Pyridine in the Treatment of 
Asthma. 
BY 
JOSEPH S. NEFF, A. M., M. I)., 
PHILADELPHIA, 
ATTENDING PHYSICIAN TO THE PHILADELPHIA HOSPITAL 
AND TO THE JEFFERSON MEDICAL COLLEGE 
H08PITAL, ETC. 
REPRINTED FROM 
<EI)c "Neto York jWe&ical journal 
for March 13, 1886. Reprinted from the New York Medical Journal 
for March 13 1886. 
PYRIDINE 
IN THE TREATMENT OF ASTHMA* 
By JOSEPH S. NEFF, A. M., M. D., Philadelphia, 
ATTENDING PHYSICIAN TO THE PHILADELPHIA HOSPITAL AND TO THE JEF- 
FERSON MEDICAL COLLEGE HOSPITAL, ETC. 
It was at the instigation of my colleague, Dr. J. C. 
Wilson, that Mr. Louis Genois, Pharmacist, 1410 Walnut 
Street, first procured this drug, and to him I am indebted 
for its use. Pyridine has been known in chemistry for 
some time, Etarde and Caliours having discovered a pyridic 
nucleus in nicotine in 1880. Its use in medicine, however, 
is novel, as the first mention of it was made in a paper read 
by Germain See before the Academy of Sciences last June. 
He had remarked so frequently the benefit derived from 
empiric and secret formulae, to which he was so often forced 
to resort, that he endeavored to ascertain the true physio- 
logical agent to which these results could be traced. To- 
gether with Bochefontaine, he instituted a chemical analysis, 
showing that their action was due to a uniform base de- 
veloped by the combustion of certain plants and alkaloids, 
as, for example, chinoninc, pilocarpine, atropine, nicotine, 
and morphine. It has also been found by Wohl and Eulen- 
berg (“ Bulletin gen. de therapeutique medicale, chirurgicale, 
* Read before the Philadelphia County Medieal Society, January 27, 
1886. 2 
PYRIDINE IN THE TREATMENT OF ASTHMA. 
et obstetricale,” June 30, 1885) in tlie condensed products 
of tobacco-smoke, and during the destructive distillation of 
dry organic matter in the products of bony tissue and coal 
tar. 
The name pyridine is derived from the Greek word irvp 
(pyr), meaning fire, indicative of its source of preparation ; 
when pure, it is a clear, colorless liquid, with a specific 
gravity of 96, boiling at 274° F., inflammable, having a strong 
penetrating odor, evaporating in the air at ordinary tem- 
peratures, and miscible with water in all proportions. Its 
chemical formula is C6IIBN, being that of a base belonging 
to a series of bases of which picoline (CeH7N) and lutidine 
(C7HflN) are the most important, being analogous to the ani- 
line bases, and it forms salts with the mineral acids, which are 
very soluble but easily disintegrated; the latter constitutes 
one of its difficulties in administration. S6e’s* experiments 
show that the sensibility of the pneumogastric nerve and 
the excitability of the medulla oblongata are decidedly 
diminished in the dog. “ The blood-pressure, which is 
14° ctm. of mercury in the normal state, rises to 32° ctm. 
upon central excitation of the pneumogastric, severed in the 
neck. After the injection of one gramme of pyridic nitrate, 
practiced twenty times, the arterial tension gradually fell, 
and, if centripetal excitation was repeated, the pressure re- 
mained unchanged—that is, the gray substance of the spinal 
cord had lost its reflex power.” 
Physiological experience at first would indicate a simi- 
larity to the action of nicotine—contraction of the pupils, 
dyspnoea, convulsions, and death ; this I have not found as 
yet to be the case. Owing to my inability to procure a 
proper combination for internal use, I have been compelled, 
in administering it to the lower animals, to use it in the form 
of vapor, and the observations are not sufficient to warrant 
* “Bulletin generate de therapeutique,” June, 1885. PYRIDINE IN THE TREATMENT OF ASTHMA 
3 
positive conclusions; but I would express the opinion that 
in the healthy animal the respirations are at first quickened, 
then slowed, the pupils are but little affected, there are no 
convulsions or dyspnoea at any time, but drowsiness and 
stupor. The respirations become slower and slower until 
they cease. After death the heart continues to beat for a 
considerable period, the cavities containing black fluid blood. 
