ON 
oxYGen 
Bs f\ REMEDIAL BgERT 
WALLIAN 
Reprint from The Medical Record,, 1883-4. tJ'CC*- ijl u,ttlo^. ON OXYGEN 
AS A REMEDIAL AGENT 
BY 
SAMUEL S. WALLIAN, A.M., M.D. 
Member of the Essex and Franklin County Medical Societies; Member 
of the Medical Association of Northern New York; Corresponding 
Member of the State Historical Society of Wisconsin ; Del- 
egate to the American Medical Association, etc. 
Reprinted from The M 
NEW YORK 
TROW’S PRINTING AND BOOKBINDING CO. 
201-213 East Twelfth Street 
1884 PREFATORY NOTE. 
The trend of modern medical thought is toward the 
solution of the scientific problem : 
How are we to more fully avail ourselves of the evi- 
dently potent, perhaps wholly competent, influence of nor- 
mal elements and natural agencies, i?i the removal of 
morbid cotiditions called diseases, and the amelioration of 
human suffering ? 
There is a growing and rational distrust of, and revolt 
against, what may be appropriately styled abnormal and 
artificial, as well as far-fetched and heroic, agencies in 
the treatment of disease. 
“ If they threw physic to the dogs only, we might 
commiserate the unfortunate brutes; but when we think 
of the human, everywhere, down whose unsuspecting 
throats the vandal dose must go, we may well shrink 
aghast at the unrecorded mischief done.”1 
A prominent professor in one of our leading medical 
schools says : “There is in every science a mythological 
part, which is handed down from generation to genera- 
tion, whose disbelievers formerly were crucified, now are 
ostracized. Shall I tell you where the mythology of 
medicine is stored up ? In the handbooks of materia 
medica, allopathic as well as homoeopathic.” 
Among the natural agencies oxygen easily and un- 
questionably stands at the head of the list. All organized 
beings must have a constant supply of it, inspire it with 
every breath, drink it with every draught, move in it at 
every step, and live immersed in it as a perpetual bath, 
or perish. 
1 Welch. Medical Record, vol. xxv., p. 663. 4 
The ancients recognized but three ordeals of purifica- 
tion—air, water, and fire. In each of these the potent 
and only active element is oxygen. Without this there 
could be neither air, nor fire, nor water. The first food 
of the infant at birth, and the last gasped for by the dying 
patriarch is diluted oxygen. We may abstain from or- 
dinary and grosser means of physical sustenance for days 
and weeks with impunity ; robbed of oxygen we do not 
survive so many minutes. Tanner prolonged his fast 
from meat and bread, even to the duration of the original 
deluge, without serious discomfort; but he constantly 
required and really subsisted on air and water—oxygen. 
Every vital process, construction, maintenance, repair, 
disintegration, is accomplished directly or indirectly 
through the same all-pervading and potent agency. 
Priestley would have been justified in naming it zodgen, 
since without it animal existence would have been an 
impossibility. 
It is quite time we should practically realize, for we 
already theoretically admit, that this omnipresent, almost 
omnipotent, and yet thoroughly commonplace element, 
cannot be replaced, scarcely supplemented ; that there 
is no known alterative, eliminator, or disinfectant com- 
parable with it; that disease-propagating germs cannot 
withstand a free supply of it, but are soon robbed of their 
virulence or destroyed in its presence ; and that the 
original, normal, and only unobjectionable and universally 
ejficient antiseptic is pure oxygen. 
Yet with these facts daily and hourly staring us in the 
face, no other necessity of life is so parsimoniously dis- 
pensed, so universally adulterated, or so little appreciated. 
Robbed of a due proportion of it all along the devious 
path, from the cradle to the grave, it is little wonder that, 
“ however we brave it out, 
We men are a little breed.” 
And little wonder that anaemia, and scrofula, and tuber- 
culosis are the rule, robust health the exception. 
As a therapeutic agent oxygen is not yet popular, not 
yet the fashion ; although for years enterprising quacks 5 
have been gathering a generous harvest, from honest 
dupes who have sickened of cruder quackery, by broad- 
cast heralding of the magic virtues of some impossible 
“compound” of it. 
Is it not high time that its intelligent use should be 
undertaken at the hands of legitimate and competent 
physicians, who have no secret wares to hawk about the 
country, in competition with other cheap and nasty nos- 
trums ? 
Bloomingdale, N. Y., September 15, 1884. ON OXYGEN 
AS A REMEDIAL AGENT. 
Priestley, who divides the honor of its discovery with 
Scheele, was the earliest experimenter with oxygen as a 
physiological agent. He demonstrated that birds, dogs, 
rabbits, and other animals immersed in an atmosphere 
of this gas became more lively, active, and brilliant; 
that dogs trained for the chase could endure greater 
hardships, and for a longer period, when allowed to 
breathe the gas for a short time previous to the start, 
than similar animals not thus prepared ; and that animals 
asphyxiated by being compelled to inhale carbon dioxide 
or other noxious gases were speedily resuscitated if 
treated immediately with pure oxygen. 
Lavoisier confirmed these results, and further demon- 
strated that the muscles of animals repeatedly subjected 
to the influence of the gas became very firm, decidedly 
interfering with their tenderness if speedily designed for 
the shambles ! 
These results attracted some attention, and were fol- 
lowed by considerable experimentation on the part of 
pathologists and physiologists. 
Among these early investigators, Dr. Beddoes—not 
“ Eddoes ” as quoted in the London Lancet—was the 
first medical man of repute who gave the subject any se- 
rious attention. He was assisted by some of the most 
eminent scientists of his day, including Sir Humphry 
Davy. These original experimenters labored under se- 8 
rious disadvantages, particularly that of evolving the gas 
in suitable quantities and of sufficiently pure quality for 
medical use. After many trials and numerous failures, 
with not a few accidents, Beddoes declared himself beaten, 
not by his own loss of faith in the potency of the new 
remedy, but “by the difficulty of making it available.” 
He did not escape the usual storm of ridicule which in- 
variably greets an innovation, especially if the latter 
falls short of an immediate and pronounced success. 
However, his partial success inspired other efforts in the 
same direction, and he was followed by Drs. Hill, Thorn- 
ton, Cavallo, and others. Over-sensitive to unkind pro- 
fessional criticism, the latter conducted their experiments 
in comparative seclusion. 
In 1820 Dr. Hill published a brochure reporting the 
results of these efforts, which, although full of instructive 
facts and suggestions, attracted little attention, and mem- 
bers of the profession at the present day would be sur- 
prised to know that experiments so conclusive were so 
long since attempted, or that a work of such unusual 
professional candor was ever issued. 
Thornton, Cavallo, and McCormack followed, some- 
what later, with still more searching and extensive trials 
of the gas, and each unequivocally asserted that it would 
eventually be found a potent and valuable therapeutic 
agent. They failed to awaken much interest in the sub- 
ject, and met with the customary storm of ridicule and 
unreasoning opposition. 
Within the last quarter of a century, although little 
has been said on the subject, various men of note in the 
profession, including Goolden, Birch, Alexander, Erich- 
sen, Richardson, Demarquay, and others, have more or 
less investigated, occasionally used, and without excep- 
tion admitted the potency of oxygen in the treatment of 
disease. 
In this country but casual attention has been given to 
the subject, and beyond an occasional exhibition in some 
extreme case in hospital practice, little has been re- 
ported, the opinion still obtaining with those who have 
considered the subject at all, that the use of non-atmo- 9 
spheric oxygen in the treatment of disease is of doubtful 
utility, if not positively dangerous. 
Literature on the subject is meagre and unsatisfactory. 
Little has appeared in this country, and, as yet, no 
American publisher has ventured the reproduction of 
such fragmentary foreign works as have occasionally ap- 
peared. 
In an article (“Super-Oxygenation as a Therapeutic 
Measure”) in the Chicago Medical Journal, vol. xxvi. 
(1869), pp. 116-120 and 139-152, I gave the results of 
some of my earlier experience with various super-oxidiz- 
ing agents. 
As a rule, the medical press, both at home and abroad, 
has shown very little interest in the subject, evidently 
acquiescing in the prevailing verdict—the only marked 
exceptions being the London Lancet and the British 
and Foreign Medico-Chirurgical Review, in both of 
which interesting articles have occasionally appeared. 
Demarquay’s reports to the Academy of Medicine 
(Paris, 1866)1 were considered conclusive and satisfac- 
tory as far as the subject was covered by his experiments, 
but have never been reproduced for American readers. 
In 1856 appeared in London a small volume under the 
extremely classical title of “ Pneuma-Therapeia.” Its 
author, who was presumed to be McCormack, withheld 
his name, probably for prudential reasons, since its argu- 
ments and reports of cases were addressed more to the 
public than to the profession ; and in an appendix, the 
Medical Pneumatic Apparatus Company, with the ad- 
dress “46 Regent Circus, Piccadilly, London,” adver- 
tised to supply both oxygen and the necessary apparatus 
for manufacturing and administering it. 
This little anonymous volume repeated some of Hill’s 
reports of cases treated, including scrofula, dyspepsia, 
chronic dysentery, asthma, dyspnoea, and asphyxia ; also 
referring to the experiments of Beddoes, Davy, Weeks, 
Cavendish, Coleman, Goodwin, Menzies, Liebig, and 
others. 
1 See also Gazette Medicale, Paris, 1866. IO 
Dr. S. B. Birch, of the Manchester Medical School, 
issued a monograph on the subject of oxygen as a cura- 
tive agent (“ On Oxygen,” London, 1857), but it met with 
very ungenerous criticism and did not find its way to this 
side. A second edition (London, 1858) was the first 
contribution to the literature of the subject which com- 
manded any degree of attention. 
Ten years later, already investigating the subject of 
oxygen compounds, I procured a copy of Birch, and am 
indebted to him for valuable suggestions. 
This author says (op. cit., p. 148): 
“It (oxygen artificially prepared) is a powerful, really 
scientific, and agreeable curative agent; is capable of far 
more extensive range in its application to the rational 
treatment of chronic disease than, perhaps, any other 
remedy—is pre-eminently Nature's 07t>n therapeutic, 
affording assistance in her own way without opposing the 
intentions of her ever-present vis medicatrix, and is en- 
titled to the position of a curative in a variety of intract- 
able diseases, otherwise incurable by any other known 
means, or tacitly acknowledged to be so; . . . 
is occasionally the remedy, and then the only one 
worthy of the name, in certain contingencies where life 
must be (and frequently is) sacrificed by neglecting a 
fair trial of it.” 
He adds: “It may with safety be predicted that, 
sooner or later, non-atmospheric oxygen will be univer- 
sally admitted as one of our most valued remedial 
agents” (op. cit.y p. 149). 
