ATROPHIC CATARRH.-A New Method of Treatment. 
THE USE OF OZONE IN 
ATROPHIC CATARRH. 
CLARENCE C. RICE> M. D. 
REPRINTED FROM THE 
New ^ork IHebical Journal 
for August igth, 1893. 
The Ozone Company, 
' 122 East 23RD St., New York. 
Suite 1115, Masonic Temple, Chicago. Read before the American Laryngological Association 
at its Fifteenth Annual Congress. 
THE USE OF 
OZONB IN ATROPHIC CATARRH. 
By CLARENCE C. RICE, M. D. 
This paper will necessarily be a short one, 
since what can be said of the chemical composi- 
tion, physical properties, and therapeutic value 
of ozone can be easily read in any chemistry or 
in pamphlets compiled by the Ozone Company of 
New York. I have used ozone only during the 
past two months, and while I cannot speak de- 
cidedly of its value in the treatment of catarrhal 
diseases, the results so far have been satisfactory 
enough to warrant calling the attention of this 
association to its use in atrophic catarrh. 
Dr. William J. Morton, of this city, for wdiom 
the Ozone Company have manufactured an ex- 
tensive apparatus for the generation of ozone, 
and who has used it for various purposes during 
the past year, first called my attention to the use 
of ozone in catarrhal disease of the upper air 
passages, and alleged a therapeutic value for it. 
Before speaking of the therapeutics of ozone and 
the method of using it in catarrhal disorders, I 
may give a short history of what is known of 2 
chemical composition and physical properties and 
describe the methods used for its manufacture. 
I am indebted to the Ozone Manufacturing Com- 
pany of this city for the larger apparatus which 
they have placed here for your inspection, and to 
Dr. Augustus Caille, of this city, who has loaned 
me the smaller apparatus of Messrs. Labbe and 
Oudin. 
Physical and Chemical Properties of Ozone. -In 
1775 Van Marum noticed that the passage of an 
electrical discharge through the atmosphere pro- 
duced a peculiar odor, but the reason of this was 
not discovered until 1840, when Schcenbein ob- 
served that this same odor accompanied the pro- 
cess of electrolysis in acidulated water. He dis- 
covered, too, that these odoriferous gases had the 
power of decomposing iodide of potassium and 
liberating iodine. By experimentation it was 
found that ozone was similar to, though quite 
different from, chlorine. The credit of discover- 
ing the true composition of ozone is due to Marig- 
nac and De la Rive, who demonstrated that ozone 
could be obtained by simply passing a current 
of electricity through pure oxygen gas. In this 
way it became apparent that ozone could be noth- 
ing else than an allotropic modification of oxygen. 
Schcenbein named this peculiar gas ozone, from 
the Greek word "ozein", which means "to emit 
an odor.'' The knowledge of the present day in 
regard to the relation between the two kinds of 
-oxygen-O2 and O3 -has been derived principal- 
ly from the writings of Professor Tait. As is 
well known, the chemical formula for ozone is O3 
and it is an allotropic form of oxygen, just as 
carbon may be found in the allotropic forms of 3 
charcoal, graphite, and the diamond. Oxygen 
may exist in the different forms of O, or active 
oxygen ; O2 or common oxygen, and O, or ozone. 
In the formation of ozone three volumes of oxygen 
are condensed to form two volumes of ozone- 
that is, 3O2 = 2O3 . In volume, then, it bears 
the relation to oxygen of 2 to 3. Common oxy- 
gen, O2. when coming in contact with active 
oxygen, O,, becomes concentrated into ozone, or 
O3. Ozone has been called ozonized air, ozonized 
oxygen, and electrified oxygen. 
From Sir Benjamin Brodie's experiments 
{Proceedings of the Royal Society, 1892, p. 435) it 
is positive that ozone differs from ordinary oxygen 
merely in the fact that its molecule contains three 
atoms instead of two, 0-0 being oxygen. 
O 
A being ozone. 
0-0 
Ozone is a colorless gas, quite similar in chemi- 
cal properties to chlorine. It will liquefy at a 
temperature of 105° under a pressure of 125 at- 
mospheres, and in this form is of a deep blue. 
At one time Schcenbein advanced the theory, 
and it was generally believed, that ordinary oxy- 
gen gas was a compound made up of two kinds 
of oxygen, one being positively and the other 
negatively electrical. Marignac observed that 
when oxygen was exposed to the influence of 
electricity it underwent a contraction in volume 
and acquired very different properties, its chemical 
activity being greatly increased. 
