb and 
 then from it through the horizontal tube, and escapes 
 at its distal extremity. The current of air thus pro- 
 duced draws up, on account of the vacuum formed in 
 the lower tube, the liquid in the bottle, which is trans- 
 formed into spray very near the two spray-tubes at 
 their farthest end, where they incline to each other at 
 right angles. 
 
 In many hand-ball atomizers the pressure of the 
 air from the bulb acts directly upon the surface of the 
 liquid contained in the bottle of the spray-producer 
 through a hole or tube, merely passing through the 
 stopper. The liquid in the bottle is thus forced up 
 through a somewhat fine tube which enters it, as 
 
in the other form described, and owing to progres- 
 sive narrowing of this tube, when the liquid approxi- 
 mates its outer extremity, or tip, it takes the form of 
 spray. The walls of the tip itself have everywhere a 
 thickness of several lines, and its shape is ordinarily 
 oval. Sometimes the tip, instead of being fixed upon 
 the tube, which goes to and passes through the stopper 
 and into the liquid, is movable, and is either slipped 
 or screwed on the extremity of this tube. In that case 
 several tips of different shapes and curves are usually 
 sold with the same atomizer. 
 
 In the instrument just described, the inner tube 
 terminates by a small orifice, when it reaches the mov- 
 able tip, but not yet small enough to produce a spray, 
 so that when the movable tip is taken off and the bulb 
 worked with the hand, the liquid flows from it in a 
 very small stream, and a spray is produced only when 
 the movable tip is replaced. A precaution, in regard 
 to the use of movable tips in the throat, is worth men- 
 tioning. Never make use of a movable tip, in spray- 
 ing either the larynx or the naso-pharynx, which slips 
 on the main tube of the atomizer, as it is liable to fall 
 off and lodge in the throat, thus causing distressing 
 and dangerous asphyxia. 
 
 Movable tips of any kind are rendered unnecessary 
 by the use of Goodyear 's atomizer, as in this one the 
 main tube can be bent in any required direction, with- 
 out obstructing the inner tube, or interfering at all 
 with the formation of a spray. The objections to this 
 
form of atomizer are two. i. If the tip or tube be- 
 comes occluded it is cleared with more difficulty than 
 those atomizers in which the tip is movable, and the 
 inner tube at its distal extremity is of somewhat larger 
 calibre.* 2. By reason of the relatively soft quality 
 of the rubber of which the outer layer of the spray 
 tube is made, it is not so durable, when bent frequently, 
 as the more solid spray-producer made of hard rub- 
 ber. Still, despite these objections, I have found 
 it to be a serviceable instrument and therefore 
 recommend it. Usually, when its terminal extremity 
 has become obstructed, I have been able to loosen 
 any impacted substance, if it be soluble, by soak- 
 ing the end in warm water for a few moments; after- 
 wards the force exercised by the bulb is sufficient to 
 free it completely. A slender wire is, also, often 
 serviceable for the same purpose, when the other 
 method fails. A hard rubber atomizer made by 
 Riker (fig. 6) is provided with a tongue depressor of 
 the same material attached to the tube. This addi- 
 tion is very practical as it enables the physician or pa- 
 tient to use it with great advantage in holding the 
 tongue down and out of the way of the spray. In re- 
 gard to the utility of cold tnedicated sprays\ and the 
 instruments, of course, which produce them, opinions 
 
 * This objection cannot be made to their atomisers at 
 present, as the tips are movable. 
 
 fBy cold sprays I mean in this place and elsewhere, 
 those having a temperature of about 80° F. 
 
— 13 — 
 differ. My own belief is that as a cleansing instrument 
 for diseases of the anterior and middle nasal passages, 
 no one is more generally useful than Leffert's (fig. i). 
 
 Fig. 6. — Riker's Hard-Rubber Atomizer. 
 
 Whenever these parts are partially, or completely 
 coated with mucus, or pus in a fluid, semi-solid, or 
 dried, inspissated state, the more or less frequent and 
 prolonged use of a coarse spray is our best means of 
 ridding them of these secretions. 
 
— 14 — 
 
 The fountain syringe and Davidson's syringe are 
 both objectionable: 
 
 i. They may occasion median otitis by reason of 
 an excessive flow of fluid, which fills the nose, and 
 under pressure may pass into the eustachian orifices. 
 
 2. The stream of watery fluid which is made in 
 their use is more irritating to the pituitary membrane 
 than a coarse spray. 
 
 3. The fluid does not reach the upper portion of 
 the nasal fossae, and naso-pharynx, as a rule, and hence 
 does not loosen and detach morbid secretions from 
 these regions so thoroughly. 
 
 On the other hand, in instances of old fetid and 
 atrophic coryza, the time required for the effective 
 use of a coarse spray is often so considerable, that we 
 are glad to recur to the use of instruments which 
 furnish a large amount of cleansing fluid in a short 
 time. In ridding the naso-pharynx, therefore, of 
 secretions similar in character to those mentioned in 
 the anterior and middle nasal passages, a moderately 
 coarse spray may be used at times advantageously, 
 but when the mucus is very hard and adherent, it is 
 preferable to employ the posterior nasal syringe 
 (fig. 7), as we cannot then use the spray long enough, 
 on account of intolerance of the patient's throat, to 
 render it entirely satisfactory. In the larynx, the Sass 
 apparatus, downward spray in all cases where mucus 
 and pus are visible in this organ, is the best cleansing 
 means. Rarely, however, are we forced to combat in 
 
— *5 — 
 the larynx the formation of hard crusts like those 
 which are so often present in advanced chronic dis- 
 ease of the nasal passages, are naso-pharynx. 
 
 Fig. 7. — Posterior Nasal Syringe. 
 
— 16 — 
 
 There are no serious objections to the use of cold 
 sprays or liquid in the manner described, whenever 
 the indications for cleansing the mucous membrane of 
 the nose or throat are evident. When, however, the 
 nasal passages are not obstructed in any notable de- 
 gree by mucus or pus; when a mere effort of moderate 
 blowing will rid the nose of its contents very com- 
 pletely, I object to the use of cold medicated sprays, 
 except in rare instances. 
 
 I do not believe any but the fine sprays, and pre- 
 ferably those made by Sass's tubes, are followed by 
 appreciable beneficial results. In instances of sub- 
 acute inflammation, either idiopathic or grafted on a 
 chronic condition, similar in type, I have frequently 
 known benefit to be derived from the use of these 
 sprays, at first repeated several times a day, and later 
 on once a day, or every other day. I do not, how- 
 ever, approve of their too long continuance, espe- 
 cially if frequently repeated, as a curative means of 
 treating catarrhal inflammations of the anterior, or 
 middle nasal passages. I believe that they often tend, 
 to produce occlusion of these passages. The turbi- 
 nated bodies become chronically irritated, are puffed 
 up and swollen, and whenever the nasal passages are 
 somewhat narrow, more or less permanent occlusion 
 is then produced. Indeed, I am now of the opinion 
 that many reflex neuroses of nasal origin owe their 
 development, or accentuation, to the injudicious and 
 
— ly — 
 
 prolonged use of various medicated sprays.* When- 
 ever the nasal fossae are particularly capacious and 
 open, as is true if there be beginning atrophy of the 
 soft parts, sprays, even though employed quite awhile 
 on each occasion and repeated many times each day, 
 are not injurious, simply because the turbinated bodies 
 do not, or cannot, swell as much as in the hypertrophic 
 form of nasal catarrh. Moreover, even supposing they 
 do swell to the same degree in both forms of disease, 
 they cannot produce occlusion of the nasal passages 
 to the same annoying and injurious extent. Medi- 
 cated cold sprays when used in the summer months 
 through the nose are often useful, or seemingly so, 
 even in cases in which during the fall and winter 
 months, they have proved decidedly detrimental. I 
 attribute this fact: i. To the temperature of the sur- 
 rounding atmosphere, which approximates very nearly 
 that of the spray employed. 2. To the presence in 
 the air of sulphurized, or balsamic vapors — as is true 
 whenever the patient is sojourning at sulphur springs, 
 or in the pine woods. During the inclement period 
 of the year in our climate, if one ventures into the 
 open air he is, of course, exposed to the action of a 
 cold and humid atmosphere. This air if breathed, as 
 it often is, a considerable portion of each day, is 
 particularly injurious to the mucous membrane 
 
 *I have recognized this fact several times even in the 
 treatment of hay-asthma by cocaine spray. 
 
— iS — 
 
 of the respiratory tract. The result is that very many 
 people suffer from recurrent attacks of acute catarrhal 
 inflammation of this region, or from chronic catarrhal 
 inflammation upon which an acute attack, more or 
 less severe, is being almost continuously grafted. 
 The individuals to whom I refer, and of whom there 
 are such great numbers in New York at least, are 
 hypersensitive so far as their respiratory mucous 
 membrane is concerned. They cannot withstand the 
 slightest draught of air. Even a moderate change of 
 temperature or atmospheric moisture will occasionally 
 give them an attack of sneezing or coughing. Their 
 passage from a warm to a cold room, or vice versa, 
 going to the theatre, or into a crowded ball-room, 
 sitting at dinner near a door partly open, being at a 
 concert for an hour or more with a window sash 
 drawn down at the far removed end of the room; all 
 of these slight causes, and many others, i. e., such as 
 fatigue, excess in eating or drinking, emotional strain, 
 are, each and all, sufficient at times to become efficient 
 factors in the production of coryza, pharyngitis, 
 laryngitis, or bronchitis. If such an individual come 
 to us for treatment, as of course he often will, what 
 shall we do for him ? Shall we further increase the 
 injurious influences to which he is, more or less, of 
 necessity exposed, by telling him to make use daily of 
 a cold, watery fluid introduced into his nose, mouth, 
 larynx, or bronchi, under the form of a fine spray ? 
 If we do, I am convinced that in a certain propor- 
 
— ly — 
 tion of cases of nasal inflammation we unquestion- 
 ably do our patients harm, and particularly is this true 
 if the local treatment be persisted in for any consider- 
 able length of time. The harm done in these cases is 
 without doubt occasioned by the imbibition of the 
 turbinated bodies with cold watery fluids, even though 
 of proper density, which at once irritates and causes 
 them to swell. This injurious result is more likely to 
 follow the use of cold sprays than of those suitably 
 warmed. Yet if, in cold weather, we warm the fluids, 
 the pituitary membrane is rendered even more sensi- 
 tive than before to changes of temperature, and if it 
 be afterwards exposed to contact with the outer air, 
 occlusion more or less permanent from local irritation 
 or contact is sure to be produced. The only way to 
 obviate this undesirable consequence in part is to in- 
 terdict the patient from leaving his room during one 
 hour after the use of the warm spray through the nasal 
 passages. Even though this precaution be observed, 
 in order to re-establish by degrees the ordinary state 
 of local circulation, the bad effects of such treatment 
 are so obvious as to be convincing, at least from a 
 clinical standpoint. 
 
