1082 



THORAX. 



exist in the breathing movements ; the only 

 difference being that these movements are 

 more limited. 



(c) Of the deep expiratory position. In 

 figs. 711. and 712. the margin of the shade is 

 the position of the thoracic boundaries in 

 deep expiration. 



We have supposed the figures above men- 

 tioned as standing with the back fixed, for 

 the purpose of making clearly manifest the 

 relative position of these several breathing 

 movements, \nfig. 716. the body is quite free, 

 and wholly alters its position in performing 

 expiration and inspiration. This should al- 

 ways be considered in noticing the breathing 

 movements in diagnosis. 



Fig. 716. 



Respiratory Movements. Male, standing. 

 Expiration, dotted line. Inspiration, continuous line. 



(rf) Of the change of position by extreme 

 breathing. In expiration the head is pro- 

 truded and lowered (see Jigs. 713. and 714.). 

 Therefore, by inspiration the body is raised, 

 and the more erect the more can be inspired ; 

 by expiration it is lowered, so much so that 

 we have seen men when displacing their vital 

 capacity volume stoop themselves to one-half 

 their natural height, to one-sixth frequently : 

 we speak from a large number of cases, 

 nearly 4000. Physiologists have reasoned 

 that, as upon the principle of a bladder becom- 

 ing longer when empty than when inflated, 

 so the chest is shorter when inflated than 

 when empty. But this example in no way 

 corresponds. The bladder expands, because 

 it is inflated ; the chest is inflated because 

 it expands. 



We have given the position of the breath- 

 ing parts (the body fixed) : we shall describe 



the movement of these parts relatively in 

 time and order to each other, and " the 

 peculiar character of these movements in 

 health, and some of their modifications by 

 disease. 



Ordinary breathing. In men this is sym- 

 metrical, and very limited, and commences 

 with an advancing and receding of the abdo- 

 men at and above the umbilical region, accom- 

 panied with a slight lateral enlargement, and 

 immediately followed by a bulging outwards 

 at the cartilages of the 7th, 8th, 9th, and 10th 

 ribs, and that part of the abdomen contiguous 

 to them, with a slight advance of the lower 

 third of the sternum. This is abdominal 

 breathing, because the abdomen moves first ; 

 and is confined to motion of the base of the 

 thorax. In women it is likewise symmetrical, 

 commencing with a gentle heaving of the upper 

 part of the thorax, more or less apparent ac- 

 cording to the fulness of the mammae. This 

 expansion commences with the 1st and next 

 three ribs following each other in succession, 

 accompanied with a slight elevation of the 

 shoulders and a slight lateral enlargement of 

 the chest, which is immediately followed by a 

 bulging outwards of the abdomen. So quick 

 is this motion of the diaphragm after the mo- 

 tion of the ribs, that at times they appear to 

 be synchronous, especially when the individual 

 examined is .conscious of the observation, 

 though it is only an accommodating movement 

 of the diaphragm. This is costal breathing, 

 because the ribs move first, and the motion is 

 chiefly confined to the apex of the thorax. 

 Therefore that which is a healthy respiratory 

 movement in women is pathological in men. 



Of the extraordinary breathing in both sexes 

 {Inspiration). This, like ordinary breathing, 

 is symmetrical: the clavicles, shoulders, sca- 

 pula, and superior ribs are raised, the sternum 

 advances, the infra-clavicular region swells re- 

 markably upwards and outwards (particularly 

 in females) like a rolling wave, the supra-cla- 

 vicular region is raised but this sometimes ap- 

 pears comparatively deepened (merely bv the 

 action of the sterno-cleido-mastoideus), the 

 whole apex of the thorax is rendered more ob- 

 tuse, particularly in the antero-posterior dia- 

 meter. The lower ribs, at their cartilaginous 

 extremities, spread outwards, increasing both 

 the lateral and the antero-posterior diameter 

 of the base of the thorax, the cartilaginous (go- 

 thic) arch formed by the junction of the 6th, 

 7t,h. 8th, 9th, and 10th ribs below the sternum, 

 becomes more obtuse by their lateral motion, 

 the abdominal space within this arch, down to 

 the umbilicus, sinks inwards. Therefore this 

 breathing is costal, commencing with the 

 superior ribs, and terminating over the ab- 

 domen. The peculiar character of healthy 

 breathing (and it is impossible to lay too much 

 stress upon the movements of deep inspira- 

 tion, because they are so indicative of thoracic 

 disease) is that the ribs expand in succession. 

 There is an indescribable undulating roll, pro- 

 duced by the consecutive action of the re- 

 spective ribs, which always commences with 

 a superior rib ; in costal breathing, a lower 