The verification of this rather sanguine prediction has 
not yet transpired. Whether on account of the serious 
and hitherto insuperable difficulties of making the treat- 
ment generally available in private practice, or from lack 
of professional enterprise and ingenuity, remains to be 
investigated. 
With the general profession a sort of chronic impres- 
sion prevails, based on neither science nor experience, 
that the therapeutic use of non-atmospheric oxygen has 
been tried and failed. 
Professor Da Costa says : “ Of all the gases oxygen is 11 
now being most tried, particularly for the relief of dysp- 
noea and in low fevers, or during convalescence from 
low fevers, and in chlorosis. We must await these new 
trials, for the former experiments were unsatisfactory. 
But excellent results have quite lately been claimed for 
oxygen inhalations by Demarquay—who is at present in- 
vestigating the subject—not only in the conditions named, 
but in diabetes, in senile gangrene, and in prolonged 
suppuration” (“On Inhalations,” Philadelphia, 1867). 
In this country, very little has been heard from these 
later investigations, except in connection with the sub- 
ject of antisepsis. In fact, the past decade, in the history 
of medicine, may not inaptly be termed the age of the 
gertn-craze. The microscope has monopolized the labor- 
atory, and well-nigh superseded the inductive method. 
Morbid products have been accorded more prominent 
attention than vital processes; results studied with the 
most elaborate minuteness, to the exclusion or ignoring 
of their underlying causes. 
There is no doubt, however, that the shortcomings of 
impure and carelessly manufactured gas have done more 
than all else to bring the use of oxygen and its congeners 
into disregard, if not discredit, and to prevent its timely 
use by the profession at large. 
Again, the usual methods of generating it in a suffi- 
ciently pure form for medical use are a conspicuous 
drawback to its general use by even those who are 
aware of its value and anxious to avail themselves of it. 
Some apparatus is required, and careful chemical manip- 
ulation, which in time, no doubt, will be delegated to the 
pharmacist and manufacturing chemist. 
At present the process by means of chlorate of potassium 
and manganese dioxide is the most practical and eco- 
nomical for ordinary purposes. The apparatus required 
is neither complicated nor expensive. Some care is req- 
uisite, but the gas afforded can be secured in a state of 
almost absolute purity. Various inventors and manufact- 
urers of surgical instruments have, from time to time, 
brought out unique and ingenious contrivances for evolv- 
ing and administering the gases, of which might be men- 12 
tioned one by Dr. Biegel, and that of Galante, of Paris. 
The Pneumatic Medicine Company, and also Barth, of 
London, condensed the gas in iron flasks, and added 
devices for its convenient dispensation. 
Fleitmann proposed a process for the rapid liberation 
of oxygen in a tolerable state of purity (which in a medi- 
cal sense is nothing short of by means of 
calcium chloride and monoxide of cobalt. Since it re- 
quired that the chloride should be in a state of saturated 
solution previous to the addition of the cobalt, it was un- 
wieldy and never became popular. 
Improving on this suggestion the Messrs. Robbins & 
Co., of London, succeeded in combining the two sub- 
stances in the form of dry powder, which is ready for in- 
stant use on the addition of simple boiling water, and, it 
is said, may be preserved indefinitely without deteriora- 
tion. The process of combining the two substances is 
reserved by this firm as a manufacturing secret. 
An intimate ally of oxygen, therapeutically speaking, 
is found in nitrogen monoxide, N^O—the “ nitrous oxide” 
of the old nomenclature. It is almost as potent an oxi- 
dizing agent as oxygen itself. It supports combustion 
nearly as well; its specific gravity is greater, and it is 
distinguished from oxygen by its much greater solubility 
in water. Doubtless, from this cause, it is much more 
rapidly and extensively absorbed into the system when 
inhaled. 
It is best known through its general use as a dental 
anaesthetic. When perfectly pure—a rarer circumstance 
than need be—it may be inhaled for some time with im- 
punity ; in fact it may be safely assumed that the rational 
use of the pure gas is practically, if not absolutely, free 
from danger, since out of the millions of instances of its 
exhibition to patients of all ages and conditions, the very 
few fatal cases reported were quite probably attributable 
to impure gas, irrational or ill-timed administration, or 
accidental causes. 
The anaesthesia induced by its free inhalation, quite 
unlike that from chloroform, ether, ethy-bromide, and 
other anaesthetics, is transient, pleasurable, unaccom- 13 
panied by a stage of excitation, and is not followed by 
depression or other unpleasant after-effects. 
Under a pressure of fifty atmospheres, it becomes 
liquid, and at —120° F., Faraday succeeded in reducing 
it to a solid. In the latter form, applied to the skin, it 
produces a painful, burn-like blister (Fownes). 
That it is an oxidizing agent in a marked degree, and 
that its therapeutic value is not limited to its use as an 
anaesthetic, is evident from its chemical and physical 
characteristics. At the same time it combines properties 
so different from those of oxygen, that the two are by no 
means therapeutically identical. 
Several small volumes have been devoted to this gas, 
all but one of them, so far as I am informed, limited to 
a study of its claims as an anaesthetic. 
In i860 Dr. George J. Ziegler, of Philadelphia, issued 
a little volume, now out of print, in which he claimed 
much for this gas in the treatment of several forms of 
chronic disease. Experimenting somewhat extensively, 
his success led him to assert emphatically that, if properly 
exhibited in suitable cases, it would be found not only a 
materia medica but also a valuable materia alimeniaria. 
Classing its anaesthetic and antispasmodic properties as 
secondary, he insisted that it served as a direct source of 
supply to the blood and tissues. 
Later, some enterprising but unscrupulous pretenders 
“ discovered ” in this gas the so-called “ oxygenized air,” 
which a dozen years ago was extensively advertised as a 
cure-all. “ Rights ” to manufacture and administer it (!) 
were sold to gullables for a round sum, the process of 
generating it being bunglingly disguised by the addition 
of ferric carbonate or other inert coloring material to the 
ammonium nitrate used. Even to this day a firm in 
Philadelphia is still harping on the miraculous alchemy 
of “compound oxygen.” What their office remedy 
may be I do not know the trash they send to their 
mail correspondents, calling it “ home treatment,” is a 
barefaced swindle and utterly worthless, being nothing 
more than a weak solution of the nitrates of lead and 
ammonium, or of ammonium muriate and St. Croix rum. 14 
The process for evolving nitrogen monoxide is simple 
and well known to every tyro in chemistry. The gas 
should be washed through not less than four waters 
(wash-bottles)—half a dozen would be still better—before 
it is fit for inhalation. 
The peroxide of hydrogen, H202, was discovered by 
Thenard in 1818, but has not until quite recently at- 
tracted any attention as a physiological agent. Assmuth 
and Schmidt made some unsatisfactory experiments with 
it in 1864. Richardson soon after used a solution of it 
in water, and approved it for internal administration. Its 
very unstable nature and disagreeable flavor, however, 
prevented any degree ol popularity, and not until 1878 
were any satisfactory experiments conducted. In that 
year Gutmann and Schwerin demonstrated that it under- 
went decomposition in the tissues, liberating free oxygen 
in quantity sufficient, when pushed, to induce gaseous 
pulmonary embolisms, with arrested capillary circulation, 
and finally fatal results. 
About the same sirne Stohr, experimenting with it as 
a disinfectant, employed it extensively in cases of phage- 
daenic and syphilitic ulcers and diphtheria. According 
to this author the pus from venereal ulcers lost its virus 
after two hours’ contact with a concentrated solution of 
peroxide of hydrogen. The discharge from ulcers treated 
with it quickly assumed a more benign character, healthy 
granulations appeared and losses of substance were rap- 
idly repaired. 
More recently MM. Pean and Baldy have given this 
agent quite extended trial in the surgical wards of the 
Hopital St. Louis (Paris), as a substitute for carbolic acid 
in antiseptic dressings. Under its use the general sani- 
tary condition of the wards notably improved, cases of 
traumatic fever and erisipelas became less frequent, and 
it was found especially desirable as an application in 
dressing flaps, after amputations, union by first intention 
being decidedly encouraged by it. As compared with 
carbolic acid and other antiseptics it possessed the mani- 
fest advantage of being devoid of both unpleasant odor 15 
and toxic influence, while its application was painless, if 
not even agreeable. 
Following in the wake of these promising and sug- 
gestive tests, Dr. Landolt found its use in ophthalmic 
surgery to be a great advance over that of any known 
antiseptic, since it can be used of a strength sufficient to 
effectually destroy all forms of microzoa without injury 
to the delicate structures to which it is applied in ocular 
surgery, which is not true of carbolic acid, alcohol, sali- 
cylic acid, etc. He also found it to be possessed of very 
remarkable detergent properties, promptly cleansing sup- 
purating surfaces, arresting septic fermentation, and rap- 
idly checking suppuration in even neglected cases of 
gonorrhoeal ophthalmia. 
For more extended details of Dr. Landolt’s interesting 
experience, see the London Medical Record, for March, 
1883. 
At this point, some inquiry as to the modus operandi 
of super-oxidizing agents and the final disposition of the 
quantity of oxygen daily consumed or appropriated in 
the human system will not be out of place. 
A healthy adult, at active exercise in the open air, in- 
spires daily one thousand gallons of oxygen, diluted with 
four thousand gallons of nitrogen. 
Regnault and Rieset have shown that the decarboni- 
zation of the blood is one of the minor offices of the 
oxygen inspired. Of the one thousand gallons daily re- 
quired, from ten to twenty-five per cent.—one hundred 
to two hundred and fifty gallons—is absorbed, directly 
and in a free state, into the blood (Magnus). 
The marked affinity of the blood for oxygen is indi- 
cated by the physical fact that the former readily absorbs 
two and one-half times as much of the latter as water at 
the same temperature. 
Nor is it true that the carbon dioxide exhaled during 
animal respiration is wholly formed in the lungs. It al- 
ready exists in the venous blood before it reaches the 
lungs, while both carbon dioxide and free oxygen exist in 
arterial blood (Dalton). 
Magnus found the proportion of free oxygen to car- 16 
boniq acid by volume in arterial blood was as io to 25 ; 
in venous blood as 10 to 40. 
Thus in the pulmonary circulation carbon dioxide is 
given off and oxygen absorbed, while in the general cir- 
culation the oxygen gradually disappears, and is replaced 
in the venous blood by carbon dioxide. The free oxygen 
in the general circulation exists there in the form of a 
simple solution. It is finally absorbed from the blood 
of the capillary vessels, and becomes fixed in the substance 
of the vascular tissues. The blood is therefore a circu- 
lating fluid destined to transport oxygen from the lungs 
to the tissues, for it is the tissues themselves which finally 
appropriate the oxygen a?id fix it in their substance 
(Dalton). 
