900-1300: The Soporific Sponge

Physicians at the School of Salerno in the 15th century are believed to be the first to provide anesthetics during surgery.  The method used was to turn a simple sponge into an inhaler, what surgeons referred to as the "soporific sponge," according to historian Garrison Fielding Hudson. (1, page 142)

Hudson explains that "surgical sleeping draughts" are referred to as the "soporiphic sponge" as early as the 11th century in "the beautiful Jenson imprint of the Antidotarium of Nicholas of Salerna that was published in Venice in 1471.  (1, page 142)

This was a sponge that was "steeped in a mixture of opium, hyoscyamus, mulberry juice, lettuce, hemlock, mandragora and ivy, dried, and, when moistened, inhaled by the patient, who was subsequently awakened by applying fennel-juice to the nostrils." (1, page 142)

This "prescription" was believed to be derived from earlier treatments of "anodyne applications" used to treat insomnia at the temples of the Aesclepius by the Ancient Greeks and Romans. Later on Mandragora became "preferable to opium and hemlock." (1, page 142)

Could you imagine the stress that a physician wanted to give you such a medicine in an age when it was still greatly feared to be operated on? This type of fear was noted in a poem in Marlowe's Jew of Malta: (3, page 143)

"I drank of poppy and cold mandrake juice. And being asleep, belike they thought me dead."

So the anesthetic may have been taken internally by some, yet it was due to this fear that the anesthetic was not taken "internally by Salernitan physicians." I think this was a wise decision, and this made the "Soporific Sponge" a wise alternative.

The"Soporific Sponge" is an early, yet primitive, example of one of the first uses of an inhaling device. It is for this reason I mention it here. 
It is also surmised that the Salerno medical community greatly influenced Arabic medicine.  Yet, ultimately, Arabic medicine would grow so that it superseded the old Greek traditions taught at Salerno, and this is believed to be what caused the fall of Salerno from its "high estate."  The School of Salerno met its demise sometime in the middle of the 13th century.(1, page 187)

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company

1870-1900: The Pneumatometer (Part II) x

By 1903 there were various pressure devices used to provide positive pressure breaths for therapeutic reasons and for artificial respiration.  The devices were mainly operated by some form of physical labor, such as through pumps and bellows.  I described some of them in my previous post, and here I will list a few more.

Stoerk's Apparatus (Figure 30)(1)

Please note that all of these apparatus's are described in a book called, "Pneumotherapy: Including Aerotherapy and inhalation methods," by Paul Lewis Alexandre Tissier, and edited by Solomon Solis Cohen.

Stoerk's Apparatus:  It allows for inspiration by positive pressure and exhalation through rarified (less oxygen that what's in the air) air.  Rarified air causes a sort of suction or negative pressure that  causes a negative intrathoracic pressure that induces expiration.  

Unlike the other pressure devices, this one didn't require direct or physical depression of bellows or pumps, instead "compression is obtained by a change of level in the water in a system of communicating vessels, brought about by setting up an oscillatory movement which changes their relative positions (Fig. 30).

An oscillating motion is created by swinging it back and forth with your hand.  So the oscillations cause positive pressure (condensation) to cause inspiration, and negative pressure (rarified air, or suction) that causes expiration.  

Dorell's Residual Air Pump (1)

Dobell's Residual Air Pump:  The device was small and compact, and could be carried in your pocket.  (See figure 31)

It's described as "kind of mask which isfitted to the front of the mouth and held in place with a ribbon which passes around behind the ears; the apparatus is provided with valves to embarrass inspiration while expiration remains free. As a result the intrathoracic air is rarefied, and at the end of three to six respirations the residual air is reduced to a minimum and the diaphragm attains its maximum elevation. The patient then inspires in ordinary air, and this inspiration being freer than he is accustomed to, he experiences a sense of increased comfort. The same manoeuver is repeated several times at each sitting. The apparatus is certainly ingenious, but there is no means of determining with accuracy the degree of success attained."

Water Engine Bellows (Figure 32)(1)

Water Engine Bellows:  It's also referred to as The Water-blower or Double Ventilator of Geigel and Mayer.  The container is made of sheet iron and is filled to two thirds of it's capacity with water.  The container is completely enclosed except for four openings at the top.  To of these openings communicate with room air.  One holds a meter to measure volumes.  The fourth opening is where the pressure escapes.  A tube is connected to this opening, and a rubber mask is connected to the opposite end.  

