Friday, January 25, 2013

1800-1920: Oxygen cylinders and chambers

Fig 1-- Left to Right: Oxygen tank, rubber bag (400 cc), thermometer
in glass tube, water-manometer and small cannula (1908)(1, page 288)
While the benefits of oxygen therapy were known, it took a long time for its use to be accepted by the medical community.  The main reason was that there were no efficient and inexpensive means of making it and delivering it to patients.  Plus experiments provided sketchy results at best.  

So for the most part, oxygen wasn't used therapeutically during the 19th century until a cholera outbreak in Europe in 1832.  In 1857 S.B. Birch described a "renaissance of oxygen."  His writings did create a "renaissance" of sorts.  Yet, once again, results were sketchy.  (1, page 282)

During the 1860s Ernst Victor von Leyden performed experiments, and soon thereafter gave up the task.  He postulated the following theories why oxygen failed to be accepted by the medical commuity:
  1. It was thought to have curative powers, and it doesn't
  2. It's difficult and expensive to make, and difficult to transport and deliver to patient
  3. When prepared by physician it often contains poisonous gases
  4. The apparatus to deliver it is clumsy
  5. Hypercritical attitude of physicians
  6. Negative results by experiments
The most effective means of employing oxygen during the 19th century was mainly by putting the patient in an oxygen chamber or room, pumping in pure oxygen, and having the patient breathe normal.  This concept was used in the variety of oxygen parlors that opened up.  Patients with various ailments, and probably some people just wishing to stay healthy, came to breathe the medicated air.

By 1868 cylinders were used to store oxygen, allowing it to be used during anesthesia.  This also made it possible to experiment with oxygen for other means rather than just medical, such as as part of scuba gear. (9, page 20)

Fleuss Apparatus
Henry Fleuss (1851-1933) was working to create a method so that scuba divers didn't have to rely on a person working a pump to provide air for him to breathe.  He was aware that the first person to discover oxygen in 1773 kept bees alive in a jar by drawing out the carbon dioxide.  Later studies showed animals could survive in a sealed chamber if oxygen was supplied.  So Fleuss intended to use this knowledge to invent an apparatus that allowed divers to supply themselves with air.  He, in turn, invented the compressed air or oxygen cylinder in 1879.  (2, page 83)

The device allowed for a "breathing bag mounted on the chest and scuba canister mounted on the back.  His device was called a "rebreather" because air was repeatedly rebreathed. Oxygen was added from the tank, and carbon dioxide removed.  He used his device to rescue coal miners who were trapped in a mine.    (2, page 83)

So the oxygen cylinder was now available for use in therapeutics as well, if the medical community was willing to use it.  Various manufacturers were now producing oxygen and storing it in steel cylinders.  

Figure 3 -- Oxygen tank, rubber bag, wash bottle,
rubber tubing, mouthpiece (3, page 304)
Tissier describes the tank in Figure 3 as containing "40 gallons of oxygen under 1800 pounds pressure are contained in a cylinder 3 inches in diameter, less than 13 inches in height, and weighing but 11 pounds. The gas will have a purity of 95 or 96 per cent., being diluted by the small quantity of air in the container. Mounted on the cylinder are a rubber bag of one gallon capacity, and a wash-bottle—so arranged that the gas passes first to the bag and then through the wash-bottle to the patient." (3, page 304)

Tissier explains that a manometer may be attached, although generally the pressure can be estimated by watching the bubbles through the wash bottle.  He writes that a "gentle, steady stream that does not cause appreciable splashing, and in which the individual bubbles can be distinguished, is best."  I imagine regulators at this time weren't very accurate anyway, and someone would be required to make regular checks on the cylinder anyway to make sure there is still oxygen in it.  (3, page 304)

Oxygen flows from the oygen tank, some is stored in the rubber bag, which acts as a reservoir, through the wash bottle, through the rubber tubing, and to the patient by means of a nose piece, mouth piece, or face mask.  Tissier recommends a hard rubber mouthpiece to prevent the patient from biting through it.  For the nostril, glass, or rubber could be used.  He also states, "if nothing better, a funnel of paper cone may be held over the nose and mouth, but not touching the face -- so that expiration may take place beneath it."  (3, page 304

The oxygen is set at the desired flow, which there was no way of measuring with accuracy, so it was basically by the gut feeling of the operator.  Then the flow is "allowed to flow for a definite time, or, in urgent cases, almost continuously, unless distressing to the patient."  (3, page 304)

The funnel is really not preferable because, as Tissier notes, it will probably waste a considerable amount of oxygen.  However, particularly with pneumonia, it "may save a life."  
Oxygen Chamber for the treatment of pneumonia (6, page 480)
To view more pictures of the chamber click here.

