Respiration in Women
January 3, 1896 — Second annual meeting, California Science Association, Oakland CA
In my senior year in Stanford University, having come to the study of respiration in the regular order of the course in Experimental Physiology, my attention was attracted particularly to the statements concerning the breathing of women. That I am a woman, lent especial interest to the statement that women breathe costally and men abdominally and to the reasons given in explanation. Watching my own breathing, led me to think that one woman did not breathe costally, and the following study is the outcome of that conclusion.
It is with great reluctance, at the present stage of my work, that I present even a preliminary report. Not only the small number of cases examined distributed in several classes, but the small proportion of the appended bibliography which I have been able to review at first hand, and the limited apparatus available, make it impossible for me to offer more than an outline of the ground covered and suggestions for future study.
Hutchinson, an English physician, the inventor of the spirometer, was referred to in every Physiology and article on respiration, which I consulted, It was only after a diligent search that his work was found to be an article in [Robert B.] Todd’s Cyclopaedia of Anatomy and Physiology on the Thorax, which was obtained from the State Library of California, which so far as I can learn is out of print. Since the results of his experiments are still quoted an the rule for the increase of vital capacity for very inch of stature from five feet to six feet of the average man, is still used, it would seem desirable to give in some detail his methods and the result of his work. It is to be noted, however, that his work especially emphasized the subject of vital capacity. He examined 2430 cases, distributed as follows:
Sailors, . . . . . . . . . . . . . .121
Fire brigade, . . . . . . . . . . 82
Metro. Police, . . . . . . . . . 144
Thames “ . . . . . . . . . . . . .. 76
Paupers, . . . . . . . . . . . . . 129
Mixed (artisans) . . . . . . . 370
Gren. Guards, . . . . . . . . .. 87
Horse Guards . . . . . . . . . . 59
Chatham Recruits, . . . . . .185
Woolwich Marines, . . . . . 573
Pugilists and Wrestlers, . . 24
Giants and Dwarfs, . . . . . . 4
Printers, . . . . . . . . . . . . . . 73
Draymen, . . . . . . . . . . . . . 20
Girls, . . . . . . . . . . . . . . . . . 26
Gentlemen, . . . . . . . . . . . 97
Diseased cases, . . . . . . . 360
“Each individual was subjected to the following observations:
1. Number of cubic inches, given by the deepest expiration following the deepest inspiration. This was taken three times and the highest observation noted.
2. The inspiratory power.
3. The expiratory power.
4. The circumference of the chest over the nipples.
5. Mobility of the chest with a tape measure measured during deepest inspiration and deepest expiration.
8. The pulse (sitting).
9. Number of ordinary respirations per minutes (sitting).
11. Temperature of the air expired.”
He made profile shadow pictures by fixing the back so that all movements were forward, in order to show the type of breathing in both men and women, and casts of the thorax, showing the space encompassed by the separate ribs.
For vital capacity in another instance, he examined 4800 cases — males at three periods of life.
He also examined 24 girls between the ages of 12 (11) and 14; whether in addition to the 26 mentioned in the foregoing table or not, is not evident. He says: “The question why women breathe costally and men abdominally, we cannot pretend to answer; we doubt its being caused by any tight costume, for we found the same to exist in 24 girls between the ages of 12 and 14, none of whom had worn any tight dress. This peculiarity may be a reservation against the period of gestation, when the abdomen can not allow so free a descent of the diaphragm. The greatest enlargement of the thoracic cavity in both sexes, is made by the ribs and not the diaphragm, as is generally believed. Ordinary breathing in men in symmetrical and very limited and commences with an advancing and receding of the abdomen in the umbilical region, accompanied with a slight lateral enlargement and immediately followed by a bulging outwards at the cartilages of the seventh, eighty, ninth and tenth ribs, and that part of the abdomen contiguous, with a slight advance of the sternum. This is abdominal breathing because the abdomen moves first.