Burdon-Sanderson has further shown that the red 
blood-cells are the main carriers of oxygen, and that the 
condition of inflammation, in its earlier stages, essentially 
consists in a sluggish and finally immobile condition of the 
white blood-cells, from want of a due and regular supply 
of oxygen; and that the activity of the white blood-cells 
is in exact proportion to the amount of oxygen present. 
This would seem effectually to refute the prevailing im- 
pression that an over-supply of oxygen to any part neces- 
sarily induces an inflammatory condition. 
The principal source of the carbon dioxide of the blood 
is the decomposition of the tissues, an essential part of 
their constant metamorphosis. The experiments of 
Marchand prove that even here it is not a process of direct 
union of oxygen with the carbon of the tissues, but in some 
other and more indirect mode. 
Further evidence that oxygen and its congeners are im- 
portant elements in every stage of the process of tissue- 
building, that oxygen itself is an element in qtio multum 
alimenti est, is scarcely necessary. It is evident, how- 
ever, contrary to the generally accepted ideas, that 
oxygen should be classed as a restorative rather than a 
destructive, and as contributing directly toward construc- 
tive rather than destructive metamorphosis. 
Instead of constantly breaking down tissue by true 
chemical oxidation, as is almost universally taught and 17 
unthinkingly accepted, it really replenishes wasted tissue, 
both by supplying in itself an essential element toward 
such repair, and by stimulating and correcting, at every 
step, the assimilative process. 
On the other hand, admitting that the stereotyped as- 
sumptions in physiology are true, the rate of metamor- 
phosis is held to be the gauge of vitality. Imperfect or 
impeded metamorphosis is disease, arrested metamor- 
phosis is death. 
In many of our therapeutic efforts of late are we not 
too eager to hasten transformation, almost 
forgetting that this process must in all cases be both pre- 
ceded and accompanied by destructive action ? And do 
we not ignore the glaring fact that no molecule of matter, 
whether of nerve or muscle-fibre, bone element, or blood- 
plasma, can be made to assume its positioti in the animal 
economy except through its direct association with this 
vital and inevitable element—oxygen ! 
Throughout the organic world oxygen in some of its 
protean forms is the universal basic element; the addi- 
tion or elimination of a single equivalent often sufficing 
to transmute the blandest article of food into the most 
virulent poison, and vice versa. 
It is an every-day fact in chemistry that substances 
identical in ultimate composition, as far as our yet im- 
perfect art can discover, are strikingly different in a 
physiologic or therapeutic sense. Whether this difference 
consists in varying modes of atomic and molecular ar- 
rangement, or in different, but as yet indistinguishable, 
states of the oxygen base, is yet beyond our scientific ken. 
Hence it does not follow that oxygen as found in 
common air, and the same element in doubtless a nascent 
and hyper-active state, as artificially generated—liberated 
would be a more accurate term—are either physiologi- 
cally or therapeutically identical. 
Again, the physiological relations of oxygen are definite 
and limited, while its nature and potency as a therapeu- 
tic agent are, as yet, not generally understood, entirely 
unlimited, and as different from the former as though it 
were in reality another element. 18 
While all physio-chemists assert that it is an active 
eliminator, depurant, disintegrant, resolvent, and perhaps 
sorbefacient, and alterative, very few have taken the 
pains to investigate it in the light of a materia alimeti- 
taria, and hence a direct invigorator and renewer of the 
whole vital organism. Nor do we yet practically realize 
the evidently demonstrable fact that there is no antiseptic 
known of equal potency with pure oxygen ; or that there 
is no known antiseptic compound which does not con- 
tain this vital element. It may yet transpire that all 
antiseptics depend for their special properties, directly 
or indirectly, on the free or feebly combined oxygen they 
contain. Should this presumption prove to be well 
founded it devolves on this micro-chemic age to devise 
methods for the convenient and successful use of the real 
and safe factor, to the exclusion of the noxious, carbon- 
ized elements at present so largely composing antiseptic 
mixtures, and thus forever do away with carbolic, salicylic, 
and all other “ antiseptic ” septaemia ! 
Thus, Pasteur has demonstrated that by cultivating 
the disease-germ of chicken cholera for several genera- 
tions in fluids having free access to the oxygen of the 
air it is gradually robbed of its virulence and eventually 
becomes inert; and Buchner succeeded in transforming 
the dreaded bacillus anthracis into the harmless bacillus 
subtilis—the hay bacillus—and vice versa, by repeated 
cultures in fluids freely supplied with oxygen, or wholly 
deprived of the same, according to the results desired. 
Prof. Law’s1 experiments with the virus of hog cholera 
fully confirm the foregoing results. The virus attains its 
maximum of virulence after cultivation in fluids occluded 
from free contact with the oxygen of the air, and is grad- 
ually, but surely, robbed of all malignancy by culture in 
fluids freely supplied with that element. 
The same principle holds with regard to the propaga- 
tion of yellow fever, typhoid fever, Asiatic cholera, diph- 
theria, croup, and the pleuro-pneumonia or lung-plague 
of cattle. 
1 Malignancy of Disease Germs Mitigated by Oxygen. The Medical Record, 
vol. xix., p. 673. 19 
Another idea, not quite foreign to the subject, suggests 
itself: Has any chemical or physiological investigator 
queried whether the fundamental difference in the toxic 
tendencies of the two anaesthetics, ether and chloroform, 
is to be found by a comparison of their chemical compo- 
sition? CHCl3 = chloroform; C4H10O = sulphuric ether. 
In the latter one equivalent of oxygen does duty, while in 
the former none of the elementary constituents would sus- 
tain animal life for a moment. 
The question of ventilation in crowded cities, public 
buildings, and even in private dwellings, will eventually 
resolve itself into improved methods for supplying and 
distributing, in suitable quantities, artificial oxygen, and 
if the bacillus tuberculosis prove to be a veritable entity 
—the essential factor in the induction and propagation of 
phthisis—then must we find in pure oxygen, by one mode 
or another of admitiistration, its one efficient germicide 
and antidote l 
If Koch be right, then is mountain air and the air of 
new countries, in phthisis, but a removal from germ-fos- 
tering to germ-discouraging atmospheres. And whether 
he be right or wrong, bad air is the culture-fluid of all 
zymotic and germ-engendered diseases the world over. 
The field of profitable investigation suggested is fairly 
exhaustless, but space forbids its further exploration in 
this connection. 
Recurring to the practical side of the subject, I have 
personally used oxygen in only its simple gaseous form, 
and exclusively by inhalation. As to proportions and 
combinations, I have exhibited the gas, first, pure or un- 
diluted ; second, diluted with common air; and, third, 
admixed with nitrogen monoxide in various propor- 
tions. 
In asphyxia from drowning or the inhalation of noxious 
gases, in threatened fatal syncope, suspended animation, 
and some other emergencies, as uraemic coma, chloroform 
or ether narcosis, opium-poisoning, etc., the first form 
of administration is indicated. For general use in chronic 
diseases the undiluted gas is seldom appropriate ; but is 
to be modified by proper dilution, or associated with ni- 20 
trogen monoxide in various proportions, according to the 
exigencies of each case. 
MODUS AND METHODS. 
In attempting to formulate rules for its indication and 
exhibition the most difficult part of my task remains, since 
in no other form of therapeutic effort is more careful dis- 
crimination necessary, and in none are we confronted by a 
greater dearth of precedent. Ordinarily the diagnosis 
furnishes the indication, and the age, condition, and 
temperament of the patient are accredited as safe guides 
to the proper dosage, 
The agents now under consideration are potent for 
good or evil in a superlative sense, and cannot be so ex- 
hibited. Nor have we in our libraries half a century’s 
accumulations of lfterature on the subject, to which, as 
in ordinary cases, we can refer for aid in case of a 
dilemma. 
One of the first misconceptions, or misapprehensions, 
to be thoroughly uprooted—for it is always necessary to 
unlearn errors before we can comprehend facts—is the 
inference or impression that since these agents are prin- 
cipally used by inhalation they are, on this account, par- 
ticularly adapted, if not practically limited, to the treat- 
ment of pulmonary complaints. Nothing could be 
farther from the truth, as will appear from the general 
tenor of arguments used and facts presented throughout 
this series of papers. Oxygen may be now, or may in 
time become our chief reliance in combating the strumous 
and tubercular, as well as other diatheses ; but it is not 
and will not be because it is taken directly into the lungs, 
the apparent principal seat of tubercular manifestations. 
Its specific action is by and through its absorption into 
the blood and its direct and rapid distribution to every 
tissue throughout the entire system. It thus becomes, as 
already set forth with sufficient emphasis, an important 
source of supply to the blood, an element of repair and 
yiutrition, already prepared for direct and immediate as- 
similation, requiring neither gastric solution nor intestinal 21 
modification in order to become an integral part of the 
vital organism. Its effects, therefore, must not be com- 
pared with those which follow a dose of “ medicine ” in 
the ordinary acceptation of that term. Hence, while cer- 
tain immediate or acute morbid conditions are quickly 
removed by its timely exhibition, it cannot be ranked as 
a drug to be divided into definite doses and exhibited 
promiscuously in all acute and chronic diseases at stated 
intervals, as is the case with the ordinary articles of the 
Pharmacopoeia. 
If, therefore, I were to be asked whether the oxygen 
treatment will “ cure ” this or that particular malady or 
disease by name, as phthisis, carcinoma, rheumatism, 
epilepsy, I should promptly answer, No, it will “ cure ” 
no disease whatever. If, on the other hand, a profes- 
sional brother should inquire, In what diseased condi- 
tions do you consider it particularly indicated ? I should 
as promptly respond, In every chronic morbid condition 
of which it is possible to form a conception. 
This may seem an extravagant estimate, but it really is 
not, since the question is like asking in what conditions of 
the system is it proper to administer nourishment ? It is 
merely recognizing the view now coming to the front in 
medical philosophy, that, in the language of Ordroneaux, 
“ We are to treat it [disease] not as a personal devil en- 
tirely, to be exorcised by philters and mummery, but 
rather as the perversion of a natural state struggling to 
regain its equilibrium." 1 
Another stereotyped error in connection with the use 
of oxygen as a remedy must be eradicated from the 
average medical mind. It is assumed, on the basis of 
an ancient chemical dogma, that this element is pre-emi- 
nently a destroyer ; that it is the principal, or even sole 
office of the oxygen inspired to break down used tissues, 
to eliminate refuse material, to “burn up” waste prod- 
ucts ; and that more oxygen means simply and neces- 
sarily more extensive waste, more rapid destruction—a 
hotter fire ! This is another of the superannuated myths 
1 Journal of Insanity, vol. xxix., p. 333. 22 
of science. It is true that living is synonymous with 
wasting, disintegration—burning, if you insist on the 
misnomer—but to cease to waste, to interrupt disinte- 
gration, to put out the fire,” even for a moment, is to 
cease to live; it is irrevocable death. Nor can repara- 
tion, or even primary assimilation, proceed without its 
twin process—destruction. Admitting all this as abun- 
dantly established by both analogy and observation, 
there is still every corroboratory assurance, in both chem- 
istry and physiology, that the element under considera- 
tion is less a destructive than a agent, 
less a detergent than an aliment, less a burner than a 
builder. 
