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June 1930


Arch Surg. 1930;20(6):1016-1020. doi:10.1001/archsurg.1930.01150120134007

In this paper I shall point out in what manner adhesions between the diaphragm and the wall of the chest can act to further the healing of pulmonary tuberculosis and how, in their presence, the production of diaphragmatic paralysis may be harmful rather than beneficial.

As a basis for this consideration, one must accept the fundamental proposition that movement of a tuberculous lung discourages healing while rest favors it.

Since the time of Galen there has been active discussion concerning the effect of contraction of the diaphragm on the ribs to which it is attached. Galen1 believed that it raised them slightly. Borelli1 and later von Haller1 were of the opinion that it tended to draw them downward. In 1853, Duchenne,2 of Boulogne, presented the results of experiments on dogs, horses and human beings, which seemed convincing substantiation of the earlier conception of Galen. In 1896,