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for November 5, 1887. 
THE CORSET: 
QUESTIONS OF PRESSURE AND DISPLACEMENT.* 
By ROBERT L. DICKINSON, M. D., Brooklyn, 
LECTURER ON OBSTETRICS AND OBSTETRICIAN TO LONG ISLAND COLLEGE 
HOSPITAL. 
IDICULE, argument, and invective have been freely 
expended upon the artificial small waist since the 
days of Martial and Galen. Yet the habit of corset- 
wearing has received little systematic study, and 
men's opinions are widely at variance. We fre- 
quently meet with the statement that corset- 
wearing works great injury; we discover a catalogue of 
five-and-ninety different diseases and disorders due to tight 
lacing; we find Bouvier, who has written the elaborate 
and interesting history of this article of dress,vigorously 
asserting that "the modern corset, moderately tightened, is 
without appreciable influence on the health of the healthy 
woman "-and we encounter all shades of opinion between 
these extremes. But unsupported assertion is poor evidence, 
although a general impression must carry some weight. To 
obtain clear perceptions of the action of the corset, I have 
endeavored to measure the amount of pressure it exerts, to 
ascertain the distribution of the pressure, and to determine 
the displacements resulting therefrom, studying the subject 
with as little bias as possible, stating bald facts, and rarely 
expressing opinions. 
* Read before the Brooklyn Pathological Society, April 28, 1887. 2 
THE CORSET: 
First a few words as to past usages. In the day of the 
primitive man, writes Bouvier, as soon as men were sufficiently 
elevated above the beast to admire the forms of women, 
women began to shape themselves to an ideal. Homer's 
Juno wore a many-layered girdle. The Greek women raised 
up hanging breasts and bandaged in prominent abdomens. 
The fascia and strophinum of the Roman lady, that the later 
poets tells of, were accused of deforming a chest, or crowding 
in an abdomen, or bringing about a curvature as effectually 
as any tight lacing of our day. These were the bandages, 
numerous and variously stiffened, that Galen inveighed 
against. In the dark ages the accomplishment vanished from 
western Europe, not to reappear until the sixteenth century. 
Then came the day of the perfect flower of small waists, as 
they have not been known before or since. The old portraits 
excite our wonder with good cause. The " corps" or corset 
of Catherine de Medici and Elizabeth was a ''terrible en- 
gine," a case or sheath of nearly solid metal, rigid and 
unyielding. " To make their forms thin as a Spaniard's," 
cried Montaigne, ''what hell will not women suffer, strained 
and lashed {quindbes et cenglees) to the very quick?" Deep 
excoriations resulted from this pressure, and sometimes, he 
says, death ensued, even as Ambrose Pare also testified, 
citing his sectio cadaveris on a patient who died from such 
cause, in whom the lower ribs rode over one another 
(chevauxqaienf). Before the year 1600, iron, ivory, and 
wooden busks * are credited with many abortions and much 
pulmonary haemorrhage. 
Men wore corsets for a time. The next step was to 
begin at the cradle. In order to produce men and women of 
beautiful proportions and new forms one could not com- 
mence too early, and "any mother would have laid herself 
open to the charge of gross indifference to her childern's 
welfare who neglected these early cares, reputed indispensa- 
ble to any regular formation of body." 
* The " busk" is the front plate of the corset, which may be broad 
and of one solid piece, or divided and furnished with buttons as in the 
modern model. QUESTIONS OF PRESSURE AND DISPLACEMENT. 
3 
The French Revolution 
swept away the iron and 
bone cuirass and brought in 
its stead the comparatively 
pliable and yielding corset 
of our time. I find in the 
journals and current stories 
evidence that in the early 
part of this century tight 
lacing was far more preva- 
lent than to-day. Women 
occasionally died in the 
harness. Goodman, of Bos- 
ton, writing in 1829, speaks 
of a not unusual practice 
of wearing the corset at 
night, tightening it when 
lying down, and again in 
the morning on rising. He 
found servants wearing 
such busks as to prevent 
sufficient stooping or 
crouching to put the kettle 
on, or place it on any lower 
level than a bench. 
FiG. 1-A manometer for testing the 
pressure. The bag, E, is slipped 
under the corset. 
Observations on Corset Pressure.-The first test applied was to deter- 
mine the external pressure by the manometer.* The bent U-tube car- 
ries betweenits arms a sliding scale, graduated.in both directions. All 
the tubing is practically inelastic. That near the bag and the bag itself 
are re-enforced with cloth so that it is entirely inelastic. The T-branch 
running downward permits the bag to be filled or emptied without dis- 
turbing the mercury. The whole apparatus is filled with water to the 
perfect exclusion of air; the mercury is poured in so as to displace the 
water, and the water in the long limb adjusted above the mercury to 
the same level as that in the horizontal bend opposite. The bag must 
contain just sufficient water to bring its sides parallel and about one 
fourth of an inch apart, so that we get four square inches of contact 
whenitisheld between two plane surfaces. When the bag is on the 
same level as the fluid in the tubes, the mercury columns exactly bal- 
ance; the zero point of the scale is then adjusted to the top of the mer- 
cury ; the bag is slipped beneath the corset, the instrument is so held 
* This apparatus is modified from those of Croom and Schatz. 4 
THE CORSET : 
that the bag and tops of the water columns are on the same level, the 
corset is closed, and the readings are made. Care is taken, before 
every observation, to make sure that the levels are right, since a slight 
lowering of the manometer sends up the mercury column appre- 
ciably. Two inches of mercury displaced-i. e., an inch on each side- 
will signify a pound of pressure to the four square inches of bag sur- 
face. To obtain the number of pounds pressure on one square inch of 
surface, the reading is divided by eight. The division tends to minim- 
ize any error. 
