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Ptisis is a substantial consumption of the humidity of the body, due to ulceration of the lungs. For when a solution of continuity occurs in the lungs, the inspiratory and expiratory forces fail. Hence the lungs do not inspire sufficient air to mitigate the innate heat of the heart, and the heart fails to purify itself of the fumosity or fumous vapors generated in itself.
Breathing is a reflex or involuntary act. The respiratory centre, consisting of an expiratory and inspiratory division, is situated in the bulb, or medulla oblongata, the portion of the brain just above the spinal cord.
The Inspiratory Force.—When the thoracic cavity is enlarged in breathing, the unbalanced atmospheric pressure is exerted from all directions towards the thoracic space. It will be noted that both of the large lymph ducts terminate where their contents may be influenced by the respiratory movements.
As we looked we saw it was a woman, her head sweating profusely, and her hands cold and clammy. There was a strange twitching of the muscles of the face, the pupils of her eyes were widely dilated, her pulse weak and irregular. Evidently her circulation had failed so that it responded only feebly to stimulants, for her respiration was slow and labored, with loud inspiratory gasps.
The singer must have perfect control of the breath, and at the same time relieve the larynx and throat of all pressure and strain. To obtain this control the singer must govern the expiration by means of the muscles of inspiration. When the lungs are filled the inspiratory muscles are not to be relaxed as in ordinary breathing, but are to be held on tension throughout the action of expiration.
A convulsive, inspiratory grunt, a bashful, receding, turning away of the head and body, a raising of the hands to cover her face and hide her tears, and hasty, running steps to get away, while murmuring audibly "Let me go away," followed rapidly one upon the other. I gently seized her hand, calmed and reassured her.
For the sake of great accuracy in the statement of our prognosis are we to add a hundred times to the mother's alarm by stating the possibility of death? In each case we must use our own judgment. I believe that in a child over a year old the risk is almost negligible. Fortunately in all save the rarest possible instances the apnoea yields and a deep inspiratory movement follows.
In the case of the expiratory pressure of five units of strength being "controlled" by an inspiratory contraction of four units, nine units of strength are exerted, and the same result could be obtained by the exertion of one unit. There is a clear waste of eight units of strength.
For example, in the diaphragm we make voice by an eccentric action of the inspiratory muscles. We take breath by a concentric action of the diaphragm, we give out breath in making voice by eccentric contraction. Rhythm, therefore, means primarily that there should be a rest after each exercise. If we feel very weary we should especially emphasize this rest.
The blood being thus but imperfectly purified, all the processes of nutrition go on imperfectly, the vital powers languish, the inspiratory efforts become more and more feeble, while the elasticity of the lung is constantly tending to empty the small cells of air and to oppose its entrance, and next the temperature sinks and the infant dies.
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