Some Points on the Physical Examination of the Chest (Classic Reprint), Smith Andrew Heermance

Spirometry, once much in vogue, seems now to have fallen almost into disuse. Yet the indications afforded by it are valuable, and the more so as they are capable of exact record. Perhaps one reason that it has lost favor is that, as generally practiced, it is inherently uncleanly An instrument that is blown into by numbers of people of all sorts and conditions, and in all stages of pulmonary disease, and that cannot conveniently be cleansed after each use, must soon become repulsively and dangerously contaminated. This may be avoided by having the patient breathe from the receiver, instead of into it. The receiver, properly balanced, is filled with air by drawing it up to its fullest height, and the patient, having emptied his lungs as completely as possible, inhales from the instrument until his chest is expanded to the utmost. The number of cubic inches of air withdrawn from the receiver is then read off from the scale. If the instrument is properly arranged, the results should not vary from those procured in the usual manner. Of course the scale should read from below upward, instead of from above downward.

The chief usefulness of the spirometer, it appears to me, is in the indications it affords for pulmonary gymnastics. In no other way is the need for such exercises, in suitable cases, made so apparent, both to the practitioner and the patient, and in no other way can the good results be so readily demonstrated, and perseverance on the part of the patient secured. Moreover, the use of the instrument is in itself of no small value in correcting the very defects it brings to light. In fact, it is very common to find that a decided increase in the vital capacity, to use Hutchinsons term, follows upon the first few efforts to inflate the lungs to their fullest limit.

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