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\
PRACTICAL OBSERVATION
                    ON THE


INHALATION OF VARIOUS VAPORS AND POWDERS


             IN  DISEASES

                    or THE


       AIR   TUBES  AND  LUNGS.
     —t
BY WM. M. CORNELL, M.D.
           . :~■ r  . \ <i''

          BOSTON:
PRINTED BY DAVID CLAPP, 184 WASHINGTON STREET.
       Medical and Surgical Journal Office.
              1850. 

C2i4p
 \$50
\ 
INHALATION  OF  VAPORS  AND  POWDERS.
   I have for  some  time contemplated  writing a somewhat extended
 article on this subject, believing, as  I  do, that  more  benefit may be de-
 rived from inhalation, than has yet been experienced.   Inhalation  of va-
 pors and  gases, through the  air tubes, to the pulmonary mucous tissue,
 has been  more or less practised  from the early ages;  but several reasons
 may be assigned why it has not been  attended  with  more favorable re-
 sults, though, as will appear in the sequel, benefit has  followed  its adop-
 tion.   In  some cases, the articles  inhaled, or  breathed, have not been
 of  a  character  lo be beneficial ; in others, the instruments for inhaling,
 or breathing  the  substances  or  vapors, have been  of  so clumsy a kind,
 that the thing could not be  properly done ; and lastly, it has, generally,
 not been done at all, till the diseases had assumed so grave a character
 that no human  means could arrest them.  These  are good  reasons for
 the results not  having usually proved favorable.
   I shall refer to  several methods of breathing various atmospheres, gases,
 powders, &c, in  consumption, catarrh, croup, asthma, and other diseases
 of the air-passages.    It is well known that Dr. Beddoes  recommended
 breathing  an atmosphere of factitious airs, and  Sir  Humphrey Davy
 seems to  have  concurred  in the same opinion.   The former, also, ad-
 vised patients  threatened  with,  or  laboring under, phthisis,  to have a
 communication  made from  their rooms, lo  " cow-houses and  stables,"
 for  the purpose of  breathing the warm air  of such places ; and, when
 threatened with this disease myself, twenty-five years since, a physician
 of no small celebrity  advised me " to keep about cows, oxen and  horses,
 as  much as possible."  Nor do I  even now imagine this  advice  was
 given without some  reason for it, as there is undoubtedly a mildness and
 warmth of atmosphere about such places, very  grateful and  healthful  to
 the shivering, hectic invalid.   But I believe it  would  be much better to
 breathe such an  atmosphere by going into  it, than to admit a current of
 air  from these places into a tight room or bed-chamber.
  The  vapor of  tar was once highly recommended, as being very bene-
ficial in phthisis.  Its  balsamic  powers were said  even to heal ulcars in
the  lungs.   Drs. Mudge, Crichton, Paris, and others, all advocated its
use.   But still,  it  has ceased to be used.   It is, however, quite  proba- 
4
Inhalation in Diseases of the Lungs.
ble, that there are stages  in  phthisis, in which  its inhalation  would  be
serviceable, though when  ulcers had  formed, it would not heal  them ;
and though I would not claim for it anything like what some of the cele-
brated gentlemen just named did, yet I think  1 have seen benefit de-
rived  from its use in threatened phthisis.   It  should  be further tried,
watching carefully the period of the disease (if there be any) when it is
useful.   It might be done in every public hospital,  by having  a room
specially devoted  to the  purpose.  The temperature of the air, and  its
proper  medication, could, under hospital regulations, be critically  adjust-
ed, while in  private practice  it would  be attended with much inconve-
nience.    The tar employed should  be such as is used for manufactur-
ing ship cordage; and  it has been recommended to add half an  ounce
of the sub-carbonate of potass to every pound  of the tar, to neutralize
the pyroligneous  acid  generally found mixed with it.   This  acid would
be likely to produce coughing.  When thus  prepared, the tar should be
placed in a proper vessel over a lamp, and  be kept slowly boiling in  the
chamber, both  night and  day, care being taken  that  the vessel should be
cleaned and replenished every twenty-four hours.
   The  vapor of  iodine has also been used in diseases of the air-passages
and lungs.   Drs.  Murray, Scudamore, Corrigan and Barton,  all wrote in
favor of it.  Iodine sublimes, in a moist atmosphere, at  a  temperature
below thai of boiling water, and also  in a moist atmosphere remains dif-
fused, at  its  common  temperature, in  the warm season.   Iodine  derives
its name from the beautiful violet color in which it sublimes, when a vial
containing it is placed in  a stream of vapor ; so that  a person need not
fear, as Dr. Murray says  a young lady, a patient of his, did,  " when she
saw the vapor approaching  her breath, purpled almost like the ominous
color of blood."   Sir  Charles Scudamore,  in his " cases illustrative of
various  medicines  administered  by inhalation  in  pulmonary consump-
tion,"  used  the  compound  solution  of iodine  with alcohol  for  procur-
ing the  vapor to be  inhaled, varying the  proportion of the ingredients
as the circumstances of the case required.
   The  directions given  by  Sir Charles are as  follows.   The recipe
of inhalation is composed  of:—R. Iod., potassse  iod., aa grs. vj.; aquae
dist., |  v.  3 iv.;  alcohol, 3 ij.  M.   Fiat solutio, in inhalationem ad adhi-
benda.    For each  inhalation,  he used from  3 j. to  3 vj. of this  solu-
tion ;  and from  tn.xx. to xxv.  of a saturated  tincture of conium—the
time of inhaling being from thirty to forty minutes.  The conium should
be added to  the iodine solution just before inhaling.
   Sir Charles gives the following directions for inhaling these remedies.
"At the temperature of 90° the volatile properties of iodine are given
off very sensibly ; but the conium requires  more heat, and that of 120°
is not too much  for  the  iodine.  This  degree, therefore, I  most recom-
mend ; or, if the patient have not a thermometer, Jet  the instruction be,
to put the water into the inhaler (first warming it  a  little to prepare it)
quite as  hot as the finger can bear without  pain.   The inhaler should
be kept immersed in rather hotter water during the process.  A good glass
inhaler, also, is a material consideration.  If it be  small, and  the  tubes
too contracted  in the  bore,  the difficulty of inhaling  would  be  great to 
Inhalation in Diseases of the Lungs.
5
the invalid, whose  respiration is easily embarrassed ;  whereas, with a fit
apparatus, the  process  is  perfectly  easy and tiot fatiguing.   The tem-
perature of the water with which the preparation is  to be  mixed should
be  from 115° to  120°  Fab.,  and. when  the proportion of iodine is
increased to a  full  measure for  each inhalation, I direct that the quan-
tity be divided into two equal portions, the  one to be  used  for the first
ten minutes, and the other for  the  same space of time in  continuation  ;
and, at  the average frequency, three  times a-day.   But  sometimes it
may  be expedient  to  use it for ten or  fifteen minutes only at a  time.
and three  or  four times a-day.   The inspiration should be as strong as
can be  conveniently  made,  in  order  that  the vapor may freely  enter
into the lungs : but the patient should  inhale  in a manner  not  to  fa-
tigue the  chest; and this evil will be avoided if  he  allow  himself  suffi-
cient interval, between  the periods of inhaling, to recover power.   1 lay
it down as a  principle that  inhalation shouH always be  so conducted
as not  to  produce distress to  the patient '•  , .y way, either as  regards
the composition of  the  mixture,  its  str  -gu), or  the  period  of carrying
on the  process.
   " In  first  entering  on  the  treatment of  inhaling,  the  irritation  of
coughing  is usually produced,  and in some  cases this happens on every
subsequent occasion ;  but unless this  prove excessive, or  permanent,  it
does not form an objection to the treatment, for the power of expecto-
rating is remarkably facilitated, and, the bronchial tubes  being cleared,
a material subsequent relief to the cough is afforded.   But a curative and
not  mere  palliative effect is  the object to be  held  in view.  The pro-
portion of alcohol  contained in  the  different materials is  too small to
produce any inconvenient stimulation ;  it is  necessary as the menstruum,
and it  is  useful, as causing the  volatile  parts of the  medicine to rise
more freely with the watery vapor.
   " In the commencement of the treatment, I advise very small propor-
tions of the iodine mixture ; for example, only from half  a  drachm to  a
drachm, for an inhaling  of eight or ten  minutes, to be  repeated two or
three  times  a-day.  Of the soothing tincture, I  direct  half a drachm.
which  I usually find sufficient ;  but it may be  increased  if the cough be
very troublesome.   I soon augment the quantity of  the iodine, and, pro-
gressively, from   3 j. to  5 iv.;  but,  also, then  prolonging the time  of in-
haling.   1 divide  the  iodine dose, putting  two thirds at  first, and  the
rest after  the expiration  of seven or eight minutes.   It is  of the  utmost
importance that the strength of the  inhaling  mixture  should be con-
sidered  in  relation  to  the particular case ;  the  feelings of the  patient
will be a great guidance.  In  acute phthisis, the  inhaling doses should
be very weak.   No remedy with which  1 am acquainted exerts so much
influence  over the hectic fever, used in  the intervals, as  the inhalation
in  question.   The patient should  have  the sense  of relief, and  not of
inconvenient   irritation,  produced.    The cough,  arising, occasionally,
durino- the process, is not an  objection ;  but if it be  more  irritable after-
wards"  it shows that  it  has  been  used too strong.   There is a certain
stage of the  tubercular  disease,  when over-excitement,  from employing
the iodine in too  strong quantity,  might  hurry on the  softening pro-
                  1* 
6
Inhalation in Diseases of the Lungs.
cess too quickly.   It  is here  that the  treatment  demands the greatest
judgment.
   " In the employment of inhalation, perseverance is  necessary, and in
some instances, for  many  months.   The object sought to  be obtained is
not merely palliative benefit—not merely a  temporary impression on the
morbid  function—but the  superseding  of the  diseased  action  by  a
healthy one, and the  effecting some organic change."
   Sir Charles gives  a description  of his inhaling  apparatus.   He re-
commends a double-necked  glass bottle;  or  a common wide-mouthed
bottle may be used, the cork  having two perforations through which the
glass tubes are to be  passed.   About an inch  of water should be placed
in  the  bottom of the bottle, and  to this, the  inhaling mixture must be
added.   Through one of  the  necks of the bottle, or through one of the
perforations in the coik  (if a wide-mouthed  bottle be used), a straight
glass tube should be passed,  so as to dip under  the  water.   The other
neck or opening  should  have  a  curved glass  tube  passing  through it,
through which the patient should  inhale.
   Dr. S. says, "The bottle should  be large  and the tubes  capacious.
The one issuing from  the bottle should be  upright, passing off  in a gra-
dual slight curve, so  that  the  vapor  shall  not be  much cooled in the
course of its  progress.  The  ingress  tube should dip  very near to the
bottom of  the bottle, that all  the air so introduced may receive impreg-
nation.   The patient must  be desired  to  inhale, by using, at the  same
time, suction  and a  pretty full inspiration, then  to drop  the under lip
from the mouth-piece, and  make a free expiration ;  so conducting the
process by pausing, and, if he like, little suspensions, in order that he may
not  experience any fatigue, which would certainly happen by breathing
quickly, or using  an inhaler with  small tubes,  or with too much water in
the bottle."
   I have thus given the  process  of  inhalation  by Sir Charles, because  I
consider the subject  of great  importance, and fully  believe that much
good may yet be reaped from  it.
   The  results of Dr. S.'s experiments were much in favor of the  prac-
tice.   He  says, he " could relate the cases  of a  gentleman, aged 54 ;
of  a  lady, aged 20;  and of  a medical practitioner, aged  30,  in whom
the  most unequivocal symptoms  of tubercular  disease were  strongly
developed, in whom there was every threatening of danger; and in all of
whom, I was happily quite successful."
   In 1840, Dr. S.  added  to his former results, notices of other  cases, in
which cures had been effected, or, at least, great alleviations.
   Five years after the description of these cases, and several others, in
the Medical Gazette,  he says, " The patients  whose symptoms of tuber-
cular phthisis, with the treatment, were fully described in  this Gazette,
have not had any relapse, and are now enjoying  excellent  health ;  a pe-
riod of  rather more than five years having elapsed."
   Other cases, equally satisfactory,  are  related,  where there was  every
evidence, both from auscultation  and  other signs, of  tubercular disease
of  the lungs, and sometimes it had advanced to the  second stage.
   " In  every case one of the following events may be expected to hap- 
Inhalation in Diseases of the Lungs.
7
pen:  either that the tubercular irritation will be  arrested and gradually
removed, be arrested  and suspended, but not cured ;  or pass  on to the
softening process, which terminates in  the production of an excavation.
In all these different states of the disease, I advise the inhaling treatment
to be employed."
   Of all the  various agents which Dr. S. used for inhalation (and they
were many), among which  were the tincture of opium, tincture of digi-
talis, tincture of stramonium, of ipecacuanha, hydrocyanic acid and  ether,
he considered the tincture of iodine, or  that  and  conium, the  most effi-
cient.   He considers ihe  iodine  to  be the only agent which exerts any
influence  in  the cure of phthisis.   But the iodine inhalation must  not
be employed  when any  inflammatory action exists.  Its  effects  might
be very injurious, and it should always  be a fundamental principle of  all  •
medical treatment, that no injury should be done.
   Dr. Berton, as quoted  by Dr. Bell, says " In a flask  with  two tubular
openings, I put diluted  sulphuric  acid, and on  this a  quarter rr  half a
grain a°day of the hydriodate of potassa ; the iodine is  promptlv isengaged
in the  form  of vapor, and  this is  inhaled  by  tl-  pati^v  through  one
of the  tubes  of the flask.   The process  is  repeated iiom four to  ten
 times a-day; the  duration  of each being from  four  to five minutes."
 This is the  most  easv and  simple  form of  inhaling  iodine, and  it  seems
 as though all its good" effects  can be secured by such  an inhalation.  I
 have tried it  in this form with some success.
   There can be no  doubt  but  that the  introduction of iodine  into  the
 system in the manner of inhaling, must have a salutary effect upon  the
 disease.  Why not as much so  as  the dermatic  process of introducing
 medicines into the system ?  We  know this is  often  a successful me-
 thod, when  the medicine can be introduced in no other  way.  Dr. Cor-
 rifran, who was an advocate for the inhalation of iodine in phthisis, says,
 "If we suppose the patient to  inhale only  one  twentieth of the iodine
