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.  

1847 definition: Asthma the opposite of consumption

Consumption (later known as tuberculosis) was the most common lung disease in the mid 19th century.  So one physician defined asthma by comparing it with a disease many people back then knew all too well -- consumption.

The physician was Dr. Samuel Sheldon Fitch, and he defined asthma in his book "Six lectures on the uses of the lungs."  He described it as this: (1)

"It is a disease caused by consumption or consumptive tendency in the lungs, and always arrests the progress of consumption.  It is a vastly lesser disease given in place of a greater, and instead of being a curse, is a greater blessing.  In consumption, the lungs are too small; in asthma they are too larger.  A disease like asthma may be produced by ossification of blood vessels of the heart; but in nearly all cases, it is produced by consumptive irritation of the lungs.  It often takes place suddenly, in earliest childhood, continues until between 12 and 20, then goes off and is never seen again; but the person falls victim to consumption.  Or asthma my reappear and secure the patient from consumption.  If properly treated it is a passport to old age; but when badly treated it may terminate in dropsy of the chest." (1)

Next to this description is a picture of an asthmatic rib cage and a consumptive rib cage. The asthmatic rib cage is large and expanded as thought the patient had his chest puffed out.  The consumptive rib cage is small, narrow and weak.

Thus, Fitch believed since asthma produces a larger rib cage it protects against consumption.  It's strong and mighty while consumption is weak and frail.  While both are diseases that cause discomfort, asthma is minor compared to consumption.  Asthma is temporary and goes away, and consumption is long lasting.

Yet under it all he believes consumption causes asthma in some cases, and this is good because asthma protects against the wasting effects of the underlying consumption. (1)

He wrote:

"Asthma all but always cures consumption, or what is made consumption by very bad treatment.  The asthma leaves the person, and he rapidly is overcome by the consumption that had always been on him whilst he had the asthma, and resumes it's rapid and fatal course, on asthma leaving him.  If asthma is cured without perfectly expanding the lungs, and keeping them so, the person is extremely liable to consumption."

Asthma is a blessing and masks the underlying diseases, and even protects the person from wasting or consumption. He describes a patients who had asthma, didn't take care of it not knowing he had underlying consumption, and died of consumption. (1)

"As in heart disease, woe to the person who is cured of asthma.  Without a free, and perfect, and continued expansion of the chest; as he will, in nearly all cases, sooner or later fall into consumption."

The patient must be brought up well, he proposes.  He must be exposed to outdoor occupations and he must exercise.  This is how to treat asthma and prevent it from going away so consumption doesn't show it's ugly head again, destroy him, and ultimately kill him.

So basically he's saying take care of your asthma if you have it because it's a blessing protecting you from the course of your underlying consumption.

There were other physicians who had similar beliefs about asthma and consumption.  Orville Harry Brown gives us the following quote from two physicians named Hall and Hall (further detail eludes me):  (2, page 33)

"Asthma is a spasmodic contraction of the membranous portion of the windpipe. In consumption the patient dies because there are not lungs enough to receive sufficient air for the wants of the system; that is, they cannot get enough air in; while in asthma they cannot getenough air out; hence asthma and consumption are antagonistic, the former is preventive of the latter and a consumptive is cured on the supervention of asthma."

The idea of asthma as an underlying disease, and of asthma as a blessing, is ironic to say the least.  This was not the first time in history that asthma was considered a blessing.  In Ancient Greece it was considered a blessing to have asthma.

References:

1. Fitch, Samuel Sheldon, "Six lectures on the uses of the lungs," 1847, page 69-71
2. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
   
   
   

x1898: Yearning for help for asthma patient x

So it's the year 1898 and you are a physician. One of your patient's has intractable asthma, where everything you prescribed failed.  What can you do?  Well, why not submit a letter to the editor to medical magazine asking for help. Here's one example of a doctor doing just that.

Editor Medical World :—I ask help for a case of simple but intractable bronchial asthma. I can find no complications. The patient is a lady, about 40 years old, weight 200 pounds, ruddy complexion, red hair. There is no hereditary taint. She is now five months pregnant, but the asthma does not seem to be much worse than before she became so. I have given her a good many remedies with only temporary relief. J. R. Mclaurin, M.D. Toomsuba, Miss. ,

A humble submission on the part of a doctor who had the best interest of his patient at hand. 

