. A practical treatise on medical diagnosis for students and physicians . e of breathing is seen in women, in whomthe upper half of the chest moves more actively. The areas below theclavicles and the upper portion of the sternum swell more distinctly dur-ing inspiration, but the movements of the lower portion, and especiallyof the diaphragm, are limited. The costal type occurs most frequently in children. It is the type ofbreathing in both sexes during sleep; and is observed during deep respi-ration. Littens Diaphragm-phenomenon. The diaphragm and walls ofthe thorax approach each other during
. A practical treatise on medical diagnosis for students and physicians . e of breathing is seen in women, in whomthe upper half of the chest moves more actively. The areas below theclavicles and the upper portion of the sternum swell more distinctly dur-ing inspiration, but the movements of the lower portion, and especiallyof the diaphragm, are limited. The costal type occurs most frequently in children. It is the type ofbreathing in both sexes during sleep; and is observed during deep respi-ration. Littens Diaphragm-phenomenon. The diaphragm and walls ofthe thorax approach each other during expiration, coming in apposition atthe end of this act, and become separated during inspiration. In personswhose chest-walls are not too thick the movements of the diaphragm areindicated on the surface of the chest by the rise and fall of a shadowyline. The patient must lie on his back with his face turned away fromthe light and with the head slightly elevated. The light should fall fromthe head or foot of the bed. The observer stands a distance of three or Fig. 146. .. four feet with his back to the light, scanning the chest at an angle ofabout 45 degrees. In the act of inspiration a horizontal shadow or un-dulation is seen to start on either side about the sixth interspace and topass during inspiration downward over a distance of two or more inter-spaces, even to the margin of the ribs. In expiration the shadow beginsbelow and moves upward to the starting-point. By this phenomenonthe volume or vital capacity of the lungs can be estimated. In nor-mal individuals the shadow should move more than 2\ inches. The Movements of the Chest in Disease. In disease, as in health, thetype, character, rate, and rhythm of the respirations, the degree of expan-sion, and Littens phenomenon must be observed. The Types op Eespiration in Disease. Any of the normaltypes of respiration may predominate abnormally or may be abnormallyincreased. Abnormal costal breathing may be caused by oedema or in
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