Ohio History Journal

URINALYSIS, INSTRUMENTS OF PRECISION, THE

STETHOSCOPE, ET CETERA, OF THE PERIOD,

1835-1858

 

By HOWARD DITTRICK, M. D.

 

The period 1835 to 1858 was one during which there was little

or no advance in the scientific side of medicine. According to

F. H. Garrison, the scientific movement did not start until well

after the middle of the nineteenth century. Medicine of the early

half was, with a few exceptions, only part and parcel of the sta-

tionary theorizing of the preceding age. This was particularly true

regarding development and use of instruments of precision.

The field of my assigned topic is restricted within two limita-

tions: first, instruments of precision, that is, those of definite

scientific measurement in the field of diagnosis; and second, those

used in Ohio within this comparatively barren period.

If, therefore, this paper should be restricted to precision in-

struments of this period certainly used in Ohio, there would be

little to say and I would have saved much time for myself and

some twenty minutes for you. I had almost reduced it to the

well-known essay of a school boy on baseball--"Rain, no game."

But I propose to adhere to the outline set forth by your chair-

man in his letter of last January, in which he allotted to me, in

addition to precision instruments, chemical analysis of urine, the

stethoscope, etc. I crave your indulgence if I place undue em-

phasis on the et cetera. Under that heading you may mentally

catalogue all those instruments which you may not agree to be

properly classified as instruments of precision.

For even that line of demarcation may be vague. Dr. Ralph

H. Major said that while stethoscope, thermometer and blood

pressure apparatus were classed as instruments of precision when

first introduced, they are not now considered more precise than the

finger-tips. Because since we have become familiar with them,

we have learned that they are subject to strange caprices, and can

(347)

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348   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

easily lead us astray. Evidently the et cetera must salvage the

only remaining shreds of my topic. I shall begin with urinalysis.

The story of the examination of urine is very intriguing, and

goes far back into history. May I touch briefly on these facts

leading up to the period under discussion today, in order to afford

perspective for progress within this era.

For example, the Fehling test for sugar goes back to Un-

guentum Egypticum. In the preparation of this ointment, which

contained verdigris, honey and vinegar, it was noted that boiling

produced a change in color, due to the reaction of the copper and

sugar. This led ultimately to the present test which results from

the reduction of copper solutions by glucose.

In the middle ages the examination of urine, or uroscopy,

consisted of observations of urine in large flasks, these having

been collected by pages and brought to the doctor in woven straw

containers called matulas. This practice is frequently illustrated

in old art.

Modern qualitative analysis dates from Lorenzo Bellini

(1643-1704) who evaporated the urine and found that the gross

characteristics were due to the variations in amounts of water and

solids present. Hermann Boerhaave (1668-1704) emphasized the

measurement of urine. He discovered urea, but little heed was

paid to it until Ruelle, in 1771, again directed attention to it.

In 1772 Matthew Dobson studied the urine in diabetes, and

described it as clear, pale, and sweet. By evaporation he obtained

a residue indistinguishable by taste and smell from ordinary sugar

(Burroughs-Wellcome). Later William C. Cruickshank pointed

out that the residue was a vegetable sugar differing from sugar of

milk. He also noted that, in the urine of dropsy, the addition of

nitrous acid produced cloudiness, and that, in the presence of bile,

the addition of muriatic acid produced a green color. John Black-

all, in 1813, discovered the heat test for albumen, and two years

later, M. E. Chevreul observed that the sugar in diabetic urine

differed from cane sugar and was more like grape sugar. William

Prout, in 1820, was the first to use litmus paper in urinalysis.

Jonathan Osborne in The Nature and Treatment of Drop-

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OHIO MEDICAL HISTORY, 1835-1858               349

sical Diseases, published in 1837, recommended "heating the urine

in a spoon over a candle, when a white coagulate will be found in

those portions of the fluid next to the metal, long before the heat

has advanced to the boiling-point. As the heat is continued, the

coagulate will become more firm and distinct."

In 1839 Pierre Francois Olive Rayer called attention to the

value of the microscope in examining urinary deposits. Trommer

developed the copper test for diabetes in 1841. Hermann Fehling's

description of the test was first published in 1848 (Burroughs-

Wellcome).

