Septicemia and its Treatment 
with Oxygen 
BY 
ANDREW F. CURRIER, M.D. 
• New York 
RBPR1HTBO FROM 
The American Journal of Obstetrics 
Vol. XXVII., No. 6,1803 
NEW YORK 
WILLIAM WOOD & COMPANY, PUBLISHERS 
1893 SEPTICEMIA AND ITS TREATMENT WITH 
OXYGEN.1 
There is scarcely a physician, whatever his line of practice 
may be, who is not brought into more or less intimate contact 
with septicemia. Perhaps there is no disease from which phy- 
sicians suffer so frequently in their own persons. Its treatment 
is consequently a matter of unusual importance, whether it be 
regarded from the prophylactic standpoint or include the con- 
sideration of measures for attacking it when actually present. 
The disease has many varieties, or perhaps it is better to say 
grades of intensity, and I shall only attempt to consider, at 
least in the main, those of its forms and phenomena with which 
the gynecologist and the obstetrician are apt to be confronted. 
It is only since the development of bacteriological science that 
our knowledge of the etiology of this disease has been definite. 
Upon bacteriological investigation we must also depend, to a 
greater or less degree, for the settlement of questions concern- 
ing its prognosis and treatment. Notwithstanding these facts, 
the part which the clinician has to play in this disease always 
will be an important one, perhaps the most important. 
Fundamental to the consideration of this subject are the fol- 
lowing facts: The blood is the vehicle by which noxious as 
well as nutritious elements are carried to all parts of the 
body. The blood, in the infectious diseases, contains injurious 
elements which are clearly demonstrable, and their injurious ef- 
fects are also susceptible of demonstration. The virulent effect 
of these elements varies under different conditions, according 
as their number and vitality are small or large, and, with refer- 
ence to the individual, according as his resisting power is great 
orsmall; it being understood that different individuals differ 
in their resisting power, and that the same individual offers 
1 Read at the annual meeting of the American Gynecological Society, 
Philadelphia, May 16th, 1893. 2 
CURRIER SFPTICEMIA AND ITS 
greater resisting power at one time than another. These pre- 
liminary considerations are of importance, for they explain the 
varying intensities of septicemia and the varying effects of thera- 
peutic agents and measures at different periods even upon the 
same individual. In Keelson's classification 1 septicemia is de- 
fined as a toxic acute mycosis of the blood. Or, in plainer Eng- 
lish, it is a condition of the blood in which poisonous effects are 
produced more or less rapidly and intensely by germs which it 
contains, the germs having entered the body from without as 
elements foreign to it or as normal parasites of the body, and, 
comparatively harmless under ordinary conditions, have under- 
gone changes which have made them a source of injury. 
These statements presuppose the fact that the normal blood 
of healthy animals does not tolerate pathogenic organisms; 
that when they are present it tries to get rid of tliem. The pro- 
cess of phagocytosis is the chief means of disposing of them and 
effecting a cure,2 but when this process is defective for any 
cause, or when the vital forces of the body are feeble in their 
resistance or the pathogenic organisms especially active, the 
symptoms of septicemia are apparent. The present pathology 
of septicemia seems to rest upon foundations which are firm. 
The experimental portion of the evidence upon which it rests 
appeals strongly to the convictions even of those who are with- 
out practical experience in bacteriology, and may fairly be ad- 
duced as argument by such. Some of that evidence is as fol- 
lows : In rabbits fatal septicemia may be produced in eight 
days by injections of the Microbacterium agile of Davaine.3 In 
house mice septicemia may be induced by injections of Koch's 
bacillus of septicemia or the putrefying fluids which contain 
it. The symptoms produced are considered characteristic of 
the disease, and the bacilli themselves may be found in the leu- 
cocytes and subcutaneous tissue about the seat of inoculation 
and in the blood vessels. Rabbits and guinea-pigs may also be 
infected by similar means, but not to the same extent.4 Injec- 
tion of a few drops of a culture fluid of Bacillus pyogenes feti- 
dus will induce septicemia in mice and guinea-pigs.5 
1 See Parke, " Miitter Lectures," 1892, p. 27. 
2 Arloing, " Les Virus," 1891, p. 203. 
3 Arloing, 1. c., p. 130. 
4 Delafield and Prudden, "Handbook of Pathological Anatomy and His- 
tology," 1889, p. 89. 
