Tuesday, February 04, 2014

1867: Steam powered inhalers

Since the time of Hippocrates, and more than likely even before that, the inhalation of steam was often recommended for people suffering from various ailments, which included syphilis, asthma, bronchitis, pneumonia, hay fever, phthisis, etc.  It was something that appeared to provide some immediate relief to the airways and breathing.  And it was also very easy to apply medication to the water to be inhaled.
Stern's Inhaler (3)

There were many methods available, some of which I will mention here.  Although please note that these are but a few samples.  If you had trouble enough with your breathing, you could get quite creative in seeking a remedy or cure.

1.  Hippocratic Inhaler (400 B.C.):  It wasn't called an inhaler back then, and may not even have been used for asthma.  The model basically consisted of a jar with a hole in the lid. The steam itself may have been palliative, although adding certain balsamics or resinic substances may have added an additional benefit for various symptoms of lung disorders. Eggshells or a sponge may be placed between the patient's mouth and reed t prevent scolding. You can read more about this inhaler here

2.  Teapot:  Any simple teapot would do.  Boil the water and inhale the steam.  If the water is too hot, you simply waited until it was cool enough to inhale.  This was kind of the same principle as the Hippocratic inhaler, and may even have lead to it's design.  Like the Hippocratic model, it was a simple and inexpensive inhaler. 

Inhalation Of Hot-water Vapor With The Use Of Pitcher And Towel
3.  Sponge:  Dr. John Scutter describes dipping a sponge into boiling hot water, place your face into the sponge, and inhale.  If you like you can drop some medications onto the sponge for direct inhalation.  It's an inexpensive and effective means of inhaling steam or medicated steam.  For medicines like chlorine, the medicine could be dipped on a cloth, placed over your face, and you could inhale the fumes that way.

4.  Wine Bottle or jug:  Another simple method mentioned by Dr. Scutter is to simply place a wine bottle "partly filled  with hotwater" near your face and inhale the vapors as they pass from "the mouth of the bottle."  Another idea would be to insert a sponge into the bottom of a wide wine bottle and insert the water and medication onto the sponge.  You could use the sponge or wine bottle method, or a combination, and place a towel over your head for the full steam effect.  You could basically play around with these ideas until you found something that worked for you.  I remember my grandma turning on the hot water in the bathroom sink, having me set my head up close, and placing a towel over my head.  It never really worked, and there was no medicine involved, although it made her feel like she was helping.

Dr. Mudge's Inhaler
5.  Phillip Stern's Contraption (1768):  It's a unique design playing on the Hippocratic inhaler. Dr. Cohen describes it well.  The lid is angled in a conic fashion so that it creates a pointed mouthpiece whereby the patient places his lips over the device, inhales, and then takes his mouth off to exhale.  Her marketed it to be used with his own balsamic effluvium.  Half a pint of boiling water is to be inserted into the contraption, and about 30-40 drops of his balsamic effluvium (of which he does not divulge the ingredients).   The patients to whom he aimed his product at were consumptive and asthmatic patients. To learn more about this "inhaler" click here.

6.  Dr. Mudge's Patented Inhaler (1778):  It's another design based on the Hippocratic model, and it's the first inhaler to allow both inhalation and exhalation through the inhaler.  Mudge was also the first to use the term "inhaler," and because Dr. Stern wasn't respected by the medical community, is given credit as the inventor of the inhaler.  Dr. Mudge describes this inhaler well in his book.  To learn more about this inhaler click here

Flask inhaler (2)
4.  Flask inhaler:  Dr. Scutter describes that this inhaler could easily be made by any patient using random items around the household, or that could be easily purchased for a reasonable price at any general store.  Basically all it requires is a container that can hold heated water, and "a tube to conduct that vapor to the patient.   Fig. 1, represents such an instrument. The flask is made of flint glass, and will usually bear an elevated temperature. The cork is perforated by an opening for the attachment of the rubber tube, and for a smaller glass or metal tube for the admission of atmospheric air, as the patient inhales the vapor." (2, page 28-9)


Tin cup inhaler (2)
5.  Tin cup inhaler:  Another cheap method of making an inhaler (see figure 2).  Dr. Scutter mentions that he often recommends this in place of the (much preferred) Nelson Inhaler (see below).  In the words of Scutter:  "It consists of a tin cup, perforated at the bottom and a three quarter inch tube inserted and soldered. To this, is attached two or three feet of rubber tubing, which is terminated by a mouth and nosepiece as represented in the wood cut. The cup contains two cross wires to hold the sponge, which should be coarse and open. In using this apparatus, the sponge is pressed out of hot water and put in the cup, or it may be wet in the cup, and the medicine then sprinkled on it in sufiicient quantity. The cup being placed upon the floor,a chair, or, if more heat is required, upon the stove, the patient inhales the vapors as they arise. In country practice, it is well to have the cup made the size of a tea-kettle, or tin teapot lid, so they can be turned over these vessels if it is desirable to inhale the vapor of water. This apparatus recommends itself, in that it is simple, cleanly, and cheap, being easily manufactured wherever a tinner can be found, at a cost of 75 cents."