Although Ohio publications of the period under discussion

contain abstracts and editorials on progress in all fields of medi-

cine, including discoveries in urinalysis, references to activity in

this field are few and far between. The majority of references are

of a general or casual nature, but occasionally there appears a

comprehensive article. In the Western Lancet for 1850, a test is

described in which the urine is heated with mercury dissolved in

nitric acid. This gives a bright red color in the presence of al-

bumen. Again in 1855 an editorial in the same journal discusses

presence of sugar in the urine but no definite statement indicates

the frequency with which tests are made.

In an editorial in the Ohio Medical and Surgical Journal for

1855, there appears the following:

 

We have received from the author, John King, M.D., of Cincinnati,

Ohio, "Table of Urinary Deposits, with Microscopical and Chemical Tests

for Clinical Examination." . . . These deposits relate to a field of inquiry

vast in extent and difficult of explanation, and nothing like a general interest

in regard to it has yet been awakened. . . . What are we to infer from

the presence of alubmen, . . . of cystine, . . . of oxalate of lime and

oxalurate of lime? Or even in the presence of phosphates? . . . Albumi-

nous urine has a latitude in disease not yet understood. The same may be

said in regard to the other articles noticed. To such points investigations

should now be directed and that they will be rich in results, and practical,

no one who has paid the least attention to the subject can for a moment doubt.

In the Ohio Medical and Surgical Journal for July 1855,

there appears an excellent contribution on the "Systematic Quan-

titative Analysis of Urine" by Dr. Theo. G. Wormley of Co-

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350    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

lumbus, Ohio, which indicates the possibilities of urinalysis at

this period. Since the tests for albumin, sugar and bile are not

nearly as intricate as many that he describes, it is evident that

they were purposely omitted from this discussion. He does fur-

nish, however, clear and definite tests for determination of urea,

uric acid, mucus, water and solids, fixed salts, earthy and alkaline

salts, chlorides, chloride of ammonia, phosphoric acid, lime, sul-

phuric acid, potassium and inorganic substances. The prepara-

tion of the reagents is also fully described. Those used by Worm-

ley were caustic and nitrate of baryta, chloride of barium, nitrate

of silver, nitrate of mercury, oxalic acid, bichloride of platinum,

chloride of lime, carbonate and caustic ammonia.

Among the apparatus required were the following, "specific

gravity bottle (with perforated stopper), a few Berlin evaporating

dishes, a few beaker glasses, a small platinum crucible, a graduated

tube, a balance, a few small funnels, and a small quantity of filter-

ing and litmus paper."

In the advertising pages of the above journal prices of equip-

ment are listed by Bullock and Crenshaw of Philadelphia. They

offer urinometer cases "containing a urinometer and graduated

glass for floating it, a delicate thermometer and test paper com-

plete for $5.00." Bear in mind that the urinometer had only re-

cently been introduced in 1849 by Johann Florian Heller of

Vienna. Another form of urinometer contained "a delicate ivory

scale, very accurate" and made in London. Thermometers used

in testing temperature of urine and reagents cost from $1.50 to

$6.00.

Wormley's remarks are of interest. "In making an analysis

of the urine, the discharge of an entire day should be received in

a clean vessel, and the amount noted, as also its reaction to litmus

paper. The specific gravity taken at a temperature of 60?? F. . . .

It is scarcely necessary to add that the urine should be well agi-

tated before taking its specific gravity." "Unfortunately," he adds,

"the complex character of that fluid in regard to its chemical con-

stituents, and the difficulties attending the methods of analysis

have heretofore prevented any but the scientific chemist from at-

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OHIO MEDICAL HISTORY, 1835-1858          351

 

tempting its systematic investigation." Such a scholar was Worm-

ley. Later he filled with distinction the chair of chemistry and

toxicology in the University of Pennsylvania, and wrote an excel-

lent work on the micro-chemistry of poisons (1867).

