[Reprinted from the Boston Medical and Surgical Journal 
of July 16, 1885.\ 
THE TREATMENT OF PULMONARY DIS- 
EASES BY MEANS OF " PNEUMATIC DIF- 
FERENTIATION." i 
It is my purpose to speak of a new method of 
treatment for pulmonary diseases, which was brought 
to my notice not long since in the Journal of the 
American Medical Association, February 14, 1885, 
in which the writer referred to an article in the 
New York Medical Record of January 17, 1885, by 
Dr. Herbert F. Williams, of Brooklyn, New York, 
who speaks of the " Antiseptic Treatment of Pul- 
monary Diseases by means of Pneumatic Differen- 
tiation," and records with their results a ^series of 
cases which have undergone this method of treat- 
ment. 
I speak of it as a new method, because I believe 
it to be a step forward in the treatment of one of 
the most formidable diseases with which we have to 
contend, and whatever may be the results of future 
investigations, I deem it worthy of the eyeful con- 
sideration of all members of the regular profession, 
and if the results are not what we have been led to 
hope for, we can, at least, say that no harm has 
been done by our endeavor to find a new weapon 
against a terrible disease. 
The treatment of pulmonary diseases by the 
BY VINCENT Y. BOWDITCH, M.D. 
1 Read before the Section for Clinical Medicine, Pathology, and 
Hygiene of the Suflblk District Medical Society, May 13,1885.' 2 
The Treatment of Pulmonary Diseases 
inhalation of compressed and rarefied air has been 
for several years used by well-known scientific men 
with apparent success in many cases in Europe, 
especially in Germany, and to a much greater ex- 
tent than in our own country, where I think I am 
right in saying that comparatively little attention 
has been paid to either method by members of the 
regular profession. Various irregular practitioners 
have used inventions of their own, having more 
or less similarity to each other, for the disease 
in question, but whether from the fact that 
such people usually keep their inventions to them- 
selves, or because they have been proved to be 
utterly worthless, no marked movement toward a 
general adoption of such therapeutic measures has 
been made. 
It has been my good fortune in studying the sub- 
ject to come across the methods of treatment of one 
or two irregular practitioners, which at first seemed 
to resemble closely that adopted by Dr. Williams, 
but which upon closer examination were found to 
differ in essential points. Of these methods I shall 
speak more fully later. 
The treatment of pulmonary diseases by means 
of compressed and rarefied air, as used in Europe, 
is meant chiefly to accomplish the same result as 
removal to some different section of the country 
where the air has the requisite degree of density or 
rarefaction for the treatment of the disease in 
question. To obtain this, air-tight compartments 
are constructed, in which the patient sits for a given 
time, and the air is then partially exhausted or 
compressed, according to the needs of the case, 
which treatment is continued for a certain number 
of hours in the day for several weeks, or possibly 
months, and the results seem to justify the fact that By Means of " Pneumatic Differentiation." 
3 
these methods are in constant use in Europe.2 
Various portable instruments have been devised by 
different scientific men for inhalation of compressed 
air, and vice versa, the best known being the appa- 
ratus of Waldenburg, of Tobold, of Schnitzler, or 
of Geigel and Meyer ; also another of J. Solis-Cohen,3 
of Philadelphia, all being modifications of the same 
idea, illustrations of which I shall show you to-night, 
as seen in books upon the subject. It will \be 
noticed that in the use of these last-mentioned in- 
struments the surface of the body is exposed to the 
ordinary atmospheric pressure, whereas in the case 
of the pneumatic chambers the atmospheric pressure 
upon the body and in the lungs is increased or 
diminished according as the air in the cabinet is 
compressed or rarefied. 
Still another method has been invented by Hauke, 
called by him the "Wanne," or tub, spoken of 
in Ziemssen's Handbuch der allgemeineu Therapie ; 
but, as far as I can discover, the apparatus has 
not been universally used. In following out this 
method, a rubber hood, closely fitting about the 
head and leaving the face only exposed, comes 
down over the shoulders like a shirt. The patient 
is then made to lie down in the " Wanne," which in 
shape resembles a tub, having a close-fitting rubber 
cover which encircles the neck of the patient, and 
the hood is then fastened to the edge of the cover 
by means of an elastic band. The air is then par- 
2 Compartments of this nature exist in Lyons, Montpelier, Nice, 
Stockholm, London, and St. Petersburg, also in several places in 
Germany, but I am not aware that any similar chambers are con- 
structed in this country. They are expensive and need the care of 
experienced persons in the regulation of the various devices used 
in connection with them, and it is probably for this reason that they 
are not more universally used. 
