Cheyne-Stokes respiration / by George Alexander Gibson.

  • Gibson, George Alexander, 1854-1913.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Cheyne-Stokes respiration / by George Alexander Gibson. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    In the discussion which followed Filehne's paper, Ewald' stated that he had examined during breathing as wcdl as pause the retina of a patient in whom the pulse underwent alterations, but had been unable to detect any distinct changes. Traube'^ promptly came forward in defence of his theory. In his reply he points out that Filehne had arbitrarily postulated that the respiratory centre must have less irritability than the vaso-motor centre, and that this postulate had been based on the gratuitous assum])tions,—1, that the vaso-motor system is always iniplicat(Hl; 2, that the vaso-motor is normally less irritable than the respiratory centre; and 3, that two centres are not proportion- ately affected by a proportional diminution of oxygenated blood. He states, with regard to the first of these points, that there is very often no change in the arterial tension during the different phases of the })henomenon ; with reference to the second, that the vaso-motor is more irritable than the regulator, while this is more sensitive than the respiratory centre ; and he curtly dismisses the third as absurd. He holds that a rhythmic periodicity of the respiratory centre has been proved as distinctly as in the case of the vaso-motor and inhibitory centres—all being dependent on the changing quantity of carbonic acid and consequent stimulation and exhaustion of the centres. Traube concludes his reply with a restatement of his theory, pointing out that all cases in which the phenomenon appears have lessened irritability of the respiratory centre, and therefore require more carbonic acid to excite respira- tion, which of necessity requires a longer interval of time. At first the necessary carbonic acid will be in the lungs, and the peri- pheral endings of the vagi are the earliest to be stimulated. This, however, causes no dyspncea, only the superficial breathing, but when the carbonic acid has accumulated in sufficient quantity to excite the sensory nerves dyspnoea is produced. In consequence, however, of the diminution of the carbonic acid, as well as on account of the exhaustion of the respiratory centre by the powerful irritation, the breathing loses its dyspnceic character, and as the exhaustion of the centre gains ground more rapidly tlian the accumulation anew of carbonic acid, the breathing becomes more ' Firliner klitiwhe IVorhen^rhrifl. xi. Juhi-ijai)',', S. 169, 1874. ■•* Ibid., S. 185 uiul 2o9, 1874.