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Surgical experience, hospital size and severity adjusted mortality: James Y Simpson, 1869

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Do experienced surgeons have better outcomes? Is mortality lower in “the wards of our (large) palatial hospitals”? To make such comparisons of outcomes of care between providers, it is necessary to adjust for the severity of the patient’s illness. Should hospitals with poor results be publicly named? These are some of the hot topics in quality research today.1–3

If you visit the handsome Playfair Library Hall of Old College, University of Edinburgh, you will see among the marble busts of 19th century professors and notables that of Sir James Young Simpson MD (1811–1870). Son of a baker in Bathgate Scotland, educated at Edinburgh, qualified as a surgeon at age 18, and elected to the Professorship of Midwifery there in 1840. In 1847 he was appointed “Physician Accoucheur to the Queen for Scotland”. He is remembered in Edinburgh today for his introduction of chloroform as an anaesthetic. Queen Victoria received it in April 1853 during childbirth.4 His collected published works fill several volumes. Of all this, our interest is in his forgotten comparative study of severity adjusted surgical mortality in 1869.

Simpson sent out survey questionnaires to practising country surgeons in England and Scotland. 374 replies were received. He asked …

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