To Professor Simpson, of Edinburgh, in reply to his letter to Dr. Collins, on the "Duration of labour as a cause of mortality and danger to mother and infant" : second letter / by Robert Collins, M.D.

  • Collins, Robert, 1801-1868.
Date:
1848
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Licence: Public Domain Mark

Credit: To Professor Simpson, of Edinburgh, in reply to his letter to Dr. Collins, on the "Duration of labour as a cause of mortality and danger to mother and infant" : second letter / by Robert Collins, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    labour accompanied by malformation or disproportion, is ex- tremely hazardous, the mortality from it is strikingly small/' notwithstanding the imaginary proportional tables you have given us; still more especially when we reflect, that the pro- portional mortality above given, of one death in 1,492 deliveries in all labours protracted l3eyond forty-eight hours, is the re- sult of hospital practice, where the most hazardous cases are accumulated ; and that it is notorious, as will be proved in a subsequent part of this letter, that in the same number of cases out of hospital, the mortality would not be more than one- half. A death from labours exceeding forty-eight hours, should not odQuv m private practice more than once in 2,984 deliveries ; and thus, we demonstrate, scarcely ever to be met with by most practitioners. I can truly state, that I never had a death from protracted labour, and the invaluable results which I am about to publish of Dr. Joseph Clarke's practice will prove, that he never met with such an occurrence in nearly fifty years' active practice; and, will you believe it, he only used the crotchet twelve times, the forceps once, and tbat without elBTeGting the delivery, in 3,847 labours. I shall not now state his mortality further than to assure you, it was not one in forty-two. The grand point for the practitioner seriously to consider is, how the patient can be conducted with the greatest safety through the most laborious labours, where there is extreme dif- ficulty in the birth, owing to deformity in the brim of the pelvis, or other causes. You advocate the speedy delivery of the patient with the forceps, or by turning the child ; but having so little practical experience of your own to submit m proof of the safety of this mode of proceeding, you struggle to prove, what no physician ever doubted, that protracted labour is dangerous I! You then give us the enlightening discovery made in your table, that where the labour is protracted beyond 36 hours, the proportion (!) of deaths is one in &ix. As you have so little information to submit respecting the re- , suits of delivery, by turning the child in deformity of the pelvis, let us examine the mortality resulting from the speedy mode of delivery by forceps, in the hands of some of the most expe- rienced practitioners. These are cases which, in my humble opinion, should be attended with trifling danger to the patient, compared with those where the disproportion is so great as to make it impracticable to deliver with this instrument.