k New Method of Laryngeal and Bronchial 
Medication by Means of a Spray and 
Tube During the Act of Deep 
Inspiration. 
BY 
J. MOUNT BEEVER, M.D., 
OF NEW YORK. 
Read in the Section of Laryngology and Otology at the Forty-first 
Annual Meeting of the American Medical Association, 
Nashville, Tenn., May, 1890. 
Reprinted from " The Journal of the American Medical 
Association," November 1, 1890. 
CHICAGO : 
Printed at the Office of the Association.. 
1890. A NEW METHOD OF EARYNGEAE AND 
BRONCHIAL MEDICATION BY MEANS 
OF A SPRAY AND TUBE DURING 
THE ACT OF DEEP IN- 
SPIRATION. 
I bring before you a novel method and use of 
the ordinary cold spray. By the extra aid of a 
hard rubber tube six inches in length and three- 
quarters of an inch in diameter on both sides of 
its openings, through which a cold spray with 
tip pointing downwards is passed and held in the 
mouth between the lips which are clasped over 
the tube. With this tube, spray, and position of 
the lips and deep inspirations any desired medi- 
cated fluid amounting from a half to one ounce 
may be forcibly inhaled during the act of ten 
deep inspirations, and thus reach the deeper por-. 
tions of the respiratory tract, without coughing, 
gagging, or immediately expectorating the fluid 
thus inhaled. The time occupied for re-expectorat- 
ing the fluid medicament thus inhaled varies in 
different individuals. Some begin lightly within 
from five to ten minutes after the inhalation, 
others again half to three-quarters of an hour 
later. The sputa which is expectorated for sev- 
eral hours after contains a certain amount of the 
medicated inhalent used, showing thereby that 2 
the desired medicament used remains in contact 
with the diseased parts long enough to have its 
therapeutic effect. 
The Method of Making an Application.-The 
patient is placed in an upright position, or, bet- 
ter, standing. The collar or tight dress about 
the neck is removed so that nothing interferes 
with taking deep and slow inspirations. The 
position of the head is an important point to be 
observed. It must be inclined backwards dur- 
ing the act of each inspiration so as to destroy as 
much as possible the rectangular curve that the 
windpipe makes with the oral cavity. The pa- 
tient before being made to use these two instru- 
ments, must be shown how to take deep inspira- 
tions and slow expirations without exerting him- 
self. He must also be taught how to hold in the 
breath for a few seconds after each inspiration. 
Those are some of the cardinal points to be looked 
after in order to get the results from each inspir- 
ation. These points are easily acquired by pa- 
tients. When once understood how to make use 
of such inspiratory and expiratory powers, with- 
out the spray and tube, then begin the same 
method over again; with this exception that the 
instrument (spray and tube) are now used for 
practice, as if the patient was taking an inhala- 
tion. Place the tube half its length into the 
mouth; the lips are clasped over it. The spray 
is placed into the opening of the hard rubber tube 
into which the spraying tube is inserted so that 
its inner end protrudes not more than one-quarter 
of an inch. This point regarding the size and 
position of the tube is very important. The best 
motor power for the propulsion of the spray, to 
my mind, is compressed air. The pressure need 
not exceed 60 lbs. This will suffice for any ap- 
plication. 3 
It will be found during the act of deep-forced 
inspiration that the vocal cords separate and, still 
further, on inspiration they will separate to their 
entire extent. In the subsequent expiration 
they will again approach each other. During in- 
spiration the vocal cords form a wide and almost 
pentagonal opening, and under favorable circum- 
stances one can on examination then see the 
bifurcation of the trachea; as seen in the accom- 
panying drawing. 
Figure i. 4 
The epiglottis stands nearly erect, if not, 
through its anatomical formation, is curled upon 
itself or may assume another shape. These phy- 
siological facts are known to every one who prac- 
tices with a laryngoscope. 
The tube serves as an adjunct to the propulsion 
of the specified inhalent. The tube, and the act 
of deep inspiration, also diverts the attention of 
the inhaler, and thereby calling into action an- 
other set of muscles favoring the passage of the 
inhalent. During the act of deep inspiration the 
tongue lays flat in the mouth, and as described 
before, the vocal cords and epiglottis are now in 
a position to permit the passage of the medicant, 
and assisted in reaching the desired spot by the 
propelling force of compressed air. 