Again, the underlying idea in all rational therapeutic 
endeavors, aside from surgical conservation of structure 
and the temporary palliation of excessive pain, is to 
hasten metamorphosis, both destructive and constructive, 
since it is universally recognized that destructive action 
—elimination, depuration—is but one and a very essen- 
tial part of constructive change. It is the thrusting 
aside of obstacles which impede or bar the progress of 
true repair and rebuilding. 
On the part of those who have been in the habit of 
thinking, teaching, and acting in the old rut—for rut it 
certainly is—it will take some time to fully comprehend, 
and will require a considerable effort to frankly admit 
this ; for the rut has long been revered as the regular 
way; in it we have always had, and still have, plenty of 
company, and that of eminence the most unquestioned. 
Nor is it any novelty, or in the slightest degree an in- 
novation, to assert this. Acknowledged authorities in 
physio-chemistry have all along taught it. It will be a 
surprise to even well-read and experienced members of 
the profession to refer freshly, in the face of this asser- 
tion, to standard works on physiology, and see how 
strong and positive is the evidence to this effect—evi- 
dence which most of us have all along blundered over, 
ignored, or but half comprehended. 
“ To describe fully the physiological action ol oxygen 
would involve a description of the processes of respira- 23 
tion, sanguification, nutrition, and tissue-change, for to all 
these, and to life itself, it is essential.” 1 
“ Preyer showed that a greater saturation from oxygen 
inhalation is, a priori, probable, . . . and Demar- 
quay proved it by showing that suppurating, indolent, or 
unhealthy wounds on the extremities of animals became 
quickly florid and hyperaemic when pure oxygen was in- 
haled. . . . Allen and Pepys, and later Limousin, 
showed that by inhaling an equal quantity of atmo- 
spheric air at one time and oxygen at another, double 
the amount of carbonic acid was expired, and this in- 
crease continued for fifteen minutes after the inhalations 
had finished.” 
“ Other observers have reported that the elimination 
of uric acid during a course of oxygen inhalation is 
markedly lessened, i.e., that more complete combustion 
occurs within the system (Schmidt’s Jahrb., t. i, s. 28, 
1865).”a 
Kollman found that the quantity of uric acid in an 
equal amount of urine was reduced nearly fifty per cent, 
by free oxygen inhalation. In one experiment the 
amount of acid fell from one hundred and thirty-four to 
twenty-five milligrammes. 
Gubler’s experiments proved that active inspiration of 
pure oxygen gas slowed the pulse and respiratory move- 
ments, produced a general sense of comfort, did not 
cause dyspnoea, and that the pause between inspiration 
and expiration could be prolonged from the ordinary 
limit of thirty to as much as ninety or one hundred 
seconds after breathing oxygen ; and as a result of his 
observations, he asserts that the blood receives the gas 
in proportion to its physical capacity for it, rather than in 
proportion merely to the vital necessity of haematosis. 
The globules absorb what they need, while any excess 
circulates free and enters into combination only as the 
haemoglobin loses oxygen in passing through the capillaries. 
Quinquaud, by certain chemical tests, which, to make 
them reliable, need corroboration, estimated that the 
J Phillips : Mater. Med. and Therapeutics, vol. i., p. 2. ed. Wood’s Library. 
1882. 2 Phillips, op. cit., p. 5. 24 
capacity of the blood for oxygen in healthy subjects was 
quite uniformly two hundred and forty cubic centime- 
tres of oxygen to every one thousand grammes of haemo- 
globin. 
The experiments of Buckheim, Klebs, Husemann, 
Naoumoff, Beliaiefif, Savory, Richardson, Ewald, Hering, 
and others, have not given us much additional light on 
the subject. They were chiefly of that crude, forced, 
and unnatural character, too common in physiological 
experiments, which add so little to our practical knowl- 
edge of the “action” of any remedy when properly ex- 
hibited. For example, what would it profit the patholo- 
gist to learn, by cruel experiment on the lower animals, 
or perhaps on some helpless, hospital-stranded human 
wretch, that an exclusive diet of absolute alcohol pro- 
duced a train of untoward symptoms and speedy death ? 
Would we therefore proscribe all the alcoholic mixtures— 
brandy, gin, wine, whiskey, etc., etc. ? 
Nature does not suggest the use of oxygen in a “pure 
and nascent state,” as used by these experimenters, and 
I do not consider such use of the agent, unmixed and 
undiluted, permissible, much less advisable, except in a 
few emergencies, and then only to cover the exigencies 
of the particular cases as presented. Hence I have 
little interest in the class of experiments referred to. 
Tests of the gas as a therapeutic agent must be based on 
conditions which do not do viole?iceto well-known and well- 
proved natural laws. The safe guides in this, as in all 
therapeutic investigations, are common-sense, the recog- 
nition of known facts, and the simple rules of analogy. 
Above all, we must “ take a hint from nature.” 
Among the acute or immediate conditions which oxy- 
gen and its congeners can be made to promptly, safely, 
and surely relieve, may be cited asphyxia, from drowning, 
hanging, or from inhaling carbon dioxide or other noxious 
gases; suspended animation, from syncope and from 
opium or chloroform narcosis ; poisoning, from various 
toxic agents; spasmodic asthma (the paroxysm); ob- 
structed respiration, as in diphtheritis and membranous 
croup ; and in cyanosis, from whatever cause. 25 
Of the many chronic conditions which may be con- 
fidently attacked, 1 may specifically mention atuemia 
(Birch, Demarquay, Da Costa, Dujardin-Beaumetz, et 
als.) ; chlorosis (iidem); the cachexia and dyscrasice in 
general ; all the indigestions and dependent disorders 
(Hill, Beddoes, Birch, Goolden, et als.) ; struma and 
tuberculosis (omnescit.) ; empycemia ; chronic glandular 
enlargements; intra-thoracic and intra-pelvic abscesses 
and degenerations ; epilepsy; emphysema (palliative) ; 
asthma (curative) ; the typhoid state ; zymosis, septicaemia, 
and malarial poisoning; neurasthenia, and nearly all 
forms of neuralgia. 
From this imperfect generalization, it will not be diffi- 
cult for the observant medical mind to discern the special 
indications and contra-indications for treatment in any 
given case. 
It may be asserted, in general, on rational as well as 
experimental grounds, in connection with this treatment, 
that those chronic cases show most marked and striking 
results which are selected from the great army of house- 
prisoners, “ delicate ” people who, from necessity, habit, 
preoccupation, or negligence, have been long deprived 
of wholesome air and everything like active out-door 
life ; or who have long suffered from miasmatic location, 
sedentary occupations, or unsanitary surroundings ; or 
from those who have*been too tenderly reared—over- 
coddled (and this virtually includes every close resi- 
dent of a populous city). To these may be added the 
phlegmatic, the “lymph-albuminous,” and the lazy—of 
whom every community shows numerous examples— 
patients with sluggish circulation, small respiratory ap- 
paratus, torpid or enlarged livers, fatty heart or kidneys, 
and with habitually retarded excretory functions generally. 
As far as individual experience with oxygen goes—my 
first cases were treated sixteen years ago—I have found 
thoroughly satisfactory, and in some instances very remark- 
able, results in cases of inveterate asthma. As a pallia- 
tive of the immediate attack, a mixture of oxygen and 
nitrogen monoxide has invariably given instant and happy 
relief; and the continued use of the two, variously mod- 26 
ified, has never failed, in my hands, to effect a, to all ap- 
pearances, complete and perfect “cure,” If more ex- 
tended trial proves equally successful, the treatment might 
very properly be termed a “ specific” in the treatment of 
this distressing malady, which so often resists all ordinary 
as well as extraordinary measures. 
In the severer forms of the indigestions the results have 
been scarcely less brilliant. Scanty or suppressed secre- 
tions are gradually restored, absorption and assimilation 
resume normal activity, and the functions of depuration 
and defecation, long deranged, obstructed, or interrupted, 
are surely, normally, and, in a medical sense, permanent- 
ly restored. 
Hill’s first experiments with oxygen (1820) covered 
cases of hydrocephalus, epilepsy, chronic arthritis 
(gouty?), paralysis, and morbus coxarius. In each of 
these he reported flatteringly encouraging results. 
Another, by no means unimportant, but as yet almost 
wholly ignored use for oxygen, is in connection with the 
administration of anaesthetics. On purely rational 
grounds, as well as from some years of practical experi- 
mentation, 1 am thoroughly convinced that the dangers 
heretofore presumed to be inseparable from the use of 
ether, chloroform and other anaesthetics, can be reduced 
to a minimum, if not rendered altogether nil, by the 
timely, previous, and perhaps occasionally subsequent 
exhibition of oxygen. A few inspirations of the gas, 
slightly diluted, taken just before inhaling chloroform or 
other anaesthetic, while it does not interfere with the de- 
gree of anaesthesia produced, effectually prevents the 
usual untoward symptoms—nausea, headache, delirium, 
etc. And while not materially abbreviating the stage of 
complete anaesthesia, it shortens the recovery stage and 
effectually forestalls the symptoms of imminent danger 
which so frequently alarm the operator and jeopardize 
the life of the patient. 
In the use of nitrogen monoxide as an anaesthetic in 
short surgical operations, dentistry, etc., the effects are 
much more desirable when a certain percentage of pure 
oxygen is added. 27 
On this point I would quote a summary of results ar- 
rived at by Dr. Klikowitsch after a series of experiments 
in Prof. Botkin’s laboratory, at St. Petersburg (Virchow's 
Archiv) : 
1. Anaesthesia induced by it [nitrogen monoxide] is 
closely associated with insufficient oxidation of the blood, 
and hence not absolutely free from danger. 
2. The association with it of twenty per cent, of pure 
oxygen completely removes all possibility of asphyxia, 
without interfering with the completeness of the anaes- 
thesia. 
3. By the use of this mixture the heart-pulsations of 
healthy subjects are increased, the pulse-wave diminished, 
respiration increased in depth but decreased in frequency; 
these effects lasting from three to five minutes. 
