Experiments and Observations on Different Kinds of Air — APPENDIX, Number III

NUMBER III.

_Observations on the MEDICINAL USES of FIXED AIR.

By THOMAS PERCIVAL, M.

D.

Fellow of the ROYAL SOCIETY, and of the SOCIETY of ANTIQUARIES in LONDON.

_ These Observations on the MEDICINAL USES OF FIXED AIR have been before published in the Second Volume of my Essays; but are here reprinted with considerable additions.

They form a part of an experimental inquiry into this interesting and curious branch of Physics; in which the friendship of Dr. Priestley first engaged me, in concert with himself.

Manchester, March 16, 1774. In a course of Experiments, which is yet unfinished, I have had frequent opportunities of observing that FIXED AIR may in no inconsiderable quantity be breathed without danger or uneasiness.

And it is a confirmation of this conclusion, that at Bath, where the waters copiously exhale this mineral spirit,[15] the bathers inspire it with impunity.

At Buxton also, where the Bath is in a close vault, the effects of such _effluvia_, if noxious, must certainly be perceived.

Encouraged by these considerations, and still more by the testimony of a very judicious Physician at Stafford, in favour of this powerful antiseptic remedy, I have administered fixed air in a considerable number of cases of the PHTHISIS PULMONALIS, by directing my patients to inspire the steams of an effervescing mixture of chalk and vinegar; or what I have lately preferred, of vinegar and potash.

The hectic fever has in several instances been considerably abated, and the matter expectorated has become less offensive, and better digested.

I have not yet been so fortunate in any one case, as to effect a cure; although the use of mephitic air has been accompanied with proper internal medicines.

But Dr. Withering, the gentleman referred to above, informs me, that he has been more successful.

One Phthisical patient under his care has by a similar course intirely recovered; another was rendered much better; and a third, whose case was truly deplorable, seemed to be kept alive by it more than two months.

It may be proper to observe that fixed air can only be employed with any prospect of success, in the latter stages of the _phthisis pulmonalis_, when a purulent expectoration takes place.

After the rupture and discharge of a VOMICA also, such a remedy promises to be a powerful palliative.

Antiseptic fumigations and vapours have been long employed, and much extolled in cases of this kind.

I made the following experiment, to determine whether their efficacy, in any degree, depends on the separation of fixed air from their substance.

One end of a bent tube was fixed in a phial full of lime-water; the other end in a bottle of the tincture of myrrh.

The junctures were carefully luted, and the phial containing the tincture of myrrh was placed in water, heated almost to the boiling point, by the lamp of a tea-kettle.

A number of air-bubbles were separated, but probably not of the mephitic kind, for no precipitation ensued in the lime water.

This experiment was repeated with the _tinct.

tolutanæ, ph.

ed.

_ and with _sp, vinos.

camp.

_ and the result was entirely the same.

The medicinal action therefore of the vapours raised from such tinctures, cannot be ascribed to the extrication of fixed air; of which it is probable bodies are deprived by _chemical solution_ as well as by _mixture_.

If mephitic air be thus capable of correcting purulent matter in the lungs, we may reasonably infer it will be equally useful when applied externally to foul ULCERS.

And experience confirms the conclusion.

Even the sanies of a CANCER, when the carrot poultice failed, has been sweetened by it, the pain mitigated, and a better digestion produced.

The cases I refer to are now in the Manchester infirmary, under the direction of my friend Mr. White, whose skill as a surgeon, and abilities as a writer are well known to the public.

Two months have elapsed since these observations were written,[16] and the same remedy, during that period, has been assiduously applied, but without any further success.

The progress of the cancers seems to be checked by the fixed air; but it is to be feared that a cure will not be effected.

A palliative remedy, however, in a disease so desperate and loathsome, may be considered as a very valuable acquisition.

Perhaps NITROUS AIR might be still more efficacious.

This species of factitious air is obtained from all the metals except zinc, by means of the nitrous acid; and Dr. Priestley informs me, that as a sweetener and antiseptic it far surpasses fixed air.

He put two mice into a quantity of it, one just killed, the other offensively putrid.

After twenty-five days they were both perfectly sweet.

In the ULCEROUS SORE THROAT much advantage has been experienced from the vapours of effervescing mixtures drawn into the _fauces_[17].

But this remedy should not supersede the use of other antiseptic applications.

[18] A physician[19] who had a very painful APTHOUS ULCER at the point of his tongue, found great relief, when other remedies failed, from the application of fixed air to the part affected.

He held his tongue over an effervescing mixture of potash and vinegar; and as the pain was always mitigated, and generally removed by this vaporisation, he repeated it, whenever the anguish arising from the ulcer was more than usually severe.

