10
REPORT ON THE
needed. At the same time an abundant water-supply will remove all possi
-
bility of complaint on this score. Thus, though the enquiry disproved the
fact of comparative insalubrity in the College Hospital, and showed that the
real cause of septic disease could not be that which had been speculatively
assigned for it, ample provision has been made for the supply of all that was
demonstrably wanting.
20. But the doctrine of radical defect in the building had been held by
high authority, and though thoroughly satisfied with the evidence collected, the
Lieutenant-Governor desired that the course of hospitalism should still be closely
watched and reported from time to time. The scrutiny has been peculiarly
close through the intervening years, for the antiseptic system has been on its
trial in the surgical wards, and cases have been examined with a minuteness
before unknown. General surgical mortality and the results of test cases have
confirmed the judgment and the policy of 1878, and from the words of the
Resolution on the Report for 1880, it is clear that the Government considers the
question of the origin of hospitalism to have been finally set at rest. I shall
not, therefore, in this connexion, offer any remarks on the results of surgical
practice in 1881, merely noting that their evidence agrees closely with that
already adduced.
21. Apart, however, from the production of hospitalism, the Lieutenant
- G o v e r n o r h a d e x p r e s s e d a d e s i r e f o r i n f o r m a t i o n c o n c e r n i n g t h e p r o g r e s s o f
antiseptic surgery at the College, and last year the experience of the Surgeons
was given in their own words, which represented two different, but not opposite,
aspects of the question. To measure with precision the merits of a new
method, is seldom the simple task it may appear to be, for the adoption of such
a method is seldom unaccompanied by aids and accessories which contribute to
results; and that this is true of Listerism, is seen in the scrupulous care with
which cleanliness and other precautions have been enforced in the treatment of
wounds—matters which before would have been left to nurses and dressers.
Nor is the public value of a system measured solely by its results. It must be
practicable, that is to say, it must be within the reach of the mass of the
people who will use it. If Listerism needs skilful hands and long purses for
its application, it will be as reasonable to tell a sickly English labourer
to take a holiday in the South of France as to offer antiseptic treatment
to the people of this country at large. It is right, perhaps, that the true
technical value of Listerism should be determined in the College Hospital
without regard to its difficulty or cost; but it must also be remembered that
the hospital is an educational institution, that its pupils are not, as a class,
destined to practise among the rich families of the metropolis, with the aid
of a staff of skilful assistants, but alone, and among people of limited means,
living at a distance, and that if such practitioners come to think that costly
foreign appliances are indispensable to their work, their usefulness to the public
will be comparatively small.
22. I proceed to summarise the evidence which has been furnished by
the Surgeons of the Medical College from the experience of 1881 on the results
of antiseptic surgery. The First Surgeon has carried out the Listerian system
rigorously. Dr. McLeod writes:—"There has not been much hospitalism in my
wards during the past year. I have had no case of erysipelas either imported
or developed. Suppurative and gangrenous cellulitis have been exceedingly
rare, and wounds have, as a rule, behaved themselves in a satisfactory manner.
There have been seven deaths from septic disease, three from pyæmia and four
from septicæmia. Four of these occurred after operation and two after
injuries In all the cases the causation of the fatal disease has been complex.
Constitutional defects have existed, such as intemperance, habitual opium-eating,
shock, and general debility. Unfavourable local conditions have occurred, severe
injury to tissues, extensive wounds, putrefaction of discharges; and it is difficult
to estimate what share the hospital has had in causation, or to affirm that a
similar sequence of events would not have taken place out of hospital. The
general excellence of the process of repair, and absence of constitutional
disturbance after wounds and injuries, and the rarity of septic complications,
constitutional and local, argue favourably for the hospital, though there are
sanitary defects of construction."