A temple of Lord Shiva lay on my way to school in my native town where I received my early education. The temple was less than half a kilometer away with a rivulet dividing the location. I used to see a few half clad sadhus smoking through small clay pipes sitting around a ‘pipal’ tree. Smoking appeared a ‘cool’ habit which a few bullies in the school also used to boast of. I and my childhood cousin were strictly warned to avoid the bad habit at all costs. “It is a poisonous stuff which children must not touch”, I was always told. “Why do the sadhus smoke bad stuff?” I used to question my mother. “They are the disciples of the Lord; they cannot be harmed in this fashion. Lord Shiva had survived even the strongest poison in the world to keep his followers safe from the ill effects”, my mother replied. I was quite satisfied at the convincing reply.
As I progressed in my profession, I came to understand the history of smoking and its importance in human life. I also learnt that the story of inhalation was far more important than that of the intoxicants which one would inhale. Going back to the ancient Hindu epic, it was the inhalation of the miraculous herb (Sanjeevni booti) which was used to bring Lakshmana, the brother of Lord Rama back to life after he fell unconscious in the war.
In Greek mythology, the priestess Pythia of the Temple of Apollo at Delphi would inhale the vapours from clefts in the slopes of Mount Parnassus where the temple was located. In a delirious state due to effects of those vapours, she used to deliver prophecies. It is moot question now if the vapours contained some euphoric ingredients (such as in the laughing gas) from rocks which induced the gibberish talk which Pythia spoke or the intoxicating chemicals from bushes of cannabis herbs which might have growth in the charm.
Inhalation also found its use in relieving pain of an individual. Both ether and nitrous oxide were successfully employed to induce anesthesia for surgical procedures in the 19th century. In the Middle Ages, warriors used to carry soporific sponges with various ingredients which were squeezed into the nostrils for quick relief of pain.
Inhalation was however a more popular method for treatment of cough and breathlessness. Fumes of different herbs had been used several centuries before the Christian era in India, China, Egypt and Greece. Indians used fumes of stramonium and hemp while the Egyptian produced vapours of black henbane by heating the weed on hot bricks. Dhatura continued to be smoked for its cough relieving properties practically throughout the past five millennia in most of the ancient cultures in the world.
People who smoke tobacco in modern times have similar reason to justify their habit. A few of my patients believed that it cured their toothache while many others smoked to get rid of the phlegm from their lungs. Constipation is other important problem which smokers find it hard to fight in the absence of a smoke.
The ‘inhalation habit’ is not just limited to smoking of tobacco, it widely extends to the old ‘cannabis’, ‘marijuana’ and some other habituating drugs. Such smokers find their ‘inhalers’ pleasing and assuring. The ‘pot’ and the cigarette have been the most widely used ‘inhalers’, the world over. More recently, a number of youngsters are reported to get the kick from inhalation of petroleum vapours. I had been personally told by the parents of a few youth that they spent hours together in their garages and kept on smelling the petrol from their motor bikes.
Inhalation treatment has made a steady progress in the last two hundred years or so. Several different kinds of inhalers varying from earthen and metal pots to the sophisticated form of metered dose devices had been developed and used. Technological advances of the modern era have made inhalation a popular and effective route for administration of drugs in medicine. For anesthesia, the initial inhalational anesthetic gases have been replaced with more efficient intravenous drugs. On the other hand, the treatment for respiratory diseases such as asthma and airways obstruction is now more effectively done with inhalational drugs. Inhalers have come to occupy the centre-stage for asthma management even though the asthma patients find inhalers as difficult. Nonetheless, the inhalation therapy for airway diseases has withstood the test of time.
Inhalation route is also employed for a few antibiotics for respiratory infections. The respiratory route may be used for administration of a number of other drugs as well. Inhalational forms are already available for some hormonal preparations. It is safe to anticiate that the list of such drugs will continue to expand in future.