as far as I can ascertain, fifty-nine scutch mills, but at the beginning of the eight years of which I treat there were hardly thirty; at present the mills could employ about 2,500, but so many as this, are never employed even in the busiest part of the scutching season, which lasts three or four months, the work then gradually decreases, and for five or six months most of the mills are idle, so that I am sure I over-estimate the numbers employed in scutch mills on the average of the whole year at a quarter of those employed in the four factories. Were accidents in proportion to employment there would be at least four from the factories for one from the mills. How different the real proportion is will be seen at once by the table subjoined : Even this table does not show fully the disproportion, for reference to the list of accidents will show a disproportion in severity which cannot be sufficiently expressed in a tabular form. During the eight years the factories have occasioned the loss of two forearms and seriously impaired three arms, whereas, in the same time, the scutch mills have killed six people, seven survive minus a limb, and others with seriously impaired arms. Twelve of the sixteen mill accidents are more severe than any of the five factory accidents. The following accidents are all on the books of the infirmary, except two, in which the injuries were too quickly fatal for the removal of the patient. 1. Both arms caught in the rollers, and chest crushed against them. This man died almost immediately. 2. The left arm caught in rollers; ribs of that side broken; died the day after the accident. 3. Robert Smith, aged fifteen, admitted Jan. 19, 1859. Left arm drawn in by rollers; soft parts lacerated; blood-vessels and nerves torn; bones comminuted; at least two ribs, left side, broken; amputation at the shoulder joint; in a few hours the side became emphysematous where the ribs were broken. Died the day after admission. 4. Richard Hanlon, aged thirty, admitted 30th September, 1863. Right arm drawn in up to shoulders by rollers; no bone broken, only a slight wound in the upper and inner part of the arm; brachial artery not pulsating; arm evidently infiltrated with blood; cold; sensation destroyed. He positively refused to submit to operation till the next day; acute mortification set in during the night, extending to the wall of the chest. Died 4th of October. 5. James Bothwell, aged sixteen, admitted 2nd November, 1863. Right arm drawn in by rollers; humerus broken close below articular head; axillary artery and plexus of nerves torn; thoracic side of axilla bruised and torn; amputation at shoulder joint, but a clean wound could not be left; wound became sloughy; third day secondary hemorrhage, which was arrested, but he never recovered this second loss of blood, and died on 13th November, 1863. Were I called on to treat a similar case again, viz., amputation at the shoulder necessary, and some sloughing in the wound inevitable, my first step would be ligature of the third stage of the subclavian artery, trusting to the branches of the thyroid axis for the vitality of the wound and flap, and having the ligatured part of the artery as far as possible from the probable sloughing. 6. James Ringland, aged seventeen, admitted 20th January, 1865. Was cleaning behind handles when the machinery was put in motion; one leg and thigh torn, and bones broken in many places; the other less injured; body crushed; never recovered from collapse. Died 21st January, 1865. 7. Joseph Cleland, aged nineteen, admitted 1st December, 1863. Hand and wrist injured by wheels; amputation of forearm. Re covery. 8. Eliza Harbison, aged fifty, admitted 30th September, 1863. Left arm drawn in by rollers to above elbow; would not consent to operation; more than six months after forearm dropped off. 9. Isabella Coulter, aged sixteen, admitted 23rd December, 1863. Not a regular mill operative, but helped in the rolling; caught by rollers; right arm drawn in to near shoulder; amputation at shoulderjoint. Rapid recovery. 10 James Fisher, aged twenty-nine, admitted 2nd November, 1864. Both arms drawn in by rollers; right arm amputated above elbow; left saved; now a tolerably useful limb; has recently been a patient of the infirmary, with lumbar abscess. 11. Edward Rogan, aged thirty, admitted 3rd February, 1865 Left arm drawn in by rollers; muscles, vessels, nerves, and bones all injured; amputation at shoulder-joint. Recovery. In this case, it being the left arm, I operated by dissecting up the flap, and think it a more tedious proceeding, more troublesome in securing the arteries that surround the neck of the humerus, and certainly clumsy-looking surgery. I would prefer to make the flap standing at the outside of the patient's arm, transfixing is so much easier, and more quickly performed. 12. John Hinds, aged forty-three, admitted 22nd March, 1865. This was a most peculiar accident. The right arm was drawn in by the rollers to near the shoulder; no bone was broken, nor was there the slightest solution of continuity of the skin, but sensation was destroyed; no pulsation to be felt in any artery below the axilla; the limb was cold, and slightly discoloured. Every effort was made to try and convince the man of the danger and uselessness of trying to keep the limb; but when he saw no wound, and knew no bone was broken, he would not be convinced. So, exactly one year after, the forearm bones came off. He has a humerus covered with discoloured skin, devoid of sensation, and still largely ulcerated. I saw him a few days ago, so can answer for the state a year and nine months after the accident. 