Friday, December 30, 2016

1870: Briante's Indian methods of healing asthma and bronchitis

On the title page of his book "The Old Root and Herb Doctor" published in 1870, John Goodale Briante said that he lived "for many years with the St. Francis Tribe of Indians, at Green Bay; also for several years with the Pottawattamies and other tribes. "otanic

He said his book contained "directions for preparing and using their most valuable remedies, as used by him (Briante), in his extensive practice throughout the Eastern and Middle States." (1, page 136-7)(2, title page)

In the preface of his book, he said:
The Remedies given may be relied upon, and are the result of a long and careful study of the system followed by the natives of this country, whose singular success in the treatment of disease is well known;and are the same used by the Doctor, during a successful practice of thirty years.
If the directions here laid down are carefully followed it will, in many cases, save the expense and trouble of calling upon the family physician and prove of the greatest value at times when his attendance cannot be procured.
Did he really learn from the Indians?

We may never know.

It is possible, however, that many of the remedies he described were actually Indian remedies.  Yet it is also possible they were simply made up remedies, or remedies borrowed or stolen from Aborigines of some other nation.

Most Indian remedies were simple, containing only one or two roots or herbs. Most remedies containing more than this were probably just made up remedies. 

Regardless, he profited by selling his products, and his book, during the later course of the 19th century, providing hope for millions of people seeking the all mighty cure for the ailments that plagued them, while at the same time avoiding the costly trip to a medical doctor's office.

He did this near the end of the hey day of Indian, or botanic medicine, before there were laws regulating it.

The following are his remedies for asthma and bronchitis:

1.  Asthma:
Take one half ounce Elecampane root (good for diseases of the chest), pulverized, one half ounce of Flos Sulphur, four scruples of Belladonna leaves, pulverized, one Drachm of Senega root; Mix them well and divide into ninety powders, one of which is to be taken three times a day. (1, page 27, 91)
2.  Asthma:
  • DROPS FOR ASTHMA. Take two ounces Syrup of Orange Pee, on-e half ounce Wine of Ipecac, one half drachm Tr. Stramonium, one drachm Tr. Opium. In severe attacks, give one tea-spoonful every hour. (1, page 53)
  • Indian Turnip, or Dragon Root,  Poplar Bark and Owen's Root (2, page 90-91).
2. Bronchitis:
Take Blue or White Vervain, steep and give a wine-glass full three times a day. Rub the neck and stomach with "Specie of Oil." (See Receipt.)
All of the ingredients could easily be found in their natural environment and prepared by anyone.

References:  
  1. Vogel, Virgil, "American Indian Medicine," 1970, London, Oklahoma University Press
  2. Briante, John Goodale, "The Old Root and Herb Doctor, or the Indian Method of Healing," 1870, New Hampshire, Granite Book Company
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Wednesday, December 28, 2016

1870: The Eclectic Inhaler

The Eclectic Inhaler (3, page 181)
Along with the Nelson inhaler, there were various other inhalers supplied by the S. Maw and Son allowing people to inhale medicated vapors.  One such inhaler was the Eclectic Inhaler.

It was long recognized by the medical profession that the inhalation of moist air would benefit people with breathing difficulty, but also the inhalation of medication inhaled with the moist air.  The eclectic inhaler was another such inhaler device that allowed for the inhalation of medicated steam.   (1, page 64)

Dr. Morell Mackenzie directed the production of the inhaler and recommended its use in his 1865 book "Use of the laryngoscope in diseases of the nose and throat" and an 1881 book he edited "The Pharmacopoeia of the Hospital for Diseases of the Throat and Chest."