As to the use of instruments of precision in Ohio, little evi-

dence can be presented except by inference based on their discus-

sion in medical literature written by physicians of Ohio. Some

instruments will be discussed with more certainty, those which

have come into our museum in the Cleveland Medical Library as

the property of Ohio physicians of that era.

As part of their equipment, there comes to us certain instru-

ments necessary and helpful in both diagnosis and treatment such

as the uterine sound, as old as the Talmud, and instruments for

exploring the vagina, which go back to Paul of Egina and the

Arabians, though the vaginal speculum was introduced to modern

medicine by Joseph Claude Anthelme Recamier in 1818. The

rectal speculum was used as far back as Hippocrates, indeed we

have in our museum a reproduction of one buried in the ashes of

Pompeii in 73 A. D. The ophthalmoscope, devised by Hermann

Ludwig von Helmholtz in 1851, and the laryngoscope, devised by

Manuel Garcia in 1855, were of such recent discovery that I have

found no evidence of their local use within this period.

The stomach-pump was used, but rather for treatment than

diagnosis. There was in local use a general utility kit which con-

tained a combination pump and tube for emptying the stomach, a

second for giving an enema, a third for colonic irrigation, a glass

device for use as a breast-pump, and a cup for letting blood. For

this kit a Dr. L. B. Coates was sales representative, and it was

advertised to sell "at a price to bring it within the means of every

physician, being peculiarly adapted to the wants of our brethren

in the country." The enterprising Coates had "obtained certifi-

cates in its favor from the entire faculty of Transylvania Univer-

sity and two of the professors in the Medical College of Ohio."

I can well believe it for we have in our museum a similar combi-

nation package, this one made about the same time in Oshawa,

Ontario, which was recommended by the entire faculty of the

University of Toronto. Another Yankee salesman, no doubt.

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352    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

Of the instruments of precision, the Western Lancet, pub-

lished in Cincinnati in 1850, mentions a galactometer invented in

New York, to test the quality of milk. The editor of the New

York Commercial had tried it and found his household supply had

been diluted with one fourth part of water. In our museum we

have a milk tester based on a color index, intended for breast milk,

but probably of later origin.

The galvanometer, which might be called the germ of the

electrocardiogram, may be classed in this group. Although its

use is founded on the work of Michael Faraday and G. B. Du-

chenne de Boulogne, we read that in 1835, Dr. John Locke of

Cincinnati invented a new galvanometer. He stated:

In qualifying myself with the proper knowledge of the new sciences of

Electro-Magnetism, I find myself unable, from the works within my reach,

to get an intelligible account of the Galvanometer or Electric-Magnetic

Multiplier, so I finally undertook to supply the deficiency by inventing one.

. . . This instrument indicates the direction of the galvanic current and

measures its intensity.

The facial goniometer and other anthropological measuring

devices are described in the Ohio Medical and Surgical Journal

for 1855, in an abstract from the Philadelphia Medical and Sur-

gical Journal. The author, Dr. Samuel G. Morton, also describes

an accurate method of obtaining the cubic contents of the skull

through the use of shot and an accompanying cylinder fitted with

a scale.

A few other contemporary devices were of little importance

except as antecedents of future scientific precision. The ther-

mometer was in use at this time for some purposes. For example,

there were indications of its use for finding the temperature of

urine before testing its specific gravity, and also for preparing re-

agents. An abstract from a French journal advises preparation

of a mustard plaster with cold water, since "water heated to 190??

F. and upwards prevents the disengagement of the volatile prin-

ciple of mustard."

Dr. Elisha Bartlett, professor of the theory and practice of

medicine in Transylvania University, wrote on typhoid and typhus

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OHIO MEDICAL HISTORY, 1835-1858          353

 

fevers in 1842. There is no mention of any instrument of pre-

cision being used, although he quotes observations made by John

Cheyne of Dublin on temperature of the skin in a series of fever

cases. Dr. T. W. Forshee of West Jefferson, Ohio, in 1855,

speaks of increased heat in muscle following exercise, and adds

"the average temperature of the human body is 98?? or 100??."

