Exhibition of an Improved 
Apparatus for the Therapeu- 
tic Use of Compressed and 
Rarefied Air, with Re- 
marks on the Home- 
Treatment of Pul- 
monary Affec- 
tions. 
SOLOMON SOLIS-COHEN, A.M., M.D., 
PROFESSOR OF CLINICAL MEDICINE AND APPLIED 
BY 
THERAPEUTICS, PHILADELPHIA POLYCLINIC 
AND COLLEGE FOB GRADUATES IN MEDI- 
CINE; CONSULTING PHYSICIAN TO THE 
JEWISH HOSPITAL, ETC. 
StJje 'Nrto Yorfe ftteliical journal 
for November 23, 1889. 
KKPEINTED FROM Reprinted from the New Yorlc Medical Journal 
for November S3, 1889. 
EXHIBITION OF AN IMPROVED APPARATUS 
FOR THE THERAPEUTIC USE OF 
COMPRESSED AND RAREFIED AIR, 
WITH REMARKS ON 
THE HOME-TREATMENT OF PULMONARY AFFECTIONS * 
By SOLOMON SOLIS-OOHEN, A. M., M. D., 
PROFESSOR OF CLINICAL MEDICINE AND APPLIED THERAPEUTICS, 
PHILADELPHIA POLYCLINIC AND COLLEGE FOR GRADUATES IN MEDICINE ; 
CONSULTING PHYSICIAN TO THE JEWISH HOSPITAL, ETC. 
The apparatus which 1 Lave the honor to exhibit to the 
fellows of the college is primarily designed for use at the 
home of the patient, though the same features of construc- 
tion which enable it to fulfill this purpose likewise recom- 
mend it for use at the physician’s office; and by multiply- 
ing the number of delivery-tubes and introducing a motor 
and reservoir, it may be adapted for use in hospitals. In 
the “New York Medical Journal” for February 28, 1889, I 
have illustrated the arrangement of an apparatus for hos- 
pitals, permitting the treatment of seventy patients in the 
course of about two hours. The apparatus for inhalation 
of compressed air has been exhibited previously, though 
October 2, 1889. 
Remarks made before the College .of, Physicians of Philadelphia, 2 
AN IMPROVED APPARATUS FOR 
not before this body. But the apparatus for expiration into 
rarefied air has not yet been publicly described. 
My attention had been called to the value of modifica- 
tions of respiratory pressures in the treatment of pulmonary 
affections, and especially of phthisis, even before I became 
a student of medicine, by some rather remarkable recoveries 
ensuing upon such treatment in the practice of ray brother. 
The apparatus which he employed was that of Waldenburg. 
A description of this instrument, by Dr. Pepper, and re- 
marks upon its therapeutic employment by Dr. J. Solis- 
Cohen, may be found in the proceedings of the college 
(Feb. 2, 1876), “ Transactions,’’ third series, vol. ii. 
Much of the success of this therapeutic measure depends 
upon its regular and continuous use. To insure this at 
such times as visits to the physician’s office are impracti- 
cable, the apparatus must be placed in the patient’s home. 
Waldenburg’s apparatus is large and cumbersome. It is 
not continuous in action, its adjustment is troublesome, 
and its cost, fifteen years ago, was excessive. These con- 
siderations induced my brother to undertake some experi. 
ments with the view of providing a substitute which should 
be small, cheap, easily managed by a patient or nurse, and 
reliable as well as cleanly. He, however, abandoned the 
gasometer plan, and his efforts were not entirely successful. 
Taking the matter up where he had left off, I soon realized 
that the only available method of securing a certain, regular, 
and continuous pressure was to return to the gasometer; 
but I found that the desired reduction in size could be ac- 
complished by using the gasometer as a regulator only, and 
not as a reservoir. This necessitated the introduction of 
another source of air supply ; and as the simplest, cheapest, 
and most practicable, I chose the foot-bellows of the den- 
tist’s blow pipe. Any form of pump available under the 
particular conditions, or even city water pressure, might THE USE OF COMPRESSED AND RAREFIED AIR. 
