""REPRATED fro^KtJi^tTherapeutic palette, 
J^'yrS^ptdnbf' 15, 1887. / / 
OXYGEN 
EN EMATA. 
J. H. KELLOGG, M.D., 
President of Calhoun County Medical Society. Reprinted from the Therapeutic Gazette, 
for September 15, 1887. 
OXYGEN ENEMATA. 
J. H. KELLOGG, M. D„ 
Battle Creek, Mich. 
gOME months ago, while employing the carbon-di-oxide 
and sulphuretted hydrogen enemata, it occurred to me 
that oxygen gas might be employed advantageously in the 
same manner. Having at that time under treatment a case 
of lithiasis, I resolved to make a trial of the administration 
of oxygen by enema, in the hope that by the introduc- 
tion of oxygen directly into the portal circulation the con- 
version of uric acid into urea might be aided, and my pa- 
tient thereby relieved. I was at first deterred from the 
attempt by the supposition that oxygen would probably 
give pain, as it has been claimed that the pain sometimes 
occasioned in the employment of sulphuretted hydrogen by 
the Bergeon method is produced by the accidental injection 
of small quantities of atmospheric air. I determined, how- 
ever, to try the experiment, and made the first injection of 
two litres of pure oxygen gas on June 20. At this time 
the patient, a man of 28 years, was passing very great 
quantities of uric acid daily, a large quantity of crystals 
being thrown down from every specimen of urine passed. 
The symptom had persisted most stubbornly for weeks, in 
spite of the enforcement of a non-nitrogenous diet, the pa- 
tient also taking, by direction, from three to five pints of hot 
water daily. The beneficial effect of either regimen or treat- 
ment was so slight as to be scarcely perceptible. Two litres 
of oxygen were administered regularly each day about IO 
A. M. At the end of three days the excess of uric acid dis- 2 
OXYGEN ENEMATA. 
appeared entirely from the urine, and has appeared only 
twice since, and then in small quantity, when the injection 
had been discontinued for a day or two. At the beginning 
of treatment the patient's skin was very muddy, sclerotics 
dingy, tongue coated, and he complained of a constant and 
very annoying brassy taste in the mouth and distressing 
headache. The brassy taste and headache both disappeared 
very soon after the injections were begun, and there has 
been a steady improvement in every other particular. The 
■coat has disappeared from the tongue, the skin and sclerot- 
ics have become nearly normal in appearance, and the pa- 
tient has gained several pounds in weight, though before he 
had been constantly losing weight for some weeks, and 
seems to be in every respect improved. The patient, a very 
intelligent gentleman, attributes his improvement almost 
wholly to the employment of the oxygen, as the measures 
which had been previously employed had had little or no 
favorable influence upon his condition, and no change in 
regimen or treatment has been made, with the exception of 
the administration of the oxygen. It seems to the writer 
that there may be a large field of usefulness for oxygen 
employed after this method. The advantages of the em- 
ployment of oxygen by enemata, as compared with the inha- 
lation of oxygen, are very great. 
i. In the inhalation of oxygen, only a very small portion 
of the gas inhaled can be used, the greater part being 
wasted, as experiment has shown that not more than one- 
fourth of the oxygen contained in the air is extracted by 
the lungs during the passage of the air through them in or- 
dinary respiration, and that a very much smaller proportion 
is absorbed when the quantity of air passing through the 
lungs is increased, as in deep breathing. Hence, in order to 
get into the system any considerable quantity of oxygen, it 
is necessary for a person to inhale a very large amount, 
making the treatment very expensive. 
2. Experiments which have been made for the purpose of 
testing the therapeutic value of oxygen inhalations, have shown 
that the proportion of oxygen absorbed by the lungs is not J. H. KELLOGG. 
3 
proportionally increased by the increase of the percentage 
of oxygen in the respired air. Indeed, the reported results 
of careful experiments show that very little more oxygen 
was actually received by the system when breathing pure 
oxygen than in the breathing of ordinary atmospheric air. 
