Early use of oxygen outside the operating theatre

Cover photo.

Mine rescuer wearing Draeger oxygen apparatus, Avondale Shaft, Delaware, Lackawanna and Western Railroad Colliery, Pennsylvania, 1911. Source: Lewis Wickes Hine. National Child Labor Committee collection, Library of Congress, Prints and Photographs Division.

A man may live a month without food, a week without water, but dies in a few minutes when deprived of oxygen.

           John H Kellogg, May 1888 ¹

During the early 1770s in Sweden, Carl Scheele commenced a series of experiments investigating the chemical nature of air and fire. Heating a variety of substances, including saltpetre (potassium nitrate), and the red calx of mercury (mercuric oxide), he produced a colourless, odourless gas, in which a ‘candle burnt with a large flame, of so vivid a light that it dazzled the eyes’. ² Scheele named the gas ‘feuerluft’ (fire air), and postulated that it was the means by which ‘the circulation of the blood, and … juices in animals and plants’ ² were supported.

Scheele’s findings were first published in 1777, by which time Joseph Priestley had reported the results of similar experiments undertaken in England, between 1774 and 1775. ³ The widely accepted phlogiston theory held that all combustible materials contained phlogiston, a common fire-like element, that was released into the air on burning. This substance was thought to be taken up by metal calxes when they were heated. Accordingly, if a calx was heated in a closed space, all the phlogiston in the surrounding air would be absorbed, leaving what Priestley referred to as ‘dephlogisticated air’. ³ He noted: ‘from the greater strength and vivacity of the flame of a candle, in this pure air, it may be conjectured, that it might be peculiarly salutary to the lungs in certain morbid cases’. ³

Priestley’s work was quickly of interest to others. In his ‘Proposals for the recovery of people apparently drowned’, ⁴ presented to the Royal Society of London in March 1776, John Hunter recommended the use of bellows to insufflate the victim’s lungs, and suggested that ‘the dephlogisticated air, described by Dr Priestley may be more efficacious than common air’. ⁴ Around the same time in Paris, Antoine Lavoisier repeated the experiments of Scheele and Priestley, and expanded on their work. He initially described the gas as ‘eminently respirable air’, and later ‘oxygène’. ⁵

Soon after, physicians in France and Switzerland began investigating the therapeutic role of this new agent. On 9 March 1783, Dr Caillens published a short report in the Gazette de Santé describing the administration of oxygen to two patients with pulmonary tuberculosis, in whom ‘all conventional remedies had been exhausted’. ⁶ He observed that the intermittent inhalation of oxygen reduced pain, facilitated expectoration and provided strength. One year later in Geneva, Louis Jurine reported a similar case, in which the patient ‘very much benefited’ ⁷ from the daily inhalation of oxygen.

The following decade in England, Thomas Beddoes turned his attention to the employment of ‘pneumatic medicine’ in the treatment of conditions ‘hitherto found incurable’. ⁸ In 1793, he proposed that ‘a mixture of air containing about thirty-five parts in a hundred of oxygen may be employed with probable advantage’ in ‘a considerable variety of diseases’, including asthma, typhus, hysteria and diabetes. ⁸

Five years later, with the assistance of James Watt and Humphry Davy, Beddoes established the Pneumatic Institution in Bristol, where this mode of treatment was tested on an extensive scale. Oxygen was among the many ‘factitious (manufactured) airs’ ⁹ administered to patients, and was inhaled from an oiled silk bag, via a faucet, or mouthpiece. A typical ‘dose’ comprised ‘a pint of oxygen air in a bagful or half a bagful of common air’. ⁹ Concomitantly in London, Daniel Hill conducted similar experiments, investigating the utility of oxygen in cases of hydrocephalus, epilepsy and nervous irritability. ¹⁰

Despite the efforts of these early protagonists, the intermittent inhalation of oxygen yielded little benefit for patients. In 1800, Davy wrote: ‘pneumatic chemistry in its application to medicine, is an art in infancy, weak, almost useless … an immense mass of pneumatological, chemical and medical information must be collected, before we shall be able to operate with certainty, on the human constitution’. ¹¹

While a handful of practitioners endorsed oxygen as a ‘panacea’ ¹² during the early 19th century, and its use was trialled in France, Russia and Poland during the second cholera pandemic, ¹³ the wider medical community remained sceptical of its employment. Reviewing the status of oxygen therapy in 1842, Jonathan Pereira noted: ‘on the whole … I believe oxygen to be almost useless as a remedy’. ¹³

In the decades that followed, oxygen continued to be ‘hawked by quacks’. ¹⁴ They extolled the virtues of oxygenated bread and water, ¹⁵ as well as oxygen enemas, ¹ for diseases of the liver and intestinal tract, and recommended its inhalation in a host of other conditions, including leukaemia, uraemia, hydrophobia, tetanus and pelvic cellulitis. ¹⁶

In 1870, Andrew Smith was among the first to consider the use of oxygen on a rational and scientific basis. Reflecting on its physiological action, Smith asserted that ‘any disease which gives rise to dyspnoea will be benefitted, at least temporarily, by the use of oxygen’. ⁷ Seven years later, George Holtzapple published a scholarly account outlining its intermittent use in two cases of pneumonia, ¹⁷ and on 18 February 1890, Albert Blodgett conceived its continuous inhalation to be ‘the only means of prolonging life’ ¹⁸ in a moribund woman with right lower lobe consolidation. Blodgett later recalled: ‘when I directed the continuous administration of the gas, I did so under the positive conviction that the patient was irrevocably doomed … At this time I had only employed the gas in the manner ordinarily directed, that is, two or three gallons at a time, several times daily. I now directed its use without cessation, and to my great surprise, the patient not only obtained the relief desired, but was enabled to carry on the function of respiration. The amount of gas employed was not far from two hundred gallons in twenty-four hours’. ¹⁸

By the end of the 19th century, continuous oxygen therapy had become an accepted treatment for pneumonia. Nevertheless, some continued to question its value. In 1898, William Osler stated: ‘personally when called in consultation to a case, if I see the oxygen cylinder at the bedside I feel the prognosis to be extremely grave’. ¹⁹

In 1906, Max Michaelis, Professor of Medicine at the University of Berlin, published his Handbuch der Sauerstofftherapie (Handbook of oxygen therapy). ²⁰

Among the authors of this comprehensive textbook was Heinrich Brat, who developed several devices for the delivery of oxygen, ventilation and anaesthesia. ²¹ Brat’s inventions influenced the design of equipment manufactured by the firm Dräger, which included oxygen apparatus for use in mine rescue. This was utilised widely in Europe and America, and it proved so effective in saving lives that mine rescuers in the USA quickly became known as ‘Draegermen’. ²²