5 Parke, 1. c., p. 81. TREATMENT WITH OXYGEN. 
3 
Yet more convincing are the experiments of Garre, Bumm, 
Bockhardt, and Schimmelbusch, because performed upon them- 
selves. Garre produced phlegmons on his arm from injections 
of a pure culture of Staphylococcus pyogenes aureus of the third 
generation, the phenomena of the disease continuing several 
weeks. Schimmelbusch found that the bacteria, when rubbed 
into the unbroken skin, penetrated the hair follicles, prolife- 
rated and then infected the tissues. In Bumm's experiments 
abscesses were produced, and the abscesses contained large num- 
bers of Staphylococcus pyogenes aureus, with cultures of which 
the experiments had been performed.1 Evidence of another 
character is furnished by Escherich, who examined milk ob- 
tained from the breasts of thirteen women who were suffering- 
with puerperal fever. In none of the cases was there excoria- 
tion of the nipple or glandular abscess. From ten of the speci- 
mens staphylococci were obtained from the secretions of both 
breasts, and from one from the secretion of one breast. In 
these cases it was believed, and on evidence which seems to be 
perfectly trustworthy, that the organisms entered the blood by 
way of the uterus and were excreted with the milk. Bacteria 
in the lochia of women suffering with puerperal fever were 
found by Mayerhofer. Coze and Feltz. investigating the 
same disease in 1869. found punctiform bodies, solitary or in 
chains, in the blood and secretions. Injections of solutions of 
these substances into the bodies of healthy animals resulted in 
evidences of infection. Further investigations in this disease 
were made by Chauveau in 1882, and puerperal fever was re- 
produced in animals with the first two generations of cultures 
of the isolated microbes. In 1883 Arloing showed that the 
virulent microbe in puerperal fever could be reproduced with 
its morphological and pathogenic characters in almost an indefi- 
nite series in a medium of beef tea. The same conclusions 
were readied by Frankel, at about the same time, with cultiva- 
tions upon gelatin.2 
The following interesting experience of Eiselsberg is quoted 
by Parke:3 In four cases of fever following injury and opera- 
tion a diagnosis of septicemia was made by means of a bacterio- 
logical examination of the blood. Acute rheumatism was known 
1 Parke, 1. c., p. 73. 
2 The foregoing quotations from Arloing, 1. c., p. 35 et seq. 
3 Loc. cit., p. 43. 4 
CURRIER : SEPTICEMIA AND ITS 
to be present in one of them, but the bacteriological examina- 
tion showed that there was also osteomyelitis. In three of the 
cases the blood contained staphylococci, in the fourth strepto- 
cocci. In eight other cases of septic disorder which were seen 
by Eiselsberg a correct diagnosis was reached by bacteriological 
examination. 
The microbes which are to be found in cases of septicemia 
are the streptococci1 and staphylococci, together with their sol- 
uble products.2 
In the cases of so-called mixed infection other microbes are 
also to be found. Much attention has been paid during the past 
year to the Bacterium coli commune, which is ordinarily a 
harmless inhabitant of the intestine, but becomes pathogenic in 
the presence of decomposing matter in the intestine, as in cases 
of prolonged constipation. 
The forms of septicemia with which one necessarily becomes 
acquainted in the practice of gynecology and obstetrics may be 
the result of- 
1. Decomposition of retained material in the intestines, with 
absorption of toxic products resulting therefrom. 
2. Absorption of the products of retained and decomposed 
material following abortion or labor at term, through the uterine 
lymphatics or any divided portion of the uterine mucous mem- 
brane. 
3. Intoxication associated with surgical procedures upon the 
abdominal and pelvic organs. 
The first of these varieties is very much more common than 
is generally believed. Women who suffer with constipation 
1 The streptococcus has been found by Predohl and Frankel in cases of 
peritonitis (Parke, loc. cit., p. 130). 
The streptococcus and staphylococcus have been found by Bumm in puer- 
peral peritonitis. Bumm considers putrid peritonitis as usually the result of 
surgical procedures (Parke, loc. cit., p. 140). 
Babes considers ordinary puerperal fever as a streptococcus invasion, but 
the pyemia following abortion as the work of the staphylococcus (Parke, loc. 
cit., p. 72). 