In women it is likewise symmetrical, commencing with a gentle heaving of the upper part of the thorax, more or less apparent according to the fullness of the mammae. This expansion commences with the expansion of the first and the next three ribs following each other in succession, accompanied with a slight elevation of the shoulders and a slight lateral enlargement of the chest, which is immediately followed by a bulging outwards of the abdomen. So quick is this movement of the diaphragm after the motion of the ribs, that at times they appear to be synchronous, especially when the individual examined is conscious of the observation, although it is only an accommodating movement of the diaphragm. This is coastal breathing, because the ribs move first and the motion is chiefly confined to the apex of the thorax consequently what is healthy in women is pathological in men.”
It is to be observed that he arrived at these definitions largely by the sense of touch aided by sight, the subjects being seated; that is, by placing the left hand upon the shoulder of the person examined, the thumb crossing the clavicle, the fingers resting on the scapula. From his vital capacity tests, he found that mobility had no relation to vital capacity; the mobility might be good while the vital capacity was poor, because we can move the walls of the chest without breathing. He also said that vital capacity was modified by five things, height, position, weight, age, disease. In regard to external compression he says: “The imprudent custom of females wearing a hard, unyielding piece of wood, steel, or whalebone up the front of their corset, commonly produces compression upwards of the sternum. We once noticed a case where the sternum was forced inwards to such an extent, that the entire depth of the thorax, by external measurement, from the middle of the sternum to the corresponding part of the back, only measured two inches instead of eight or nine inches. Slight external pressure in early life may be productive of a permanent deformity of the thorax. The effect of strong and permanent constriction as from tight stays, occasions a distortion in the form of the chest. This kind of compression principally affects the lower part of the thorax; so that the fifth, sixth, seventh, eighth, ninth and tenth ribs are pressed downwards because the length of their cartilages allow them to yield readily; and the viscera corresponding to these ribs also undergo alterations in their position and figure, encroaching on the thoracic cavity, compressing the lungs upward, with the apices of the chest.
CONCLUSIONS: Comparing the sexes structurally he says: “There is perhaps a difference in dimensions of the two sides of the thorax in favor of the left side. This difference we have found not to bear any relation to sex or stature.
The greatest perpendicular depth of the thoracic cavity, nearly corresponds with the greatest lateral measurements in both sexes. The antero-posterior diameter is always less than the greatest lateral breadth, being six to nine in the male, and six to eight in the female. In both sexes the right lung is more shallow than the left.
Absolute dimensions of the thoracic cavity are in proportion to the size of the body in male and female. Although the proportion of some diameters may differ, yet that of the total cubic measurements appear not to do so.”
The only scientist earlier than Hutchinson, quoted on this subject, appears to be Boerhaave, whose article or book I have not seen. Dr. Mays (whose work will be reviewed later) says that Boerhaave was an eminent Dutch physician who made observations as long ago as 1744. Rosenthal quotes Boerhaave as having observed the difference in the types of male and female respiration in infants of one year. Professor Sewall and Miss Pollard in their article re-quote this from Rosenthal; but I have seen Rosenthal’s article in Hermann’s Physiology, and I find that the following footnote has been overlooked:
- “Quoted by Donder’s Phys. p. 385, in Hermann Boerhaave’s Physiology, translated, and supplemented by E. P. Eberhardt, Halle, 1754: ‘I have not been able to find the passage quoted. He there says only (page 978) with those women the sternum is pressed down farther; consequently it happens that when they inspire they can breathe freely even with an inflated abdomen.’
It appears then, the statement concerning difference in types of respiration in infants of one year which has been so often quoted, may not be found in the original of Boerhaave.
Prof. Angelo Mosso of Turin in his article “Ueber die gegenseitigen Beziehungen der Bauch- und Brust-atmung,” shows among other things by tracings made on 2 men (?) only, “that the type of respiration in sleep in both sexes is thoracic, while at the same time the inspiratory dilation of the chest precedes the elevation of the abdominal wall.”
The shortness of the time has not permitted my reading this article in detail so as to verify the statements made.
