;ompounfc Mill c^^ Hberapeutical T^niUS States Ccmpouno ©XEQen Company 99999999999� WB 300 U58c 1889 33020780R NLfl DSlSbMflfi t NATIONAL LIBRARY OF MEDICINE ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 Section Number 3.11$ 4.. *s # NLM051564886 *"€&*_ m COMPOUND OXYGEN AND ITS THERAPEUTICAL VALUE. UNITED SPRINGFIELD, MASS., U. S. A.: STATES COMPOUND OXYGEN COMPANY. 1889. ~b66 U52c Copyrighted 1889, By United States Compound Oxygen Company. CONTENTS. Directory,.........vi, vii Inscription, ......... viii Chapter I.—Historical Statement..... i, 2 Chapter II.—Scientific Basis...... 3-6 Chapter III.—Therapeutical Value, ... 7-12 Chapter IV.—Prophylactic Function, . 13-28 Chapter V.—Pathological Indications :— Part I.—General........29-57 Part II.—Anaemia and Dyspepsia, 57—73 Part III.—Monograph on Phthisis, . . 73-88 Part IV.—Physiological Action, etc., . . 88-116 Part V.—Application in Surgery, . . . 116-156 Chapter VI.—Preparation and Administration, . 157-171 Chapter VII.—Clinical Exhibits:— Part I.—S. M. Birch, M.D.......172-202 Part II.—Andrew H. Smith, M.D., . . 202, 204, 205 Hermann Biegel, M.D.....203, 207 C. E. Ehinger, M.D., .... 204 John Aulde, M.D...... 206 Dr. Frauenstein,..... 206 R. Kingman, M.D., .... 208 Appendix.—Oxygen Administered in Water, . . 209-213 Observations on use of Oxygen in Phthisis, by Arthur Ransome, M.D.......213-221 DIRECTORY OF AUTHORS AND AUTHORITIES CONSULTED IN THE PREPARATION OK THIS WORK. " Our Home Physician," . . . George M. Beard, M.D. " Therapeutics of the Respiratory Passages," Prosser James, M.D. " Human Physiology.".....John C. Dalton, M.D. " Materia Medica and Therapeutics," C. D. F. Phillips, M.D. " Hand-book of Therapeutics," . . Sidney Ringer, M.D. " Practical Treatise on Materia Medica and Therapeutics," Roberts Bartholow, M.D. "The Year-book of Treatment," 1887. "Text book of Physiology," . . M. Foster, M.D., F.R.S. "Class book of Chemistry," . Edward L. Youmans, M.D. " Therapeutics and Pharmacology," George B. Wood, M.D. " The Urine and Common Poisons," J. W. Holland, M.D. " Pyuria and its Treatment," . . Robert Ultzmann, M.D. " Consumption : its Nature, Causes, Prevention, and Cure," J. M. R. Kitchen, M.D. " Action, Use, and Value of Oxygen in the Treatment of Various Diseases,".......S. B. Birch, M.D. 'Monograph," . . . . . John Eric Erichsen, F.R.S. ' Inhalation, its Therapeutics and Practice," J. Solis Cohen, M.D. " Oxygen Gas in Disease," . . . Andrew H. Smith, M.D. " Oxygen in Therapeutics," . . . . C. E. Ehinger, M.D. " System of Medicine," . . William Pepper, M.D., LL.D. " Therapeutics and Materia Medica," Alfred Stille, M.D. Vll " Treatise on Therapeutics," . . Trousseau and Pidoux. "Consumption and How to Prevent it," Thos. J. Mays, M.D. " Chronic Bronchitis," .... J. M. Fothergill, M.D. " Systematic Treatment of Nerve Prostration and Hysteria." W. S. Playfair, M.D. "Treatise on Bright's Disease and Diabetes," J. Tyson, M.D. " Fat and Blood,".......S. W. Mitchell, M.D. " The Physiology of Sleep," . . . W. A. Hammond, M.D. " Morbid Throat and Consumption," . G. W. Timins, M.D. " Principles and Methods of Therapeutics," A. Gubler, M.D. "The Relations of Micro-Organisms to Disease," W. T. Belfield, M.D. " Pathologic Researches in Phthisis," E. C. A. Lewis, M.D. " Treatment of Acute Rheumatism," ... J. Owen, M.D. " The Field of Disease.—A Book of Preventive Medicine," B. W. Richardson, M.D. " Points Connected with Diabetes," . . F. W. Pavy, M.D. " Experiments and Observations on Different Kinds of Air," Robert Priestley, M.D. " Observations on the Nature and Cure of Calculus, Sea- Scurvy, etc.,"......Thomas Beddoes, M.D. "Considerations on the Medical Use, and on the Pro- duction of Factitious Airs," . Thomas Beddoes, M.D. " Oxygen and Some of its Compounds as Therapeutic Agents,"......• . • • S. S. Wallian, M.D. " The Physiological, Pathological, and Therapeutical Effects of Compressed Air," Andrew H. Smith, M.D. " Essay on Medical Pneumatology," J. N. Demarquay, M.D. " Lectures on Chemistry," . Prof. Benjamin F. Silliman. " Beigel on Inhalation," . . . Hermann Beigel, M.D. The standard Dispensatories, the current Medical Magazines and Journals, and various occasional and miscellaneous Papers, Pamphlets, etc. INSCRIPTION. With sentiments of high regard for all honorable medical practitioners, and in the hope that our effort may prove a valuable contribution, we venture re- spectfully to inscribe these pages to the "profession." U. S. Compound Oxygen Co. We are indebted to V. M. Simons for valuable services rendered on this book. Also to D. J. Brown, M.D., for translation. HISTORICAL STATEMENT. CHAPTER I. In a treatise, such as is now proposed, not much need be said by way of historical statement. It is assumed that those into whose hands this work will fall are suffi- ciently informed, if not of the general truth of oxygen treatment, then of the history of oxygen as a gas. With a brief word, therefore, let us proceed to consider the relations of oxygen to the treatment of various dis- eases. The history of oxygen, from the time of its dis- covery by Priestley in 1774, covers a period of more than a century, during which experimental chemistry has en- larged the domain of our knowledge of it, until it has now come to be thought of, by many eminent medical authors and practitioners, as a powerful remedial agent in an increasingly wide range of those ills under which our bodies waste and suffer. Oxygen was first employed as a remedy in disease in a single case in 1783 by Caillens. There is, however, only a brief reference to the case. Six years after Chaptal made record of two or three cases. Then the French government desired an investigation of oxygen with special reference to its use in disease. The investiga- tion was intrusted to Fourcroy, but he proved himself too much of a theorist and contributed little really valuable to the subject. "Everything," says Prof. Silliman, "connected with 2 the history of oxygen is elegant, beautiful, and instruct- ive. Without it there would be no beginning of animal life nor any adequate means of producing and regulating heat. " What has been called the modern theory of chemistry was occupied principally in unfolding the agencies of oxygen and this exposition still continues the most important part of the science." We seek, in these pages, to set forth the relations of this "unfolding agency of oxygen" to disease, more especially to its relief and cure. SCIENTIFIC BASIS. CHAPTER, II. The very nature of things suggests the fact of the scientific basis of oxygen treatment in disease and as a prevention of disease. All nature indicates the relations of oxygen to the maintenance of life and to the integrity of even inanimate existence. The earth itself lives by its atmospheric enswathement and molecular interpenetra- tion of oxygen. Prof. Youmans says, and the same, in substance, is said by every writer on the nature and relations of oxygen in the economy of human life: "Oxygen is the universal supporter of respiration, and hence, as this is the most important of the vital processes, it is the imme- diate supporter of life." And as the body is an intricate "oxidizing apparatus," in which every organ, muscle, nerve, and membrane is constantly operated upon and chemically and physiologically changed, there is an ever- present primal necessity that this apparatus be constantly supplied with the requisite quantity of oxygen. A lack here, and especially if long continued, may involve the whole body in irremediable ailment. Prof. Liebig has strongly set forth the value of the discovery of oxygen and of the vast practical consequences to civilization of that discovery. He says:— " Since the discovery of oxygen the civilized world has undergone a revolution in manners and custom's. 4 The knowledge of the composition of the atmosphere, of the solid crust of the earth, of water, and of their influ- ence upon the life of plants and animals, was linked with that discovery. It may well be said that the material prosperity of empires has increased manifold since the time oxygen became known, and the fortune of every individual has been augmented in proportion." Says another eminent scientist: "The discovery fur- nished the master-key by which man has been enabled to open the mysteries of nature." In no department of scientific inquiry and application is this truer than in the increased knowledge which more recent years have brought to us on oxygen as a valuable therapeutic. By this knowledge the physiological fort- une of every individual has been augmented and in a sense and to a degree not thought of by Prof. Liebig when he wrote this wonderful paragraph. Let us see how this is. What Liebig calls " eremacausis " goes on in all the vast domain of nature. But for this nature itself would by the processes of corruption and congestion, themselves not only causes but forms of disease, waste and die. This "eremacausis" this oxidation, serves to keep the whole realm of nature pure from noxious contaminations and to relieve it from the vast accumulations of a sur- plusage of elementary decay. This is a principal office of oxygen in nature. This may explain the fact of its great superabundance, entering as it does, in proportion to other elements, so largely into the constituency of all material things. Though forming only about one-fifth of the composition of the air we breathe, yet it is dis- tributed everywhere, and the total quantity of it, pressing down upon the earth's surface, has been computed to be 5 not less than 1,178,158,000,000,000 tons. This, if spread over the earth in a layer of uniform density, would be a mile deep. Oxygen serves in human life a purpose similar to that which it serves in nature. Human life, like nature, is itself supported by a continual " eremacausis." Without this it withers and dies. Hence the whole matter of the physiological conditions of the " eremacausis" is, if we would keep ourselves in health, or if diseased recover ourselves, of prime concern to us. Inasmuch then as all forms of disease are only forms in which the want of vitality shows itself, and inasmuch as oxygen is the chief element of that vitality, it is easy to presume that the idea of the treatment of disease by inhalations or applications of oxygen would prove to have, upon close study, a thorough scientific basis and that some diseases would assuredly be amenable to such treatment. If oxidation, going on through all the vast realm of nature, serves to keep it pure and sweet and full and round with life, if in this way its constantly accumulating impurities are purged away and its pestilential predispositions held in check, and if where this oxidation is wanting these im- purities gather and spread themselves into epidemics and contagions and these pestilences assert their devas- tating power over vast districts, and if human nature is constituted with reference to the same principle of oxida- tion, then the claim for oxygen treatment in certain emergencies of diseased human nature is thoroughly scientific. The simple truth then is, that the oxygen treatment involves the very science of properly regulat- ing the physiological conditions of the "eremacausis," the oxidizing work which, if carried on as it should be, pro- motes life and preserves health, and if otherwise carried 6 on superinduces disease and death. This is all there is of it, the real secret, the whole simple science of the oxygen treatment. 7 THERAPEUTICAL VALUE. CHAPTER III. What has been said in the foregoing chapter on the " Scientific Basis" of the oxygen treatment is clearly justified by the facts entering into its therapeutics. Let us then, without going too much into detail, consider these facts. In ascertaining the therapeutical value of oxygen, con- ditions of activity must be taken into the account. The same individual will, when active, absorb more oxygen than when at rest. Lavoisier and Seguin have shown that activity greatly promotes both pulmonary and mus- cular oxygen absorption. The man who in a quiescent state will receive into his system about 19,000 cubic cen- timeters of oxygen per hour will, when active, use nearly three times as much. Spallanzani, by experiments with chrysalis formations as compared with the higher life- states, has shown this, while the experiments of Regnault and Reiset, upon the marmot, demonstrate the same fact of largely increased oxygen consumption under active conditions. Whoever, then, would rightly estimate the therapeutical value of oxygen inhalations must not only consider the general physiological state, but also con- ditions of rest and activity. In short, all the conditions that interfere with perfect health must, when we would intelligently appreciate the value of oxygen, be taken into the account. A chief reason of this is that oxygen 8 inhalations and carbonic acid exhalations go on to- gether. They are interdependent and are regulated, according to this interdependence, by substantially the same physiological relations and conditions. We mean by this to say that muscular exertion increases the carbonic acid exhalations largely beyond those that take place when the body is inactive. Prof. Scharling's experiments have indisputably settled this point. So also in practical experience with oxygen, " age, sex, con- stitution, and development," as Prof. Dalton says, must, for the same reason, be carefully considered. If, as we have said, there is an interdependence between oxygen inhalations and carbonic acid exhalations, then the thera- peutical value of oxygen treatment, in any given case, cannot, except in consideration of the differences above named, be estimated, for the individual variations are very great and very marked. Androl and Gavorret made investigations touching certain of these differences, upon five different subjects, as nearly as could be under uni- form conditions. These investigations showed, in the minimum and the maximum, a variation in the quantity of carbonic acid exhalations per hour of more than seventy-five per cent. The lowest was 15,888 cubic cen- timeters per hour and the highest 26,060 per hour. Moreover, considerations of age are of great impor- tance. This difference of age must have close attention. A young person does not require as much oxygen as one in mature years. Hence any treatment with oxygen gas should be made, if the matter of therapeutics is thought of, with reference to this physiological fact. An eight year old boy throws off, under conditions of health, an average of 9000 cubic centimeters of carbonic acid per hour ; when he is twice as old nearly double the quan- 9 tity. The maximum is supposed to be reached some- where from twenty-five to thirty, at which time the average exhalation is, in round numbers, 23,000 cubic centimeters per hour. During a period of from ten to twelve years thereafter this becomes the regular order of things, and then diminution slowly begins. For twenty years it is usually very slight. This is during the period of full life. Afterward the diminution is likely to go on rapidly until the quantity of carbonic acid gas thrown off in a given time—say an hour or a day—is reduced to that of young manhood or even boyhood. It has been known to fall during this period as low as 13,000 cubic centi- meters per hour and in the case of a very old man—a centenarian—as low as 11,000 cubic centimeters. This is the general law, though of course subject to not a little modification. Thus no consideration in theory or practice of the therapeutics of oxygen inhalation can be relied on, as even approximately correct, which does not mark these differences of "age and sex and constitution and development," in short, the general physiological status. The law of interdependence is so fixed in its principle and so immediate and powerful in its action that no view of the therapeutical value of oxygen treatment that does not make these just distinctions can be of much worth. The professional who handles oxygen in a mercenary and unscientific way will, of course, miss the mark with it and bring it perchance into undeserved disrepute. In general, then, it may be said that certain physiological conditions, such as are common to us all,—eating and fasting, waking and sleeping, action and repose, vigor and fatigue,—must not, in a right view of the therapeu- tics of oxygen inhalations, be overlooked. 10 It is in conformity with this general physiological truth that many eminent practitioners claim so much for the oxygen treatment. Dr. Flint, Jr., says, " It is the only rational basis of the practice of medicine," and which, as he distinctly intimates, will be with the profession generally, more and more controlling in its influence. Dr. Birch says : " Facts in my own experience have clearly proved to me that, in permitting and augmenting for a certain period daily the natural transformations of tissue, we pro tanto confer upon the system an increased power of reconstruction. The bodily powers which may have been long depressed by disease, unable to get the necessary lift up to par, and consequently becoming weaker daily and incapable of renovation by any other available means, will frequently, under a judicious exhi- bition of this powerful remedy, at once receive perma- nent invigoration. Then the almost stagnant circulation resumes its healthy motion, the torpid digestive and assimilative functions again become active, and congested organs are again capable of their work of secretion and excretion, and the constitution, after the lapse of a proper period, becomes renewed." Indeed, if, as has been said in the chapter on " Scientific Basis," the whole phi- losophy of the oxygen treatment involves nothing more and nothing less than the regulation of the physiological conditions of the "eremacausis" then what Dr. Birch found in his experience is only what we might expect. Oxygen is not properly classed among the stimulants but rather among the non-stimulating exhilarants. It does not, in its physiological work, come under the law of stimulation. If it were a stimulant like alcohol there would indeed be a large chance that the medicinal use of it would prove injurious. It might then super-excite the 11 physiological action only to fall back to corresponding reaction. This is the law of the operation of a stimulant, and more or less pronounced as the stimulation is pro- nounced. But the oxygen treatment comes under no such law. As Dr. Wallian well says: " The stereotyped im- pression that oxygen is a physiological stimulant belongs with scores of other scientific delusions. The feeling experienced after inhaling oxygen, artificially prepared, is one of restfulness rather than one of stimulation." Dr. Birch, in his first essays with oxygen, and, as he says, "before he had fully initiated himself in its application," was troubled with occasional contretemps, but with more knowledge and larger experience overcame them. He found, what every other wise experimenter with oxygen gas before or since has found, that there need be, even in constitutions predisposed to "vascular" excitement, no injury. He says : " Far from being a temporary stimu- lant, it frequently is not felt as a stimulant or excitant at all. Even where oxygen has been inhaled daily for some months I never met with one indication of excitement or irritation of the lungs, but on the contrary I have had several striking cases of cure in chronic pulmonary congestion which had been pronounced incurable, as well as in sub-acute inflammation." Demarquay is of the opin- ion that one of the chief medical offices of oxygen inhalations is to facilitate the absorption into the blood of the remedies prescribed. An eminent practitioner said recently to us : "I am able with oxygen, in average cases, to get better results and get them quicker than I could without it, and in some cases I get results with it that I could never get without it." Where then lies the secret of the therapy of oxygen inhalations? Where but in the strange power oxygen 12 has to take hold of the very innermost centers of vitality and thus tone up the nervous and muscular systems? Thus it is able to augment largely the general functional force and maintain or re-establish, as may be, the physio- logical integrity. The treatment, then, is most likely to be indicated as a therapeutic in those cases where the vital force has suffered no long-continued drain, and yet it has wrought wonders, as the "Clinical Exhibits" show, in not a few cases of utter vital exhaustion. In these cases it has done what all other means failed to do. " It is possible," says the New York Medical Record, " that the systematic very slight increase in the per cent, of oxygen in the blood caused by inhaling pure gas may give an im- petus to the growth of haemoglobin, especially when the substance is below the normal amount. The best results appear to have been obtained in the dyspnoea of pneu- monia, asthma, asphyxiation, gas poisoning, and anaemia." Dr. Birch notes some of the physiological conditions in which, par excellence, the oxygen treatment in his hands proved eminently satisfactory. Among these he specially mentions "a state of general malaise with great liability to colds and sluggish circulation, either constitutional or super-induced by an atonic and oppressive condition through over-feeding or other luxurious and indolent habits." The study of oxygen gas as a therapeutic agent must be among the first steps in this called-for and much-needed advance. These general remarks, in support of the remedial value of oxygen inhalations, may be considered prefatory to what follows in the chapter on " Patholog- ical Indications." In the detail of those indications the therapeutics of the treatment will be especially seen in the light of high authority. PROPHYLACTIC FUNCTION. CHAPTER IV. To prevent is sometimes better than to cure. The pre- vention of disease is coming to be almost as truly a science as its cure, and prophylactic as compared with therapeutic treatment is having among physicians much attention. We must therefore put in an earnest word for this truth of prevention and for the power of the oxygen treatment as a preventive. " Medical science," says Dr. Fleck, " has grown beyond the mere art of prescribing remedies. It has become a science of protecting man against disease and enabling him to attain threescore years and ten." Dr. Thomas J. Mays in his "Therapeu- tic Forces " says, " There is no question of greater mag- nitude to the sanitarian than that of the relation which exists between oxygen and the preservation of life. To secure to man a liberal supply of this vital gas, whether he is in his office or dwelling, in his counting house or store room, sitting in church or walking in the street, delving under ground or working in the factory, or whatever legitimate calling he may follow, is a problem which presses itself for solution upon the attention of every thoughtful individual." " The conception," says Dr. B. W. Richardson in his large work on " Preventive Medicine," " that disease can be prevented is of modern times, and indeed we may say practically of the present century or even of the latter two-thirds of the present 14 century." This is a truth worthy our attention. Indeed, the fact that in this country so great a change in the standpoint from which the highest medical authorities view disease as that implied in Richardson's statement is one in which we may all rejoice, for " an ounce of pre- vention is worth a pound of cure." Beside, the expense of prevention is as a rule indefinitely less than that of cure. The most distinguished medical practitioners are intent now upon availing themselves of those remedies that offer in their use the power of timely prevention of disease. The remedies sought out and used have been largely curatives, while to prevent the need of their use by preventing the disease has hardly, until recently at least, been thought of; and now the entire scheme of prevention as well as cure is challenging more and more our attention. With this there comes, of course, broader and wider consideration of remedial agents. Some are now added to the list that never would have found a place there but for this state of things. Through long- continued and stout opposition electricity has at last come to be definitely recognized as a valuable therapeu- tic with special virtue to prevent disease. In like man- ner the treatment of diseases by applications or inhalations of oxygen gas has now, after a century of struggle with strange vicissitudes of favor and disfavor, come to its time and power and come to stay. And one of the fields inviting its very general use is that of prevention, technic- ally its prophylactic function. Let us see wThy this is so. The reason will be found in that famine of oxygen under which we all, in our modern civilized life, suffer, in the systemic possibility of large oxygen absorption, and in the physiological action of oxygen especially in its relations to organic processes. 