THE ROYAL UNIVERSITY AND UNION HOSPITALS.

1887. lations varying between 50,000 and 100,000 ; while the to take a position other than it deserves; the saving of life population of the remaining thirty-nine towns range be- is too earnest a thing to stand behind personal interest. 1 ’tween 12,000 and 50,000. According to this return, the may, however, be permitted to point out that the treatment death-rate. per 1000 of the population during last year was of cases of placenta prævia clinically may be divided into 28-5 in Vienna, 39’0 in Prague, 39’8 in Trieste, 34’4 two classes: one where we are suddenly called without in Lemberg, and 30’4 in Graz. In the smaller towns previous acquaintance with the case, without any means at still higher rates prevailed, and it is noteworthy that command but our hands; the other where, having seen the in only four of the forty-nine towns was the death- patient beforehand, we can calmly set our plans to bear on rate in 1886 below 25 per 1000; in thirteen it was the treatment. In the former, particularly, the plan I have between 25 and 30; in eighteen between 30 and 35; suggested gives us the command of the position such as in eleven between 35 and 40; and in three towns the none other can give. In those cases where we have time rate exceeded 40 per 1000. These strikingly high rates of the importance of terminating the pregnancy cannot be mortality in the Austrian cities present a remarkable con- overrated; it is that which I have for years inculcated in trast with the rates that prevailed last year in English my lectures, and I have no doubt others have in theirs; but towns. In the twenty-eight large towns of England and in this I make no claim to originality, for it is to Dr. Wales, with an average population many times greater than Greenhalgh we are indebted for the first definite laying the average population of the Austrian towns, the death- down ot what Dr. Murphy in his letter wishes to In 1864, in a rate last year ranged from 17’1 in Brighton and 18’2 in enunciate as a ninth great proposition. Derby, to 26’3in Manchester and 28’9 in Preston. The range paper read before the Obstetrical Society of London, of mortality in the Austrian cities above referred to was Dr. Greenhalgh said that "in any given case of hæmorbetween 21’4 and 48’1. This marked excess was in great rhage due to placenta prsevia occurring after seven and a half months of utero-gestation, when the child is viable, it measure due to the mortality of zymotic diseases, to which is expedient, both for the safety of the mother and child, to further reference will shortly be made. expedite labour-unless the condition of the exhaustion be such as to preclude this step; and if so, then as soon as possible after she has recovered from the shock." This is THE SERVICES. virtually the same as Dr. Murphy enunciates as his ninth proposition. In the discussion on that paper my plan of Deputy Surgeon-General Sir J. A. Hanbury, K.C B., the turning is compared with that of the older internal mode, Principal Medical Officer of the Home District, has been to the great advantage of the "combined." In that disordered to hold himself in readiness to proceed to the cussion I said that I "quite agreed with Dr. Greenhalgh as Mediterranean, for the purpose, we presume, of taking up to the necessity of inducing labour in placenta praevia as soon the appointment of Principal Medical Officer at Gibraltar in as arrangements could be made, which I believed to be the succession to Surgeon-General Fraser, who will be placed on plan adopted by all who saw much midwifery in that city; - the retired list under the provisions of the age-clause of the it was the practice I had alwaysadopted" (op, cit.), and in my Warrant. The Times correspondent at Rangoon states that paper read in 1863 at the Obstetrical Society, and in the the commissariat and medical arrangements for the police little work " Combined External and Internal Turning," of in Upper Burmah have been very defective, and that Mr. the same year as Dr. Greenhalgh’spaper, I allude to the advanCrossthwaite has selected Surgeon-General Farrell, of the tage also given us in dilating the os with Barnes’ bags and Indian Medical Service, to take charge of the medical separating the placenta around the os. " The value of these bags is very great, and they give us the power of operating arrangements. WAR OFFICE. -Army Medical Staff : Surgeon-Major at a date far earlier than we ever possessed before." But the Francis Henry Welch to be Brigade Surgeon, vice John separation of the placenta by the finger in placenta prsevia, is not always without severe loss. 1 have had several cases Henry Hunt, deceased. Dated Feb. 24th, 1887. ADMIRALTY.—The following appointments have been where on peeling off the placenta the haemorrhage was so made: Surgeon G. H. Meaden, to the Seaflower ;Surgeon violent that had I not been able to use the bipolar method E. A. Spiller, to the Martin; Surgeon G. E. Kennedy, to the serious results would almost certainly have occurred. Nautilus; Surgeon J. E. Webb, to the Pilot.. Surgeon J. F. Doubtless, the mortality from placenta prævia has been Bate, to the Sealark; Surgeon J. Andrews, to the Liberty latterly much lessened by the rule laid down by Dr. Green(all to date from the 25th inst.); and Surgeon R. Hickson, halgh of early termination of the pregnancy, by those who have followed it; but it still needs to be more generally to the Lion. known and practised, and Dr. Murphy’s emphatic endorsement will assuredly do much good. I am, Sirs, yours truly,

Correspondence.

George-st., Hanorer-sq ,

March 21st, 1887.

J. BRAXTON HICKS.

"Audi alteram partem."

THE ROYAL UNIVERSITY AND UNION TREATMENT OF PLACENTA PRÆVIA. HOSPITALS. To tile -E, ditors of THE LANCET. To the Editors of THE LANCET. SIRS,—I have onlyjust read your complimentary remarks SiRs,--I have received a communication from the Piivy of March 5th on my recommendations in treating placenta Council in which marked prominence is given to the fact prsevia, and the letter of Dr. Jas. Murphy on your approval that the utilisation of union hospitals is still under the conof them. There is one remark of yours I should like per- sideration of the General Council. One member of that mission to correct, when you say, " though some facts in the body fell into the strange error of stating that these hoslacked material for teaching. The Irish Local Governpathology of placenta praevia (such as the arrest of hæmor- pitals ment Report for 1886 will show that 52,000 were admitted rhage after turning and before extraction) were unknown to in 1885 in sickness from the outside. These were all cases him and his contemporaries." On page 27 of my " Combined that were of course too sick to be treated in the disExternal and Internal Version" (1864) I say: "Ibelieve that pensaries. They were admitted under an Act which in nearly every case the bleeding will be found to be con- opened up these hospitals to the general public, and of trolled by the drawing down the child after version so as to whose existence our critics seem to be unaware. That fill up the os uteri. I have never found any bleeding after report will further show by its table of the causes of deaths - this point has been ained." Again, page 28: " Should there that at least 24,000 sick paupers were likewise entitled to be reason to fear haemorrhage was going on internally, then be placed among the boi?ti-fide clinical material. The further the delivery might be hastened ; but I have in all the cases pretence of the Royal University that they could not exernarrowly watched for any externally or internally without cise proper supervision over such hospitals is met by their having met with it. Such a state is of course possible, but own action in recognising other hospitals over which they 1 think it must be rare," &c. could not exercise it, and in their not exercising it where With regard to Dr. Murphy’s letter, I may say that it they could do so. The time is not far distant when selfaffords me great pleasure to be in happy rivalry with plans respecting provincials will be able to defend their own that have reduced the former mortalities to so low a point. interests. I am, Sirs, yours truly, For my own part, I do not wish anything I have suggested Cashel, March 15th, 1887. THOMAS LAFFAN.