Historical background to the extreme of BPD/hyperventilation
The first description of hyperventilation in Western medical literature dates back to the American Civil War, when a surgeon published a paper entitled âOn irritable heart: a clinical study of a form of functional cardiac disorder and its consequencesâ (Da Costa 1871). The series of 300 soldiers studied suffered breathlessness, dizziness, palpitations, chest pain, headache and disturbed sleep. The symptoms improved when the soldiers were removed from the front line, but their recovery was slow. Although Da Costa recognized the symptoms as functional in origin, he did not identify hyperventilation as the primary cause.
Physiologists Haldane & Poulton (1908) associated numbness, tingling, and dizziness with overbreathing. A year later, Vernon (1909) added an additional symptom, muscular hypertonicity. These symptoms occurred with respiratory alkalosis when patients were hyperventilating.
Kerr and colleagues (1937) introduced the term âhyperventilation syndromeâ (HVS) and pointed out the diversity and variability of symptoms in many systems of the body. Before these publications, a number of cardiologists following up Da Costa's syndrome had debated whether the heart was involved and coined phrases to fit in with their own views. Thomas Lewis (1940) used the terms âsoldierâs heartâ and âeffort syndromeâ in relation to British soldiers in and after the First World War, whereas US cardiologists were reluctant to label the symptoms as cardiac or related to effort. They preferred the term âneuro-circulatory astheniaâ.
These arguments were largely settled when Soley & Shock (1938) found that all the manifestations of âsoldierâs heartâ and âeffort syndromeâ could be induced by hyperventilation and consequent respiratory alkalosis. Since then, many names have been given to this complex set of symptoms â changing with the fads of the time. âDesigner jeans syndromeâ (Perera 1988) was popular in the 1970s, and the current so-called Gulf and Balkan War syndromes include many of the same signs and symptoms. Broadly speaking, HVS/BPD was accepted as being of psychiatric origin in the USA and readily diagnosed, whereas in the UK physicians were reluctant to recognize it. A number of factors may have been operating. Most of the reports were in psychological and psychiatric literature, unnoticed by general practitioners and physicians. Influential UK cardiologist Paul Wood (1941) had reviewed Da Costa's syndrome and firmly placed it in the hands of the psychiatrists. Sadly there was little dialogue between the two specialties.
More recently, chest physician Lum (1977), writing from the Addenbrooke and Papworth hospitals in Cambridge, England, with physiotherapists Innocenti (1987) and Cluff (1984), who developed assessment and treatment programmes, has done much to enlighten the medical practitioners in the UK and re-ignite scientific interest and research into the condition. Since that time there has been a flowering of literature on the subject as more sophisticated and accessible research equipment has become available.
Despite such progress, there are still considerable numbers of cardiologists, general and specialist physicians, or general practitioners who are reluctant to diagnose or seek treatment for their patients with hyperventilation (Hornsveld & Garsson 1997). Endless, increasingly sophisticated tests are carried out. Alternatively, patients are referred to further specialists for symptoms related to other fields, or they are told ânothing is wrongâ with them. If hyperventilation as a causative factor is not considered and tested for, investigations may be protracted, diagnosis avoided, and the patient and the patient's file relegated to the âtoo hardâ basket. This puts patients at great risk of invalidism or of being labelled as malingerers. Medical historians have suggested, for example, that the chronic invalidism of Florence Nightingale and Charles Darwin in the 19th century was more likely chronic hyperventilation, rather than heart disease resulting from infections picked up in the Crimea and the Andes respectively, as was previously believed (Timmons & Ley 1994).
