Friday, 19 September 2014

Cheyne-Stokes respiration on display

Within LHSA’s collection are a number of display boards and captions, created for exhibitions over the years, which bring together images and stories from the history of medicine in the Lothian region. As such, they have become archive items themselves, a record of how the history of medicine has been displayed and many have been rarely viewed since their original display period. One of these items is a board illustrating Cheyne-Stokes respiration (ref. D P264 FM), probably dating from the 1970s or 1980s. The display shows on the left a portrait of John Cheyne and on the right is a portrait of William Stokes with a sample trace of Cheyne-Stokes respiration between them.

John Cheyne was born in Leith in 1777, the son of a general practitioner. Initially apprenticed by his father, he studied for an M.D. at the University of Edinburgh, graduating in 1805. Cheyne worked as an army surgeon, then at the Ordnance Hospital at Leith Fort. In 1809, he moved to practice in Dublin where he became the first Professor of Medicine at Royal College of Surgeons in Ireland in 1813. While there he published his description of a phenomenon of malfunctioning breathing in very sick patients. He noted that the patients’ breathing would stop entirely for a quarter of a minute then it would start again slowly, increase by degrees until it was heaving quickly then gradually cease again, with a total of approximately 30 breaths per minute. Some of the principle causes of this condition are brain haemorrhaging, advanced renal failure, heart failure and narcotic poisoning, therefore it is often thought of as a sign of imminent death.

William Stokes (1804 -1878) is regarded as one of the greatest teachers of clinical medicine. Stokes studied in Glasgow and Edinburgh and like Cheyne he relocated to Dublin. Twenty-eight years after Cheyne’s work, Stokes recorded another example of the respiration phenomenon for publication in the ‘Dublin Hospital Reports’ and quoted Cheyne, although he apparently added no new details. Perhaps because of his renown in the medical world, Stokes’ name has become inextricably linked to John Cheyne in the definition of Cheyne-Stokes Respiration.

What is also interesting on the display is that below the Cheyne-Stokes trace is another for comparison, where the patient has been injected with a drug, theophylline-ethylenediamine. In this case the respiration has gone back to normal, showing 20th century developments towards preventing the condition. According to the caption, this trace is from the first use of the drug in Great Britain for this treatment, in 1937 in Edinburgh.
Cheyne-Stokes respiration demonstration board (ref. D P264 FM)

Reference: Notable Names in Medicine & Surgery, Third Edition, Bailey, H and Bishop, W.J., 1959

No comments:

Post a Comment