Bellows inside are operated by a crank.  The principle is similar to the way water engine or gasometer is operated. The patient holds the mask over his face, and turns the crank  As the crank is turned pressure escapes through the fourth opening, and this causes inspiration.  (see figure 32)

Dupont's Apparatus (Figure 35)(1)

Dupont's Apparatus:  It's based on the principle of the Bunson water pump or aspirator, is inexpensive, allows for inspiration as deep as you desire, and can be used wherever there is a flow of water  The pressure is regulated by a mercury pressure manometer    

Tissier describes it as the best apparatus for the reasons indicated in the previous paragraph.  Rarification and compression of air is done simply by pumping a pump alongside the apparatus.  Pressure is determined by flow of water or by working a stopcock on the patient tubing  

S. Solis Cohen's Double Apparatus:  This is combination gasometer (a container that stores gas)  and water pump and was created by the author of one of our other 19th century respiratory therapy books.  There are various advantages to this device:

1. It corrects the flaws of the other pressure devices
2. It is continuous in action and relatively compact
3. The price is moderate
4. It can be used by the patient at his or her home

Cohen's Apparatus (1))

The device is described as follows:  

"It is true that the degree of compression of the air is regulated by means of weights placed on the upper portion of the condensed-air cylinder, and that the degree of rarefaction is regulated by means of weights attached to a system of cords and pulleys by which the cylinder containing the rarefied air is raised; but the apparatus is operated and the pressure modification obtained by means of a double-acting bellows—so that air is drawn out from the cylinder which is to contain rarefied air and discharged into the outer atmosphere, while fresh air is forced into the cylinder intended for condensed air. Although one stroke of the footlever accomplishes both condensation and rarefaction, the two systems are independent, and there is no communication between the cylinders except through the air-passages of the patient. This is an extremely ingenious idea, which, in addition to the other good qualities of the apparatus, should insure its success."

The Cohen's Apparatus was invented in 1883, and introduced to the medical community via the New York Medical Journal in the October 18 issue  Since he based his ideas on the other previously mentioned models, that would date all of them to before this time.

I think these are all "ingenious" ideas for helping patients breath easier, considering a lack of electricity.  Still, every one of these devices required labor to get them to work.  Still, they were options for both the physician and the patient

References:

1. 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 296-224.  If the profession of respiratory therapy existed in their era, we would be reading their books.  However, as it was, their books were written for the medical profession.

1910: Hiram Maxim Pipe of Peace

Sir Hiram Maxum (1840-1916) (2)

Sir Hiram Maxim (1840-1916) became famous for inventing a killing machine, and then he was ridiculed for inventing a life saving machine.  The killing machine was the Maxim gun, the first machine gun, capable of firing 160 times in one minute.  The other was a breathing machine used by people suffering from respiratory diseases, including asthma, catahrr, hay fever, emphysema, etc.

In his 1915 book, "My Life," he tells his own story:

 I think it was about the year 1900 that I had a very severe attack of bronchitis. First, we had the family physician; then he called in two experts on throat troubles; but they did me no good. They recommended, however, that I should go to Bournemouth and put myself under the treatment of a noted specialist. It was a failure. I returned to London and consulted the greatest specialist on throat troubles in England, and a few days later he sent me about half a ton of stoneware bottles containing mineral water. I took some of the water and followed the treatment for a time without the least effect. I was then recommended to go to Mont Dore, where they have strong and hot mineral springs and there are many doctors who make a speciality of treating bronchitis. I submitted to a very long system of steaming and boiling and taking the waters with no effect. I next learned that at Royat, not far distant, there was an English physician who was supposed to be the greatest expert on throat troubles in France. After he had been working on me about three weeks he said: "There remains only one thing for you to do, and that is to go to Nice and go through a system of treatment at Vos' Inhalatorium."

The Maxim inhaler and his "calming concoction" Dirogo (5)

I spent the next winter at Nice and was much gratified to find that I was greatly benefited by the treatment. It was very long and very severe. Every day I had to inhale an hour at a time; but the bronchitis had disappeared completely by the beginning of April, when I returned to England. However, with the cold and foggy weather of the next autumn the trouble returned as bad as ever; so again I went to Nice and went under the treatment. While there I heard a great deal of discussion regarding throat troubles—generally in the French language. Mr. Vos became very much interested in my case, perhaps more so on account of the comic sketches that I made for him, some of which greatly amused the Russian Grand Dukes who were his patients. At any rate I made a point of learning all that could be learned about the treatment of bronchitis before I left Nice, and the next season, when the trouble commenced again, I bought some glass tubing and made a few glass inhalers myself. By making a mouthpiece of such a shape that the vapours were introduced directly into the throat instead of medicating the inside of the mouth I found that my simple device was much more effective than the very elaborate machinery of Mr. Vos.

When I became fully satisfied that my apparatus would ward off bronchitis, I gave a few away, and they all did very well indeed. The next move was to get two hundred of them made by a glass-blower, and these I also gave away, with splendid results. This created a demand, and I placed the sale of the instruments with the eminent firm of John Morgan Richards and Sons, of London, since which time hundreds of thousands have been sold and have given entire satisfaction.

A short time ago, while returning from the seaside, I found myself in a first-class compartment with a distinguished-looking gentleman. He asked me if I were not Sir Hiram Maxim, and upon telling him that I was he gave me his own name, which I recognized as being one of the most eminent of the Harley Street physicians.

He said: "I have tried your inhaling apparatus with very good results; it is a splendid thing; I recommend it to all my patients who have throat troubles. You have prevented an immense amount of suffering in the world and you ought to be very proud of it."

This is the way that one of the greatest physicians in the world looked at the subject, but some of my friends not altogether unconnected with the gun business have told me that I have ruined my reputation absolutely by making a medical inhaler, and a scientific friend has written me deploring the fact that one so eminent in science as myself should descend to "prostituting my talents on quack nostrums." However, this little inhaler enables me to live all winter in England and large numbers are now being sold all over the world. So I think I shall be able to withstand the disgrace of having brought out such an invention.