 In catarrhal diseases of the naso-pharynx the use 
 of sprays, moderately coarse, or fine, are scarcely ever 
 injurious. Indeed, in the great majority of cases in 
 which this space is affected by acute or sub-acute in- 
 flammation, they are not merely grateful to the patient, 
 but in a less or greater degree, beneficial. I have 
 
little doubt that in acute and sub-acute inflammation a 
 properly formulated and moderately fine spray, ap^ 
 plied one or more times in twenty-four hours, moder- 
 ates irritation, reduces the quantity of the secretions 
 formed, changes their physiological character for the 
 better, and tends to diminish the thickening, or infil- 
 tration of soft tissues, which has taken place in a more 
 or less rapid manner. Unless, however, these applica- 
 tions be followed by the use of a stronger topical 
 application under the form of powder or liquid, made 
 by means of the brush, sponge, or insufflator, the pa- 
 tient does not, except in very acute cases, get all the 
 local treatment which his case requires. In chronic 
 inflammatory diseases of this region, except as a 
 cleansing means, sprays, as ordinarily employed, are 
 of questionable utility. One may persist day after 
 day, week after week, and month after month, in the 
 use of weak sprays, and if these be the sole curative 
 measures employed, patients do not notably improve, 
 as a rule, under the unfavorable surrounding circum- 
 stances. I mean by this, that they do not improve if 
 the outer air be cold, damp, rainy, blustering, or contains 
 much irritative dust. I eliminate from present con- 
 sideration, daily employment, habits, and ambient con- 
 ditions other than those mentioned, because these are 
 not different with the majority of individuals during 
 any considerable time. 
 
 In these cases strong astringent or alterative 
 applications, preferably of fluids, combined or not 
 
with a proportion of glycerine, must be made once, 
 twice, three times a week, or every day for a time as 
 the condition may clearly indicate. If this be done 
 and all theory be set aside for the while, such patients 
 as a rule improve and ultimately recover — this latter 
 result depending much upon the skill and knowledge 
 of the practitioner and the fidelity of the patient to 
 prescribed local treatment. 
 
 The general treatment of course is assumed to be 
 precisely what it wouid be if the patient were treated 
 solely by sprays. 
 
 Why, it may be asked, cannot strong sprays be 
 used with as much, or more, good effect in chronic 
 catarrhal disease of the naso-pharynx as when local 
 treatment is carried on by means of strong applica- 
 tions made with the sponge, cotton, or the brush ? 
 For two reasons; first, because such applications are 
 very painful; second, because their action is not suffi- 
 ciently limited and they come into contact with adja- 
 cent parts, whose condition, or structure, is opposed 
 to this ill-advised treatment, and hence a manifest 
 revolt of function is the consequence, as shown by dis- 
 tressing, and often lasting, symptoms thus produced. 
 
 Some such sufferers were victims of the specialists, 
 only a few years since, who pretended to cure chronic 
 follicular diseases of the naso-pharynx by means of 
 concentrated nitrate of silver and other caustic sprays 
 repeated many times at short intervals. In the fauces 
 and pharynx, while moderately coarse sprays are fre- 
 
quently serviceable and grateful in removing morbid 
 secretions, fine sprays suitably medicated have rather 
 more curative effect than they have in the naso- 
 pharynx. Indeed, for acute, or sub-acute inflamma- 
 tions of these regions which have existed but a short 
 time, I should not like to be left without this means 
 of local medication. Some patients, particularly small 
 children, and nervous, debilitated women, cannot 
 gargle at all; few persons, men or women, can gargle 
 effectually. It requires instruction to know how to 
 do it; it requires habit to be able to accomplish it. 
 Troltsch has shown this, and Roosa has further in- 
 sisted upon it. In chronic pharyngitis, accompanied 
 by more or less inflammation and thickening of the 
 palate, fauces and tonsils, cure takes place, as a rule, 
 not on account of the repeated use of the spray, but 
 mainly on accouut of the astringent and alterative appli- 
 cations made with the sponge, or brush after morbid 
 secretions are removed by means of the spray. 
 
 I do not wish, however, to be quite as formal 
 in my small estimate of the utility of spray appli- 
 cations, as I am in regard to this treatment of 
 chronic diseases of the nose, or even the naso- 
 pharynx. Indeed, I am confident that in many neuro- 
 pathic disorders of the pharyngeal wall due to inflam- 
 matory infiltration, and in many cases of similar 
 infiltration unaccompanied by marked hyperesthesia, 
 undoubted and lasting benefit has been attained by 
 treatment solely with sprays. 
 
— 23 — 
 
 In the treatment of diseases of the larynx, I am 
 of the opinion that sprays are frequently very useful 
 in allaying cough, and irritation, diminishing sputa 
 and abolishing the objective signs of inflammation, 
 i. e., redness and thickening. 
 
 Attention, however, should here be directed to 
 some important considerations. 
 
 The spray must be a very fine spray in order to be 
 deeply inhaled. It must be projected against the 
 pharyngeal wall with a certain force, or directly down- 
 wards beyond the base of the tongue, so as to reach 
 directly the interior of the larynx and medicate it 
 
 properly. 
 
 The ordinary hand-ball atomizer is of very little, 
 or no practical use. The spray thus produced, does not 
 usually penetrate the larynx, but simply lodges in the 
 back of the throat and every few minutes is spit up. 
 Occasionally, some of the fluid gets into the 
 larynx and trachea, it is true, while the patient is mak- 
 ing efforts to inhale it, but instead of proving bene- 
 ficial it occasions immediate distressing cough, some- 
 times followed by retching. These symptoms are 
 evidently brought on by the coarse quality of the spray, 
 for which there is usually great laryngeal intolerance. 
 In the treatment of diseases of the trachea and 
 bronchi, as in that of the larynx, if sprays be employ- 
 ed, spray tubes made after the manner of those of 
 Sa'ss, and connected by means of rubber tubing with a 
 cylinder of compressed air, are alone practically use- 
 
— 24 — 
 
 ful. I do not, however, commend the use, even of 
 these fine sprays, so much now as I formerly did. In 
 acute catarrhal diseases of the lower air passages and 
 when the patient remains in his room for several days, 
 I have found them occasionally useful. In many such 
 instances they have no appreciable utility. Whenever 
 the affection has become subacute or chronic, the 
 temporary relief afforded by their use is more striking, 
 and rarely, perhaps, they may effect, unassisted, a 
 cure. I am inclined to believe from clinical experi- 
 ence, that fine sprays penetrate into the smaller sub- 
 divisions of the bronchi, when they are properly and 
 deeply inhaled. Despite the carrying out of this con- 
 dition, however, they are not invariably soothing and 
 kindly in their action. Frequently they are either re- 
 latively inert, or else, as is occasionally remarked, 
 they produce local, artificial irritation which renders 
 the patients worse rather than better, and more sus- 
 ceptible to sudden, or even moderate changes of 
 temperature. 
 
 In regard to the duration of application, or fre- 
 quency of repetition, of sprays in the affections con- 
 sidered, a general rule only can be formulated. In 
 acute inflammation of the nose, and naso-pharynx if 
 employed they should be continued but a very few 
 minutes. In the latter region, they may be repeated 
 with benefit three or more times in twenty-four hours. 
 In acute inflammation of the pharynx and larynx, a 
 fine spray may be continued three to five minutes, and 
 
— 25 — 
 
 be repeated every two or three hours, if found to af- 
 ford relief from annoying or painful symptoms. 
 
 In chronic disorders of the kind considered, 
 either in the nose, naso-pharynx, pharynx, and rarely 
 in the larynx, trachea and bronchi, these sprays may- 
 be employed as a cleansing means, so often and so 
 long as is required to rid the patient of objectionable 
 secretions. As a curative means, twice a day is as 
 frequent as they should ever be employed, and their 
 duration may be, depending upon the organ involved, 
 from a few seconds to several minutes. After a time, 
 in the diseases referred to, sprays ought not to be 
 used oftener than once a day, or once every other day. 
 
 If sprays be used too frequently, in chronic dis- 
 eases of the air passages, they finally produce a re- 
 laxed condition of the parts, and besides by accustom- 
 ing them to a form of repeated artificial irritation, 
 they rather tend to prolong diseased action than to 
 be curative. 
 
CHAPTER II. 
 
 STEAM ATOMIZERS. 
 
