1907: Dr. James Sawyer's Asthma Powder

The following is the recipe for making Dr. James Sawyer's Asthma Powder as per The British Pharmaceutical Codex:

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PULVIS STRAMONII COMPOSITUS.

Compound Stramonium Powder.

Synonym.—Sir James Sawyer's Asthma Powder.

Stramonium Leaves, in powder ... ... 50.00

Lobelia, in powder ... ... ... ... 6.oo

Anise Fruit, in powder 12.00

Tea Leaves, in powder ... ... ... 6.oo

Oil of Eucalyptus 1.oo

Potassium Nitrate, sufficient to produce ... 100.00 

Mix the oil with the vegetable powders, then add the potassium nitrate.

This powder is used to relieve asthma. About half a teaspoonful is pressed by the fingers into the shape of a cone, which is then lighted at the top; the patient inhales the fumes as the powder burns. The powder is used several times daily, as may be necessary, for asthma. Pulvis Lobeliae Compositus is a similar preparation.

Note.—A simpler form of Sir James Sawyer's Asthma Powder consists of 50 of stramonium leaves in powder, mixed with 25 each of potassium nitrate and anise fruit in powder; it may be distinguished as Pulvis Stramonii Nitratus.

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1876: The first modern Dry Powdered Inhalers

Figure 1 -- Gilewski and Rauchfuss Insufflator for
dry powder application. A, compressing bulb ;
B, slot covering D, aperture into which the powder
 is inserted; C, shower of powder leaving the instrument. (1, page 340)

Physicians prescribed inhaling powders for certain ailments going all the way back to the 1st century A.D., and probably further back then that. By the late 19th century physicians had access to some devices that we might aptly refer to as the first dry powder inhalers (DPIs).

John Solis Cohen was an expert on inhalation devices in the 19th century, and he published a book detailing inhalation devices in 1876.

He said Galen described an ancient technique of blowing astringent powders into the larynx using a bent reed. This technique, as Galen wrote, was used by the first century physician Aesculpius. Choen said this primitive DPI was still "being considered something of a novelty, even at the present day."   (1, page 336)

The problem with using a bent reed, Cohen noted, is the powder would be inhaled back into the oral cavity upon exhalation.  To remedy this problem, Cohen said that "Czermak attached a rubber ball compressor to flexible tubing, which is compressed at the proper moment.  The patient may do this treatment by his self, although most often it's done by the physician, or some assistant. (1, page 340)

F1g. 2.—Powder Inhaler Or Insufflator With Interchangeable Tubes.
It was designed by  Lewin and Oertel 

Yet, according to Cohen, these two methods are called insufflation as opposed to inspiration or aspiration. Insufflation is Latin for "blowing into." The patient must hold his breath after application of the insufflation, and resist the urge to exhale to improve deposition of the medicine.

Gilewski and Rauchfuss composed a good insuflator (Fig. 1), "which consists of a properly shaped tube, with a gum ball for the purpose of propelling the powder forwards. The powder is inserted into a slot in the tube, over which a tubular cover slides after the introduction of the medicine, which can be propelled in any direction desired by arranging the apertures of exit at the distal extremity of the tube"  There were various similar products composed, although none, according to Cohen, was better than the original. (1, page 340)

Cohen described a variety of insufflators, and so did his cohort, Paul Tissier.  Tissier would be our other expert on inhalation devices in the 19th century.

Lewin and Oertel devised an insuflator that, according to Tissier, "consists of a sort of horn furnished with an opening; through this penetrates a glass tube, to the outer portion of which is attached a rubber bulb; gentle manipulation of the bulb produces in the horn a thick cloud of dust, which is propelled toward the narrow end of the instrument, where it is directly breathed by the patient. In the United States there is sold an instrument (Fig. 2) to be used either with a hand-bulb or a current of compressed air from a reservoir." (2, page 446)

Two more old DPIs from Tissier's book

Bryant created an "auto-insufflator, consisting of a bent tube, having at one point an opening, which may be closed by a stopper. Through this opening the powder is introduced; one end is placed in the nose, the other in the mouth, and gentle blowing is performed. A simple rubber tube answers the same purpose. For insufflation into the larynx and trachea one uses special curved instruments. (Figs. 114, 115.) For insufflation into the pharynx and upon the tonsils any tube may be employed, such as a reed, quill, glass or rubber tube, or a special instrument," according to Tissier. (Fig. 116).

Various physicians provided various different recommendations for the medicine to be applied to the larynx for various disorders, such as hoarseness, inability to speak, and inflammation of the palate and throat.  Remedies included:  lycopodium, cinchona, acetate of lead, nitrate of silver, and tannin,  Other physicians recommend igniting the powder and inhaling the smoke.  (1 page 340)(page 448)

References:

1. Cohen, John Solis, "Inhalation in the treatment of disease," 1876
2. Tissier, Paul Lois Alexandre, "Pneumatherapy: including Aerotherapy and inhalation," 

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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

1654: Bennet describes the inhaler

The Bennett Inhaler (3)

While the inhaler wasn't invented until the 19th century by Dr. Stern and Dr. Mudge, Dr. Christopher Bennett (1617-1655) was the first to draw up an illustration of an inhaler for the medical community in his 1654 book "Theatri Tabidorum."

His "inhaler" was essentially the first known method of inhaling medicine aside from primitive methods such as inhaling steam from a teapot or smoke from a pipe.  (1, page 173)

Bennett was an English physician who had tuberculosis, and might have invented this device to benefit himself, although he must have thought it would also benefit his patients who suffered from the disease. (2, page 530)

According to the 2011 book "Controlled Pulmonary Drug Delivery:

(Bennnet) gave us four woodcut drawings of an inhalation device, with measurements enabling the reader to have their own inhaler made. The treatment was balsam. There is no evidence that Bennett's inhaler was ever manufactured. Bennett succumbed to tuberculosis the following year." (2, page 530)

He was only 38 when he died.  (3)  Perhaps had he lived the inhaler would have been of greater significance to our history of respiratory therapy, lung diseases, and inhalers.

References:

1. Korting, Monika Schafer, editor, "Drug Delivery," 2010, Germany, Springer-Verlag Berlin Heidelberg
2. Smyth, Hugh D.C, Anthony J. Hickey, "Controlled Pulmonary Drug Delivery," 2011, Springer, New York Dordrecht Heidelberg London
3. Sanders, Mark, "Bennett's Inhaler,"  http://www.inhalatorium.com/page162.html, the picture is also compliments of Sanders.  

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1 A.D.: The first Dry Powdered Inhalers

Today we may think of the dry powder inhaler (DPI) as a relatively new concept. We often credit the Intal Spinhaler, first produced in the 1960s, as the first DPI. Yet we would be wrong. The first one was actually used in the ancient world.

In an 1876 book, John Solis Cohen said that Galen explained how the ancient physician Aesculapius blew "an astringent powder into the larynx by means of a bent reed" in patients who presented with angina, or chest pain. (1, page 336)

The medicines used were nutgall and myrrh.

So chances are pretty good other physicians in the ancient world relied on patients inhaling powders as remedies for various respiratory ailments (and probably other ailments too) all the way back to the beginning of civilization, and maybe even into the primitive world.

References:

1. Cohen, John Solis, "Inhalation in the treatment of disease," 1876