3 
also be adapted; but the bellows is preferable under ordi- 
nary circumstances. This combination of foot-bellows and 
small gasometer solved the problem so far as the inhalation 
of compressed air is concerned. With the assistance of 
Mr. Charles Richardson an apparatus was constructed in 
1883 which has been in continuous use ever since by 
others as well as by myself, and has given complete satisfac- 
tion. Though it has already been described in print,* I 
may be pardoned for again exhibiting its construction, as 
several mechanical improvements have been introduced that 
have not yet been published. 
It consists of a gasometer (“ Compressed air,” Fig. 1), of 
which the air chamber is eight inches in diameter and twenty- 
four inches high. The water chamber is pierced at the level 
of the base of the overflow tank (seven inches from the top) 
with a row of perforations, allowing the water to escape into 
the tank under pressure of air in the air cylinder. The air 
cylinder carries, two inches f from its open base, two shelves, 
one on each side, on which are placed ballast-weights for 
the purpose of lowering the center of gravity, and thus 
maintaining the steadiness of the apparatus. Both shelves 
and weights are perforated to avoid resistance of water. 
As the area of the top of the a,ir chamber is just fifty square 
inches, atmospheric pressure upon it equals, in round num- 
bers, 750 pounds. With the ballast upon its shelves, the 
cylinder weighs ten pounds, giving an excess pressure of j 
atmosphere. Weights are furnished in two sizes, in the 
shape of rectangular blocks of iron 4|- by 2 inches surface, 
and about \ inch and 1 inch thick, respectively. The 
smaller ones are bored out to weigh pound each; the 
larger ones to weigh 2\ pounds each. 
* “N. Y. Med. Jour.,” Oct. 18, 1884, and other places. 
f The shelves have been raised to avoid catching the weight of the 
escape-valve. Fig. I.—Explanation of figure. The parts are numbered in order of attachment, and in the 
direction of air-current; from the window to the mask through the compressed-air gas- 
ometer ; and from the mask to the discharge pipe of the rarefying bellows through the 
rarefied-air gasometer. The discharge-pipe may also be connected with window if desired. 
The direction of air-current is indicated by the arrows. THE USE OF COMPRESSED AND RAREFIED AIR. 
5 
Being placed on top of the air chamber in successive 
pairs (one on each side, to preserve balance), they bring the 
pressure up to any desired amount not exceeding -f at- 
mosphere. Thus: 
Cylinder and bottom weights = 10 lbs. = + -A- atmosphere. 
21 lbs. (two small weights) additional = 12J, lbs. = + -gLu- atmosphere. 
21 lbs. (two small weights) additional = 15 lbs. = + -fa atmosphere. 
3| lbs. (one small weight and one large weight) additional = 18f lbs. 
= + -4XO- atmosphere. 
6) lbs. (one small weight and two large weights) additional =25 lbs. 
= + Yff atmosphere. 
The air cylinder is furnished with two goose-necks, one 
(8) for the attachment of the tube (6, V) from the bellows, 
conveying compressed air; the other (9) for attachment of 
the tube (10,11) connected with the stop cock (12, 13) and 
face-mask (14) or mouth-piece, through Which the patient 
inhales. A perforation two inches in diameter is fitted with 
a*screw cap carrying a hook on which a sponge may be placed, 
which is to he saturated with any volatile medicament (e.g., 
terehene) that may be desired. The cap likewise contains 
a smaller perforation, into which an air-gauge may he fitted. 
When the gauge is not in use this is closed with a rubber plug. 
Still another perforation in the top of the air chamber is fitted 
with a valve, which permits escape of air should too much be 
sent over from the bellows. This valve, which is superior to 
my own arrangement for the same purpose, is the ingenious 
device of Mr. F. Metzger, of this city, who now makes the 
apparatus in every respect according to my instructions, 
and who has devoted much time and care to the details of 
construction in order to secure both strength and lightness. 
