Vapor Massage for the Prevention and 
Cure of Pulmonary Tuberculosis. 
By 
H. M. DUNLAP, M. ID. 
BATTLE CREEK, MICH, 
[Read before the American Congress of ^Tuberculosis, New York, May, 1901.] [Read before the American Congress of Tuberculosis, New York, May, 1901.] 
VAPOR MASSAGE FOR THE PREVENTION 
AND CURE OF PULMONARY 
TUBERCULOSIS. 
H. M. DUNLAP, M. D„ Battle Creek, Mich. 
Careful observation during an experience of fifteen 
years with various methods and forms of treatment for 
pulmonary affections has confirmed my belief in the 
value of direct medication in the form of nebulized 
vapor for the prevention and cure of Pulmonary 
Tuberculosis. 
My early views on this subject were expressed in a 
paper read before the Michigan State Medical Society 
in 1892. More or less skepticism was then manifested, 
but at the present time this form of treatment is used 
and indorsed by many prominent members of the 
profession. 
For all medicaments which are intended to act 
locally, either as antiseptics or otherwise, direct appli- 
cation is the only rational method of administration. 
This secures the direct and primary action of the 
agents without having undergone chemical changes and 
without disturbing the digestion, secretions and other 
important functions. 
For the purpose of direct medication the nebulizer 
meets every requirement much more perfectly than any 
other form of apparatus. Either volatile or non-volatile 
medicaments may l^^iypi^yqd, as.the vapyr, or nebula, 
is producech mecShtulidally, the fluid beir g broken up 
into infinit^kS^^irti'eles so $nat they are readily carried with the air into the most remote por- 
tions of the respiratory tract, thus bringing the desired 
agents into direct contact with the tissues that are 
involved. Fortunately this rational method of treat- 
ment is rapidly coming into general use, though there 
are many physicians who still adhere to the old- 
fashioned, irrational, round-about way of stomachic or 
hypodermic medication, even when a purely local action 
on the pulmonary tissues is desired. 
Some have gone to the other extreme, recommend- 
ing the use of the nebulizer where purely constitutional 
action is desired. This is equally irrational because it 
is not the natural or most direct channel. However, 
where a combined local and constitutional effect is 
wanted, nebulization may be used to advantage; for if 
we will but consider the vast area of absorbing surface 
that can be bathed by nebulized vapor, it will be seen 
at once that a constitutional effect can be quickly 
obtained if desired. For instance, the physiological 
action of nitro-glycerine can be secured by inhalation 
of nebulized vapor as quickly as by hypodermic 
injection. 
Between the years i860 and 1864 experiments were 
made by Demarquay, Poggiale, Trosseau, See, Le 
Conte, Tonerine, Gratiolet, Auphan, Sales-Girons, 
Pietra-Santa, Rene Briau, Claude Bernard, Edward 
Fourni, Waldenberg, Morrell MacKenzie, Niemeyer 
and many others to determine the penetrability of neb- 
ulized vapor. In a few instances the results were 
negative, but on the whole they were positive and 
satisfactory, notwithstanding the fact that the neb- 
ulizers then in use were very crude and inefficient in 
comparison with the elegant and practical outfits now 
obtainable. 
4 5 
On January 7, 1862, Poggiale, as chairman of a 
committee appointed by the Paris Academy of Med- 
icine, made a favorable report based upon many careful 
experiments. After a thorough discussion of the sub- 
ject, the Academy almost unanimously accepted the 
report of the committee, endorsing their conclusion 
that nebulized vapor could be inhaled deeply into the 
respiratory tract. Recent experiments have demon- 
strated the correctness of conclusions above referred to 
and have established beyond a possible question the 
fact that nebulized vapor will reach every part of the 
respiratory tract to which the air itself is accessible. 
In the earlier use of the nebulizer the vapor was 
administered by inhalation only. About ten years ago, 
while using a nebulizer in connection with the pneu- 
matic cabinet, it occurred to me that nebulized vapor 
might be administered under pressure, thus securing a 
more thorough application, combined with the beneficial 
effect of dilatation, etc. A series of careful experi- 
ments extending over several years furnished abundant 
evidence that the idea was a practical one, and in 1895 
I had a compound or multiple nebulizer constructed 
having a storage chamber and controlling valve with 
which the nebulized vapor can be produced, stored and 
administered under pressure, either constantly or with 
rapid interruptions, producing a vibratory effect. I 
have applied the term "VAPOR MASSAGE" to this 
method of administering nebulized vapor, and I believe 
both the term and method are original. 
The massage-like effect of the vapor when applied 
in this manner acts very favorably upon the circulation, 
absorption, nutrition, and upon other functions, and at 
the same time secures a more effective application of 
the medicament employed, 6 
The value of VAPOR MASSAGE for the preven- 
tion of Tuberculosis depends entirely on the fact that 
the bacilli require favorable conditions for their develop- 
ment. The healthy tissues resist their action, but an 
acute attack of congestion or inflammation favors their 
development, and the histories of tubercular cases 
show that a large proportion have their origin in these 
Multinebulizer Designed by the Author for the Treatment of Pulmonary 
Tuberculosis and Other Affections of the Respiratory Organs. 
