NEW USES OF THE IN AND EXHALE! 
HY CHARLES DENISON, M. I)., DENVER, COLORADO 
This air pressure In and Exhaler, first described in the Medical Record, 
issue of February 10, 1H94, has gained for itself an enviable reputation for its 
efficacy and as an aid in the arrest of consumption. 
It has proved itself a lung developer of greater force than its diminutive 
size would seem to warrant; for when used with the persistency, regularity and 
energy intended by its originator, few methods of pulmonary gymnastics can 
equal this gently persuasive influence on the closing air-cells and bronchioles of 
a chronically affected or inefficient lung. 
The results obtained by the author both of increased spirometrical and 
manometer power and of lung development have been noted by others; while, 
incidentally, due to 1 he anodyne and antiseptic effects of vaporizable oils and 
odorous salts used, cough and irritation of the trachea and bronchial tubes have 
very generally been allayed; cavities in the lungs and bronchial dilatations have 
been ventilated and strengthened as to their peripheries, and furthermore ren- 
dered as nearly aseptic as possible. The latter effect has been shown by the 
decreasing number of strepto cocci and diplo-cocci, as well as of bacilli in the 
sputum of cases with the often found “mixed infection.’’ This decrease is not 
only as to the total amount of expectoration in patients using the In and Ex- 
haler, but relatively as to the proportion of these evidences found before treat- 
ment was commenced. 
In the connective tissue increase, which always accompanies chronic pulmo- 
nary disease (and an especially prominent feature in fibroid and chronic catarrhal 
pneumonias, chronic pleurisy and bronchitis, and always aggravated in tuber- 
cular infection) we need to get up a resulting opposition to the shrinkage. With 
this inhaling method this is in no small degree accomplished through the artifi 
cially increased density or pressure of the contained air in the lungs during e.r- 
piration. This opposition must be as persistent as is the influence it is intended 
to combat. Hence the convenience of this pocket method, which is always on 
hand for a five or ten minutes use in each of ten or twelve separate hours of the 
day. 
The nasal nozzle addition, lately devised, introduces new uses of the Tn and 
Exhaler. The increased air pressure during expiration should not equal that 
usually employed with the lung method; yet in the head use a certain amount of 
air tension can be seen to be desirable in driving into closed cavities and against 
hypertrophied membranes, the oily, astringent, pungent, antiseptic, soothing or 
anodyne vapors selectible for this method. The inlet valve had better be left 
quite open, and the outlet valve instead of 9-10 to 5-10 shut, as in pulmonary use, 
9-10 to 5-10 open. Even then pressure can be produced (partly indicated by the 
clicking of the closing exit valve during expiration', sufficient to drive the previ- 
ously medicated air into the middle ear, similar to the Politzer air bath method. 
The advantage of this method in poet-nasal catarrh; with extension to the 
middle ear cavities (otitis media and its resulting deafness) and in hypertrophic 
rhinitis can easily be conceived by one of mechanical tendency of mind. 
At the same time the large and extremely sensitive area in the nasal passages 
to receive the impression of menthol producing oils and salts, of antiseptic vapors and 
ofanodyne ethers, makes this way to reach many troublesome ills far bettor than 
to crowd the stomach with drugs, as is too often done for la grippe, headache, hay 
fever, catarrh, fontal neuralgia, angina pectoris and asthmatic or epileptic seizures. 
It is in such conditions as these last mentioned that the nose avenue of using 
the In and Exhaler opens up a new method of relieving a large class of vexa- 
tious, prevalent and even fashionable, although not extremely dangerous, dis- 
eases. Such a little vest pocket device then, suitable as this is to hold and sur- 
render at will, many combinations of healing vapors and soothing odors, is bound 
to prove itself a boon and comfort to many semi-invalids the catarrhal and 
neuralgic degenerates- as well as to those really and seriously ill. 
Now as to the remedies which can be used on the absorbent in the medica- 
ment chamber, the reason a physician cannot ordinarily duplicate the two in- 
halents (one for lung use and one for head use) which go with the Inhaler and 
the two nozzles, as supplied by the Denver Surgical Instrument Co., is that drug 
stores do not make a practice of giving out the finest oils in filling prescriptions. 
