Some few years since, Mr. Harrison Weir (whose drawings of natural history
are known probably to a wider circle of the general public than the works
of most artists), wishing to pursue his favorite study of animals and
horticulture, erected on the steep hillside of the road leading from
Paddock Wood to Brenchley, a small "cottage ornée" with detached studio.
Afterward desiring more accommodation, he carried out the buildings shown
in our illustrations. Advantage has been taken of the slope of the hill on
one side, and the rising ground in the rear on the other, to increase the
effect of the buildings and meet the difficulty of the levels. The two
portions--old, etched, and new, shown as black--are connected together by a
handsome staircase, which is carried up in the tower, and affords access to
the various levels. The materials are red brick, with Bathstone dressings,
and weather-tiling on the upper floors. Black walnut, pitch pine, and
sequoias have been used in the staircase, and joiner's work to the
principal rooms. The principal stoves are of Godstone stone only, no iron
or metal work being used. The architects are Messrs. Wadmore & Baker, of 35
Great St. Helens, E.C.; the builders, Messrs. Penn Brothers, of Pembury,
Kent.--_Building News_.
[Illustration: ARTISTS HOMES NO 11 "WEIRLEIGH" BRENCHLEY, KENT. THE
RESIDENCE OF HARRISON WEIR ESQ'RE WADMORE & BAKER ARCHITECTS]
* * * * *
RAPID BREATHING AS A PAIN OBTUNDER IN MINOR SURGERY, OBSTETRICS, THE
GENERAL PRACTICE OF MEDICINE AND OF DENTISTRY.
[Footnote: Read before the Philadelphia County Medical Society, May 12,
1880, by W. G. A. Bonwill, M.D., D.D.S., Philadelphia.]
Through the kind invitation of your directors, I am present to give you
the history of "rapid breathing" as an analgesic agent, as well as my
experience therein since I first discovered it. It is with no little
feeling of modesty that I appear before such a learned and honorable
body of physicians and surgeons, and I accept the privilege as a high
compliment. I trust the same liberal spirit which prompted you to call this
subject to the light of investigation will not forsake you when you have
heard all I have to say and you sit in judgment thereon. Sufficient time
has now elapsed since the first promulgation of the subject for the shafts
of ridicule to be well nigh spent (which is the common logic used to crush
out all new ideas), and it is to be expected that gentlemen will look upon
it with all the charity of a learned body, and not be too hasty to condemn
what they have had but little chance to investigate; and, of course, have
not practiced with that success which can only come from an intelligent
understanding of its application and _modus operandi_.
Knowing the history of past discoveries, I was well prepared for the
crucible. I could not hope to be an exception. But, so far, the medical
profession have extended me more favor than I have received at the hands of
the dental profession.
My first conception of the analgesic property of a pain obtunder in
contradistinction to its anaesthetic effect, which finally led to the
discovery of the inhalation of common air by "rapid breathing," was in 1855
or 1856, while performing upon my own teeth certain operations which gave
me intense pain (and I could not afford to hurt myself) without a resort to
ether and chloroform. These agents had been known so short a time that no
one was specially familiar with their action. Without knowing whether I
could take chloroform administered by myself, and at the same time perform
with skill the excavation of extremely sensitive dentine or tooth-bone, as
if no anaesthetic had been taken, and not be conscious of pain, was more
than the experience of medical men at that time could assure me. But,
having a love for investigation of the unknown, I prepared myself for the
ordeal. By degrees I took the chloroform until I began to feel very plainly
its primary effects, and knowing that I must soon be unconscious, I applied
the excavator to the carious tooth, and, to my surprise, found no pain
whatever, but the sense of touch and hearing were marvelously intensified.
The small cavity seemed as large as a half bushel; the excavator more the
size of an ax; and the sound was equally magnified. That I might not be
mistaken, I repeated the operation until I was confident that anaesthetics
possessed a power not hitherto known--that of analgesia. To be doubly
certain, I gave it in my practice, in many cases with the same happy
results, which saved me from the risks incident to the secondary effects of
anaesthetics, and which answered for all the purposes of extracting from
one to four teeth. Not satisfied with any advance longer than I could find
a better plan, I experimented with the galvanic current (to and fro) by so
applying the poles that I substituted a stronger impression by electricity
from the nerve centers or ganglia to the peripheries than was made from the
periphery to the brain. This was so much of a success that I threw
aside chloroform and ether in removing the living nerve of a tooth with
instruments instead of using arsenic; and for excavating sensitive caries
in teeth, preparatory to filling, as well as many teeth extracted by it.
But this was short-lived, for it led to another step. Sometimes I would
inflict severe pain in cases of congested pulps or from its hasty
application, or pushing it to do too much, when my patient invariably would
draw or inhale the breath _very forcibly and rapidly_. I was struck with
the repeated coincidence, and was led to exclaim: "Nature's anaesthetic."