Figure 2 -- Diagram of Eclectic Inhaler (1, page 64)
In the Pharmacopoeia he described the simplicity as to how the product worked (refer to figure 2).

a.  An open vase that contains the boiling water and the medicine.  It is shown in figure 2 A filled to the black line, which is about a pint of water.  Above the black line is a space for moist hot air. (1, pages 65-66)

b.  A lid resembling an inverted tumbler.  When the patient inhales air is drawn in from holes in the lid, over the surface of the hot water, and up an opening to the mouthpiece, as you can see by the course of the arrows.  An opening in the lid allows for the insertion of a thermometer to make sure the water is the desired temperature. (1, pages 65-66)

c.  This is a stand on which the vase rests.  It is made hollow with an opening to allow easy insertion of a heated lamp.  (1, pages 65-66)

Using it was as easy as removing the lid, pouring in boiling water to the black line, adding cold water to make the water an ideal temperature for inhalation, pouring off excess water until it reaches black line again, adding volatile medicine, replacing the lid, placing a heated lamp into an opening under the vase, inhaling the medicated water. (1, page 66)

For treatments lasting longer than six minutes, a spirit lamp may be used in place of the heated lamp.  (1, page 66)

When used properly, a bubbling noise will be heard while inhaling.  The benefits of inhaling the medicated vapor should be soon received.  (1, page 66)

As an additional warning, the authors of the encyclopedia add:
Inhalations should, as a rule, be used before meals, and not more than six inspirations should be taken in a minute. In order to avoid catching cold, the patient should not go out of doors for half an hour after inhaling. (1, page 67)
The product was distributed by S. Maw and Son, the same distributors of the Improved Nelson Inhaler and the Earthenware Inhaler. The company paid for a full page ad in the December 24, 1870, edition of the British Medical Journal in which it advertised all three products

Included as part of that ad was a description of the eclectic inhaler, which was described and recommended by Dr. Morell Mackenzie in his 1871 book "Laryngoscope."
BULLOCK AND REYNOLDS' ECLECTIC INHALER AS RECOMMENDED BY DR. MORRELL MACKENZIE Physician for the hospital for Disease of the Throat; and assistant physician to the London Hospital... This apparatus can be used for all medicated vapours, and may be employed from all positions of the patient. It requires no effort on inspiration, insures the thorough medication, of the vapour, and accurately maintains the temperature desired... S. MAW, SON, AND THOMPSON... (2, see ads between pages 673 and 673)
The ad further noted an additional charge for thermometer, heated lamp, and spirit lamp.

There was also a brief review of the Eclectic Inhaler in the July 16, 1870 edition of the British Medical Journal:  
INVENTIONS, &c., IN MEDICINE, SURGERY, DIETETICS, AND THE ALLIED SCIENCES... A NEW INHALER... Messes. Maw & Son have supplied us with a description of Dr. Morrell Mackenzie's new "Eclectic Inhaler." It is believed that this apparatus combines, in a manner hitherto unattained, the qualities necessary for a perfect inhaler. It holds a considerable quantity of water, and has a large chamber for mixed air and medicated vapour; it can be kept at a nearly uniform temperature for a considerable time; it's use requires but little effort on the part of the patient, and it may be employed either in the sitting or incumbent posture... The inhaler will probably be exhibited at the annual meeting of the Association, when members will, no doubt, be able to inspect it. (2, page 67)
It was a good inhaler for its time, and if you were a patient of Dr. Morell Mackenzie, chances are it was the inhaler he recommended to treat your difficult breathing.

References:
  1. Mackenzie, Morell, editor, "The Pharmacopoeia of the Hospital for Diseases of the Throat and Chest," 4th edition, 1881, Philadelphia, Plesley Blakiston
  2. Hart, Ernest, editor, "Maw's double valved earthenware inhaler," British Medical JournalThe Journal of the British Medical Association, volume II, July-December, 1870, (December 24, page 672 of this publication)
  3. Sanders, Mark, "Inhalatorium.com," Eclectic Inhaler, page 181, 
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Wednesday, December 21, 2016

1869: 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 made 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 described 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. (1, page 190)

Lewin's glass nebulizer (1)
Yet another problem with inhalers prior to Lewin was 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 was also graduated with markers so the operator knew 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 the medicine that might be used in it.

Yet tthere were still flaws with it. It was made of glass.  It was bulky.  It was expensive.

