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Historical Perspectives on the Control of Breathing

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Abstract

Among the several topics included in respiratory studies investigators have focused on the control of breathing for a relatively few number of years, perhaps only the last 75 to 80. For a very long time, the phenomenon of respiration presented a great mystery. The Chinese had suggestions for proper breathing, and later the Egyptians sought to understand its purpose. But in the western world, the early Greeks made the more significant observations. Centuries passed before the anatomical structures pertinent to respiration were properly visualized and located. There followed efforts to understand if lung movement was necessary for life and what happened in the lung. The rise of chemistry in the 18th century eventually clarified the roles of the gases significant in respiratory behavior. More time was needed to understand what gases provoked increases in breathing and where those gases worked. At this point, control of breathing became a significant focus of respiratory investigators. Studies included identifying the structures and functions of central and peripheral chemoreceptors, and airway receptors, sources of respiratory rhythm and pattern generation, the impact of the organism's status on its breathing including environment and disease/trauma. At this same time, mid‐ to late‐20th century, efforts to mathematicize the variables in the control of breathing appeared. So though wonderment about the mysterious phenomenon of respiration began over two millennia ago, serious physiological investigation into its control is by comparison very young. © 2012 American Physiological Society. Compr Physiol 2:915‐932, 2012.

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Figure 1. Figure 1.

A recent search of PubMed by Zapata and Larrain for the International Society for Arterial Chemoreception using carotid body‐related terms produced more than 5,000 citations of which most of the early ones treated carotid body tumors. Presented here are carotid body publications in 5‐year intervals starting in 1945 which are focused more on anatomy, cytology, neurophysiology, neurochemistry, resulting reflex responses to stimulation.

Figure 2. Figure 2.

Galen (130‐199 A.D.) of Pergamum was a prominent Roman physician (indeed, to the Emperor Marcus Aurelius) and philosopher of Greek origin. His anatomical views of the cardiovascular system were based on studies in the monkey since dissection was not allowed at that time; these views were taught for 1,300 years. The “spirits” added to the blood in Galen's view came from the left ventricle (vital spirit) as the blood coursed through the invisible pores of the interventricular septum between right and left ventricles. The “animal spirit” came from the brain.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.
Figure 3. Figure 3.

Ibn Sina (980‐1037 A.D.), known in the West as Avicenna, was the foremost philosopher and physician of his day. He was greatly influenced by Aristotle, and, in turn, greatly influenced Thomas Aquinas, Galileo, Harvey, and several others. Avicenna wrote over 400 treatises of which about half have survived. Most focus on philosophy (for which he was criticized); about 40 deal with medicine. His encyclopedic Canon of Medicine (completed before Avicenna was 21 years old) was a commonly used source in many medieval universities, and was a textbook at the Universities of Louvain and Montpelier as late as 1650 A.D. Avicenna's medical system combined his own extensive experience with Islamic medicine, a system used by Galen.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.
Figure 4. Figure 4.

Andreas Vesalius (1514‐1564A.D.), born in Brussels, Belgium with the non‐Latinized name of Andreas van Wesel into a family of physicians, a grandfather being Royal Physician of Emperor Maximilian. While pursuing his medical education in Paris he became interested in anatomy. He is often called the Father of Modern Anatomy. He was among the first to experiment in the area of respiratory physiology. He corrected many of Galen's errors. This plate and several others from his De Humani Corporis Fabrica confirmed that anatomy had switched from Galenic to Vesalian.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.
Figure 5. Figure 5.

Marcello Malpighi (1628‐1694 A.D.), an Italian physician, greatly clarified the microscopic anatomy of the lung, especially the “orbicular” shape of the alveoli and the role of the tortuous pathways of the capillaries across the alveoli from larger arterioles to the venous side. His drawings really provided the first correct anatomical basis for understanding the role of the alveoli and their relation to the pulmonary circulation.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.
Figure 6. Figure 6.

Antoine Laurent Lavoisier (1743‐1794 A.D.) was truly the Father of Modern Chemistry. Discovered the similarity between respiration and combustion, involving the uptake of oxygen from the air and the production of carbon dioxide. But he thought, incorrectly, that all the heat produced by the combination of oxygen with combustible substrates took place in the lung. This notion was later corrected by Spallanzani. Probably should be credited as the investigator who most solidly disproved the then currently popular phlogiston theory.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.
Figure 7. Figure 7.

