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Cause of Mortality in Difficult LaboursAuthor(s): Robert CollinsSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 12, No. 23 (Nov. 15, 1848), p.634Published by: BMJStable URL: http://www.jstor.org/stable/25500559 .

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634 CAUSE OF MORTALITY IN DIFFICULT LABOURS.

of the affection and the date of Dr. Wards letter, and

it is scarcely to be supposed that such after-recollected

symptoms could be admissible in evidence here. But I

refer to the time Dr. Smith attended the patient, when

the choking came on in an instant, and when the

paroxysm as suddenly vanished, and when the case was

treated with, and cured by, antispasmodics, by stimu

lants, by brandy-and-water; and here again I emphati

cally deny, on the ipse dixit of Dr. Smith, that there

was any inflammatory affection whatever.

In conclusion, then, it must be admitted by the

impartial reader, that Dr. Ward has unquestionably failed to maintain his point, or set aside the doctrine

which I gave in the first articles touching this

question. The girl Cooper, and the young man John

P., as also Dr. Smith's illustration, are abundantly sufficient in confirming my own argument, and I trust

when Dr. Ward takes a more philosophic and compre hensive view of the question, he will not dwell so much

upon effects as causes, and that he will see that irrita

tion, transmitted or originatingin the laryngeal nerves, is not always the result of positive inflammation in

that organ, and consequently, instead of an antipblo

gistic, (as his theory would ever presuppose,) an anti spasmodic and tonic mode of treatment is indicated.

"We agree with Dr. Wardell," says the Editor of

Ranking's "Abstract of the Medical Sciences," in

the last volume, "that his cases were instances of

spasm of the glottis in the adult, which are far from

being as uncommon as represented. We have seen

three or four instances at least of this affection, as a

symptom of reflected uterine irritation. We have

treated the paroxysm in the adult as in the child, by

dashing cold water on the face, emetics, &c. Had

they been cases of acute laryngitis, as supposed by Dr.

Ogier Ward, the pulse would not have remained under

100, nor would the remissions have been so distinct."*

I am, Sir, Your obedient servant,

JOHN RICHARD WARDELL.

27, Acacia Road, Regent's Park, October 30, 1848.

CAUSE OF MORTALITY IN DIFFICULT LABOURS.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL.

SIR, I agree with you that, as Professor Simpson's calcula

tions and mine are now before the profession, we may leave them to form their own conclusions. I wish,

however, to correct some important errors of statement

as tofacts, in his letter to me in the last number of your Journal. He asserts that I maintain that the mere pro traction of labour is not a material cause of danger to

the mother. I never made any such statement: my statements have invariably been made to prove that

the mortality from protracted labour was strikingly small, and that the great mortality is from other causes.

Professor Simpson also asks, why I did not state, that

* Vol. vii.,p.38.

during the first three years of my Mastership, out of 5,629 women delivered, 106 died, or one in 53? I answer, I could not state so and state a fact, as there were 7,547 deliveries in the period stated, and 110 deaths, including 59 from puerperal fever, or one in 68. Professor Simpson states I was Assistant Physician in the Hospital in 1826. This is also contrary to the fact. I was

appointed Master in November that year, and my calcu lations are all given from that period.

Professor Simpson asks why I did not report the mortality during five years I had nothing whatever to do with the hospital ?

Professor Simpson states, in reply to my remark upon the excessive mortality of one in 21 in the Edinburgh

Hospital, under the late Professor Hamilton. "You

know that this high mortality arose from the prevalence of puerperal fever." I beg to say that Dr. Hamilton

peremptorily declares that not one case of puerperal fever occurred in the above period. (See the late Dr.

Mackintosh's Essay, published in 1823, where he asserts

the mortality was one in 18.) Professor Simpson states that he thinks he sent a

report of the Edinburgh Hospital, which I never even

heard of. He also states that I choose to criticize him

for losing in his private practice, two mothers from

puerperal fever, when using anesthetics. I made no

observation of the kind: I stated that he lost four

patients out of 170, or in the large proportion of one

in 42.

In conclusion, I beg leave to state, that I have no obser

vation to make upon Professor Simpson's novel calcula

tions of the comparative average mortality between

patients where there is no difficulty whatever in the

labour,and those that are accompanied by the most extreme

difficulty and danger. I am, Sir, Your obedient servant,

ROBERT COLLINS, M.D., President of the King and Queen's

College of Physicians in Ireland.

Merrion Square, Dublin, Nov. 6, 1848.

PROVINCIAL

jI ilaI l caI& urgical Sournal.

WEDNESDAY, NOVEMBER 15, 1848.

It is gratifying to have to state, that at this

period, when the cholera has actually made its so long anticipated invasion, the state of the

public health is in a more satisfactory condition

than it had been for some time previously. From the Quarterly Return of the Registrar General recently issued, we learn that the

mortality of the last quarter is considerably below the average, and that a marked improve ment has very generally taken place in the

public health throughout the country. "The mortality of the country," says the

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