Hospital construction and management / by Frederic J. Mouat and H. Saxon Snell.
- Date:
- 1889
Licence: Public Domain Mark
Credit: Hospital construction and management / by Frederic J. Mouat and H. Saxon Snell. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![may fairly say that the returns now before us afford as reasonable a basis for estimating what really is the mortality of our general hospitals, as can be obtained;” and he adds, “that if all hospitals would keep their records correctly, and publish all necessary details, their relative and absolute utility could be rightly estimated.” * The same accurate authority shows that mere size has not a constant influence in raising the death-rate of a hospital, and that by mismanagement and other causes, a small may be made as unhealthy as a large hospital. Again, although I at one time accepted and acted upon the doctrine of averages as the surest basis for determining mortality rates in public institutions, I am now disposed to think that a more correct comparative estimate of the healthiness or unhealthiness of hospitals would be obtained, by calculating the number of deaths on the actual number treated, and by determining the actual risk to life of a day’s residence in each institution. From a statement of this kind recently published by Monsieur Loua in the Journal de la Societe de Statistique of Paris, it appears that in the hospitals of the whole of France the mortality rate from 1871-6 oscillated between 8-5 and 10-5 per cent, of the actual number treated, and the risk to life of a day’s residence in hospital from 0-00237 to 0-00327. In 1876 it was 0-00268, while the daily risk to life of each individual of the entire population was 0-000063, from which it follows that the chances of death in a hospital were forty-two times greater, than in the ordinary conditions of life. The sick, however, are only subject to this increased risk during their actual stay in hospital. All such modes of calculation must, however, of necessity be incomplete and fallacious, and no plan will afford even an approximation to scientific accuracy until the whole of the factors involved—age, sex, hereditary tendencies, actual disease, accident or injury, occupation or position in life, &c., &c.—are carefully collected and collated. All this has not yet been done, even in relation to amputations and obstetrics. A curious experience of the superior value of the pavilion to the block system of hospital construction, was acquired during the occupation of Paris by the allied armies in 1814. The sick and wounded soldiers, French and foreign, were treated in the hospitals until no more room could be found for them, when they were placed in the slaughter-houses, vacated for the purpose. In the great hospitals, the Hotel Dieu, Pitie, and St. Louis, the mortality of wounded French soldiers ranged from 1 in 5, to 1 in 8. In the abattoirs (slaughter-houses) of the Roule, Montmartre, and Menilmontant, the number of deaths among the French varied from 1 in 7, to 1 in 13. Of the foreign soldiers wounded, the deaths in the hospitals were from 1 in 7, to 1 in 13 ; and in the slaughter-houses, 1 in 10, 1 in 11, and 1 in 19. So struck was the Conseil-General des Hopitaux by these results, that they reported, “ That the use made of the buildings (abattoirs) for the treatment of the sick had made it manifest that their distribution was better fitted for their new use, than any of the existing hospitals. That experience had thus proved the correctness of the views of Tenon and Bailly in their reports on the [old] Hotel Dieu, and the utility of the division of hospitals into separate pavilions—an idea which should be followed in the construction of all hospitals, in which should be united conditions of health and An Essay on Hospital Mortality, by Lawson Tait, F.R.C.S. : London, 1877 ; pp. 42 and 43. D 2](https://iiif.wellcomecollection.org/image/b21911319_0061.jp2/full/800%2C/0/default.jpg)