From the foregoing it will be seen that it is a very creditable thing to invent a killing machine, and nothing less than a disgrace to invent an apparatus to prevent human suffering.

It is a curious and interesting fact that one of the gentlemen who has ridiculed me the most recommends these inhalers to his friends and always takes one with him when travelling.

While at Nice I learned that the inhalants could be taken very much stronger if a small quantity of cocaine were used, but as cocaine was regarded as a poison, it was not expedient to use it. I spent my boyhood in the State of Maine, where there is a little plant which, although it is used for flavouring confectionery, really benumbs the mouth and throat just as cocaine does, only in a less degree. By mixing a small quantity of the oil of this plant with pine essence, the vapours may be inhaled very strong without producing coughing, and this little discovery is one of the things that has made the inhalers such a remarkable success.

I suppose I shall have to stand the disgrace which is said to be sufficiently great to wipe out all the credit that I might have had for inventing killing machines. (1)

Sir Hiram Maxim's Pipe of Peace and Maxim Inhaler (3)

He patented his inhaler in 1909 and "resembled a glass retort and delivered menthol and evergreen essence." (4, page 67) 

The medicine was prepared by John Morgan Richards and Sons Ltd., in London. (6)  The medicine was referred to as Drigo, and a few drops of it were dipped into warm water in the inhaler reservoir.  

Maxum also wrote a book about asthma, and how you can treat your disease in the comfort of your own home without any medicine.  In his book he also introduced the world to his new invention, the Pipe of Peace.  It was marketed for "relief of all affections of the nose, throat, bronchial tubes, and lungs," according to a 1910 advertisement in the Tribune Almanac and Political Register. (2)

The ad states that "nothing can be more economical or effectual than the Maxum System of Treatment -- Direct Inhalation -- which conveys the vapour direct to the spot where it is needed.  It is, in fact, natures cure carried by a clever device to the very part affected, thereby enabling all sufferers to obtain immediate relief."

The ad states the book should be in the hands of all who suffer from respiratory ailments. It recommends you send a letter to the address provided to enter for a chance to receive one of 10,000 free copies of the book.  To view the ad you can click here. 

According to The Science Museum a few hundred thousand were sold in the first decade after it was invented.  (5)  This inhaler is also considered the first combination inhaler.  

References:

1. Maxum, Sir Hiram, "My Life," 1915, New York, McBride, Nast and Company, pages 313-315.  
2. This information is from an ad for the Hhiram Maxum Pipe of Peace from the Tribune Almanac and Political Register, 1910, page 774, edited by Horace Greely, Tribune Association.  The photo of Maxum is compliments of the ad, and even more so compliments of Google Books for providing access to this and other material to which the copy write has expired.  
3. The picture was taken from a really nice website about the life of Sir Hiram Maxum, Browninmgcom, "http://browningmgs.com/Maxim/Maxim-Vickers.htm, accessded 10/10/12
4. Smyth, Hugh D.C. Smyth, Anthony J. Hickey, "Controlled Drug Delivery," 2011, London, Springer, page 67
5. "Sir Hiram Maxim's 'Pipe of Peace' bronchial inhaler, 1909-1910," Science Museum/Science & Society Picture Library, image number 10324710, http://www.sciencemuseum.org.uk/images/I057/10324710.aspx, accessed 10/10/12
6. "Sir Hiram Maxim's 'Pipe of Peace' bronchial inhaler, 1909-1910," Science Museum/Science & Society Picture Library, Inventory number1981-982 , http://www.sciencemuseum.org.uk/images/I057/10324710.aspx, accessed 10/10/12, the inhaler is currently on display in: Making the Modern World.  

For further reading on Sir Hiram Maxim refer to:

1. Brown, Malcolme, "100 Years of Maxim's 'Killing Machines,'" The New York Times, November 26, 1985
2. Science Museum and Society Picture Library,

1959: Nebu-Halent Inhaler x

1954 ad for Nebu-Halent Inhaler (You could use bronchodilator of your choice)

The nebuhaler was a product that entered the market in the late 1950s following the release of the first inhalers:  Medihaler Epi and Medihaler Iso. 

The new product was a Freon-powdered pocket unit with a reservoir chamber with a self-cleaning, baffling device.  

It was called the Nebu-Haler.  The medicine used was Nebu-Halent, or you could use the medicine of your choice.  

This device makes it possible to deliver finer, smaller particle-sized aerosols to the patient.  

It did not gain the popularity of the original Medihalers that entered the market in 1956, although it was another option for asthmatics.  

1954: The DeVilbiss Pocket Nebulizer x

During the 1930s the DeVilbiss number 40 nebulizer could by found in the homes of many asthmatics.  It was a nice product that provided quick relief by the use of one or another epinephrine product (such as Asthma Nefrin, a.k.a., epinephrine).  

Chances are if you knew an asthmatic you probably saw one of these at one point or another.  Either one of these or a similar brand of glass nebulizer with rubber bulb syringe.  Either one of these or one or another brand of asthma powder.

