Wednesday, December 7, 2016

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 said 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." (1, page 465-466)

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 were various inhalers or nebulizers similar to this design, and you can see them 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
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Monday, December 5, 2016

1865?: Dr. Nelson's inhaler

Nelson Inhaler with glass mouthpiece
By the mid 19th century various methods were invented for the inhalation of medications through steam.  One such device was the Nelson inhaler, which ultimately became one of the most popular inhalation devices.

Spencer Thomson described the inhaler in his 1866 book "A dictionary of domestic medicine and household surgery."  He said:
Dr. Nelson's improved earthenware inhaler, an apparatus for the inhalation of  ether, chloroform, henbane, creosote, vinegar, etc., in affections of the throat and bronchial tubes, asthma, consumption, etc. (6, page lii)
John M. Scudder described it in his 1867 book "On the use of medicated inhalations, in the treatment of diseases of the respiratory organs."  He said:
"The most efficient apparatus for the inhalation either for simple steam or of medicated vapors... It is constructed of earthenware, and, in addition to its complete adaption to the purpose for which it is intended, possesses the triple recommendation of cleanliness, portability, and cheapness." (1, page 22)
The inhaler was manufactured by Maw & Son of Aldersgate St., which was later changed to Maw, Son, and Thompson.  Dr. Nelson's name with directions were on the side of the inhaler.  The inhaler was commonly sold and used for many years, and sold by various manufacturers who made slight adjustments to the design.  (2, page 258)

The Nelson inhaler was called "New and Improved," perhaps because of the unique design and that it was small and relatively portable compared to other inhalers, or tea pots.

Here is a news clip from the February 11, 1865, edition of the Medical Times and Gazette:  (3, page 160)

NEW INVENTIONS

NELSON’S INHALER

We have tried "Dr. Nelson's New Improved Earthenware Inhaler," and believe it to be a cheap and convenient instrument.  It serves both for simple hot water or for hot water medicated with the extracts of soothing plants such as are suitable for acute catarrh and quinsey, as well as for various medicinal substances which are tried in the advanced stages of phthisis, in spaspotic asthma, etc.  The instrument is easily cleaned, and cannot be misused.


Here is a description of the new inhaler from the February 11, 1865, edition of the Lancet. (5)

Diagram of Dr. Nelson's inhaler (5)
NEW INVENTIONS
IN AID OF THE
PRACTICE OF MEDICINE AND SURGERY
DR. NELSON'S IMPROVED EARTHENWARE
INHALER
The utility of topical medication of the air-passages by the inhalation of the vapour of water impregnated with various substances extensively recognised by the profession. The absence of any simple and efficient apparatus for the purpose is often the only reason why the great relief which such applications are capable of affording is withheld from the patient. Medical men will find in the little inhaler of Dr. Nelson, made by S. Maw and Son, a very handy, cheap, simple, and effective apparatus. It answers very well all the purposes for which it is intended, and no hospital or infirmary ought to be without it. Its construction will be seen from the annexed woodcut. The hollow tube at B; and, having replaced the latter, inhale the vapour through the mouth-piece at A, the exhaled breath passing freely through the tube at C. For the inhalation of the vapour of hot water only, or the infusion of stramonium, hops, or other medicinal plants, the sponge in the tube need not be displaced." We recommend it for general adoption
Here is an advertisement from the British Medical Journal, December 17, 1870: (4)

DR. NELSON'S IMPROVED
EARTHENWARE INHALER


Will be found a most efficient Apparatus for the inhalation of Vapour of Hot Water, either alone or impregnated with Ether, Choriform, Henbane, Creosote, Vinegar, etc., in affections of the Throat, and Bronchial Tubes, Asthma, Consumption, etc. 

Price to the trade, 3s 6d each; Retail, 5s 6d.
DESCRIPTIVE HANDBILLS ON APPLICATION
S. MAW, SON, AND THOMPSON
10,11 & 12, ALDERSGATE STREET, LONDON, E.E.

While it's no longer recommended by the medical community, the various versions of the Nelson Inhaler can still be found online.