This then reminded me of boyhood's bruises. The involuntary action of every
one who has a finger hurt is to place it to the mouth and draw violently in
the air and hold it for an instant, and again repeat it until the pain is
subdued. The same action of the lungs occurs, except more powerfully,
in young children who take to crying when hurt. It will be noticed they
breathe very rapidly while furiously crying, which soon allays the
irritation, and sleep comes as the sequel. Witness also when one is
suddenly startled, how violently the breath is taken, which gives relief.
The same thing occurs in the lower animals when pain is being inflicted at
the hand of man.
This was advance No. 3, and so sure was I of this new discovery, that I at
once made an application while removing decay from an extremely sensitive
tooth. To be successful, I found I must make the patient take the start,
and I would follow with a thrust from the excavator, which move would be
accomplished before the lungs could be inflated. This was repeated for
at least a minute, until the operation was completed, I always following
immediately or synchronously with the inhalation.
This led to step No. 4, which resulted in its application to the extracting
of teeth and other operations in minor surgery.
Up to this time I had believed the sole effect of the rapid inhalation was
due to mere diversion of the will, and this was the only way nature could
so violently exert herself--that of controlling the involuntary action of
the lungs to her uses by the _safety valve_, or the voluntary movement.
The constant breathing of the patient for thirty seconds to a minute left
him in a condition of body and mind resembling the effects of ether and
chloroform in their primary stages. I could but argue that the prolonged
breathing each time had done it; and, if so, then there must be some
specific effect over and above the mere diversion by the will. To what
could it be due? To the air alone, which went in excess into the lungs in
the course of a minute! Why did I not then immediately grasp the idea of
its broader application as now claimed for it? It was too much, gentlemen,
for that hour. Enough had been done in this fourth step of conception to
rest in the womb of time, until by evolution a higher step could be made at
the maturity of the child. Being self-satisfied with my own baby, I watched
and caressed it until it could take care of itself, and my mind was again
free for another conception.
The births at first seemed to come at very short intervals; but see how
long it was between the fourth and the fifth birth. It was soon after that
my mind became involved in inventions--a hereditary outgrowth--and the
electric mallet and then the dental engine, the parent of your surgical
engine, to be found in the principal hospitals of this city, took such
possession of my whole soul, that my air analgesic was left slumbering. It
was not until August, 1875--nineteen years after--that it again came up in
full force, without any previous warning.
This time it was no law of association that revived it; but it seemed
the whispering of some one in the air--some ethereal spirit, if you
please--which instituted it, and advanced the following problem: "Nitrous
oxide gas is composed of the same elements as ordinary air, with a larger
equivalent of oxygen, except it is a chemical compound, not a mechanical
mixture, and its anaesthetic effects are said to be due to the excess of
oxygen. If this be a fact, then why can you not produce a similar effect by
rapid breathing for a minute, more or less, by which a larger quantity of
oxygen is presented in the lungs for absorption by the blood?"
This query was soon answered by asking myself another: "If the rapid
inhalation of air into the lungs does not increase the heart's action and
cause it to drive the blood in exact ratio to the inhalations, then _I can_
produce partial anaesthesia from this excess of oxygen brought about by the
voluntary movements over their ordinary involuntary action of the lungs."
The next question was: Will my heart be affected by this excess of air in
the lungs to such an extent that there will be a full reciprocity between
them? Without making any trial of it, I argued that, while there is no
other muscular movement than that of the chest as under the control of the
will, and as nature has given to the will the perfect control over the
lungs to supply more or less air, as is demanded by the pneumogastric nerve
for the immediate wants of the economy, when the _involuntary action_ is
not sufficient; and the heart not being under the control of the will, and
its action never accelerated or diminished except by a specific poison, or
from the general activity of the person in violent running or working, the
blood is forced into the heart faster and must get rid of it, when a larger
supply of oxygen is demanded and rapid breathing must occur, or asphyxia
result. I was not long in deciding that the heart _would not be
accelerated_ but a trifle--say a tenth--and, under the circumstances, I
said: "The air _is_ an anaesthetic."
From this rapid course of argument, I was so profoundly convinced of its
truth, that without having first tried it upon my own person, I would have
sat where I was, upon the curbstone, and had a tooth removed with the
perfect expectation of absence of pain and of still being conscious of
touch. While yet walking with my children, I commenced to breathe as
rapidly as possible, and, as anticipated, found my steps growing shorter
and shorter, until I came to a stand, showing to my mind clearly that my
argument in advance was right, so far as locomotion was concerned; and,
upon referring to my pulse, I found but little acceleration.
To what other conclusion could I arrive from this argument, with the
foundation laid nineteen years before, when I established on my own person
by experiment the fact of analgesia as induced from chloroform, with the
many experiments in rapid respiration on tooth bone?
From this moment until its first application to the extraction of a tooth
you can well imagine my suspense. That I might not fail in the very first
attempt, I compelled myself and others in my household to breathe rapidly
to investigate the phenomenon. This gave me some idea as to the proper
method of proceeding in its administering.