Yet there were obvious flaws with the DeVilbiss No 40, such that it was made of glass and was fragile, and the aerosolized particles were too large for getting inhalents to the bronchi and alveoli.

This product was improved upon in the 1950s based on suggestions of doctors (and probably patients too) with the DeVilbiss Number 41 Pocket Nebulizer.  You can see a 1954 advertisement for the product here.  

1930s: Asthma Nefrin and the Devilbiss Nebulizer x

One of the cheaper options for asthmatics during the 1930s was to purchase a DeVilbiss Glass Nebulizer No 40 and use it to inhale epinephrine or another solution.  It came with a rubber bulb syringe. 

Epinephrine (Asthma Nephrine was a brand name) was removed from the glass vial by using a bulb syringe dropper.  Two to three drops were placed into the nebulizer, or as instructed by a physician. 

The directions, per the package insert, for using the inhaler are as follows:

"This Nebulizer is especially designed for use with 1:1000 Epinephrine solution prescribed in the treatment for asthma.  It produces a vapor free from drops that can be inhaled into the air passages.  Also available for water, oil, or glycerine base solutions where the treatment requires a vapour instead of a spray...

"Grasp the bulb firmly using the fingers against the palm of the hand, rather than two or three fingers against the thumb.  Keeping the mouth wide open, place throat tube (A) just inside the teeth and direct it toward the back of the throat.  Inhale deeply while compressing the bulb.  

Directions and box for the DeVilbiss Glass Nebulizer Number 40

"If less volume is required cover the vent hold (B) with a finger or the stopper.  After using nebulzer, always replace both stoppers to prevent any possible entry of dust or dirt."

The instructions recommended washing the nebulizer with a water solution with vinegar in it.  This was the same instructions I was given for my plastic nebulizer in 1985, although the new recommendation is just to use soap and water. 

Asthma-Nefrin

Epinephrine solution (Epinephrine Chloride, Asthma Nefrin)  was a nice option until 1972 when the FDA removed the solution from the market due to a scare that the medicine was linked to asthma related deaths. 

However, the FDA also noted that there was no specific evidence linking asthma nefrin with asthma deaths. 



The Devilbiss Nebulizer remained on the market until the 1950s when the modern inhaler was invented. 

1940s: The Collision Nebulizer x

Photo compliments of E.M. Collision's own book (5, page 4)

While the 1930s gave us the first electric nebulizer, they were large, bulky, and expensive.  Most people who needed aerosolized inhalations simply resorted to other means, such as a glass nebulizer with rubber bulbs like the DeVilbiss number 40, or by igniting asthma powders of various sorts.

It was believed that the aersolized particles produced by most nebulizers or atomizers were large and impacted in the upper airways.  This was proved by experiments performed by Huckel and published in 1925.  He determend that aerosol particle had to be 5 microns or less, and be dense enough, to make it to the bronchi and alveoli to be effective. (1, page 10-11)

Another concern of physicians was that experiments "demonstrated that atomization robs air of oxygen."  This was a major concern especially when a treatment was given with a rubber face mask.  It was for this reason atomization was mostly "limited to hand sprays, and it's employment confined to quite short inhalations of a palliative nature to stop an asthma attack or for the treatment of the upper air passages." These short treatments were generally accomplished with two or three puffs using glass nebulziers.(1, page 6-7)



1, page 23)

So there was an obvious need for an improved product that would solve these problems.  And such a product was invented in the early 1930s  by W.W. Collisoin and introduced to the market in 1932 by a company named Collision.  The product was called the Collision Nebulizer.(2)

It was an interesting product that was connected to the top of an oxygen tank, and this pretty much solved the oxygen dilemma.

Flow was adjusted to meet the demands of the patient, and is generally between 7-8 liters per minute.  (1, page 5, 14, and 25)  

Flow from the oxygen tank filled a reservoir bag, so flow was monitored by monitoring "movements of a bag."  (1, page 5)

It also had a baffle in it to filter out large particles, and this ensured most of the particles inhaled by the patient were small enough and dense enough to make it into the lungs where they could do some good.  In this way, this product distinguished an "atomizer" from a "nebulizer."  Atomizers from this point on were used for perfume, disinfectant and paint products, and nebulizers were used for respiratory medicine. 

Studies at this time also showed that the rate and depth of breathing also effected where the aerosolized particles deposited.  If the patient breathed too fast and too deep many of the particles impact in the upper airway, so it was determined the patient should breathe calmly. (5, page 14)

This device was nice because it allowed the physician to prescribe a "precise" dose of medicine, and also be assured the medicine would reach the lungs where it's desired and have the greatest effect.  Collision describes his own device this way:

"It presents none of the tiresome features associated with medical apparatus, and is readily understood by patients.  While providing a vapour that meets the requirements of modern medicine, it embodies most simple and easily understood controls, and is comparatively small and compact.  These features have overcome the impracticability of patients taking a proper course of duly prescribed treatment at home, and of having the inhalations available at any time and during the hours of the night." (1, page 21)

