ON THE DIFFERENCE OF THE RESPIRATORY MOVEMENTS AT DIFFERENT AGES, &c.

We are not aware that the phenomena, to which MM. Beau and Maissiat allude in the following remarks, have been sufficiently dwelt upon in any of the recent works on physiology; and yet they are of that practical importance as to merit the attentive consideration of all medical men. The gist of their observations is that the type of the respiratory movements, or, in other words, the manner in which these are performed, varies not a little in the two sexes, and also at the different periods of life. The following abstract of their elaborate memoir will enable our readers to judge of its contents.

They describe what they call three distinct types of the respiratory movements, viz. 1, the abdominal type; 2, the inferior costal type; and 3, the superior costal type. In the first, the cavity of the chest is increased during inspiration, chiefly by the descent of the diaphragm and the protrusion of the abdominal muscles, the ribs being nearly motionless;-in the second, by the elevation and expansion of the lower six ribs, the movement of the upper ones becoming less and less considerable as we ascend, till it ceases altogether in the second and first;-and in the third, chiefly by the elevation and expansion of the upper ribs, the movement becoming less and less marked as we descend, till it nearly ceases entirely in the lowermost. In the second variety, the lower half of the sternum is much more moved, i. e. elevated and depressed, than its upper half; while the reverse of this is the case in the third variety.

In the majority of cases, each individual has, what may be called, his peculiar type of respiratory movements; and this seems to be remarkably constant at all times. One person breathes chiefly by the abdomen, so to speak; another by the lower ribs; and a third by the upper ones. A good deal however depends on age, and not a little on sex also, as we shall now endeavour to explain.

In the early period of life, and often indeed until three or four years of age.. the respiration usually exhibits the abdominal type: the ribs are scarcely moved at all; and when the breathing is very much oppressed, as in many cases of pneumonia, the cartilages of the lower ribs are observed to be drawn somewhat inwards during each act of inspiration.

After this period of life, the three types begin to be marked in a more or less distinct manner, according to the individual's sex and constitution. The superior costal type is observed particularly in girls; while the other two types are found, in nearly equal frequency, in boys. As a person advances in life, we find that the first-mentioned type becomes more and more predominant in females; and one of the latter types more and more so in males.

The superior costal type in the female sex is readily recognisable not only in our hospitals, but in any assemblies of women, and more especially in actresses on the stage. Who has not observed that the upper part of the thorax, including the sternum and clavicle, is often, during the representation of strong mental emotions, most strikingly elevated and depressed? Nothing at all similar is ever witnessed in male performers. It may be supposed that this peculiarity in women is in some degree induced by the wearing of stays and the consequent compression of the abdomen and the lower part of the chest. But, although this absurd and most pernicious custom may unquestionably increase the degree or amount of the peculiarity in question, it certainly does not give rise to it; for we

To do all manner of justice to the ladies, we must frankly admit that our authors are by no means so much opposed to the use of corsets as most medical "We may here state en passant," they say, "that the use of the corset is not nearly so hurtful to females, as is generally imagined. Indeed it.

men are.

find it to exist in girls before they ever wore stays, and in country-women who never wear them at all.

One important end gained by the respiration being superior-costal in the female sex is abundantly obvious-the breathing is thus much less disturbed than it otherwise would be during the period of pregnancy. This point, although seldom or never alluded to in modern lectures or writings, has not escaped the attention of some of the older physiologists. Boerhaave, in his Prælectiones, thus makes mention of it: "Hinc in fæminis inspirantibus sternum rursum et oblique extrorsum vertitur, totusque thorax quasi assurgit; hinc etiam tumente abdomine, liberius respirant." Haller, the great commentator of Boerhaave, is still more exact and minute in his description of the peculiarities of the respiratory movements in the two sexes: "Considerate puerum anni unius et puellam ejusdem ætatis in eodem lecto unà dormientes, videbis in puellâ, quando inspirat, totam thoracis molem ascendere versus jugulum; in puero verò inspirante thoracem et claviculas vix moveri. In viro adulto pectus vix movetur equidquam, dum respirat; in fæminâ totum sursum trahitur, ut â diaphragmate recedat. Ergo vir abdomine maxime respirat, fæmina thorace. Nisi hanc fæmina diversitatem natura fecisset, gravida perpetuâ dyspnoâ laboravissant. æque ac viri hydropici."

