On the curative effect of carbonic acid gas or other forms of carbon in cholera, for different forms of fever, and other diseases / by C.J. Lewis.

Lewis, C. J. (Charles James), 1875-1937.

Date:: 1903

Credit: On the curative effect of carbonic acid gas or other forms of carbon in cholera, for different forms of fever, and other diseases / by C.J. Lewis. Source: Wellcome Collection.

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$the air in the intestines is liardly likely to contain carbonic acid gas in any- thing like so large a percentage as experiment shows is necessary to pre- vent growth of the cliolera organism at the body temperature. It is not easy to concei\-e that the carbonic acid gas given off from 180 grains of bicarbonate of soda (six doses of 30 grains each witli sufficient acid nsuaUy prodncing marked effects according to I’arkin) would impregnate the intestinal atmosphere to a percentage of 60 or 70, and less than this is not ^’ery powerful in restraining growth of the cholera organism at the temperature of the body. Some of the gas is lost during imbibition of the mixture, more is probably absorbed by the stomach, and only a proportion of the gas ad- ministered may be expected to reach the habitat of the vibrios. Certainly if a sufficient quantity reach the organisms it will tend to check their development, and to this may be attrikited part of the alleged efficacy of the gas in the disease. It is quite possible to admit that if in our eases of cholera we could maintain in the intestinal cavity an atmosphere containing not less than 50 per cent, of carbonic acid gas, the cholera vibrios would be placed in an unfavourable environment, would have some difficulty in surviving, and would probably be overcome by the patient instead of overcoming him. ’Wliether this is possible with safety, and how it is to be achieved in the stress of acute cholera, are subjects pertaining more to the clinical than to tlie experimental aspect of the qiiestion. The experiments of Eosenbach and Oliven, founded upon Fraenkel’s statement of the antagonism between carbonic acid gas and the cholera bacillus, are stated to have shown that it is possible to inflate the intestine with carbonic acid gas either from the rectum Ijy means of a rectal tube, or from the stomach by means of an oesophageal tube. At tbe same time, relaxation of the j^yloric orifice and of the ilio-ceecal valve is produced by tlie administration of opium either internally or I)y injection. In addition frequent repetition of the gas injections are required in order to produce in the small iiitestine an atmosphere highly charged with earbonic acid gas. The procedure does not seem to me to be one which lends itself very easily to adoption as a therapeutic measure in acute cholera. The I)road fact that pure carbonic acid gas inhibits the development of cholera organisms supports, in a way which Parkin could never have foreseen, his reiterated epithet of ‘ antidotal.’ When the conditions of the application of tins fact are investigated, the support given to Parkin’s contention is seen not to be so conclusive as at first sight might seem to be warranted. As I have shown by experiment, and contrary to Guyon s conclusions, carljonic acid gas is not nearly so powerful in destroying grown cultures as in preventing development of the organism in newly- moculated media. From tliis one might suspect that clinically carbonic acid gas would exert a more favourable influence in the very early stages of the disease than when symptoms were fully estalflished. A furtlier point for consideration may take the form of tliis query—Is there any other way, in addition to inhibition of growth of cholera vibrios, whereby carbonic acid gas may cure choleraic illness ? Without being pre- ])ared to assert that there is snch a way, one may speculate on the possihdity of carbonic acid gas, absorbed by the stomach and reaching the blood, meeting there a toxin produced by tbe cholera bacillus and neutralising its effects. That the cholera bacillus does ])roduce a toxin is generally behoved, both on account of certain sym])toms and clinical features of cholera and on account of the lalioratory exper iments of Pfeiffer and others with recent$