The Schengen area and external borders: countries and their neighbours
Maintaining good relations with neighbors is necessary, but often not so easy. Disputes can be caused by such things as the height and shape of the fence, the boundaries of the site, who and when removes the snow, where and how to fry kebabs and receive guests. The neighbors are too Intrusive, then, on the contrary, unsociable. Do they say Hello or not? Do the weeds on the site get weeded in time? In short, everything is not easy with expensive neighbors.
Biological systems must also cooperate to function properly. At some stage in the process of evolution, a pair of unicellular creatures, tired of the eternal neighborly differences, came to the decision that a multicellular organism would be easier to cope with life’s difficulties. They entered into a partnership agreement, and for a while everything was fine. But this partnership did not remain unique for long: other single-celled animals also cooperated, as a result of which squabbles and quarrels began anew. Cooperatives grew, complex organisms emerged, vertebrates appeared, and eventually man was created — the more hostile and threatening the world around its once independent inhabitants, the more closely they United.
But is a person consisting of many systems a single whole, or is he still the sum of various components? Are we really as individual and indivisible as we think we are? Can we consider ourselves a free and Autonomous organism? In any case. Biological systems — both physical and mental — are not centralized unitary States. Yes, they have some General framework and rules, but still they are based on a strong Federal system, the components of which are subject to only limited control and management. Only when one of the organs is out of line do we begin to guess what all our autonomy is worth. Who controls the liver, kidneys, and pancreas? Who provides uninterrupted breathing while we sleep? Who decides when we need to go to the bathroom? What do we know about more than 50 billion white blood cells? For example, do you have any idea what they are doing during the day? Did you know that every night they all commit suicide? And who provides the top – up? Don’t know? Do you have any control at all?
I advise you as a doctor: relax and do not torment yourself with questions, otherwise you can go crazy. “I am the other,” said the French poet Arthur Rimbaud. As you can imagine, he ended badly. Better trust the power of federalism and regional autonomy. Imagine your body in the form of the European Union or another Union of States with different regions. No matter how “separatist” we may be as a result of medical specialization, and no matter how we defend the exceptional importance of “our” organs, in practice we still can not do without a holistic, “Federal” approach to the body. Health is a consequence of good neighborly bodies: if everyone pulls the rope in the same direction, we will succeed. If one or more members break away from the General mass, everyone begins to suffer. It’s a familiar story, isn’t it?
Due to its vital function of supplying the body with oxygen, the lungs are a very significant factor, and you can’t do without them. The brain can go without oxygen for only a few minutes, and the heart will stop beating very quickly if there is no fuel from the lungs. Perhaps they can be compared to Germany in Europe: they are also located in the center, have a relatively large size, they are not attributed to any spiritual and moral qualities, but they are irreplaceable in economic terms, playing the role of an economic locomotive. They also try to maintain good relations with everyone, but they depend on some of their closest neighbors in a special way. The bony structure of the chest ensures the inviolability of the external borders of the lungs and protects them from damage. The diaphragm acts as a mechanical pump that pumps air. The heart supplies blood — the raw material to be enriched with oxygen.
What does the outer border look like? The lungs are completely surrounded by the chest, which consists of the ribs, thoracic spine, and sternum. It has a hole at the top (small) and a hole at the bottom (large). The lower opening is covered by the diaphragm, and the upper one, located above the clavicles, is covered by the neck muscles, costal pleura, and connective tissue. Within these external borders is the Schengen area, which is characterized by close cooperation, a lively exchange between authorities and very conditional internal borders. Outside of this zone, the lungs maintain diplomatic relations, such as with the intestines or brain, which are also parts of certain restricted spaces, such as the abdomen and skull. The exception is the “exclave”, consisting of the trachea, larynx, pharynx and nose — they belong to the respiratory organs, but are not protected by the chest. Inside the chest, in turn, there are three separate spaces — the left and right pleural cavities, in which the left and right lungs are placed, respectively, and the mediastinum, or mediastinum, located between them, in which the heart, arteries, veins, nerves and lymphatic vessels are located. The esophagus passes between the lungs and leads to the stomach. Both pleural cavities and mediastinum are completely separated from each other. Only in the middle part of the lungs there are so-called gates, through which large blood vessels that depart from the heart pass. Placing both lungs in isolated cavities is of particular importance for breathing.
Remember the design problem described at the beginning of this Chapter: how to fix shapeless lungs inside the chest? Before I introduce you to the solution, I will ask: “do you have children? Did they show you magic tricks with the young illusionist’s kit? Or maybe you yourself had such a set?» Then you probably remember two classic tricks that do not require any special skills at all. For the first trick, you need to stick an adhesive tape on the inflated balloon, and then pierce it with a needle through this tape. The balloon won’t burst. For the second trick, use two ordinary-looking dice from the set, which, however, have a very smooth surface. One cube lies on the table, and the second magician holds in his hand and imperceptibly moistens its lower surface with saliva. After that, he presses the second cube with the wet side to the first and lifts it. The lower cube sticks and “magically” rises with the upper one. The same thing happens to the chest wall and lungs, but without any magic.
