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as deduced from an instrument called the spirometer, constructed on a similar plan to the gasometer, and intended to ascertain the capacity of the lungs for air. The person using it should have his garments loosened, and should stand erect, with his head thrown back, and immediately after taking a full, slow inspiration, adjust the mouth-piece closely to his lips, and empty the lungs as far as possible by a slow, complete expiration. Dr. Hutchinson* has deduced from an extensive series of observations the remarkable law, that in a state of health the vital capacity has a relation to the height of the individual, and that it increases in the proportion of eight cubic inches of air for every inch of stature from five to six feet. : In several hundred cases examined at this hospital, we have found the average reduction of vital capacity after the second stage, that is after softening has commenced, to be more than fifty per cent. ; whilst in the first stage,—that, namely, before softening,—the average reduction has been about thirty per cent. It is desirable to mention, by way of caution, that in their early trials with the instrument, "some patients, in consequence of nervousness or inexperience, do not expire an amount of air equal to their vital capacity ; unfavourable conclusions, therefore, should not be hastily drawn ; but when an individual expires his average quantity, it is fair to assume that he is free from tubercular disease;"+ and when the quantity nearly approaches the average, we may also reasonably conclude that tubercular disease, if existing, has made little progress. *-* See “Medico-Chirurgical Transactions," vol. xxix.
+ First Medical Report of the Hospital, p. 26.
You perceive that in the table before you, the weight of the patients is also recorded. Change of weight is one of the most valuable single indications of the course which the disease is taking, whether favourable or otherwise. In many instances, you will find a deficiency of weight to be one of the first circumstances calculated to excite your suspicions. It is, however, important to have carefully deduced averages for our guidance ; and here, again, I avail myself of the laborious investiga. tions of Dr. Hutchinson, the averages represented in the table being given on his authority. It is a fair approximation to say that a person five feet high should weigh 120 pounds; one at five feet four inches, 140 pounds; at five feet eight inches, 160 pounds ; and at six feet, 180 pounds; thus calculating an addition of about five pounds' weight for every additional inch in height. This calculation you will find sufficiently near the fact for ordinary purposes. There are, however, remarkable exceptions to any general law in reference to such standards ; great deviations in this respect are consistent with health. One of the most striking examples is that of Smith, the pedestrian, who, at the age of about forty, with a height of five feet five inches, weighs only 102 pounds, instead of the average which I have mentioned of 145 pounds, or as registered by Dr. Hutchinson, 142 pounds. Nevertheless, Smith may be adduced as an example of a healthy, energetic man. His stride is from four feet two inches to four feet four inches, and he has been known to walk twenty miles in two minutes less than three hours. • The circumstance of most importance in applying the question of weight to diagnosis, is not the absolute
weight, but the direction of any change which may be in progress. With this view, you should always endeavour to ascertain the greatest known weight of a . patient ; for no single fact is more frequently associated with the setting in of phthisis than a marked reduction in this respect. The common, and in many cases stealthy approach of consumption, among the inmates of prisons, is often first detected by a progressive diminution of weight, notwithstanding the influence of improved and regular diet.
Allow me, in conclusion, to recur to the principal subject of this lecture-namely, wavy inspiration. Patients in whom this sign is observable, in addition to slightly impaired vital capacity, and probably diminished weight, are generally delicate in appearance, and easily fatigued. Cough is not necessarily present, and rarely severe. There may be occasional uneasiness of chest ; but symptoms calculated to attract attention to the lungs being often absent, it is expedient, in all obscure cases of impaired health in patients whose countenances are expressive of deficient or imperfectly aërated blood, to examine the chest in order to ascertain whether this variety of altered inspiration be present. The conclusions to which I am conducted in pursuing this inquiry are :
1st. That wavy inspiration may be occasionally observed in cases of bronchial inflammation, pleurisy, and rheumatism ; but that the most common variety is unconnected with those affections.
2ndly. That the variety most frequently observed (and distinguishable from the other varieties) may occur at various parts of the chest, but most frequently at the upper part of the left lung.
3rdly. That the symptom rarely disappears, excepting when superseded by definite signs of phthisis, but that it often continues for years without the supervention of that disease.
4thly. That when phthisis does ensue, there is reason to apprehend rapidity in its progress.
Assuming these views to be correct, this symptom cannot be regarded as conclusive evidence of the presence of tubercular disease, but it does not the less retain its interest and value. Although patients in whom it occurs unassociated with other signs, may be considered on the verge of phthisis, it is gratifying to feel authorised to assure them that they present no evidence of tubercular disease, and that under favourable circumstances we may hope to avert any more serious impairment of health. The indications of treatment are, to promote healthy nutrition, to correct hepatic congestion as far as possible, to obviate depressing mental emotion, to adjust clothing, and select climate, so as to secure, as far as possible, without unseasonable exposure, much easy exercise in the open air. Iodide of potassium is often an appropriate remedy, and, in many instances, iodide of iron; and counter-irritation is sometimes useful ; but we must always remember that, although the disease is tending to localize itself in the lungs, yet the source is elsewhere.
Appearance of the gums in consumption—The border streaked ;
margined; pearly; thickened—Often changed at an early period of the disease-Influenced by habits, &c.—Clubbed fingers—Indigestion modified by consumption—Theories of the origin of the gingival margin-Its use in diagnosis and prognosis.
The precision which auscultation has introduced into the diagnosis of established phthisis, has probably a tendency to induce partial neglect of some collateral indications, which, although affording us no certain information respecting the amount of local disease, nevertheless possess peculiar value as evidence of constitututional changes intimately connected with the morbid element. In the investigation of chronic diseases, one of the most important objects is to ascertain, as far as possible, the condition of the blood, and the degree of firmness or tenuity of the bodily structure in general. With this view I propose to-day, gentlemen, to invite your attention to a symptom which may perhaps have reference to some change in these conditions, as manifested in a part of the mucous membrane of the mouth. The introduction of some poisons into the system is occasionally manifested at the edge of the gums, where they are reflected around the teeth. Remarkable evi