The escape valve is composed of two fiat plates of brass, the 
upper perforated, the lower unperforated. They are held 
in apposition by a spring, and when in apposition no air 
escapes. The lower plate carries a chain, thirty-five inches 6 
AN IMPROVED APPARATUS FOR 
long, which is attached to a weight which rests upon the floor 
of the water chamber. Should too much air enter the c} Un- 
der, lifting it too high, the plates are pulled apart, the air 
escapes through the perforated plate, and the cylinder falls 
to the proper level. This obviates any liability to splashing 
of water, which, before this attachment was made, would 
occur if attention was not paid to a line painted on the 
cylinder to indicate cessation of pumping. By means of 
the automatic escape-valve we are enabled to introduce a 
continuously acting pump if desired. 
As an additional precaution against splashing, the air- 
chamber and overflow tank are each provided with a de- 
flecting hood about an inch and a half wide, and inclined 
at an angle of forty-five degrees. 
With these improvements over its original construction, 
being the gradual suggestions of six years’ experience, the 
compressed-air apparatus is felt to be complete. ri here is 
no particular in which I find it deficient, or can now think 
of a change which would increase its mechanical conven- 
ience or therapeutic efficiency.* 
I have for some time been endeavoring to combine with 
it an apparatus for expiration into rarefied air—a procedure 
which has a certain limited degree of applicability, being 
sometimes employed alone, sometimes in combination with 
the inhalation of compressed air. There was no difficulty 
in constructing an apparatus merely for expiration into 
rarefied air. All that was necessary was to reverse the con- 
nection with the bellows, so that the latter would take air 
from the gasometer and deliver it into the room or the 
street, and to suspend the air chamber from a small pulley, 
counterpoising it with weights varied according to the de- 
sired negative pressure. The mechanical arrangement of 
* My friend, Dr. D. D. Stewart, suggests that care be taken that 
the rubber tubes employed are not of the variety weighted with lead. THE USE OF COMPRESSED AND RAREFIED AIR. 
7 
pulleys and weights, the devices for adjusting the weights, 
the lowering of the outer water-tank (now a reservoir, and 
not for overflow), etc., are so obvious and so easily under- 
stood by looking at the instrument before us (“ Rarefied 
air,” Fig. 1) that description in detail is unnecessary. Mr 
Metzger has made the various parts with his accustomed 
care, and has used a wire rope in preference to one of hemp. 
The difficulty lay in the combination of the two gasometers 
into one instrument by means of a bellows which should, 
at the same stroke, compress air for delivery into one 
cylinder and rarefy air in order to exhaust the other cylin- 
der. As we could not get any bellows manufacturer to con- 
struct this, Mr. Metzger at last made an experimental one 
with his own hands (see Fig. 1), and it answers the pur- 
pose perfectly. It is in reality two bellows, mounted back 
to back, on the same frame. The downward stroke of the 
lever compresses the upper bellows and expands the lower 
one. The recoil of the spring in the upper bellows ex- 
pands that one and compresses the other. There is no 
communication between the two bellows. By means of a 
tube (2, 3) passing out of a window-board (1), the external 
opening being protected by wire gauze, the supply of air 
for inhalation is drawn from out of doors. 
When both instruments are used together, as 1 show 
now, being brought into communication through the lungs 
of a patient by means of a double stop-cock connected with 
the face-mask or mouth-piece, the route for the air is as fol- 
lows ; 
(a) From the street, (b) through the upper bellows, (c) 
to the compression gasometer, (<f) thence to the lungs; (e) 
from the lungs (/) through the rarefaction gasometer (g) 
to the lower bellows, (h) which expels it into the room or 
into the street. 
Apparatus for warming, drying, or moistening the in- 8 
AN IMPROVED APPARATUS FOR 
haled air may be interposed at any desired point between 
the window and the patient. 
