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Updated: June 1, 2025


Thomson has collected 86 cases of thoracic defects and summarizes his paper by saying that the structures deficient are generally the hair in the mammary and axillary regions, the subcutaneous fat over the muscles, nipples, and breasts, the pectorals and adjacent muscles, the costal cartilages and anterior ends of ribs, the hand and forearm; he also adds that there may be a hernia of the lung, not hereditary, but probably due to the pressure of the arm against the chest.

Sir Morell Mackenzie recognized that artistic inspiration is a combination of methods. "When costal or diaphragmatic breathing is spoken of," he writes in "Hygiene of the Vocal Organs," "it must always be remembered that in the normal human body both methods are always used together, the one assisting and completing the other.

Sand was carried to the hospital and guarded with the utmost strictness; the wounds were serious, but, thanks to the skill of the physicians who were called in, were not mortal; one of them even healed eventually; but as to the second, the blade having gone between the costal pleura and the pulmonary pleura, an effusion of blood occurred between the two layers, so that, instead of closing the wound, it was kept carefully open, in order that the blood extravasated during the night might be drawn off every morning by means of a pump, as is done in the operation for empyaemia.

The correct method combines the three adds to the inflation of the central and upper parts of the lungs accomplished by costal breathing, the inflation of the lower part accomplished in diaphragmatic breathing and of the extreme upper part accomplished in clavicular breathing. In other words, the correct method inflates the whole of the lungs and creates a cavity large enough to accommodate them.

Percussion dull over base of the left lung, near the spine, and respiration feeble in the same regions. Autopsy. Left lung strongly adherent to diaphragm and costal pleura; the long adhesions well smoothed off; pleura-costalis shining and healthy.

Right lung hardened at base; adherent to diaphragm and costal pleura; lump separated on one side only. Cyst beginning to form, outside of separation; pus between cyst and lump, but in a very small quantity.

For the term "full, pan-costal inspiration," substitute "mixed costal and diaphragmatic," which will imply that the diaphragm has done its duty by the singer and it is that apparently effortless performance of its duty that gives it its real importance.

Both chests filled with water; deposits of lymph over all the pleura-costalis, presenting the same velvety, furzy appearance as in Case 1. Both lungs were hardened at the base, and the left throughout its whole extent, and firmly adherent to diaphragm and costal pleura, near the spine.

True empyema is not often seen; but, at all times, the adhesions between the costal and visceral pleura are extensive, and there is much effusion in the chest.

Poyet means the coördination of the three when he speaks of mixed costal and diaphragmatic breathing, and that Dr. Van Baggen also means this when he speaks of diaphragmatic breathing.

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