14 REPORT ON THE
Erysipelas.
6. "There were seven European and two native erysipelas admission
cases during the year, one in each of the Physician's, one in the midwifery,
and three in each of the Surgeon's wards. It is well worth remark that in no
instance did these infect other patients. This is a very strong proof of the
healthy quality of our hospital air, notwithstanding all that has been said about
faulty construction. A fact of this nature is to me of greater value by far than
the wrong going of cases after serious injuries or after severe surgical operations,
many of which would become septic in the open air itself, and which it would
be a simple absurdity to charge against hospital construction, though this has
been too often done."
Dr. Palmer strongly insists on this point. He writes—"The construc-
tion of the surgical wards is so radically defective that no conceivable altera-
tion or addition can possibly improve it. All the naturally salutary advantages
of ventilation being in it perverted into agents of infection and means of pro-
pagating disease."
He cites the percentage of deaths after operations from the year 1863
up to 1876, averaging 22.5 per cent., and then observes that, while the post-
operation deaths in 1875 were 26 and in 1876 was 23.8, those estimated to be
from "hospitalism" were, 25.8 and 5.0 per cent. respectively; and, again, in
1864 "hospitalism" is said to have caused 50, and in 1869 only 5.4 per cent.
of the total mortality, while the average was nearly the same, viz. 22.3 and
22.2. He considers it unsafe to draw any deduction from these data except
this that no material improvement has taken place in the surgical wards of the
hospital for the past 14 years.
"I cannot avoid drawing the following conclusions from the above state-
ments:—1 st, that it is quite clear that the so-called 'hospitalism' has not
affected all operations alike, as it should have done if constant causes be
followed by constant effects; 2nd, that in the years when it is said to has existed
it did not cause a mortality over and above the average as it should have done
if it existed at all; and 3rd, that the error lies not in hospital construction, but
in the minds of the estimators."
"Dr. McConnell, who has been here since 1871, states that, so far as he is
aware, the vexed question. of the hospital insalubrity has never been raised by
the Physicians. My inference from this is, if 'hospitalism' existed it would
effect the wretchedly debilitated and exhausted patients who enter the medical
and midwifery wards as freely and as fatally as in the surgical."
Dr. McConnell also observes that he has traced out the 30 septicæmic
post mortem surgical cases, which have been dissected in 1873, and that 14 or
nearly one half of these had been admitted into hospital actually suffering
from the diseases to which they succumbed. The fatal result, therefore, cannot
be charged to "hospitalism," the septicæmia being imported, not bred, within
the hospital walls.
Of the remaining 16 cases a certain number might possibly have been
contaminated by unclean dressings and dressers.
Death-rates after
operations.
7. Dr. Coates next gives a table showing the death-rates after operation
in the hospital from 1866 to 1877.
Death-rate after operation.
Years.
Number of cases.
Died.
Mortality per 1,000.
1866
. . .
. . .
. . .
141
42
268.8
1 8 6 7
. . .
. . .
...
161
40
283.7
1868
. . .
...
...
163
36
223.7
1869
. . .
. . .
. . .
157
28
153.4
1870
. . .
. . .
. . .
165
35
222.9
1871
. . .
. . .
. . .
177
37
224.2
1872
. . .
. . .
. . .
187
31
173.4
1873
. . .
...
. . .
163
36
192.8
1874
. . .
. . .
...
156
49
300.6
1875
. . .
. . .
. . .
119
32
235.29
1876
. . .
. . .
. . .
136
40
294.11
1877
...
. . .
. . .
185
39
200.00