Thomas Beddoes to the Editor of A Journal of Natural Philosophy, Chemistry and the Arts, 13 December 1805
Sir,
Dr. Pfaff's paper on respiration will probably draw the attention of the scientific towards the gaseous oxide of azote, which has been too much neglected in a medical point of view. I was only sorry to see that he proposes to use it in melancholia. No combination of ideas can be more obvious than the application of an agent which has so frequently proved exhilarating, and never yet been observed to be followed by exhaustion where it did exhilarate, to a complaint, in which depression of spirits is a striking circumstance. But I am apprehensive that the first thoughts of inexperience here (as so often happens) will prove illusory, and that this project will not be followed by the expected advantage in many cases of melancholia. For if it be true that there is no real distinction between mania and melancholia, as far as the sensorium is concerned, and that the vivacity of ideas in melancholia answers to the violence of muscular actions in mania, as I have endeavoured to shew in my Essays on Health; is there not ground to apprehend that the actions of the brain, already too strong, will be increased by this gas, or the diseased contemplations rendered more intense?
If there be any state of melancholia which it may be of service, this will probably happen when the nervous system is falling into debility, in consequence of having been kept too much on the stretch.
But I do not here warn against gaseous oxide from mere theory. The manager of a lunatic asylum near Bristol, respectably known to the public, concurred with me some years ago in the opinion which I expressed to him concerning its probable advantage in melancholia; and a patient that had been under his care inhaled it fairly without benefit. The administration was tried in two other cases as fruitlessly: Indeed I discontinued it in one, from some indications of an aggravation of the symptoms. I was by this time alive to suspicion, having thought much on the subject, and reasoned myself into the idea that it would often do injury upon the above-mentioned principle. It has long been my opinion, and there are striking observations on record to prove that hidrogen, hidro-carbonate, azotic, or carbonic acid gases, would be more likely to answer in active insanity under whatever form. These observations I shall take occasion to quote hereafter.
The very first time I witnessed the effects of gaseous oxide on a person in health, I concluded that it would be a remedy is certain cases of palsy. A patient who had emerged from apoplexy with the loss of the power of one side of his body, was accordingly put under a course of the gas. The result completely answered expectation. The case was most carefully watched; and on withholding the gas, the symptoms repeatedly grew worse, and vice versa. After the patient’s recovery, he was kept under inspection for a considerable time, and did not relapse. This has been confirmed by other results; and, in palsy, where the brain is primarily affected, I expect that Dr. Pfaff will find either a cure or great relief to follow the use of this gas in a respectable proportion of cases.
I have very fairly tried it in palsy apparently from cold, beginning at the extremities and creeping from muscle to muscle, without good or bad effect. There is a case of this kind, related by Dr. Kentish, with the patient's name, and corroborated by testimony superior to all exception in Considerations on factitious Airs (Johnson) in which a perfect cure was obtained from oxigen gas; and I have since learned by experiments carefully repeated before various philosophical observers, that in essential respects, oxigen gas and gaseous oxide act in a very different, nay opposite manner upon the living fibre.
These experiments I hope to publish before midsummer.
From palsy, analogy led me to other cases of debility. I fully tried gaseous oxide in dropsy of the chest (anasarca of the lungs), but without good or bad effect. I was much disappointed, conceiving that in dropsy (at least in one species) we have a paralytic state of the lymphatics. But I have been since assured by a physician, that for some dropsies he has found a remedy in this gas. There are dropsies which doubtless depend on excess of exhalant action. These are easily distinguished; and they require bleeding as much as pleurisy.
In debility, arising from residence in hot climates and from intense application to business, I have known gaseous oxide completely successful after an infinity of remedies, Bath and other waters, had been tried in vain.
The particulars of these cases are also destined for publication: But I resolved to wait for some years after the use of the gas; for I have found that a single circumstance vitiates a large proportion of our medical records. Patients after an apparent recovery fall again into the same complaint; and there are other considerations, which I shall for the present pass over.
If Mr. Pfaff uses gaseous oxide in palsy, he will probably sooner or later see a phenomenon as extraordinary as any in galvanism, and which after it has been described by a philosopher of high reputation, will become equally celebrated. This is the instantaneous restoration of voluntary power over a limb deprived both of motion and feeling by palsy succeeding to apoplexy, while the patient is respiring gaseous oxide. This was witnessed in common with myself, by several respectable persons; and among others by some of your philosophical acquaintance, if I do not mistake. It was in the case of Mr. G. a member of the last parliament, who completely recovered: But as other means were afterwards adopted, I do not impute the result to the gas, which however, when used alone, was visibly of great service: for I have no idea of claiming for a remedy under scrutiny any cure, if other powers have been called in at the same time.
I transmit these observations to you, Şir, in preference to the Editor of any Medical Journal, because I think them likely to meet the eye of Dr. Pfaff sooner in your Journal. I should be extremely sorry that he should set out wrong in his trials, because the fault will be imputed to the power itself, and not to its misapplication; and the disabled will still, be left to languish and be cut off, notwithstanding we have a remedy at hand.