References:

1. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, page 251

3533-2600 B.C.: The birth of rational/civilized medicine

Among the first things I learned in my study of medicine in primitive and ancient societies is that given the limited medical wisdom of these people, they "rationalized" medicine to the best of their ability.  They "rationalized" disease as being caused by evil spirits, demons, ghosts and gods.  While we may think of this as mythology and irrational, to them it was quite rational.  (1, page 248)

We must keep this in mind as we continue our quest to learn the history of medicine, and the history of asthma.  Our quest today, however, is to learn about the time in history when what we consider to be rational  medicine was born.  We want to know at what time in history physicians started prescribing medicine that is not mythical, and might actually make your breathing easier, or make your chest pain go away.

To prevent confusion of the term "rational," many historians use terms like magical, religious, or magico-religious to refer to mythology and religious medicine, and terms like civilized, empirico-rational, or natural to refer to real remedies.  Personally, I like the terms magico-religious and civilized, and for this reason I will try to use these terms throughout this history. Still, it's important to understand the confusion here, as the various terms continue to pop up in various historical writings. (2)(4)

By studying ancient Egypt we learn how mythology influenced medicine, and we also learn how civilized medicine was born.  Since Egyptians believed diseases were caused by gods and demons that were ubiquitous, the only means of treating and preventing disease was magic.  The person responsible for medicine was the medicine man.  He offered incantations, prayers and amulets to treat disease.  He was a busy person, sought out daily by those afflicted with chronic pain, discomfort, or injuries. (2)

Generally speaking, if you suffered from basic symptoms, such as if you had a cold, you'd deal with it on your own, as you wouldn't want to be a burden to your family or clan.  If you had any symptoms of asthma -- dyspnea, chest pain, coughing, wheezing, or increased sputum -- you'd probably suffer through it until your trouble went away on their own.   If it persisted and you couldn't bare it any longer, then you might give in and seek a medicine man to treat your symptoms.

By trial and error more treatment options were learned, and these are your civilized medicine, your "physical, dietetic and pharmacological treatments."  Methods of setting of broken bones, and cutting with a knife (surgery) were developed and passed on by the language that developed. (2)

The job of the medicine man became a specialized profession, and as time went by there were basically three branches of medicine that formed:  (2)

• Sorcerer: They specialized in magic, creating a link between the patient and the spirits 
• Priest: They specialized in religion, creating a link between the patient and the gods
• Physician: They specialized in civilized medicine, treating ailments with prescriptions

More than likely, all three of these paradigms existed side by side, with a patient having all three as options for healing. (1)  And even while physicians used civilized medicine, to them such remedies were gifts from the gods, and worked by magical or religious means.  Incantations were often chanted as they prepared them, and as they offered them to their patients.  (5, page 4)

As noted by Walter Libby in his 1922 book "The history of meidicne in its salient features,": (5, page 4)

On account of the conservatism of the priestphysicians, Egyptian medicine never advanced far beyond primitive medicine with itssimple faith in magic spells and the virtue of a rich pharmacopoeia, and its belief that the cause of disease was the malice of a demon,the justice of an avenging god, the ill-will of an enemy, or the anger of the dead.

Technically speaking, rationalized/civilized medicine probably started early, perhaps as early as 30,000 B.C., only to be known by a few people.  As word spread of the success of these new remedies, more and more medicine men learned of them, and used them on their own patients with success.  Such wisdom was then shared by word of mouth from one generation to another, mainly through easy to remember poems and songs, until the first medical writings were available.

For the most part, however, most historians recognize rational/civilized medicine as starting early in Egypt and Mesopotamia, only to develop over a thousand  years later in China. So it's easy to see that such wisdom was slow to advance and spread from man to man, and society to society.

Historians acknowledge there is evidence of physicians early on in Egypt's history, although such knowledge is sparse.  Edward Withington, in his 1894 book "Medical History of the Art of Healing," describes the discovery of a tomb of Sekhet' enanch who was chief priest/ physician of the Pharaoh Sahura sometime around 3533 and 3000 B.C. .  Inscriptions show he "healed the king's 'nostrils' for which his majesty wishes him 'a long life of holiness.'" (4)

The next priest/ physician we know of is Imhotep, who was the vizier (chief adviser) and architect of King Djoser around 2,600 B.C. He was believed to be the architect who designed the first great stone pyramids, and to have designed many of the tools used to build these pyramids. He was also believed, for a generation perhaps, to be the priest who communicated with the god Thoth (Hermes), thus writing the medical wisdom of the gods on stone tablets, which are known to history as the Hermatic texts.

