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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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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400 B.C.-1881: Steam inhalers

Stern's Inhaler (3)

Since the time of Hippocrates, and more than likely even before that, the inhalation of steam was often recommended for people suffering from various ailments, which included syphilis, asthma, bronchitis, pneumonia, hay fever, phthisis, croup, laryngitis, influenza, etc.  It was something that appeared to provide some immediate relief for difficult breathing.  

At some point in history it was determined that an additional benefit was supplied to the patient when certain medicines were added to the water to be inhaled.  

Initial steam powered inhalers were home made devises that resembled a tea pot, although by the 1870s various inexpensive and portable devices were available on the market for the inhalation of medicated vapors.

By traveling back in time we will find many different devices that were used as steam powered inhalers, some of these I covered in other posts.  Today, for your convenience, I am providing a list of all the various steam powered inhalers used over the years.

That in mind, here are some steam powered inhalers.

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

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

Inhalation Of Hot-water Vapor With The Use Of Pitcher And Towel

3.  Sponge:  Dr. John Scutter described dipping a sponge into boiling hot water, placing your face into the sponge, and inhaling. If the patient wanted he could drop some medications onto the sponge for direct inhalation.

This was an inexpensive and effective means of inhaling steam or medicated steam.  For medicines like chlorine, the medicine could be dipped on a cloth, placed over your face, and you could inhale the fumes that way. (2, page 22)

4.  Wine Bottle or jug:  Another simple method mentioned by Dr. Scutter was to simply place a wine bottle "partly filled  with hotwater" near your face and inhale the vapors as they pass from "the mouth of the bottle."

Another idea would be to insert a sponge into the bottom of a wide wine bottle and insert the water and medication onto the sponge.  The patient could use the sponge or wine bottle method, or a combination, and place a towel over your head for the full steam effect.

The patient could basically play around with these ideas until you found something that worked for you.  I remember my grandma turning on the hot water in the bathroom sink, having me set my head up close, and placing a towel over my head.  It never really worked, and there was no medicine involved, although it made her feel like she was helping. (2, page 22)

Dr. Mudge's Inhaler

5.  Phillip Stern's Contraption (1768):  It was a unique design, an advancement of sorts, on the Hippocratic inhaler.

Dr. Cohen said the lid was angled in a conic fashion so that it created a pointed mouthpiece whereby the patient placed his lips over the device, inhaled, and then took his mouth off to exhale.

Stern marketed it to be used with his own balsamic effluvium.  Half a pint of boiling water is to be inserted into the contraption, and about 30-40 drops of his balsamic effluvium (of which he does not divulge the ingredients).

The patients to whom he aimed his product at were consumptive and asthmatic patients.

6.  Dr. Mudge's Patented Inhaler (1778):  It's another design based on the Hippocratic model, and it was the first inhaler to allow both inhalation and exhalation through the inhaler.

Mudge was also the first to use the term "inhaler." Because Dr. Stern wasn't much respected by the medical community, Dr. Mudge is often given credit as the inventor of the inhaler.  (1, pages 18-20)


Flask inhaler (2)

4.  Flask inhaler:  Dr. Scutter said this inhaler could easily be made by any patient using random items around the household, or that could be easily purchased for a reasonable price at any general store.

Basically, all it required was a container that could hold heated water, and "a tube to conduct that vapor to the patient.  Fig. 1, represents such an instrument. The flask was made of flint glass, and will usually bear an elevated temperature. The cork was perforated by an opening for the attachment of the rubber tube, and for a smaller glass or metal tube for the admission of atmospheric air, as the patient inhales the vapor," said Cohen. (2, page 28-9)

5.  Tin Cup Inhaler.  Another cheap method of making an inhaler (see figure 2). 

Dr. Scutter said he often recommended this in place of the (much preferred) Nelson Inhaler (see below). 

