Mostafa Ahmed SHEHATA.HISTORY OF INHALATION THERAPY.

10/22/10 11:39 AM

PROCEEDINGS OF THE FIRST INTERNATIONAL CONFERENCE “TRADITIONAL MEDICINE AND MATERIA MEDICA IN MEDIEVAL
MANUSCRIPTS” (BAKU, 12-14 JUNE, 2006)
__________________________________________________________________________________________________________________.

HISTORY OF INHALATION THERAPY

Prof. Dr. Mostafa Ahmed SHEHATA
Alexandria University, Alexandria, Egypt.

Inhalation therapy is the intake of medications through the nose or mouth for therapeutic purposes by natural
or helped respiration. Ancient man discovered the therapeutic material by trials and observation. In this may
he used many plants, minerals and organic materials for the treatment of his body troubles.
Inhalation of powder, smoke or vapour of the dry, burnt or boiled medications was well known at that
ancient time.

The religious ceremonies in ancient Egypt, Babylon, India and China were usually practiced in an
atmosphere of burning incense and fumigating odorous material. The evolved odour inhaled by the
attendants gave some relief of the respiratory troubles, calmness and self comfort that were needed at such
holy circumstances (1).

Ancient Egyptian Medicine:

Credit goes to ancient Egypt for the first use of inhalation therapy for the treatment of the oral, pharyngeal
and chest troubles. Many prescriptions in the Ebers and Berlin medical papyri, written four thousands years
ago report the first use of inhaled dried medicinal plants, boiled medications or the smoke of some burnt
material, in the form of nasal snuff, oral insufflations or vapour inhalation (2) (3) (4).

The main medicinal plants and minerals that were used for inhalation therapy at that time were Benzoin,
Hyocyamus, Cucumis, Cannabis, Alum, Jesminum, Bitumen and Arsenic Sulphide (3) (4). The vapour of
boiled leaves of Frankincense and Commiphora was described for the relief of the throat and chest troubles
(4) (5).

Special pots and clay containers for the preservation and use of such plants and their powders were used (2).

The Babylonian civilization was contemporary to the old Egyptian era. Physicians knew many drug
prescriptions and used them by different means for inhalation. Their medications were mostly non-
materialistic, highly mixed with mythologies and superstitions (7).

The Greek medicine, flourished at the fourth century B.C. and its physicians quoted a lot of the Egyptian
medicine. They used burnt incense extensively, beside the inhalation of many dried plants. Galen the late
Greek physician (130-201 A.D.) described the powdered snuff of many medicinal plants and the inhalation
of their volatile vapour and smoke for the treatment of nasal and head troubles (7) (11).

The Persian physicians before the seventh century B.C. recognized inhalation therapy. Their well known
king and physician Jamshid described the inhalation of the volatile vapours of boiled roses, flowers, musk,
eucalyptus and ambergris for the relief of respiratory troubles(9)(22)(24).

In ancient India, physicians used some forms of drug inhalation. The well known one was Cannabis indica.
Its burning fumes were required for sedation and narcosis (31).

The Romans were very keen to establish good sanitation and public hygiene. They constructed public baths

http://www.aamh.az/index.files/28.htm Page 1 of 6
Mostafa Ahmed SHEHATA.HISTORY OF INHALATION THERAPY. 10/22/10 11:39 AM

in their old cities, supplied with cold and warm water. In these places steam inhalation was available that
gives some health comfort to respiratory troubles (7) (21).

The Arab civilization flourished at the eighth century and gave a good progress to medical practice. They
revolutionised the inhalation therapy in technique and indications, with the addition of many medicinal
plants and minerals to inhalation therapy.
They modified the use of public baths to give a therapeutic role, by the addition of volatile medicinal plants
to the warm water, patients were submerged to the level of the neck in warm water, covered by a blanket to
retain the vapours for inhalation. They can be considered the pioneer organisers of the recently developed
baths of Sauna (16) (21).

They added many new medicinal plants to inhalation therapy in the form of powder for sniffing, volatile
vapour for inhalation or burnt smoke for breathing. The most important ones were Eucalyptus, Mint,
Benzoin, Thymol, Violet, Musk, Helleborus, Saffron, Mustard, Camphor, Cloves, Birthwort, Bine, Fennnel,
Lavander and Jasmine.

