The mortality by classes and by certain of the more important diseases was as follows:

Deaths by sex, color, and social condition, were as follows.

392 26

Still-births, excluded from list of deaths, were as follows:

Certain foreign and American cities show the following death-rates for the

Total deaths, 5 to 20..

66

66

20 to 40.

66

40 to 60..

60 and upwards..

month of June:

The mortality by classes and by certain of the more important diseases were as

Deaths by sex, color. and social condit on, were as follows:

Still-births, excluded from list of deaths, were as follows:

Certain foreign and American cities show the following death-rate for the month

THE

BROOKLYN MEDICAL JOURNAL

PUBLISHED MONTHLY BY THE MEDICAL SOCIETY OF THE COUNTY OF KINGS.

EDITORIAL COMMITTEE:

JOSEPH H. RAYMOND, M. D.,

ALEX. HUTCHINS, M. D.,

JOSEPH H. HUNT, M. D.,

GLENTWORTH R. BUTLER, M. D., FRED. D. BAILEY, M. D.

VOL. IV. No. 11.
WHOLE NO. 35.

BROOKLYN, N. Y., NOVEMBER, 1890.

Single copies 25 cents. $2 a year, in advance.

ORIGINAL ARTICLES.

RAPID AND EASY METHODS OF ESTIMATING UREA AND SUGAR IN URINE.

BY E. H. BARTLEY, M.D.

Read before the Medical Society of the County of Kings, June 17, 1890.

It is probably unnecessary for me to insist here upon the importance of quantitative estimations of the daily excretion of urea as a measure of the functional power of the kidneys. In cases of renal disease the danger lies in the inability of these organs to eliminate from the blood certain nitrogenous elements of retrograde metamorphosis, which, in health, they discharge into the urine in the form of urea. Heretofore the busy practitioner has regarded the estimation of urea and sugar as processes only for the chemist. It is my purpose to bring to your notice easier and simpler methods, and simplified apparatus, for these estimations. The apparatus for the estimation of urea consists of two parts:

1. A pipette with one graduation, and marked 1 c. c.

2. A graduated tube about 1 c. c. in diameter and about 30 c. long, and closed at one end.

The process depends upon the well-known decomposition of urea by a solution of hypobromite of sodium, with the production of nitrogen, carbonic dioxide, and water. The two latter bodies remain

dissolved in the solution, while the nitrogen escapes. The measure of the nitrogen is depended upon to calculate the weight of urea which produced it.

The books direct the hypobromite to be prepared freshly, from ico grms. of caustic soda, and 25 c. c. of bromine in 250 c. c. of water. Bromine is a very disagreeable and even dangerous liquid to handle, and the process is tedious. Instead of this, I use two solutions, and mix them when used. These are a twenty per cent. solution of potass. bromide and Labaraque's solution of hypochlorite of soda, which when mixed produce the hypobromite of soda and chloride of potassium. These reagents may be found in every drug-store.

The process is performed as follows: The graduated ureometer is filled to the sixth mark with the solution of potass. bromide, then to about the fifteenth mark with Labaraque's solution, and finally to about the twentieth with water. With the pipette deliver into the water the I c. c. of urine, and close the open end of the ureometer with the thumb of the right hand, holding the tube firmly. The ureometer is now inverted a few times to mix the contents thoroughly. When effervescence ceases the height of the liquid in the inverted tube is noted; the open end is then plunged into a vessel of water, the thumb removed, the tube is lowered until the surface of the water within and without the tube are on the same level, and another reading taken. The difference be tween the two readings gives at once the number of grains of urea in each fluid ounce of the urine under examination.

The graduations of the instrument represent grains per fluid ounce when I c. c. of urine is taken. The time required for an estimation is about five minutes, and no especial skill is needed. The instrument may be had of Eimer & Amend, of New York.

ESTIMATION OF SUGAR.-For the estimation of sugar, the solution used is Fehling's solution, with the addition of a small quantity of potass. ferrocyanide (yellow prussiate of potash), which is added to prevent the precipitation of the red oxide of copper. By this procedure (for which we are indebted to Causse, "Bulletin de la Société de Chem.,' 1889, p. 625) we are better able to see the discharge of the blue color of the copper solution. The apparatus consists of a short burette, terminating in a comparatively wide delivery-tube, beveled at the end. The delivery-tube of the burette passes through a cork in the neck of a flat bottom flask of about four ounces capacity. Another tube, bent at right angle, passes through the same cork, for the escape of steam, during the boiling. The burette is graduated in c. c. and also with a second graduation, representing grains per fluid ounces, when 5 c. c. of Fehling's solution are taken.

The process is performed as follows: Fehling's solution is poured

into the burette until it is filled exactly to the 5 c. c. mark, which on the burette is marked F. A 1 to 20 solution of potassium ferrocyanide is added until the 7 c. c. mark is reached.

The stop-cock is now opened and the liquid allowed to run into the flask. The burette is filled with water, and this is allowed to flow into the flask. The apparatus is now put upon a sand-bath, or other source of heat, and allowed to come to a boil. The burette is now filled to the zero mark with the urine to be examined, and added carefully until the blue color of the solution in the flask is discharged. The exact point is easily seen. It is only necessary to read off the grains of sugar per fluid ounce on the left-hand graduations.

In most cases of diabetes it will be necessary to dilute the urine to about 5 grains per ounce after a preliminary test. This is easily done in the burette. We may simplify the preparation of the solution by adopting the following formula for the preparation of Fehling's solution, which is now usually made in two parts and mixed when needed for

For use, mix equal quantities of these two solutions, measured out with the burette. I have had but a few months' experience with the keeping power of Solution No. 2; but, so far as I have tested it, there is no reason for not adopting this formula.

NOTE.-Dr. Squibb's "Solution of Chlorinated Soda" answers admirably.

NOTE ON EPISIOTOMY.

BY CHAS. JEWETT, M. D.

Read before the Medical Society of the County of Kings, June 17, 1890.

According to Olshausen perineal lacerations are unavoidable in fifteen per cent. of primipare without episiotomy. This may be taken as the extreme limit attainable in skilled hands. In general obstetric practice the proportion is certainly not less than 20 to 30 per cent. and that, too, of tears sufficient to impair in greater or less degree the function of the pelvic floor. On a priori grounds alone, then, the operation