- Sibson “whose painstaking accuracy is almost Teutonic” says: “In the adult female the form of the chest and abdomen and the respiratory movements are often undoubtedly modified by tight lacing. The form of the chest and the respiratory movements do not differ perceptibly in girls and boys below the age of ten. Although the form of the chest remains nearly the same until the age of twelve, the abdominal movement is then somewhat less and the thoracic somewhat greater in girls than boys. At this age and earlier, stays are worn, and though they do not compress the body materially, yet they restrain the free expansion of the lower ribs during free exercise. After the age of fourteen, the form of the chest and the respiratory movements differ materially in males and females.
When stays are on there is a great exaggeration in the thoracic movement, the second ribs moving forward from 0.06 to 0.02 inch, while, when the stays are off, they only move forward from 0.03 to 0.1 (that is, one half as far). On the other hand, the movements of the lower ribs are much more restrained when the stays are on, the abdominal movement then being 0.06 to 0.11 inch, whereas when they are off it is 0.08 to 0.2 inch. The difference at the waist when measured with a tape is very striking, the increased measure during extreme inspiration being 0.05 to 0.3 of an inch when they are on, and from 0.6 to 1.5 when off (from two to thirty times as much). I have found the circumference at the waist from one to two inches less when stays are worn than when they are taken off.
“I think it probable that in females, even if they wore no stays, the thoracic respiration would be relatively greater and the diaphragmatic less than in man; but this is only surmise.” “Delicate men,” he says further, “approximate to the female thoracic breathing, vigorous women to the male abdominal breathing, and long distance runners have the least thoracic breathing of all men (in the quiescent condition)”.
Walshe objects to the supposition that the sexual difference is “preordained to meet the difficulties of pregnancy”, as Boerhaave maintains. “If we were forced”, he says, “to the admission that the activity of infra-clavicular respiration-movement in the female is in the main designed 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 part to the unyielding cases interfering with inferior costal and phrenic action. The agricultural woman, who knows not stays, breathes more like a man than the town female. Besides, during sleep, the conditions of pectoral and ventral action of 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 the horse and mare; the action is abdominal and lower costal.”
Robert L. Dickinson, M.D. has published an article on the “Corset: Questions of pressure and Displacement.” For this study he used a manometer modified from Croom and Schatz. The least number of pounds of pressure he estimated was twenty one and the greatest eighty eight”. The total pressure exerted by a given corset, is obtained as follows: The areas of like pressures are chalked out on the corset by shifting the bag about under the corset, and testing at every move with the manometer. Knowing the number of square inches in area and the number of pounds of pressure, to the square inch, the pressure exerted on that area is found; adding the pressures in the various areas gives us a total. This is by no means absolutely accurate, but furnishes a tangible figure. “Six inches difference between the circumference of the waist over the corset and the waist with the corset removed, is the greatest difference I have measured. Five and a half and five I have met with one each. The least difference is in those cases where the measurement with and without is the same”. In the woman who wears no corsets the many layers of bands about the waist on which heavy skirts drag, are sufficient to cause considerable constriction, as Dr. Mosher states”.
Dr. Dickinson made tracings of the changes in the contour of the thorax and abdomen on a black-board or by shadows thrown on manilla paper, and verified the results by caliper measurements. He says: “The principal constricting effect is exerted below the fifth rib.” He quotes Sibson as saying: “The transverse diameter of the chest from the seventh rib to seventh rib, instead of being greater than that from fifth to fifth as it is in males, is in females considerably less. The difference is greater or less as the stays are worn more or less tight.”
Dr. Dickinson adds: “Below the seventh rib the transverse diameter of the bony cage normally dwindles (Sappey) and from eleventh to eleventh is from one to one inch and a half less than the transverse diameter at the seventh or eighth. Bouvier measured one hundred and fifty subjects of both sexes and all ages, and found this relation constant. The corset increases this difference, and starts the downward taper at the fifth rib instead of at the seventh, Narrowing of the triangle between the cartilages of the lower ribs to a groove of the width of a finger, is the extreme that Engel has sometimes seen.
“The inferior edge of the lung is therefore compressed, and its ability to distend the lower part of the pleural cavity seriously crippled. Compensation in part is effected by the tendency of the corset when firmly adjusted to raise the shoulders — which I find quite constant — forcing the upper lobes to do the breathing, as Sibson has proved, raising the thoracic, or five upper ribs, widening the interspaces (also a constant condition in the female), and in this way expanding the highest part of the conical thoracic cavity.”