It would seem that most of the authors of the present day have quite overlooked these interesting peculiarities in the phenomena of the respiratory movements, so well described almost a century ago. It has been generally supposed that the movements are nearly alike in all persons; and hence one of the chief objects of enquiry among modern physiologists has been to determine the where and in what direction the principal enlargement of the chest takes place. We cannot therefore be surprised at the difference of opinion on this point. While M. Gerdy maintains that the greatest enlargement of the thoracic cavity occurs in a transverse direction on the level of the lower ribs, we find MM. Hourmann and Dechambre infer from their observations-on the old female inmates of the Salpetriere hospital-that it is in the upper part of the chest, and that, "in this general movement of ascension, the sternum is, on an average, raised from eight to twelve lines." And what is the general conclusion to which they come? That "in proportion as a person advances in years, the motory powers of respiration-and more especially those which tend to increase the transverse dimensions of the chest-become considerably impaired in their energy." It is scarcely necessary to say that the mode of respiration, described by these gentlemen, is not the result of age, but is natural to the female sex. It is however much more conspicuous in young than in old women.

MM. Beau and Maissiat proceed to notice the peculiarities of the respiratory movements in different animals; for the type, so to speak, is far from being alike in all. In the rabbit, the horse, the cat, &c. it is chiefly abdominal; while in the dog, it is inferior costal in a very marked degree. In no animal is it superior costal, at least in the natural and healthy condition; and perhaps for this reason that the alternate elevation and depression of the upper ribs and of the sternum would have interfered not a little with the movements of the fore legs in running. This mode of respiration may therefore be regarded as peculiar to the human race, and more especially to the female sex.-Encyclographie des Sciences Medicales.

may almost be asserted that they are, so to speak, organised for the wearing of this piece of dress. (!) On the other hand, it is an absolute physiological absurdity (contresens) for men to wear stays; for their breathing is chiefly by the lower ribs and the abdomen."

PULMONARY EMPHYSEMA: DISCUSSION AT THE ROYAL ACADEMY.

The pathology of this disease is still a subject of dispute among medical men ; and therefore the recent discussion at the Royal Academy, in which many of the most experienced physicians of the French metropolis took a part, was attended with more than usual interest. The discrepancy of opinion has most probably arisen from the circumstance of certain writers alleging, or, at all events, seeming to imply that its proximate cause, or producing lesion, is always the same; whereas this unquestionably varies not a little in different cases. In some, it seems to depend on a mere abnormal dilatation of the pulmonary vesicles, (these having lost their natural elasticity,) or in a junction at the same time of two or more of these into one, in consequence of a partial rupture of their thin parietes. In others, along with this dilated state of the air-cellules, there seems to be a greater or less degree of thickening of their mucous liningthe result of chronic bronchitis, or, as it is usually called, catarrh; while in a third set of cases, the inspired air has become extravasated into the inter-vesicular cellular tissue of the lungs, in consequence, no doubt, of a sudden giving way of the air-cells from their over-distension. This last kind of pulmonary emphysema is almost always the result of a violent exertion, by which the respiration has been much embarrassed, and during which the inspired air has been forcibly held to enable the individual to put forth more than usual muscular strength. Hence it is more frequent in horses than in any other animal, or than in man himself; but in the latter it has been not unfrequently observed during some extraordinary effort of the body, or some violent emotion of the mind.