Both the wall of the abdominal cavity and the lungs are covered with a smooth thin film, which is called the pleura. One layer of it lines the bone wall of the chest from the inside, and the second — the outer surface of the lung. The space between both layers is filled with a small amount of liquid. If you remove air from this structure, the lung is firmly attached to the wall of the chest cavity, but at the same time retains mobility due to the pleural fluid, which ensures that the pleural layers slide relative to each other. This ingenious solution gives the lung the ability to change shape and automatically adjust to any movement of the chest during breathing. The only problem is that this compound is based solely on the properties of the vacuum and does not provide any backup plan. Thus, if air enters the space between the chest wall and the lungs, they immediately fall off like a wet bag — a similar condition is called “pneumothorax”. It occurs quite often with external, and sometimes with internal injuries. The chest provides good protection, but when it is affected by brute force, such as excessive pressure or a sharp object that causes a penetrating wound, the protection does not work.
The shape of the chest is optimal in terms of resistance to pressure. From the upper angle, it looks more like an ellipse than a circle, and when viewed from the front, it has the shape of an egg, set with the sharp end up. Twelve ribs can be compared to the bars of a cage, the volume of which increases with inspiration and decreases with exhalation. The first seven ribs (starting from the top) are “true”, they have a movable connection to the vertebrae in the back by means of joints, and in front they are motionless connected to the sternum. The “false” ribs (from the 8th to the 12th) do not have a direct connection to the sternum: their front ends either have a cartilaginous connection with the ribs located above them, or do not attach to anything at all (the 11th and 12th pairs). This design is quite resistant to shock and pressure from the outside and at the same time provides mobility when breathing. How strong is this structure and what extreme loads can it withstand?
“Professor Horror: crash tests with corpses!” was the headline of the Bild newspaper in November 1993. What happened? A journalistic investigation showed that scientists at the University of Heidelberg in the 1970s and 80s used human corpses, including children’s, to study bone loads. A scandal? But no secret was made of the research. In one experiment, the body of a dead person was placed in the front seat of a car, which then crashed into an obstacle at high speed. After that, the body was opened to fix broken ribs and internal injuries. In another experiment, the corpse was placed on a solid base, and pressure was applied to the chest in the sternum area until the bones broke. This may sound like a horror movie scenario to you, but it’s actually all the available materials from textbooks on biomechanics or injury mechanics that are more than 50 years old. There is a scientific logic behind such experiments: if you want to find out what kind of load a bone can withstand, you need to bend it until it breaks. And it is better to conduct these experiments on corpses, and not on living people. However, at the same time there are questions of an ethical nature: are such experiments permissible? Do I need them, and if so, who has the right to give them permission? What goals can justify such means, and is there any place for ethics in the process of learning? Not the most convenient, but justified questions.
Whatever unpleasant feelings these experiments may cause you, you owe biomechanics a lot, perhaps even your life. The designer of our chest took into account many circumstances, but he did not expect that the car would be invented! It is this invention that is involved in almost all cases of chest injury. More than half of all road accidents result in chest injuries, and one-third of all road traffic deaths are caused by injuries to the chest and chest cavity. In the early 1970s, about 21 thousand people were killed on German roads every year-an incomprehensible figure for today (for comparison: in 2017, 3177 people died). Something had to be done, the head and chest needed extra protection. But how do I do this? Experiments with human corpses have shown that the chest has great strength — it can withstand pressure up to 400 kilograms, and that the bones began to break, you need to push it at least 6 centimeters. However, such loads are achieved when hitting the steering wheel, even at a relatively low collision speed. How can we tame this force and save the lives of drivers?
The result of research was the appearance of first three-point seat belts, and then airbags. This is a unique success story of biomechanics, because these inventions have saved millions of lives. Today, experimenters are no longer working with corpses, but with mannequins, the design of which took into account the results of experiments on corpses. Of course, such things are not told at school when they spend a class hour on the topic “who my parents work for”. But this is medicine, someone has to do it.
Despite seat belts and airbags, injuries to the chest as a result of road accidents are quite common today, and no protective mechanisms can save you from a head-on collision at high speed. The impact may break one or more ribs. A fracture of one rib is usually not dangerous and does not require special treatment, but this injury is very painful, and a person needs several weeks of rest to fully recover. Severe pain is due to damage to the very sensitive rib pleura, which makes itself felt with each breath. Good anesthesia is important here, as gentle breathing can lead to lung infection. Breaking several ribs at once is much more dangerous, because the stability of the chest can be disrupted, and this in turn will lead to a failure of the breathing mechanism. The situation becomes critical if air enters the chest as a result of external damage, or if rib fragments damage the surface of the lungs. If the vacuum between the rib pleura and the lung is violated, the lung collapses, and the person in this case faces death from suffocation. Emergency doctors can insert a tube from the outside to suck out air and re-stabilize the lung.