He emphasizes the effect on the abdominal organs especially and concludes that “thoracic breathing in women is largely due to corset-wearing.”
Dr. Thomas J. Maya of Philadelphia who investigated the chest movements of the inmates of Lincoln Institute, a school for the education and training of Indian girls, by means of a pneumograph, says: “In this manner, I examined the movements of eighty one chests, and in each case took an abdominal and a costal tracing. While all these girls were Indians, most of them had white blood in their veins, and their ages ranged from ten to twenty years. Thus there were thirty three full blooded Indians, five one fourth, thirty-five one half, and two were three fourths white. (Seventy-five showed a decided abdominal type of breathing, three a costal type, and three in which both were about even. Those who showed a costal type, or a divergence from the abdominal type, came from the more civilized tribes, like the Mohawks and Chippewas, and were either one-half or three-fourths white, while in no single instance did a full blooded Indian girl possess this type of breathing.”
“In figure 2 will be found a tracing which is characteristic of the abdominal type as compared with the costal type of breathing among these Indian girls. The abdominal tracing which is shown in the first half of the diagram, was in each case taken first, and the costal tracing, which is shown in the latter half, was taken afterward.
“When this tracing is compared with that which is obtained from the chest of the civilized male (fig. 3) no practical difference is observed between them.
I think then, it obviously follows that, so far as the Indian is concerned, the abdominal is the original type of respiration in both male and female, and that the costal type of the civilized female, a tracing of which is shown in Fig. 4 is developed through the constricting influence of dress around the abdomen. In other words, the respiratory movements of the female chest have been markedly modified by this influence, and by no other, during the transition period from savage to civilized life. They have, in part, been completely reversed, the abdominal type of the Indian becoming the costal type of the civilized female. This is well shown in the greater prominence of the costal movements in those girls who were either one half or three fourths white “and hence were dominated to a greater or less extent by the influence of civilized blood. While these tracings were being taken, an incident occurred which demonstrated that abdominal constriction can readily modify the movements of the chest during respiration. At my first visit to the school I obtained an exceptionally well developed costal breathing from a full blooded Indian girl. I concluded to repeat this observation at my next visit, and then found that, contrary to my instructions concerning loose clothing etc. this girl had on my first visit worn three tight belts around her abdomen. After these were removed, she gave the abdominal type of breathing which is characteristic of nearly all the Indian girls. I have also succeeded in producing a modification in the cheat movements of the civilized male, similar to that which was observed in the Indian girl, by placing a broad band around the abdomen sufficiently tight to interfere with the motion of the diaphragm. It is also true, on the other hand, that the costal type of breathing is much less pronounced, or may be absent, or may even revert to the abdominal type, in those civilized women who never wore corsets, or practised tight lacing of any kind. This I verified repeatedly with the pneumograph.”
- Dr. Mays finally concludes that “the original type of breathing in both the male and female sex as far as the Indian is concerned, is abdominal, and that the costal type of breathing in the civilized woman has been developed through the indirect influence of abdominal constriction producing greater motion in the upper part of the lungs”.
Does Dr. Mays believe in the Lamarckian theory and mean to assume the questions of heredity to be settled? It should be noted that from his own statements, his tracings were made over clothing of some kind. It would seem to me, when he says that “civilized women who never wore corsets or practised tight lacing of any kind, may revert to the abdominal type”, that he assumes that costal breathing is normal for the modern woman. May it not yet be proved to be an abnormal condition, however common?
- Hasse has studied the changes of the body and the internal organs during respiration. His work, I think, was done entirely on men. In 1893, he published an article discussing at length which was the original type of breathing; he concludes the abdominal to be the original type and the costal a later development which has been superadded.
Dr. J. H. Kellogg gives the following table of waist proportion:
He says: “No physiological reason can be given, and well-known anatomical facts suggest, that if there is any natural difference in proportion, woman requires a larger waist than man. It is interesting to note, also, in this connection, that the waist proportion to height of the Venus de Milo, who may be considered as the typical woman of the ancient Greeks, is 47.7 per cent, while that of the average Grecian man is 46.4.