Either way, these nebulizers provided another option for physicians and patient. They were also 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
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Monday, December 19, 2016

1867: Abbots says hayfever often confused as something else

In his 1867 book, Dr. William Abbots Smith said that many people suffer from hay fever for years not knowing that they have the disease. He said:
Many individuals suffer from this affection for years, and, in fact, may continue to do so during their whole lifetime without being aware of the nature of the ailment from which they suffer. Persons find that, after going into fields where grass is ripening, or where hay is being made, they suffer from severe attacks of sneezing, watery discharges from the eyes, and other annoying symptoms; but they do not, in any direct manner, connect these symptoms with the actual cause. (1, page 29)
He gave two cases to prove his point.  In the first, a patient has the disease for many years without recognizing it.
A patient of mine having taken a house at a distance from London, was in the habit of making a near cut through some meadows on his way to and from the railway station, every morning and evening. This he continued to do with impunity during the earlier months of the year; but, as the summer came on, he found himself often* troubled with sneezing fits, occasional head-ache, and lassitude, which he attributed to the heat, and to the weariness produced by close application to business. He consulted me about the middle of June, on account of the debility from which he supposed that hewas simply suffering. Noticing the lachrymation and frequent sneezing, I inquired about the hay crops in the neighbourhood of his country-house, and in the course of conversation I soon ascertained what his ailment was attributable to. He was rather sceptical when I told him that his "weakness" would disappear speedily if he would adopt a different and more circuitous route to the , railway station, going along the turnpike-road instead of through the meadows, and if he would follow a course of alterative and aperient medicine which I prescribed for him. He adopted my advice, however, and the regimen and treatment which I prescribed, and in about a fortnight had completely recovered his accustomed good state of health. A relapse happened later in the year, but yielded in a few days to the same treatment as that previously successful. (1, pages 29-30)
In the second case he describes a case that was suspected to be measles, when it was actually hay fever.
Another instance of a similar kind occurs to my recollection. Some years since, in the month of June, I visited a patient at a school in Surrey. After I had prescribed for the case, my opinion was asked as to the probability of measles occurring in one of the other pupils, who had been suffering for two days from running at the eyes and nose, and other symptoms analogous to those observable before the eruption of measles presents itself. The weather was hot and close, and through the open window of the parlour, where the lad was laying on the couch, came an unmistakable aroma of newly-madehay. Struck by the coincidence of the boy's illness and of the hay-making in the immediate vicinity, I made inquiry and learned that the grass in the field next the play-ground haoV been cut three days previously, and that the boys had been allowed to assist in the hay-making. This lad became so ill after a few hours that he was taken into the house, and the head master of the school, fearing an outbreak of measles among the boys, had intended to send the patient to his home, but waited for my advice in the matter. I was able to assure him that he need be under no apprehension of an epidemic. The lad was, according to my directions, removed into a room on the other side of the house, as far as possible, from the exciting cause of the affection. I treated' the case afterwards by -correspondence, and the patient recovered in ten days. (1, pages 30-31)
These are some early examples of why it's important to get the word out about hay fever.  Dr. Abbotts said that when it was recognized early it was easier to treat, and was essentially preventable if the exciting cause was avoided.

Physicians, he said, need to recognize that when sneezing and headache occur during the early months of summer "when the hot weather sets in suddenly," the cause of the symptoms might be the flowering of grass or the conversion of grass to hay.  The episodes occur at intervals, and usually about the same time of the year, such as always during the month of May, or the months of August and September.   (1, pages 32-33)

References:
  1. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw
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Friday, December 16, 2016

1867: The four best nebulizers

By 1867 there was quite a selection of nebulizers to choose from. Dr. John Stutter 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 were as follows:  (see 1, pages 26-36):

Elsberg's Nebulizer
1.  Elsberg's Nebulizer:  "The simplest instrument is that known as "Elsberg's Nebulizer," Stutter said, 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 angles, 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," said Stutter.  "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 nebulizer 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 was 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 (called the eclectic inhaler) of Dr. Mackenzie," said Dr. Stutter, "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 in Dr. Stutter's book, although I wrote about the inhaler here.  I will write about Dr. Mackenzie in an upcoming post.)

