193

J. Physiol. (I954) I24, I93-2I2

MOVEMENTS OF THE THORACIC CAGE AND DIAPHRAGM

IN RESPIRATION*
BY 0. L. WADEt
From the Pneumoconiosis Research Unit of the Medical
Research Council, Cardiff
(Received 31 July 1953)
Comprehensive investigations of the movements of the diaphragm were made
shortly after the introduction of radiology by Jamin (1906), Daily (1908) and
Keith (1907, 1909). Jamin and Daily both reported difficulty in measuring
the extent of diaphragmatic movement because in some subjects the whole
chest lifts at the end of deep inspiration and with it the diaphragm which may
lie at a higher level at the end of deep inspiration than at the end of quiet
respiration. Dally attributed this to extension and flexion of the vertebral
column which occurs in some subjects on deep inspiration.
The relationship between movements of the thoracic cage and the dia-
phragm has been investigated by Sewall & Pollard (1890) and Staehelin &
Schutze (1912) who attempted to assess the diaphragmatic component of
respiration by observing changes of circumference of the abdomen, and by
Herxheimer (1949) who recorded ventilation with a spirometer and changes of
chest circumference with a thoracometer designed by Verzar (1946). None of
these workers observed diaphragmatic movements directly. Herxheimer has
suggested that there is dissociation of the movements of the chest and diaphragm
and that at different phases of deep respiration first one and then the other
plays the predominant part in ventilating the lungs.
Wade & Gilson (1951) described a method of measuring diaphragmatic
movement and showed that with changes of posture the extent of dia-
phragmatic movement in both quiet and deep respiration varied little, but
the resting level of the diaphragm at the end of a quiet respiration changed
greatly and the pattern of diaphragmatic movement in relationship to this
resting level showed great changes. These authors realized, however, that
some of their measurements of diaphragmatic movement were unreliable
because vertical movements of the thoracic cage that occurred with respiration
* Part of a thesis accepted for the doctorate of medicine by the University of Cambridge.
t Present address: The Department of Medicine, University of Birmingham.
PH. CXXIV. 13
194 0. L. WADE
distorted the recording and measurement of the diaphragmatic movements.
The studies here reported were made to determine the relationship between
movements of the diaphragm and changes of chest circumference during
respiration, and to determine whether there can be independent movements
of the diaphragm and the chest wall and whether these are under voluntary
control. In this investigation vertical movements of the thoracic cage have
been recorded and measured so that error due to this cause in assessing the
extent of movements of the diaphragm could be eliminated as far as possible.
TABLE 1. Corrections for geometric distortion made to measurements from records of
diaphragmatic movement
Extent of movement of
diaphragm away from
its resting level as
tracked from screen Correction made
(cm) (cm)
0-19 No correction
2-3X9 Subtract 0-5
4-59 Subtract 0-75
6-10 Subtract 1.0
10 or more Subtract 1-3
Side Front

Cross wires
4/< ~~~~~~~~~~~~~~~~~In
screen

Mercury-rn-rubber
transducer Bowden cable
tochest
X-Ray table Expiration

Inspiration

Fig. 1. Diagram showing the method of tracking diaphragmatic movement and of recording
vertical movements of the chest and changes of chest circumference. Inset diagram
illustrates the geometric distortion for which corrections were made.
METHODS
Respiration and diaphragm movements are recorded and measured by the method described by
Wade & Gilson (1951). While a spirogram is being made, the subject is screened and the move-
ments of the shadow of each dome of the diaphragm are tracked on a fluorescent screen (Fig. 1).
Corrections (Table 1) are made for geometric distortion (Fig. 1).
 CHEST AND DIAPHRAGMATIC MOVEMENTS 195
In this investigation vertical movements of the front of the thoracic cage are also recorded.
A small Perspex plate, part of the apparatus for recording changes in chest circumference, is
strapped firmly to the chest wall over the sternoxiphistemal joint and vertical movements are
recorded by a Bowden cable. The tension of the spring loading of this cable is 800 g. Fig. 2
shows a typical recording of respiration, diaphragmatic movement and vertical chest movement.
The nomenclature employed in this study is also shown.
Standing Supine
R.D.M.,
;~_ n ,,Resting
g \ level
Right diaphragmatic
movement
c C.D.M. JV J kINI
L T.D.M. Descent
Resting level LUfting Thoracic
cm
~ ---I vertical
movement

I.C.

