Carbon Dioxide in Medicine was published already in 1905. At the time of publishing, Dr. Achilles Rose and his colleagues had already given carbon dioxide to their patients for more than 20 years. The book is a fascinating read and a great testimony to the success of carbon dioxide treatments.
Among the transactions of the Congress of Balneologists which met in Berlin from March 9 to March 13, 1905, perhaps the most important were the papers read by Hornberger and Fellner on the effect of carbon dioxide baths. These two papers are certainly the best which have been written on the physiological action of carbon dioxide externally applied. They present investigations of Winternitz, Fellner, Hornberger, and others, which furnish a scientific basis for a number of facts, thus far only empirical. These publications, of which I have availed myself, reached me just in time before I placed the manuscript of this book in the hands of the typographer.
The history of carbon dioxide in medicine is very little known. At least, textbooks hardly speak of it. The material for the historical sketch here given I found in great part in French and German books not translated into English. Among these was Lavoisier, ” Methode de nomenclature chimique. Memoire sur la necessite de reformer la nomenclature de la chimie,” lu à I’ Assemble publique de I’ Academie Royale des Sciences du 18 Avril 1787. This precious and probably rare book I found in the New York Academy of Medicine. It had formerly belonged to the library of the New York Hospital. Some of my readers will be pleased to have their attention called to it.
In writing the chapter on the Physiology and Chemistry of Respiration I availed myself of Hammarsten, “Lehrbuch der physiologischen Chemie.” Several chapters are to some extent a reproduction of papers published by me during the last twenty-two years. The observations on the value of carbon dioxide in dysentery, rhinitis, vomiting in pregnancy, and the solution of the problem of curing rectal fistula without operation I am confident will be confirmed in time, despite misocainia, with which we have to reckon when presenting a new subject.
I desire to express my gratitude first of all to Dr. E. C. Dent, the Medical Superintendent of Manhattan State Hospital, Wards Island, for his courtesy in permitting me to introduce carbon dioxide gas baths in his institution, and to the members of the staff of Manhattan State Hospital, among these especially my friend Dr. R. C. Kemp. They all aided me generously in my investigations. I wish to express my thanks also to my colleagues of the New York Post-Graduate Medical School: Drs. Thomas E. Satterthwaite, Duncan Macpherson, and Frank Newton Irwin, who took an active interest in my modest labors.
Friends have asked me how I came to devote myself to the study of carbon dioxide. This question always brought to my mind an anamnesis: the memory of my dear old friend Mr. Thomas Warker who early excited my interest in it. During the last decades of his life, he had been industrious and indefatigable in inventing contrivances for the application of carbon dioxide. His relations with Demarquay had inspired him with enthusiastic faith in the future of carbon dioxide in medicine.
A Rose, New York August 20, 1905
I. The Physiology and Chemistry of Respiration
II. History of the Use of Carbon Dioxide in Therapeutics
III. Inflation of the Large Intestine with Carbon Dioxide Gas for Diagnostic Purposes
IV. The Therapeutic Effect of Carbon Dioxide Gas in Chloriasis, Asthma, and Emphysema of the Lungs
V. Carbon Dioxide Gas in the Treatment of Dysentery and Membranous Enteritis and Colic
VI. Carbon Dioxide Gas in the Treatment of Whooping Cough
VII. Carbon Dioxide Gas in Impotence and Some Gynecological Affections
VIII. On the Effects of Carbon Dioxide Baths on the Circulation
IX. Rectal Fistula Promptly, Completely, and Permanently Cured using Carbon Dioxide Application
X. Carbon Dioxide in Chronic Suppurative Otitis and Dacryocystitis
XI. Carbon Dioxie Application in Rhinitis
XIII. The Continuous Warm Bath
CHAPTER I – THE PHYSIOLOGY AND CHEMISTRY OF RESPIRATION
Carbon dioxide is a constant constituent of the animal organism, the minor portion being supplied by the atmosphere. The absorption of carbon dioxide from the atmosphere is partly due to the respiratory function of the skin. Abernethy (1764-1831) already had demonstrated that the skin is a vast respiratory surface; it is true it can not be compared with the lungs, but it is nevertheless very efficient. Abernethy’s experiments to find the degree of absorption of different gases by the skin shows that, after oxygen, carbon dioxide is the most absorbable.
Carbon dioxide is taken up also through nutrition, but the larger part is derived from the tissues and the blood, and forms one of the most important end-products of oxidation and tissue metamorphosis. It develops the effects of a weak acid as well as those of an excitant and paralyzing agent, similar to alcohol. It enters the blood in the capillary circulation from the tissues in which it is formed.
The gases occurring in the blood under ordinary physiological conditions are oxygen, carbon dioxide, and nitrogen. The latter is present only in minute quantity and seems to play no important role in the vital processes, its quantity in different parts of the circulation being approximately the same.
The amounts of oxygen and carbon dioxide present differ, not only in the blood derived from various parts of the circulation but also in their correspondence to the rapidity of the blood current, the different temperatures, rest, labor, etc.
According to Setschenow, oxygen is contained in the arterial blood of man to the amount of 21.6 percent by volume. The amount carried by the venous blood differs. Ludwig and Szeltcow found 6.8 percent of oxygen by volume in the venous blood of nonactive muscles, and still smaller quantities in that of those in action. Oxygen is entirely absent, or present only in traces, in the blood of the asphyxiated. Zuntz states that the venous blood of the right heart contains on an average 7.15 percent less oxygen than the arterial blood.
The proportion of carbon dioxide contained in the arterial blood is usually forty percent by volume, but varies between thirty and forty percent. It always corresponds exactly, or very nearly, to the amount contained in the air of the alveoli. Every change in the composition of the alveolar air must be followed by a corresponding change in the tension and the absolute quantity of the carbon dioxide in the arterial blood. Again, the carbon dioxide tension of the arterial blood affects primarily the diffusion between the blood and the tissues; hence any variation in the proportion of carbon dioxide in the alveolar air, when continuing for some time, will cause a corresponding change in the proportion- of the carbon dioxide in the blood and tissues, where it is always found in considerable quantities.
The proportion of carbon dioxide contained in the venous blood varies still more. According to Zuntz, the venous blood of the right heart contains 8. 2 percent of carbon dioxide more than the arterial blood. The average quantity is about forty volumes percent. In the blood of the asphyxiated Holmgren found even 69.21 volume percent of carbon dioxide.
Almost all the oxygen in the blood is loosely held by the oxyhemoglobin, and only a small portion-0.26 percent-is absorbed by the plasma or serum. The circulating blood does not appear to carry oxygen entirely up to the point of saturation. Of the carbon dioxide found in the blood, the smaller portion according to the examinations of Alex. Schmidt, Zuntz, and L. Frederiks at least one-third-is contained in the blood-corpuscles, by far the larger quantity being carried by the plasma and serum.
The carbon dioxide in the blood-corpuscles forms a loose chemical union, first with the alkalies which there enter into combination with phosphoric acid, oxyhemoglobin, or hemoglobin and globulin; and, secondly, with the hemoglobin itself. The red blood corpuscles do not contain enough alkali phosphate to be of importance in the formation of carbon dioxide. In all probability, the diphosphates present are converted into monophosphates and alkali carbonates when the partial pressure of carbon dioxide is increased, while, when the same is diminished by the preponderance of phosphoric acid, a reformation of diphosphates takes place and carbon dioxide is again liberated. It is generally conceded that the blood-coloring matters, especially oxyhemoglobin, which by its presence in vacuo with bicarbonate of soda causes the liberation of carbon dioxide, act similarly to acids; and, since the globuli have a similar action, they may also occur in the blood corpuscles as alkali compounds. The alkalies of the blood-corpuscles die when thus found in combination with phosphoric acid, carbon dioxide, and such parts of the corpuscles-e.g., the coloring-matter-as act similarly to acid. In the presence of a preponderance of or of a greater partial pressure of carbon dioxide, bicarbonates may be formed at the expense of the diphosphates and the alkali compounds just mentioned; while, when the partial pressure of carbon dioxide is lowest, a reformation of the diphosphates and the alkali compounds will take place, and carbon dioxide will be liberated from the bicarbonates.
