. Physical diagnosis . Eespiratory Movements. (a) Normal Respiration. During normal respiration, one sees the ribs move outward andupward with inspiration, and downward and inward with expira-tion. Possibly one catches somehint of the movements of thediaphragm at the men, diaphragmatic breath-ing is more marked, while inwomen breathing is mostly ofthe costal type; that is, isdone by the intercostal certain diseases an exaggera-tion of the costal or of the dia-phragmatic type of breathingmay be seen. In emphysema,for example, and in some casesof asthma, the ribs move v
. Physical diagnosis . Eespiratory Movements. (a) Normal Respiration. During normal respiration, one sees the ribs move outward andupward with inspiration, and downward and inward with expira-tion. Possibly one catches somehint of the movements of thediaphragm at the men, diaphragmatic breath-ing is more marked, while inwomen breathing is mostly ofthe costal type; that is, isdone by the intercostal certain diseases an exaggera-tion of the costal or of the dia-phragmatic type of breathingmay be seen. In emphysema,for example, and in some casesof asthma, the ribs move verylittle, and most of the work ofrespiration is performed by thediaphragm, whose pull upon thelower ribs can sometimes be distinctly seen during inspiration. Onthe other hand, when the movements of the diaphragm are impededby the presence of fluid or a solid tumor, as in cirrhosis of theliver or leukaemia, the breathing has largely to be performed by theribs, and becomes, as we say, costal in type (see below, p. 72).. Fig. 47.—Barrel Chest. Chronic bronchitisand emphysema. (&) Anomalies of Expansion. If we watch the patient while he takes a full breath, we maynotice certain variations from the normal type of respiratory move- 70 PHYSICAL DIAGNOSIS. ments. We may see: (1) Diminished expansion of one side (as awhole, or at the apex). (2) Increased expansion of one side. (1) If diminished expansion of one side is due to pleuritic effusion,pneumothorax, or solid tumor of the lung or pleura, the affectedside is usually distended as well as immobile. When, on the other
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