The compression and rarefaction are made in the re- 
spective bellows. The gasometers act, to a certain extent, 
as reservoirs, but chiefly as intermediate regulating cham- 
bers, rising and falling to maintain a constant pressure in 
exact accordance with the weight placed upon them, and 
independent of the volume of air inhaled or exhaled, their 
available capacity being a little more than eight hundred 
cubic inches. 
For purposes of observation, sufficiently accurate for 
clinical comparisons, though not for physiological data, the 
air chambers carry a scale of cubic inches, enabling us to 
see the approximate volume of air inhaled or exhaled at each 
respiration. 
I have yet to describe the stop-cock by which the in- 
gress or egress of air to or from the face-mask or mouth- 
piece is governed. It is modeled on the cornet-piston, and 
consists of a central barrel, carrying a hollow cylinder, con- 
trolled by a spring, and a horizontal tube, communicating 
freely with the central barrel. The face-mask or mouth- 
piece (14, Fig. 1) is connected with the proximal extremity 
(13) of the horizontal tube; the delivery tube of the com- 
pression gasometer (10, 11) with the distal extremity (12). 
The inner central cylinder contains two, or rather three, 
perforations. Two of these are opposite to each other, 
and, when brought in line with the horizontal tube, form 
with it a continuous channel. In this position air is 
allowed to pass from the compression apparatus through 
the month piece or face-mask to the air-passages of the 
patient. The other perforation has no opposite fellow, and 
is on the side facing the mask or mouth-piece, so that when 
it is brought opposite the horizontal tube the air enters 
from the patient’s lungs, and escapes through the inferior THE USE OF COMPRESSED AND RAREFIED AIR. 
9 
opening (15) in the central barrel. If it is desired to have 
exhalation made into rarefied air, this inferior extremity 
of the central barrel is connected (16, 17, 18) with the rare- 
faction gasometer. If the rarefaction apparatus only is to 
be used, the attachments to the compression gasometer are, 
of course, omitted. 
If it is desired to have the patient exhale into com- 
pressed air, instead of connecting the stop-cock with the 
rarefaction gasometer, we can insert into this lower opening 
(15) an expiration resistance valve, as made for me by 
Messrs. Codman and Shurtletf, of Boston, and described in 
the “New York Medical Journal” for December 3, 1887. 
If it is desired to have him inhale rarefied air, instead 
of connecting the stop-cock with the compressed-air appa- 
ratus, we insert into the horizontal tube (12) an inspira- 
tion resistance valve. 
The “ resistance valves,” which I have called by that 
name because they offer a resistance to the passage of air, 
are simply little cylinders containing ebonite valves con- 
trolled by spiral springs. The tension of the spring is regu- 
lated by screwing the cap of the cylinder, and a scale en- 
graved upon the side gives its value in fractions of an 
atmosphere. The expiration valve is arranged to move 
toward the perforated distal end of the cylinder, thus allow- 
ing the expiration current to escape whenever the pressure 
of the expired air reaches the indicated figure. The valve 
of the inspiration cylinder is arranged to mo mo, from the 
perforated top of the cylinder, thus allowing the inspiration 
current to pass toward the patient whenever the rarefaction 
within the lung reaches the indicated figure. The two 
valves, suitably mounted in one instrument, may be used 
independently of the gasometers (Fig, 2). 
Thus, with these two gasometers, the double bellows, and 
a pair of resistance valves, we are able to obtain the me- 10 
AN IMPROVED APPARATUS FOR 
chanical satisfaction of all the conditions required for any 
of the following therapeutical expedients : 
Fig. 2. 
I. Inhalation of compressed air. 
2. Inhalation of rarefied air. 
3. Exhalation into compressed air. 
4. Exhalation into rarefied air. 
5, Inhalation of compressed air with exhalation into 
compressed air. 
6. Inhalation of rarefied air with exhalation into rare- 
fied air. 
