Applications to the Broncho-pulmonary Mucous Membrane.—By the method of insufflation solid medicinal agents in a finely-divided state are applied to various parts of the respiratory tract. Insufflation-tubes with a rubber air-bag attached are now found at the instrument-makers. The powder, contained in a chamber intended for its reception, is forced by the compression of the air-bag through the straight or curved delivery-tube of the instrument. Powders may be projected by such an apparatus into fauces, larynx, and anterior and posterior nares. In the absence of an insufflator, a simple glass tube or goose-quill may be used for the purpose—the powder being blown in by the operator, or drawn in by a forcible inspiration by the patient.

The method of insufflation is a useful mode of making local applications to the nares, fauces, epiglottis, and the aryteno-epiglottidean folds, but it is of little utility as a means of reaching the larynx and trachea, for, as is well known, the glottis is exceedingly intolerant of foreign bodies whether solid or gaseous. By this method we can use tannin, the zinc salts, nitrate of silver, alum, morphine, etc. Any remedy thus applied should be in small quantity, should be minutely subdivided and mixed with some unirritating, impalpable powder, so as to insure uniform distribution over the surface to be acted upon.

The nasal douche is a mode of applying remedies to the nasal passages now much practiced. This consists of a bottle or funnel-shaped reservoir to contain the medicated fluid, and a flexible rubber tube to which is attached a hard-rubber or glass nose-piece. The reservoir being placed on a higher level than the head, the nose-piece adjusted and the mouth being kept open, the fluid is permitted to flow. As when the mouth is open, the patient breathing quietly, the palate applies itself closely to the posterior wall of the pharynx, it is obvious that the fluid will be conducted from the one to the other nostril and thus make its exit. Not every patient can succeed perfectly in the performance of this feat. In some persons, even when breathing quietly through the open mouth, the veil of the palate does not apply itself perfectly to the posterior fauces and the fluid flows into the oesophagus. Other persons can not refrain from attempts at swallowing when the fluid reaches the posterior nares. It happens not infrequently that the fluid, or the insufflation powder, gets into the Eustachian tube and middle ear, so that pain and inflammation follow with impaired hearing, and sometimes cause destructive inflammation and suppuration. If pain in the ears follows its use, it is quite certain that mischief will result if the douche be persisted in. The following rules should be adhered to in making applications by this method:

The fluid used must be tepid.

The first applications must be bland and unirritating.

The applications, if strong enough to excite irritation, must not be used frequently.

Under the most favorable circumstances this mode of treating diseases of the nasal passages has very limited utility, for the fluid reaches but a part of the Schneiderian mucous membrane. It is a useful means for cleansing the nares, and for applying deodorizing agents to correct fetor. Chlorides of sodium, potassium, and ammonium, permanganate of potassa, carbolic acid, iodine, and many other agents of the same kind, are applied by means of the nasal douche.

An ordinary Davidson's syringe, made to act as a siphon, may be used in the same way as the Weber's or Thudichum's nasal douche. The mode of proceeding with this instrument is as follows: the vessel containing the medicated fluid is placed on a higher level than the patient's head; the syringe is filled by compressing the bulb to expel the air, and then inserting the suction-pipe in the fluid; the nozzle of the delivery-pipe is put into the nose, when a steady stream will discharge into the nostril and escape by the other.