4. In four cases of weak heart-action, the exhibition of 
this mixture produced no unfavorable symptoms. On the 
other hand, the pulse increased in strength and decreased 
in frequency; these effects lasting from one to two 
hours. 
5. In cases of disturbed respiratory innervation, the 
mixture rapidly removed the symptoms of deficient 
blood-oxidation and regulated the respiratory rhythm. 
6. This mixture quickly relieves suffering in angina 
pectoris, and when pushed, produces very perfect tran- 
sient anaesthesia. * 
7. It is preferable to chloroform as an anaesthetic in 
labor. 
8. Vomiting and cough of reflex origin are arrested by 
a few inhalations of these mixed gases. 
The various methods of exhibition of this agent may be 
briefly adverted to : 
1. Direct inhalation will probably always stand at the 
head of all methods. 
2. Cutaneous absorption has been resorted to in Eu- 
rope, and may be found advantageous in certain cases. 
3. Oxygenated water is a feasible and pleasant me- 
dium for stomachal administration. It is prepared by 
saturating steam with the gas, at high pressure, and after- 
ward condensing the steam. 28 
4» Oxygenated bread has been used to some extent in 
England, and there is no reason why the “ aerated bread” 
of our cities should not be easily transformed into oxygen- 
ated bread at will. 
Of this bread Dr. Birch {op. cit., p. 18 et seq.) says: 
“ Its relative effect on the appetite is singular. Thus on 
the one hand (as might be expected) it stimulates the ap- 
petite when absent or capricious, while, on the other 
hand, it tends to produce such a feeling of epigastric 
fulness, when sufficient food has been taken, as to effect- 
ually suspend (if not satisfy) some morbidly craving ap- 
petites. . . . 
“ I?i some cases it will be found advantageously to 
supersede artificial pepsin, pancreatin, and even quinine 
and the mineral acids. . . . It is particularly indi- 
cated in cases of delicate children with continually re- 
curring ascarides, functional derangement of the stomach 
and bowels, and mesenteric weakness.” 
In the matter of proportions and combinations, and as 
respects the quantity to be exhibited in a given case, 
there is as wide latitude for the exercise of professional 
discretion as in the compounding and selection of ordi- 
nary drugs. 
Appliances for clinical exhibition.—As will be in- 
ferred, the use of these agents, although not necessarily 
restricted to these, is more especially adapted to office 
and hospital practice. For a complete office equip- 
ment in every considerable practice there should be 
at least three separate reservoirs. One should contain, 
at all times, pure oxygen, ready for instant use in cases 
of emergency; a second may contain pure nitrogen 
monoxide, and a third such modified admixture as is 
found best adapted to the class of cases under treat- 
ment. One or more additional reservoirs will at all 
times be found a matter of convenience, and in 
undertaking the treatment of a variety of cases in an 
extensive hospital or general office practice, quite essen- 
tial. A receiver containing condensed air will make the 
armamentarium still more complete and comprehensive, 
and will frequently prove of great value. These should 29 
be arranged so as to be readily connected when desired. 
They may be placed in a suitable hall, closet, or private 
Apparatus for making and administering pure Oxygen Gas. 
room adjoining the office, and connected with the latter 
either by ordinary gas-pipe or by rubber tubing. The 30 
latter may be neatly covered, as a matter of taste, with 
rep or other suitable material. 
The mouth-piece or inhaler may be of glass or hard 
rubber, and it is to be connected with the reservoir 
through covered rubber tubing and a glass bell, or a 
small-sized wash-bottle half filled (with simple water, a 
solution of caustic soda, or of any medicated solution 
desired), through which the gas is drawn in brilliant 
bubbles. A number of these bells or wash-bottles being 
kept on hand, each patient, or at least each class of 
patients, may thus be provided with an appropriate and 
separate solution. 
In regard to proportions, a mixture very much used 
by me is composed of O two volumes, N20 two volumes, 
and common air (to be drawn from a pure source) four 
volumes. In cases of extreme vascular torpor and func- 
tional inactivity a stronger mixture will be indicated, 
as O two volumes, N20 one to two volumes, and com- 
mon air one volume. Such a mixture is almost as effi- 
cacious, in emergencies and extreme cases, as pure 
oxygen ; it is far better for ordinary use, and will answer 
every purpose in case of a sudden demand for the pure 
gas. Delicate patients will require the weaker mixture 
from the start, and after a few days of the mqre active 
treatment, very few cases will require any stronger. 1 
would again most emphatically repeat what I have 
already several times asserted, that a majority of experi- 
menters with oxygen and congeners have failed and will 
contitiue to fail of good results on account of using the 
agents in too concentrated form. 
For a limited practice, in which one quality of gas 
must be made to serve a variety of patients, a com- 
promise mixture of equal volumes of O, NaO, and common 
air is as strong as should be used. This will be suffi- 
ciently potent for the severer cases, and must be cau- 
tiously administered to susceptible patients and those 
in anything like a critical condition. 
Tune and freque7icy of administration.—Except in 
emergencies, the treatment should not be given either 
on an empty stomach or after a prolonged fast. In a 3i 
majority of cases the mid-meal hours between break- 
fast and dinner are most favorable. It is well to avoid 
Apparatus for making and administering pure Nitrous Oxide. 
giving any active treatment within an hour of any prin- 
cipal meal, or at any time when there is present an 32 
unusual degree of fatigue. Mere weakness or nervous 
prostration do not, however, contra-indicate, but are 
usually relieved by oxygen. 
In cases complicated with persistent or periodic neu- 
ralgia, it will be advisable to supplement the regular 
daily sitting with a few inhalations just before retiring ; 
and in these, as well as in extremely “ nervous ” or in 
hysterical cases, this evening exhibition should consist 
of as much as fifty per cent. N20. 
As a rule, in ordinary chronic cases one treatment 
per diem is all that is advisable ; in many cases it is all 
that is allowable. This should be carefully borne in 
mind by the inexperienced, since it is quite easy, and I 
had almost said natural, in the anxiety of both physician 
and patient to see palpable signs of immediate improve- 
ment, to overdo in the matter of dosage. 
Dosage and intervals.—When feasible, let the pa- 
tient stand erect, throwing the shoulders well back 
and as thoroughly as possible expelling the residual air 
from the lungs before inspiring the gas; then with a 
steady effort slowly inspire from the mouth-piece until 
the lungs are as full as they can be readily filled. Let 
the inspired gas be retained as long as convenient with- 
out discomfort, then slowly and deliberately expired. 
There should be an interval of from five to twenty 
minutes, according to the nature of the case, before a 
second inspiration is given, and during this interval the 
patient may walk about, sit, or recline, as he seems most 
inclined. It is well to hold the nose while inspiring. 
In ordinary non-critical cases, accompanied with ve- 
nous stasis and general functional torpidity, from four to 
ten inspirations, comprehending two to six gallons, may 
be given at each daily seance ; but this limit should sel- 
dom be exceeded. Some cases will present in which two 
full inspirations will be all that should be exhibited during 
the twenty-four hours. In this [regard the practitioner 
must be constantly on the alert, and must use the most 
careful discretion. 
A systematic record should be kept of each case 
treated, beginning with a summarized history, a thorough 33 
physical examination, an examination of the urine, noting 
pulse- and respiration-rates, capacity of lungs, etc. The 
quantity per diem and specific gravity of the urine, as 
observed at stated intervals, daily in critical or important 
cases, and at least weekly in all, during treatment, will 
furnish suggestive data from which to regulate the qual- 
ity and quantity of gas to be exhibited. 
If there be a tendency to haemoptysis, oxygen is not 
necessarily contra-indicated, but evidently should be ad- 
ministered with more caution. I have not hesitated to 
advise the treatment in these cases, if not otherwise 
contra-indicated, and have never witnessed any untoward 
results; but the lungs should never be forcibly inflated, 
nor should the inspired gas be so long retained. As a 
further precaution, which, however, I am inclined to think 
is superfluous, it should be much diluted at the outset 
and gradually increased in strength with the progress of 
the case. I have even thought the use of the gas, with 
due precautions, has eventually lessened the liability to 
hemorrhage. 
In acute cases, as of asphyxia from any cause, alarm- 
ing dyspnoea, cyanosis, suspended animation, narcosis, 
severe paroxysms of asthma, etc., no definite rules can 
be formulated. The indications must be gathered in 
each instance from the nature and progress of the case, 
and the judgment of the practitioner must in all cases 
supersede all rules. 
In cyanosis and asphyxia there is little danger of push- 
ing the treatment too rapidly or too far, short of posi- 
tively relieving the patient. The immediate demand is 
for oxygen, and it may be given, freely and constantly, 
until the imminent crisis has been passed and the urgent 
symptoms are relieved. 
A practical suggestion.—In its incipiency every “new” 
treatment is called on to perform miracles, since at first 
only the most inveterate and apparently incurable cases 
will seek its aid. I would therefore utter this warning, 
and suggest that no such cases be received except with 
the express stipulation that the treatment shall be punctil- 
iously followed for a definite period of, say, not less than 34 
two, three, or four months. It will be worse than throw- 
ing away time, or than placing pearls before swine, to per- 
mit the grand army of physical vacillators to spasmodically 
attempt the treatment, foolishly expecting that it will ac- 
complish greater wonders than the touch of Midas’ wand, 
and fully believing for a day that it is the latest “wonderful 
discovery” among patent nostrums. These will follow it 
for a few days or weeks, and will insist upon giving it up 
long before it has accomplished any definite or perma- 
nent good. They will be only a block of stumbling to 
its success with others, and will give you no end of annoy- 
ance by their irrational and short-sighted criticisms. 
Better decline to treat not only hopeless incurables, but 
all who will not stipulate to give the treatment a fair and 
thorough opportunity to accomplish tangible and perma- 
nent results. I would insist on this, even though it 
might appear to savor of the methods of the advertising 
charlatan. Thus, it would be a stroke of business pru- 
dence to charge each patient a maximum fee by the 
month for the first month, and minimum or perhaps grad- 
uated fees for subsequent months of treatment, since this 
will encourage perseverance on his part, and since the 
first month covers the period requiring most watchful 
care and intelligent adjustment of all the conditions. 
Adjuvants.—As regards concurrent treatment by means 
of drugs, this must be left to the discretion of each practi- 
tioner, guided by the exigencies of each particular case. 
It must not be omitted whenever it rationally appears to 
be either synergistic or complementary. To reject any 
source of aid in treating maladies is to raise (or lower) 
any method ot treatment to the questionable rank of a 
hobby. 
Theoretically, iron is an oxygen carrier, and in some 
instances it may be given with advantage during an 
oxygen course ; but if the patient’s diet be sufficiently 
varied so that it shall contain the earthy salts in due pro- 
portion, there will be little need for increasing the chalyb- 
eate element. 