7. Inhalation of compressed air with exhalation into 
rarefied air. 
8. Inhalation of rarefied air with exhalation into com- 
pressed air. 
If a pump and motor are substituted for the foot-bellows, 
the only inconvenience connected with office use of the 
apparatus can be obviated. The additional cost is not ex- 
cessive, and it leaves the apparatus still well within the 
price of any other capable of doing the same work.* 
* Mr. Metzger sells either the compression or rarefaction apparatus 
singly, with all necessary attachments, for $3O, and the double appa- THE USE OF COMPRESSED AND RAREFIED AIR. 
My endeavor has been throughout to use the simplest 
and least expensive methods and mechanical devices, and I 
have tried to induce the manufacturers to reduce their prices 
to the lowest point, in order to secure the widest possible 
and freest possible diffusion of the method, which I look 
upon as one of the most valuable within the reach of the 
therapeutist. The therapeutic expedients most generally 
employed are inhalation of compressed air and exhalation 
into rarefied air, and I shall speak of these only and briefly. 
In using the apparatus the patient should preferably 
stand, but he may sit if necessary. If a face-mask is used, 
it should be accurately adjusted over the nose and mouth, 
and made to lie close to the cheeks to prevent escape of air. 
A glass mouth-piece may be used instead of a face-mask 
in many cases; and it is unnecessary to close the nostrils, 
as the nose and mouth can not be conveniently employed 
together for forced respiration, and there will be no inter- 
ference. Each patient should have his own mask or mouth- 
piece. 
At first the smallest pressures only should be employed 
G?V or eV atmosphere), and these may be gradually in- 
creased according to indications. It is never advisable to 
exceed atmosphere. From ten to fifty or even one hun- 
dred respirations, occupying from five to twenty minutes, 
are made continuously, beginning with the smallest number 
and gradually increasing. After inhaling for a while, say 
ten minutes, a rest of ten minutes or more is taken, after 
which the process is repeated. This may be gone through 
ratus for $6O. With pump and electric motor, the cost would be in- 
creased from $25 to $35 additional. Codman & Shurtleff sell the re- 
sistance valves for $5 a pair. Both manufacturers inform me that the 
time necessary to secure accurate adjustment of all parts of the appa- 
ratus in order to insure uniformity of pressures, and the present limited 
demand for the instruments, render it impossible for them to reduce 
these figures still further, as I have requested. 12 
AN IMPROVED APPARATUS FOR 
with once, twice, or three times daily, according to indica- 
tions. Where the patient has an instrument at his home, 
it is employed more frequently than when it is necessary to 
visit the physician’s office in order to obtain the facilities. 
The physiological effects of these expedients are very 
apparent. The effect upon the circulation of increasing the 
pressure within the thorax, as compared with the pressure 
upon the periphery, by inhalation of compressed air, is, in 
brief, to drive the blood toward the point of least pressure 
—that is, out of the thorax. On the other hand, the effect 
of exhaling into rarefied air, thus increasing the pressure 
upon the periphery, as compared with that within the thorax, 
is to drive the blood into the heart and lungs. 
The effect upon the respiratory act is equally obvious. 
If the pressure within the thorax be made greater than that 
without, expansion will be effected with less muscular effort. 
The air-cells are fully dilated, and occluded areas of lung 
tissue are forced open where the pathological process is 
not of such a nature as to prevent this result. There is 
also pressure upon the inflammatory congeries of new cells 
and upon congested blood-vessels, tending still further to 
increase the amount of available lung tissue, and to a cer- 
tain extent to relieve congestion and promote resolution of 
inflammation. It acts as pressure by means of the bandage 
acts in external inflammations. The activity of the pulmo- 
nary circulation being increased, as well as the activity of 
the systemic circulation, a greater volume of blood passes 
through the pulmonary capillaries in a given time, and is 
exposed to a greater amount of oxygen under pressure— 
conditions which slightly favor the absorption of oxygen. 