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. Bennion, Elisabeth, "Antique Medical Instruments," 1980, California, University of California Press
  3. "Medical News: New Inventions: Nelson Inhaler," Medical Times and Gazette: A Journal of Medical Science, Literature, Criticism, and News," February 11, 1865, 2nd edition, London, John Churchill and Sons, page 160
  4. Hard, Ernest, editor, "Maw's double valved earthenware inhaler," British Medical Journal, The Journal of the British Medical Association, volume II, July-December, 1870, (December 24, page 672 of this publication)
  5. "New inventions in aid of the practice of medicine and surgery:  Dr. Nelson's Improved Earthenware Inhaler," Lancet: The Journal of British and Foreign medicine,"  1865, Volume I, Boston, Boston Medical Library, published by George Fall, ata the office of the "The Lancet" 423 Strand, page 152.  The diagram is also from page 152 of this resource.  
  6. Thomson, Spencer, "A dictionary of domestic medicine and household surgery."1866, London, Charles Griffin and Company
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Thursday, December 1, 2016

1865: Mackenzie specializes in diseases of throat and chest

Morell Mackenzie (1837-1892)
Dr. Morell Mackenzie was one of the preeminent experts on diseases of the throat during the second half of the 19th century. He would either write or edit various books on diseases of the throat and chest and the best remedies to treat them.

He was born in Leytonstone, Essex, in 1837, and was educated at London Hospital Medical College and in Paris and Vienna.  (4)

He became one of the first experts on the laryngoscope that was invented by Manuel Garcia of Paris.  By using this device he was able to see with the aide of this scope the effects of various diseases on the larynx, pharynx, bronchi, and bronchioles.

In 1862 he opened one of the first hospitals dedicated specifically to diseases of the throat and chest called "Free Dispensary for Diseases of the Throat and Loss of Voice at 5 King Street (later renamed Kingly Street).  (1)

He went on to become assistant physician at the London Hospital, and then full physician.  He was also appointed lecturer on diseases of the throat, an appointment he held for the rest of his life. (4)

The building on Golden Square
as it appeared in 2008,
owned by Clear Media Group
The Dispensary was an instant success, and by 1865 had moved to larger premises (32 Golden Square), to a building that had previously housed the London Homeopathic Hospital from 1851-1856.  The name of the Dispensary was then changed to "The Hospital for Diseases of the Throat."  (1)

This was the first hospital that specialized in diseases of the throat in the United Kingdom, and it was in this year, in 1865, that the hospital took in its first inpatients. (1)

As the number of patients being admitted to the hospital with consumption was steadily increasing, in 1877 the name of the hospital was once again changed to Hospital for Diseases of the Throat and Chest." (1)

Another picture of
the former hospital.
The hospital initially provided free treatment, although eventually a system was established allowing patients to contribute payments based on the their incomes.  (1)

In 1865, Dr. Mackenzie published what he learned about diseases of the throat and chest, and their treatments, in his book "The Use of the Laryngoscope in Diseases of the Throat."  It was in this book that he discussed how directed the invention of the Eclectic Inhaler for the direct application of moist, medicated steam to the throat.

In January of 1887, Prince Frederick III of the German Empire and the Kingdom of Prussia, developed hoarseness that progressively worsened.  Initially German physicians thought this was due to the prince speaking too much, but then it was decided he had a case of catarrh, or the common cold.  (3, page 1)

However,  none of the usual catarrhal symptoms made their appearance, and the usual inhalations to treat catarrh were ineffective.  Because of this, Surgeon General Dr. Wegner and Adolf Bardeleben performed a laryngoscopy on March 6, 1887, where they were able to see a growth between the vocal cords.    (3, page 1)

At first it was thought to be a harmless growth, such as a polyp.  Various treatments were made to remedy the situation, but none of them worked.  At one point the growth had been removed, and then grew back larger than it was before the operation.  It was at this time, in May, 1887, that his physicians decided he had cancer of the throat.  (3, pages 4-6)

In order that he would receive the best treatment, his leading physician requested he be seen by Dr. Mackenzie, who was the leading expert on diseases of the throat at the time.  (1)(2)(3, page 1, 8)

Basing his decision on a biopsy report by German pathologist Rudolf Virchow that showed throat lesions in the prince's throat were not cancerous, and his own examination of the patient's throat, Dr. Mackenzie decided the prince did not have throat cancer after all. This decision was made despite evidence the prince still had throat hoarseness. (1)(2) (3, page 34)

Dr. Mackenzie recommended to the prince's physicians that, instead of rushing the prince to surgery, that it be delayed until further testing was performed. All of the prince's physicians, respecting Dr. Mackenzie's expert consultation, decided to heed his recommendation and delay further treatment.   (3, page 10)

At first this seemed like a good idea, as the treatment offered by Dr. Mackenzie seemed to benefit the prince, who continued to hold the doctor in high regard. In September 1887,  Dr. Morell Mackenzie was held in such high regard at this time that he was knighted by Queen Victoria* for his service to medicine and to prince Frederick.  (4)(2)

A few months later, in November of 1888, as the prince's condition continued to deteriorate, it became quite clear that Dr. Mackenzie was wrong, that the prince actually did have throat cancer. (2)

That same month, after a thorough assessment of the patient, his physicians, which included Dr. Mackenzie, offered the prince the risky option of having surgery to remove the cancerous tumor, and he declined.  He opted, instead, to have a tracheotomy inserted when it might become necessary. (3, page 44)

Emperor Frederick III (1831-1888)
Reign (March 9-June 15, 1888)
In March, 1888, Frederick III became emperor of the German Empire and the Kingdom of Prussia.