Litres IVentilation
V.tres; Ar.V. J Allnst{ nspiration
Resting respiratory level
Expansion
Change of
R.C.M. Resting level chest
cm C.C.CMl _ . on C .M circumference
Time
Fig. 2. Tracing of typical records of movements of the right leaf of the diaphragm, of vertical
movements of the chest and of changes of chest circumference with simultaneous spirogram
made in the supine and erect posture. R.D.M. = Reserve diaphragmatic movement.
C.D.M.=Complemental diaphragmatic movement. T.D.M.=Tidal diaphragmatic move-
ment. I.C.=Inspiratory capacity. E.R.V.=Expiratory reserve volume. T.V.=Tidal
volume. R.C.M.=Reserve chest movement (change of circumference). C.C.M.=Comple-
mental chest movement (change of circumference). T.C.M. =Tidal chest movement (change
of circumference).
The recording and measurement of chest expansion
A modification has been made of a method used by Whitney (1949) to measure changes in limb
volume. A transducer of rubber tubes filled with mercury is wrapped round the chest. Stretching
the tubes lengthens and narrows the columns of mercury and increases their electrical resistance.
These mercury resistances form two arms of a balanced Wheatstone bridge and slight changes in
the balance of the bridge which occur when the resistances vary, are amplified and recorded by
a sensitive galvanometer (Fig. 3 and Appendix).
Design of the transducer
Four 60 cm lengths of rubber tubing of 0.5 mm bore and 1-5 mm external diameter are filled
with mercury and plugged with pins formed from the heads of brass bolts. The bolts are fixed to
two Perspex bars (Fig. 4) and are used as electrical contacts to incorporate the mercury resistances
as part of the Wheatstone bridge circuit. The mercury filled tubing is looped over small pulleys
countersunk into a Perspex plate. The instrument is wrapped horizontally round the chest, the
plate is fixed firmly by strapping to the skin over the lower end of the sternum and the two bars
are clipped together and strapped to the skin over the spine.
13-2
196

1’9 _,~ ~ ~ H.T+

0. L. WADE
Each mercury-filled tube weighs 4 g and its resistance unstretched is 3.5 LI. The weight of the
whole instrument is 300 g. Fig. 5 is a graph showing the changes of tension that accompany
changes of length of the whole instrument.
When the apparatus is fixed around the subject’s chest, the Wheatstone bridge is balanced so
that the galvanometer gives zero reading for the circumference of the chest corresponding to the
resting respiratory level at the end of quiet expiration. The galvanometer gives a deflexion above
zero when the chest contracts in expiration and below zero when it expands on inspiration.
Although the apparatus records changes of chest circumference, it cannot be used to measure the
initial circumference of the chest. This is done with a spring-loaded measuring tape (Morant &
Gilson, 1945) to the nearest half inch when the subject is at the end of a quiet expiration.

Fig. 3. Circuit for mercury-in-rubber transducer and Hughes pen recorder. A and A’, resistance
of mercury-in-rubber transducer. B and R’, coupled variable resistance for balancing bridge
circuit. Details of the circuit are given in an appendix.

Fig. 4. The mercury-in-rubber transducer. The Bowden cable for recording vertical
movements of the chest is attached to the central plate.
Calibration of the instrument
The response of the apparatus to changes in length is found to vary with the current across the
bridge circuit, being more sensitive with high current (up to 400 mA), and when the initial state
of stretch of the instrument is great. Fig. 6 is a graph showing the deflexion of the galvanometer
needle that occurs with changes of length of the apparatus when the bridge circuit has been
balanced (galvanometer reading zero) at an initial length of 30, 34, 36 and 39 in. and with currents
of 230, 325 and 400 mA. Full scale deflexion of the galvanometer needle is 20 mm either side of
zero and within most of this range its response to change of length is almost linear.
Speed of response of the instrument
The recording galvanometer is capable of responding accurately to signals of a frequency of
60 cls. The limiting factor of frequency response is inertia of the maas of the mercury. Fig. 7
shows the response of the instrument when its length is changed manually by 10 cm as rapidly
as possible (about 60 movements to a minute). It gives a full response whether being lengthened
 CHEST AND DIAPHRAGMATIC MOVEMENTS 197
700 I .

0
600~-

500 I

64 400 1- 0
I-
-I

0
300 j-
.
200 1-
0
100 F
0 ! LLII JI ILI L LI1
60 70 80 90 100
Length of tubing (cm)
Fig. 5. Graph showing the tension required to stretch the rubber tubes of the
mercury-in-rubber transducer over the range 60-100 cm.

20 - 0

18-0
16 -

I
14-
12-

r-6
0

x; 4

12

0 ~ ~~~ ~ ~ ~ ~ ~ ~~~~~00-
14 (
28 29 30 3 2 3 4 35 3 7 3 9 4

Fig. 6. Calibration of mercury-in-rubber transducer. Deflexion of galvanometer plotted against

change in length of the strain gauge when balanced (galvanometer reading zero) at initial

length of 30, 34, 36 and 39 in.