The investigations of Setschenow, Zuntz, Bohr, and Torup, however, make it appear probable that hemoglobin itself, even in the presence of alkalies, can loosely bind carbon dioxide. Bohr found, in addition, that the curve showing dissociation of carbon dioxide hemoglobin, and that showing increase or decrease of carbon dioxide in the blood, essentially correspond; and hence Bohr and Torup ascribe considerable importance to the hemoglobin itself, rather than to its alkali compounds, in the formation of carbon dioxide in the blood. Moreover, hemoglobin possesses the ability to absorb the two gases, oxygen, and carbon dioxide, both independently of each other and simultaneously. Bohr believes that the granules of coloring matter absorb the oxygen and that the carbon dioxide is bound by the albumin component. The main amount of carbon dioxide in the blood is found in the plasma or serum. It is more abundant in the serum than in the other constituents. We find the carbon dioxide in the serum and blood-plasma distributed as follows:
1. A part is simply absorbed.
2. Of the remainder the larger part is loose, the smaller part in firmer, chemical union.
The quantity which is simply absorbed can not be exactly determined. Setschenow estimates that in the serum of the dog it forms about one-tenth of the entire carbon dioxide contained in the blood. The quantity of carbon dioxide in a firm chemical combination must be determined by the amount of alkali carbonates; it is, however, not exactly known, since the alkalies of the blood are not only associated with carbon dioxide, but also with other components, especially with the albumins.
Part of the loosely bound carbon dioxide of the serum which can be separated by the exhaust pump is found as bicarbonate; in fact, alkali is the most essential and most important component uniting with carbon dioxide in the blood serum as well as in the blood itself.
The amount of carbon dioxide in the blood lessens with a lessening amount of alkali. Such is, for instance, the case when poisoning with mineral acid takes place. Thus Walter found only 2.3 volumes percent of carbon dioxide in the blood of rabbits, into the stomach of which he had introduced hydrochloric acid. It seems as if, during the comatose stage of diabetes mellitus, the alkali of the blood was saturated to a large extent by acid combinations (oxybutyric acid). Minkowski found only 3.3 volumes percent of carbon dioxide in the blood of a comatose diabetic.
The oxygen of the blood exists in dissociable combination with the hemoglobin; and this combination, the oxyhemoglobin, depends on a certain partial pressure of the oxygen, which pressure varies with the temperature. The same is the case with carbon dioxide in the blood, that contained in the corpuscles as well as that in the plasma; it exists there in combinations which depend to a high degree on partial pressure. As we see from the foregoing, quite a number of elements act together with carbon dioxide, making it apparently impossible to decide the quantitative part of every single factor in the entire effect.
It is of great importance to know the amount of tension of oxygen and carbon dioxide in the blood, in order to decide the question of the exchange of gases between the blood and the alveolar air on the one hand, and the blood and the tissues on the other; and especially to decide how far this exchange of gases takes place under the law of diffusion, and how far other forces may be active.
The change of gases in the tissues, the so-called internal breathing, takes place in the following manner: Oxygen leaves the capillaries to enter into the tissues, and simultaneously the main mass of the carbon dioxide of the blood which is derived from the tissue leaves the latter and enters into the capillaries. The change of blood in the lungs, the so-called external breathing, is the taking up of oxygen by the blood from the air in the lungs and giving up carbon dioxide to the latter.
These processes of the double gas exchange are not yet sufficiently explained. The question which is yet to be solved is: Does the exchange of these gases take place in consequence of the difference between their tensions in the blood and the air in the lungs and the tissues respectively, or through the laws of diffusion, or are there other factors in operation?
Oxygen in the blood exists for the most part as oxyhemoglobin. To find the tension of oxygen in the blood it is necessary, first, to consider the laws of dissociation of oxyhemoglobin. G. Huefner and others have examined this dissociation under the temperature of 35° and 39° C (95°and 102° F), and their experiments have shown that when the partial pressure of oxygen is reduced to the level of the pressure existing in atmospheric air, there is no marked influence noticed regarding the quantity of oxygen, either in the blood or in a correspondingly concentrated oxyhemoglobin solution. The investigators— Paul Bert, Herter, and Huefner—have found by their experiments that the tension of oxygen in the arterial blood at the normal temperature of the body is equal to an oxygen partial pressure of 75-80 mm. of mercury. The tension of the oxygen of the air in the lungs was compared with these figures.
Numerous investigations regarding the composition of the inspired atmospheric air as well as the air of expiration have been published. These two kinds of air have on an average, at 0° C and under a pressure of 760 mm. of mercury, the following composition expressed in volumes percent:
|Air of expiration||16.03||79.59||4.38|
The partial pressure of the oxygen in the atmospheric air the barometer having the average 760 mm. corresponds with a pressure of 159 mm. of mercury. The loss in oxygen which the air of inspiration sustains during respiration is therefore 4.93 percent, while the air of expiration contains about one hundred times as much carbon dioxide as the air of inspiration.
For the exchange of gases in the lungs, the composition of the alveolar air is of paramount significance. Of the composition of this air in man, we possess no positive but only approximate calculations; the probable amount of carbon dioxide contained in the alveolar air has been set down at 5.44 percent, the amount of oxygen as 14.96 percent-the latter corresponding with a partial pressure of 114 mm. of mercury.
Bohr believes that the lungs take an active part in the absorption of oxygen; other authors have controverted this assumption. The present state of the question is such that we can not produce sufficient reasons for abandoning the view as yet generally adopted, viz., that the entrance of oxygen into the lungs takes place simply through diffusion; and further, after what has been said of tension and dissociation of oxygen in the blood, it is to be supposed that the amount of oxygen in the blood, at least within certain limits, does not especially depend on the amount of oxygen in the atmospheric air. Indeed, it is known that the increase of the oxygen pressure, even to the strength of one atmosphere, has no essential influence on either the amount of oxygen taken into the lungs or the amount of carbon dioxide which is exhaled.
Paul Bert found that animals placed in pure oxygen under a pressure of three atmospheres, or in ordinary atmospheric air under a pressure of fifteen atmospheres, have convulsions and quickly perish; whence it would appear that oxygen at high tension is inimical to life.
This oxygen intoxication is characterized by an extraordinary reduction of the consumption of oxygen and by the formation of carbon dioxide. All organisms, animal as well as vegetable, succumb alike. Even seeds of plants which in general are possessed of great power of resistance lose for a certain time, when exposed to oxygen under high pressure, their germinative power. Oxygen exerts a deleterious effect on the different organisms when they are exposed to it for a greater length of time, even at a tension far below the one which kills quickly. Bert observed that the development of eggs and the metamorphosis of insects were injured by a long stay in pure oxygen under ordinary pressure. When we inhale pure oxygen its consumption and the formation of carbon dioxide become diminished. The deleterious effects of excess oxygen and overaccumulation of carbon dioxide when occurring together cause an animal to perish even when neither of the two gases by itself is present in a dangerous dose.
Pflueger, in order to bring the remarkable effects of compressed oxygen nearer to our understanding, has called attention to its analogous behavior toward phosphorus. In pure compressed oxygen phosphorus does not give light and does not absorb oxygen; as soon, however, as sufficient nitrogen is added, or the pressure is diminished, the production of light takes place and the oxygen becomes absorbed.
Although carbon dioxide is a matter for excretion and life can be continued only when this gas is eliminated from the system regularly by rhythmically recurring respiration, it would be erroneous to deny it any further role in the economy of the system. The carbon dioxide in our system, with its normal quantitative changes, seems to be necessary to excite important vital functions, especially respiration and circulation. The symptoms of intoxication making themselves noted at the respiratory pneumogastric and the vasomotor centers when excessive quantities of the gas have been inhaled may be explained, to some extent at least, as suggestions of normal physiological processes.
