History of Endoscopy



History of Inhalation Therapy

Mostafa Ahmed SHEHATA*

*Prof. Dr. Alexandria University, Alexandria, Egypt.

e-mail: m_shehata@

Summary

Inhalation therapy was known many thousands of years ago as one of the main therapeutic methods.

In this paper, inhalation therapy is examined from ancient times to today.

Key Words: Inhalation Therapy, History of Medicine

Inhalation therapy is the intake of medications through the nose or mouth for therapeutic purposes by natural or helped respiration.

Ancient man discovered the therapeutic material by trials and observation. In this may he used many plants, minerals and organic materials for the treatment of his body troubles.

Inhalation of powder, smoke or vapour of the dry, burnt or boiled medications was well known at that ancient time.

The religious ceremonies in ancient Egypt, Babylon, India and China were usually practiced in an atmosphere of burning incense and fumigating odorous material. The evolved odour inhaled by the attendants gave some relief of the respiratory troubles, calmness and self comfort that were needed at such holy circumstances (1).

Ancient Egyptian Medicine:

Credit goes to ancient Egypt for the first use of inhalation therapy for the treatment of the oral, pharyngeal and chest troubles. Many prescriptions in the Ebers and Berlin medical papyri, written four thousands years ago report the first use of inhaled dried medicinal plants, boiled medications or the smoke of some burnt material, in the form of nasal snuff, oral insufflations or vapour inhalation (2) (3) (4).

The main medicinal plants and minerals that were used for inhalation therapy at that time were Benzoin, Hyocyamus, Cucumis, Cannabis, Alum, Jesminum, Bitumen and Arsenic Sulphide (3) (4). The vapour of boiled leaves of Frankincense and Commiphora was described for the relief of the throat and chest troubles (4) (5).

Special pots and clay containers for the preservation and use of such plants and their powders were used (2).

The Babylonian civilization was contemporary to the old Egyptian era. Physicians knew many drug prescriptions and used them by different means for inhalation. Their medications were mostly non-materialistic, highly mixed with mythologies and superstitions (7).

The Greek medicine, flourished at the fourth century B.C. and its physicians quoted a lot of the Egyptian medicine. They used burnt incense extensively, beside the inhalation of many dried plants. Galen the late Greek physician (130-201 A.D.) described the powdered snuff of many medicinal plants and the inhalation of their volatile vapour and smoke for the treatment of nasal and head troubles (7) (11).

The Persian physicians before the seventh century B.C. recognized inhalation therapy. Their well known king and physician Jamshid described the inhalation of the volatile vapours of boiled roses, flowers, musk, eucalyptus and ambergris for the relief of respiratory troubles(9)(22)(24).

In ancient India, physicians used some forms of drug inhalation. The well known one was Cannabis indica. Its burning fumes were required for sedation and narcosis (31).

The Romans were very keen to establish good sanitation and public hygiene. They constructed public baths in their old cities, supplied with cold and warm water. In these places steam inhalation was available that gives some health comfort to respiratory troubles (7) (21).

The Arab civilization flourished at the eighth century and gave a good progress to medical practice. They revolutionised the inhalation therapy in technique and indications, with the addition of many medicinal plants and minerals to inhalation therapy.

They modified the use of public baths to give a therapeutic role, by the addition of volatile medicinal plants to the warm water, patients were submerged to the level of the neck in warm water, covered by a blanket to retain the vapours for inhalation. They can be considered the pioneer organisers of the recently developed baths of Sauna (16) (21).

They added many new medicinal plants to inhalation therapy in the form of powder for sniffing, volatile vapour for inhalation or burnt smoke for breathing. The most important ones were Eucalyptus, Mint, Benzoin, Thymol, Violet, Musk, Helleborus, Saffron, Mustard, Camphor, Cloves, Birthwort, Bine, Fennnel, Lavander and Jasmine.

The dried leaves, roots or barks of these plants were the material for inhalation for the treatment of the throat, larynx and chest troubles beside the relief of several head and body troubles (10) (13) (15) (16).

The Arab physicians are credited by developing the first inhalation anaesthesia at the ninth century under the name of Al Marquad (General Anaesthesia). Powdered Opium, Hyocyamus, Mandrake and Henbane dissolved in water and imbibed by a sponge, to be used by inhalation at surgery. It gives good sedation and narcosis that was required at surgical operations (11). This inhalation anaesthetic method was first described by the Arab physician Isa bin Ali at 910 and confirmed by Avicenna (980-1037) and written in details by Ibn Al Quff (1233-1286) in his book Al Omda(19)(20)(23). The contemporary German historian Dr Sigrid Honke assured the fact that the anaesthetic sponge is an Arabic addition (20).

The first early trial for resuscitation of comatosed patients by drug inhalation through forced respiration by a manual bellow was practiced at the eighth century by the physician Saleh ben Bahla, who succeeded to recover consciousness to a comatosed patient by forced manual respiration and inhalation of the medicinal drug Al Kondus (Helleborus) (27 (33).

This newly practiced inhalation procedure was later wrongly attributed to the European Polish physician Theodorick of the thirteenth century (17), and other historians, claim it to be an addition of Paracelsus of the fifteenth century (17).

The used tools for inhalation therapy at that time were large clay pots for volatile oils, metal containers for boiling liquids and wood snuff box for powdered drugs. For vapour inhalation, the liquids were heated on stoves or hot stones and the evolved paper received by the patient under a blanket (10) (13).

The European Renaissance gave a good progress to inhalation therapy. Many new medicinal plants, minerals and chemicals were added to inhalation therapy, with a progress in the technique and practice to this speciality.