Even more vulnerable are the two weakest points in the design of the chest — its upper and lower openings. There is a particularly high risk of damage from stabbing weapons. Do you remember the murder scene from the film adaptation of Agatha Christie’s novel murder on The Orient Express? The victim, Signor Cassetti — was stabbed twelve times. Although Cassetti was stunned at the time of the murder and could not resist, detective Poirot, when examining the corpse, is convinced that only three stab wounds were fatal. This is a typical mistake of beginners who strike perpendicular to the surface of the chest. Nine out of ten such attempts result in the knife Bouncing off the ribs. If most passengers on the Orient Express can be excused for such an amateurish mistake, then Colonel Arbuthnot (played by Sean Connery), who has experience in combat, could have been expected to do a more professional job. Experienced killers use the weak points of the chest and strike either from above or from below. As a result, the probability of success increases to 50 percent. Agree that this is a dubious achievement, but if you ever find yourself in a situation where you have to defend your life with a dagger in your hand, you may remember these grim statistics.
In the spaces between the ribs are the muscles that are called intercostal. Do you like fried ribs (pork, of course)? So, these muscles are edible. Their fibers run from top to bottom at a certain angle, and in different directions: in the outer layer they are directed to the center of the chest, and in the inner layer — Vice versa. This ensures better protection of the chest, while the muscles can act as antagonists to each other when performing respiratory movements: the external intercostal muscles increase the distance between the ribs when inhaling, and the internal muscles reduce it when exhaling. The proportion of muscles in the total effort made during breathing is only 20 percent, and the main work is performed by the diaphragm. Intercostal muscles play an auxiliary role in breathing when the body makes significant physical effort. At the same time use other auxiliary respiratory mechanisms, for example, some muscles of the neck and back. They can be trained with special exercises, and this can save lives when the effort of the diaphragm alone is not enough to breathe. With severe attacks of suffocation, you can observe a very dramatic picture: the patient is sitting, clutching the table, and desperately gasping for air, the muscles in the throat area are pulsating rhythmically. Even the muscles of the shoulder girdle and neck are used in this struggle for survival. This improvised “resuscitation” allows you to buy precious time before the arrival of medical assistance, but the auxiliary muscles quickly get tired, they are only enough for a few minutes.
The main motor of respiration is the diaphragm — a powerful flat muscle with a tendon center. This is the ultimate endurance champion. The lungs themselves are not capable of movement, they cannot contract or make undulating movements, like the intestines, they do not move at all. If you look at the chest on the screen of the x-ray machine, you will see calm and relaxed lungs. The idyll would be complete if it were not for the heart, which, like a young man at a disco, can not stand in one place and constantly twitches. Light, in contrast, behave in a respectable and reserved, they only allow themselves to move. Any movement of the lungs is performed passively, under the influence of external forces, and this is what the diaphragm does, the dome of which is attached to the lower ribs and separates the chest cavity from the abdominal one. The diaphragm is the absolute master of the entire respiratory mechanism. When it moves, the whole body moves with it. Contracting, the dome falls down and comes out from under the protection of the chest. With a deep breath, the diaphragm can drop 10 centimeters, and the lungs follow it, as if under the action of a pump piston. An involuntary sharp contraction manifests itself in the form of hiccups. And when the diaphragm during a fit of laughter contracts and relaxes at the speed of a machine gun, the whole body shakes with such force that the meaning of the expression “die laughing”becomes clear. The diaphragm takes on 80 percent of all the effort of breathing — 15 contractions per minute, 24 hours a day, 365 days and nights a year, and so on tirelessly throughout life. Each contraction increases the volume of the lungs by at least half a liter. We inhale and exhale more than 10,000 liters per day, and by the end of our lives, this figure increases to the volume of a supertanker — 250 million liters of air or more. Each breath is taken with the participation of the diaphragm. In addition to the fact that the diaphragm brings the lungs out of a state of comfortable slumber, forcing them to move, it also exerts pressure on the abdominal organs.
What happens in this case? Nothing good. To compensate for the pressure of the descending diaphragm, the wall of the abdominal cavity protrudes forward, and quite noticeably, too noticeably — we call this abdominal breathing. It’s designed very smart and functional, but it doesn’t look very nice. At the very least, there is a reason to complain because of poorly performed work. For people of both sexes who are concerned about their figure, every deep breath is tantamount to surrender. And all this is repeated 15 times a minute! There is a belly — no belly, there is a belly — no belly. You can’t live like this, you have to do something!
-Pull in your stomach, — advises the body designer.
— How to pull it in?