The tension of the carbon dioxide in the blood has been calculated in various ways by Pflueger and his pupils, Wolfberg, Strassburg, and Nussbaum. According to Strassburg, it is 2.8 percent of one atmosphere, corresponding to a pressure of 211 mm. of mercury. Nussbaum found in the blood from the right heart a carbon dioxide tension of 3.81 percent of one atmosphere, corresponding to a pressure of 28.95 mm. of mercury. Bohr, by his experiments on carbon dioxide tension, arrived at other figures.
A comparison of the carbon dioxide tensions in the blood and in the tidal air showed in several instances a greater carbon dioxide pressure in the air of the lungs than in the blood, and the maximum difference was 17.2 mm. in favor of the air of the lungs. The alveolar air contains more carbon dioxide than the air in the bronchi; therefore Bohr’s experiments show that the carbon dioxide in the alveoli has moved against the higher pressure. It has been assumed that oxygen has a certain significance in regard to the elimination of carbon dioxide in the lungs. Some attribute to oxygen the power to drive the carbon dioxide out of its combinations in the blood. Experiments seem to show that the oxygen from the alveoli, entering into the blood, intensifies the tension of carbon dioxide, and hence that the oxygen becomes an auxiliary factor for the elimination of carbon dioxide. This assumption, however, has met with opposition, and the question is yet an open one.
Concerning the elimination of carbon dioxide gas in the lungs, we are still without convincing reasons for abandoning the generally adopted view; according to which the carbon dioxide gas coming from the blood enters the lungs simply by the law of diffusion. There is a considerable difference of pressure in regard to the oxygen in the blood and the oxygen in the tissues, and, owing to this difference of pressure, the tissues are supplied with the necessary amount of oxygen. Quite the opposite is the case with carbon dioxide; the tension is higher in the tissues than in the blood, and all the investigations thus far made have produced no evidence against the assumption that carbon dioxide from the tissues enters the blood simply by the laws of diffusion.
Considering even superficially the quantities of oxygen in the blood, it appears at once plain enough that the main amount can not have been absorbed physically; for the serum of the blood, as a solution of different substances, absorbs less oxygen than pure water. It can absorb hardly 0.3 volume percent of oxygen from the atmospheric air at the ordinary temperature of the body. In reality, however, arterial blood holds not less than seventy times this quantity of oxygen.
The same law applies to carbon dioxide, the larger part of which, as has been shown, is held in a chemical union in the blood and can not to any great extent be absorbed physically. The partial pressure of the carbon dioxide in the blood is much too small to allow the gas being simply absorbed. The carbon dioxide tension in the venous blood of the dog is 41 mm. of mercury. This would permit 2.5 volume percent of carbon dioxide to be physically absorbed therein, while, according to the same reasoning, arterial blood would show only about half that amount. In reality, however, the venous blood contains forty-six and the arterial thirty-eight volume percent of the gas.
A comparison of the gases of the arteries with those of the veins is of great importance, because it furnishes directly the evidence that real processes of combination do not occur to any considerable extent in the lungs, but that almost the whole amount of oxygen which has entered the lungs can be separated from the blood of the arteries using the exhaust pump.
The mass of inspired air has to be divided, in regard to its action on the renewal of the air in the alveoli, into two parts. A certain amount remains in the upper air-passages and is removed again by expiration. The rest enters into the alveoli to mix with the air which is already there. On account of the smallness of every single infundibulum, the diffuse mixture of old and fresh air likely takes place instantaneously, while the bronchial tubes are too long to allow the exchange of their gases with those of the alveoli by diffusion, which could hardly be accomplished in the time between two respirations.
The next process in respiration is that air from the alveoli takes the place of the expired contents of the bronchi, and only when the extent of the expiration exceeds in volume that of the air-passage will alveolar air pass out directly. The movements of respiration, therefore, can have but little success when the volume of each expiration does not exceed that of the air-passages – that is, does not more than exhaust the contents of the air-passage. Thus a very superficial breathing will only insufficiently ventilate the alveoli, even though the frequency of respiration is increased. The residual air, which during lifetime can not be expelled from the lungs, has been calculated by Vierordt to be from 1,230 to 1,640 c.c.
The expired air is richer in carbon dioxide and poorer in oxygen in proportion as the larger part of it comes from the alveoli – that is to say, the more profound the expiration.
CHAPTER II – HISTORY OF THE USE OF CARBON DIOXIDE IN THERAPEUTICS
The application of carbon dioxide gas for therapeutical purposes can be traced to the earliest times. We all have read of the stone of Memphis, which stone was pulverized, dissolved in vinegar, and applied to parts of the body in order to anesthetize them. Dioscorides and Plinius speak of this stone. But exact observations of the gas were not made before the seventeenth century.
Mineral springs, with their large volume of carbon dioxide gas dissolved in water, have served therapeutical purposes long before carbon dioxide had been demonstrated. They often present remarkable appearances when relieved from subterranean pressure, by losing their gases with more or less rapidity, according to the tension to which they had been subjected. Some of them issue from the earth with rumbling, gurgling, or hissing noises; others do so only at regular intervals, and rise to a height of from twenty to forty feet; some ascend from the bottom of the sea, of lakes, and rivers; others appear many thousand feet above the level of the ocean; some break at a boiling heat through a crust of ice and snow; others issue with icy coldness near shrubs and flowers; some destroy vegetation in their immediate neighborhood, while others penetrate and cover organic structures with calcareous incrustations and preserve them.
Such phenomena were replete with wonder and attracted the attention of philosophers from an early period. Supernatural properties were ascribed to the springs. Strange theories were propounded regarding their origin,.and wonderful tales and fables were current of their curative powers.
Strabo relates that the springs of Hierapolis imparted a red color to the roots of trees and shrubs and that the juices of the latter, when mixed with the water, produced a purple liquor which was used for dyeing wool. We shall see how this reaction of carbon dioxide was interpreted by Hoffmann, who lived in the seventeenth century. Philostratus, when speaking of the sanguinary battle which the Greek army fought with Telephus, on the banks of the river Caicus, states that the wounded Greek soldiers who resorted to Agamemnon’s spring, near Smyrna, were all restored. According to Herodotus, a spring in the country of the Ichthyophagi (fish-eaters) prolonged life to beyond one hundred and twenty years. A spring in Chios caused insanity; another in Magnesia improved the voice of singers, and the spring of Alysson was specific for hydrophobia. The springs of Lethe and Mnemosyne are often mentioned in classical literature; the former gave oblivion and the latter memory.
Little is mentioned of mineral springs in the Old Testament. According to the Genesis, Anah, the father of Esau’s wife, discovered some thermal springs in the desert; and in the second book of Kings, we find mention made of a spring at Jericho which made the ground barren, and was made wholesome by the prophet Elisha throwing salt into it. But from the New Testament, we learn that the Jews, before Christ, used thermal waters extensively. “There lay a great multitude of impotent folk, of blind, halt, and withered, in the porches of the lake Bethesda, by the sheep-market at Jerusalem, waiting for the moving of the waters; and whosoever first after the troubling of the water stepped in, was made whole of whatsoever disease he had.” This water had a reddish-brown color, from sediment of ochre probably deposited by the escape of carbon dioxide gas; sulfur was also found in the mud, and the more rapid disengagement of carbon dioxide and sulfureted hydrogen when the water was stirred up may account for its increased curative power at such time.
Mineral springs play an important part in the religion of the ancients. The priests of Aesculapius erected temples to the god of medicine in the vicinity of mineral springs. They were not only provided with theaters and places of amusement as our fashionable modern water-resorts, but also with hospitals and medical schools for the instruction of students. The most important of these were the springs of Nauplia, in the sacred grove of Aesculapius. They have been described by Pausanias, and from the remains of their structures, we can judge their former greatness. The water of Nauplia has been analyzed by Landerer and found to contain carbon dioxide.
The Castalian spring had a temperature of only 33° C.; in this spring Pythia had to bathe before ascending the tripod in the steaming cave in Apollo’s oracle at Delphi. There are copious exhalations of carbon dioxide gas in that cave, and from the short and incoherent sentences which the priestess uttered in her excitement and paroxysms the prophecies were drawn. Such was also the gas-springs of Dodona, the most ancient oracle of the Greeks.
