Hold the breath two counts, and exhale through the mouth with six short expiratory puffs, drawing the ribs in at the side with each puff.
"Resonance in Singing and Speaking"
Thomas Fillebrown
In some cases the patient can, by a violent expiratory effort, such as coughing, project the goitre upwards into the neck.
"Manual of Surgery Volume Second: Extremities--Head--Neck. Sixth Edition."
Alexander Miles Alexis Thomson
Therefore the skin, properly speaking, is an expiratory apparatus, which, under ordinary conditions of the organism, exhales, in an insensible manner, products analogous to those expired from the pulmonary surface; with this difference, that the quantity of carbonic acid is very much less considerable in the former than in the latter of these exhalations; according to Burbach, the proportion of carbonic acid, as inhaled by the skin, being to that expired by the lungs as 350 to 23,450, or as 1 to 67. The experiments made on inferior animals, such as frogs, toads, salamanders, or fish, have demonstrated the waste by general transpiration to be, in twenty-four hours, little less than half the entire weight of the body.
"The American Reformed Cattle Doctor"
George Dadd