He tried a combination of potash and oil of vitriol well diluted with water; but this proved stimulant and increased his pain;

probably owing to some particles of the acid thrown upon the tongue, by the violence of the effervescence.

For a paper stained with the purple juice of radishes, when held at an equal distance over two vessels, the one containing potash and vinegar, the other the same alkali and _Spiritus vitrioli tenuis_, was unchanged by the former, but was spotted with red, in various parts, by the latter.

In MALIGNANT FEVERS wines abounding with fixed air may be administered, to check the septic ferment, and sweeten the putrid _colluvies_ in the _primæ viæ_.

If the laxative quality of such liquors be thought an objection to the use of them, wines of a greater age may be given, impregnated with mephitic air, by a simple but ingenious contrivance of my friend Dr. Priestley.

[20] The patient's common drink might also be medicated in the same way.

A

putrid DIARRH[OE]A frequently occurs in the latter stage of such disorder, and it is a most alarming and dangerous symptom.

If the discharge be stopped by astringents, a putrid _fomes_ is retained in the body, which aggravates the delirium and increases the fever.

On the contrary, if it be suffered to take its course, the strength of the patient must soon be exhausted, and death unavoidably ensue.

The injection of mephitic air into the intestines, under these circumstances, bids fair to be highly serviceable.

And a case of this deplorable kind, has lately been communicated to me, in which the vapour of chalk and oil of vitriol conveyed into the body by the machine employed for tobacco clysters, quickly restrained the _diarrhoea_, corrected the heat and foetor of the stools, and in two days removed every symptom of danger[21].

Two similar instances of the salutary effects of mephitic air, thus administered, have occurred also in my own practice, the history of which I shall briefly lay before the reader.

May we not presume that the same remedy would be equally useful in the DYSENTERY?

The experiment is at least worthy of trial.

Mr. W----, aged forty-four years, corpulent, inactive, with a short neck, and addicted to habits of intemperance, was attacked on the 7th of July 1772, with symptoms which seemed to threaten an apoplexy.

On the 8th, a bilious looseness succeeded, with a profuse hoemorrhage from the nose.

On the 9th, I was called to his assistance.

His countenance was bloated, his eyes heavy, his skin hot, and his pulse hard, full, and oppressed.

The diarrhoea continued; his stools were bilious and very offensive; and he complained of griping pains in his bowels.

He had lost, before I saw him, by the direction of Mr. Hall, a surgeon of eminence in Manchester, eight ounces of blood from the arm, which was of a lax texture; and he had taken a saline mixture every sixth hour.

The following draught was prescribed, and a dose of rhubarb directed to be administered at night.

Rx.

_Aq.

Cinnam.

ten.

_ oz.

j. _Succ.

Limon.

recent.

_ oz.

ß.

_Salis Nitri gr.

xij.

Syr.

è Succo Limon.

dr. j. M.

f. Haust.

_ _4tis horis sumendus.

_ July 11. The _Diarrhoea_ was more moderate; his griping pains were abated; and he had less stupor and dejection in his countenance.

Pulse 90, not so hard or oppressed.

As his stools continued to be foetid, the dose of rhubarb was repeated; and instead of simple cinnamon-water, his draughts were prepared with an infusion of columbo root.

12. The _Diarrhoea_ continued; his stools were involuntary; and he discharged in this way a quantity of black, grumous, and foetid blood.

Pulse hard and quick; skin hot; tongue covered with a dark fur; abdomen swelled; great stupor.

Ten grains of columbo root, and fifteen of the _Gummi rubrum astringens_ were added to each draught.

Fixed air, under the form of clysters, was injected every second or third hour; and directions were given to supply the patient plentifully with water, artificially impregnated with mephitic air.

A blister was also laid between his shoulders.

13. The Diarrhoea continued, with frequent discharges of blood; but the stools had now lost their foetor.

Pulse 120; great flatulence in the bowels, and fulness in the belly.

The clysters of fixed air always diminished the tension of the _Abdomen_, abated flatulence, and made the patient more easy and composed for some time after their injection.

They were directed to be continued, together with the medicated water.

The nitre was omitted, and a scruple of the _Confect.

Damocratis_ was given every fourth hour, in an infusion of columbo root.

14. The Diarrhoea was how checked, His other symptoms continued as before.

Blisters were applied to the arms; and a drachm and a half of the _Tinctura Serpentariæ_ was added to each draught.

15. His pulse was feeble, quicker and more irregular.

He dosed much;

talked incoherently; and laboured under a slight degree of _Dyspnæa_.