He does not state, however, that he himself had taken any tem-

peratures.  Cornelis Drebbel, Galileo Galilei, Roemer, Santorio

Santoro and Boerhaave all contributed to the evolution of the

thermometer, but the introduction of the clinical thermometer was

made by Karl Reinhold August Wunderlich in 1868. Even in

Guy's Hospital it was not in use before 1870. Edouard Seguin's

thermoscope did not appear until 1871.

De Pulsibus has been an important contribution to medical

literature since early times. J. H. Baas testifies to its widespread

use. "Simple counting of the pulse by the watch," he writes, "a

method which (particularly as a result of Pierre Charles Alex-

andre Louis' investigations) has become popular in our day every-

where." A special pulse watch, the angiometer, was invented by

Louis Waldenberg of Berlin (1837-1881).

Another device, used in the diagnosis of circulatory disease,

was the sphygmoscope. Invented in 1856, it appears in Ohio

publications for the same year. Its purpose was to measure the

movements of the heart and blood vessels. It consisted of a glass

tube with an attached graduated scale, resembling a stethoscope.

"A trumpet mouth at one end is covered by a thin membrane, say

of gum elastic, the other end remaining open, and the tube being

filled with colored water. The large end being pressed against the

ribs, where the pulsations of the heart are seen, the impulse of the

systole is indicated by the rising and falling of the water in the

tube, and measured by the scale." About the same time (1855)

Karl Vierordt introduced the graphic method of studying the

pulse. These were preliminary steps to the sphygmograph of

Etienne Jules Marey in 1860, the sphygmomanometer of Samuel

Siegfried Karl Ritter von Basch in 1876 and that of S. Riva

Rocci in 1896.

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354   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

The spirometer, first step toward the study of basal meta-

bolism, was brought out by John Hutchinson in 1846, but there is

no evidence that it attained wide use. Hutchinson was the author

of The Spirometer, the Stethoscope and the Scale Balance. . . .

Their Value in Life Insurance Offices (London, 1852).

Pneumatometry, investigation of the amount of respiratory

pressure, was introduced by Phil. Biedert, but was not popular

(Baas).

Associated with the stethoscope in chest examination were

several other instruments, most of which are now of only his-

torical interest. One of these was the stethometer, described at

length in the Ohio Medical and Surgical Journal of May, 1851.

It was invented by Prof. Richard Quain and was intended to

measure differences in expansion or in development of corre-

sponding parts of the two sides of the chest. The instrument con-

sisted of a case like that of a watch, on the upper surface of

which was placed a dial and an index. Within was a simple

movement by means of which the index was acted upon by a silk

cord reeling in and out of the case. The cord acted as a measur-

ing device, its extension registering on the dial, and thus the

examiner could readily determine any existing difference in the

relative mobility of corresponding sides of the chest at the point

under examination. Dr. Morrill Wyman, in cooperation with Dr.

Henry I. Bowditch, introduced in 1850 a suitable aspirator for

tapping pleuritic effusions. Leopold Auenbrugger von Auenbrug

in his classical treatise (1761) made known the principle of per-

cussion in physical diagnosis. Auenbrugger, Jean Nicolas de Cor-

visart-Desmarets, and Rene Theodore Hyaccinthe Laennec elicited

the note by the fingers alone. In 1826 Pierre Adolphe Piorry in-

vented the pleximeter for the practise of mediate percussion, and

emphasis was laid not only upon the pitch of the note, but also

upon the resistance which came from underlying organs.

The pleximeter was made of a variety of materials--wood,

ivory, leather, whalebone, hard rubber, and glass. In outline this

was circular or oval, and either large or quite small. Piorry's

pleximeter, for example, was a rather large ivory semicircle with

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OHIO MEDICAL HISTORY, ₁8₃₅-1858           355

two lateral rims and a graduated scale on the straight edge; Louis

Traube used a zither-like form with adjustable rims; Seitz a

trowel-shaped one; W. Hesse, an oval glass type, and Louis, one

of hard rubber.

L. M. Lawson of the Medical College of Ohio, in his ex-

haustive articles on diseases of the chest in the Western Lancet of

Cincinnati (1850) writes, "But by far the most convenient and

. . . the best pleximeter is the index finger of the left hand; or,

if it be necessary to impress a larger surface, several fingers may

be used." It seems doubtful who first had the happy thought of

using the fingers as a pleximeter, "perhaps it was Skerrett, and

from this singular obscurity we infer that he was an individual

of rare modesty."

