Address to the Medical Society of London : together with some correspondence relative to a consultation at Norwich.

  • Murphy, Edward William, 1802-1877.
Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: Address to the Medical Society of London : together with some correspondence relative to a consultation at Norwich. 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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    Some years since, when forming a registry of obstetric cases at University College Hospital, it occurred to me that it might be made a means of determining this ques- tion, when a sufficiently largo number of cases were obtained. The following method was adopted : —When a letter for attend- ance w'as applied for, an inquiry was made os to the catamenia, the age of the applicant at its commencement, its period, and its last appearance. Tho applicant could have no idea of the object of these inquiries, and therefore could have no motive for decep- tion. With regard to the last question, its cessation, some could only give the month, some were too irregular to date from, and some were precise as to the date. Those that were irregular were excluded : for in- stance, some who were nursing either had no change or a very irregular one; others had been always irregular before pregnancy, and therefore could not be depended on ; and again, with some the catamenia had evidently continued after conception. Such cases being omitted, those that remained were noted ; and when labour took place, the time of delivery was also recorded. The interval between the two dates gave what might be called the gross duration of preg- nancy. The period so obtained was after- wards corrected so as to make as near an approach to accuracy as possible. On a former occasion, when drawing up a report of the obstetric practice of University College Hospital, a table of 186 cases was formed, in which the duration of pregnancy is given. In those cases the corrections were made in the following manner:—H the period exceeded 280 days, and the woman had given the exact date when she was last unwell, an inquiry was made as to the regularity of the catamenia; but, to avoid error, the whole menstrual interval was deducted from the gross amount. For instance, if the whole dura- tion were 328 days, and the interval of the catamenia 28 days, the last number was subtracted from the former, leaving 300 days as the true period. It was assumed that the woman might be wrong as to the exact date, and therefore it was safer to consider that conception occurred justbeforc the catamenia which had been arrested. In the present inquiry a method slightly different has been adopted. 280 days is assumed to be the true period of pregnancy, and every case that can be made to fit is included under the table of 280 days ; if it cannot, the correction is made thus :— When the month only is given, the date is taken from the last day of tho month; if the precise date is given, it is assumed to be correct, and tho menstrual interval being deducted, the result is presumed to bo accurate. For example, if from tho last appearance of the catamenia (say April 10) to February 10, include 306 days, the true duration of pregnancy would be 306—28 = 278 days ; thus reducing every case of extended pregnancy to its lowest number consistently with truth. Four tables have been fonned, containing collectively 965 cases. 1st. Those cases in which the duration of pregnancy is above 280 days. 2d. Those that are exactly that period. 3d. Those between 260 and 280 days. 4th. Those below 260 days. The first table (above 280 days) is by far the most important, and includes 303 cases. The second (280 days) 378 „ The third (between 260 and „ 280 days) .... 201 „ 882 The foui’th (below 260 days), which must be considered pre- mature deliveries . . . 83 ,, Making altogether . . 965 „ These tables give support to those formed some years back, in proving that the dura- tion of pregnancy is not a fixed period, but, just as in the lower animals, it varies witliin certain hunts. What those limits are is the important question to determine. I have taken 260 days, or 37 weeks, as the shortest period, because I have attended cases that have given birth to mature chil- dren at that period. I do not wish as yet to speak absolutely as to the longest period, because the first table that I have formed is yet under examination, and requires the corrections that I have alluded to. At some future opportunity I shall bring before the Society the results in a more perfect form. At present I shall only quote an instance of very protracted gestation, which I think may be considered as accurate. Mary Abbot, set. 40, living at 39, Gough Street, Gray’s Inn Road, apphed for a letter to the hospital, January 3, 1849. The catamenia had commenced at 14, and con- tinued regularly every four weeks. She was pregnant of her fourth child, and the menses appeared last in the month of March 1848. She states that, whenever pregnant, “ she always feels ill, the morning sickness being very bad, and a death-like feeling of faintness and sinking frequently recurring,” by which symptoms alone she has always been able to say she was preg- nant. She perfectly remembers her last pregnancy, and the particulars respecting it. The menses ceased in the beginning of March, or, she says, “ more properly in the last days of February.” It was not more than a month from this period that she began to bo sensible of the same feelings of