By this time it was determined the only operative help was to perform a palliative tracheotomy. (1)(2)(3, page 43-44)

Emperor Frederick III died on June 15, after only 99 days as emperor. He was 56 years old.

A controversy ensued where Dr. Morel Mackenzie was blamed for the emperor's death. He was adamantly criticized by German physicians, and even accused of malpractice.

Mackenzie responded by publishing his side of the story in his 1888 book  "The Fatal Illness of Frederick the Noble."

After a review of the case, it was determined that Dr. Mackenzie should have treated the growth as if it were cancerous "if only from fear that it might become malignant," said Dr. Bardeleben.  (3, page 15)

Dr. Bardeleben explained that if the tumor returned after its removal, a tracheotomy should have been performed to allow "radical extirpation of the disease." (3, page 15)

As a result of this review, and as a consequence of his 1888 publication, Dr. Mackenzie was censured by the Royal College of Surgeons. (1) (2)

Despite the controversy, the remainder of his life went on without consequence.

After suffering from bronchitis for a few days, Dr. Mackenzie developed pneumonia and died rather unexpectedly on February 3, 1892, at the age of 54. The hospital he helped to create, however, would continue to serve patients with diseases of the ear, nose, throat, and lungs until 1985, when the premises of Golden Square were closed.  (1) (4)

*Queen Victoria of the United Kingdom was Frederick's mother-in-law. He was married to Princess Victoria, the oldest daughter of the Queen.

References:
  1. Lost Hospitals of London: "Royal National Ear, Nose and Throat Hospital," http://ezitis.myzen.co.uk/rntnehgolden.html, accessed 9/5/14
  2. "Sir Morel Mackenzie," britannica.com, http://www.britannica.com/EBchecked/topic/354858/Sir-Morell-Mackenzie, accessed 9/5/14
  3. Bardeleben, Adolf, "The illness of the emperor Frederick the third," 1888, Berlin, G. Schenck, Royal Publisher
  4. Obituary: Sir Morell Mackenzie, New York Times, February 4, 1892, http://query.nytimes.com/mem/archive-free/pdf?res=9505EFDD1E39E033A25757C0A9649C94639ED7CF, accessed 9/5/14
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Wednesday, November 30, 2016

1864: Alfred Newton's Dry Powdered Inhaler

People have probably inhaled powders of certain dried and crushed herbs for their perceived benefits since the beginning of time.  Yet the first device for assisting with this process was patented in 1864 by Alfred E. Newman.  His device was the first dry powdered inhaler.

The book "Controlled Pulmonary Drug Delivery" describes the inhaler this way:
In 1864 another step forward with dry powder inhalation took place. Alfred E. Newman applied for a patent in London after correspondence with Dr. James in New York.  The dry powder device resembled a mantle clock with an orifice at one side, inside was a mesh and a crank shaft with feathers to beat the powder creating a dust, which would pass through the mesh towards the mouth.  It was not especially portable, but Newton recognized that the powder needed to be pulverized into a fine dust and that it should be kept dry, two essentials of modern dry powder inhalers. The device was designed for the delivery of potassium chlorate which today is recognized as a lung irritant. (1, page 60)
The authors also note that while dry powder inhalation was "in vogue" during the 1860s, it was generally meant to treat diseases of the throat such as laryngitis.  Still, it was a revolutionary concept and a precursor -- albeit large, bulky, un-portable, and probably -- to modern dry powder inhalers.

The device may also have been used for tuberculosis.  (2).

Quality pictures of the device can be observed by checking out either of the links in the references below.