As the increased volume of blood carries a greater number 
of corpuscles, theoretically it would seem that there should 
be a greater activity of oxygenation, and this has been con- 
firmed by exact investigations conducted by Waldenburg, THE USE OF COMPRESSED AND RAREFIED AIR. 
13 
Speck, and others, and of which a full summary is given by 
Oertel in his admirable treatise. Subsequent expirations 
are freer and longer, and a greater amount of carbonic 
acid is given out, thus increasing pulmonary ventilation. 
Masses of desiccated secretion, desquamated epithelium, etc., 
are mechanically dislodged and their expulsion by cough 
facilitated, so that at first cough is increased. It is after- 
ward lessened by correction of the conditions producing it. 
In the light of our present knowledge of auto-intoxications, 
the cleansing of the lungs from these decomposing masses 
of effete material must be considered of no little advantage. 
Expiration .into rarefied air facilitates emptying of the 
lungs, and, consequently, contraction of the chest is more 
complete. Subsequent inspirations are deeper. 
By exhaling into rarefied air after inhaling compressed 
air we emphasize the difference between the two pro- 
cesses, and make an alternation of pressure-effects upon 
the vessels. All the effects before noted are thus height- 
ened. An improved respiratory habit—that is to say, a 
fuller, freer, and more regular habitual respiration—is brought 
about, and the gain in vital capacity is very great. Not 
only is the exhalation of carbonic acid favored, but the sub- 
sequent absorption of oxygen is augmented on account of 
the greater extent to which emptying of the lungs has been 
secured. The alternating effects upon the alveoli increase 
the elasticity of the lung tissue. The alternate filling and 
emptying of the vessels stimulates circulation, increasing’ 
both rapidity and volume. 
I am aware that doubts have been cast on the possibility 
of increasing the absorption of oxygen. Be this as it may, 
the effect clinically is to vastly stimulate and increase the 
nutrition of the patient. By careful observation I have 
been led to attribute this increase of nutrition to the ease 
with which the patient is able to dispose of the greater 14 
AN IMPROVED APPARATUS FOR 
amount of nutriment which we administer. A patient over- 
fed hut not taking inhalations of compressed air, will not 
increase so rapidly in weight as one who is overfed and at 
the same time taking these inhalations. A patient taking 
inhalations of compressed air and not overfed will not in- 
crease in weight. I have thought that the great gain was 
due to the stimulation afforded to the secondary assimila- 
tion and to the general metabolism. Tissue respiration and 
the activity of the chylopoietic processes are increased by 
the increased activity of circulation, the heightened blood 
pressure, the augmented pulmonary gaseous exchange, and 
also by the pressure transmitted from the diaphragm upon 
the abdominal organs. Patients with pulmonary troubles 
who are taking iron will take larger quantities and bear it 
better. This is also the case in anaemia and chlorosis. One 
of the earliest manifestations of improvement is promotion 
of sleep, due partly to relief of cough and improvement of 
respiration ; partly, perhaps, to improvement of metabolic 
processes and consequent elaboration of physiological hyp- 
notics. There is also an obvious gain afforded by the exercise 
to the chest muscles, to which a portion of the augmentation 
in vital capacity must be attributed. Some four or five years 
ago I published a number of personal observations on the 
increase in the chest capacity from inhalation of compressed 
air. The results were not so remarkable as some of those 
published by European observers, but they indicated a gain 
of from twenty to thirty cubic inches in respiratory capaci- 
ty, and from half an inch to an inch and a half in chest ex- 
pansion. This was in patients in whom chest expansion 
and respiratory activity had been impaired by condensation 
of the lung from phthisical or pneuraonitic processes, or 
from the presence of pleuritic effusion. Pressure stimulates 
absorption of pleural effusions, and after the effusion has 
been absorbed the inhalation of compressed air tends to THE USE OF COMPRESSED AND RAREFIED AIR. 