To this end, even though it may seem pedantic, I 
would distinctly urge, in connection with an oxygen 35 
course, the daily use of those cereal and other prepara- 
tions known to be rich in phosphates and other needed 
elements, as oatmeal (coarse), white wheat (crushed or 
cracked), whole wheat flour, some of the principal ele- 
ments of which are wanting in a majority of modern 
dietaries. 
In connection with the use of oxygen the question of 
alimentation is of far more than usual significance. In 
all cases the diet should be thoroughly sustaining, and in 
some it should be abundant, even to the extent of forced 
feeding. Bearing this well in mind, no specific rules 
need be suggested. The necessity for an intelligently 
selected variety in diet suggests itself when we reflect 
that the subtle and powerful agent to which we are sub- 
jecting our patients rapidly permeates every molecule of 
matter in even the remotest tissues of the body. It ac- 
celerates at once the process of liberating worn material 
with retained and septic excretions, as well as that of 
rebuilding or repairing weakened structures. For all 
this work—destruction and reconstruction—liberal sup- 
plies of fresh material are in constant demand, and must 
be supplied with the food. 
In all cases complicated by chronic gastric catarrh or 
torpid states of any of the viscera, the somewhat over- 
done fashion of hot-water drinking, to the extent of two 
or three pints per day, an hour before meals, will be 
found a valuable adjunct. If simple hot water be voted 
flat, hot lemonade or hot soda-water may be substituted, 
as indicated. The washing away of morbid products set 
free by the treatment is also quite an essential factor; 
hence, in addition to the hot-water drinking, the warm 
full bath, or a course of systematic bathing with massage, 
with also frequent local lavements, hot douches, etc., 
should not be omitted. These are invaluable adjuvants 
to any treatment. 
The regulation of the general sanitary and hygienic 
surroundings of each patient need not be adverted to. 
The judgment of all intelligent practitioners will suggest 
this. One exception may be remarked in connection 
with this treatment : Deprivation in the matter of out 36 
door air and physical exercise, whether from negligence, 
necessity, or indifference, will not be so serious a draw- 
back as in case of ordinary treatment, since super-oxygen- 
ation to some extent supplies the lack. But blind faith 
in the treatment should not be allowed to exclude such 
aids as may be derived from any and all adjuvants. 
That the use of oxygen in medical practice requires 
considerable time and care in its manipulation, and the 
exercise of much judgment and discrimination in its ex- 
hibition, and that impatient, over-sanguine, or careless 
practitioners will fail of satisfactory results in attempting 
it, is very true ; but it may be made to add so largely to 
our therapeutic resources, is a desideratum in so many 
contingencies, and the necessity for it increases so exactly 
in proportion to the increase of artificialness in the social 
and physical habits of modern society, that the conscien- 
tious and painstaking physician of the future will un- 
doubtedly avail himself of its aid in all appropriate con- 
ditions and emergencies. 
The following cases, selected from those treated during 
a number of years past, represent the range of adaptability 
rather than any special features of the treatment, and are 
inserted, hoping that other experimenters in this promising 
field may be prompted to give to the general profession 
the results of their efforts, and that in due time we shall 
not be, as now, literally without a literature on the sub- 
ject. It will be noted in all of them that prompt and per- 
manent aid to digestion and assimilation is a decidedly 
prominent if not the principal result. 
Case I.—Mrs. J. S , aged thirty-nine, married, two 
children, the youngest several years old. By profession 
a singer and teacher of music. Family history includes 
phthisis, of which she lives in great fear. Each winter 
has severe bronchial and laryngeal troubles, with persist- 
ent cough. Anaemic, extremities habitually cold ; pulse, 
102 to 108 ; constant subclavicular pain ; dyspnoea and 
fatigue on slight exertion ; weak digestion, with bowels 
habitually constipated. She expectorates rather copi- 
ously ; sputa muco-purulent; and there is circumscribed 
dulness over the apex of the left lung. She is very 37 
despondent, and has no faith that any treatment will 
avail. 
March 25th.—She presents for treatment and is placed 
on daily inhalations for thirty minutes at a sitting—]J. 
Oxygen, one volume ; nitrogen monoxide, two volumes ; 
common air, one volume. At a forced effort she can in- 
spire 150 cubic inches of the mixture. 
April 10th.—Improvement has been manifest from the 
first. The nitrogen monoxide acts as a wonderful calm- 
ative to the nervous system. She is no longer despond- 
ent ; appetite much improved, coughs less, sputa reduced 
in quantity and less purulent. Constipation effectually 
relieved. Lung capacity, 190 cubic inches. 
April 25th.—Resumed her music classes soon after 
last record. Improvement has been rapid and constant. 
Says she is “ better than for many years eats, works, 
and sings with gusto. Considers herself “ well,” and 
treatment suspended. 
(Observed this patient eight months later, no unto- 
ward symptoms reappearing.) 
Case II.—Mrs. C. L. W , aged twenty-nine, mar- 
ried, one child aged five. Family history says father 
died of cancer of stomach ; mother of cardiac disease. 
She has “ weak lungs,” and lives in perpetual dread of 
“consumption.” Sense of constriction in left lung ; cir- 
cumscribed “sore spot” under the left clavicle ; severe 
cough for several years past, and there is now some dul- 
ness on percussion over the left apex. Has been treated 
by eminent physicians without appreciable benefit; very 
anaemic ; voice weak ; no appetite ; amenorrhoeic for 
three years past ; menstrual discharge, when present at 
all, is either profuse, acrid, and colorless, or greenish in 
color, scanty, and offensive. Has been subject to re- 
peated attacks of severe nephralgia. Urine not examined. 
May 23d.—This patient was placed on a mixture of— 
Oxygen, nitrogen monoxide, aa 2 volumes ; common 
air, 1 volume, of which she inhales, twice daily, three 
gallons at a sitting. Shows a lung capacity of 130 cubic 
inches. 
June 1st. — Improvement already manifest. Feels 38 
“ rested ; ” eats better ; says the “ soreness” has nearly 
left her. Can now inspire 165 cubic inches at an effort. 
Treatment continued twice daily. 
June 15th.—Acute nephritis suddenly developed, or 
at least the chronic condition of those organs assumes a 
subacute form. Temperature, 102° ; pulse, 122. Urine 
scanty, specific gravity 1.030 ; some albumen and casts. 
Oxygen suspended and hot hip-baths ordered, wfth de- 
mulcent drinks, to be followed by hot fomentations over 
the region of the kidneys. 
June 25th.—The acute symptoms, which were some- 
what alarming at last record, soon subsided, and general 
improvement is very evident. Lung capacity, 200 cubic 
inches. Oxygen was resumed 20th. 
July 1st.—Improvement continues. Menses appear 
naturally and without unusual disturbance. Appetite 
excellent ; walks two miles a day without fatigue, sleeps 
well, and gains flesh rapidly. 
July 10th.—Patient continues to improve. Treatment 
reduced one-half and conjoined with chalybeates. Lung 
capacity increased to 225 cubic inches. 
July 25th.—Treatment suspended. Patient returns to 
her friends very much rejoiced at her progress. 
(Two years later this patient reported no return of 
former symptoms.) 
Case III.—Miss A. B , nineteen years of age. 
Family history good, except that mother died young. 
Father, Judge B , quite robust at sixty-eight. She 
has suffered from spasmodic asthma since childhood, the 
paroxysms occurring daily and on the slightest exposure. 
She is very delicate, anaemic, and fatigued on slight ex- 
ertion. Has constant dyspnoea and marked cyanotic ap- 
pearance. Appetite weak and capricious. 
May 25th.—Placed patient on—Ijfc. Oxygen, 1 vol- 
ume ; nitrogen monoxide, 4 volumes, of which she 
inhales five gallons, once daily, with the result of im- 
mediately relieving the dyspnoea. Her lung capacity is 
but 75 cubic inches. 
June 4th.—Improvement has been steady. No more 
cyanosis; does not suffer from paroxysms; appetite 39 
fairly good. She inflates her lungs much better than at 
first; capacity, ioo cubic inches. 
June 20th.—Proportion of oxygen increased to forty 
per cent. No return of paroxysms. General health 
greatly improved. 
July ist.—General improvement continues. From 
being caught in a storm has had one mild asthmatic 
paroxysm. 
July ioth.—Patient can now endure active exercise 
without fatigue. Treatment continued every other day. 
Inspires 140 cubic inches. 
July 25th.—Treatment has been irregular since last 
record, but patient’s general health continues to im- 
prove ; breathes, sleeps, and eats well. Exposes herself 
to changes of weather and temperature with impunity. 
August ioth.—There has been no recurrence of the 
asthma, although patient asserts that she has repeatedly 
exposed herself to the same influences which invariably 
induced paroxysms previous to treatment. She is ad- 
vised to continue the treatment at intervals, but as the 
family are about to remove from the city no further ob- 
servations are practicable. 
(November 30th.—This patient writes that she con- 
tinues to enjoy excellent health, and thas had but one 
asthmatic paroxysm since leaving the city—this from be- 
ing drenched to the skin in a sudden rain-storm.) 
Case IV.—Miss' E. L. C , sixteen years of age. 
For three years past subject to epileptic convulsions. 
Family history shows the malady to be hereditary. Pa- 
tient tall, slender, with stooping, awkward gait, languid 
attitude, flabby muscles, sallow complexion, feeble pulse, 
morbid appetite, and poor digestion. Complains of con- 
stant cephalalgia, and, in short, is decidedly chlorotic. 
Has never menstruated, and her mother associates her 
malady with this fact. 
August 13th.—Patient placed on—1£. Oxygen, 1 vol- 
ume ; atmospheric air, 2 volumes ; four gallons at each 
daily sitting. [Inhales but 60 cubic inches at an inspira- 
tion. 
August 20th.—Mother reports that she sleeps better 40 
and does not have her nightly “ fit.” Can inspire 90 
cubic inches at an effort. Ordered chalybeates and nu- 
tritious diet, for the latter of which she begins to show a 
natural desire. 
August 30th.—Still no return of the paroxysms. Ceph- 
alalgia has disappeared ; appetite, digestion, and gen- 
eral health much improved. Lung capacity, 100 cubic 
inches. 
September 14th.—Proportion of free oxygen increased 
to fifty per cent.; five gallons each sitting every other 
day. Patient resumes her classes in school, walking 
several miles daily without fatigue. Inspires 105 cubic 
inches. 
October 10th.—Slight convulsion after severe expos- 
ure, attending an evening political demonstration. Daily 
treatment resumed; same formula as at last record. 
Lung capacity increased to 115 cubic inches. 