 evaporated, he will inhale  in each hour,  and apply  to  the diseased sur-
 faces, one grain and a half  of iodine  in a  state  of  the  most minute di-
 vision or solution.   This quantity,  we know, is quite sufficient to exert a
 decided action  upon  scrofulous ulceration ;  for we  find, on  reference to
 Lull's valuable work on  the employment of iodine in scrofula, that in
 external scrofulous ulceration, the preparation of iodine, which is found
 beneficial, is  a  solution  which contains only about three grains of iodine
 in each  pint of fluid."   The  beneficial effects of iodine thus inha ed in
 bronchitis, and other diseases of the air-passages, cannot be doubted  and
 a further trial  of  it  should  be  made, not  only  in  these diseases, which
 often hasten  the  development of consumption, but also in consumption
 itself  if  it  be evident  that there is  no active inflammation,  and the
 apparatus for inhaling is such that the patient can perform the operation
 rather with  pleasure than  fatigue.    These are  Hems  not  to  be  for-
 gotten nor  disregarded.   The  more simple the apparatus, the better it
 will be.   It  should be  so constructed as  to keep up a supply of vapor
 for any length of time,  and  its  evolution should be steady and  regular,
 both in quantity and quality.                               .
    Chlorine  also  has  been  inhaled in phthisis.   In favor of inhaling an 
Inhalation in Diseases of the Lungs.
atmosphere of chlorine gas, it has been said that paper-makers, who are
apparently more exposed  to consumption  than  almost any class of per-
sons, being constantly enveloped  in clouds of  dust  in the  rag rooms of
paper-mills, never  have this disease.  The argument is this—" if chlo-
rine  and  steam  spread through  the  works can prevent phthisis, is  it
not reasonable to suppose similar  means might contribute to  the cure of
persons who had  contracted  the  complaint?   Would not,  therefore, the
junction of chlorine gas and that of iodine be a rational proposal, regu-
lated, of course, according  to the different degrees of the disease ?"
   Dr.  John Bell  remarks  of the  above,  " By similar arguments  we
might  be persuaded  that the vapor from  oak-bark  decoction is useful in
phthisis, since it is  stated in some  quarters that  tanners were not observed
to be liable  to  this  disease."  Now, though   I  have ever been  an ad-
mirer of Dr. B.'s writings, and  wondered, a  thousand  times,  how he
could say so much  (and that all  good) in  so  small a space  as he does,
yet 1  cannot fully agree with him in this remark.   In the first place, the
parallel does not seem  to be a good and perfect one ; for the  atmosphere
of chlorine, all, it  seems  to me,  would judge to be more  efficient than
one of oak bark;  and then, again, it  is, if I  understand the process of
tanning in this country, much more common  to  use hemlock bark than
oak, and though the  oak bark might be good, yet the hemlock might  be
better, as it contains more of a balsamic oil.
   No doubt the inhalation of so powerful an agent  as  chlorine, requires
to be administered with great care.  If the solution to  be  inhaled is too
strong, its tendency is to constrict the  air tubes, occasion  irritation of the
bronchia, and provoke  distressing cough.   A  person, however, may be-
come so  familiar with  this  gas, that he can endure much more of it than
when he first commences its use.
   Several French writers have spoken in high commendation of the in-
halation of chlorine; and, though some of them published  most flatter-
ing results, yet  M. Louis says he has  "studied  the action of chlorine in
upwards of fifty phthisical patients,  at the  Hospital of La Pitie, the Hotel
Dieu, and the Hospital Beaujon.   The chlorine  (prepared at  the Central
Laboratory of the Paris hospitals) was inhaled with a vessel provided with
two tubes.   In  no instance  did  I obtain  any  successful result  from  its
employment."  This statement,  by so able  a practitioner as M. Louis,
has weighed heavily  against the use of chlorine gas, and there can be no
doubt that all the  good effects of it may  be secured by boiling chloride
of lime or soda, by heating it in  a  large dish,  by sprinkling it with
muriatic acid, or by pouring sulphuric acid  upon  common salt.
   I might describe various  kinds  of apparatus for inhaling chlorine gas,
which  have formerly been employed  ; but as  1 prefer  the  gradual evo-
lution of the gas from  a chloride, as that of lime, so as  to impregnate all
the air of the room with it, I  forbear to  name them.   If we wish the
vapor to be thrown off more rapidly, it may be  accomplished by adding
a small quantity of sulphuric acid to the chloride.
   Dr.  Albers  states the  following results from inhaling  chlorine gas.
" In tubercles of  the  lungs, in chronic catarrh,  in  chronic inflammation
and  ulceration  of the  bronchial mucous  membrane,  and  in  dilatation 
Inhalation in Diseases of the Lungs.
9
of the bronchi, chlorine vapor  is of no service, and  in  most cases will
not be  borne,  in  consequence  of  the irritation  it produces.  On  the
other  hand, it has  a very salutary operation in  pure ulceration of the
lungs  or vomica.   This state, however, is  not to  be confounded  with
suppurating pneumonia,  to which the  use  of chlorine vapor is  not  so
applicable.   How far patients  laboring under disease of the lungs  may
be adapted  for using this remedy, cannot be determined ; much will de-
pend  on general irritability and individual disposition, and  the  chlorine
vapor should always be tried experimentally at first.   From  the foregoing
observations, it appears that  chlorine  vapor produces salutary effects in
chronic ulcers of the lungs."
   M. Toulmanche says, " The greater number of the experiments, the
inferences  from  which are here  related, were made  under  a  period of
four years and a half in  a ' maison de detention,' where pulmonary ca-
tarrhs are very  common.   The majority  of the patients  have  borne
very  well the first impression of the chlorine, and all  have become ca-
pable of employing it  by gradually accustoming themselves to it.  With
the fewest  exceptions, such  as  where  great irritability and oppression
existed, the clorine was  employed  in  every case  which bore the name
of pulmonary catarrh, acute or chronic, inflammatory or pituitous.   Its
sensible effect is to change the quality  of the bronchial  secretion, to  di-
minish  its  quantity, and finally to put a stop  to it."  The  result of the
use of  chloiine, in 223  females,  is recorded" as follows:—" Of these
228,  144 were affected with  acute, and 65 with chronic bronchitis ;  17
of which  latter were double, 4 complicated  with pulmonary emphysema,
and 22 with phthisis.  Of the 144 acute cases, 51  were cured in from five
to six days ; 33 in from seven to ten ;  29 in two or three days, and  21
in from eleven to fifteen.  The  greater number were thus cured in from
five to  eight days ; the  smaller in  from eleven to fifteen—a result much
superior to that which is  obtained  by  the  ordinary means.  Of the 65
cases of chronic  bronchitis, 16 were  cured  in from ten to twenty-one
days  ; 15 in from  ten to eleven ; 13 in from two to  ten ; and 1  only in
eighty-eight days.  The average of cures requires, therefore, from sixteen
to°thirty days, and two thirds of the patients recovered  in  from five to
twenty  or  twenty-five days.  This is  regarded  as  a treatment two or
three times shorter than that which  is commonly employed."
   This, certainly, is a great  improvement upon the  ordinary treatment,
and  deserves a further trial.   If,  by so simple a  means as this inhala-
tion,  we can shorten the disease two thirds, we are inexcusable if we do
not adopt it.
   In  a case  of gangrene of  the  lung, I  have  found inhalation of the
chloride of lime ^ancf the tincture of opium operate favorably, both  in
removing the offensive odor and in  sustaining  the strength of the patient.
   The practice  of inhaling  ether  and sal. nitre, and smoking  stramo-
nium, in asthma, is  upon the  same principle.  These are all now well
known  to mitigate, and, generally, remove  for the time, this distressing
and very  troublesome disease.   Great  caution, however, should be used in
inhaling the smoke of stramonium, as too much of it may produce its deadly
narcotic effects.  The smoke of sal. nit., in  my opinion, is also capable of 
10
Inhalation in Diseases of the Lungs.
 poisoning the system.  The following case came under my care some time
 since.   An old  gentleman, long subject to  fits  of asthma, had been ad-
 vised by his  physician to inhale the smoke of this article.  He had done
 it  for years, and  with much relief to his  asthma.  But his  daughter,
 who always administered  it,  was  taken sick with  a  general  debility.
 She lost  her appetite, her feet and  limbs  generally were cedernatous,
 and she seemed in a  very critical  state.   It  was my opinion, and hers
 also, that the smoke of the nitre was the cause.   She has since avoided
 it, and with the  use of tonics has recovered her former health.
   In what I  have  now said on the inhalation of vapors, I have  given the
 experience of others, and  quoted  much of  their language, also, with
 some few of  my own experiments.   But in  what  follows, I shall give,
 not the  ireatirient of others only, but  also what has been  my own expe-
 rience.  1 have not attempted to be original, my principal design having
 been  to call  attention to a  mode of treatment (yet in its infancy)  which
 promises much in  a class  of diseases always distressing to the patient,
 and  perplexing to the medical attendant, and often leading to a fatal re-
 sult irrespective of the anxiety and efforts of  both.
   The  vapor bath, when either the moist or dry vapor is inhaled,  comes
 in  for a share of our  attention, while speaking  of  the  therapeutical ef-
 fect of vapor upon  the air-passages and lungs.   It  is  not designed, at
 present, to eulogize this  kind  of bath, or to show its  beneficial  effects in
certain cases and other diseases,  only as  these modify or are connected
 with that class  of diseases now under consideration ; and this, to  no in-
considerable degree, it  must be admitted, is always the case,  as  there  is        <
a very intimate relation between the lungs and skin.  Some years since,
in  various diseases, I often  had an opportunity of perceiving,  by their ef-
 fects upon that class of diseases of which I am now treating, how  essen-
 tially the lungs were influenced by  the cutaneous absorbents, and  other
organs of the skin.  The vapor bath  may be used, and it is sometimes
advisable  that  it  should  be used, without  its  being inhaled  into the
 lungs;  but of its  use  in this  form, however valuable it  may be,  in the
 treatment of  some diseases, I am not now intending to speak.
   The  kind  and form  of the vapor bath and  its administration, which 1
now refer to, are thus spoken of by Dr. Erasmus Wilson in his  " Trea-
 tise  on  Healthy  Skin,"  "The vapor bath  offers  some  points of dif-        \
 ference  to the preceding  [those where the  exterior of the body only
 was vaporized]  in  the circumstance of extending its  influence  to the
 interior as well as the  exterior of the body.   The bather is seated upon
 a  chair, in a position  agreeable  to  himself, and  the  vapor is gradually
 turned on around him,  until the requisite temperature (from 90° to  100°)
 is  attained.   The vapor is,  consequently, breathed, and thus  brought
 into contact with every part  of  the  interior  of the  lungs.   The  vapor
 bath has  undergone much improvement within  the last few years, and
 its powers, as an agent for the  cure of disease, have been increased by
 the  discovery of various  vegetable  substances,  whose volatile  elements
 are susceptible of being  diffused through the vapor, and, thus introduced
 into the blood,  are  made  to  act upon the system."   This  interior use
 of the  plain and  medicated vapor is the one now before us.  Nor is its 
Inhalation in Diseases of the Lungs.
11
use,  either by the vapor of  simple water, or with medications, new.
though  it may be, and doubtless has been, much  improved ;  for Boer-
haave  long since recommended to the medical profession,  " the em-
ployment of the vapor  of  water,  distilled  over elder  flowers,  in  pul-
monary catarrh ;" and still  further back towards the commencement of
old time,  " Hippocrates recommended fumigation—sometimes  simply
watery  vapor, sometimes  the  vapor  of. vinegar."  and  sometimes  he
caused  the vapor of water to pass through  some of the  gum resins and
emollient and quieting  herbs."  Thus  did  the father  of medicine use
both plain and  medicated  vapor baths ; and thus, too,  has  inhalation,
and  the internal  use of  breathing vapor, or vapor  baths, been legitimate
agents of the profession  as long as  it has existed.
   Celsus, who  flourished  in  the reigns of both Augustus and  Flavius
Caesar,  employed "sulphur  fumigation," and  the  old  Romans  had  a
very convenient  way of inhaling, either hot dry air, or  moist vapor—it
was  simply to heat  the  kettle with the  cover  on, sufficiently  to  render
the air of the room hot,  for a  dry  inhalation ;  and to remove  the cover,
for a moist one.
   Dr. Combe speaks of the  vapor bath, when the vapor is inhaled, as
follows—" In chronic affections, not only  of the skin itself, but  of the
internal organs with which the skin most closely sympathizes, the judi-
cious application of the  vapor bath is productive of great relief.   Even
in chronic pulmonary complaints, it is, according to the Continental  phy-
sicians,  not only  safe, but very  serviceable, particularly  in  those affec-
tions of the mucous  membrane which resemble consumption in so many
of their symptoms."
   There  is some care   necessary in the administration  of these baths.
They should  not  be  taken  when the body is  greatly fatigued, nor near
the time of taking a meal.   In administering them the feet should be  kept
warm, either  by  having  a  full share of  the vapor in contact with them,
or by immersing them in warm water.    Unless this is attended to, flush-
ing and  headache, with  dangerous  congestion  of the brain, may be in-
duced in some patients.  There  are'some  curious  physiological effects
produced by  being encompassed in hot air, or vapor, and  inhaling it.
Magendie, as  related in  the Gazette  Medicale de Paris, for April 27,
1844, gives us the following experiments :—take a  rabbit or dog (whose
normal  temperature is 102° F.), place it in air heated to the tempera-
ture of  212° F., and another in air at 140° ; the blood  in the first  will
be heated quicker, and death will ensue sooner, than in the last,  but the
temperature of both, when  first dead, will   be  111°, an increase of 9°
above  the natural  heat.  The  heat of animals, then,  it  would seem,
cannot be increased above a certain  temperature.  It also appears that a
bird  (the natural temperature of which is 111°) dies  when its tempera-
ture is raised  to 120°; showing  the same increase of 9°.  It is a ques-
tion, as to how this increase of temperature is effected ;  whether through
the medium of the skin, or of the  lungs, or both.   To solve this ques-
tion, he placed the head  of a rabbit in a stove, leaving the body out;  in
a given  period  the temperature of the rectum was slightly  increased.
He placed only  the body of another in  the stove ;  the  temperature  of 
12              Inhalation in Diseases of the Lungs.