(This instrument may be operated in connection with any air receiver.) 
acute attacks. It is not usually considered necessary to 
treat or give much attention to a mild attack of bron- 
chitis, or "cold on the lungs"; but this is a serious 
mistake which has proved fatal in thousands of cases. 
The use of VAPOR MASSAGE and the inhalation of 
antiseptic nebulized vapor in acute and sub-acute 
Bronchitis, Broncho-Pneumonia, La Grippe and sim- 
ilar affections will remove the congestion and inflamma- 
tion, restore the natural resistance of the tissues and 
fortify them against possible tubercular infection more 
quickly and effectively than any other form of treat- 
ment now in use. The infectious material has been 
scattered broadcast everywhere and will continue to be 
for some time to come, notwithstanding every effort 
that may be put forth to prevent it. It js therefore important that we should teach the laity as to the 
nature of the disease, the possibility of infection and 
the importance of attending promptly to all acute 
affections of the lungs. 
There is abundant evidence that the tubercle bacilli, 
so long as they remain exposed on the surface of the 
mucous membrane, can be destroyed or rendered harm- 
less by the action of antiseptic agents administered in 
the form of nebulized vapor, without in the least 
injuring the tissues themselves. But in most cases the 
bacilli which produce the primary infection are already 
encapsulated before medical advice is sought, making 
it impossible to reach them with antiseptic agents 
except through the circulation, which is always more 
or less impaired in the involved area. To meet this 
condition the antiseptic vapor should be administered 
Hand Nebulizer Designed by the Author Especially for Patients' Use. 
under pressure in the form of VAPOR MASSAGE, 
which should be repeated once or twice daily. This 
improves the circulation in the involved tissues and 
therefore improves the nutrition, and also causes an 
increased absorption of the antiseptic agents, in this 
way reaching the encapsulated bacilli, greatly reducing 
fheir virulence even if they are not actually destroyed. 8 
The patient should also have a hand nebulizer with 
which inhalations may be taken repeatedly, thus keep- 
ing the entire pulmonary mucous membrane constantly 
bathed with an antiseptic atmosphere. Then if break- 
ing down occurs or has already occurred, the attenuated 
bacilli that are thus liberated find conditions unfavor- 
able for their development, and instead of infecting 
new areas are thrown off by expectoration. In this 
way the progress of the disease is stayed, and if not 
already too far advanced, cicatrization will take place 
with ultimate recovery. 
VAPOR MASSAGE facilitates expectoration and 
thus lessens the tendency to ptomaine poisoning. 
The fever diminishes, night sweats soon cease, the 
appetite and nutrition improve, and there is increased 
lung capacity with better oxygenation of the blood. 
These results are frequently very noticeable, even in 
advanced cases. The irritable cough which is often 
present can be controlled by combining sedatives with 
the other agents employed. This secures their direct 
local action with the least possible constitutional effect. 
No mention has been made of the specific medica- 
ments that should be employed. Iodine, Creosote, 
Formaldehyde, Benzoin, essential oils, etc., are largely 
used; in fact any agent which can be reduced to a 
liquid can be employed as may be deemed advisable in 
each individual case. 
For the successful administration of VAPOR MAS- 
SAGE a nebulizer is required having a vapor storage 
capacity of from one to two liters. It must also have 
a valved outlet so that the vapor can be stored and 
administered under pressure. This valve must be so 
arranged as to give the operator absolute control of the 
volume and pressure of the vapor delivered. A flexible 9 
delivery tube should be provided with suitable mouth- 
piece, which is placed in the patient's mouth with the 
Multinebulizer Outfit, with High Pressure, Rapid Action, Double Cylinder, 
Lever Pump, Designed by the Author. 10 
lips tightly closed around it. After a forcible exhalation 
the nose should be closed with thumb and finger and 
the massage valve gradually opened while the patient 
inhales as deeply as possible, the vapor continuing to 
flow until the pressure is sufficient to almost force the 
mouth-piece from the patient's lips. At this point the 
valve should be closed for about ten seconds, then 
quickly opened and closed several times, producing a 
vibratory effect, which is transmitted through the com- 
pressed vapor to every part of the lungs. This should 
be repeated from five to ten times at each sitting, and 
should be preceded by an inhalation of from five to ten 
minutes' duration so as to saturate the residual air with 
the medicated vapor. The first two or three sittings 
should be short and only a moderate pressure used; 
otherwise some lameness of the chest walls may be 
produced on account of the unaccustomed expansion. 
Inhalations with a hand nebulizer should be repeated 
by the patient every two or three hours so as to main- 
tain a constant action of the medicament employed. 
This is very important. 
The treatment of tuberculosis is a subject to which 
much study has been devoted by many of the most 
eminent men in the medical and scientific world. That 
much remains to be accomplished in this direction is 
sufficiently evident from the enormous death rate. 
In the very nature of things, there is no one line or 
method of treatment that can meet all requirements. 
But when we consider the cause and nature of the 
disease and its method of development, it seems per- 
fectly apparent that direct medication with nebulized 
vapor is one of the most valuable forms of treatment 
that can be employed.