which very able and eminent midwifery practitioners preside? All these elements in the condition of the hospital would naturally indicate a certain low mortality, at least as low as that which takes place outside, where these comforts and medical superintendence are not so much available. The answer would appear to be, that the chief cause is that, which is stated by Mr. Simon and Dr. Le Fort to produce a higher mortality of parturient women in lying-in and other large hospitals, namely, the occasional introduction into them of contagious febrile diseases, particularly scarlatina and typhus fever, and thus, though indirectly, puerperal fever is produced. The introduction of such contagious diseases into the Rotundo is the more likely to take place, as fever usually, and scarlatina frequently, prevail in Dublin; and it may be occasionally expected that a woman who comes to the hospital to be confined is not only then in actual labour, but is also affected, though not perceptibly, with fever or scarlatina.

The published reports of the board of superintendence of Dublin hospitals throw much light on this subject. Previously there were no data to show what proportion of the mortality that took place in either of the Dublin lying-in hospitals was caused, year after year, by puerperal and other fevers, and the same was the case in respect to the extern attendance given by these institutions. Those reports show that in the seven years ended March, 1864, of 258 woman that died in the Rotundo, 131 died of puerperal fever, and of 45 that died in the Coombe, 15 died of it; and that this disease was a chief cause of the mortality in the Rotundo in each of the seven years.

As there is no doubt that the Rotundo authorities have considerably exerted themselves to improve the sanitary condition of that fine institution, and yet that a high mortality, chiefly from puerperal and other fevers, which are preventible diseases, takes place in it, it may not be amiss to observe that for several years the rate of that mortality has increased in it. Before 1854 the mortality ranged from one in 214, the lowest in any year, to one in 32, the highest-the average of the previous long period being one in 82; since 1854, included, the mortality has ranged from one in 64, the lowest in any year, to one in 133, the highest in any; the average of this twelve years being one in 373-facts, of which, possibly, the hospital authorities are not aware, and which can be only ascertained on a careful examination of the statistics of the institution.

We have also evidence in the returns of the board of superintendence that infectious fevers, as scarlatina, typhus, &c., are occasionally introduced into the Rotundo, and that even pyemia has prevailed there; and it is difficult, indeed, to conceive how, under the arrangement described by Dr. Shekleton, their occasional introduction can be prevented. As before observed, such women, on application, may be in the incubation stage of scarlatina, or of typhus; and even if her rejection were to depend on that circumstance being perceived by the master or assistant, he might not then be able to ascertain it. She is therefore admitted, and is placed in a ward along with other labour cases; it is only in a day or two that she is found to be ill of scarlatina or typhus, and then, whether delivered or not, she is in an unfit condition to be removed to a fever hospital. But even if so transferred, or if put into a separate ward intended for patients affected with contagious diseases, she has been long enough among the labour cases to introduce a poison which, in the existing condition of the labour patients, causes puerperal fever, a disease, of which Dr. Leon Le Fort, as well as Mr. Simon, observes that "it is by contagion that this destructive scourge exerts its ravages."

Whether the puerperal fever that caused such mortality last April was preceded by the introduction of any contagious disease does not appear, but it is certain that a still greater mortality was connected with scarlatina in the year ended March, 1862, in which 2 labour cases died of typhus fever, 11 of scarlatina, 4 of pyemia, and 34 of puerperal fever. Referring to the mortality of that year, Dr. Bristow, who examined the hospital, observes:-"The outbreak furnishes an example of the well established fact that scarlet fever, typhus, and other exanthemata, are not only peculiarly apt to attack puerperal woman exposed to their contagious influence but are peculiarly fatal to them, and that these poisons prove a frightful source of contagious forms of the so-called puerperal fever."

It seems to follow from the foregoing data and observations that one mode of lessening the mortality of lying-in women in hospitals is, to limit the admissions to the classes that more particularly require hospital treatment, and to give extern attendance to those that do not. This opinion has been expressed in reference to the Rotundo by four different boards of commissioners, which have examined and reported on it, as is expressed by the commissioners appointed to report on the Dublin hospitals in 1855.

