Wednesday, January 04, 2012

1858-1929: History of nebulizers x

While we asthmatics should consider epinephrine the greatest discovery in the history of medicine, the greatest invention may be that of the nebulizer and inhaler.

Ancient doctors as far back as 10,000 B.C had access to various herbal remedies for asthma-like symptoms, and as early as 5,000 B.C. they learned the best mode of delivery was inhalation.  Yet the only methods they knew of were steam and smoke.

The Ancient Egyptians inhaled smoke from dried and crushed belladona burned on bricks.  Ancient Indians burned cigarettes with dried and crushed strammonium.  Insents were ultimately used as well.

As we travel forward to the mid 19th century not much has changed.  Enter any random home and you'll quickly be able to tell if an asthmatic lives there by the bittersweet smell of smoke wafting through the doorway  

Surely there were a few devices called nebulizers and inhalers at this time, yet they were large, bulky, fragile, hard to operate and very expensive.  Operating them was often difficult and time consuming, and the medicine available wasn't much good anyway.
Sales-Giron and his portable nebuliser (1858)*

The first nebulizer was actually produced in 1858 by a French inventor named Dr. Sales-Girons.   His nebulizer was unique in that it had a pedal that acted like a bicycle pump, and when pulled up air was forced through an atomizer and a mist was created to be inhaled.  (1)

(A picture and good description of this first nebulizer can be seen here at Inhalatorium.)

One thing to note as we delve into the past here is that nebulizers of old came by varying names.  Some were called atomizers, some nebulizers, and some inhalers.

The idea is that an atomizer refers to any device that converts a liquid to a fine spray.  Likewise, nebulizers and inhalers create an aerosolized mist to be inhaled.

So sometimes atomizers were referred to as atomizers, sometimes nebulizers, and sometimes inhalers.  Which name was used was left to the discretion of the inventor or marketer of the device.  And while some were called inhalers, they were nothing like the inhalers we use today.

Dr. Siegel inhaler (1872)
In 1864 Dr. Siegel invented Siegle’s steam spray inhaler that used the force of steam through a small tube to draw up the medicine and turn it into a vapour that is inhaled through a glass mouthpiece.  The principle used here is similar to modern nebulizers, only now we use air instead of steam. (2)

Siegel's invention is often considered the beginning of nebulizer therapy.

There were various attempts at copying Siegel's nebulizer, yet neither Siegel's nor any of the others were effective enough to become popular among asthmatics.  Again, the medicine available back then provided only minimal relief, and this fact probably made efforts to use these devices fruitless, and perhaps too expensive to make them worthwhile investments.

So the evolution of such devices was left at a standstill until the discovery of epinephrine in 1900. Now, for the first time ever, there was a medicine available that could end an asthma attack.   The only problem now was the asthmatic in need had to seek out a doctor and have the medicine injected into a vein.

Silbe hand-held rubber bulb nebulizer (1940)*
Doctors also quickly learned that the systemic delivery in this way of epinephrine into your body caused significant side effects, such as full and bounding heart rate, increased blood pressure, and hyperactivity.  The medicine also took several minutes to take effect.  Entrepreneurs sensed an opening to a new market, and searched for a device to help asthmatics better deliver this medicine.

By 1910 epinephrine was available as a solution to be nebulized, yet nebulizers continued to be too expensive and too difficult to operate to be of much use.  However, for those willing asthmatics, there were a few nebulizers available such as the:
  •  Silbe Atomizer:  A hand held nebulizer with a bulb syringe that had to be squeezed
  •  Colossol Nebulizer:   A glass nebulizer with a rubber squeeze ball
  • Glass Collosol Nebulator with rubber bulb*
  •  Volatilizer Inhaler:  Dr. Coulter's vaporizer and inhaler was called the champion Volatizer.  It was steam powered and made of copper, brass and nickel plate. (2)
In 1929 various bulb syringe nebulizers (like this one) were available.  The asthmatic would draw up some of the epinephrine from a small vial and mix it with some water in the nebulizer cup and then squeeze the bulb to create a fine mist that could be inhaled.

As you can guess, this took a lot of time, coordination, and even muscle strength to get an adequate amount of medicine aerosolized to do any good.  I had a bulb to connect to my nebulizer cup back in 1985 to use in case of a power outage, and I tried it once just for kicks.  It took forever just to get minimal results

1892 ad for Dr. Couilter's vaporizer & inhaler*
However, I suppose if that's all you had available, you'd squeeze that bulb as long as you had to.  Yet we asthmatics yearned for something better, simpler, cheaper and easier to use.  Aware of the possibility of a new market, many investors and inventors worked overtime searching for the ideal device.

By the 1930s asthmatics finally got what they yearned for when the first electric nebulizers hit the market.  These nebulizers were a reasonable size, generally inexpensive and easy to operate.  Asthmatics could now have access to epinephrine in the comfort of their own home right away when they needed it.

Aerosolized epinephrine worked faster, almost immediately giving the asthmatic relief from an asthma attack.  Since it was inhaled instead of injected into a vein, side effects were significantly diminished.  In this way, the invention of the electric, mass producible nebulizer was a godsend to asthmatics.

Adrenalin Inhaler used to nebulize epinephrine (1930s)*
Nebulizers have continued to evolve since then, yet the general concept has not changed.

Click here for more asthma history.

References:
  1. Rau, Joseph L., "Inhaled Adrenergic Bronchodilators: Historical Development and Clinical Application," at AARC.org (American Association of Respiratory Care, July, 2000, Vol. 45, number 7),
  2. Inhalatorium.com provides pictures and descriptions of antique nebulizers and inhalers
  3. * Pictures used with permission from Inhalatorium.com.  Check out the site for more antique nebulizers and inhalers.

No comments:

Post a Comment