 In the steam atomizing apparatus the medicated 
 fluid is made to rise in a verticle spray tube by means 
 of a current of steam passing through a horizontal 
 tube. The horizontal tube enters the upper portion 
 of a small metal boiler, where the steam is generated 
 by an alcohol lamp placed underneath. The appa- 
 
 Fig. 8. — Codman & Shurtleff's Steam Atomizer. 
 
 ratus is essentially provided with a boiler, an alcohol 
 lamp, a receptacle for medicated fluid, a safety-valve, 
 a face-protector or shield, and a drip pan. The steam 
 medicated spray as it leaves the atomizing tubes, has 
 a temperature of 130° F., and a temperature of ioo° 
 F., at the spot where it is inhaled, viz., the further, or 
 distal extremity of the face shield. 
 
— 27 — 
 
 An approved form of steam atomizing apparatus 
 which is frequently used by general practitioners, is 
 shown in the accompanying figure. It is constructed 
 on the principle of the original instrument of Siegle. 
 
 I now rarely make use of inhalations of medicated 
 spray produced by steam. Sometimes in the treatment 
 of acute affections of the pharynx and larynx they 
 have undoubted efficacy, but they are troublesome to 
 manage properly, and unless employed with many 
 precautions, are productive of decided harm by in- 
 creasing the patient's liability to contract more serious 
 inflammatory disease than that from which he is al- 
 ready a sufferer. 
 
 In acute coryza their utility is questionable, and 
 it is difficult to adjust a suitable nozzle so as to make 
 them practical. In view of the latter fact, in the in- 
 frequent cases in which I consider medicated moist 
 heat of appreciable value in the relief of a patient's 
 distress from acute coryza, I prescribe a vapor 
 inhalation in preference to a steam atomized fluid. In 
 the treatment of chronic inflammatory diseases of the 
 pharynx and larynx, trachea and bronchi, steam in- 
 halations are rarely of any permanent value, increas- 
 ing notably as they do, the amount of mucous secre- 
 tions. 
 
 In atrophic, nasal, and post nasal catarrh, 
 in which the crusts are hard and adherent, I 
 have occasionally known temporary benefit to be due 
 to the use of these inhalations. They loosen the 
 
— 28 — 
 
 crusts so that they can be blown from the anterior 
 nasal passages, or hawked down from the naso-pharynx 
 without great effort and strangling being incurred. 
 As a means of deodorizing nasal secretions, they are 
 also occasionally useful in these conditions and should 
 be commended with moderation. Even under these cir- 
 cumstances, however, they should not be continued any 
 longer than is evidently necessary for the detachment of 
 hardened crusts, and always after their use the patient 
 should be particularly careful not to expose himself to 
 too great or sudden atmospheric changes, and thus 
 perhaps contract some acute respiratory inflammation. 
 Irrespective, indeed, of the action of warmth and 
 moisture, which always make patients specially sensi- 
 tive as regards taking cold, the existing disease of the 
 nasal passages seem to me a predisposing cause of 
 much importance. In acute pharyngitis and laryn- 
 gitis; steam atomized inhalations may be repeated 
 with advantage every hour, or two, until localized 
 pain, swelling and soreness have markedly diminished. 
 Of course in laryngitis we may be somewhat guided 
 in their use by the degree of dysphonia, or aphonia. 
 The latter symptoms, however, are not a reliable 
 guide by themselves, since they are frequently 
 more marked when the inflammatory condition has 
 subsided, than they were during its continuance. 
 This fact may be explained by the loss of power in 
 the intrinsic laryngeal muscles which often follows an 
 inflammation of the mucous membrane of this organ, 
 
— 2 9 — 
 
 and may persist, more or less, during several days. 
 During the entire time when the patient is repeating 
 the warm inhalations with so much frequency, he 
 should be urgently advised on no account to leave his 
 room unless it be to move into an adjoining chamber 
 in which the air has been carefully kept at a similar 
 temperature to the one just left. All exposure under 
 these circumstances, is extremely dangerous. When- 
 ever a patient makes use of these warm inhalations 
 two or more times each day, he may. perhaps, go into 
 the open air after an hour without great risk, yet I 
 doubt if this rule be followed whether any marked 
 benefit will result from such inhalations. Reason is 
 against the use of warm, or hot inhalations, if the 
 patient persist in exposing himself never so little, and 
 practice confirms the safe-guard which reason formu- 
 lates in such decisive language. In any case in which 
 warm or hot inhalations appear to be indicated, and 
 in which the patient is forcibly compelled to expose 
 himself during the day, let the inhalation be reserved 
 for the evening, at such an hour as will permit the 
 patient to remain in the same room until he retires for 
 the night. When covered up in bed, if it be deemed 
 essential to effect a cure, the warm inhalation may 
 frequently be repeated with great immediate comfort 
 and some lasting benefit. 
 
CHAPTER III. 
 
 STEAM INHALERS. 
 
 In these inhalers steam is usually charged with 
 the vapor of a volatile substance which has a remedial 
 action. The volatile substance employed is either in- 
 corporated in a mixture in its pure form, or contained 
 in flowers or leaves. In either of these conditions, it 
 is added to the hot water, already poured into the 
 receptacle of an inhaler. In the latter state, i. e., 
 when there are flowers, 01 leaves, the hot water is 
 poured upon the ingredient. It is always useful to 
 stir the medicament a few moments in the hot water 
 before commencing to inhale. The cover, or lid is 
 then placed upon the inhaler, and it is ready for use. 
 
 Any suitable shaped pitcher, or can in porcelain, 
 or tin, of proper dimensions, may be employed in this 
 kind of inhalation. A wide mouth is an essential fea- 
 ture of the apparatus employed, so that the steam may 
 arise readily, and in sufficient quantity to be really 
 beneficial, and in order to direct the vapors into the 
 nasal passages, or mouth, a cone of proper dimensions 
 must cover it. This cone should be made out of some 
 pliable material and carry the vapors in the proper 
 direction. Frequently cones are made for temporary 
 use from a newspaper, or a sheet of stiff paper, or 
 card-board. A serviceable variety of inhaler which 
 
— 3' — 
 obviates the necessity of using a cone, is known as 
 Dr. Spencer Thompson's oro-nasal inhaler, manufac- 
 tured in terra-cotta or white earthenware (fig. 9). 
 The advantages of this inhaler are its simplicity, clean- 
 
 Fig. 9.— Spencer Thompson's Oro-nasal Inhaler. 
 
 liness, ease of inhalation, and general utility in the 
 application of vapor, simple or medicated, to the air 
 passages. Many other inhalers are in the market, of 
 these the most perfect seems to me the one first intro- 
 duced by Dr. Morell Mackenzie, of London, and known 
 as the " Eclectic Inhaler " (fig. 10). Another recom- 
 
mendable inhaler, somewhat simpler and almost as 
 good practically, is that of Maw (fig. n). A third 
 kind, known as the London Inhaler, is made of ti» 
 
 Fig. io. — The Eclectic Inhaler. 
 
 with a convenient cover of the same metal, shaped so 
 as to carry medicated vapor readily into the nose, or 
 mouth (fig. 12). In a general way the principle of 
 these last mentioned inhalers is very simple and not 
 
dissimilar. A single quite large orifice is left in the 
 lid of the inhaler, or a series of holes are placed 
 around the rim of the cover of the receptacle for hot 
 medicated fluid in such a way that a current of air is 
 drawn downward with each active inspiration. At 
 first it passes through an air chamber, which, in Mac- 
 kenzie's and the London Inhaler, is situated between 
 
 Fig. ii. — Maw's Inhaler. 
 
 the sides of the cover and the sides of the reservoir 
 for the fluid, projecting downward somewhat like an 
 inverted tumbler. In Maw's inhaler the air chamber 
 is simply formed by the upper portion of the receptacle 
 into which the fluid does not reach. In the first two, 
 after passing through the air chamber the inspired air 
 passes through the upper layer of liquid and after- 
 ward a series of holes near the lower margin of the 
 
— 34 — 
 
 cover. Once in the tumbler-shaped cover it is drawn 
 upwards into the mouth-piece (Lond. Inh.), or rubber 
 connecting tube terminating in a mouth-piece (Mack. 
 Inh.). In Maw's earthen-ware inhaler the surface 
 
 Fig. 12. — The London Inhaler. 
 
 alone of the liquid is brought into contact with the in- 
 spired current of air. 
 
 In either form of inhaler the air while passing 
 through or over the surface of the hot fluid, is im- 
 pregnated with the volatile medicament, and at the 
 
— 35 — 
 same time becomes properly heated. In Mackenzie's 
 and Maw's inhalers the mouth-piece is perforated on 
 the top by a valvular orifice. 
 
 During expiration the air from the lungs passes 
 directly through this hole, and is prevented from re- 
 turning to the inhaler by a similar valve of larger size, 
 which shuts inwards. Dr. Mackenzie's inhaler is also 
 provided with a thermometer, which passes down the 
 the side of the inhaler and registers accurately at every 
 moment the temperature of the contained fluid. The 
 desired degree of heat is kept up by means of an alco- 
 hol lamp resting upon a stand under the reservoir. 
 This temperature should be about 140° F., or one at 
 which most of our volatile substances brought into use 
 medicinally, are vaporized in a sufficiently rapid man- 
 ner for practical purposes. Steam inhalations by 
 means of these different inhalers may be employed 
 with benefit under circumstances when warm atomized 
 inhalations are also indicated, as already referred to. 
 
 One special advantage which belongs to the for- 
 mer, and not to the latter, resides in the fact that they 
 are more readily made use of in many cases, since 
 they do not require necessarily any special form of 
 apparatus. On the other hand, they have this notable 
 disadvantage that they oblige the patient to perform 
 repeated acts of somewhat forced respiration in order 
 to inhale effectually, and this becomes very fatiguing 
 to nearly all patients, and to some in a very weak state 
 it is impossible. Again, I do not believe the vapors 
 
_ 36 - 
 
 penetrate as deeply or thoroughly into the larynx, 
 trachea, or bronchi, as when the steam atomized-fluid 
 inhalations are used. 
 
CHAPTER IV. 
 
 VAPOR INHALATIONS. 
 
