The introduction of oxygen for pneumonia as seen through the writings of two McGill University professors, William Osler and Jonathan Meakins

Oxygen was identified at the end of the 18th century by three independent researchers. It was first used indiscriminately with other gases for treatment of pulmonary diseases by Thomas Beddoes. In the 19th century, the physiological properties of oxygen were identified by many researchers. In that same century, physicians used oxygen empirically for a variety of conditions. Osler, who wrote on pneumonia, appreciated that blood was "imperfectly oxidised" (sic) in pneumonia, but concluded that the toxicity of oxygen more than outweighed its possible benefits. Meakins applied the lessons he learned from studying the hypoxemia that resulted from poison gas in World War I to pneumonia. He confirmed that patients with severe pneumonia were hypoxemic and that many of their symptoms appeared to be relieved by inhalation of oxygen. Oxygen then became the standard therapy for pneumonia.

Paralysis and blindness during a balloon ascent to high altitude

An account of the classic balloon ascent to over 29,000 ft (8840 m) by J. Glaisher and H. T. Coxwell on September 5, 1862, appeared in The Lancet and is reproduced here. Glaisher reported paralysis of his arms and legs and sudden loss of sight. Coxwell also lost the use of his hands and could only open the valve of the balloon to initiate its descent by seizing the cord with his teeth. These symptoms are unusual for acute hypoxia, and in a recent article Michael J. Doherty suggested that they may have been caused by decompression sickness. However, this seems unlikely based on many reported cases of subatmospheric decompression sickness.

The Discovery of Retrolental Fibroplasia and the Role of Oxygen: A Historical Review, 1942–1956

Nearly 50 years after it was thought to be conquered, retinopathy of prematurity (ROP) continues to cause vision disturbances and blindness among prematurely born infants. During the 1940s and early 1950s, researchers and caregivers first identified and struggled to eliminate this problem, which seemed to come from nowhere and was concentrated among the most advanced premature nurseries in the U.S. Research studies initially identified many potential causes, none of which could be proved conclusively. By the mid-1950s, oxygen was identified as the culprit, and its use was immediately restricted. The rate of blindness among premature infants decreased significantly. ROP was not cured, however. By the 1960s, it had reappeared. The history of ROP serves to remind us that, despite our best intentions, the care and treatment of premature newborns will always carry with it the possibility of iatrogenic disease. This caution is worth remembering as we work to expand the quality and quantity of clinical research.

Tachykinins in the control of breathing by hypoxia: pre- and post-genomic era

This article highlights major findings from physiological and pharmacological studies conducted in the pre- and post-genomic era examining the roles of substance P (SP) and other tachykinins in the response of the carotid body to hypoxia, in the ventilatory response to hypoxia and in respiratory rhythm generation. In the post-genomic period, the hypoxic ventilatory responses of mice carrying targeted deletion of genes that affect synthesis or degradation or receptor interaction of SP have been examined by us and also by other investigators. A brief summary of the findings from these investigations will also be presented. The combined observations from the pre- and post-genomic era strongly support the involvement of SP and also other tachykinins in the control of respiration during hypoxia.

James Glaisher's 1862 account of balloon sickness: altitude, decompression injury, and hypoxemia

In 1862, James Glaisher and Henry Coxwell ascended to 29,000 feet in an open hot-air balloon. During the ascent, Glaisher described marked neurologic compromises: appendicular and later truncal paralysis, blindness, initially preserved cognition, and subsequent loss of consciousness. The author examines Glaisher's account of balloon sickness by comparing it with other balloonists' observations and discussing it in the context of altitude sickness, decompression injury, and hypoxemia.

Acute mountain sickness: critical appraisal of the Pariacaca story and on-site study

The physiological and medical literature on the description of acute mountain sickness by Father Acosta in the Peruvian Andes shows many historical misconceptions and clinical misinterpretations. A recent paper by Gilbert (1983) not only contains these traditional misinterpretations but also adds geographical errors in the description of the area where Acosta described his sufferings. In view of these facts the authors have made a review of the old and modern writings on the so called Pariacaca story and during an on-site visit to the area of Pariacaca have taken actual measurements of distances, altitudes and geographical locations which they hope will put this story in the context of historical and scientific objectivity.

The first documented report of mountain sickness: the China or Headache Mountain story

This article gives the probable location within 65 km of the Big Headache Mountain where mountain sickness was first reported by Too Kin, a Chinese official, in 37-32 B.C. We believe that traveling over the western edge of the Himalayan Karakoram Range or in the Pamirs caused the major difficulties, probably when travelers crossed the Kilik Pass at an altitude of 4827 m or 15837 ft or within 60 km of this pass and at an altitude of at least 4500 m or 14750 ft. We theorize that the route Too Kin described is from Kashi, an important center in Sinkiang or Chinese Turkestan, to Kabul in Afghanistan. This particular route has two other altitude maxima; one at the Ulagh Rabat Pass in Sinkiang about 15 km west of the Muztagata peak where the elevation is 4250 m or 14000 ft, and the other at the Shandur Pass over the Hindu Kush in Pakistan where the elevation is 3734 m or 12250 ft.

The first documented description of mountain sickness: the Andean or Pariacaca story

We describe here for the first time the actual route that Acosta took when he described mountain sickness so vividly in the sixteenth century. We have shown that when Acosta mentioned Pariacaca as the geographical site where he experienced high altitude sickness, this referred not only to the modern peak of Pariachaca, but to the snow covered mountains by this Cerro, and the Central Maritime Andean Range in Peru. In addition, the name Pariacaca also referred to a tambo or inn located on the plateau or Puno of Pariacaca. The location of this route has been obtained by locating primary descriptions on maps from the sixteenth to the eighteenth centuries. Using twentieth century maps, we have been able to identify the described sites along the road and the trail which still exists by them. In addition, using detailed topographical maps, an altitude profile of the trail was obtained. The maximum altitude on this trail or old road reached 4800 m (15750 ft), about the same elevation as the summit of Mt. Blanc, the highest mountain in western Europe.

"La Pression barométrique": Paul Bert's hypoxia theory and its critics

Just one hundred years ago, Paul Bert published his most famous book, La Pression Barométrique..., summarizing his work on the physiological effects of altering barometric pressure. After a summary of Bert's life and contributions, this paper focuses on his experimental demonstration of the hypoxic etiology of altitude sickness. Bert showed that functional impairment or death occurred in each of a variety of species at a certain inspired oxygen pressure regardless of what combination of barometric pressure and oxygen percentage was used to achieve it. He further showed that the oxygen pressures impairing function were those producing arterial hypoxemia, and that raising the inspired oxygen percentage protected against the effects of altitudes that would otherwise endanger life. For the next several decades some other physiologists were unable to confirm these points. The criticisms of Setschenow, of Cyon, of Fraenkel and Geppert, of Mosso, and of Kronecker are analyzed in the light of modern knowledge.