Exhaustion
15
Septicæmia
7
Pyæmia
6
Sloughing (and secondary hemorrhage in one case) 4
Gangrene
1
Tetanus
3
Shock
2
Erysipelas and diarrhœa
1
Pleurisy and pericarditis
1
Suppurative pleurisy (empyema)
1
Pneumonia
1
Syncope
1
Dysentery
1
Peritonitis
1
Perforating ulcer of bowel
1
Enteric fever
1
Chronic cystitis
1
Albuminuria
1
Total
49
A mongst the 49 fatal cases, the causes of death were distributed as follows :—
Causes
mortality.
MEDICAL COLLEGE HOSPITAL.
23
The deaths from pyæmia and septicæmia were therefore 13, or 26 . 5 per cent. of the
total deaths after operations. The corresponding numbers for the three previous years were
16. 66, 12 . 58, and 5 . 40, and the average for the six years ending with 1869 was 31 . 06 per
cent. It thus appears that the decrease of the number of deaths from causes with which the
word "hospitalism" has recently been associated, which characterised the years 1870,
1871, and 1872, has not been sustained during 1873. My own distinct unhesitating belief
is, that we ought also to place under precisely the same category of septicæmia, or hospi-
talism, most, if not all, of the ten fatal cases which appear above under the headings of
sloughing, gangrene, erysipelas, pleurisy and pericarditis, empyema, and peritonitis, which
would increase the number of possibly preventible deaths to 23 out of 49 ; but for the sake
of uniformity, and to prevent all chance of error, I shall give the number of deaths from
indisputable nosocomial disease as 13.
On turning to the detailed statement of the operations, it will be noticed that osteo-
myelitis, which had not been recognised in this hospital for several years, was diagnosed
in two cases after amputation, necessitating secondary amputation at the shoulder and
hip-joint respectively. Both cases terminated fatally—one from pyæmia, the other from
suppurat i ve i nfl ammat i on of t he pl eura.
These statistics of septicæmia in the four years 1870-73, afford a very striking, but by
no means novel, illustration of the laws which govern the development of hospitalism.
Within this period five means of real importance have been steadily brought into use with
a direct tendency to improve the hygienic condition of the surgical patients. These are
segregation of sick, a supply of good water, new latrines, improved drainage of the hospital
and its neighbourhood, and a systematic introduction of the antiseptic plan of treating
wounds. Nevertheless last year, just at the very time when it was fair to expect that the
co-operative influence of these several improvements would act most perceptibly in lowering
the rate of surgical mortality, septicæmia increases and osteo-myelitis reappears. Upon
this fact it may be inquired, Is the whole system of hospital sanitation useless ? Is money
simply thrown away in attempts to improve the dwellings of the sick ; and is science utterly
powerless in preventing the access of morbific agents to wounds ? No; the practical result
of the most careful observation upon this question appears to be that hospitalism, when it
is not purely endemic, travels epidemically in waves. Whenever the wave comes, no know-
ledge which we at prevent possess can prevent it from breaking upon a hospital; but a large
range of statistics will always prove that the wave breaks heavily upon a bad hospital, and
lightly upon a good one.
All the sanitary care which has of late years been devoted to the improvement of this
hospital has left it subject to two great endemic causes of hospitalism,—a city atmosphere
and the imperfect separation of medical from surgical cases.
Besides this, our latrine system is still incomplete, the privy arrangements at the
western end of the building being very defective.
I have always argued that the practice of lodging medical, surgical, and obstetric cases
under one roof, would have been considered unscientific in Italian hospitals a hundred years ago.
As the hospital must be easy of access to the sick of the city, all the above evils would have been
reduced to a minimum under our first plan of erecting a new building in a large clearing south
of the Bow Bazar road. This large plan failing in consequence of want of funds, it remains
to erect a new surgical hospital.
Here the influence of sewer-tainted city air in a malarious tropical country will still be
operative.
Then our best expedients will be to obtain as much open space as possible around the
hospital, to improve the city drainage to the utmost, and to place special cases, such as those
for lithotomy, the removal of tumours, and amputation of limbs for chronic disease, in a well-
built hospital in a judiciously chosen suburban site. We shall only deceive ourselves and
mislead government if we attempt to argue that even the new hospital will be perfectly free
from the deadly influences now under consideration. All that we can do there with
o u r
present knowledge is considerably to reduce the tendency to septicæmia.
Great hopes were entertained of the antiseptic treatment of wounds, as established by
Lister, as a preventive of septicæmia in this hospital. Good as this system is, especially in
the fact that it secures the accurate apposition of surfaces which are required to heal, the
statistics of last year prove that it is by no means infallible. The experience of our surgeons
has been nearly identical with that of Mr. John Wood, of King's College Hospital, a new
Means adopted for
the improvement
of the hygienic
condition of
surgical patients
and disappointing
results.
Causes of
hospitalism.
Practice of lodging
medical, surgical,
and midwifery cases
under the same root
condemned.
Antiseptic
treatment of
wounds,
not infallible.