The dried leaves, roots or barks of these plants were the material for inhalation for the treatment of the
throat, larynx and chest troubles beside the relief of several head and body troubles (10) (13) (15) (16).

The Arab physicians are credited by developing the first inhalation anaesthesia at the ninth century under the
name of Al Marquad (General Anaesthesia). Powdered Opium, Hyocyamus, Mandrake and Henbane
dissolved in water and imbibed by a sponge, to be used by inhalation at surgery. It gives good sedation and
narcosis that was required at surgical operations (11). This inhalation anaesthetic method was first described
by the Arab physician Isa bin Ali at 910 and confirmed by Avicenna (980-1037) and written in details by
Ibn Al Quff (1233-1286) in his book Al Omda (19)(20)(23). The contemporary German historian Dr Sigrid
Honke assured the fact that the anaesthetic sponge is an Arabic addition (20).

The first early trial for resuscitation of comatosed patients by drug inhalation through forced respiration by a
manual bellow was practiced at the eighth century by the physician Saleh ben Bahla, who succeeded to
recover consciousness to a comatosed patient by forced manual respiration and inhalation of the medicinal
drug Al Kondus (Helleborus) (27 (33).

This newly practiced inhalation procedure was later wrongly attributed to the European Polish physician
Theodorick of the thirteenth century (17), and other historians, claim it to be an addition of Paracelsus of the
fifteenth century (17).

The used tools for inhalation therapy at that time were large clay pots for volatile oils, metal containers for
boiling liquids and wood snuff box for powdered drugs. For vapour inhalation, the liquids were heated on
stoves or hot stones and the evolved paper received by the patient under a blanket (10) (13).

The European Renaissance gave a good progress to inhalation therapy. Many new medicinal plants,
minerals and chemicals were added to inhalation therapy, with a progress in the technique and practice to
this speciality.

The newly discovered gases and chemicals as oxygen, ether, nitrous oxide, chloroform and cocaine were
added to inhalation therapy with wider indications (7) (11).
Unfortunately some poisonous injurious materials were introduced to inhalation therapy that resulted in
serious fatal complications.

During the eighteenth century the Hydrocyanic acid gas was described for inhalation for chest diseases and
officially registered in the British Pharmacopoeia in 1867 with high incidence of toxic complications (12)

http://www.aamh.az/index.files/28.htm Page 2 of 6
Mostafa Ahmed SHEHATA.HISTORY OF INHALATION THERAPY. 10/22/10 11:39 AM

Cocaine that was first prepared by Newman in 1859, was used as a snuff for its pleasant narcotics effect,
with many side effects (7). Tobacco was known to Europeans in 1492 and its dried leaves were used as a
powder for snuff or burnt to inhale its smoke. This was the beginning of a world sanitary disaster (14).

Many good therapeutic gases and chemicals were discovered and soon introduced to inhalation therapy.
Oxygen discovered in 1777, Nitrous oxide in 1799, Ether in 1842, Chloroform in 1831 and ethyl chloride in
1847 (7) (17).

They were extensively used for general anaesthesia during the 18th , 19th and early 20th centuries.

The Updated Inhalation Therapy:

The use of therapeutic material whether powders, liquids, vapours or gases through the inspired air has
revolutionised into a medical sub-speciality known as Inhalation therapy. Some medical centres adopted the
term “Respiratory Therapy” which is a limited term for that specialisation that covers only the treatment of
the respiratory troubles, ignoring the other body troubles.

Nowadays in nearly all medical specialities there is one procedure or more in which the medicaments are
taken through inhalation by different means for many body troubles.

The medical aims for Inhalation therapy are:

Mechanical or Physiological ventilatory support.

Broncho-pulmonary hygiene.
Broncho-pulmonary therapy.
Cardio-pulmonary resuscitation.
Hyperbaric oxygen therapy.
Maintenance of the natural airway.
Maintenance of artificial airways.
Local and general anaesthesia.
Circulatory disease management.
Tobacco cessation.
Vaccination.
Contraception.