The two first-named kinds of the disease are of much slower and more gradual development. They are very frequently associated with some other lesion of the respiratory apparatus, or of the heart and great blood-vessels. Indeed whatever tends to embarrass the natural soft and regular play of the lungs is extremely apt to be followed by a greater or less degree of dilatation of the aircells; and the reason of this is abundantly obvious.

The breath is often held much longer than it is in health;* the minute cells are more dilated than usual, in consequence partly of the air becoming expanded from the heat of the body; and thus the elasticity of the vesicles is gradually more and more impaired. If their mucous lining be somewhat thickened at the same time, and if there be also, as is generally the case, an increased secretion from its surface, we can readily understand the cause of many of the symptoms in old and obstinate lung complaints.

As will afterwards appear, objections were made to some of these positions by different members of the Academy, and we must admit that the objections in certain cases were very reasonable. However this may be, the conflict of opinions on any question of science can never fail to be attended with good, provided there be no unnecessary rambling of discourse, and no presumptuous indulgence in fanciful theories."

We have omitted to mention that the discussion arose on receiving a report, drawn up by M. Adelon, upon a paper of Dr. Prus, in which this physician endeavoured to shew that pulmonary emphysema is not unfrequently the direct cause of sudden death. On this point all the speakers-with the exception of two, the reporter and M. Ollivier-expressed their dissent from the opinion of Dr. Prus; the general impression being that this affection of the lungs, though

in

M. Collard mentioned that he had seen emphysema of the lungs induced young men, who were passionately fond of smoking, and had acquired the power of retaining the smoke of the tobacco for an unusual length of time.

often a most distressing and generally an incurable complaint, is seldom dangerous per se. The veterinary authorities took nearly the same view of the subject. M. Barthelemy, however, one of the highest, distinctly asserted that he had seen one, if not two cases, where sudden death in the horse was caused by an attack of pulmonary emphysema. The same may therefore be supposed to be possible in the human subject under particular circumstances; a rent takes place in some of the vesicles; the air is rapidly effused into the inter-lobular cellular tissue, causing great compression of the vesicles, and consequent serious embarrassment of the breathing. Now this is most apt to occur either during, or immediately after, some violent exertion, when-be it remembered— the heart is acting furiously and the respiration is hurried and laborious. Under such circumstances, we may readily suppose that a slight additional impediment will suffice to induce a rapid asphyxia.

It has been too much the fashion for the last twenty or thirty years, (when such exclusive attention has been paid to a purely material and visible pathology,) to attribute most cases of asthma to pulmonary emphysema, or to some other organic affection of the lungs. M. Ferrus exposed the fallacy of this idea with great ability, and pointed out that disordered innervation is one of the most important elements in the history of this disease. All unprejudiced pathologists must admit that it is often impossible to discover the slightest deviation from the normal structure of the lungs in those, who have long suffered from asthma. M. Ferrus is surely therefore quite right in regarding the disease as (often at least) a genuine Neurosis. He is also of opinion that, in the cases where sudden death has been attributed to emphysema of the lungs, a nervous affection of this sort had very seriously complicated this mechanical cause of disturbance.

"The symptoms" says a most judicious writer in the French Medical Gazette," attending the morbid affections of the chest, as well as of other regions of the body, can be submitted, only within a certain limit, to the explanations deduced from mere anatomical or physical interpretations. Beyond this point, it is in the vital activity which animates every organ, that we must seek for the reason of most of the phenomena that occur in disease-unless we are ready to declare, with the mechanical physicians of old, that the living body is only an assemblage of hydraulic pipes, pulleys, and levers, or, with some modern wiseacres, to regard it as a mere perfect and admirably constituted steam-engine." The most prominent symptoms of pulmonary emphysema are usually a hurried and embarrassed state of the breathing-in many cases, every now and then aggravated in paroxysms-and a dry troublesome cough; the auscultatory signs being a loud respiratory murmur, and the presence of sibilant and other dry ráles. When air has become effused into the inter-vesicular texture, there is an unusual resonance of the chest on percussion.