It is hardly necessary to say that the terms puerperal fever, puerperal cel- 
lulitis, puerperal peritonitis, and puerperal septicemia all mean practically the 
same thing-that is, that poisonous effects have accompanied the puerperal 
condition as the result of infection. 
2 Rodet and Courmont have found that the same results were to be obtained 
from the soluble products of staphylococci and streptococci as from cultures 
of the microbes (Arloing, loc. cit., p. 203). TREATMENT WITH OXYGEN. 
5 
which goes unrelieved for long periods of time, and who pre- 
sent the outward appearances of anemia and malaria, are very 
often simply victims of septicemia. Parke called attention to 
the influence of the Bacterium coli commune in such cases in 
the "Mutter Lectures" for 1892, and laid stress upon the import- 
ance of thoroughly clearing out the intestines prior to opera- 
tions in which the intestines might be directly or indirectly in- 
volved, thus anticipating harmful effects from the development 
of the bacterium. 
The second form of septicemia, in which there is decomposed 
material within the uterus, together with the toxic germs (strep- 
tococcus, staphylococcus) which develop and produce infection 
in such a medium, may present mild symptoms and be readily 
susceptible to treatment, or it may so overwhelm the entire 
organism that no treatment will be of the least benefit. Such 
cases are often extremely insidious, running a comparatively 
mild course for days or weeks while undermining the vital 
forces beyond the possibility of repair. 
The third form of septicemia with which this paper is con 
earned is usually attributed to some conscious or unconscious 
fault on the part of the surgeon ; to dirty hands or dirty instru- 
ments ; to the direct introduction of poisonous germs. This is 
but a half-truth, for we now know that a relatively clean opera- 
tion (absolute cleanliness being comparatively unattainable) in 
tissues that are unusually sensitive may result seriously. The 
individual equation eludes all attempts at antisepsis or asepsis. 
An antiseptic may be an irritant, and often provokes, in sen- 
sitive tissues, trouble which the laboratory experiment taught 
that it would prevent. A scrubbing brush may carry disease in 
its bristles, or it may be used so vigorously that the protecting 
epidermis will be removed and infection invited. The bruis- 
ing and tearing of tissues, their prolonged pressure or exposure, 
and the various faults in the use of the ligature are quite as influ- 
ential in the production of septicemia as the introduction of a 
few germs which it is the business of the blood cells, and par- 
ticularly of the peritoneum, with which most of the operations 
of the gynecologist are directly or indirectly concerned, to dis- 
pose of. 
The symptoms which more than any others mark the pre- 
sence of septicemia and demonstrate the pernicious effect of the 
toxic agent are referable to the nervous system. Such are tb@ 6 
CURRIER : SEPTICEMIA AND ITS 
paralysis of the muscular coat of the intestine, uncontrollable 
vomiting, obtuseness of the intellect, or mental excitement with 
spasmodic movements of muscles or groups of muscles. Coin- 
cidental with these grave symptoms there may be the greatest 
activity in the eliminative organs-the skin, the kidneys, the in- 
testines, the lungs-as if Nature were making frantic efforts to 
get rid of the accumulating load. With favorable conditions 
for the development of the toxic germs within the body, the 
struggle is an unequal one. Okintchitz1 has found that the 
prognosis depends directly upon the number of the microbes, a 
great number of them rendering it unfavorable, even though 
there be no metastatic deposits. The object of treatment, there- 
fore, in cases in which the blood contains or is likely to con- 
tain such toxic elements as have been under consideration, is 
twofold-namely, to sustain the natural forces, so that in the 
struggle which we are told the healthy elements of the blood 
are constantly waging against the toxic the former may be vic- 
torious, and, in addition, to use if possible such means as shall 
directly destroy or neutralize the effect of the toxic elements. 
