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Archive for December, 2016

Carbon dioxide – a medical view from 1866

Posted by Ari Jokimäki on December 22, 2016

I noticed a paper, “Transactions Of Branches” by Charles Trustram (1866), in The British Medical Journal. It contains an interesting passage, which I give below in its entirety. I have highlighted especially interesting parts:

“Medicine. I propose, on the present occasion, to depart from the course pursued by my predecessors, and instead of confining myself to that stale subject, medical reform, and that everyday recurring matter of medical ethics, to take a cursory glance of the progress that medicine has made since our last meeting.

With the exception of those improvements that the treatment of diseases of the nervous centres has derived from the researches of Brown-Séquard and Lockhart Clarke, and the introduction of that new instrument for testing the character of the circulation (which, by the kindness of one of our members, Dr. Clapton, is now on the table, and which I have no doubt he will kindly explain to us), medicine proper seems to have made no very important advance. Pathology, physiology, and vital chemistry, have been pursuing the usual course of verifying, correcting, or rejecting the discoveries of past days. Chemistry, in its more extended sense, has been investigating the condition of the atmosphere, and trying to determine how far its constitution, as to that condition of its oxygen called ozone, determines the spread of epidemics and the character of disease; but as yet with no great practical result. But the question must some day arise, if it have not already done so, whether there is not another constituent which is exerting an influence on the animal economy; I mean an increase, at present inappreciable, of its carbonic acid gas. You are all aware that the subject of the possible exhaustion of our coal-fields, and its relation to the future of our country, which has often been hinted at by the philosopher, has just now seriously engaged the attention of our senate, not as a matter of public health, but as one of political economy. A new senator, but an old philosopher, feeling that the consideration of the subject of the taxation of his country was one, and not the least important one, of his duties, and yet too honest to regard taxes as one of the many means of spending without regard to repaying, suggested that we should try to repay some portion at least of our national debt before we had exhausted that mine of wealth which our coal-beds give us. A new feature most certainly in politics, but one that speaks well for the coming times of legislation, and one from which I hope medicine may soon derive some advantage. “Sufficient for the day is the evil thereof,” and “After us the Deluge,” has been too long the ruling creed of Governments, at all events in matters of finance.

But, I think, had he consulted the two sciences of physiology and chemistry, he need hardly have troubled himself about the matter. They would, I think, have told him that, when our coal-beds (at all events, if there be the quantity presumed) were gone, there would be nobody left to claim or to pay; for, before even the half of the coal of the world is consumed (and I do not suppose our national energy will before that time have exhausted the stock of our own country), the atmosphere will have again assumed a condition fatal to animal life – nearly that condition which a Book, in which I trust we all believe, describes it to have had, when its density, nearly three times that of the present atmosphere, held up and divided the firmament of water that was above it from that which was below it; when the very matter of these coal-beds floated in a gaseous form round earth’s surface, waiting to be fixed and solidified by the action of a gigantic flora, and stored for the use of coming man.

From the sublime to the ridiculous is said to be but one step; and from our gigantic national debt to our own fireside, and domestic expenditure in this matter, is but a short one, and to us an equally interesting and important one. What would be our feelings, if told one snowy morning in December that we had come to our last bushel of coal? We who live near the woods of Sussex might hope to get through the winter with their aid; but we should certainly feel a strong disposition to move off to a warmer climate ere the next winter began, and leave our houses and lands to settle our debt; for, in this free country, whilst coal does last, the manufacturer will take care to have his wants supplied in spite of all forebodings.

To return to that medical point at which I hinted. Let me ask this question, Is the atmosphere suffering from the extraordinary evolution of carbonic acid gas which is now going on? Is the pigmy and stunted flora of the present age equal to its decomposition, to the absorption of the carbon which combustion is now daily producing? and if so, will it continue to be so, seeing that the spread of the human family is daily diminishing the forest growths? Must there not some day be a perceptible increase of the present proportion of carbon in the atmosphere? and may not some already inappreciable increase be the cause of the present type of disease, as distinguished from that which prevailed at the beginning of this century, and which I myself have lived long enough to witness?