8 Solis-Cohen's article in New York Medical Journal for October 
18,1884, entitled " Compressed and Rarefied Air as a Substitute for 
Change of Climate." 4 
The Treatment of Pulmonary Diseases 
tially exhausted from the interior of the " Wanne," 
which decreases the atmospheric pressure over the 
surface of the body, with the exception of the face. 
Upon inspiration the increased pressure of the out- 
side atmosphere materially tends to expand the 
lungs from within, and the inspiratory act is greatly 
facilitated, whereas the expiratory effort is propor- 
tionately increased, and a calisthenic action of the 
lungs and chest-walls is thereby obtained to a 
greater degree than by the ordinary respiratory 
movements. 
A similar method to this was adopted by an 
irregular practitioner, called " The Hadfield Body 
Receiver for the New Haven Vacuum Cure," used, 
I have been informed, in 1869, a sketch of which I 
have with me. 
I have mentioned quite superficially the various 
methods used by the regular profession in so-called 
pneumatic therapeutics, so far as I have been able 
to learn of them, that you may be able to under- 
stand the general principles of their use, and before 
speaking of Dr. Williams's cabinet it is only nec- 
essary to mention the various methods of inhala- 
tion familiar to us all, used all over the world in the 
treatment of pulmonary diseases ; for example, in- 
halations of atomized sprays of different substances, 
of the use of rooms filled with medicated vapors, 
etc., all of them seeming to have met with more or 
less success, but too numerous to do more than 
mention here as they bear upon Dr. Williams's 
method of treatment. 
In March, feeling much interested in what I had 
read of the Pneumatic Cabinet, I went to Brooklyn 
and was there enabled, through the courtesy of Dr. 
Williams, to study the apparatus thoroughly, and 
to examine three or four of his cases who had de- By Means of "Pneumatic Differentiation P 
5 
rived marked benefit from the use of the so-called 
differentiator. The cabinet is made of iron and 
resembles a large iron safe in general shape, in one 
end of which is a large, thick glass window. It is 
between six- and seven feet high, about three feet 
wide, and from three and one-half to four feet long ; 
in short, large enough for a man or woman to stand 
up or sit down in comfortably. Opposite the win- 
dow is a heavy iron door edged with rubber and 
furnished with heavy bolts, all moved easily by one 
handle, so that the door can be instantly opened. 
Beneath the window is a projection in the side of 
the cabinet to accommodate the patient's knees 
when sitting with the face near the window, the 
same projection serving on the outside as a shelf 
upon which the atomizer used with the apparatus is 
placed. Passing through the glass window is fixed 
a short gutta-percha tube about one and one-half 
inches in diameter, having a stop-cock on the out- 
side, and ending in a trumpet-shaped opening for 
receiving the spray, the inner end being fitted with 
a movable rubber tube and mouthpiece for the pa- 
tient's use. Near the cabinet stands a cylindrical 
iron vessel, from which the air is as nearly as possi- 
ble exhausted, communicating with the interior of 
the cabinet by means of a pipe and stop-cock. A 
barometer, connected with the inside of the cabinet 
to show the amount of rarefaction of air in the in- 
terior, is fastened to the outside of the cabinet. 
The patient enters the apparatus and seats himself 
opposite the window; the door is closed and the 
stop-cock of the pipe connected with the vacuum is 
opened. The air from the cabinet rushes to the 
vacuum, and when the barometer shows a depression 
of two tenths of an inch the stop-cock is again 
closed. A spray, usually of carbolic acid, iodine, 
iodoform, or bichloride of mercury, either singly or 6 
The Treatment of Pulmonary Diseases 
ill combination with each other, is then put in front 
of the inhaling-pipe ; the patient is directed to insert 
the end of the tube in his mouth, closing the lips 
over the mouthpiece, at the same time compressing 
the nostrils with his fingers to prevent the air rush- 
ing out through his nose ; the stop-cock is turned 
and the outside air rushes in, carrying with it the 
medicated spray and causing a more forcible invol- 
untary inspiration, giving one the sensation of 
having taken an unusually full, deep inspiration ; 
the patient then, by a voluntary forced expiration, 
exhales through the tube again, and continues these 
respiratory movements several times. Upon the 
least feeling of fatigue the stop-cock is turned and 
the patient, after removing the tube from his mouth, 
breathes the rarefied air of the cabinet again until 
ready for a second trial. The time occupied in this 
treatment varies from ten to thirty minutes, and 
usually daily applications are made, the greatest 
number given, according to Dr. Williams's pamphlet, 
being one hundred and thirty-five. The amount of 
rarefaction used in the beginning is never more than 
what would cause one tenth or two tenths of an 
inch depression of the mercury, but during the 
treatment a gradual increase of rarefaction may be 
used, up to an amount causing a one-inch depression 
of the mercury, although in many cases, doubtless, 
even a greater degree of rarefaction could be usee 
with benefit and without evil results. 
