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History of Respiratory Mechanics Prior to World War II

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Abstract

The history of respiratory mechanics is reviewed over a period of some 2,500 years from the ancient Greeks to World War II. A cardinal early figure was Galen (130‐199 AD) who made remarkably perceptive statements on the diaphragm and the anatomy of the phrenic nerves. The polymath Leonardo da Vinci (1452‐1519) contributed observations on pulmonary mechanics including the pleural space and bronchial airflow that still make good reading. Vesalius (1514‐1564) produced magnificent illustrations of the lung, ribcage, and diaphragm. In the 17th century, the Oxford School including Boyle, Hooke, Lower, and Mayow were responsible for many contributions on mechanical functions including the intercostal muscles and the pleura. Hales (1677‐1761) calculated the size and surface area of the alveoli, the time spent by the blood in the pulmonary capillaries, and intrathoracic pressures. Poiseuille (1799‐1869) carried out classical studies of fluid mechanics including one of the first demonstrations of flow limitation in collapsible vessels. The culmination of the pre‐World War II period was the outstanding contributions of Rohrer (1888‐1926) and his two Swiss countrymen, Wirz (1896‐1978) and von Neergaard (1887‐1947). Rohrer developed the first comprehensive, quantitative treatment of respiratory mechanics in the space of 10 years including an analysis of flow in airways, and the pressure‐volume behavior of the respiratory system. von Neergaard performed landmark studies on the effects of surface tension on pressure‐volume behavior. Progress over the 2,500 years was slow and erratic at times, but by 1940 the stage was set for the spectacular developments of the next 70 years. © 2012 American Physiological Society. Compr Physiol 2:609‐619, 2012.

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Figure 1. Figure 1.

Portrait of Galen. This was originally in the Juliana Anicia manuscript from the year A.D. 487, but has recently been retouched. Adapted, with permission, from .

Figure 2. Figure 2.

As described by Leonardo “… the diaphragm could not function if its extremities are not well fastened, because without this stability diaphragm would pull the ends of the ribs, and the thorax would contract instead of the necessary dilation, … but Nature has provided for this by means of the muscles which raise the ribs from m c b to m c n and from m f h to m f g, and in that way the chest dilates itself and the lung must increase with it, because there is no vacuum; and to fill this vacuum the air enters with the expansion of the lung.” (Times font letters added for clarity, since Leonardo's letters are all written from right to left.)

Figure 3. Figure 3.

One of the plates of the book by Vesalius, De Humani Corporis Fabrica (1543). This is Plate 30 and shows the thoracic cage with the diaphragm including the openings for the vena cava, esophagus, and aorta. Adapted, with permission, from .

Figure 4. Figure 4.

A figure from Mayow's Tractatus quinque medico‐physici showing the ribs and the internal and external intercostal muscles (Figs. 1‐4), the articulation of the ribs with the vertebra (Fig. ), and a bellows model to clarify how the lung is expanded when the chest wall increases in size (Fig. ). Adapted, with permission, from .

Figure 5. Figure 5.

U‐tube manometers invented by Hales and used here to measure the pressures developed by sap in a vine. Adapted, with permission, from .

Figure 6. Figure 6.

Memorial erected to the memory of John Hutchinson in Levuka, Fiji. The silhouette is a copy of an illustration in Hutchinson (1846). Adapted, with permission, from .

Figure 7. Figure 7.

Maximum expiratory and inspiratory pressure curves (I and II) together with the relaxation pressure‐volume curve (V). Also shown are the maximal expiratory muscular force (III) and the maximal inspiratory muscular force (IV). The pressure on the vertical axis is in cm H2O. Adapted, with permission, from .

Figure 8. Figure 8.

Early model of lung distortion suggested by Orsos. He considered the lung as an elastic sheet containing holes and argued that when it was expanded vertically, the holes of the top would expand more than those at the bottom because of the smaller cross‐sectional area near the apex. Adapted, with permission, from .

Figure 9. Figure 9.

Deflation pressure‐volume curves of the left lung of a hog. a is for air filling, b is for saline filling, and c is therefore the calculated elastic recoil force due to surface tension alone. The vertical scale shows the pressure in cm H2O and the horizontal scale shows the volume in milliliters. Adapted, with permission, from .



Figure 1.

Portrait of Galen. This was originally in the Juliana Anicia manuscript from the year A.D. 487, but has recently been retouched. Adapted, with permission, from .



Figure 2.

As described by Leonardo “… the diaphragm could not function if its extremities are not well fastened, because without this stability diaphragm would pull the ends of the ribs, and the thorax would contract instead of the necessary dilation, … but Nature has provided for this by means of the muscles which raise the ribs from m c b to m c n and from m f h to m f g, and in that way the chest dilates itself and the lung must increase with it, because there is no vacuum; and to fill this vacuum the air enters with the expansion of the lung.” (Times font letters added for clarity, since Leonardo's letters are all written from right to left.)



Figure 3.

One of the plates of the book by Vesalius, De Humani Corporis Fabrica (1543). This is Plate 30 and shows the thoracic cage with the diaphragm including the openings for the vena cava, esophagus, and aorta. Adapted, with permission, from .



Figure 4.

A figure from Mayow's Tractatus quinque medico‐physici showing the ribs and the internal and external intercostal muscles (Figs. 1‐4), the articulation of the ribs with the vertebra (Fig. ), and a bellows model to clarify how the lung is expanded when the chest wall increases in size (Fig. ). Adapted, with permission, from .



Figure 5.

U‐tube manometers invented by Hales and used here to measure the pressures developed by sap in a vine. Adapted, with permission, from .



Figure 6.

Memorial erected to the memory of John Hutchinson in Levuka, Fiji. The silhouette is a copy of an illustration in Hutchinson (1846). Adapted, with permission, from .



Figure 7.

Maximum expiratory and inspiratory pressure curves (I and II) together with the relaxation pressure‐volume curve (V). Also shown are the maximal expiratory muscular force (III) and the maximal inspiratory muscular force (IV). The pressure on the vertical axis is in cm H2O. Adapted, with permission, from .



Figure 8.

Early model of lung distortion suggested by Orsos. He considered the lung as an elastic sheet containing holes and argued that when it was expanded vertically, the holes of the top would expand more than those at the bottom because of the smaller cross‐sectional area near the apex. Adapted, with permission, from .



Figure 9.

Deflation pressure‐volume curves of the left lung of a hog. a is for air filling, b is for saline filling, and c is therefore the calculated elastic recoil force due to surface tension alone. The vertical scale shows the pressure in cm H2O and the horizontal scale shows the volume in milliliters. Adapted, with permission, from .

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How to Cite

John B. West. History of Respiratory Mechanics Prior to World War II. Compr Physiol 2012, 2: 609-619. doi: 10.1002/cphy.c080112