References:
  1. Smyth, Hugh D.C., Anthony J. Hickey, editors, "Controlled Pulmonary Delivery," 2011, New York, Springer, page 60-61
  2. Sanders, Mark, "Pioneers of Inhalation: Vapour Trails and Powder Monkey," from Inhalatorium.com: Online Museum of inhaler technology, slide show presentation, accessed on 11/13/12
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Monday, November 28, 2016

1864: Seigle and Adams steam powered Inhaler

Figure 1 (1)
The first steam powered inhaler was described in a paper published in 1862 by Dr. H. Walenburg of Germany. (1, page 464)

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)

Regardless of his invention, he did not get credit as the inventor of the steam powered inhaler, and this may have been because he didn't obtain a patent for his product.  (1, page 464)

Two years later, in 1864, Dr. Emil Seigle of Stuttgart did take out a patent for a steam powered inhaler, thus giving him credit for the invention.  (1, page 464)

However, to his credit, it's possible that, because the design of the Seigle inhaler was "entirely different" from that of the Walenburg inhaler, Seigle was unaware of Walenburg's paper.  (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)

Dr. Scutter said the Seigle Inhaler "was far preferable" to the other options of the day "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." (3 page 32)

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.  (1, page 464)

It was nice because the patient could simply sit it on a table and inhale the mist without much effort. It may have been this reason Seigle's inhaler was considered the first of its kind, even though it was probably not.

Yet the original Seigle inhaler (pictured in Figure 1) had its 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)

He discussed 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, mainly 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)

The principle used to create the Seigle Inhaler was used "on an extensive scale" at the Hospital for Diseases of the Throat and Chest in the United Kingdom.  Here a room was designated for the purpose of inhalations, up to twelve patients were able to inhale different medications at the same time. (4, pages 85-86)

The steam was conveyed from a boiler in the basement of the hospital, and it traveled through pipes "fixed horizontally round three sides of the inhaling room, and from this horizontal pipe there project at regular intervals, and at right angles, secondary tubes which correspond with the horizontal tube of a Seigle Inhaler.  Bottles containing different solutions are connected with each terminal tube."  (4, pages 85-86)

This was a nice design, allowing the physicians at the hospital to treat up to twelve patients, each with a different inhaled medicine, simultaneously.  (4, pages 85-86)

The principle used by Seigle and Adams was a simple one that allowed many patients to inhale a medicated mist.  Most often the patient would receive this therapy at a physician's office or hospital, and the physician, a nurse, or an attendant would prepare the medicine.

However, for those who could afford it, the devices could be purchased for a nominal fee, and the medicinal recipes prepared and inhaled in the privacy of their own homes.

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
  3. 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
  4. Mackenzie, Morell, editor, "The Pharmacopoeia of the Hospital for Diseases of the Throat and Chest," 4th edition, 1881, Philadelphia, Plesley Blakiston
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Wednesday, November 23, 2016

1862: Phoebus studies 'summer catarrh'

Christian Freidrich Schonbein (1799-1868)
While not the first to mention ozone,
he was the first to produce it in a lab.
He wrote about how to make it in 1832.
He also noted that air containing ozone
caused certain catarrhal conditions,
including asthma and hay fever.
Phoebus noted the link in 1862,
and usually gets credit for it
(5, page 80) (6, page 311)
Since Dr. John Bostock defined hay-fever for the medical community in 1819 and 1828, there was little mention of the ailment until Dr. Philip Phoebus published a book titled "On the Typical Catarrh of Early Summer, or the so called Hay-fever or Hay-asthma" in 1862.  (1)

Dr. Phoebus was professor of medicine at the University Giessen in Germany, and he was apparently one of the first physicians to study hay fever who did not have the condition.  He is said to have gained interest in it by the single case that he treated.  (4, page 17)

In 1869 he issued circulars and advertisements inviting medical men all over Europe and the United States to respond to seven questions phrased to gain particular information regarding their patients diagnosed with hay fever. The questions were well worded to gain particular information, and were related to the following: (2, page 14-15) (3, page 2) (4, page 17)
  1. Where they lived (city, country, lowlands, mountains, etc.?)
  2. What they did in their every day lives (lawyer, doctor, industrial worker, farmer, etc.?
  3. Their sex (male or female?)
  4. Social position (rich, middle class, poor?)
  5. Inheritance (was their disease hereditary? Do they have parents, grandparents, or siblings with the condition?)
  6. Constitutional peculiarities (does it affect their health and well being?)
  7. When do attacks of hay fever occur? (autumn, winter, spring, summer?) (2, page 14)
He received many replies, and used the information he received to put together a complete theory about this disease.  He then published the results of his research three years later, in 1862, in a thorough treaties. (2, page 14-15)

He learned that hay fever was most common in England than any other nation of Europe.  He learned people were predisposed to it, although he didn't understand why.  (2, page 15)

He believed the exciting cause was the first heat of summer, and that the longer days of summer exposed those predisposed to it to more light, and probably more ozone too.  In this way he was among the first to suspect a link between air pollution (ozone) and hay fever or hay asthma. (2, page 15)