 198 0. L. WADE
or shortened and shows no appreciable hysteresis under these conditions, and the response is,
therefore, adequate to record change of chest circumference at the highest rate of respiration
encountered.
The following are points of practical importance:
(1) The apparatus must be kept in the dark when not in use as the rubber tubes perish.
(2) The rubber tubes can be filled with mercury under slight positive pressure with a small
hypodermic syringe and needle.
(3) Amalgam forms at the brass mercury junction and after periods of 3-4 months increases
the resistances of the circuit and causes slight reduction in sensitivity of the instrument.
Forced breathing Vital capacity Manual

cm;

10sec time marker

Fig. 7. Response of the mercury-in-rubber.transducer.
Measurements from the records
The tidal volume, inspiratory capacity and expiratory reserve volume are measured from the
resting respiratory level to the nearest 0 01 1. Volumes are corrected to 370 C fully saturated with
water vapour. The vital capacity is taken as the sum of the two latter corrected volumes.
Measurements of tidal, complemental and reserve diaphragmatic movement are made from the
resting diphragmatic level to the nearest i cm and are corrected for geometric distortion (Table 1).
Measurements are made of vertical movement of the thoracic cage to the nearest i cm. If these
occur they distort the record of the complemental and the reserve diaphragmatic movement
and to correct for this the amount of upward movement of the thoracic cage occurring during
inspiration is added to the complemental diaphragmatic movement, and the amount of downward
movement on expiration is added to the reserve diaphragmatic movement. The total diaphrag-
matic excursion is the sum of the resulting estimates of complemental and reserve diaphragmatic
movement. To estimate the repeatability of measurement of diaphragmatic movement relative
to the thoracic cage an analysis of variance of duplicate measurements of total diaphragmatic
excursion in ten normal subjects (Table 2) was made. The standard error of a single observation is
0 45 cm.
For convenience, changes in the chest circumference are referred to as chest movement,
although they are only one component of the change in shape of the thoracic cage on respiration.
The tidal, complemental and reserve chest movement (Fig. 2), are measured from the resting
level and are expressed in centimetres of change of chest circumference by reference to the
calibration charts appropriate for the current and the initial resting circumference of the chest.
The sum of the complemental and reserve chest movement is the total chest excursion, the
’chest expansion’. Duplicate records of the changes of chest circumference during deep respira-
tion were made in ten subjects. The measurements were submitted to an analysis of variance
(Table 2) and the standard error of a single observation of total chest movement is 057 cm.
Records of total chest excursion made with the apparatus are found to agree closely with
measurements of ’chest expansion’ made in the more usual way with the spring-loaded tape
measure (Tables 3 and 5).
The present method of measuring movements of the diaphragm relative to the thoracic cage is
only approximate. It has been implied that the movements of the shadows of the domes of the
diaphragm are closely related to movements of the whole diaphragm. This cannot be fully justified
but lateral chest radiographs taken at different levels of respiration show that the antero-posterior
 CHEST AND DIAPHRAGMATIC MOVEMENTS 199
contour of the diaphragm does not change greatly even in deep respiration. It is also an approxi-
mation to assume that vertical movements of the diaphragmatic attachments to the thoracic cage,-
can be accurately measured by recording vertical movement of the front of the chest. Most of
the vertical movement is caused by extension and flexion of the vertebral column, and anterior
parts of the chest move more than posterior parts. As the domes of the diaphragm lie anteriorly
and as it is their movement which is being recorded it is reasonable to assume that the domes are
lifted or lowered with vertical movement of the chest to about the same extent as the sternum.
TABLE 2. Analysis of variance of duplicate measurements of total diaphragmatic excursion and
of total chest excursion made in ten normal subjects in the erect and supine postures
Total diaphragmatic excursion (left leaf of diaphragm)
Sum of Degree of Mean
squares freedom squares
Between postures 1-806 1 1-81
Between mean 113-400 9 12-60
Interaction 23-444 9 2-60
Error 4-125 20 0-21
Total variance 142-775
Standard error of a single observation= 0-45 cm.
Total chest excursion
Between postures 2-05 1 2-05
Between mean 98-74 9 10-97
Interaction 9-72 9 1-08
Error 6-51 20 0-33
Total variance 117-02
Standard error of a single observation= 0-57 cm.
The movements of the thoracic cage during respiration are extremely complex (Keith, 1909)
but in this work it has been assumed that the changes which occur in one circumference of the
chest are indicative of the expansion and contraction of the whole of the thoracic cage; this
assumption is only an approximation but its acceptance has allowed a practical approach to be
made to the study of the part played by thoracic cage movements in pulmonary ventilation.

