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John Hutchinson's mysterious machine.

John Hutchinson, a surgeon invented the spirometer. He coined the term, vital capacity, i.e., the capacity for life. John Hutchinson was a very precise man and a violinist of some reputation. His exacting observations allowed him to learn that the vital capacity was directly related to height and inversely related to age. In his first paper published in 1846 he reported on measurements in 2,130 individuals including deceased patients (1). He recognized that reductions in vital capacity predicted premature morbidity and mortality. Hutchinson became a consultant to the insurance industry of London and he felt that the vital capacity should be used in actuarial predictions. Hutchinson's invention was initially acclaimed. "We have no hesitation in recording our deliberate opinion, that it forms one of the most valuable contributions to physiological science that we have seen for some time. In all future investigations, the name of Mr. Hutchinson must receive honorable notice" (2). But Hutchinson's instrument (Figure 1) was not widely accepted in London or anywhere else and still remains absent from most physicians' offices and clinics. Since this is so, it is reasonable to conclude that John Hutchinson was frustrated when he left his wife and three children and emigrated to Australia at age 41. At this time, he abandoned all further scientific study of his device. Toward the end of his life he moved to Fiji where he died at age 50, possibly from tuberculosis. In 1980 it was reported that the vital capacity was a powerful prognostic indicator in the Framingham study of 5,209 men over the age of 30. "This simple office procedure is a useful predictor of pulmonary disease and cardiac failure and can effectively select groups of persons destined for premature death. Since the vital capacity predicts cardiovascular as well as noncardiovascular mortality this pulmonary function measurement seems truly a measure of living capacity useful for insurance and underwriting purposes" (3). If the vital capacity is so important in clinical medicine, why don't all physicians have a spirometer in their offices just as they have a sphygmomanometer, an EKG machine, a clinical thermometer and a tape measure? This presentation explores this question. Could it be that