Editing Spirometer (section)

====Implications====
The use of reference values has thus far not accounted for the social labelling of race and ethnicity. Often, determinations are subjective or silently ascribed by a practitioner. Another concern of using reference values is misdiagnosis.<ref>{{cite journal |id={{Gale|A452290836}} |last1=O'Brien |first1=Matthew J. |title=Practice safe spirometry |journal=RT for Decision Makers in Respiratory Care |date=1 April 2016 |volume=29 |issue=4 |pages=10–13 }}</ref> This was an important factor in the management and control of compensation for miners in Britain in the interwar period. In this politically loaded context, in which new X-ray technology could not be fully trusted, the spirometer represented secure evidence of respiratory disease in numerical terms that could be used in the complex compensation network.<ref>{{cite journal |last1=Mcguire |first1=Coreen |title='X-rays don't tell lies': the Medical Research Council and the measurement of respiratory disability, 1936–1945 |journal=The British Journal for the History of Science |date=September 2019 |volume=52 |issue=3 |pages=447–465 |doi=10.1017/S0007087419000232 |pmid=31327321 |pmc=7136074 }}</ref>

Evaluation of vital capacity has influenced other sectors of life other than medicine as well, including evaluation of life insurance applicants and diagnosis of tuberculosis.<ref name=":0" />

Regarding gender, some population studies have indicated no difference based on gender.<ref name=":1" /> Notably, spirometers have been used to evaluate vital capacity in India since 1929, recording a statistically significant difference between males (21.8 mL/cm) and females (18 mL/cm).<ref>{{cite journal |last1=Dikshit |first1=MB |last2=Raje |first2=S |last3=Agrawal |first3=MJ |title=Lung functions with spirometry: An Indian perspective-II: on the vital capacity of Indians |journal=Indian Journal of Physiology and Pharmacology |date=July 2005 |volume=49 |issue=3 |pages=257–270 |pmid=16440843 |url=https://ijpp.com/IJPP%20archives/2005_49_3/257-270.pdf }}</ref> Additionally, by 1990, around half of pulmonary training programs in both the United States and Canada adjusted for race and ethnicity.<ref>{{cite journal | author = Ghio A. J., Crapo R. O., Elliott C. G. | year = 1990 | title = Reference Equations Used to Predict Pulmonary Functions | journal = Chest | volume = 97 | issue = 2| pages = 400–403 | doi=10.1378/chest.97.2.400| pmid = 2298065 }}</ref>

The spirometer popularized notions of 'race corrections' and 'ethnic adjustments,' which suggested that black individuals have weaker lungs than white individuals. For example, Thomas Jefferson noted physical distinctions between different races such as a 'difference in the structure of the pulmonary apparatus,' which made black individuals 'more tolerant of heat and less so of cold, than the whites.'<ref>Thomas Jefferson, "Notes on the State of Virginia", in ''Race and the Enlightenment: A Reader'', ed. Emmanuel Eze (Malden, Mass., and London: Blackwell Publishing, 1997), 98.</ref> Jefferson's theories encouraged speculation on the natural conditioning of blacks for agricultural labor on southern plantations in the U.S.<ref>Braun, Lundy. ''Breathing race into the machine: the surprising career of the spirometer from plantation to genetics''. Minneapolis: U of Minnesota Press, 2014, p. 28.</ref> Samuel Cartwright, a slavery apologist and plantation owner, used the spirometer to make the claim that black people consumed less oxygen than white people<ref>Braun, Lundy. ''Breathing race into the machine: the surprising career of the spirometer from plantation to genetics''. Minneapolis: U of Minnesota Press, 2014, p. 29.</ref> in addition to racial 'peculiarities' he laid out in the ''New Orleans Medical and Surgical Journal'' that described racial differences in the respiratory system and the implication of them on labor.<ref>{{cite journal |last1=Cartwright |first1=Samuel A. |title=Report on the diseases and physical peculiarities of the Negro race |journal=New Orleans Medical and Surgical Journal |volume=7 |issue= |date=May 1851 |pages=691–715 |oclc=57141108 }}</ref>

South African studies also used the spirometer to address racial and class differences. Eustace H. Cluver conducted vital capacity measurement research at the University of Witwatersrand<ref>{{cite journal |title=In Memoriam |journal=South African Medical Journal |date=1 July 1982 |volume=62 |issue=4 |pages=144 |hdl=10520/AJA20785135_14737 }}</ref> and found that poor white people had physical unfitness but that it was attributable to environmental issues rather than genetics. Using these studies, Cluver argued to the South African Association for the Advancement of Science during World War Two that improving both nutrition and physical training programs could help produce wealth and win the war by increasing the working capacity of individuals across all races as their labor was necessary to achieve these ends.<ref>Braun, Lundy. ''Breathing race into the machine: the surprising career of the spirometer from plantation to genetics''. Minneapolis: U of Minnesota Press, 2014, p. 126.</ref> Racism and the spirometer intersected again in these studies when further research was conducted on the effects of physical training on poor white recruits; vital capacity studies showed that 'the poor-white is biologically sound and can be turned into a valuable citizen'<ref>{{cite news |title=Vital Discovery on Poor White Problem |newspaper=Johannesburg Sunday Times |date=31 May 1941 }}</ref> but no comment was made on the outcome of black South Africans.

Beyond the United States and South Africa, the spirometer was used in racial studies in India in the 1920s. Researchers found that the vital capacity of Indians was smaller than that of Westerners.<ref>{{cite journal |last1=Bhatia |first1=S. L. |title=The Vital Capacity of the Lungs |journal=The Indian Medical Gazette |date=September 1929 |volume=64 |issue=9 |pages=519–521 |pmid=29009702 |pmc=5164571 }}</ref>