Thus, if the height be above 5ft. 7in. to 5ft. 8in., the vital capacity should be 230 cubic inches, if above 5ft. 8in. to or including 5ft. 9in., 228 cubic inches, and so on. If we recollect any one quantity in this table, the vital capacity at any height can be readily called to mind. For example, at the height of 5ft. 8in. the vital capacity is 230; for every other height add to or subtract 8 cubic inches from 230, which will be the quantity sought for. Curiously, from this table of stature, we have a direct guide to measure the healthy vital capacity, and that through the most active period of life, which may be considered as forty years, from 25 to 65. The stature does not vary but at the extremes of life, whereas the weight may differ and oscillate to an enormous extent in the brief period of a few months, therefore were we to combine the weight as a guide to measure the vital capacity, we should be encumbered with calculations for correction too numerous and uncer. tain to be of much value. The spirometer is constructed to hold a vast quantity of water, to reduce the expired air (without calculation) to as nearly 60 degrees as possible; but in the extremes of the season, our rooms differ from this by many degrees, therefore a table of the correction for temperature is here introduced. The temperature is measured by any thermometer in the room, not necessarily connected with the spirometer. The vital capacity, as given in the above table, will be observed to increase in arithmetical progression, the series derived from observation (which for comparison is placed in juxta-position in the memoir,) corresponds so nearly to this, that the arithmetical series becomes the best guide. So strict is the relation between the vital capacity and the height, that an opinion may be given, touching the physical development of men now "no more"—thus, Dr. Jurin and Dr. Stephen Hales measured about 5 ft. 8 in., and were between 10 and 11 stone in weight, Davy about 5ft. 7 in., Goodwin under 5 ft. 7 in., and Kite upwards of 6 ft. This legiti. mate conclusion is gathered from the collateral observations, though their height is no where mentioned. [A table for the correction of temperature in measuring the vital capacity was here exhibited.] To take an * instance,if the vital capacity measures 230 cubic inches when the room is at the temperature of 72°, the correction will be 224, at the temperature of 60° (about 1-500 difference for every degree). of the chest, and the vital capacity. A chest 40 inches and one 30 inches in circumference, or a deep and shallow chest, in men of the same stature, is expected to measure the same vital capacity. A man may expel more air from his lungs than the whole cubic space allotted for the organs of respiration as when measured at death, or a man in health may expel much less air than the cubic measurement of this space. Two men of different heights, yet who sit the same height, and measure the same round the chest, will yet measure a different vital capacity, from some cause as yet unknown. There is no relation between the stature or weight, and the absolute cubic dimensions of the thorax. A stout man may have large langs and a spare man small lungs; small lungs are not necessarily found in stout men. There is good reason to believe that in a healthy man, there is no relation between the extent of mucous surface in the lungs and the amount of aeration or oxidation of the blood. The circumference of the chest increases with the weight in relation of one inch for every 10lbs. In measuring the chest with a common tape measure, allow a quarter of an inch for a flannel and a quarter for a shirt. Mobility of the Chest.-The vital capacity and the range of thoracic movement appears to be in strict relation. In men of the same stature, a 40inch chest with three inches mobility, must measure less vital capacity than a 40-inch chest with 4 inches mobility. Stout men have smaller thoracic mobility than thin men; the amount of aeretion of the blood is regulated by the mobility. The mobility is correctly measured by the spirometer, it can also be estimated (less correctly) by a common tape measure. Note the minimum circumference of the chest after a forced expiration, then cause the chest to be expanded to its maximum and again measured, the difference is the “ Mobility.” In healthy persons of ordinary weight and middle age of life, (by the tape measure,) the mobility averages three inches, seldom four inches. This observation is valuable and simply accomplished. Effect of Weight.-The relation between the weight and the vital capacity as yet does not appear definite ; yet when observations are more extended, this will be cleared up. In large numbers, to a certain extent, it is apparent, but probably it will never be a guide to determine the vital capacity in solitary cases, because it is difficult to tell a man's proper weight. Air-bags are constructed so that any person can be examined at home, and afterwards the bag can be 21883882232 BATH AND BRISTOL BRANCH ASSOCIATION. According to the present data it may be said the weight (which increases with the height,) does not diminish the vital capacity until the weight exceeds, by 7 per cent., the above weights at each height, and then in the relation of one cubic inch per lb. for 35lbs. ; beyond this, probably, it will be found to diminish in a geometrical relation. For example, if the man of 61 inches weigh 120lbs., he may exceed this by 7 per cent.