Before recording these figures we may glance at other pressures in 
the body. I prefer to give the figures in pounds to the square inch, in- 
asmuch as confusion arises from one observer speaking of an inch of 
mercury displacement when he refers to one column only, which would 
be named by another two inches displacement. If I speak of the mer- 
cury column I refer to the difference between the two levels. 
table of various pressures in the 
BODY AS COMPARED WITH CORSET 
PRESSURE. 
Pounds pres- 
sure to 
square inch, 
in decimals. 
In 
eighths 
of a 
pound. 
Blood-pressure, according to Foster, about . . 
3'5 
29 
During labor pains, uterine force (Schatz) . . . 
*' " pressure in bladder, average 
i'6 to 5 
(Croom) 
" " pressure in bladder, maxi- 
r88 
15 
muni 
3'2 
25 
Pressure in rectum in making straining efforts 
(Schatz) , 
3 
24 
Expiratory force of lungs in man (Hutchinson) 
2'50 to 3 
16 
Inspiratory or suction force (Hutchinson) . . . 
Pneumatic cabinet, increase of pressure bearable 
2 
12 
by patient 
" decrease of pressure bearable 
•5 
4 
by patient (Westbrook) . . 
■5 
4 
Corset.-ist, Tight Lacing. 
The maximum pressure recorded was over the 
cartilages of the sixth and seventh ribs after a 
deep inspiration 
1'625 
13 
Average pressure over sixth and seventh carti- 
lages after full inspiration 
125 
10 
Quiescent condition, over these cartilages . . . 
" mid-axillary line over sixth 
•625 
5 
and seventh ribs . . . . 
■5 
4 
epigastrium 
" " navel 
•25 
•125 
2 
I 
Loose Corsets : 0'4 less than the preceding. 
The words " tight " and " loose " as applied to corsets need 
to be defined. They lack precision, but are necessary. We 
can not determine any limit of contraction in inches as the 
dividing line, since in cases cited farther on i| inch lessening 
of waist measure with one woman will cause more pressure QUESTIONS OF PRESSURE AND DISPLACEMENT. 
5 
and more distress than 5 inches in another. The guide must 
be the patient's sensations-when we can trust her testimony 
-and signs that are readily appreciated, such as the restricted 
respiration and movement, evident discomfort when the 
corset is first hooked, flushing of the face in a warm room, 
and the indentations on the skin after removal of the corset. 
Appearance goes for nothing; a large bust and wide hips 
or shoulders give an impression of slenderness in the waist 
which may be entirely deceitful. 
The total pressure exerted by a given corset is obtained as 
follows: The areas of like pressures are chalked out on the 
corset by shifting the bag about under the corset, and testing 
at every move with the manometer. Knowing the number 
of square inches in an area and the number of pounds of pres- 
sure to the square inch, the pressure exerted on that area is 
found; adding the pressures in the various areas together 
gives us a total. This is by no means absolutely accurate, 
but furnishes a tangible figure. The estimate errs on the side 
of too low pressure by leaving out of account the pressure 
below the crest of the ilium laterally and posteriorly. 
I give two illustrative cases in marked contrast: 
X. Y., habit of tight lacing; four children; lax abdominal wall; 
corset rather short. Circumference at waist without corset, 29 inches ; 
circumference at waist over corset, 23% inches; difference, 5% inches. 
The total pressure of her corset is 65 pounds. 
A. Z., vigorous, well built; one child eight years ago ; has a strong 
abdominal wall; do not think she has worn tight corsets in some 
years, as she states; corset long. Waist measure without corsets, 27 
inches; waist measure over loose corsets, 27 inches; no difference. 
Pressure, 40 pounds. 
Same patient, waist measure without corsets, 27 inches; waist mea- 
sure over fairly tight corsets, 25% inches; difference, 1% inch. Press 
ure, 73% pounds. 
The patient X. Y. had a flabby abdominal wall from fre- 
quent pregnancies and constant corset pressure. The patient 
A. Z. has a muscular abdominal wall ; she says she works at 
home without corsets. These facts explain the seeming dis- 
crepancy that in the first case, with 5% inches of constric- 
tion, the pressure is 65 pounds, while in the second, with 
inch, it is pounds. In one the parts readily yield ; in 
the other firm resistance is encountered. 6 
THE CORSET: 
The least pressure I have estimated from a corset is 21 
pounds; the greatest pressure I have found is 88 pounds. 
A notable point in the use of the manometer is the dis- 
tinct fall of the mercury during the first twenty seconds after 
the primary rise that occurs when the corset is hooked. 
Fig. 2.-The heavy outline is the tracing of the corseted woman ; the 
light, the same without corsets. QUESTIONS OF PRESSURE AND DISPLACEMENT. 
7 
This fall is followed by a slight rise or reaction before the 
mercury steadies itself. The main fall averages one inch 
(one-eighth of a pound to the square inch), and must be due 
to the displacement of organs and the expulsion of blood 
from the liver and abdomen and of air from the lungs. 
Fig. 3.-The heavy outline is the tracing of the corseted woman ; the 
light, the same without corsets. 
Within the half minute that follows any exertion, such as 
rising, lying down, turning over, or straining; the mercury 8 
THE corset: 
rises from % to inch, then gradually falls to its steady 
level. The reasons for these facts we may best study farther 
on in connection with the two cavities and their contained 
viscera. 
On taking off a corset, one often observes that if the cir- 
cumference of the waist is taken at once, and again a few 
minutes later, an increase of about an inch will have occurred. 