15 
hasten the re-establishraent of the normal action of the 
lung. 
In two cases of asthma I have overcome the spasmodic 
dyspnoea of the acute attacks by the inhalation of com- 
pressed air at rather great pressure (-j- to -j- atm.). I 
suppose that the rationale of the effect is, in part, the para- 
lyzing of the spasmodically contracted muscles of the bron- 
chioles by the increased pressure of the air, and in part the 
relief of fluxionary congestion by direct pressure upon the 
engorged vessels, acting somewhat upon the principle of 
Monell’s method of fixing the feet against the foot-board of 
the bed, taking a deep inspiration and holding it as long as 
possible. 
The pneumatic expedient which has afforded the best 
permanent relief in asthma, especially when dependent upon 
emphysema, is, I think, expiration into rarefied air. This 
promotes collapse of the distended air vesicles and tends to 
relieve the lungs of the accumulation within them and, to 
a certain extent, to obviate paralytic distension in conse- 
quence of the presence of a greater amount of air than they 
should normally contain. It can not, of course, restore de- 
stroyed septa. 
I have also thought, in common with those observers of 
largest experience in pneumotherapy, that the inhalation 
of compressed air had some good effect in the treatment of 
dilated heart from the pressure exerted upon the pulmonary 
vessels and cardiac chambers. Latterly I have employed in 
this condition expiration against pressure by means of the 
resistance valve, an expedient still more physiological. I 
have not used expiration into rarefied air in these cases, be- 
lieving it to be counter-indicated, although it has been rec- 
ommended by some. 
There are many other obvious clinical applications of 
this method of treatment, but my object in bringing the 16 
AN IMPROVED APPARATUS FOR 
subject before the college has been more particularly to 
show what can be done mechanically by a simple apparatus 
which may be placed in the patient’s home, and not to refer 
especially to therapeutic uses. These would depend upon 
the views of the physician, and the experience which he 
obtains in the management of the method. The greater 
that experience, the more confidently will he extend it. 
The effects are purely physical and mechanical, and 
easily deducible from a knowledge of the physical and 
mechanical effects upon normal circulation and respira- 
tion. 
The one great advantage of the compressed-air machine 
is that it will enable us to treat at home patients with phthi- 
sis or threatened phthisis; and especially to prevent the 
development of tuberculosis in patients having—perhaps 
with an apical catarrh as well—insufficient expansion, insuf- 
ficient aeration of blood, insufficient nutrition, sluggishness 
of circulation, and impairment of the muscular apparatus of 
the thorax. These patients are often sent chasing around 
the world in the vain search for a restorative climate, but 
very few receive benefit, except, of course, such good as 
may be incidental to an outdoor life. There are, however, 
a very great majority of persons whose circumstances pre- 
clude the possibility of leaving home. I have elsewhere in- 
dicated how we may by a few simple expedients imitate 
many of the features of special climates.* 
I have not had a wonderful number of cases under my 
care, so that I can not give any extended statistics. But 
every year I see several cases of phthisis benefited and 
three or four cases improved in a remarkable manner. 
There is one case in particular which is in my mind, be- 
cause I received a letter from the patient to-day : 
* “Artificial Climatic Effects for ‘Stay-at-Homes,’” “Philadelphia 
Med. Times,” Feb. 6, 1886. THE USE OF COMPRESSED AND RAREFIED AIR. 
It is that of a Bostonian, thirty-two years of age, who 
spent last winter in Philadelphia and, although the weather was 
unfavorable and she had an intercurrent pleurisy, made a good 
recovery. She had a large cavity in the right lung and a smaller 
cavity in the left lung. All of her father’s family except her 
father, and many of her mother’s family, died of consumption. 
Her mother was said to have had consumption, but recovered 
under open-air life, forty years ago, and is hale and hearty. The 
father, who is some sixty-five years old, has fibroid phthisis, and 
is now breaking down. She was seen by Professor Da Costa at 
the beginning of the treatment and at the end, and he was able 
to verify both the pulmonary conditions and the great gain. 
