The following table is to be read thus: sixteen were delivered in one hour after

It is only the average duration of labor therefore, from the number of cases reported, that will yield an approximation to truth for the class, or locality in which they occurred. And it is only from such averages estimated amongst different classes and in different localities that any general laws can be deduced. These are valuable therefore as being placed upon record as occurring in Baltimore, and it is fair to repeat that a large majority of the cases were amongst the better class of society. There is also another difficulty in obtaining this average. The duration of labor was recorded in figures in but 1,178 case out of the 1,787. The remaining 608 are reported in these general terms, "very quick," "some hours," and "spontaneous." (spontané.) If we take for these the average of 4 hours we would have the average for the whole 1,787 cases recorded, 8 hours and 45 minutes as the average duration of labor for Baltimore. The following table will show the per centage of the duration of labor in Dublin, according to Dr. Collins' report for 16,414 cases, and compared with 924 cases reported by Dr. Medcalf, at Mendon, Massachusetts:

Comparison of BALTIMORE with DUBLIN and MENDON, Massachusetts :

By this table is shown the singular fact, that the results for Baltimore, are in every period, almost an average between the Dublin Hospital, and the Massachusetts country practice.

Dr. Medcalf (Amer. Journal Med. Sciences, October, 1847, page 302,) says, "the question still remains unanswered, why 95 per cent. of cases of midwifery in the Hospital practice of Dublin, should be completed within 12 hours, while only 55 per cent. are completed in the same time in Massachusetts; or why 25 cases out of every 1,000 are protracted beyond 48 hours in Mendon, and only 3 in Dublin." He also truly remarks, "I am aware that the hard worked poorly clothed, and poorly fed patients, collected from the narrow lanes and filthy purlieus of a great city, cannot be expected to exhibit the same pathological conditions, or the same catenation of obstetrical phenomena, as the robust, well fed, and warmly clad inhabitants of the country. Especially must we allow there is reason for difference when the collocation brings the squalid and suffering Irish woman into juxtaposition with the happy and healthy country-woman of our own commonwealth. But making all reasonable abatement on the score of differences that are plain and obvious, the discrepancy between the results arrived at, at the two places of observation, is still too great not to prompt the desire for a fuller and more satisfactory solution of the problem."

The fact here given, that the average taken from the luxurious and delicate ladies of Baltimore, is almost exactly between the two, may serve in a significant manner to solve the problem, at least showing more plainly the effect of condition in life upon obstetrical phenomena.

3. Flooding. Of the 1,787 cases, flooding occurred in 52, or within a small fraction of 3 per cent. This is a little less than in Dr. Medcalf's 83S cases reported from Mendon, but considerably more than the average statistics of Hospital practice. Of the 52 cases, 20 occurred after 6 months, and before labor; 11 during labor and before delivery; 6 during delivery of child and placenta ; 15 after delivery of child and placenta. Not one case is mentioned as having died from hemorrhage. Two cases of placental presentation are included in this number. Cases are given illustrative of the practice employed to check the hemorrhage and to bring them to the successful issue reported.

4. Convulsions.-There is nothing in the records of these cases of convulsions, which would tend to elucidate the doubtful points at present existing in its pathology. We regret that a statistical enumeration is the most that can be offered for this interesting disease.

Of the 1,787 cases recorded since 1829, convulsious occurred in 12 instances; 8 before delivery, and 4 afterward; 8 were mothers. for the first time, and 9 recovered. The greatest number occurred during the warm months. In Summer 4; Spring 3; Autumn 3, and Winter 2. Of the children 4 were born dead, 6 males and one case of twins. One occurred in a breach presentation, the rest in different positions of the head.

Of the 2,503 cases, as summed up in statistical form prior to 1829, only 7 cases of convulsions are mentioned, 6 during or before, and one after delivery, of these none died. Should this last record be correct it would be suggestive of a very important law, so far as the number of cases would admit of it, viz: the effect of luxury and refinement upon the convulsive tendency of females, whilst the first mentioned record gives one case in every 149, the latter is but one in every 327. These occurred when this city was comparatively small. In 1820 the population of Baltimore, was less than 60,000. The style of living of the wealthy inhabitants has much changed since then. Cases are given as illustrative of the treatment employed.