Yet Imhotep must have been a heroic physician too, because after his life he was so heralded by the people that he became a god. Although, due to his fame, Imhotep was given credit as the inventor of medicine, something that is also sometimes debated. Yet for our purposes, the writings he is said to have written contained some of the first civilized remedies, prescriptions that involved dough pills, inhalations of smoke and steam, salves, etc. He, therefore, is often considered the father of rational/ civilized medicine.

After Imhotep rational/civilized medicine spread throughout the whole of Egypt.  Some priests studied the last six of the Hermetic texts, and they became physicians.  They were often sent to the homes of the sick, and prescribed what we might refer to as rational/civilized medicine, along with the incantations that went with them.

So as the medicine man's specialties evolved, so too did the physician's specialties.  Herodotus (484-425 B.C.), was from Greece and traveled the world to learn how other societies lived.  He observed of Egypt that:

The practice of medicine is so divided among them, that each physician is a healer of one disease and no more.  All the country is full of physician, some of the eye, some of the teeth, some of what pertains to the belly, and some of the hidden diseases." (3)

Natural medicine became so common that regular folks had knowledge of it.  Common colds, asthma, headaches, and stomach aches were probably treated by the physicians in the home, as Homer noted of the Egyptians that "each one is a physician, skillful beyond all men, for verily they are of the race of Paeon (Greek physician of the gods)." (4, page 16)

What did he mean by this?  Well,  it's actually open to speculation, but some historians believe he meant that every person in Egypt was knowledgeable of medicine, at least to a certain extent.  Perhaps he meant that the average person in Egypt was like the average person in the United States today, thus with a medicine chest full of medicine, and the ability to treat the basic ailments and injuries of the day. 

Edward Withington, in his 1894 book "Medical history from the earliest times," describes two examples that may show that even non-physicians were physicians -- sort of.  The first one is the discovery of the medicine chest of Pharaoh Mentu'-hotep of the 11th dynasty around 2,500 B.C.  The chest belonged to his wife, and consisted of "six vases, one of alabaster and and five of serpentine, with dried remnants of drugs, two spoons, a piece of linen cloth and some roots, enclosed in a basket of straw-work, the whole standing in a wooden chest found in the queen's tomb." (4, page 16)

As the second example, Withington mentions a "curious letter from a husband to his dead wife, found attached to a small image of the latter.  In it he upbraids the departed spirit for having produced disease in him, and while reproachfully calling to mind his kindness to her during life, thus describes her last illness:  'When thou wast sick, with the sickness that thou hadst, did not I go to the physician and bid him make thy medicines for thee? -- yea, he did all things whatsoever thou wouldst have him do.' This seems to imply that the lady to some extent directed her own treatment, and reminds us of the Homeric description of Egypt as the land where 'each one is a physician, skillful beyond all men, for verily they are of the race of Paeon.'" (4, page 16)

It's highly likely that if home remedies didn't work, and greater help was needed or wanted, then the sick may seek a sorcerer, priest or physician.  Unexplained diseases were probably treated with magic.  Bone breaks and lacerations being treated with surgery, with lotions and salves being used to soothe the pain and speed healing.  Chronic disease may be treated with magic, or perhaps with one of the various salves, lotions, potions, pills of dough, and the like. 

And what we're most interested in here is emperico-rational medicine --rational/ civilized.  It's what is learned by observation and experimentation.  The plant Belladonna laid out in the sun and was dried, and one day an asthmatic accidentally dropped some on the fire and inhaled the smoke, getting some relief.  He remembered this and tried it the next time he was dyspneic with the same beneficial results.  He relayed this story to his friends, and to his children, until one day it was written on papyrus, and delivered to us through time via the Georg Eber Papyrus. 