The ordinary way of obtaining ozone is by 
means of a Siemens induction tube, which con- 
sists of two tubes of nearly the same diameter. 4 
one within the other. Their exterior surface is 
covered with tin foil, and this tin foil is connected 
with the electrodes from an induction coil. The 
current of oxygen is passed through the space 
between the two tubes, and is thus exposed to 
the electrical current. It is said to be very essen- 
tial that the oxygen which is to be ozonized 
should be very pure and very dry. Ozone may 
also be obtained in small quantities by decompos- 
ing water with the electric current. Ozone has 
remarkable oxidizing power. It destroys sub- 
stances like rubber, paper, etc. Its effect upon 
mercury is to deprive it of its mobility so that it 
will adhere to the surface of a mirror glass. The 
books tell us that ozone in Nature is principally 
formed by the action of the sun's rays on oxygen. 
Schcenbein maintains that ozone is the great 
purifier and oxidizer in the atmosphere, and in a 
large measure prevents decomposition. 
The Ozone Company pamphlet tells us that 
the utility of ozone as a disinfectant is hinted at 
by its early discoverer, Schcenbein, who in 1851 
{Zeitschrift fuer nat. Medtzin, Bd. xv, 391) main- 
tained that one part of ozone to 340,000 parts of 
air was sufficient to destroy the odor of decay in 
a vessel of 60 litres capacity in which 120 grammes 
of putrid meat had been placed for a minute, and 
that Wood and Richardson forced ozonized oxy- 
gen through blood in course of decay, and noticed 
that by this means the blood completely lost its 
offensive smell. 
The value of ozone as a bactericide is now un- 
der trial by Dr. W. J. Morton and Dr. W. C. 
Park. I have seen the results of their experi- 
ments, but they will be published by these gentle- 5 
men later on. Dr. W. Wyssochowicz has recent- 
ly stated, in regard to experiments with bacterial 
cultures in ozonized nutrient media, that the ozone 
effected a change in the nutrition furnished the 
cultures which prevented their propagation. 
The large apparatus for manufacturing ozone, 
which has been placed at our disposal to-day by 
the Ozone Company, consists of a dynamo, a 
blower, a transformer, and an ozone generator 
proper. The dynamo supplies the current, which 
then passes for conversion to the necessary high 
potentiality to the transformer, from which it is 
conducted by suitable connecting wires to the 
ozone generator. This latter is constructed of 
four ozone tubes, placed round and connected by 
tubes to a central metal pipe, through which the 
air is received from the blower. The air, passing 
from thence to the ozonizers, becomes ozonized 
by the silent electric discharge or effluvium which 
takes place through the walls of the concentric 
glass tubes. The blower, driven by a small belt 
from the dynamo, supplies the air to be ozonized, 
which, before reaching the generator, is forced 
through the drying tube. The latter is filled 
with glass in fine pieces, moistened with sulphuric 
acid. Ventilators are provided in the sides of the 
cabinet, containing and supporting the different 
parts of the apparatus. [These are operated by 
screwing in and out, and they serve to carry off 
the heat generated by the dynamo when in mo- 
tion.] The longer the air is exposed to the 
electric effluvium, the greater is the quantity of 
ozone produced. The flow of the air may be 
regulated by the valve which w'ill be found at the 
lower end of the glass tube, conveying the air to the generator. [The blower being provided with 
a blow-off valve, there is no danger to the appa- 
ratus from overpressure.] Experience will soon 
establish the amount of air necessary to obtain 
the most satisfactory results. When generating 
ozone, the tubes of the generator should show, in 
a darkened room, the blue light of the electric 
discharge or effluvium. The absence of this light 
shows that either the commutator or drying tube 
requires attention. Should the ozone be found 
too irritating, pass the ozonized air through a two- 
necked Woulfe's bottle containing a solution of 
caustic potash-a pound of caustic potash to the 
gallon of water. 
The smaller ozone generator which I present to 
the association was constructed by Dr. Labbe and 
Dr. Oudin, and has kindly been sent to me by 
Dr, Augustus Caille, of this city. Dr. Caille has 
used this instrument quite extensively, and pub- 
lished his observations of its use in a paper en- 
titled Experiments as to the Value of Nascent 
Ozone in Certain Forms of Diseases of Children, 
with Demonstration of an Efficient Generator. 