The only peculiar sensation which may be noticed 
in the beginning of the treatment is a slight crack- 
ling in the ears, as the air is being exhausted froir 
the cabinet, but if the patient be told to swallov 
two or three times, this symptom will entirely dis- 
appear. 
It will be seen, I think, from the- foregoing descrip By Means of 11 Pneumatic Differentiation." 
7 
tion of the apparatus, that what it accomplishes is two- 
fold in its nature, namely : it produces a much greater 
expansion of the lungs than is possible by an ordi- 
nary full inspiration; and, at the same time, the 
medicated spray being carried with much greater 
force than by a natural inspiration is deposited in 
the deeper portions of the lungs in a much more 
thorough manner than by any other method that I 
know of, as has been proved satisfactorily by Dr. 
Williams in a series of experiments referred to in 
his pamphlet. 
As to the principle of his cabinet, it will be 
noticed that it resembles in theory the " Wanne," 
or tub, of Hauke, before mentioned, in which atmos- 
pheric pressure on the surface of the body is less- 
ened, tlie face only being exposed to the outside 
air; but the simplicity of Dr. Williams's method, 
by which the patient is enabled to undergo the pro- 
cess without the discomfort of putting on extra 
coverings, as in Hauke's plan, will strike every one, 
to say nothing of the greater thoroughness with 
which the purpose is accomplished. The chief 
merit of his cabinet lies, however, in the fact of the 
combination of the medicated spray with the in- 
creased strength of the inspiratory movements. 
For full accounts of his cases which have undergone 
this treatment I must refer you to his pamphlet, 
merely remarking that the percentage of cases 
which have improved is most gratifyingly large and 
that it must be left to the future to determine 
whether others meet with equally happy results. I 
wish to speak, however, of three patients whom 
Dr. Williams kindly let me examine. [Cases I., 
II., and IV., were read from Dr. Williams's 
pamphlet.] 
Upon examination of case II. of Dr. Williams's 8 
The Treatment of Pulmonary Diseases 
pamphlet, I found him to be a young man of rather 
delicate build, but otherwise looking well, and to all 
outward appearances in good health. Percussion 
of the right chest showed slight dulness in that 
region, and upon auscultation a faint crumple was 
heard, and the respiratory murmur was harsh, but 
the gurgling sound and the amphoric quality spoken 
of at the first examination I did not get. The 
young man spoke of himself as feeling all right, but 
upon closely questioning him I found that he had 
a slight cough upon arising in the morning. Of 
the evident marked improvement from his previous 
condition as described no one would doubt, as he 
had been enabled to resume his work a year pre- 
vious. 
Case I. (a young lady), when I saw her, looked 
rather pale and anaemic, but her mother spoke to 
me especially of the condition in which her daughter 
was before beginning the treatment, and of her 
belief that she was well. Examination of right 
chest showed dulness and crumpling with inspira- 
tion,- a marked difference from the signs noticed 
before, - and the patient was able to do, as far as I 
could learn, everything that the other members of 
the family were accustomed to. 
Case IV., which was complicated with empyema, 
looked perfectly well, showing a slight fistula in the 
left chest. Upon examination, all the signs of a 
former empyema on the left side were present. Dr. 
Williams also spoke of the presence of a slight crum- 
ple heard at one time under the right clavicle in the 
course of the disease, but after the continued use 
of the cabinet it disappeared, and when I examined 
him the respiration was absolutely pure at that point. 
In regard to the first two cases it should be said 
that Dr. Williams does not wish to claim that they 
are insured against a return of the trouble : on the By Means of 11 Pneumatic Differentiation." 
9 
contrary, he believes that they both will eventually 
die of phthisis ; but he does claim the greatest im- 
provement and an arrest of the disease, and, as far 
as outward appearances are concerned, a return to 
health. He hopes for the greatest benefit to arise 
in those cases of incipient phthisis where there 
seems to be nothing more than a catarrhal condition 
of the lung, and his one desire is that his method of 
practice shall be given a fair trial by members of 
the regular profession everywhere. In those cases, 
moreover, of a slowly expanding lung after pleuritic 
effusion, the mere mechanical treatment of the 
cabinet can be of great assistance in promoting 
expansion. 
In every collection of cases of this sort it is only 
right that we should carefully weigh every evidence 
for and against the justice of the conclusions drawn. 