15 Multitudes of people are suffering from what an En- glish physicist calls " oxygen starvation," a physiological misfortune incident to our civilized mode of living. Nature seems to have taken good care that our necessary oxygen supply should not give out but be freely and fully met. However, physicians agree in the opinion that a large proportion of deaths come directly or indirectly from the slow process of oxygen starvation. This same physicist, considering the causes of this, finds a princi- pal one in the fact that we live so much indoors and in such compact populations. Every great center, like New York or Philadelphia or Boston or Liverpool or London, in which large numbers of people are crowded together, becomes a source of oxygen exhaustion and so of oxygen starvation. We may prate against this truth and say it is not so, but all that does not change the conditions of impoverishment nor relieve the famine. Dr. Wallian states what is patent to our observation, namely, the fact that the ratio of "human beings," and especially those in " civilized life," who, for the lack of oxygen, suffer what he calls " vital robbery," is con- stantly increasing. He says, "True, nature, ever on the alert for compensatory substitutes and conservative repa- ration, does her best in many ways to render this depri- vation comparatively harmless ; but as constant trickling finally splits in twain mountains of adamant, so this phys- iologic deprivation, so steadily persisted in day by day, at last makes inroads. The starved blood falters, the robbed nerves cry out, tissue-changes flag for want of material, or the tissues themselves degenerate until dis- organization in one or another of its fatal forms is finally inaugurated. Anaemia, neuralgia, dyspepsia, diabetes, albuminuria, scrofula, tuberculosis,—these are the mile- i6 stones on the downward road, the direct or indirect results of imperfect oxidation, the misere physiologique of Bouchardat." Some of the more recent foreign experimenters with oxygen, notably those of Germany and France, have undertaken to show that there is a point beyond which the blood cannot be saturated with oxygen. There is, however, better authority for a contrary view, and, if there were not, this non-absorption notion, more a notion than a fact, would have really no practical bearing on the question of the prophylactic function of oxygen treat- ment. For, as a celebrated medical writer says, " Ordi- nary mortals are in about as much danger of being translated as of damaging themselves by an excess of the vital element in question." The ordinary mortal cannot get this excess : indeed, he cannot get the supply of oxygen which nature demands. As says the writer just quoted, " Unfortunately civilization implies a sort of human hibernation, and the average modern individual is compelled to eke out his disease-pestered days on one- half this allowance or even less. And he clearly states the result which, in the absence of any health-giving interregnum, he pronounces " inevitable." His own words to state this result are best. " Functions are imperfectly and incompletely performed, changes and metamorphic processes, though initiated, necessarily flag and result in half formed tissue, or in products inimical to the healthy organism. Toxic, carbonaceous elements accumulate: degenerative processes are set up and chronic disease is the inevitable result, if even malig- nant demonstrations do not end the disastrous history." The unscientific assumption that there is a narrow and fixed natural limit to the oxygen absorbing power of the 17 blood, what one writer tersely calls " that scientific stu- pidity," which until more recently has gone substantially unchallenged, and out of which the question of therapeu- tical negation has come, must now be looked upon as exploded. Both Dalton and Phillips declare against it and support their declaration by the facts of deeper, truer knowledge. While the effect of oxygen inhalations is the reduction of the carbon in the system, yet there is another and more life-giving effect, an effect of oxygen absorption directly into the blood. This, we think, since the experiments of Magnus, is indisputable, and, to use the language of another, " This is doubtless the key-note to the action of oxygen therapeutically exhibited." "It would be a waste of time," says this same writer, "to prove that the blood can and does under certain circum- stances absorb an unwonted increment of oxygen since a large majority of the race live under conditions which positively forbid the utilization of anything like a normal supply." Thus the highest truth of modern scientific inquiry is that of the possibility of this large super-oxygenation of the blood, the end of which may be in the best sense a materia alimentaria, and so a sort of standing contribution to the physiological intent and the still unimpaired integ- rity of all the force and power of the vis medicatrix. In a single paragraph Prosser gives us the true philos- ophy of the imperfect oxidation of the blood and of the entire absence of oxygen when " the gas is entirely pre- vented from reaching the alveoli." He says, " This want of oxygen sets up convulsions. These seem to be due to stagnation of blood in the brain,—venous blood, poor in oxygen, rich in carbonic acid,—for they occur when arte- rial blood is prevented from going to the brain as well as 2 i8 when venous blood is prevented from returning, and also after hemorrhage," and he goes on to show how a " long- continued want of oxygen " not in an extreme but in a "moderate degree," lowers the temperature, increases respiration, relaxes the arteries and capillaries, and results in cyanosis. From the consideration of this truth of oxygen starvation, let us now pass to consider the larger, more important and more comprehensive truth of oxygen absorption; the physiological power the system has to absorb abnormal quantities of oxygen and store it away for emergent use. The question that arises at the outset is that which Phillips raises, whether or not an abnormal quantity of oxygen can be "taken into the blood." Some aid to the proper answer of this question may come from the many experiments made with animals which have been under certain conditions super-oxygenated. Priestley, Beddoes, and others have done much to convince us of the possibility of the blood, perhaps it were better to say of the system, taking into itself under favorable condi- tions more oxygen than can be supplied to it by the proc- esses of natural atmospheric inspiration. The opinion to the contrary held by Regnault and Reiset has been so entirely contradicted, by more recent facts of experience, that it is no longer tenable, but must be abandoned. Preyer, Demarquay, Allen, Pepys, all agree that the blood and muscles may thus be surcharged. Indeed, by actual experiment it has been shown that on the other hand the blood may, for certain reasons, lack proper oxidation, and on the other that, even where there is a normal quantity of oxygen, that quantity may be in- creased. The experiments of Kollmann, showing the less- ened elimination of uric acid under special oxidation, 19 are of much value. He makes this record :— 300 grammes of urine, 236 milligrammes of acid. The same quantity of urine after the inhalation of 12 liters of oxygen contained only 122 milligrammes of acid, a decrease of nearly fifty per cent. In another case he found the decrease under inhalations of oxygen to be still greater. Gubler has put on record a case of his own which, if there were not another, would be practical evi- dence of the claim that it is possible to store away in the blood and muscular tissues a reserved quantity of oxygen. Thus what Demarquay says can be done by venous injec- tion, it is reasonable to presume can also be done, under right physiological conditions, by pulmonary inhalation, namely, the circulatory system and the tissue substance can be surcharged with oxygen. Examining the physiological action of oxygen, Dr. Lasvkewitch insists that the blood will absorb a greater proportion of artificially prepared oxygen than that con- tained in atmospheric air ; and as a result of this he notes the following : (1) increase in the daily excretion of urea, (2) augmentation of the temperature of the body, (3) increased strength and fullness of the pulse, (4) diminu- tion of reflex activities. Of course this would be of no account unless there might come with it and because of it certain especial and invaluable therapeutical results, results that would not otherwise come. " It is estimated," says Dr. W. B. Clarke, " that the blood is capable of being saturated with about three times the amount of oxygen it can ever get from the ordinary air when the body is at rest, a most impor- 20 tant fact in relation to the inhalation-treatment of anaemic or bedridden patients." According to Gubler the phys- ical capacity of the blood, rather than any vital neces- sity of haematosis, determines the quantity of oxygen it will, at any given time, receive. What the globules do not need passes freely into the system and hence into life sustaining combinations. For this reason any diminution of the corpuscles lessens the oxygen absorption. A plethoric man would naturally have a larger oxygen capacity than a thin, spare man, though the thin man might, under certain physiological condi- tions, need the oxygen more than the other. The reason why, as a rule, oxygen treatment is indicated in cases of anaemia is that there is a deficiency of corpuscles or a lack in their power to take up the oxygen. Quinguand has made an interesting calculation concerning the possible power of the blood to absorb oxygen. Healthy blood will, according to his view, take up on an average, 240 cubic centimeters of oxygen to every 1000 grammes of blood. We cannot, however, agree with him in the opin- ion that physiological conditions make no difference in this absorption. Evidently a series of pathological conditions are against it. Others have supposed that not the pulmonary demand, but rather the demand of the tissues, regulates the absorbing power of oxygen. A candid survey of the very limited field of literature on this subject warrants the assertion that the blood can and often does take more than a normal quantity of oxygen, and that this extra absorption has a certain pre- therapeutical value. Beddoes made extensive and critical experiments with oxygen gas when he was professor of chemistry at Oxford. His experiments are, to any one seeking reliable informa- 21 tion, of great value. Two or three facts are shown by these experiments, facts not so much of a technical as of a general character, and of interest to the average reader. (i.) His experiments show that the blood can be Sur- charged with oxygen. (2.) That when thus surcharged it may be depended on to supply to the system sustenance under deficient respiration, whether from lack of air or because of bad air. (3.) That blood thus oxygenated will, by its heat pro- ducing energy, resist physiological or atmospheric con- ditions of cold. " The blood then by virtue of its corpuscles, these by virtue of their haemoglobin, takes up oxygen in the lungs, becomes, as we say, arterial, and goes as such to the tis- sues where the oxygen tension is low. They therefore receive oxygen from the blood and store it up in some suit- able combination, leaving the haemoglobin reduced, that is, more or less of it according to the activity of the tissue."— " Therapeutics of the Respiratory Passages," by Prosser James. It used to be thought that the oxygen taken into the blood by respiration was simply dissolved there, but this theory has been shown to be untenable. It may be ab- sorbed but it is not dissolved. Dr. Foster says : " The ab- sorption of oxygen by the blood does not follow the general law of absorption according to pressure," atmos- pheric pressure he means. " Certain phenomena of that absorption suggest," says Dr. Foster, "that the oxygen in the blood is in some particular combination with a substance or substances in the blood of such a kind that disassociation rapidly occurs at certain pressures and 22 temperatures." That substance is beyond a question the haemoglobin. This substance in arterial blood is well- nigh saturated with oxygen. Increase the pressure of the oxygen contact and by simple absorption the blood takes into itself more oxygen. The quantity may be almost insignificantly small, but the increased tension of it makes its physiological action of great value. It is the haemoglobin in the blood, in the red blood corpuscles, that makes them absorbents and distributers of oxygen all along the course of the circulatory system. In this oxyhaemoglobin is to be found the principle and sub- stance of tissue building. The natural physiological absorbents of oxygen are the blood globules and the tissues. Oxygen taken into the blood globules is carried by the circulatory force to the extremities of the system, in which passage the oxygen is measurably or entirely exhausted. The explanation of this loss of oxygen in the blood, and its consequent change of color from that of arterial to venous, is to be found in the absorbent power of the tissues. Different tissues have different powers of absorption. This power of absorption is greatest, first in the muscles, then in the brain, then in the kidneys, then in the spleen, and least in the anatomy. This order and degree of oxygen absorp- tion may serve in a general way to make up the indi- cations of the oxygen treatment and enable us to prognosticate with tolerable assurance its therapeutical value in various diseases. Muscular depravities, brain weaknesses, kidney troubles, and disorders of the spleen would, as compared with some other diseases, be likely to yield to the treatment. Practically this has been time and again proved. Foster, and he is good authority, considering the ques- 23 tion of how oxidation takes place, whether in the blood or in the tissues, says : " On the one hand the muscle seems to have the property of taking up and fixing in some way or other the oxygen to which it is exposed, of converting it into inter-molecular oxygen, in which con- dition it cannot be removed by simple diminished press- ure, so that the tension of oxygen in the muscular substance may be considered always nil." " The respira- tion of the muscle, then, does not consist in throwing into the blood oxidizable substance, but it does consist in the assumption of oxygen as inter-molecular oxygen, in the building up by the help of that oxygen, of explosive decomposable substances, in the occurrence of decompo- sition. We cannot as yet trace out the steps taken by the oxygen from the moment it slips into its inter-molecu- lar position to the moment when it issues, united with carbon, as carbonic acid. The whole mystery of life lies hidden in the story of that progress." All this suggests to us the fundamental truth of the physiological action of oxygen, and especially in its relation to organic processes. The physiological action of oxygen is, in the general sense, twofold : that is, it is external and internal. The external action is mostly local, as a surface treatment, applied to diseased parts. In this application of oxygen gas, sometimes in its pure but more especially and generally in its diluted form, it has a good effect upon the mucous surface and upon the skin under certain eruptions and abrasions. Some writers say that when thus used it is "stimulating." Phillips in his "Materia Medica and Therapeutics" says that the "ex- ternal and local action of oxygen in contact with mucous membrane or denuded skin is moderately stimulating," that is, stimulating in the tonical, not in the narcotical 24 sense ; for, as has already been said, oxygen administered either externally or internally is not, technically speaking, a stimulant. The other part of this twofold action of oxygen is internal. Here, as it is taken by inhalation, it reaches, with wonderful power, the most secret sources of vitality. Because of this, certain physiological changes of an absolutely therapeutic character are, to a degree not attained by medicines, brought about, and are, as a rule, of a permanent and substantial character. Indeed, when it is considered that the oxygen treatment is a constitu- tional treatment as contradistinguished from local medi- cation, this is what might be expected, for the effects reached by constitutional remedies are likely to have the most reliable conditions of permanence. Of course we do not by this mean to say that the results of oxygen treatment in those diseases in which it is undoubtedly indicated involve no possibility or it may be probability of lapse, for that would stand for a physiological integrity impossible under the unfortunate conditions in which we "live and move and have our being"; but we do mean distinctly to say that the results of oxygen treatment as compared with those gotten by the use of medicines are likely to be, so far as thoroughness and permanence go, more satisfactory. Many eminent medical practitioners who have given oxygen treatment practical attention have become aware of this fact. All forms of disease are largely some sort of decay or devitalization, and in a final analysis this can be traced to the relations of oxygen to the physiological system. Given a lack of oxygen in the air or a lack of respiratory function and the deficiency may be enough to account for bad nu- trition and imperfect tissue-change, and, indeed, in a final analysis, for the whole round of physical ail- 25 ments. All the varieties of disordered functional activ- ity may have and often do have their principal cause here. With a lack of oxygen supply or with no ade- quate power in the vital organs to receive it, assimilation is deficient, the blood becomes corrupt or sluggish in its channels, the general warmth of the body diminishes, the extremities become cold, and if this state of things con- tinues for any great length of time, the vital forces lose their tone, disease comes on apace, and sometimes death ensues. If, then, in the very incipiency of this down- ward course, in the early genesis of it only for the lacks named,—insufficient oxygen or insufficient absorption of it,—some treatment were entered upon that would over- come this lack, the far away fatal consequences might be prevented. And for this, the oxygen treatment, as it sup- plies the deficiency in the oxygen breathed and increases the capacity to breath it, must be put down as invaluable. But it is in the physiological action of oxygen in its rela- tion to organic processes that we may especially see its prophylactic power, and here its power is connected with and depends upon preceding conditions and facts of tis- sue absorption and storage. That oxygen in the physiological economy of man sus- tains a vital relation to the processes of organic substance and force is a well-known fact. " Life," says Dr. Frank Donaldson, "implies change, and its activity is in pro- portion to change, and for this oxidation is essential for the development of force." Not only does it enter into the very composition of the tissues but it enters the body, there to form certain chemical combinations by reason of which force is generated and functional integ- rity maintained. As this is so, the need which the body has of a proper supply of oxygen is an imperative one. 26 If there be any lack here, and especially if it be great and long continued, the whole system suffers. This lack often opens the way to the taking on of serious ailments, ailments that would never, were the body supplied with oxygen according to its full demands, attack it. " The large amount of force which is constantly given out by the body in the shape of mental, muscular, or other work, originates," says Dr. Mays, "mainly from the oxidation of carbon and of hydrogen." He adds, "Oxidation is the main process by which depuration of the body gener- ally takes place, by which those tissues that have sur- vived their usefulness in the body can be prepared for removal." The action of oxygen upon the albuminous tissue illustrates its depurating power. It changes these tissues from an indiffusible condition into the crystalloid state, and in this state through the uric and carbonic acid and other forces the work of depuration goes on as it should. ' Let there be any lack, however slight, in the normal supply of oxygen to the system and this defi- ciency is likely to become a disease breeder. The active physiological force must correspondingly suffer. The very large accumulation of carbonic acid in the system and especially in the lungs may and often does lead to fatal results, results that might have been, had the system been supplied in some way with the required oxygen, prevented. Dr. Mays distinctly says that " de- ficient oxygenation is the chief cause of mischief to the body." Where the exhalation of carbonic acid is in quantity under what it should be, and that acid remains too long a time in contact with the tissues and membranes, poisoning results. This is known as carbonic acid poisoning, and, as Dr. Mays says, " be this process ever so slow, its impress will nevertheless be 27 stamped on the body, and especially," he says, "on those organs which are mostly exposed to its deleterious in- fluence, as the right side of the heart, which will espe- cially bear the brunt of its action." A paragraph in Dr. Mays' book is so full of truth stated in plain terms that we feel warranted in quoting it. " This organ (the heart) is the receptacle of all the blood coming in from every part of the body, already loaded with carbonic acid even in the natural state, but when under certain circumstances the blood becomes almost completely saturated with this effete product its deteriorating effect must be vastly multiplied, and if such an abnormal state of things con- tinues for any length of time the walls of the right side of the heart will soon begin to show signs of disintegra- tion, the tricuspid valves will become deranged, and regurgitation, with all its natural consequences, will fol- low, such as anasarca, haemorrhoids, and congestion of the abdominal organs." Not only may every physician understand this and fully enter into its meaning, but as well the average un- professional reader, and both may further understand that the prevention of this state of things may be brought about by guarding against that dearth of oxygen in the system out of which these results come ; and if they have come, and especially if they are in their incipiency, or if there are evident signs of their coming, then the oxygen treatment is doubtless indicated and should be entered upon. Indeed, to neglect it where it can be had, may be criminal as it may be fatal. Bronchitis, pneu- monia, or general respiratory enfeeblement and disorder are but the natural and inevitable consequence of with- drawing from the system for a long continued period that supply of oxygen which health and strength demand. 28 Sometimes under some form of artificial aeration the vic- tim seeks to overcome these results, and it may be measurably succeeds, but as a rule the capillary resil- iency is so little that real and permanent recovery is im- possible. All this shows the vast importance of timely attention to any remedy that will prove a healthful proph- ylactic. Such a remedy is oxygen gas taken by inhala- tion. It is, in the nature of it as well as in its relations to human physiology, both preventive and curative—not only a valuable therapeutic but as well a powerful proplv ylactic. PATHOLOGICAL INDICATIONS. CHAPTER V.