The first case soon appeared, and was a perfect success, going far beyond
my anticipations, for the effect was such as to produce a partial paralysis
of the hands and arms to the elbow. Again and again I tried it in every
case of extraction and many other experiments, doubting my own senses for
a long time at a result so anomalous and paradoxical. I was reminded just
here of a phenomenon which gave me additional proof--that of blowing a
dull fire to revive it. For a minute or so one blows and blows in rapid
succession until, rising from the effort, a sense of giddiness for a
few moments so overcomes that the upright position is with difficulty
maintained. In this condition you are fitted for having a tooth extracted
or an abscess lanced.
Believing that I had something new to offer which might be of use to
suffering humanity, I read the first article upon it Nov. 17, 1875, before
the Franklin Institute. Shortly after I was invited before the Northern
Medical Society of this city to address them thereon. A number of medical
gentlemen have been using it in their practice, while the bulk of them have
spurned it as "negative" and preposterous, without an effort at trying it,
which I can _now_ very well understand.
Unless one is aware of the fact that in the use of any agent which has the
power to suspend the volition, it can be taken to that point where he is
still conscious of _touch and hearing_, and at the same time not cognizant
of pain inflicted, the action of rapid breathing could not be understood.
And I regret to say that of three-fourths of the medical men I have talked
with on the subject they had not been aware of such a possibility from
ether and chloroform. Until this analgesic state could be established in
their minds it was impossible to convince them that the excess of oxygen,
as obtained by rapid breathing, could be made to produce a similar effect.
_I_ should have been as reluctant as any one to believe it, had I not
personally experienced the effect while performing an operation which would
otherwise have been very painful. Such a result could not well be reached
by any course of reasoning.
Has it proven in my practice what has been claimed for it--a substitute
for the powerful anaesthetics in minor operations in surgery? Most
emphatically, yes! So completely has it fulfilled its humble mission in
my office, that I can safely assert there has not been more than five per
cent. of failures. I have given it under all circumstances of diseased
organs, and have seen no other than the happiest results in its after
effects. It may well be asked just here: Why has it not been more generally
and widely used by the dental profession as well as the medical, if it is
really what is claimed for it? The most satisfactory and charitable answer
to be given is, the failure upon their part to comprehend the _fact_ as
existing in chloroform and ether that there is such a state as analgesia;
or, in other words, that the animal economy is so organized, while the
sense of touch is not destroyed, but rather increased, the mind of the
subject fails to perceive a sense of pain when anaesthetics are given, and
the effects are manifested in the primary stage. As I before intimated,
such is the knowledge possessed by most of those who administer ether and
chloroform. This was enough to cause nearly every one to look upon it as a
bubble or air castle. Many gentlemen told me they tried it upon themselves,
and, while it affected them very seriously by giddiness, they still
_retained consciousness_; and, such being the case, no effect could be
produced for obtunding pain. Others told me they were afraid to continue
the breathing alarmed at the vertigo induced. And the practitioner who has
adopted it more effectively than any other laughed at me when I first told
him of the discovery; but his intimate association with me changed his
views after much explanation and argument between us.
It was hardly to be expected that without this knowledge of analgesia,
and without any explanation from me as to the _modus operandi_ of rapid
breathing, other than a few suggestions or directions as to how the effect
was induced, even the most liberal of medical men should be able to make
it effective, or have the least disposition to give it a preliminary trial
upon themselves, and, of course, would not attempt it upon a patient.
Notwithstanding, it found a few adherents, but only among my personal
_medical_ friends, with whom I had an opportunity to explain what I
believed its physiological action, and the cases of success in my own
practice. To this I have submitted as among the inevitable in the calendar
of discoveries of all grades.
My own profession have attempted to _ridicule_ it out of its birthright
and possible existence, which style of argument is not resorted to by true
logicians.
To all this I can truly say I have not for one moment faltered. I could
afford to wait. The liberality of this society alone fully compensates for
the seeming indisposition of the past, believing that it is proper that
every advance should be confronted, and, if in time found worthy, give it
God speed.
From its first conception I have diligently labored to solve its _modus
operandi_, and the doubt in my own mind as to whether I could be mistaken
in my observations. I asked the opinion of our best chemical teachers if
air could have such effect. One attributed it to oxygen stimulation, and
the other to nitrogen. Another gentleman told me the medical profession had
come to the conclusion that it was possible for me to thus extract teeth,
but it was due solely to my strong _personal magnetism_ (which power I was
not before aware I possessed).
Now, from what I have related of the successive and natural steps which
finally culminated in this process or plan of analgesia induced by an
excess of ordinary air taken forcibly into the lungs above what is
necessary for life, and from what I shall state as to the apparently
anomalous or paradoxical effects, with its physiological action, and the
simple tests made upon each of my patients, I shall trust to so convince
you of its plausibility and possibility that it will be made use of in
hundreds of minor operations where ether and chloroform are now used.