Belladonna is referred to as a herbal remedy. Other available herbs included opium, coca, cinchona, ephedrine, caffeine, carcara, sagrada, chaulmoogra, digitalis, ipacacuanha, podophyllum, pyrethrum, squill, belladonna, and strammonium. These are your natural remedies. (1)

These herbs had to be prepared in such a fashion that they had some potency, some medicinal effect.  Some were best sundried, crushed and inhaled.  Some were most effective in lotions massaged on the skin.  Some were best mixed in dough and swallowed with water.  Some were best dissolved in water and made into broths.  Some worked best as salves.  Many were best mixed with other herbs, or given before or after chanting an incantation.

While these are your natural remedies, the "pharmacological aspect of therapy must be understood, however, in the context of the supernaturalistic paradigm: the medicines worked through magic, their effect depended on the recitation of the proper words and the performance of the correct actions. In fact, the consecration of the remedies was a significant part of the sacred utterances of the healer.  The potency of herbs was usually due to their relationship with gods or goddesses who were behind their curative powers." (1)

The medicine was magical.  In this way, the physician was just another medicine man.  In a way it seems that in the absence of any truly effective remedy, the hope a priest or sorcerer provided, the hope that helped soothe your mind, may have done more for healing than any remedy of the physician. 

Just think about it:  while a prayer or incantation offered no real remedy, at least it did no harm.    The best case scenario was the placebo effect made you think something was being done.  You felt better by default.  You relax.  Your breath came back -- eventually.   I'll let you decide which healer you would have rather taken your chances with. 

Further reading:

• 5000-50 B.C.: Egyptian gods educate physicians
• 5000-50 B.C.: The role of the Bible in medicine
• 5000-50 B.C.: The Ebers Papyrus: the first asthma remedy? 
• 2600 B.C. Imhotep invents rational medicine

References:

1. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, page 248
2. Sigerist, Henry E, "A History of Medicne," 1955, second editionn, vol. I, 
3. Prioreschik, op cit, page 365-6, referring to Herodotus, II, 84, Translation by A.D. Godley.  
4. Withington, Edward Theodore, "Medical history from the earliest times: A popular history of the art of healing," 1894, London, The Scientific Press, pages 14-23 (Chapter IV: Medicine in Ancient Egypt)
5. Libby, Walter, "The History of medicine in its salient features," 1922, Boston and New York, Houghton Mifflin Company

19th century nebulizers

Dictionary.com provides us with the definition of nebulize:  "to reduce to fine spray; atomize."  And thus a nebulizer, then, would be any mechanical device that can "atomize" a solution and reduce it to a fine spray."  Quite often we refer to this spray as a mist.  So a nebulizer is any device that can create a mist. 

Turning a solution into a mist is a good means of getting medicine down into the lungs, where it's needed and can be of use.  Nebulizers were basically believed to break a solution into atoms, and thus the first nebulizers were often referred to as atomizers.  The process of creating a mist was thus termed atomization.   

Some of the first nebulizers were described by John M. Scutter in his 1867 book "On the use of medicated inhalations in the treatment of diseases of the respiratory organs.  The book was one of the first specifically dedicated to inhalation therapies, including devices to deliver it and the medications.  If the respiratory therapy profession existed back then, it would have been a must read. 

Nebulizers basically work based on the Bernoulli Principle.  The idea comes from the observation that when water hits a rock it creates a mist that can be inhaled.  Daniel Bernoulli published a book in 1738 where he described that a similar effect could be created by forcing water through a narrow tube. The faster water flows through a tube, the less the lateral pressure will be.  Thus, in nebulizer air is forced through a narrow tube, and fluid is entrained into the narrow opening.  The fluid is basically sucked in due to the negative sidewall pressure, and turned into a mist to be inhaled. (2, page 61)

So anyway, the following are the first nebulizers according to Scutter.  I will allow him to do the describing. (see pages 26-36):

Elsberg's Nebulizer

1.  Elsberg's Nebulizer:  "The simplest instrument is that known as "Elsberg's Nebulizer," which consists of two hard rubber tubes pointed at the extremities, the openings being small, and so hinged that they can be placed at right augles, the openings being immediately opposite, as in Fig. 3. One arm of the apparatus being placed in the medicated fluid, blowing through the other causes the fluid to rise in the tube, and it is carried off" in a fine spray. Rimmel's Rafraichisseur, which is the same in principle, has been employed for some years for distributing perfumes, and may be purchased quite cheap. The principal objection to this method is, that it requires a second party, and the breath cannot but prove offensive to many patients."