 The agents used for this purpose must be more 
 or less volatile and are usually balsamic or antiseptic. 
 The inhalers themselves are usually portable. There 
 are many different kinds; some are complicated, bur- 
 densome to wear for any length of time, and relatively 
 expensive. 
 
 After examining a large number and making use 
 of several modifications of the ordinary oro-nasal in- 
 halers, I have finally concluded that one of the best is 
 also the simplest and cheapest. This inhaler, which 
 is now known in New York as the perforated zinc 
 inhaler, was originally made by Squire, of London, 
 and since that time it has been slightly modified for 
 me by Mr. Ford, of New York. I have been using 
 these inhalers extensively for a year or more, and con- 
 sider them a valuable addition to our appliances for 
 facilitating inhalation. 
 
 They consist simply of a sheet of perforated zinc 
 or tin, bent into a pyramidal shape and large enough 
 to cover conveniently the nose and mouth. At the 
 apex of the pyramid a bid of sponge is firmly held by 
 means of strings, or two bends of the margin of the 
 zinc plate. Between the sponge and the mouth and 
 nose there is a vacant space which obviates the stifling 
 
- 38 - 
 
 feelings, which is so objectionable in the use of inhalers 
 that are applied closely over the face. The inhaler is 
 
 Fig. 13. — Perforated Zinc Inhaler. 
 
 held in place by two narrow elastic bands which pass 
 around the ears. Before beginning an inhalation 
 
— 39 — 
 the sponge should be properly moistened with water 
 or alcohol, and the inhaling fluid poured upon it. 
 
 With each inspiration, when the inhaler is in place, 
 and the sponge properly medicated, a current of air 
 passes through the sponge and perforated zinc plate, 
 carrying with it a perceptible amount of the volatile 
 agent and is drawn into the nose or mouth. During 
 expiration the air passes out in part through the 
 sponge and in part also through the small perforations 
 of the zinc. The inhaler may be improved at times 
 by covering a considerable portion of the sides with 
 silk, so that there is a stronger direct current of 
 air passing through the sponge with each effort of 
 inhalation and less intermixture of air entering the 
 inhaler from the sides. Valvular orifices may be made 
 on the sides of the inhaler if the silk covering be 
 added, so as to facilitate expiration, allow the ex- 
 haled breath to escape, and prevent it from passing 
 through the sponge. This is objectionable because 
 unless largely obviated one inhales with each inspira- 
 tory effort an appreciable amount of air already 
 breathed once. 
 
 Another inhaler much more elaborate and ex- 
 pensive, non-portable, but very valuable in numerous 
 instances, is that known as Beseler's globe inhaler. 
 In this instrument a large globe with small projecting 
 and somewhat flattened extremity for the mouth, all 
 made of one piece of glass, is supported upon a ver- 
 tical metallic stand. In the posterior part of the globe 
 

 Fig. 14. — Beseler's Globe Inhaler Connected 
 with an Air Receiver. 
 
— 4i — 
 
 are two short atomizing tubes, the lower one of which, 
 by means of a connecting rubber tube, passes out of 
 the globe, through a small orifice made in an occlud- 
 ing metallic plate, into a small receptacle for medicated 
 fluid. The other tube is connected by means of rub- 
 ber tubing, terminated by a metalic cut-off, with a 
 cylinder of compressed air worked by means of a 
 suitable pump. The glass globe can be lowered or 
 heightened at will by means of a sliding metallic rod 
 in the stand and be fixed in place by a screw. It can 
 also be turned horizontally in any direction. When 
 in action the air from the cylinder reduces the liquid 
 from the receiver to the form of a fine spray of which 
 the heavy globules fall into the glass globe, while a 
 column, practically regarded, of medicated vapor 
 issues constantly from the projecting mouth-piece of 
 the globe. For the sake of cleanliness and adapt- 
 ability, I have added to the globe, nozzels for the 
 nose and the mouth and these can be readily slipped 
 on or off the projecting glass mouth-piece by means 
 of a soft rubber attachment. 
 
 In addition to these two forms of inhalers, there 
 is another apparatus, somewhat on the same principle 
 as the globe inhaler, manufactured by Parke, Davis & 
 Co., and known as Semple's inhaler. In this inhaler 
 (fig. 14), which is quite portable, although not to be 
 worn by the individual, the fluid is vaporized by a 
 rubber bulb. The receptacle for the fluid is situated 
 in the lower portion of the receiver from which it is 
 
— 42 — 
 
 drawn up, owing to the cohesiveness of air (Smith), and 
 vaporized in the chamber above by means of atomiz- 
 ing tubes. A metallic tube provided with a small noz- 
 zle, comes out of the upper chamber, and carries in it 
 
 ^w 
 
 Fig. 15. — Semple's Atomizing Inhaler. 
 
 the vapor for inhalation. This inhaler may be made 
 use of advantageously in connection with a cylinder 
 of compressed air, instead of a rubber hand-ball. 
 Under these circumstances, however, preference 
 should be accorded to the globe inhaler as being a 
 
— 43 — 
 more serviceable instrument. Still, as there area very 
 large number of general practitioners who cannot 
 afford to buy an instrument as expensive as the globe 
 inhaler, Semple's inhaler will find its proper place. 
 This is, also, true for patients who cannot visit the 
 physician's office, or who for different reasons, pecu- 
 niary, or otherwise, must be treated at their homes. 
 
 In the London Lancet,* Dr. Hassall has written a 
 strong article in favor of " a new method of inhalation 
 and a new form of apparatus." In this communication 
 it is claimed that by the passage of relatively dry air 
 through a fluid medicated with carbolic acid and of 
 which the temperature may be somewhat raised, a 
 large amount of medicated vapor is carried deeply 
 into the lungs and will there undoubtedly produce 
 very evident curative results. 
 
 The apparatus of Dr. Hassall is very simple, con- 
 sisting mainly of a rather long cylindrical vessel (fig. 
 16.) through which three small tubes pass and extend 
 into the liquid to be inhaled. The remaining tube 
 is one by which the invalid is to make inspirations 
 repeatedly. When an inhalation of one hour or more 
 is terminated, a relatively large proportion of carbolic 
 acid has passed over into the lungs, and must medi- 
 cate them very thoroughly. Although, judging from 
 its description, we have in Hassall's inhaler a useful 
 addition to this class of instruments, yet I do not 
 
 January 30, 1876, p. 192. 
 
— 44 — 
 think it is so perfect as the globe inhaler, mainly be- 
 cause the effort of inhalation is considerable, whereas, 
 with the latter there is no effort at all and the air 
 
 Fig. 16. — Hassalj.'s Inhaler. 
 
 breathed must be saturated with any volatile substance 
 employed. 
 
 Inhalations of volatile balsamic and antiseptic 
 
— 45 — 
 substances, employed by me in the oro-nasal in- 
 haler, and latterly, also, in Beseler's globe inhaler, 
 have proved to be more or less useful in almost every 
 form of acute and chronic catarrhal inflammatory dis- 
 order of the nose, naso-pharynx, larynx, trachea and 
 bronchial tubes. It is no^exaggeration to say even at 
 this time, and before ultimate conclusions can be 
 properly formulated, that in my judgment, we have 
 in the method of vapor inhalation with the globe in- 
 haler, a distinct advance over what has been previ- 
 ously practised. In many instances, undoubtedly, it 
 is superior to other kinds of inhalation and apparently 
 there are no decided objections to its general adop- 
 tion. 
 
 In the use of cold, atomized inhalations there is 
 the objectionable feature at times of low temperature 
 and always the one of an excessive proportion of 
 water, which cannot be lessened very much, as remark- 
 ed before, on account of the pain occasioned, or the 
 intolerance of surrounding parts of a more impression- 
 able, or sensitive structure. 
 
 In the use of steam atomized inhalations, or warm 
 vapor inhalations, the heat and excessive moisture are 
 both frequently undesirable because they increase 
 notably the susceptibility of fresh attacks of coryza, 
 pharyngitis, laryngitis, or bronchitis. 
 
 Does not our general experience teach us clearly 
 that the points urged by me against the indiscriminate 
 use of hot, or cold atomized inhalations are both theoret- 
 
_ 4 6 — 
 
 ically and practically true ? To what climates do we 
 send our patients suffering from chronic inflammation 
 of the mucous membrane of the respiratory tract, when 
 called upon to give advice in this regard ? Usually to 
 moderately warm, equable, dry climates; sometimes to 
 cold, clear, elevated regions, where the daily average 
 of temperature shows but moderate changes; some- 
 times, also to temperate regions, where there is con- 
 siderable moisture in the air, but where at least there 
 are no rapid changes of temperature, and no prevail- 
 ing chilling winds. In the matter of artificial inhala- 
 tions, therefore, to be truly rational, should the indi- 
 cations be changed, or should we not rather approxi- 
 mate, so far as we are able, nature's laws and nature's 
 cure ? In what regions do laryngeal and bronchial 
 affections improve, or get well ? Is it not certain 
 that the answer comes back, wherever, provided 
 other surrounding conditions of temperature, drain- 
 age, and soil, are healthful, balsamic odors may be 
 constantly breathed, and life in the open air rigidly 
 adhered to? Witness the multiple cures made in the 
 x\dirondacks during the summer and early autumn; in 
 the pine regions of the Carolinas and Georgia during 
 the winter months. In cases in which great irritability 
 of the peripheral nerves is characteristic, a certain 
 degree of moisture is useful. Such an amount, for 
 example, as is found in southern Florida, in regions 
 some miles from St. Johns river, or the sea. In just 
 such cases where home treatment during the winter 
 