Oxygen can also be given with a desired amount of pressure, if pressure is desired to assist with the patient's breathing and/or to help diminish dyspnea.  If this is the case, the oxygen system may be hooked up to one of the various gasometers.  Oxygen may also be blended into the air of pneumatic chambers if so desired.  (3, page 305) (I will describe gasometers and pneumatic chambers in later posts)

By the 1890s pure oxygen could be piped into rooms or chambers, although this method wasn't often used.  Still, in 1922 Alvin Barach wrote that piping oxygen into a room, or a room within a room (also known as an oxygen chamber) provided for the best means of giving oxygen to patients simply because it was the least cumbersome.  However, the oxygen provided wasn't always enough to be therapeutic, and the the chambers were inconvenient and expensive. Plus they weren't portible.

An efficient oxygen chamber that was somewhat portable was introduced to the world during WWII by Sir Joseph Barcroft.  He created an air tight chamber that is "leak tight in order to provide an atmosphere rich in oxygen and which is artificially ventilated in order to provide a comfortable environment.  The oxygen content of oxygen is between 40-60 percent, which is considered the therapeutic range.  It is ventilated in order to remove excess carbon dioixde, moisture and heat." (7)

Oxygen could also be provided to the patient by means of crude oxygen tents.  These tents were comprised of a canopy that covered the patient's bed, and oxygen was piped into the canopy from a cylinder at the patient's bedside.  Yet these early oxygen tents were poorly engineered.

Dr. Andrew H. Smith of New York provided one of the greater contributions to therapeutic oxygen when he wrote "The Inhalation of Oxygen in Acute Affections of the lungs," in 1898.  He recommended oxygen for lung diseases that caused dyspnea.   In the 1860s he showed the effectiveness of using oxygen to treat animals, and in 1870 he proved the inhalation of pure oxygen was harmless (although we later learned oxygen is a drug with side effects).  (5)

Smith explains how methods of creating oxygen and filling rooms with oxygen were actually available in the 1860s, and experiments on animals proved that filling rooms with enriched oxygen can prolong the lives of people who would otherwise have died.   Smith also writes about the use of compressed oxygen, (5) which was discovered in 1895 by Karl Paul Gottfied von Linde of Germany and William Hampson of England.

Generally speaking, if a patient required oxygen he or she would have to seek out an institution or physician with access to it.  Oxygen wasn't available in hospitals until the 1920s.  

References:
  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. Stephens, Jack, "Living Mirrors: A Coral Reef Adventure," 2003
  3. Tissier,Paul Lewis Alexandre, edited by Solomon Solis Cohen, "Pneumotherapy: Including Aerotherapy and inhalation methods," volume X, 1903, Philadelphia, P. Blakiston's Sons and Co.
  4. Arthur, T.S., et al, editors,  "Oxygen, The Great Health Restorer," Arthurs Home Magazine, 1882, Philadelphia, page 770
  5. Smith, Andrew H. "The Inhalation of Oxygen in Acute Affections of the lungs," Trans Am Climatol Assoc, 1898, volume 14, page149-153
  6. "Studies from the Rockefeller Institute for Medical Research,",volume XLII, New York, 1922,  Rockefeller Institute for Medical Research
  7. Barach, Alvin L., "A New Type of Oxygen Chamber," April 26, 1926,  http://www.jci.org/articles/view/100060/files/pdf, reviewed 10/28/12
  8. Heffner, JE, "The story of oxygen," Respiratory Care, January, 2013, volume 58, number 1, pages 18-30

1 comment:

  1. nice information.. I just know it from this blog how oxygen cylinder works..thanks for information

    ReplyDelete