RESULTS
Chest and diaphragmatic movements in quiet and deep respiration
Ten normal male subjects were examined; their ages and anthropometric
measurements are given in Table 3. Each subject was examined in the erect
posture and then in the supine, and in each posture duplicate records of
respiration, of movement of the right and left leaves of the diaphragm, of
vertical movements of the thoracic cage and of changes of chest circumference
were made first while breathing quietly, and then during a deep inspiration
followed by a full expiration. Fig. 2 shows parts of a typical record made in
both postures in one subject.
In this group of subjects the mean height of the iliac crest from the feet is
110-7 cm (standard deviation 6-1). The mean distance of the right leaf of the
diaphragm above the iliac crest when erect, is 19-9 cm (S.D. 1-0) and when
supine it is 23-7 cm (S.D. 1-4). The respective measurements for the left leaf
of the diaphragm being 19-3 cm (S.D. 1-2) when erect and 22-2 cm (S.D. 1-4)
when supine. Although there is a marked change in the resting level of the
200 0. L. WADE
diaphragm with change of posture there is little change in the resting chest
circumference. In the erect posture the mean is 90 5 cm (S.D. 80) and supine
it is 91-6 cm (S.D. 8.0).
TABLE 3. Anthropometric measurements of ten normal subjects in which the relationship of
chest and diaphragmatic movements to respiration was investigated
Chest expansion
measured to the
nearest i in. with
spring-loaded tape
measure and con-
Chest verted to cm (mean
Age Weight Height circumference of 4 observations)
Name (yeain) (kg) (cm) (cm) erect erect
Hy. 36 68 171 102 6-3
Mo. 34 77 168 100 4.5
La. 32 65 174 82-5 12-0
McK. 31 74 185 89 7.6
Re. 30 74 178 87 5-1
Th. 35 68 170 83 5-7
Co. 35 74 184 915 8-3
Ri. 27 82 172 91.5 70
Jo. 35 90 183 100 6-4
Mor. 24 57 160 79 5.1
Range 24-36
Mean 73 175 90 5 6-80
S.D. 9-2 8-0 8-0 2-2
Measurements made during quiet respiration
These are recorded in Table 4. The mean tidal volume erect is 799 ml.
(S.D. 210) and supine it is 758 ml. (S.D. 161). The tidal movement of the right
and left leaves of the diaphragm is almost identical in each subject and
changes little with the change of posture. The mean right diaphragmatic tidal
movement is 1-63 cm (S.D. 0.18) erect and 1-70 cm (S.D. 0.26) supine, and for
the left leaf the respective figures are 1-65 cm (S.D. 0.27) erect and 1-78 cm
(S.D. 0.25) supine. No vertical movement of the thoracic cage is recorded in
any subject during quiet respiration. There is a decrease in the tidal movement
of chest circumference with the change from the erect to the supine posture.
The mean tidal chest movement erect is 1-2 cm (S.D. 0.4) and supine 0-7 cm
(S.D. 0.2).
Measurements made during deep respiration.
These are recorded in Table 5. In deep respiration vertical movements of
the thoracic cage occur. Their extent is very variable from individual to in-
dividual and is most marked at the end of deep inspiration and is always
greater when subjects are erect than when supine. Despite the great differences
in the vertical movement of the thoracic cage in the erect and supine postures
the measurements of the total excursion of the diaphragm relative to the
thoracic cage in these two postures are very similar. The mean total dia-
phragmatic excursion of the left leaf of the diaphragm is 10-28 cm (S.D. 2.23)
erect, and 9-88 cm (S.D. 1.57) supine.
 CHEST AND DIAPHRAGMATIC MOVEMENTS 201
The change in the resting level of the diaphragm with change of posture
leads, however, to considerable changes in the pattern of diaphragmatic
movement. When erect the mean complemental movement of the left dia-
phragm is 6-35 cm (S.D. 0.97) and the mean reserve diaphragmatic movement
is 3-93 cm (S.D. 1.62). When supine the mean complemental movement is
7-95 cm (S.D. 1.32) and the mean reserve diaphragmatic movement is 1F93 cm
(S.D. 0.70). Measurements of movements of the right leaf of the diaphragm
are similar throughout to movements of the left leaf-but are slightly smaller.
TABLE 4. Measurements of diaphragmatic movement, changes of chest circumference and
ventilation in ten normal subjects during quiet respiration in the erect and supine postures
Tidal diaphragmatic movement Tidal chest
(cm) (mean of 2 measurements) Tidal volume movement (cm)
r A- 5 (ml.) (mean of (mean of
Subject Right leaf Left leaf 4 measurements) 4 measurements)
ERECT
Hy. 1.50 1*75 1250 1-6
Mo. 1*75 1.50 800 1.4
La. 1.50 1.50 575 0-8
McK. 2-00 1-75 700 1.1
Re. 1.50 1.50 980 1.5
Th. 1-50 1*50 650 1.1
Co. 1-75 1-75 950 10
Ri. 1.50 1-75 580 0-6
Jo. 1.50 1*25 700 0-7
Mor. 1-75 2-25 800 2-0
SUPINE
Hy. 2-00 1.50 1150 0-6
Mo. 1-75 2-25 780 05
La. 2-00 2-00 600 04
McK. 1.50 1-75 600 0-4
Re. 2-00 1-75 750 0.8
Th. 1*50 1-50 600 0*9
Co. 1*50 1-50 780 1.0
Ri. 1-25 1-75 750 1.0
Jo. 1-75 1-75 810 05
Mor. 1*75 2-00 760 0-8
A similar change in the pattern of respiration as judged by spirometry is
observed in all subjects. The mean vital capacity is 4-86 1. (S.D. 0 84) erect and
4-801. (S.D. 0.77) supine, but in the erect posture the mean inspiratory
capacity is 3-17 1. (S.D. 0-45) and the mean expiratory reserve volume is
1*68 1. (S.D. 0.52) and in the supine posture these are respectively 3-87 1.
(S.D. 0.54) and 0-93 1. (S.D. 0.32).
No such change in the pattern of chest movement is found. The mean total
chest excursion is 7-4 cm (S.D. 1F8) erect and 7-7 cm (S.D. 1.7) supine, the mean
complemental chest movement is 5-9 cm (S.D. 1.5) erect and 6-0 cm (S.D. 1.6)
supine and the mean reserve chest movement is 1P5 cm (S.D. 0.6) erect and
1-8 cm (S.D. 0.5) supine.
The duplicate measurements of diaphragmatic movement, of respiratory
ventilation and of changes of chest circumference made in the two postures
 _
202 0. L. WADE