— 47 — 
 months in one of our large cities is necessitated, by 
 reason of the fact that the patient cannot go away 
 from home, moist inhalations of relatively warm spray 
 vapor are frequently useful in lessening irritability, 
 and if, while using them, we could at the same time 
 give such patients the benefit of open-air treatment, 
 and yet shield them carefully from all vicissitudes of 
 temperature and climate, I doubt not we should have 
 far greater success in the treatment of such cases than 
 we ordinarily meet with. Already, in acute and 
 chronic nasal catarrh, in acute and chronic pharyngitis, 
 in acute and chronic laryngitis, in acute and chronic 
 tracheitis and bronchitis, I have had excellent, and I 
 believe durable results, by means of simple vapor in- 
 halations. As I have stated elsewhere,* this method 
 is not new; it is old. But it is also a case of revival 
 with more exact knowledge to establish its special in- 
 dications for employment. These vapor inhalations 
 were re-introduced to the profession some years ago, 
 by Dr. W. Roberts, of Manchester, England, and 
 since that time have been more or less extensively 
 employed by H. Curschman, of Hamburg, and by 
 several other able practitioners at home and abroad. 
 Among these I would cite particularly William 
 Pepper, in the "Transactions of the American Medical 
 Association" for 1880; J. H. Tyndale, New York 
 "Medical Record," March 18, 1882; J. Burney Yeo, in 
 
 N. Y. Med. Jour., July 18, 1885. 
 
- 4 8 - 
 
 his "Lectures on Consumption," London, 1882; J. Solis 
 Cohen, in Philadelphia "Medical News," October 11, 
 1884; J. Ward Cousins, "Lancet," July 19, 1884; and 
 A. Hill Hassall, "Lancet," August 16, 1884, and "In- 
 halation Treatment," London, 1885. 
 
 In favor of this method may be cited the follow- 
 ing propositions: 1. There are no risks of future colds 
 attendant upon its employment. 2. The relief afforded 
 by inhalations of the vapor of volatile substances, is in 
 my experience, frequently greater than that given by 
 the other methods of inhalation. 3. This medication 
 is well adapted to all forms of irritative diseases of the 
 respiratory passages. In favor of this method, when 
 employed by means of the ordinary portable oro-nasal 
 inhaler, it may be additionally claimed, that the ap- 
 paratus required costs but a trifle, and may be used, 
 therefore, even by the poorest classes. 
 
 I know of only one serious objection which can 
 be properly urged against its very general adoption, 
 and it is the statement that the vapor of volatile anti- 
 septic, or balsamic substances, when they are em- 
 ployed in the ordinary oro-nasal inhaler, or in the 
 globe inhaler, do not penetrate far enough to reach 
 the larynx or bronchial tubes, and therefore cannot 
 modify the mucous membrane of these structures 
 in any sensible degree. Upon experimental grounds, 
 Arthur Hill Hassall ("Lancet," May 5, 1883) has 
 endeavored to show that the agents most fre- 
 
— 49 — 
 quently employed hitherto, such as carbolic acid, crea- 
 sote, thymol, etc., are but feebly volatile at ordinary 
 temperatures. He has been unable after prolonged 
 inhalation with the ordinary oro-nasal inhaler, to re- 
 cover any notable quantity of these substances in the 
 sputa, or secretions from the air-tract. In fact, he has 
 not even remarked that the sputa, soon after they were 
 expectorated, were penetrated with their odor. In- 
 deed, after continuous inhalations of one or two hours' 
 duration, he has succeeded in obtaining, by Chande- 
 lon's process, from the sponge or cotton in the inhaler, 
 very nearly the whole quantity of the agent employed. 
 A sufficient answer to these objections, it seems 
 to me, may be found in the fact that the patients them- 
 selves, when questioned after they have used the inha- 
 lations during a few days, or weeks, almost invariably 
 reply that their subjective symptoms have been nota- 
 bly relieved. Not only do they make this statement, 
 but they add, further, that their sputa have diminished 
 in quantity, and at times have notably changed in ap- 
 pearance. Moreover, while I am willing to admit that 
 such vapors, when obtained by means of the oro-nasal 
 inhaler do not enter the bronchial tubes so deeply as 
 we might presume, or desire— yet even by means of 
 this inhaler they probably penetrate as far, or farther, 
 than the sprays for which they are frequently advan- 
 tageously substituted. In regard to the globe inhaler 
 working by means of a pressure of 15, 20, or more 
 pounds to the square inch, I am convinced that these 
 
— 5° — 
 objections of Hassall would hold even less — but in 
 regard to the application of these objections to this 
 instrument, no experiments have yet been made, other 
 than those obtained by close clinical observation of 
 patients. 
 
 These observations, however, prove to me conclu- 
 sively that even the smaller bronchi are thus favorably 
 modified by suitable inhalations properly used. I am 
 of the opinion, also, that the small loss of the volatile 
 substance which has not been recovered in liassall's 
 experiments with the ordinary oro-nasal inhaler, and 
 which possibly does penetrate not only the small bron- 
 chial tubes, but the pulmonary air cells themselves, is 
 sufficient to modify notably, after several days or 
 weeks of more or less continuous inhalation, the in- 
 spired air in such a manner that it is made compara- 
 tively aseptic, and thus we have an influence for good 
 that we can properly estimate only by the evident 
 effect produced. 
 
 If this be true for the ordinary oro-nasal inhaler, 
 it is in a much greater degree true with regard to the 
 use of Beseler's inhaler. 
 
 In regard to the areas of cough in different 
 organs of the respiratory tract, this much can now be 
 affirmed in view of experiments by Hack, J. 'H. Mac- 
 kinzie and myself, viz., that these areas are probably 
 more or less limited, and if, therefore, we reach this 
 sensitive area thoroughly with our remedial measures, 
 it is not essential for the arrest of this symptom that 
 
— 5i — 
 we should be able to medicate the whole inflamed 
 tract. 
 
 In commencing bronchitis, particularly when it 
 is situated in the upper divisions of the primary bron- 
 chi, cough is a specially obstinate and constant symp- 
 tom. In the other localizations of bronchitis, cough 
 very frequently has only moderate intensity and occa- 
 sions relatively much less annoyance and distress. 
 Again, it is proven in certain diseases, as for example, 
 chronic dysentery, that a local application to the 
 ulcerated rectum, may be the means of producing such 
 changes that the ulcerated bowel far above the points 
 of contact with the acid will soon recover their tone 
 and normal function, and the patient get entirely well. 
 It will be objected that this is scarcely an analogous 
 condition. Perhaps it is not, but analogy even though 
 remote serves to illustrate and to enable us sometimes 
 to appreciate facts which otherwise would be shrouded 
 in great obscurity. At all events, the results of my 
 experience with vapor inhalations up to the present 
 time, prove clearly the utility of this method in all 
 catarrhal affections of the throat and chest; including 
 particularly those cases of pulmonary phthisis which 
 are now considered to take their origin in tubercular 
 disease, and yet are accompanied by well marked 
 catarrhal complications — in the form of localized, or 
 generalized bronchitis, with more or less active hyper- 
 aemia of portions of lung tissue. 
 
 In acute and chronic nasal catarrh inhalations of 
 
— 5 2 — 
 vapors are agreeable and useful. While the ordi- 
 nary oro-nasal inhaler may be beneficially used, as 
 was my habit some months ago, I must insist that 
 Beseler's instrument is really much more valuable. 
 By its means the effect in acute coryza is occasionally 
 very remarkable. Inhalations of compound tincture 
 of benzoin, combined with an equal portion of alcohol 
 and glycerin, have latterly seemed to me particularly 
 commendable in these cases. The effect of the in- 
 halation is to stop in a great measure the sneezing 
 and serous flow from the nasal passages. After a few 
 inhalations, also, the stuffiness of the nasal passages is 
 greatly diminished. 
 
 In cases of chronic nasal catarrh dry inhalations 
 frequently repeated diminish the discharges from the 
 nose very much. And this is true not only of the an- 
 terior and middle nasal passages, but also of the naso- 
 pharynx. 
 
 Whenever the nasal passages are more or less oc- 
 cluded by reason of the swollen mucous membrane 
 covering the septum and turbinate bodies, this condi- 
 tion will often be much improved and the breathing 
 rendered notably freer. In those instances in which 
 there is accompanying aural catarrh affecting the 
 Eustachian tubes, or the tympanic cavity, these inhala- 
 tions, particularly with the large globe inhaler, are 
 specially desirable and beneficial, and the patients 
 soon express a sense of relief and improvement. The 
 upper portion of the naso pharynx, however, will still 
 
— 53 — 
 require applications of compound tincture of iodine 
 twice or three times a week, in order to show the best 
 effects from local treatment. 
 
 We must not expect, however, the impossible 
 from dry inhalations in these cases of chronic nasal 
 catarrh and look always for manifest improvement 
 rapidly and in all cases. Sometimes weeks, nay even 
 months, may elapse before the patient will be able to 
 note that he has steadily and permanently improved. 
 As compared, however, with all other methods of in- 
 halation hitherto in vogue in the treatment of chronic 
 inflammations of the nose, this one is so satisfactory 
 that I throw out a warning voice so as not to allow 
 myself to be too enthusiastic. It must not be inferred, 
 however, because I recommend the use of dry inhala- 
 tions so strongly that I therefore consider it proper to 
 put aside all other treatment, both local and general. 
 Not at all, for I still hold with conviction, to the use 
 of remedial agents elsewhere indicated by me.* By 
 comparisons, however, between my cases of chronic 
 nasal catarrh, in which vapor inhalations were em- 
 ployed, and those in which these inhalations were 
 not used, although internal remedies were often in- 
 hibited in both cases, I believe these inhalations are de- 
 cidedly beneficial in the manner stated above. In an 
 instance in which nasal catarrh was complicated by 
 epiphora, due to occlusion of the nasal duct by a 
 
 * Nasal Catarrh, and Allied Diseases. 
 
— 54 — 
 
 swollen pituitary membrane, dry inhalations relieved 
 this symptom in a measure. 
 