Devices and Tools for Inhalation Therapy:

Ancient Tools:

Clay pots.
Metal containers.
Snuff box.
Inflating bellows.
Tubs for warm water

Modern Tools:
Insufflators.
Sprayers.
Atomizers: - Vacuum atomizer.
- Plastu bottle atomizer.
- Mistometer.
Nebulizer: - Hand Nebulizer.
- Jet Nebulizer.
- Aerosol Nebulizer.

http://www.aamh.az/index.files/28.htm Page 3 of 6
Mostafa Ahmed SHEHATA.HISTORY OF INHALATION THERAPY. 10/22/10 11:39 AM

- Ultrasonic Nebulizer.
Inhalers - Dry Inhaler.
- Steam Inhaler.
- Gas Inhaler.
Vaporizer and Humudifier.
Hyperbaric oxygen chamber.
Bathing devices.

Forms of Drug Inhalation:

Smoke: of burnt reeds, plants or minerals.

Powder for snuffing or insufflation.
Liquids, inhaled by Dropper, Sprayer, Atomizer or Nebulizer.
Vapours inhaled by Inhalers, Vaporizers or Humidifier.
Gases, Therapeutic or anaesthetic (14) (25) (26) (29) (32).

Indications and Medicaments for Inhalation Therapy:

Nasal vasoconstrictors.
Adrenaline, Ephedrene, Phenylephrine.
Bronchodilators
Ephedrine, Epinephrine, Isoprenaline, Turbutaline
Prostaglandine, Sabutamol, Methoxyphes amine
Cortisone acetate, Hydrocortisone, Dexamethasone
Beclomethasone
Prevention and Control of Burn Shock
Glucocosticoids
Control of acute pain crisis
Nitric oxide gas
Antimicrobials and Antivirals
Tobramycin
Neurolgical and Metabolic diseases
Hyperbaric oxygen
Control of Diabetes mellitus
Insulin powder
Control of Hydrogen sulphide toxicity
Amyl nitrite
Control of arrhythmia
Nitrates
Local anaesthesia
Lidocaine
General anaesthesia
Nitrous oxide gas, Halogenated Hydrocarbons (Halothane, Isoflurane, Enflurane, Sevoflurane, Desflurane)
Vaccination
Anthrax vaccine
Anti influenza vaccine
Contraception
Mucolytics and Mucokinetics
Water spray, water vapour
Immunologic agents
Diethyl carbamazine, Chloroquine
Cromolyn sodium
Care of Premature infants
Lung surfactant

http://www.aamh.az/index.files/28.htm Page 4 of 6
Mostafa Ahmed SHEHATA.HISTORY OF INHALATION THERAPY. 10/22/10 11:39 AM

Hyperbaric oxygen
Neurological disorders, resistant chronic infections
Auto-immune diseases, Vascular disorders(6)(17)(18)(25)(28)(29)(30)(32) .

Conclusion

Inhalation therapy was known many thousands, of years ago as one of the main therapeutic methods. It is
actually an old therapeutic method, as old as the pyramids and is still used as an effective treatment for
variety of diseases in every country of the world.
The enormous knowledge gathered through the past centuries and the present time added great advances to
the methods, techniques and indications of inhalation therapy and gave it a great therapeutic importance.

References:

1. H. Abdol-Salam “Zakhirat El Attar” (In Arabic Langugage) Dar El Maaref, Cairo 1947.
2. N.M. Doghaim “Medicine and Surgery of the Ear, Nose and Throat in Ancient Egypt” The Alexandria Medical Journal
Supplement, 18(4) 1972.
3. Samir El Gammal “History of Medicine and Pharmacy in Pharaonic Egypt (In Arabic Language) The Public Egyptian Organization
of Books, Cairo, 1994.
4. Hassan Kamal “Dictionary of Pharaonic Medicine” Second Edition, The National Publication House, 1967.
5. Hassan Kamal “The Ancient Egyptian Medicine” (In Arabic Language) Third edition, The Public Egyptian Organization of Books,
Cairo 1998.
6. J.A. Young and D. Crocker “Principles and Practice of Respiratory Therapy” Second edition, Year book Publisher, Chicago, U.S.A.
1977.
7. A. Castiglioni “A History of Medicine” Alfred Knopf Publisher, New York, Second edition, U.S.A. 1955.
8. Ibn Abi Osaibia “Classes of Physicians”(In Arabic Language) Dar El Hayat Publishers, Beiruth, Lebanon, 1965.
9. El Mahi, T. “Introduction to the History of Arabic Medicine” (In Arabic Language) First Edition, Misr Press, El Khartoom, Sudan,
1959.
10. Dawood El Antaky “Tazkirat Ouly Albab and El Gameh Lel Agab El Ogab” (In Arabic Language) The Osmanic Printing House,
The First Volume, 1266 Hegra (1849).
11. C. Singer and A. Underwood “A Short History of Medicine” Second Edition, Oxford Publisher, 1962.
12. The Editor “Sometimes the Treatment Feels Worse Than the Symptoms” Archives Otolaryngology, USA, 108(1), 1982.
13. Avicenna “Al Canon in Medicine” (In Arabic Language), Dar Sader, Beiruth, Lebanon, Third Book, 5th Chapter, Fourth Book,
First Chapter and Fifth Book, Second Chapter.
14. Collier’s Encyclopedia “Tobacco” William Halsey and Louis Shores, Inc, U.S.A., Vol. 22, 1966.
15. Obn El Goziah “Medicine of the Prophet” (In Arabic Language), Revival of Arab Books Printing House, Cairo, 1957.
16. M.R. Hussein, A. El Tennir, Al Roby, Arab, Abu Zeid, et al. “The Concise History of Arabic Medicine and Pharmacy”, (In Arabic
Language) The Arab League, Cairo, 1978.
17. R.S. Atkinson, G.B. Rushman and A. Alfred Lee “A. Synopsis of Anaesthesia” 9th edition, Wright PSG Bristol, London, Chapter
38, 1982.
18. Al Mazrooa Adnan and Abdel Halim “Anaesthesia, 100 years Ago” Middle East Journal of Anaesthesiology 15: 383-339, 2000.
19. Ibn Al Quff “Al Omda-Authority on Surgery” (In Arabic Language) Part 1, P 204-219, 13th Century.
20. Hunke Sigrid “Allah Sonne Uber Dem Adenland Unser Arabisches Erb” (Arabic Translation) Dar El Kitab Al Jadidah, 7th Printing
Issue, Beiruth, Lebanon, 1982.
21. Reginald Reynolds “Baths and Bathing” The Encyclopedia Americana, Grolier Incorporated, U.S.A., Vol 3, 1982, P 346.
22. http/legisweb.state.lwy.u.s/statutes/title33/chapter43.htm.
23. Fouad Salim Haddad “The Spongia Somnifera” The Middle East Journal of Anaesthesiology, Vol 17, No. 3, 2033, P 321.
24. Firdausi “Shah Nameh” The Encyclopedia Americana, Grolier Incorporated, U.S.A., Vol 24, 1982, P 649.
25. Abdol Hafize “Medical Pharmacologies Series” The Scientific Book Centre, Cairo, First edition, 1980.
26. A. Osol “Remington’s Pharmaceutics Sciences” 16th edition, 1980.
27. El Jasser “Resuscitation of Who is Apparently Dead in Arabic Medicine” The Proceedings of the Third Annual Meeting of the
Syrian Society of History of Sciences, Aleppo, Syria, 1978.
28. M.M. Paparella and D.A. Schumrick “Otolaryngology” Vol 1, 2nd edition, Saunders Company “Publisher, U.S.A., 1980.
29. St. Clair Thomson “Diseases of the Nose and Throat” Cassell and Company LTD, 6th edition, London, 1955.
30. H.C. Churchill-Davidson “A Practice of Anaesthesia 4th edition, Iloyd-Luke Medical Books, London, 1978.
31. A. Baraka “Historical Aspects of Opium” The Middle East Journal of Anaesthesiology, Beiruth, Lebanon, 1982.
32. H. Wollman and T. Smith “The Therapeutic Gases” In the “Pharmacological Basis of Therapeutics” by Gilman, Goodman, 6th

http://www.aamh.az/index.files/28.htm Page 5 of 6
Mostafa Ahmed SHEHATA.HISTORY OF INHALATION THERAPY. 10/22/10 11:39 AM

edition, Macmillan Publishing Company, New York, 1980.

33. Payne “Resuscitation of Apparently Dead” A lecture of the Royal College of Surgeom, London, Britain, 1969.

BACK TO CONTENTS

http://www.aamh.az/index.files/28.htm Page 6 of 6