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)
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-
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-
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-
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.
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
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.
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
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
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
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
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,
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:
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).