They observe "We are of opinion that the practice of attending on patients beyond the walls of the hospital is not sufficiently followed in this institution. On this point we concur in the opinion which was expressed by the Board of Health in 1820, and which is referred to in the Reports of the Commissioners of 1830 and 1842. We consider this subject to be worthy of more attention than it has hitherto received, and that the principle of attending on extern lying-in cases, especially, during the prevalence of puerperal fever, should be acted on as extensively as possible." The reports of the Board of Superintendence of Dublin Hospitals show that this recommendation has not been much acted on, as it appears by them that, in the year ended March, 1862, of 978 labour cases that were admitted, 80, or one in 12 died in the hospital-39 of puerperal fever, and that only 144 had home attendance; and that in the succeeding year 1,040 labour cases were admitted, and 41, or one in 253, died, of whom 29 died of puerperal fever, and that only 2 had extern attendance in the year.

THE MORTALITY OF CHILDREN IN LYING-IN HOSPITALS.

We learn from Sir William Wilde's work, before quoted, that out of 23,322 births which took place in the Vienna Lying-in Hospital, 1,482 children, or one in 15, died before the ninth day, and, that, of 4,453 births in that institution, in 1838, there died 200 children, which was one in 21 births.

The census report, of 1851, contains a table, which shows that of 35,131 births that had taken place, in ten lying-in hospitals, in Ireland, 2,258 children died, which was an average of one in 15 births.

The census report, of 1861, shows that in the ten years then ended, 25,249 children died in Ireland, under one month old, which is a mortality of one in 55 births.

I am not aware of any return that shows the mortality of infants under, about, ten days old, in the whole population; but if it be one in 55 at a month, it must be a lower mortality within ten days, as many die within the other twenty days.

The printed statistical table, of the Rotundo Hospital, shows that 177,708 children were born alive in that institution and in the old hospital; and that 6,745 of them died in it, that is, in the few days, generally 8 or 10, during which the mothers remain in it. This was a mortality of one in 264 children born alive. The proportions in which this mortality took place under the different

masters is very remarkable as will be perceived by the following table.

Table showing the Mortality of Children Born in the Rotundo Lying-in Hospital, under the Different Masters, and the Proportion of such Mortality to the Number of Children Born Alive.

Why that mortality should be from one in 4 to one in 71, under the five first masters, and only one in 86, 99, and 172, under others, might suggest grave considerations. The subject appears to deserve more attention than, so far as I am aware, it has

yet received. Dr. Clarke's improvement in the hospital ventilation would seem to have reduced the mortality from one in 12 to one in 244; but it appears remarkable that the mortality of women under him was one in 87, being in the time of his predecessors only one in 131, and in that of his successor one in 93. It would be curious if an improvement that would be beneficial to infants should not also be useful to the mothers.

STILL-BORN CHILDREN.

We also learn from Sir William Wilde's work that 278,613 births that were registered in twelve cities in the Austrian dominions, and that 9,697 of the children were still-born, which was an average of one in 36 births. The proportion ranged from one in 593 in one district to one in 21 in another. But in Trieste it was so low as one in 155. In the Vienna Lying-in Hospital 939 were still-born, in 23,413 births, which was one in 24.

The Rotundo statistical table shows that 186,209 births took place in the old hospital and in the Rotundo, up to the end of 1864, and that 11,289" were still-born, which was in the proportion of one to 16 births, ranging from one in 22, under one master, to one in 124 under another.

A question of considerable importance cannot be overlooked, namely, by which mode of attendance is medical and obstetric science best promoted. Doubtless, were the advantages of both equal, or nearly so, the greater and the more exact experience obtained in hospitals would decide in their favour, but, if there be far greater loss of life attendant on that mode, the question cannot arise. That there is far greater loss of mothers and of children in hospitals is now an admitted fact; but, though a much greater proportion may get home attendance, there will still be a sufficient number (of the exceptional cases that require hospital treatment) to afford ample materials for the instruction of pupils, and for affording information to the medical attendants.

P.S.-I beg to observe, that all the data and other sources of information referred to in this paper were obtained from published documents, which are as accessible to others as they are to me.-D. P.

a The total is 10,447, but 11,289 is the number.