1084 



THORAX. 



proves simply that there is air in the chest 

 of different density to the external air ; and 

 if so, there must be some impediment in the 

 air tubes, preventing the restoration of at- 

 mospheric equilibrium. 



Disease of the thoracic viscera affects the 

 breathing movements, causing them to be 

 more limited, or non-symmetrical, reversed, 

 massive, interrupted, partial, quick, slow, ir- 

 regular, or double. 



(a) Of limited breathing movement. 

 The mobility of parts when disease attacks 

 the chest may be surprisingly drawn forth. 

 Haller allows scarcely any mobility to the first 

 rib; Magendie asserts that the lower ribs are 

 immovable, because they either reasoned 

 from the healthy body, or anatomically : but 

 it is not uncommon in phthisical patients to 

 see strong and well-marked respiration kept up 

 by the 1st, 2nd, and 3rd ribs, or by the 10th, 

 llth and 12th; these ribs are movable, 

 but it requires disease to bring their mo- 

 bility forth. We are satisfied that there is a 

 latent respiratory mobility during health, which 

 is manifested only by disease. 



In disease particular parts take up ex- 

 aggerated movements, but the sum of these 

 movements is more limited than in health. 

 In the earliest cognisable stage of phthisis 

 pulmonalis the expansion of the thoracic 

 apex is diminished ; the shoulders incline 

 forwards and inwards, and become rounded j 

 the spine is less erect ; the apex cannot ex- 

 pand. The mobility of the inferior ribs does 

 not so diminish, but sometimes maintains 

 life to the last. With an exaggerated move- 

 ment, the respiration is frequently costal and 

 abdominal at the same time, as if no part 

 could afford to be unemployed. 



In 233 cases of phthisis pulmonalis (males) 

 in the first stage we noticed that the breathing 

 of 46 was costal, of 96 abdominal, and of 91 

 costal and abdominal. The mobility by tape 

 measure was, instead of 3 inches and upwards, 

 as follows' 



TABLE F F. Diminished Mobility over the 

 Nipples on '23:3 Phthisical Males. 



(b) Qf non-symmetrical brcatliing move- 

 ments. In advanced stages of phthisis pul- 

 monalis non-symmetrical movements are no- 

 ticed ; but this may exist without a cavity or 

 effusion of fluid in the lung ; or a cavity 

 may exist with symmetrical movements (but 

 a cavity never exists without extensive dimi- 



nution of mobility). Generally a cavity is at- 

 tended with non-symmetrical movements, or 

 a dragging up of one side of the chest; and 

 in extreme cases there is no movement at all 

 in the region of the cavity. That symmetrical 

 movements may coexist with extensive disor- 

 ganisation or solidification of one lung is con- 

 trary to the opinion of many persons. It may 

 be explained by the fact of our having so much 

 spare lung. It has been found by experiment 

 that 310 cubic inches of air could be forced 

 into the lungs taken from a man with a healthy 

 chest (height, 5 feet 4 inches ; weight, 107 Ibs. ; 

 vital capacity, 198 cubic inches), the absolute 

 capacity of whose thorax at death, was 245 

 cubic inches : therefore there was spare lung 

 for more than 100 cubic inches a space 

 which he could not command during life. 

 May it not be possible that when a part of 

 the lung is consolidated or disabled, this spare 

 portion may come more completely into use, 

 and allow of the symmetrical movement ? 



(c) Of reversed breathing movements. A 

 man's breathing may be costal or abdominal 

 for a month, a week, a day, an hour, a minute, 

 and change again, every possible alternation 

 may occur. This may take place with or 

 without a cavity in the lungs, with or without 

 phthisis pulmonalis, as if a specific motion 

 drew in air to certain parts of the lungs to 

 excite some local change of condition. Al- 

 though costal respiration is maintained at a 

 greater expense of vital force, yet we see 

 when the vital power is fast ebbing the re- 

 spiration is always costal, and the last breath 

 is a deep costal inspiration followed by the last 

 expiration. 



(d) Of massive breathing movements. 

 Massive breathing is a marked feature of the 

 presence of emphysema in the lungs. There 

 is a total absence of that undulating, rolling, 

 and consecutive motion of the ribs. The 

 breathing is always costal, though it may be 

 conjoined with abdominal breathing, and the 

 ribs are elevated in the mass, sometimes 

 together with the shoulders clavicle and sca- 

 pula. Massive costal breathing is indicative 

 of emphysema of the lungs or pneumo- 

 thorax. In all other forms of dyspnoea the 

 undulating movement is more or less pre- 

 sent, though limited. 



(e) Of interrupted breathing movements. 

 In those diseases termed " nervous," parti- 

 cularly in young women, the breathing, espe- 

 cially the expiration, is sometimes interrupted 

 and jerking. This appears to be merely a 

 functional derangement ; it may sound to the 

 ear like deficient respiration, for the intensity 

 of the " murmur" is generally diminished, as 

 if the jerking "eased away" the expiring 

 air. This is sometimes the case in men. It 

 is very seldom combined with organic disease 

 of the lungs. 



(f ) Of partial breathing movements. By 

 this we mean independent movement of cer- 

 tain ribs, or of some two or three of the res- 

 piratory regions. All the ribs may move as in 

 emphyscmatous breathing, or none of them 

 may move, or the lower, the upper, or the 