^ARD RUBBER rubt ■, Genius Iona 
Figure 2. 
I have made numerous experiments with this 
method of application upon the dog and rabbit 
before using it upon my patients, the details of 
which are beyond the scope of this paper. Never- 
theless, I will give a short description of one of 5 
these experiments in order to show the effective- 
ness of this method in the application of medica- 
ments in a fluid state to the deeper portion of the 
respiratory tract. 
A healthy dog weighing fifty pounds was 
placed upon a table. The mouth was opened 
and the rubber tube inserted to its proper length. 
The mouth was then fastened over the tube by 
straps made for the purpose. The tube being 
open the respiration was thus carried on un- 
disturbed. The spray was then attached and 
the animal made to inhalate. The substance 
used was a strong solution of the extract of rhat- 
any, the quantity sprayed being half an ounce. 
This almost immediately brought out a bright 
Figure 3. 
redness of the larynx, trachea, and of the bronchi, 
which entirely disappeared after the discontinu- 
ance of the spray in about two hours from those 
parts under examination. 
The sputa, however, continued to be red some 
five hours longer; at this point the animal was 
killed and a post-mortem examination was made. 
Quantities of the fluid inhaled were found depos- 
ited throughout the trachea and smaller bronchi. 
Other experiments made with the same end in 
view gave similar results. 
It is a well known fact that finely divided sub- 
stances do penetrate into the air cells, as in the 
case of colliers, grinders and others who are con- 
stantly inhaling pulverized particles and matter 
while engaged in their occupations. On the 6 
other hand it is extremely doubtful if any of the 
medicaments used in any of the numerous in- 
halers at present in vogue ever reach the walls of 
the ultimate lung alveoli. The conditions under 
which and the extent to which sprays and vapors 
enter the lungs are to- a certain extent satisfac- 
tory, most authorities who have written upon the 
subject and carried on experiments in this line, 
as, for instance, those made by Dr. Arthur Hill, 
Hassall, of St. Remo; Fournie, D'Bmarguay, 
Tavernier, Bataille, Schnitzler, Storck, Fieber, 
and others which tend to confirm my own obser- 
vations. 
Figure 4.-Position of the larynx during the act of deep 
inspiration. 
The advantages of the method I have described 
are as follows: 
i. Cheapness of the instrument, which is sim- 
ply a hard rubber tube. 
2. The advantage of the continued effects of 
the remedy as the time between each application 
lasting five hours, until another is necessary, and 7 
then the patient can satisfactorily make it him- 
self and thus keep up the remedial effects. 
3. No cough or gagging is excited whatever, 
as compared with the use of the spray alone in 
making laryngeal application. 
4. The quantity of fluid inhaled at each sitting 
is half to one ounce in from three to four min- 
utes' time. 
5. When applied to the larynx, trachea and 
bronchi no spasmodic contractions arise during 
its use whatsoever. 
6. Irritating medicaments in solution can be 
thus applied without exciting much cough. I 
often use nitrate of silver, thirty grains to the 
ounce, iodine, tannic acid, peroxide of hydrogen 
of full strength without any trouble or bad effects. 
My results in the treatment of (Storck's disease) 
or ozsena of the trachea, acute and chronic bron- 
chitis, laryngitis, tracheitis, phthisis, etc., have 
given me such satisfaction that I bring this 
method before your notice. 
For the want of more time I was compelled to 
shorten my paper. 
Several drawings accompany this paper. Fig- 
ure 1 demonstrates the exact position of the 
lips around the tube during the act of deep in- 
spiration. 
Figure 2 shows a Sass' glass downward point- 
ing spray passed through the hard rubber tube, 
the spray points looking out at the opposite open- 
ing a quarter of an inch. 
Figure 3 shows the tube. 
Figure 4 illustrates the position that the vocal 
cords take during the act of deed-forced inspira- 
tion. 
Tubes are made by Tiemann & Co., New York 
City. 
83 2nd avenue, New York City.