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) was designed so that steam delivered the medicine to the patient, so that no assistance, nor cranking, was needed.  I describe this inhaler in more detail here.

So while there were many varieties of mist inhalers, these were your basic nebulizers of this era, at least according to Dr. Stutter.  This was basically what you had to deal with until the 1930s when electricity became available. It was either one of these or inhaling smoke, which was another common remedy for difficult breathing.

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,"
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Wednesday, December 14, 2016

1866: Catologue of stethoscopes

Check out these stethoscopes from the a physician's catalog of S. May and Son from 1866. Keep in mind these are not actual size.:


Reference:
  1. S. Maw and Son, Manufacturer of respiratory equipment, "A catalogue of surgeon's instruments, air and water beds, pillows, and cushions, bandages, trusses, elastic stockings, inhalers, galvanic apparatus, and other appliances used by the medical profession," 1866, London, 11 Aldersgate St., Buttler and Tanner, The Selwood Printing Works, page 127-8
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Monday, December 12, 2016

1865: Dr. See supports diaphragmatic theory of asthma

Germain See (1818-1896) was a German physician wrote several articles on asthma and other lungs diseases in the various medical publications of his era, and he is referenced more than once in this asthma history.  It is obvious, that through his writings, he was well acquainted with respiratory disease, including our asthma.

In 1865 he gave his support to the ideas of Alton Wintrich and Heinrich Bamberger that asthma was not caused by spasms of the muscular fibres in the lungs, and instead was caused by spasms of the diaphragm. (1, page 5) (2, page 2) 

In his 1890 book, Ernest Shmiegelow said See reviewed all the theories of the day.  He quotes See:
"Asthma is a neurosis in the medulla oblongata, that is to say in the centre of respiration, caused by an acquired or native elevated reflex irritability in this organ. The cause of the attacks must be sought for in irritations, which originate in pneumogastric nerves or other peripheral nerves. The effect of the reflex exhibits itself in the motory nerves of the inspiratory muscles, specially those of the diaphragm. We have, therefore, before us a permanent neurosis, whose attacks are caused by an irritation especially of the pneumogastric nerves, and which is always concluded by a tetaniform contraction of diaphragm, this theory only (in contrast to the bronchial spasm) can explain the dilatation of the lungs... The principal factor in the asthmatic attacks is therefore not (as in the bronchial spasm) a direct motor effect of the pneumogastric nerve, only the sensitive pneumogastric fibres take a part in this respect as they lead the irritation up to the noeud vital of the spine, whence the irritation spreads through the nervi phrenici to the diaphragm. " (1, page 9-10)
Joseph Berkart, in his 1878 book, said See divided asthma into three elements: (2,page 2)
  1. Dyspnoea
  2. Bronchial exudation
  3. Emphysema of the lungs (2, page 2)
See believed asthma was always accompanied by organic lesions, and diseases such as chronic bronchitis and emphysema, but never caused by them. (2, page 37)

While others, such as George Kidd, believed asthma was a symptom of emphysema or chronic bronchitis, See believed it was, according to Berkart: (2, page 37)
...always a substantive disease, accompanied, but never produced by organic lesions. He recognised, however, only one form of it. In his opinion, asthma was essentially a neurosis of the vagus and its branches, and manifested itself by a tetanus of all the respiratory muscles, and by a bronchial exudation. The presence of these two "elements" combined was alone characteristic of the affection, whereas emphysema of the lungs was only their constant attendant. Emphysema, he maintained, was not an essential, but merely the consequence of the inspiratory traction during, and the bronchial exudation after, the attack.
Berkart said a goal of German experts, such as See, was, to...
"...maintain that, to warrant a diagnosis of pure bronchial asthma, the bronchial mucous membrane should appear healthy, nor should any other cause for the dyspnoea be discoverable. Still, not all supporters of this definition adhere to it throughout. They admit that asthma may be complicated 'with' or 'grafted on' other cardiac and pulmonary affections. But, as these affections are themselves capable of producing asthmatic seizures, the distinction in a given case between this symptom and the supposed complication would be purely arbitrary." (2, page 3)
In other words, according to Berkart, pure bronchial asthma was only diagnosed when there were no other scars found upon the lungs or the heart, at least according to the Germans. (2, page 3)