The method of administration is by inhalation, as it can 
not be given by the mouth or subcutaneously, owing to its 
excessive irritative action in the first place, and to the in- 
stability of its salts in the second. The direct application 
of the drug to the nose or mouth provokes nervous troubles, 
as well as irritates the mucous membrane. 
I have suggested the use of capsules, but its volatility 
prevents the closure of those made of glass, and its perma- 
nence in those made of gelatin. I think that proper com- 
binations may be made to be inhaled directly from a bottle 
or towel. I have used from two to four grammes at a sit- 
ting, poured upon a saucer, placed in one end of a small 
room with doors and windows closed, or, what is better 
still, a large closet, and allowed the patient, sitting a little 
distance from it, to inhale the pyridic vapors mixed with 
the air. The absorption is immediate, the drug being de- 
tected in the urine in a few moments. 
Upon the healthy adult, as shown in assistants, 
and nurses, there has been almost universally a flushing of the 
face, with quickening of the pulse and respiration, the latter 
lasting but a few moments, the former from fifteen minutes 
to ten hours, depending largely upon the length of time of 
inhalation. In several instances temporal headache of a 
slight character has persisted for several hours; at times a 
peculiar full sensation approaching giddiness is experi- 
enced. 
The fact that in the healthy the pulse and respiration 4 
PYRIDINE IN TIIE TREATMENT OF ASTHMA. 
are quickened for a few minutes does not hold good in 
asthmatic patients, for, almost without exception, the heart’s 
action, which previously may have been accelerated, slowly 
falls to the normal, without change in character or rhythm ; 
and less rapidly the respirations, which become slower, easier, 
and more full, the intense longing for air disappearing, with 
diminution of the oppression. 
In most cases there is a desire to sleep, which in some 
becomes irresistible; this resembles, however, normal sleep, 
from which they are easily aroused, and without insensi- 
bility or loss of intelligence, thus distinguishing it from the 
sleep produced by narcotics and anaesthetics, although there 
is a slight loss of muscular reflex action. 
I have used this preparation many times in a series of 
twelve cases of asthma. Brief histories of a few will, however, 
serve to show its clinical action. [For the careful attention 
to every detail in taking notes on many of the following 
cases I am indebted to Dr. D. H. Lake and Dr. John Da 
Costa, resident physicians in the Philadelphia Hospital.] 
Case I.—Jane T., aged sixty-five, white, admitted to Phila- 
delphia Hospital (Ward 2, bed 12) early in October, 1885. Has 
suffered for many weeks from severe asthmatic paroxysms ; rest- 
less and wakeful at night; spends most of the time sitting up, 
occasionally rushing to the window for air. Complains also of 
a constricted feeling around the chest. Kidneys normal ; lungs 
are slightly emphysematous; heart shows advanced muscular 
degeneration. Patient was placed upon quebracho with slight 
benefit, but, owing to nausea, she refused to continue its use. 
October 15th.—During a paroxysm, respiration 42; pulse very 
weak, 84; one gramme of pyridine was prepared for inhalation. 
After five minutes, pulse was 80, respiration 30; fifteen minutes, 
pulse 78, respiration 24. Breathing became easy and lost its 
irregular character; cheeks red ; in twenty-five minutes seemed 
half asleep; respiration 20, pulse 78, strong. She was put to bed 
at once; fell asleep. Four hours after, was still sleeping, but it PYRIDINE IN THE TREATMENT OF ASTHMA. 
5 
was not profound, as she awoke on the doctor feeling her pulse, 
but went to sleep immediately after. Cheeks still red; slept the 
remainder of the night. 
The following day respiration and pulse normal. 
October 20th.—During past five days there has been no re- 
turn of paroxysms, some little dyspnoea occurring on exertion. 
Present time quite a severe onset; before inhalation, pulse in- 
termittent, 96; respiration 36. Grm. 3 pyr. used at 3.15; 3.35, 
pulse 84, regular, and fuller, breathing, twenty-two times per 
minute, quiet and without exertion. The last sitting took place 
October 25th, the patient being discharged a few days later en- 
tirely free from asthmatic attacks. She still had slight dypsnoea 
upon exertion. (Fatty heart.) 
Case II.—Anne D., aged fifty-two, chronic bronchitis, with 
morning asthma. Admitted to Philadelphia Hospital (Ward 2). 
The iodides were not tolerated ; quebracho gave but slight re- 
lief; morphia, however, was of decided benefit. 