The percussion hammer was the invention of Max Anton

Wintrich (1813-1882), and consisted of a metal handle and hard

rubber head. Austin Flint simplified this somewhat, while Eugen

Seitz devised one made of horn. Bigelow used an elastic ball

covered with velvet for the hammer head, which fitted into a

wood stethoscope. Charles J. B. Williams substituted whalebone

in the handle and shot covered with leather and velvet in the

heavy end.

These instruments are described in Ohio medical literature

of the period and many examples of both percussion hammers

and pleximeters have found their way into our museum.

Divers other instruments appeared in the literature -- the

acoustic sound for investigating vesical calculi, the solid akuoxylon

of Paul Niemeyer, the so-called resonators (closed at either end

by elastic rubber), the hydrophone (stethoscope filled with water),

the sphygmophone combined with chimes of bells. Autophony

and acouophony were suggested, the latter by the Americans G. P.

Cammann and Alonzo Clark. Karl Christian Adolph Jacob Ger-

hardt studied heart sounds through a tube introduced into the

larynx. All aspects of auscultation were scrutinized closely and

overemphasis placed on unimportant features as they searched for

new truths. Varieties of sound and qualities of tone were deemed

of special significance. Even "the atmosphere of a greatly heated

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356    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

room, although but slightly changed, is, nevertheless, not the most

favorable for the examination of cases in which it becomes neces-

sary to appreciate very slight variations in degrees of sound."

But the final reductio ad absurdum was Ferdinando Verar-

dini's investigation of uterine sounds by a stethoscope introduced

into the vagina, which he designated impressively as "Intravaginal

Auscultation."

So now to the stethoscope. Laennec's first instrument (1815)

was a cylinder of paper consisting of three quires, secured by

paste. He investigated glass, metal and wood and presented a

table of conductivity which demonstrated that wood was ten times

as efficient as air. "In consequence of these experiments," wrote

Laennec, "I now employ a cylinder of wood an inch and a half

in diameter, a foot long, perforated longitudinally by a bore three

lines wide, and hollowed out into a funnel-shape to the depth of

an inch and a half at one of the extremities." The stethoscope is

divided in the middle to make it more easily portable. The hol-

lowed out extremity has an obturator which, when inserted, is

utilized in studying heart sounds. There is a slight concavity of

the ear extremity.

Many changes were made in the Laennec stethoscope. The

plug in the chest extremity proved to be useless, the tube was

shortened and made thinner, and the ear-piece made removable.

The material of which it was made varied widely, and included

cedar, lignum vitae, maple, walnut, dogwood, ivory, silver, hard

rubber, metal and many other varieties. The stethoscope of Dr.

John B. Harmon of Warren was made of ebony with an ivory

earpiece. His son was the preceptor of Dr. J. M. Lewis of Cleve-

land whose stethoscope was made of lignum vitae. Most of our

stethoscopes are made of cedar, but others are of boxwood, metal,

celluloid, hard rubber and one beautiful specimen of ivory.

Examples of Laennec's stethoscopes may be seen in medical

museums of Paris, Rouen, Rome, Florence, Zurich, London, and

doubtless in many other places. We have two replicas in Cleve-

land. Lawson of Cincinnati wrote in 1850, "I have in my posses-

sion about twenty varieties of stethoscopes collected in Europe and

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OHIO MEDICAL HISTORY, 1835-1858           357

America . . . Judging from the specimens before me, very wide

differences have existed in regard to these modifications (ear-

piece and pectoral extremity); some use a convex and others a

concave ear-piece; one employs perfect conical, another irregu-

larly conic, and still another, parabolic chest extremities."