May not the altered type of disease have been produced rather from the presence of a depressing agent in the shape of carbonic acid gas, than from a less vivifying condition of the oxygen or its compounds of ozone?

We all, I am sure, regret to find that that dire and fatal malady, the cholera, has again reached our shores. Though it is now nearly fifty yers since this malady first skewed itself in our dependencies, where it has pretty constantly been under the eyes of our professional brethren, and more than thirty years since it came among us, it must be confessed that, beyond treating the symptoms and succouring the powers of life, we have learned but little about it. Various plans of cure have been tried, and each has had its advocates; but as yet there has not been one that has been admitted to be the best by the general voice of the profession. I have ventured to bring this subject to your notice, because I hold that it will, should this malady again spread in this country as it did in 1832, be the duty of every one of us to try to add his mite to the elucidation of the disease or verification of any plan of treatment that may come before him. The last plan of treatment propounded, which its author calls the eliminative one, is founded on the assumption, undoubtedly a true one, that the disease is a blood-poison, and that, therefore, it is desirable to assist Nature in the efforts she makes to rid herself of the poison by mild purgatives, and not by the opiates and stimulants that have been hitherto used. It is asserted that the one rids the system of the poison, which the other locks up. Before we place implicit confidence in this view, it must, I think, be shown that the diarrhoea that generally prevails at the same time as the cholera is not choleraic, or connected with that disease, but only an accompaniment, under the influence of which the poison of cholera has a better chance of exerting its power; for most assuredly hitherto it has been set down as a fact, that the cholera has generally attacked those in whom this condition has been neglected. Now, if elimination is to be the plan, it surely ought to be applied before that storm of symptoms begins, which, however curative they may be, so frequently prove fatal by their own severity. There is unquestionably a stage of incubation, even in those cases which die ere Nature sets up this eliminative action. The poison cannot well begin its action the moment it is taken into the system. Is there, then, no symptom by which this period can be distinguished? and is there no mode by which the poison can be neutralised, ere it makes itself an integral part of the blood? Can inhalation and hypodermic injection offer us no ready means of making a quick impression on the system? Certainly, if we are to look upon spasm of the smaller pulmonary arteries as the chief of the pathological conditions, inhalation would seem to offer us the readiest mode of reaching it. There is another plan of treatment which has been suggested in our JOURNAL; namely, that of transfusion of defibrinated blood. But I think the proposers of this would have done well to have taken a leaf out of the book of that sagacious cook who advised her readers to catch the hare before deciding how it was to be dressed; for, however good this plan, it would be only the rich who could hope to get it in any extensive epidemic.

Whilst doing all we can to treat this disease, we surely should not neglect to ask why and whence it comes, and what are the conditions that favour its spread? However convinced we might have been that the first epidemic was an imported one, we have lately had unmistakable evidence that it can arise in our own country. Then whence comes the poison, and what is it? Is it gaseous or molecular? Abounding, as the sunbeam shews us our atmosphere does, with matter, we can hardly regard it, however much it may assist the propagation of the disease by the deportation of its poisonous molecules, as the source of the poison. The mode of the progress of the disease forbids that. Dirt and bad water seem its almost invariable associates; but we had these for years without cholera. May we come to a conclusion that Nature occasionally loses her power of re-combining the poisonous results of decomposition? or do some intensified electro-magnetic currents occasionally revivify some dormant changes and so evolve this poison? or does this agent occasionally act electrically on some older source which was locked up in the earth’s crust ages past. The fitfulness of the disease favours the idea, either that the poison is not always present, or not liable to be evoked by every day recurring agency. On the other hand, if we are to believe what we bear of its origin among the Arabian Pilgrims, and look at what has lately occurred on board some emigrant ships, it would almost seem, that this poison, like that of typhus, may be produced by overcrowding and bad diet. What if in the end we should find it to be a modified typhus, which, instead of attacking the brain, tries conclusions with the sympathetic? If so, spasm of artery and engorgement of veins may be more dependent on the sympathetic than the direct action of a morbid agent.”

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