‘Great ease and simplicity of action’: Dr Nelson’s Inhaler and the origins of modern inhalation therapy

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Unveiled at the conclusion of a meeting of the Royal Medical and Chirurgical Society in 1861,[1] ‘Dr Nelson’s Improved Inhaler’ was one of the most important milestones in the genesis of reliable treatment of respiratory ailments in the modern era. Affordable and suitable for self-medication, the Dr Nelson’s Inhaler offered simple and reliable relief for patients with respiratory and pulmonary ailments. Conspicuous for its modesty and simplicity, it was one of the most widely produced, reproduced, and used inhalation devices in the final third of the nineteenth century. By reconstructing the ‘biography’ of the Nelson Inhaler, this article will attempt to sketch a network of medical and commercial interests and expertise in London which aligned in the 1860s to help establish inhalation as a popular, inexpensive, and trusted form of medical therapy for pulmonary ailments. This article will look at what connects physicians, apothecaries, and patients in the era: the medicines and technologies that were prescribed, made, bought, and which caused wellness, side-effects, and even death. This approach allows us to develop a narrative of respiratory illness as it was experienced by practitioners and patients alike.Peer reviewe

Dispersing the Mists: An Experimental History of Medicine Study into the Quality of Volatile Inhalations

This document is the Accepted Manuscript version. The final publication is available from Mary Ann Liebert, Inc. Publishers at https://doi.org/10.1089/jamp.2016.1357.Background: Dr. Nelson's Improved Inhaler was first marketed with an advertisement in The Lancet in 1865. Revolutionary at the time for its ease of use and patient-friendliness, the inhaler is still in use for self-treatment by many all over the world. On the occasion of its 150th anniversary, this study reports an experimental historical medicine approach to identify evidence for the quality of vapor inhalers. Methods: Through accessing reviews of the device's use by the contemporary medical establishment, it was established that Dr. Nelson's Inhaler enjoyed a reputation of quality and efficacy among reputable physicians generating empirical evidence of clinical performance. There was a general absence of product performance tests during this period. Therefore, modern inhalation performance testing was applied to test the aerosol delivery performance for Friars' Balsam, and its key chemical constituent, benzoic acid (BA). Results: A respirable dose of 59.9 ± 9.0 μg of BA was aerosolized in a 10 minutes period from a dose of 3.3 mL Friars' Balsam (equivalent to 35.1 ± 0.2 mg of BA) in 375 mL of steaming water using the glass twin stage impinger at a flow rate of 60 L·min−1. The respirable dose from a standardized aqueous BA inhalation formulation increased from 115.9 ± 10.6 to 200.2 ± 19.9 μg by increasing the simulated inhalation period from 5 to 10 minutes. When tested with a simulated inhalation maneuver (500 mL tidal volume, 13 minutes−1 respiration rate, 1:2 inspiratory:expiratory ratio) a respirable dose of 112.8 ± 40.3 μg was produced. Conclusions: This work has highlighted the potential for aerosol drug delivery using steam inhalers that are popular with patients. Physicians should therefore be aware of the potential for lung dosing with irritants when patients self-medicate using the Nelson Inhaler with vaporizing formulations such as Friars' Balsam.Peer reviewedFinal Accepted Versio

A Professional Keeping Shop: The Nineteenth-Century Apothecary

Using the Niagara Apothecary as a focus, the paper explores how pharmacy evolved during the nineteenth century from a profession stressing extemporaneous dispensing of drugs largely of natural origin to one emphasizing scientific knowledge about highly potent agents, usually of chemical origin and usually manufactured in large manufacturing plants. It touches upon the influence of increasing standards of education and professional organizations, as much as the remarkable growth of the sciences and technology that provide the basis for pharmacy. It also analyzes the part that commonly held attitudes of laissez-faire had upon the development of botanico-medical sects, the groivth of proprietary or patent medicines and their blatant advertising, and the involvement of non-health related sidelines in the practice of pharmacy. While trying xvhere possible to make the bridge to the twentieth century, it will focus primarily upon the nineteenth-century world of work from the perspective of pharmacy. Résumé Prenant la boutique d'apothicaire de Niagara comme modèle, cette communication étudie l'évolution de la pharmacie au XIXe siècle: comment cette profession, qui consistait à distribuer au petit bonheur des médicaments faits, pour la plupart, d'ingrédients naturels, est devenue la science de substances extrêmement puissantes, presque toutes d'origine chimique et fabriquées en usine. L'étude relie les effets d'une meilleure instruction et l'influence d'organismes professionnels aux progrès remarquables de la science et de la technologie, qui sont à la base même de la pharmacie. L'auteur analyse également les façons dont une attitude généralisée de laisser faire dans l'exercice de la pharmacie a favorisé l'apparition de sectes botanico-médicales, la multiplication des spécialités pharmaceutiques et des médicaments brevetés, commer-cialisés avec fanfare, de même que l'entrée en jeu de petits métiers connexes sans rapport avec la santé. Tout en essayant dans la mesure du possible de faire le lien avec le XX' siècle, l'auteur met l'accent avant tout sur l'univers du travail au XIX siècle, du point de vue de la pharmacie

Turlington’s Balsam of Life

Robert Turlington (1697-1766), weaver, patent medicine vendor, and entrepreneur left his mark in our archaeological record. Bottles embossed BY THE KING’S ROYAL PATENT GRANTED TO / ROBT TURLINGTON FOR HIS INVENTED BALSAM OF LIFE / JANUY 26 1754 / LONDON bear witness to a medicine marketed in distinctive packaging for close to 175 years. Turlington successfully used several strategies to market Balsam of Life, but was less able to protect Balsam of Life from imitators. After his death, his business survived until 1804. The distinctive bottles were still being made in 1919. Turlington’s patent, dated 1743/44, listed 27 ingredients in an alcohol solution, all having perceived medicinal value at the time. Over time, the number of ingredients significantly decreased. His advertisements described numerous ailments treatable by Balsam of Life. In a highly competitive environment, Turlington, and others like him, with no formal medical training, selling pre-packed medicines to people he would never meet, was called a quack and an empiric. In his time, Balsam of Life was consistent with current medical practice and would have been considered appropriate for treating many of the disorders claimed in his advertising