Waist Measure.-Six inches difference between the cir- 
cumference of the waist over the corset and the waist with 
the corset removed is the greatest difference I have measured. 
Five and a half and five I have met with occasionally. The 
least difference is in those cases where the measurement with 
and without is the same. 
The average contraction of the 52 cases given in the table 
is 2JX inches. The maximum there is inches, the mini- 
mum 1 inch. 
In the woman who wears no corsets the many layers of 
bands about the waist on which heavy skirts drag are suffi- 
cient to cause considerable constriction, as Dr. Mosher states. 
We have seen that the amount of contraction at the 
waist bears no constant proportion to the amount of press- 
ure exerted by a corset; we shall see that it bears no con- 
stant proportion to the diminution of vital capacity, except- 
ing a very general one. The shape of the corset and the 
strength of its bones are other factors we must know, and 
the habit of the individual, the resisting or yielding nature 
of the abdominal walls, and the readiness with which organs 
are displaced, bear largely on the problem. 
Effects of Pressure on the Thorax and Abdomen.-The 
"statical and dynamic mechanism of the thoracic and ab- 
dominal cavities'' differ widely, as Walshe remarks. The 
chest may be said to be filled with air, the belly with 
water. Schatz connected a glass tube filled with water 
with the water-filled lower bowel, and found that the fluid 
in the tube was always on a level with the highest part of 
the abdominal cavity,* whether the patient stood, sat, or 
lay down, and whether much or little water was injected. 
The thoracic organs may readily accommodate themselves 
to a pressure that simply squeezes out some residual air; 
* With certain allowances easily explained. QUESTIONS OF PRESSURE AND DISPLACEMENT. 
9 
the abdominal viscera must be displaced. Accommodation 
can only be favored by expulsion of blood from the cavity 
and reabsorption of the gases distending the intestine. Let 
us first consider the cavity of the chest. ' 
Effect on the Chest-Alteration in Shape.-My sketches 
of the changes in contour of the thorax and abdomen were 
made by accurately ascertaining the normal and the corset 
outline in the same subject by blackboard tracings or shad- 
ows thrown on manilla paper. These seemingly exaggerated 
proportions have been verified by caliper measurements, and 
Figs. 4 and 5.-Diagram of the shape of the cavity when the corsets are 
tight; the same without corsets. 
I have been careful to undervalue rather than to overstate 
my fact. The organs were filled in from the frozen sections 
of Braun, Ruedinger, and Hart, from the valuable atlas and 
illustrated writings of Sibson, and from Frerichs. 
The thoracic cavity suffers less diminution in size and 
alteration in shape from corset-wearing than the abdominal. 
The principal constricting effect is exerted below the fifth 
rib. In the mid-axillary line the lung does not descend be- 10 
THE CORSET: 
low the sixth rib in tranquil breathing. Below this level the 
" chest-wall " practically is the cover for the abdominal vis- 
cera, and it is on these that the corsets bear. ''The trans- 
verse diameter of the chest from the seventh rib to seventh 
rib, instead of being greater than that from fifth to fifth, as 
it is in males, is in females considerably less. The difference 
Lungs. 
Lungs. 
Liver and 
Stomach. 
Liver 
Intestines. 
Intestines. 
Bladder. 
Fig. 6.-Diagram of the displacement of viscera. Fig. 7.-The normal 
position of the organs (tracings). 
is greater or less according as the stays are worn more or less 
tight" (Sibson). Below the seventh rib the transverse 
diameter of the bony cage normally dwindles (Sappey), and 
from eleventh to eleventh is from one to one inch and a half QUESTIONS OF PRESSURE AND DISPLACEMENT. 
11 
less than the transverse diameter at the seventh or eighth. 
Bouvier measured one hundred and fifty subjects of both 
sexes and all ages, and found this relation constant. The 
corset increases this difference, and starts the downward 
taper at the fifth rib instead of at the seventh. Narrowing of 
the triangle between the cartilages of the lower ribs to a 
groove of the width of a finger is the extreme that Engel 
has sometimes seen. The inferior edge of the lung is there- 
fore compressed, and its ability to distend the lower part of 
the pleural cavity seriously crippled. Compensation in part 
is effected by the tendency of the corset when firmly adjusted 
to raise the shoulders-which I find quite constant-forcing 
the upper lobes to do the breathing, as Sibson has proved, 
raising the thoracic, or five upper ribs, widening the inter- 
spaces (also a constant condition in the female), and in this way 
expanding the highest part of the conical thoracic cavity. 
This broadening above and constriction below are shown in 
Figs. 2, 4, 5, 6, and 7. Freer play of the apices in women 
who wear corsets would lead one to expect consolidation at 
these points to be relatively less frequent than in men, while 
affections at the base should be more commonly met with. 
An increased tendency to emphysema of the upper lobes 
might also be anticipated. 
One other change may be noted in some frozen sections, 
and is occasionally observed in examination of the chest- 
namely, a more marked inward curve in the lower part of 
the sternum than is usually found in men, whereby the an- 
tero-posterior diameter of the lower part of the chest is 
somewhat diminished. 
77z<? Thoracic Breathing of Women. - May the peculiar 
character of the respiration in women be attributed to the 
use of corsets? Two observers who are especially qualified 
to testify have stated the case so forcibly that I quote them 
entire. Sibson has made by far the most extended of all the 
studies of the mechanism of respiration. His painstaking 
accuracy is Teutonic. Walshe's opinion carries great weight. 
