CHAPTER XI – CARBON DIOXIDE GAS APPLICATION IN RHINITIS
John Kanold, in the year 1708, wrote: “It is to be hoped that at this time no one who has common sense will deny that the historia morborum is the most important and most valued support of the whole of medicine, because, by thorough knowledge of this history, we learn to arrive at the true pathologico-etiologic conception, and consequently we find the necessary and reliable indicationes curative.”
The historical chapter demonstrates how well these words of Kanold apply to the present conditions. From the history of the carbon dioxide treatment, we can learn a great deal to find the necessary and reliable indications curative in regard to rhinitis.
Percival, as mentioned in the historical chapter, successfully treated ozena (atrophic rhinitis) by local applications of carbon dioxide gas. It was brought in contact with the nasal cavities through tubes. He speaks of this remedy as the best means of curing the offensive odor of ozena. Many physicians of the eighteenth century have used and recommended it in the treatment of ozena, but in our modern literature this is not even mentioned, altho Demarquay again, in the middle of the nineteenth century, wrote: “The douches ( carbon dioxide) modify and promptly cure the morbid discharges of the Schneiderian membrane.” Except in the writings of Demarquay, I did not find records of new observations of the employment of carbon dioxide gas in rhinitic affections until the quite recent publications of Dr. Joal, a French physician. He found that the gas acted as a vasoconstrictor, as an anesthetic, and as an antiseptic. He describes the effects as follows: When the gas is brought in contact with the nasal mucous membrane it produces at first a prickling but quite tolerable sensation, followed by an agreeable, refreshing effect of warmth and dryness. The examination of the mucous membrane shows reduced sensibility to such an extent that otherwise painful cauterizations and explorations will cause no pain; then follows excitation of the nerve ends, producing vasomotoric dilatation and glandular hypersecretion; after this nervous activity becomes exhausted, the vessels become constricted, and again anesthesia will be noted.
The best results were observed in the treatment of hyperesthetic rhinitis, especially in that form which characterizes hay fever.
In case the application of the gas does not cure completely vasomotoric coryza, it will at least ameliorate to a marked degree the inflammatory symptoms.
Dr. Joal believes also that the employment of carbon dioxide gas is indicated to combat the microbic element of hay fever; he believes in the antiseptic effect of carbon dioxide in these instances. I have not been able to see the original of Dr. Joal’s report. In the extract from which I quote, nothing is said upon which facts Dr. Joal bases his theory. All I know is that carbon dioxide as an antiseptic is of limited value. I may be permitted to repeat here what I said in the chapter on dysentery. When antiseptic principles were first established in the treatment of wounds, all wound remedies were tried as to their germicidal powers. In regard to carbon dioxide we know now that certain bacteria can live and thrive in it almost as well as in atmospheric air; that others develop imperfectly or slowly, and that a third-class grows in it only when the cultures are exposed to breeding temperature. Saprophytes, altho they do not thrive in it, do not perish in carbon dioxide. It does not affect the bacillus of typhoid fever, but it destroys the bacteria of anthrax and cholera. It interested me very much to learn from Dr. Alice Byram Condict, of Bombay, India, one of the matriculates of the New York Post Graduate Medical School, while I was lecturing on carbon dioxide before the class, that the physicians in India—the home of cholera—insist strictly that people should drink no other water than that charged with carbon dioxide.
According to Joal’s and my own experience carbon dioxide gas is to be regarded as a remedy of the first order in the initial stage of ordinary rhinitis, but in all forms of rhinitis as a means to ameliorate the intensity of the symptoms.
Finally, he describes a case of anosmia which he cured by means of carbon dioxide gas applications.
It is impossible to exaggerate when I speak of the gratifying effect of the nasal carbon dioxide gas douche in the case of children, even in infants; but most of all in nasopharyngeal diphtheria. Here it surpasses by far the methods of irrigation or syringing, which are so disagreeable and by no means harmless. While children will struggle and rebel against the syringe and irrigator, they like the gas application so much that they ask for it after they have once experienced the pleasant effect. The nose becomes cleared of the accumulated mucus and matter, and the little patient can keep the mouth closed and breathe freely through the nose. They apply the nozzle themselves as soon as they again feel the necessity for relief.
A curious observation which will prove of importance if it becomes confirmed in more instances is this: I found that patients once treated for some length of time with nasal carbon dioxide gas douches lost the vulnerability of the Schneiderian membrane, inasmuch as they no longer suffered from their accustomed rhinitis during the cold season.
The first apparatus which did good service and which has the advantage over the others that it can be easily improvised, as a rule, with the aid of a nearby druggist, consists of a bottle, holding a pint or a little less, with a wide neck and a rubber stopper perforated so as to admit a tube, with a nozzle, as the case may be, for nose, rectum, or vagina. A solution of about 6 drams of bicarbonate of soda in about 6 or 8 ounces of cold water is introduced into the bottle, and 4 drams of crystallized tartaric acid (if pulverized acid is used the development of the gas goes on too rapidly) are added. The larger these crystals are the better. Instead of the tartaric acid crystals, discs of acid sulfate of soda may be used. It may be easier to find large citric acid than tartaric acid crystals in the drugstores. It is of course immaterial which of the two we choose. The bottle is then closed, and the carbon dioxide developing in the water rises through the tube, the nozzle of which has been placed in position. This form of gas generator serves quite well to apply the gas to the nasal cavities, to inflate the rectum, and in some instances, it can be used to give vaginal gas douches (see Fig. 2). Gas develops during about ten to twelve minutes. Its disadvantage is that the current of gas can be neither regulated nor interrupted.
A much better apparatus, especially convenient for use in our office, is the one represented in Fig. 1, made by the Kny-Scheerer Company, consisting of a gas drum containing about two and one-half pounds of liquid carbon dioxide. The current of gas passing through a tube (leading into a wash bottle as shown in the cut) attached to the drum can be regulated to a nicety and its strength is watched with exactness
Both contrivances are of great simplicity, and there can be no reasonable objection to introducing them into practice.