the rectum was much increased.  He therefore concluded, that  the heat
entered the system rather through  the medium of the skin, than that of
the lungs.
  In  the dry  air bath, the weight  of the animal is  decreased ; but in
the moist air bath, it is  rather increased.  Thus, a  man in the hot air
bath is lighter  than when he entered it; in the hot moist vapor, heavier.
The former is  occasioned by the evaporation, the  latter by the absorption
of vapor both  by the skin and  lungs.
  Another curious  phenomenon, in connection with  these vapors, is, we
can endure a higher temperature of dry than  of moist heat.   It has been
found that  230° F. can be endured by man in a dry air; when, in the
vapor bath, he will be very uncomfortable at  130°.  An animal will die
in a lower temperature in a vapor than in an air bath.   This is easily
explained  upon  the principle of pulmonary  absorption and cutaneous
evaporation.   But it  is a fact worthy of  being remembered  in adminis-
tering, for inhalation, these hot air  and vapor baths.  The  lungs  will
bear a higher  temperature than the body.  Thus, if we plunge an  ani-
mal's  head only into  a heated vapor, he will  live longer than he will if
we  plunge  only his body in  the vapor.   This, also, is worthy of being
remembered, when  we  wish  to  administer  moist vapor into the lungs
only, or to the  air-passages, as is often done in croup or stricture.  Every
practitioner knows that the administration of a stream of heated vapor
from hot water, through  the spout of a  tea-pot,  often affords  relief in
such cases, when- apparently  nothing else will  do it.   Now, when we
wish to do this, it is well to remember that, while the vapor poured  up-
on  the body at  122° or  125° is uncomfortable, we can  pour a vapor of
the temperature  of  140° or 145° into  the lungs  without unpleasantness
or injury.  The  lungs  have  but  little influence in  heating  the body
in the vapor bath.  Magendie showed this  in  the  following way : he
kept a rabbit twenty minutes in water at  50°, its temperature then be-
ing  70; it  was placed in a temperature  of  194, and in fifteen minutes
more  it was taken out expiring ; the temperature in the rectum being
only 77, instead of  111, the heat being mostly taken up in  evaporating
the water from the  hair of the rabbit, so that the system  could be af-
fected only through  the medium of the  lungs.
  In following out the idea that we  can  endure  a  much greater tem-
perature  of dry  heat  than of moist, it may  be added  that Dr. James
found himself  nearly suffocated in  Nero's  vapor  bath, at 122°, while he
could endure quite  comfortably the dry bath  of Testaccio at 176.  The
moist vapor grows uncomfortable at 112°, and cannot be tolerated above
the temperature of 125° ; but we are told by  Dr. Carpenter, in  his
" Principles of Physiology," that the  workmen  of the  English sculptor
Sir F. Chantrey, could enter a furnace in which  his  moulds were dried,
when the floor was  red-hot and the  thermometer in the air stood at 350.
Chabert, called the  " Fire King,"  habitually entered an oven, when its
temperature was from 400 to 600° F.
  I wish to impress upon  the profession  the importance  of the vapor
of simple  water in croup and kindred obstructions of the air-passages.
As I have  said of other  modes and articles  to  be  inhaled, so I say of 
                 Inhalation in Diseases of the Lungs.              13

