1862: The Bergson Apparatus and Inhaler

Figure 1

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 called Bergson Tubes.(3, page 463)

The concept that Bergson used 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 water 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, who was from Germany, 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)

Dr. Scutter said he used Dr. Sales-Giron's Nebulizer "in my practice with excellent results," yet noted that a lot of cranking was required by the operator to generate only a small amount of mist. (1, page 31)

So perhaps all the work required to get only a little mist was the reason why Dr. Bergson decided to concentrate his efforts on improving the Mathieu nebulizer.

In 1862 Bergson 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.

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 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 was 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

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1820-1850: Race to define asthma

In the year 1840 Dr. Charles J.B. Williams proved the bronchospasm theory of asthma, and Dr. William Budd rejected this proof by performing experiments of his own.  This theory was debated for the rest of the century.

Likewise, from this year on you had one physician after another come up with his own theory as to the cause of asthma, with each being convinced he was right, and each offering proof.  Historians can argue whether this slowed down or sped up search for better asthma wisdom.

Dr. Franz Daniel Reisseissen:  He was a German physician who studied the lungs, and concluded "there is another apparatus appointed for contracting the bronchi, which consists of transverse muscular fibres.  As far as the cartilaginous rows extend, these fibres are inserted...." (1, page 186)

Reissiessen proved muscle fibres wrap around the air passages of the lungs almost all the way to the alveoli.  His writings are published in Berlin in 1822. You can check out his 1835 book by clicking here.

Charles J.B. Williams later proved that certain irritants cause contraction of the muscular fibres that Reisseissen proved wrap around the air passages in the lungs.

Francis Hopkins Ramadge:  In 1835 he described food as an asthma trigger, recommends moving from the city to country,  and of asthma being mostly a nocturnal disease. He discourages use of opiates because they impede respirations that are already impeded. He mainly recommends strammonium because it "produces a grateful forgetfulness and a balmy oblivion like opiates." (2, page 7)

He regarded asthma as a neurosis of the respiratory organs.

Prize essays of Bergson and Lefevre:  This occurred in 1836.  They regarded, as did Ramadge, asthma as a neurosis of the respiratory organs (3).

Lefevre observed his own asthma and that of a friend and concluded asthma could only be caused by bronchospasm, and that this bronchospasm was caused by the mind, according to J.B Berkart. (4)

Berkart said that ant "in essence of the disease he (Lefevre) considered to be an increased irritability of the nerves of the lungs, in consequence of which the slightest irritation applies to the bronchial surface induced spasm of the bronchial tubes." (4)

Romberg:  He further established the view of asthma as a nervous disorder in 1841, and based his conception of the disease as a spasmus bronchialis, upon the discovery by Reiseissen (1808) of muscular tissue in the finer bronchial tubes, and the contraction of these tubes under galvanization of the lungs by Charles J.B. Williams (1840), and irritation of the vagus (nerve) by Dr. Francois Achille Longet (1842)." (3)

Dr. Francois Achille Longet:  According to a brief history of asthma by W.H. Geddings, "It was ascertained by (Charles J.B.) Williams that by irritating the lung he could cause contraction of these fibres, and Longet subsequently proved that the same effect could be produced by galvanizing the pneumogastric nerve."  (5, page 184)

Berkart said that in 1842 Longet performed experiments to prove "irritation of the pneumogastric nerve always produced spasmodic contraction of the bronchi, whereas section of the nerve led to emphysema, which was described as distention of the air vesicles."  (4, page 27)

Longet also believed bronchospasm and emphysema were both parts of asthma.

Rudolph A. von Killiker:  In the 18th century William Cullen believed the muscle was just a continuation of a nerve.  Von Killiker was a histologist who proved this was not true.  He basically confirmed the works of Williams and Reisseissen when he isolated smooth muscles in the lungs  (6, page 422)

This essentially proved Cullen wrong, that the muscle was not just a continuation of a nerve.  Yet since nerves still connected to muscles, van Killiker's discovery was unable to stop the fallacy of the nervous theory of asthma. (6, page 422)

Interesting notes:  Williams must have agreed with Rene Laennec and J.B. Berkart that asthma was an abused term. James Thomas Whitaker noted that in 1768 there were 17 different types of asthma (as described by Savage) and in 1822 this was reduced to 11 (by Richter). This was confusing. Williams wanted to simplify the definition of asthma.(3)

The thing to note about most of these experts is that even while they believed in the bronchospasm theory of asthma, they continued to believe in the nervouse theory of asthma, and their experiments proved the two co-existed  -- or so they thought.

During the 1850s, asthma was described by Dr Henry Hyde Salter as a disease of bronchospasm caused by an exciting cause that triggers the nervous system.

References:

1. Floyer, John, ed., "The Cyclopaedia of practical medicine," 1833, volume 1, page 186
2. Brenner, Barry E, ed, "Emergency Asthma" 1998, page 7 (chapter one is a history of asthma written by Brenner)
3. Whitaker, James Thomas, "The theory and practice of medicine," 1893
4. Berkart, J.B.,"On Asthma:  It's Pathology and Treatment, 18xx, volume 1878, London, J. & A. ChurchillI, page 23 (Berkart started his book with a good history of asthma up to his time.
5. Geddings, W.H., writer, "Bronchial Asthma," in the book, "A System of Practical Medicine," edited by William Pepper and William and Louis Star, Volume 3, Philadelphia, Lea Brothers & Co., pages 184-209
6. Daintith, John, editor, "Biographical encyclopedia of scientists." 2009, 3rd edition, Florida, CRC Press
7. Ramadge, Francis Hopkins, "Asthma, its species and comications, 1835, London

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