Medical oxygen, key to fight Covid-19, used to be feared

It took nearly two centuries to overcome strange theories, outright quackery and trench warfare in the medical community about oxygen

By Stephen Mihm

The desperate scenes playing out in India may foreshadow a dangerous new phase of the pandemic where people die in droves, not of the disease so much as a lack of proper medical care. The situation could get a lot worse thanks to a sudden shortage of medical oxygen in the country.

Oxygen is one of most straightforward and proactive ways of treating the disease, which causes hypoxia. When patients begin gasping for air, a steady supply of concentrated oxygen does wonders.

It may seem like an obvious treatment in hindsight, yet it took nearly two centuries to overcome strange theories, outright quackery and trench warfare in the medical community and beyond.

Oxygen’s history in medicine begins in the 1770s when the Swedish pharmacist Karl Scheele and the British scientist Joseph Priestly independently isolated oxygen gas. Priestly unfairly received the lion’s share of the credit.

Read | Gujarat oxygen crisis killed more than Covid did in 3 days, say Congress

To make matters worse, Priestly was a believer in phlogiston, an invisible substance allegedly released during combustion. What we call “oxygen,” he called “dephlogisticated air.” When he breathed it, his chest felt “peculiarly light and easy for some time afterward.” Priestley subsequently bragged in a scientific tract that “only two mice and myself have had the privilege of breathing” the miracle gas.

Since the new substance seemed to make candles burn brighter, Priestley speculated that it might be “peculiarly salutary to the lungs in certain morbid cases, when the common air would not be sufficient to carry off the putrid effluvium.” Yet he remained wedded to his phlogiston theory, warning that breathing pure oxygen might also carry dangers – that it might be the equivalent of burning the candle at both ends.

Eager to test the effects of the new substance on patients, Priestley and other engineers and scientists, including James Watt, founded the Pneumatic Institution in Birmingham. Though they made no promises of a cure, they offered to treat a range of maladies – including “obstinate venereal complaints” – with dephlogisticated air.

They weren’t very successful, but there was an upside. As one medical historian has noted, this unlikely crew managed to invent most of the oxygen-delivery apparatus still in use today, from mouthpieces to corrugated, non-crushable breathing tubes to methods for mass-producing the gas.

The Pneumatic Institution went defunct, but oxygen lived on as a quack remedy. Most of these treatments didn’t actually use concentrated oxygen, dispensing nothing more than mixtures of gases not so different from ordinary air, typically a few gulps’ worth and nothing more.

Read | Delhi's woes continue: Scramble for beds and oxygen, deaths on streets

But that didn’t stop purveyors of these panaceas from making ludicrous claims for their products. Makers of the so-called “Oxygen Treatment,” a typical remedy from 1884, sent patients one bottle of “Oxygen” and one bottle of “Oxygen Tonic.” This was supposed to treat everything from dyspepsia to arthritis for two full months.

By the late nineteenth century, oxygen therapy was synonymous with quackery. In 1890, though, a physician named Dr. Alfred Blodgett had a patient with pneumonia whom he deemed “irrevocably doomed.” In the hopes of merely easing her final moments, he hooked her up to an oxygen cannister, turned on the gas – and left it running.

This may have been the first continuous application of oxygen to a patient in history. To Blodgett’s astonishment, the woman stabilized, her breathing becoming regular. He published his results, arguing that oxygen could save lives. “Many cases will be found in which the period of greatest danger may be safely tided over which would otherwise unquestionably be lost,” he wrote.

And yet this was just the very beginning of oxygen’s resurrection. After Blodgett’s article, other researchers tried administering oxygen, but not via the lungs. They pumped it under the skin, up the urethra and into the stomach. Most bizarre of all was the idea of an oxygen enema, which came courtesy of corn-flake promoter Dr. J. H. Kellogg, who also gained fame for popularizing medical treatments of questionable value.

It took a Scottish doctor named John Scott Haldane to cut through this nonsense and do the research necessary to show that breathing oxygen would be best – and that it had to be continuous and at high enough concentrations to have the desired effect. In 1917, he published his landmark paper, “The Therapeutic Administration of Oxygen.”

His timing was perfect. In World War I, both sides used poison gas. Haldane developed equipment that dispensed oxygen to soldiers hit in a gas attack. After much trial and error, the British managed to develop mobile equipment that could be used to treat survivors, giving them steady supplies of oxygen for extended periods of time.

Read | Fertiliser firms to supply 50 tonnes of oxygen per day to Covid-19 patients

All of this should have opened the medical profession’s eyes to the value of administering continuous oxygen. But it would take another 50 years to win over many doctors, who insisted on administering oxygen in intervals in order to avoid harming patients.

Haldane criticized intermittent oxygen therapy, comparing it to “bringing a drowning man to the surface of the water — occasionally.” But it would take until 1962 before medical researchers conclusively backed him up. Intermittent oxygen therapy, they found, actually hurt patients more than if they had never been given oxygen at all.

Over time, a growing number of doctors embraced the idea of continuous oxygen therapy. In the U.S., Dr. Thomas Petty took the lead in using it to treat patients with advanced pulmonary diseases. In 1970, a study of patients with advanced pulmonary disease showed that while 28% of patients treated with continuous oxygen died, 62% of untreated patients did. This finally settled the question, paving the way for more research on oxygen’s many benefits over the past 50 years.

The breakthrough seems to have a big impact on victims of Covid-19. Preliminary research of how different nations administered oxygen in the early months of the pandemic suggests that supplemental oxygen makes the difference between life and death for many patients. Other studies have shown that oxygen can keep patients off ventilators and save lives, particularly if the oxygen is administered early.

This simplest of treatments has been around for ages. It can be deployed in a range of settings, from the trenches of war to the parking lot of a hospital. Luckily, the US is “working around the clock” to gather oxygen supplies for India, and the UK is sending nearly 500 devices to administer it. It’s a good start, though far more may be needed.