November 1st.—Improvement has been constant; ap- 
petite fairly insatiable ; digestion excellent, and is one 
of the most boisterous of her class on the playground. 
November 10th.—Treatment continued every other 
day. Catamenia appear, naturally and without disturb- 
ance. 
November 25th.—Patient decidedly robust, and ap- 
parently, as she asserts herself, “perfectly well.” Treat- 
ment suspended. 
(Six months later there had been no return of the 
epilepsy ; general health of the patient continuing excel- 
lent.) 
Case V.—A. S. , aged fifty-one, married, several 
grown-up children ; by occupation, commission merchant. 
Has been twenty years an invalid ; a confirmed dyspep- 
tic, and suffers from constant and extreme nervous irri- 
tability and prostration (neurasthenia?). Constant fron- 
tal headache and frequently recurring paroxysms of a 
dull, benumbing pain referred to the medulla and base 
of the brain. Appetite wanting ; constipation habitual, 
alternating occasionally with diarrhoea ; extremities cold, 
is very despondent, and has suffered for years from a 
masked or “ dumb ” ague. Liver and spleen somewhat 41 
enlarged ; urine turbid, specific gravity 1.030, abounds 
in alkaline phosphates, but deficient in urea and uric 
acid. 
September 20th.—Daily treatment instituted, using— 
IJ. Oxygen, nitrogen monoxide, aa four gallons at each 
sitting. Lung capacity, 160 cubic inches. 
September 29th.—The evidence of retention of urea 
in the system corroborated, and the value of oxygen as 
an eliminator well illustrated. Crowding the treatment 
from day to day, patient last night inhaled eight gallons of 
the mixed gases. Urine now loaded with urea ; specific 
gravity, 1.035. Treatment continued, the dosage di- 
minished. 
October nth.—The disturbances noted after first week 
of treatment have nearly subsided. Urine nearly nor- 
mal as to quantity, but still shows excess of urea ; spe- 
cific gravity, 1.028. 
Mixture changed to— Oxygen, 1 volume ; nitrogen 
monoxide, 2 volumes ; eight gallons at each daily sitting. 
Lung capacity increased to 200 cubic inches. Patient is 
less irritable, sleeps better, and feels greatly encouraged. 
October 18th.—Improvement has been gradual but 
constant since last record. Cephalalgia is becoming a 
much less frequent symptom, and when present is less 
severe. Specific gravity of urine, 1.025. 
November nth.—Has steadily improved since last 
record, in spite of the 'drawback of constant business 
worry and overwork/ Urine normal ; lung capacity,- 220 
cubic inches. 
November 20th.—Digestion good; sleeps \yell; no 
longer despondent or irritable ; no headache ; extremi- 
ties in a comfortable glow ; all his functions well per- 
formed. Treatment discontinued. 
(Four months later this patient reported himself in ac- 
tive business and feeling strong and well.) 
Case VI.—Miss E. A. W , aged thirty-one; 
superintendent of a fur manufactory, the confinement 
and dust of which is very irritating. Strumous habit, but 
family history negative. Is anaemic, despondent, and 
complains of a constant cough ; areas of dulness over 42 
right lung, with persistent bronchial irritation and bron- 
chial catarrh. 
April 20th.—Placed this patient on a mixture of equal 
volumes of O, N20, and common air. Lung capacity 
but 130 cubic inches, although a woman of more than 
average stature and weight. Advised daily exercise in 
the open air and nutritious diet. 
April 30th.—No apparent improvement; cough rather 
worse ; expectoration very profuse, and sputa containing 
fetid cheesy (tubercular ?) matter. Treatment con- 
tinued. 
May 10th.—Appetite rather better, and sleeps more 
regularly; otherwise no visible improvement. Cannot 
secure out-door exercise to any extent. Treatment 
changed to O two volumes, N20 and atmospheric air, 
aa one volume. Lung capacity 150 cubic inches. 
May 20th.—Lung begins to clear up, but no outward 
signs of improvement. Patient much discouraged, and 
only consents to continue the treatment on my positive 
assurance that she has made some progress. Lung 
capacity 160 cubic inches. 
May 30th.—Now reports her general health as very 
decidedly improved; cough perceptibly better; her 
former sallow (“ bilious ”) complexion has cleared up, 
and is now fairly ruddy. Eats and sleeps well, and en- 
joys a buoyancy of spirits unknown for years. 
June 10th.—Reports herself “cured,” and is loud in 
her praise of the treatment. Says she had no faith in 
it in the start. Her cough is almost entirely gone ; 
respiratory murmur audible all over both lungs, and has 
gained twenty pounds in flesh. Lung capacity 195 cubic 
inches. Treatment discontinued, patient going to the 
country for a vacation. 
August 8th.—She returns for additional treatment. 
Took a severe “cold” en route from the country, and 
her bronchial trouble returned. Severe passive conges- 
tion of both lungs, annoying cough with muco-purulent 
expectoration. Pulse, 94. At the first sitting she in- 
hales two full inspirations of O one volume, N20 one 
volume, and common air two volumes. Within five 43 
minutes her pulse falls to 84, and the immediate dyspnoea 
is decidedly relieved. 
August 20th.—Some cough yet, but great general 
improvement is evident. Severe bronchial irritation per- 
sists, and, continuing the oxygen treatment, a local spray 
is added. Potas. chlor. 3 j - 3-d aqua § iv.; alternat- 
ing every other day with FI. ext. hyosc. 3 ss. ad 
aqua § viij. per steam atomizer. Complains of pectoral 
and intercostal myalgia, for which ordered a stimulating 
lotion and tonic regimen. 
August 29th. — Notable improvement is evident. 
Bronchial difficulty is much relieved ; myalgia gone, and 
not much cough left. Treatment interrupted. 
September 20th.—Treatment resumed every other 
day, improvement having continued since last record. 
October 10th.—This patient now considers herself 
well, but is advised to leave the factory and live more 
out of doors, if possible. 
Saw this patient six months later, and although she 
has not left the unwholesome factory she continues well. 
Case VII.—L. P. N , aged twenty-five; theo- 
logical student; nervous temperament; family history 
good, but is a confirmed dyspeptic, and has spermator- 
rhoea of several years’ standing, nocturnal emissions occur- 
ring almost every night. Over the latter he is despondent, 
even to desperation. Fears he is going into a “de- 
cline.” Studies hard far into the night, preaches, be- 
comes very excitable; after which he suffers from pro- 
tracted insomnia. Has consulted a number of physicians 
here and elsewhere, but without benefit. Is now trying 
movement-cure, but thinks it weakens rather than 
strengthens him. 
April 13th.—Begins the use of a mixture composed of 
O one volume, NaO two volumes, and common air two 
volumes. Lung capacity 160 cubic inches ; countenance 
expressing haggardness and hopelessness; urine loaded 
with oxalates. 
April 20th.—Already reports a marked change in his 
appetite and digestion. Says his food no longer dis- 
tresses him. 44 
April 30th.—Nocturnal emissions have entirely ceased. 
He sleeps and eats well, and does not give way to ex- 
citement as formerly. Lung capacity increased to 190 
cubic inches. Feels greatly encouraged. 
May 10th.—Improvement has been constant and 
rapid since last report. Appetite and digestion excel- 
lent. Has gained in flesh, feels fresh and buoyant, and 
no return of emissions. In short, this patient is quite 
himself, and attributes the change wholly to the oxygen 
treatment. Lung capacity 200 cubic inches. No fur- 
ther treatment deemed necessary, and patient passed 
from observation. 
Case VIII.—E. W , aged forty-nine; insurance 
agent—one of the toughest of his kind ! Could talk a 
graven image into taking a policy, if he had time. Mixes 
his family history so much with Farr’s tables and the 
“ actuaries’ experience ” that 1 cannot make much of it. 
Is suffering from a chronic “ cold on his lungs,” which 
I diagnose as bronchitis—subacute, with some pulmo- 
nary congestion. Has a very harassing cough, is quite 
dyspeptic, constipated bowels, harsh, dry skin, haggard 
appearance. 
April 8th.—Placed him on the use, daily, of the stand- 
ard admixture of equal volumes of O, N20, and com- 
mon air. Lung capacity 150 cubic inches. Urine heavy 
with chlorides, etc. 
April 16th.—Decidedly relieved; coughs less, raises 
more easily, sleeps and eats better. Treatment contin- 
ued, increasing the proportion of O. Lung capacity 180 
cubic inches. 
April 25th.—Patient says he is pretty much “cured,” 
and that the treatment has benefited his general health 
more than all the tonics, bitters, and “blood renewers” 
he has ever taken. Has a more natural appetite than 
for twenty years, and is quite relieved of his habitual 
constipation. 
May 8th.—Reports himself “ well; ” no cough, respi- 
ration free and natural, all his bodily functions well per- 
formed. 
Saw this patient six months later; no relapse. 45 
Case IX.—Mrs. L. F. L , aged forty-seven, mar- 
ried ; one child, aged twenty. Family history shows 
rheumatism in her mother (arthritis, both subacute, and 
deformans), who is still living. Father dead. Brothers 
and sisters enjoy very fair health. Some twelve years 
ago had a miscarriage at three months, from which she 
made a poor recovery. Her account would indicate that 
the secundines were retained for several weeks, and 
finally expelled, with a spasmodic effort, and in a very 
fetid condition ; pelvic cellulitis supervening and event- 
uating in chronic abscess (intra-pelvic), which four 
years ago found exit through a tortuous sinus and 
reached the surface in the right labia majora. Free in- 
cision was made, and the immediate or superficial ab- 
scess cavity was syringed repeatedly with tincture of io- 
dine, carbolic acid, and glycerine. It healed, but soon 
filled again, and a careful exploration with flexible probe 
proved its origin to be as above stated, the seat of the 
original abscess being, apparently, in the vicinity of the 
right ovary. 
During the past three years patient has suffered from 
lumbo-sacral neuralgia and wandering arthritic pains. 
Six months since her neuralgia culminated in a painful 
and disabling sciatica of the left side. After exhausting 
all the domestic remedies to be had or heard of, try- 
ing salicylates, manaca, lotions, and anodynes without 
limit, she came to me in sheer desperation. I found her 
anaemic, suffering paroxysms of excruciating pain, which 
extended from the hip to the ankle ; bowels constipated 
and moved only by enemas, dysuria a frequent symptom, 
appetite wanting, and much gastric distress accompany- 
ing the process of digestion. Tonics, iron, stimulants, 
counter-irritation, the deep injection of chloroform, and 
in some of the worst paroxysms, of morphia and atropia, 
as also the constant current, were all thoroughly tried, 
and afforded some temporary relief. However, these 
remedies severely aggravated her stomach troubles, in- 
ducing intense cephalalgia and almost unendurable nau- 
sea ; and on omitting them the paroxysms returned with 
even greater severity. 46 
As a last resort I advised a persistent trial of the 
oxygen treatment ; and for the purpose of making the 
test a thorough one, took the patient into my own 
family. Her complexion is quite sallow, and skin, 
especially on her hands, covered with patches of “salt 
rheum,” which has persisted for thirty years. She suf- 
fers from periodic attacks of rheumatic headache, and 
her countenance is a petrified epitome of seriousness and 
distress. 