5. Puerperal Fever.-We regret that a point of such practical and vital importance as puerperal fever should be omitted in the records offered, since the discussion between two learned professors has recently excited much attention, concerning the nature and causes of this disease. Between the authors in question as well as the members of the profession at large, there is an issue. How frequently is it sporadic in its origin? How frequently the result of communication? How often produced by other poisons-particularly that of erysipelas?

A careful study of the varied cases upon record, and the experience of a majority of physicians in large practice, ought, as far as our information now extends, to be sufficient to assure any one of the probability that this fatal disease may have its origin in any of the three sources.

It is not to be supposed that the corroborated testimony of the most reliable authors has been hastly penned; and where these authorities conflict, abstact science is misapplied in raising doubts on points of practice which common sense and experience are best able to determine.

It is possible to prevent the two last, viz: spreading it by communication, as by inoculating the direct poison; or secondly carrying other poisons, particularly that of erysipelas into the obstetric chamber. An appreciation of the possibility of spreading this disease by these means, and the easy ability of avoiding them, at once indicates the remedy and our duty. It is only in this way that your committee can speak of puerperal fever, for to enter upon its discussion was not proposed, and you are aware to what length it might be carried.

Valuable information concerning the epidemic which existed here in 1845 could be obtained from the Alms-House records and from private sources, which we would respectfully recommend to the Chairman upon obstetrics next year.

In selecting a few cases to read before the society, as illustrative of the practice of this physician, who won and retained the confidence of our community for more than half a century, we have sought for and arranged them in the same order in which the statistics were offered: Firstly,-As having an especial reference to the mother; Secondly,-Relating more particularly to the child; and Thirdly, those involving some peculiarity of the placenta.

The records were in French-the translation has been made as literal as possible. The task of selection was a difficult one, where so many cases of equal merit were offered; we hope those selected will meet the approbation of the society.

CASES RELATING ESPECIALLY TO THE MOTHER.

I.

Rupture of the Perineum-MARCH 8th, 1829.-Mrs. K second labor; child male, weighing 9 pounds. First position of the vertex,-labor quick, and produced a laceration of the perineum, notwithstanding pressure. This means, however, is not always as efficacious as some accoucheurs have thought proper to declare.

II.

Rupture of the Perineum-MARCH 16th, 1829.-Mrs. P

tall and of a delicate constitution, child male, weighing 8 pounds: First position of the vertex. There was a laceration of the perineum, notwithstanding the pressure used upon this part to prevent the accident. I would here observe, that some authors have regarded this precaution as nothing better than a preventative, and that it seemed to them useless. I am, notwithstanding, of opinion that when efficiently performed it is laudable, rational, and in many cases very useful.

III.

Hemorrhage and Convulsions.-Mrs. M—; primipara—a girl, weighing 8 pounds: First position of the vertex,—14 hours of continued labor. This woman had a slight convulsion one hour after child birth, and frequent faintings. She had been bled during labor; this, however, did not prevent a considerable discharge of blood, which was overcome by the continued application of cloths steeped in vinegar, on the abdomen-by the compressive bandage, and administration of 6 grains of acetate of lead and 25 drops of laudanum at one dose.

IV.

Hemorrhage and Convulsions.-Mrs. S

, nearly hemiplegic since infancy, in consequence of variola, is very nervous and has had several miscarriages in a more or less advanced stages. Had notwithstanding, a son at full term 8 years since; her last miscarriage dates 3 years back. Having attained this, her 8th month, she has felt heaviness in the head, with great indistinctness of vision. Eight ounces of blood are taken from the arm in the afternoon, and at 4 o'clock in the morning she is alarmed by an epistaxis, accompanied by slight uterine pains. Regarding this hemorrhage as useful, I did not judge it proper to attempt to arrest it. After having continued 2 hours and produced a loss of 8 or 10 ounces of blood, I had recourse to the tampon, which accomplished my design. The uterine pains having increased during 9 hours, the delivery was accomplished naturally. The child was a girl, in the first position of the vertex. Half an hour after its birth a strong convulsion occurred, which lasted 10 minutes.