Sibson says : 
"In the adult female the form of the chest and abdomen 
and the respiratory movements are often undoubtedlp modi- 
fied by tight lacing. 12 
THE CORSET: 
" The form of the chest and the respiratory movements 
do not differ perceptibly in girls and boys below the age of 
ten. Although the form of the chest remains nearly the 
same until the age of twelve, the abdominal movement is 
then somewhat less and the thoracic somewhat greater in 
girls than boys. At this age and earlier stays are worn, and 
though they do not compress the body materially, yet they 
restrain the free expansion of the lower ribs during free ex- 
ercise. After the age of fourteen the form of the chest and 
the respiratory movements differ materially in females and 
males. 
' ' When stays are on there is a great exaggeration in the 
thoracic movement, the second ribs moving forward from 
o-o6 to 0'2 inch, while, when the stays are off, they only move 
forward from 0'03 too'i (that is, one half as far). On the 
other hand, the movements of the lower ribs are much more 
restrained when the stays are on-the abdominal movement 
then being o-o6 to o-ii inch, whereas when they are off it is 
o'o8 to 0'2 inch. The difference at the waist when measured 
with the tape is very striking, the increased measure during 
extreme inspiration being 0'05 to 0'3 of an inch when they 
are on, and from o-6 to 1'5 when off (from two to thirty times 
as much). I have found the circumference at the waist from 
one to two inches less when stays were worn than when they 
were taken off. . . . 
" I think it probable that in females, even if they wore 
no stays, the thoracic respiration would be relatively greater 
and the diaphragmatic less than in man; but this is only 
surmise." 
Delicate men, he says further, approximate to the female 
thoracic breathing, vigorous women to the male abdominal 
breathing, and long-distance runners have the least thoracic 
breathing of all men (in the quiescent condition). 
The diaphragm would seem, therefore, to be a muscle 
capable of developing to meet increased demands as much 
as any other that the athlete strengthens. 
Walshe objects to the supposition that the sexual differ- 
ence is " preordained to meet the difficulties of pregnancy," 
as Boerhaave maintains, and asks whether ascitic females 
escape dyspnoea. " If we were forced," he says, " to the ad- QUESTIONS OF PRESSURE AND DISPLACEMENT. 
13 
mission that the activity of infra-clavicular respiration-move- 
ment in the female is in the main designed by nature " - for 
which no cause can be detected- " and independent of ex- 
traneous influence, still I cannot help thinking that the 
great excess of that movement and the limitation of thoracic 
play to the upper thorax in the civilized adult female are 
due in no small part to the unyielding cases interfering with 
inferior costal and phrenic action. The agricultural woman, 
who knows not stays, breathes more like a man than the 
town female. Besides, during sleep the conditions of pec- 
toral and ventral action of the female are much less strik- 
ingly different from those in the male than in the waking 
state; the waist is relieved for a time from constriction. 
And, further, the male and female dog breathe almost ex- 
actly alike, as do the horse and mare; the action is abdomi- 
nal and lower costal." 
Dr. Mays, of Philadelphia, has recently studied the res- 
piratory movements of Indian girls in the Lincoln Institu- 
tion. They had always worn loose clothing. They ranged 
between ten and twenty years of age. Tracings from their 
costal and abdominal respiratory movements showed a very 
close analogy to those of the civilized male, and that, ''so 
far as the Indian is concerned, the abdominal is the original 
type of respiration in both male and female, and that the 
costal type in the civilized female is developed through the 
constricting influence of dress around the abdomen. This 
is markedly shown in the greater prominence of the costal 
movements in those girls who were either one half or three- 
fourths white, and who were hence dominated to a greater 
or less extent by the influence of civilized blood. ... It is 
also evident that the costal type of respiration in the civil- 
ized female is not due to the influence of gestation." * 
''The expansion of the lower ribs," says Sibson, ''is much 
more impeded than the descent of the diaphragm." By 
measurements to be detailed farther on, I find that, compar- 
* Note.-January, 1891. That the type of breathing in man and 
women does not differ may be now considered settled. Dr. Kellogg, of 
Battle Creek, Michigan, has shown that the Indian, the Chinese, and 
the uncorseted woman, breathe with the abdominal movement of man. 
Dr. Wilberforce Smith has clinched it. These three observers agree in 
their independent observations on a large number of cases. 14 
THE CORSET: 
ing full inspiration and complete expiration, the pelvic floor 
has a range of respiratory movement about one-fourth less 
when the corsets are fairly tight than when they are off, 
whereas the lower ribs are so firmly incased as scarcely to 
expand at all. An old, broken, or very loose corset allows 
some play of the lower ribs ; but, since this is the location of 
the ring of most marked constriction, even these cripple it 
considerably. 
In what degree the total expansion is limited by this 
article of dress I have attempted to work out by studying the 
vital capacity* with and without corsets. To compare the 
expansion as measured ordinarily in men by passing a tape- 
measure about the chest is scarcely accurate when applied 
to women, since the soft parts vary in thickness, the mammae 
being pushed upward by the corset and hanging down with- 
out it. The spirometer test is not open to any serious objec- 
tion. I am greatly indebted to Dr. L- M. Hall for the labor 
involved in wyorking out for me the following table : 
Table showing the Effect of Corsets on Expansion in Fifty-two Women. 
Age. 
WAIST. 
Differ- 
ence. 
VITAL CAPACITY. 
Differ- 
ence. 
With. 
Without. 
With. 
Without 
Totals 
Averages . . . . 
Extremes . . | 
I,IOO 
21'15 
13 
35 
1.245I 
23'95 
21 
29 
i.37«S 
26'52 
234 
3°1 
1334 
2'57 
I 
4i 
6,944 
133'54 
So 
220 
8,487 
163'21 
100 
260 
1.543 
29-67 
5 
75 
The average age is twenty-one. The average waist with 
the corset off measures inches. The average measure- 
ment over the corset is 24 inches, or 2)4 inches less. The 
average vital capacity is 163 cubic inches without corsets. 