References:
  1. Shmiegelow, Ernst, "Asthma, considered specially in relation to nasal disease," 1890, London, H.K. Lewis
  2. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London, J. & A. Churchill
  3. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company; reference used: ee, Germain: Nouv. Diet, de Med. et de Chir. Practiques, 1865, iii, p. 585, pages 36, 89
  4. Gee, Samuel, A lecture on permanent asthma, delivered at the Hotel Dieuj, by Prof. Germain See, translated from the Union Medicale, by H. McS. Gamble, "Gailard's Medical Journal," volume 37, edited by Edward Samuel Galliard, 1884, New York
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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

Friday, December 9, 2016

1865: Bamberger supports diaphragmatic theory of asthma

Heinrich von Bamberger (1822-1888)
Heinrich von Bamberger was an Austrian pathologist who provided evidence, similar to Duchenne before him, that he said supported the diaphragmatic theory of asthma.

Born in Prague in 1822, he earned his medical degree in 1847.  He worked as a pathologist at the University of Wurzburg and, beginning in 1872, at the University of Vienna.  (1)

While he wrote two books that were well received by the medical community, including his 1857 book "A Treaties on the Diseases of the Heart," he also published a book for physicians in 1865 sharing his knowledge of asthma called "Ueber Asthma Nervosum."  (1)

He supported the theories of Alton Wintrich, Guillaume Benjamin Amand Duchenne, and Michael Anton Biermer.  Joseph Berkart, in his 1878 book "Asthma: It's Pathology and Treatment," said:
In a case of fatal dyspnoea he had occasion to observe the tetanus of the diaphragm, and to convince himself by post mortem examination, of the absence also of structural lesions. Although the symptoms of that case by no means resembled those usually assigned to asthma, he, nevertheless, regarded them as characteristic of the disease. Reviewing then the theories held on the nature of the affection, he arrived at the conclusion that the presence of the bronchial muscles did not warrant the assumption of a bronchial spasm. If this existed, he would expect to find the diaphragm ascended, the intercostal spaces drawn in, and a dull resonance on percussion; indeed all the physical signs described by Williams and Bergson in conformity with their theory. But, as yet, he had never met with a case presenting those symptoms. So far as his observations went, he had always found dilatation of the thorax and hyper-resonance on percussion. These signs could be accounted for only by assuming a tonic spasm of the diaphragm and the auxiliary muscles of respiration; and he therefore inclined to the opinion of Wintrich, Duchenne, and Valette. (2, page 36-37)
Berkart said Bamberger further divided asthma:
  • Central: Nervous asthma that causes tetanus of the diaphragm (he also beleived that paralysis of diaphragm was a cause of asthma, especially in cases of muscular atrophy observed by Duchenne.) (2, page 37)(3, page 7)
  • Peripheral: Asthma that accompanies emphysema, bronchitis, pleuritic effusions and tuberculosis (2, page 37)
Other physicians who supported the diaphragmatic theory of asthma were Lehmann, George H. Kidd, and Germain See.  (2, page 37)

So you can see that the diaphragmatic theory of asthma garnished some very respectable support during this era.

References: 
  1. "Bamberger, Heinrich von, "The Encyclopedia Americana," 1920, compliments of wikisource, http://en.wikisource.org/wiki/The_Encyclopedia_Americana_(1920)/Bamberger,_Heinrich_von, accessed on 3/6/14
  2. Berkart, J.B., "On Asthma: It's pathology and treatment," 1878, London, J. & A. Churchill; Berkart references the following: Ueber Asthma nervosum: Wiirzb. Mediz. Zeitsch., Bd. vi, 1868, p. 102-116.
  3. Thorowgood, John Charles, "Notes on Asthma," 1878, 3rd edition, London, J and A Churchill
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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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