Collins, Robert

Robert Collins (1800 – 1868)

Control of Puerperal Fever, Use of Stethoscope in Obstetrics

Robert Collins became Master of the Rotunda in 1826, only four years after his qualification in Glasgow, aged 26 years.

At the time, puerperal fever was the scourge of maternity hospitals, due to infection of the placental site, which is a raw wound after birth, easily infected by ascending infection.   It affected up to 16% of women after birth, and had a mortality of about 30% - even higher in epidemics in overcrowded hospitals.   There was no formal knowledge of the agents of infectious disease.   The prevailing theory was that of Miasma – disease being spread by noxious vapours.  

Collins developed the practices of his father-in-Law predecessor Joseph Clarke.   These were to encourage home births and hospital cleanliness.   He maintained a rigorous practice of cleaning wards with chloride of lime, rotation of wards, and isolation of those who were sick in separate wards from those who were well.   These practices had a dramatic effect in the Rotunda with no deaths occurring from puerperal fever during the last four years of his Mastership.    Collins described these practices in his textbook, A Practical Treatise of Midwifery, (London, 1835).   This influenced the Viennese obstetrician Simmelweiss, who battled for hygienic obstetric practices for many decades, though ridiculed by his conservative colleagues.

Collins also promoted the use of the stethoscope in obstetrics.   This had previously been used almost exclusively by physicians, mainly for diagnosis of conditions of the heart and lungs, and occasionally in pregnancy.   The detection of a foetal heartbeat by stethoscope allowed for confirmation of pregnancy, for diagnosis of twins, and foetal distress in labour.

References

Coakley, D. (1997)   Irish Masters of Medicine,   Town House.

De Costa, C. (2002) "The contagiousness of childbed fever": a short history of puerperal sepsis and its treatment, Med Journal Aus,   177 (11/12) : 668-671.