I have another reason. I most sincerely wish any thing I could say would hasten the period, which must arrive, when medical science shall not be merely what the Germans call a Brod-wissenschaft, or pursued only for a livelihood. If philosophical men without a profession would take it up, it is I think certain, that it must soon become both more efficient and more liberal. Any study is capable of interesting the feelings; and most surely that of the laws of the organic world is as much so as any other. Opportunities of anatomical, chemical, and clinical information are at band. A person so prepared will, heaven knows, with ardour and industry soon acquire all that is useful in medical practice. Let him then, animated with no other motive than the pure desire of benefiting his fellow men, apply himself to the improvement of medicine. It is impossible that he should not succeed as fully as our Tennants, our Hatchetts, and Chenevix’s have done in chemistry; for it is not its inherent difficulty, but collateral circumstances, that retard the progress of this art. Many apothecaries, for example, and old women in general, who are the great controulers of the destiny of physicians, would by no means allow the use of gaseous oxide in palsy, though the patient in the course both of nature and of ordinary medication be sure to die, and perhaps in a very miserable manner. But the philosophical cultivator of medicine, without troubling himself about the good opinion of the one or the other, would proceed on his career under the guidance of the collective light of science and of humanity.
N. N. advanced in years, of a thick set stature, and with a short neck, shewed signs of palsy many years ago. The writer of these lines warned his friends of the danger. Concurring in this apprehension, Dr. Ingenhousz proposed to him to inhale oxigen gas, a practice familiar to that accurate philosopher, and by which he hoped the constitution might be recruited. The execution of the idea was deferred. Meanwhile the gaseous oxide was discovered to be respirable, and its power in palsy was to a degree ascertained. The writer now pressed the use of this gas with the utmost earnestness. The patient saw it taken by others; He himself consented to inhale it, when behold! the distress of a lady present, as excited by some apprehended imaginary bad consequences, put off the inhalation. The predicted paralytic seizure arrived: but there was ample time still for the use of the oxide. I proposed that another patient, situated as similarly as possible, should be sought; and that if he consented upon the credit of the successful exhibition, and upon my responsibility, to use the gas, the result should determine as to its employment in the case first in question. At the same time, I stated from the average course of paralytic attacks in general not immediately fatal, that a little apparent amendment would take place, and the stroke return with additional violence. My proposal was acknowledged to be highly reasonable; but that plan of routine treatment was followed which is so much more advantageous to the idle and unscientific of our profession than it is to the sick, and the patient died of a return of his complaint. Such is probably the condition of thousands of the diseased at this moment! Rather than use a recently proposed plan not in the Pharmacopeia, or seek a new one in analogy, we persevere in painful or disgusting means, from which, on the faith of long experience, no good of any sort can be expected for the sufferer. May the rising generation of natural philosophers exercise their talents and their benevolence in putting an end to so crying an evil!
I am, Dear Sir,
Respectfully your’s,
Thomas Beddoes
Clifton, Dec. 13, 1805.
P.S. A case in your Journal, where a gentleman accustomed to breathe gaseous oxide for amusement, experienced very disagreeable feelings on one particular occasion, seems to me clearly referable to hysteria. Now the trials at the Pneumatic Institution, as related in Mr. Davy’s Researches, had clearly shewn that in the predisposed, gaseous oxide is a specific for exciting an hysteric paroxysm. Perhaps in the individual whose case is related by himself in the Journal, no obvious predisposition, either temporary or permanent, existed: Nothing to this purport is stated. But that the affection was simply hysterical cannot I think be doubted by any one conversant both with hysteria and the administration of gaseous oxide. It seems to be strongly marked by that idea of immediate danger, which is so common in hysteria. Dr. Garnet very unnecessarily, and, I believe, very mistakenly, called up the whole Brunonian theory on the emergency. It led him, however, to give cordials; and they were proper. A tea-spoonful of sal volatile, from time to time, would probably have answered without the Brunonian theory. But it is certainly the business of the physician to avoid gaseous oxide in the hysterical, as it is wine in those who labour under acute inflammation. If your correspondent who related his own feelings could specify any cause which might have rendered him nervous, or state the fact whether he was so or not, it would give satisfaction to the present writer, and perhaps also to future inquirers.
To interdict a remedy because its use requires discrimination, would, in many disorders, be leaving the sick to certain destruction. I imagine that the outcry against such means as gaseous oxide, will arise from those who daily use the most hazardous remedies, and who are enabled to do it without reproach, because they are put into a phial, and the patient and his friends never trouble themselves about the nature of the articles which they are receiving into the stomach.
Published: The Journal of Natural Philosophy, Chemistry and the Arts, 13 (1806), 11–16 under the title Facts and Observations on the medical Respiration of gaseous Oxide of Azote. In a Letter from Dr. BEDDOES to Mr. NICHOLSON.