Sales-Giron's Nebulizer

2.  Sales-Giron Nebulizer:  "The second form of apparatus consists of a cylinder in which works an air tight piston, like the barrel of a syringe. Fluid being placed in it, is forced through minute openings in the nozzle, as a delicate spray.  Fig. 4, represents the instrument of M. Sales Giron, which I have used in my practice with excellent results. When inha

lations are much used, I have no doubt they will be manufactured by our hard rubber manufacturers, at a price to bring them within the reach of all"  This nebulzier required lots of work to get a mist, and sometimes may have required two people if the person needing the medicine was too sick.  For this reason it probably wasn't very marketable.  This nebulizer of often listed as the first nebulizer, and for that reason I wrote about it in greater detail here.  

3.   Dr. Mackenzie's Nebulizer:  "The apparatus of Dr. Mackenzie is a very good one. The piston is drawn back by a wheel and rack at its upper part, and is forced down by a circular spring which surrounds the cylinder. The apparatus is filled with liquid by a funnel in its top, and all the spray, except that which is inhaled, passes back into the apparatus. He claims the following advantages for jt.

"1. Its simplicity, requiring only a few turns of a handle to set it in operation. 2. The extremely fine state of subdivision which it effects. 3. The uniform pressure exerted. 4. The fact that the Waste liquid returns into the apparatus. 5. The ease with which it can be taken to pieces and cleaned."

Dr. Seigle's Inhaler

4.  Dr. Seigle's Inhaler:  "The third form of apparatus is that of Dr. Seigle, and is preferable to the others, for its simplicity and because it is automatic. The best reason for preferring it, however, is, that its price is such as to bring it within the means of any patient, as it is furnished through the druggists for$5,00, and its construction is so simple, that it is readily operated by any one."  The inhaler (or nebulizer) is designed so that steam provides the flow that makes the bournoulli principle work, and in this way the operator doesn't need assistance to create a mist.  The device simply sits on a table and the patient can enjoy the mist, and hopefully relief in breathing.  I describe this nebulizer in more detail here. 

So these are your basic nebulizers of the 19th century.  It's basically what you had to deal with until the 1930s when electricity became available. 

  References:

1. Scudder, John Milton, " On the use of medicated Inhalations in the treatment of diseases of the respiratory organs," 1867, Cincinnati, 2nd edition, Moor, Wilstach, and Baldwin
2. Wyka, Kenneth A., Paul Joseph Mathews, William F. Clark, "Foundations of Respiratory Care,"

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, 1908, Vol. 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

1750-1870: Air is defined

Stephen Hales (1677-1761)

So by the 1750s it was well known that air was more than just an element, that it was composed of certain gases.

In 1553, Michael Servetus was the first to speculate that it was the lungs that caused dark blood to become bright red, and not the heart.

In 1640, William Harvey was the first to describe the systemic circulation of the blood through the vessels of the body.

In 1668, John Mayow was the first to speculate that the purpose of the lungs was not to cool the heart, but for the exchange of gases.  He believed a substance in the air -- nitro-aerial gas -- was inhaled into the lungs, and when it entered the blood stream the blood turned from a dark color to a bright red.  This, he speculated, was why venous blood was dark and arterial blood red.

He also speculated that a vapor produced by the blood was exhaled by the lungs. He did not know that nitro-aerial gas was oxygen, and he did not know that the substance produced by the blood and exhaled by the lungs was carbon dioxide. He may have made thes discoveries had he not died at the young age of 35, before any of his works were published.

So, by 1750, investigators had determined that one of these gases was fixed air that was exhaled by the lungs, and the other was a vapor that was inhaled by the lungs.  In the next 50 years the composition of air, and the purpose of respiration, would be well known.

