Correspondence between Dr. Simpson, Dr. Ramsbotham and Dr. Lee in relation to uterine hæmorrhage from placental presentation.

  • James Young Simpson
Date:
[1845]
Catalogue details

Licence: Public Domain Mark

Credit: Correspondence between Dr. Simpson, Dr. Ramsbotham and Dr. Lee in relation to uterine hæmorrhage from placental presentation. Source: Wellcome Collection.

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    given you a moment’s annoyance, as nothing could be further from my wishes than to do so. The paper you refer to is a statistical one, requiring no small degree of labour on my part; and I was at last obliged to print it amidst all the hurry and turmoil of a busy academic session. You are well aware of the almost in¬ superable difficulty of securing perfect accuracy in such tabular returns. I had occasion, some time ago, to point out to yourself, when writing you on the subject, an error of some impor¬ tance in your own printed returns of placental cases belonging to the Mater¬ nity Charity. To ensure as great accu¬ racy as possible in the various tables which I published in the memoir referred to, all the data in them were gone over more than once, and I was assisted by Dr. Keith and other friends in revising them ; and the results, as they now stand, give no adequate idea of the labour expended in arriving at these results. For instance, in order to obtain as many data as possible from the fifty cases of placental pre¬ sentation which had been recorded by you as occurring in the practice of the Maternity Charity, I searched over all the different volumes of the Medical Gazette, in which your reports are contained, and entered each individual case by itself in a table shewing, under different headings, the number of the pregnancy, the date at which labour supervened, &c. &c. &c. Two con¬ tiguous columns contained the entries of the “ results to the child,” and the “ results to the mother.” In summing up the fifty resulting lines containing your fifty different cases, in order to get the single line to be found in the table which you complain of, I had either inadvertently entered, or subse¬ quently copied the results to the child for the results to the mother, and the reverse. If the “ results to the child” had been published in the first part of the Memoir, I should at once have seen the error, and corrected it; but unfor¬ tunately I held the results to the child, in yours and other cases, in reserve for future publication. Before leaving Scotland, I had nearly passed through the press, and had ready for separate publication, a long Memoir on the whole subject of the treatment of unavoidable haemorrhage by the extraction of the placenta before the child. In that Essay you will find the error I had made on your returns acknowledged and rectified, though (if I recollect properly) I still make out the number of maternal deaths to be different from you. However, a special reference to each fatal case is given. You state in your letter that the 44 cases of placental presentation which I have appended to your name in the table were all cases of partial placenta, prcevia. I am quite aware of it. The table was made to shew the maternal mortality in all varieties of the compli¬ cation, and under all modes of treat¬ ment—whether the membranes merely were ruptured, or the child turned, or the placenta spontaneously expelled, or the mother sun & without aid of any kind. If I had rejected the partial placental cases, such as your 44, be¬ cause they were not so fatal as the complete, or the cases in which the liquor amnii was artificially evacuated, or the placenta spontaneously sepa¬ rated and expelled, because they were by no means so fatal as the turning cases, I might have easily brought out a result apparently stronger, but it would have been at the expense of strict and truthful accuracy. The pro¬ portion of maternal deaths under turn¬ ing in placenta praevia, and where the presentation was generally central, forms, you will find, a subject of inquiry in a later part of the Essay. I hope to be able to send you a copy of the Essay itself in a few days after I return to Edinburgh.
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