On turning, as an alternative for craniotomy and the long forceps / by Robert Collins.

  • Collins, Robert, 1801-1868.
Date:
[1848]
Catalogue details

Licence: Public Domain Mark

Credit: On turning, as an alternative for craniotomy and the long forceps / by Robert Collins. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ON TURNING, % AS AN ALTERNATIVE FOR CRANIOTOMY AND THE LONG FORCEPS, . :*t / . .•**»> By ROBERT COLLINS, M.D., Dublin. ■■+*$*■ to pa.h.i'Ksso^si v5® &£•; & Os,- Src.y Kafiwstav ■ ' My Dear Sir,— I beg to thank you for forwarding me the proof sheet of your “ Memoir on Turning, as an alternative for Craniotomy and the Long Forceps, in Deformity of the Urim of the Pelvis.” You are so good as to state in the letter which accompanied the first part of your memoir, that, “ If it contains any errors of statement I shall feel greatly obliged by your pointing them out that I may correct them.” It gives me pleasure to comply with your request, and I shall feel obliged by your publishing my letter as an appendix to your memoir. The first statement I shall notice, is the partial, and, consequently, erroneous calculations you have given from my work; withholding the total mortality, as well as the cause of the fatal result, in every case of protracted labour met with, out of the vast number of sixteen -thousand-cut-hundred —fidtyrfojfr births', minutely recorded by me. Surely this is a great omission on your part; and thus, as you so justly condemn in others at page 9,* “ you have drawn your deductions, not from the whole of the practice, but from parts only ; you have not reckoned upon the certain results of the general collection of facts, but depended upon the fallacious results of isolated and individual instances.” Again, you well remark, “ the medical mind has ever been too apt. to recollect and found upon those facts only which are in favour of any preconceived opinion or opinions it may chance to have adopted; and the causes of failure are too often forgotten amid the more agreeable remembrance of the cases of success,” “It is on this acccount that the numerical method of reasoning and investigation, by obliging us to count up all our cases and all our results, whether good or had,—whether instances of recovery or instances of death, — is no doubt destined to revolu- tionize, in a great degree, our modes of inquiry, particu- larly in surgery and midwifery, by imparting infinitely more precision and certainty to our present deductions and precepts where they are true, and shewing us in language that cannot be misunderstood, the erroneous- ness of our doctrine where they are not true.” In these sentiments I oawrfwily. agree; and the new era which my “ Practical Treatise ” has established in reporting the results of obstetrical practice throughout Europe, affords me extreme satisfaction. No report that is not minute can now command the attention of the profession ; and where all cases and all results are faith- fully recorded, mere extracts taken from such registries, can have no weight with those who are competent to judge for themselves. The various errors you have fallen into by founding • Provincial Journal, February 9th, 1848, p. 58. your doctrines upon partial data, and thus totally obliter- ating what is really most instructive in the^ercera/results, should not, I think, have occurred with the ample details I had furnished, and unquestionably not without printing what has been recorded as diametrically opposed to your conclusions. You extract from my work, that during the seven years I had charge of the Dublin Lying-in Hospital 16,414 woman were delivered in it; and of those 164 died, or 1 in every 100; and this you have followed up by a table, which you think proves that the deaths are increased in proportion to the duration of the labour, viz., where the duration of labour was within 1 hour, one woman in 322 died; from 2 to 3 hours, one in 231; from 4 to 6 hours, one in 134; from 7 to 12, one in 80; from 13 to 24, one in 2.6 ; from 25 to 31), one in 17; above 36 hours one in 6. Why were these obscure calculations given, and the -following highly important' geneial results; and 2ause of death, in all cases where the patient was more than TWENTY HOURS in labour withheld ? It is clearly stated by me that there were forty-two in number out of 16,414 ; or in the proportion of 1 in 391; and of the forty-two women who died, where the labour was above 20 hours, one-third of the children were born alive,—of the forty-two, three died of typhus fever; nine of puerperal fever; one of stricture of the intestine, with effusion into the thorax ; three where the placenta was retained; two of convulsions; one of abdominal inflam- mation previous to labour; nine of rupture of the uterus ; one of inflammation of the intestines, with pus in the uterine sinuses; three of anomalous disease; one of diffuse cellular inflammation ; six of inflammation &c., subsequent to difficult labour ; one of ulceration and sloughing of the vagina ; one of disease of the lungs and haemorrhage; and one of abdominal abscess. Where we see from the simple statement given, that only forty-two died who were even above twenty hours in labour, and at the same time look to the cause of death ; the fallacy of extracts in support of fancied realities is apparent. Why, I would again ask, is my table not given which shews the cause of death in all cases in the hospital, and proves that 97 of the 164 deaths arose from causes not the results of childbirth ? Considerably above ONE- THIRD of the entire mortality during my Mastership, occurred from puerperal fever during the first three years. That this very intractable disease is not the result of protracted labour, as you erroneously state, is notorious to those who have had opportunities of observing it, and is fully proved in my report, the total number of cases being eighty-eight; 71 of which were delivered within 12 hours, and 80 within 24 hours. If we were only to deduct the deaths from this fatal disease, which may be