Paracelsus (1493-1541) made use of carbon dioxide gas for therapeutic purposes, calling it Spiritus sylvester. He knew that the gas produced by burning charcoal is identical to that developed when limestone is heated to a high degree. Paracelsus’s full name was Philippos Aureolus P. Theophrastus Bombastus Paracelsus ab Hohenheim. Paracelsus examined most of the chemical products with which he became familiar as to their therapeutic properties, saying that the true usefulness of chemistry was not to make gold but to prepare healing remedies. For his labors in this direction, we can hardly overestimate his merits. Many medicines which are highly valued to this day were discovered and introduced by him. The internal administration of mercury in different forms, and several preparations of lead, antimony, sulfur, copper, and iron were first taught by Paracelsus. With his method of extracting from medicinal plants the essence—the quintessence, as he called it—and prescribing this essence instead of the whole plant, he was far ahead of his time.
Jan Baptist van Belmont (1577-1644), who can be regarded as one of the greatest chemists who preceded Lavoisier, was the founder of pneumatic chemistry. He was the first who used the word gas as a generic name for all elastic aeriform fluids, in order to distinguish them from atmospheric air. He paid much attention to the study of gases and showed that they entered into the composition of the atmospheric air. He first described carbon dioxide, which he called gas sylvester, and described its development, when the acid is brought into contact with limestone or potash, at wine and beer fermentation, during putrefaction, its appearance in the stomach, and showed that it was contained in the mineral water of Spa, that it was rising from the ground in some places, for instance, at the dogs’ grotto near Naples. However, his distinction of the different kinds of gases was still imperfect; he knew no means to handle the different gases he had developed. Under the name of gas sylvester, which he sometimes designates by the term gas carbonicum, he understood principally carbon dioxide.
Jan Baptist van Belmont, a Brabant nobleman, was born in Brussels in the year 1577. In Louvain, he attended the ordinary philosophical course until his seventeenth year, then studied with the Jesuits mystic philosophy and even magic, later on, theology and especially mysticism. This led him to the decision to renounce the world for a religious life with devotion to good works. He transferred his large estates in favor of his sister. To make himself the more useful, he studied medicine. At first, Hippocrates and Galen were his guides, until he began to doubt their system and to study the works of Paracelsus.
From these works, he became so greatly inspired that he now exerted all his powers to combat Galen’s system, to develop further the chemicomedical theory, to establish more firmly the reformation in medicine instituted by Paracelsus. He traveled a long time in France and Italy and acquired great fame as a physician. Returned to his native country, he lived a retired life, occupied with chemical investigations. van Helmont had an advantage over Paracelsus on account of his profound, scientific education, but he always refers to Paracelsus with the highest esteem. There exists a certain similarity of characters between the two: both were inspired enthusiastically by a wish to work for a total reform in medicine. van Belmont still believed in the possibility of metamorphoses of metals, but with him begins our knowledge about the gases. Indeed, the fact that there exist aerie elements which differ from the ordinary atmospheric air was known before his time, but it was Belmont who pointed out how these elements could be distinguished exactly, and it was Belmont who showed how these elements found in nature could be artificially produced, how thereby one can conclude as to their origin.
He was one of the men with new ideas who had to combat misocainia. Because he wrote against a certain sympathetic remedy, he was taken before the Archbishop of Mechelen and punished with two years’ imprisonment; he had denied the healing power of religion. His colleagues called him all sorts of names because he was opposed to blood-letting, the universal remedy for almost all diseases at those times. Gui Patin wrote the following necrology: “van Helmont etoit un mechant pendard flamand, qui est mort enrage depuis quelques mois. Il n’a jamais rien fait qui vaille. J’ai vu tout ce qu’il a fait. Cet homme ne meditoit qu’une medicine toute de secrets chimiques et empiriques, et pour la renverser plus vite, il l’inscrivoit fort contre la saignee, faute de laquelle pourtant il est mort frenetique”
van Helmont was an exact observer, which shows itself in other works of his not concerning the gases. What characterizes him especially as representative of the era in which he lived, is the application he made of his chemical knowledge to physiology, pathology, and therapy. He directed his attention to chemical properties in the human system, showed that the most important functions of the body were in relation to the acid or alkaline condition of its fluids and to processes of fermentation.
van Helmont, however, did not consider digestion an exclusively chemical process. Inclined to spiritualism – many phenomena in nature, as thunder, earthquake, rainbow, etc., he took for voices or actions of different spirits – he assumed that there was a special spiritual regent in man, whom he called Archeus, as Paracelsus already had taught. By Archeus he understood the involuntary functions in man, among them digestion. The Archeus, he believed, had his abode in the stomach. Therapeutically he aimed to influence Archeus, either to calm or to animate him, as the case might be. Notwithstanding these views, he has done a great deal to establish chemical principles in the preparation of medicines, a great deal to unite chemistry with medicine, a work which had begun by Paracelsus.
Robert Boyle (1627-1691) confirmed the discoveries of Paracelsus and van Helmont and showed how to separate and how to handle gases, but he was not aware yet that carbon dioxide and hydrogen were essentially different. Friedrich Hoffmann (1660-1742), who was in correspondence with Robert Boyle, discovered some qualities of the gas contained in mineral springs, and called it spiritus mineralis. Observing that when in watery solution it would color certain vegetable matters red, he judged that it was a feeble acid.
Joseph Black (1728-99) was another great promoter of the study of chemistry. His important experiments with carbon dioxide demonstrated its combination with alkalies. He assumed that it existed in solid form in alkalies, and called it fixed air. He supposed that it was produced by the act of respiration, proved that it is absorbed by caustic alkalies, and disengaged again under effervescence when acid is made to act upon the combination.
Joseph Priestley, born March 13, 1733, educated for the Christian ministry and became a minister in the year 1755, had been a great theologian, entangled a good deal in sectarian polemics. A study of his life gives an idea of what extent human passion was excited in England on account of the difference of opinion in religious questions and what cruel prejudices existed. While prominent as a theologian he was more notably a man of science, and chiefly notable as a chemist and the discoverer of oxygen. His fuller interest in science dates from 1758, when he bought a few scientific books, a small air pump, an electric machine, and other instruments, with the help of which he made experiments for his pupils at Nantwich as well as for his own amusement and that of his friends. During his visit to London, in January 1766, he met Richard Price, Sir William Watson, John Canton, and Benjamin Franklin. Franklin encouraged him to undertake the “History of Electricity.” The book drew him into a large field of original experiments. Franklin and Canton corrected the proofs and it was published in 1767. Priestley’s electrical work shows him at his best, although the discoveries contained therein are of less importance in the history of science than his later discoveries in chemistry.
After 1770 he practically abandoned the study of electricity for that of chemistry, to which he had been led incidentally. He had attended a course of chemical lectures given in Warington Academy by Dr. Turner, of Liverpool. He admitted that he knew very little of chemistry at the time when he began his experiments; he was possessed of no apparatus and had scarcely the means of procuring any, but he attributed his success to the ignorance which forced him to devise apparatus and processes of his own. In his memoirs he says:
“If I had been previously accustomed to the usual chemical processes I should not have so easily thought of any other, and without new modes of operation I should hardly have discovered anything materially new.”
One of the earliest pieces of apparatus which Priestley devised is the well-known pneumatic trough – a simple enough piece of chemical furniture certainly, but one that required a considerable amount of experimenting. He began his chemical work by attacking the problem of combustion, the solution of which created the science of modern chemistry. He was led to study gases by watching the process of fermentation in a brewery next to his house; and in March 1772, he read his first paper, “On Different Kinds of Air.” This paper, inspired by the work of Stephen Hales, Joseph Black, and Cavendish, marked an epoch in the history of science. Priestley here set forth improvements in the methods of collecting gases, and especially the use of mercury in the pneumatic trough, which enabled him to deal for the first time with gases soluble in water. He announced the discovery of marine acid air (hydrochloric acid) and nitrous air (nitric oxide). He showed that in air exposed over water one fifth disappears in processes of combustion, respiration, and putrefaction, and that plants restore air vitiated by these processes, and that no known gas conducted electricity.
