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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    During tlie pauses the eyes closed, ami the pupils became small and reactionlcss; two or three seconds before the return of the breathing the pupils dilated, and sometimes executed a series of oscillations during the dyspncwa; during the i)eri<>d of hnsithing they were sensible to liglit. There was considerable agitation at the height of tlie dyspntea, at which time consciousness was unim- l)aired, and there were no convulsions. By speaking to the patient during the ])eri()d of l)reathing tliis phase could be prolonged con- siderably. Sphygmograpliic tracings showed during the pause a fall of tension and an increase in rate; during the respiratory period the reverse occurred along with irregularity of the pulse. There was never a rise of tension at the end of the pause, but, on the contrary, sometimes a fall. After an excellent description of this case, accompanied by ad- mirable tracings, the authors give a brief notice of another case, under the care of Caizergues, which appears to be that previously referred to. They then proceed to analyze the symptoms attending this phenomenon with great care, and subsequently criticise the views of previous observers, to which they, in the early jiart of their paper, had called attention. This brings them to consider the view of their teacher Grasset, which they fully expound. According to him, llie dyspnoea is the primordial fact, the apnoea being merely a consequence of it; and the type of breathing is a symptom of excitement. The aniemia of the medulla, far from lowerin^^ increases the irritability of that organ. In anajmia of the nerve- centres such phenomena of excitement as convulsions are common. The diminution of the blood-current and consequent lessening of the nutrition reduce the vitality of the nerve-cells. This increases the irritability, but at the same time tends to produce weakness and liability to exhaustion of the nerve centres. In short, it leads to what the authors call, that peculiar condition which the English have so happily termed irritable weakness. This gives the key to the causation of Cheyne-Stokes breathing: bulbar anivmia produces greater irritability of the centres which it con- tains; their usual excitant, carbonic acid, acts upon them with unaccustomed intensity ; the breathing assumes the character of dyspncea, which will be more marked if excitement of the vaso- motor centre causes constriction of the arterioles, thus increasing