Friday, June 3, 2016

1800-1900: Oxygen used to treat asthma

The first known person to recommend supplemental oxygen therapeutically was Thomas Beddoes, who inhaled oxygen every day.  He performed various studies using the gas, applying it to various patients, including those inflicted with tuberculosis and asthma.  He showed oxygen could be useful as a marketable drug to treat diseases.

Yet, like most new discoveries in medicine, oxygen therapy for diseases did not catch on right away, wrote Brainbridge in a 1908 article in the New York State Journal of Medicine.  While it was used from time to time, he said:
"Here, as elsewhere, however, the efforts were desultory and ephemeral, and the quarter-century following the discovery of oxygen found its position as a therapeutic agent still anomalous." (1, page 282)
Brainbridge explained that it wasn't until 1818 that "the true value of oxygen came to be recognized."  It's increase in use was due to the appearance of the monograph, or detailed paper or study on one subject, according to  (1, page 282)

Yet it wasn't used as a medical gas until 1832 due to an episode of cholera in Europe.  Then it's use faded and it wasn't until another quarter century that it received attention again. (1, page 282)

He said there was a renaissance of oxygen usage in 1857 due to the works and writings of S.B. Birch of London.  Between 1860 and 1870 Ernst Victor von Leyden (the same guy who discovered crystals in sputum) experimented with oxygen.  Yet he didn't get significant results and abandoned his research. (1, page 282)

Soon thereafter many prominent physicians began to recommend it, including Rene Laennec, the famed physician who invented the stethoscope.

According to an 1882 article in Arthur Home Magazine, Dr. Armand Trousseau (1801-1867), of Paris, in his work on Therapeutics, gives the names of nine physicians who recommend the use of oxygen to treat asthma. (3)

The writers quote Trousseau:
"The attack of Asthma is an affection very suitable for the use of oxygen. What more rational than to offer a purer and more vivifying air to the unhappy patient who inspires so little oxygen and becomes asphyxiated? At the very best Beddoes used it with the greatest success; then Marching; Poulie of Montpelier, in 1782; Stoll in 1774; Chaptel, and at last Thornton, partner of Beddoes, who gave it to a great many patients, and declared that the asthmatics were extremely relieved in the immense majority of cases."
Trousseau likewise adds,
"The experience we have had of oxygen in Asthma is very encouraging, and there are few remedies which give hope of such a speedy relief, except the bath of compressed air."
Emphasis was added by the original author.

By 2012 we know that oxygen is not necessary in mild or moderate cases of asthma, yet as the acute exacerbation turns into status asthmaticus, and mucus plugs start to block off parts of the lungs, the intake of oxygen may become inhibited and supplemental oxygen helpful.

While oxygen won't cure the asthma episode, it will treat the symptom of hypoxia until other remedies resolve the exacerbation.  The same is true for oxygen use for other disorders, such as and chronic bronchitis, pneumonia and heart failure.

Although, in all due fairness, Trousseau, as with other physicians of his era, might easily have confused these diseases with asthma, which was still a rubric term for dyspnea caused by anything except for diagnosed tuberculosis or pneumonia.

According to an 1861 editorial in The Cincinnati Lancet & Observer, most authors originally believed oxygen actually treated the disease of asthma.  As noted:
In the disease, says Professor J. Rowell, the lungs are so constructed that they cannot furnish to the blood its wonted amount of oxygen and eliminate from it carbonic acid.  The treatment (of oxygen), therefore, has either to relax the spasm of the bronchial tubes and thereby increase the breathing capacity of the lungs, or further an atmosphere for the respiration of the patient richer in oxygen, proportionate to the diminished capacity for breathing."  (2, page 564)
Yet oxygen alone should not be used.  The authors recommend if oxygen is needed, it should be supplemented by inhaling strammonium or chloroform, or by rubbing chloroform on the chest, or by burning selpetre paper (thought to make the air "richer" in oxygen).

The authors further add:
"The Chlorate of potassa... gives the same and greater relief, because from it more oxygen is eliminated.  Better still is oxygen carefully prepared and set free in the sick room, or inhaled from an ordinary gas-bag, diluted with one, two, or three measures of atmospheric air.  (2, page 564)
So this was the beginning of the use of oxygen to treat asthma and other disorders of the lungs.

  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. Stevens, Edward B. Stevens, John A. Murphy and Gustav C.E. Weber, editors, The Cincinnati Lancet & Observer, editorial, 1861, volume 4, Cleveland, page 564
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