PATHOLOGY AND PRACTICE OP MEDICINE.
Note on the Breathing-Movements in the two Sexes, and on the alleged
Influence of Stays in producing Pulmonary Consumption. [Excerpt
from a Clinical Report.] By W. II. Walshe, M. D., Fellow of the
Royal College of Physicians, London ; Professor of Medicine and Clinical
Medicine at University College, London; etc.—Here, then, gentlemen,
is a woman, (laboring under dilatation of the heart, with probable tricus-
pid regurgitation, and old pericarditis, general bronchitis, congestion,
and oedema of both lungs,) whose maximum thoracic respiration-move-
ments are translated from the upper to the lower regions of the chest.
Her breathing-play is inferior-costal and abdominal, instead of being in-
fraclavicular. She breathes, under the influence of her complicated ma-
lady, as the healthy male, and may be said to be unsexed, quoad respira-
tion, by her disease. Observe, however, that this perversion only holds
in calm breathing; the moment she takes a forced inspiration, the infra-
clavicular regions rise abruptly, fully, and equably, (she is non-tubercu-
lous, be it remembered,) after the type of health. In the state of forced
respiration she breathes—at least in the present point of view—precisely
as both sexes breathe when the contents of the thorax are sound.
What is the cause of this perverted condition of breathing-movement in
the female, when laboring under certain thoracic diseases ? A prepara-
tory point to determine is, the how—and, if possible, the why—of the
difference in the calm breathing-movements of the sexes in health. And
to this preliminary question we will confine our inquiries to-day.
The healthy, calm breathing of the male is essentially effected by the
descent of the arch of the diaphragm; the amount of abdominal is greater
materially than of pectoral expansion-movement; and the former com-
mences sensibly before the latter, which is, besides, confined almost ex-
clusively to the lower ribs. The male action is inferior costo-abdominal.
But is not the ordinary breathing of the female carried on by similar
play of the diaphragm ? Judging from outward appearances, no. In the
female the abdominal expansion is almost null, and always slightly pos-
terior in point of time to the upper costal; neither do the lower ribs
move notably, whereas the clavicles and infraclavicular regions rise and
fall with freedom. The male seems to the eye to breathe with the ab-
domen and lower ribs from the sixth downwards ; the female with the
uppei' third of the chest alone. These statements refer to adults only.
To adults only, I say; for it is yet a point sub judice, whether, and to
what proportional extent, the discrepancy of adult life prevails in infancy
and early youth. I have examined a considerable number of female
children, aged between four and ten years, who had never worn stays,
or any substitute for Uiese, and found in them the predominant infra-
clavicular action of the adult. But the excess of upper movement is
very positively less than among their seniors. On the other hand, Boer-
haavc, one of the earliest observers of the difference in the respiratory
action of the sexes, speaks as though the boy and girl of “ one year old ”
breathe as distinctively, the one with the abdomen, the other with the
chest, as the full-grown man and woman. Per contra, Beau and Mais'
siat affirm, that in earliest infancy, and often up to the third year, the
respiration is abdominal in the female as well as in the male. It has
appeared to me, too, that in earliest youth, when the pectoral and ven-
tral modes of breathing become obvious, the chest action in the female is
more general than at a later period, and less limited to the upper regions.
Age, then, does seem to me to exercise an influence upon, or to be con-
nected with, the typical breathing of the sexes.
Social position exercises none; the washerwoman and the peeress
breathe exactly alike.
The habit of forced breathing is not without modifying power on the
calm action in both sexes. For instance, the extensive play of the upper
regions in full-chested soprani, kept up in the exercise of their art for
many hours daily, ends by increasing the amount of infraclavicular
movement in ordinary conversational breathing. It has appeared to me,
that, even in tenor singers, some perversion of the ordinary condition—
some degree of unnatural infraclavicular movement—may be detected in
calm respiration.