There were two phials, one amber and one and one white.  The amber phial was for photosensitive inhalents.  A large teaspoon of each inhalent prescribed was placed in one or the other phial.  For daily curativetreatments Collision recommended placing camphor, menthol, or creosote in the white phial.  These treatments should be taken every day, even when you feel good.  Although many asthmatics are tempted not to take these treatments when they feel good. (1, page 22-3, 32-33)

, and to end an asthma attack, he recommended placing adrenaline in the amber phail.  If the patient had an asthma attack while inhaling from the white phial, a handle can be switched from "white phial" to "amber phial." Or, when necessary, the handle could be switched to "both phials" to take in medicine from both.(1, page 22-3)

Rubber tubing leads to a mask with two one way valves, one opens on inspiration, and the other opens on expiration.  This prevents exhaling into the system, and allows expiration into ambient air.  A small hole allows for some ambient air to be drawn in during inspiration.  (1, page 24)

After each use the oxygen gauge should be checked to assure there's enough oxygen in the tank to support a treatment, if the patient requires one for an asthma attack during the night. 

References:

1. Collision, W.E., "Inhalation therapy technique," 1935, London, William Heinemann
2. Rau, Joseph L, "Conference Proceedings:  Design Principles of Liquid Nebulization Devices Currently In Use," November 2002, Volume 47, Number 11, Page 1257einemann

1859: Lewin's Inhaler

Mathieu's Nephogene (from Lewin) (2)

There were many problems with the Nephogene (nebulizer) created by Mathieu.  The greatest concern was that the spray produced was so forceful most of the mist created pounded into the oral cavity and produced a cough, according to Jacob Cohen in his book "Inhalation: its therapeutics and practice."

This made it certain little of the spray made it to the lungs.  Of course Cohen makes sure to mention that this device was not first devised to deliver respiratory medicine, but to spray medicines on any part of the body.  

The person to fine tune the device to make it more appropriate for the inhalation of respiratory medications was Lewin of Berlin.  Cohen describes the device as such: (1, page 190)

Lewin, of Berlin, has constructed an apparatus with an ordinary suction pump (syringe) which forces the liquid into a reservoir, the air within which is thus compressed, and in its turn becomes a propelling force, driving the fluid, on the opening of a valve, out of a very fine aperture, whence it impinges on a convex button, and becomes thus broken into spray. This apparatus once set in action will continue to work for a considerable time without further pumping.

Lewin's glass nebulizer (1)

Yet another problem with inhalers prior to Lewin is that they were all mostly made of medal.  This meant that certain medicines couldn't be used if they interacted with metal.  Lewin aimed to correct this problem by using a "strong glass reservoir" instead of metal."  It's also graduated with markers so you know how much water to put into it.   (1, pages 194, 195)

It was covered by a "strong metal cap with three openings: one for the introduction of the liquid and the subsequent attachment of the condensing syringe; one affords exit to the capillary extremity of a slender tube which reaches to the bottom of the glass; and the third is covered by a spring safety-valve, through which the compressed air may escape after a certain pressure has been produced.  "  (see figure 19) (1, pages 194, 195)

To work it a "finger is placed upon the capillary extremity of the exit-tube until the air in the reservoir has been sufficiently compressed by a few strokes of the piston, when the finger is removed, and the fluid rushes out with great force and breaks upon a gilded metallic convex button secured in a glass drum, perforated to admit the stream, and attached by a support to the side of the instrument. The drum is not furnished with a waste-pipe, but is so inclined that the excess of fluid will flow over its edge into any convenient receptacle." (1, pages 194, 195)

So there were various advancements made by Lewin both to his nebulizer and to that of Mathieu's.   Yet his most significant contribution was the use of material that wouldn't react with medicine that might be used in it. Yet there were still flaws with it.

Either way, these nebulizers provided another option for physicians and patients, and were yet another step in the evolution of nebulizer therapy.  (1, pages 194, 195)

References:

1. Cohen, Jacob Solis, "Inhalation in the treatment of disease: it's therapeutics and practice," 1876, Philadelphia, Lindsay and Blakiston, part II, "Inhalation of nebulized fluids, or sprays:  nebulized medicaments and the apparatus for their production," pages 184-212

1865: Clarks spray Producer

Figure 1

The Bergson tubes became "widely known among English practitioners," and they were used in a variety of products.  One physician by the name of Dr. Andrew Clark of London used the tubes to create an inhaler of his own.  (1, page 465)

George Beaston explains that Clark wanted to "have an instrument that would give a continuous spray, and with this view he had a pair of Bergson's tubes fitted into the cork of a graduated glass bottle, and had attached to them a double hand bellows with suitable valvular arrangements which allowed of a constant spray being kept up for an indefinite time. This instrument was made for him by Krohne & Sesemann (London surgical equipment producer) in the spring of 1865, and has since been known as Clark's spray producer. It is seen in Fig. 1, and it will be at once recognised as merely an improved edition of Bergson's original idea.

You can see it was a little more compact than the original Bergson Inhaler, although still required some work to obtain a mist -- the squeezing of the bulb.  There are also various other inhalers or nebulizers playing on this same theme, and you can check them out by clicking on the link below.  

