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RECORD OF MEDICAL SCIENCE.
NEW SERIES.-No. XXV.-JANUARY, 1847.
Remarks on the Urinometer. By W. S. W. RUSCHENBERGER, ,
M. D., U. S. N.
New York, December 5th, 1846. MY DEAR SIR,,Those members of the profession who may be engaged in investigating the changes induced in the constitution of urine by disease, may be led into error by using a gravi. meter or urinometer, manufactured in Philadelphia, and known as Prout's, for ascertaining the specific gravity of the fluid. The instrument to which I allude consists of a copper ball, surmounted by a graduated stem of box-wood, balanced below by a brass wire and pea. The point at which the stem floats in distilled water is marked at zero, and the point at which it stands in a saturated solution of common salt, forms the opposite extremity of the scale, the interval being divided into sixty degrees.
If placed gently in a fluid under examination it will stand, say for illustration at 30°, but immerse the instrumeut entirely, so as to completely wet the stem, it will rise and fall, and become quiescent at 20°. I have repeated the experiment very frequently with the same result, in the same fuid, after wiping the stem dry, and in different fluids. I have also compared the specific gravity of fluids ascertained by this gravimeter, with the specific gravity of the same Auids ascertained by an accurately made specific gravity bottle, and found the result different in every instance, and without any corresponding ratio of difference. VOL, X.
Supposing it possible that the error might be confined to the particular instrument in my possession, I submitted it to the manufacturer for adjustment, and took the opportunity to compare it with four other instruments then on sale in his shop. We found that no two of the five instruments corresponded in their respective indications of specific gravity; and further, that every instrument varied from 6 to 10 degrees in its indication of specific gravity, according as it was gently permitted to subside into the fluid, or entirely immersed so as to wet the whole stem or scale. The price of the instrument with the case is seven dollars; its value for practical purposes is noi a cent. The indications by it are too uncertain and too irregular to be even proximative to accuracy.
This instrument was exhibited at the fair of the Franklin Institute in 1845, but whether it received approval or not I do not remember. The objections to it might possibly be removed, if, instead of box-wood, metal were used for the gratuated scale or stem of the instrument.
The hydrometers of Beaumé and Gay Lussac are almost equally fallacious. After very numerous experiments the conclusion arrived at is, that the only true way of arriving at the specific gravity of urine or other fluid, is by means of the thousand-grain bottle and counterpoise.
If you consider the above information of any interest, it may be worth a place in the “Medical Examiner.”
W. S. W. RUSCHENBERGER. Professor R. M. Huston, Philadelphia.
Three cases of presentation of the Face to the Sacrum, successfully treated without turning. By T. VAN Valdau, M.D., of MiMinburg, Pennsylvania.
Mrs. Shively, on the 12th day of February, 1828, sent for me in great haste, on account of a very profuse heniorrhage. When I entered the room, I found her lying on her back near the bed. side. With as little delay as possible I made an examination, and found the face low in the hollow of the sacrum. Under these unfavourable circumstances, according to the directions of Dr. Dewees, I determined on turning and delivering by the feet. So without changing her position, I directed an assistant to support her left knee, and supporting the right one myself, I introduced my right hand into the vagina, and placing two fingers on each side of the nose, having the forehead in the hollow of my hand, I raised the whole head up out of the pelvis, and as it became disengaged, by a very little traction with the points of my fingers, the chin fell back towards the sternum, and fortunately at that instant the uterus began to contract with great force. The head being now in the first position I withdrew my hand as it advanced, and the whole cranium was born with the same pain, and the body with the next. The placenta was thrown off in about fifteen or twenty minutes. The mother and child both did well.
April 13th, 1842. Mrs. Beckley, residing in Mißinburg, sent for me in the evening. On examination I found the face coming down with the chin in the hollow of the sacrum, the os uteri but partially dilated. Encouraged by my success in the treatment of the former case, I now awaited the dilating process very attentively for about two hours, when it became sufficiently great to operate. I then had my patient placed on her back near the bed stock, and directing an assistant to support the left knee, while I supported the right myself, I introduced my hand into the vagina, placing two fingers on each side of the nose, having the forehead in the hollow of my hand, I disengaged the head from the pelvis by raising it up, at the same time directing the chin towards the sternum. The head being now in the first position, I withdrew my hand as it advanced. The labour progressed speedily and safely. The mother and child both did well.
April 21st, 1842. Mrs. Kleckner, about to be confined the eighth or ninth time, sent for me in the afternoon. On making an examination,“ per vaginam," I found this also to be a face presentation, and in every respect similar to that of Mrs. Beckley, which occurred but eight days before. It is sufficient to say that I treated this case precisely as I did Mrs. Beckley. Mother and child are both living and well at this time.
Case of Retention of Fætal Bones in the Uterus during four years.
Communicated in a letter to the Editor, by JAMES B. ELLIS, M.D., of Ripley, Miss.