John Scott Haldane (1860‐1936 A.D.) was a Fellow of New College at Oxford where he had his laboratory. But he was also an honorary Professor at Birmingham University. He is credited with opening a new phase of physiology with his experiments using human subjects. With J.G. Priestley he first clearly demonstrated that resting ventilation was more under the control of carbon dioxide than under the control of oxygen. Dyspnea in his subjects occurred if the former rose to only 3% in an enclosed chamber, whereas oxygen had to drop to 14% to generate the same level of dyspnea. His many other experiments had significant practical applications

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.
Figure 8. Figure 8.

Isidoor Leusen, pursuing chemosensitive structures in the CNS, perfused the lateral ventricles of anesthetized dogs with CO2‐rich fluid (while collecting from the cisterna) and saw an increase in ventilation; this altered the level of CO2 in the cerebrospinal fluid. CO2‐poor fluid provoked a decrease in ventilation. Data was highly suggestive of where hypercapnia exerted its effects on ventilation. But at the time the changes in ventilation were thought to be due to the direct action on the respiratory centers.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 294
Figure 9. Figure 9.

Robert Mitchell (left) and John Severinghaus in collaboration with Hans Loeschcke soaked cotton pledgets in CO2‐rich or H+‐rich solutions and applied them to selected, discreet areas on the ventral lateral surfaces of the medulla in the anesthetized cat. Hyperpnea was the result. They concluded that an area sensitive to CSF H+ (a “central chemoreceptor”) was at or near the surface—within or just beneath the pia.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 296
Figure 10. Figure 10.

John Pappenheimer (right) and Vladimir Fencl used a ventriculo‐cisternal perfusion technique in unanesthetized goats. They concluded from their results that the acid‐sensitive zone (i.e., a “central chemoreceptor”) was not superficial but rather two‐thirds to three‐fourths of the distance along a bicarbonate concentration gradient between blood and CSF in the brainstem.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 297
Figure 11. Figure 11.

Sagittal view of rat brainstem showing location of superior olive (SO), trigeminal nerve 5, facial nerve 7, Bötzinger complex (BötC), pre‐Bötzinger complex (pre‐BötC), retrotrapazoid nucleus (RTN), and parafacial respiratory group (pFRG). pre‐BötC and BötC are thought responsible for inspiratory rhythm; RTN/pFRG more involved with expiratory efforts.

Figure 12. Figure 12.

Plot of the ventilatory response to CO2 in unanesthetized, unsedated lamb. The animal was fitted with an extracorporeal carbon dioxide membrane lung (CDML) through which subclavian arterial blood was passed, and returned to the jugular vein. Functioning like a kidney dialyzer, the CDML gradually removed as much CO2 as the animal was producing. Total CDML removal of CO2 produced a 100% decrease in ventilation. The data supported the notion that peripheral input is needed for the central pattern generator and other central neural mechanisms to operate.

with permission from Anesthesiology 46: 138‐141, 1977
Figure 13. Figure 13.

Diagram illustrating the principal features of the existential organization of the neural factors controlling breathing, revealing the pathway for suprapontine/medullary input. Output is not just to striated muscles to expand the lungs but also to muscles of the airways via the premotor and motor neurons. Hypothal, hypothalamus; pulm, pulmonary; extern. Intercost, external intercostal; intern. Intercost, internal intercostal; MN, motor neuron; preMN, premotor neuron.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 256
Figure 14. Figure 14.

Corneille Heymans (left) and Fernando DeCastro were pioneers of carotid body physiology. DeCastro provided superb drawings of the carotid sinus area and the carotid body. As early as 1928, he correctly distinguished the function of each structure. Heymans using anesthetized dogs reported the reflex responses resulting from stimulation in the area for which he was awarded the Nobel Prize in Physiology or Medicine for 1938. After winning the prize he was asked by the press corps if he thought people could live without their carotid bodies. He replied that he thought they could, but thought his own career certainly would have suffered terribly.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 303
Figure 15. Figure 15.

Carlos Eyzaguirre was the patriarch of carotid body studies in the U.S. He with his many colleagues investigated virtually every aspect of chemoreception, and advanced the field in a unique and major way. It is unlikely that any mentor active today has trained more investigators (with permission from Respiratory Physiology People and Ideas, edited by John West, p. 306).