Let us consider more closely some of the points of difference

in stethoscopes of the period, most of which have been used in

Ohio. First let us examine the chest-piece. The Laennec and

Trousseau types, according to Lawson, had a bell or parabolic

curvature. Dr. Peter Allen of Kinsman, and Dr. J. S. Smith of

Wellington had stethoscopes of this type. The Skoda, Stokes and

Louis chest-pieces were all conical. The walls of the cone in the

chest-pieces of the Skoda instrument were all conical. In the

Skoda instrument they appeared convex on the outer surface. Dr.

John B. Harmon's stethoscope shows a similar convexity. The

Stokes pattern was like our instrument with a short cone, and

the Louis specimen like one presented by Dr. E. P. Edwards,

with a very much larger cone. The Stokes chest-piece, by the

way, was encircled by a rounded band of rubber, in order that it

might be used as a percussion hammer. One of this type in our

museum formerly belonged to Dr. W. A. Hobbs of East Liver-

pool.

Occasionally in these short stethoscopes the obturator was re-

tained, as in one which belonged to Dr. Allen, of Kinsman, and in

another used by Dr. J. E. Darby of Cleveland.

In some of the early stethoscopes the ear-piece was fashioned

with a protrusion to adapt itself to the external auditory meatus.

This is seen in stethoscopes of Dr. Harmon of Warren, and Dr.

Darby of Cleveland, and in another small cedar stethoscope

donated by Dr. T. C. Young of Cleveland.

The surface of the ear-piece also reveals individuality.

Laennec used a very shallow concave arc. Recamier's ear-piece

was of wide diameter, but the contour was convex. The Stokes

ear-piece was also wide, with the center concave and the peri-

phery convex.

The length of the stethoscope varied from very short, about

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358   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

four inches, to seven or eight inches. The short one was used to

listen to the fetal heart. We have an example of this type. Other

lengths were a matter of choice of the designer.

The late Dr. T. Wingate Todd donated to our museum some

monaural stethoscopes of boxwood, which had belonged to his

teacher, Dr. Steell of Manchester, England. One was nine and a

half inches long, the current length for that time and place.

Graham Steell added an improvement, making it thirteen inches

in length, "just beyond the hop of a flea."

Dr. Alfred Stengel of Philadelphia, in looking over our col-

lection, told of the stethoscope owned by a member of the Dublin

school which was long enough to serve as a walking stick, "and it

was so convenient in case of the vermin."

Arnold and Jean Baptiste Bouillaud used a flexible tube be-

tween the top of the stem of the stethoscope and the ear, increas-

ing the length in this way. The flexible tube could be dispensed

with and the ear-piece applied to form the ordinary short stetho-

scope.

Lawson recommended as the ideal stethoscope "an instru-

ment made of cedar, from six to seven inches long, with concave

ear-piece two and a half inches in diameter, and expanding into

a cone at the pectoral extremity, two inches in length, which ter-

minates in a central canal a quarter inch in diameter." He also

stated that a good copy of the Stokes instrument "is manufactured

in this city by Reeze, of Sixth Street, and Wocher of College

Street, who, by my directions, omit the india-rubber margin of

the ear-piece. Wocher makes a longer cone than belongs to the

original instrument. These instruments, I have no hesitation in

saying, are decidedly superior to any others in the United States."

Toward the end of the era under discussion today, the bin-

aural stethoscope made its appearance, the Scott-Alison with two

tubes and ear-funnels, with which one can listen to the heart and

lungs at the same time. The Cammann stethoscope of two gutta-

percha tubes attached to the chest-piece at one extremity, and at

the other to the ear-pieces, was completed in 1852. Since this

time numerous modifications have been made in the outward form,

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OHIO MEDICAL HISTORY, 1835-1858                 359

 

but little has been added to the essential principle of a single chest-

piece with sound collection chamber and a tube leading from it to

dual ear-pieces. The monaural stethoscope still survives in Europe,

but with us it survives only as a museum piece.

Physicians and their friends are cordially invited to visit our

museum in the Cleveland Medical Library and to examine our

collection of monaural stethoscopes.