-8.4lbs. may be added, making 128lbs. (128-4) then the vital capacity may be expected to diminish. (120 × 7=840÷100=8.4lbs.) A full meal will diminish the vital capacity from 12 to 20 cubic inches. Effect of Age.-Time affects the animal kingdom in a two-fold manner-bringing it to perfection and then deteriorating that perfection. From 15 to 35 the vital capacity increases, and from 35 to 65 it decreases nearly 1 cubic inches per year. Perhaps, generally, age need not be taken into account before 40 or 45, yet it is considered correct for Insurance Offices to take it into account from the age of 35. Intercostal Muscles.-Every external intercostal muscular lamella can elevate the rib above it, independently of any other intercostal muscle. The eleven external intercostal lamella on either side, can each independently lift two ribs, so respiration can be carried on without the first or superior rib of necessity being fixed. The GENERAL REMARKS AND PRACTICAL DEDUUCTIONS. Boerhaave says "scarcely any particle remained in the body which was not more or less concerned in the business of respiration;" therefore this great function must be extensively knit to our well-being. spirometer is believed to be useful in measuring this function; it is a guage in a two-fold sense,—a measure for mobility, as well as a measure for capacity, because a man cannot breathe without moving. If disease affects the mobility of the body, the spirometer must measure this effect. The discovery of the seat of disease demands the consideration of a number of circumstances-every observation is a link in the chain, leading one way or another, and that observation which can be measured and is capable of definite expression, will be found to weigh heavily in our diagnosis. All we know is gathered from physical observation, through the medium of our senses; physical alterations in the conditions and relations of parts, can only be determined by sight, touch and hearing; the more surely these are tested and definitely expressed, the more perfect is our comprehension of any change. No science is useful unless capable of this sure expression; the great epoch in chemistry was the atomic theory, founded on evidence, not involving hypothesis, an arbitrary measure is selected and a luminous explanation of the laws of combination of matter is made apparent. This definite language is figures-a language of relative powers. If a man breathe into the spirometer 200 cubic inches of air it is neither 199 nor 201. Two thousand men thus examined demonstrate that the vital capacity is under certain circumstances the same, and it may be proved that by a little training we can measure the most delicate deviation from this constant quantity. 215 From the mean of many observations in phthisis, in the early stage the vital capacity measured 149 cubic inches instead of 224; in the advanced stage, 83 instead of 220 cubic inches. If we express a man's state in such language, we shall feel it beget a confidence pleasing in diagnosis. The physician to an insuranee office is at the same time shielded against certain remarks from the actuary or board of directors, that great reproach of the art "its uncertainty." An example of a book headed and filled up with Here is expressed as an illustration, this method of observation upon cases actually examined. The eye at once will perceive a great difference in these ten persons. ་ The first three are healthy cases; the vital capacity corresponds with the height according to the rule laid down. The inspiratory and expiratory powers are not only considerable, but bear their proper relation to each other. The mobility of the chest is also natural, and the weights are indicative of health. Therefore it may safely be said, these three men have healthy lungs, or, at least, permeable to air, throughout their entire extent. Their respiratory power is indicative of great physical strength. The fourth case (D.) has a remarkable vital capacity; The next case, though measuring a vital capacity of 80 cubic inches, is of short stature, (3 ft. 9 in.) This little man's respiratory power appears better than the case of D., though his pulse and respiration per minute is certainly objectionable. He is now dead, but his height is seven feet. The respiratory power of | quantities. Percussion on the anterior part of the this man is below par, particularly his expiratory chest under the clavicles gave on the right side a very power, which indicates that there is some cause existing dull sound, on the left one much clearer, but still I which prevents his expiratory muscles acting with think less resonant than natural. I made but one healthy vigour. attempt at auscultation, but could come to no conclusion, from a rather singular reason,-the ribs were so large, the intercostal spaces so wide, and so sunk in from the extreme state of emaciation to which Freeman was reduced, that I could not find a level space large enough to receive the end of the stethoscope,-could not, in short, bring its whole surface into contact with the chest. Freeman's great debility, and the clearness of the diagnosis from other sources, prevented my repeating the attempt. Freeman, after death, measured 6 ft. 7 in., and weighed 10st. 1lb. On opening the chest, the lungs on both