Tuesday, August 28, 2012

1856-1858: The first nebulizer

Dr. Sales-Giron's portable nebulizer (5)
Dr. M. Sales Giron, of Pierrefond, France, is given credit for inventing the first portable nebulizer.  (8, page 461)

According to Mark Sanders at Inhalatorium.com, the device had a pump handle that operated like a bicycle to draw liquid from a reservoir and forced it through the atomizer.  This provided a fine mist for the patient to inhale whatever medicines were in the reservoir.  (1)

This idea actually came about because the main ways for people to inhale medicines in the mid 19th century was by either inhaling the smoke or steam of volatile medicine.  Doctors knew that many non volatile medicines would also be of use for diseases of the airways, and the only way to get the medicine to the lungs was to produce a mist.  (8, page 461)

James Prosser, in his 1884 book "The Therapeutics of Respiratory Passages," notes a mist would work well for non volatile and volatile medicines because "it carries with it particles of solids (the medicine) as it may contain in solution." (3)

This concept was first thought up when persons observed that when a rapid stream of water hits a rock a spray or mist is produced that can be inhaled.  The idea that this could be used for the inhalation of medicine was first played with by Auphan at the spa of Euzet-Les-Bains in in 1849.  (9, page 184)

At such spas mineral water was put over heated rocks and the steam was inhaled.  Prosser writes:  (2)
"The  idea of atomizing the mineral waters seems to have originated, or at any rate to have been first carried into effect, by Auphan at (the spa of) Euzet-les-Bains in 1849; he projected a jet of the mineral water on the wall of the inhaling room with sufficient force to break it up into a spray, which was inhaled by his patients.  This method was adapted at several spas."
The July 30, 1870 edition of The Medical Times and Gazette reported that the so called inhalation room was often referred to as an 'inhalation saloon,' and by this means did actually charge the atmosphere with the spray, or, as he termed it, the 'pulverized' or 'atomized' water.  (4)

The problem with inhalation saloons, as Prosser notes, was the difficult proving actual mineral waters were being used or just plain water.  This method of treatment was generally determined to be "ineffective" and "not suitable for private practice."  (8, page 461)
Figure 1:  The original Sales-Giron Nebuliser

So the market was open for a device that would allow a person to create a mist of mineral water in his own home.  M. Sales-Giron was charged with the challenge of inventing such a device by M. de Flube, owner of a watering place at Pierrefond. (9, page 184)

Sales-Giron worked on this project for many years, until finally introducing his final product to the Academy of Medicine in Paris on May 20,  1856.  In Pierrefond a Sales-Giron Inhalatorium was opened where 1-15 patients could inhale the mist at the same time.  (9, page 185)

By 1858 he introduced to the market a portable device that could be used anywhere. In it any medication can be used to produce a spray "as fine as the mist created in an Inhalatorium. (9, page 187) He referred to it as "Pulverisateur portatif des liquides medicamenteux."(8, page 461)

The original product can be seen by the woodcut in figure 1, and is described here:
"It consists of a vessel filled with the fluid to be atomised, while above it is placed an air-pump, A, which compresses the air above the surface of the water, the pressure being indicated by a manometer, c. When the instrument is at work the fluid escapes through the fine opening of a tube with a stopcock, D, and strikes against a small metal disc, E, where it is broken and turned into a very minute vapour, any of the condensed vapour escaping through a small tube, G." (8, page 461)
The device is also described by Dr. John Milton Scudder in his 1867 book "On the use of medicated Inhalations in the treatment of diseases of the respiratory organs."  He writes:
"(The instrument is) so constructed that the medicated fluid is forced, by the agency of compressed air, through a tube having a very small opening against a metal plate.  At this point the steam of fluid is checked, and it becomes divided into fine spray, (to which the term of pulverized, or atomized, has been applied), and in this condition can be inhaled by the patient."  (5, page 23)
While it appeared to be a great idea, something asthmatics had waited thousands of years for, it was slowly accepted by the medical community.  One of the main concerns at the time was whether the mist actually made it to the lungs.

Prosser writes:
"But at length Sales-Giron constructed a portable apparatus for atomising fluid, and brought it before the Academy of Medicine of Paris n 1858.  This was undoubtedly an epoch in the history of inhalations, and the greatest interest was excited.  It was not, however, until 1862 that the committee of the Academy appointed to investigate the new method brought in its report, and during the interval prolonged discussion had taken place as to whether the spray penetrated deeply into the air passages.  The report stated that it was proved that both the water and the mineral constituents employed penetrated not only to the bronchi but even to the air-cells; and this report was founded on extensive independent experiments and was almost unanimously adapted by the Academy.  The conclusion and practice of Sales-Giron, who has been called the Father of Atomization, thus received the highest authority and rapidly spread over the civilized world.  Demarquay was one of the earliest to adapt it, and to prove independently that atomized liquids rapidly pass into the respiratory passages."  (2, 6)
Prosser adds that the device was later improved upon by Dr. Lewin, Dr. Bergson, Dr. Siegle and Dr. Baigel.  I will write about these devices in a later post.

However, one problem with the device was it was large, fragile, and expensive.  Another major obstacle was that it was hand powered and difficult to use.  For this reason none of these original nebulizers were readily accepted.

References:
  1. Inhalatorium.com, "Sales-Giron's Pulverisateur," viewed April 30, 2012
  2. Prosser, James, "The Therapeutics of Respiratory Passages," 1884, New York, pages 281-282
  3. Prosser, ibid, page 284
  4. "The Progress of Therapeutic Science," The Medical Times and Gazette: A Journal of Medical Science, Literature, Criticism and News," volume II for 1870, 1870, July 30, London, John Churchil and Sons
  5. Scudder, John Milton, " On the use of medicated Inhalations in the treatment of diseases of the respiratory organs," 1867, Cincinnati, 2nd edition, Moor, Wilstach, and Baldwin
  6. "The Progress of Therapeutic Science," , ibid, provides a more precise description of the process of doubt and inevitable proof that the Sales-Girons nebuliser did get medication directly to the air passages is provided in this article.  See page 125
  7. Picture compliments of Mark Sanders of the inhalatorium (inhalatorium.com
  8. Beatson, George, "Practical Papers on the Materials of the Antiseptic Method of Treatment," Vol. III, "On Spray Producers," Coats, Joseph, editor, "History of the Origin and Progress of Spray Producers  ", Glasgow Medical Journal, edited for the West of Scotland Medical Association, July to December 1880, Vol. XIV, Alex and Macdougall, pages 461-484

  9. Cohen, Jacob Solis, "Inhalation in the treatment of disease: it's therapeutics and practice," 1876, Philadelphia, Lindsay and Blakiston

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