But what influence does dress exercise ? Looking at an adult female,
and remembering her habit of drawing in the lower ribs by apparatus
more or less unyielding, the inference seems unavoidable, that the
reason why a woman does not breathe like a man is, that her mode of
dress mechanically obstructs phrenic play. Certain mischiefs entailed by
tight lacing we see positively in displacement of the liver; in mis-shape-
ment of it, so that its height is made to exceed more or less its breadth,
(as ascertained the other day, for instance, in the body of E. Smith,
University College Hospital Female Case-Book, Vol. IX., p. 130;) in
alterations of its texture, so that true lobular substance is replaced to a
greater or less depth by induration-matter functionally inert. We see
them exhibited in displacement of the heart,—in narrowing of the lower
intercostal spaces, etc. And if, from certain of the facts concerning age
just passed in review, we are forced to the admission, that the activity
of infraclavicular respiration-movement in the female is in the main de-
signed by nature, and independent of extraneous influence, still I cannot
help thinking that the great excess of that movement, and the limitation
of thoracic play to the upper thorax in the civilized adult female, are
due in no small measure to the use of unyielding cases interfering with
inferior costal and phrenic action. The agricultural female laborer, who
knows not stays, breathes more like a male than a town female. Besides,
during sleep, the conditions of pectoral and ventral action in the female
are much less strikingly different from those in the male than in the
waking state ; the waist is relieved for a time from constriction. And,
further, the male and female dog breathe almost exactly alike, as do also
the horse and mare; the action is abdominal and lower costal.
It would seem, then, that stays are in part productive of the peculi-
arity of adult female breathing, but certainly are not its sole cause.
Boerhaave, and his commentator, Haller, however, holding that the
sexual difference obtains from birth, looked upon the free upper costal
action in the female as a pre-ordainment to meet the difficulties of preg-
nancy. “ Nisi lianc/’ says Boerhaave, Ct in foemina. diversitatem natura
fecisset, gravidas perpetua dyspnoea, laboravissent, seque ac viri hydro-
pici.” But it seems here to be forgotten, that if the illustration be sound,
ascitic females ought to escape dyspnoea. The final cause of the differ-
ence in the sexes is of less interest, however, than the mechanism by
which it is actually worked out; but of this, also, nothing is known.
Haller ascribed the predominant costal action in females to the greater
flexibility of their bones and cartilages (Op. Cit., pp. 98, 145.) The
upper interspaces are relatively wider in the female, the lower in the
male; but is this effect, or cause, or neither one nor the other ?
I have just reminded you of some of the evil influences exercised by
the use of tightly-laced, unyielding stays on the liver. Do they inflict
mischief on the lungs ? It appears to me this will altogether depend
on the amount of constriction. If this be simply sufficient to transfer
the maximum chest-play from the base to the apex of the thorax, (or,
rather to magnify somewhat the breathing difference superiorly and in-
feriorly natural to the female,) I cannot very clearly descry what evil is
to come to the lungs, especially if the stays be cut bias, and be formed
of yielding material. If, on the other hand, rigid wood-work or metal
plates be used to stiffen stays of which the main material is hard and
cut straight, then it is conceivable, a priori, that serious evil may come
to the lungs. Remember, however, the wide difference in the statical
and dynamic mechanism of the thorax and abdomen, and you will feel
at once that the fact of serious compression of the liver being produced
by tight lacing gives no shadow of proof that the pulmonary organs
must suffer to similar amount, or even in similar fashion. I know not,
as matter of clinical experience, what the mode of disturbance is which
constriction of the base of the chest actually and demonstrably entails on
pulmonary action or pulmonary structure. But such ignorance as this
is not commonly avowed; on the contrary, the mass of information on
the point is held to be positive and of ominous, most ominous, quality.