Stephen Hales performed experiments on air and respiration, and he proved that there is no circulatory system in trees like there is in humans and animals.  (4, page 193)

Fixed air was further studied by Joesph Black.  He was the first to recognize that this gas was burned off during the exhalation phase of respiration.   He discovered it "was deadly to animals, and could distinguish a flame." (3) (4, page 193-194)

Joseph Black (1728-1799)

Oxygen was first described in 1740 by Alexander Ferguson, yet it wasn't discovered until 1773 by Carl Wilhelm Scheele (1742-1786).  Scheele would later describe the discovery of a gas (empyreal air) that made candles burn brighter. The problem for him was that by the time he wrote about it someone else had already gotten credit. (2, page 282)

Unaware of the works of Scheele, and unaware that a third man -- Antoine Lavoisier (1743-1794) -- was doing similar research, (1) Joseph Priestly (1733-1804) published a work in 1772 called "Observations on different kinds of Air."

He described experiments he performed, and thus gained the interest of the science community. He "noticed that blood placed in an atmosphere of hydrogen or nitrogen gave off what we now refer to as oxygen. It was in this book that he described his discovery of oxygen, and for this reason he is given credit for its discovery, despite the works of other men.    (5, page 517)

Joseph Priestly (1733-1804)

He also observed that mice living in an environment with supplemental oxygen lived longer than mice who breathed normal air.  This was the first proof of the therapeutic benefits of supplemental oxygen.  (2)

Priestly then concluded the work of Michael Servetus, who noticed that the lungs changed the color of the blood and were the reason arterial blood was a brighter color.  Priestly proved that oxygen is inhaled into the lungs and exchanged from the alveoli to the capillaries and then into the arteries.

I think it's interesting to note why Priestly referred to oxygen as "dephlogisticated air."  It's explained best here:  

(Priestly's) experiments were sound, but his views on respiration were erroneous, vitiated as they were by his belief in the old theory of "phlogiston" introduced by (George) Stahl (1659-1734) in 1697. Phlogiston was the material and principle of fire, not fire itself, and respiration, according to Priestley, was a phlogistic process, whereby the phlogiston absorbed by animals with their food was discharged. Venous blood was phlogisticated, arterial blood dephlogisticated; a clot of blood placed in "fixed" or phlogisticated air became very dark, but regained its red colour when it was transferred to oxygen or dephlogisticated air. This old theory was overthrown a few years later by Lavoisier, who extended and explained correctly the discoveries of Mayow, Black, and Priestley; he showed that there were differences in the so called phlogistic processes. (5, page 476)

Antioine Lavoisier (1743-1794)

Yet while Priestly is given credit for the discoverey of oxygen, it was Lavoisier who was given credit for the name. While each early discoverer gave the new element his own name (Priestly called it "dephlogisticated air), the term "oxygene" was chosen by Lavoisier because he believed his new molecule was the great 'acidifying principle in nature. Oxygen is Greek for generator of acids.(1)
Lavoisier believed oxygen was acidic in nature because of some of the things it did. For instance, Lavoisier discovered that oxygen was involved in the rusting of metals, the formation of dew, as well as the respiration of animals and humans. Because it created such changes he believed it was an acid.

Stephen Hales (1677-1761)

Lavoisier, working with Pierre-Simon Laplace, determined, in 1780, that the body's heat was a byproduct of combustion that takes place in the body.  So in this way he disproved Galen's theory that a body's heat was produced in the heart. He later determined this combustion took place both in the lungs and other places in the body. It was later proved by others that it was in the tissues that respiration occurs.  So this was the beginning of knowledge of respiratory exchange.  (5, page 476)

The rush to learn more about air was on. Hales continued his research, and he created a device he called a pneumatic trough that he used to collect both carbon dioxide and oxygen, and now he was certain that plants obtained their nourishment from this air. (4, page 193)

Henry Cavendish (1731-1810)

Henry Cavendish (1731-1810) discovered hydrogen, or what he referred to as "inflammable air." He "exploded a mixture of hydrogen and oxygen and thus proved that water was not an element, but a compound of two gases." (4, page 194)

It has since been discovered that oxygen is present in most acids.  So for this reason the name "oxygen" really isn't an appropriate name for oxygen.  Yet the name stuck.  (1)

Experiments on animals by these men, and many other men to follow, proved that oxygen was the essential element of life.