sides were found adhering by their apices to the superior boundaries of the thorax, and studded throughout their substance with tubercles. The tubercles on the whole were much less numerous in the right lung than in the left; both lungs were nearly healthy at their base; the tubercular matter gradually increased in quantity towards their inner parts, and the apices of both lungs were almost completely occupied by large cavities partly filled with pus, and capable of containing two or three ounces of fluid each. The heart was remarkably small. The rest of F. and G. are examples of persons labouring under phthisis. The stature shews that their vital capacity is very much below the natural standard: instead of 108 it should have been 254, and, instead of 80, 238 cubic inches. Their respiratory powers are also much too low-the thoracic mobility two-thirds below the standard. All this disturbance is the effect of serious disease; the number of respirations and pulse are out of proportion. In casting the eye along the line of figures in the case of H., the striking part is the respiratory power, which is so deficient, while every other observation looks healthy; this was a case of rupture of the membrani tympani. When the man closed his ears, his respiratory power was manifested as nearly three times stronger. In the case of I., the respiratory power is deficient the viscera appeared healthy." from hernia being present. The last case is phthisis in an early stage: the measures here are sufficiently marked to excite attention. In one case the tubercular matter was not equal | to one cubic inch, yet the diminution in the quantity of expired air was 47 cubic inches. The most interesting case followed throughout, from the commencement to the termination, is that of Freeman, the "American Giant." This man came over to England in 1842, and, in November of that year, trained for a prize fight; I examined him immediately before his professional engagement, when he might be considered in the "best condition." His powers were as follows:-Vital capacity, 434 cubic inches; height, 6 ft. 11 in.; weight, 19 st. 5 lb.; circumference of his chest, 47 inches; inspiratory power, 5.0 inches; expiratory power, 6.5 inches. In November, 1844, exactly two years afterwards, he came to town in ill health. I then examined him in the same way as before, twenty times at various intervals, during which his vital capacity varied from 390 to 340, and the mean of all the observations was 344 cubic inches, a decrease of 90, or more than 20 per cent.; his respiratory power had decreased one fifth, and his weight two stone. At this time I took him to two physicians well skilled in auscultation, and they both affirmed that they could not detect any organic disease. After January, 1845, I lost sight of Freeman, and, in the October following, I was kindly favoured with the following account of him from Mr. Paul, Surgeon to the County Hospital, Winchester : "Freeman was admitted into this hospital on the 8th of October, in an extreme state of debility and exhaustion; he was reduced almost to a skeleton, complained of cough, and was expectorating pus in large It is very remarkable to see that Freeman lost so much weight; in his prime he never appeared stout, but strong and muscular. I have been informed, when he first came to England, his weight was 22 stone; he died 10 stone. His natural height was nearly 7 feet, and he died 6 ft. 7 in. The spirometer was useful to me in this case, by indicating the commencement of the disease which ultimately caused his death, and that BEFORE THE USUAL MEANS AVAILED. SHEFFIELD MEDICAL SOCIETY. Sixth Session, Eleventh Meeting, Feb. 18th, 1847. The President, Mr. TURTON, in the chair. DISEASED BONE. Mr. Thomas exhibited the leg of a female, aged 22, a prostitute, which he had removed in the morning. There was a large and extremely painful ulcer, together with considerable thickening of the periosteum and enlargement of the bone. The ether was used, and produced insensibility in rather less than two minutes and a half. In consequence of great retraction there was difficulty in securing the posterior tibial artery, and the ether was inhaled a second time. During the operation there was some moaning and screaming, but she does not know anything about the operation. Mr. Thomas also exhibited the blood drawn from a moderately sized opening in the arm of a female aged 29, in the eighth month of pregnancy, for the relief of pneumonia. The coagulum presented the buffed appearance in every part. Dr. Branson laid on the table "Dupuytren, on the Injuries and Diseases of Bones," the new volume of the Sydenham Society. SHEFFIELD MEDICAL SOCIETY. 