On diseases of the spine and of the nerves / by Charles Bland Radcliffe, John Netten Radcliffe, J. Warburton Begbie, Francis Edmund Ainstie, and John Russell Reynolds.

Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: On diseases of the spine and of the nerves / by Charles Bland Radcliffe, John Netten Radcliffe, J. Warburton Begbie, Francis Edmund Ainstie, and John Russell Reynolds. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    18/244 (page 8)
    the male, Tq calm breathing, in fact, the diaphragm does more and the ribs do less in males than in females, and this difference is so real that, for the sake of distinction, calm breathing may be spoken of as diaphragmatic in males, and as costal in females. This difference, indeed, is such that respiratory movements which are healthy in women are morbid in men; and vice versa, that movements which are healthy in men are morbid in women. In forced breathing, Dr. Hutchinson again savs, the greatest enlargement of the thoracic cavity in both sexes is made by the ribs and not by the diaphragm, as is generally believed; and that this statement expresses what really happens, appears to be evident in the fact that in such breath- ing the hollow at the pit of the stomach, instead of being filled out and protruded, as it must be if the diaphragm descended in any marked degree, is actually drawn in and depressed. In forced breath- ing, indeed, the costal inspiration of women becomes more costal, and the diaphragmatic inspiration of men changes from this form to the costal. It is certain, however, that there may be forced diaphragmatic breathing as well as forced costal breathing, and that the one may be made to take the place of the other by an easy effort of the will, or by changes of position which interfere with the action of the dia- phragm on the one hand, or of the ribs on the other. There is, in- deed, no difficulty in understanding why diseases which interfere with the action of the diaphragm or ribs should make the breathing costal or diaphragmatic, as the case may be. As regards the expiratory movements of respiration there is little to say. In tranquil breathing, in males and in females alike, expiration is performed by the relaxa- tion of the diaphragm allowing the abdominal viscera to press up into the position from which they had been depressed in inspiration by the contraction of this muscle, by the relaxation of the costal muscles allowing the ribs to spring back into the position from which they had been pulled up in inspiration by the contraction of these muscles, and by the resiliency of the air-passages themselves. In forced expi- ration the lateral and inferior muscular walls of the abdomen will help to empty the chest by pulling down the ribs and by contracting upon the abdominal viscera, so as to cause them to push up the dia- phragm more effectually. It is easy, indeed, to see how a lesion of the spinal cord which paralyzes the lateral and inferior abdominal walls must interfere with the movements of expiration, and especially with such violent movements as coughing or sneezing. In a word, the whole case of the respiratory movements is one which makes it impossible to continue in the belief that the one reason why the divi- sion of the cord at or above the origin of the phrenic nerve proves fatal, is because the diaphragm is paralyzed; for the plain fact is, that the injury which paralyzes the diaphragm paralyzes the muscles which elevate the ribs, both ordinary and extraordinary, and so puts an end to movements which are quite as important as those of the diaphragm, if not more so, in carrying on respiration. Of the other phenomena which may be present when the injury which interrupts the continuity of the cord as a conductor is in the neck, but not so high as to destroy life immediately, and which are not likely to be