the reason that I now give has been evolved from my own brain or whether I have learned it from others.
When a man is sitting upright the diaphragm moves up and down during respiration (Fig. 16). At each inspiration it descends and displaces the intestines and the abdominal walls outward.
During each expiration the diaphragm ascends and the intestines and abdominal wall return back to their former position. In the upright posture the diaphragm moves vertically, but the abdominal walls and intestines move in a horizontal plane and there is no lifting work for the diaphragm to do. The case is quite different when a man is lying on his back, for then the diaphragm moves in a horizontal plane and the abdominal walls and intestines in a vertical one. During inspiration as the diaphragm encroaches on the abdomen for the purpose of enlarging the thorax (Fig. 17) it has actually to raise the intestines and the abdominal walls instead of merely moving them in a horizontal plane. As the diaphragm returns into the thorax during inspiration its progress will be accelerated by the weight of the descending intestines, and thus the recumbent posture may be sometimes useful in cases of bronchitis with emphysema, and so such cases may be seen sometimes lying down although there is considerable interference with the aëration of the blood. In cases of cardiac disease no benefit of this kind is obtained, and therefore we find that a large proportion of those whom we see sitting upright in bed in a hospital ward are suffering from disease of the heart.
When a patient lies upon his side the intestines also move in a horizontal plane, and this is the position usually assumed during healthy sleep, for in it there is no interference with expiration any more than when the patient is sitting upright, while at the same time the rest obtained is much more complete. The side upon which one lies is immaterial to most healthy persons, and they frequently lie first upon one and then on another, turning over perhaps several times in the course of the night; but in cardiac disease or cardiac irritability without organic disease patients frequently are unable to lie upon the left side because the heart beats against the ribs with such force as to cause physical discomfort. At the same time the heart itself appears to be stimulated by the blows which it gives itself against the thoracic walls and to palpitate more violently than before. The patient is therefore obliged to lie upon the right side. A similar result
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