The paper also contained a proposal to saturate water with carbon dioxide under either atmospheric or increased pressure, which has led to the creation of the mineral-water industry. Of this means of making “Pyrmont water” (which he described in a pamphlet in June 1777), he wrote: “I can make better than you import, and what cost you five shillings will not cost me a penny.” Priestley likewise described the preparation of pure nitrogen, a gas to which he gave the vague name of phlogisticated air, only recognizing it later as a distinct species. Priestley noted, without comment, that he had produced two other gases, which were subsequently recognized as carbonic oxide and nitrous oxide, and that he had disengaged from niter a gas which was later on recognized as oxygen. The paper received the Copley medal of the Royal Society (November 30, 1773), and was at once abstracted at length by Lavoisier and criticized by him. Henceforth Lavoisier acted as a sieve to separate the inaccurate work and conclusions of Priestley from the accurate.
From 1774 to 1786 Priestley published six successive volumes of researches on air. The first volume records the discovery of alkaline air (ammonia gas) and dephlogisticated nitrous air (nitrous oxide), and the synthesis of sal-ammonia, as well as his first general view of the current hypothesis of Becker and Stahl-that fire, is decomposition, in which phlogiston is separated from all burning bodies. At various periods Priestley identified phlogiston with electricity and with hydrogen. But his whole scientific energies from this time forward were devoted to the upholding of the phlogistic theory, which his own experiments (and their completion by Cavendish) by a strange fate were destined in the hands of Lavoisier completely to overturn.
On August 1, 1774, at Lansdowne House, Priestley discovered oxygen. By the heating of oxid of mercury, he obtained what was to him a new gas, in which a candle burned vigorously. He, later on, found it purer than ordinary air, i.e., to support respiration, as well as combustion, better, and called it dephlogisticated air. From its property of yielding acid compounds, this gas was named oxygen by Lavoisier at a later date. As it both came from the atmosphere and would also be produced by heating certain metallic nitrates, Priestley concluded that the air is not an element, but consists of the nitrous (nitric) acid and earth, with so much phlogiston as is necessary to its elasticity. Priestley’s great discovery of oxygen contained the germ of the modern science of chemistry, but, owing to his blind faith in the phlogiston theory, the significance of the discovery was lost upon him.
Priestley made the first public announcement of his discovery of oxygen in a letter to Sir John Pringle, dated March 15, 1775, which was read to the Royal Society on May 25. But while in Paris, in October 1774, Priestley, according to his own account, spoke of the experiments he had already performed, and of those he meant to perform, in relation to the new gas. Fifteen years later-in the 1790 edition of “Experiments on Air ” – Priestley declared specifically that he told Lavoisier of his experiments during his visit to Paris.
There is no doubt that immediately after that date Lavoisier made oxygen for himself, and in May following published the first of a long series of memoirs, in which he used his experiments to explain the constitution of air, combustion, and respiration, the Greek idea of the conservation of matter, thus founding chemistry on a new basis. Priestley refused to accept Lavoisier’s sagacious views.
The centenary of Priestley’s discovery of oxygen was celebrated in Birmingham and Northumberland, Pa., on August 1, 1874, but there is some divergence of opinion as to who is entitled to the full credit of the original discovery. Although Priestley was in possession of the gas before November 1771, it is admitted that Karl Wilhelm Scheele, the Swedish apothecary, working quite independently, first recognized it as a distinct species before 1773; but Scheele did not publish his researches until after Priestley.
In November 1774, Priestley discovered vitriolic acid air (sulfur dioxide), and before November 1775, continuing an investigation by Scheele, fluor acid air (silicon tetrafluoride). This completes the list of Priestley’s great discoveries of gases, nine in all.
Priestley’s memoir on respiration, read in January 1776, in which he regards respiration as a true phlogistic process, was not original in idea but was acknowledged by Lavoisier as the starting point of his own work on the subject, published in the next year. In the spring of 1778, Priestley returned to the important researches on vegetable physiology of 1772 and discovered that oxygen is given off in the light from the green leaves. He did not publish his observation until 1781. Meanwhile, John Ingenhousz had published the main facts in 1779.
In 1781 Priestley decomposed ammonia using the electric spark. In the same year, he continued, with John Warltire, of Birmingham, certain observations of the latter in 1777 on the burning of hydrogen. Priestley, Cavendish, Warltire, and James Watt found that water was not an element, but a compound of dephlogisticated air and phlogiston. A controversy arose as to the relative claims of Watt and Cavendish with regard to priority, which Priestley might have settled but did not.
In 1785 Priestley made an admirable series of quantitative experiments on the oxidation of iron and the reduction of the oxide by hydrogen, with formation of water. In the condensed edition of his works, published in 1790, he described interesting experiments on the thermal conductibility of gases, which he found to be much the greatest in the case of hydrogen. In 1796 Priestley published his considerations on phlogiston, adhering to his error. He created quite a controversy, which was continued, mainly in America.
The French Revolution excited passionate controversy in England, and Priestley was on the side of the revolutionists. In 1791 the anniversary of the capture of the Bastille was observed in Birmingham by a dinner at which he was not present and with which he had nothing to do. But the mob wished to testify by some signal deed their abhorrence of the un-English notions propounded at the dinner, and therefore burned down Priestley’s chapel and house. Before the deed was done they waded knee-deep in torn manuscripts. The blow was a terrible one. Priestley and his family had escaped violence by timely flight, but every material possession he valued was destroyed and the labor of years annihilated. In 1794 he went out to the young States, whose cause he had advocated, to spend the last ten years of his life in the land of the future.
In 1800, when he confessed himself all but alone in his opinions, he published his last book, “The Doctrine of Phlogiston Established.” In his last papers, he replied to Noah Webster and Erasmus Darwin, attacking the theory of spontaneous generation and evolution.
Priestley’s eminent discoveries in chemistry were due to an extraordinary quickness and keenness of imagination combined with no mean logical ability and manipulative skill. But, owing mainly to lack of adequate training, he failed to apprehend to the full the true value of his great results. Carelessness and haste, not want of critical power, led him at the outset to follow the retrograde view of Stahl rather than the method of Boyle, Black, and Cavendish. Priestley is unjust to himself in attributing most of his discoveries to chance. His researches offer admirable examples of scientific induction. He has been called by Cuvier “a father of modern chemistry… who would never acknowledge his daughter.”
Lavoisier upset the phlogiston theory of Stahl, according to which the same inflammable matter existed in all combustibles. He promulgated his theory of the admission of oxygen during combustion and thereby began a new era in chemistry. He opened the way for the understanding of processes in the organic and inorganic worlds by his discovery of the law of the conservation of matter. He developed the discoveries of Black and Priestley, analyzed the atmospheric air, studied the process of respiration, of fermentation, and found that carbon dioxide was a compound of oxygen and carbon. Based on Priestley’s discovery, he showed the composition of acids and demonstrated that the diamond really could be burned. With Cavendish, he shares the honor to have demonstrated nitrogen and oxygen and the composition of water.
Antoine Laurent Lavoisier, born in Paris in the year 1743, received an excellent education. Very soon his interest in the study of natural sciences developed. As early as 1764 he distinguished himself through scientific investigations when he won a prize offered by the French Government for the solution of a difficult problem. The prize of 2,000 francs accorded to him alone he volunteered to share with his three competitors, in order to reimburse them for outlays they had had in experimenting.
This generous deed was rewarded by the King with a golden medal, given to him during the session of the Academy in 1766. In the year 1768, he was elected to membership of the Academy. All his attention he devoted to chemistry. Deciding to exert all his power to that end and at the same time to secure the means needed for his experiments, he applied for the remunerative post of fermier general, and in 1776, as such, he was placed at the head of the powder department. Here he found an opportunity to apply his exceptional talents to make scientific observations useful for technical purposes. As long as Lavoisier directed the fabrication of it, the French powder surpassed all others in quality. He was drawn to all commissions where for practical purposes a man of scientific knowledge was needed.