 this, it is not new, but it is a good remedy, frequently affording relief to
 the distressed patient and agonized  friends, when many other remedies
 have been tried in  vain.  It seems to me', I  have seen life saved by this
 simple remedy.  In  acute inflammation of the throat and  air-passages,
 I have found relief from the use of vapor at as low a temperature as 90°,
 and gradually increasing the temperature till it comes up to 125 or 130°..
 Dr. Bell, speaking of the vapor bath, says, " If the head  be exposed
 to  the vapor, so that it is inhaled, the  stimulating effects of the bath are
 increased, and the  amount of the fluid absorbed very greatly augmented.
 The imbibition* by  the  pulmonary veins is considerable, and so far serves
 to  moderate the hurried respiration which  the caloric of the  vapor natu-
 rally tends to produce.  When the  dose  of the caloric is not great, its
 stimulating action  will be mitigated  by the moisture, which may even
 predominate and give rise to soothing and sedative effects."   The elastic
 power of  vapor is  a so much less conductor of heat  than water, that a
 moist vapor bath  at 100° F. only equals, in  its stimulating effects, a
 water bath at 90°.
    When there is any disease of the  internal  mucous  membrane, as in
 bronchitis, or any of the air  tubes, it  is always preferable to inhale the
 vapor of the bath, whether  it be simply that of water, or  impregnated
 with various aromatic herbs or gums; though such is the relation of the
 skin to the lungs, that much relief might be found to such diseases, even
 when the  vapor is  brought in contact with the skin :  for, what the skin
 does not do, the  lungs  must, and vice versa, or the  patient  must  sink.
    " Dicam pauca me," as Cicero often said.   I cannot well forbear doing
 this, in  this connection, however much it may savor  of egotism.  For
 several  years,  I was subject  to turns of hoarseness upon taking the
 slightest cold ; indeed,  there was such a chronic weakness of the laryn-
 geal and bronchial tubes,  that the  simple effort of speaking for a few
 minutes  produced  it, even when no cold was induced;  and when any
 was contracted, the  difficulty of speaking was greatly augmented.  A
 feeling, as though  something were lodged in the larynx, and a constant
 disposition or effort to swallow it, was ever present.   When otherwise in
 tolerable health, the voice was hoarse or grum, like the low bass of a viol,
 or  the croaking of  a frog, such was the relaxation of the vocal cords and
 their adjacent tubes.  The  difficulty was so  serious, and continued so
 long, that  I was compelled to  desist  from  speaking in  public.   After
 consulting many physicians and experimenting with many  remedies—
 after having the uvula  truncated, which was done by  Dr. Lane, senior,
 of this city—and the application  of solutions of the nitrate of silver, and
 Lugol's solution of iodine, all of which afforded some relief, I  derived the
 most permanent benefit from the use of the vapor  bath,  applied  to the
 skin and interior organs of the  throat and lungs, in the manner above-
 named by  Mr. Wilson.  Generally,  nothing  but  the vapor of simple
 water was  employed, though sometimes it has been medicated with elder
 flowers, bone-set, and other  aromatic herbs, and a few times, with some
 of the resinous  substances.   Though I  have been much more free from
this difficulty for several years, than formerly, yet there is still  a tendency
to bronchial and laryngeal  disturbance ; and whenever this  is the case,
                 2 
14            .  Inhalation in Diseases of the Lungs.
whether  immediately induced by over-action in speaking, or by sudden
changes in the weather, I have resorted to the vapor bath.   This has had
the desired effect.   Its influence, generally, upon the skin is to make one
feel as though he were newly " swept and garnished," or as the Syrian
General did when  he " had dipped himself seven times in Jordan ;" and
inhaling the vapor  at the same time has soothed the irritated membranes,
freed them of mucus, and  thus restored them to their proper state.   In-
stead of taking medicine, or applying astringents or caustics, this has  been
my talisman in  every such emergency ;  and, having found it thus bene-
ficial,  it is not surprising that  I should be partial to its use, in accordance
with the old adage, " We should speak well of a bridge which carries us
well over."   I never take the bath without inhaling the vapor.   In any
case, unless where there is a  strong determination of blood  to the  head
(and even this may  generally be obviated by applying to the cranium a
towel  wet with cold water), this would be to deprive the bath of half its
beneficial  effects.  There  is no danger of taking cold, provided the  bath
be raised  to a temperature  sufficiently high to  cause  some  excitement
upon the skin and  some acceleration of the  pulse, and the ordinary pre-
caution be taken of not getting chilled after leaving it.
   The bath, thus administered, is  an excellent  substitute  for the whole
catalogue of diaphoretics and  counter-irritants.  It procures free perspira-
tion from  the cutaneous vessels and  expectoration from the  air tubes,
which, if we attempt to accomplish by drugs, we are always in danger of
irritating the stomach and  bowels and augmenting the functional derange-
ment of all the  visceral organs.    It is no new  thing to cure a cold, or      i
chronic catarrh,  by the use of the  vapor  bath, applied  both to the skin
and air passages, as is illustrated by the account  of  Dr. Kentish, quoted
in a note  by Dr. Bell, which also shows that there is but little danger of
taking cold after its use.  The case referred to is but another illustration
of th*  intimate relation  and  sympathy between  the skin and  the lungs,
and shows that though,  by inhaling  the vapor, we may accomplish much,
yet, often, in order to effect a cure, we must apply the vapor also to the
skin ;  and though  it is  not designed, at present, to speak  of the usual
advantages of the  vapor bath in the treatment of chronic diseases gener-
ally, yet this subject may  well  form the  basis of another paper, at some
future  time.                                                               \
   Dr.  Bell, after enumerating  the various  diseases in which  the vapor
bath was highly  beneficial, when administered without inhaling the vapor,
adds, " Immersion  in the vapor bath is, however, sometimes complete, so
that it  is inhaled into the lungs, and thus  applied to their mucous surfaces
in a long list of diseases.  This mode of  administration would even  have
marked advantages " (and this is all the mode of which the writer of this
article  designs to speak, or which  is applicable  to  the class of diseases
now under consideration), "  when  the pulmonary mucous lining is in a
state of irritation, and the  skin at the same time dry, and the perspiration
deficient, as we find  in  catarrh, bronchitis, croup, asthma, and a certain
stage of measles and smallpox.  When,  likewise, the lungs are perfectly
sound and clear of irritation,  while there  is febrile disturbance of the sys-
tem, with small or active  hard  pulse, there would be great advantage in 
                Inhalation in Diseases of the Lungs.              15