The natural forces are to be sustained by the greatest possible 
abundance of the most concentrated food substances, especially 
milk, and by an abundance of alcohol. A starvation diet is as 
inappropriate in the treatment of septicemia as in the treatment 
of typhoid fever and other wasting diseases. The role which is 
played by alcohol is probably identical with that which it exer- 
cises in the fevers. The tolerance which delicately organized 
women show for large quantities of alcohol in all these conditions 
is remarkable, and seems to indicate that its toxic effects are ex- 
pended in antidotal action upon some other poison. But I do 
not propose to argue at length upon the value of alcohol as a 
germicide at the present time, decided though I believe its value 
is, and conscious though 1 am that there are few substances 
which can so readily be brought in contact with the elements of 
the circulation. The object of this article is more particularly 
to direct attention to the availability and utility of oxygen as a 
means of treatment. The facility with which oxygen is ab- 
sorbed by the blood, the function of the hemoglobin in carrying 
it and distributing it to the tissues, and the oxidation which is 
accomplished through its affinity for nitrogen, hydrogen, and 
carbon, are fundamental physiological facts which require only 
1 Parke, loc. cit., p. 78. TREATMENT WITH OXYGEN. 
7 
a passing notice. The capacity of the blood for absorbing oxy- 
gen is a more complex matter, for it involves consideration of 
the state of the blood at the time of treatment, the functional 
activity of the lungs, the tension of the gas, etc. 
For these reasons the experiments which have been made 
upon animals (Thompson, Valenzuela), and those which have 
been made by individuals in health upon themselves (A. H. 
Smith, Krafft), as to the influence of inhalations of oxygen, can- 
not furnish us with positive deductions as to what may be ex- 
pected when disease is present. I do not hesitate to say, how- 
ever, that they are of great value, and should be studied side by 
side with the clinical investigations, which, up to the present 
time, have not been numerous. 
The negative evidence of the value of oxygen consists in the 
distress which one feels when the supply is insufficient, and the 
anemia which is so common in the winter among those who are 
shut up more or less completely in over-heated and under-venti- 
lated houses. We are too apt to lose sight of the fact that in the 
ordinary sick-room, say twelve to fifteen feet square, with a pa- 
tient and one or more attendants, each of whom requires sixteen 
cubic centimetres of atmosphere per respiration, with a stove 
fire or hot air from a furnace, and with the combustion from 
lamps, gas, or candles, the windows being tightly closed, the con- 
ditions are not favorable for the patient who has to remain in 
the room all the time. The difference in results between a de- 
ficient and an abundant supply of oxygen is seen in the records 
of treatment of epidemics of typhus fever and other infectious 
diseases when the cases in one series are treated in hospital 
buildings and in another in tents. Another instructive fact is 
the comparative absence of septicemia among Indian puerperal 
women so long as they lead an out-of-door life; and the same is 
more or less true of all women who lead an out-of-door life. 
This also is indirect evidence, but nevertheless quite convincing. 
On the other hand, if it is not oxygen which guards against 
septicemia in such women, it is not cleanliness, that being un- 
known as it is understood in w'ell-appointed hospitals; and, 
again, when these people become partly civilized and live in 
houses they suffer with infectious diseases like other people. 
Dark blood, outside the body, which absorbs oxygen becomes 
decarbonated, bright-that is, arterial. The effect will be the 
same when it is diffused into the blood through the mucous 8 
CURRIER : SEPTICEMIA AND ITS 
membrane of the lungs or alimentary tract. This suggests the 
very important question of tension and pressure in the use of 
oxygen. Atmospheric air being a mixture (O + 4N), one vol- 
ume of oxygen will contain the equivalent in oxygen of five 
volumes of air, and the pressure of one atmosphere of oxygen 
will give an equivalent in oxygen of five atmospheres of air. 
