Friday, May 13, 2016

1890: Blodgett first to recommend continuous oxygen

Throughout most of the 19th century, when oxygen was prescribed by physicians, which wasn't very frequently, it was prescribed intermittently, which meant that it was only inhaled by the patient for 2-3 hours a day for a few days or weeks.  So when Dr. Albert Novatus Blodgett proposed the idea of inhaling oxygen continuously in 1890, it was a new idea. (2)

He described in the Boston Medical and Surgical Journal a woman who presented with all the symptoms of severe pneumonia, including cyanosis and air hunger.  His patient was a 46 year old woman suffering from pneumonia.

He said the recommended administration of oxygen that he was aware of was "two or three gallons at a time, several times daily." He decided this recommendation was the next proper course of action.  He said: (3, pages 482-483)
At this time I advised the use of oxygen gas, in the hope to increase the respiratory function by furnishing the limited lung-area with an augmented amount of oxygen, so that the condition of the circulation might be improved, and possibly the constant apprehension of asphyxia be relieved. I cannot say that I looked for any permanent good from it, but I hoped to at least gain for the patient the comfort of euthenasia. The gas employed was diluted with ten per cent, of nitrous oxide, and in this form caused no appreciable sensation of discomfort to the patient. The amount given was limited to a few gallons, the exact quantity not being ascertained, owing to a leak in the holder, but the effect was soon noticeable in the appearance of the patient, who became much more quiet, and was relieved to a great degree of the embarrassment in respiration. The face soon became less dusky, the con- junctival clearer ; the intelligence of the patient was much benefited, and she expressed herself as feeling better. The oxygen was now withdrawn, and the patient fell into a gentle sleep. (3, page 482)
However, by 3 a.m. the next morning the patient was in respiratory distress once again.  At this time Dr. Blodgett said he recommended oxygen again.  The patient benefited from this as before, and then the oxygen was withdrawn.

Yet the symptoms returned again by 8 a.m. later that morning.  This time, he decided to do administer the oxygen for a longer period of time. However, when he discussed this idea with the dealer of the oxygen, he was concerned about the risks of doing so.  Of this, Blodgett said:
The dealer who supplied the gas was astonished at the amount re- quired, and, thinking to do me a service, sent me a cautionary message, implying that no human being could possibly stand so great an amount of oxygen, on account of the dangerous degree of stimulation to the system and the increased combustion of tissue.
However, he decided to go forward with it anyway, noting that he did this...
...under the positive conviction that the patient was irrevocably doomed, and the best result that I looked for, was simply relief to the sensation of suffocation, and not any curative action. (3, page 483)
So, he said:
At this time I directed the continuous employment of oxygen, as the only means of prolonging life, and averting the paroxysms of distress which recurred at intervals. The gas was conveyed from the tank in which it is supplied through a wash-bottle directly to the mouth of the patient, and a constant stream of gas was flowing through the tube all
the time, so that with each of the rapid respirations the patient was obtaining a constant increased amount of oxygen. This method of administration, of which I have thus far found no account in the means of information at my command, seemed to afford considerable
relief in a short time, and after watching the case for an hour, I left, giving directions to continue the gas. (3, page 482)
The patient was kept on oxygen for a period of 106 hours, which amounted to about 200 gallons in 24 hours.  The modern equivalent to the amount of oxygen given by Blodgett would have been 6lpm, or about 44% oxygen. (2) (3, page 483)

This was the longest amount of time a patient had ever been on supplemental oxygen prior to this time.  Blodgett said that while "judicious employment" of oxygen in similar situations will not cure a patient, "I think that many cases will be found in which the period of greatest danger may be safely tided over,which would otherwise unquestionably be lost." (3, page 483)

While this experiment proved the usefulness of continuous oxygen, it would be another 30 years before it would be adapted by the medical profession as a recommended treatment for anoxia.

  1. Brainbridge, William Seaman, "Oxygen in Medicine and Surgery -- a contribution with report of cases," New York State Journal of Medicine, 1908Vol. 8, June, No. 6, pages 281-295
  2. Grainge, CP, "Breath of Life: the evolution of oxygen therapy," Journal of the Royal Society of Medicine, October, 2004, 97 (10), pages 489-493
  3. Blodgett, Albert Novatus, "The continuous inhalation of oxygen in cases of pneumonia otherwise fatal, and in other diseases," Boston Medical and Surgical Journal, 1890, 123 (21), pages481-484

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