—PART I. In this chapter we propose a somewhat detailed setting forth, from the standpoint of well accredited authority, of the pathological indications for oxygen-treatment. We shall then be pardoned if, in order to show this authority, we make the setting forth largely in the language of others. The reader will then be sure that we do not speak of ourselves nor give merely our own unsupported opinions supports life. Oxygen supports life eminently in respiration and is the only agent that is adapted to this purpose, but it is necessary that its great energy should be mitigated by dilution. Prof. Benjamin Silliman. relation to disease. Oxygen gas is eminently salutary in some cases, espe- cially in diseases of the thorax, in paralysis, general debil- ity, and so forth. Prof. Benjamin Silliman. defective respiration. When from any cause there is defective respiration and the system suffers in consequence from imperfect oxygen- ation of the blood, the inhaling of pure or slightly diluted 30 oxygen, by enabling something like a normal quantity of the gas to be presented to the blood at each inspiration, affords prompt and decided relief, and is, of course, pro tanto of great benefit. Hence in such affections as asth- ma, pulmonary emphysema, croup, diphtheria, dyspnoea from heart disease, inhalations of oxygen are then ex- ceedingly useful. In other diseases, generally those of mal-nutrition, such as consumption of the lungs, anaemia, severe dyspepsia, indolent ulcers, and so forth, experience has shown that in some cases much benefit has followed inhalations of oxygen. Edward Curtis, M. D., New York. secretory functions. In persons of " plethoric habit," and especially if the " functions of one or more of the secretory organs " have been interfered with, Dr. Birch says oxygen-treatment is undoubtedly indicated. In such cases he says : " The commencement of the curative process has sometimes been ushered in by sudden and unexpected efforts of nat- ure to throw out peccant matters, efforts for so long a period previously unattainable from the most judicious treatment, and so immediately following two or three large doses of the gas, as to afford almost unquestionable evidence of the true sequence. The assistance urgently demanded by the system has been given. Nature has thus had a starting point and a critical discharge has made its appearance. " It has been my fortune to see this exemplified in cases of long suppressed catamenia, in torpidity of hepatic functions with pent up biliary secretion, and in gouty affections with much cerebral, nephritic, and other dis- 3i tress. In the last I have known the urine, which had been for many weeks uniformly clear and limpid, to become, to the horror of the patient, turbid, dense, and loaded with urates and phosphates. I would venture particularly to draw attention to the ascendency of oxy- gen over the cutaneous capillaries not unfrequently felt on the commencement of its use in torpid and unhealthy conditions of the cutaneous function, and cachexia aris- ing therefrom. The benefit afforded will occasionally demonstrate itself in profuse perspiration when a dry, harsh skin had been previously the order of the day, or a relaxed and moist state of the cutis with consequent chilliness and liability to colds will give place to a warm, healthy, and comfortable state to which the invalid had long been a stranger. Even inveterate skin affections the history of which points to a congenital origin, and in- curable, in the permanent sense of the word, may, nevertheless, receive much benefit from an occasional resort to this remedial agency." BOILS AND CARBUNCLES. Dr. Birch also records " its occasional singular value in unmanageable boils and carbuncles." He was able " under the influence of oxygen," and " where every other known means had failed and the patients were apparently in a hopeless state," with " rapidly spreading ulcers and sloughing even of the worst description," as well as " slowly progressing senile gangrene, to get the best of results"; his experience writh oxygen in such cases warranted him in expressing to the profession his con- viction to the effect that " not a few fatal cases of these difficulties might be prevented, were oxygen administered at the right time and with sufficient care." 32 That the whole range of surface ulcers and gangrenes may, under given conditions, be favorably subjected to applications of oxygen gas is, we think, beyond reason- able question. Of course the treatment may, if not rightly given, excite rather than allay inflammations. Envelop an abrased or ulcerous limb in some kind of " rubber sleeve " and introduce the gas into this sleeve, and the chemical action of the contact will inevitably produce excitement. But apply the gas without such envelope freely and openly upon the surface of the diseased parts and such application may be very salutary. In the external application of oxygen there would seem to be no doubt that it has power to resist the progress of tissue destruction, to subdue inflammations, and materi- ally aid in the work of restoration to a natural state. " Dr. Goolden," says Prof. Phillips, " has recorded several severe cases of phagedenic ulceration " in which this use of oxygen was successful. He especially notes one of severe throat affection in which the treatment was phenomenally successful. So profoundly convinced is Dr. Goolden of the great value of oxygen applications to gangrenes and ulcers that no longer ago than 1879 ancl as recently as 1886 he has advocated its use in strong though conservative papers in the London Lancet. Dr. B. W. Richardson, after declaring his opinion to the effect that oxygen is indicated in many acute, sub-acute, and chronic diseases, in chronic and sub-acute rheumatism, in scrofulous tumors, in paroxysms of whooping cough, in chronic bronchitis with dyspnoea, and in phthisis (early stages),and dyspepsia, distinctly says, "It is useful as an antidote to the narcotic poisons and as a local application to gangrenous ulcers." Maurice Raynaud ably discusses the whole philosophy 33 of the production and procession of gangrenes, and con- cludes that the want of oxygen sustains, as much as any- thing, the existence and continuance of the " lesion." It was, however, left for another—Langier—to do what Raynaud did not do, namely, suggest the use of oxygen and to make application of it directly to the affected parts ; and he found such applications successful in re- lieving the pain, reducing the inflammation, and in elimi- nating and measurably or entirely curing the difficulty. The professional reader is referred for further truth of this sort not only to Demarquay but to Bull's Therapeu- tics. SCROFULOUS DISEASES. In strumous and scrofulous subjects Dr. Birch proved the great advantage of resort to oxygen-treatment, and this, too, in cases " where all the usually anti-strumous remedies had failed." He says, " It ought to be regarded as a sine qua non whenever glandular enlargements and ulcers and vascular congestions, internal or external, have been found unmanageable or incurable under ordi- nary treatment with the best hygienic regulations, while, for example, pulmonary consumption in strumous sub- jects affords a special example of the positive necessity of oxygen, if such disease is to have a fair chance of cure." Nearly a century ago Dr. Alexander Thomson, an eminent medical author and practitioner, wrote in a published work of his on the "Prevention and Cure of Disease" these words: " The most extraordinary in- stances that we meet with of success in treating scrofu- lous trouble are some cases in which the inhalation of vital or super-oxygenated air has performed a perfect cure after all the usual remedies had been tried to no purpose. This unexpected discovery is of singular im- 3 34 portance and if fully ascertained by a greater number of trials will serve to extirpate a disease which has hitherto generally baffled the utmost efforts of medicine." HEADACHES AND NEURALGIA. These, says Dr. Birch, as well as " other nerve affec- tions of the most persistent kind, will often succumb to oxygen, either alone or with gentle adjuncts, suitably prescribed. In a few instances even intense, long con- tinued suffering has yielded in a few days." We can but feel that in the whole range of nerve disorders the oxy- gen-treatment has a large and legitimate field, and that its wider use would avail to subdue many of these ail- ments which are now, under the usual courses of treat- ment, mostly intractable. This feeling grows out of our experience for several years in the administration of the gas in a variety of nerve-disturbances. Having wit- nessed its power over these disturbances, even in their severity and long continuance, we could not, if we would, doubt that the oxygen-treatment is, as a rule, distinctly indicated, and is for the debilitated nervous system a valuable therapeutic. Birch records several cases of both acute and chronic neuralgia which resisted other treatment and yielded to this, and Dr. Hooper had a simi- lar experience. "Oxygen," says Dr. Richardson, "is a remedy for all excess of nerve-action." " Oxygen can," says Dr. Birch, " in many susceptible temperaments and in certain diseased conditions, exer- cise a peculiarly powerful influence rarely met with in persons enjoying perfect health, and by taking advan- tage of this peculiarity many cases will quickly undergo a change for the better, where the most enlightened and judicious treatment had previously failed to produce any 35 beneficial effect." There can be no doubt of the power of oxygen inhalations to strengthen the nerve-tone and favorably disturb the nerve-centers. DERANGEMENTS OF THE LIVER AND SPLEEN. In such derangements and especially where there is " congestion of the portal and mesenteric veins and ten- dency to piles," Dr. Birch found oxygen treatment "strikingly exemplified." " Many cases of these difficul- ties," he says, "which prove either very troublesome or fatal might be cured with the timely and judicious agency of oxygen." He records "an extreme case " which was a wonder to himself. The case is reported verbatim under Clinical Exhibits. TONIC DISEASES OF THE HEART. In these diseases Dr. Birch found oxygen "a remedy of high value," though sometimes, because of evident contra-indications, he advised care in the selection of subjects. He says, " Fatty degeneration, relaxation of the muscular walls, dilatations, and passive congestion are the abnormal conditions in which oxygen will usually be found to yield the most satisfactory results. It has been the means of saving several apparently hopeless cases with death impending, where all stimuli had be- come useless or worse than useless." He makes extended notes of a case which he calls a "clinical curiosity." In his own language the case is this. " Nearly a dozen years ago a lady, aged 48, came under my care, with all the symptoms of fatty degenera- tion, dilatation, and passive congestion of the heart, in a puffy relaxed subject, possessing flabby muscles with large deposit of loose, interstitial fat. She was kept alive 36 for three years under my frequent observation by a dose or two of oxygen almost daily. On many occasions, during this patient's treatment, the heart's action, capa- ble of only partial and temporary restoration from col- lapse by brandy and other stimulants, began instantly to revive under the influence of oxygen. She lived by exercising great care, avoiding much physical exertion and inhaling almost daily, according to circumstances, from fifteen to forty pints of oxygen in thrice the quantity of atmospheric air; a good example of direct super-oxygen- ation. During the latter half of the three years healthy nutrition and power (cardiac and general) were regained step by step, and then was afforded a remarkable proof of "that singularity of action and peculiar development of potency under altered conditions of the animal economy which it devolved upon me originally to urge in opposition to author- ity. The patient after requiring such large doses for so long a time, and feeling pleasure as well as surprising benefit therefrom, became quite intolerant of the full dose, undue cardiac excitement and uterine irritability following any dose beyond from two to four pints, and then the minimum quantity being borne with advantage only in alternate doses. Thus was also offered some testi- mony of the groundless nature of the fear often expressed that oxygen, if used for any length of time, would lose its influence." Pepper says, " Defective oxidation in whatever way brought about seems the common factor in all forms of fatty degeneration." Where there is a "special prone- ness to fatty degeneration of the heart muscle " he posi- tively says, " So great is the need of an abundant oxygen supply that it early feels any deficiency and in conse- quence is the first muscle to show nutritional changes." 37 Because of this it is easy to see how valuable might be the work of artificial aeration. BRONCHITIS. "Chronic bronchitis and congestion of the lungs are," says Dr. Birch, " it is almost needless to say, pathological conditions peculiarly indicative of the use of oxygen by in- halation, ordinary means failing to cure. Many a valuable life on the very point of being extinguished from bron- chitis or congestion of the lungs might be saved by properly detailed management with oxygen, all other means proving futile. Sometimes I have been inclined to wonder why life has been permitted to slip away with- out even a trial of oxygen. Not unfrequently my opin- ion has been requested when too late, even where twenty- four or forty-eight hours earlier would probably have sufficed to save the patient." ASTHMA. In asthma or in asthmatic asphyxiation there is a very general, almost a unanimous, concurrence in the opinion that oxygen may be relied on. Such men as Beddoes, Poulle, Stoll, Marching, Chaptal, Thornton, and others made frequent use of oxygen inhalations in asthmatic cases, and with large success. Indeed, the treatment re- lieved or cured in most of the cases. " What more rational," says Trousseau, "than to offer a purer and more vivifying air to the unhappy patient who inspires so little oxygen and becomes asphyxiated?" "An attack of asthma," he says, "is an affection very suitable for the use of oxygen." There may, of course, be reason in the nature of things to doubt the exceptional value of oxygen inhalations in hard cases of humid asthma, but even then it may sometimes avail to bring relief. Trous- 38 seau records a case of asthma treated by oxygen inha- lations and with remarkable, yea, almost phenomenal success. It was that of a young woman who suffered annually about mid-summer with the disease. He was called to her in the night and found her suffering severely from asthmatic suffocation. Gradual inhalations of oxy- gen were resorted to, and in a half hour relief came. The respiration was reduced from 40 to 18. The pulse, which was slightly accelerated, remained about the same, save that it became ampler and stronger, and in an hoUr the asthma had subsided and the patient was soundly asleep. He followed up the treatment for several days until conditions of permanent relief were established. The dyspnoea ceased, the suffocation was overcome, the respiration became normal, and the pulse asserted its energy and power. We are not surprised, then, to find him saying, "There are few remedies which give hope of such speedy relief in asthma as oxygen." Dr. Birch says, " In asthma there will be found a fair percentage of cases in which oxygen can cure or greatly relieve. As a rule the subjects most benefited are those in which we can trace no congenital or hereditary pre- disposition, and where the affection owes much of its origin to chronic bronchitis or partial congestions and indurations of the pulmonary parenchyma." Dr. Solis Cohen thinks this disease is that where oxy- gen is specially indicated. Phillips gives an interesting case reported by Dr. John Hooper. The patient was 52 years old and had been for a long time afflicted with asthma, suffering periodical paroxysms that would yield to nothing but oxygen inhalations. Under these, however, he found rapid and wonderful relief in greater mobility of the ribs, in increased powrer of inspiration, and in the disap- 39 pearance of lividity. Demarquay, in his " Essay on Medi- cal Pneumatology," page 725, reports the case of a young man "subject from childhood to asthmatic attacks which ceased as if by magic as soon as he began to inhale oxy- gen." Secretary Stanton's case is well known. Under the directions of Surgeon-General Barnes he took daily inhalations of oxygen and they never failed to arrest the dyspnoeic spasms and give relief. Dr. Ehinger reports the case of a woman 60 years of age afflicted for thirteen years with asthma complicated with emphysema, a very bad case. The patient had to sit nights propped up in a chair. She could not walk far nor go up stairs without being all out of breath. There was at times great de- rangement of the stomach, so much so that it would not tolerate either food or water. She could not, because of her coughing, sleep nights. Dr. Ehinger gave her oxy- gen, home-treatments sent out in rubber bags, not a very good way to administer the gas, certainly not the ideal way, yet spite of this the woman began at once to im- prove, and continued to improve until, at the expiration of the third week of treatment, she " often slept through the whole night without coughing, and this too in bed in- stead of in her chair as formerly." He continued the treatment for two months, during which time all the symptoms improved and "almost every trace of asthma " left her. ALBUMINURIA. Many observations have been made testing the effect of oxygen inhalations in albuminuria. Eckart made several and with a uniform result of marked cessation. Trousseau gives us an interesting case, a form of Bright's Disease (see "Treatise on Therapeutics," Vol. III., page 232) in which oxygen inhalations brought about the best 40 results. However, after a time, the bad symptoms re- asserted themselves and the patient died. But when we learn that the patient had been previous to treatment afflicted with severe cerebral disturbances, we are not surprised that, though oxygen-treatment "stopped the albuminuria in one month" and "brought back the appetite and strength for a time," yet at last the patient succumbed. However, Trousseau, notwithstanding the limited experience of himself and others with oxygen gas in these cases, and notwithstanding the partial and unsatisfactory results, thinks well enough of it to recom- mend its use. Dr. C. Paul reports several cases of Bright's Disease treated by oxygen inhalations with partial success. A remarkable case is reported in the Medical Record for March, 1879. The victim was a patient of Dujardin Beaumetz, and he was in the "last stages" of the diffi- culty. Oxygen inhalations, as a kind of dernier ressort, were administered and with marvelous results. In twenty- four hours the excess of albumen had disappeared, and when the case was reported, two weeks afterward, the patient was holding his own. Pepper recommends, in connection with other treatment for Bright's Disease, " the daily inhalations of oxygen gas," and says, " it is of very great service." An evident reason for this is, as Dr. Kollman of Munich says, that the quantity of uric acid in the urine is rapidly dimin- ished by the use of oxygen. PNEUMONIA. There is no doubt that oxygen is definitely indicated in this treacherous disease, and that, if seasonably re- sorted to, many cases otherwise fatal might be saved. A 4i reverend gentleman writes to us giving the substance of his family physician's opinion of oxygen-treatment for pneumonia. " If the pure oxygen could be utilized he had no doubt it would be a good thing in certain diseases, instancing pneumonia, when, in consequence of a tempo- rary incapacity of the diseased lung to discharge its func- tion, the blood is poisoned and the patient succumbs. If in some way the blood might be artificially vitalized un- til the organ recovers its normal tone, the life might be saved." The Medical Record for November, 1885, reports the address of Dr. E. G. Janeway before the New York State Medical Association. In this address Dr. Janeway gives it as his opinion, based upon personal experience, that oxygen inhalations are of "great value in many cases of pneumonia," though he is careful to say, " they should be taken at the very commencement of cyanosis," and that when " begun later, after cyanosis is fully estab- lished, they are less useful." He recommends the con- tinuance of the inhalations as often as the "blueness of the skin appears." In the Lancet of March, 1866, Dr. Golden reports an interesting case of pneumonia treated with oxygen inha- lation and which was in four days substantially cured. Dr. Andrew H. Smith speaks of his knowledge of a case of "circumscribed pleuro-pneumonia" which was aborted by oxygen inhalations in the short space of " 36 hours." Dr. Frauenstein gave Dr. Smith notes of "a case of pneu- monia in a child of two years," in which the whole " lower half of the left lung " was involved. Dr. Smith says of this case: " The disease was ushered in by convul- sions so persistent and severe as to require the use of chloroform. This agent, however, produced alarming depression and oxygen was resorted to to correct its ac- 42 tion, which it did very satisfactorily, but only to open the way for a return of the convulsions. Chloroform was therefore repeated and its action kept within safe limits by the oxygen until the tendency to convulsions passed away. The oxygen was then continued, until at the end of three days, the inflammatory products had become almost entirely absorbed and the pulse, respiration, and temperature had fallen, and the child desired to sit up. At this time, however, a relapse took place and the whole of the lung became involved. Oxygen was again resorted to to the extent of from thirty to forty gallons daily, of which, however, a portion was wasted, as is necessarily the case in giving it to a child. Treatment otherwise expec- tant and supporting. In two days the patient was consid- ered out of danger, and thenceforth the convalescence pro- gressed steadily." He also refers to a case of Dr. But- ler's, of New York, reported in the New York Medical Journal, and says of it : " It is a very interesting case of chronic pneumonia in which the deposit was rapidly absorbed under the use of oxygen." " In his recent dangerous illness (pneumonia and bron- chitis), Prof. Billroth, whose name as the great Vienna surgeon is almost as much of a household word among his English-speaking brethren as it is in Germany, after everything else that science could suggest had been done for his relief, appears to have derived much benefit from inhalations of pure oxygen. Under this treatment the dyspnoea diminished, the pulse became stronger, and consciousness returned." Dr. Smith says: " In a case of double-pneumonia, there- fore, I should not hesitate to employ it, nor should I allow any case of this disease, which appeared to be tending toward a fatal termination, to proceed without a 43 trial of its effect. The fear formerly entertained that oxygen would excite pneumonitis by its local action is refuted by its entire history as a remedy. Especially in the typhoid form of pneumonia I should expect to get great benefit from the gas." And yet, in the face of all this evidence of the power of oxygen gas to prevent or overcome the degenerative processes of pneumonia, there will be, it may be feared, physicians who will not use it and who, for lack of it, will allow their patients to die. DIPHTHERIA. J. Solis Cohen, in his valuable work on " Inhalation in Disease," refers to several cases treated by Beigel with alternate inhalations of oxygen and nebulized fluids. " One of these," he says, " was that of a child six years of age who was cured by the inhalation of oxygen gas, one gallon morning and evening, and the inhalation of a solution of the tincture of chloride of iron, ten minims to the fluid ounce of water, a remarkable alteration in the patient's condition being perceptible after the first inhalation of oxygen." Another case was that of " a very severe case of diphtheria after small-pox, with exudation lining the whole pharynx, laryngeal implication, suf- focative paroxysms, and so forth. The patient, a boy ten years of age, was seen by Dr. Beigel on the fourteenth day of his illness, after the administration of calomel for six days had afforded no relief. The case was treated by inhalations of the spray of hot water, afterwards of lime water, and subsequently of tannin, oxygen being administered to relieve the suffocative attack with com- plete success and being continued twice a day as long as requisite, the combined treatment resulting in cure." Dr. Beigel thought that the septicism connected with 44 diphtheria and