How a forgotten 1905 medical text “Carbonic Acid in Medicine” reveals the real regulator of life
The introduction is also posted on Spotify as a podcast by “Gerry at The Health Equation”
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Gerry Gajadharsingh writes:
“I was sent a copy of this very old book on the importance of adequate CO2 and its impact on breathing by one of my colleagues and friends in Germany Mr Markus Beer, thank you Marcus.
I still find it incredible that despite doctors and scientists knowing about the importance of carbon dioxide over 100 years ago, that when I assess a patient via capnometry, I have to explain the importance of CO2, such is the pervasiveness of the incorrect understanding of how breathing actually works, with many people still thinking the important thing is just deep breathing and getting as much air/oxygen into the lungs as possible.
https://www.thehealthequation.co.uk/heart-rate-variability-hrv-and-capnometry/
We tend to think of breathing as the act of taking in oxygen — the essential fuel for life — and exhaling the “waste” gas, carbon dioxide. The very language of breathing reflects that bias: “take a deep breath,” “get more air,” “oxygenate your body.”
But what if we’ve misunderstood the real hero of respiration?
More than a century ago, a New York physician named Dr Achilles Rose published a remarkable book titled Carbon Dioxide in Medicine. Long before pulse oximeters and breath-training apps, Rose argued that the body’s health — its circulation, metabolism, and even emotional stability — depends as much on carbon dioxide (CO₂) as on oxygen. Republished in 2022 by the Conscious Breathing Institute, his forgotten text reads like a revelation: an early map of how our breathing chemistry governs everything from energy to calmness.
Today, modern science is beginning to rediscover what Rose already knew — that carbon dioxide is not a poison to eliminate, but a regulator to respect.
- The Oxygen Myth
We live in an oxygen-obsessed world. Fitness ads promise “oxygen boosts.” Spa devices claim to “oxygenate the skin.” Even meditation teachers sometimes urge people to “take big gulps of air.” The implicit message: more oxygen = more vitality.
Yet inside the body, that equation doesn’t hold. Once oxygen enters the bloodstream, it must be released from haemoglobin to reach our cells — and that release depends on carbon dioxide. Without enough CO₂, oxygen clings too tightly to haemoglobin, leaving tissues paradoxically starved despite plenty of air. This elegant exchange, described by Danish physiologist Christian Bohr in 1904, became known as the Bohr Effect.
Dr Rose’s own observations mirrored this principle. He noted that the proportion of carbon dioxide in arterial blood “corresponds exactly to the amount contained in the air of the alveoli” — meaning every change in alveolar CO₂ alters the entire chemistry of life. Even then, he recognized carbon dioxide’s power to modulate the nervous system, circulation, and respiration itself.
The irony is clear: in our rush to “breathe more,” we often breathe away the very molecule that allows oxygen to work.
- The Body’s Forgotten Regulator
Carbon dioxide isn’t merely a waste product. It’s an ancient signal, a messenger of balance. Every breath subtly tunes CO₂ levels in the blood, which in turn regulate pH, blood flow, and nerve excitability.
- pH and acid–base balance: CO₂ dissolves in the blood to form carbonic acid, maintaining the narrow pH window (7.35–7.45) in which life operates.
- Circulation: Higher CO₂ dilates blood vessels, improving perfusion to the brain, heart, and muscles. Low CO₂ — often from over breathing — constricts them, reducing blood flow.
- Respiratory drive: The urge to breathe arises not from lack of oxygen, but from rising CO₂. It is the body’s metronome, setting the rhythm of respiration.
Rose wrote that carbon dioxide “seems to be necessary to excite important vital functions, especially respiration and circulation.” He observed that both an excess and a deficit disturbed the nervous system — a view now confirmed by modern physiology.
When we chronically over breathe — sighing, mouth-breathing, or taking unnecessary deep breaths — we expel too much CO₂. The result? Dizziness, cold hands, anxiety, fatigue, and reduced oxygen delivery. In contrast, calm, slow, nasal breathing maintains CO₂ equilibrium and keeps the autonomic nervous system balanced between sympathetic “drive” and parasympathetic “rest.”
- What Dr Achilles Rose Knew
At the turn of the twentieth century, medicine was mesmerized by oxygen. Hospitals were beginning to use oxygen tents, and “fresh-air cures” were prescribed for tuberculosis. Yet Rose stood apart. Drawing from physiology, chemistry, and decades of observation, he insisted that carbon dioxide was the true governing agent of respiration — both a by-product and a controller of life.
In his chapter on the Physiology and Chemistry of Respiration, Rose described how carbon dioxide binds loosely to haemoglobin, how its tension in blood influences gas exchange, and how even small fluctuations affect the entire metabolic system. He saw carbon dioxide not as inert exhaust but as a dynamic participant: an “excitant and paralyzing agent, similar to alcohol,” capable of stimulating or calming depending on concentration.
Rose was also one of the first physicians to apply CO₂ therapeutically. In his time, carbon dioxide baths were popular across Europe for circulatory and nervous disorders. He documented remarkable results: improved blood flow, relief of pain, and faster healing of chronic ulcers. CO₂ insufflation — gently introducing the gas into body cavities or wounds — was used to treat conditions from asthma to menstrual pain to impotence.