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 CHEST AND DIAPHRAGMATIC MOVEMENTS 203
were submitted to analysis of variance. Variance due to change of posture
constitutes 80 and 87%, respectively, of the total variance observed of
complemental and reserve diaphragmatic movement but only constitutes
13% of the variance of measurements of total diaphragmatic excursion.
Similarly the variance due to posture constitutes 81 and 87 %, respectively,
of the total variance observed of inspiratory capacity and expiratory reserve
volume measurements but only a small proportion of the variance of vital
capacity measurements. In contrast, in measurements of change of chest
circumference the variance due to posture is only 7 and 12 %, respectively,
of the total variance found in measurements of complemental and reserve
chest movements.
The relationship between diaphragmatic and chest movements and the
volume of air ventilated
The relationships between the movement of the diaphragm and the changes
of chest circumference and the volume of air ventilated are extremely variable
from subject to subject and the regression coefficients obtained are not
statistically significant. This is to be expected in view of the arbitrary nature
of the measurements used as representative of the diaphragmatic movement
and chest movement. A movement of the shadow of the diaphragm of
a centimetre or a change of chest circumference of a centimetre would not be
expected to be associated with the same amount of ventilation in two indi-
viduals of different build.
It is possible however to consider the mean values of movement of both
leaves of the diaphragm, chest movement and respiratory ventilation in the
group, and the following equations can be postulated for each posture and
can be solved simultaneously.
Equation 1 (erect)
5-6 cm complemental diaphragmatic movement + 5-9 cm complemental chest
movement_ 317 1. ventilated.
Equation 2 (supine)
7*7 cm complemental diaphragmatic movement + 6-0 cm complemental chest
movement- 3 87 1. ventilated.
This gives the result:
1 cm of complemental diaphragmatic movement 0-33 1. ventilated.
1 cm of complemental chest movement =0-22 1. ventilated.
Similar equations can be postulated for the expiratory reserve volume and
when solved give the result:
1 cm of reserve diaphragmatic movement-0-37 1.
1 cm of reserve chest movement =0-17 1.
204 O. L. WADE
These figures suggest that in a full vital capacity about one-quarter of the
ventilation is due to chest expansion and three-quarters to diaphragmatic
movement.
These estimates must be treated with extreme reserve for a number of
assumptions have been made. It has been assumed that respiratory ventilation
can be expressed solely in terms of diaphragmatic movement and chest
movement, as measured by the methods described, and that its relationship
to these movements is linear, and, further, other factors which must affect
the respiratory volumes such as changes in the volume of blood in the thorax
have been neglected.
The co-ordination of chest and diaphragm movements
There is no evidence in any of the records reported above that in any part
of deep inspiration or expiration, the movements of the diaphragm and the
changes of chest circumference are dissociated. But it is found that lifting of
the thoracic cage tends to occur mainly at the end of full inspiration. This
movement, variable from individual to individual, appears to be produced
mainly by movements of extension of the vertebral column, but its presence
or absence makes little difference to the extent of diaphragmatic movement,
or to the ventilation.
Three subjects were examined by the method ingeniously devised by Herx-
heimer (1949). While records of respiration and of chest and diaphragmatic
movements were being made, each subject was asked to start a deep inspira-
tion, to pause for 3 sec when the inspiration was half completed and then to
finish the inspiration; they were then asked to breathe out pausing at the
same level of respiration again. The interruptions of respiration were recorded
on the spirogram and were accompanied by interruptions of the records of
chest and diaphragmatic movement (Fig. 8), so that it was possible to find
from the records whether a volume of air inspired was accompanied by the
same amount of movement of the chest and diaphragm when it was expired.
None of the records give support to the suggestion that the beginning of
expiration after a deep inspiration is accompanied by much movement of the
diaphragm and by little change of chest circumference. Vertical lifting of the
thoracic cage occurs mainly near the end of deep inspiration, but the chest is
lowered steadily throughout the expiration of the complemental air till it is
again at its resting level and in some subjects it is further lowered during the
expiration of the expiratory reserve volume.
Voluntary control of the chest and diaphragmatic movements
It is claimed by physiotherapists (MacMahon, 1934; Asthma Research
Council, 1937) that it is possible to control the chest and the diaphragm
separately by voluntary effort during respiration.
 CHEST AND DIAPHRAGMATIC MOVEMENTS 205
Four subjects, one a trained physiotherapist, one a teacher of singing and
two patients who had training in breathing exercises, all claiming to be able
to take breaths that were predominantly ’thoracic’ or ’diaphragmatic’, were
examined in the erect posture. Each subject was asked to breathe quietly
and then to inspire and expire as fully as possible, attempting on the first
occasion to use the chest predominantly and on the second the diaphragm