References:

1. 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

1864: Seigle and Adams steam powered Inhaler

Figure 1 (1)

The first steam powered inhaler was described in 1862 by Dr. H. Walenburg of Germany.  It was described as "an instrument by means of which he could produce medicated spray in combination with steam and through the motive power of that principle." according to George Beatson in an 1880 article in the Glasgow Medical Journal. (1, page 464)

Walenburg's product must not have garnished much attention, because the next person to improve upon the nebulizer was Dr. Emil Seigle.  On April 22, 1864, he took out a patent on a product he referred to as a "steam spray producer for inhalation." (1, page 464)

The design was "entirely different from that of Seigle's," and whether or not Seigle knew of Walenburg's works is unknown.  Yet what is known is that it was Seigle and not Walenburg who is credited as the producer of the first steam powered mist producing nebulizer.  (1, page 464)

Seigle's Inhaler was a significant improvement in nebulizer design because it was the first nebulizer to create a mist completely on its own, without any manpower.  (1, page 464

Like the Mathieu and Bergson inhalers the Seigle design used the Bernoulli Principle to create a mist.  Yet the older designs required a stream of air to create the mist.  Without electricity, this required manpower.  A flow had to be produced by blowing into a tube, by cranking a peddle, by squeezing a bulb syringe, or by depressing billows.

Dr. Seigle used steam instead of air. This eliminated the requirement of manual effort to create the stream.  From figure 1 we can see that what he "did was connect Bergson's spray tube with a glass boiler, using steam for producing and conveying the spray instead of air."  (1, page 464)

Figure 2 (1)

There apparently were other similar devices for using steam to produce a medicated spray, but these other devices were not as simple in design and ease of use as the Seigle Inhaler.  So Dr. Seigle generally is credited with producing the first self powered, steam powered nebulizer.  (1, page 464)

It was nice because the patient could simply sit it on a table and inhale the mist without much effort.  Dr. Seigle is not necessarily the first to invent a device like the Berson tubes, as a similar device was used for other industries.  Although he was the first to employ the concept for the use of inhalation devices. (?)

The original device as pictured in Figure 1 had many flaws, including the fragile glass boiler, which occasionally overflowed, and "the water flowing over through the stream escape is projected forcibly in the face of the patient... it required much persuasion on the part of the physician, and considerable nerve on the part of the patient, to face Seigle's Patent Inhaler after one or two experiences of this nature." (2, page 218)

The device was updated many times, and ultimately was accepted by the medical community and recommended to some patients who could afford it.  (1, page 465)

Dr. Adams with "Face Protector"  (2)

One of the most significant improvements on the device was made by Dr. Adams in 1868, who improved the boiler system so that it was no longer made of glass.  He introduced his new design in the Glasgow Medical Journal in 1879,  (1, page 465) and retrospects on his new design ten years later in his 1889 article "On an improved apparatus for spray inhalations," (2, page 317)

Future designs of the Seigle inhaler were based on the Adams design.  Overall, these inhalers were nice because "they gave off a steady, uniform stream of spray, warm in character and so fine as to cause little irritation, while being self-acting, they neither fatigued the patient nor required an assistant.  In this way they became extensively used." (1, page 465)

Figure 2 is nice in that it allows you to visualize how the Seigle and Adams inhaler worked by means of the Bernoulli Principle.  You can see how the steam rises, flows through the vertical tube rapidly, and a negative side stream pressure is created that draws medication up from the medicine reservoir.  The example shown is actually the Adams Inhaler, although the same concept was used with the Seigle Inhaler and other similar designs.

The Seigle's inhaler was later improved and re-marketed, or as Dr. Adams wrote "pirated," by Dr. Seigle and re branded as "Dr. Seigle's Patent Steam Spray Inhaler, with Boiler as suggested by Dr. Adams." (1, page 465) (2, page 317)

References:

1. 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
2. Adams, "On an improved apparatus for spray inhalations," The Retrospect of Medicine," W. Braithwaite, editor, Vol. LXXX, July-Dec., 1879, London, published by Simpkin, Marshall, and Co, pages 317-321 Inhaler

Seigle inhaler 1865 invention british medical journal








Medical gazetteEdward John Bermingham - 1883 -xxxxxxxxxxxxxxxx

book

The Throat and Nose, and Their Diseases: With Five Hundred and Fifty ...

 By Lennox Browne, James Cagney, Vitruvius Harold Wyatt Wingrave  5th ed, 1899 (see glossary of photosat beginning of book.  page xviii, and page 1551 improved siegles. inhaler

The Adams Inhaler:  Below are good articles. It's an improvement on the Spiegle inhaler

The Retrospect of medicine: being a half-yearly journal ..., Volume 80, page 319, "ON improved aparatus for spray inhalations," page 317  great pics of bournoulli principle.  by James Adams

REference to his article 10 years earlier:  "medicated inhalations with discription of an improved aparatus for the production of medicated vapours, james adams, 1868 (book not found) By James Adams

 
Another great article  The Inhalation treatment of diseases of the organs of respiration
 By Arthur Hill Hassall  Many inhalers and oxygen stuff

4.  Dr. Seigle's Inhaler:  "The third form of apparatus is that of Dr. Seigle, and is preferable to the others, for its simplicity and because it is automatic. The best reason for preferring it, however, is, that its price is such as to bring it within the means of any patient, as it is furnished through the druggists for$5,00, and its construction is so simple, that it is readily operated by any one."  The inhaler (or nebulizer) is designed so that steam provides the flow that makes the bournoulli principle work, and in this way the operator doesn't need assistance to create a mist.  The device simply sits on a table and the patient can enjoy the mist, and hopefully relief in breathing.  I describe this nebulizer in more detail here. 