13. Pat M'Conville, aged sixteen, admitted 17th October, 1865. Caught in the metal wheels which move rollers; right arm injured to above elbow; artery torn; amputation in the upper third of arm. Recovery. 14. John Armstrong, aged fifty-four, admitted 22nd May, 1861. Caught in rollers; comminuted fractures of arm and forearm. Recovered, with a permanently damaged limb. 15 Pat. Gribben, aged thirty-four, admitted 31st October, 1862. A farm labourer, not a regular mill operative. Caught in rollers; vessels and nerves escaped; limb saved, but permanently deteriorated. 16. Thomas Martin, aged twenty-nine, admitted 18th November, 1865. Back of the hand struck by handles; extensor tendons destroyed; a permanently deteriorated limb. There have been many injuries of less severity than the foregoing from both sources, and there is not the same disproportion between them that there is in the severe accidents; this I attribute to the want of fencing in the scutch mills. When machinery is well fenced, a finger or two may be caught, and the tops injured or lost, but the whole arm cannot be drawn in, and the more fatal forms of accident are avoided. I believe reasons exist why the present Factory Act could not well be extended to scutch mills, at least without some modifications; yet if, in other localities where flax is much grown, accidents are as numerous as here, I think there are sufficient reasons for subjecting them to close inspection, forcing owners to adopt new and safe machinery, and use every effort in their power to prevent carelessness and exclude amateur operatives. ART. VIII. Observations on the Comparative Advantages of Affording Obstetric Attendance on Poor Women in Lying-in Hospitals and in their own Homes. By DENIS PHELAN, M.R.C.S., London; late P. L. Medical and General Inspector. It seems, for many reasons, desirable to ascertain whether, in large cities and towns, such as London, Dublin, Glasgow, &c., society is as much benefited by affording obstetric attendance in lying-in or other hospitals to such poor women as wish to be confined in them as if it be afforded in their own residences—that is, in the residences of those who have a home in which they can be conveniently attended. Of course, for such exceptional cases as require careful medical watching or professional treatment the hospital is necessary. The subject may be considered under these heads:-1. Which mode of attendance is the least expensive, assuming each to be efficient; and 2, by which is there less loss of life of mothers and children? In respect to the comparative expense of hospital and of home attendance, we have the following data. The Reports of the Board of Superintendence of Dublin Hospitals show that, in the seven years ended March, 1864, 9,039 labour cases, and 1,272 patients affected with chronic female diseases, were admitted into the Dublin Rotundo Lying-in Hospital, and that the expenditure amounted to £16,018, which sum (excluding the cost of buildings and furnishing such buildings) was an average cost of 31s. per head. During these seven years 617 extern labour cases were attended from the hospital, for which the expense is not given, probably because there is no officer paid for that particular duty, the cost of which is mixed up with the general expenditure. During these seven years 3,496 labour cases, and 244 chronic patients were admitted into the Coombe Lying-in Hospital in Dublin, the expenditure being £5,600, which is an average cost of 298. 10d. per head; but in this is included the expenditure on a dispensary for women and children, for which a medical officer is specially employed and paid. During that period 4,473 home labour cases were attended by the hospital medical officers and pupils. If the cost per head be calculated on the totals attended in and out of hospital, that on the 10,928 cases attended by the Rotundo would average 29s. 3d. per head, and on the 8,210 attended by the Coombe, 13s. 6d. per head. This disparity of cost arises from the greater number of externs attended by the Coombe than by the Rotundo. The expenditure of the London Royal Maternity Charity is stated to average £1,830 yearly, and the number of women to be 3,500 annually, which is an average cost per head of 10s. 6d. The attendance by this institution is exclusively extern. I am not aware of any other published data to show the cost of home attendance on lying-in women. As that by the Rotundo Hospital is almost exclusively intern, the cost, of course, is proportionately high; the mixed system adopted by the Coombe reduces the average cost to a moderate sum, whilst the exclusively home attendance in the London Maternity is still less expensive. MORTALITY OF MOTHERS IN CHILD-BED. 1. The Registrar-General reports that, in the year 1861, 886 died of metria (puerperal fever) in England and Wales, and 2,109 of the accidents of child-birth; in 1862, 940 died of metria, 2,137 of the accidents; and in 1863 the mortality was 1,115 from the former, and 2,483 from the latter. These returns show that the mortality from |
