Hyper-Distention of tie Pulmonary Alveoli 
AS A THERAPEUTIC AGENT IN 
CHRONIC DISEASE OF THE RESPIRATORY 
MUCOUS MEMBRANE. 
BY J. SOLIS COHEN, M.D., 
Of Philadelphia. 
Reprinted from the Medical and Surgical Reporter. 
As mentioned in the last edition of my little 
treatise on “ Inhalation,”* I have long sought 
for an apparatus applicable to the convenient 
administration of inspirations of condensed air. 
All the available apparatus that I have seen are so 
bulky as to practically confine the treatment to 
the office of the practitioner, to the great con- 
sumption of his time, and to the corresponding 
expense of the patient; circumstances which 
necessarily limit resort to this valuable thera- 
peutic agent. The apparatus of Waldenburg, 
figured and described in the volume referred to, 
is very satisfactory, and in the cheap form con- 
structed for the clinical room of the laryngo- 
scopic department of Jefferson Medical College 
Hospital, is not beyond the reach of patients in 
quite moderate circumstances ; but it is by no 
means a portable instrument. And until a 
portable instrument is constructed at a moder- 
ate cost this method of treatment is not likely 
to make much progress in America, despite the 
favor that has been awarded it in Europe. 
It was with great pleasure, therefore, that 
about a" year ago I received a letter from my 
esteemed friend, Dr. W. Y. Gadbury, of Yazoo 
City, Mississippi, detailing me a plan he had 
adopted successfully in a number of instances, 
* Philadelphia, 1876, page 55. 2 
and requesting me to avail myself of my better 
facilities for encountering suitable cases, to put 
his plan to the crucial test from which he was de- 
barred by lack of proximity to a large medical 
centre. 
Dr. Gadbury employs the rubber compressor 
of the hand-ball atomizer; and his plan is as 
follows: The patient, having dilated his lungs 
to their greatest capacity by a forced volun- 
tary inspiration, immediately compresses the 
nasal passages with one hand, while he places 
the tube of the compressor between his lips 
with the other, then closes the lips gently 
upon it, and rapidly works the compressor. A 
few squeezes pump an intermittent current of 
compressed air into the lungs ; and as soon as 
the distention becomes unpleasant, or the 
need of an expiratory movement is required, the 
instrument is withdrawn, to be replaced and re- 
employed in the same manner a few moments 
subsequently; the operation being repeated four 
or five times in succession. 
I have given this plan a trial during the past 
year, in my private practice, and in the clinical 
practice of the hospitals with which I am con- 
nected ; and am in a position to estimate its 
value and capabilities. It cannot be safely em- 
ployed in all the cases in which insufflations of 
compressed air, as supplied from the apparatus 
of Waldenburg and others, are applicable ; but 
it has a sufficiently wide range of utility to com- 
mend it to professional attention ; and in a cer- 
tain class of cases, to which allusion will be 
made presently, it is of greater service than the 
bulky machines adverted to. 
In patients liable to haemoptysis, or other 
hemorrhages, and in certain cardiac and visceral 
disorders, the intra-thoracic compression, if left 3 
to the patient, is apt to be too powerfully exer- 
cised, and thus to be absolutely detrimental; and 
it is to the hands of patients that the instrument 
is to be confided. It is seldom safe to employ 
compressed air with a pressure exceeding from 
one-sixtieth to one-thirtieth of an atmosphere, 
and quite delicate handling of the ball-com- 
pressor is requisite to keep within this limit, 
while the size of the compressor prevents access 
of air in large volume, or at constant pressure. 
Thus, for general purposes, this plan, unmodi- 
fied, cannot supersede the use of more compli- 
cated appliances. 
There is one use of the Gadbury method, how- 
ever, to which I desire to call the attention of the 
profession prominently ; and that is its employ- 
ment as a mechanical expectorant. Time and 
again I have placed the little compressor in the 
hands of a patient with bronchioles and air cells 
clogged with mucus and pus, to see its use immedi- 
ately followed by copious expectoration, to the 
great comfort of the patient. The process is re- 
peated until it ceases to be followed by expecto- 
ration, and then there is absolute or relative relief 
from the desire to cough, until re-accumulation in- 
dicates a renewal of the procedure at intervals of 
a couple of hours, or longer, according to circum- 
stances. I have frequently availed myself of this 
method of clearing the air passages previous to 
careful physical examinations, when abundance 
of moist rales were present, and have been better 
able to estimate the actual conditions of the res- 
piratory organs on auscultation afterward. 
Hence, in chronic bronchitis, of whatever origin, 
compressed air can be employed with advantage 
in this way, to discharge the mucous accumula- 
tions from the air passages, and spare them much 
of the topical irritation to which they are other- 4 
wise subjected. In a few instances I have seen 
chronic bronchitis relieved by the use of this 
method, without any medication whatever, and 
far more rapidly and effectually than follows the 
administration of medicinal expectorants, which 
are too often coupled with the disadvantage of 
interference with the processes of nutrition by 
their nauseant influence upon the alimentary 
tract. 
The physical action of this mechanical expec- 
torant is simple. The hyper-distention of the air 
cells permits the access of air under pressure to 
points beside and beyond the masses of mucus 
clinging to the walls of the bronchioles and 
alveoli, and excites effective cough, which re- 
moves the partially detached masses. Several of 
my consumptive patients clear their passages out 
at bedtime in the manner indicated, and secure 
a good night’s rest, free from disturbance by 
cough, without the administration of opiates. 
When they rise to dress, they clear the parts of 
the accumulation over night, in like manner, and 
attack their breakfast with relish. Some individ- 
uals have little or no occasion to expectorate 
during the intervals, and can pursue their voca- 
tions, relieved of the frequent and recurring 
plague of an annoying and harassing cough. 
The therapeutic advantage of an agent capable 
of doing this much is incontestable ; and it is for 
the purpose of drawing attention to this simple 
and inexpensive contrivance, and of having its 
merits tested on an extended scale, that this ar- 
ticle has been written.* 
*Dr.Cohen presents the above as a preliminary article, 
to be followed, as leisure permits, with a description of 
the adaptation of a blow-pipe contrivance for the same 
and similar purposes, and some remarks on the patho- 
logical conditions in which it may be resorted to with 
prospect of advantage.