"The instrument consists of a little kettle, into which is screwed a fine cork perforated with a horizontal tube, in which there is a fine opening. Placed at right angles to the horizontal spou> is a vertical tube, which dips down into a small cup contain i ng the medicated fluid. As the steam issues from the hoc. zontal tube, it causes a vacuum in the vertical tube, and the medicated liquid rising up becomes mechanically incorporated in the steam, and is blown off in the form of a minutely divided spray. The dilution of the medicated liquid which takes place is very slight, as the conversion of a drachm of water into steam will take up three drachms of medicated liquid. The temperature of the steam is lowered by the incorporation of the liquid, so that at the end of the cylinder, it has only a temperature of seventy degrees. The instrument represented in Fig. 5, is manufactured by Mr. Max Wocher of this city.

"In this apparatus there is, of course, no current of cold air.

The amount of liquid taken up varies, that is, it depends on the amount of heat applied, on the height of the column of liquid, etc. This is not an important defect; but when it is desired to take up a definite quantity of liquid, the author uses the following apparatus: A graduated glass tube, about eight inches high, has from its lower part a fine piece of tubing, which is bent round and up again, and then extends about au inch horizontally, and ends with a minute opening. In the vertical portion of the fine tubing, there is a stop-cock. The small apperture of the tube is beut at right angles to the tube from the kettle, and asthe liquid emerges, it becomes incorporated in the steam. By means of the stop-cock, the amount of liquid which passes from the tube can be regulated, so that the same amount can always be taken up at the same time."

I have employed this instrument in every case where inhalations could be used with the least prospect of advantage, and feel justified in recommending it to the profession. There can be no doubt, but that the medicated fluid is carried through all parts of the respiratory tubes. This diffusion is an objection in the treatment of some affections, as we would like to restrict the remedy to the diseased surface. Still as we learn more of the action of medicine upon the body, we will care less about its concentration, and more about selecting the appropriate remedy.

1867: The four best nebulizers

By 1867 there was quite a selection of mist producing nebulizers to choose from. Dr. John Sutter described four of the most significant ones in his 1867 book "On the use of medicated inhalations in the treatment of respiratory organ."  

The four nebulizers are as follows:  (see 1, pages 26-36):

Elsberg's Nebulizer

1.  Elsberg's Nebulizer:  "The simplest instrument is that known as "Elsberg's Nebulizer," which consists of two hard rubber tubes pointed at the extremities, the openings being small, and so hinged that they can be placed at right augles, the openings being immediately opposite, as in Fig. 3. One arm of the apparatus being placed in the medicated fluid, blowing through the other causes the fluid to rise in the tube, and it is carried off" in a fine spray. Rimmel's Rafraichisseur, which is the same in principle, has been employed for some years for distributing perfumes, and may be purchased quite cheap. The principal objection to this method is, that it requires a second party, and the breath cannot but prove offensive to many patients."

Sales-Giron's Nebulizer

2.  Sales-Giron Nebulizer:  "The second form of apparatus consists of a cylinder in which works an air tight piston, like the barrel of a syringe. Fluid being placed in it, is forced through minute openings in the nozzle, as a delicate spray.  Fig. 4, represents the instrument of M. Sales Giron, which I have used in my practice with excellent results. When inhalations are much used, I have no doubt they will be manufactured by our hard rubber manufacturers, at a price to bring them within the reach of all"  This nebulzier required lots of work to get a mist, and sometimes may have required two people if the person needing the medicine was too sick.  For this reason it probably wasn't very marketable.  This nebulizer of often listed as the first nebulizer, and for that reason I wrote about it in greater detail here.

3.   Dr. Mackenzie's Nebulizer:  "The apparatus of Dr. Mackenzie is a very good one. The piston is drawn back by a wheel and rack at its upper part, and is forced down by a circular spring which surrounds the cylinder. The apparatus is filled with liquid by a funnel in its top, and all the spray, except that which is inhaled, passes back into the apparatus. He claims the following advantages for  it:  1. Its simplicity, requiring only a few turns of a handle to set it in operation. 2. The extremely fine state of subdivision which it effects. 3. The uniform pressure exerted. 4. The fact that the Waste liquid returns into the apparatus. 5. The ease with which it can be taken to pieces and cleaned."  (no picture available)

Dr. Seigle's Inhaler

4.  Dr. Seigle's Inhaler:  "The third form of apparatus is that of Dr. Seigle, and is preferable to the others, for its simplicity and because it is automatic. The best reason for preferring it, however, is, that its price is such as to bring it within the means of any patient, as it is furnished through the druggists for$5,00, and its construction is so simple, that it is readily operated by any one."  The inhaler (or nebulizer) is designed so that steam provides the flow that makes the bernoulli principle work, and in this way the operator doesn't need assistance to create a mist.  The device simply sits on a table and the patient can enjoy the mist, and hopefully relief in breathing.  I will describe this inhaler in greater detail in my next post. 