Are you interested in the cost of some of these instruments

at the time of their current use?   Tiemann quotes the following

prices:

Glass pleximeter ....................................... $ .50

Hard rubber pleximeter ................................    .40

Ivory  pleximeter  .......................................1.00

Percussor, whalebone stem .............................                                1.00

Wintrich's hammer ....................................                                    2.50

Flint's percussion hammer ..............................                                                                          .75

Quain's  stethometer  ...................................15.00

Stethoscopes

Elliottson          ............................................. 5.00

Stokes         ................................................                                   1.00

Quain -- telescopic ............................. .....                                                                                  2.00

Short cedar ........................................                                                                                            .75

Cammann           .............................................                                                                                4.50

Scott-Alison           ........................................                                                                              6.00

The diagnostic armamentarium of Piorry (1794-1879), who

invented the pleximeter, consisted of a taper for illumination,

tongue spatula, magnifying glass, warm water, grease for anoint-

ing the finger, stethoscope, pleximeter, tape measure, rectal and

vaginal specula, dressing forceps and tweezers, oesophageal, rectal

and urethral sounds, nitrate of silver for marking, test tube, nitric

acid and other reagents, litmus paper and graduated glasses. This

impressive array indicates that physical diagnosis had reached a

high standard during the time that we are discussing.

Have you remembered the commonest precision instrument

of them all, the watch? Quoting at length from Dr. S. Weir

Mitchell in The Early History of Instrumental Precision in Medi-

cine, 1891, we have the following information filled with charm

and flavor:

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360     OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

Floyer in 1707 tells us "I have for many years tried pulses by the

minute in common watches and pendulum clocks and then used the sea minute

glass" such as was employed to test the log. At last he was more happy.

One Daniel Quare, a Quaker, had in the last ten years of the seventeenth

century put in watches what Floyer called a middle finger, or, as we say, a

hand. Floyer's pulse watch ran sixty seconds and you may like to know

"can be had of Mr. Samuel Watson in Long Acre. The inventor tests this

and a half-minute watch which has a cover, by a sand glass which runs for

one minute, and finds them not quite correct; one must add, he thinks, five

beats."

In the eighteenth century one finds now and then a pulse count, as

when Morgagni describes a pulse which beat twenty-two times in the sixtieth

of an hour. Evidently the minute had not yet gotten into the daily life of man.

Statements of the numbers of pulse and respiration are very rare in

Rush, Cullen, and their Contemporaries. It was not until a later day and

under the influence of the great Dublin school that the familiar figure of the

doctor, watch in hand, came to be commonplace.

I have thought it well to illustrate thus fully the medical history of the

watch as an instrument of precision. How small, but how essentially a part

of the pulse study are the enumerations it enables us to make accurately, you

all well know. We could better lose this knowledge than the rest of what

the pulse teaches, and yet it is the only pulse sign we can put on paper with

perfect precision, as Heberden remarked a hundred years ago.

You know that we now use as many instruments as a mechanic, and that

however much we may gain thereby, our machines are not labor-saving.

They force us, by the time their uses exact, to learn, to be rapid and at the

same time accurate.

The instrument trains the man; it exacts accuracy and teaches care; it

creates a wholesome appetite for precision which, at last, becomes habitual.

Unless men keep ahead of their instrumental aids these . . . will merely

dementalize them.

Bibliography

Baas, J. H., History of Medicine, tr. by H. E. Handerson (New York, 1889).

Bartlett, Elisha, History, Diagnosis and Treatment of Typhoid and Typhus

Fevers (Philadelphia, 1842).

Burroughs-Wellcome, Evolution of Urine Analysis (Los Angeles, 1911).

Garrison, F. H., History of Medicine (Philadelphia, 1917).

Lawson, L. M., "Diseases of the Chest," Western Lancet (Cincinnati, 1850).

Locke, John, "Galactometer," Western Journal of the Medical and Physical

Sciences (Cincinnati, 1835).

Major, R. H., "Diagnosing Disease without Instruments of Precision,"

Kansas Medical Society, Journal (Topeka, 1939).

"Quain's Stethometer," Ohio Medical and Surgical Journal (Columbus,

1851).

Tiemann, G., Armamentarium Chirurgicum (New York, 1879).

Wormley, T. G., "Systematic Quantitative Analysis of Urine," Ohio Medical

and Surgical Journal (Columbus, 1855).

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