Specific gravity

I came across this unusual case in a book published in 1876, A Dozen Cases: Clinical Surgery by William Tod Helmuth, a distinguished homeopathic surgeon. The phrase ‘homeopathic surgeon’ might sound like a contradiction in terms, if all you know of homeopathy is sugar pills and massively diluted tinctures. But in nineteenth-century America, where homeopathy was one of several rival medical factions struggling to prove their worth, Helmuth did his best to demonstrate that a committed homeopath could be just as accomplished a surgeon as one with a background in conventional medicine.

William Tod Helmuth
William Tod Helmuth and his impressive moustaches.

In the operating theatre there was little to distinguish Helmuth’s practice from that of his allopathic contemporaries. He was a skilled operator who used anaesthesia and was an enthusiastic advocate of the antiseptic techniques introduced by Lister. Indeed, he was one of the first surgeons in America to perform an operation using Lister’s antiseptic methods, an ovariotomy (removal of an ovary) in 1876. It was not in his surgical techniques, but the treatments his patients received before and after surgery, that his approach differed from orthodox methods.

There is barely a hint of the unconventional – or ‘alternative’ – in this case report. Unless you count Helmuth’s writing style, which is rather less straitlaced than your average journal article:

Glass tube removed from urethra

A middle-aged and healthy-looking man was sent to the hospital to be relieved of his sufferings. The patient was employed in the oil yards at Williamsburg, and fancying he had a stricture (‘tis strange how many fancies men have), introduced into his urethra a glass tube in shape, similar to a thermometer, which is used in testing the specific gravity or quality of the oil.

Williamsburg is an area of Brooklyn just over the river from downtown Manhattan. Oil refineries were a major part of the New York economy at this date, with more than 50 on the East River alone. A stricture is a narrowing of the urethra, typically caused by illness or injury, that makes it difficult to urinate.

These instruments are made of the most brittle glass, and have inside the tube a scale of degrees printed upon paper. This individual, as I have said, believing he had an obstruction in the urinary canal, thought to himself on a fine Sunday morning, that he, having some time to spare, would proceed to cure himself of “his complaint,” and, having no instrument handy, concluded that one of these oil gauges, if I may so call it, would be the proper thing to use.

It is a delightful irony that the oil gauge, used to check the specific gravity (i.e., density) of oil, might also be helpful to a modern clinician. The specific gravity of urine is often measured today as a way of testing kidney function. That said, an oil gauge is not recommended as a substitute catheter.

Therefore, without more ado, he introduced the brittle tube into his urethra, and having pushed it down to the membranous portion of the canal, was proceeding to turn it in a most scientific manner when, from some unforeseen accident or unlooked-for circumstance, the tube broke! He hastily removed the top portion of the glass, and then walked to New York for treatment.

When the surgeon first saw him, the patient seemed quite calm, and the broken portion of the glass tube could be easily felt.

I first introduced a pair of alligator forceps into the urethra, and had the satisfaction of fishing up the paper, on which was marked the scale of degrees, bloody and twisted. A second application of the forceps brought up a second fragment.

That’s all very well, but what about the glass?

Then the attempt was made to withdraw the broken glass tube through the meatus…

The opening at the end of the penis.

…but the sharp end of the forward portion of the broken glass having forced itself into the floor of the canal, caused considerable hemorrhage, and fixed the fragment firmly in its place. Moreover, the brittleness of the glass forbade its withdrawal, for every time the jaws of the forceps would grasp the tube it would break; therefore there was nothing else to do but to remove the fragments by external incision.

Something of a nightmare scenario. The number of tiny sharp glass fragments now rattling around in the patient’s urethra doesn’t bear thinking about.

This was accordingly done, but great difficulty was experienced in the operation, not only on account of the flaccid and elastic nature of the scrotum, but from hemorrhage. It is a well-known fact that the vessels of the scrotum retract into the elastic tissue, and sometimes give rise to a rather profuse hemorrhage, which is often difficult to check.

After the removal of the glass there was extensive sloughing of the scrotum, but by the care and attention of Dr. Cranch, the patient made a good recovery, and does not recommend brittle glass tubes as an application of even fancied stricture.

Sloughing of the scrotum does not sound much fun, but at least it was eventually cured.

It’s evident from this short case report that William Tod Helmuth fancied himself as a writer. In addition to his surgical textbook A System of Surgery, which went through many editions, he also published several volumes of prose and poetry aimed at a general audience. Helmuth was sometimes called the ‘poet-surgeon’, and he was fond of writing doggerel for special occasions. Here’s a (mercifully brief) excerpt from one of his poems, ‘The Ball at the Lindell Hotel’:

Now listen, dear reader, a story I tell,

Of the ball that took place at the Lindell Hotel ;

The structure, itself, is an ornament fair

To the city to which it belongs, I declare.

If he was a bad poet, at least he knew it. The preface to one of his poetry collection concludes:

To those who now see these rhymes for the first time I would respectfully advise the sustained effort of getting into ‘an after-dinner condition’ before criticism is attempted.

That said, I do rather like the final stanza of his ‘Ode to the bacillus’, an early example of microbiological poetry.

But, bacillus, oh! bacillus,

You try in vain to kill us,

Yet we thrive.

And though you try to blind us.

Next year I hope you’ll find us

Quite alive.


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