In the words of Scutter: 

Tin cup inhaler (

"It consists of a tin cup, perforated at the bottom and a three quarter inch tube inserted and soldered. To this, is attached two or three feet of rubber tubing, which is terminated by a mouth and nosepiece as represented in the wood cut. The cup contains two cross wires to hold the sponge, which should be coarse and open. In using this apparatus, the sponge is pressed out of hot water and put in the cup, or it may be wet in the cup, and the medicine then sprinkled on it in suficient quantity. The cup being placed upon the floor, a chair, or, if more heat is required, upon the stove, the patient inhales the vapors as they arise. In country practice, it is well to have the cup made the size of a tea-kettle, or tin teapot lid, so they can be turned over these vessels if it is desirable to inhale the vapor of water. This apparatus recommends itself, in that it is simple, cleanly, and cheap, being easily manufactured wherever a tinner can be found, at a cost of 75 cents." (2, pages 29-30)

So it was easily made and cheap.

Wolfe-Bottle Inhaler (1)

6.  Wolfe-Bottle Inhaler: Cohen described this inhaler as...

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

So this was another simple inhaler.

Mackenzie's Eclectic Inhaler (1) (5, page 64)

7. Morell Mackenzie's Eclectic Inhaler:  It was one of the most "complete instruments of it's kind," said Cohen. 

It was made of porcelain, and basically consisted of three parts:  A stand that was hollowed out so it could hold a heated lamp (c), a vase filled with a quart of hot water and medicine (a), and a lid that had two openings. (1, page 24)

One of the openings on the lid consisted of a pipe to allow free flow of air so te patient could breathe through the inhaler.  The other opening was attached a hose allowing the patient to inhale the steam.  (1, page 24)


Mandl Inhaler (1)

8.  Mandl's Inhaler or Fumigator:  This was a smaller version of the eclectic inhaler with some advancements. 

The lamp was inserted to the bottom of the vessel to gain better control of the temperature of the water. 

Cohen said there were a variety of inhalers of this type, but this one was the best.

The reservoir or vessel was made of glass that "rests on a stand over the spirit lamp.  The inspired air as it passes over the vapor becomes impregnated with it, and the expired air escapes by the opening of entrance. The vapor being evolved by heat there is no necessity for an air-tube to dip into the fluid. The amount of heat necessary to evolve the vapor is regulated by altering the size of the wick, or by the occasional removal of the lamp." (1, page 24-26)

Cohen must have been impressed enough with this inhaler that he made it the feature inhaler on the cover of his book. (1, page 25-26)


The Nelson Inhaler: This was by far the best of all the steam powered inhalers, and is actually still available.

The most marketable aspect of this inhaler is it allows the patient to inhale steam, or medicated steam, through a device that is portable. 

Nelson Inhale9.  

As you can see by the picture, it's quite small and compact compared to the devices mentioned above.  It's also easy to use by following the simple directions inked on the back:  "Remove the corked stopper, and fill the vessel half full of hot water; then pour the remedy to be employed upon the sponge on the mouthpiece. Place lips on mouthpiece. Breathe easily in and out as in full respiration. When only the vapor of hot water or any infusion is desired, remove the sponge from mouthpiece."

The Nelson Inhaler was one of the most common inhalers.  Due to its simple design and ease of use it was also the most copied design.

10. Maw's Double Valved Earthenware Inhaler:  It was similar in design to the Nelson Inhaler and sold by the same distributor: S. Maw, Son, and Thomson.  An ad in the December 24, 1870, edition of the British Medical Journal advertised this inhaler, along with the Eclectic Inhaler and the Nelson inhaler.

Here is what this ad said about the Earthenware Inhaler:

"For the inhalation of vapour of Hot Water, either alone or impregnated with Ether, Chloriform, Henbane, Creosote, Vinegar, etc, in affections of the throat and bronchial tubes, Asthma, Consumption, etc. For this apparatus, is especially adapted for Chloriform, Ether and other active volatile substances, as from its construction the exact quantity required may be inhaled. The lower valve opens only during inhalation, whilest the exhaled breath passes freely from the upper valve, instead of through the vessel, dissipating a large portion of the medicated vapour, as is the case in the use of most other inhalers. (6)

It was yet another inexpensive and easy to use option.

