S. Place a drop on a cube of sugar and dissolve in the mouth. After any steam inhalation the patient should not go out into the open air for a number of hours. If more continuous inhalation is desired, various simple apparatus, made of fine wire mesh covering a cotton or absorbent pad for the medicament, may be obtained and fastened over the nose and mouth. These inhalers will probably prevent contagion. A gauze mask may prevent an individual infected with influenza or other germs from spraying the atmosphere and therefore spreading contagion. Whether these gauze masks will prevent the inhalation through this open filter of the minute germs of disease is another question. Asthma has long been treated by inhalations with the object of administering medicaments that relax spasm of the bronchial tubes, by a sedative action on the peripheral nerves in the upper air passages or by allaying irritation and inflammation of the larynx, trachea, and upper bronchial tubes. Most of the papers, pastiles or powders that are burned and inhaled for asthma contain potassium nitrate (giving some nitrite action) and stramonium, more frequently than any other atropine carrying drug. The beneficial action from the stramonium is due to its atropine, and atropine dulls the peripheral nerves, while nitrites relax spasm. Cocaine and morphine have been added to such inhalations, but such medication is rarely justifiable. If these drugs are given, the physician must understand that he is likely to cause the necessity for more such doses and perhaps cause the formation of a habit. ATOMIZATION The upper air passages are more frequently and directly treated by atomizers or by spray apparatus. In the physician's office such treatments are given by electric (or other) pumps forcing the medicated liquid through fine spray points. At home various simple atomizers may be used to advantage under certain conditions. When using pumped or compressed air the spray must not be sent at too great pressure, especially into the nasal passages, else injury to the mucous membranes may be done. The greatest advantage of atomizing, when gargling or swashing are not advisable, is to wash away with some mild alkaline solution (best warmed) the mucopurulent and purulent secretions of the nose, nasopharynx, mouth, tonsils, and throat. Also the spray from the atomizer may be directed to the part that needs such treatment. Most any of the mild alkaline mixtures that are in vogue may be used for cleansing and soothing purposes. The liquid preparations should generally be diluted with two or three parts of warm water. The so-called "Alkaline Antiseptic Tablet" should be dissolved in about 50 mils of warm water. The main advantage of an alkaline soothing wash or spray is obtained from about the following combination, however such a mixture containing them may be camouflaged: R Sodium chloride.. Gm. or mil I. I. 100. To this may be added wintergreen or peppermint flavor, and small amounts of eucalyptol or thymol, if desired. After cleansing the parts with an alkaline spray or wash, if a medicament is advisable it may be then applied, as a weak suprarenal solution for local contraction of blood-vessels; some mild silver solution as 5 per cent. argyrol (stronger solutions are better applied by a swab); a tannic acid solution; an iron solution; or an iodine solution. If the condition to be treated is an infection, as follicular tonsillitis, after washing off the surface mucus and pus, hydrogen dioxide solution, diluted with an equal part of warm water, may be sprayed on the part, to be quickly followed by some alkaline wash; or a boric acid solution may be used. Applications of tincture of iodine (full strength or diluted) to some particular part of the throat or mouth, where its germicidal action is required, are often made. Other valuable applications are boroglycerin, Lugol's solution (Liquor lodi Compositus), various silver solutions, and sometimes iron solutions, depending on the particular object to be attained. Various oils, applied by means of an atomizer, are especially valuable for the mucous membranes of the nose when the nose has been douched or sprayed, before the patient leaves the office to go into the outside air. Most oil sprays have a very pure mineral oil as a base, and contain one or more of the following medicaments: menthol, thymol, camphor, oil of santal, pine oil, eucalyptol, oleoresin of cubebs, and some aromatic. If they are used too frequently on the mucous membranes of the nose, throat and larynx, they do harm by drying the membrane; a normal amount of mucous secretion is a protection. Whether oil protection is used or not, after spraying the nostrils, if the patient is going directly into the outside air, a pledget of cotton or medicated lamb's wool should be placed in the nostrils, to remain for an hour or more. Simple pocket inhaling tubes containing menthol, camphor, oil of eucalyptol, thymol, and pine oil medicaments can be obtained. They are supposed to aid in aborting colds, and it is quite possible that sometimes they do. Pungent ointments are often applied to the nostrils for colds. The following combination is a suggestion for such a purpose: Insufflations of powders by means of a powder-blower is another method of local treatment of the nose and throat. The most used powders for this purpose are boric acid, bismuth subgalate, and diluted tannic acid powder. The most valuable is boric acid, as it tends to promote the secretion of mucus from the membrane and aids in removing other exudates, and also leaves the surface of the membrane moist and not dry, which always promotes the health of mucous membranes. Before leaving this subject let it be emphasized that both the layman and the physician often use too active and irritant gargles and sprays on the membranes of the mouth, nose and throat. It should be the aim to gently cleanse and carefully treat infected areas and to promote the normal secretions of these membranes, and not to destroy sensitive and tender tissues or to impair their normal resistant and recuperative power. NASAL DOUCHING Nasal spraying has already been described. Nasal douching is valuable for certain conditions, but may be harmful in any condition if not properly done, and, like nasal spraying, it may also be done too frequently. Its greatest value is in ozena. Nasal washing is much recommended as a preventive of "colds," by cleansing the nostrils of dust, irritants, and germs as soon as the indvidual returns to his home, and before going to bed if some other member of the household has a coryza, a sore throat, or is coughing. Nasal douching or washing is advisable, when properly done, in antrum disease. The danger from improper nasal douching is that fluid containing substances that cause irritation and infected mucus may be forced not only into healthy antrums but into the eustachian tubes, and later cause inflammation of the middle ear. Therefore, the pressure must never be sufficient in the nasal passages or in the nasopharynx to force the fluids in these directions. Toward this end, the nostrils should not be completely plugged with the nozzle of the douching apparatus, or at least there should be free exit somewhere for the fluid injected. A safe method for cleansing the nostrils is to snuff up fluid placed in the hand, or in a receptacle. The very fact of snuffing causes the fluid to pass back into the pharynx where it can be expelled through the mouth. It cannot by this means enter the eustachian tubes. Many nasal douches on the market are dangerous because they plug the nostril, and the pressure in the nasopharynx becomes abnormally great. When nasal douches are given by a siphon, the fluid flowing from an elevated receptacle, the elevation of the reservoir must not be higher than the patient's head else the pressure will be too great. For cleansing purposes the mildest alkaline solutions are used. Half a teaspoonful of bicarbonate of sodium and an equal amount of sodium chloride to a pint of warm water makes a cleansing, non-irritant, soothing douche. If an antiseptic is required, boric acid or sodium borate may be used in a warm, one per cent. solution. Other stronger antiseptics or deodorants may be advisable in ozena. In douching for nasal and nasopharyngeal cleansing the liquid should enter the nostril that is the most stopped, in order for the fluid to have a freer outlet than inlet. This greatly diminishes the danger of forcing liquid or secretion up the eustachian tubes. After douching the head should be held forward and downward, allowing the fluid to drain out; also both nostrils should be blown at the same time. GARGLING Though gargling is one of the most effective methods of cleansing the tonsils and pharynx, but few individuals know how to gargle. The patient should first take a deep inspiration, then taking a suitable amount of liquid into the mouth (not more than would represent two swallows for the individual) he should make an abortive attempt to swallow, with the mouth held open. He cannot swallow into the esophagus with the mouth open. He then immediately begins to expel air through the fluid, and this bubbling will agitate the fluid enough to properly wash off the pharynx and tonsils. To clean the nasopharynx, at the end of the gargling process he should throw his head quickly |