Accessible online at: www.karger.com/journals/ibe Carbon monoxide is the most ancient of poisons: as old as the discovery of fire itself. However, poisoning by it was probably of no great significance until the general use of coal as a domestic fuel had became widespread and consequent upon that the use of town gas made from coal or oil which was distributed to industry and to homes. A third development was, of course, the internal combustion engine. In this volume we are not concerned with carbon monoxide poisoning in the past rather we are concerned that it is still with us today. We know a lot about carbon monoxide and how dangerous it is and we should, by now, have developed strategies to avoid the danger. Unfortunately the lessons have not been learnt as several of the papers in this issue relate. Probably the best starting point for a study of carbon monoxide poisoning today is the work of Claude Bernard, who opened a modern history of the condition in his lectures on the action of poisons [1]. Bernard devoted a lot of attention to carbon monoxide. He showed that blood saturated with the gas was no longer able to take up oxygen and he attributed its poisonous effects to this action. By preventing the combination of oxygen with haemoglobin carbon monoxide is the perfect asphyxiant. Also, since the combination with carbon monoxide is so much more stable than that made with oxygen and the reaction takes place more readily the gas in a very effective way prevents the process of respiration. In fact, the affinity of haemoglobin for carbon monoxide is some 240 times that for oxygen [2]. A simple chemical reaction that takes place as readily in the body as it does in the testtube. Experiments suggest that this formation of carboxyhaemoglobin is the main, possibly the only, important, biochemical event of carbon monoxide poisoning. Insects without haemoglobin, such as cockroaches, have survived for weeks breathing an atmosphere of 80% carbon monoxide and 20% oxygen. To them the gas is as inert as nitrogen. Even an animal as large as a mouse can survive with its blood fully saturated with carbon monoxide if it is breathing hyperbaric oxygen because, through simple solution, sufficient oxygen for life dissolves in the blood. Larger animals would not be so lucky. The use of oxygen in the treatment of carbon monoxide asphyxia is not modern medicine. It can be traced back to the work of Claude Bernard noted above and when reading it we should remember that oxygen had only been discovered less than 100 years before in 1772 by Scheele. Bernard did not have the advantage of purified gas conveniently delivered in a metal cylinder. He had to prepare the element and store it in a bladder or a gas jar. Not an easy task. Since then, and with oxygen more readily available, experience both in the laboratory and in the field has amply demonstrated the beneficial effect of inhaling oxygen in both mild and severe carbon monoxide poisoning. It is long proven that recovery from dangerous asphyxia as well as alleviation of the headaches and other symptoms of less severe poisoning is substantially promoted when oxygen is given. If an individual is poisoned by carbon monoxide then to maintain life the remaining available haemoglobin in their blood will have to be saturated with oxygen when the blood passes through the lungs. To ensure complete saturation it is necessary to increase the concentration of oxygen breathed from the