The Value of Inhalations in the Treatment of Lung Disease
Authors: C. T. Williams
Journal: BMJ (1888)

THE direct aplplication of medicinal agents to the air passages is tin ancient practice, and dates from the time of Hippocrates, who used fumigations, employing a pot, thlrouglh the lid of which a reed l)assed conducting the vapour to the mouth, which was pro- tected from scalding by moistened sponges.Ilnhalations were recommended by Greek, Roman, and Arabian phlysicians, and in later times have hlad their period(s of use and of disuse, of observ- ance and neglect, which may be attributed by some to the freaks of fashlion, by others to their failinig to fulfil the expectations entertained of their effects.To me it lhas always seemed that their use has beeni dictated by the common sense view of the advantages of direct over indirect application of remedies to dis- eased organs, a view which is easily comprehended, and whichl commends itself strongly to the non-medical mind.Whly should the lungs be approached tortuously through the stomach, the skin, and the circulation, when they can be reachled more speedily through the trachea and bronchi?Thle answer, however, isplain; that, llad inhalations been entirely successful, the treatment of pulmonary disease throughl other channels would never have been attempted, and the fact of other treatment being in vogue argues against the efficacy of direct treatment of the air passages.The return to the use of inhalations of late years may be traced partly to the undoubted( proofs of the penetration of fluids and substances to the air passages, and partly to the antiseptic system.The practice of atomising fluids applied by Sales-Giron to the mineral waters of PI'ierrefonds raised the question in the French Academy whlether pulverised fluids do penetrate beyond the larynx, whichl was largely discussed, and ended in a report drawn up by Poggiale in the aflirmative, and based on very strong evi- dence, one portion of whichl was furnished by a nurse with a tracheal fistula, through which the medicaments inhaled by the mouthl were detected( in the trachea, and another portion by ex- periments on rabbits, in the lunIgs of whichl the sprays werefound to have produced inflammatory processes.Trousseau's remark was: "That the larynx was a vigilant sentiiiel over the air pas- aages, but one that can be taken by surprise; that often the couli.which should preclud(le, followed the introduction of the fluii."This conclusion was confirmed by Schlultz aniid Zoldekauer's cases treated by perchloride of iron sprays, wliere the metal was detected in large qutantities in the cavities of the lungs after death, and out of all proportion to what could have been yielded from any blood effused.The greatest proof, however, of the penetration of the air passages is shlown by the investigation of Peacock and Greenhow into thle lungs of millstone grinders, col- liers, potters, and others following dusty occupations, whichl re- vealed the presence of the matters inhaled in their trades in large quantities in the pulnionary tissue.No one can doubt the possibility of reaching even the alveoli by inhalations, but the question is whether by our methods of inhalation, as atl)resent practised, we do reach them, and as effectively as through the stomach and circulation.The other grotund for the return to the use of inhalations is the idea of ap- plying tlhe antiseptic methlod, so successful in surgery, to the treatmenet of lung diseases, and this has been generally attempted in the form of antiseptic respirators.Now what are the principal metlhods of inhalation?They may Ibe r,ighly classified as follows.1. Ilnhalation of ga.ses, suchl as oxygen, nitrous oxide, atmo- spheric air (conldensed or rarefied), or vapours of certain medi- cine.v-olatile at low temperatures, as ethler, chloroform, nitrite ofluinyl, and iodide of ethyl.