A Pithy History of Nebulizers, Inhalers
My neighbor is 69-years-old. He said he had asthma as a kid. He said he remembers having to order an inhaler from Europe. They were hand-held devices, sort of like a nebulizer cup. They were made of glass, so they were very fragile. You had to squeeze a bulb to generate a mist. You inhaled the mist to get your breath back.
He said he felt lucky to have it. He said he had utmost respect for all the asthmatics who lived before his time.
What inhalers were like before 1950
This conversation is what inspired this post. Here, I would like to take you on a journey through time. What were inhalers and nebulizers like before 1950. Who had access to them? What medicines were used?
Most asthmatics, for most of history, did not have nebulizers or inhalers. These are neat devices used to inhale medicine. But, there have been inhalers going all the way back to the primitive world. There were asthma medicines too. But, only a select few had access to them.
There were no ancient words describing inhalers and nebulizers. The terms nebulizer and inhaler are modern terms. Ancient documents describe inhaling medicine. They also describe methods for inhaling the medicine. But, that’s about it. What they used them for is anyone’s guess.
For instance, the most primitive inhalers were fumigations. They were used in the primitive world. I’m talking, like, long before Sumer, Mesopotamia, Egypt, and Greece. But, you had medicine men back then. They picked herbs. They crushed the stems and roots of these herbs. They dried these overheated bricks. They experimented.
One day, probably by accident, dried and crushed belladonna was tossed into a fire. Those standing around it must have experienced an enjoyable effect. Their breathing improved. They felt a feeling of euphoria. Later on, this was done intentionally to communicate with spirits. This was 30,000 B.C.
Ancient Egypt had physicians. Their documents describe asthma-like symptoms. One document describes what might be considered the first inhaler. They took dried and crushed stems and roots of the belladonna plant. They tossed them onto heated rocks or bricks. The patient inhaled the smoke. This helped the patient to relax and breathe easier. This was 1,500 B.C.
The first true inhaler was used in ancient Greece. It was written about by Hippocrates. There are no pictures of one. But, I imagine they were sort of like tea pots. You placed water in them. You placed a solution of medicine into it. Then you heated them over a fire or oven. You inhaled the steam. This would have been around 400 B.C.
So, steam or smoke were the only ways to inhale respiratory medicine for most of history. Neither was ideal because they involved chemical reactions. These reactions changed the composition of the medicine. So, you could only use certain medicines.
Throughout the years, many physicians experimented with inhalers and nebulizers. In 1778, John Mudge described one. It was basically just another inhaler like the Hippocratic inhaler. It was basically a glorified tea pot. He patented his idea and made a small profit.
But, one day, a physician walked over a waterfall. He observed how he was inhaling a mist. He saw how the water was slammed onto rocks. This created a mist that he inhaled.
He thought, “Hmm, what if I put a medicine in there?”
So, in 1849, Euzet-Les-Bains created spas. Here, water was rapidly pounded onto rocks and a mist produced. Medicine was placed into the water. Patients would sit around the spas inhaling the mist. Some patients were asthmatics.
Mists are nice for inhaling respiratory medicine. No chemical reactions occur. This meant that both volatile and in volatile medicine can be used. You can also mix 2 or more medicines without it changing the chemical compositions of them. This was ideal for inhaling respiratory medicine.
In 1856, Sales-Giron produced the first mist nebulizer. It was a small device, but it was complex. It required you to turn a handle that operated like bicycle pedals. The water was pounded on surfaces inside the device. A mist was produced. This was the first mist inhaler.
It was not called a nebulizer. It was also not called an inhaler. He called it a pulverizer because it pulverized water against a surface. He also called it an atomizer, because it charged the atmosphere with a mist.
It was a noble idea, but it was a flop. It flopped not because the idea was bad. It flopped because it was too much work for someone having an asthma attack. So, the idea was placed on the table.
But, the concept did not go away. Over the ensuing years, many physicians tinkered with either the mist or steam inhaler/nebulizer concept. They all used random names, like inhaler, nebulizer, atomizer, pulverizer. There was no consensus of how any of these terms were defined. What a device was called depended on the inventor, or the inventor’s location.
So, many inventors tinkered with the concepts of mist or steam inhalers. All made minor adjustments. But, none were mass produced.
That is, until the turn of the 20th century. By this time a new method of creating a mist was discovered. It was based on the Venturi Effect. This involved a rapid flow moving through a small opening.
The flow moves fast enough to generate a negative pressure. Water sitting in a cup is drawn (sucked) into the flow. This produces a mist for inhaling. This was ideal for inhaling a new medicine called epinephrine.
In order to power the nebulizer/ inhaler you had to squeeze a bulb. This was what my neighbor described. If you could get one, it was ideal for inhaling asthma medicine.
My neighbor said he remembers them not being available in the U.S., for some reason. So, his parents had to order one from Europe. But he was so happy to have it. It ended many asthma attacks. A problem was they were large, fragile, and bulky.
So, my neighbor grew up in the days before modern inhalers. It’s kind of a neat story to tell. He said he remembers getting his first inhaler in the 1950s. The story of modern inhalers and nebulizers will be the subject of my next post.