standing so much in the way of success- ful treatment could be best prevented or overcome by oxygen, while, at the same time, it would serve to arrest the "danger of death by apnoea." Dr. A. H. Smith states a case which he saw in connection with Dr. Elliot, and in which " inhalation of oxygen was of great service." "The patient, a child two and a half years old, pre- sented well-marked diphtheric croup. The dyspnoea, which was very decided, was greatly relieved by the gas, and it was Dr. Elliot's opinion, as well as that of other gentlemen who saw the case, that the oxygen also aided materially in overcoming the tendency to death by as- thenia, and that without it a fatal termination would have been inevitable. The inhalation was kept up al- most continuously for a week, the last three days only as a tonic, the tendency to asphyxia having ceased on the fourth day." Ehinger reports a case of " diphtheria with scarlatinoid eruption." "The pulse," he says, " was too rapid to be counted, but seemed about two hundred." He admin- istered oxygen "and in twenty-four hours the eruption had entirely disappeared and the pulse had fallen to one hundred and twenty. The fourth day the child sat up and ate. No other treatment except local." Dr. Frauenstein, in a letter to Dr. Smith, refers to a case of his own, a case of diphtheretic scarlatina, ac- companied with delirium and angina. He treated it with large doses of oxygen, which never failed to subdue the delirium and induce sleep. The oxygen he adminis- tered daily for about a month, and there was no accessory treatment save wholesome nourishment and local appli- cations of chlorate of potassia and carbolic acid. Vogelsang, so late as 1886, suggests the inhalation of 45 oxygenated water, and makes mention of two cases which under the treatment rapidly recovered, the false membrane sloughing away and a good appetite coming. Pepper says, " Ozone has been used as an anti-fer- mentative in inhalation during four or five minutes every hour or two " in cases of diphtheria. CROUP. In membranous croup, in catarrhal and diphtheretic laryngitis, Pepper says, " The inhalation of oxygen has proved rather advantageous in my hands in a few in- stances." The case of a child is given "upon whom tracheotomy had been performed." The invasion of the bronchi by the " pseudo-membranous process " produced dyspnoea, cyanosis, and convulsions. Upon the introduc- tion of oxygen into the lungs these would cease, to ap- pear again when the inhalations were stopped. " It is my firm conviction," says Dr. Andrew H. Smith in his " Essay on Oxygen in Disease," " that oxygen will do in most cases of croup all that could be done by tracheot- omy, but neither the one nor the other is competent to undo the mischief wrought by severe and protracted dyspnoea." He, however, adds the caution to use it as the knife should be used, " early," and not to resort to it " only at the last minute, as if it were a more desperate remedy even than tracheotomy." Cohen and others express serious doubts, amounting well nigh to positive non-con- currence, in this view of Dr. Smith. It is, however, worth our attention, for it would seem on general principles to have some warrant in the natural power of oxygen over diseased membranes. Beigel, in his work on " Inhalations," makes note of a 46 case which would seem to support measurably Smith's opinion. It was a severe case, and the usual modes of treatment had all failed. At the time oxygen inhalations were begun the patient's pulse was too frequent to be counted, the lips were livid, respiration forty per minute, and the face pale and convulsed. Oxygen was given with immediate improvement. Under the influence of it the child fell asleep and waked to gradual improvement and ultimate recovery. J. M. Bleyer, M.D., records that he makes large use of oxygen in laryngeal intubation. He says: " Up to this date I have operated in seventy-nine cases of intubation of the larynx in croup and diphtheria. In twenty-nine cases I operated without the aid of oxygen. In the last fifty cases I have used oxygen inhalations prior to opera- tion, to prepare my patients, and find that, whereas I could not work in the passages longer than eight to ten seconds without producing an alarming degree of as- phyxiation, I can now prolong a single effort to as much as fifty or sixty seconds without serious trouble. I con- sider the use of oxygen prior to and after the operation of intubation so indispensable that I now peremptorily refuse to operate without its aid. My record shows a decrease in mortality of fifteen per cent, since I began its use." RECTAL INJECTIONS. These have been recommended on good authority as a valuable treatment in phthisis. Dr. Kellogg employed them successfully in lethiasis, and in his judgment they might be substituted in a "variety of diseases" for pul- monary inhalations. These injections insert the gas by absorption into the " portal blood " and so act directly upon the digestive and hepatic functions. Dr. Kellogg; 47 is of the opinion that the absorption of oxygen during these injections was much greater than takes place by any process of inhalation. (Therapeutic Gazette, Sept., 1887.) BRONCHIAL DILATATION. " There is," says Trousseau, " only one observation of bronchial dilatation treated by inhalations of oxygen." The case is one reported by Cosmao-Dumenez in Demar- quay, and in this case Trousseau suggests the inconclu- siveness of the observation "as regards diagnosis." Whether there be any just reason for this depreciation of the case or not, one thing we know, both appetite and strength came to the patient under the oxygen inhala- tions, and the sputa changed from a purulent abundance to that which was proper in quantity and wholesome in character. DIABETES. Bouchardat, Limousin, Demarquay, Birch, and others report cases of diabetes successfully treated by oxygen inhalations. Limousin found that under the oxygen- treatment there was a large diminution of the " propor- tion of glucose," and consequently a corresponding im- provement in the general condition of his patients. Bouchardat and Demarquay both proved the value of oxygen in cases of consumptive diabetics. The improve- ment in one of Demarquay's patients was so marked that he says, "The family thought him cured." Trous- seau does not speak of his own experience, because, as he says, he has none, having never " given oxygen to diabetic patients." But he knows of no experiments, not even those of Voit and Pettenhofer, that " form a con- trary indication," and he concludes from all his re- searches that, as diabetics absorb less oxygen than people 48 in health and give out more urea, " this is surely no reason for not giving a diabetic person more oxygen than the external air supplies him with." Dr. Birch says: " Diabetes as a result of a derangement of nerve- function and nutrition affords an example of a disease in some cases of which oxygen ought to be employed before the supervention of extreme symptoms." There are many cases on record where oxygen inhala- tions have availed to give marked relief, though in most of them there is no evidence of conditions of perma- nence. Phillips makes mention of five cases in all of which there were strong symptoms of dyspnoea and cyanosis. He says that " oxygen inhalation certainly re- lieved for a time the symptoms mentioned, although it did not in any instance reduce the sugar in the urine." Others have succeeded better. Dr. Howard Pinkney re- ports two cases in both of which " the urine was excess- ive in quantity and high in specific gravity," in one over 1,040, in the other over 1,050. " Both," he says, " im- proved rapidly under the use of oxygen gas," and he specially notes the "lowering" in both cases of the " specific gravity," and a " rapid decrease in the amount of sugar." He reached in both cases substantial condi- tions of permanence, and for many months after oxygen inhalations had been discontinued the results still held. Dr. Pinkney himself was rather surprised at this. The reason why sea air is good for diabetics, Demarquay thinks, is the fact that it cannot be breathed without breathing a large quantity of oxygen. He records that he reached the best of results with several diabetic pa- tients by oxygen inhalations and that too with no die- tetic change. The quantity of sugar in the urine very perceptibly diminished, and while there was a notable 49 reduction of the corpus, there was, at the same tima, an increase of life force. He recommended several of his medical confreres to use it, which they did with no little success. Demarquay is, however, frank enough to confess that in his opinion oxygen inhalations after all acted only or mainly upon " the symptoms of the dis- ease "; " but in the present state of science," he says, " what other treatment can we apply to diabetes since science has not determined either the nature or the real cause of the disease ?" VASO-MOTOR NEUROSIS. In this disease, Pepper, in his " System. of Medicine," mentions oxygen as definitely indicated, and says, " Oxy- gen inhalations are of service." MEDICAL USES. Concerning the medical uses of oxygen we gather from the " National Dispensatory " substantially these facts. In chronic bronchitis and other affections of the respira- tory organs attended with symptoms of asphyxia, the in- halation of oxygen has certainly appeared to prolong and even to save life. This has been demonstrated in asphyxia from emphysema with bronchitis, in laryngitis of various forms, in compression of the lungs by the gravid uterus, in opiate narcotism, in poisoning by char- coal fumes or by illuminating or privy gas, and in similar conditions. A case is recorded in which it seems to have saved the life of a child poisoned by a very large dose of carbolic acid. Its most striking benefits are observed when the gas is inhaled by dyspeptic chlo- rotic patients. It revives the appetite, quickens the diges- tion, and arrests vomiting if present, and consequently 4 _____ 5° increases the excretion of urea. Such is the testimony from Bull's Therapeutics to the value of oxygen, but Bull adds, " This improvement is not permanent unless iron is used as supplementary to the oxygen." Dr. Richardson says, " Inhalations of oxygen in cases of tetanus are said to have caused profuse diaphoresis and muscular relaxation." ACTION ON THE HEART. There ought to be no fear of bad results from the ad- ministration of oxygen in cases of heart affection, pro- vided proper care is had in the administration, the treatment is so very normal to the whole circulatory system and to the heart, the central organ of that system. A series of experiments made by different practitioners has fully established this. An experiment by Cyon is worth our attention. Taking the heart of a frog he made the double test of introducing into the cavities serum strongly impregnated with carbonic acid gas, and afterward with oxygen gas, and he found that the effect of the one was to stop the heart's beating and that of the other to rescore it. Erichsen experimented on as- phyxiated animals, and though at first he could get no results, yet afterward, using not atmospheric air but arti- ficially prepared oxygen, he was able to re-excite " ven- tricular contraction." Whether or not the regular breathing of oxygen be indispensable to the action of the heart, one thing is certain, its right action without it is impossible. In the Dietetic Gazette, April, 1888, Dr. L. C. Win- sor, under the title of " Heart Foods," speaks of oxygen as follows : " It is a fact that tissue will absorb oxygen and give off carbonic acid without the intervention of 5i the circulation, and so we may believe that the propor- tion of oxygen is due simply to the demand of the cells, and not to any peculiar form of oxygen or any combina- tion of it in the blood. The sluggish circulation of the blood in organic heart disease does not supply sufficient oxygen to the body, and hence the symptoms, dyspnoea, headache, fainting spells, debility, etc., which arise. A rational method of diet should not only include proper foods but also an increased supply of oxygen. We can see no objection to classing oxygen as a food and plac- ing it permanently as such. (It may be classed as a fuel food, but as a tissue food it has no equal.) It is the basis of all tissue building. An increased supply of oxygen rather than a stimulated circulation, a saturating of the blood with oxygen rather than an increased supply of poorly oxygenated blood, is the ultimatum of diet in heart disease. The effect of this plan of diet will be to increase the supply of readily digestible tissue food and to fur- nish an abundance of oxygen, the agent which of all is the most valuable for tissue building. This done there will be but little left for drugs to accomplish. LUNG DISEASES. Sir Morel MacKenzie, in a paper printed in the London Medical Times and Gazette, Nov., 1865, on the "Treat- ment of Chronic Diseases of the Lungs by Inhalation," gives us a remarkable showing of the therapeutics of oxygen treatment. He mentions more than twenty cases treated during a period of less than four months, includ- ing ten cases of bronchitis, six of phthisis, and seven of asthma. In the phthisical cases the treatment was not positively curative but was in a direct way beneficial, inasmuch as it shortened the " intercurrent bronchitis." 52 In the bronchial cases positive and permanent cures re- sulted in eight out of the ten, relief came to one, and one was not benefited. The times of treatment ran all the way from six to forty days, the average time being less than sixteen days. A notable result in the phthis- ical cases, and he especially mentions four of them, was diminished expectoration and relief from pain and inflam- mation. One case of asthma that had defied the whole round of other treatments yielded with readiness to this. A case of " whooping cough " was immediately cured. To be sure these were not pure oxygen inhalations but medicated, yet they support the theory of the great value of treatment of disease by inhalation, and by logical consequence, as oxygen gas is beyond a doubt a valuable therapeutic, and as the best results are reached by oxy- gen inhalations in these ailments, they support the gen- eral truth. HEART DEGENERATION. William Pepper, M.D., LL.D., says: "Defective oxi- dation, in whatever way brought about, seems the com- mon factor in all forms of fatty degeneration. The process may be almost confined to the heart or be more or less general in the solid viscera and voluntary muscles. The diaphragm is sometimes much involved with the heart. This is when the other muscles show no signs of the change. There seems to be a special proneness to fatty degeneration in the heart muscle, which may per- haps be associated with its incessant activity. So great is the need of an abundant oxygen supply that it early feels any deficiency and in consequence is the first muscle to show nutritional change." 53 FATTY liver. Pepper mentions as a causative element " the forma- tion of fat from the albumen of the hepatic cells in con- sequence of diminished oxidation." In the treatment of the liver when thus diseased this "consumption of oxy- gen " becomes then an " important factor." Inasmuch, then, as the liver from a connection of causes lacks a " supply of oxygen," and inasmuch as it is "also want- ing in blood," the oxygen treatment would seem to be indicated. GOUT. Pepper, in his " System of Medicine," says : " The purely chemical theory of gout and diabetes, that they are diseases of sub-oxidation, a theory most ably de- fended by Bence Jones (see his lectures on some of the applications of chemistry and mechanics to pathology and therapeutics : H. Bence Jones, London, 1867), has much to commend it from the valuable suggestions which it affords in the clinical management of these maladies; but it must be acknowledged that while de- fective oxidation seems to be an essential factor in the production of gout and diabetes, it is impossible to re- duce the process to the simplicity of a chemical equa- tion." According to Garrod there may be and often is in the blood of a gouty subject, an excess of eleven one- hundredths grains of uric acid in the serum. One thing is certain, the anaemic condition often appearing in gout indicates a " marked diminution of red blood corpuscles," and so indicates oxygen treatment. DYSPNCEA. Of all known remedies for this distressing ailment oxy- gen inhalation must have the pre-eminence. It is in the 54 very nature of it to give relief and to make the condi- tions of that relief permanent, though of course the question of permanence depends upon so many possible relations and complications that too much emphasis should not be given to it. Biegel reports the case of a patient who could walk only a " few steps at a time " without being distressfully out of breath relieved by oxygen inhalations, though unable without their contin- ued use to prevent the recurrence of the dyspnceic spasms. However, permanent good results ensued in reducing an enlargement of " one side of the chest," in diminishing the " area of tympanitic sound," and in increasing the res- piratory power 1,050 cubic centimeters. Dr. Smith reports a case in the New York Medical Journal, 1869, in which oxygen inhalations relieved the dyspnoea, greatly re- tarded the pulse, and reduced the respiration from thirty-six to twenty. The relief with each periodic inha- lation was transient, but each inhalation gave relief. ASPHYXIA. " Materia Medica and Therapeutics," by Trousseau and Pidoux, is authority for what follows. As early as 1776 Dr. Goodwin of Edinburgh treated asphyxia successfully by insufflations of oxygen gas. Subsequently Gorey of New Breisach, Van Marum of Haarlem, and one or two other contemporaneous celebrities, attempted a similar practice and would doubtless have succeeded had they properly distinguished between suffocation and strangu- lation. For the want of this they had only a narrow and comparatively transient success. Their misuse of oxygen gas tended rather to its disuse in asphyxia than other- wise. Demarquay says little of oxygen gas in asphyxia, though he does make mention of its therapeutical 55 value in cases of large glands that by pressing upon the trachea threaten suffocation. Trousseau is of the opinion that the lack of its use in " accidental suffocation " may be explained more by the fact that it is not usually procurable at the time than by any claim that it is not indicated. Indeed, he records a case of " asphyxia from pulmonary and cervical congestion " in which he used oxygen gas with eminent satisfaction. He gives us another case in which "asphyxia was com- plicated with an apoplectic condition," and resort was had to oxygen inhalations with, as he says, " still more signal service." It was a case of opium poisoning and the patient was seventy-four years old and much en- feebled. The first treatment resorted to was that of the injection of sulphate of atropia, accompanied " with black coffee." For a brief time this treatment seemed to avail to check the progress of the poison, but it wras, if not all in the seeming, then all too transient and inef- fectual, for in only a few hours afterward " the patient was in a state of coma and was thought to be lost." He marks the precise condition of the patient when he says, "The pulse was very rapid and hard, but full, and the respiration was only seven in the minute." Now mark what was done. "At this point we caused her to inhale fifteen liters (a little over two gallons) of oxygen ; con- sciousness returned almost at once and she knew the by- standers. From that moment she improved and the next morning was out of danger." This one case, and there are many others, is enough to warrant the conclu- sion to which Trousseau comes, namely, " that oxygen ought to be tried in cases of asphyxia by suffocation." Claude Bernard has shown very distinctly the charac- ter of what is known as "charcoal poisoning." It is not 56 technically considered to be asphyxia, but, to use Ber- nard's own words, "an intoxication by the oxide of car- bon." This oxide intoxication of the blood does not facilitate the absorption of oxygen but rather the con- trary, yet it has, in several cases of this sort, been suc- cessfully administered. Some of the most eminent physicians and surgeons agree in the opinion that it is definitely indicated in "all asphyxias." To refer once more to Trousseau, after stating the fact of Dr. Jackson's use of oxygen as early as 1847 i° a case of ether-as- phyxia of a patient of his in Philadelphia, he gives us a list of eminent names that belong contemporaneously in the same category: Blanchet, Fairre, Gianetti, Martin, Saint-Ange, but " especially Duroy and Ozanam," and while he cautions practitioners against undue reliance on oxygen inhalations in cases of overmuch anaesthesia by ether or chloroform, yet he says, " it is a resource which should not be neglected." In the report of the committee on " Suspended Ani- mation," made to the " Royal Medical and Chirurgical Society " of London in 1862, artificial respiration by " Dr. Sylvester's method is recommended." This report was signed by a number of eminent men, as follows:— J. B. Williams, C. E. Brown-Sequard, W. S. Kirkes, H. Hyde Salter, George Harley, E. H. Sieveking, J. B. Sanderson, W. S. Savory. The " Scientific Committee " of this same Society, in their report on the " Uses and Effects of Chloroform," say that " the most certain means of restoring life after poisoning with anaesthetics is artificial respiration." (See proceedings of the Royal Medical and Chirurgical Soci- ety, Volume IV., 1864.) 57 Robert T. Edes, A.B., M.D., says : " After inhalation of various poisonous gases, such as coal, illuminating or sewer gas, oxygen may be of great value in facilitating the elimination of the toxic agent and sustaining life until the normal exchange of gas can go on again." oxygen activity. Dr. Edes also says: "The extreme and universal ac- tivity of oxygen in the processes of organic life would, of course, as soon as this were known, suggest it as a therapeutic agent of the greatest activity." Phillips gives to oxygen a wide range of physiological activity. " It is as essential," he says, " to respiration, sanguification, nutrition, and tissue-change as it is to life itself." PART II. ANAEMIA AND DYSPEPSIA. Dr. Andrew H. Smith reports two cases in both of which oxygen treatment gave satisfactory results. One was the case of a patient brought to him by Dr. P. Hirsch. He had given him, with only partial satisfac- tion, quinine and iron. Dr. Smith put him on oxygen— about four gallons a day—and in ten days his pulse had been reduced to nearly a normal one, headaches had disappeared, strength increased, and conditions of per- manent convalescence had been established. The other case was that of a young man seventeen years of age and of phenomenal overgrowth. Recover- ing from a " malignant pustule," articular rheumatism set in and he suffered with it for a half year. The in- 58 flammation had been subdued and yet there was con- stant pain in the joints and a troublesome stiffness " in the right hip." In this condition he began oxygen treatment. The record says: " He was pale and anae- mic, with pulse at 108, and so feeble that it would be lost every few seconds and the counting have to begin anew." In less than a month—four gallons daily—oxy- gen inhalations effected a cure and returned the man to his accustomed business. In a case of leuchaemia, Kirnberger reports that "after the failure of arsenical treatment, inhalations of oxygen produced a rapid increase of strength, with diminution of the swelling of the spleen, the red globules regaining their normal proportion. After a few months a relapse took place, but, although the red corpuscles were dimin- ished, the white were not increased—a pseudo leuchaemia. Finally, arsenic having failed again, the oxygen inhala- tions were again resumed and resulted in a definite cure." Dr. Edes says: " In some conditions of anaemia and dyspepsia oxygen has seemed to have a beneficial tonic effect, which may, under certain conditions, be made permanent." Dr. Smith quotes an entire paragraph from an article by Hanfield Jones on the " Functions and Diseases of the Liver." The paragraph is this:— " The oily contents of the hepatic cells are subject to great variation both in individuals and in different classes of animals, the less perfect the type of the res- piratory process the greater the quantity of oily matter in the hepatic cells. This statement suggests the inquiry how far fatty liver may be owing to defective haematosis. May it not be that the confinement which produces the foiegras so delicious to the epicure acts by preventing 59 the reception of a due proportion of oxygen into the blood ? Surely the ' type of the respiratory process ' under such conditions must be anything but perfect. In the human subject sedentary habits or improper alimenta- tion may act to diminish the capacity of the blood to carry oxygen, and thus a condition of the respiratory process be produced approximating to the type of those classes of animals in which the hepatic cells are normally loaded with fat. Accepting this hypothesis, the system- atic use of oxygen ought to be beneficial in such cases." Trousseau, " whose knowledge," says Ehinger, " of the resources of therapeutics has rarely if ever been sur- passed,"—a remark in which we shall all concur,—speaks in high praise of oxygen in the treatment of dyspepsia. He records that in several instances it availed to " recall to life women regarded as lost," overcoming the depres- sion of the digestive powers " consequent upon puerperal hemorrhage or excessive lactation." He gives an exam- ple in the case of a young mother, which will be found in his Clinical Exhibits. There are several cases reported by Demarquay of the successful treatment by oxygen inhalations. There can be little doubt, as Birch suggests, that it is directly in the nature of oxygen inhalations to reduce the con- gested liver and so overthrow one of the principal causes of dyspepsia. Birch, too, records several cases of his own. See Clinical Exhibits. " One thing noted by all the experimenters with the gas," says Dr. Ehinger, "from Priestley down to those of the present day, is the decided and beneficial influence which it exerts upon the digestive system. It stimulates the appetite, improves digestion, and induces healthful and regular action of the bowels." 