A. The inhaler with woolen cover
C. The inhaler without the woolen cover
B. The upper part disconnected from the inhaler1

It also came with a woolen cover to keep the temperature of the fluid contained in it from dropping too fast, and to prevent the person handling it from getting burned. (5, pages 68-69)

A thermometer came with the device, and when not in use it could be stored inside the apparatus.  (5, pages 68-69)

When the inhaler was needed (see figure), the thermometer was inserted through a hole in the lid.  Hot water was poured into the device (f) to just below the holes in the side of it (c).  (5, pages 68-69)

11. Martindale's Portable Inhaler: It was similar to the Eclectic Inhaler of Dr. Mackenzie, although it was made of tin, which made it more portable and less costly. (5, pages 68-69)

As the patient inhaled through the mouthpiece, air is drawn into the fluid through the holes (c), becomes medicated as it passes through the fluid, and is inhaled.  As the air goes through the holes it makes a gurgling sound. The exertion required by the patient is minimal, and using the apparatus is very easy.  (5, pages 68-69)

Bullock's Hospital Inhaler.
Left: The inhaler with mouthpiece
Right: The lid with India-rubber nasal dilator

12.  Bullock's Hospital inhaler:  It's a strong stoneware jug covered with a metal lid.  An India-rubber band holds the lid to the jug.  There are two holes in the metal lid.  In one hole is inserted a tube with mouthpiece used to inhale medicated steam.  Into the other hold was the thermometer to measure the temperature of the fluid to make sure it was not too cool and not too hot.  It could also be used for nasal inhalations by removing the tube and mouthpiece and adding an India-rubber nasal dilator.  Directions on how to use the inhaler came with it.  (5, pages 67-68)

How much medicine, if any, was usually directed by a physician. The 1881 "Pharmacopoeia of the Hospital for Diseases of the Throat and Chest" edited by Morell Mackenzie suggested that most of the devices described above required about a pint of water with about a teaspoon of the medicine, which is made according to specific recipes.  The dose may be increased or decreased slightly for desired effect.  (5, page 69) 

As noted, there were many variations of all these inhalers, many of which can be found in the various medical books and magazines from the 18th and 19th centuries.  

Note:  There were other inhalers that were steam powered, such as the Siegle Inhaler and Adams Inhaler. However, the inhalers described above allow the patient to inhale a medicated steam, while the Siegle and Adams Inhalers use steam to allow the patient to inhale a mist.  It should be noted there is a difference, as mist inhalers allow a patient to inhale both volatile and non-volatile solutions, while steam inhalers only allow for the use of volatile solutions. 

References:

1. Cohen, Jacob Solis, "Inhalation in the treatment of disease: it's therapeutics and practice," 1876, Philadelphia, Lindsay and Blakiston
2. Scudder, John Milton, " On the use of medicated Inhalations in the treatment of diseases of the respiratory organs," 1867, Cincinnati, 2nd edition, Moor, Wilstach, and Baldwin
3. Sander, Mark, "Inhalatorium.com,"  page 41, http://inhalatorium.com/page41.html, accessed on 9/27/12.  Photo used by permission from Mark Sanders. 
4. Tissier,Paul Lewis Alexandre, edited by Solomon Solis Cohen, "Pneumotherapy: Including Aerotherapy and inhalation methods," volume X, 1903, Philadelphia, P. Blakiston's Sons and Co., pages 353-
5. Mackenzie, Morell, editor, "The Pharmacopoeia of the Hospital for Diseases of the Throat and Chest," 4th edition, 1881, Philadelphia, Plesley Blakiston
6. Hart, 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)

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