Dr. Caille says of this ozone generator that it is 
made up as follows; "A mild electric current, 
from a zinc-carbon cell or storage battery, is sent 
into a Ruhmkorff or spark coil, and from there 
enters the inhaler, which is a double cylinder of 
glass, the inner cylinder being closed and holding 
an aluminium plate in vacuo and surrounded by 
an aluminium cone. The electrical discharge is 
not in the form of a spark, but presents a diffuse 
electrical glow." I suppose that the aluminium 
tin foil simply acts as a conductor for the electrical 
current, and thus presents a large electrified sur- 
face to the oxygen. 
6 7 
Dr. W. J. Morton began to use ozone in cases 
of nasal catarrh without special regard to the kind 
of nasal disease. The method employed has 
been to instruct the patient to take a deep inspira- 
tion, and then hold the breath while the ozone 
gas is allowed to pass into the nostrils through 
the tube. The current of ozone is passed as long 
as the patient can hold his breath. The patient 
is then instructed to blow the ozone out of the 
nostrils before taking the first inspiration of at- 
mospheric air. The degree of irritation produced 
by ozone upon the nasal and pharyngeal mucous 
membrane is in proportion to the volume of gas 
employed, and depends also on the purity of the 
gas used. One of the patients accidentally in- 
spired a strong current of ozone, and the next 
day suffered from an aphonic laryngitis. 
Ozone in condensed form irritates the respira- 
tory mucous membrane, and may cause active 
acute inflammation, etc. In Dr. Caille's paper, 
already referred to, he states that Messrs. Labbe 
and Oudin have published extensive experiments 
in the use of ozone, and that they allege for its 
use, first, increased metabolism in consequence of 
the high oxidizing power of ozone, and, second, 
the destruction of the tubercle bacillus, in conse- 
quence of the oxidizing power and diffusibility of 
ozone, and its ability to reach directly and indi- 
rectly the foci of disease in the lung. 
Dr. Caille's experiments with ozone were em- 
ployed to test its efficacy in the first stages of 
pulmonary tuberculosis, in extreme anaemia, and 
in pertussis. His observations extended over five 
months and comprised twenty-two cases. His 
conclusions are: That the daily inhalations of 8 
ozone increase the oxyhaemoglobin in the blood 
from two to four per cent, in a short time; that 
no local improvement was obtained in three typi- 
cal cases of limited apex tuberculosis, but that, in 
pertussis, ozone inhalations have a distinct cura- 
tive effect as regards the duration and severity of 
the disease. Also that, in anaemia, ozone inhala- 
tions are exceedingly valuable from a therapeutic 
standpoint, and give better and prompter results 
than any other form of medication. And, lastly, 
that atmospherical disinfection is readily secured 
by means of the ozone current, making this 
probably a valuable procedure in the treatment of 
diphtheria, scarlet fever, and other infectious 
diseases. 
Before calling your attention to my own cases 
I wish to refer to a paper written by Henry S. 
Norris, M. D., of this city. The title of this paper 
is The Internal Administration of Ozone in the 
Treatment of Phthisis, with a Report of Cases.* 
The report has no special bearing upon the object 
of this paper, except as it shows that the general 
tone of the patients treated with ozone was im- 
proved. The report covers fifteen cases, fourteen 
of which are put down as catarrhal phthisis and 
one as fibroid phthisis. The inhalation of ozone 
gas was not used in these cases, but aquzon 
and ozonized cod-liver oil were administered. 
The aquzon was given, four doses daily of 
three ounces each, before meals, and half an ounce 
of the oil containing six volumes per cent, of 
ozone after each meal. The results in many of 
the cases were beneficial. 
* Norris. New York MedicalJournal, November 5, 1892. Speaking now of the effect of ozone gas when 
admitted into the nostrils of patients suffering 
from nasal disease, I may say that the first case I 
observed was treated by Dr. W. J. Morton. He 
treated this case for the purpose of checking a 
profuse nasal discharge. 
It was a boy of twelve years of age who suffered 
from apparent nasal obstruction and constant nasal 
discharge so irritating in character as to keep the 
upper lip constantly excoriated. He used ozone gas 
in the nostrils two or three times weekly, covering a 
period of a few weeks, and the result was that the 
discharge was almost entirely stopped, the inflamed 
lip cured, and the patient breathed better through the 
nose. The patient was sent to me for examination, 
and I found it to be a case of rather marked adenoid 
enlargement in the vault of the pharynx. The entire 
mucous membrane was quiescent at the time I saw 
him. 