Aside from my assertion and that of its friends, that the effects can be
produced by air alone, you must have some light shed upon the causes of its
physiological action, which will appeal to your _medical_ reason.
To assign an action to any drug is difficult, and in the cases of ether and
the other anaesthetics a quarter of a century still finds many conflicting
opinions. This being true, you will deal leniently with me for the opinion
I hold as to their analgesic action. Of course it will be objected to,
for the unseen is, to a great extent, unknowable. Enough for my argument,
however; it seems to suit the case very well without looking for another;
and while it was based on the phenomenon resulting from many trials, and
not the trials upon it as a previous theory, I shall be content with it
until a better one can be found.
What is it I claim as a new discovery, and the facts and its philosophy?
I have asserted that I can produce, from rapidly breathing common air at
the rate of a hundred respirations a minute, a similar effect to that from
ether, chloroform, and nitrous oxide gas, in their primary stages; and I
can in this way render patients sufficiently insensible to acute pain from
any operation where the time consumed is not over twenty to thirty seconds.
While the special senses are in partial action, the sense of pain is
obtunded, and in many cases completely annulled, consciousness and general
sensibility being preserved.
To accomplish this, each patient must be instructed how to act and what to
expect. As simple as it may seem, there is a proper and consistent plan to
enable you to reach full success. Before the patient commences to inhale he
is informed of the fact that, while he will be unconscious of pain, he
will know full, or partially well, every touch upon the person; that the
inhalation must be vigorously kept up during the whole operation without
for an instant stopping; that the more energetically and steadily he
breathes, the more perfect the effect, and that if he cease breathing
during the operation, pain will be felt. Fully impress them with this
idea, for the very good reason that they may stop when in the midst of an
operation, and the fullest effects be lost. It is obligatory to do so on
account of its evanescent effects, which demand that the patient be pushed
by the operator's own energetic appeals to "go on." It is very difficult
for any person to respire more than one hundred times to the minute, as he
will become by that time so exhausted as not to be able to breathe at all,
as is evidenced by all who have thus followed my directions. For the next
minute following the completion of the operation the subject will not
breathe more than once or twice. Very few have force enough left to raise
hand or foot. The voluntary muscles have nearly all been subjugated and
overcome by the undue effort at forced inhalation of one hundred over
seventeen, the normal standard. It will be more fully understood further on
in my argument why I force patients, and am constantly speaking to them to
go on.
I further claim that for the past four years, so satisfactory has been the
result of this system in the extracting of teeth and deadening extremely
sensitive dentine, there was no longer any necessity for chloroform,
ether, or nitrous oxide in the dental office. That such teeth as cannot be
extracted by its aid can well be preserved and made useful, except in a
very few cases, who will not be forced to breathe.
The anaesthetics, when used in major operations, where time is needed for
the operation, can be made more effective by a lesser quantity when given
in conjunction with "rapid breathing." Drs. Garrettson and Hews, who have
thus tried it, tell me it takes one-half to three-fourths less, and the
after effects are far less nauseating and unpleasant.
As an agent in labor where an anaesthetic is indicated, it is claimed by
one who has employed it (Dr. Hews) in nearly every case for three years, he
has used "rapid breathing" solely, and to the exclusion of chloroform and
ether. For this I have his assertion, and have no doubt of it whatever, for
if any agent could break down the action of the voluntary muscles of the
parts involved, which prevent the involuntary muscles of the uterus from
having their fullest effect, it is this. The very act of rapid breathing so
affects the muscles of the abdomen as to force the contents of the uterus
downward or outward, while the specific effect of the air at the end of a
minute's breathing leaves the subject in a semi-prostrate condition, giving
the uterus full chance to act in the interim, because free of the will to
make any attempt at withholding the involuntary muscles of the uterus from
doing their natural work. It is self evident; and in this agent we claim
here a boon of inestimable value. And not least in such cases is, there is
no danger of hemorrhage, since the cause of the effect is soon removed.
In attestation of many cases where it has been tried, I have asked the
mother, and, in some cases, the attendants, whether anything else had been
given, and whether the time was very materially lessened, there has been
but one response, and that in its favor.
Gentlemen, if we are not mistaken in this, you will agree with me in saying
that it is no mean thing, and should be investigated by intelligent men and
reported upon. From my own knowledge of its effects in my practice, I am
bound to believe this gentleman's record.
I further claim for it a special application in dislocations. It has
certainly peculiar merits here, as the will is so nearly subjugated by
it as to render the patient quite powerless to resist your effort at
replacing, and at the same time the pain is subdued.
It is not necessary I should further continue special applications; when
its _modus operandi_ is understood, its adaptation to many contingencies
will of a sequence follow.
It is well just here, before passing to the next point of consideration, to
answer a query which may arise at this juncture:
What are the successive stages of effects upon the economy from its
commencement until the full effect is observed, and what proof have I that
it was due to the amount of air inhaled?