The newly discovered gases and chemicals as oxygen, ether, nitrous oxide, chloroform and cocaine were added to inhalation therapy with wider indications (7) (11).

Unfortunately some poisonous injurious materials were introduced to inhalation therapy that resulted in serious fatal complications.

During the eighteenth century the Hydrocyanic acid gas was described for inhalation for chest diseases and officially registered in the British Pharmacopoeia in 1867 with high incidence of toxic complications (12) Cocaine that was first prepared by Newman in 1859, was used as a snuff for its pleasant narcotics effect, with many side effects (7). Tobacco was known to Europeans in 1492 and its dried leaves were used as a powder for snuff or burnt to inhale its smoke. This was the beginning of a world sanitary disaster (14).

Many good therapeutic gases and chemicals were discovered and soon introduced to inhalation therapy. Oxygen discovered in 1777, Nitrous oxide in 1799, Ether in 1842, Chloroform in 1831 and ethyl chloride in 1847 (7) (17).

They were extensively used for general anaesthesia during the 18th, 19th and early 20th centuries.

The Updated Inhalation Therapy:

The use of therapeutic material whether powders, liquids, vapours or gases through the inspired air has revolutionised into a medical sub-speciality known as Inhalation therapy. Some medical centres adopted the term “Respiratory Therapy” which is a limited term for that specialisation that covers only the treatment of the respiratory troubles, ignoring the other body troubles.

Nowadays in nearly all medical specialities there is one procedure or more in which the medicaments are taken through inhalation by different means for many body troubles.

Devices and Tools for Inhalation Therapy:

Ancient Tools:

- Clay pots.

- Metal containers.

- Snuff box.

- Inflating bellows.

- Tubs for warm water

Modern Tools:

- Insufflators.

- Sprayers.

- Atomizers: - Vacuum atomizer.

- Plastu bottle atomizer.

- Mistometer.

- Nebulizer: - Hand Nebulizer.

- Jet Nebulizer.

- Aerosol Nebulizer.

- Ultrasonic Nebulizer.

- Inhalers - Dry Inhaler.

- Steam Inhaler.

- Gas Inhaler.

- Vaporizer and Humudifier.

- Hyperbaric oxygen chamber.

- Bathing devices.

Forms of Drug Inhalation:

- Smoke: of burnt reeds, plants or minerals.

- Powder for snuffing or insufflation.

- Liquids, inhaled by Dropper, Sprayer, Atomizer or Nebulizer.

- Vapours inhaled by Inhalers, Vaporizers or Humidifier.

- Gases, Therapeutic or anaesthetic (14) (25) (26) (29) (32).

Indications and Medicaments for Inhalation Therapy:

- Nasal vasoconstrictors.

Adrenaline, Ephedrene, Phenylephrine.

- Bronchodilators

Ephedrine, Epinephrine, Isoprenaline, Turbutaline

Prostaglandine, Sabutamol, Methoxyphes amine

Cortisone acetate, Hydrocortisone, Dexamethasone

Beclomethasone

- Prevention and Control of Burn Shock

Glucocosticoids

- Control of acute pain crisis

Nitric oxide gas

- Antimicrobials and Antivirals

Tobramycin

- Neurolgical and Metabolic diseases

Hyperbaric oxygen

- Control of Diabetes mellitus

Insulin powder

- Control of Hydrogen sulphide toxicity

Amyl nitrite

- Control of arrhythmia

Nitrates

- Local anaesthesia

Lidocaine

- General anaesthesia

Nitrous oxide gas, Halogenated Hydrocarbons (Halothane, Isoflurane, Enflurane, Sevoflurane, Desflurane)

- Vaccination

Anthrax vaccine

Anti influenza vaccine

- Contraception

- Mucolytics and Mucokinetics

Water spray, water vapour

- Immunologic agents

Diethyl carbamazine, Chloroquine

Cromolyn sodium

- Care of Premature infants

Lung surfactant

- Hyperbaric oxygen

Neurological disorders, resistant chronic infections

Auto-immune diseases, Vascular disorders(6)(17)(18)(25)(28)(29)(30)(32).

Conclusion

Inhalation therapy was known many thousands, of years ago as one of the main therapeutic methods. It is actually an old therapeutic method, as old as the pyramids and is still used as an effective treatment for variety of diseases in every country of the world.

The enormous knowledge gathered through the past centuries and the present time added great advances to the methods, techniques and indications of inhalation therapy and gave it a great therapeutic importance.

References:

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22- http/legisweb.state.lwy.u.s/statutes/title33/chapter43.htm.

23- Fouad Salim Haddad “The Spongia Somnifera” The Middle East Journal of Anaesthesiology, Vol 17, No. 3, 2033, P 321.

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28- M.M. Paparella and D.A. Schumrick “Otolaryngology” Vol 1, 2nd edition, Saunders Company “Publisher, U.S.A., 1980.

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30- H.C. Churchill-Davidson “A Practice of Anaesthesia 4th edition, Iloyd-Luke Medical Books, London, 1978.

31- A. Baraka “Historical Aspects of Opium” The Middle East Journal of Anaesthesiology, Beiruth, Lebanon, 1982.

32- H. Wollman andT. Smith “The Therapeutic Gases” In the “Pharmacological Basis of Therapeutics” by Gilman, Goodman, 6th edition, Macmillan Publishing Company, New York, 1980.

33- Payne “Resuscitation of Apparently Dead” A lecture of the Royal College of Surgeom, London, Britain, 1969.

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