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John Mudge
Spotlight
Published Online November 17, 2015 http://dx.doi.org/10.1016/ S2213-2600(15)00422-1
Historical Profile John Mudge English physician and amateur inventor of both telescope mirrors and the first inhaler. Born in Devon, UK, in 1721, he died on March 26, 1793, aged 72 years. John Mudge was born in Bideford in Devon, UK, in 1721, and was the fourth—and youngest—son of Mary Fox and notable English clergyman, the Reverend Zachariah Mudge. His father was the master of Bideford Grammar School when John was born, but later became the vicar of St Andrew’s, Plymouth, in 1732, where the family subsequently relocated. The young John Mudge first went to school in Bideford, followed by Plympton grammar school in Plymouth, and then went on to study medicine at Plymouth Hospital, where he initially trained as a surgeon. During Mudge’s many years as a successful surgeon, he made frequent trips to London, where he witnessed innovative surgical procedures being performed in hospitals there that had not yet reached the rural depths of England’s west country. Although his colleagues encouraged him to establish a successful career in the 16
thriving city of London, he returned to Devon, determined to bring his newly acquired knowledge back to his homeland and undertake the novel procedures safely in hospitals there. He was innovative and resourceful, with a strong interest in new approaches and methods. In 1749, he wrote a widely acclaimed letter published in Philosophical Transactions proposing improvements to the existing lateral method for the surgical removal of bladder or kidney stones (lithotomy). Mudge had an enquiring mind and a keen interest in all aspects of science, ranging from medicine to astronomy. His hobby in mirror-making and interest in astronomy occupied much of his spare time, and led him to invent the first reflecting telescope in 1777, for which he was awarded the Royal Society’s prestigious Copley Medal. He became a fellow of the Royal Society that same year, and continued to spend much of his free time working on telescopes, including the creation of two large ones with a 200-fold magnifying power. In medicine, he published several acclaimed treatises on timely topics, including a dissertation on inoculated smallpox in 1777. Just a year later, in 1778, he published “A Radical and Expeditious Cure for a Recent Catarrhous Cough” in which he described his groundbreaking invention, the world’s first inhaler. Mudge’s inhaler was basically a modified pewter beer tankard with a lid. To use it, hot water with added herbs or medicinal products (such as opium) was poured into the bottom of the tankard and the lid was closed. A flexible breathing tube was attached to an opening in the lid. The patient was advised to tuck the device under their arm to keep it warm and then inhale the steam vapours through the breathing tube, in a form of humidificationbased therapy. The hollow handle of the tankard had air inlet holes drilled into it, so that an influx of fresh air could mix with the steam. When the patient breathed out, their exhaled air passed through a valve in the lid, so that it did not need to pass back through the hollow handle. The whole process could be completed without the patient removing the mouthpiece of the breathing tube from their mouth. Mudge was the first person to use the term “inhaler” and his patented invention was the first commercially available version of the device. It could be purchased from pewterer William Barnes in Fleet Street, London, UK. Mudge recommended that the inhaler should be used to treat catarrhous cough, for which his prescribed treatment was elixir paregoricum—a mixture of opium, benzoic acid, and camphor. He advised that no other medications should be used with his inhaler, in case they were ineffective and damaged the reputation of his device; however, this recommendation was generally ignored by the patients using it. In any case, the portable Mudge inhaler proved to be extremely popular, and remained commercially available for the following www.thelancet.com/respiratory Vol 4 January 2016
Spotlight
160 years. Although inhalers are now used to treat asthma, patients who used the Mudge inhaler did so for general respiratory ailments such as coughs and lung complaints. Apparently there were no links between the pioneering device and the treatment of asthma until many years later in the 1900s. Despite the obvious success of Mudge’s inhaler, some controversy persists over whether or not his inhaler was indeed actually the first, since another physician, Dr Philip Stern, claims to have been the first to invent such a device 10 years earlier in 1768. His simpler version involved the inhalation of steam through a metal pipe, although he did not actually use the term “inhaler”, instead referring to his device as a vessel or urn. However, in 1767 Dr Stern had published a small booklet about respiratory illnesses entitled “Medical advice to the consumptive and asthmatic people of England”. As its title suggests, the pamphlet was aimed at patients (rather than at other physicians, as was customary at the time), which led to him being alienated by his fellow doctors. As a result, Stern was not widely respected by the medical community, and Mudge is generally accepted as the inventor of the first inhaler. Later in his life, Mudge obtained a diploma from Kings College, Aberdeen, Scotland, in 1784, and he
began to practice as a physician. He was well connected and popular among his contemporaries. Some of his more notable friends and acquaintances included the acclaimed painter Sir Joshua Reynonds, the renowned writer Samuel Johnson, and the “father” of civil engineering John Smeaton. Mudge was apparently a charming man, regularly and freely giving advice to his friends and acquaintances about their symptoms and ailments. Doctors from London would often send their patients to him because of the “life-giving” qualities of his conversations and personality. During his fairly long life, Mudge married three times and had 20 children. His third wife, Elizabeth Garrett, whom he married in 1767, survived him following his death on March 26, 1793. In Mudge’s long and successful career, his innovative inhaler was arguably his most notable achievement. Although not developed specifically for the treatment of asthma, the inhaler was a key step in the development of inhalation therapy. It was a basic but crucial precursor to the range of advanced treatments now available to treat asthma and other lung diseases, and the concept of humidification remains a key element of many therapies used to treat respiratory illnesses today.
