BEFORE AND AFTER LISTER 161 



To-day we do not even know the bacteriology of this 

 foul disease. I saw many cases of it during the Civil 

 War, but since 1865 I have never seen a single case. 

 There has been no opportunity to discover its germ if, as 

 is probable, it is a germ disease. Lister made its return 

 impossible. 



But let us come down next to the period immediately 

 before Lister's work. 



You cannot do better than read that remarkable and 

 revolutionary paper entitled "Hospitalism" by Sir James 

 Y. Simpson, of Edinburgh, published in i867- 13 It was 

 a bombshell whose explosion aroused the profession as 

 hardly any other paper in my lifetime. The controversy 

 was bitter and widespread. Fortunately, antisepsis came 

 close upon its heels and has forever done away with such 

 a disgrace. 



Simpson collected the statistics of the obstetrical mor- 

 tality in hospitals and in homes with the following start- 

 ling result. 



Of 888,302 women delivered in hospitals, 30,394 



died or I in 29 3.4 per cent. 

 Of 934,781 delivered at home, 4,045 died, or I in 



212 0.47 per cent. 



The reason for the greatly increased mortality in ma- 

 ternity hospitals over seven times greater than in in- 

 dividual homes was chiefly puerperal fever. After 

 Oliver Wendell Holmes (1843) and Semmelweiss (1861) 

 had attacked the evil, Pasteur finally in 1879 showed its 

 bacteriological cause and gave it the coup de grace. 



The 0.47 per cent, of Simpson's home cases has been 

 reduced to 0.15 per cent, and even 0.08 per cent, in the 

 maternity hospitals of to-day ! 



But his chief assault was upon the surgeons. He ana- 

 lyzed the four main amputations arm, forearm, thigh 



18 Simpson's Works, Vol. II., p. 345. 