217 FIBROUS TUMOUR OF THE DURA MATER. Dr. Branson exhibited a portion of dura mater from which a tumour, about the size of a small pullet's egg, grew, presented by Mr. Martin to the museum of the Infirmary. The patient was an elderly gentleman. When first seen by Mr. Martin, he was suffering from paralysis agitans of long duration, and extensive sloughing of the hips and sacrum. He had suffered from one or more convulsive attacks, and his habits and disposition had been materially affected by the disease. There was no loss of motion on the opposite side of the body to that on which the tumour was found until a few days previous to death. On inspection post mortem the tumour was found adherent to the dura mater, pressing upon the right middle lobe of the cerebrum towards its anterior and lateral part. The substance of the brain in its immediate neighbourhood was in a state of ramollissement. The pia mater beneath the tumour was absorbed, and that surrounding the part much injected. The tumour was of a fibrous nature, which was shown in a microscopical drawing made by Dr. Branson. Mr. Hunter exhibited a scirrhous breast from a female aged 38, in the centre of which was commencing INSUFFICIENCY OF THE AORTIC VALVES; DISEASED Mr. Law exhibited the heart and kidneys of a scissorgrinder, who had suffered most probably from fever prior to admission into the Infirmary. When admitted his symptoms were,-voracious appetite, severe cough, general anasarca, increased space of dulness in the præcordial region, and a loud bruit de soufflet accompanying both beats of the heart, heard most distinctly near the cartilage of the fourth rib, and having with the first beat a somewhat musical character. It was obvious that both obstructive and regurgitant disease of the aortic valves existed, with hypertrophy and dilatation of the left ventricle. On inspection post mortcm a large deposit was found on the ventricular surface of the valve, which it is obvious would offer considerable obstruction to the passage of the blood from the ventricle, and it accounts for the musical character of the bruit which accompanied the first beat, and is precisely the condition of valve which gives rise to eccentric hypertrophy and dilatation of the left ventricle. The insufficiency of the valve was proved by experiment, water passing readily out of the artery into the ventricle. The kidneys were good specimens of Bright's disease, and were most probably, rather than the heart, the cause of the anasarca. The urine was light-coloured, but did not coagulate either with heat, nitric acid, or bichloride of mercury. Mr. Jackson exhibited Avery's instrument for the inspection of internal cavities. Dr. de Bartolomé read a paper " On Pericarditis."* An abstract of this paper will be given in the next number of the Journal, Twelfth Meeting. March 4th, 1847. The PRESIDENT in the Chair. Mr. Porter, through the kindness of Mr. H. Taylor, V.S., exhibited an apparatus for the administration of the vapour of æther to horses, and explained its construction. SCIRRHOUS MAMMA. Mr. H. Jackson then exhibited a scirrhous breast, which he had that day removed from a patient, aged 44, a married woman, who had borne four children, and in whom menstruation still continued at the regular periods. The patient had enjoyed good health, and according to her account, it was only seven months ago that she perceived a slight tumour immediately below the nipple of the right breast. This existed for two months, when it became painful, and the intensity of pain has increased, and also the duration, up to the period of admission into the Infirmary. She could assign no cause for it. The tumour was completely free; no enlarged axillary gland; and, with one important exception, there was every indication of success in the operation. The skin was of a dusky yellowish colour, as after jaundice. The operation was performed, the æther being used. It did not produce the indications recommended to be obtained for twelve minutes, and then there was no upturning of the eye, but rather a fixed state, together with an evident filling of the vessels of the cheeks. Under these circumstances the operation was proceeded with, and on the first incision, the patient uttered screams, and afterwards moans. During the progress of the operation, she sank into a state of insensibility, from which she soon revived. She was not conscious of having uttered any expression of pain whatever, not having felt any, and was not aware of the first incision being made, the first thing which she recollects being an expression made use of by Mr. Thomas, during the securing of the vessels. In about an hour after, when the wound was dressed, she complained of great soreness and pain on the passing of the sutures. The difference between arterial and venous blood was very evident. The scirrhus appeared to have originated just below the nipple, which was retracted, and was about the size of a small orange, and exceedingly firm. Taking into account the fact of the patient being insensible to pain, although apparently awake to everything when the operation was commenced, Mr. Jackson suggested that it might not be impossible, by repeated trials and careful observation, to establish the point at which all the useful purposes of the æther vapour might be procured, so far as inducing insensibility to pain, without arriving at the apoplectic appearance recommended to be attained previous to the commencement of the operation. General Retrospect. PRACTICAL MEDICINE. TETANUS SUCCESSFULLY TREATED BY TOBACCO INTERNALLY. After this process had been continued for a quarter of an hour, a watery humour began to run from the excoriated surfaces. The apparatus was removed, and towards evening she began to speak more audibly and the improvement continued next day, but was lost again on the fourth or fifth day. The process was then left on all night, with the effect of permanently restoring the voice.