So while there were many varieties, these are your basic nebulizers of the 19th century.  It's basically what you had to deal with until the 1930s when electricity became available. It was either one of these, a steam inhaler, or inhaling smoke.

References:

1. 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
2. Wyka, Kenneth A., Paul Joseph Mathews, William F. Clark, "Foundations of Respiratory Care,"

1867: The Bersgson Apparatus and Inhaler

In 1858 Dr. M. Sales Giron invented the first nebulizer to produce a fine spray by blasting a jet of water onto a hard surface, and in 1859 Dr. Mathieu invented the first nebulizer utilizing the bernoulli principle.  In the following years various nebulizers were introduced to the market, all improving in one way or another either the Sales-Giron or mathieu models.  Yet this all changed in 1862 due to an invention by Dr. Bergson.(3, page 463)

The concept that Bergson was to use was not new to the world.  Similar tubes were used in fire trucks to draw water out of the truck's reservoir, through the hose, and spray onto the fire.  Similar tubes were also used for various other industries to spray solutions, such as for the perfume and disinfectant industry.  (2, page 196-197)

So the recommendation was made by Dr. Nathanson to Dr. Bergson that he try to implement this idea to producing a nebulizer.  Thankfully Dr. Mathieu had already started on such a project.  (2, page 196-197)

In 1867 Dr. Scutter wrote that he used Dr. Sales-Giron's Nebulizer "in my practice with great results," yet noted that a lot of cranking was required by the operator to generate only a small amount of mist.  (1, page x)

So perhaps this was why Dr Bergson decided to concentrate his efforts on improving the Mathieu nebulizer.  In 1862 Bergson, of Germany, introduced to the market what he referred to as the "Hydrokomion" or "Water Dust Apparatus." It was "an important modification of Mathieu's idea," (3, page 463) and would result in the Bernoulli Principle being mist producing concept of most nebulizers from that point on.

Figure 1

The Bergson Tubes resulted in a major improvement in the Mathieu design.  Scudder described them this way: (2, page x)

"The apparatus, as constructed by Bergson, consists of two tubes at right angles, placed with their extremities together, and so joined that the extremity of the perpendicular tube should stand in front of the axis of the horizontal tube, as seen in the accompanying diagram. (see figure 1)

"If two tubes are thus arranged, and the vertical tube placed in a vessel containing a liquid, and then a current of air be blown from the mouth through the horizontal tube, the transverse current will carry over with it, as it were, the top of the column of air in the vertical tube, which, of course, will force up a current of the liquid to occupy the space of the air; and this continuing, the liquid will at length reach the top, and be blown by the transverse current into a coarser or finer spray. The fineness of the spray, and, consequently, its facility of ingress into the respiratory tract, will depend upon the minuteness of the extremities of the tubes, principally upon that of the tube dipping into the liquid. If the fluid is to be nebulized by the breath alone, the opening of the horizontal tube must not be too small, otherwise force enough cannot be produced. If the current is produced by means of a bellows, as the Davison's injecting syringe, the opening of the horizontal tube can be smaller.

"For the production of a continuous stream, an air reservoir must be attached to the syringe, and, for this purpose, Dr. Bergson adopted the arrangement of a rubber bellows worked with the foot, connected to the horizontal tube by rubber tubing, in the continuity of which is placed a globular elastic ball as an air reservoir. (Fig. 6.) 

The Bergson nebulizer was therefore was designed as such (refer to figure 3):

"a, reservoir for fluid; b,.waiter ; c, vertical tube ; d, horizontal tube ;  f, flexible tubing ; g, air reservoir ; h, rubber bellows to be compressed by the foot; i, joint connecting the Bergson tubes; k, nebula or spray; I, rim or cap of reservoir to which the nebulizing tubes are attached.   

The nebulizer worked pretty much as the description above describes, except the flow used to generate the mist is created by depressing the foot bellows.  When the bellow (h) is pressed, air is forced through the tube (f) "the air in the middle ball (g) is compressed and is forcibly blown through the horizontal tube (d).  When the air flows over the opening of the other tube," the negative pressure draws in the medication in the reservoir (a).  A mist is then created.  (3, page 463-4)

This product was a nice improvement, although it still took a lot of work to produce a mist.  Plus the tubes were made of glass, the product was clumsy, and it was costly and fragile. There was still room for improvement.

References:

1. Scudder, John M, "On the use of medicated inhalations, in the treatment of diseases of the respiratory organs," 2nd edition, 1867, Cincinnati, Moorz, Wilstach & Baldwin
2. Cohen, Jacob Solis, "Inhalation in the treatment of disease: it's therapeutics and practice," 1876, Philadelphia, Lindsay and Blakiston
3. 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