Figure 16. Figure 16.

Location and neural connections of one of the most important peripheral interoreceptors for ventilatory control, the carotid body (CB). Selective stimulation of the CB with hypoxia, hypercapnia, acidosis, or hypoglycemia can precipitate increases in tidal volume, respiratory frequency, functional residual capacity (FRC), airways resistance, airway secretions, and decreases in pulmonary vascular resistance.

Figure 17. Figure 17.

Jerome Dempsey (center), Hubert Forster (left), and Gerald Bisgard were leaders in the “Wisconsin Group” which spearheaded studies elucidating the importance of carotid bodies to control eupneic breathing and the response to hyperoxic hypercapnia. They also studied ventilatory acclimatization to hypoxia in several animal species and in humans. They concluded that changes in cerebral spinal fluid bicarbonate was not the critical factor in the process of acclimatization, and not nearly as important as previously believed; rearrangement of carotid body sensing mechanisms during hypoxia seemed to be more responsible (with permission from Respiratory Physiology People and Ideas, edited by John West, p. 298).

Figure 18. Figure 18.

Abbreviated dorsal view in rat of peripheral input into pontine‐medullary region of information important/essential for the genesis of respiratory rhythm. Proceding via the glossopharyngeal (IX) nerve is the critically important information from arguably the most important peripheral interoreceptor in the organism, the carotid body (CB). Carotid sinus baroreceptor information also proceeds along IX and solitary tract to the nucleus tractus solitarii (NTS). Information via the vagus (X) comes from the slowly adapting receptors in airway smooth muscle (SARs), from the rapidly adapting receptors in the airway epithelium (RARs), and from the C‐fibers in the parenchyma of the lung. Facial nerve nuclei (geniculate and facial motor nerve), located in the pontine area, seem to have little direct impact per se on ventilatory control. The ventral respiratory group has several different important loci: nucleus ambiguus sends efferent fibers to control airway smooth muscle, as well as cardiac performance. Excitatory inspiratory neurons innervating the phrenic nucleus are also found in the ventral respiratory group. AP, area postrema also called the calamus scriptorius (medullary landmarks); PBr/KF region, parabrachialis/Kölliker‐Fuse nucleus—components of the pontine respiratory group.



Figure 1.

A recent search of PubMed by Zapata and Larrain for the International Society for Arterial Chemoreception using carotid body‐related terms produced more than 5,000 citations of which most of the early ones treated carotid body tumors. Presented here are carotid body publications in 5‐year intervals starting in 1945 which are focused more on anatomy, cytology, neurophysiology, neurochemistry, resulting reflex responses to stimulation.



Figure 2.

Galen (130‐199 A.D.) of Pergamum was a prominent Roman physician (indeed, to the Emperor Marcus Aurelius) and philosopher of Greek origin. His anatomical views of the cardiovascular system were based on studies in the monkey since dissection was not allowed at that time; these views were taught for 1,300 years. The “spirits” added to the blood in Galen's view came from the left ventricle (vital spirit) as the blood coursed through the invisible pores of the interventricular septum between right and left ventricles. The “animal spirit” came from the brain.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.


Figure 3.

Ibn Sina (980‐1037 A.D.), known in the West as Avicenna, was the foremost philosopher and physician of his day. He was greatly influenced by Aristotle, and, in turn, greatly influenced Thomas Aquinas, Galileo, Harvey, and several others. Avicenna wrote over 400 treatises of which about half have survived. Most focus on philosophy (for which he was criticized); about 40 deal with medicine. His encyclopedic Canon of Medicine (completed before Avicenna was 21 years old) was a commonly used source in many medieval universities, and was a textbook at the Universities of Louvain and Montpelier as late as 1650 A.D. Avicenna's medical system combined his own extensive experience with Islamic medicine, a system used by Galen.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.


Figure 4.

Andreas Vesalius (1514‐1564A.D.), born in Brussels, Belgium with the non‐Latinized name of Andreas van Wesel into a family of physicians, a grandfather being Royal Physician of Emperor Maximilian. While pursuing his medical education in Paris he became interested in anatomy. He is often called the Father of Modern Anatomy. He was among the first to experiment in the area of respiratory physiology. He corrected many of Galen's errors. This plate and several others from his De Humani Corporis Fabrica confirmed that anatomy had switched from Galenic to Vesalian.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.