On April 18, 1787, Lavoisier presented, at a public session of the Royal Academy of Sciences, a memoir on the necessity of a reform of chemical nomenclature, which reform he wished to be considered as a national work. He reasoned as follows: Onomatology furnishes the real instruments for the operation of the mind; these instruments must be of the best kind, and it is indeed working in the interest of science – it is for the progress of science when we exert ourselves to improve our onomatology. Referring to how we acquire knowledge in general, he points out the importance of a perfect onomatology for those who begin to devote themselves to the study of science. The logic of science essentially adheres to scientific language. Science can not teach anything which is confessedly unscientific and false. In science we have to distinguish three things: the series of facts that constitute science, the ideas which recall facts, and the words to express ideas. The word has to develop the idea, the idea has to embrace the fact; these are three impressions with the same seal. Since the words preserve the ideas and transmit them, perfection in science is impossible without perfection in language. However true the facts may be, however, correct the ideas developed by facts, only wrong impressions will be transmitted as long as the expressions by which they are communicated are not exact.
The reform of language effected by Lavoisier, in conjunction with Guyton de Morveau, Berthollet, and Fourcroy, was an indispensable prelude to the reform of thought. With the current alchemistic jargon, science, properly so-called, could have no fellowship. By creating a scientific botanical nomenclature Linne has created scientific botany, and Lavoisier, by his scientific chemical nomenclature, scientific chemistry.
Bergman, the great scientist, the pupil of Linne, who died in the year 1784, wrote during the last days of his life to M. de Morveau, one of Lavoisier’s cooperators: “Do not spare one single improper term.” All Lavoisier’s chemical works distinguish themselves by the precision of observation, masterly description of facts, and clear deduction of conclusions. Ingenious in the selection of requirements for his investigations, inventive in construction of new apparatus, persevering in all his researches, Lavoisier succeeded in demonstrating new arrangements of facts in chemistry and in establishing new truths of great importance to science. With productive originality, Lavoisier united profound knowledge of all that had been accomplished already in chemistry. His influence on chemistry has been immeasurable.
All his merit as a patriot, his fame as reformator of science, did not save him in the reign of terror, during which Robespierre had every man of true merit condemned to the guillotine, everyone who was not insignificant enough to escape the suspicion of the tyrant. Upon a frivolous accusation that he had practiced extortions while fermier general and had added water and injurious ingredients to tobacco while manager of the tobacco traffic, he was indicted in 1794. Indictment at that time meant sentenced to be guillotined. The courage of a friend, who ventured to appear before the tribunal of terror and to enumerate the accomplishments of Lavoisier, was in vain, as an opposition to the brutality of those in power. This brutality is illustrated by the answer of the president of this tribunal: “Nous n’avons plus besoin des savants.”
This man with the gigantic mind, whose great works in science will live for all time, was guillotined on May 8, 1794, out of revenge on the part of the people because he had held high positions under the King. Lavoisier was only fifty-one years of age when his life was taken on the scaffold in the name of the French Republic, the beautiful and glorious life of one of the greatest sons of France.
In 1823 Faraday succeeded in liquefying, and Thilorien in 1835 in solidifying carbon dioxide. Hey (1736-1819), Withering (1741-99), Percival (1740-1804), Dobson, Warren (1753-1815), Macbride (1726-78), Ingenhousz (1730-99), Beddoes (1760-1808), Henry, Lee, Rotheram, and White were the first to make systematic use of carbon dioxide gas for therapeutical purposes.
Percival, of Manchester, found that carbon dioxide had antiputrid properties and observed also good effects from it in the treatment of advanced pulmonary tuberculosis. He was aware, however, that in the treatment of pulmonary tuberculosis it acted only as a palliative. He appears to have been the first, or at least one of the first, who conceived the idea of employing carbon dioxide in cases of sordid ulcers. He reasoned: “Since the fixed air can modify the purulent surface in the lungs, it seems natural that it should be successful when applied externally on sordid ulcers.” And this he found confirmed by experience. In cases of cancerous ulcer, in which the poultices of carrots had produced no effect, carbon dioxide caused a disappearance of purulent matter, relieved pain, and gave a better aspect to the wound surface. The cases which he reported were treated in the Infirmary of Manchester, in the service of Dr. Withering. His observations were published in May 1772. Two months later he wrote that the remedy had been applied during these two months, but without further result, and added: “It appears that the course of the cancer is arrested by the employment of fixed air, but it is to be feared that not a single cure can be obtained by this means. Nevertheless, a palliative in such a frightful and hopeless disease should be considered as a precious acquisition.”
Dobson, who likewise tried carbon dioxide in case of cancer, came to the same conclusions. He could never report that the application of fixed air had produced a sensible effect toward a cure, but found that the pain had successfully been combated. In non-malignant old ulcers of bad condition, the gas produced excellent results. The pain was always relieved, the appearance of the condition markedly improved and in some cases, a complete cure ensued.
The analgesic and cicatrizing effects of fixed air were already well established when Beddoes learned, from the Dutch physician and chemist, John Ingenhousz, that carbon dioxide had the remarkable property of quieting almost instantly even very severe pain, such, for instance, as is produced by vesication. The experiment of Ingenhousz was the following: He produced a blister on the finger, removed the epidermis, and exposed the finger to the air; then placed it in a bell filled with oxygen and afterward in another bell filled with carbon dioxide. The pain, which already had been lively while the finger was exposed to the air, became more intense in the oxygen bath but disappeared quickly after the finger had been plunged into carbon dioxide. This experiment was repeated several times by Beddoes, always with the same result. Macbride applied the gas to scorbutic ulcerations.
In the year 1794 Ewart published two cases of ulcerated cancer of the mamma treated with carbon dioxide. The first of these was that of a woman, fifty-eight years of age. The ulcerated surface was situated on the upper part of the left breast and had an extension of from four to five inches. The ulcer emitted an offensive odor and had an ichorous, fetid discharge; the patient suffered severe and almost constant pain at the seat of the cancer. Already the next day after the application of carbon dioxide the ulcerated surface had a better appearance and the pain had entirely disappeared. There was no odor anymore and the wound soon began to cicatrize. After two and a half months only a fistulous opening remained, and this also closed finally. Shortly after the publication of this case a report was spread and appeared in print that the patient had died. Contradicting this statement, Ingenhousz wrote to Beddoes on October 12, 1795, the following letter:
“On my return to Bath, I saw the first patient, whose cancerous ulcer of the breast had healed, but had reopened again after carbon dioxide application had been discontinued. However, the ulcer has a less hideous appearance and pain is controlled by carbon dioxide applications. I believe it will heal again under renewed gas application because there is always amelioration of the symptoms when gas is administered.”
About ten months later, on August 26, 1796, Ewart himself wrote to Beddoes to inform him that the woman, the subject of the first observation, was still alive, but that the receded ulcer had not cicatrized as the primary one had done, notwithstanding the constant application of carbon dioxide. The only result obtained, and this was a permanent one, was the entire absence of pain and odor. There was no complete cure, in this case, only temporary cicatrization.
As to the second case, which resembled the first very much and in which also carbon dioxide treatment had relieved pain and arrested the invading course of the ulcer, the patient died from intercurrent pulmonary disease.
Some years after the publication of Percival’s observations and experiences (May 1772), French physicians began to employ carbon dioxide in the treatment of cancerous ulcers, and Ewart’s two cases (1794) were much quoted. Follin claimed priority in introducing into France the gas as a therapeutic measure. He writes: “I have tried on some patients a new method of local anesthesia, which has never been practiced in France before, and which consists in exposing ulcerated and painful surfaces to a continuous current of carbon dioxide gas.” But such priority is not accorded to him by Demarquay, who wrote that the method had been practiced in France twenty-four years prior to Follin’s claim.
The results obtained in England by Percival, Hey, Warren, and others were too important not to be considered by some French practitioners, and indeed everywhere in France experiments with carbon dioxide were made to verify what had been learned from the experience of English physicians and what Priestley especially had popularized.