The average vital capacity, wearing the corset, is 30 cubic 
inches less. 
The individuals upon whom these observations w'ere made 
were servants of the best class. One half were native-born, 
the other half Irish (seventeen), German, Swedish, and 
* Hutchinson employed "vital capacity" to indicate the total num- 
ber of cubic inches of air a man could expel from his lungs after the 
deepest inspiration. QUESTIONS OF PRESSURE AND DISPLACEMENT. 
15 
English. Except on festive occasions, our immigrants have 
rarely worn corsets before reaching this country. All these 
are women who work, and, consequently, should have a 
more vigorous muscular system and better expansion than 
wealthier corset-wearers, although Dr. Hall states that these 
servants lace tighter and are less healthy in appearance than 
the young ladies of the institution in which the observations 
were made. Among women who lead less active lives, while 
wearing closer-fitting street- and evening-dresses, it might 
be expected that the interference with expansion would be 
greater and of more serious import. In the cases given above 
the limitation is three-sixteenths, or nearly one-fifth. 
We must remember always that our witnesses are inclined 
to perjury. The testimony is made to favor the corset, if 
possible, and to prove that it is not tight. 
This table contains no instance of the eighteen- or sixteen- 
inch waists of which we hear accounts. The least measure 
is 21 inches. Nineteen inches and a half is the smallest cir- 
cumference I have measured over the corset; the patient's 
normal measurement was 24 inches. 
To ascertain whether there was any constant proportion 
or relation between the amount of constriction and the dimi- 
nution of the vital capacity, I worked out a number of tables, 
which showed that the lessening of the circumference of the 
waist and the lessening of the vital capacity bore no constant 
relation. The problem is not so simple. Hutchinson found 
in his study of vital capacity (in 4,800 males) that the chest 
circumference bore no direct relation to the vital capacity. 
In a man of five feet one inch the vital capacity averages.175 
cubic inches, and it varies eight cubic inches for each inch 
in height. I have not been able to find the average height of 
woman, or any statements relating to her vital capacity as 
compared with man's. From occasional measurements in 
gymnasiums, however, I know that it is less than man's in 
proportion to her height. 
Effects of the Pressure on the Abdomen.-The abdominal 
cavity has far greater pressure and much more marked altera- 
tion in shape to suffer than the thoracic. The change in its 
lateral walls has been considered in part, and figured in Figs. 
3 and 4. In antero-posterior section (Fig. 9) the deformity 16 
THE CORSET: 
to which I would especially direct attention is the close ap- 
proximation of the belly-wall to the spinal column, and the 
bulging of the lower abdomen. I have pictured no exag- 
gerated instance, but give the tracing from a muscular young 
woman who has never been pregnant, with an abdominal 
wall of better vigor than common. 
Fig. 9.-Antero-posterior section ; shape of cavities with and without 
corsets. 
It will be seen that without the corset the breasts pro- 
ject beyond the abdomen, just as in a finely developed man 
the pectorals first touch a perpendicular; whereas, when 
the corset has raised the "bust" and crowded the abdomen 
down and out, the supra-pubic wall becomes the most promi- 
nent and projecting part of the profile. 
In transverse section the abdominal area at the level of 
the ensiform (Fig. 12) is normally about twice as great as 
that at the umbilicus (Fig. 10)-above, deep, roomy, bean- 
shaped ; below, narrowing and contracting to scarcely more 
than a slit that curves about the broadened mass of the spinal 
column and psoas muscles. QUESTIONS OF PRESSURE AND DISPLACEMENT. 
17 
Fig. 10.-Section through navel, least pressure; the black spaces indi- 
cate the empty intestines. (Braun : frozen section.) 
Fig. ii.-Through first lumbar vertebra, great pressure; the intestine 
(black) is the colon. (Braun.) 
Fig i2.--Section through epigastrium, area subjected to greatest 
pressure by the corset. (Braun.) 18 
THE CORSET: 
The corset reverses this. The constriction binds closest 
the broadest part; the viscera are displaced downward ; the 
lower umbilical region swells out; the greatest area must 
grow small, and the smallest enlarge. 
The point of greatest pressure, we have seen, was over 
the cartilages. On both sides the liver will be pressed upon, 
and this at a point where it is covered by lung only during 
deep inspiration (Fig. 12). The lateral pressure will crowd 
liver and spleen toward the median line. The stomach will 
be pinched between its more solid neighbors, though both 
liver and spleen mold readily under pressure. 
Two inches lower, the section (Fig. 11) contrasts strongly 
with the first. That showed nearly solid viscera; this pre- 
sents large air-filled spaces. Here the pancreas, kidneys, 
and a small part of the liver only would receive stress, and 
they are protected by large air-cushions in front. 
Again, two inches lower, the section greatly differs from 
the second. At this level, that of the navel, there are no 
viscera, except intestines distended with gas. 
So that we find that 
(1) Where the solid organs are, the greatest pressure comes; 
(2) Where the hollow viscera lie, little pressure comes; 
(3) On organs that are comparatively fixed in their places, 
much stress is brought to bear; and 
(4) On organs freely movable, like the intestines, less 
direct displacing force is exerted. 
Effect of Pressure on the Abdominal Wall. - Fong con- 
tinued compression of the wall of the abdomen in the epi- 
gastric and hypochondriac regions gradually brings about a 
thinning of its adipose layer.* Below the ring of constric- 
tion the fat accumulates. The woman who abhors a " stom- 
ach " yet adopts the most effective means of cultivating one. 