The heart's action is not increased more than from seventy (the average) to
eighty and sometimes ninety, but is much enfeebled, or throwing a lesser
quantity of blood. The face becomes suffused, as in blowing a fire or in
stooping, which continues until the breathing is suspended, when the
face becomes paler. (Have not noticed any purple as from asphyxia by a
deprivation of oxygen.) The vision becomes darkened, and a giddiness soon
appears. The voluntary muscles furthest from the heart seem first to be
affected, and the feet and hands, particularly the latter, have a numbness
at their ends, which increases, until in many cases there is partial
paralysis as far as the elbow, while the limbs become fixed. The hands are
so thoroughly affected that, when open, the patient is powerless to close
them and _vice versa_. There is a vacant gaze from the eyes and looking
into space without blinking of the eyelids for a half minute or more. The
head seems incapable of being held erect, and there is no movement of the
arms or legs as is usual when in great pain. There is no disposition on the
part of the patient to take hold of the operator's hand or interfere with
the operation.
Many go on breathing mechanically after the tooth is removed, as if nothing
had occurred. Some are aware that the tooth has been extracted, and say
they felt it; others could not tell what had been accomplished. The
majority of cases have an idea of what is being done, but are powerless to
resist.
With the very intelligent, or those who stop to reason, I have to teach
them the peculiarities of being sensible of touch and not of pain.
One very interesting case I will state. In extracting seven teeth for a
lady who was very _unwilling_ to believe my statement as to touch and no
pain, I first removed three teeth after having inhaled for one minute, and
when fully herself, she stated that she could not understand why there was
no pain while she was conscious of each one extracted; it was preposterous
to believe such an effect could be possible, as her reason told her that
there is connected with tooth extracting pain in the part, and of severe
character, admitting, though, she felt no pain. She allowed one to be
removed without anything, and she could easily distinguish the change, and
exclaimed, "It is all the difference imaginable!" When the other three were
extracted, there was perfect success again as with the first three.
One of the most marked proofs of the effects of rapid breathing was that of
a boy of eleven years of age for whom I had to extract the upper and lower
first permanent molars on each side. He breathed for nearly a minute, when
I removed in about twenty seconds all four of the teeth, without a moment's
intermission or the stopping the vigorous breathing; and not a murmur,
sigh, or tear afterward.
He declared there was no pain, and we needed no such assertion, for there
was not the first manifestation from him that he was undergoing such a
severe operation.
Another case, the same day, when I had to extract the superior wisdom teeth
on both sides for an intelligent young lady of eighteen years, where I had
to use two pairs of forceps on each tooth (equivalent to extraction of four
teeth), and she was so profoundly affected afterward that she could; not
tell me what had been done other than that I had touched her four times.
She was overcome from its effects for at least a minute afterward. She was
delighted.
With such severe tests I fear very little the result in any case I can have
them do as I bid.
There can be no mistake that there is a _specific action_ from something.
It cannot be personal magnetism or mesmeric influence exerted by me, for
such cases are rare, averaging about 10 per cent, only of all classes.
Besides, in mesmeric influence the time has nothing to do with it; whereas,
in my cases, it cannot last over a half minute or minute at most. It cannot
be fear, as such cases are generally more apt to get hurt the worse. It is
not diversion of mind alone, as we have an effect above it.
There is no better way of testing whether pain has been felt than by taking
the lacerated or contused gums of the patient between the index finger
and thumb and making a gentle pressure to collapse the alveolar borders;
invariably, they will cry out lustily, _that is pain_! This gives undoubted
proof of a specific agent. There is no attempt upon my _own_ part to exert
any influence over my patients in any way other than that they shall
believe what I say in regard to _giving_ them _no pain_ and in the
following of my orders. Any one who knows how persons become mesmerized can
attest that it was not the _operator who forces them under it against
their will_, but it is a peculiar state into which any one who has within
themselves this temperament can _place_ themselves where any one who knows
how can have control. It is not the will of the operator. I therefore
dismiss this as unworthy of consideration in connection with rapid
breathing.
Then you may now ask, To what do I attribute this very singular phenomenon?
Any one who followed, in the earlier part of this paper, the course of
the argument in my soliloquy, after twenty years had elapsed from my
observation upon myself of the analgesic effects of chloroform, can almost
give something of an answer.
That you may the more easily grasp what I shall say, I will ask you, If it
be possible for any human being to make one hundred inhalations in a minute
and the heart's action is not increased more than ten or twenty pulsations
over the normal, what should be the effect upon the brain and nerve
centers?
If the function of oxygen in common air is to set free in the blood,
either in the capillaries alone, or throughout the whole of the arterial
circulation, carbonic acid gas; and that it cannot escape from the system
unless it do so in the lungs as it passes in the general current--except
a trace that is removed by the skin and kidneys--and that the quantity of
carbonic acid gas set free is in exact relation to the amount of oxygen
taken into the blood, what effect _must be_ manifested where one hundred
respirations in one minute are made--five or six times the normal
number--while the heart is only propelling the blood a very little faster
through the lungs, and _more feebly_--say 90 pulsations at most, when to
be in proportion it should be 400 to 100 respirations to sustain life any
length of time?
