ART. II. Observations on Professor Hamilton's "Deviations," &c. By ROBERT COLLINS, M.D., late Master of the Dublin Lying-in Hospital.

A SENSE of duty again forces me to expose to my junior professional brethren, the hasty, and if generally acted upon, mischievous measures urged by Professor Hamilton, of Edinburgh, for the artificial dilatation of the mouth of the womb within twelve or fourteen hours, and the actual delivery of the patient within twenty-four hours from the commencement of labour.

I am led thus, a third time, to register the most solemn protest against Professor Hamilton's unnecessary and mischievous intermeddling, in consequence of a letter published by him in the preceding volume of this Journal; and I state, without hesitation, that the said letter is one of the most perfect demonstrations of his often-exercised powers of evasion ever offered to public consideration.

When stigmatizing Professor Hamilton's doctrine, regarding the artificial dilatation of the mouth of the womb, in a communication made by me in this Journal, March, 1837, I have given the following quotation from Dr. Hamilton's work: "When the pains take place, if the dilatation proves tedious, that is, if the continuance of strong pains for six or eight hours do not advance the dilatation to such a degree as to give reason to expect its completion within a few pains, it becomes necessary to interfere lest the patient's health should suffer." In my second communication, September, 1838, (to which Professor Hamilton pretends to reply in the last number of this Journal,) I state the following are Dr. Hamilton's own words, upon the validity of which the key-stone of his arch ideas rests, and which, although inculcated by him for a series of years to some thousand pupils, he complains the practitioners in London, Paris, and Dublin reject.

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MANAGEMENT OF THE FIRST STAGE OF LABOUR.

"One of the earliest innovations in the treatment of human parturition, which I found good reason to introduce, was the limiting the duration of the first stage of labour to twelve or fourteen hours, WHENEVER THE UTERINE CONTRACTIONS CONTINUE TO BE REGULAR AND PROGRESSIVE; and I have stated in my Practical Observations, that the following are the necessary effects of the protraction of that process beyond the time specified."

In the learned Professor's reply to my second communication, he slips back, cautiously, to the Dublin Journal of Medical science, No. XXXI., where my first criticisms are published, and gives the first extract which I have supplied above; shunning his "innovations," as set before his eyes in the very glaring manner just recorded, as the key-stone upon which his ideas rest. In reference to the passage given in my first article, the Professor now, as he thinks, cunningly remarks, "In this quotation Dr. Collins has left out certain words, and transposed others, which completely misrepresent what I have published; for, firstly, I do not state that the full dilatation of the os uteri should be completed within twelve or fourteen hours from the actual commencement of labour, as the natural efforts can no longer be trusted to;' my statement being in the following words: If uterine contractions continue regular the full dilatation of the os uteri should be completed within twelve or fourteen hours, &c.' This condition, which Dr. Collins has carefully suppressed, changes altogether the proposition which he has thus alleged to be mine." And it is added, " for this misrepresentation he can have no excuse." I ask is it not to Dr. Hamilton's everlasting shame, that I am compelled to thus expose him. Who could read such sleight of hand efforts, without contempt for the writer?

Have I not proved that the identical words were absolutely emblazoned in order to attract notice; and yet Dr. Hamilton

has had the presumption to accuse me of wilful misrepresentation.*

I have now to expose the Professor's second accusation; and in truth it will bear the light badly as the first; but it must be told. The Professor states, "The second misrepresentation of Dr. Collins, in the words quoted, seems to me still more inexcusable. I allude particularly to the following: 'He (meaning Dr. Hamilton) says, that the patient should almost never be allowed to continue longer (viz. than twenty-four hours) without being delivered.' The following are his own words: When the pains take place, if the dilatation proves tedious, that is, if the continuation of strong pains for six or eight hours do not advance the dilatation to such a degree as to give reason to expect its completion within a few pains, it becomes necessary to interfere, lest the patient's health should suffer.' These words (the Professor adds) have been detached from the sentences which explain them, and afford one of the most perfect specimens on record of a deliberate intention to pervert and misrepresent the doctrines which Dr. Collins has undertaken to controvert."