October 23d.—Two grammes of pyridine were used at 10.45. 
Pulse 90, respiration 38, great distress in obtaining air; 10.58, 
pulse 84, respiration 21; 11.05, pulse 78, respiration 18; 11.15, 
after cold air had been allowed to enter room for five minutes, 
owing to the oppressive heat of the apartment, the pulse was 
102, respiration 24 (evidently due to excitement). 
Breathing was very irregular, cheeks red; complained of 
feeling dizzy, and, on endeavoring to stand up, fell over. In a 
few minutes she started to walk, which she did like a person 
intoxicated. She was drowsy and inclined to sleep all day, but 
felt very comfortable and much relieved. 
25th.—Next paroxysm, pulse 90, respiration 34 and extreme- 
ly difficult. After fifteen minutes, pulse 84, respiration 24, com- 
fortable, with no repetition of unpleasant symptoms previously 
experienced. This patient had but one attack up to November 
1st, when sbe insisted upon being discharged, feeling able to re- 
sume her duties as domestic. 
She was readmitted in December on account of severe cold. 
I may add that there was some dilatation of the bronchial tubes, 
with hronchorrhoea. Although under constant observation to 
the present lime, there has been no return of asthmatic seizures. 6 
PYRIDINE IN THE TREATMENT OF 
ASTHMA. 
Case III.—Sallie K., aged forty-four, admitted January 13, 
1886 (Ward 2). Asthma dating from childhood, never having 
been free from attacks for over a month at a time. There were 
marked emphysema and some dilatation of the tubes; patient 
was robust and apparently well nourished. Being thoroughly 
conversant with the therapeutics of this disease, she stated that 
she never had relief from any drugs—commenting upon a large 
number—except the iodides, which she had been taking off and 
on for twenty-seven years. 
January 22d.—A severe paroxysm occurred. Respiration 
44; pulse weak, 120; body bathed in a cold sweat; some cya- 
nosis. After using 2 grm. of pyridine for twenty minutes, the 
breathing became normal. After inhalation the patient walked 
up three flights of stairs without trouble. No drowsiness. 
21fth.—Was seized while in the hospital yard with another 
severe attack. She was again in great distress, and occupied 
fifteen minutes in walking 150 yards to the room for inhalation, 
where 2'8 grm. of pyridine were used. Upon entering, pulse 
144, respiration 32, very labored, great depression, and cyano- 
sis. After thirty-five minutes, respiration 24, pulse 108; wheez- 
ing absent, and breathing free. 
Case IV.—Annie , colored, admitted January 23d to the 
Philadelphia Hospital, with advanced syphilitic phthisis. Very 
much exhausted, pulse 120, weak, and compressible. History 
of daily asthmatic seizures for some time. Breathing labored, 
not increased in frequency . She was allowed to inhale the va- 
por from 2 grm. of pyridine for five minutes, at which time 
there was no change in the character of the respirations, and, as 
the pulse was still weak and very compressible at 100 per min- 
ute, the patient was removed to the ward. 
Case V.—W. A., male, aged twenty-eight (private practice). 
Nervous pulmonary asthma, poorly nourished, anamiic, subject 
to frequent attacks of bronchitis; no emphysema or organic dis- 
ease. Family record phthisical. Had marked paroxysms for 
one week, recurring in the mornings between two and four 
o’clock. The remedies in general use were employed, for com- 
parison, during five mornings, including fluid extract of que- 
bracho, lobelia, the various fumes from burning pastils, stra- PYRIDINE IN THE TREATMENT OF ASTHMA 
7 
monium, etc. Notwithstanding treatment, the patient was 
never able to sleep after the onset, with the exception of the 
fifth day of treatment (or thirteenth of the disease), when mor- 
phia was administered hypodermically. The following night 
he inhaled the vapor from 3 grm. of pyridine placed in a large 
closet. At first, owing to fright, the pulse, and with it the res- 
pirations, were slightly quickened, but after five minutes both 
became slower. In fifteen minutes respirations were perfectly 
free. He was allowed to remain fifteen minutes longer, when 
he returned to bed complaining of some temporal headache and 
drowsiness. lie slept until his usual time of rising, when there 
were no unpleasant symptoms. The next night the paroxysm 
returned a little later than usual. The drug was administered 
as before, with the same beneficial effect. This time there was 
no acceleration of pulse or respiration upon starting the inhala- 
tion, nor was any headache noted, although drowsiness was 
present after a sitting of twenty-five minutes. 
