UPON THE GENERAL SALUBRITY OF SURGICAL HOSPITALS 255 



without a single case of it ; but, on the other hand, there was a time when it 

 was frequent. This was during a concurrent epidemic of small-pox and erysipelas 

 in Edinburgh two years ago. The erysipelas was of a very virulent t\'pe, and 

 some patients in private practice in the city died of erysipelas affecting the 

 puncture of revaccination. At this time we had several cases of erysipelas 

 admitted into my wards from the town, and several, also, took origin within 

 the hospital. But the constitutional rather than the local cause of these cases 

 was shown in several instances by the disease occurring not in or near the wound, 

 but at some remote part, as in the head after an operation upon the penis. And 

 it was somewhat remarkable that in no case did the disease as it originated 

 in the hospital assume the malignant form which it sometimes exhibited in 

 private practice. 



Tetanus also appears to be rendered much less frequent by antiseptic 

 treatment. Far be it from me to say that putrefaction is the only cause of it ; 

 we all know it is otherwise ; but when I say that, in six years, with an average 

 of sixty severe surgical cases, I have only had two cases of the disease, and 

 those both of them in connexion with septic wounds, I show strong grounds 

 for believing that, if we exclude putrefaction, we exclude one — and the most 

 common — exciting cause of tetanus. 



One objection that has been urged against my treatment is the inordinate 

 length of time patients remain in hospital. No doubt it is so in some cases ; 

 but, as a rule, these are instances in which we expect to cure otherwise incurable 

 cases, such as spinal abscess. But, on the other hand, on comparing Mr. Syme's 

 case-books with my own, during two periods of three years, the unexpected 

 result has lately been arrived at that, in proportion to my number of beds, 

 I have had a larger number of operations than Mr. Syme ; showing that, while 

 some patients, kept alive by antiseptic treatment, have remained long in the 

 hospital, this was more than counterbalanced by the rapid cure of others. 



I trust, gentlemen, that the facts which I have now had the honour to bring 

 before you will be considered pretty strong proof of the value of strict antiseptic 

 treatment in promoting the general salubrity of surgical hospitals. 