Right diaphragm
Descent

cm
I ~~~~~~~~Lifting
I- 1 Vertical chest
movement

cm _ _ I
~~~~~~~
- C~~~hange of chest
ci rcumference

Fig. 8. Tracing of records of respiration, diaphragmatic movement, vertical chest movement

and changes of chest circumference showing the effect of pausing d’uring the inspiration
and exrpiration of the inspiratory capacity. The record of vertical chest movement i8 displaced
8 mm to the left.

predominantly, while records of respiration, movements of the diaphragm,

vertical movements of the thoracic cage and changes of chest exrpansion were
recorded. Tracings of part of the record from one of the subjects and the
measurements made from the original record are given in Fig. 9. These experi-
ments show that the main difference between these two breaths, each with
approximately the same ventilation, is the difference in the vertical movement
of the thoracic cage; the diaphragmatic movement, measured relative to the
thoracic cage, is substantially the same in the ’ costal ’ and the ’ diaphragmatic ’
206 0. L. WADE
breaths. But in the ’diaphragmatic breathing’ the thoracic cage is not lifted
during inspiration and the anterior abdominal wall is protruded, and in the
’costal breathing’ the thoracic cage is lifted very greatly during inspiration
and the abdominal wall is retracted and becomes scaphoid at the end of deep
inspiration. The subjects all believed that movements of the diaphragm were
indicated by the movements of the anterior abdominal wall; when the anterior
’Diaphragmatic ’Costal
respiration’ respiration Right diaphragm
g
+, \\~~~~~VSt
~~ Descent

- \ > ~~~~~~~~~~~~~Lifting
Vertical chest
movement

Litres Inspiration

Spirogram

Expansion
cm _ _ - >
Change of chest
ference
circum
Fig. 9. Tracing of records made when a subject took a deep breath attempting to use the chest
predominantly and then attempting to use the diaphragm predominantly. Standing.
’Diaphragmatic ’Costal
respiration’ respiration’
Ventilation (1.) 4.3 4*2
Total diaphragmatic excursion (cm) 10.5 12-5
Total chest movement (cm) 6-2 741
(change of circumference)
abdominal wall was protruded at the end of inspiration they assumed the
diaphragm had descended greatly, and when it was retracted at the end of
a full inspiration they assumed it had not descended at all.
There is no evidence that the diaphragm is under any direct voluntary
control; the extent of its movement seems to be determined entirely by the
depth of breath that is taken and it is under voluntary control only in the
sense that respiration is under partial voluntary control.
 CHEST AND DIAPHRAGMATIC MOVEMENTS 207
The vertical movements of the thoracic cage are caused by flexion and
extension of the vertebral column; these movements can be completely
controlled by voluntary effort.
Although subjects have no direct control over the diaphragm during respira-
tion, they have some direct control over movements of expansion and
contraction of the chest for they are sometimes able to inhibit these move-
ments when they attempt to use the diaphragm alone. The physiotherapist
believed that she had more separate control over the diaphragm and the chest
’Diaphragmatic respiration’ ’Costal respiration’
Right diaphragm
}_ \ > ~~~~~~~~~~~Descent
cm

Lifting
Vertical chest
movement

Spirogram
Litres Inspiration
TJ Y
0r1I
Expansion
cm [F 4
Change of chest
circumference
Fig. 10. Tracing of records made during deep ’costal’ and ’diaphragmatic’ breaths in the supine
posture.
’Diaphragmatic ’Costal
respiration’ respiration’
Ventilation (1.) 2-80 3-08
Total diaphragmatic excursion (cm) 8-50 8-25
Total chest movement (cm) 2-8 5.6
(change of circumference)
when she was supine than when she was standing. Fig. 10 is a tracing of part
of the records made from this subject when supine, and it shows that although
the extent of diaphragmatic movement was almost identical in the costal and
the diaphragmatic breaths, the complemental chest movementwas considerably
reduced when she attempted to use the diaphragm alone.
After examining the records this subject suggested that she might find it
possible to be able to move the chest or the diaphragm alone if she only took
small breaths. Fig. 11 is a tracing of part of the records of one of her most
successful attempts. Over a very limited range of ventilation she had con-
208 0. L. WADE
siderable control over movements of expansion and contraction of the chest,
but diaphragmatic movement was only slightly smaller when she used her
’ chest alone’ than when she used the ’diaphragm alone’, even though she was
making very great efforts not to use the diaphragm.
’Chest alone’ ’Diaphragm alone’

Right diaphragm
cm Descent

. - ~~~~~~~~~~~~~~~~~Lifting
Vertical chest
movement

Litres Spirogram

4I
Inspiration

Expansion
cm
Change of chest
circumference

Fig. 11. Tracings of records made when a subject tried to breathe using the ’diaphragm alone’
and then the ’chest alone’.
