loss of heat from the intestinal vessels. Many people are unable to get to sleep when they are at all cold; and Rosenthal has shown that this attitude is commonly adopted by men, dogs, and other animals when preparing to sleep, so as not only to maintain the bodily temperature during sleep, but to allow the intestinal vessels to dilate and accommodate a mass of blood which would otherwise be driven into the cerebral circulation, stimulating it to functional activity and keeping the person or animal awake.
The attitude of the body may be altered permanently by occupation or disease in such a way that one accustomed to pay attention to this subject can frequently make out, with a little trouble, a good deal regarding the patient's history and illnesses. Thus, a chronic cough has the effect of inflating the chest and rounding the back, so that one might almost guess from the figure (15) that the person so shaped was liable to chronic bronchitis. The more tightly a bladder is blown up with air the more tense does it become
|Fig. 15.||Fig. 16.|
and the more does it take a circular form. In the same way the more an alveolus of the lung is blown up by the efforts of coughing the more does it resemble the inflated bladder. What is true of a single alveolus is true of the chest as a whole. It tends as nearly as possible to become globular, with a circular outline not only in the transverse but in the longitudinal direction. The sternum and vertebræ prevent it from becoming completely globular, notwithstanding all efforts, and it thus assumes the barrel shape so characteristic of emphysema, as being the nearest possible approach to a globe. In going through a hospital ward one sees here and there patients who are constantly sitting up in bed and do not lie down at all; these are for the most part people who have great difficulty of breathing. The reason for this position has no doubt been often given, but I do not recollect coming across it in print and I can not say whether