His urine, which had hitherto assumed no remarkable appearance, now became pale.

Though he discharged wind very freely, his belly was much swelled, except for a short time after the injection of the air-clysters.

The following draughts were then prescribed.

Rx _Camphoræ mucilag.

G.

Arab, solutæ gr.

viij.

Infus.

Rad.

Columbo oz.

jfs Tinct.

Serpent.

dr. ij Confect.

Card.

scruple j Syr.

è Cort.

Aurant dr. i m. f. Haust.

4tis horis sumendus.

_ Directions were given to foment his feet frequently with vinegar and warm water.

16. He has had no stools since the 14th.

His _Abdomen_ is tense.

No change in the other symptoms.

The _Tinct.

Serpent.

_ was omitted in his draughts, and an equal quantity of _Tinct.

Rhæi Sp.

_ substituted in its place.

In the evening he had a motion to stool, of which he was for the first time so sensible, as to give notice to his attendants.

But the discharge, which was considerable and slightly offensive, consisted almost entirely of blood, both in a coagulated and in a liquid state.

His medicines were therefore varied as follows: Rx.

_Decoct.

Cort.

Peruv.

oz.

iss Tinct.

Cort.

ejusd.

dr. ij.

Confect.

Card.

scruple j Gum.

Rubr.

Astring.

gr.

xv.

Pulv.

Alnmin.

gr.

vij.

m.

f. Haustus 4tis horis sumendus.

_ Red Port wine was now given more freely in his medicated water; and his nourishment consisted of sago and salep.

In this state, with very little variation, he continued for several days; at one time ostive, and at another discharging small quantities of fæces, mixed with grumous blood.

The air-clysters were continued, and the astringents omitted.

20. His urine was now of an amber colour, and deposited a slight sediment.

His pulse was more regular, and although still very quick, abated in number ten strokes in a minute.

His head was less confused, and his sleep seemed to be refreshing.

No blood appeared in his stools, which were frequent, but small in quantity; and his _Abdomen_ was less tense than usual.

He was extremely deaf; but gave rational answers to the few questions which were proposed to him; and said he felt no pain.

21. He passed a very restless night; his delirium recurred; his pulse beat 125 strokes in a minute; his urine was of a deep amber colour when first voided; but when cold assumed the appearance of cow's whey.

The _Abdomen_ was not very tense, nor had he any further discharge of blood.

Directions were given to shave his head, and to wash it with a mixture of vinegar and brandy; the quantity of wine in his drink was diminished;

and the frequent use of the pediluvium was enjoined.

The air-clysters were discontinued, as his stools were not offensive, and his _Abdomen_ less distended.

22. His pulse was now small, irregular, and beat 130 strokes in a minute.

The _Dyspnoea_ was greatly increased; his skin was hot, and bedewed with a clammy moisture; and every symptom seemed to indicate the approach of death.

In this state he continued till evening, when he recruited a little.

The next day he had several slight convulsions.

His urine which was voided plentifully, still put on the appearance of whey when cold.

Cordial and antispasmodic draughts, composed of camphor, tincture of castor, and _Sp.

vol. aromat.

_ were now directed; and wine was liberally administered.

24. He rose from his bed, and by the assistance of his attendants walked across the chamber.

Soon after he was seized with a violent convulsion, in which he expired.

To adduce a case which terminated fatally as a proof of the efficacy of any medicine, recommended to the attention of the public, may perhaps appear singular; but cannot be deemed absurd, when that remedy answered the purposes for which it was intended.

For in the instance before us;

fixed air was employed, not with an expectation that it would cure the fever, but to obviate the symptoms of putrefaction, and to allay the uneasy irritation in the bowels.

The disease was too malignant, the nervous system too violently affected, and the strength of the patient too much exhausted by the discharges of blood which he suffered, to afford hopes of recovery from the use of the most powerful antiseptics.

But in the succeeding case the event proved more fortunate.

Elizabeth Grundy, aged seventeen, was attacked on the 10th of December 1772, with the usual symptoms of a continued fever.

The common method of cure was pursued; but the disease increased, and soon assumed a putrid type.

On the 23d I found her in a constant delirium, with a _subsultus tendinum_.

Her skin was hot and dry, her tongue black, her thirst immoderate, and her stools frequent, extremely offensive, and for the most part involuntary.

Her pulse beat 130 strokes in a minute; she dosed much; and was very deaf.

I directed wine to be administered freely; a blister to be applied to her back; the _pediluvium_ to be used several times in the day; and mephitic air to be injected under the form of a clyster every two hours.