Flabby, old, or obese persons are especially prone to pile up 
panniculus adiposus below the navel. I have examined many 
stout young men in good condition, and have yet to find one 
in whom this tendency is evident. On the contrary, the 
fatty layer above the umbilicus is usually thicker than that 
below it. These men wear suspenders. In eleven healthy 
women below thirty who have been in the habit of wearing 
corsets (of varying degrees of tightness) the fat below the 
* First mentioned, I believe, by Larget. " Thfese de Paris," 1827. QUESTIONS OF PRESSURE AND DISPLACEMENT. 
19 
navel has always been found to be more than twice as thick 
as that above, while one to three is no uncommon ratio. 
That this is not normal is proved 
by the fact that in two women, 
teachers of gymnastics, measured 
for me by Dr. Mosher, the fatty 
layer wras thicker above. 
The two sections in Fig. 13 
speak for themselves. The man 
and woman were each twenty- 
one years of age. The woman, 
Braun says, was well developed 
and finely formed, and her ab- 
dominal wall had never been 
stretched by a pregnant uterus, 
as one would suppose at first 
glance. Above the pubes the 
wall is four times as thick as it 
is higher up. 
That the compression acts on 
muscle as well as fat is clear 
when we call to mind the con- 
trast between the hard abdomi- 
nal parietes of the average man 
and the lax belly of most women. 
How could the gynaecologist 
make his bi-manual were it 
otherwise ? Engel reports cases 
in which the peristaltic move- 
ments could be watched through 
walls thinned from tight lacing. 
Of course disuse and the less 
need of constantly balancing 
the body has much to do with 
the atrophy of the abdominal 
muscles of the female. If 
Schroeder and his followers are 
right in attributing the expul- 
sion of the head after it reaches 
the pelvic floor mainly to these 
Navel. 
F M 
Fig. 13.-Sections of the ante- 
rior abdominal wall of the 
young female (F) and male 
(M), showing thinning from 
the pressure of corsets. 
(Braun, frozen.) 20 
THE CORSET: 
muscles, we must credit the necessity for the use of forceps 
in a large number of cases to the practice of corset-wearing. 
It is worth noting that the, figure given by Schatz as the 
intra-abdominal pressure not uncommon in man during 
straining efforts is nearly the same as the maximum pressure 
in the bladder during expulsive pains (Croom), which the 
uterine wall has some part in augmenting by its forward 
displacement. 
Effect of the Pressure on the Pelvic Floor..-With the cor- 
sets snugly adjusted the general cavity of the trunk is cased 
in walls that are nearly unyielding at all places but two. 
Symphysis. 
Coccyx. 
Vagina. 
Anus. 
Fig. 14.-Tracing from the pelvic floor with and without corsets. 
The ribs, spinal column, and corset-bones sheathe the body as 
far down as the iliac crests laterally and the hypogastrium 
in front. Of the supra-pubic projection we have spoken. 
The other outlet for the pressure is the pelvic floor. It can 
be studied only in the horizontal position, either by tracings 
taken from the thin lead strip passed along the groove from QUESTIONS OF PRESSURE AND DISPLACEMENT. 
21 
symphysis to sacrum and accurately molded, Or by measure- 
ment of the projection of the floor by the instrument of Dr. 
Frank P. Foster. This projection is measured on a perpendi- 
cular erected on a line joining the tip of the coccyx and the 
lower edge of the symphysis pubis. In Sim's position, while 
the patient "has her clothing on but the corset unbuttoned,"* 
the average projection was determined by Dr. Foster to be 
2'5 cm., or one inch. I find that tight lacing increases this 
projection over one-third-the average of 5 cases measured 
being o-9 cm. (o-8 cm. minimum, ui cm. maximum). This 
is twice as much depression as the deepest inspiration causes 
(o-4 cm.), and often is very close to the extreme yielding of 
the pelvic floor brought about by straining or bearing down, 
which is in the neighborhood of 4 centimetres, or one and a 
half inch plus. 
I quote the figures in a well-marked case (Sims's position): 
Pelvic Floor Projection. 
Without corsets. 
With corsets tight. 
Quiet 
Deep inspiration 
Straining 
(i inch). 2'6 cm. 
(i| inch). 3'2 cm. 
(i| plus). 4'o cm. 
(i| in. scant). 37 cm. 
(if in.) 4 cm. 
in.) 4 cm. 
I am inclined to believe that after a large number of cases 
have accumulated I can show that it is those women having 
roomy pelves, or pelves of less inclination than usual, whose 
pelvic floors sag most under pressure from above. 
Effect on the Uterus.-This displacement of the pelvic 
floor and this abdominal pressure, acting on a cavity prob- 
ably governed by the laws of fluid pressure, bear largely on 
the moot question of the importance of the corset as an 
agent in producing uterine disease and displacement. I 
think there can be no question that the uterus must descend 
with the structures about it. With a corset that is "quite 
tight," but not so tight as the patient "could bear it, as in 
a new dress or at a ball," this displacement is a third of an 
inch. The distance seems insignificant, and may only be 
considered of importance in view of the following facts : 
* Letter from Dr. Foster, April 8th. 22 
THE CORSET: 
1. That this is almost the deepest position to which the 
structures can be forced by straining down. 
2. That the long-continued action of the depressing 
force is exerted during the period of growth. 
