THORAX. 



1085 



intermediate set may maintain the respiratory 

 function. 



Anclral observes, " The partial immobility 

 of the ribs is not without interest in a physio- 

 logical point of view. Does not this fact 

 prove that, in inspiration, the ribs can move 

 independently of each other, and that they 

 have not merely a common movement ? If," 

 says he, " as we have often seen in phthisical 

 patients, the lower ribs can still move when 

 the upper ones remain motionless, it proves 

 that independently of the action of the scaleni, 

 the intercostal muscles are capable of taking, 

 an active part in the act of respiration."* 

 In this way respiration may be separately car- 

 ried on by any of the twelve costal regions. 

 We have seen a man ill of rheumatism, lying 

 on his back, breathe solely with the diaphragm, 

 and not present the slightest motion of any 

 one of the ribs. And we have seen the con- 

 trary, viz., costal breathing, without the 

 slightest movement of the diaphragm. They 

 can act quite independently of each other. | 



(g) Of quick and slow breathing move- 

 ments. Not only thoracic disease, but most 

 illnesses, particularly febrile conditions, quicken 

 the respiration. In health the number of respi- 

 rations average twenty per minute (TABLE 

 G G), and it has been found that in 244 

 phthisical cases (males), the average number 

 was from twenty-four to twenty-eight per 

 minute (sitting) (TABLE 1 1), the highest 

 number was forty-four per minute. There 

 is every reason to believe that the che- 

 mical quality of expired air is the same 

 whether we are in health or in advanced 

 disease, though our requirements at these two 

 times may be very different; just as the quality 

 of smoke from a fire is the same whether it 

 burns briskly or slowly. The quality is con- 

 stant, and the required modifications are ob- 

 tained by the difference of quantity in a given 

 time. Quick breathing is short, and slow 

 breathing is long, respiration. The natural 

 time of breathing may change by habit. We 

 have seen a man in health, whose ordinary 

 respirations were six per minute. This extra- 

 ordinary slowness was induced by an attack 

 of asthma, during which attack (lasting about 

 six years), his character of breathing changed 

 from eighteen short, to six long and deep, 

 respirations per minute ; though the asthma 

 entirely left him the character of the re- 

 spiration remained as first changed by the 

 dyspnoea. In this case the return of eighteen 

 respirations per minute, would be to him the 

 rapid respiration of fever, although formerly 

 the respiration of health. Time and volume, 

 in respiration, are the great modifiers of the 

 energy of aeration. 



(h) Irregular breathing. Irregular breath- 

 ing movements are less common when organic 

 disease is present. A nervous person, as well 

 as a phthisical person, may have every form of 

 irregular breathing, but in the phthisical per- 

 son the change is less frequent, and is probably 

 due to some change in the disease ; in the 



* Andral, Clinique Medicale, torn. iv. 3d ed. 8vo. 

 Paris, 1804. 



nervous person the change is frequent, some- 

 times once or twice during an examination of 

 the chest, Nervous breathing is generally well 

 marked in hysteria. 



(i) Double breathing. By this is meant cos- 

 tal and diaphragmatic breathing synchronous 

 with each other ; this is not uncommon in 

 severe cases of emphysema, when the mobility 

 of the ribs is much diminished. It is fre- 

 quently met with in phthisis pulmonalis; 

 in ninety-one cases out of 233. We have 

 no voluntary power to command this form 

 of breathing in health. It is to be looked 

 upon as a serious modification of respira- 

 tion. All the modifications of the respira- 

 tory movements, induced by disease, may 

 return to healthy breathing again, if the 

 derangement has not been kept up too long. 

 As a general rule, the respiratory movements 

 become natural soon after restoration of the 

 diseased parts to health. 



Of the number of respirations in a given 

 time. The ordinary respirations should 

 be counted without the individual being con- 

 scious of the observation ; otherwise they be- 

 come disturbed in number, and sometimes in 

 character. 



TABLE GG. Number of Respirations per Minute 

 (sitting) in 1897 males. 



Out of 1897 cases, 1731 of them breathed 

 from sixteen to twenty-four times, and nearly 

 one-third of them twenty times a minute. 



The mean relative velocity of the breathing 

 and the pulse is about one respiration to four 

 pulsations of the heart (twenty to eighty), 

 and the variation in health in the number of 

 respirations is from sixteen to twenty-four, 

 and of the pulse from sixty-four to eighty- 

 eight per minute. 



TABLE H H. Relation between the Respiration 

 and the Pulse (sitting) 1407 males. 



From TABLE 1 1, phthisis pulmonalis in- 

 creases the velocity of the breathing move- 

 ments from twenty (the healthy mean) to 

 twenty-eight, and cases are numerous up to 

 thirty-six respirations per minute. 