 In dysphonia, frequently connected with, or de- 
 pendent upon, chronic nasal catarrh, vapor inhalations 
 will often produce marked benefit to the voice and to 
 the general condition of the pharynx. This it accom- 
 plishes in one of two ways: "By diminishing local 
 inflammation which has extended to the pharynx, or 
 by restoring nervous power to the pneumogastric 
 trunks as they pass down alongside the pharyngeal 
 walls, and through them giving more tone to muscular 
 contraction of the intrinsic laryngeal muscles. Vapor 
 inhalations are undoubtedly useful in the treatment of 
 simple chronic pharyngitis, and in tnis disease when 
 accompanied by numerous enlarged follicles. They 
 diminish the amount of secretion, while promoting 
 the healthy functional activity of the glands of this 
 region, and lessen and cause to disappear, at times, 
 those painful feelings in the throat which are often 
 the source of anxiety and considerable annoyance to 
 debilitated patients in whom a neurotic element pre- 
 dominates. 
 
 In Acute and Chronic Laryngitis.— Jn these affec- 
 tions they quiet irritation, lessen hoarseness, diminish 
 cough, change the aspect of the inflamed mucous 
 membrane, and, in certain cases at least, evidently 
 hasten the disappearance of symptoms and the estab- 
 lishment of a cure. In one case, in which there was 
 concomitant post-nasal catarrh, pharyngitis sicca, and 
 
paresis of the tensors of the vocal cords, producing 
 hoarseness, there was also " a red, swollen epiglottis, 
 arytenoid cartilages and ventricular bands." 
 
 In this case there was moderate cough, still it per- 
 sisted and caused much mental distress, despite vari- 
 ous medications internally, and numerous local appli- 
 cations of pigments, sprays and powders. One week 
 after inhalation was begun the cough had disappeared 
 completely. The larynx was less inflamed, the pha- 
 rynx was not at all glazed, there were little or no 
 frothy sputa, and, indeed, the patient was so far 
 recovered that the dry inhalations were stopped. 
 These consisted of ten drops of turpentine used in 
 Kinnicutt's inhaler during five minutes every three 
 
 hours. 
 
 In cases of acute, sub-acute, and chronic bronchitis 
 these inhalations are markedly beneficial, and deserve 
 further and more extensive trials on the part of the 
 medical profession. In acute bronchitis inhalations of 
 compound tincture of Benzoin, or of oil of tar are 
 productive of great ease to the patient in lessening 
 the hard, irritating cough, and the tightness over the 
 anterior thorax which is usually present in these cases 
 to a more or less marked degree. In sub-acute and 
 chronic bronchitis, inhalations of tincture of benzoin 
 and fir-wood oil— one part of the latter to eight parts 
 of the former— after one, or several weeks, diminish 
 the cough, expectoration and hoarseness. In one in- 
 stance the patient stated distinctly that the cough was 
 
- 56 - 
 
 stopped by the inhalation. The amount of the fluid 
 used with the oro-nasal inhaler was ten to fifteen 
 drops, one or more times a day, and the inhalation 
 was repeated ten minutes every three hours. If the 
 globe inhaler is used, the contents of the receptacle 
 may be inhaled upon each occasion as a rule. Some- 
 times only one-half of this amount will be required. 
 Sometimes, though very rarely, twice as much as the 
 receptacle holds may be advantageously used on each 
 occasion. Of course it is understood that nine-tenths 
 of this, or more, of the inhalant employed at any one 
 time in the globe inhaler, falls back into the globe and 
 may be utilized a second time with the same patient 
 for further inhalations. 
 
 In pulmonary phthisis, at its initial stage, or at a 
 more advanced period, and whenever accompanied by 
 a catarrhal condition of one, or both lungs, localized 
 or not, much benefit is derived from vapor inhalations.* 
 The result of my observations would seem to show 
 that the most generally useful inhalation in the begin- 
 ning of pulmonary phthisis is creasote and alcohol, 
 equal parts. Creasote by itself is a little too irritant, 
 and is not so readily manipulated. Whether or not 
 the mixture of alcohol increases its volatility I am not 
 
 * I merely refer here to the utility of vapor inhalations in 
 the treatment of catarrhal complications of pulmonary phthisis, 
 although I am of the opinion, as I have written elsewhere, 
 that tuberculosis is also benefited in this way. 
 
— 57 — 
 positive, although 1 believe it does, regard being paid 
 to the statements of patients. At the present time, 
 whenever the cough is distressing, I add an equal 
 quantity of spirits of chloroform to the creasote and 
 alcohol, and find the patients express a sense of the 
 benefit received after a short trial of this combination. 
 If the oro-nasal inhaler be used in these cases, the 
 amount of inhaling fluid employed with best results, 
 varies from ten to twenty drops. It is also renewed 
 most advantageously two or three times in twenty-four 
 hours. After one or two weeks inhalations could be 
 continued without unpleasant effects, one-half or one 
 hour at a time, and repeated three or four times in 
 twenty-four hours. If a larger quantity of the inhal- 
 ing fluid were used at first upon the sponge of the 
 oro-nasal inhaler, or if at first the time for each inha- 
 lation was extended beyond fifteen minutes, the 
 patient on several occasions suffered from irritation of 
 the throat and increased painful cough. 
 
 And yet one of the objections urged against the 
 efficacy of most oro-nasal inhalers is the fact that too 
 small a supply of vapor is given off from the small bit 
 of sponge, cotton, or tow, which comes with them, to be 
 of any benefit to the patient. In the globe inhaler of Dr. 
 Hassal, this writer has remedied the supposed defect. 
 For my part, I have not usually found it a defect, even of 
 the ordinary oro-nasal inhaler, and with the combina- 
 tions, or mixtures of medicinal remedies employed 
 hitherto by me in this method of inhalation, rarely have 
 
- S» - 
 I found the slightest difficulty in supplying my patients, 
 by means of the perforated zinc inhaler, with all the 
 medicated vapor they could comfortably endure. In- 
 deed, I have observed several times, as other observers 
 have done before me, that the quantity of antiseptic 
 or balsamic liquid added to the sponge of the inhaler 
 must be limited to a few drops (10 to 20), if the in- 
 haler is worn more than a short time. If a relatively 
 large quantity of volatile pungent, irritating fluid be 
 added to the sponge, the vapor proceeding from it 
 is too concentrated and shortly becomes very intoler- 
 ant to the air passages and must be abandoned alto- 
 gether, or the inhalant modified as to quantity, or 
 combination. Instead of doing good, therefore, by 
 increasing the quantity of fluid upon the sponge of 
 the inhaler, we occasionally do actual harm and render 
 a very serviceable agent a decidedly objectionable 
 one. I am, therefore, not of the opinion of Dr. Has- 
 sall as regards this point in inhalation, viz: that with 
 the ordinary forms of oro-nasal inhalers we do not 
 volatilize a sufficient quantity of antiseptic, or balsamic 
 fluid to be of service as an inhalant; and that when 
 we volatilize sufficient fluid, not enough vapor is 
 inhaled to modify the air cells to any notable degree. 
 I shall not attempt to combat these statements 
 of Dr. Hassall as regards the Beseler globe inhaler, 
 because if I do not admit their truth for the ordinary 
 oro-nasal inhaler, in which the only power present is 
 that of the in-drawn current of air during ordinary 
 
— 59 — 
 inspiration, I would not consider them to apply to 
 the globe inhaler, since in inhalations' from Beseler's 
 inhaler, we have in addition all the power afforded 
 by any number of pounds pressure (in reducing a 
 given fluid to a state of vapor) which we shall deem 
 advisable. Of course, it is understood, therefore, that, 
 in a certain measure at least, the proportions of active 
 ingredients suitable in the oro-nasal inhaler are not 
 always appropriate for use with the globe inhaler of 
 Beseler. 
 
 This is, also, evident when we consider the rela- 
 tively large amount of vapor which is inhaled in quite 
 a short period in the globe inhaler as compared with 
 the oro-nasal inhaler. 
 
 In regard to the influence on the cough in various 
 conditions of catarrhal inflammation — both acute and 
 chronic — and with different localizations in the nose, 
 pharynx, larynx, trachea, and bronchial tubes we have 
 observed the following additional effects: 
 
 At times, repeated and prolonged inhalation un- 
 doubtedly gives a feeling of ease to the throat and 
 chest, and yet frequently the cough is neither arrested 
 nor very markedly ameliorated. This is particularly 
 true of catarrhal disease complicating tubercular in- 
 filtration of the lungs. Even in these cases, however, 
 the inhalation seems to give a sort of renewed vigor, 
 and the patient feels decidedly cheered and en- 
 couraged. In rare cases of this kind the inhalation 
 obviously induces cough at the time of its use, but 
 
— 6o — 
 
 even then it does not appear to permanently irritate 
 the throat or chest. 
 
 I desire to direct special attention to one point in 
 the use of all inhalations. Frequently they are useful 
 in allaying cough and the symptoms depending upon 
 it, even though it is evident that the inhalation does 
 not penetrate below, or even so far as the larynx. 
 This fact may be explained in two ways: First, as is 
 well known, the cough may in reality be occasioned 
 by a morbid condition of some part of the respiratory 
 tract, in front of the larynx, although this organ, the 
 trachea and bronchial tubes may also be inflamed. 
 
 This morbid condition may be an elongated 
 uvula, post nasal catarrh, chronic pharyngitis, acute 
 or subacute laryngitis, etc. 
 
 Again, in the use of all forms of inhalation, while 
 the soothing and modifying effects are partly due to 
 direct local application, still there are similar effects 
 produced by the process of absorption and elimination 
 going on in the mucous membrane lining the affected 
 parts. 
 