The first reported experiments using oxygen on humans was done in 1783 by Francois Chausier (1746-1848). His experiments involved patients who had consumption (tuberculosis) and were dyspneic. He also used it for asphyxiated newborns. His and other early experiments using oxygen proved oxygen could be therapeutic for respiratory disorders, such as any disorder that caused dyspnea.  (2)

Francois Chaussier (1746-1848)

Realizing there might be therapeutic benefits from oxygen, and perhaps a profit to be made, Thomas Beddoes (1730-1810)  opened up the "Pneumatic Institute" in Bristol shortly after its discovery.  This was the first of what would later be referred to as oxygen parlors, which became common in the 19th century.  (2, page 281)

Beddoes devised a system where any amount of oxygen could be added into the atmosphere of small compartments.  A patient would spend a certain amount of time in these compartments breathing supplemental oxygen.  He described the following as being treated satisfactorily with such oxygen therapy: obstinate ulcers, leprosy, spasms, cancer, dropsy, hydrocephalis, headache, poisoning by opium, paralysis, scofulous tumors, scorbutus, venereal, deafness, white swelling, melancholy, general dibility, continued fever, intermittent fever, and coldness of the extremities.  (2, page 281)

Thomas Beddoes (1730-1810)

Yet despite the therapeutic experiments of Beddoes, oxygen was not accepted by the medical community, perhaps mainly due to the fact there were not efficient and inexpensive devices for making it and delivering it to the patient.  (2, page 281)

Of course there was also no experiment that proved without a doubt the benefits of using it either.  (2, page 281)

After Beddoes oxygen wasn't used therapeutically again until a cholera outbreak in 1832. (2, page 281)

Still, investigators continued to learn more about the microscopic structures in the body responsible for the transfer of oxygen through the body.

In 1840 Hunefeld found crystals in the blood of earthworms, and essentially became the first to observe hemoglobin.  He is therefore the person credited with its discovery.

Hemoglobin is the essential protein on red blood cells that carries oxygen or carbon dioxide in the blood.

In 1862 Hoppe-Seyler described the transport of oxygen on hemoglobin, and in 1864 George Stokes (1819-1903) described why oxygen changes the color of hemoglobin, and therefore darkens arterial blood. (5, page 525)

In 1870, Pfluger described tissue oxygenation.

In 1857 Claude Bernard (1813-1878) described that the color of blood was changed from bright red to dark because the dark blood contained more carbon dioxide. (6, page 239)

Carl Ludwig (1816-1895)and others proved the change in color had more to do with oxygen's attachment to hemoglobin.  When oxygen is attached to the hemoglobin the blood is redder, and when oxygen jumps and carbon dioxide replaces it the blood becomes darker. (1816-1895)

This explanation better explains the difference in color between arterial (freshly oxygenated blood from the lungs to tissues) and venous blood (deoxygenated blood from tissues going back to the lungs).(6, page 239)

It wasn't until the mid 19th century, however,  that oxygen parlors became readily available for use.  They essentially create dan oxygen enriched environment for those who wished to inhale it try it, either therapeutically or for entertainment.  (2)

By the turn of the 20th century physicians knew why breathing was essential to life, and the process of inhaling oxygen and exhaling carbon dioxide was referred to as ventilation.

The first two decades of the 20th century would see an increased effort to determine the benefits of oxygen therapy, and to invent better technology of delivering it to patients.  These efforts would gain urgency due to poisonous gases used in WWI.

References:

1. Gray, Alonzo, "Elements of Chemistry:  Containing the Principles of the Science, both experimental and theoretical," 1840, Massachusetts, page 118
2. Brainbridge, William Seaman, "Oxygen in Medicine and Surgery -- a contribution with report of cases," New York State Journal of Medicine, 1908, Vol. 8, June, No. 6, pages 281-295
3. "Carbon Dioxide,"  Scienceclariied.com, http://www.scienceclarified.com/Ca-Ch/Carbon-Dioxide.html#b, observed the site on May 4, 2012 (this information is available at a variety of sources, although I chose to give sciencedaily.com credit)
4. Magner, Lois N., "History of Life Sciences," 2002, 3rd edition, New York, Marcel Dekker
5. Hill, Leonard, Benjamin Moore, Arthur Phillip Beddard, John James Rickard, etc., editors, "Recent Advances in Physiology and bio-chemistry," 1908, London, Edward Arnold
6. Fruto, Joseph S, "Proteins, Enzymes, Genes: The Interplay of Chemistry and Biology," 1999, New York, Yale University