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 Journal, The 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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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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