 In regard to effects of vapor inhalations upon 
 the sputa and dyspnoea in phthisis, where these symp- 
 toms depend in a certain degree upon concomitant 
 bronchial catarrh, the following facts have been noted: 
 not only are the sputa diminished, as a rule, by in- 
 halation, but they show, not infrequently, manifest 
 changes of color. They also become decidedly less 
 thick and viscid, and from being green-looking and 
 
- 61 — 
 
 tenacious, they are soon foamy, like soap-suds, and 
 thinner, or show the aspect of mingled mucus and pus. 
 The breathing is also improved frequently, and the 
 patient can make more exertion without panting or be- 
 coming exhausted from lack of breath. At times the 
 improvement of breathing, of cough, and of the 
 amount and character of the sputa are accompanied by 
 ausculatory changes which seem to indicate improve- 
 ment as regards the bronchial catarrh located at the 
 apex or apices. 
 
 Owing to the diminution of cough and the de- 
 crease in the abundance of the sputa, the patient's 
 sleep is not so much disturbed — and thus I have 
 found the use of the dry inhaler during the evening, 
 and even at bed-time, evidently a greater promoter of 
 rest than cough mixtures containing anodynes. 
 This may occur even when direct examination with 
 the mirror shows that the larynx is red, swollen and 
 inflamed. 
 
 One of my patients stated in emphatic terms 
 that although she had taken all sorts of drugs for her 
 cough none of them helped her so much as the in- 
 halation. 
 
 Frequently patients will do well for a time with 
 one kind of inhalation, and we shall feel greatly en- 
 couraged; and" then, through some exposure or im- 
 prudence, the cough again grows worse, the sputa be- 
 comes tenacious, frothy, and difficult of expectoration, 
 and the dyspnoea is increased. Later still all these 
 
-63- 
 
 distressing symptoms are again relieved, but by some 
 new form, or combination of inhalation. 
 
 In one case I employed at different times, and 
 during many weeks, extending in all over many 
 months, several different kinds of inhalants. Each 
 one of these relieved for a time and afterward lost its 
 beneficial soothing effect. Still, everything considered, 
 I concluded I had a means which, contrary to 
 Hassall's opinion, was powerful for good, and, despite 
 failures, was more useful in many instances than steam 
 inhalations, or cold atomized fluids. In not a single 
 instance have I been convinced that vapor inhalations 
 when properly employed — and by this I mean when 
 the quantity of medicinal fluid used and the duration 
 and frequency of inhalation were judiciously regulated 
 — increased the cough except in a very temporary 
 manner, or was productive of any evidently bad re- 
 sults. 
 
 The amount of inhaling fluid employed with the 
 oro-nasal inhaler so as to have the best results should 
 vary from ten to twenty drops. This amount may be 
 renewed, most advantageously, two or three times in 
 twenty-four hours. 
 
 The dry inhalations used after this manner must 
 be continued at first about ten minutes every two, 
 three, or four hours. After a week or two they 
 can be continued, without even temporary unpleasant 
 effects, one-half or one hour at a time, and repeated 
 three or four times in twenty-four hours. If a larger 
 
-6 3 - 
 
 quantity of the inhaling fluid be dropped at first on 
 the sponge of the oro-inhaler, or if at first the time for 
 inhalation be extended beyond fifteen minutes, the 
 patient is apt to suffer from irritation of the throat 
 and increased painful cough. These rules should be 
 modified considerably for the large globe inhaler, with 
 which the quantity of the inhaled fluid may vary on 
 each occasion from half an ounce to an ounce, and the 
 time of the inhalation should be limited to between five 
 and ten minutes. During the inhalations, especially 
 at first, even though relatively bland fluids be used, 
 the patient will be forced to stop inhaling for a few 
 moments from time to time, on account of the par- 
 oxysms of cough produced. 
 
 This cough, however, is not of a violent, or dis- 
 tressing kind, as a rule, and quickly stops so soon as 
 the inhalation is temporarily arrested. 
 
 The advantages of the inhalation with the large 
 globe inhaler appear to me greater than those of the 
 ordinary oro-nasal inhaler, i. on occount of the more 
 certain penetration by this method of the balsamic or 
 antiseptic vapors into the ultimate divisions of the 
 bronchi. 2. because a larger quantity of inhaling 
 fluid is vaporized and can be inhaled without endur- 
 ing unpleasant effects in a short time. The disad- 
 vantages are the non-portability of the instrument 
 and the fact, therefore, that the inhalation can as 
 a rule only be properly taken at the physician's 
 office. These inhalations can scarcely be repeated, 
 
- 6 4 - 
 
 therefore, more than once a day in any but acute 
 cases, and then only when the patient is able to leave 
 the house. 
 
 Of course this difficulty could be obviated, when 
 desirable, by having such an instrument (though ex- 
 pensive) in permanence at the patient's home. 
 
 It has been sought to work the globe inhaler con- 
 structed somewhat after the plan of Beseler's, by 
 means of two powerful rubber balls, but on account 
 of the lack of power in the balls, or owing to the 
 fatigue caused to the patient, this plan has hitherto 
 appeared to me impracticable. 
 
 The better way in the majority of cases is to use 
 occasionally — every day, or every ,other day — an in- 
 halation from the globe inhaler,, and supplement its 
 action by use of the ordinary portable and cheap oro- 
 nasal inhaler. 
 
CHAPTER V. 
 
 MEDICINAL FORMULA. 
 
 A.— FOR COLD ATOMIZED FLUIDS OR SPRAYS. 
 
 i. R Sodii bicarb., 
 
 Sodii biborat. , aa 3 j. 
 
 Glycerini, 3 ss. 
 
 Aquam, ad § viii. 
 M. S. Use with the atomizer for cleansing purposes. 
 
 2. Whenever the odor of the breath is offensive 
 by reason of the nature of the discharges, the follow- 
 ing formula may be advantageously used either as a 
 cleansing and deodorizing solution, or with a view 
 also to its curative action: 
 
 1{ Acid Carbolici liq., n^xl. 
 Sodii bicarb., 
 
 Sodii biborat., aa 3 j — 3 tj. 
 Glycerini, § ss — 3" j. 
 Aq. rosar. § ss — § j. 
 Aquam ad, 3 viii. 
 M. S. Use with the atomizer. 
 
 Instead of, or combined with, carbolic acid in the 
 above formula salicylic acid (grs. xxx), chloral 
 (grs. xx — xl), liq. potass, permang ( 3 ss), thymol 
 (gtt. x), may all be used advantageously at times, 
 according to the varying indications of the disease, or 
 merely to change the precise nature of the medication 
 
 5B 
 
— 66 — 
 
 when the mucous membrane of a particular organ has 
 become too much accustomed to a given formula. 
 
 3. Among the astringent and stimulant solutions 
 for the nasal passages and naso-pharynx the following 
 can be recommended: 
 
 ty Zinci sulphatis, grs. v. aq. ad. § j. 
 Ferri chloridi, " " " 
 
 Acidi tannici, " " " 
 
 Argent, nitratis, " " " 
 
 Potass, chloratis solutio ad saturand. 
 
 These solutions should be made about four times 
 the strength just given for the pharynx and larynx. 
 One drachm of glycerin incorporated with each ounce 
 of the various solutions is usually a grateful and useful 
 addition. 
 
 The bromides of sodium, potassium and am 
 monium (grs. xx — f j), extract of opium and bella- 
 donna (grs. v), Magendie's solution (W*), may be 
 used with any one of the astringent solutions when a 
 sedative action is required — or they may be dissolved 
 in water with the addition of a small quantity of 
 glycerin ( 3 ss — § j). 
 
 -FOR STEAM INHALATIONS. 
 
 1. By means of the steam atomizing apparatus: 
 Any one of the solutions already recommended 
 for the nose, and of similar strength, may be thus em- 
 ployed. 
 
- 67 - 
 
 2. By means of ordinary steam inhalers (Mac- 
 kenzie's, Maw's, etc.) 
 
 Many formulae are mainly composed of one or 
 more volatile oils, held in suspension by means of 
 carbonate of magnesia, or prepared kaolin, and made 
 with water to the volume of one or two ounces. Of 
 these mixtures one or two teaspoonfuls should be 
 added to a pint of water at 140 Fah., for each inhala- 
 tion, which should be employed one, or several times 
 a day, according to the nature and the stage of the 
 affection. The following is a formula similar to which 
 several others can be made by merely substituting a 
 different volatile oil: 
 
 IJ Olei pini folii (fir-leaf oil), niXL. 
 Magnesia carbonatis, gr. xx. 
 Aquam ad, § j. 
 M. 
 
 The oils which may at times replace the one 
 above with good effect, are those of cubebs, juniper, 
 myrtle, calamus, lemons, etc. All of these are more 
 or less stimulant in their action, and may be beneficial 
 both in acute and chronic catarrhal inflammations. In 
 the latter the proportion of the essential oil may often 
 be increased. As a rule, from one to ten drops is 
 about the limit of practical utility. Besides the essen- 
 tial oils named, the following substances may be com- 
 bined in a like manner, viz.: terebene, thymol and 
 creasote. From one-half to two grains of magnesia 
 
— 68 — 
 
 carb. for each minim of the different substances men- 
 tioned above, is the quantity usually employed. 
 
 In the ordinary steam inhaler the steam may also 
 be charged with benzoin, iodine, ammonia, camphor, 
 hydrocyanic acid, ether, chloroform, and nitrite of 
 amyl, previously dissolved in alcohol or water, and 
 stirred in suitable proportions into the hot liquid at a 
 temperature from 8o° F. upwards, to i 4 o° F. These 
 different substances are sedative, stimulant, or anti- 
 spasmodic. The inhalations should last about five 
 minutes upon each occasion, and the patient, during 
 their continuance, must inspire slowly and deeply. 
 
 C— FOR VAPOR INHALATIONS. 
 
 I.— By means of the ordinary oro-nasal inhaler: 
 
 i. Creasote, alcohol, and spirits chloroform, equal 
 parts. 
 