The

I would anxiously refer to my first communication on this subject in this Journal, March, 1837, page 39, from whence this quotation is culled, with Dr. Hamilton's artful tact; it is the first sentence in my abstract of his "doctrines," and has reference alone to the first stage of labour. second sentence is, "Since the year 1800, the author has advised his pupils to secure the termination of the first stage of labour within twelve or fourteen hours from its actual commencement." The third sentence is, 66 Again,

Doctor Hamilton states, with reference to my first extract of his doctrines, that "Dr. Collins has left out certain words, and transposed others, which completely misrepresent what I have published."

This is a shameless misrepresentation on the part of the Professor, as I have given the quotation in the identical order, and to the very letter, as printed in his Observations, Part I., page 225.

when treating of LABORIOUS LABOURS, the author feels it incumbent upon him to declare, that when the uterine contractions proceed regularly, without decided interruption; or when the infant, after the rupture of the membranes, remains in close contact with the passages, the sufferings of the woman should almost never be allowed to continue longer than twenty-four hours, reckoning from the beginning of true labour throes."

The

Could a more deceitful representation of my explanation of the Professor's doctrines be put in print, than this demonstration exhibits? If the two latter sentences do not explain the Professor's doctrines to the very letter, they must have been inserted by "mistake"!!! by Doctor Hamilton, in his Observations on Midwifery, Part I. page 195, and Part II. page 42. That the hasty and MISCHIEVOUS doctrines given above were REALLY and TRULY the "innovations and deviations" INCULCATED by Professor Hamilton, I cannot permit him to retract. following extract, from a letter received by me from Doctor Hamilton, in explanation* of the doctrines advanced in his work, proves without the possibility of doubt, that even the hasty measures above recorded, fall far short of the speed he uses in private, viz., "It appears to me that the only important point on which we differ respects the time during which, in cases of laborious labour, the practitioner should wait for the efforts of nature. According to my solemn conviction that should never exceed from Two to TEN hours, and as your experience has led you to believe that the stethoscope unequivocally indicates the death of the infant, if after that event, the pains cease to advance the labour, every hour's delay must add

• Doctor Hamilton states in his letter, that "Doctor Collins referred to the information communicated by him in a private letter, on which he has most unceremoniously commented." I totally deny ever having had any private correspondence with Professor Hamilton. I know him solely as an author, and every letter received from him was strictly in illustration and explanation of his doctrines, as the extracts given amply testify.

to the danger of the patient; and I cannot help being impressed with the notion, that the cases which you have detailed from page 464 onwards, completely confirm my opinion. I have only to add, that I have never imputed any error in the practice to which I object, to yourself personally, for I have invariably stated, that it is to the modes of practice generally adopted at present in London, Dublin, and Paris, to which my animadversions refer."

Such are my remarks upon two of the charges of wilful misrepresentation with which Doctor Hamilton had the audacity to accuse me, and I leave the impartial reader to detect even a syllable in any of my references to his doctrines not scrupulously in accordance with what he has been endeavouring to inculcate so injuriously for nearly half a century. Truth scorns all kinds of equivocation, and never fears rigid examination. It would have been well for Professor Hamilton had he recollected, that "a goose quill is more dangerous than a lion's claw," before he published" innovations and deviations" so devoid even of the semblance of proofs, and so diametrically opposed to the results of the records of all the largest hospitals in Europe.

The next tale I shall unfold from Professor Hamilton's Letter is told by him at pages 185-6, and I "may" be believed when I solemnly state, that I "never heard tell of, nor ever have seen" a more insufferable and shuffling attempt to disavow and disown the very essence of every doctrine he has advanced, on the truly important practical points at issue be

tween us.

Let us examine the wily attempts of the Professor to retract clandestinely every iota of what he has advanced on the subject; and the efforts he makes to create as great a mist as it "may be possible," to prevent his retreat from being discovered. The attempt, however, is miserably paralytic, and unfeelingly depicts his own overthrow. The Professor states,* "Dr. Collins says, page 407 of your Journal, No. 39, two untoward circum

See last Number of Journal, pages 185-6.