Thursday, February 07, 2013

1800-1900: Oxygen used to treat asthma

The first person to recommend oxygen in the treatment of asthma was Thomas Beddoes who actually experimented on himself by inhaling oxygen every day.  He did extensive studies about oxygen, and applied it to various diseases, including asthma.  He showed oxygen could be useful as a marketable drug to treat diseases.

Yet, like most new discoveries in medicine, oxygen therapy for diseases did not catch on right away, wrote Brainbridge in a 1908 article in the New York State Journal of Medicine.  While it was used from time to time, he explained, "Here, as elsewhere, however, the efforts were desultory and ephemeral, and the quarter-century following the discovery of oxygen found its position as a therapeutic agent still anomalous." (2)

Brainbridge explained that it wasn't until 1818 that "the true value of oxygen came to be recognized."  It's increase in use was due to the appearance of the monograph.  Yet it wasn't used as a medical gas until 1832 due to an episode of cholera in Europe.  Then it's use faded and it wasn't until another quarter century that it received attention again. (2)

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

Soon thereafter many prominent physicians began to recommend it, including Rene Laennec who invented the stethoscope.  He was also the first to describe lung sounds such as rhonchi and rhales to go along with wheezes.

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

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

Emphasis was added by the original author.  By 2012 we know that oxygen is not necessary in mild or moderate cases of asthma, yet as the acute exacerbation turns into status asthmaticus, and mucus plugs start to block off parts of the lungs, the intake of oxygen may become inhibited and supplemental oxygen helpful.  While oxygen won't cure the asthma episode, it will treat this symptoms until other remedies resolve the exacerbation.  The same is true for oxygen use for other disorders, such as pneumonia and chronic bronchitis.

According to an 1861 editorial in The Cincinnati Lancet & Observer, most authors originally believed oxygen actually treated the disease of asthma.  As noted:
"In the disease, says Professor J. Rowell, the lungs are so constructed that they cannot furnish to the blood its wonted amount of oxygen and eliminate from it carbonic acid.  The treatment (of oxygen), therefore, has either to relax the spasm of the bronchial tubes and thereby increase the breathing capacity of the lungs, or further an atmosphere for the respiration of the patient richer in oxygen, proportionate to the diminished capacity for breathing."  (4)
Yet oxygen alone should not be used.  The authors recommend if oxygen is needed then treatment with strammonium (a mild bronchodilator I wrote about here) is also indicated, and strammonium was usually inhaled by asthma cigarettes or incense.  Another treatment was inhalation of chloroform or by rubbing it on the chest.  They also believed burning selpetre paper made the air "richer" in oxygen.

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

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