The following night no well-marked seizure occurred, al- 
though the patient took a seance of fifteen minutes. 
A mild attack occurred the next night. Inhalation as be- 
fore. 
Three nights following, did not awaken. 
Thirteenth night of treatment he awoke at 4 a. m. and stated 
that he felt oppressed, when he resorted to the remedy as usual. 
There was no typical seizure, and I am inclined to think there 
was no threatening of any. There has been no return of asth- 
ma since, the last paroxysm occurring December 19th. 
These few cases will serve as an illustration of the twelve 
that fell under my observation. Four were in females, eight 
in males; the ages ranged from twenty-six to sixty-five, 
divided as follows: 
Nervous pulmonary asthma, 3. No return of attacks 
in any. 
Cardiac asthma, 3. All were relieved of attacks. One 
remained under observation three months, and one for two 
weeks only. 8 
PYRIDINE IN TIIE TREATMENT OF ASTHMA. 
Bronchial asthma, 3. In one there was no return dur- 
ing ten weeks’ stay in the hospital. The two others were 
relieved of their attacks and insisted upon their discharge, 
being under treatment less than three weeks. 
Asthma in advanced phthisis, 2. In one there was but 
slight relief during the paroxysm; in the other there was 
absolutely no benefit. 
Asthma as a complication of gout, 1. No return in a 
month. Albuminuria from interstitial nephritis was present. 
Of the fourteen cases reported by See, four were in 
females, ten in males, from thirty to sixty-eight years of 
age. Nine were what he terms “pure asthma,” all of 
which were more or less relieved, and five cases of cardiac 
asthma. 
In one case of twelve years’ duration pyridine caused 
nausea and vertigo after eight days of treatment, which ne- 
cessitated its discontinuance, although great relief 'was ob- 
tained. Nausea I have not seen; vertigo but once. 
In one or two cases where the expectoration had been 
purulent it lost that character after the inhalation. 
All unpleasant symptoms seem to be confined to cases 
with long-standing emphysema, or valvular or degenerative 
heart disease, with small, irregular pulse. In young, robust 
people with “simple” pulmonary asthma there seems to be 
drowsiness alone. 
Since these observations * were made I have noted, in a 
more recent report by Lublinski,f one case of marked tre- 
mor of the limbs with nausea, and another with vomiting, 
dizziness, and severe headache. In all of these, however, 
the length of time of each inhalation was prolonged from 
one to one and a half hour. 
* Report of a clinical lecture delivered November 11th at the Philadel 
phia Hospital. “Medical and Surgical Reporter,” December 5, 1885. 
\ “Deutsche Medizinal-Zeitung,” Beilin, November 5, 1885. PYRIDINE IN THE TREATMENT OF ASTHMA. 
9 
The beneficial results obtained from this remedy seem 
to be from its action on the sympathetic and the medulla. 
Any depressing effects on the heart noted in Case IV 
would seem due rather to the interference with the pul- 
monary functions, death being caused, in the lower animals 
at least, by paralysis of the respiratory centers. 
Pyridine is not to be classed as a curative agent. Most 
likely its greatest value will be seen in cases of simple or 
nervous pulmonary asthma, when the iodine preparations 
can not be borne, or nitro-glycerin and sodium nitrite are 
contra-indicated. Although in the bronchial or catarrhal 
forms of the disease the relief of the paroxysms has been 
marked in ninety per cent, of the eases treated, of the re- 
maining number nearly all had emphysema of long standing. 
In asthma occurring in advanced phthisis the drug 
should be given with care on account of the small amount 
of lung tissue left unaffected, especially where there is a 
great degree of consolidation with fibroid induration, as in 
Case IV, when, perchance, the spasm may be relieved, but 
few air vesicles remain in condition to respond. Here at 
least morphine will hardly be superseded. 
I have used pyridine in several forms of dyspnoea occur- 
ring in different diseases wdthout much benefit. 
In phthisis the recurring dyspnoea and orthopnoea are 
relieved during the period of inhalation only, returning in 
a few moments, and at times with increased violence. 
With so little experience, this drug must be adminis- 
tered with a certain degree of caution until its action is 
thoroughly understood, severe or persistent headache, nausea, 
vomiting, and vertigo acting as danger signals, warning us 
to proceed with care. 
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