Katherine Gourd
Profile Drawing breath
www.thelancet.com/respiratory Vol 4 January 2016
patients inspired her, years later, to investigate breathing and breathlessness in her art. Wilton currently collaborates on the Life of Breath project, which is funded by the Wellcome Trust and led by Durham University, UK, and Bristol University,
For more on Wilton’s work see Spotlight Lancet Respir Med 2015; 3: 433. For more on Life of Breath see http://lifeofbreath.org
Jayne Wilton
The Lancet Respiratory Medicine is excited to announce that visual artist Jayne Wilton will be creating a series of unique cover images for the journal throughout 2016. Wilton’s work focuses on breathing; using a wide and innovative range of materials, she aims to capture the breath, making the invisible visible. Her interest in respiration was piqued in 2004 when she worked alongside patients in the Hospice of St Francis in Hertfordshire, UK, many of whom suffered from breathlessness. Working in the hospice as an art practitioner, she ran workshops that involved recording, with a range of media, the patients’ breath moving the flame of a candle. “I was astounded and moved by the generosity of patients to donate their precious and finite breath”, she says. “I felt a real responsibility to create something suitably celebratory of each patient’s breath—a poignant record of a moment in time.” But her experience of respiratory medicine goes further back than that, to her role in brand management for a pharmaceutical company where she worked on asthma management products. The commitment of respiratory physicians, family doctors, asthma nurses, and respiratory health organisations to improve the lives of asthma
17
Published Online November 17, 2015 http://dx.doi.org/10.1016/ S2213-2600(15)00422-1
Historical Profile John Mudge English physician and amateur inventor of both telescope mirrors and the first inhaler. Born in Devon, UK, in 1721, he died on March 26, 1793, aged 72 years. John Mudge was born in Bideford in Devon, UK, in 1721, and was the fourth—and youngest—son of Mary Fox and notable English clergyman, the Reverend Zachariah Mudge. His father was the master of Bideford Grammar School when John was born, but later became the vicar of St Andrew’s, Plymouth, in 1732, where the family subsequently relocated. The young John Mudge first went to school in Bideford, followed by Plympton grammar school in Plymouth, and then went on to study medicine at Plymouth Hospital, where he initially trained as a surgeon. During Mudge’s many years as a successful surgeon, he made frequent trips to London, where he witnessed innovative surgical procedures being performed in hospitals there that had not yet reached the rural depths of England’s west country. Although his colleagues encouraged him to establish a successful career in the 16
thriving city of London, he returned to Devon, determined to bring his newly acquired knowledge back to his homeland and undertake the novel procedures safely in hospitals there. He was innovative and resourceful, with a strong interest in new approaches and methods. In 1749, he wrote a widely acclaimed letter published in Philosophical Transactions proposing improvements to the existing lateral method for the surgical removal of bladder or kidney stones (lithotomy). Mudge had an enquiring mind and a keen interest in all aspects of science, ranging from medicine to astronomy. His hobby in mirror-making and interest in astronomy occupied much of his spare time, and led him to invent the first reflecting telescope in 1777, for which he was awarded the Royal Society’s prestigious Copley Medal. He became a fellow of the Royal Society that same year, and continued to spend much of his free time working on telescopes, including the creation of two large ones with a 200-fold magnifying power. In medicine, he published several acclaimed treatises on timely topics, including a dissertation on inoculated smallpox in 1777. Just a year later, in 1778, he published “A Radical and Expeditious Cure for a Recent Catarrhous Cough” in which he described his groundbreaking invention, the world’s first inhaler. Mudge’s inhaler was basically a modified pewter beer tankard with a lid. To use it, hot water with added herbs or medicinal products (such as opium) was poured into the bottom of the tankard and the lid was closed. A flexible breathing tube was attached to an opening in the lid. The patient was advised to tuck the device under their arm to keep it warm and then inhale the steam vapours through the breathing tube, in a form of humidificationbased therapy. The hollow handle of the tankard had air inlet holes drilled into it, so that an influx of fresh air could mix with the steam. When the patient breathed out, their exhaled air passed through a valve in the lid, so that it did not need to pass back through the hollow handle. The whole process could be completed without the patient removing the mouthpiece of the breathing tube from their mouth. Mudge was the first person