When oxygen is introduced into the alimentary canal, the 
entire quantity introduced is absorbed, and thus utilized, 
making it possible to introduce a known quantity of oxygen 
into the system, and in a manner which leaves no room for 
doubt that it has been received and appropriated. 
3. In cases in which it may be considered desirable that 
a considerable quantity of oxygen should be introduced into 
the system for the purpose of encouraging the oxidation 
processes by which effete matters are disintegrated and 
prepared for elimination, especially those which are acted 
upon by the liver, the oxygen enema offers a means by which 
the gas can be applied where it is most needed. Oxygen 
received by the lungs passes at once to the left side of the 
heart, and thence through the arterial system to the entire 
body, so that the liver receives no more than its due propor- 
tion of the gas. Consequently, a very considerable increase 
in the quantity of oxygen absorbed through the lungs would 
scarcely increase to an appreciable degree the amount of oxy- 
gen available for use by the liver. This fact is made particu- 
larly conspicuous when we reflect that the chief source of blood- 
supply to the liver is the portal circulation. It is apparent, 
however, that when oxygen is introduced into the lower part 
of the alimentary canal, it is at once received through the 
venous absorbents into the portal circulation, through which 
it is conveyed directly to the liver, precisely where it is 
needed, thus making the entire amount of oxygen adminis- 
tered available for the purpose for which it is administered. 
Is it not, then, apparent that this method of administering 
oxygen possesses, for cases of the sort referred to, an immense 
advantage over its use by inhalation? 
4. The process of digestion is, from a chemical stand- 
point, chiefly a process of hydration and oxidation. The ex- 
periments of Dujardin-Beaumetz, performed some time ago, 4 
OXYGEN ENEMATA. 
showed that the drinking of oxygenated water exerts a very 
beneficial effect upon the digestive process in persons suffer- 
ing with slow digestion. (I have not seen any extended 
account of experiments of Dujardin-Beaumetz; I have simply 
seen in medical literature a mention of the fact stated.) May 
it not be true that, in some cases at least, the difficulty 
under which the digestive organs labor is a lack of a suffi- 
cient supply of oxygen in the blood, or, at any rate, that the 
introduction of oxygen into the portal, circulation by oxy- 
gen enemata may be found to facilitate the digestive process ? 
It is very easy to make a practical test of the matter, and I 
am now engaged in a series of experiments in the use of 
oxygen in various forms of dyspepsia, the results of which I 
will report at some future time. 
5. It seems to me that oxygen enemata may be em- 
ployed advantageously in a great variety of cases; in fact, 
in all cases in which there is such a disturbance of the nor- 
mal interchange of gases in the lungs as deprives the system 
of its proper amount of oxygen. The mucous membrane of 
the intestines presents an absorbing surface, very small, it is 
true, when compared with the amount of surface presented to 
the air in the lungs, and yet it is sufficiently great to allow 
of the introduction into the system of a large amount of ox- 
ygen in addition to that which can be gotten in through the 
lungs; and this additional quantity, though small when com- 
pared with the total amount received by the lungs, may be 
of sufficient value to the system to be of immense advantage 
to it, especially on account of its introduction at this partic- 
ular point in the circulation. 
The notable functional disturbances of the stomach which 
accompany various pulmonary disorders, such as emphysema, 
chronic bronchial catarrh, chronic pleurisy, pneumothorax, 
etc., suggest a very important relation between the digestive 
function and the quantity of oxygen received through the 
lungs. The same relation is also suggested by the frequency 
with which dyspepsia occurs among sedentary persons, who 
are habitually air-starved in consequence of deficient muscu - 
lar activity. Oxygen enemata may prove a valuable remedy J. H. KELLOGG. 
5 
in cases of this sort, as well as in others in which an addi- 
nal supply of oxygen is needed. 
I have carefully questioned patients respecting the reten- 
tion of the oxygen injected, and have found that it has 
always been retained without difficulty, and does not pass off 
as flatus from the bowels or as eructations from the stomach. 