introducing  moisture  freely into the  pulmonary cavities, as it would be
rapidly and  greedily absorbed and carried into the circulation, and act as
an effectual  diluent.   The main point on all these occasions, from which
our attention is never  to  be diverted, is, that the degree of heat of the
vapor shall  bear a due proportion to the heat and  febrile excitement of
the system,  so that  there shall  be an inverse ratio between the two : the
greater the excitement, the lower the temperature of the vapor bath, and
the reverse."
   M. Rapou gives  examples of the entire relief  afforded  in cases appa-
rently of incipient phthisis, by the use of the vapor  bath, when the vapor
is inhaled, or in his Oriental bath, which was, by inhaling it.
   The  inhalation  of  vapor, or  the vapor bath  of which  I have  thus
spoken, has  no resemblance to the  " steam bath " of modern times ; nor
is it new.   It has  been employed and  recommended  by many eminent
members of the medical profession, for many  years  past; and in calling
attention to  its use, I have only imitated many who have gone before me.
I am confident more of these baths, and less drugs, would be an improve-
ment  in general practice.  Nor, by this remark, do I mean to censure
the present  routine of medical practitioners, as it is believed,  there has
been an improvement  in  the use of  drugs within the  last twenty years,
both creditable  to the profession and beneficial to  patients.  The  phy-
sician who prescribes a proper course of living, in all its minutiae, for his
patient, does more for  the benefit of his employer, than he who simply
prescribes a cathartic or emetic, or a tonic  course of quinine and  iron.
As a general remark, it will be found  true, that inflammation and irritation
of the air passages will be greatly soothed and relieved by moist vapor,
especially when it is made to convey the anodyne, narcotic  and expecto-
rant properties of certain  medicines ; and, that  a  relaxed state of the
mucous membrane  of all  these passages, with much secretion,  will  be
greatly benefited by dry air, heated  by flues  passing through the apart-
ment of the  patient (or in some other manner) ;  and this good effect will
frequently be  augmented if the properties of  various aromatics and resin-
ous substances are held in suspension by such a rarefied atmosphere.
   In consumption and diseases of the air-passages, in addition to the arti-
cles already named, which were used in  the form of vapor or factitious
atmosphere,  may be named, various salts, and other substances, combined
with some  light, innocuous menstruum, used  simply  as  the  vehicle of
the medicine.   Cinchona, sulphate  of iron,  myrrh, sub-nitrate  of bis-
muth, sulphate of zinc, sulphate of copper, alum,  acetate of lead and
nitrate  of silver, have all  been used  by inhalation. • The method in
which  they were formerly  employed, was  by being mixed with sugar.
Thus, the zinc might  be  gr. j. to  sugar grs. xxx.; sulphate of  copper,
gr. j. to xxv. grs. of sugar; alum, grs. v. to grs.  x. of sugar;  acetate of
plumbi, grs. ij. to grs. xiv. of sugar  ;  nitrate of silver, gr. j.  to grs.  lxxij.
of sugar.   The sub-nitrate of  bismuth might be used alone or combined
with sugar.
   These powders were all made of the substances of the medicines, and
thus the  substances  must be  inhaled.  It  was not so easy to do this,
and the sugar was quite too heavy for a vehicle.   Still, no doubt, they 
16              Inhalation in Diseases of the Lungs.
 were useful in laryngitis, bronchitis, and other affections  of  the air-pas-
 sages ;  but it  is doubtful, whether the medicines actually reached the air-
 cells of tfie lungs, as, when  compounded with so heavy a vehicle, they
 would be likely to stop in the pharynx and the larynx, especially as they
 were directed  to be inhaled with a simple tube or quill, one end of which
 was dipped into the  powder and the other put into the mouth.
   Since the  noticeable  appearance of the pharyngo-laryngeal disease
 of  the mucous membrane of the throat, or clergyman's  sore throat, as it
 has been called, the  nitrate of. silver, and other kindred salts, have  been
 employed with great  success, in almost all inflammatory diseases of the
 throat, or air-passages.   The, introduction of solutions of  these  articles,
 of  various strength,  from ten grains  up to  eighty  or ninety, with  the
 probang, camel's hair  pencil, or syringe, has  been  very common  treat-
 ment ; and, often, though not always, it has been followed  by recovery.
   Having  previously  given some attention to this class  of diseases, soon
 after Dr. Green, of New York, commenced  his  practice  of introducing
 this remedy into  the larynx, and published his book on  the  pathology
 and treatment of "The Diseases of the Air-passages,"  I began to  treat
 them after his manner, using various other salts besides the nitrate.
   I think it was in March, 1818, that Dr. T. K. Chambers, of London,
 published in the  London Lancet, and  alsot in  the Medical Gazette, an
 account of his use of an inhaling powder;  and giving  its composition,
 1 immediately had some of it prepared according to  his  formula, which
 is as follows :—
   " The plan  is, the inhalation of a  light innocuous powder, which  may
 carry with it the required substance, either diffused in the air or absorbed
 in its pores. That which I have found well suited to the purpose is the pol-
 len of the lycopodium,  or club-moss, which  has been made  to imbibe
 as much as it would take up of a saturated solution of nitrate of silver, or
 of sulphate of  copper, or of  the two combined, and then  carefully dried,
 and reduced again to an impalpable  powder.   Mr. Squire  has  made me
 some, which, in two  grains and  a half, contains  one grain of nitrate of
 silver, and another, which in  five grains contains one of nitrate of  silver
 and two of sulphate  of copper.   The patient should introduce into his
 mouth, as  far  as he can without choking, a  well-dried glass  funnel, and
 thaw in his breath strongly, whilst he himself, or a  second party, dusts
 the powder in a dense cloud into the large end with a nursery puff-ball.
 If the dust be raised  by an attendant, the patient  can indicate the mo-
 ment he inspires by raising his hand.  To obviate the necessity for  with-
 drawing  the funnel-during expiration, to  prevent  the dust being blown
 about the room, an  apparatus  may be used  with a  double valve and a
closed  powder-box, which allows the dust to pass inwrtrds only ;  but the
employment of  metal makes the machine  less agreeable than  the more
awkward but cleaner-looking and less formidable  glass."
   I have  found this  powder  serviceable  in  several  cases of bronchitis,
laryngitis, ulcerated sore  throat, inflammation  of the mucous follicles, and
 in incipient phthisis.   It is much  preferable,  prepared as here directed,
to that mixed  with sugar, as the real pulverized nitrate was then used •
but, as here prepared, the nitrate is  first dissolved  in pure water,  then 
                        Inhalation in Diseases of the Lungs.               17

