The herald., 1897-02-28
Trc tment of Diseases Of the Res
piratory Organs by Butchers
Direct Contact Method
BY r. n. r. Spendiove, c. NJ, I'D.

sand persons die annually from con-
sumption, and the number suffering
from catarrhal diseases of the air-pas-
sages is computed to be over five mill
ions.
1t is evident from these facts that we
as profession are either negligent of
this branch of our healing art, or that
our means Of combating these diseases
are inadequate. That we are not neg
ligent is proven by the fact that the
searchlight of some of the brightest in
tellects of our profession have long been
turned into this dark corner. from which
reports of startling discoveries follow
each other in regular succession; each in
turn, however. when subjected to the
searching test Of clinical use at the bed
side" has proven but an ignis fatuus
This fact, as we'll as the great preva-
lence and mortality Of this class of dis
eases, should make us examine we'll into
our methods of treatment, as we'll as the
means employed. Two methods are in
use in the treatment of this class of dis
eases-the indirect and the direct con-
tact method.
III the lHQlEeCt IIlcluOu thc iIiCulCiuc 10
taken into the stomach, where 1t must
first come into contact with the digest
i've fluids, which in the case Of many
drugs completely alter their composition.
From the digestive tract part chow
much we know not, neither its compost
tion) enters the general circulation, is
carried to all parts of the body. finally
lr rivc to VII thrOnuh the various
emunctories, and, with the exception of
a minute quantity of very limited num-
ber of drugs which pass out of the sys-
tenn through the bronchial mucous men,
brane, never reaching the pulmonary
surface. That this method is both IRA
tional and unscientific is evident on
momont's consideration.
BY the direct contact method an en-
deavor is made to apply medicinal sub
use of respirators. nebulizers. inhalers.
etc. This method has occupied the at
tention of the profession from a very
early period. 1t has given promise to
be competent to the production of re-
suits which probably no other means
are capable of affecting."@ 1t has the
sanction of the most eminent clinical
teachers in respiratory therapeutics in
all countries. Competent and trust
worthy observers have repeatedly cited
cases where 1t would appear that this
method had been instrumental in effect
ing cures, or at least retarding the pro-
gress Of the disease. Yet with all this
It cannot be said that the direct contact
methods which have heretofore been
employed have fulfilled the high expec-
tations entertained of them, nor have
they found permanent resting place
in the practice of the profession. If we
seek for the cause Of this we have not
far to go. The means hitherto employ
ed for bringing medicinal agents in con-
tact with the mucous membrane of the
respiratory tract have but imperfectly
fulfilled their object. From time to time
physicians Of a mechanical turn of
mind have brought forward some new
or modified form of respirators, nebuliz-
ers. inhalers, etc., but with the con-
struction of each there has been fall
ure to recognize the important fact that
neither air, steam nor water can be en-
ployed as vehicle for carrying solid
medicinal substances to the air pas
sages in quantities corresponding to
their recognized therapeutic doses.
No better proof of this statement is
needed than the experiments made by
Arthur Hill Hassell, M. D." London.
which are as applicable to the instru-
ments now in use as they were to those
with which the experiments were made.
Detailing the results Of his expert
ments with the naso-oral respirators then
in use, he states that after the compile
tion of one or two hours inhalation
more than four-fifths of the medicine
was recovered from the respirator;
necessary to its recovery. A still larger
amount was absorbed by the skin of the
lips and the mucous membrane of the
mouth, nose and throat; so that it Is
extremely doubtful II any portion ever
reached the pulmonary surface-and this
doubt is greatly strengthened by the
fact that the sputum brought up short
ly after the inhalation had no odor of
the drug used, i.e.. carbolic acid. An
other fact correborating this is that the
expired air during innalatlon OF the
acid was passed through distilled water,
which was afterward tested for the acid
and gave only the minutest trace.
In his experiments with air and steam
sprays q very large proportion of the
drug was also recoverable In sum-
ming up the results Of his experiments
with the different methods employed he
states that sit Is difficult to suppose
that the small quantity of medicine lost
during the several inhalations could ex-
ercise any marked effect, even If the
whole quantity made it's way to the seat
of the disease, which 1t does not"
In Butchers direct contact method
the nascent vapor Of ammonium chic
ride is used as vehicle for carrying the
drugs to the affected surfaces; not as a
mer dicament itself, as with other ammo
MUM chloride inhalers. 1t is important
to note this distinction. d
The medicine to be inhaled Is put IN
the large bottle; few drops Of strong
solution Of ammonia are added The
small bottle or vial inserted In the cap
Of the inhaler is Allied nearly full of
professor of materia medica and thera-
peutics, faculty Of medicine, University of
bishops college: attending physician Mon
treal d;spensary and out-patient depart
ment Western hospital etc.
.'Dr; Charles Gibson tAmerican rspsint).
~ ssssi,ancet. May ana Oct. T. 1883.