Wolfe-Bottle Inhaler (1)
6.  Wolfe-Bottle Inhaler:  Cohen describes the inhaler as "An efficient inhaler in common use is composed of a three-necked Wolfe's bottle (Fig. 2). Two of the corks are perforated. Through one an air-tube passes nearly to the bottom of the vessel; through the other the inhaling-tube passes a short distance. When in use, the bottle being partially filled with liquid, the external air passes through the straight tube into the liquid, and then out of the bent tube, to which tubing and mouthpiece may be attached. A wide-mouthed bottle, with a doubly-perforated cork (Fig. 3), answers the same purpose, and can be arranged extemporaneously at short notice. The bottles should be of the capacity of a quart, and the tubes of large calibre, so that respiration may take place with as little impediment as may be. The great defect in most modern inhalers is that the tubes are insufficient in calibre for the air to be drawn through them by mere aspiration, so that an accessory movement of suction becomes requisite." (1, page 21)


Mackenzie's Eclectic Inhaler (1)
7. Mackenzie's Eclectic Inhaler:  It was one of the most "complete instruments of it's kind," wrote Cohen.  It was made of porcelain, and basically consisted of three parts:  A stand that was hollowed out so it could hold a heated lamp (c), a vase filled with a quart of hot water and medicine (a), and a lid that had two openings.  One of the openings on the lid consisted of a pipe to allow free flow of air so you could breathe through the inhaler.  The other opening was attached a hose to  to allow you to inhale the steam.  (1, page 24)

Mandl Inhaler (1)
8.  Mandl's Inhaler or Fumigator:  This is a smaller version of the eclectic inhaler with some advancements.  The lamp is inserted to the bottom of the vessel to gain better control of the temperature of the water.  Cohen notes there were a variety of inhalers of this type, but this one was the best.  The reservoir or vessel was made of glass that "rests on a stand over the spirit lamp.  The inspired air as it passes over the vapor becomes impregnated with it, and the expired air escapes by the opening of entrance. The vapor being evolved by heat there is no necessity for an air-tube to dip into the fluid. The amount of heat necessary to evolve the vapor is regulated by altering the size of the wick, or by the occasional removal of the lamp." Cohen must have been impressed enough with this inhaler that he made it the feature inhaler on the cover of his book. (1, page 25-26)

9.  The Nelson Inhaler:  This was by far the best of all the steam powered inhalers, and is actually still available in 2012.  The most marketable aspect of this inhaler is it allows the patient to inhale steam, or medicated steam, through a device that is portable.  As you can see by the picture it's quite small and compact compared to the devices mentioned above.  It's also easy to use by following the simple directions inked on the back:  "Remove the corked stopper, and fill the vessel half full of hot water; then pour the remedy to be employed upon the sponge on the mouthpiece.  Place lips on mouthpiece.  Breathe easily in and out as in full respiration.  When only the vapor of hot water or any infusion is desired, remove the sponge from mouthpiece."  Over time a variety of marketers copied this design. The inhaler was one of the most common inhalers due to its simple design.    For pictures and more information about this inhaler click here.  

As you look into old physician's books and medical equipment magazines for the 18th, 19th and early 20th centuries you'll find many other designs for steam inhalers, although the basic design is similar to the ones described here.  

References:
  1. Cohen, Jacob Solis, "Inhalation in the treatment of disease: it's therapeutics and practice," 1876, Philadelphia, Lindsay and Blakiston
  2. 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
  3. Sander, Mark, "Inhalatorium.com,"  page 41, http://inhalatorium.com/page41.html, accessed on 9/27/12
  4. Tissier,Paul Lewis Alexandre, edited by Solomon Solis Cohen, "Pneumotherapy: Including Aerotherapy and inhalation methods," volume X, 1903, Philadelphia, P. Blakiston's Sons and Co., pages 353-

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