In the cases enumerated in Dr. Williams's pamphlet 
we must think of the moral effect of the new method 
upon the patient. No doctor is unaware of the mar- 
velous influence which the mind has over the body, 
and of the marked improvement which often takes 
place in the general condition of a patient upon 
trying a new physician or a new method of treat- 
ment. We must think, moreover, of the possi- 
bility of the enthusiasm of the inventor blinding his 
eyes to certain facts which must be considered, 
while wishing at the same time to be perfectly fair 
and unbiased in his statements ; we must also not 
be too greatly influenced by the delight of friends 
and relatives, who, seeing a marked improvement 
in one dear to them, exaggerate to themselves the 
signs of a return to health. Nevertheless, with a 
collection of cases such as Dr. Williams gives us in 
his pamphlet, it becomes the duty of responsible 
physicians throughout the country to investigate the 
subject thoroughly in a spirit of perfect fairness and 10 
The Treatment of Pulmonary Diseases 
without prejudice, and to let the future decide 
whether others meet with equally successful 
results. 
It has been my desire since seeing Dr. Williams's 
cabinet to find if any similar method of practice 
has been used before ; and my attention was called 
to a cabinet used by a practitioner not of the regu- 
lar profession in this city. In a pamphlet issued 
by him, a woodcut of his cabinet was shown which 
seemed to resemble almost precisely in principle 
that of Dr. Williams ; and the description of its 
use as expressed in the pamphlet led me at first to 
believe that they were identical, with the exception 
that no attempt was made to use a spray in connec- 
tion with the cabinet. I visited the gentleman and 
was received with courtesy, and the principles of 
the cabinet were explained to me. The description 
of the apparatus in the pamphlet speaks of the air 
being partly exhausted about the patient at his will. 
Upon questioning the gentlemen more closely, how- 
ever, I found that the breathing-tube and stop-cock 
on the inside of the cabinet were not used at all in 
the same manner as in Dr. Williams's apparatus ; 
and I cannot do better than quote the gentleman's 
words as nearly as possible : "I exhaust the air in 
the cabinet to an amount causing a pressure on the 
outside of the cabinet of about three to five pounds 
to the square inch (an equivalent of a depression 
of six to ten inches of the mercury), and direct the 
patient if he become nervous to open the stop-cock 
very slightly, so that the outside air may enter 
enough to reassure him, and then let him sit in the 
rarefied air for a certain length of time, and at the 
end of the sitting make him take one or two deep 
inspirations to expand his lungs, opening the stop- 
cock a little at the same time, the end being in the 
mouth." From this description it will be seen that By Means of "Pneumatic Differentiation." 
11 
his method resembles more those previously spoken 
of, in which the patient merely sits in a rarefied at- 
mosphere for a given time. No attempt is made to 
breathe in and out as in Dr. Williams's cabinet; 
indeed, this would be impossible with the great 
amount of rarefaction used, for the force of air rush- 
ing in through the wide open stop-cock would se- 
verely injure the patient; moreover, as I said 
before, no attempt is made to combine the spray 
with his apparatus. So it will be seen how essen- 
tially the two methods differ at the outset, to say 
nothing of the fact that while in the one 
case we are dealing with a scientifically edu- 
cated physician, in the other we come in contact 
with one who professes to " diagnosticate his case 
by his eye"; who " never auscults nor percusses 
his patients nowadays," and who " draws the cor- 
ruption out through the skin," etc- etc. 
I have endeavored to give the important facts re- 
lating to Dr. Williams's apparatus, and to show how 
it differs from other methods of treatment as far as 
I have been able to learn of them by reading or by 
personal observation. My object will be accom- 
plished if the paper shall excite discussion ; and I 
trust if there is any one present who knows of meth- 
ods of treatment resembling those of which I have 
spoken, he will speak of them to the Society this 
evening. 
REFERENCES. 
Journal of the American Medical Association for February 14, 
1885. Editorial on Dr. Williams's article. 
New York Medical Record for January 17, 1885: "Antiseptic 
Treatment of Pulmonary Diseases by Means of Pneumatic Differen- 
tiation." By Herbert F. Williams, M.D. Brooklyn, N. Y. 
Ziemssen's "Handbuch der allgemeinen Therapie." I. Band. 
IV. Theil. Edited by Oertel. 1882. 
Hassall's " Inhalation Treatment of Organs of Respiration, In- 
cluding Consumption." London. 1885. 
New York Medical Journal for October 18,1884. " Compressed and 
Rarefied Air as a Substitute for Change of Climate." J. Solis-Cohen. 
Philadelphia.