       the  " pollen of the moss " is dipped  in  a saturated  solution  (or that of
       any other strength desired), then dried, and finely pulverized.   It can be
       made of any desirable  strength, and should contain  less  of the  nitrate
       than that made from a saturated solution, when employed with very irri-
       table patients.
          The caustic and astringent  property of the nitrate is  often useful in
       chronic catarrh, or in a recent cold, by combining a little of  this powder
       with any kind  of snuff, or snuffing  the simple  powder.   It  can also be
       conveniently applied to indblent ulcers, and answers every purpose of the
       stick  of lunar  caustic, or  solutions of it.   It  is useful, also,  in various
       cutaneous  diseases, such  as  ringworm, nettle rash, &tc.   I had one case
       of tetter, which was cured by it, after resisting  numerous other remedies.
       But I  need  not speak here of the  power  of this salt over  this class of
       diseases, and have referred to it only to say, that used in this form it is
       quite as convenient as  in any other, and as efficacious.
          To  return to inhalation—I have sometimes combined  with the  " ni-
       trate," instead of the "pollen of the moss," or with  it, the flowers
       of the papaver somniferum, but am not aware that it has afforded any
       more satisfactory results,  than  when  made according  to  the  formula
       given  above.   In fact, it does not form so light  a  vehicle,  and  it is'
       doubtful whether there is any  of  the narcotic  property  of the  poppy
       in the  leaves or flowers.
          For inhaling this powder I used various kinds of instruments ; at  first
       such an  one as Dr.  Chambers  has above recommended.   Then various
t       others were tried, all calculated  to  make a dust of  the powder, and thus
       prepare it to be drawn into the lungs with  the  air.   A small  quantity.
       say three or four  grains, of the powder, is put into the receiver  of the in-
       haler, the inhaler is then placed  in  the mouth of the patient, as far back
       upon the tongue as can be conveniently borne ;  then held  by the lips, or
       left hand of the patient, while with the right hand the receiver is twirled
       round  to scatter the powder,  and, by a full  inspiration at the same time,
       it  is conveyed  into the throat.  This  process  may be repeated once a
       day, or more frequently, if desirable.   If the solution is used, the shower
       syringe is  altogether  more  convenient and easy  of application, and
       agreeable both  to practitioner and patient, and does the work much more
*       thoroughly, t'^n the Dtobang.
         If the  mucous  membrane  of the pharynx or larynx  is  inflamed, or
       very tender,  and the  powder contains the  full  strength of a  saturated
       solution of the nitrate, it will  produce slight  smarting  or tingling in
       these parts.   I  have  used  it  in  canker in the  throat, in what  has  been
       called clergyman's sore throat, and   in  chronic  mucous inflammation of
       any portion of the air-tubes, with much satisfaction—its specific effects
       beintf soon* perceived.   In  ulcerated sore throat, I think it the best reme-
       dy that can  be used.  In bronchitis, it does what, I think, no  other reme-
       dy will do so well, causing a speedy clearing of the  tubes,  and  disposing
       them to take on a healing action.   In  phthisis,  I cannot speak so confi-
       dently of its success, though, in  its  first stage, I have often, and once or
       twice in the  second stage, seen it prove very serviceable.   I have sent it,
       with  an inhaler, to  more  than  thirty  physicians  in  the  country,  from 
H              Inhalation in Diseases of the Lungs.