Figure 5.

Marcello Malpighi (1628‐1694 A.D.), an Italian physician, greatly clarified the microscopic anatomy of the lung, especially the “orbicular” shape of the alveoli and the role of the tortuous pathways of the capillaries across the alveoli from larger arterioles to the venous side. His drawings really provided the first correct anatomical basis for understanding the role of the alveoli and their relation to the pulmonary circulation.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.


Figure 6.

Antoine Laurent Lavoisier (1743‐1794 A.D.) was truly the Father of Modern Chemistry. Discovered the similarity between respiration and combustion, involving the uptake of oxygen from the air and the production of carbon dioxide. But he thought, incorrectly, that all the heat produced by the combination of oxygen with combustible substrates took place in the lung. This notion was later corrected by Spallanzani. Probably should be credited as the investigator who most solidly disproved the then currently popular phlogiston theory.

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.


Figure 7.

John Scott Haldane (1860‐1936 A.D.) was a Fellow of New College at Oxford where he had his laboratory. But he was also an honorary Professor at Birmingham University. He is credited with opening a new phase of physiology with his experiments using human subjects. With J.G. Priestley he first clearly demonstrated that resting ventilation was more under the control of carbon dioxide than under the control of oxygen. Dyspnea in his subjects occurred if the former rose to only 3% in an enclosed chamber, whereas oxygen had to drop to 14% to generate the same level of dyspnea. His many other experiments had significant practical applications

Courtesy of the Institute of the History of Medicine, The Johns Hopkins University.


Figure 8.

Isidoor Leusen, pursuing chemosensitive structures in the CNS, perfused the lateral ventricles of anesthetized dogs with CO2‐rich fluid (while collecting from the cisterna) and saw an increase in ventilation; this altered the level of CO2 in the cerebrospinal fluid. CO2‐poor fluid provoked a decrease in ventilation. Data was highly suggestive of where hypercapnia exerted its effects on ventilation. But at the time the changes in ventilation were thought to be due to the direct action on the respiratory centers.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 294


Figure 9.

Robert Mitchell (left) and John Severinghaus in collaboration with Hans Loeschcke soaked cotton pledgets in CO2‐rich or H+‐rich solutions and applied them to selected, discreet areas on the ventral lateral surfaces of the medulla in the anesthetized cat. Hyperpnea was the result. They concluded that an area sensitive to CSF H+ (a “central chemoreceptor”) was at or near the surface—within or just beneath the pia.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 296


Figure 10.

John Pappenheimer (right) and Vladimir Fencl used a ventriculo‐cisternal perfusion technique in unanesthetized goats. They concluded from their results that the acid‐sensitive zone (i.e., a “central chemoreceptor”) was not superficial but rather two‐thirds to three‐fourths of the distance along a bicarbonate concentration gradient between blood and CSF in the brainstem.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 297


Figure 11.

Sagittal view of rat brainstem showing location of superior olive (SO), trigeminal nerve 5, facial nerve 7, Bötzinger complex (BötC), pre‐Bötzinger complex (pre‐BötC), retrotrapazoid nucleus (RTN), and parafacial respiratory group (pFRG). pre‐BötC and BötC are thought responsible for inspiratory rhythm; RTN/pFRG more involved with expiratory efforts.



Figure 12.

Plot of the ventilatory response to CO2 in unanesthetized, unsedated lamb. The animal was fitted with an extracorporeal carbon dioxide membrane lung (CDML) through which subclavian arterial blood was passed, and returned to the jugular vein. Functioning like a kidney dialyzer, the CDML gradually removed as much CO2 as the animal was producing. Total CDML removal of CO2 produced a 100% decrease in ventilation. The data supported the notion that peripheral input is needed for the central pattern generator and other central neural mechanisms to operate.

with permission from Anesthesiology 46: 138‐141, 1977


Figure 13.

Diagram illustrating the principal features of the existential organization of the neural factors controlling breathing, revealing the pathway for suprapontine/medullary input. Output is not just to striated muscles to expand the lungs but also to muscles of the airways via the premotor and motor neurons. Hypothal, hypothalamus; pulm, pulmonary; extern. Intercost, external intercostal; intern. Intercost, internal intercostal; MN, motor neuron; preMN, premotor neuron.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 256


Figure 14.

