(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 emphysematous breathing, or none of them may move, or the lower, the upper, or the intermediate set may maintain the respiratory function.
Andral 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 I I), 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 dyspncea. 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 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.