— he demonstrates.
— And how then to breathe?
— With the help of auxiliary muscles.
— Draw in your belly and spread your chest!
This is no longer posing to demonstrate the figure, but a necessary measure of survival, an emergency breathing mechanism.
“It looks good,” you say, ” but I won’t last long.” I don’t have enough air.
“Just enough to get from the sunbed on the beach to the water. It doesn’t matter there.
But this decision does not suit you, because it is a temporary measure.
— And you don’t have another, more stable method?
A corset? Too old – fashioned. Although even if our grandmothers used it, it means that there is nothing wrong with it. Indeed, Google searches open up a lot of options. In addition, these things are now called not corsets, but jeans with a high waist, “trimmers” for the waist, wide belts. And all of them give a slim figure! It’s just a miracle. So we’re buying? Wait a minute.
In female representatives, with the onset of puberty, the mechanism of respiration changes, they move from purely abdominal respiration to mainly thoracic. What was taken for granted as a child begins to be perceived as a hindrance, and belly-pulling becomes a habit. What’s the problem? Obviously, as you grow up, your perception of your own body changes, and a bulging belly seems unsightly and unfeminine. So, you can solve this problem with a “trimmer”?
Be careful! If you do not take into account the short-term and purely optical effect, all these tools for gaining harmony are not just useless, but even dangerous to health with prolonged use. Along with squeezing the organs when they are tightened too much, they significantly complicate diaphragmatic breathing. For women who put themselves in such modern corsets, the loss of lung volume can reach up to 40 percent. In combination with grueling fitness training, such “trimmers” under certain conditions can pose a real threat to life, because in this case, the breath literally does not keep up with the load. But even if we are not talking about extreme training, restriction of breathing leads to the accumulation of mucus in those places of the lungs that the air does not reach, and this contributes to the development of infections. If you are uncomfortable, remember that there were times in your life when abdominal breathing was perceived absolutely normally and did not interfere with anyone, especially yourself. If you want to make your stomach flat and elastic, achieve this through proper nutrition and physical exercises to develop endurance. Thus, you will simultaneously train your breathing and diaphragm. First, the diaphragm, like any other muscle in the body, responds to physical exertion by increasing strength and endurance (in professional athletes, the maximum breathing rate can exceed 70 breaths per minute). Secondly, the reduction of the fat layer in the abdominal area reduces the mechanical pressure exerted from below by the abdominal organs on the diaphragm. In fact, a fat stomach can have unexpected long-term consequences for breathing: if the pressure of subcutaneous fat on the diaphragm makes the lungs unable to fully stretch, a person is at risk of respiratory diseases. In the US today, being overweight has come out on top among the risk factors for developing asthma in children!
In short, forget about the cosmetic aspects of abdominal breathing and make sure to give it more space. It is necessary to free up space for the diaphragm as the main respiratory muscle. Try the following exercise: kneel and pull your pelvis back so that your belly hangs down freely. First, do this without witnesses. Forget about the habit of drawing in your belly over the years, let it hang down without interference, and the lower the better. Did you reach the floor? Well, never mind. Do you look like a late-term pregnant woman? So what? Now take a deep breath through your nose and slowly exhale through your mouth. Breathe at the rate that the lungs themselves set. Give control to a large and strong muscle, a tireless worker, which the ancient Greeks called “Fren” (the center of the senses), because they believed that part of the soul lives in it (that’s why we call people with mental disorders schizophrenics). It is impossible to live without a diaphragm, which is beyond doubt, because if it fails, a person has to breathe with the help of equipment. Previously, these “mechanical lungs” were huge and not only resembled instruments for torture, but actually caused pain to patients. Patients (usually victims of polio) were locked in an iron cage, where machines were used to create low pressure. The thin air helped to straighten the chest, due to which the person could breathe. Today, artificial ventilation devices have become smaller and more practical, they cause less inconvenience. But this does not change the fact that life without a diaphragm is very difficult. So treat her with respect!
However, with all due respect to the diaphragm, we must admit that all this mechanics of inhaling and exhaling is ultimately useless if there is no consumer of the most important raw material extracted from the air — oxygen. This consumer is the blood, and here the heart comes into play, even if only for a short time.
The heart is an inconspicuous organ of small size, located between the lungs and lost in their background. It is enclosed in a strong shell of connective and adipose tissue. It consists of four cavities of different sizes and looks quite different from how we usually draw it. Its lower side is adjacent to the diaphragm and obediently follows its movements. The functions of the heart are exaggerated. Its main task is only to mechanically pump oxygen-poor blood (the right half) to the lungs, and then to further transport the already oxygenated blood throughout the body (the left half). The heart is a real sissy. Smoking tolerates worse than the lungs. It is not a receptacle of the soul.
That’s all there is to it. Or did I miss something? No, there’s nothing more to say. That’s enough!