254 
Proceedings of the Royal Society 
even small-pox might be, if not extinguished, at all events 
arrested, and so cease to be epidemic, by strict confinement and 
complete isolation of the first individual attacked. 
His views on the subject of large hospitals were founded on the 
same principle. He insisted that, where large numbers of sick 
persons were accommodated in one building, the atmosphere of 
the building became tainted, so that the patients had less chance 
of recovery; and this position he attempted to prove, by contrast¬ 
ing the proportion of recoveries in hospitals with those in private 
dwellings.* On these grounds Simpson advocated the abolition of 
large hospitals in towns, and the substitution of detached cottages 
in the country; but if hospitals were to be retained, then instead 
of wards, with from fifty to one hundred beds in each, and reached 
by lobbies and staircases inside of the house, he urged that the 
wards should contain as few beds as possible, and that access should 
be had to them by stairs outside of the hospital altogether. 
That the principle on which these views are based, as to the 
expediency of isolating persons afflicted with any complaint what¬ 
ever, is a sound one, none can doubt, who has read the recent 
discoveries of minute and invisible organic dust in the atmosphere, 
consisting in many cases of germs—germs which, inhaled, and 
v O O 
entering the blood, engender diseases in the body. 
I see it stated in a well-informed medical paper that, among 
* In the speech which he made on receiving the Freedom of the City, he 
remarked that—“ When such a simple operation as amputation of the fore¬ 
arm is performed upon a poor man in the country, and in his own cottage 
home, only about one in ISO dies. But the statistics of our large metro¬ 
politan hospitals disclose the stern and terrible truth, that if these men had 
been inmates of their great wards, thirty of them, or about one in six, would 
have perished; a fact, among many others, which calls earnestly and strongly 
for some great reform in our large hospitals, if these institutions are to main¬ 
tain their ancient character as the homes of charity and beneficence.” These 
statistics applied to the amputation of the arm. He gathered similar statistics 
from the hospitals, and from country practitioners, in regard to amputations 
of the leg, which showed that these amputations in like manner were always 
more successful in the country than in town hospitals, notwithstanding the 
greater skill of town surgeons ; and he deduced the following conclusions :— 
“ Is/. That about three times as many patients die after limb amputations in 
our large hospitals, as die from the same operations in private and country 
practice. 2</. That to reduce the death-rate from operations in our surgical 
hospitals, we should strive to assimilate their form and arrangements to the 
condition of patients in private and country practice.” 