From all this it is rendered highly probable that pulmonary emphysema is present, in a greater or less degree, in most cases of asthma or spasmodic dyspnoa-not indeed as the sole and essential element of the disease, but as one of several morbid affections that are very generally co-existent. We now give a very brief abstract of the more important remarks which some of the leading academicians made, upon the reading of the report on M. Prus' paper.

M. Louis.-I see no reason for believing that the disease, known by the name of pulmonary emphysema, is ever attended with danger to the life of a patient, however distressing and painful may be its effects. That sudden death may be produced by such a cause alone, I am scarcely prepared to admit the co-existence of heart disease being of very frequent occurrence. Let it be well remembered that it is often exceedingly difficult to account satisfactorily for many sudden deaths, either by the symptoms during the life of the patient, or by the appearances discoverable on dissection. That the proximate or organic cause of pulmonary emphysema is an hypertrophied state of the pulmonary vesicles is cer

tainly most probable: but the truth of this has not been positively demonstrated.

M. Dupuy. It is now ten years ago since I proved by anatomical preparations that the seat of pulmonary emphysema is the inter-lobular cellular tissue of the lungs. By drying the lungs first, the dissection is rendered much more satisfactory. In many instances I have been able to shew most distinctly that there was an effusion of air hors des vesicules.'

M. Bouillaud.—I quite agree with M. Louis in his opinion that there is a close relation between emphysema of the lungs and organic diseases of the heart; the former is very frequently the effect or result of the existence of the latter. With respect to there being an hypertrophy of the air-vesicles in cases of pulmonary emphysema, we must admit that all analogy is strongly in favour of such an opinion. It is very often to chronic bronchitis that emphysema is consecutive; and, as it is the character of inflammation, wherever this be seated, to leave a thickened and hypertrophied state of the parts affected, we may reasonably suppose that such will be the case after an inflammation of the air-passages. My experience quite confirms another remark of M. Louis, that there is seldom any danger from pulmonary emphysema per se, and that, however alarming the symptoms may be for a time, seldom or never is any case of sudden death attributable to this cause.

M. Rochoux.-A great deal has been said of Hypertrophy of the pulmonary vesicles; but has any one ever seen this state of the lungs? we deem not; it is only by reasoning, by analogy, that its existence is presumed; voila tout. Emphysema by itself occasions nothing more than merely a certain difficulty and embarrassment in breathing. It will never do to attribute to it the many serious alterations, with which it is so frequently associated.

M. Piorry. The most important question that we have to determine is this: when the pulmonary cells are much dilated, does the individual necessarily experience difficulty in breathing? But then we may ask, does not the air penetrate as well into a dilated cell as into one of the ordinary dimensions? and moreover, is it not the case that in ordinary breathing a part only of the lungs is called into play? Let us here observe that, in cases of emphysema, the rale is heard during the act of expiration, and not during that of inspiration; and moreover that the dyspnea and other distress of the patient are always relieved by expectoration. In my opinion, the true cause of the embarrassment of breathing in emphysema is a constriction of the bronchial tubes; and certainly its most prominent symptoms are strictly in accordance with this view of its pathology. That sudden death should be caused by pulmonary emphysema alone seems to me to be scarcely probable.

M. Renault.—If the disease be of frequent occurrence in the human subject, it is still more so among horses. From a pretty extensive experience, I may confidently state that short-windedness is the most frequent and characteristic symptom of pulmonary emphysema during the life of the animal. I have never however been able to discover, even with the aid of the microscope, any appearance of thickening in the pulmonary vesicles. Emphysema not unfrequently occurs on a sudden and almost instantaneously: it is then the result of a rupture of the pulmonary cells, and of a consequent effusion into the interlobular cellular texture.* I have never known sudden death to be caused in such a way, nor

* There is manifestly a mighty difference between the dilated or-as it is most