This fact offers good evidence of its absorption, but to 
determine the fact beyond the possibility of question, I made 
on July 20 an experiment on a guinea-pig. After placing 
the animal under chloroform, the abdomen was opened, and 
the intestines drawn out and spread out in such a way that 
the dark portal veins were in full view. A quantity of gas. 
was then injected into the rectum, and to my great satis- 
faction I found that the dark venous blood assumed a bright 
red hue almost equal to that of arterial blood within less than 
one minute after the injection of the gas, showing the rapidity 
with which the absorption of the oxygen takes place. To 
confirm the result, I allowed the oxygen to escape from the 
bowels, afterward replacing it, and repeating the experi- 
ment several times. In each instance the color of the blood in 
the mesenteric veins assumed its ordinary dark purple color im- 
mediately after the oxygen was withdrawn, while the bright 
color returned almost instantly when the new supply of oxy- 
gen was introduced. 
I am not aware that the gas has been used in this man- 
ner for therapeutic purposes prior to my own experiment in 
the case which I have reported. I shall, however, be much 
surprised if I learn that I am entitled to the credit of priority 
in this matter, as it seems to me that I must have been very 
dull not to have sooner thought of this mode of employing 
so valuable an agent as oxygen. 
It has been long known to physiologists that in certain 
fishes the mucous lining of the alimentary canal performs a 
very important part of the work of the respiratory system. 
Some members of the gar family are killed as quickly by 
cutting off the supply of oxygen to the alimentary canal as 
by interrupting the gill respiration. Great numbers of illus- 
trations might be given from the lower classes of the animal 6 
OXYGEN ENEMATA. 
kingdom in which the entire process of respiration is carried 
on by the mucous lining of the alimentary canal. Why, then, 
should not man, whose alimentary canal is very much more 
extensive and better fitted for absorption than in some lower 
animals, also be able to receive a very appreciable and effi- 
cient amount of oxygen through this channel? In my ex- 
periments thus far I have found that patients take without 
inconvenience from one to two litres of the gas at a time, 
and this dose can be repeated three or four times in the 
twenty-four hours without any difficulty. I have never found 
any serious discomfort to be produced, although in large 
quantities it does not seem to be tolerated quite so readily 
as the carbon-di-oxide and sulphuretted hydrogen mixture. 
I am employing the oxygen enemata in a variety of cases, 
in one of which, a case of phthisis, the beneficial results aris- 
ing from the gas have been surprising. When the treatment 
was begun, the patient had for some time had an evening 
temperature varying from two to three degrees above nor- 
mal. The morning temperature was from 99° to 99 3-50- 
Within forty-eight hours after the use of the oxygen was be- 
gun, the temperature fell to normal, and did not rise above 
990 at any time until about two weeks after the beginning 
of treatment, when the febrile symptoms reappeared as a re- 
sult of an operation for the relief of a troublesome hemorrhoid, 
following which the patient by imprudence contracted a slight 
cold. 
In the use of the oxygen enemata I have employed a new 
form of apparatus, which I devised some time ago. The 
especial advantages of this apparatus are convenience in use, 
precision in dose, and an easily regulated and perfectly uni- 
form flow. 
Since writing the above I have continued the use of oxy- 
gen enemata, and have in connection therewith carried out 
a careful series of analyses of the urine for the purpose of 
determining the exact amount of uric acid contained in the 
urine at the beginning of the treatment and as it progressed. 
The quantitive analytical work was carefully done for me by J. II. KELLOGG. 
7 
one of my assistants, and in two cases showed the following 
very sti iking results:- 
CASE i. W. P. The first case in which this treatment 
was employed, no quantitive analysis of uric acid was made 
until the patient had been under treatment for three or four 
weeks. The results of analyses made on four different dates, 
as given below, show a progressive diminution of the quantity 
of uric acid. 
Aug. 2nd-.56 grms. 