many of whom favorable  accounts have  been returned.    Some have
found it so  successful  that  they  have sent, at many different  times, for
more of it.  Some have said  that they have raised patients with it whom
they felt confident could  not have been  raised  by former modes of
treatment.
   As I claim no originality, as  to  the  invention  of the  powder, so I
have had no secrecy as to  its use, having given the recipe as I found it,
and  my manner of employing it,  to the public, in the Boston Medical
and  Surgical Journal, as soon as  I had fully tested it.
   I  have also  made trial of the  zinc, copper, alum, and  some  other  as-
tringents, prepared in the same way, but I think the  nitrate, for general
use.  is  preferable to any other.   The sulphate of copper, in  some cases.
has  been  as serviceable, and I have thought,  even  more so, in  syphilitic
sore  throat.
   It yet remains to be seen what will be the full and  final result of this
remedy, as applied  in the  manner here spoken  of, in  diseases of the air-
passages and lungs.  In a class of diseases  which have so very  generally
resulted in  death, it seems to claim the attention of medical men, and to
deserve a fair and thorough trial.
   There is one other way in  which  I  have recently employed the nit.
argent, in  this class of diseases,  and which, so far as  I  know,  has  been
original with me—at least,  I  have never seen  any account of  its being
so used—and that is, inhaling the vapor of water impregnated with the
salt.   This I have done  very recently, in a few cases, and  with  appa-
rently good effects ; though sufficient time  has not  yet  elapsed, since I       \
commenced this mode of using the nitrate, to speak very confidently about
its success.  I  have, as yet, used  it mostly in those  cases in  which in-
haling the  powder produced severe coughing, or so disturbed  the patient,
at the time of using it,  that  it seemed  advisable  to  discontinue  its
use  in  that form.   The following has been  the  proportion of the nit.
ardent, to  the quantity  of  the water employed :—R. Aqua fontis  fer-
ventis, Oss. ; nit. argent., grs. xlviij.  M.  The vapor of this mixture has
been imbibed  from  the  spout of a tea-pot, like  the vapor of  simple
water in cases of croup.   The vessel which  contains the vapor had bet-
ter be made of glass.  I have thought it advisable to add  to the foregoing
remarks the following cases which have come under my treatment.             '
   Case  I.—A  gentleman, aged 22, a  bookseller,  naturally of a  good
constitution, called  on me for  medical advice in  October,  1848.   He
was  laboring under a hard,  severe cough, which had lasted several days.
It commenced with coriza, sore  throat,  hoarseness ;  a feeling  of chilli-
ness, lassitude  and weakness in  the limbs, more or  less febrile action,
and, in short,  all  the ordinary  symptoms of acute  bronchitis.  There
were present, also, a sense  of tightness or stricture,  weight and  soreness
in the chest.  I prescribed the  ordinary remedies  used  in  acute bron-
chitis.  The amendment was but'little, during the first four days.   At
this  period  I directed him to inhale two or three grains of the  powdered
nitrate, compounded according  to  the  above formula.   There w as a
marked improvement within the  first  twenty-four hours, and in  one week
more, the patient was discharged, cured. 
                 Inhalation in Diseases of the Lungs.               19

   Case  II.—Nov., 1849, Mr. S., aged 35, called  on me with  all the
ordinary  symptoms of chronic bronchitis.   There were cough, expectora-
tion of a greenish, tenacious mucus, sometimes streaked with blood, with,
occasionally,  small, whitish, opaque solid  particles  mingled  with  the
sputa ; such  as by some have  been supposed to be tubercles, but which
were  really concrete, secretions of mucous follicles in the fauces.   The
pulse was somewhat  more  than  ordinarily frequent, and  there was pre-
sent,  every day, a slight febrile paroxysm.  Indeed, he had all the symp-
toms  of what was formerly called  catarrhal consumption.  While inhal-
ing a small quantity of this powder, two  or three  times a-day for  four
weeks, he recovered his usual health, and has as yet (now more  than  a
year) had no relapse.   Other treatment was also employed, and so it was
in all these cases,  but this powder seemed the most  efficient.
   Case  III.—A  lady, aged 35,  had been  afflicted for three  months
with  the following symptoms:—hard cough, severe dyspnoea, copious
expectoration  of a ropy, glairy, transparent and  ftothy mucus.   The ex-
pectoration was very profuse, often amounting to  two or three pints  in  a
day.  Auscultation developed, at first, dry morbid sounds, then  the  mu-
cous rale, showing that there was  occasionally congestion and  tumefac-
tion  of the  bronchial  mucous  membnne.  The physical signs clearly
showed the existence of what was once  called  humoral  asthma, and by
Laennec pituilous catarrh.   She began immediately to improve upon in-
haling the powder; and though  still subject   to  occasional  attacks of
irritation  in the bronchia from sudden  vicissitudes of the weather, has
for a year and a half enjoyed tolerably comfortable health.  She  felt re-
lieved within a week after commencing the inhalation.
   Case  IV.— Mr. S.,  aged 20, a well-marked case of phthisis, with but
slow development in the softening of the tubercles.   Chronic inflammation
of the pharynx and larynx—could not inhale the powder on account of
the irritation.  Applied solution of the strength  of 40 grains to § j. wa-
ter, with the syringe.   Soreness of the pharynx and larynx relieved, but
tuberculization continued to go on, and death followed.
   Case  V.—Mr. D., a mechanic, aged 38, had been afflicted with acute
bronchitis, but had recovered  from  the attack.   Some months after, be-
gan to be hoarse ; had irritation about the throat;  made frequent efforts
to hawk  up something  for relieving the larynx ;  had a sense of soreness
in the laryngeal cavity.   The fauces and laryngeal membrane were cover-
ed with granulations of various sizes,  very much like the  pustular  inflam-
mation of varioloid.   The uvula  was elongated, and  the  lower third of
it covered with similar  follicular papulae.   In fact, this was a marked  case
of Dr. Green's follicular  disease of the pharyngo-lanmgeal membrane.
An alterative  course of  medicine was prescribed, and the  powder of the
nitras argenti inhaled.   The diseased follicles  very soon (where  they
were  visible)  put on a  more  healthy appearance, the  general  health
improved, the hoarseness gradually disappeared,  and in six weeks  he was
apparently free from disease.
   Cask  VI.__A  sea captain, aged 48, had visited  many portions of the
globe, been a free liver, and not always prudent.  The whole, throat was
much diseased,  much  atrophied  and  cavernous ;  the  mucous  lollicles 
20
Inhalation in Diseases of the Lungs.
were much  enlarged, very vascular and  tuberculous.  The  uvula was
elongated, and the.epiglottis  cedematous.  There were cough, expecto-
ration of a serni-purulent mucus, and some dyspnoea.   The physical signs
indicated  bronchial disease, with pectoriloquy.   There were, also, present
in the system, unmistakable symptoms  of  the  disease  in which all his
troubles originated.   He had had a solution of  the nitrate applied to the
pharynx in  the form  of a gargle, as he stated, and proved by  the follow-
ing recipe from an eminent physician.  R.  Arg. nitrat.,  9j. ; aqua  rosa?,
 5 v.   M.   He was directed to inhale the pulvis  nit. argent,  et licopod.
bis diem ;  and to go into the vapor bath three times  a  week.    The fol-
lowing  prescription  was given :—R. Potassii  iodic!.,  5 iij.; aqua  dist.,
 5 v.   Dose, a teaspoonful, ter diem.  The fauces, pharynx,  and, so far
as could be  seen, the larynx and the whole of the throat, had   improved
much in three weeks.   At the expiration of this time, the following was
substituted for the iodide :—R. 01.  jecoris aseli,  § iv. ; sol. carb. potas.,
 | ss. ; syr.  limo.  cort. § ij.; aqua  carui, § ss.   M.   Dose, two table-
spoonfuls, bis diem.  The epiglottis was visible,  erect  and  cedematous.
There was pain  in  the larynx,  and   soreness over  the thyroid  cartilage.
The voice was husky, at times quite hoarse, cough, emaciation ; in a word,
all the symptoms of constitutional syphilis, with several of the rational
signs of phthisis, were present.  He had tried many remedies,  had had a
physician  in every port, and exhibited  a  handful of recipes which he said
fie had " dearly paid for," and tried  the medicines.  Still he  " was no
belter, but rather worse."
   As he  had taken  the bichloride  of mercury and iodide of  potassium        t  1
pretty freely, 1 directed him  to take  three of the following pills,  three
times a-day :—R. Extract  conii, grs. xv. ; ext. podophylli, 3ij. M.  Fiat
masse, in  pilulas  no.  80.   To use  the vapor bath three times a week,
and to inhale the  pulv. nit. arg. ter diem  every  other day.  I also applied
the lunar  caustic  in  stick  form to all the diseased  follicles that could be
reached in  the fauces and pharynx.  Under  this treatment,  he began,
very gradually, to  improve, and  at the end  of three  months  was  dis-
charged cured.
   Case  VII.—A gentleman from  the country, aged 28.   All the ex-
ternal appearances indicate phthisis : countenance pale, anxious, haggard
and emaciated, night sweats, distressing cough, short breathing; expecto-        \
ration of mucus, mixed with  pus ;  voice husky, deglutition difficult, and
breathing  stertorous.  Both tonsils  are  much enlarged and ulcerated ;
uvula elongated, and nearly one half the  length  ulcerated ;  pain in the
larynx  and soreness in the region over  it.   The physical signs manifested
tubercles  in  process  of softening.   The prognosis  was very  doubtful.
He was ordered  tinct. sanguinaria, % j.  gits. 30 bis  die.  R.  Morphia,
grs. iij.;  tinct. actae racemosa, |j.  M. gtts. 25 ad noctern.  Also a very
weak solution  of nit. arg.,  grs. iij.,  to  |j.  aqua distil., applied  with
a camel-hair pencil to the enlarged tonsils and  elongated uvula.   The
strength of the sol. nit. arg.  was increased  on each application by grs.
iij. to grs.  Ixxx. to  § j. aqua.   Twice  the tonsils were touched with Lu-
gol's iodine caustic, and twice the stick of lunar caustic was passed into;
and  around the surfaces of the hollows  which did here, and  usually do 
                 Inhalation in Diseases of the Lungs.              21