3. In view of the results likely to ensue in case of weak- 
ened and enfeebled supports, in case of increased size and 
weight of the uterus-normally present during menstrua- 
tion- and in case of incipient displacement. It naturally 
follows : 
4. That this forcing downward is sufficient to render 
the uterine supports tense (be they ligament, "column," or 
pelvic surroundings in toto), and that in their taut condi- 
tion any extra or added stress, like deep breathing, or exer- 
tion, or bending, might well be enough to each time slight- 
ly overstrain these stretched supports. Slowly and steadily 
as this force acts, yielding must in time occur. 
In fact, Engel states that in every one of thirty autopsies 
in which evidences of tight lacing were found, prolapsus 
was present in some degree, except where adhesions had 
prevented it. 
It might be noted that the ovarian veins, which usually 
are valveless, run upward into the region of greatest press- 
ure to empty there, and that the haemorrhoidal branches of 
the portal vein, which also lack valves, will suffer from the 
damming back that must be caused by the severe com- 
pression of the liver. 
The distortion of Fig. 15 does not need much commen- 
tary. The more this damsel bends, the greater the down- 
ward and backward push of her busk. Will not this account 
in part for the uterine troubles of women supposed to be due 
to many of their sedentary occupations, such as sewing- 
machine work? The man who bends forward relaxes his 
abdominal wall and enormously lowers his intra-abdominal 
pressure (Schatz), but the corseted female, when writing or 
sewing, produces the opposite effect. In some cases I have 
recorded that in this position the pressure over the navel is 
about double that in the erect position, notwithstanding the 
abdominal relaxation. The exceptions to this augmentation 
of pressure are found where the corset-bones are broken or QUESTIONS OF PRESSURE AND DISPLACEMENT. 
23 
weakened and bend in into the episgastrium, and out again 
away from the pubes.* 
Fig. 15.-The effect of bending forward, when seated, with and 
without corsets. 
Effect of the Pressure on the Liver.-In viewing the 
transverse sections (Figs, n and 12) we saw that the zone 
of most marked pressure was over the liver, Laterally the 
ribs may be resistent enough to counteract this strain to a 
considerable extent; but over the cartilages, where the 
strongest compression of all is exerted, and in the epigas- 
tric region, the force must act with greater directness to push 
the anterior edge downward. Corbin, who has studied this 
displacement post mortem, states that, as this viscus is fixed 
behind, its anterior part drops, so that the surface, normally 
superior and horizontal, becomes anterior and vertical. . . . 
This effect is constant and found in all, however loose the 
lacing may have been." 
" On the face that is anterior there exists in most 
women a transverse depression or gully, more or less pro- 
*Dr. Kellogg's tracings show that, instead of the free up-and-down 
movement of the uterus during respiration without the corset, that 
ogran is almost motionless while the corset is on. 24 
THE corset: 
nounced, so marked in some cases that the liver looks almost 
cut in two. The bottom of this groove is at times whitish in 
Fig. 16.-The heavy outline with corsets, the thin outline without 
corsets, the patient seated and bending forward. 
color from thickening of the peritonaeum, capsule, and 
cellular tissue." In the discussion following the reading of 
this paper instances were cited to show that a habit of 
wearing about the waist a very tight cord or belt by men will 
cause like furrows, and that such fissures may result in more 
or less complete detachment of portions of the organ. QUESTIONS OF PRESSURE AND DISPLACEMENT. 
25 
Indeed, Braun asserts that " it is open to proof that the form 
of the liver is not an independent one, but varies with the 
pressure and volume of neighboring organs; so that in a nor- 
mal condition it must possess a softness of structure which 
Fig. 17.-Diagram of the tilting of the liver in certain cases of tight 
lacing. How the furrow of Fig. 6 is produced. 
can be compared with fat and connective tissue, and which 
yields to the movements and change of position of the organs 
in contact with it." 26 
THE CORSET: 
I am the more inclined to believe this on account of the 
exceeding great blood supply of the organ. It is said to con- 
tain about one-fourth the blood in the body. This peculiarity 
would allow of very marked fluctuations in size and in shape. 
The very distinct fall of the mercury column-one-half to 
one inch and a half-twenty seconds after hooking the corset 
may be due in part to the liver emptying itself of blood. 
The earlier corsets are worn, the more the liver would be 
affected, since it is proportionately much larger in the child 
than in the adult. Previous to puberty its weight may be 
as much as one-thirtieth, or even one-twentieth, of that of 
the entire body; in the adult it averages one-fortieth. 
"The practice of tight lacing," says Murchison, "may 
cause displacements and malformations of the liver which 
may simulate enlargement and which are of considerable 
importance in diagnosis. Tight lacing may act on the liver 
in three ways-according to the situation, the tightness, and 
the duration of the constricting cause. 
"a. The liver may be displaced upward or downward 
according as the pressure is applied below or above. The 
precise situation where the pressure is applied will vary with 
the prevailing fashion of dress; but most commonly in this 
country the displacement is downward, and this may be to 
such an extent that the lower margin reaches the ilium, and 
the liver appears to fill up the whole of the right side and 
front of the abdomen." [Frerichs and other writers speak of 
this amount of change in location.] 
" b. In consequence of lateral compression the liver may 
be elongated in its vertical diameter so that a larger portion 
of it is brought into apposition with the abdominal and 
thoracic walls. This is a very common result of tight lacing " 
(Figs. 6 and 17). 
" c. When the pressure is exerted by a tight cord, it may 
produce deep fissures in the substance of the liver, as the 
result of which portions of the organ may be more or less 
detached, and may even be felt as movable tumors through 
the abdominal parietes." 
" Apparent enlargements of the liver from tight lacing are 
far more common than is generally believed." QUESTIONS OF PRESSURE AND DISPLACEMENT. 
27 
Though it is somewhat of a repetition, I must give an epi- 
tome of some thirty autopsies that Engel reports. 