Corneille Heymans (left) and Fernando DeCastro were pioneers of carotid body physiology. DeCastro provided superb drawings of the carotid sinus area and the carotid body. As early as 1928, he correctly distinguished the function of each structure. Heymans using anesthetized dogs reported the reflex responses resulting from stimulation in the area for which he was awarded the Nobel Prize in Physiology or Medicine for 1938. After winning the prize he was asked by the press corps if he thought people could live without their carotid bodies. He replied that he thought they could, but thought his own career certainly would have suffered terribly.

with permission from Respiratory Physiology People and Ideas, edited by John West, p. 303


Figure 15.

Carlos Eyzaguirre was the patriarch of carotid body studies in the U.S. He with his many colleagues investigated virtually every aspect of chemoreception, and advanced the field in a unique and major way. It is unlikely that any mentor active today has trained more investigators (with permission from Respiratory Physiology People and Ideas, edited by John West, p. 306).



Figure 16.

Location and neural connections of one of the most important peripheral interoreceptors for ventilatory control, the carotid body (CB). Selective stimulation of the CB with hypoxia, hypercapnia, acidosis, or hypoglycemia can precipitate increases in tidal volume, respiratory frequency, functional residual capacity (FRC), airways resistance, airway secretions, and decreases in pulmonary vascular resistance.



Figure 17.

Jerome Dempsey (center), Hubert Forster (left), and Gerald Bisgard were leaders in the “Wisconsin Group” which spearheaded studies elucidating the importance of carotid bodies to control eupneic breathing and the response to hyperoxic hypercapnia. They also studied ventilatory acclimatization to hypoxia in several animal species and in humans. They concluded that changes in cerebral spinal fluid bicarbonate was not the critical factor in the process of acclimatization, and not nearly as important as previously believed; rearrangement of carotid body sensing mechanisms during hypoxia seemed to be more responsible (with permission from Respiratory Physiology People and Ideas, edited by John West, p. 298).



Figure 18.

Abbreviated dorsal view in rat of peripheral input into pontine‐medullary region of information important/essential for the genesis of respiratory rhythm. Proceding via the glossopharyngeal (IX) nerve is the critically important information from arguably the most important peripheral interoreceptor in the organism, the carotid body (CB). Carotid sinus baroreceptor information also proceeds along IX and solitary tract to the nucleus tractus solitarii (NTS). Information via the vagus (X) comes from the slowly adapting receptors in airway smooth muscle (SARs), from the rapidly adapting receptors in the airway epithelium (RARs), and from the C‐fibers in the parenchyma of the lung. Facial nerve nuclei (geniculate and facial motor nerve), located in the pontine area, seem to have little direct impact per se on ventilatory control. The ventral respiratory group has several different important loci: nucleus ambiguus sends efferent fibers to control airway smooth muscle, as well as cardiac performance. Excitatory inspiratory neurons innervating the phrenic nucleus are also found in the ventral respiratory group. AP, area postrema also called the calamus scriptorius (medullary landmarks); PBr/KF region, parabrachialis/Kölliker‐Fuse nucleus—components of the pontine respiratory group.

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Further Reading

Respiratory Physiology People and Ideas edited by John B. West. New York, Oxford.  Published for the American Physiological Society by Oxford University Press, 1996.

A History of Breathing Physiology edited by Donald F. Proctor. New York, Marcel Dekker, Inc., 1995.  Volume 83 of the Lung Biology in Health and Disease series.  Executive Editor: Claude Lenfant.

John F. Perkins, Jr. “Historical development of respiratory physiology” In: Handbook of Physiology.  Section 3: Respiration Volume I.  Section Editors: Wallace O. Fenn and Hermann Rahn.  Washington, DC, American Physiological Society, 1964.

John E. Remmers.  A century of control of breathing.  Amer. J. Resp. Crit. Care Med. 172: 6-11, 2005.


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Robert S. Fitzgerald, Neil S. Cherniack. Historical Perspectives on the Control of Breathing. Compr Physiol 2012, 2: 915-932. doi: 10.1002/cphy.c100007