When she began treatment her weight was 107 pounds; when 
she left Philadelphia in May it was 135 pounds, and in a letter 
received to-day she states that she now weighs 152 pounds. 
She had an evening temperature of 100-5° F., and all the trouble- 
some symptoms of phthisis in the stage of softening. She went 
home with normal temperature and troubled only by more or 
less coughing, which has steadily decreased. The treatment 
was simply that of nutrition, overfeeding with nitrogenous 
and fatty aliments, whisky and hot water, aided by inhalation 
of compressed air, which enabled the increased quantities of 
food to be disposed of. The patient was kept out of doors as 
much as possible, and instructed to take deep and slow respira- 
tions continuously. Medication was principally symptomatic, 
for relief of cough, for disinfection of the alimentary tract, or 
for stimulation of digestion. She was given at different times 
creasote, iodoform, arsenic, amyl nitrite, and compound spirits 
of ether, with inhalations of terebene, chloroform, or ethyl 
iodide from the Yeo (perforated zinc) respirator, or from the 
Oliver nebulizer. I must not forget to add, in defense of a 
method of treatment now abused in neglect, as formerly in ex- 
travagant use, that the Bergeon injections of hydrogen sulphide 
and carbon dioxide served a useful temporary purpose in con- 
trolling a recurrent suppuration in the partially healed cavity of 
the right lung, following the pleurisy. 
This woman evidently inherits a consumptive diathesis—but 
also a good recuperative force, which only required to be put 18 
THE use of compressed and rarefied air. 
under favorable conditions. She had a machine at her hotel, 
and she obeyed orders as to diet with religious exactitude. 
Patients who recover like this, stay recovered. I have 
two patients treated in 1883 and reported in 1885, who 
are still well; and some of ray brother’s cases referred to 
at the opening of these remarks have been well for twelve 
and thirteen years. Even patients that do not recover can 
be greatly improved. Life is not only prolonged, but it is 
made much more comfortable. And to return to what I 
deem the most important considerations, the treatment is 
essentially a home treatment, and it is within reach of 
those of moderate means. REASONS WHY 
Physicians Should 
Subscribe 
FOB 
The New York Medical Journal, 
Edited by FRANK P. FOSTER, M.D.,” 
Published by D. APPLETON & CO,, 1, 3, & 5 Bond St. 
I. BECAUSE : It is the LEADING JOURNAL of America, and 
contains more reading-matter than any other journal of its class. 
2. BECAUSE : It is the exponent of the most advanced scientific 
medical thought. 
3. BECAUSE; Its contributors are among the most learned medical 
men of this country. 
4. BECAUSE : Its “Original Articles” are the results of scientific 
observation and research, and are of infinite practical value to the 
general practitioner. 
5. BECAUSE ; The “Reports on the Progress of Medicine,” which 
are published from time to time, contain the most recent discov- 
eries in the various departments of medicine, and are written by 
practitioners especially qualified for the purpose. 
6. BECAUSE : The column devoted in each number to “ Therapeu- 
tical Notes” contains a resume of the practical application of the 
most recent therapeutic novelties. 
7. BECAUSE : The Society Proceedings, of which each number con- 
tains one or more, are reports of the practical experience of 
prominent physicians who thus give to the profession the results 
of certain modes of treatment in given cases. 
8. BECAUSE : The Editorial Columns are controlled only by the 
desire to promote the welfare, honor, and advancement of the sci- 
ence of medicine, as viewed from a standpoint looking to the best 
interests of the profession. 
9. BECAUSE : Nothing is admitted to its columns that has not some 
bearing on medicine, or is not possessed of some practical value. 
10, BECAUSE: It is published solely in the interests of medicine, 
and for the upholding of the elevated position occupied by the 
profession of America. 
Subscription Price, $5.00 per Annum. Volumes begin in January 
and July.