Dr. Copland, for instance, writes, in a recent and otherwise admirable
article, that the use of stiff stays produces “ ultimately a morbid state
of the blood, tubercular deposition, especially in the lungs, haemoptysis,
anaemia, etc.” But it may be fearlessly asserted, that neither Dr. Cop-
land, nor any other man living, could prove that the abuse of stays pro-
duces the specific disease, tubercle. I look in vain for evidence of such
power in the writings of those who most loudly proclaim its existence;
declamatory passages, arguing a priori from a loose physiology to a yet
looser pathology, are all I have ever succeeded in finding—at least, with
one seeming exception—a seeming one only. Mr. Farr, in truth, speaks
thus :	“ Thirty-one thousand and ninety English women died in one
year of the incurable malady, consumption. Will not this impressive
fact induce persons of rank and influence to set their countrywomen right
in the article of dress, and lead them to abandon a practice which dis-
figures the body, strangles the chest, produces nervous or” [this “ or”
is probably the “ etc.” of Dr. Copland] “ other disorders; and has an
unquestionable tendency to implant an incurable hectic malady in the
frame.” Strange, Mr. Farr should forget to compare the relative mor-
tality of the sexes in elucidating this question. Look at this table
giving the mortality from consumption in three years to a million living
of each sex in England and Wales :
Deaths from Phthisis to 1,000,000 living of
years.	each Sex.
Males.	Females.
1837	3/771	4j55
1838	3,783	4,077
____________1839	___________________3,722__________________4,015 _______
What evidence does this table give of the dependence of tuberculiza-
tion on stays ? It simply shows that the phthisical mortality of females
is somewhere about 300 per 1,000,000 living greater than that of males.
Granting that the female excess is really due to stays, what scientific
justification does its amount give of Mr. Farr’s startling phrases ? None,
absolutely none. But let me assure you, no particle of evidence exists
that the moderate excess of female destruction is really traceable to the
abuse of stays. Not a few arguments might be adduced, tending to
prove their absolute innocence. Thus, in France, as is well known, fe-
males rarely use stays until the afternoon ; in England, women tighten
themselves up the moment they rise in the morning; yet the excess of
female phthisical mortality over the male is greater in France than in
this country. Again, in certain parts of Europe, the men tighten them-
selves at the base of the chest, so as to produce a tolerably fair image of
the figure of a wasp, and yet they do not seem thereby to increase their
relative quota of phthisical mortality. Further, it will be conceded, that
tight lacing is, as a rule, pushed to greater lengths among metropolitan
than among rural female populations ; so that, if the influence assigned
to stays be other than a figment of the brain, the plus destruction of wo-
men over males ought to be relatively greater in London than in the
country. Now, such evidence as I can get at tells in precisely the con-
trary direction. Thus, examine these figures :
Kent County.
Males.	Females.
Population in 1841	....................'	232,228	236,885
Absolute deaths from Phthisis .	-	-	726	778
Deaths from Phthisis per 1,000,000 living -	3,126	3 242
Metropolis.
Year.	Males.	Females.
Population in 1838	-	913,077	971,767
Absolute deaths from Phthisis -	-	-	4,057	3,630
Deaths from Phthisis per 1,000,000 living -	4,443	3,735
So that, actually, where, by fair inference, the amount of stay-constric-
tion is greatest, and its prevalence widest, (in the Metropolis,) females
are destroyed by phthisis to a less degree than males; whereas, amid a
country population, which we may honestly assume to undergo a less
mean amount of tightening, females die consumptive in notably larger
proportion than males.
No, gentlemen, if the abuse of stays produces consumption, its power
to do so most indubitably remains to be proved; and while the laws of
sin enlightened pathology point to the excessive improbability of an es-
sentially diathetic disease springing from a mechanical cause, I entreat
you not to adopt the popular creed, that “stays cause consumption,”
unless on direct and unimpeachable logical evidence. There is quite
enough in the demonstrable evils entailed by tight lacing to justify you
in warring against the abuse; you have no need to support your argu-
ments by the unfair appeal to an imaginary mischief.—London Med.
Times and Gaz.