Hospitalism and zymotic diseases : as more especially illustrated by puerperal fever, or metria a paper read in the hall of the College of Physicians, on the 13th of March and 10th of April, 1869, before the Obstetrical Society of Dublin also, a reply to the criticisms of seventeen physicians upon this paper delivered on the 10th of July, 1869 / by Evory Kennedy.

  • Kennedy, Evory, 1806-1886
Date:
1869
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Licence: Public Domain Mark

Credit: Hospitalism and zymotic diseases : as more especially illustrated by puerperal fever, or metria a paper read in the hall of the College of Physicians, on the 13th of March and 10th of April, 1869, before the Obstetrical Society of Dublin also, a reply to the criticisms of seventeen physicians upon this paper delivered on the 10th of July, 1869 / by Evory Kennedy. Source: Wellcome Collection.

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    of the remaining nine amounts to 1 in 59. Why I doubt whether a stronger case could be made for the cottage or isolated hospitals, than that furnished in this table of Dr. Churchill, or, if properly investigated, that any stronger proof could be given of the accuracy of my propositions, No. 3 and 4, which asserts the mortality to exist in proportion to the number of parturient patients cohabiting and breathing the same atmosphere, and that metria finds its habitat where large numbers are delivered under the same roof. Propositions that imply number in proportion to space, as well as absolute number; and yet, these pro- portions have been cavelled at by almost all my critics. Thanks to Dr. Churchill, however, he has answered these unanswerably in this table. But, we have one more matter to touch upon with my friend Dr. Churchill. He very properly insists in statistical calculations upon “ the numbers being very large, and the time embraced in them being considerable.” Very justly he remarks, “in a small hospital or private practice you may go on for years without a death, yet after the lapse of another year the average death-rate may be fearfully high, just because an epidemic intervened.” Now, I apply this rule to his table, and I find that the first and second entries, Dr. Beatty and Dr. Churchill’s hospital statistics, only embrace three years, and are, compared with the Waterford Hospital, embracing thirty. It is hard to say whether, if the statistical kaleidoscope to which we alluded on our first night’s discussion had revolved for the other twenty-seven years, Dr.Churchill and I might not have agreed upon this point, as we do on most others, and thus the convictions of his own well stored mind, the result of years of ample experience and deep study, might have remained unchanged, and been applied in co-operating with me in this my arduous struggle for the benefit of our suffering fellow-creatures. Be this as it may, however, I would strongly urge upon him, when he is tempted to be led astray again by statistics, to hold fast by his own excellent maxim—“ That in comparing numbers with numbers we must take care that we are comparing like with like.” Dr. Morgan’s report of the mortality in childbirth in the Lock Hospital, 1 in 74, is extremely interesting in its bearings upon this discussion. It is quite evident that the paucity of the births and the consequent segregation of the parturient element was a main cause of the compara- tive absence of metria in his cases. But, on the other hand, we had the parturient exposed to what we laid down as a mischievous influence in her inhaling the atmosphere of a surgical hospital, an elemen that should have increased the mortality, as we have found it do, in the foreign hospitals in which surgical cases and deliveries are congregated, unless some corrective principle was in operation. We imagine we have exactly met a principle in the theory, old as the fathers in medicine themselves, namely, that morbid poisons cannot co- exist in the same individual. Here the syphilitic virus was in occupation and may have resisted the metria zymotocene.