You cannot deny the fact that a definite amount of oxygen can be absorbed
and is absorbed as fast as it is carried into the lungs, even if there be
one hundred respirations to the minute, while the pulsations of the heart
are only ninety! Nature has _made it_ possible to breathe so rapidly to
meet any emergency; and we can well see its beautiful application in the
normal action of both the heart and lungs while one is violently running.
What would result, and that very speedily, were the act of respiration to
remain at the standard--say 18 or 20--when the heart is in violent action
from this running? Asphyxia would surely end the matter! And why? The
excessive exercise of the whole body is setting free from the tissues such
an amount of excretive matter, and carbon more largely than all the others,
that, without a relative action of the lungs to admit the air that oxygen
may be absorbed, carbonic acid gas cannot be liberated through the lungs
as fast as the waste carbon of the overworked tissues is being made by
disassimilation from this excess of respiration.
You are already aware how small a quantity of carbonic acid in excess in
the air will seriously affect life. Even 2 to 3 per cent, in a short time
will prove fatal. In ordinary respiration of 20 to the minute the average
of carbonic acid exhaled is 4.35.
From experiments long ago made by Vierordt--see Carpenter, p. 524--you will
see the relative per cent, of carbonic acid exhaled from a given number of
respirations. When he was breathing six times per minute, 5.5 per cent of
the exhaled air was carbonic acid; twelve times, 4.2; twenty-four times,
3.3; forty-eight times, 3; ninety-six times, 2.6.
Remember this is based upon the whole number of respirations in the minute
and not each exhalation--which latter could not be measured by the most
minute method.
Let us deduct the minimum amount, 2.6 per cent, of carbonic acid when
breathing ninety-six times per minute, from the average, at twenty per
minute, or the normal standard, which is recorded in Carpenter, p. 524, as
4.35 per minute, and we have retained in the circulation nearly 2 per cent.
of carbonic acid; that, at the average, would have passed off through the
lungs without any obstruction, and life equalized; but it not having been
thrown off as fast as it should have been, must, of necessity, be left to
prey upon the brain and nerve centers; and as 2 to 3 per cent., we are
told, will so poison the blood, life is imperiled and that speedily.
It is not necessary we should argue the point as to whether oxygen
displaces carbonic acid in the tissues proper or the capillaries. The
theory of Lavoisier on this point has been accepted.
We know furthermore, as more positive, that tissues placed in an atmosphere
of oxygen will set free carbonic acid, and that carbonic acid has a
paralyzing effect upon the human hand held in it for a short time. The
direct and speedy effects of this acid upon the delicate nervous element of
the brain is so well known that it must be accepted as law. One of the most
marked effects is the suspension of locomotion of the legs and arms,
and the direct loss of will power which must supervene before voluntary
muscular inactivity, which amounts to partial paralysis in the hands or
feet, or peripheral extremities of the same.
Now that we have sufficient evidence from the authorities that carbonic
acid can be retained in the blood by excessive breathing, and enough to
seriously affect the brain, and what its effects are when taken directly
into the lungs in excess, we can enter upon what I have held as the most
reasonable theory of the phenomenon produced by rapid breathing for
analgesic purposes; which _theory_ was not _first_ conceived and the
process made to yield to it, but the phenomenon was long observed, and
from the repetition of the effects and their close relationship to that
of carbonic acid on the economy, with the many experiments performed
upon myself, I am convinced that what I shall now state will be found to
substantiate my discovery. Should it not be found to coincide with what
some may say is physiological truth, it will not invalidate the discovery
itself; for of that I am far more positive than Harvey was of the discovery
of the circulation of the blood; or of Galileo of the spherical shape of
the earth. And I ask that it shall not be judged by my theory, but from the
practice.
It should have as much chance for investigation as the theory of
Julius Robert Mayer, upon which he founded, or which gave rise to the
establishment of one of the most important scientific truths--"the
conservation of energy," and finally the "correlation of forces," which
theory I am not quite sure was correct, although it was accepted, and as
yet, I have not seen it questioned.
In all due respect to him I quote it from the sketch of that remarkable
man, as given in the _Popular Science Monthly_, as specially bearing on my
discovery:
"Mayer observed while living in Java, that the _venous blood_ of some of
his patients had a singularly bright red color. The observation riveted
his attention; he reasoned upon it, and came to the conclusion that the
brightness of the color was due to the fact that a less amount of oxidation
was sufficient to keep up the temperature of the body in a hot climate than
a cold one. The darkness of the venous blood he regarded as the visible
sign of the energy of the oxidation."
My observation leads me to the contrary, that the higher the temperature
the more rapid the breathing to get clear of the excess of carbon, and
hence more oxygenation of the blood which will arterialize the venous
blood, unless there is a large amount of carbonized matter from the tissues
to be taken up.