February ist.—Prepared a mixture of O two volumes, 
N20 two volumes, and diluted this with twenty per cent, 
of common air. Of this, four full inspirations to be taken 
at to a.m. and the same on retiring. Lung capacity ioo 
cubic inches. The first few doses of the mixture pro- 
duced such complete muscular relaxation and semi- 
insensibility that she sank helplessly to the floor unless 
supported ; no unpleasant sensations or effects superven- 
ing. 
February xoth.—Sciatica still recurs, but less fre- 
quently and with less severity. 
February 20th.—Appetite improves ; complexion a 
little clearer; no dysuria except after the use of ano- 
dynes ; discharge from the abscess less profuse and less 
fetid. Patient very impatient, and not at all encour- 
aged. 
February 28th.—No further discharge from the ab- 
scess ; digestion constantly improving ; sciatica decidedly 
modified. Lung capacity 140 cubic inches. 
March 5th.—Headaches less frequent and less severe ; 
lameness almost wholly overcome ; complexion rapidly 
improving. Patient eats, sleeps, and walks better, and 
shows a buoyancy of spirits unknown for years. Lung 
capacity 150 cubic inches. The treatment is continued 
with some interruptions, changing the proportions by 
adding twenty per cent, of common air and increasing 
to five full inspirations at each sitting, twice per diem. 
March 12th.—Improvement steadily continues in all 
directions. 
March 20th.—Is gaining flesh quite perceptibly, but it 
is as much a gain of quality as quantity. Paroxysms of 47 
headache rare and light; sciatica persists, but is mild. 
“ Salt rheum ” gone ; skm smooth as a child’s. 
April ist.—She declares she is ready to “certify” to 
any kind of statement I may ask as to the efficacy of 
the oxygen treatment. Avers that it has made her “ a 
new woman,” etc. Wants to go home. I express my 
conviction that the treatment should be continued much 
longer to insure permanent results. She goes home, 
promising to return soon, especially if any old symptoms 
reappear. 
April 24th.—Has worked considerably about the house 
and garden since last report. General health continues 
good, but sciatica returns in mild form. Again place 
her on four inspirations daily of equal volumes of O, 
N20, and common air. Lung capacity 200 cubic inches. 
May 3d.—Steady improvement since last report. Sings 
with good voice, which she has not done for years; 
walks and rides without pain or extra fatigue ; also does 
considerable light work about the house. Her complex- 
ion is now clear and fairly ruddy ; headaches slight and 
infrequent. No sciatica, no eczema. 
May 18th.—Treatment suspended. This patient has 
astonished her friends—and her physician ! 
September 15th.—Continues free from all her former 
complications, except occasional disturbances of a physi- 
ologically weak heart. Most of these are, however, at- 
tributable to her own indiscretion in the matter of active 
exertion. She has attended to active household duties 
ever since treatment was omitted. APPENDIX. 
In 1870, Dr. Andrew H. Smith read a paper on “Oxy- 
gen Gas as a Remedy in Disease,” which was made the 
Prize Essay of the Alumni Association of the College of 
Physicians and Surgeons of New York, and was pub- 
lished in pamphlet form ; later it was republished, with 
some additions, by the New York Oxygen Gas Company. 
This paper escaped my notice at the time, and not 
until the present season (1884) has a copy come to 
hand; otherwise some apology would be due to Dr. 
Smith for an apparent neglect to recognize his very 
valuable and able resume of the subject. In addition 
to his own unequivocal testimony, Dr. Smith cites many 
of the authorities quoted by me and also others whose 
reports had not come to my notice. But he seems to 
have used oxygen unmixed and unmodified, except by 
occasionally diluting it with atmospheric air. 
As will be seen by reference to what I have written on 
the subject, I have constantly insisted that the proper 
modification and dilution of oxygen, when exhibited as a 
remedy, is as essential as any other feature of the treat- 
ment. 
Nothing can be more thoroughly established, at least 
empirically, than the fact that while nitrogen monoxide 
is itself a therapeutic agent of decided value when used, 
properly diluted, by itself, it is fairly invaluable as a 
modifier, adjuvant, and synergist of pure oxygen. In 
addition to its own “tonic,” “alterative,” and soothing 
effects on the .nervous, vaso-motor, and circulatory sys- 
tems, it renders the oxygen with which it mingles more 
assimilable, and hence more promptly available in the 
general system. 49 
The precise rationale or modus operandi of this im- 
portant result it is yet impossible as well as unnecessary 
to discuss. 
Compressed or condensed air is being tried as a diluent 
and modifier of oxygen. Dr. Younghusband, of Detroit, 
reports encouraging results from the use of this agent, 
and it may, in time, be found a valuable addition to our 
resources. The careful study of its capabilities opens an 
extensive and interesting field, and no resolute or per- 
severing inquirer will be dismayed by the recent adverse 
report of Professor Germain See. His experiments are no 
more conclusive than have been those of some equally 
eminent investigators in connection with oxygen. 
Under a certain degree of tension or condensation, it is 
at least presumable that the nitrogen and oxygen elements 
of common air assume new and unusual states, from a 
changed molecular arrangement. Further inquiry in this 
direction is desirable. 
At Reichenhall, Germany, the condensed-air baths 
have been quite extensively used for some years, and the 
professional interest in them is steadily increasing. Dr. 
Von Liebig, son of the eminent chemist, has written a 
pamphlet on the subject, which does not accord with the 
unsatisfactory experiences of Professor See. However, it 
is noteworthy that the latter confines his observations to 
those maladies—chiefly cardiac complications—in which 
Dr. Von Liebig asserts that the condensed-air treatment 
is contra-indicated. 
There are many morbid conditions, particularly visceral 
congestions and capillary engorgement, in which con- 
densed air, either by inhalations or by general baths, is 
rationally indicated; for in addition to the marked im- 
pression which may be produced on the entire physical 
economy by a gradual but distinct change in the pressure 
of the surrounding media, as well as of the air inspired, 
it is evident that the system at the same time receives, 
and doubtless utilizes, an increased quantity of oxygen. 
Therefore, while I appreciate the valuable work done 
and research made by Dr. Smith, he certainly fell short 
of the fullest measure of success by neglecting to make 50 
use of any form of modifier or adjuvant with his oxygen, 
as well as by want of thoroughness and care in his method 
of evolving the gas. 
Despite these serious drawbacks, this earnest and 
accomplished experimenter arrived at results which ought 
to have commanded more attention from the general pro- 
fession. 
I take pleasure in quoting some of his conclusions, 
which, from my own experience, I can fully corroborate. 
It is to be hoped Dr. Smith will not permit his Prize 
Essay to be the sum total of his contributions to the 
literature of pneumatic medicine. 
“ When we shall be able to regulate the proportion of 
oxygen in the atmosphere of the sick-room as easily as 
we now regulate the temperature ; when closely packed 
and ill-ventilated tenements can be supplied with this 
element, the free enjoyment of which is necessary to 
health; when by its use the contamination of the atmo- 
sphere by the furnaces of factories and machine-shops 
shall be prevented or counteracted, who can tell what 
will be the sum total of the result ? Yet all this seems 
now attainable whenever the public shall become suffi- 
ciently awake to its importance” (p. 9). 
“Small quantities of oxygen inhaled daily frequently 
have the effect of stimulating the appetite to a remarka- 
ble degree. . . . That the increased amount of food 
is assimilated is shown by a corresponding gain in weight ” 
(p. 20). 
“ The effects heretofore obtained have resulted from 
a hap-hazard use, such as in the case of any other remedy 
would have insured its total failure. Only when we 
learn to use it with the same discrimination and care that 
we exercise in the use of opium or strychina, shall we 
know the limit of its power for good ” (p. 33). 
“ There is much to encourage the systematic use of 
oxygen in phthisis. Indeed, considering the extremely 
limited number of cases in which it has been thoroughly 
tried, and our ignorance as yet of its proper manage- 
ment, the results may well challenge comparison with 
those from any other mode of treatment” (p. 39). 51 
He [Trousseau], whose knowledge of therapeutics 
has rarely, if ever, been surpassed, speaks of having by 
its means in several instances ‘ recalled to life women 
regarded as lost,’ from great depression of the diges- 
tive powers consequent upon puerperal hemorrhage or 
excessive lactation” (p. 41). 
Among the diseases named by Dr. Smith as having, on 
the authority of eminent observers, including Trousseau, 
Demarquay, Byfield, Goolden, Kollmann, Hooper, La 
Passe, Mackey, Beddoes, Ramskill, Birch, etc., been 
cured or greatly improved under oxygen treatment, I 
may mention ancemia, asthma, Bright's disease, capillary 
bronchitis, consumption, croup, cardiac diseases, diabetes, 
diphtheria, epilepsy, emphysema, gout, neuralgia, pneu- 
monia, poisoning from chloroform, opium, chloral, etc., 
etc. 
It has been tried in cholera, a few authorities report- 
ing marked and immediate success, the majority, how- 
ever, abandoning it. These failures are no more conclu- 
sive than the many failures reported in connection with 
other diseases in which other observers have achieved 
the most marked success. Hence no earnest experi- 
menter need be discouraged by them. 
It is not impossible that hydrophobia, hitherto consid- 
ered intractable, will eventually be made to succumb to 
oxygen. 
A correspondent of the New York Herald asserts that 
a discovery of a cure for the fearful malady (rabies) has 
been made in Russia, this remedy being pure oxygen. A 
little Russian girl was recently attacked by the disease, 
and the physician thereupon made her inhale three 
cubic feet of oxygen. In the course of an hour and a 
half all the symptoms disappeared, and the child re- 
mained calm. On the next day but one the malady re- 
turned in all its distressing characteristics. A fresh in- 
halation of oxygen was tried, and at the end of forty-five 
minutes the attack subsided and never returned. 52 
A new method for obtaining oxygen cheaply is an- 
nounced by M. Zenno. The full details are not given, 
but it is stated that the gas is obtained by the reaction of 
potassic permanganate and baric peroxide, placed to- 
gether in water. These salts are cheap, and are said to 
yield two hundred centimetres of the gas for every 
gramme of the mixture. A cheap supply of oxygen 
would be more valuable to the world than the discovery 
of a score of silver mines.