•[Reprinted from the Dietetic and Hygienic Gazette of June, 1897.1 They prefer or are accustomed to use the cheaper varieties which are either di 
agreeable or not menthol producing. Take for instance the three followin 
which, by the way, make a very excellent basis for many prescriptions. FirK 
the oil of pine needles, nothing in this line equals Merck’s “Olium Pini Pumifi 
onis” for amount of menthol and delicacy of aroma. Second, the Tyndale Oil of 
Eucalyptus, in fine fragrance and volatility of its menthol principle, is -far 
superior to the many cheap oils found in drug stores, of % or % its original 
cost. Third, the Schering and Glatz Liquid Guiacol furnishes a very useful 
means of carrying the antiseptic creosote principle in volatile form to the mucous 
membranes of the respiratory tract. In the nasal passages the Guiacol vapors 
have an anodyne and benumbing as well as antiseptic effect. This fact renders, 
this preparation especially valuable as a base in conjunction with Eucaine with 
or without Camphor Chloral, the Oleoresin of Lupulin, “A. C. E ,” etc , when a 
soothing influence is needed, as in headache, either of neuralgic character or such 
as accompanies la grippe, coryza, ozena, etc “Eosot” and “Geosot” are also 
excellent. 
It is, however, in spasmodic seizures, such as angina pectoris and some 
epileptiform attacks, where quick relief is desired to be at hand, that this new 
form of the In and Exhaler is quite serviceable. This happens through the ex- 
cellent control that the user has of some otherwise dangerous remedies, as Nitrite 
of Amyl, Chloroform, etc Then no other method equals this, so far as relates to 
the safety, convenience and economy in the amount of such remedies used. A 
few drops of a two to a five per cent solution of Nitrite of Amyl in alcohol is 
sufficient on the absorbent in the medicament chamber for an ordinary attack of 
angina pectoris; and the same can be kept shut up in the inhaler box under the 
patient’s pillow for use as needed at night. 
Or a better form for such cases, and certain forms of asthma, is some modi- 
fication of the following: 
. Eucaine 5 per cent , Nitrite of Amyl 3 per cent., in equal parts of “A. C. 
E.,” Camphor, Chloral and Oil of Eucalyptus; or to two parts “A. C. E.”andoneof 
Choral Camphor, 10 per cent, of Eucaine, and 5 per cent, of Amyl Nitrite can be 
added, and an anodyne effect will be produced by inhaling 5 to 15 drops of it, 
which will be sufficient in five to ten minutes to overcome spasm, to relieve head- 
ache and induce sleep to a degree which cannot be accomplished by dosing the 
stomach with drugs, except by the use of large and injurious quantities. It is 
doubtful anyway if the habit of drug taking has any defense in preference to 
such milder means, especially where only such transient effects are desired. 
It is not intended to infer a claim that this little device is a “cure-all.” Not 
at all. If, as is the author’s custom, this is used in conjunction with an out-door 
life in this rarefied pure air of Colorado; if besides, the patient is individualized as 
to his diet, tonics and personal hygiene; if the help is added which one can derive 
from the assiduous and well directed teaching of an expert in gymnastic train- 
ing, or even, in a case otherwise too difficult or complicated for the climatic cure, 
if one trusts to the immunizing influence of Antiphthisin or Purified Tuberculin, 
he in so far shows that he has no desire to magnify the inhaler’s effects above the 
average of any of these means. It is only as an aid to other intelligent handling 
of a case that this pocket affair is recommended. At the same time it does seem, 
from experience up to date, that this aseptic healing and gymnastic methed 
might prevent many a narrow-chested and thin-blooded youth from ever having 
to resort to a climate like this, if, in the beginning of his trouble, he could 
continuously braced up by this or an equivalent phlmonary method. The 
mechanism of the thing explains where its chief utility lies, namely in forced 
expiration, and herein rests its superiority to ordinary inhalers. 
Other and ordinary methods of inhaling in vogue are most of them opposcuf 
to the principle of distension of the lungs here advocated. The inspiration 
through a medicated sponge, muslin or packed gauze device, obstructing the a c*' 
like nasal obstruction,* has a tendency to draw together the air cells, and there 
is no after exercise effect to counteract this contracting influence in the lungs. 
Consequently, while the affected lung seems to be freed of catarrhal secretions 
by these faulty inhaling methods, the diseased parts are left in a shrunken state, 
i. e., worse than before In obstructed fibroid and catarrhal lung affections the 
inhalation should be free and the exhalation intensified by increased air pressure 
within the chest. 
This purpose is accomplished by assiduous breathing with the In and Exhaler 
for one-fifteenth to one-eighth of the time during the waking hours. A pocket 
device, not larger than a watch, it combines the equivalent in air pressure 
effects to the high altitudes of the Rocky Mountains with the balsamic odors of 
the pine forests of Florida. 
* “ The Causative Relation of Nasal Obstruction to Lung Disease.” By the author.