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APPENDIX A

Thoracic Surgical Unit for 803d and 15th Hospital Centers 160th General Hospital

INSTRUCTIONS FOR THE PATIENT

In the past, people who have had injuries or diseases of the chest have been left deformed. You have had such an injury. You can look in the mirror and see this deformity. Your injured side does not move, when breathing, as well as your good side. In severe cases, the head and neck are shifted to the injured side-the shoulder on that side is lower-the chest is sunken, there is curvature of the spine, and the hips are tilted. This deformity of the head, neck, shoulder, chest, spine, and hips, labels a man as a "chest cripple" (fig. 1).

When the chest does not expand, the lung does not move; and when the lung does not move it becomes diseased.

There is no reason to have "chest cripples" because we now know how to prevent this tragedy with SPECIFIC REMEDIAL BREATHING EXERCISES and proper calisthenics. The use of breathing exercises for 10 minutes in every hour is a small price to pay for health.

SOLDIER, WE'VE TRIED TO CONVINCE YOU; YOU HAVE TO BE CONVINCED BEFORE YOU'LL TRY; AND YOU HAVE TO TRY IN ORDER TO GET RESULTS. FOLLOW INSTRUCTIONS AND LOOK AT YOUR CHEST IN THE MIRROR AND YOU'LL BE CONVINCED.

SOLDIER, IT'S YOUR CHEST, YOUR BODY, YOUR HEALTH AND YOUR LIFE!!

Specific Remedial Breathing Exercises

There are three main types of breathing exercises, (a) lower chest (fig. 2); (b) upper chest (fig. 2); and (c) diaphragmatic (fig. 3). You should become so expert with these that you will be able to breathe with your injured side alone-without moving your normal side. You will even do better than this before long-you will be able to breathe with the upper or lower part of the injured side, as you like. This sounds like a circus act, and certainly you didn't know that a person could train himself to breathe with one or the other side of his chest-much less part of one side-but you can if you concentrate and persist.

Do each of the three types of exercises six times with a few seconds' rest between each group of six. If you do not rest a few seconds, you will get dizzy. Take in as much air as possible, and force out as much as you can each time. After 6 lower chest, 6 upper chest, and 6 diaphragmatic exercises, run through them again, and again and AGAIN for 10 minutes. DO THIS EVERY HOUR.

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FIGURE 1.-Classical deformity of the fused left chest with remedial breathing exercises.

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FIGURE 2.-Lower chest. Place your hand flat on the lower chest wall of your injured side. The finger tips should come just to the rib margin. Rest your hand lightly on the surface as you take in air slowly through your nose (inhale). Press firmly to help force air out through the mouth as you exhale. Take in as much air as possible then push out as much as you can. CONCENTRATE ON MOVING THE ONE SIDE. YOUR HAND HELPS LOCALIZE THE AREA THAT YOU ARE TRYING TO USE. WATCH YOUR HAND MOVE AND CONCENTRATE AS THE CHEST PUSHES IT OUT ON INSPIRATION AND AS YOUR HAND PUSHES THE CHEST IN ON EXPIRATION.

FIGURE 2.-Continued. Upper chest. Same principle as lower chest exercise but the hand from the opposite side is used. The fingers fall just below the collar bone. It is more difficult to gain upper chest control, but as you can see in the mirror, this is an especially important area as it is generally badly sunken.

CALISTHENICS

You will have a period of calisthenics every day, and these are very important too, but do not confuse your breathing exercises with calisthenics. Your calisthenics will straighten your spine, set your head straight on your shoulders, put your hips back in line and get you so that you can raise your arms above your head. Soon you will not look like a human question mark-or a feeble old man carrying a bucket of lead.

CONCENTRATE-PERSIST-CARRY YOURSELF STRAIGHT-WATCH YOUR PROGRESS IN THE MIRROR

IT'S YOUR CHEST-YOUR BODY-YOUR HEALTH-YOUR LIFE-YOU OUGHT TO CARE

Dwight E. Harken
Major, MC
Consultant in Thoracic Surgery
803d and 15th Hospital Centers

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FIGURE 3.-Diaphragmatic. The idea of diaphragmatic breathing is difficult to get over because you cannot see it work. The diaphragm is the partition between the organs in your abdomen and chest. This big sheetlike muscular partition is fastened to the lower rib margins, and when it moves up into the chest-like a piston-it forces air out of the lungs. If you push in with your hands on your abdomen and blow out air through your mouth, you are making the diaphragm force air up and out of the lungs. When you take in a very deep breath you must relax the pressure on your belly wall (and let it swell out)-this means that you are making the piston move downward and sucking in air through the nose. Again, to make it clearer; push in on the belly and push air out through the mouth-then-breath in through the nose and push the belly out.

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