Respiratory exercises in the treatment of disease : notably of the heart, lungs, nervous and digestive systems / by Harry Campbell.
- Campbell, Harry, 1860-1938.
- Date:
- 1899
Licence: Public Domain Mark
Credit: Respiratory exercises in the treatment of disease : notably of the heart, lungs, nervous and digestive systems / by Harry Campbell. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![The degree to which the chest expands in emphysema depends upon its mobility at the onset of the disease, and also upon the vigour and activity of the muscle-system. Thus expansion is facilitated by free mobility of the chest. Little enlargement takes place in senile emphysema—i.e., the chest, and hence . . . the air-cells. This agency is not counteracted as it should be by the natural elasticity of the lungs ; and the air-cells, as well as the cavity of the chest, are permanently dilated ' (Med. Cliir. Trans., xxiii., 1840, p. '>T}. Cohnhcim attributes emphysema in a large number of cases to a congenital defect of the pulmonary elastic tissue (' Principles, etc., of Medicuae,' 3rd edit., vol. i., p. 967, C. H. Fagge). Sir Richard Douglas-Powell also alludes to the loss of pulmonary elasticity as a factor in the pathology of hypertrophous emphysema, though I am not able to accept all his deductions. He argues thus: the elasticity of the lungs is greatly diminished, and may be lost in this disease, and pulmonarj- suction thus being inadequate, the chest- walls are no longer sucked in and bent beyond the neutral point at the end of an ordinary expiration; wherefore the thorax will have the same circumference at the beginning of inspiration as normally it has at the end thereof [it is not explained why the chest expands consider- ably beyond this point in emphysema], and inspiration is no longer aided by the passive recoil of the ribs, which have in consequence to be lifted with every inspiration (' Diseases of the Lungs,' 4th edit., chap. X.). This explanation does not appear to me to be satisfactory, for I do not see how inspiratory recoil aids inspiration, since it is neutralized by pulmonary suction, upon which, indeed, it depends. Suppose the latter to be represented by six, the inspiratory recoil of the ribs operating in the opposite direction will be represented by the same numeral, and the resultant, as far as inspiratory movement is concerned, is nil. Disappearance of pulmonary suction impUes the disappearance of inspiratory recoil, but such disappearance will make no difference in the amount of inspiratory force needful. The need for increased inspiratory force, referred to by Douglas-Powell, is, I believe, due to that expansion of the chest which is a feature of the disease; for the more the chest is enlarged, the more difficult does it become to enlarge it further. Jenner develops Budd's idea, and refers to the (possible) influence of duuinished costal elasticity in the pathology of hypertrophous emphy- sema, contending that this interferes with proper costal recoil during expiration, which therefore is imperfectly performed. VI](https://iiif.wellcomecollection.org/image/b21226398_0189.jp2/full/800%2C/0/default.jpg)
