Oxygen therapy in WWII

[GliderRiderMedic]

Does anyone have any information on how oxygen would have been given to troops in field hospitals and such? Were there provisions for it to be given to patients who needed it prior to or after surgery? I Know there were the tight-fitting facial masks (similar to what aircrews wore) for surgical patients, but were there things like nasal catheters and such? I know the nasal cannula commonly used now was not developed until after the war, but one would think that there would have something similar for treatment of folks who did not have a need for high-flow oxygen?

BTW, I am a respiratory therapist and this particular aspect of care, therefore, interests me a great deal.

[Ben]

Stephen,

There were two types of apparatus used in the field to provide oxygen therapy. These were:

- Oxygen Therapy Outfit, with Manifold (Item # 9364300)
- Oxygen Therapy Apparatus, Closed Circuit (Item # 9364000)

You can see illustrations of these kits in the MED3 Supplement of the 1944 Medical Department Supply Catalog. The actual procedure that was used is described as follows (please note that this was taken from TM 8-230 Medical and Surgical Technicians dated August 1950, although the process was the same during WW2):

a. DESCRIPTION. Methods of treatment that increase the concentration of oxygen in the air breathed by a patient are called oxygen therapy. Oxygen therapy is not a specific treatment for any particular disease; it may be used when there is reason to suspect oxygen deficiency regardless of the disease. It is a type of therapy which, by itself, is generally not lifesaving, but it may be a very important adjunct to other types of treatment. Though it may not prevent death, it makes the terminal stage easier, and its use in critically-ill patients is often justified for this reason.
b. APPARATUS. Atmosphere air contains approximately 21 percent oxygen. Effective oxygen therapy requires that the concentration be at least 45 to 60 percent. In some cases concentrations 90 to 100 percent may be ordered. Oxygen is delivered for use in heavy metal cylinders to which a regulating mechanism is attached. The gas is carried from the cylinder to the patient through tubing and various types of delivery apparatus. The type of apparatus used will determine to a large extent the concentration of oxygen breathed by a patient. Relatively low concentrations are obtained by using a nasal catheter. The oxygen tent can achieve higher concentration, and the face mask can deliver 100 percent if required.

I hope that the above excerpt is some use to you. Just bear in mind that the method mentioned above is taken from the 1950 manual, unfortunately I do not have a WW2 dated example of the manual to compare, but perhaps another Forum member might...

Thank you, and Happy Holidays,
Ben.

Thanks,
Ben.

[GliderRiderMedic]

That's excellent information (as always) Ben. I figured they used nasal catheters, but I would still hope someone on the forum has a WWII era copy of that reference so I can verify that for certain. I would really hope someone has an image of the oxygen devices in question as well. We are working on a training manual for the unit and it has proven to be quite the pain in the butt to cross check every modern practice in trauma care to see what was done in WWII.

I would assume the cylinders used were more or less identical to what we use today and I can attest that they are heavy as hell. The big "M" cylinders weigh about as much as I do and have a girth similar to a telephone or power pole.

[Ben]

Steve,

Do you have the MED 3 Supplement commonly available from NCHS reprints? It contains photographs of the items I mentioned. In case you don't, here are the illustrations from mine for your reference.



Thanks,
Ben.

[LOSMP]

"That's excellent information (as always) Ben. I figured they used nasal catheters, but I would still hope someone on the forum has a WWII era copy of that reference so I can verify that for certain. I would really hope someone has an image of the oxygen devices in question as well. We are working on a training manual for the unit and it has proven to be quite the pain in the butt to cross check every modern practice in trauma care to see what was done in WWII."

Here's a reference to a tube/cannula, from the US Army Center of Military History "Surgery in World War II" series, prepared under the direction of the Surgeon General. This is from the volume "Orthopedic Surgery in the Mediterranean Theater of Operations", p. 68. under the heading "Resuscitation":

"Many casualties were in moderate or severe shock and required some resuscitation as part of the preoperative preparations. The measures employed to combat shock included...1. The use of the Trendelenburg position......, 2. Oxygen administration by nasal tube if cyanosis was present."

Lois

[LOSMP]

Here's a copy of the MTO surgery book online
http://history.amedd.army.mil/booksdocs ... efault.htm

And here's a resuscitation story which includes nasal administration of oxygen:
From this book:
http://history.amedd.army.mil/booksdocs ... matter.htm
Here:
http://history.amedd.army.mil/booksdocs ... apter1.htm

"Case 2.-On 21 April 1945, during the fighting in the Po Valley, a 26-year-old infantryman received compound fractures of the left femur and both ankles, a penetrating wound of the chest with hemothorax, and multiple lacerations of the legs and face from shell fragments. In the collecting station, to which he was brought at 1315 hours, 15 minutes after injury, he was given 15 mg. (gr. ¼) of morphine and 1,500 cc. (6 units) of blood plasma. Dressings were applied to his various wounds, and his legs were supported by splints. He was then evacuated to a clearing station, where he was given another 250 cc. (1 unit) of blood plasma and 20,000 units of penicillin intramuscularly. Because of his exceptionally poor appearance, he was also given a transfusion of 1,000 cc. of whole blood, which was obtained from the adjacent field hospital. His blood pressure was then 90/60.

When the patient was received in the field hospital at 2100 hours, his blood pressure was not measurable. His face was pale, but the skin was warm. The extremities were cool, and the veins were collapsed. He was classified as in severe shock. Laboratory studies showed the hemoglobin to be 9.8 gm. percent; the hematocrit 29; and the blood volume 5,010 cc., or 19 percent below his normal calculated blood volume. When the values were corrected for fluids which had been administered, it was found that, since wounding, he had lost 76 percent of his normal blood volume and 55 percent of his normal hemoglobin.

In the 4 hours which followed his admission to the field hospital, the patient was given 500 cc. (2 units) of plasma, 2,000 cc. of whole blood, and 25,000 units of penicillin intramuscularly. At the end of this period, his blood pressure had risen from 0 to 110/65, and his pulse was 138 and of good volume.

Operation was performed at 0330 hours 22 April, 14½ hours after wounding, under endotracheal nitrous oxide-ether anesthesia. It lasted 2½ hours. It consisted of a guillotine amputation of the lower third of the left leg, together with debridement of the wounds of the extremity and chest wall. Twenty-five thousand units of penicillin were placed in the right pleural cavity, after 1,000 cc. of blood had been aspirated from it. Nasal oxygen was instituted as soon as the operation was ended. Blood was also used liberally in the postoperative period.

The patient made a rapid, uncomplicated recovery."

[sgtpeter]

Hi Steve -

I don't have a WW2 copy of the TM Ben referenced but I do have 1944 training reference that discusses treatment of gas casualties. The training guide references TB Med 1, 16 Dec 1943. In part, it says "treatment for effects of inhaled gas ... intranasal oxygen is invaluable". Then it mentions the use of a Boothby-Lovelace oxygen therapy apparatus (which I'm now assuming is the nose/mouth mask). I'm not sure what that is, but when I googled it, I found this link which discuss thoraic surgery and mentions "Oxygen inhalations by means of the nasal catheter or the Boothby-Lovelace-Bulbulian ".

Hope that helps.

Peter