6o KIDNEY DISEASE. Having given directions for reducing the dropsy, Dr. Pepper says: " For the anaemia iron given by the mouth combined with daily inhalations of oxygen gas is of very great service." INSOMNIA. Dr. William A. Hammond, in his valuable monograph on " Wakefulness and the Physiology of Sleep," lays down the principles that should prevail in the treatment of insomnia, and though in the application of these principles he makes no mention of oxygen, yet such mention would be as germane to these principles as that he makes of food and water, of potassium and opium, of hydrocyanic acid and valerian, and assafoetida, and all the anti-spasmodics. These principles, as stated by him, are in substance as follows, that is, they include only such remedies as may be calculated to soothe the nerves and strengthen the nervous system, or so act upon the circu- lation as to correct irregularities, especially to relieve the brain of congestion. To do this is the very natural and essential power of the oxygen treatment, as has been in hundreds of cases clearly shown. Dr. Andrew Bay- lies says, " I exercised my brain last evening to a late hour, and instead of taking a dose of bromide, as I usually have to do under such circumstances, I took your treatment for insomnia. The result was I slept well all night and felt sleepy until late in the afternoon." ASPHYXIA. Our best medical authors agree that where asphyxia results from poisonous gases, resort should be forthwith had to inhalations of oxygen gas. There is here, on the 6i part of all the authorities named, with perhaps a single exception, in the directory, a substantial agreement. The British Medical Journal gives the substance of a case reported by Dr. Charles B. Ball. Three persons were asphyxiated by inhalations of coal gas. Two of them on being exposed to the atmosphere recovered, but the third, notwithstanding all the efforts put forth to save her, still remained unconscious, and there seemed no help for her, though she was finally restored by inha- lations of oxygen, at first slight inhalations of pure gas and then larger doses of diluted gas. Prof. Phillips well says, comparing such a case as this with certain other cases of gas-asphyxia differently treated and fatal, " If we compare the result in Dr. Ball's case we shall better realize the importance of using oxygen in prefer- ence to other measures." He adds in this connection a further word, to the effect that in all forms of asphyxia artificial oxidation " offers the best means of saving life." Rosenthal, Leube, Ananoff, as well as others, have proved by unimpeachable experiments that the whole range of phenomenal blood poisons may be effectually counteracted by timely inhalations of oxygen. Dr. Simeon Abrahams reports the case of " a young man attached to the laboratory of the New York Medical College, asphyxiated from the inhalation of the vapor of chloroform, and so far had its effects been carried that he became pulseless and all hopes of his resuscitation abandoned, and, as all the usually recommended reme- dies had been tried without success, nothing but the death of the young man was looked for, when I pro- posed as a dernier ressort the application of pure oxygen gas as the only chance by which resuscitation could be brought about; but at the time the proposal met with 62 opposition from the medical men present, who were anxiously watching what seemed to be the expiring ef- forts of the poor boy, expecting each moment to be his last. Having, however, consented, the gas had not been more than a few seconds applied to his nostrils when he, who was apparently beyond the help of human aid and absolutely in articulo mortis, arose and placed himself upon a chair, proving most conclusively how correct I was in proposing an application of oxygen gas as a remedy against the deleterious effects of chloroform as an anaesthetic." oxygen use. Giving the views of Demarquay, Dr. Cohen says: " Oxygen is indicated in anaemia and many of the affec- tions with which it is associated, such as chlorosis and dyspepsia. Asthma is the affection for which it is most frequently prescribed. In acute phthisis with fever it is contrarily indicated on the ground that super-excitation of the nervous and circulatory system is injurious. But in the earlier stages associated with dyspepsia and im- paired appetite, its effects are beneficial. It has been of service also in dilatation of the bronchi, in chlorosis, and in many cases of cephalalgia." " Demarquay thinks oxygen will be found of service in typhoid and intermittent fevers, in neuralgia, paraly- sis, and other affections of the nervous system. As the result of his extensive clinical experience he recom- mends inhalations of oxygen in all chronic affections associated with debility, dyspepsia, and anaemia, an enumeration of which it is needless to repeat. In most of this experience, however, oxygen was not adminis- tered as the direct curative agent but as part of system- 63 atic treatment for its use in surcharging the tissues with oxygen and facilitating the combustion of the elements of excretion." He further says: "Almost all writers on oxygen cite its use in anaemia, chlorosis, asthma, emphysema, and the pretubercular stage of phthisis. It has also been used in diphtheria. Dr. Francis used it with advantage in a case of malignant scarlatina with diphtheretic exu- dation of the throat." Concerning the value of compressed air, the very es- sence of oxygen treatment, Dr. Cohen says: "Inspira- tion of compressed air is indicated in dyspnoea of almost every origin, in the chronic stages of pleurisy and em- physema, in certain conditions of consumption, in bron- chitis, asthma, emphysema, inflammatory stenosis of the air passages, asphyxia, insufficiency of the mitral valve, and in stenosis and insufficiency of the aortic valves. " The physiological effect of compressed air being to drive the blood from the periphery, it follows that con- gestions, tumefactions, inflammations, excessive secre- tion, and the like, at the peripheral portions of the circulatory system, should be relieved by subjection to the treatment. The ease afforded to respiration suggests its employment in cases in which dyspnoea is associated, and we find its chief application, in fact, in pulmonary emphysema, asthma, and chronic bronchitis. The aug- mentation of vital capacity of the lungs acquired by the process suggests its employment in cases of insufficient expansion of thorax and therefore in non-febrile cases of phthisis and tuberculosis." POISONING. Ranking's Abstract, 48th vol, reports a case of opium 64 poisoning from Dr. Const. Paul, in which oxygen gas " was successfully used, after atropia had failed and when the patient appeared to be dying, and another in which it was successfully employed in narcosis from charcoal gas." Prof. John Law says, " Under certain conditions the exposure of the anthrax germ to the free action of oxy- gen determines its death." Says the Sanitary Era, " The deadly potency of germs depends on a geneological pri- vation of oxygen and is overpowered by propagation for a few hours in full exposure to the oxygen of the air." Pasteur says, "The oxygen of the air thus ap- pears to be the cause of modification of the virulence of the microbe." Dr. Campbell says, " In cases of opium poisoning it is simply necessary to keep the lungs sup- plied with oxygen. This one condition will save nearly every case." " Recent observations," says the Scientific Miscellany, " confirm the observation of Laveran that blood drawn from the fingers of patients during a febrile paroxysm contained parasitic infusoria. Osier and Councilman have found all the forms described by Lave- ran, and in recent researches, in which the blood was ob- tained directly from the spleen, the flagellate form was almost constantly found." " The best way to destroy these infusoria is to super- oxygenate the blood, and for this what is known as the " oxygen-treatment " is, when wisely administered, invaluable." RHEUMATISM. Something should be said of another disease not specially named, with perhaps a single exception, by any of the authorities mentioned in this work, and yet the treatment of which by oxygen inhalations is, from a 65 scientifico-medical point of view, distinctly indicated. This disease is rheumatism. A principal cause of rheumatism is the presence of uric acid in the blood and the muscular tissue. Pepper, in his " System of Medicine," says, " It has been sup- posed, as one atom of uric acid can be split by oxidation into two atoms of urea and one of mesoxalic acid, that uric acid was the penultimate of urea, the result of a lower degree of oxidation." If this be so, a higher de- gree of oxidation would result in a diminution of uric acid and so would be likely to reach and remove the chief cause of rheumatism. Practically this is what it does. We may be allowed to record in a word our own experience with oxygen in rheumatism. We have suc- cessfully treated not a few hard cases. We will not take the reader's time nor tax his patience to make showing of them in progressive detail. One case was that of a married woman who, when she began the treatment, had been confined to her bed for six weeks with inflamma- tory rheumatism. She suffered constantly and could sleep but a few minutes at a time, and had to be moved every hour both day and night. Up to this time, her leg had been all the while, from the knee to the foot, wrapped in cotton batting and flannel, and bottles of hot water kept near it, and yet it was cold and she often had chills. After one week's use of oxygen the leg was warm enough without artificial heat, and the chills were less frequent. In two weeks the pain was gone except when being moved, and she was able to lie without being moved from 10 p. m. until 7 a. m. From this point On- ward she continued to gain, her general health improved, and though now lame from the effects of the inflamma- tion, yet her health is good and she goes and comes 5 66 much as do other people. It is three years since she began the oxygen-treatment. Another case is that of a man for several months so afflicted with rheumatism that it was a task for him to get about. He began oxygen inhalations Dec. 16, 1885. Six inhalations, one each day, relieved him of all pain, and within a month he had no sign of rheumatism, and has had nothing of it since. Another case was that of a business man who had suffered with lumbago for many years. Six weeks' treatment availed to give him relief and since that his general health has been better than it had been for a dec- ade before. Another case was that of a lady suffering with rheuma- atism confined to the lower extremities. Her feet were much swollen and painful in the extreme, and it hurt her to walk and her face was puffed. One month of home treatment supplemented with one month of office treatment reduced the swelling, relieved the pain, and enabled her to walk off as well as ever. The conditions of relief were substantially permanent. Another case was that of a business man who had suffered for years with rheumatism, dyspepsia, and a complication of troubles. He had been, before taking the treatment, laid up for several weeks. He began the treatment with the understanding that if it did anything for him its work would be slow, but he resolved on being thorough. He kept up the treatment for four months with inhalations of from two to four gallons daily, and was himself surprised at the results. He steadily gained in strength and flesh and was completely cured of his rheumatism. In short, the treatment seemed to take hold of all his troubles and physically regenerate him, ^ and though that was more than eighteen months ago the good results still remain. Another case was that of a young merchant whose rheumatism, in no sense chronic, was cured in less than thirty days, daily inhalations of about three gallons of gas. Dr. Andrew Baylies records a case of a young man who came to him after having tried various remedies prescribed by his attending physician. He put him upon oxygen and in four weeks it effected a perfect cure. TYPHOID. S. H. Piatt, A.M., M.D., reports " two cases of typhoid almost identical in general aspects. One, besides other remedies, I gave two bags of oxygen (U.- S.) a day and he was up in ten days. To the other I gave one bag of oxygen (U. S.) a day and he was up in fourteen days. Both gave fair indications of from four to six weeks'run. CHLOROFORM NARCOSIS. Referring to Ducroy, J. Solis Cohen adopts his recom- mendation to the effect that " every patient awakening from a chloroform narcosis inhale oxygen in order to rid himself of headache and other inconveniences follow- ing the administration of that anaesthetic." FREER RESPIRATION. "The effect of inhaling considerable quantities of pure oxygen," says Dr. Ehinger, "varies greatly in dif- ferent subjects. Some will inhale a number of gallons without any apparent effect. It usually, however, causes a slight feeling of warmth about the chest, which may or may not pervade the entire body, giving a sensation of 68 warmth to previously cold hands and feet. The respira- tory movements seem to be accomplished with greater freedom. Occasionally a tingling is felt in various parts of the body, particularly in the finger tips." HEALTHIER NUTRITION. It is the opinion of Dr. Gustav Lange that " the effi- cacy of compressed air principally rests upon the blood being more richly supplied with oxygen, and that a healthier nutrition is the immediate consequence of it." ACTION ON THE MUSCLES AND NERVES. What Prof. Phillips calls the "musculo-nervous sys- tem " is, as we think, likely to be, in cases of average de- rangement, especially amenable to oxygen-treatment. Certain facts of experiment unmistakably point in this direction. Those of Brown-Sequard are among the best. By these he proved the power of oxygen gas to excite musculo-nervous activity, even where death had, for many hours, supervened. His experiments and those of others, which are matters of accurate record, go to show that certain debilities of the muscles and nerves may be, by the oxygen-treatment, mainly overcome. ACTION ON NERVES. "The performance of the functions of the nervous system is dependent upon the presence of oxygen in the blood, its deficiency causing an accumulation of carbonic acid and a state of coma." Charles L. Hogeboon, M.D. FEMALE CONGESTIONS AND WEAKNESSES. In " congestive diseases of female life," says Dr. Birch " especially at the primary and secondary periods of cat- 69 amenial change and persistent relaxation and weakness after child-birth, oxygen has, even in complicated cases, given me perhaps more therapeutic success than in any other direction," and he refers, with special satisfaction, to his record of "selected cases." These cases are given in the " Clinical Exhibits." Dr. Smith, in his " Essay on Oxygen in Disease," gives convincing evidence of the fact that in " fatty placenta " oxygen inhalations are distinctly indicated. He reasons forcibly that if Prof. Simpson's theory be correct and such cases should be treated with " chlorate of potassa," then oxygen should, in the nature of things, be a more powerful remedy. He says, " Once prove that the foetus perishes from a deficient supply of oxygen from the maternal blood and the indication for oxygen-treat- ment is as plain as in croup or asthma." There can be little doubt that oxygen inhalation may be relied on to correct irregularities of menstruation. In several re- markable cases the best results have been reached. Birch reports one in which the patient suffered every month with terrible headache which came on two days before the menses and continued for twTo days afterward. During all this time the patient was obliged to keep in bed and remain in a darkened room, and this had been so for several years. Oxygen inhalations effected " a perfect cure." Dr. Smith reports the case of a patient who had reached the climacteric with a sense of fullness about the neck and at the " base of the brain," with " paralysis of one side of the tongue and impairment of some special senses." Under a course of six weeks of oxygen " a complete cure " came. An eminent practitioner mentions a single case of ;o " bronchial asthma, recurring with each menstrual epoch," " very largely modified " by oxygen inhalations. We have treated cases of restricted and painful men- struation by oxygen inhalation with good results, sub- duing the pain, causing the evacuations to be more full and free, and gaining under continued treatment condi- tions of substantially permanent relief. A remarkable case is reported by Dr. Schmidt (see London Lancet, Sept. 19, 1885) of puerperal eclampsia. Only by chloro- form had the patient been kept from convulsions and only then by a liberal use of it until unconsciousness had supervened. A few deep inspirations of oxygen, continued until upwards of a " cubic foot of the gas " had been inhaled, were enough to bring back conscious- ness and there were no more convulsions, and recovery was gradual and complete. Dr. Ehinger gives the substance of two cases of puer- peral eclampsia, reported by Dr. Farr of Kharkov, in which " oxygen inhalations were followed by brilliant results." Ehinger reports one of these cases. A seam- stress, aged nineteen, brought to the hospital in an un- conscious state, cyanotic with stertorous breathing and frequent convulsions preceded by uterine contraction. No relief could be given by the usual means of wet packings and warm baths and enemata. Neither hydrate of chloral nor inhalations of chloroform would avail to relieve the paroxysms. As a dernier ressort oxygen was tried and in five minutes proved its power. The pulse fell from 120 to 90 per minute, and delightful sleep supervened. Oxygen inhalations have been effectual in cases of reflex vomiting. In incipient pregnancy Lasvkewitch found inhalations of oxygen sufficient to arrest severe 7i vomiting, and "in two days the patient was cured." Dr. Pinard treated several obstinate cases of vomiting in this way and with the best results. In the Medical Current, F. A. Churchill, M.D., sets forth a remarkable case. The patient was in the second month of preg- nancy. For three weeks, notwithstanding a variety of remedies that had been given, she had not " retained a mouthful of food nor any of the nutritive enemata given her." Dr. Churchill records that under this condition of things "one good inhalation of the gas " was enough to cause her to exclaim, "That seems to dissolve the lump in my throat." He kept up the inhalations every day for two weeks during which time " she did not vomit once," and after that she got on finely. There is, it should be said, sufficient proof of the great value of this treatment in reflex vomiting. Tschaud- nowsky makes record of gratifying success with oxy- gen inhalations in several cases of reflex vomiting. " In some cases of vomiting during pregnancy this treatment has," says the National Dispensatory, " ar- rested the symptoms when all other measures had failed." As may be easily inferred from the foregoing indica- tions of oxygen in disease, a wide curative range must be assigned it. Dr. Birch broadly summarizes its cura- tive power. He says : " Certain beneficial effects of oxygen may be mentioned as not unfrequently imme- diate and well marked. Such are, (i) complete relief from excessive oppression of the brain; (2) sight im- proved in defective vision consequent on nervous con- gestion; (3) general warmth even to the ends of the toes and fingers, succeeding to extreme chilliness and collapsed condition; (4) sudden departure of great nerv- 72 ous depression ; (5) permanent relief afforded to the uterus, ovaries, and spine by sudden induction of long suppressed catamenia, particularly at the change of life; (6) relief of unexpected diarrhoea of highly offensive character, with dark, inspissated bile, in long-continued torpor of the liver and portal system; (7) improved ap- petite and powers of digestion and assimilation, a feel- ing of being much more " up to the mark," less lassitude, more ability to bear physical exertion, and—that to which ladies are pre-eminently partial and some of the ruder sex not less so—a clearer, fairer, and softer skin." " It powerfully promotes," he says, " the dissolution, ab- sorption, or elimination of.morbid growths and infiltra- tions; hence, in a therapeutic sense, it is available in nearly every form of chronic disease and in many acute conditions." " It is only necessary to consider rightly its nature, ig- noring all specious claims and enthusiastic overcoloring, in order to infer the wide range of adaptability and ap- plicability of the treatment. Without exaggeration, it is almost unlimited. Oxygenation is as essential to life and health as alimentation. No sane therapeutist asks, in what conditions and diseases is it proper to nourish his patient! And super-oxygenation is as logically and naturally indicated—fairly, in fact, self-suggesting—to overcome the diseases which result from deficient oxy- genation, as alimentation to revive and restore the starved survivors of the Greely expedition. This rule or indication is simple and definite, and covers the subject better than pages of hypothesis, or whole volumes of pathological finesse." " Oxygen alone presides over and renders possible all vital transmutations, and hence, in a more perfect oxy- 73 genation of elements, designed for heat production and tissue formation, we have the key to the success of the oxygen-treatment. Hence also its unlimited range of cura- tive action. It is adapted to the general or constitutional betterment of nearly every chronic morbid condition to which the human organism is subject, no matter by what name it may be called." Such, as set forth by correct authority, are the patho- logical indications of oxygen-treatment. Why should not every reader, and especially every physician, pay attention to this invaluable remedy ? PART III. MONOGRAPH ON PHTHISIS. What has been poetically called " the dream of the early partisans of oxygen," that by it a new life would come to the victims of this deceptive disease, and the whole race of consumptives be rejuvenated as by magic, has not, assuredly, been realized. Indeed, their visions, when compared with the results, seem to be hardly more than exaggerated delusions. Anxious to find some means of relief to the hundreds and thousands struck through with this lingering death, they seized upon this in the hope that it would prove a specific. While