Anaesthesia, or the employment of chloroform and ether in surgery, midwifery, etc. / by J.Y. Simpson.

  • Simpson, James Young, 1811-1870.
Date:
1849
Catalogue details

Licence: Public Domain Mark

Credit: Anaesthesia, or the employment of chloroform and ether in surgery, midwifery, etc. / by J.Y. Simpson. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    Out of 5000 cases collected by Mr. Inman, 765 patients died, or 1 in 7|. Out of 14 cases operated upon by Mr. Syme, and recorded in his surgical reports in the Edinburgh Medical and Surgical Journal (toI. xxxiii. to vol. xxxix.), 5 died, or I in 24. Since adopting his present plan of lithotomy, however, he had performed 17 operations in the hospital, of which 2 only have proved fatal, or 1 in 8^. Now, this difference could not be educed or stated with accuracy in any other way than by figures, or by the statistical method ; for by it alone can we determine the special averages of different operators or of the same operator at different times. But take care (observed Sir Astley Cooper) how you draw any deduction from particu- lar cases. I and many others have for a length of time met with extraordinary success in operating for the stone, when 4 or 5 unsuccessful cases in succession have come, which have generally brought down the result to the amount I mentioned, viz., that 2 in 15 die.* Mr. Martineau's practice afforded a curious illustration of the necessity of this caution. In the 11th volume of the Medico-Chirurgical Transac- tions of London, Mr. Martineau published an account of 74 cases, in which he had performed the operation of lithotomy in the Norwich Hospital from the year 1804 to 1840.t Only 2 of these 74 died, or 1 in 37. We learn further, however, from a paper of Dr. Yelloly,J that Mr. Martineau operated in the same hospital on 73 additional cases (147 in all). Out of these 73 additional cases, 15 died, or 1 in 4,%. And I repeat, that it is statistics only which could properly and fully prove to us this great special difference in the success of Mr. Martineau's practice at different periods. At the same time, however, the same case proves to us further, that if we wished to obtain not this special average of practice at a selected time, but the general average of all his practice at all times, it would amount to nearly ihe general average of most other operators. For out of his whole 147 cases, 17 died, or 1 in 8, which we have seen to be nearly the common degree of success in lithotomy, according to the investigations of Drs. Willis and Inman. The special average success of some operators has been greater than this. We have already seen that Cheselden, out of 216 recorded hospital cases, only lost 20, or 1 in 10]L. The special average success of other operators has been less. Out of 356 Parisian cases collected by Dupuytren, 61 died, or 1 in 6. * Lectures on Surgery, p. 321. + He records 84 cases in all, with 2 deaths; but 10 of these 84 cases had oc- curred in private practice. t Philosophical Transactions for 1829, p. 63. The whole number of Dr. Rigby's operations [in the Norwich Hospital] was 106, with 15 deaths; and of Ulr. Martineau's 147, with 17 deaths.