The next day her stools were less frequent, had lost their foetor, and were no longer discharged involuntarily; her pulse was reduced to 110 strokes in the minute; and her delirium was much abated.

Directions were given to repeat the clysters, and to supply the patient liberally with wine.

These means were assiduously pursued several days; and the young woman was so recruited by the 28th, that the injections were discontinued.

She was now quite rational, and not averse to medicine.

A decoction of Peruvian bark was therefore prescribed, by the use of which she speedily recovered her health.

I might add a third history of a putrid disease, in which the mephitic air is now under trial, and which affords the strongest proof both of the _antiseptic_, and of the _tonic_ powers of this remedy; but as the issue of the case remains yet undetermined (though it is highly probable, alas!

that it will be fatal) I shall relate only a few particulars of it.

Master D. a boy of about twelve years of age, endowed with an uncommon capacity, and with the most amiable dispositions, has laboured many months under a hectic fever, the consequence of several tumours in different parts of his body.

Two of these tumours were laid open by Mr. White, and a large quantity of purulent matter was discharged from them.

The wounds were very properly treated by this skilful surgeon, and every suitable remedy, which my best judgment could suggest, was assiduously administered.

But the matter became sanious, of a brown colour, and highly putrid.

A _Diarrhoea_ succeeded; the patient's stools were intolerably offensive, and voided without his knowledge.

A black fur collected about his teeth; his tongue was covered with _Aphthæ_; and his breath was so foetid, as scarcely to be endured.

His strength was almost exhausted; a _subsultus tendinum_ came on; and the final period of his sufferings seemed to be rapidly approaching.

As a last, but almost hopeless, effort, I advised the injection of clysters of mephitic air.

These soon corrected the foetor of the patient's stools; restrained his _Diarrhoea_; and seemed to recruit his strength and spirits.

Within the space of twenty-four hours his wounds assumed a more favourable appearance; the matter discharged from them became of a better colour and consistence; and was no longer so offensive to the smell.

The use of this remedy has been continued several days, but is now laid aside.

A large tumour is suddenly formed under the right ear; swallowing is rendered difficult and painful; and the patient refuses all food and medicine.

Nourishing clysters are directed; but it is to be feared that these will renew the looseness, and that this amiable youth will quickly sink under his disorder[22].

The use of _wort_ from its saccharine quality, and disposition to ferment, has lately been proposed as a remedy for the SEA SCURVY.

Water or other liquors, already abounding with fixed air in a separate state, should seem to be better adapted to this purpose; as they will more quickly correct the putrid disposition of the fluids, and at the same time, by their gentle stimulus[23] increase the powers of digestion, and give new strength to the whole system.

Dr. Priestley, who suggested both the idea and the means of executing it, has under the sanction of the College of Physicians, proposed the scheme to the Lords of the Admiralty, who have ordered trial to be made of it, on board some of his Majesty's ships of war.

Might it not however give additional efficacy to this remedy, if instead of simple water, the infusion of malt were to be employed?

I am persuaded such a medicinal drink might be prescribed also with great advantage in SCROPHULOUS COMPLAINTS, when not attended with a hectic fever; and in other disorders in which a general acrimony prevails, and the crasis of the blood is destroyed.

Under such circumstances, I have seen _vibices_ which spread over the body, disappear in a few days from the use of wort.

A gentleman who is subject to a scorbutic eruption in his face, for which he has used a variety of remedies with no very beneficial effect, has lately applied the fumes of chalk and oil of vitriol to the parts affected.

The operation occasions great itching and pricking in the skin, and some degree of drowsiness, but evidently abates the serous discharge, and diminishes the eruption.

This patient has several symptoms which indicate a genuine scorbutic DIATHESIS; and it is probable that fixed air, taken internally, would be an useful medicine in this case.

The saline draughts of Riverius are supposed to owe their antiemetic effects to the air, which is separated from the salt of wormwood during the act of effervescence.

And the tonic powers of many mineral waters seem to depend on this principle.

I was lately desired to visit a lady who had most severe convulsive REACHINGS.

Various remedies had been administered without effect, before I saw her.

She earnestly desired a draught of malt liquor, and was indulged with half a pint of Burton beer in brisk effervescence.

The vomitings ceased immediately, and returned no more.

Fermenting liquors, it is well known, abound with fixed air.

To this, and to the cordial quality of the beer, the favourable effect which it produced, may justly be ascribed.

But I shall exceed my design by enlarging further on this subject.

What has been advanced it is hoped, will suffice to excite the attention of physicians to a remedy which is capable of being applied to so many important medicinal purposes.

NUMBER IV.