On the 29th of January, 1846, I was called by Dr. James Thompson, to see Mrs. Mary Ann Fields, about 25 miles distant from this place, aged 27 years, who gave me the following account of her case:
In Cass county, Georgia, early in April, 1842, she was confined at full time in her first pregnancy; her labour was very lingering, and the physician she sent for advised her to trust to the powers of nature, and left her. Her pains soon after ceased. At the time, she was unable to rise from her bed, and she therefore sent for two other medical gentlemen, and requested them to assist her. They told her that her pains would very probably return again, and all would terminate well. Her pains, however, did not return, and in about four months after, the decomposed flesh of the child commenced passing off rapidly, per vaginam; she said the fetor was insupportable to her friends, so much so that visiters could scarcely come into her room.
In about six months from her confinement to bed, the discharges ceased, and her health began to improve rapidly.
From this time her menstrual discharges returned, and continued regular in tine, quantity and consistence, for more than three years. During this period there was a tumour in the epigastrium, that always gave a dull pain on pressure. Her disposition was cheerful, and continued as good as usual during this time. She consulted every medical gentleman that she could conveniently, but none agreed with her that the bones of the fætus remained in the uterus. One expressed it as his opinion that the case was one of extra uterine conception. This, however, could hardly have been so, for she says the putrid flesh passed away rapidly per vaginam. About the middle of the summer of 1845 she was taken with typhoid fever, a disease that prevailed very generally in this section of country at that time. During the existence of her illness, there was considerable pain developed in the tumour spoken of, and she expressed to her attending physician her confident belief that the bones of her child were still in the uterus, and requested him to endeavour to extract them, but she said he only laughed at her and told her such a thing was impossible. After the abatement of her fever, her physician discontinued his visits, but she was still unable to walk from the violence of the pains in the uterus. During the succeeding winter, my friend Dr. James Thompson was called to see her. He found the tumour very large and painful, and the os uteri hard, and apparently sealed, and her general health very bad. He commenced treating her case on general principles, giving her tonics, alterants, anodynes, hip baths, etc. During the time I was occasionally consulted by him with reference to her case. A few days before I was first called to see her, she passed several very hard rough substances per rectum, which on examination were found to be bones. In a day or two she passed 25 or 30 bones, mostly small. At my request, Dr. Black accompanied me to see her, and on examination per rectum, I could distinctly feel a large fistulous opening from the rectum to the uterus, and could tell from her discharges that ulceration was going on rapidly. The ends of some of the long bones passed into the rectum and prevented a free discharge from her bowels, and at every attempt at defecation the bones were borne down against the raw edge of the fistula, which gave her excruciating pain. We had no instruments with us at the time for extracting the bones, having gone as much for curiosity as any prospect of doing her any good. We mustered up such rude instruments however as we could command on the spot, and requested Dr. Laird to assist us. With these we dilated the rectum, and with a pair of long curved forceps extracted the projecting bones. The operation was so very painful, the whole mucous membrane of the rectum being ulcerated, that she utterly refused to suffer any attempts at further efforts. She said she knew she would die, and would not suffer any pain that she could avoid.
We recommended Dr. Thompson to use anodyne mucilaginous enemas, pulv, charcoal, as a laxative, warm astringent hip baths, and such tonics as she could bear. This treatment she submitted to, although sometimes reluctantly. She continued to pass off bones more or less every day, and sometimes entertained hopes of recovery. At her death, (about the 20th of March, 1846,) Dr. Thompson thought she had discharged nearly all the bones; only a few of the cranium remaining. The fistulous opening was very large at the time of her death. A post mortem examination, I regret to state, could not be obtained. "The statements made by Mrs. Fields, of her symptoms and sufferings, are all confirmed by her husband, and I have no doubt of their correctness. Some of the bones are in my possession now, which I will exhibit to you next winter, when I hope to have the pleasure of listening to your lectures again.
I have the honor to be, very respectfully,
JAMES B. ELLIS.
On the Inhalation of Sulphuric Ether. By J. B. Flagg, M. D.
of Philadelphia, Surgeon Dentist. The medical world is pretty fully advised as to the narcotic influence of this drug, when its vapour is inhaled into the lungs under peculiar circumstances.
Desirous of promoting the cause of science, and curious to test its efficacy when applied to painful operations, I have been engaged for several weeks past in experimenting with it, both in its pure washed state, and compounded to a very limited extent with oil of wine; first upon myself, and then upon many friends. I will proceed tu give a few remarks as to its legitimate use, and its recent illegitimate introduction to the profession of surgery.
The effects of sulphuric ether, when inhaled, have long been known to be similar to those of nitrous oxide; varying, according to idiosyncrasy and to the object in view. If inhaled with a certain degree of doubt as to its capacity to effect, it is most sure to produce a melancholy train of thought for the time being, accompanied