their hopes have not been realized yet something ^has been done in the advance of knowledge to show the value of oxygen inhalation in the pulmonary diseases, and it may yet be, in view of more recent investigations, that these inhala- tions will prove to have, in pulmonary tuberculosis, a value now hardly thought of. We shall, toward the close of this monograph, say something more at length of this. 74 PULMONARY PHTHISIS. Not a little doubt is expressed by various writers concerning the value, in phthisis, of oxygen-treatment. Some think it of almost no value, some think it of great value, while others condemn it as too irritating. The notion held by Lavoisier, Priestly, and their contempora- ries, to the effect that, physiologically considered, oxygen undiluted when taken into the lungs by inhalation is " always an irritant," needs, to say the least of it, under our advanced knowledge, some modification. The truth is that even pure oxygen, to say nothing now of any dilution of it, is not per se, an irritant. When introduced into the lungs by breathing, it may or may not prove irritating. The result one way or the other depends upon the nature and progress of the disease, the general physiological condition, and largely and especially upon the character of the administration. Considering the whole matter, we think it the highest truth to say that even pure oxygen, if rightly administered, is not likely to set up inflammatory conditions. Dr. Ehinger records that he experienced no ill effects from inhaling from two to ten gallons at a single sitting, he also administered it to his patients with impunity. Thus, while he disavows the notion that the "prolonged use of pure oxygen" should be much indulged in and distinctly says that "he does not advocate its use in this way," yet he thinks that many modern "experiments demonstrate the fallacy of the old claim, that breathing oxygen will cause inflam- mation and other dangerous symptoms." Hausemann, Naoumoff, Beliaieff, and others reached, by their experi- ence, a like conclusion. The experiments of Savory upon animals would seem to be conclusive against the earlier and more immature view of irritation. Dr. Bartholow 75 distinctly states it as his opinion that undiluted oxygen produces little if any "constitutional disturbance." A genial and general systemic warmth, specially perceptible in the bronchial region, sometimes an accelerated and sometimes a retarded pulse, accompanied with a delight- ful sense of exhilaration, improved appetite, and greater disposition to activity, Bartholow notes as the usual results attending upon the use of oxygen. All this would seem to assure us that there is no need in cases of phthisis of exciting by oxygen inhalations those in- flammations and disorganizations and sudden relapses which Caillens and Chaptal and their contemporaries report. Something of their non-success was doubtless due to the bad character of the "vital airs" used, or to the imperfect way of using them. It may not, on the whole, be advisable, in cases of either incipient or ad- vanced phthisis to administer pure oxygen, though in such cases it has p'roved, beyond a question, its value. However, while pure oxygen may not be indicated, some dilution of it, some compound of diminished strength, and yet stronger than the atmosphere, might avail to save life. There is, we venture in the face of some professional depreciation to the contrary, reason to think that in the vast majority of cases of phthisis, and especially in its incipiency, oxygen is a valuable therapeutic. So eminent an author as Phillips, considering well the whole subject, and himself speaking from experience, does not think that oxygen inhalations, suitably diluted, "can at all irritate or inflame the lung-tissue." This, on the whole, seems to us to be the truth. Oxygen inhala- tions, in dilution and properly taken, do not so much act directly on the pulmonary tissues as indirectly upon the 76 blood, increasing the appetite and augmenting the power of assimilation, and in this way attacking the disease, by connectional and systemic vitalization resisting its prog- ress, and perchance overcoming it. Beigel's philosophy of the operation of oxygen in phthisis is doubtless accord- ing to the truth, that is it supplements the deficiency of oxygenation caused by the diseased conditions of the impaired respiratory surface. It may in some cases do more than this, it may carry its good effects quite beyond such as would come of breathing, under proper conditions, a normal quantity of atmospheric air. In ten cases reported by Dr. C. E. Hackley, six of them gained under the oxygen-treatment an "aggregate of 491 pounds," while the other four " lost 7 pounds." Dr. Mackey reports several cases in which marked improvement resulted from inhalations of diluted oxy- gen. One patient inhaled a gallon every two days, and after sixteen such inhalations was so much better that no more were needed or taken. Another was the case of a young man of sedentary habit, with inherited ten- dencies to consumption, who began oxygen inhalations, and though cod liver oil and iron accompanied the treat- ment, yet he records the special benefits of the oxygen inhalations. He gives another case in which the oxygen increased the power to breathe, subdued the inflamma- tion, diminished the expectoration, and improved the appetite : and though these results were not permanent, but transient, yet Mackey gives it as his opinion that imprudent exposure was the cause of the collapse, and that in every case the oxygen-treatment proved its value. Considering these and other like cases, Prof. Phillips frankly says that they prove nothing against the oxygen- treatment, and considering other cases, and especially 77 the large number reported by Dr. Andrew H. Smith in his " Prize Essay on Oxygen Gas in Disease," he says, " The results are so favorable as to warrant still further trials with this agent." Having used oxygen gas in a score of phthisical' cases, Dr. Read of Long Island records his deliberate conviction that the oxygen-treatment is of great value, especially in connection with regular and well considered medication. In one of several cases reported by Dr. Andrew H. Smith, in all of which there was more or less "ameliora- tion of the symptoms," the menses that had been for some time in a state of suppression started again, and consequent upon this there was a decided general im- provement. Stille", in referring to more than a dozen cases treated by Dr. Read, says, " The greater number were permanently benefited by the treatment." He goes out of his way to say of these cases that inasmuch as cod liver oil was given in connection with the oxygen inhalations "it may therefore be supposed that the benefits derived" were not so much "in a direct influ- ence upon the pulmonary disease as in the indirect advantage which the gas conferred in promoting the digestion of the oil." This would seem to be an un- necessary and gratuitous depreciation of the oxygen, for in the first place it is only suppositive and in the next place the results with the cod liver oil are such as would not come without the oxygen. Whatever, then, may be the truth of the relation of oxygen treatment to cases of advanced phthisis, there would seem to be no good reason to doubt its thera- peutical value in the very incipiency of the disease. The whole truth seems to be expressed by Bartholow when he disallows after "hectic fever" has set in and 78 " excavations have occurred," the value of oxygen inha- lations save as they may relieve dyspnoea, but on the contrary avers that the evidence is satisfactory that oxygen inhalations produce good results in some cases of phthisis, arid these cases, he says, are those where the structural condition of the lungs is not seriously im- paired, and where the symptoms are secondary rather than primary. In diseases of the respiratory organs where the chief cause may be deficient oxygenation, inhalations have been used, says Bartholow, "with success." He mentions certain cases likely to be amenable to oxygen-treatment and says there is no mystery involved in its therapeutical effects, but on the contrary the manner of its action is " perfectly obvious." The expla- nation is twofold. First, the mechanical work of breathing is made easier to the patient, and, secondly, the super-oxygenation lessens the wear and tear to the respiratory organs. Bartholow says that in most of these diseases, and he specially names anaemia, leucocy- themia, diabetes, albuminuria, and others largely caused by "insufficient oxidation," the administration of "pure oxygen is not necessary." He advises, rather, some dilution of it with inhalations twice each day, " morning and evening." In considering the "ill success" of the ordinary treat- ment of phthisis in all its various stages and modifications, Dr. Birch, twenty years ago, ventured to suggest to the profession the cause, or at least one of the causes, of it. He charitably calls it " the negative error " of inattention to the "scientific use of that great element, oxygen." And he refers, as is clearly evident by reference to his book, to non-atmospheric oxygen, though he allows with 79 Drs. Ramadge and Smith and Balbirnie and MacCormac, the preventive value, in cases of consumptive tendency, of full and strong breathing of natural air. When we consider the predisposing causes, aside from heredity or in connection with it, of many cases of consumption, it would seem to be easy to see how oxygen-treatment is indicated. These may be named in a single phrase, a vitality so lowered as to make functional integrity im- possible, and the control of chemical and physiological affinity out of the question. Beginning here, a low train of disordered action leads the way to and lays the founda- tion for future ill results. Unhealthy nutrition, organic insufficiency, deteriorated blood, short and languid in- spirations, chest contraction, collapsed air-cells, and, it may be, either chronic solidification or scattered emphy- sema, make up the constitutional nidus in which the disease burrows until the conditions of its existence make permanent interference with its progress impossi- ble. If such conditions and tendencies do not clearly indicate a demand for oxygen then our physiology is seriously at fault. The want of oxygen becomes, as Dr. Birch says, the "great exciting cause of disease." "The products of digestion, the incipient cell-formations in the blood in their course through the capillary vessels of the lungs, cannot receive the normal vitalizing changes, nor can the blood-corpuscles get a sufficiency of oxygen to convey to the systemic circulation. The blood be- comes impoverished, destructive metamorphosis and equivalent reconstruction of tissue progress too slowly, and the vital powers can no longer control the tendency to decomposition and disorganization." This seems to be the unquestionable fact, a fact that indicates not that the little oxygen the patient may be able to get is too 8o much for him, but rather that he wants more, and that for the want of it he is wasting away to prospective and premature death. It is not the oxygen that carries on to a fatal issue the consumption that is preying upon him and eating his life away, but the want of oxygen. Of course it may be that his vitalities have become so im- paired that they cannot be restored by any work of natural breathing, but just here is where it may be possible by artificial oxygenation to start them up again. This has been done in many instances as will clearly appear in the chapter on "Clinical Exhibits." Let us here quote again from Dr. Birch. He says, " Based upon sound physiological principles of treatment with oxygen as an associate properly detailed and carried out, accord- ing to the peculiarities of each case, the cure of pulmon- ary consumption in the earlier stage ought to constitute the rule, not the exception:" and he says this without qualifying it by considerations of either " hereditary or acquired predisposition " to the disease, or the "patho- logical character " of it. And he carries this statement to the disease, not only in its very early incipiency, but to what he calls " the middle stage," and avers that "great success" can be attained from the "vital dy- namics " of the oxygen-treatment. His, however, is not a theory of mere super-oxygenation. Indeed, he says this "must be dismissed from the mind." Nor is it a theory of more "mountain air," or more "sea air," for he stoutly protests against what he ventures to call this " prevalent scientific error." Admitting the paradox that because of "lowered vitality" the patient cannot make good use of what little oxygen he is able to take in out of the atmosphere, and that the emergency of his disease requires more, " the scientific principle," says Dr. 8i Birch, " presented for our contemplation is, how can w-e make such temporary impressions with artificially pre- pared oxygen as shall invigorate the imponderable forces in the animal economy, give an impetus to assimilation and nutrition, and augment the absorption of atmospheric oxygen." And this he thinks can be, in a large number of cases, done through the superior "vital dynamics" of artificially prepared oxygen. His own experience and that of others since makes good his statement. Beigel gives it as his opinion that in incipient phthisis oxygen inhalations are always indicated. Presumably this is so. At any rate there is a general consensus of opinion to this effect among those who have given the relations of oxygen-treatment and disease sufficient attention. Beigel says: "In children predisposed to phthisis, the inhalation of oxygen gas would delay or even prevent the outbreak of the disease, and even after the develop- ment of the affection inhalations of oxygen gas some- times render astounding service." He gives a case, that of an engineer, which is put down at length in Cohen's "Inhalation." The patient was twenty-three years of age and of scrofulous diathesis. There was " tubercu- losis, infiltration of the left apex, and bronchial catarrh of the right lung," with a general systemic condition such as usually attends such an exhibition of phthisis. He inhaled twice a day " a gallon of oxygen at each time and a solution of sesqui-chloride of iron twice a day for five months, at the end of which time the patient was so improved as hardly to be recognized as the same man." Dr. Beigel saw him one year after the dis- continuance of the treatment and found him still enjoy- ing his convalescence. Cohen is frank enough to say for himself that his experience with " oxygen gas as a 6 82 therapeutic agent has "been comparatively limited," though he gives as the reason the fact that he had not had the success with it which others record, yet he says, " I have employed oxygen in a number of cases of im- perfect aeration of the air-cells of the lungs from defi- cient inspiration and with decided benefit." And though he is indisposed from his own experience with oxygen to regard it with " any special favor" as a treatment for "confirmed phthisis," yet he declares that he has "seen considerable comfort follow the institution of the treat- ment," and expresses his opinion that "oxygen may be legitimately resorted to upon suitable occasions." In his valuable work on " Consumption, its Nature, Causes, Prevention, and Cure," J. M. W. Kitchen, M.D., says, " Oxygen gas is variously rated as a beneficial agent in the treatment of phthisis. In some cases the effect of its inhalation is very good. It seems to suc- ceed better with the phlegmatic than it does with nerv- ous individuals. It gives the patient some increased force and stimulates the general system." He agrees with a large number of eminent physicians in this, and especially in his view of the value of a timely tonic in cases of incipient phthisis. " Millions of human beings," he says, "could be saved from the ravages of this dis- ease if a simple tonic could be administered to them at just the right period. The temporary help which they would receive at this critical time would give the pulmo- nary tissues sufficient ability to resist the commencing action of the disorder." What better tonic than oxygen, in incipient pulmonary debilities, can be named ? If the attending symptoms of consumption are such as are usually apparent, bad nutrition, insufficient heart action, high temperature, and excessive expectoration, 83 bronchial and laryngeal trouble, insomnia with night sweats, and generally low vital force, then there can be no reasonable doubt of the indication of oxygen-treat- ment as of probable therapeutical value. This point is now, in the advanced stage of medical science, so well established by the agreeing views of eminent practition- ers that it would be superfluous to write more at length in support of it. And yet a further word may be of value. If, as Dr. Cohen says, the "systematic inhalation of atmospheric air is often of great therapeutical serv- ice," then it is reasonable to suppose that there may be physiological conditions under which the systematic breathing of an artificial atmosphere, properly surcharged with oxygen, would be increasingly beneficial. These conditions are likely to environ those of sedentary habits by reason of which the lungs are not able to do their full work, and for which lack the blood must suffer from imperfect aeration. Under these circumstances even the "forced respiration of atmospheric air," as Drs. Ramadge, Drake, Langenbeck, Morell, and others sug- gest, is likely to be of immediate and permanent value. Much more, then, an atmosphere enriched with oxygen somewhat above that of the natural air. The vital ca- pacity of the lungs under systematic inhalations of oxy- gen gas is, as a rule, much improved. Many cases might be cited in proof of this. Dr. Cohen, in his " Inhalation: its Therapeutics and Practice," speaks specially of five cases immediately relieved from " distressing cough and copious expectoration," and he mentions a single case of phthisis in which " the vital capacity of the lungs in- creased from 2,850 to 3,100 cubic centimeters," and another case in which there was an increase " from 2,100 to 2,300 cubic centimeters." Such facts as these ought 84 to be enough to assure any candid person that in all dis- eases of the respiratory tract oxygen inhalation is indi- cated, and that phthisis, in its incipiency or its malig- nancy, should be considered no exception. In a recent able and suggestive paper on "A Possible Revolution in Medicine," Dr. Austin Flint makes some statements that may naturally and easily connect them- selves with the theory of oxygen inhalations in phthisis. The pivotal point of Dr. Flint's " Possible-Revolution " is that of the recent more complete " discoveries in bacteriology." Speaking of this he says:— "The science and practice of medicine and surgery are indicating a revolution of such marked importance that its limits can hardly be conceived. Looking into the future in the light of recent discoveries it does not seem impossible that a time may come when the cause of every infectious disease will be known, when all such diseases will be preventable or easily curable, when pro- tection can be afforded against all diseases, and when no constitutional disease will be incurable." And he goes on to say that " these results indeed may be but a small part of what will follow discoveries in bacteriology." He further says, " What has been accomplished within the past ten years as regards knowledge of the causes, prevention, and treatment of disease, far transcends what would have been regarded, a quarter of a century ago, as the wildest and most impossible speculation." In his opinion, it will in the near future be shown that " bacteria play an important part " in the " physiology of digestion." He bases his opinion upon the fact that the whole intestinal region is infested with bacteria, though the part they have in the work of digestion or of indi- gestion is not yet well understood. Pasteur has recently 85 found in the mouth as many as seventeen different micro- organisms, over which the gastric juice had no power. Dr. Flint goes on to say: " In the practice of medicine recent discoveries in bacteriology have brought about changes which amount almost to a revolution." This revolution has already taken place, or is already im- minent, in the treatment of such diseases as the fevers, the whole range of catarrhs, a large variety of skin troubles, most of the contagious affections, yellow fever, diphtheria, erysipelas, pneumonia, and tuberculosis. Assuming in all these the causative agency of bacteria, the question of superinducing conditions becomes an important one. " The conditions necessary," says Dr. Flint, " to the development of these diseases seem to be a susceptibility on the part of the individual and the lodgment and multiplication of special bacteria in the system." An inherited constitution or the ever present physiological integrity makes some persons only in a small degree, if at all, susceptible in the usual way to " certain infections," while others are, by a different in- heritance, or a less sound physiology, peculiarly suscep- tible and easily take on infections. Dr. Flint expresses it as his conviction that " a person with an inherited tendency to consumption would never develop the dis- ease if he could be absolutely protected against infection with the tubercular bacillus," and distinctly says that " in the light of modern discoveries consumption can no longer be regarded as an incurable disease." He says, and not a few physicians will be surprised to hear him say it, " In certain cases the bacteria if confined to the lungs may be destroyed." The problem, then, is, as Dr. Flint suggests in a case of pulmonary tuberculosis, to destroy the bacteria—the bacillus tuberculosis—and to 86 do this without injury to the patient. Here, then, is the fact: certain diseases, and among them consumption, may be cured by destroying the causative organisms. In this way fermentative indigestions may be cured. So, too, may certain skin diseases. So, too, may diphtheria, and presumably, in many cases, pneumonia. That is, the causative germs may be attacked and destroyed. Dr. Flint says nothing of the power of oxygen gas in any form to do this, but others, in some respects as emi- nent as he, do. They affirm that all bacteria are, under some given action of oxygen, destructible. If this be so, then there is in cases of incipient if not advanced tuber- culosis, a reasonable presumption in favor of inhalations of oxygen. There can be little doubt that were, say, a handful of bacilli directly exposed to the action of pure oxygen, the result would be their destruction. Whether or not they can be gotten at, when lodged in the tubercular matter, may depend upon so many conditions in indi- vidual cases that only a knowledge of these cases could warrant the expression of an opinion ; but if they can- be acted on there by oxygen inhalations with sufficient en- ergy and without any unfortunate over-action on the ulcerated surface and the delicate pulmonary tissue, the destroying tendency of that action hardly admits of doubt. Then, too, if, as is probable, inhalations of pure oxygen might be too strong, the question arises whether or not some considerably diluted preparation, and yet well charged with the gas, would be sufficient. Perhaps if wisely taken, and taken long enough, it might be. At any rate, the probability that the bacteria might be killed or their propagation held in check or prevented by inhalations of oxygen ought to be enough to sug- 87 gest its use and warrant the experiment. Beside oxygen inhalations ought to have some value in relation to the theory of natural heredity and constitutional suscepti- bility to consumption. Where there is such a suscepti- bility or such a hereditary tendency it would assuredly seem to be in the nature of the oxygen-treatment to counteract it. Thus it might prove a powerful prevent- ive, and by its timely work save many a victim from the fatal consequences of bad primogeniture or special phthisical susceptibility. No matter, then, by what theory the deceits and mys- teries of pulmonary consumption be explained, it would seem to be only the dictate of professional prudence to consider the probable value of oxygen as a natural and harmless therapeutic and in connection with other sound physiological and medical treatment to use it. Call the bacterian theory what an eminent physician has unwisely called it, " the now prevailing germ craze," yet if it be true, and as it is true, and as oxygen is both a germicide and a sporicide, and can act upon any organism permea- ble to any form " of infection or contagion," it would seem to be only driveling illiberality or ignorance to deny its probable value and decline its use in incipient or advanced pulmonary troubles. And if the germ theory be set aside and the fostering nidus of tubercular deposit be a con- glomerate of imperfect assimilation and organization, of depreciated epithelium and the miscellaneous wastes of absorption and expiration, then we well know that all the processes of the further disorganization call loudly for such vitalizing resistance as it is in the power of inhala- tions of oxygen to give. Indeed, what other element could be introduced into the diseased lungs so well cal- culated to aid in the discharge of the decomposed fibro- 88 albuminoid substance, to check the exaggerated formation of epithelial cells, to prevent the undue deposit of gran- ular and calcareous disintegrations, and to effectually stop the progress of purulent infiltrations. The one subtile substance upon which our very existence depends, the most powerful electro-negative element in nature, the means by which the physiological integrity is main- tained and the equal and heathful relations of the many membered organism kept up, in short, the very sine qua non of life, oxygen may be the one factor in the treat- ment of phthisis, the omission of which may make all others unavailing. As it may in many instances offer the only chance of life, and as, in the very nature of things, it is indicated, it would seem to be unwise on the part of the physician not to recommend it. PART IV. PHYSIOLOGICAL ACTION FROM THE INHALATION OF OXYGEN GAS. An Important Fact.