Inhalation

“ Let me take up the first factor--diversion of will--and show that nature invariably resorts to a sudden inhalation to prevent severe infliction of pain being felt. It is the panacea to childhood's frequent bruises and cuts, and every one will remember how when a finger has been hurt it is thrust into the mouth and a violent number of efforts at rapid inhalation is effected until ease comes. By others it is subdued by a fit of crying, which if you will but imitate the sobs, will find how frequently the respirations are made.
One is startled, and the heart would seem to jump out of the chest ”

“ Inhalation is harmful because it not only exposes the absorbent tissues of the mouth and upper throat to the smoke, but thrusts the smoke throughout the throat, lungs, and nose, all of which are lined with a specially sensitive membrane of great absorptive capacity. Thus from the smoke of the cigarette the system takes up many times as much poison as it takes up from the uninhaled smoke of the pipe or cigar. Indeed, it may be added that the purer and higher the grade of the tobacco, the more harmful it is to the smoker, for the more will it tempt him into inhalation. ”

“ It is, however, known by experiments on animals that if the inhalation be prolonged beyond the period necessary to produce these effects, the respiratory functions are interfered with by the insensibility extending to the nerves on which they depend. The breathing of an animal thus treated becomes irregular, feeble, or laborious, and death ensues. However nearly dead from inhalation of ether vapour the animal may be, provided respiration has not actually ceased, it always recovers when allowed to breathe fresh air. ”

“ Sylvia.—Inhalations of steam impregnated with medicinal substances are exceedingly useful, especially in bronchitis or catarrh of the throat. If you have an inhaler handy so much the better; if not, you can make an excellent inhaler out of a jug. Fill the jug or inhaler with hot water, add the drugs prescribed (most probably, compound tincture of benzoin or camphor) , place your face over the jug, being careful not to scald yourself, and cover your head with a large dry towel, shrouding yourself with the jug beneath its folds. ”

“ Insensibility can, indeed, be generally induced with chloroform in the time above mentioned, but there are many cases in which there is considerable delay at the commencement of inhalation, owing to the pungency of the vapour, especially in nervous and in sensitive patients, and in persons with irritability of the air-passages from chronic bronchitis, phthisis, or any other cause. ”

“ When the pains grow heavier we use less oxygen and permit three or four deep inhalations just before a bearing-down pain. At the first suggestion of a contraction, the patient must begin to inhale the gas; while after the patient has pulled hard on the traction strops—just as the contraction pain is passing—she is given an inhalation containing a larger percentage of oxygen. ”

“ Practice will soon overcome the tendency to divide the inhalation into three movements, and will result in a uniform continuous breath. You will be able to complete the inhalation in a couple of seconds after a little practice. ”

“ An accurate knowledge of the neural anatomy of a particular region enables the operator to anesthetize large areas and to operate with entire freedom from the necessity of observing the appearance and conduct of his patients, many of whom, notably the alcoholic ones, behave badly, become cyanotic and breathe intermittently when under the effects of inhalation anesthetics. The absorption into the body of the substances employed by inhalation may also exert a baneful influence by reducing the powers of resistance upon an economy already lowered by disease, and also by retarding convalescence. ”

“ Our almost absolute ignorance of the causes of some of the most fatal diseases, and the empirical nature of nearly all our best medical treatment, have been often recognised. The medicine of inhalation is still in its infancy, and yet it is by inhalation that Nature produces most of her diseases, and effects most of her cures. ”

“ Breathing.—The proper management of the breath is of the greatest importance in speaking and reading. Inhalation and exhalation should be gradual and natural, not spasmodic. The reader should never allow his supply of breath to be wholly exhausted, but should replenish it at regular intervals. Inhalation should be through the nostrils, not the mouth. This prevents gasping, and promotes and preserves a healthy condition of the vocal organs. It is not necessary to keep the mouth closed in order that the breath be inhaled through the nostrils. ”

“ Another mode in which violent effort injures the lungs is by the rapid and continued inhalation of great quantities of air during rapid breathing, so as to dilate the lungs suddenly to their fullest extent. Sometimes from irregular distribution of the ærial current or from the want of tone in a particular part of the lung that gives way under the pressure and the air cells become overdistended or ruptured. ”

“ Death is frequently preceded by muscular spasms. The foudroyant character of the illness, and the speedy death of the patient, coupled with the peculiar odour of the acid in the breath and atmosphere around the body, seldom leave any doubt as to the nature of the case. The treatment consists in inhalation of fumes of strong ammonia, drinks of warm and cold water alternately, friction of the limbs, and artificial respiration. ”

“ Inhalation pneumonia is not uncommon, and although it is often attributed to the anæsthetic, especially ether, it is doubtless due to a combination of causes, such as a cold room, undue exposure of the body, septic teeth, the chilling effects of ether on the tissues of the lung, and occasionally to a dirty face-piece belonging to the ether or chloroform apparatus. ”

“ If the rapid inhalation of air into the lungs does not increase the heart's action and cause it to drive the blood in exact ratio to the inhalations, then I can produce partial anaesthesia from this excess of oxygen brought about by the voluntary movements over their ordinary involuntary action of the lungs. ”

“ The patient usually becomes conscious within five minutes after the inhalation has been discontinued. After a short inhalation, for a very brief operation, consciousness sometimes returns immediately, and after a prolonged inhalation the recovery of consciousness is sometimes retarded till ten minutes have elapsed. Old people are often longer than others in awaking from the effects of chloroform, owing, no doubt, to their slower breathing and circulation. ”