Carbon dioxide treatment became popular in France; it was foremost at the Academy of Sciences and Art of Dijon, where great scientific activity was developed and where facts were established showing the beneficial effect of the gas on all kinds of ulcers and other affections. J. L. Targioni, of Florence, reported to this academy the details of a case of cancer of the mamma treated by fixed air. The gas had relieved the pain, corrected the bad character of the suppuration, and improved the general condition of the patient. About one-half of the cancerous ulcer had become cicatrized.
In Paris there were also cases published by the Royal Society of Medicine, proving sufficiently the efficacy of the remedy. This society established a commission to investigate the subject; Lalouette was elected chairman. This commission confirmed that carbon dioxide, although it did not cure cancer, would relieve pain and beneficially act on open ulcers by modifying the secretion and cause, to a certain extent, cicatrization.
In the year 1776 Abbe Magellan reported a case of very extensive ulcerating cancer, which under the influence of carbon dioxide had become reduced to one-quarter of its former size. At a later period Demarquay, who has written the history of carbon dioxide treatment, reported from his practice analogous cases in which long-continued carbon dioxide gas douches ameliorated the condition of cancerous ulcers, relieving pain and arresting the progress of the disease to such an extent that the patients gained in strength and courage, that their general health became comparatively very good; but all this was only temporary. He had also cases in which the patients thus benefited and apparently on the way to perfect recovery died at an earlier or later period from a non-related disease. Cases of the latter kind were also reported in Demarquay’s time from England. There appeared many publications on this subject in France, including one by Rozier, in 1776; Lalouette’s report appeared in 1778.
Among the channels by which carbon dioxide was introduced into the system was respiration. In former times carbon dioxide gas inhalations of a specified degree were a well-known and extensively employed therapeutic measure. From the observation that the fumes of freshly plowed earth did good service to consumptives – as the belief was – the conclusion was arrived at that the carbon dioxide of these fumes was the essential agent. Physicians went so far as to order patients to be covered with earth; they recommended them to stay in the cowshed and even to sleep there. This treatment was widely accepted and became very popular.
In almost all European countries there exist records, dating from the end of the eighteenth and the first quarter of the nineteenth century, according to which inhalations of air containing a high percentage of carbon dioxide affected an improvement in, and sometimes the cure of, pulmonary tuberculosis. Later on, asthma was subjected to this mode of treatment. As recently as 1883 Edmond Weill spoke in the Academie des Sciences of Paris on his experience in applying carbon dioxide gas inhalations to patients suffering from dyspnea. The sittings lasted from two to five minutes, once or twice daily, the inhalations being of pure carbon dioxide gas, the quantity being from 2 to 4 liters at each sitting. At no time were there experienced unpleasant symptoms, while the results were encouraging. Patients thus treated were consumptives and emphysematics. Coughing spells were relieved and prevented. It is not difficult to explain the effects thus obtained. The reports given leave no doubt that the relief secured was due to narcotic action, to a slight intoxication. The application of carbon dioxide gas in this form did not remain in practice very long; the recognition of the merely symptomatic character of its curative effect on the one hand, and the risk associated with its employment on the other, caused it to be abandoned. Intravenous injections of carbon dioxide gas, which have been used repeatedly on animals, can not be taken into consideration and are not qualified to be enumerated as a methodical application for therapeutic purposes.
In 1834 Mojon, of Genoa, published his experiences with the gas in gynecological practise, recommending carbon dioxide gas douches in dysmenorrhea, a mode of treatment long before known but at that time forgotten. During the fifth decade of the nineteenth century Verneuil, Broca, and Demarquay in France, with Simpson in Scotland, made extensive use of carbon dioxide in gynecological practice.
Brown-Sequard demonstrated the anesthetizing effect of the gas on the larynx. He showed that carbon dioxide gas applied to the mucous membrane of the larynx would induce anesthesia independently of its absorption by the blood. He experimented on animals inhaling fresh air through a tracheal opening, thus excluding symptoms of intoxication during experimentation. When both laryngeal nerves were intact, both sides of the body would become anesthetic after carbon dioxide gas had been insufflated for only a short time. When one nerve was severed, the opposite side of the body became anesthetic after carbon dioxide gas inflation, but somewhat less so than it did when both nerves were intact. The anesthesia lasted only a short while and was followed by hyperesthesia. When both laryngeal nerves were severed, no anesthesia could be produced by carbon dioxide gas insufflation.
For some time the gas was discredited as a consequence of an event that took place in Scanzoni’s clinic. A pregnant woman who had received vaginal douches of carbon dioxide gas died. Scanzoni attributed her death to the entrance of carbon dioxide into the uterine cavity. The experiments of Claude Bernard and other French investigators brought conclusive evidence that Scanzoni was in error in attributing the cause of death in this case to the gas.
Breslau and Vogel published in 1858, in the Wiener Medizinische Wochenschrift, several important experiments which they had made on pregnant rabbits. They inflated the vagina with carbon dioxide gas without producing thereby any toxic effect; no harm was done to the life of either rabbit or fetus. These investigators concluded that vaginal douches of the gas were entirely harmless in case of pregnancy and that they endangered neither the life of the mother nor the life of the child. My own experience furnishes additional evidence.
Diruef, whose remarks are given in Demarquay’s book, “Essai de pneumatologie medicale,” Paris, 1866, as not having been published previously, says: “The baths of carbon dioxide gas which are given at different watering-places in Germany are known to have a very great effect in the treatment of such affections of the locomotor apparatus and the nervous system as resist ordinary therapeutic measures. Chronic rheumatism and gout, before the establishment of permanent anatomical changes, are affections in which the application of carbon dioxide gas produces the most satisfactory results. There are even patients in this category whose skin does not support any kind of water-bathing, but only dry gas.”
Rotureau (“Etudes Sur Les Eaux de Nauheim,” 1856) says: “The carbon dioxide gas baths have been successfully employed, especially in rheumatic affections. The most severe of rheumatic affections is perhaps paralysis; the gas treatment has a most powerful effect on this manifestation of rheumatism. Of all forms of paralysis, paraplegia is the quickest to vanish under this treatment and to attain the most complete cure. Paralytics who come to Nauheim, with the lower extremities more or less deprived of mobility, are subjected to the dry-gas treatment. Even when the paralysis is complete, the mobility returns gradually from day to day in a most remarkable manner, so that the effect of each bath can be noticed. There are cases in which the baths have been so effective that a rheumatic patient, who for whole years had not been able to use his limbs, was enabled to walk after the fifteenth bath. One is surprised also to see what powerful effect the gas application has in cases of hysterical paralysis.” This author wishes it distinctly understood that what he says of the effect of the baths of Nauheim has no reference to those forms of paralysis which are manifestations of organic disease of the brain.
Certain chronic neuralgias, such, for instance, as tic douloureux, sciatica, etc., have been successfully treated using the gas-bath and douche in cases in which numerous remedies had been tried for a long time previously and had failed. All observers are unanimous on this point, especially with regard to sciatica, excluding, however, those cases in which an advanced organic lesion is the cause.
According to the literature of the middle of the nineteenth century, gas douches are of service in oculopalpebral inflammation, but the treatment must be modified in the different forms of epipephycitis (barbarously called conjunctivitis) – namely, acute and chronic. In acute epipephycitis, the douche is at first to be directed upon the eyelids because its direct application would cause pain and increase inflammation. The gas is to be applied until the eyelids redden; improvement is seen to follow even in the most acute stage. The action is prompt; photophobia, dacryorrhea, lagophthalmus, and the swelling of the eyelids disappear; these douches, therefore, offer, according to these reports, a valuable aid in the treatment of chronic epipephycitis. The gas-douche is also praised in the treatment of more profound inflammation-namely, in keratitis, even when ulceration has developed. It is said that in vascular, superficial, and even interstitial keratitis, relief follows generally after the first applications of the gas. Much more is found in the literature of our ancestors on the treatment of keratitis using the gas-douches, but this treatment has been abandoned, whether justly or unjustly is for ophthalmologists to decide. Unjust it is not to mention it anymore in the textbooks.