—Gas has the advantage over a great many therapeutical agents, inasmuch as, with slight precautions, it can be administered without pro- ducing serious accidents, and in my opinion it is destined to bring about results that would be well to note. J. N. Demarquay, M.D. The first inhalations of oxygen are sometimes accom- panied by a slight sensation of heat in the mouth, which is communicated to the larynx, from there to the inte- rior of the thoracic cavity. The sensation is rather agreeable. This is at least what we have felt. Beddoes experienced an ardent sensation of heat in the chest. This heat was transmitted very rapidly to the 89 hypogastric region, but it generally disappeared shortly after one ceased to inhale the gas. There is, as a rule, an elevation of the pulse after inhalation, from four to twenty pulsations. Many persons experience during the period of inhala- tion a sensation of heat in the skin followed by profuse perspiration. The effect upon the senses is slightly marked, aside from the central nervous system. We ex- perience at times slight intoxication, and nervous people experience a pricking or itching sensation in the tips of the fingers, some become excited, others have pleasant sensations, others experience a very marked want of muscular action. We have experienced a sense of con- striction, many times, during the inhalation, in the tem- poral region. Others have experienced more or less pain, from inhalation, following the course of many branches of the trifacial nerve rather than those of the supra- and infra-orbital and temporal nerves. It increases the appetite by promoting assimilation. In 1843 Dr. Demarquay ascertained by experiments upon himself that it was possible to remain in an atmos- phere heavily saturated with oxygen, without experi- encing other symptoms than those of increased vitality, and it has at the start relieved fierce headaches, and by frequent inhalations many chronic afflictions of the res- piratory organs have both been soothed and cured. Still further the author adds : " There is an accelera- tion of the pulse, ten pulsations in a minute. This symptom lasts in the neighborhood of an hour after taking the gas. The digestive functions are increased, marked by increased appetite. There is a sensation of general improvement. Also a decided improvement in the respiratory functions. 90 It is possible to be shut up in a cabinet for hours, pro- vided you are supplied with oxygen, and have cups inside the cabinet containing lime and potassium to absorb the carbonic acid, and on coming out you will find an increase of appetite, and that night you will experience profound sleep. The following was reported to me by a friend of mine, a professor of medicine :— This young lady, Miss M----, aged 31 years when she came for treatment, was decidedly phthisical. She had tried every means to effect a cure or even find some ease, but to no avail. The disease was daily progressing, when she determined to try the oxygen. She commenced the 24th of April. A short time after taking, her strength, which was very much impaired, began to improve, so much so that at the end of May she was sufficiently recovered to take long rides on horseback. This young lady inhaled each day from a glass bell containing seven hundred ounces of water, keeping the nose closed until she experienced difficulty. Then we closed the bell and let it rest upon the water about twelve hours, at the end of which time she would again inhale for a period of five minutes. After which a taper plunged into the bell would not burn any better than in the atmospheric air, and sometimes not as well. The patient continued the use of this treatment during six months. She ceased the treatment in October, and died the following winter. My friend, the doctor, was fully convinced that if she wished to follow his advice she might have lived much longer, but she abused all the benefit derived from this treatment in living a gay life. J. N. Demarquay, M.D. 9i REMARKS. Report of Case.—Among many facts which have come under my observation, there is one wThich is quite forcible. It is relative to a man who entered the hos- pital, during my term of service, to be treated for a comminuted fracture of the leg. This unfortunate man was subject to asthma; he found it impossible to remain in a horizontal position. He was obliged to have the win- dows open at night, and to be elevated in bed. The inha- lation of oxygen relieved him, but did not effect a cure. I therefore mixed (one quart of) carbonic acid with (three quarts of) oxygen, and my patient recovered, that is to say the attacks ceased. J. N. Demarquay, M.D. There is nothing surprising in it, if we could see the number of paroxysms controlled in certain persons under the influence of a good supply of air. Others, on the con- trary, prefer low, swampy regions to elevated places; some find relief in cities, others in the country air. That would explain the good results which we have obtained from oxygen in its pure state, also mixed with hydrogen and carbonic acid. I do not find in Hill's work any mention of the oxygen-treatment in asthma. But he cites the case of a young lady troubled with a nerv- ous cough. Tonics and anti-spasmodics cured her after two months' treatment. But at the end of a month she had a return of the symptoms; she was then treated by oxygenated air. At the end of five days, recovery was almost complete. A very eminent English authority says that "under the influence of this medication a child improves won- derfully." How are these facts explained ? Is it by the direct 92 action of the oxygen or hydrogen, or the carbonic acid upon the bronchial mucous membranes that the parox- ysms of asthma are modified, or rather by the action which these gases exercise upon the central nervous system through the medium of the blood ? All these questions will, no doubt, one day be solved, but for the present we must confine ourselves to facts, and we will not accept any explanation that does not point, strictly speaking, to direct observation. Case i. A Case of Nervous Asthma Treated by Oxygen.—It is with the greatest of pleasure that I publish the follow- ing case, with the hope that others may derive benefit from like treatment. Shortly after the age of thirteen I became subject to frequent attacks of nervous asthma which caused me unspeakable suffering. Blisters applied to the chest together with expectorants invariably soothed me, but not without many hours of suffering. A moist rather than a cold temperature seemed to be the most beneficial. My strength was very much exhausted after each attack and remained so for quite a length of time. Toward the middle of the month of September last (1795), upon the advice and under the guidance of Dr. Beddoes, I began the inhalation of oxygen gas. At the end of a few weeks my health began to improve. To- wards the latter part of October I caught cold, which brought on another severe attack of asthma, less severe, however, than the preceding ones. Since that time up to the present writing I have only had five attacks, all of which have been slight and of short duration. For many years I have felt indisposed each spring. But this year I have not been ill a single hour, and during 93 the last six months I have enjoyed better health than any preceding year. The heat and moisture affect me less, and, contrary to all expectations, I have taken cold without producing an attack of asthma. I have inhaled the oxygen once a day—with the exception of a few interruptions—for nine months. I ceased treatment at the commencement of the present month, with the hope that I may be able to do without it, but with the inten- tion however of resuming it in case it should reappear. J. Hare, Esq. Conduit St., Paris, July 29 (1796). Case 2. Asthma by Oxygen.—Mr. X---, aged nineteen, born in Scotland, was admitted to the hospital, for hydrocele, during the service of Dr. Demarquay, the 10th of De- cember, 1863. The hydrocele yielded readily to proper treatment, and a cure was effected. But the day after his arrival, he was taken with an attack of asthma. Dr. Demarquay always treated these attacks by the inha- lation of oxygen. And strange to say each paroxysm ceased the moment the patient began to inhale the gas. Among other things are a few details relative to the pathological history of this young Scotchman, and the results which have been obtained by the inhalation of oxygen. His mother died at an early age from pulmo- nary tuberculosis. His father is still living and enjoys good health. Since his eighth (8th) year he has been subject to these attacks of asthma. Up to the age of thirteen and fourteen he has had attacks regularly once a month, the effect of which lasted a fortnight. His health was very much impaired. From the 14th to 18th year the attacks were less frequent—once in two 94 or three months—nevertheless they caused him very much suffering. At the age of eighteen he left his native country and came to France. Thanks to a most delightful climate, which is characteristic of the latter place, the attacks diminished both in intensity and in the number. Since his sojourn here he has had but two attacks, the first three months ago, the second just after his entrance to the hospital. December 13th. Last night, at the beginning of an attack, the patient inhaled from 20 to 25 liters of oxy- gen. From the first inhalation he began to grow better, and after having inhaled all the oxygen (in the bag) the attack had completely subsided. December 17th. At nine o'clock, p. m., the patient had another attack of asthma. The oxygen was imme- diately supplied him, and the dyspnoea ceased almost immediately. We were informed by the nurse that a bag containing 25 to 30 liters of the gas was not emptied be- fore the patient was asleep. December i8th-22d. Patient had no attacks. 22d he had an attack, stopped by the oxygen. December 23d-27th. No attacks. December 27th. The patient had a severe attack of dyspnoea, which was immediately relieved by the oxygen. Dr. Demarquay. EXPERIMENTS. INJECTIONS OF OXYGEN INTO THE CELLULAR TISSUE AND SEROUS MEMBRANES. Oxygen can be injected into the cellular tissue and serous membranes of animals without causing any incon- venience. The results of our first experiments, corrob- 95 orated by Mr. Lecompt, have been recorded in 1859 in the " General Archives of Medicine." In that work (or rather report) we have not only shown how utterly de- void of harm are these injections of oxygen, ozone, acid carbonic, but also the laws of absorption. Oxygen brought in contact with the tissues is absorbed very rapidly. Two hours and a half after the injection we can withdraw but feeble quantities of the mixture, whether we operate during a period of fasting or during digestion. But absorption appears to undergo inter- ruptions, at least from exhalations of other gases. During these series of experiments, an important fact was the finding of more gas at the second rather than the first trial. In the cellular tissue during fasting, for example, at the end of forty-five minutes, analysis showed 66 t8A parts oxygen, and about one hour later it furnished 78 tW In the peritoneum (likewise during fasting) at the end of forty-five minutes we found 77to5o; at the end of an hour, fix 86 O I TOO. Animals do not seem to suffer from the injections of gas into the cellular tissue as the symptoms produced pass away. This idea of studying the action of oxygen in- jected into the cellular tissue occurred to Dr. Beddoes, and he reports as follows :— "We injected under the skin of a dog four pints of oxygen ; slight ill-feeling during the first hour, but after that the animal appeared to enjoy excessive vitality. The following day the gas commenced to diminish. To- wards the tenth day all of the gas appeared to have been absorbed. Upon another dog weighing nineteen pounds, three and a half pints of gas were absorbed in eight days. 96 Upon a third dog weighing twenty-one pounds, three pints in eight days. Upon a fourth dog weighing twenty pounds, three pints in seven days. The second and third dogs were affected like the first dog, but the fourth experienced no ill feelings.—" General Archives of Medicine, 1859." Dr. Demarquay. methods of obtaining oxygen. Oxygen prepared from mercurial oxides is dangerous, as salivation invariably occurs at the end of a few days. Dr. Demarquay. At the present day many means are employed for pre- paring oxygen gas. We shall examine successively the six principal ones :— 1st. By the decomposition of manganese peroxide. 2d. By the decomposition of chloride of lime. 3d. Boussingault's method. 4th. Decomposition by heat of sulphuric acid upon the sulphates. 5th. Reaction of sulphuric acid upon potass bichro- mate. 6th. Decomposition of potass chlorate. 1. The objections to the first method of obtaining oxygen are : aid of heat, a high temperature must be kept up ; second, obtaining it by the agent sulphuric acid upon the manganese would necessitate many wash- ings, owing to the impurity of the commercial acid ; then again the manganese contains earthy matters, and we have read of the case of an English chemist who, while preparing the oxygen from manganese peroxide, met with a serious accident, and his assistant was killed 97 outright, owing to an explosion. Another objection is that manganese may contain organic matters. 2. The objections when prepared from the chloride of lime are that too much chlorine is set free, which necessitates many washings with water rendered alkaline. 3. Boussingault's method consisted in employing barium. High temperature was necessary, also a cur- rent of moist air, which was hard to regulate, for if it passed a certain degree it formed a slimy paste,—hydrate of barium. It is also necessary that barium should be free from nitrates and nitrites. This, together with the high temperature, renders it unworthy of trial. 4. Decomposition by heat of sulphuric acid or of sulphate of zinc. These two methods, which we unite into one, because in both cases oxygen is produced by the decomposition of sulphuric acid, are due to Messrs. St. Claire Deville and Debray, who proposed to use it in the art of plating. Their procedure lay in the property which, by the aid of heat, sulphuric acid had to change itself into sulphurous acid and oxygen, and the sulphate of zinc to oxide of zinc,—sulphurous acid and oxygen. But, unhappily, again we must denounce the method on account of the agent employed (acid sulphuric). 5. Reaction of sulphuric acid upon bichromate of pot- ash. You form by this method chromate of alum. The same author, Dr. Richardson, proposed treating binoxide of barium with sulphuric acid ; you form the sulphate of the protoxide of barium. We do not get all the oxygen by this method. Again, the cost is too much. Dr. Bouchardat advocated a mixture, little by little, of the peroxide of manganese with the peroxide of barium, with equal parts of rectified acetic acid. The disadvantages, in making and to the patient, are many, so we have discarded this method. 7 98 6. By the decomposition of chlorate of potash. When we decompose the chlorate of potash by heat, we obtain the chloride of potash and oxygen. KC103 = KCl + 03. The chlorate of potash is the body which readily parts with all of its oxygen. The gas thus ob- tained is almost pure, and the operation is conducted very easily. It is with gas obtained from the chlorate of potash that I have made all my experiments. Dr. Demarquay. anaemia following parturition. by th1erry-mieg, m.d. Mrs. L----, of Boston (U. S. A.), aged thirty-seven years, was delivered of twins, in March, 1862. Placenta adherent. Labor was followed by a post partum hem- orrhage, after which there was a state of profound anae- mia (lymphatic constitution), and, being worn out by successive labors, in spite of preparations of iron and sojourns in the country, she did not seem to recover, so her physician advised a trip to Europe. In July, 1864, she arrived at Spa and commenced using the chalyb- eate waters, which seemed to improve her considerably. But after the first three weeks the improvement received did not maintain itself. Appetite diminished, so she decided to take a month's trip in Switzerland. She arrived in Paris in September, 1864 ; she was yet very anaemic, feeble, could not go out without a carriage, and her appetite was absolutely gone. Having been informed by Dr. Demarquay how useful oxygen was in this case, I advised Mrs. L----to inhale twice a day at least, before each of her principal meals, seven liters of oxygen at a time. The day after eight liters, then nine liters, until 99 she had reached fifteen liters at a time, and finally thirty liters, and continue that dose. Also a slight rubbing of the muscles. Rare meats, Bordeaux wine, and a slight exercise every morning. Upon the 24th of September she commenced inhalations of oxygen. The 30th of Sep- tember there was yet little change. During the first days of October Mrs. L----commenced to regain her appetite. A few days after, appetite became stronger, and digestion was much better. Her strength returned, and Mrs. L----was able to take much more exercise. She was much better than she had been for two years, and she continued to inhale thirty liters of oxygen up to December 8th, that is to say the inhalations lasted during six weeks. She believed herself completely cured, having regained her strength, appetite, etc. However, knowing her condition, I advised the use of a little cod liver oil and the hypophosphite of iron, with a few pep- sin powders, to be taken each day if the appetite dimin- ished. Mrs. L----passed an excellent winter, and she attributed the great change to the oxygen. In March, 1865, she experienced a sudden fright, followed by a change in her health. Her appetite disappeared. Dys- pepsia appeared, and the pepsin, iron, and nux vomica did not seem to improve her. She began again the in- halation of gas, and a decided improvement manifested itself at the end of three weeks. The time having arrived to depart, Mrs. L----was obliged to leave Paris. At the moment I write these lines, I learn that a sojourn in the mountains of Tyrol had a beneficial effect. But I regret very much that I did not prescribe the inhalation •of oxygen (in Paris) at least six weeks before the depart- ure of Mrs. L----, seeing that the last three weeks gave better results than the first three weeks. It can be 100 readily seen that Mrs. L----did not improve upon iron and general tonics. I have every reason to believe, that had I insisted upon Mrs. L----taking the oxygen for three consecutive months at the start, instead of allowing an interval of four months to elapse, the brilliant results obtained would have maintained themselves, despite the attending evils which occurred. I may say that a very distinguished physician of Boston, who always cared for Mrs. L----during illness, insisted upon tonics, etc., for one year. Then we remember how shortly the waters of Spa lost their beneficial effect. I am, therefore, fully justified in claiming all beneficial results received as due to the oxygen. Dr. Demarquay's Report. Experiment 9. " Injection of oxygen by the jugular vein.—Blood in the right side of the heart and pulmonary artery red and frothy." May the 25th, at thirty-one minutes after ten o'clock, we injected oxygen into the jugular vein of a dog, with a slight wound. During the first thirty seconds the animal presented nothing abnormal. Fifteen sec- onds after we heard a gurgling sound caused by the mixing of the gas with the blood, and almost immediately the animal uttered plaintive cries, res- piration became embarrassed, and he died. Nothing particular noticed on the side of the wound. Autopsy showed contraction of the auricles. The right auricle and ventricle, the pulmonary artery and its ramifications (first) were found filled with blood, red and frothy in character. On a level with the right auricular ventricu- lar opening, also the tricuspid valve, we found fibrinous 101 clots of considerable density. By the aid of electricity you can determine the energetic contractions in the mus- cles of a living animal. The heart remains insensible to this irritation. Experiment 10. " Injection of eighty cubic centimeters of oxygen by the jugular vein.—Ecchymosesand watery secretion from the surface of the wound.—Asphyxia, and return of life by arti- ficial respiration.—Experiment lasted fifteen minutes." The dog about to be experimented upon had a wound on a level with the shoulder, dating back three days. May 29th, at 9.15 a. m., we injected oxygen by the jugu- lar. At the end of three minutes the animal was irrita- ble, and uttered cries. We heard at the same time in the region of the epigastrium a bruit peculiar to a chop- ping sound, breathing is difficult, and the heart sounds are increased. We therefore closed the gasometer. At the end of two minutes we again inject the gas. At this moment if the ear be placed near the region of the epi- gastrium we perceive that which resembles an intense blowing sound, which may be mistaken for a bruit (cir- cular in movement). The appearance of the wound is an intense red in color. Its surface is riddled with blood spots and an abundant watery secretion. We continue to inject the oxygen; but at a given time the dog falls as though he had received a shock. Nevertheless we brought him back to life after employing artificial respi- ration for fifteen minutes. Dr. Demarquay. Experiment 11. "Injection of oxygen in the jugular vein of a dog with a wound near the shoulder.—Small blood spots.— Watery secretion upon the surface of the wound." 102 Upon the 14th of May at ten minutes past ten o'clock we injected oxygen into the jugular of a terrier dog with large wound (which had a pale and livid looking appearance) on a level with the pectoralis major muscle. At the end of two minutes the appearance of the wound began to change. It became rose colored. A few reddish spots appeared on the surface. Proud flesh became more apparent, and a watery secretion was noticeable from all parts of the wound. During the first four min- utes the respiration was regular, after that it became profound and difficult ; we closed the gasometer. After one and a half minutes we again established communica- tion between the jugular and the gasometer. Very soon the appearance of the wound was a bright red, and the surface was covered with blood spots. During the sec- ond part of the experiment the animal did not show any signs of irritability or uneasiness. The experiment ended at twenty-two minutes past ten, having lasted twelve minutes. Dr. Demarquay. Experiment 12. " Injection of two hundred cubic centimeters of oxygen by the crural vein.