We can draw but one conclusion from these considerations, namely, that the small waists of the women of modern times are an abnormality. My tables also show the average modern feminine waist to be nearly two per cent larger in proportion to the height than the modern male waist, when it is allowed a chance for natural development.”
He states that the waist of the average girl from 9 to 12 years is 23.5, while that of the young woman from 18 to 30 years who has worn tight clothes or bands is only 23.3 inches. “Why should the waist decrease in size with age while every other bodily dimension increases?” “That the respiratory movements are practically alike in adult persons of the two sexes, I think has been fully established by the observation of Mays, Dickinson and others, as well as by my own studies upon Indian women of various tribes, Chinese women, Italian peasant women, and American women whose breathing has never been interfered with by tight-fitting clothing.”
He presents a number of tracings made by means of a pneumograph on a normal woman, woman in corset, man, man in corset, Indian woman, dog, dog with corset on, etc. In commenting on these, he calls attention to the increase in the time of inspiration as compared with expiration in a subject wearing a corset, as compared with the same subject without the corset; showing the resistance to inspiration. He also speaks of the change in the character of the curves.
Dr. Kellogg compares waist girths with heights rather than with girths of ninth rib and hips, not taking into consideration the type of figure which might take the smaller waists in some cases quite as correct in proportion as the larger. Many of the statements of numbers of cases examined are vague. His material seems to have been gathered from many sources and the data and measurements accepted without question. He entirely ignores the variation in measurements made by different people.
Prof. Sewall and Miss Pollard state that one of the objects of their paper is “to emphasize the physiological relations already known to exist between the different groups of respiratory muscles, and to call attention to the fact that they are frequently simultaneously employed in opposite phases of inspiration and expiration; a class of phenomena here known as the complementary movements of respiration.”
They divide the “respiratory muscular machinery into two separate working groups; the first including the numerous muscles which produce changes in the capacity of the thorax by direct movement of its bony frame work, the second embracing the muscles of the abdominal wall. The mechanical relations of the parts are such that we should expect to find in normal respiration no complete severance of action between the two groups; common observation has, however, given rise to the differentiation of two distinct types of breathing, ‘abdominal’ or ‘diaphragmatic,’ and ‘costal.’
“The latter type may be further subdivided into 1st, ‘Clavicular’ respiration, characterized by isolated lifting of the upper ribs and the clavicles, a mode which teachers of vocal art appear to unite in condemning; 2d, a costal respiration characteristic of males, in which the amplitude of rib movement appears to increase from above downward and is probably chiefly produced by contraction of the external intercostals and levatores costarum; 3d, a costal type, most common in females, in which the movement is chiefly confined to the superior half of the chest, and which may normally involve the action of that great group of muscles which connect the upper ribs and sternum to the shoulder girdle and spinal column.
Experimenters have not yet made clear the physiological relationship of these various mechanisms which are so rarely used as a whole, but all of which subserve the same general purpose in the body. “Looking at the question from an a priori standpoint we should expect to see normal quiet respiration carried on by that group of muscles which with least expenditure of energy could bring about the introduction of the greatest amount of oxygen and the elimination of the greatest amount of carbon dioxide in a given time; the other mechanisms being chiefly reserved for special and excessive respiratory needs. Observation confirms the anticipation that the muscular apparatus used in quiet breathing is largely determined by the modified resistance to inspiratory expansion such as produced by tight fitting clothing or even by the posture of the body.”
They quote extensively from Hutchinson and refer to Bean and Maissiat, Walshe, Sibson, Dr. Mays, Dr. Kellogg and Mosso.
One quotation beside the one previously referred to from Rosenthal I will give in full: “In any case it must be admitted as Rosenthal points out, that costal breathing in females has become more or less firmly fixed by heredity into what Darwin calls ‘a secondary sexual character.’ ”
They call attention to the fact “that movements of the abdominal wall only indicate motions of the diaphragm in so far as these produce an uncompensated change in the volume of the abdominal cavity;” also “a secondary but very important function of the respiratory movement is to aid the circulation of the blood.