exist, in indurated tonsils.   The cauterization was employed once a week
—:the design being rather to preserve, than  to destroy the tonsils.   After
thus applying the caustic for four weeks, the tonsils were so far reduced
that  I thought it expedient to commence inhaling the  pulvis  nit. arg.,
which would affect  the  tonsils, pharynx,  larynx, bronchia and lungs.
This  was continued  as often  as every  two days for six weeks longer,
when the tonsils had come to  their normal size, the  inflammation  about
the air-passages had disappeared, and  the patient was every way  much
improved.   At the end of three months he was discharged, cured.
   Case  VIII.—A child  5.}  years old.  Tonsils very  much  enlarged ;
considerable cough ;  stertorous  breathing ; apparently  much   bronchial
dilatation ;  voice husky, sometimes quite hoarse.  Some signs  of tuber-
culization present.   Evidently  of a strumous habit.    Parents  say  " she
has always had a cough."   Face cedematous.  Prescribed  :—R. Potas-
sii iodid., 3 i.;' aqua dist., § v.   S.   A teaspoonful ter diem, in mucilage
acacia, or sugar and water.   And  the  following ointment applied exter-
nally, under the ears jand chin, night  and morning.   R. Potassii iodid.,
 9'iss. ;  adipis, § i.  M.   The chronic  amygdalitis was treated  upon  the
plan  already spoken  of  in these  observations, viz. commencing  with a
very  weak solution of the nitrate, two  grains to the ounce of water,  and
gradually increasing  until a  saturated  solution was  employed.  Thus,
instead  of aiming  gradually  to destroy the tonsils,  their  preservation
rather was sought.   The  stick caustic  was applied to  the surfaces of  the
hollows in the tonsils.  The tonsils in  five weeks had  lessened.considera-
bly, and the inhaling of the pulvis. nit. argent, was commenced.  Under
this treatment the child's  health continued  to improve.  The tonsils be-
came of the normal size,  and  the  cough and  bronchial  irritation disap-
peared.  The local  difficulty  was very much removed by the pulvis.  nit.
arg. et licopod., while the disease seemed to be eradicated by the altera-
tive medicine.
   Case IX.—A girl, aged  13.   Enlarged  indurated tonsils; cough.
stertorous breathing  when sleeping  ; general debility  ; bronchial irritation :
hoarseness, sometimes entire loss of voice.  Treatment commenced with
inhaling  the  pulvis nit. argent, once a-day.    Ordered a tablespoonful of
the  following alterative,  morning  and  evening.   It. Decoct, sarsapa-
rilla,  Oi.; iod. potassii, 3 iii.  M.   In  six weeks she was discharged from
treatment, cured  ; but directed to take the medicine still longer.
   The unguent,  iod. pot. was applied  externally as in the  above case.
   My design in  this pamphlet has been to call the attention of both the
medical  profession and  patients to a  mode of treating a very  distressing
;md often fatal class of diseases,  which  promises more for the restoration
to health of this  class of  patients than any other that has  come to my
knowledge.  The plan of treatment is simple, but, nevertheless, much is
depending upon  the powder  for inhalation being well prepared and pro-
perly inhaled.   It  requires great  care to make this  powder in a proper
manner, and the inhaler should be such as will easily convey it into  the
air tubes.   I have inhalers at my office of various forms and construction,
and varying  in  price  from one to three dollars, which will  be carefully
put up, with two vials of the powder,  containing two drachms each, a 
■)•)
Inhalation in Diseases of the Lungs.
 quantity sufficient to make a fair trial in any given case, and sent  to any
 part of the country.
   It should not, however, be used  in all cases, indiscriminately, as by so
 using it, injury, instead of benefit, might  sometimes be the  result.   It
 will be always the safer course for each patient to consult his physician.
 before employing it, and  always  to use it under the watch and care of
 some one competent to decide upon its effects.   In writing this pamphlet
 I have had no wish to take these cases  out of the hands of their  physi-
 cians,  nor to induce patients to become their own medical advisers.   I
 know from some  experience, both  personal  and as a practitioner, that
 this class of diseases requires much  study and practice to be successful^
 treated.
   It should  be further stated, that the inhalation of the powder, or any
of the vapors named above, is  not  designed  to  interfere with any other
 medical treatment which  any physician may choose to prescribe for his
 patient.  These observations were intended, originally, as an  Appendix
 to the book, or indeed to  the  two books  which Jiave  been  heretofore
published, one on  "Consumption  Prevented,"  and  the other on the
" Curability and Treatment of Consumption." They form a part of the
treatment of  that  disease.
   Boston, Dec. 20, 1850.
     No. 496 Washington Street. 
) 
I 
PRACTICAL OBSERVATIONS
INHALATION OF  VARIOUS VAPORS AND POWDERS

            IN  DISEASES

                   OF THE  -

      AIR  TUBES AND  LUNGS.
         BY WM. M. CORNELL, M.D.







             BOSTON:
PUBLISHED BV CROSBY &, NICHOLS, lit WASHINGTON STREET.
                 1850. 
 
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