“ I will now give an account, seriatim, of my inhaler, the anodyne fluid which I employ, and the mode in which I direct the inhalation to be made.
The Inhaler [A] is similar to one very commonly used in administering chloroform. It has, however, in addition, two tubes, an inch and a quarter long and a quarter of an inch in diameter, running parallel to the floor of the inhaler. These tubes, being placed above and to the sides of the inspiring valve, admit two small streams of [Pg 11] fresh air, which to a great extent are inspired unmixed with the vapour of the anodyne. ”

“ The Inhaler should then be removed immediately, and one or two full, deep, quick chest-inspirations taken. This will be found sufficient to [Pg 14] relieve all pain, and there will be no loss of consciousness. During the entire process it is desirable to have a full light upon the face, to watch the countenance and feel the pulse occasionally, and observe the pupils. These, in some cases, are very quickly affected, and then the inhalation requires to be suspended for a time. ”

“ Effects of Suspended Matters.—The inhalation of dust is followed by deleterious effects. We may divide the solid substances inhaled as dust into three kinds:—dead substances, living substances, and the contagia (microbes or germs) of various diseases.
1. Dead Substances inhaled for a prolonged period in various occupations are a common cause of premature death. The potter draws into his lungs a fine silicious dust, which irritates his lungs, and finally produces a fatal disease, known as potter’s asthma. ”

“ During all of the previous century it was known as a drug, and allusion to its inhalation was made in 1795 in a pamphlet, probably by Pearson. Beddoes, in 1796, stated that "it gives almost immediate relief, both to the oppression and pain in the chest, in cases of pectoral catarrh." In 1815, Nysten spoke of inhalation of ether as being common treatment for mitigating pain in colic, and in 1816 he described an inhaler for its use. ”

“ As simple as it may seem, there is a proper and consistent plan to enable you to reach full success. Before the patient commences to inhale he is informed of the fact that, while he will be unconscious of pain, he will know full, or partially well, every touch upon the person; that the inhalation must be vigorously kept up during the whole operation without for an instant stopping; that the more energetically and steadily he breathes, the more perfect the effect, and that if he cease breathing during the operation, pain will be felt. ”

“ Cohausen, “consists of an inhalation and an exhalation: and if I speak scientifically, I say that when man breathes he lets forth the thick and thin airs through his mouth and nostrils, which he had before received into his lungs, where they had become impregnated with the evaporations from his body, the subtilised watery particles and vitalising blood, the balsamic and sulphuric atoms. Wherefore the human breath when outside the spiracles has a material character, namely, an exhalation from the vapours and gases which are intermixed with the blood and sap of the human body ”

“ The first suggestion to produce anæsthesia by the inhalation of drugs was made by Sir Humphry Davy in 1800. He discovered by experiment upon himself that the inhalation of nitrous oxide gas—commonly known as a laughing gas—had the power of relieving toothache and other pains ”

“ If the precaution be taken to ensure that the air the patient breathes shall never contain more than five per cent. of vapour, the pulse can never be seriously affected by the direct action of the chloroform, and the state of the breathing affords the best warning against continuing the inhalation too long at a time. ”

“ In collapse from hemorrhage, we have learned the value of injections of warm saline water, either into the veins, the skin or the rectum, and the same treatment is available in other cases of collapse with contracted vessels.
“Another measure which has proved most efficacious is the inhalation of oxygen gas. This is especially useful in cases in which alcohol is decidedly injurious, namely, those in which there is increasing congestion of the lungs, which the heart, [Pg 188] though doing its utmost, is unable to overcome. ”

“ When he had obtained any substance which would produce insensibility favourably on animals, he pushed it, in one or two experiments, to its extreme in animals of different kinds; and having produced death by the inhalation, both by giving rapidly a large dose, and by giving a small dose for a long period, he observed the mode of death, whether it occurred by cessation of the heart, or by cessation of the respiration primarily. If the agent seemed to promise favourably from these inquiries, he commenced to try it on man; and the first man was invariably his own self. ”

“ By inhalation of substances requiring heat for volatilization, e.g. mercury and sulphur. The patient, enveloped in a sheet, sits on a chair, while the substance, placed in a vessel on the floor inside the enveloping sheet near the patient, is heated by a spirit lamp or similar method. Mercury is used for chronic and syphilitic laryngitis and pharyngitis; sulphur for scabies and other skin diseases.
(c) By inhalation of steam or warm-water vapour with a drug added. ”

“ The odor of the membrane and surrounding parts becomes sweetish and musty, and occasionally so fetid that it contaminates the atmosphere of the room, and the air in its transit through the nose and over the pharynx becomes by inhalation dangerous to the patient. His throat becomes more swollen, his respiration loud; he keeps his mouth open constantly, has an indifferent expression; the saliva dribbles continually, the color of the skin is sallow and livid, the [p. 669] appetite very poor, and pulse both frequent and small. ”

“ You will find it quite a help to you if you will practice this breath before a large mirror, placing the hands lightly over the abdomen so that you may feel the movements. At the end of the inhalation, it is well to occasionally slightly elevate the shoulders, thus raising the collarbone and allowing the air to pass freely into the small upper lobe of the right lung, which place is sometimes the breeding place of tuberculosis. ”

“ About a fluid ounce of ether is usually inhaled by an adult patient in becoming insensible; fully one-half of this is, however, thrown back from the lungs, windpipe, nostrils, and face-piece, without being absorbed. I usually put two fluid ounces of ether into the inhaler above described, at the beginning of the inhalation, and this quantity often lasts to the end of the operation, if it is not a protracted one. The inhaler is connected, by means of a wide elastic tube, with a face-piece similar to that described and delineated in treating of chloroform. ”