He also believed that odors, dust, the blossom of rye, and hay were also exciting causes. (2, page 15)

In reviewing the ideas regarding of Dr. Phoebus on hay fever, Dr. William Abott Smith said Phoebus described six groups of symptoms, of which may vary from one case to another. (1, page 16)

1.  Nostrils.  Severe catarrh (common cold) leads to sneezing, and this may irritate the bronchi, causing spasm.  (1, page 17)

2.  Eyes.  Catarrh and increased secretions. The eye feels full, itchy and irritating.  The eye looks red and swollen.  Eyesight is weakened, and there is an intolerance to light. Both eyes are usually affected simultaneously. (1, pages 18-19)

3.  Throat. Pharynx is red, and swollen; there is intense itching of the back of the mouth behind the tongue.  This causes an unpleasant sensation that is aggravated by the patients efforts to relieve the itching. Sometimes there is difficulty swallowing. (1, pages 19-20)

4.  Head.  A headache might occur, that might be caused or worsened by sneezing.  The patient might also complain of a feeling of itching over the forehead, nose, chin and ears. (1, pages 20-21)

5.  Airway.  The mucus  membrane of larynx all the way to the bronchi may become irritated, causing asthma or dyspnea.  This may result in a cough, increased sputum production, irritation of the throat, a heavy feeling over the chest, and a muffled and coarse voice.  If the bronchi become affected, this may result in wheezing that results from bronchial catarrh or asthma or, more specifically, hay asthma or periodic asthma.  Dyspnea generally occurs in the evening and continues through the night. Hay fever that affects the lungs in this way tends to be more severe, with the patient waking up gasping and struggling to breathe. (1, pages 21-22)

6.  Nervous disturbance.  This is coupled with catarrhal fever that results in shivering and cold perspirations with sneezing and coughing. When this happens the patient becomes restless, weary, and unable to perform normal activities. The patient becomes irritable, with something as simple as a cool breeze being disturbing to the patient.  These patients generally develop a nervous and anxious disposition during the paroxysm. (1, page 22)

All in all, Dr. Phoebus went into more detail on hay fever, what causes it, and the symptoms that resulted, than any of his predecessors. Yet, and he knowingly admitted, he left many questions still unanswered for future investigators to answer. (2, page 15)
---------

Dr. Blackley took the observations of Phoebus and Schonbein regarding their suspected link between hay fever and ozone, and set out to perform experiments with the substance.  He spent six hours in his office inhaling the substance and observed no effect. (11, page 35) (8, page 8, pages 79-91)

However, while he proved ozone had no effect on hay fever, he became the first to suggest that dust might cause hay-fever symptoms.
-----------

References:
  1. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24. 
  2. Beard, George Miller, "Hay Fever; Or, Summer Catarrh: Its Nature and Treatment," 1876, New York, Harper & Brothers, Publishers
  3. Wyman, Morril, "Autumnal Catarrh (Hay Fever)," 1872, New York, Published by Hurd and Houghton, The Riverside Press
  4. Mackenzie, Morell, "Hay fever and paroxysmal sneezing," 5th ed., 1889, London, J&A Churchill
  5. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
  6. Dickenson, Samuel Henry, "Elements of Medicine: a compendious view of pathology and therapeutics, or the history and treatment of diseases," 1855, Philadelphia,  Blanchard and Lea
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Monday, November 21, 2016

1861: Merkel supports nervous theory of asthma

Another physician who discussed his ideas regarding asthma was Dr. L. Merkel.
In his 1917 review of the history of asthma, Dr. Orville Henry Brown said the following of Merkel:
Merkel, after an exhaustive survey of the literature of asthma, comes to the following conclusions:
  1.  Asthma is an affection of the bronchi caused by a neurosis or by an over-stimulation of the nerves of the respiratory system.
  2. The cramps are sometimes useful for the purpose of preventing the entrance of foreign bodies into the respiratory tract.
  3. But from various causes this function may be exercised when it is of no benefit or use.
  4. The spasm involves the muscles of respiration.
  5. Bronchorrhea, bronchitis, dilation of the bronchi,and congestion commonly result.
  6. Asthma is usually complicated by catarrh, emphysema, and heart disease.
  7. Treatment is most efficacious if directed toward the nervous system.
  8. Inhalations are the most efficacious treatment. 
  9. The location of the neurosis cannot be stated but on that account cannot be denied. (1, page 35)
That's all I have for today.

References:
  1. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company; reference used: "Merkel, L.: Schmidt's Jahrb., 1861, cix, p. 225.
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