" 3rd-.51 
" 4th-.29 " 
» " 7th-.08 " 
CASE 2. A lady, aged about fifty, rheumatic, and a 
marked subject of lithiasis. Urine showed a heavy deposit 
of uric acid and urates. 
BEFORE TAKING TREATMENT. 
July 29.-1.37 grms. 
Aug. 1.-1.30 grms. 
Aug. 2.-1.84 grms. 
AFTER BEGINNING TREATMENT. 
Aug- 3---71 grms. 
Aug. 8.-.64 grms. 
Aug. 10.-.64 grms. 
Aug. 14.-.22 grms. 
Aug. 16.-.58 grms. 
The normal amount of uric acid is placed by most authori- 
ties at less than .5 grms. in twenty-four hours. It thus ap- 
pears that in the second case the amount of uric acid which 
was at first more than three times the normal amount was 
diminished more than one-half the first twenty-four hours, 
and was in a few days reduced to less than one-half the nor- 
mal amount. 
I am continuing these studies on a quite extensive scale, 
and hope to be able to give in a few weeks still more inter- 
esting facts respecting this new mode of treatment. 8 
OXYGEN ENEMATA. 
A NEW FORM OF APPARATUS FOR THE 
ADMINISTRATION OF GASEOUS 
ENEMATA. 
Since the publication of the above article, I have re- 
ceived so many letters asking further information respecting 
the construction of the apparatus referred to that I append 
a description of it here. This apparatus was devised some 
months since while experiment- 
ing with the " Bergeon Meth- 
od " by means of a novel ap- 
paratus, which I found open to 
many objections, chief of which 
were, I. Inaccuracy ; 2. Incon- 
venience ; 3. Irregular action. 
The apparatus offered is free 
from all of these objections. 
The apparatus was first de- 
scribed by me in a paper read 
before the American Medical 
Association, at which time I 
also exhibited the apparatus 
in a somewhat less perfect form 
than that in which it is now 
presented. 
The accompanying cut cor- 
rectly represents the new form 
of apparatus which I have de- 
vised, the action of which will be clear with a little explana- 
tion. The apparatus consists of four parts, as follows:- 
1. The tank, or reservoir, shown at A. This is con- 
structed precisely as an ordinary gasometer or storage tank. 
The tank may be of any size. I find a twenty-gallon tank 
convenient in use. 
2. The measuring and pressure bottles, B, D. One bot- 
tle is filled with water, while the other is full of oxygen. 
3. A four-way stop-cock, I. Connected with the stop-cock 
are four tubes, one of which, F, connects it with the tank. The 
Apparatus for the Administration of 
Gaseous Enemata. J. H. KELLOGG. 
9 
tubes E and H connect the stop-cock with the two meas- 
uring bottles, and the remaining tube G, connects it with- 
4. The warming bottle. This is an ordinary wash bottle, 
the same as was used in the administration of sulphuretted hy- 
drogen, only it is nearly filled with ordinary water at uo° F., 
instead of water charged with H2S. 
In the use of the apparatus, the tank having been filled 
with well-washed oxygen, it is simply necessary to elevate 
the measuring bottle which is filled with water, as shown in 
the cut, and then properly adjust the stop-cock, when the 
gas will at once begin to flow. 
It is now only necessary to connect the discharge pipe 
with the patient, and the gas passes into the bowel at a reg- 
ular rate and with no discomfort to the patient, if the pre- 
caution has been taken to empty the bowels an hour or two 
before the treatment. 
While the water is running out of the elevated measuring 
bottle, oxygen is running in from the tank to take its place; 
and when the bottle is emptied of water, it is filled with oxy- 
gen, and the other bottle is filled with water. The flow of 
oxygen into the bowels will now cease; but on reversing the 
bottles and adjusting the stop-cock, the gas begins to flow 
again as before. 
I find an elevation of the pressure bottle to a height of 
about twenty inches is necessary to overcome the ordinary 
degree of intra-abdominal pressure. 
The cost of this apparatus is moderate, and it is really 
essential to the proper carrying out of this new method of 
using oxygen.