Nor must it be denied because of the reasoning as presented to my mind by
some outside influence in my soliloquy when I first exclaimed, "Nature's
anaesthetic," where the argument as to the effects of nitrous oxide gas
being due to an excess of oxygen was urged, and that common air breathed in
excess would do the same thing.
I am not sure that _it_ was correct, for the effects of nitrous oxide is,
perhaps, due to a deprivation of mechanically mixed air.
Knowing what I do of theory and practice, I can say with assurance that
there is not a medical practitioner who would long ponder in any urgent
case as to the thousand and one theories of the action of remedies; but
would resort to the _practical_ experience of others and his own finally.
(What surgeon ever stops to ask how narcotics effect their influence?)
After nearly thirty years of association with ether and chloroform, who can
positively answer as to their _modus operandi?_ It is thus with nearly the
whole domain of medicine. It is not yet, by far, among the sciences, with
immutable laws, such as we have in chemistry. Experimentation is giving us
more specific knowledge, and "practice alone has tended to make perfect."
(Then, gentlemen will not set at naught my assertion and practical results.
When I have stated my case in full it is for _you_ to disprove both the
theory and practice annunciated. So far as I am concerned I am responsible
for both.)
You will please bear with me for a few minutes in my attempt at theory.
The annulling of pain, and, in some cases, its complete annihilation,
can be accomplished in many ways. Narcotics, anaesthetics--local and
internal--direct action of cold, and mesmeric or physiological influence,
have all their advocates, and each _will surely_ do its work. There is one
thing about which, I think, we can all agree, as to these agencies; unless
the _will_ is partially and in some cases completely subjugated there can
be no primary or secondary effect. The voluntary muscles must become wholly
or partially paralyzed for the time. Telegraphic communication must be cut
off from the brain, that there be no reflex action. It is not necessary
there should be separate nerves to convey pleasure and pain any more than
there should be two telegraphic wires to convey two messages.
If, then, we are certain of this, it matters little as to whether it was
done by corpuscular poisoning and anaemia as from chloroform or hyperaemia
from ether.
I think we are now prepared to show clearly the causes which effect the
phenomena in "rapid breathing."
The first thing enlisted is the _diversion of the will force_ in the act of
forced respiration at a moment when the heart and lungs have been in normal
reciprocal action (20 respirations to 80 pulsations), which act could
not be made and carried up to 100 respirations per minute without such
concentrated effort that ordinary pain could make no impression upon the
brain while this abstraction is kept up.
Second. There is a specific effect resulting from enforced respiration of
100 to the minute, due to the _excess of carbonic acid gas set free from
the tissues_, generated by this enforced normal act of throwing into the
lungs _five times_ the normal amount of oxygen in one minute demanded, when
the heart has not been aroused to exalted action, which comes from violent
exercise in running or where one is suddenly startled, which excess of
carbonic acid cannot escape in the same ratio from the lungs, since the
heart does not respond to the proportionate overaction of the lungs.
Third.--Hyperaemia is the last in this chain of effects, which is due to
the excessive amount of air passing into the lungs preventing but little
more than the normal quantity of blood from passing from the heart into
the arterial circulation, but draws it up in the brain with its excess of
carbonic acid gas to act also directly upon the brain as well as throughout
the capillary and venous system, and as well upon the heart, the same as if
it were suspended in that gas outside the body.
These are evident to the senses of any liberal observer who can witness a
subject rapidly breathing.
Some ask why is not this same thing produced when one has been running
rapidly for a few minutes? For a very good reason: in this case the rapid
inhalations are preceded by the violent throes of the heart to propel the
carbonized blood from the overworked tissues and have them set free at the
lungs where the air is rushing in at the normal ratio of four to one. This
is not an abnormal action, but is of necessity, or asphyxia would instantly
result and the runner would drop. Such sometimes occurs where the runner
exerts himself too violently at the very outset; and to do so he is
compelled to hold his breath for this undue effort, and the heart cannot
carry the blood fast enough. In this instance there is an approach to
analgesia as from rapid breathing.
Let me take up the first factor--_diversion of will_--and show that nature
invariably resorts to a sudden inhalation to prevent severe infliction of
pain being felt. It is the panacea to childhood's frequent bruises and
cuts, and every one will remember how when a finger has been hurt it is
thrust into the mouth and a violent number of efforts at rapid inhalation
is effected until ease comes. By others it is subdued by a fit of crying,
which if you will but imitate the sobs, will find how frequently the
respirations are made.
One is startled, and the heart would seem to jump out of the chest; in
quick obedience to nature the person is found making a number of quick
inhalations, which subdue the heart and pacify the will by diversion from
the cause.
The same thing is observed in the lower animals. I will relate a case:
An elephant had been operated upon for a diseased eye which gave him great
pain, for which he was unprepared, and he was wrathy at the keeper and
surgeon. It soon passed off, and the result of the application was so
beneficial to the animal that when brought out in a few days after, to have
another touch of caustic to the part, he was prepared for them; and, just
before the touch, he inflated the lungs to their fullest extent, which
occupied more time than the effect of the caustic, when he made no effort
at resistance and showed no manifestation of having been pained.