’Diaphragm
’Chest alone’ alone’
Ventilation (1.) 1-70 1’58
Diaphragmatic movement (cm) 4’0 5’0
Change of chest circumference (cm) 3’9 1.1

Forced respiration
Fig. 12 is a tracing of part of some records of diaphragmatic movement,
vertical movement of the thoracic cage and chest expansion made while
untrained normal subjects were hyperventilating. Unfortunately it was not
possible to make simultaneous records of respiration as the resistance of the
closed circuit and the characteristics of the spirometer, although otherwise
satisfactory, were unsuited for recording rapid respiration. The records show
that in these subjects the diaphragmatic movement and the chest expansion
movements that occur in forced respiration occur in the range of movements
associated with the complemental diaphragmatic movement and the comple-
mental chest movement. They also show that during forced respiration there
 CHEST AND DIAPHRAGMATIC MOVEMENTS 209
is very marked and rapid vertical movement of the thoracic cage which is in
the opposite direction to the movements of the diaphragm and which seems
to aid the rapid movements of the diaphragm which are needed in this
artificial form of forced respiration. The most interesting finding is that in all
subjects the chest circumference is increased at the beginning of this forced

Right diaphragm
v 0\j4ivF Descent

Lifting
cm 4
Vertical chest
movement

Expansion

Change of chest
_______________________ circumference
Fig. 12. Tracing of records made during forced hyperventilation.

respiration but in many subjects the movements of the chest about this
increased circumference are small. This increased circumference of the chest
is only maintained as long as subjects make an effort to continue the forced
breathing, and it is possible that the increase in circumference increases the
ventilatory efficiency by increasing the effective area of the diaphragm.
Verzar (1946) has previously shown that the chest circumference is increased
during exercise.
DISCUSSION
Many workers, Dally (1908), Keith (1909) and Wade & Gilson (1951), have
reported that the diaphragmatic movement in quiet respiration is about
1-2 cm and this is here confirmed. Herxheimer’s (1949) assumption that the
diaphragm moves more in the erect posture than in the supine during quiet
respiration has not been confirmed.
Most previous investigators have found the full excursion of the diaphragm
in deep breathing to be about 5-7 cm. Keith (1907) and Daily (1908) found
smaller movements. The larger movements recorded in this investigation are
due to the regard given to vertical movements of the thoracic cage. These
PH. CXXiV. 14
210 O. l. WADB
movements are variable from subject to subject and are more marked in the
erect posture than in the supine. It is to variations in these movements that
the main difference between so-called ’costal’ and ’diaphragmatic’ respiration
is due, and movements of the anterior abdominal wall have been shown to be
no indication of the extent of diaphragmatic movement in respiration. In
a full vital capacity it has been shown that movement of the diaphragm plays
a larger part in ventilating the lungs than does change of circumference of the
chest. The diaphragm is directly affected by postural redistribution of visceral
weight and the consequent changes in the pattern of its movement clearly
reflect the well-known changes in lung volume similarly induced.
No evidence has been found that subjects have any direct control over the
diaphragm except in as much as they have some control over respiration.
This confficts with opinions that are widely held by many physicians and
physiotherapists. It supports the concept (Jones, 1926) that there can only
be cortical voluntary control over movements of which man has conscious
knowledge, and that no such control can be exerted over individual muscles or
over structures such as the diaphragm which are inaccessible to direct observa-
tion and of which there is no postural sensibility that reaches consciousness.
The thoracic cage is a large and massive structure and the redistribution of
visceral weight that occurs with change of posture makes little difference
either to its circumference or to the pattern of its movement. The smallness
of the movements of chest expansion during rapid forced respiration may be
related to the mass and inertia of the thoracic cage. Movements of chest
expansion differ from diaphragmatic movements in that they can to some
extent be inhibited voluntarily, at any rate in trained subjects.
SUMMARY
1. A method of recording and measuring movements of the diaphragm
relative to the thoracic cage, is reported and a mercury-in-rubber strain
gauge for recording and measuring changes in chest circumference is described.
The accuracy and repeatability of the measurements have been investigated.
2. The relationship between diaphragmatic movements, chest movements
