Excerpt from Notes on Hospitals: Being Two Papers Read Before the National Association for the Promotion of Social Science, at Liverpool, in October, 1858, With Evidence Given to the Royal Commissioners on the State of the Army in 1857

No one, I think, who brings ordinary powers of observation to bear on the sick and maimed can fail to observe a remarkable differ ence in the aspect of cases, in their duration and in their termina tion in different hospitals. To the superficial observer there are two things only apparent - the disease and the remedial treatment, me dical or surgical. It requires a considerable amount of experience, in hospitals of various constructions and varied administrations, to go beyond this, and to be able to perceive that conditions arising out of these have a very powerful efi'ect indeed upon the ultimate issue of cases which pass through the wards.

It is sometimes asserted that there is no such striking difference in the mortality of different hospitals as one would be led to infer from their great apparent difference in sanitary condition. There is, un doubtedly, some difficulty in arriving at correct statistical comparison to exhibit this. For, in the first place, different hospitals receive very different proportions of the same class of diseases. The ages in one hospital may differ considerably from the ages in another. And the state of the cases on admission may differ very much In each hospital. These elements, no doubt, affect considerably the results of treatment, altogether apart from the sanitary state of hospitals.

In the next place accurate hospital statistics are much more rare than is generally imagined, and at the best they only give the mor tality which has taken place in the hospitals, and take no cognizance of those cases which are discharged in a hopeless condition, to a much greater extent from some hospitals than from others.

We have known incurable cases discharged from one hospital, to which the deaths ought to have been accounted, and received into another hospital, to die there in a day or two after admission.

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