Demarquay speaks further enthusiastically on the treatment of amaurosis using carbon dioxide gas douches and says that their effect in this condition has excited the greatest attention. Mention is made also of the gas treatment in diseases of the ear, such as ulceration, and certain forms of deafness.
Inquiry among many well-read specialists on eye, ear, nose, and throat diseases showed that they were not even aware of the fact that carbon dioxide gas had formerly been used as a remedy in a number of eye, ear, nose, and throat affections. Our later literature has omitted all mention of this even as a historical fact. It may further be stated that the gas has been employed in skin diseases.
A very gratifying and prompt effect is reported from the application of carbon dioxide gas in certain cases of cystitis and vesical neuralgia. Broca published his experience on this subject in the Moniteur des Hopitauz, 1857, but I have been unable to see this journal. Demarquay, however, has published a large number of observations showing that carbon dioxide is one of the best palliatives or adjuvants in such conditions. He relates the case of a woman, thirty years of age, who suffered from neuralgia of the bladder without any known cause. The patient had frequent attacks, about twenty a day, lasting from five to ten minutes each time. Injection of carbon dioxide gas into the bladder practiced twice a day brought about prompt relief. On the fourth day of this treatment, the patient had only three attacks and was completely cured after fifteen days’ treatment. Before the gas douches had been resorted to, antineuralgics had been prescribed without avail. Demarquay speaks of the good results of the gas treatment in cystitis. In all cases, according to him, carbon dioxide acts as a sedative in a characteristic manner. At first, it produces marked excitation of a very short duration, which, while it lasts, seems to increase the symptoms of inflammation already existing. This may be due simply to its mechanical effect – that is, to its action as a foreign body, and also to its irritating effect on some mucous membranes, like that of the nose, at the first moment of application, particularly when the current of gas is very strong. Afterward, especially on account of the facility with which it is absorbed by the mucous membrane of the bladder, it produces analgesia in this organ.
Demarquay describes the different modes of application. As the best method, he recommends that a rubber bladder, of the capacity of from thirty to forty centiliters, be filled with the gas, which is introduced from the rubber bag into the bladder using an ordinary catheter attached to the bag. Mondollot, in order to fill the bladder with carbon dioxide gas, employed a double-current catheter. If such an instrument is employed, care has to be taken that the gas may enter slowly, while the hypogastric region is closely observed in order to guard against excessive inflation. Such an accident may happen when one of the eyes of the catheter becomes obstructed by mucus; and, indeed, this accident did happen in Demarquay’s own practice in a case of cystitis. The patient suddenly uttered a piercing cry and said that his bladder had burst, and such was found to be the case.
Such an accident can now be avoided since we are enabled to measure exactly the amount of gas we wish to introduce and to regulate the current likewise with absolute certainty.
“If, instead of the carbon dioxide gas, atmospheric air had been injected,” rays Demarquay, “I should have felt alarmed; but, knowing with what great facility the mucous and serous membranes absorb this gas, and knowing how harmless it is when brought in contact with the tissues, I felt almost reassured in regard to the consequences of this gas infiltration.” In fact, although the patient suffered some pain, probably caused by the rupture of the bladder, the gas became gradually absorbed, and after two hours it seemed to have disappeared completely.
Topical application of carbon dioxide gas in the shape of baths or douches has been tried quite extensively by balneologists of a former period, but a rational base for this kind of balneotherapy they have not given; in the literature of their time we fail to find specified rules based on exactly controlled observations. All we can learn from them is that the gas exerts certain decided effects.
These effects are described as follows: When the patient is in the bath the pulse at first increases, but after half an hour’s stay in the gas bath this frequency becomes reduced. The gas produces a sensation of warmth to the skin, prickling and redness, especialy at those parts which are most richly supplied with nerves-for instance, the scrotum; and in not a few patients perspiration follows. Micturition becomes increased in frequency and the quantity of urine voided; there has been noticed an increased amount of urea in the urine. In women continued bathing has increased the amount of menstrual flow. The patient feels for hours after the bath cheerfully animated and freer in all his movements.
The physicians of Nauheim were the first to give a scientific description of the influence of carbon dioxide water baths in different nosological conditions, especially in disorders of circulation. Beneke has demonstrated that the water bath saturated with carbon dioxide gas is a powerful and effective stimulant for the weakened heart. He was the first who dared to place dyspnoic patients suffering from an uncompensated valvular disease in the bath. He also tried the effect of these baths in other morbid conditions, as in arthritis and nervous diseases. Schott and Groedl continued to work on this basis which had been laid down by Beneke. The brothers Schott have established a system of their own of physical therapeutics for disorders of the circulation, in which carbon dioxide plays a role.
While this form of making use of the beneficial effects of carbon dioxide gas has become so popular with the medical profession, very little is known, or rather, as the foregoing historical sketch demonstrates, a great deal has been forgotten, about the external application of carbon dioxide gas in dry form.
The external application of dry carbon dioxide gas, considered in Franzensbad as an extraordinarily valuable therapeutical agent, is the product of the mineral springs there, which contain this gas in an astonishingly large amount. At different points, it rises in the form of jets of dry gas. One of these springs – the so-called Polterbrunnen, renowned for centuries – surpasses in regard to the amount of contained gas all springs of this kind in the world. There the gas comes out of the ground with great force and a great deal of noise (hence the name Polterbrunnen). The gas is caught in a wooden receptacle and conducted from this vessel using a metallic pipe to the gas bath-house erected over the Polterbrunnen.
It is astonishing with how great force the gas is expelled constantly day and night in everequal volumes; this spring, Polterbrunnen, producing every minute 4 cubic feet, that is, in twenty-four hours 5,760 cubic feet, making 2,102,400 cubic feet of gas every year. Yet, immense as is this amount, it is only a small part of the immeasurable quantity which arises daily from the many thousand larger and smaller gas springs of the extensive moor layer of Franzensbad.
In the bath-house over the Polterbrunnen, there are common baths for several bathers at one time, and also separate bath-tubs. The common baths are two wide, basin-shaped recesses with steps all around the walls, and benches to be occupied by the bathers. The single bathtubs are about one meter deep, also with benches of graduated height. In the bathtubs, as well as in the common bathbasins, the bathers remain with their clothes on, the gas at once penetrating the clothing and acting on the skin.
From the more recent history of the employment of the gas for medical purposes, we learn that Ziemssen, in the year 1883, published experiments to establish the value for diagnostic purposes of artificial inflation of the large intestine with carbon dioxide gas.
The introduction of carbon dioxide gas into the circulation by way of the rectum is an idea of recent date; at least, in older literature, there are only a few notes here and there to suggest that this form of application had been thought of. The earliest recommendation of carbon dioxide gas douche into the rectum I found in a materia medica published in the year 1863.
Bergeon, in the year 1886, published his new method of treatment of pulmonary tuberculosis, based on the fact, established by Claude Bernard, that volatiles introduced into the rectum pass through the venous blood current to the lungs, where they will be eliminated without entering into the arterial system or developing any deleterious effect. Bergeon expected, using enemata of sulfureted hydrogen, diluted with carbon dioxide gas, to destroy the tubercle bacilli within the lung. His method became widely known and was extensively practiced in France and America. The great majority of those who had employed this method confirmed the observation that the general condition of the patients treated was improved, but they soon found that the tubercle bacilli did not disappear and that all improvement of the general condition was due to carbon dioxide and not to sulfureted hydrogen. This method was then completely abandoned because it did not answer the main expectation; it did not cure tuberculosis.
Remarkable it is, however, and all observers agree on this, that improvement of the symptoms noticed in a wonderfully short time. Cornil and others explained this fact by saying that, if the improvement were due to the destruction of the bacilli, one would suppose that the morbid symptoms would disappear only gradually.
Ephraim has treated patients with carbon dioxide gas inflations of the rectum. Bergeon made use of this method in the treatment of whooping cough. Demme, of Philadelphia, has successfully employed the carbon dioxide-gas douche in a case of puerperal eclampsia.