The effect of very high pressures (twenty or more atmospheres) 
is harmful, or even destructive, to the essential elements of the 
blood.1 A pressure of even three atmospheres produces convul- 
sions in rabbits (Thompson). It is evident, therefore, that some 
care should be exercised to prevent the irritating effect of exces- 
sive absorption of oxygen. The saturation of the hemoglobin 
is a variable term in every case. It can be approximately deter- 
mined for the blood in health, but in septicemia the corpuscles 
are small and many of them are disintegrated. The plasma, 
which in health contains but two per cent of the total volume of 
the oxygen of the body, will absorb somewhat more than this 
under pressure, and its increased volume of carbon dioxide, 
urea, and uric acid in septicemia will still further favor oxygen 
absorption and oxidation. Consequently the volume and pres- 
sure of oxygen which are appropriate in each case of septicemia 
must be determined by experiment in each case. The dark 
color of the blood, the small size and disorganized condition of 
many of the red globules in septicemia, and the shallowness of 
the respiration indicate a deficiency in the oxygen supply. The 
effect of an increase in the supply of oxygen in the blood upon 
the microbes of septicemia has not yet been definitely deter- 
mined. Dr. William II. Welch, of Baltimore, in a personal 
communication says: ''I do not think that it will be easy to 
explain the beneficial effects of inhalations of oxygen, which 
you have observed in cases of septicemia, by any known influ- 
ence of oxygen on the bacteria themselves. When bacteria are 
submitted to an atmosphere of oxygen under high pressure, 
some species are killed. Some kinds of bacteria die more 
quickly when exposed to oxygen than when the air is excluded, 
but this is generally a matter of days. The products of bac- 
terial growth are often of a very different nature when there is 
free admission of oxygen than when this is excluded. Then one 
has to consider whether a beneficial therapeutic agent which has 
ao apparent effect on the bacteria or their products may not 
1 Arloing, " Les Virus," 1891, p. 99. TREATMENT WITH OXYGEN. 
9 
enable the animal organism to contend more successfully against 
the bacteria. The question, you see, is a complex one, but I 
do not think that you would be warranted in believing that the 
good results of your treatment are attributable directly to a 
germicidal influence of the oxygen on the bacteria themselves." 
The experiments of Grossmann and Mayerhauser,1 Pasteur,2 
Chauveau,3 and Arloing4 simply confirm the statements of 
Welch that a positive germicidal effect of oxygen upon microbes 
circulating in the blood cannot as yet be demonstrated, at least 
under such conditions as would be compatible with the welfare 
of the rest of the organism.5 The beneficial influence of oxygen 
inhalation in septicemia probably depends, therefore, upon some 
other than a germicidal action. 
That which is noticeable when chemically pure oxygen is in- 
haled at such a pressure as is compatible with existing conditions 
of respiration is usually as follows : a stimulus to deeper respi- 
ration ; warmth of the extremities, perhaps warmth of the entire 
body ; increased tension of the pulse ; a more natural color of the 
surface of the body, if it has been dark or very pale.' 
If the discoloration of the surface were an evidence of sepsis, 
1 Bacteria in general do not live more than twenty hours in oxygen at a ten- 
sion of five to seven atmospheres. 
* Culture fluids of the bacterium of chicken cholera are attenuated by ex- 
posure to atmospheric air. 
' Attenuation of culture fluids of carbuncle bacteria results from exposure to 
oxygen under high tension. 
4 A tension of five to eight atmospheres of oxygen will suspend microbic life 
in the interior of a culture, and then destroy it. Simple contact of oxygen at 
normal tension, if sufficiently prolonged, will weaken the virulence of cul- 
tures (Arloing, " Les Virus," p. 235). 
6 With reference to the influence of the higher equivalences of oxygen. 
Welch writes : " Ozone and nascent oxygen are more powerful than ordinary 
oxygen in checking the growth of bacteria" (Medical Record, May, 1889). 
W. G. Thompson (Medical Record. May, 1889) says it is impossible to take 
ozone into the blood through the lungs, and that even if it were possible its 
presence would be incompatible with the normalJJcontinuance of the circulation. 
Oberdbrffer (Centralbl. fur Bakteriol. und Parasit., 1890, vii., p. 3-0) found 
that cultures of Staphylococcus pyogenes aureus were destroyed after half an 
hour of exposure to a stream of ozone which had been passed through a Babes' 
ozone tube, and concluded that ozone was unfavorable to the development of 
disease-producing micro organisms, also that the ozone in the blood, if in suffi- 
cient concentration, exercised a destructive influence upon micro organisms 
which were introduced therein. 
6 Thompson says he has never seen a favorable change in the color of the 
surface when oxygen was inhaled by cyanotic individuals, nor incases in gene- 
ral in which there was heart disease. 10 
CURRIER : SEPTICEMIA AND ITS 
improvement in this symptom is to be expected from the use of 
oxygen, provided it was used before intoxication had become too 
general.1 
The stimulation of the blood current and of the respiratory 
function is, of course, directly favorable to the purification of 
the blood by elimination of its toxic elements. The stimulation 
of the nerve centres presiding over functional activity, which is 
possible if intoxication is not too pronounced, is apparently the 
effect of the oxygen, and this, if sufficient and continuous, will 
produce a favorable result whether there is direct germicidal ac- 
tion upon the bacteria in the blood or not. 
