265 CHAP. XVII. ON THE EXERCISE OF RESPIRATION. MIGHT not more be done in practice towards the prevention of pulmonary disease, as well as the improvement of general health, by expressly exercising the organs of respiration that is, by practising according to some method those actions of the body, through which the chest is alternately in part filled and emptied of air? Though suggestions to this effect occur in some of our best works on consumption, as well as in the writings of certain Continental physicians, they have hitherto had less than their due influence; and the principle, as such, is little brought into general application. In truth, common usage takes for the most part an opposite course; and, under the notion or pretext of quiet, seeks to repress all direct exercise of this important function in those who are presumed to have tendency to pulmonary disorders. Yet, on sound principle, and with reasonable care, it is certain that much may be done in this way to maintain and invigorate health, even in constitutions thus disposed. Omitting some points of controversy, particularly as to what regards the mechanical influence of respiration on the circulation through the heart and lungs (points meriting, however, much attention from their importance), the free and equable expansion of the latter by full inspiration is beneficial — first, in maintaining their healthy structure, by keeping all the air passages duly open and pervious; secondly, in preventing congestion in the pulmonary circulation ; — thirdly, in pro viding more completely for the necessary chemical action on the blood, by changing at each act of respiration a sufficient proportion of the whole air contained in the lungs, and giving it more complete access to the vascular tissues; - all objects of great importance, and all capable of being promoted more or less by the means in question.* The phrase of exercise of respiration may indeed be used almost in the same sense, and with the same fitness, as that of muscular exercise. Each is capable, in its respective way, of increasing the power and facility of the function concerned. It is remarkable how speedily this is often attained in the instance of the former. A person in ordinary health may so exercise the lungs by repetition of a given exertion, that what produced breathlessness at first is soon performed without effort or fatigue; a fact familiar to common observation, and attested by particular examples in those professing athletic exercises, which show not only the speed, but the great extent, to which the effect may be produced. This of course is not equally true where the liability to disease exists; but even then the express exertion of the organs, under observance and regulation, may often be made a means of augmenting their capacity and power. We might take lesson on this subject from some of the provisions made by nature for relief to these organs, when oppressed in their functions. The acts of sighing and yawning are instances to this effect. Coughing, another mode of expiration (far less to be dreaded in itself than from the in *The ingenious suggestion of Dr. Carswell, as to the cause of more frequent tuberculous deposit in the superior lobes of the lungs, is well known, and applies to the subject of this chapter. In the excellent work of Sir James Clark on Consumption will be found some valuable remarks having more direct reference to it. ference it conveys) is an instrument in keeping the air tubes free from obstruction; and there are many cases where the mistaken efforts of medicine to suppress this symptom, augment the very mischief it is sought to obviate. Other instances, however, occur, where, without any evil, coughing might be partially superseded, or lessened in severity, by the gentler exercise of respiration; so performed under the direct influence of the will, as somewhat to exceed, without passing into labour and fatigue, the ordinary course of the function. Trial is necessary in each particular case to give assurance of the effect, and often the irritability of parts of the membrane may be such as at once to negative any repetition. But the test is so easy and certain from the observation of the patient himself, that no undue risk can be incurred in making the experiment. Whatever the case in this particular example, we may still affirm the fact that good is occasionally to be gained from the regulated exercise of respiration, even when diseased actions are already going on within the lungs; much more, where there is yet only threatening of these, from hereditary or accidental causes in the constitution. Here such exercise is beneficial, as well through its influence on the general health, as more directly by its effect on the lungs themselves, in the several ways mentioned above. There is even reason to affirm (however this opinion may contravene all common belief on the subject) that, under discreet use of the remedy, a larger proportion of good may be obtained from it in these cases, than in any other where it can be employed. It is a good we are in nowise entitled to neglect; seeing the paucity of the means we possess for dealing effectually with the most frequent and fatal form of pulmonary disease; that which has been so often cited as a reproach upon medicine; though - perhaps unjustly, when the nature and difficulties of the object are fully taken into account.* It is scarcely needful to say that the same regard which is paid to the quality of air in ordinary respiration, and especially under tendency to pulmonary disorder, must be extended * In adverting to this disease of pulmonary consumption (tubercular phthisis), it must be fairly be admitted that the progress of medical science has hitherto effected nothing towards a valid cure, whatever may have been done by methods for protecting the constitution against its earlier inroads, or in certain degree abating the symptoms in their progress. This, however, as remarked above, is less an opprobrium upon medicine than on first view it might appear. The more distinct knowledge that has been acquired of the tubercular diathesis — of the tendency in certain habits and in particular textures to the growth or deposit of a peculiar morbid matter and of that more especial direction to the lungs, warranting M. Louis's assertion, that after the age of fifteen tubercles are never found in any part without appearing also in this organ, - all this points directly to a specific constitutional disease, for which none other than a specific antidote is likely to be of complete or certain avail. Whether such will ever be found (either general for the tubercular disease in the habit, or more especially preventive of its deposits in the lungs), is still very doubtful; though the research is amply justified, both by analogy and by the urgency of the cause requiring it. This analogy, however, does not extend to the nature of the morbid matter itself, or its relation to other specific remedies. We have nothing yet ascertained as to these points, which can be considered even a plausible clue; and the discovery, if made, is more likely perhaps to be the effect of some happy accident, than of any concerted plan of inquiry. These difficulties, which can be rightly understood by medical men only, become a vindication for that which the science has not yet attained, though sedulously sought for. Meanwhile, and in conjunction with these efforts, attention has justly been directed towards the means best calculated to guard constitutions so disposed against the active ingress of the disease. This is obviously the only alternative as a principle of treatment; and it has been successfully pursued in many ways, so as undoubtedly to place the preventive practice in phthisis on a better footing than at any former period. More, however, is probably still attainable; and the subject of the present chapter is one which furnishes evidence to this effect. even more carefully to cases where the quantity inspired is thus by effort augmented. Where experience has clearly shown that air below a certain temperature produces irritation in the air passages, it is certain that this cannot be fitted for the exercise of respiration as here recommended. And the same with respect to a humid atmosphere, under which any given degree of cold produces much more effect on an irritable membrane, from the medium through which it is applied. These points, indeed, though adverted to as maxims in the treatment of phthisis and other pulmonary diseases, are not sufficiently made the subjects of trial in particular cases. Two or three experiments, readily devised for each case and unattended with risk, might suffice to decide a question which applies alike to the preventive and curative practice in these disorders, and throughout every part of their progress. As respects the modes of exercising the respiration, they should be various, to suit the varying powers and exigencies of the patient. The "clara lectio" is one recommended from antiquity, the good effects of which are not limited to this object alone. It might be well, indeed, were the practice of distinct recitation, such as implies a certain effort of the organs beyond that of ordinary speech, more generally used in early life, and continued as a habit and exercise, by those especially whose chests are weak, and who cannot sustain stronger exertions. Under judicious observation as to posture, articulation, and the avoidance of all excess, such exercises may be rendered as salutary to the organs of respiration, as they are agreeable in their influence on the ordinary voice. Even singing may for the same reasons be allowed in many of these cases; but within narrower limits, and under more cautious notice of the effects. One or two remarkable cases are known to me, where a |