—Death.—Autopsy.—Blood in the right auricle vermilion red." The 22d of June at twenty minutes past ten o'clock we injected by the crural vein one hundred and fifty cu- bic centimeters of oxygen at two trials and at intervals of five minutes. At thirty-four minutes after ten we in- jected fifty cubic centimeters of the same gas. Respi- ration was increased, the animal uttered a cry and died. Immediate autopsy :—Contractions of the right auricle, blood was vermilion. We opened the anterior jugular 103 and we found a great quantity of gas mixed with the fluid, so much so that we asked ourselves if the gas did not pass into the circulation, and if the animal did not die from heart failure. Guided by this idea, we opened the brain, we found it very much congested. No gas was found there. It is justifiable, therefore, to believe that the gas found in the jugular flows into this vein owing to the contraction of the auricle. The right auricle was found distended with gas. We did not find one bubble of gas either in the left auricle, or in the aorta. The blood found in the liver and kidneys was fluid in char- acter and mixed with a notable quantity of the gas. Dr. Demarquay. Experiment 13. " Injection in thirty minutes of nine hundred and twenty-one cubic centimeters of oxygen by the portal vein.—No accidents from the heart." The 17th of June, at twenty-five minutes past ten, we opened the left flank of a dog, slightly wounded, and laid bare the portal vein. We injected by the vein at ten different times, and at intervals of three minutes, nine hundred and twenty-one cubic centimeters of oxy- gen. During all the experiment the animal did not manifest any uneasiness. Upon ausculfation we could hear an intense blowing sound, resembling the sound of a locomotive. At fifty-five minutes past ten we opened both sides of the chest. We saw the beating of the heart increased and confused. We made a last injection by the portal vein (the animal still living), and we could hear at a distance a sound produced by the arrival of the gas into the heart. The animal was not yet completely gone. The eye was yet capable of irritation, a few min- utes after the dog died. 104 Autopsy the following day:—From a cut made upon the liver we could squeeze blood which was very fluid and frothy in character. We could not find any gas either in the vena cava inferior or in the right auricle, which contained dark blood. Dr. Demarquay. Experitnent 14. "Injection during forty-five minutes of one thousand eight hundred cubic centimeters of oxygen by the portal vein.—Intense redness of the spleen.—Injection of the intestinal capillaries.—Frothy blood found in the ab- dominal aorta." The 23d of June, at fifteen minutes past ten o'clock, we injected at twelve different times, and at intervals of four minutes, one hundred and fifty cubic centimeters of oxygen through the portal vein of a dog, slightly wounded, who did not show any inconvenience from the injections. The spleen presented a very reddened ap- pearance. If pressed between the fingers a very notice- able crepitation was produced. The intestines were very much injected, even to the ramification of the capillaries, —suggillations between the folds of omentum. The veins were brownish in color and contained gas, which was seen to travel through their walls. The blood allowed to flow from one of these veins is fluid-like and frothy. Finally, after the experiment, we opened the chest and the dog died almost immediately. We then pricked the abdominal aorta, which allowed a frothy blood to es- cape, thereby proving that the gas passed through the pulmonary circulation without all having been exhaled through the surface of the lung. Dr. Demarquay. io5 Experiment 15. " Injection of six hundred cubic centimeters of oxy- gen by the vena cava inferior.—Injection of all the cap- illaries of the intestines.—Death." The 20th of June at fifteen minutes past ten we in- jected oxygen through the vena cava inferior of a dog, slightly wounded, by means of a syringe, the capacity of which was one hundred and fifty cubic centimeters. At the moment we pushed the injection, and applied the ear to the chest-wall, there was a peculiar blowing sound resulting from a mixing of the gas with the blood. During the experiment we have been able to observe curious phenomena occurring in the intestinal circulation. All of the capillaries were injected. All of the small vessels that are situated between the two folds of omentum, and upon the convex border of the intestine, formed a very beautiful net-work from the sufficiently closed meshes. It produced at the same time suggillations between the bands of omentum. All the capillaries had the color of arterial blood. The last injection having been pushed without interruption, the heart-beats, which had heretofore been frequent, were now suddenly dimin- ished. Respiration became labored, then profound and less frequent and the dog died. At this moment the thoracic cavity was opened ; contraction of the right auricle, that of the ventricle slightly apparent. The vena cava was distended five or six cubic centimeters below the heart with gas. The blood in the right auricle was a golden color. That in the lungs bright red. case of chloro anemia, treatment BY oxygen. g. P----, aged seventeen years, nine months, com- plained of a feeling of languor and general feebleness. io6 Palpitation and dyspnoea upon the least exercise, and especially upon going up stairs. She was pale and very much emaciated ; for many months each day, toward evening, and especially after a slight exercise, the feet and ankles would become oedematous. There were gas- tric pains, frequent coughing, accompanied at times by pains in the side. Appetite diminished. Pulse one hundred and twelve. Menstruation had never ap- peared, and the patient had not even experienced the symptoms which ordinarily precede this function. She had been ailing now about two and one-half years. She had taken many remedies but without any benefi- cial effect. February 14th, 1795,1 advised, each day, inhalations of oxygen mixed with atmospheric air in proportion of three to seventeen parts. February 18th. This proportion had not as yet pro- duced any effect, I therefore prescribed seven liters of oxygen diluted with sixteen liters of ordinary air. February 23d. After the dose of oxygen had been in- creased, the patient did not sleep much, and she com- plained of a general internal heat. Cough was more frequent. Pulse, 125. February 26th. Could not sleep ; cough increased ; gastric pains always the same ; pulse, 120 to 125. I then reduced the proportions to the same as first pre- scribed. March 1st. At night rest, sleep ; fever not so great; cough less frequent; gastric pains not diminished ; pulse, no. March 6th. The patient suffered less from stomach. Her appetite and strength were returning. Exercise gave less fatigue and dyspnoea. Pulse, 100. The external 107 appearance was certainly very re-assuring, coughing was less frequent, less palpitation and dyspnoea, sleep normal. CEdema, which was constant, did not appear excepting after prolonged exercise. March 15th. Steady improvement. The cough and gastric disturbance have not troubled her for many days. So slight is the dyspnoea and palpitation that the patient is able to walk quite a little distance without experienc- ing it, and without fatigue. Pulse, 89. March 20th. General health improved ; paleness has been replaced by normal color ; her cheeks, lips and nails have recovered their rose tint; pulse, 81. As yet not the least symptom of menstruation; but as this function is, to a certain extent, dependent upon the tonicity of the arterial system, I have no doubt but that it it will manifest itself when recovery has become complete. March 28th. Recovery increases each day. Prognosis very favorable. John Carmichael, M.D. Birmingham, March 29, 1795. TUBERCULAR EPIDIDYMITIS.--PULMONARY PHTHISIS; THIRD STAGE.--OXYGEN GAS.--REMARKABLE IMPROVEMENT.-- OBSERVATIONS BY DR. COSMAO DUMNEZ. Mr. X----, aged thirty-two years, entered the hospital ' February 20th, 1864. Toward the end of January, the patient, after a long voyage, was taken with a very severe pain in the right testicle. The scrotum was red- dened in appearance. He was obliged to call his physi- cian, who prescribed rubbing with blue ointment, and application of poultices. The treatment was continued for many days, but the tumor was daily increasing. Mr. X----then decided to enter the hospital. The skin of io8 the scrotum presented a reddish violet appearance. The size of the testicle was nearly that of the fist. The tumor was hard and dented. Pain was noticeably increased on pressure. Never had syphilis. Has had a urethral dis- charge for many months. At present time there is not the slightest indication of any discharge. Patient was very much emaciated, pale and anaemic. Cough of long standing, never had any hemorrhages, coughing was followed by expectorations, muco-purulent, nummular, and containing greenish shreds. Percussion :—Dullness at the apex of the lungs, in the supra-spinous fossae above and below the clavicle. Auscultation :—Right side, vesicular murmur, feeble in character. Left side, if patient was made to talk during examination rales were found anteriorly in the fossa below the clavicle, moist rales in the supra-spinous fossa close to the spinal column. Fever, intense at night. Slight diarrhoea after a few days. Treatment :—Drinks of a decoction of extract gram- inis; applications of blue ointment and poultices to the testicle ; Bordeaux wine, 250 grammes. February 25th. Application to the testicle of *emplas- trum Vigo, f pil. Dioscorides, bismuth and extract of , opium ; injection of starch. Diarrhoea is much more intense. March 1st. Patient was submitted to inhalations of oxy- gen gas, four liters of gas to ten liters of atmospheric air. *The French codex gives a formula for emplastrum De Vigo, cum mercurio, emplatre mercuriel dit De Vigo, which is occasionally used here. It is made by fusing together lead plaster, 200 parts, yellow wax and resin each 10 parts; add thereto the following powders: olibanum, ammoniac, bdellium, and myrrh, of each three parts, and saffron two parts, also 60 parts of mercury extinguished by 10 parts of turpentine, and finally, 30 parts of liquid storax, and one part of oil of lavender. t Pil. Dioscorides contains cantharides. 109 March 3d. Yesterday the patient experienced a sensa- tion of fullness in the chest. Half an hour after taking there was nausea and eructations. Appetite is no better, but the cough is less frequent, and expectoration less abundant. Resting good to-night. Oxygen, twelve liters. No immediate change in the pulse. No colora- tion of the mucous membrane after the inhalations. The patient desires to eat. March 4th. Yesterday slept during the day. Appetite less to-day; some cough, no expectoration. Oxygen, twelve liters. Respiration seemed better than during the first days. The pulse is slightly irregular during the administration of the gas, but returns to normal after inhalation has ceased. March 6th. Good appetite yesterday ; slept well; appearance better; general feeling of improvement; oppression much less. Took twelve liters of oxygen. March 8th. Yesterday headache, palpitation of the heart, restlessness, troubled dreams. This morning the patient is better ; took fifteen liters of oxygen. March 10th. The patient has been about for two days promenading the corridors. His appetite is such that after partaking of hospital diet he has food sent him from town. Face has good color, and the. cheeks suffi- cient fullness. Respiration is easy. The size of testicle is diminished to great extent. March 12th. A point of fluctuation is felt in tumor ; punctured, we succeed in obtaining about a spoonful of fluid, serous in character. March 14th. General condition wonderfully improved. Oxygen fifteen liters. March 16th. Mr. Cazolis, who saw the patient when he entered the hospital, found a tuberculous lesion the no size of a hen's egg ; the apex of the left lung was not acting (hepatized). Examined to-day, the doctor reports the cavity still existing, but the tissue surround- ing it, which had lost its functional power, was now acting. The act of inspiration was increasing ; his chest was much enlarged, and yesterday the patient was out walking for one-half hour. His appetite is very much improved, and he states that it will be necessary to supply him regularly with food if we persist in giving him the oxygen. The digestive and circulatory functions are normal. His personal appearance is not indicative of one afflicted with phthisis. The testicle is greatly diminished in size. It is less hard and painful. Still con- tinue the fifteen liters of oxygen. Wine of quinine and the syrup of the iodide of iron. March 18th. Slight stomach-ache after the inhalation of the oxygen. March 19th. Appetite always good, and his strength is such that he is enabled to take long walks. Sleep, good ; dreams at night. March 20th. Again slight stomach-ache after taking the oxygen. March 26th. Patient took thirty liters of oxygen. Dozed, slight vertigo, sight blurred. The cough and expectora- tion have been entirely suppressed. There are no raies at the point previously stated a month ago. The respi- ration is amphoric. March 30th. Henceforth the thirty liters of oxygen at the request of the patient will be divided into two doses of fifteen liters of oxygen each, night and morning. Appe- tite is very good in the morning; general condition very satisfactory. The patient continued to inhale the oxygen during Ill the month of April. His health is excellent, and he had decided to leave the hospital April 29th, when he noticed, in the morning, small cutaneous hemorrhages on the left arm and two lower limbs, purple in character. General condition good. April 30th left hospital in good condition. CASE OF DILATATION OF THE BRONCHI SUCCESSFULLY TREATED BY INHALATION OF OXYGEN.—OBSERVA- TIONS BY MR. COSMAO DUMNEZ. Mr. S----, a banker residing in Paris, was submitted to oxygen-treatment May 10th, 1864, for a chronic affec- tion of the respiratory tract. He has had a cough for many years, though not painful. It had increased in frequency during night and morning, and was accom- panied with an expectoration of greenish spittle—opaque, and adherent to the bottom of the vessel. Respiration is generally troublesome, except during a period of moist- ure. Appetite slight. Mr. S----has become very much emaciated since beginning of his illness. Auscultation revealed mucous rales disseminated here and there in the chest, but particularly at the base of the right side. Percussion did not reveal any abnormal thoracic sounds. Mr. S----states that there is no previous history of any tuberculous affection; he is the father of many children, all of whom are enjoying good health; never had any hemorrhages; no night sweats. Taking the symptoms, and particularly the character of the expectoration, into consideration, I was led to believe that Mr. S----was suffering from dilatation of the bronchi. May 10th. He inhaled three liters of oxygen morning and evening, with an equal quantity of air. He experi- 112 enced during the first inhalations a strong sensation of heat in the chest. Nothing particular with organs of sense, nor in the oesophagus. The nth, 12th, 13th, and 14th con- tinued the inhalations, increasing gradually from five to six, seven, and finally ten liters, night and morning. He experienced slight dizziness after inhaling, also tingling sensation in the hands and feet. After a time this all disappeared, and the sensation of hunger produced was such that the patient was obliged to eat two or three times between meals. He stated that the cough became less frequent, the expectoration became clearer and less abundant; his general condition has greatly improved, and he began to gain in flesh. From the 14th to 18th we did not see the patient, who continued to inhale ten liters night and morning. The expectoration, which was greenish in character, became almost white; appetite was excellent. Mr. S----then departed for London, where he continued the inhalations for many weeks, al- ways deriving great benefit from them. We have not seen the patient for many months. I desire to report the following case, which to me does not seem less interesting than the others. It is the case of a young lady who was afflicted with glandular swell- ings in the shoulder, neck, along the trachea, and prob- ably the bronchi. She entered during my term of service to have tracheotomy performed. Under the influence of oxygen her condition immediately improved, and she left my charge, not cured, but so much improved that she was able to attend to her duties. Presently having been subjected to cold and privation, she had a relapse, and again under the influence of the oxygen the dyspnoea dis- appeared, and relief was immediate. The following is a report of the case. H3 TUBERCULOUS ENGORGEMENT OF THE NECK.—COMPRESSION OF THE RESPIRATORY TRACT, THREATENING ASPHYXIA.— OBSERVATIONS BY DR. BOUCHER, INTERNE. Mrs. S----, aged thirty-five, entered the hospital March 14th, 1865. This woman began to menstruate at the age of fourteen, and has menstruated regularly since that time. She is the mother of a child eight years old, who enjoys good health. Family history excellent. Father and mother both living, and in good health. She had en- joyed excellent health in her youth. She had glandular swellings in the clavicular region. The cicatrices now on the left side at the angle of the jaw are probably due to the suppuration of those glands. The glandular swellings which made their appearance in youth made their dis- appearance at the time of puberty. About six years ago there appeared in the left supra-clavicular fossa a tumor which attained a very large size, but which disappeared very suddenly and almost completely. Three years after other glands made their appearance in the left axillary fossa. Following these appeared a number of glands in the right supra-clavicular region. When she entered the hospital we found the following condition: There were four or five small indurated glands on the left shoulder, one of these, which encroached slightly on the mammary region, had attained the size of a pigeon's egg. In the right supra-clavicular region there existed a chain of glands, small in size. All of the glands near the trachea that could be felt with the hand were hard and of good size. To the left in the cervical region there ex- isted a mass of glands, hard, which exerted such a press- ure as to cause an alarming condition. Two months before she entered the hospital the respiration was nor- 8 H4 mal. But for the past few days the respiration has be- come so difficult that the patient is actually obliged to blow in order that the resistance to the ingress of air may be overcome. If she walks any length of time, or even rap- idly, respiration becomes more difficult. In a word, walking is not to be thought of. There exists at times paroxysms of actual asphyxia. Sometimes they are spontaneous, occurring after a rapid walk, or after eating. Respiration is slightly affected when the patient is in bed; when standing it becomes painful, and there is a whistling sound. Percussion : Nothing abnormal. Auscultation : Harsh respiration, whistling sound, due no doubt to pressure on the bronchi. The patient re- quested us to perform tracheotomy. But it certainlv would not be practical to perform this operation, for the swelling did not exist alone in the cervical region, but all along the trachea, and probably the bronchi. The only thing to do was to keep up the nutrition and favor the resolution of the general ganglionic enlargement. We prescribed tonics, and at the same time advised inhala- tion of fifteen liters of oxygen, and continued this treat- ment for a month. The appetite increased a little, and some of the glands diminished in size. But when the patient was out of bed, the respiration was yet painful. The paroxysms of asphyxia were less frequent, but yet came on from time to time. We doubled the quantity of oxygen, so that night and morning the patient inhaled fifteen liters of the gas mixed with an equal quantity of air. After five or six days of this treatment we noticed considerable increase of appetite, so much so that the pa- tient was obliged to eat at night, and many times be- tween meals. In the mean time the general appearance "5 became improved, the skin and mucous membranes had good color. We also noticed a considerable diminution in the enlarged glands. The mass of glands which were pressing upon the trachea became less hard, much dimin- ished, and more movable. The respiration was normal when the patient was in bed. While standing it was yet difficult, but we did not hear the whistling sound. There were as yet at times paroxysms of asphyxia, but they were shorter in duration and not so painful. Walking is also less painful. We continued thus to give the patient thirty liters of oxygen each day. The most extraordinary thing is the enormous appetite. Her condition improved daily, and she left the hospital May 26th. INTERMITTENT FEVER TREATMENT.--OXYGEN.--OBSERVA- TIONS BY HILL. Mrs. Priest, of feeble constitution, was suffering in Au- gust, 1795, in the county of Essex, with such a severe attack of intermittent fever that her life was in danger. The intervals between the attacks were so short that any remedy did not seem to stop it. Quinine, mercury, bal- sams, change of air, and other treatments advised by dif- ferent physicians, and followed for three months, did not abate it any, and finally the disease took on the form of a " tertian ague," which so weakened the patient that she was obliged to almost continually lie in bed. This general feeling of weakness was accompanied with hyper- trophy of the spleen, which occupied all one side of the abdomen and produced, by compression on the vessels back of it, oedema of the lower extremities. At the out- set jaundice was present, and when I saw Mrs. Priest in 1798, there were yet signs of engorgement of the liver. n6 Among other things the jaundice persisted during one year. Under these circumstances I had difficulty in find- ing some remedy. In the mean time I prescribed oxygen with the hope that it would so render the system that tonics might bring about a cure. After administering the oxygen for a period of ten days (one liter to forty air), I had the satisfaction of seeing the attacks shorter and less violent, and at the same time was restored to the body its heat, moisture, and sleep. By gradually increasing the dose of oxygen the symptoms disappeared. Thanks to this treatment, aided by iron and mild cathartics, the pa- tient was cured in one month. The general condition was excellent. The size of the spleen was considerably diminished, although I did not attach much importance to it. I however was afterwards informed that the swell- ing had completely disappeared. Thus we see that im- pure air caused and pure air cured this disease. PART V. APPLICATION IN SURGERY.--LOCAL APPLICATION OF OXYGEN. The application of oxygen to a sound or diseased limb does not present any more difficulty than the inhalation of the same agent, thanks to the great zeal and intel- ligence employed by Mr. Galante in constructing appa- ratuses for local administration of gas. We have con- structed for this purpose muffs of vulcanized rubber in which we place the limb. Strips of diachylon plaster are so arranged as to keep the orifice firmly adherent to the limb on which we wish to operate. A tube is so arranged that communication is set up between the inte- rior of the muff and the external air,—by which means the gas may be made to penetrate. H7 The patients upon which we have operated having ex- perienced no sensation, one of our assistants wished to make a series of experiments upon himself. The tem- perature of the lower limb was taken with great care. This latter was placed in the muff and the oxygen was introduced. No appreciable sensation was experienced, but at the end of an hour when we took off the apparatus there was an elevation in temperature A degree, and at another time j%,—we thus found moisture of the limb, from the condensation of perspiration, perceptible or im- perceptible. This elevation of temperature is not of much account; for we have obtained, by the application of a muff filled with air at two different trials at inter- vals of an hour each, an elevation of the temperature in the first case 2 degrees, in the second 2 T2