 2. Creaoste, one part. 
 
 Ol. pini sylvestris, two parts. 
 
 Compound tinciure of benzoin, eight parts. 
 
 3. Compound tincture of benzoin. 
 
 4. Fir-wool oil. 
 
 5. Compound tincture of benzoin and fir-wool oil. 
 
 equal parts. 
 
 6. Compound tincture of benzoin, eight parts. 
 Carbolic acid and tincture of iodine, of each one 
 
 part. 
 
- 69 - 
 
 7. Pine needle oil. 
 
 8. Terebene, four parts. 
 
 Spirits of chloroform, one part. 
 
 9. Iodoform and oil of eucalyptus, of each two 
 
 parts. 
 Creasote, one part. 
 Alcohol and ether, of each twenty-four parts. 
 
 (Dreschfield.) 
 
 II.— By means of the large globe inhaler: 
 
 1. Tine, benzoini comp., 
 Glycerini, 
 Alcoholis, aa § j- 
 
 2. Ol. picis liq., 3 ss. 
 Inhalant No. 1, § j.* 
 
 The two formulas just mentioned were taken from 
 Parke, Davis & Co.'s list, and have been found very 
 useful by me. 
 
 The most agreeable and generally useful fluid, 
 however, I have yet employed in this method of inhal- 
 ation, is the oil of pine needle, such as I believe was 
 first introduced into this country by Messrs. Gardner 
 & Co., of Sharon Springs, N. Y. This essential oil is 
 
 * This is a petroleum product, introduced first, I believe, 
 by Parke, Davis & Co., which is especially adapted for inhala- 
 tion and for use as a base, or diluent, for inhalants. " It is free 
 from all irritating properties, on account of which it is much to 
 be preferred to similar preparations from which the sulphuric 
 acid, or other objectionable agents used in process of purifica- 
 tion, have been imperfectly removed." — (P., D. & Co.) 
 
— 7o — 
 
 extremely volatile, has a very fragrant odor, and in 
 the majority of instances in which I have used it with 
 Beseler's inhaler, it has been of great service to the 
 patient. Such cases were generally sub-acute, or 
 chronic cases of nasal catarrh, or bronchitis. I have 
 also known the vapor of alcohol to be of considerable 
 use in giving relief in chronic nasal catarrh, by dimin- 
 ishing the quantity of the mucous secretions which are 
 abundantly and constantly formed. Inhalant No. i 
 and creasote may sometimes be combined advantage- 
 ously in the proportion of § ss of the latter to § j of 
 the former, and employed as an inhalation in cases of 
 more or less advanced phthisis. The extract of pine 
 needle, combined or not, with Sharon sulphur water, 
 has likewise proved serviceable in old cases of nasal 
 catarrh. More than one such case has been under my 
 professional care. Inhalant No. i (P., D. &Co.) is not 
 at all miscible with alcohol, and where this liquid is 
 present it must be removed by evaporation with gentle 
 heat and the mixture afterward filtered before it is 
 used in the globe inhaler. This is true of certain fluid 
 extracts (yerba santa) if the proportion of them in the 
 mixture be large, and of the compound tincture of 
 benzoin. Inhalant No. i is partly soluble in chloro- 
 form and ether, viz: It forms apparently a very fine 
 emulsion with each one of these liquids, and thus 
 combined makes a fluid suitable for use in the globe 
 inhaler. 
 
TABLE OF CONTENTS. 
 
 INTRODUCTION. 
 
 CHAPTER I. 
 
 Medicated Sprays.-Different Instruments-Description- 
 Staining Fluids-Sass' Spray Tubes and Air Receiver- 
 Principles and Action of Spray Tubes-Movable T.ps- 
 Objections to a Fixed Tip-Utility of, and Objections to, 
 Cold Medicated Sprays-Advantages of Topical Applica- 
 tions by Sponge or Brush in Chronic Catarrh-Duration 
 and Frequency of Spray Applications. 
 
 CHAPTER II. 
 Steam Atomizers.-Description-Utility in the Tieatment of 
 Acute and Chronic Inflammatory Diseases of the Nose and 
 Throat— Objections— Subsequent Precautions. 
 
 CHAPTER III. 
 Steam Inhalers.-Manner of Using-Varieties-Principles 
 and Description— Advantages— Objections. 
 
 CHAPTER IV. 
 
 Vapor Inhalations.-The Perforated Zinc Inhaler-Beseler's 
 Globe Inhaler-Semple's Inhaler-Utility of Vapor Inhala- 
 tions— Comparison with Cold Atomized Inhalations-What 
 
— 72 — 
 Experience Teaches— Health Resorts for Catarrhal Pa- 
 tients—Home Treatment— Late History of the Use of 
 Vapor Inhalations— Reasons for Their Adoptk n— Objec- 
 tions— Answers to Them— Areas of Cough— Diseases in 
 which Dry Inhalations are Useful— Frequency and Dura- 
 tion of These Inhalations— Amount of Medicament Em- 
 ployed—Relief of Symptoms— Advantages and Drawbacks 
 of the Globe Inhaler. 
 
 CHAPTER V. 
 
 Medicinal Formulae.—^, for Cold Atomized Fluids— B. for 
 Steam Inhalations— C, for Vapor Inhalations. 
 
 

For Use in Atomizing Inhalers. 
 
 ESPECIALLY ADAPTED FOR SEMPLE'S ATOMIZING INHALER. 
 
 For illustration and description of Semple's Inhaler, see this book, pages 41 and 42. 
 
 Complete descriptive circular will be mailed on application. 
 
 For Semple's Inhaler a petroleum product described below as Inhalant No. i is 
 
 used as a base for the medicament. This gives stability to the medicated vapor and 
 
 secures a constant reservoir of it for use. 
 
 A great variety of formula may be employed. We give below a series of 
 standard preparations which we shall be pleased to supply in quantities desired by 
 purchasers. Orders for special formulae will receive the prompt attention of our 
 Private Formula Department. 
 
 Inhalant No. 1. . „ „.,..., 
 
 A petroleum product especially adapted for inhalation and lor use as a base, or 
 diluent, tor inhalant-;. It is free from all irritating properties, on account of which 
 it is much to be preferred to similar preparations from which the sulphuric acid or 
 other objectionable agents, used in process of purification, hive been imperfectly 
 removed. 
 
 Inhalant No. 2. 
 
 Hals. Copaiba, Jss. 
 
 Klhcr, 5j 
 
 Inhalant No. i, q. s. to make 5 iv. 
 
 Inhalant No. 3. 
 
 Fl. Hxt. Yerba sanla, 5J- 
 Glycerin, $ j. 
 Tinct. Opium, 5 j- 
 Alcohol, (]. s. to make * n| 
 
 Inhalant No. 4. 
 
 hi. Ext. Srammonium seed. 
 Fl. Ext. Hy scyamus, a'a 3(j. 
 Fl. Ext. Brlladonna, 3 ss. 
 G'yctrin, $j. 
 Alcohol, q. s. to make 5'ij- 
 
 Inhalant No. 5. 
 
 Tinct. Htnzoine comp. 
 (.Tiycerin . 
 Alcohol, aii I j. 
 
 Inhalant No. 6. 
 Oil of Tar, J ss. 
 Inhalant Na. i, I j. 
 
 Inhalant No. 7. 
 
 ol Uucalyp'us, 3 j- 
 Inhalant No. i, J j. 
 
 Inhalant No. 8. 
 
 Tinct. Iodine, 3 iss. 
 
 Glycenn, $j. 
 
 Alcohol, q. s. to make 5 iij 
 
 Inhalant No. 9. 
 
 M. tixt. Blood-root, 3 j- 
 Fluid Tolu. soluble, 5 SS - 
 Glycerin, ?j. 
 Alcohol, q. s. to make ? M i 
 
 Inhalant No. 10. 
 
 Tiuct. iodine, 3 ij. 
 
 Acid Carbolic, 3 ij. 
 
 Fluid Tolu soluble, I j. 
 
 Glycerin $j. 
 
 Alcohol, q. s. to make J iij. 
 
 PARKE, DAVIS & CO., 
 
 NEW YORK : 
 
 Office. 60 Maiden Lane. 
 
 Warehouse an'l Shipping Depot, 21 Liberty St. 
 
 Crude Drug Warehouse, 218 Pearl St. 
 
 Inhalant No. 11. 
 
 h 1. Ext. Cubeb, 3 j. 
 Fluid Tolu, soluble, 3 j. 
 Tine. Iodine, 3 j. 
 Tine. Camphor, 3 j. 
 Acid Carbolic, 3 j. 
 Glycerin, 5 'M- 
 Alcohol, q. s. to make 5 !▼« 
 
 Inhalant No. 12. 
 
 kther. 
 
 Inhalant No. i, a'a ; j 
 
 Inhalant No. 13. 
 
 Tr. Iodine, 3 ss. 
 Glycerin, Jss. 
 
 Inhalant No. 14. 
 
 ■\cid Carbolic, gr. x. 
 Inhalant No. i, f j. 
 
 Inhalant No. 17. 
 Chloroform. 
 
 Inhalant No. i, of each f j. 
 
 Inhalant No. 18. 
 
 Beech wood t^ieasote, 3 j- 
 Inhalant No. i, \ ij. 
 
 Inhalant No. 19. 
 Iodoform, gr. xx. 
 Creasote, ttcx. 
 Oil Eucalyptus, nj;xx. 
 Ether, 3ij. 
 Oil Sweet Almond, 3 vj. 
 
 Inhalant No. 20. 
 
 leiebene, 3j- 
 Oil Sandalwood, 3 j- 
 Oil Cubeb, 3 j. 
 Inhalant No. i, 3 v. 
 
 Manufacturing Chemists, 
 
 DETROIT, MICHIGAN. 
 
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