One of the most noteworthy symptoms attending this method 
of treatment is the drowsiness and sleep which are induced. I 
have observed the same thing when the windows of a sick-room 
were thrown open and a large volume of fresh air was intro- 
duced. The increased freedom of respiration, the warmth which 
suddenly diffuses through the entire body, the condition of bien 
aise which patients at once assume, are certainly suggestions that 
a powerful change is being wrought in the body, and if the ad- 
ministration of oxygen is begun sufficiently early-that is, before 
the centres of functions are paralyzed by the poisonous agencies- 
it would seem that much benefit could be expected from the use 
of this remedy. The only ill effect which I have ever seen con- 
sists in pain referred to the region of the stomach, which was 
probably due to swallowing the oxygen, which may have been 
administered under too great pressure. (I have observed this 
symptom in two cases, one a case of septicemia attending pro- 
longed retention of feces, and the other a case of mammitis fol- 
lowing labor at term.) 
With reference to the method of administering the oxygen, 
my experience leads me to believe that the simpler it is the 
more desirable will be the result. The principal precautions 
seem to me to be the determination that the oxygen is pure, 
that it be administered sufficiently early in the history of the 
disease, and that it be administered oidy in sufficient volume to 
be readily and comfortably tolerated. 
The histories of two cases are added, in one of which it was 
used successfully ; in the other it produced decided benefit at 
1 A. H. Smith reports two cases of diphtheria cured by Beigel by this means 
and a case of pyemia of his own, also cured. Valenzuela placed rabbits suf- 
fering with induced septicemia in a chamber containing pure oxygen, and 
cured them of the disease. TREATMENT WITH OXYGEN. 
11 
first, but this improvement was followed by overwhelming symp- 
toms of intoxication, the case terminating fatally. The two cases 
are given as types of what may be expected in the way of bene- 
fit from the gas, and of its limitations. 
Case I.-Mrs. F., German, age 48. Hegar's operation, Octo- 
ber 6th, 1890, for large myoma uteri. Operation very difficult 
on account of adhesions. Peritoneum torn in many places. 
Profound shock. Drainage tube two days. Bowels moved 
third day. Evidences of heart failure third day. Tincture of 
digitalis and tincture of strophanthus in ten-drop doses every 
two hours ; turpentine, muriate of iron, and carbonate of am- 
monia also used at sufficiently frequent intervals. Eighth day, 
urine contains albumin. Tenth day, abscess of abdominal 
wound discharging freely. Eleventh day, collapse ; pulse 150, 
temperature 103°, respiration 40, cyanosis. Atropia, morphia, 
whiskey, ammonia administered. Oxygen by inhalation at- 
tended with great relief to respiration and refreshing sleep. 
Acute nephritis developed, and oxygen inhalations were con- 
tinued during subsequent week. The oxygen was inhaled 
from five to ten minutes at a time, according to the urgency 
of the symptoms, and discontinued as the respirations became 
deeper and the skin natural in appearance. The patient ulti- 
mately made a complete recovery. It was believed that the 
oxygen repeatedly warded oft impending death. 
Case II.-Mrs. II., American, age 39. Operation for re- 
moval of dead and macerated fetus, January 11th, 1892. Sep- 
tic at time of operation. Uterine tissue very firm and dilated 
with great difficulty. Septic peritonitis quickly developed. 
Uterus irrigated frequently. Symptoms urgent, oxygen inha- 
lation on the fourth day, with immediate relief to dyspnea. 
Drowsiness and sleep, apparently due to the oxygen. Catarrhal 
gastritis very troublesome; delirium. Renal functions very ac- 
tive ; bowels thoroughly evacuated, fecal matter having been 
retained a long time. Sepsis became universal, without forma- 
tion of pus. Oxygen used at intervals for a week, and then 
for two days almost continuously. After the intoxication be- 
came general there was no decided benefit from the oxygen, 
except in a certain amount of relief to dyspnea. It may have 
delayed the fatal issue, which occurred on the twelfth day. The 
effect during the first few days was markedly beneficial, but evi- 
dently insufficient to stem the tide of advancing sepsis. 
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