Sir James Simpson and Hospital Cross Infection.

NINETY-FIVE years after his deathJames Young Simpson is generally remembered for his pioneer work on anaesthesia. Gynaecologists also celebrate his memory daily by their use of the uterine sound; obstetricians occasionally resurrect such instruments as his obstetric forceps, and may even know of his early work in 'modern' fields such as vacuum extraction. Two other notable and very different facets of Simpson's work are now, however, almost entirely forgotten. His remarkable contributions in medical and general archaeology' gained him a European reputation and still repay our attention; whilst his studies on the problems of hospital infection were a preoccupation in his last years, and foreshadow much of our current thought on this subject. An obituary writer in i8702 observed with remarkable insight 'perhaps ... the greatest work in which Sir James engaged was his attempt to diminish the mortality of Surgical Hospitals'. One of the purposes of the present study is to reaffirm this belief from the vantage-point of our own time. In addition, however, it is hoped that attention will be drawn to a branch of medical history whose general neglect has led to much haphazard and repetitious modern work. The ramifications of Simpson's work on cross-infection are best explored by starting with puerperal fever, then moving by way of 'surgical fever' on to the broader issues of 'Hospitalism'. The fallacy of dividing up the territory with inflexible boundaries was, however, clearly shown by Simpson, and his unified view of the whole is, indeed, one of his major contributions. Simpson's firm belief in the communicability of puerperal fever originated in observations he made in I836 at the age of twenty-four, four years before his early appointment to the Edinburgh Chair of Midwifery. Following his participation in the dissection of two fatal cases of puerperal fever, Simpson had in his own practice, for the first time, an outbreak of this disease. It then spread to patients attended by a friend. As a result, from as early as 1840-three years before the publication of Holmes's celebrated paper on puerperal fever3Simpson lectured on the contagiousness of the disease.4 His established views were not, however, published until I850;5 and his early experiences were fully described at a meeting ofThe Edinburgh Medico-Chirurgical Society in 1851.6 On that occasion he gave a brilliant exposition of the mode of transmission of puerperal fever, and he also welcomed the recent but neglected work of Semmelweis7 as a vindication of his own teachings. He declared that Semmelweis was quite wrong, however, to believe that the disease was transmitted by animal matter in a state of putrefaction. It was evident to Simpson that any putrefaction was incidental and that the disease was spread rather by 'an inflammatory secretion, just as the inoculable matter of smallpox, cowpox,