to use the term “inhaler” and his patented invention was the first commercially available version of the device. It could be purchased from pewterer William Barnes in Fleet Street, London, UK. Mudge recommended that the inhaler should be used to treat catarrhous cough, for which his prescribed treatment was elixir paregoricum—a mixture of opium, benzoic acid, and camphor. He advised that no other medications should be used with his inhaler, in case they were ineffective and damaged the reputation of his device; however, this recommendation was generally ignored by the patients using it. In any case, the portable Mudge inhaler proved to be extremely popular, and remained commercially available for the following www.thelancet.com/respiratory Vol 4 January 2016
Spotlight
160 years. Although inhalers are now used to treat asthma, patients who used the Mudge inhaler did so for general respiratory ailments such as coughs and lung complaints. Apparently there were no links between the pioneering device and the treatment of asthma until many years later in the 1900s. Despite the obvious success of Mudge’s inhaler, some controversy persists over whether or not his inhaler was indeed actually the first, since another physician, Dr Philip Stern, claims to have been the first to invent such a device 10 years earlier in 1768. His simpler version involved the inhalation of steam through a metal pipe, although he did not actually use the term “inhaler”, instead referring to his device as a vessel or urn. However, in 1767 Dr Stern had published a small booklet about respiratory illnesses entitled “Medical advice to the consumptive and asthmatic people of England”. As its title suggests, the pamphlet was aimed at patients (rather than at other physicians, as was customary at the time), which led to him being alienated by his fellow doctors. As a result, Stern was not widely respected by the medical community, and Mudge is generally accepted as the inventor of the first inhaler. Later in his life, Mudge obtained a diploma from Kings College, Aberdeen, Scotland, in 1784, and he
began to practice as a physician. He was well connected and popular among his contemporaries. Some of his more notable friends and acquaintances included the acclaimed painter Sir Joshua Reynonds, the renowned writer Samuel Johnson, and the “father” of civil engineering John Smeaton. Mudge was apparently a charming man, regularly and freely giving advice to his friends and acquaintances about their symptoms and ailments. Doctors from London would often send their patients to him because of the “life-giving” qualities of his conversations and personality. During his fairly long life, Mudge married three times and had 20 children. His third wife, Elizabeth Garrett, whom he married in 1767, survived him following his death on March 26, 1793. In Mudge’s long and successful career, his innovative inhaler was arguably his most notable achievement. Although not developed specifically for the treatment of asthma, the inhaler was a key step in the development of inhalation therapy. It was a basic but crucial precursor to the range of advanced treatments now available to treat asthma and other lung diseases, and the concept of humidification remains a key element of many therapies used to treat respiratory illnesses today.
Katherine Gourd
Profile Drawing breath
www.thelancet.com/respiratory Vol 4 January 2016
patients inspired her, years later, to investigate breathing and breathlessness in her art. Wilton currently collaborates on the Life of Breath project, which is funded by the Wellcome Trust and led by Durham University, UK, and Bristol University,
For more on Wilton’s work see Spotlight Lancet Respir Med 2015; 3: 433. For more on Life of Breath see http://lifeofbreath.org
Jayne Wilton
The Lancet Respiratory Medicine is excited to announce that visual artist Jayne Wilton will be creating a series of unique cover images for the journal throughout 2016. Wilton’s work focuses on breathing; using a wide and innovative range of materials, she aims to capture the breath, making the invisible visible. Her interest in respiration was piqued in 2004 when she worked alongside patients in the Hospice of St Francis in Hertfordshire, UK, many of whom suffered from breathlessness. Working in the hospice as an art practitioner, she ran workshops that involved recording, with a range of media, the patients’ breath moving the flame of a candle. “I was astounded and moved by the generosity of patients to donate their precious and finite breath”, she says. “I felt a real responsibility to create something suitably celebratory of each patient’s breath—a poignant record of a moment in time.” But her experience of respiratory medicine goes further back than that, to her role in brand management for a pharmaceutical company where she worked on asthma management products. The commitment of respiratory physicians, family doctors, asthma nurses, and respiratory health organisations to improve the lives of asthma
17