Some of his claims now sound extravagant, yet the core insight endures: carbon dioxide enhances local circulation and tissue oxygenation. Modern dermatology and wound-healing research confirm that controlled CO₂ exposure increases capillary blood flow and nitric-oxide release, speeding repair.
- Modern Echoes — The CO₂ Renaissance
After decades in obscurity, carbon dioxide is quietly re-emerging in science and practice.
- The Buteyko Method (developed in the 1950s) trains people to reduce breathing volume, raise end-tidal CO₂(ETCO₂), and restore calm autonomic tone. Thousands with asthma and panic disorder report improvement.
- Sports physiology now measures CO₂ tolerance as a marker of endurance. Athletes who can maintain higher CO₂levels without distress show greater efficiency and recovery.
- Capnography, once a hospital-only tool, is used by breathing coaches to track ETCO₂ — a window into how efficiently a person is ventilating.
- Nasal breathing, championed by modern breath educators, naturally preserves CO₂ by slowing airflow and engaging nitric-oxide pathways.
In all these contexts, the message is the same: comfort with carbon dioxide equals resilience.
When we learn to tolerate gentle rises in CO₂ — through slower breathing, brief breath holds, or mindful relaxation — our body adapts. Blood vessels open, the diaphragm softens, the nervous system steadies. Paradoxically, by breathing less, we oxygenate more.
- A Shift in Perspective — From Elimination to Regulation
For most of human history, breathing was an unconscious rhythm in harmony with environment and effort. But modern life — with its stress, screens, and shallow postures — has turned it into a subtle imbalance. We exhale our stability with every anxious sigh.
The old paradigm viewed carbon dioxide as a threat to expel. The new (and very old) understanding sees it as a regulator to cultivate. When we intentionally slow down, breathe through the nose, and let CO₂ accumulate slightly, several beneficial things happen:
- Oxygen delivery improves through the Bohr effect.
- Heart rate and blood pressure stabilize as vagal tone increases.
- Mental clarity and calm rise, since CO₂ buffers over-excitability in the nervous system.
- Inflammatory pathways quiet, as micro-circulation and cellular pH normalize.
Dr Rose anticipated this systemic view. He saw that “the carbon dioxide in our system, with its normal quantitative changes, seems to be necessary to excite important vital functions.” He regarded the gas not as waste but as an instrument of regulation — an idea that took medicine another hundred years to appreciate.
Today’s breathwork and functional-medicine movements echo that sentiment. The best breathing, it turns out, is not about more air but better balance — between oxygen and carbon dioxide, inhalation and exhalation, activity and rest.
- Breathing as Balance — Practical Reflections
You don’t need a laboratory to experience the power of carbon dioxide regulation. Simple, consistent habits can shift the entire physiology:
- Breathe through the nose — it filters, humidifies, and slows airflow, preserving CO₂.
- Let the exhale be longer than the inhale — this gently raises CO₂ and signals safety to the brain.
- Pause comfortably after exhale — a brief natural hold trains CO₂ tolerance.
- Move with the breath — walking or stretching while breathing quietly through the nose synchronizes circulation and gas exchange.
The goal is not hyperventilation or “breath holding contests,” but restoring the quiet chemistry of balance that modern stress erodes. Within a week of mindful practice, many people notice warmer hands, steadier mood, and deeper sleep — subtle evidence that CO₂, the so-called waste gas, is finally being allowed to do its work.
- From Waste to Wisdom
Reading Carbon Dioxide in Medicine today feels like opening a time capsule of forgotten wisdom. Amid his Victorian prose, Dr Achilles Rose sounds almost modern when he insists that health lies in the body’s ability to self-regulate. He lamented the “hatred of new ideas” that met his work — and indeed, for much of the twentieth century, CO₂ was cast as the villain of pollution and suffocation.
Yet the pendulum is swinging back. Neuroscientists study how CO₂ shapes anxiety and panic. Athletes measure it to optimize endurance. Clinicians monitor it to assess ventilation and stress. And ordinary people, rediscovering slow breathing, find in it a key to calm, clarity, and connection.
Perhaps the greatest shift is philosophical. To honour carbon dioxide is to recognize that life depends as much on what we release as on what we take in. Oxygen drives the spark; carbon dioxide shapes the flame. One without the other is imbalance — in chemistry and in living.
- Conclusion — Returning to Equilibrium
Dr Achilles Rose closed his preface with gratitude to colleagues who dared to explore new frontiers. His work reminds us that science advances not only through discovery but through re-discovery — seeing the familiar with new eyes.
Each gentle breath offers that opportunity.
When we stop chasing oxygen and start listening to carbon dioxide, breathing becomes less an act of effort and more a practice of equilibrium — a quiet dialogue between the body and the atmosphere, between past and present, between doing and being.
So, the next time someone tells you to “take a deep breath,” smile — and instead, try taking a slow one. Let it fill you just enough and linger just a little. In that pause, between inhale and exhale, the wisdom of carbon dioxide — silent, steady, and essential — goes to work.”