“That costal respiration exerts an aspiratory force upon the blood in the veins; that the increase in the thoracic cavity by the descent of the diaphragm also acts in this way but the pressure on the abdominal viscera is an important function in squeezing the blood and lymph out of them toward the heart.”
They studied comparative vital capacity by the use of the costal, then the diaphragmatic method of breathing of the same subjects and found that the costal capacity was greater than the diaphragmatic; “this result agrees with the fact that breathing is always of the costal type when the respiratory needs of the body are unusually urgent.”
They conclude: “That the character and rhythm of the respiratory movements do not for long periods continue unchanged in the same individual”; that “Graphic tracings taken simultaneously from chest and abdomen do not ordinarily manifest that alteration in phase of rib and diaphragm action, which constitutes the complementary movements of respiration.”
The remainder of their article is devoted to “The relation of the so-called complementary movements of respiration” to vocalization, with which we need not here concern ourselves.
Dr. George Fitz of Harvard University writes: “I am on the point of publishing the results of my respiratory work. Altogether I made four hundred and twelve records including boys and girls, college men, American young women, and nearly two hundred men, women and children, at Chicago last summer, of all nationalities there represented, so that I was able to make a fairly complete study of respiration movements of the abdominal chest from the standpoint of nationality, age and dress. The records show distinctly that dress is the main factor; that age and nationality apparently have no effect.”
Quetelet’s work as quoted in the Cyclopedia Britannica was in part at least on the relation of age to respiration rate. He gives the rates as follows:
Dr. Vierordt says “that normal breathing takes place in this wise: inspiration only as active: that is is accomplished by muscular action; expiration, on the contrary, is produced wholly by the elasticity of the lungs, by the weight of the chest wall, and the pressure of the abdominal organs.”
He uses the same relation of age to respiration rate, as that quoted above from Quetelet.
He says further: “The breathing is generally regular, and the single breaths of equal strength; but under the influence of the slightest psychical disturbance it easily becomes irregular and unequal. Many persons of sound health, as snorers in sleep, often breathe irregularly or unequally deeply. Breathing is either exactly or very nearly symmetrical though the left side frequently inclines to breathe a trifle stronger.
The inspiratory enlargement of the thorax is occasioned by the elevation of the ribs and sternum, and the simultaneous drawing of the former upward and outward (intercostales externi and interni muscles — “costal breathing”); moreover, by the contraction of the diaphragm and hence, flattening of its dome. The latter movement, at the same time, draws down the intestines, and so with every inspiration the whole anterior wall of the abdomen projects, but especially the epigastrum . . .
. . . they ascribe as a cause the greater flexibility of the ribs of children and women, which permits the muscles of the chests to act more efficiently upon the ribs.”
All assume that women breathe costally. All the authority for it would seem to be the examination of 24 girls by Hutchinson (although he found 5000 men none to many to base his work on for other purposes); Sibson, who says that after the age of fourteen the form of the chest and the respiratory movements differ materially in males and females, although he previously states that stays are worn at the age of ten; the pathological eases examined by Kellogg, and the study of Prof. Sewall and Miss Pollard on subjects not fully divest d of clothing.
Hutchinson states that there is no structural difference in the thorax or lungs in the two sexes; Hasse has stated that the abdominal type is the original and costal breathing a later development superadded. is it not then still an open question, and worthy of study as to what the type of breathing of the normal, that is, the well developed, properly clothed woman really is? A question to be settled by a series of observations through a period of years. Before this can be settled, must not a comparative study of the normal male and female thorax be made. If it be true that woman’s type of respiration is costal, will not the thorax show a specialization away from the male type?
I have not yet seen M. Henke’s article, “Zur Topographie de Weiblichen Thorax.”
Source: “Respiration in Women: A Report of Progress in a Study of Respiration in the Roble Gymnasium, Leland Stanford Junior University,” by Clelia Duel Mosher, May 1984,” p. 1-29. Hygiene and Physiology of Women, Vol. 1 Respiration, Box 3, Clelia D. Mosher Papers, SC11, Courtesy of the Department of Special Collections, Stanford University Libraries.