Irregular Respiration Research Articles

PERSISTENT CLOACA AND OTHER ANOMALIES IN A FEMALE INFANT

History.—Almost immediately after it was born, baby B. was admitted to the Touro Infirmary from the Child Welfare Association because of malformations and because of difficulty in resuscitation, cyanosis and short and irregular respiration. The family history showed that three of the grandparents were still living at the ages of 55, 58 and 60, respectively. The paternal grandmother had died of heart trouble at the age of 51. The members of both sides of the family were long-lived. There were no abnormalities in the parents nor in any other member of the family so far as was known. There was no history of hereditary disease, and there was no consanguinity. The father was 37 and the mother was 28 years old. There were two other children in the immediate family, both healthy; the eldest was 8 years of age and the youngest 3 years. One child had died at

Effect on Costal Respiratory Movements of Division of the Phrenics Following Transection of the Midbrain.

It has been shown that section of the dorsal roots of the thoracic nerves is followed by cessation of costal respiratory movements which are promptly resumed if the phrenics are excised, the vagi and midbrain being intact. (The effect of section of the dorsal roots is somewhat greater when the cervical as well as the thoracic roots are sectioned.) Section of the midbrain alone at the level of the inferior colliculi is followed by a diminution of costal movements and the rate of respiration is somewhat slowed, but remains regular. The question arises therefore whether section of the phrenics would have the same effect on costal respiration after section of the midbrain as after section of the dorsal roots of the thoracic nerves. The observed effects of division of the phrenics subsequent to transection of the midbrain in 30 cats are: 2. The respiratory rhythm immediately becomes irregular. There may be pauses of 5 to 10 seconds followed by from 5 to 10 costal movements and a succeeding pause. In some cases the tendency to grouping is slight. The character of the individual movements may vary. Sometimes there may be a rapid abrupt inspiratory movement followed without pause by an equally abrupt expiratory movement with a rhythm of 10 to 12 a minute. A series of from one to 3 small inspiratory movements may precede the actual large abrupt inspiration. When the group character is more pronounced, the inspiration is not so abrupt and expiration follows after a more appreciable interval. So long as the vagi are intact, section of the dorsal roots of the phrenics, following transection of the midbrain does not elicit irregular respiration.

IV. Irregular Respiration, and the Response of Tibialis Muscle to Reflex and Direct Motor Stimulation.

In the course of the series on reflex response of the tibialis anterior muscle several animals were found in which the respiration was very irregular. There were periods of hyperpnea followed by varying periods of apnea. In 3 experiments in which periodicity occurred during the administration of room air, hyperpnea was accompanied by increased reflex response and apnea, especially when profound and long continued, by periods of reduction or total disappearance of reflex response. In one experiment periodicity occurred during both the administration of room air and of 7% oxygen in nitrogen. The effect here was the same as in the 3 experiments above. In another, irregular respiration occurred while the animal was breathing room air and while breathing pure oxygen. Again the results were the same. The response of the muscle to direct motor nerve stimulation was similar to the reflex response of the opposite muscle. From these and the preceding experiments it seems probable that there is no single point in the system which can be said to control the response of the anterior tibialis muscle to sensory stimulation. The evidence seems, rather, to suggest that the response may be the result of a number of factors which may vary individually. On the whole, with the exception of carbon dioxide, the reflex response and the response of the tibialis muscle to direct motor nerve stimulation varied roughly with the magnitude of respiratory movements.

SPASMODIC FORCED RESPIRATION AS A SEQUEL OF EPIDEMIC ENCEPHALITIS

The protean character of the sequelae of epidemic (lethargic) encephalitis has come to be well recognized as evidence of its involvement of almost any part of the brain or spinal cord. Its syndromes are legion, and it bids fair to rival neurosyphilis as a waste basket for the vagaries of neurologic diagnosis. During the last year, certain disturbances of the respiratory mechanism have come under my observation as a sequel to epidemic encephalitis, which have resulted clinically in disorders of breathing of a very bizarre nature. In each instance, the symptoms have conformed to the same general pattern, but there has been a different coloring as far as the individual respiratory difficulty was concerned. We are all familiar with the dyspnea that accompanies respiratory or cardiovascular diseases, the toxemias and the well known Cheyne-Stokes respiration. Quite different in all their characteristics are those disorders of respiration to which encephalitis has given rise. These are more in the realm of disturbances of rhythm and amplitude than of rate, though tachyrespiria is also present. The literature on this disease contains no histories of cases similar to those reported here, though several writers mention respiratory syndromes following encephalitis. Aronson 1 reports the case of a young child who developed a persistent rapid respiration, about 45 a minute, accompanied by certain character and psychic changes. Grossman2 mentions in his review of the sequelae that three patients complained of difficulty in breathing without any pathologic con¬ dition in the lungs. Hoover 3 reports an unusual case of inspiratory dyspnea due to paralysis of the dilators of the nares, which was relieved by raising the nares. Barker4 says that peculiar disturbances, such as t.ichypnea, irregular respiration and paroxysms of deep breathing, are seen, and specifically notes one of these cases which was accompanied by a tetanic attack. This peculiar respiratory disorder varies consider¬ ably as to its time of onset, following the acute disease 1. Aronson, L. S.: Encephalitis with Unusual Sequelae, Neurol.

A PNEUMOGRAPHIC STUDY OF RESPIRATORY IRREGULARITIES IN MENINGITIS

It has long been common knowledge that irregularities in respiratory, rhythm were occasionally to be seen in meningitis. In general, however, these respiratory irregularities have been regarded as of much less frequent occurrence and as of much less diagnostic significance than irregularities of the pulse and heart action. In most writings on the subject of meningitis, these respiratory symptoms are either not mentioned at all or are referred to only briefly and casually, the usual statement being that the Cheyne-Stokes type of breathing is sometimes seen toward the end of the disease. By certain of the earlier writers, however, especially among the French, the disturbances of respiration were recognized as of common occurrence and were described at some length. Biot,¹in 1878, writing on the subject of Cheyne-Stokes breathing, devotes several pages to quotations from various authors, which show that they regarded the disturbances of