-Dublin Quarterly Journal, Febr. 1847. EFFECT OF HYDROPATHY ON THE BLOOD. Mr. Pridie, of Stockton-on-Tees, reports the follow-repeated, with the same results, and the apparatus was ing case:-A female, aged 44, injured her arm by falling upon a nail. On examination, a lacerated wound was found near the elbow, but it gave rise to no anxiety until the end of a week, when the granulations were observed to look flabby. Sulphate of copper lotion was applied, and the bowels were freely acted upon by colocynth and elaterium. After this time, considerable difficulty was experienced with the bowels, and on the 14th day after the injury, the patient began to complain of pain in the head and back, with trismus, and rigidity of the legs and left upper extremity. The heart's action was slow and languid, and convulsion followed attempts to swallow. As the tetanic symptoms increased, it was determined to try the tobacco, and accordingly half-an-ounce of an infusion of thirty grains to nine ounces, was given every one, two, or three hours, according to its effect. The bowels acted after the third dose, and the pain appeared less during the paroxysm. The medicine was continued, and on the next day produced great nausea and vomiting, after which the paroxysms abated in frequency. The same plan was persevered in, with the addition of enemata of tobacco, for five days, when opium was added. The tobacco was finally omitted on the eighth day.-Monthly Journal of Medical Science, March, 1847. [This case appears at first sight to afford strong evidence in favour of the remedy employed, but it must be recollected, that, as has been noticed as long ago as the days of Hippocrates, cases of tetanus which survive the fourth day, and become chronic, frequently if not generally do well; we are therefore here at a loss how much to attribute to the tobacco, and how Lest there should be any- amongst us, which I trust there is not, with a tendency to desert legitimate medicine for the crooked ways of water-quackery, we may mention, as a caution, that a German physician, M. Albert, who has had ample opportunities of witnessing the operation of the water-cure, has remarked that persons who have pursued the system uninterruptedly for two or three months, are apt to acquire a habit of becomes accelerated, soft, and feeble. The patient is body not dissimilar to that of scurvy. The pulse subject to palpitations and a continual feeling of lassitude, and eventually suffers from spongy gums and aphthous ulcerations of the interior of the lips and cheeks. From these symptoms M. Albert concludes that the immoderate use of water has a tendency to impoverish the blood.-Dr. Ranking's Retrospective Address. TREATMENT OF APHTHE. Professor Lippich, of Padua, employs, with success, the sulphuric acid against aphthæ, and in syphilitic mercurial stomatitis, when the mucous membrane of the mouth and lips is covered with ulcerations, which render deglutition difficult. He uses the following formula:-R. White honey, 30 grammes; sulphuric acid, 2 grammes. Mix, and make a liniment. In severe increased to eight grammes to the same quantity of cases the proportion of the sulphuric acid may be honey. The ulcerated surfaces are to be frequently touched slightly with this liniment by means of a soft much to the greatly neglected agency of the vis pencil.-Gazette Méd. and Dublin Med. Press. medicatrix.] GALVANISM IN APHONIA. Dr. Coudray reports several cases of aphthæ in which the topical application of pure muriatic acid was followed by complete success. In many cases, when the exudation did not occur in thick lamine, and when it occupied the tongue and lips only partially, it sufficed to use the acid diluted by an equal proportion of water, or two parts of the latter to one of the former. But whenever the pseudo-membranous material was thick, resisting, and yellowish, and the child refused the breast, he had recourse to the pure acid, one or two The following is the description of one of the earliest modes of applying galvanic action to the treatment of disease, and on account of the long continuance of its effects, is thought by Mr. Donovan to hold out con. siderable advantages:-In the case of a young lady, affected four years with hoarseness, and more or less complete aphonia, blisters, mercurials, &c.,had been used without any relief. Her physician, Dr. Grapengiesser, then thought of increasing the action of blisters by gal-applications of which caused the separation of the false vanism, and accordingly, having vesicated each side of the larynx to the size of a shilling, he covered the excoriated spots on one side with a zinc plate, to which a wire of the same metal was attached, and on the other with a piece of silver. As soon as he brought the two plates in contact, a burning sensation at those spots arose, and the larynx heaved up and down convulsively, with loud sobbing. On alternately breaking and re-joining the contact, these motions became so violent, as to be almost insupportable. membranes. Its use, he states, is attended with very little pain, and infants who had been unable to take the breast for several days before, became capable of sucking in a few hours afterwards. Bretonneau, many years ago, extolled the use of muriatic acid in this form of stomatitis; and again, last year, Trousseau and Delpech called attention to the great efficacy of the fuming acid, as one of the most powerful modifying remedies in severe aphtha. Dr. Coudray, therefore, proposes nothing new. His cases, |