In many cases of extraction of the temporary teeth of children, I make them
at the instant I grasp the tooth take _one_ very violent inhalation, which
is sufficient. Mesmeric anaesthesia can well be classified under diversion
or subjugation of the will, but can be effected in but a small percentage
of the cases. To rely upon this first or primary effect, except in
instantaneous cases, would be failure.
The second factor is the one upon which I can rely in such of the cases as
come into my care, save when I cannot induce them to make such a number of
respirations as is absolutely necessary. The _whole secret of success lies_
in the greatest number of respirations that can be effected in from 60 to
90 seconds, and that without any intermission. If the heart, by the _alow
method of respiration_, is pulsating in ratio of four to one respiration,
_no effect can be induced_.
When the respirations are, say, 100 to the minute, and made with all the
energy the patient can muster, and are kept up while the operation is going
on, there can hardly be a failure in the minor operations.
It is upon this point many of you may question the facts. Before I tried
it for the first time upon my own person, I arrived at the same conclusion
from a course of argument, that rapid breathing would control the heart's
action and pacify it, and even reduce it below the normal standard under my
urgent respirations.
In view of the many applications made I feel quite sure in my belief that,
inasmuch as the heart's action is but slightly accelerated, though with
less force from rapid breathing at the rate of 100 to the minute, there is
such an excess of carbonic acid gas set free and crowding upon the heart
and capillaries of the brain, without a chance to escape by the lungs, that
it is the same to all intents as were carbonic acid breathed through the
lungs in common air. Look at the result after this has been kept up for a
minute or more? During the next minute the respirations are not more than
one or two, and the heart has fallen really below, in some cases, the
standard beat, showing most conclusively that once oxygenation has taken
place and that the free carbonic acid gas has been so completely consumed,
that there is no involuntary call through the pneumogastric nerve for a
supply of oxygen.
If any physiological facts can be proven at all, then I feel quite sure of
your verdict upon my side.
There is no one thing that goes so far to prove the theory of Lavoisier
regarding the action of oxygen in the tissues and capillaries for
converting carbon into carbonic acid gas instead of the lungs, as held
prior to that time, and still held by many who are not posted in late
experiments. At the time I commenced this practice I must confess I knew
nothing of it. The study of my cases soon led me to the same theory of
Lavoisier, as I could not make the phenomena agree with the old theory of
carbonic acid generated only in the lungs.
When Vierordt was performing his experiments upon himself in rapid
breathing from six times per minute to ninety-six, I cannot understand
why he failed to observe and record what did certainly result--an extreme
giddiness with muscular prostration and numbness in the peripheries of the
hands and feet, with suffusion of the face, and such a loss of locomotion
as to prevent standing erect without desiring support. Besides, the very
great difference he found in the amount of carbonic acid retained in the
circulation, the very cause of the phenomena just spoken of.
One thing comes in just here to account for the lack of respiration the
minute after the violent effort. The residual air, which in a normal state
is largely charged with carbonic acid, has been so completely exhausted
that some moments are consumed before there is sufficient again to call
upon the will for its discharge.
As to hyperaemia you will also assent, now that my second factor is
explained; but it is so nearly allied to the direct effect of excessive
respiration that we can well permit it to pass without argument. If
hyperaemia _is present_, we have a more certain and rather more lasting
effect.
In conclusion, I will attempt to prognosticate the application of this
principle to the cure of many diseases of chronic nature, and especially
tuberculosis; where from a diminished amount of air going into the lungs
for want of capacity, and particularly for want of energy and inclination
to breathe in full or excess, the tissues cannot get clear of their
excrementitious material, and particularly the carbon, which must go to the
lungs, this voluntary effort can be made frequently during the day to
free the tissues and enable them to take nutritious material for their
restoration to their standard of health.
Air will be found of far more value than ever before as one of the greatest
of factors in nutrition, and which is as necessary as proper food, and
without which every organization must become diseased, and no true
assimilation can take place without a due amount of oxygen is hourly
and daily supplied by this extra aid of volition which has been so long
overlooked.
The pure oxygen treatment has certainly performed many cures; yet, when
compared to the mechanical mixture and under the direct control of
the will, at all times and seasons, there is no danger from excessive
oxygenation as while oxygen is given. When every patient can be taught to
rely upon this great safety valve of nature, there will be less need for
medication, and the longevity of our race be increased with but little
dread by mankind for that terrible monster consumption, which seems to have
now unbounded control.
When this theory I have here given you to-night is fully comprehended by
the medical world and taught the public, together with the kind of foods
necessary for every one in their respective occupation, location, and
climate, we may expect a vast change in their physical condition and a hope
for the future which will brighten as time advances.
I herewith attach the sphygmographic tracings made upon myself by another,
showing the state of the pulse as compared with the progress of the
respiration.