THORAX. 



1079 



We met with a case in which the lungs 

 could not, in consequence of pleuritic adhe- 

 sions, be removed from out of the thorax; in- 

 deed there was not one square inch of pleura 

 which was not firmly adherent. The lungs 

 had to be torn out by little pieces, and so 

 strong was the adhesion to the diaphragm, 

 that in removing them this muscle was 

 ruptured, yet the living respiratory mobility 

 of the thoracic walls exceeded by three inches 

 the whole thoracic space allotted for the heart 

 and lungs, as measured after death. This 

 space to the mobility was as 248 to 251. In 

 other respects the lungs were healthy. 



Of all diseases, phthisis pulmonalis most 

 readily affects the vital capacity, not only 

 when the lunijs are beginning to be infiltrated 



o o o 



with tubercular matter, but probably before 

 this. 



This is shown in fg. 710. Taking all the 

 cases together, the difference is about 50 

 per cent. 



The effect of this disease upon the vital 

 capacity in the case of Freeman was very 

 remarkable. This man came from America 

 in 1842 "trained for a prize fight." He was 

 examined when in his "best condition," and 

 his vital capacity measured 434 cub. in. (temp. 

 00) ; height, 6 ft. 1 If in. ; weight, 19st. 5 Ibs. ; 

 circumference of the chest, 47 in.; inspiratory 

 power, 5*0 in. ; expiratory power, 6'5 in. 

 Freeman fought his buttle, and for the sub- 

 sequent two years lived a rambling and 

 dissolute life. In November, 1844, exact!}' 

 two years afterwards, he came to town in ill 

 health. At this time there was no ausculta- 

 tory evidence of phthisis pulmonalis ; but the 

 following difference appeared in his vital 

 capacity-volume : 



In October, 1845, he died at the Winches- 

 ter hospital ; and Mr. Paul, surgeon to that 

 charity, stated that Freeman died of extreme 

 exhaustion and debility, expectorating pus ; 

 and that his lung was throughout studded with 

 tubercles ; his weight at death was 10 st. 

 1 Ib. ; height, 6 ft. 7 in. Another remark- 

 able case was that of a man of perfectly 

 healthy appearance, and in whom there was 

 no auscultatory or general sign of organic 

 disease, but whose vital capacity was deficient 

 by 47 cub. in.; and it was found, within three 

 days of the time when he was examined, that the 

 left lung at the apex was studded with miliary 

 tubercles, the whole not extending beyond 

 a square inch. 



In diseases of the spine, particularly in 

 angular curvature, the mobility is changed 

 sometimes to such a degree that the vital 

 capacity is diminished to 20 cub. in. A full 



meal will even make a difference in the thora- 

 cic mobility, of from 12 to 20 cubic inches. If 

 the vital capacity is deficient, there must be 

 some cause producing the t'ffcct. It may or 

 may not be in the thoracic cavity. Collateral 

 observations must point more definitely to 

 the diseased part. The spirometer is only a 

 gauge to measure the mobility and perme- 

 ability of the lung; other circumstances must 

 point out the cause of the mobility and per- 

 meability being affected. Taking the observa- 

 tions upon the diseased cases by calculation, 

 the vital capacity volume may be arranged for 

 all heights as follows : * 



TABLE E E, Effect of Phthisis Pulmonalis upon 

 the Vital Capacity. 



The question naturally arises, How far defi- 

 cient of the standard may be the vital capacity 

 without indicating disease ? It has been found 

 that ten cubic inches below the due quantity, 

 i. e. 220 instead of 230 inches, need not excite 

 alarm ; but there is a point of deficiency in the 

 breathing volume at which it is difficult to say 

 whether it is merely one of those physiological 

 differences dependent on a certain irregularity 

 in all such observations, or deficiency indicative 

 of disease. A deficiency of 16 per cent, is sus- 

 picious. A man below 55 years of age breath- 

 ing 193 cub. in. instead of 230 cub. in., unless 

 he is excessively fat, is probably the subject of 

 disease. 



In phthisis pulmonalis the deficiency may 

 amount to 90 per cent., and yet life be main- 

 tained. The vital capacity volume is likewise 

 a measure of improvement. A phthisical 

 patient may improve so as to gain 40 upon 

 220 cub. in. 



OF THE RESPIRATORY MOVEMENTS. The 

 breathing volumes have been divided into 

 three kinds ; so likewise the breathing move- 

 ments admit of a similar division, one ordi- 

 nary and two extraordinary movements. 



By the independent action of the intercostal 

 muscles, every intercostal lamella can act sepa- 

 rately, therefore we have the thorax furnished 

 with 22 spaces by which it can enlarge; and 



* See " Spirometer Observations," First Report 

 of tin- Hospital for Consumption, p. 23. ct seq. Loud. 



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