Medicine 100 Years in the Past

Treatment of carbon monoxide poisoning 100 years ago.  Courtesy of the American Journal of Public Health (NY) 1922 Apr; 12(4): 355-358.

The authors “insist on the vital importance of eliminating carbon monoxide poisoning from the blood as rapidly as possible.”  This is absolutely still the treatment 100 years later–albeit with more nuance these days.  They then recommended the use of a Tissot army face mask (think gas mask) delivering oxygen from a gas tank and doing so for at least 3 hours.  While this would be reasonable treatment even by today’s standards, they did have some odd items recommended.  Later the article suggested the patient “should be kept quiet for fear of heart failure for some time after recovery.”  Reasonable enough until you add the next line calling for the use of “stimulants.”  If you are worried about heart failure, it is best to avoid whipping the heart with stimulants.  

Carbon monoxide (CO) is an odorless gas that is quite deadly.  It comes from the combustion of natural gas and as a byproduct of combustion in a car engine–among other sources.  Hemoglobin is the protein within our red blood cells that carries oxygen around the bloodstream.  Imagine a globby protein molecule grabbing an oxygen molecule and wandering about the body to give that oxygen to an organ in need.  

The problem is that hemoglobin loves carbon monoxide even more than oxygen.  When the environment contains high levels of CO gas, our hemoglobin will grab and hang onto the CO more tightly–so-to-speak–than it does oxygen.  Our bodies can’t use CO the same way we use oxygen so when CO levels in the blood are rising, our oxygen levels are decreasing.  Initially mild symptoms such as headache or fatigue can progress to brain or heart damage if not death if someone is exposed to high enough levels for a long enough period of time.  

So the treatment is to flood the body with as much oxygen as possible so that, even though the hemoglobin loves to hang onto CO, oxygen is so abundant that eventually it replaces the CO molecules being held in the red blood cells.  

One of the main differences in treatment these days includes improved methods of oxygen delivery.  We now have oxygen masks that can deliver much higher concentrations than old masks.  Additionally we use hyperbaric oxygen treatments for some CO poisoning cases.  This involves putting a patient into a high pressure super-oxygen rich environment to further speed the elimination of CO from the hemoglobin in the bloodstream.  The faster the CO is gone, the more likely long term consequences are likely avoided.

So here we have a case where the old treatment is still good.  Now, it’s just a bit more refined and better understood with the benefit of the past 100 years of research.

#histmed #medicalhistory #medicalfacts #carbonmonoxide #occupationalhealth

Max

Doctor with a mustache.