History of Inhalation Therapy
Mostafa Ahmed SHEHATA*
*Prof. Dr. Alexandria University, Alexandria, Egypt.
e-mail: m_shehata@yahoo.com
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:
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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
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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.
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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 (9801037) 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
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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 18 th,
19th and early 20th centuries.
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The Updated Inhalation Therapy:
The use of therapeutic material whether powders, liquids, vapours or
gases through the inspired air has revolutionised into a medical subspeciality 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.
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- 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
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- 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
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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.
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