I wrote Dr. Morton that in such a case I did 
not think ozone was as applicable as in atrophic 
rhinitis, as I believed that the removal of the 
adenoid would entirely relieve both the nasal ob- 
struction and the pent-up secretions of the nose. 
It seemed to me that if ozone possessed the pow- 
erful oxidizing, germicidal, and bactericidal 
properties alleged for it, its use would be indicated 
in those forms of nasal disease which were char- 
acterized by decomposing secretionsand degenera- 
ting tissues, the entire condition possibly depend- 
ing upon the action of nasal bacteria. Since then 
Dr. Morton and I have employed the local effect 
of the ozone gas upon eight different patients, all 
of them suffering from various grades of atrophic 
rhinitis and dry pharynx. Of these eight patients, 
three were treated at the office of Dr. Morton, 
and he has used a much larger amount of ozone 
9 10 
gas than I have at my office. Dr. Morton's appa- 
ratus was, as I have said, manufactured by the 
Ozone Company, while the apparatus at my com- 
mand is that of Labbe and Oudin. I had the 
smaller apparatus connected with the storage 
cells of my cautery battery, and have my patients 
breathe it into the nose and lungs and exhale it 
through the mouth. With Dr. Morton's appara- 
tus the current of ozone gas is so strong as to be 
too irritating for inhalation into the lungs, 
although it can be modified to any degree. It is 
hardly necessary to give a detailed history of the 
cases-that is, the pathological condition in each 
case-because they are all very much alike. 
Three of my cases were advanced to an extreme 
condition of atrophic change, so familiar to all of 
you. In two the turbinates had almost entirely 
disappeared. The saeptum was ulcerated, and 
the secretions were collected in thick scabs. Of 
the two cases I sent to Dr. Morton's office, one 
was far advanced in atrophic change and the 
second was but moderate in degree. All of the 
cases were treated with ozone gas from five to 
eight minutes. In Dr. Morton's cases the gas 
was passed into the nostrils three times-that is 
while the patient was holding the breath for three 
different periods. The immediate effect of the 
ozone gas was alike in kind in all the cases, but 
differed in degree according to the volume of the 
gas employed, and probably according to the 
sensitiveness of the nostrils. It produced a mild 
smarting of the nasal mucous membrane for sev- 
eral hours. It increased the secretions of mucus 
very markedly for eight or ten hours. The con- 
gestion of the mucous membrane of the nose was also exaggerated. In some of the cases, where 
the volume of gas was large, the patients com- 
plained of headache, which, however, had disap- 
peared by the following day. It was almost the 
universal testimony of these patients that the 
nasal pharyngeal mucous membrane was less dry, 
and that the tenacious secretions were more easily 
got rid of. For the first twenty-four hours after 
the ozone was used the patient had the symptoms 
of a cold in the head, but after that the nose felt 
unusually clear and the mucous membrane more 
comfortable than before the application of ozone. 
The milder cases of atrophic catarrh were very 
quickly benefited, and remained improved for 
several days after the inhaling of ozone, but most 
of them relapsed somewhat. The benefit was 
again obtained, however, by the further treatment 
with ozone. Whether permanent moistening of 
the mucous membrane and decrease of secretions 
can be obtained by the use of ozone can be told 
only after a longer trial. In the more severe 
cases the benefit was not obtained so quickly. 
In all the cases we instructed the patient to dis- 
continue the use of all sprays and douches while 
we were using the ozone. In a case of ozaena 
treated by this method the deodorizing power of 
the ozone seemed to be as marked as is obtained 
by the use of peroxide of hydrogen. The odor 
from the nostrils was very foetid, but disappeared 
altogether after the second inhalation of ozone 
gas. I have used a preparation called by the 
Ozone Company "THBRAPOR," a combination 
of sweet oil and 8'75 volumes per cent, of ozone, 
applying it locally on cotton, with an applicator, 
11 12 
iii two cases of ozaena, with the result of deodor- 
izing the nostrils. 
As to the manner in which ozone may be 
expected to produce beneficial results in atrophic 
disease of the upper air passages, it is known that 
ozone is an active oxidizing agent, furnishing the 
active Ob which is ever ready to seize upon and 
form itself into new combinations. Upon this 
oxidizing power its germicidal properties may be 
based. It is possible that in atrophic rhinitis 
there may be bacteria of a peculiar variety, the 
destruction of which, if it can be accomplished 
by ozone gas, will tend to greatly ameliorate the 
disease. Possibly the irritation produced, which 
we usually term stimulation, is of therapeutic 
value. 
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Used by inhalation in catarrhal affections. 
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