and ventilation has been investigated in ten normal subjects.
3. In quiet respiration the tidal diaphragmatic movement is about 1-5 cm.
The tidal change in chest circumference is about 1-2 cm when the subjects
are erect, and 0*7 cm when supine. In deep respiration the total diaphragmatic
excursion is between 7 and 13 cm and the change in chest circumference is
between 5 and 11 cm. The measurements suggest that in a full vital capacity
about one-quarter of the ventilation is due to chest expansion and three-
quarters to diaphragmatic movement.
4. The change from the erect to the supine posture causes a marked change
in the pattern of movement of the diaphragm about its resting level. This
 CHEST AND DIAPHRAGMATIC MOVEMENTS 211
change parallels the change in the pattern of the inspiratory capacity and the
expiratory reserve volume that accompanies the change in posture. No such
change in the pattern of movements of chest expansion is found.
5. There is close co-ordination between movements of the diaphragm and
movements of chest expansion. An exception to this is found during voluntary
hyperventilation.
6. Vertical movements of the thoracic cage occur in some subjects mainly
at the end of deep inspiration and are usually most marked when they are
standing. The movements are caused by flexion and extension of the vertebral
column. They seem to play little part in ventilating the lungs. They are
especially marked during voluntary hyperventilation and here they may aid
the rapid and large movements of the diaphragm that occur.
7. No evidence has been found that subjects have any direct voluntary
control over the diaphragm. Movements of the anterior abdominal wall do
not indicate the extent of diaphragmatic movements. There is evidence that
some subjects are able to inhibit changes of chest circumference during
respiration.
I wish to acknowledge the advice and helpful criticism I received at every stage of this work
from my colleagues at the Pneumoconiosis Research Unit, and in particular from the Director,
Dr C. M. Fletcher. I am deeply indebted to Mr A. D. Thomas who designed the amplifying
circuit and to Messrs Dunlop Special Products Ltd., who supplied the fine-bore rubber tubing.

APPENDIX
The bridge circuit and amplifying circuit of the mercury-in-rubber tran8ducer
1. The bridge circuit
(a) The circuit consists of a basic Wheatstone bridge (Fig. 3) where A and A’ are two mercury-
in-rubber transducers and R and R’ are two equal variable resistances mechanically coupled.
When the bridge is balanced, any slight change in the value of A, A’ or of both, upsets this balance
and gives rise to an out of balance voltage across the junctions b and d of the bridge.
(b) By making the mercury-in-rubber transducer in two halves, A and A’, and connecting
them as the opposite arms ab and cd of the bridge, the sensitivity of the instrument is twice that
which it would be if both transducers were incorporated as one arm of the bridge only.
(c) By mechanically linking the two equal variable resistances R and R’ it is possible to bring
the bridge to a balance at the initial length of the mercury-in-rubber transducers. In practice
this means that the bridge can be balanced whatever the resting level of chest circumference of
an individual.
(d) For any given value of A, A’, R and R’ the sensitivity of the instrument is varied by altering
the flow of current across the bridge; this is done by means of a small variable resistance in
series with the battery, the current being indicated by a milliameter in the battery circuit.
2. The amplifying circuit
(a) Since the output signal from the bridge is small a considerable degree of direct coupled
(d.c.) amplification is necessary to drive the recording pen, which like most commercial fast-
recording instruments needs about 5 W. Conventional d.c. amplifiers are rather unstable and to
eliminate this error as much as possible, a two-stage amplifier with valves in push-pull is used.
Any change of the high tension voltage is thus compensated for as it affects both valves simul-
taneously and there is no need for elaborate regulations of the power supply.
14-2
212 0. L. WADE
(b) The recording instrument, a Hughes pen recorder, has a centre tapped coil. This is con-
nected to the anode circuits of both the output valves and it is then possible to make use of the
full-scale deflexion of the instrument either side of its zero.
(c) The recording instrument can be switched out of the circuit, compensating resistors being
automatically switched in so that the amplifying characteristics of the circuit remain unchanged.
This arrangement prevents the delicate galvanometer being damaged when the instrument is
being adjusted on subjects.
(d) The sensitivity of the recording instrument at any frequency between zero and 60 c/s is
nowhere more than 6 % different from its sensitivity at zero frequency.

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