1111LEADING ARTICLES

Why Don’t We Tell ?

THE LANCET.

LONDON 27 NOVEMBER 1965

THE time has come for a full and frank airing of theissues raised by the eye infections at a Birminghamhospital in 1964, as a result of which six patients lost thesight of an eye. According to a newspaper report 2 anofficial of the Birmingham Regional Hospital Board saidrecently that so far as that Board was concerned thematter was closed, and that the report of an inquiry byeminent men could not be published in its present formsince no member of the lay public would have under-stood it. Restrained comment on such an arbitrary andsuperior attitude is difficult. Irresistibly the official’scommunication recalls MARK TWAIN’S words about theBible: he was worried, not by the passages that he didnot understand, but by those that he did. Strangely, thesame official of the Board said that the gist of the reportwas known to eye specialists in his region. But, in theworld beyond the Birmingham region, only publicationcan ensure that the lessons are correctly learned fromthe truth and not uncertainly from rumour. Now at last,more than a year after the last incident, the BirminghamRegional Hospital Board and the Dudley Road HospitalManagement Committee have issued a cautious state-ment on the infections and a promise of a detailed reportin a medical journal.On the basis of this statement and what we have

been told by people who believe that they know theessentials of what happened, six technical lessons shouldbe learned from the episode:

(1) Advice needs to be given widely and specificallyabout the right methods of dispensing, sterilising,distributing, and storing fluids used in eye surgery.

(2) As should already be well known, certain populardisinfectants, in the concentrations often used in hos-

pitals, fail to kill Pseudomonas aeruginosa ; and this is a

dangerous cause of infection in eyes. Under quitecommon conditions, the organism may actually grow insome of these disinfectants.

(3) Storage of a syringe in a container with disinfectantsolution offers at best a very incomplete guarantee that thesyringe will be sterile. Sterile fluids distributed by con-taminated syringes into sterile containers are certain to becontaminated. It is wrong to attempt to distribute sterilefluids in this way even with a sterile syringe.

(4) The right way to sterilise a syringe is to heat it ina hot-air oven or to autoclave it.

(5) A suitably experienced member of the medical staffof each hospital must undertake the duty of seeing thatthe methods used with a view to attaining asepsis are wellconceived and clearly understood by those who apply

1. Crompton, D. O. Lancet, 1964, ii, 965.2. Daily Mail, Nov. 15, 1965, p. 6.

them. Such a person will require moral support from hisprofessional colleagues and from administrators, as well asa capable and sufficient staff to discharge this serious

responsibility which has been taken too lightly for toolong.

(6) The administration should provide enough fundsand planned organisation to ensure that materials are

reliably sterilised.

Beyond these technical propositions, there is a widerissue which concerns all accidents and misadventures in

hospitals. Why has information been issued so tardily ?When were the expert investigations into the outbreakscompleted; and why has the hospital’s short statementbeen issued at this late stage, if not in response to

clamour in these columns and in the lay Press ? 2-4 Infurther incidents of this sort, must similar pressure beexerted each time before the public is allowed to learnsomething of the truth ? Reserve carried to this extremeundermines faith both in the profession and in theHealth Service. Not all who remain silent are neces-

sarily acting from dishonourable motives, althoughwe think that they are misguided. Ignorant and evenunscrupulous publicity leading to the atmosphere of awitch hunt and the seeking of a scapegoat for everyerror of method, real or imagined, would soon impairpublic confidence in hospitals besides the morale ofthose who work in them. Timid medicine and surgery,with doctors preoccupied in avoiding risks, howevernecessary or justified, could easily result from irre-

sponsible interest in sensational headlines. It wouldbe patients who would lose in the end if doctors lostwillingness to practise with courage as well as skill.Such possible dangers should not be underestimated.But we believe that an even greater danger lies in failureto acquire and deserve a reputation for candour andtruthfulness. A serious rail, air, or sea accident leads toan inquiry, with publication of the findings and com-pensation for the victims. Yet public confidence in thesafety of our trains, planes, and ships remains high.Here the correct actions are inescapable, because theaccident cannot be concealed. In hospital the accidentcan often be hidden; and too often it is. As a com-

promise, anonymous publication of hospital accidentshas been suggested. This would certainly be better thansilence, but lessons are best learned from the records ofspecific examples properly described and authenticatedby those with first-hand knowledge. The plea that suchfrankness would be too expensive may not be wellfounded. A tradition of fair-minded willingness to admitmistakes and allow proper compensation might go far todiscourage irresponsible actions for damages. In anyevent we have a duty to see justice done. Certainly weare ill served by the present widely held belief thatdoctors cover up for each other and for their hospitals ina way which takes too little account of the true interestsof our patients and others. Surely we must be consciousof one of the roles which Fox 5 set out for the doctor:to be a servant of his fellow men.

3. Crompton, D. O. Lancet, Oct. 30, 1965, p. 900.4. Daily Telegraph, Nov. 15, 1965.5. Fox, T. F. Lancet, Oct. 23, 1965, p. 801.