The lower edge of the liver, he says, is often displaced 
below the iliac crests. It is nothing unusual to find the fun- 
dus of the gall-bladder at the level of the crest. The furrow 
is often a hand wide. It rarely runs into the left lobe. The 
portion of hepatic tissue connecting the two parts is scarce 
over a finger's breadth. Not seldom scar-like bands and 
obliterated vessels of large caliber traverse the isthmus. Yet 
adhesions at this point are of the rarest occurrence. 
Above the furrow, in the upper division of the right lobe, 
which is often much thinned from pressure, one sometimes 
encounters two deep indentations which run from behind 
obliquely or directly forward. In these the peritonaeum and 
underlying hepatic tissue are normal. 
The portion below the transverse groove may be thicker 
than that above. Its lower edge is blunt and rounded. Be- 
hind, it is strongly concave. 
The ligamentum rotundum is displaced to the left. These 
changes are shown in Figs. 6, 7, and 17. 
If, from the testimony of these five observers-Braun, 
Corbin, Engel, Frerichs, and Murchison-the extreme mobil- 
ity of the liver has been proved, although we grant that 
these extremes result from tight lacing, are we not justified 
in believing that even a loosely adjusted corset must definitely 
displace so mobile an organ? The difference between the 
loosest corset and the tightest is less than might be imagined. 
I have not been able to double the pressure on requesting a 
patient to lace her loose corset to the utmost she could bear. 
Engel found the stomach displaced in the following re- 
markable manner: It was shoved to the left. Its long axis, 
from a horizontal or oblique direction, was changed to a ver- 
tical, so that the lesser curvature ran down directly to the 
left of the spinal column. The pyloric end was depressed as 
far as the fourth lumbar vertebra. Constriction not unlike 
the liver-furrow was occasionally met with, but without patho- 
logical changes in the walls. The pancreas may be dragged 
down to a perpendicular position on the face of the vertebral 
column, reaching down to the promontory. These were ex- 
treme cases, of course. 28 
THE CORSET: 
A few of the most palpable changes brought about by 
corset pressure have thus been briefly described. There are 
many others as much more important as they are more subtle 
and difficult of proof, such as the disturbances of abdominal 
circulation, the effect on digestion, the limitation of exercise, 
and the slowly increasing action on the general health-ques- 
tions of disturbed physiology which I hope to attack in the 
future. The necessary observations accumulate slowly. The 
conclusions reached at this time may be tabulated as fol- 
lows :- 
1. The maximum pressure at any one point was if pounds 
to the square inch. This was during inspiration. The maxi- 
mum in quiet breathing was over the sixth and seventh car- 
tilages, and was | pound. 
2. The estimated total pressure of the corset varies be- 
tween thirty and eighty pounds-in a loose corset about 
thirty-five pounds, in a tight corset sixty-five pounds. 
3. During the first half minute after hooking the corset 
the pressure is greater than this : then an adjustment occurs 
and a distinct fall in pressure results. 
4. The circumference of the waist is no criterion of tight- 
ness. The difference between the waist measure with and 
without corsets gives no direct clue either to the number of 
pounds pressure or to the diminution in vital capacity. Re- 
laxation and habit seem to affect these factors largely. 
5. The capacity for expansion of the chest was found to 
be restricted one-fifth when the corset was on. 
6. The thoracic character of the breathing in women is 
due to corset-wearing. 
7. The thoracic cavity is less affected by the corset than 
the abdominal. 
8. The abdominal wall is thinned and weakened by the 
pressure of stays. 
9. The liver suffers more direct pressure and is more fre- 
quently displaced than any other organ. 
10. The pelvic floor is bulged downward by tight lacing 
one-third of an inch (0'9 cm.). 
Conclusions. QUESTIONS OF PRESSURE AND DISPLACEMENT. 
29 
Partial Bibliography. 
Bouvier-" Etudes historiques et medicales sur l'usage des 
corsets," ''Bull, de 1'acad. de med. de Paris," i852-'53, 355. 
Bouvier et Bouland.-''Corset," ''Diet, encycl. dessci. 
med.," Paris, 1877. 
Winslow.-''Mem. de l'acad. des sciences," 1741. 
Soemmering.-" Ueber die Wirkungen d. Schniirbriisten," 
1793- 
Engel.-''Wiener med. Wochenschrift, " i860 (529), ''Die 
Wirkungen d. Schniirleibes." 
Frericlis.-" Diseases of the Diver." 
Mays.-Therapeutic Gazette," May, 1887. 
Murchison.-''Diseases of the Diver." 
Walshe.-Dondon " Med. Times and Gazette," 1829. 
Sibson.-" Medical Anatomy," p. 962, " Med.-chir.Trans.," 
1848. 
Croom.-''The Bladder during Parturition." 
Schatz.-''Archiv f. Gyn.," iii. 58; iv. 193. 
Corbin.-''Des effets produits par les corsets sur le foie," 
''Gaz. med. de Paris," 1830. 
Foster.-''Am. Jour, of Obstet.," 1870. 
Hutchinson, J.-"The Spirometer, the Stethoscope, and 
the Spring Balance," Dondon, 1852. 
Dennox Browne.-"Voice, Song and Speech." 
Kellogg, J. H., of Battle Creek, Mich, (reprint).-"Re- 
lation of Dress to Pelvic Diseases of Women."-Important: 
large number of tracings showing that abdominal breathing 
is normal in women, and that respiratory movements of pel- 
vic organs are stopped by corsets. 
Smith, Wilberforce.-"Brit. Med. Jour.," Oct. 11, 1890. 
Tracings proving abdominal breathing to be normal in 
women as in men. 
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