Disease of the thoracic viscera affects the breathing movements, causing them to he 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, I I th 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; 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: — (b) Of non-symmetrical breathing 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 lbs. ; 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 puhnonalis, 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 dyspncea the undulating movement is more or less pre sent, though limited.