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INTRODUCTION X1X 
Still more serious than these local troubles was the frequent occurrence of 
general septic diseases, such as septicaemia, pyaemia, erysipelas, tetanus, or 
hospital gangrene. In a large proportion of the cases in which a wound of 
any considerable size was produced, whether by an accident or by the surgeon’s 
knife, the patient suffered more or less severely from one or other of these surgical 
diseases. After major amputations, for example, the mortality was very high 
the average in the practice of various surgeons at that time varied from 30 to 50 
per cent. Lister collected his statistics of amputation for two years (1864 and 
1866), just before he introduced the antiseptic method of treatment, and found 
the mortality to be 45 per cent.1 The causes of death are not definitely stated, 
but almost all the deaths were due to infective diseases ; for example, of six deaths 
following amputation of the upper extremity four were due to pyaemia and 
one to hospital gangrene. In his paper on excision of the wrist-joint, published 
in 1865, he refers to fifteen cases in which he had performed this operation, 
and incidentally remarks that six were attacked by hospital gangrene, while 
one died of pyaemia.? 
Volkmann, in one of his earliest papers * on antiseptic treatment, stated that 
for the four years preceding the adoption of Lister’s method, that is down to 
1872, he had left his wounds entirely open. During the first year in which this 
method was carried out, the results were very favourable, and he was thoroughly 
convinced of its superiority over the plans which he had formerly adopted. As 
time went on, however, and as overcrowding of the wards became unavoidable, 
infective diseases of wounds increased progressively, and at last, in the sum- 
mer and autumn of 1871, the deaths from pyaemia and septicaemia were so 
numerous that he made up his mind to close the hospital altogether for a 
time. Before resorting to this desperate remedy, however, he determined to 
try the Listerian method for a few weeks, and the result of this trial was 
entirely to alter the aspect of affairs. 
Similar facts were published by Nussbaum of Munich, who commenced the 
treatment two years later than Volkmann. The hospital at Munich, a building 
by no means satisfactory as regards sanitary arrangements, became a hot-bed 
of septic infections to so great an extent that almost every case of open wound 
was attacked by one or other of these diseases. Pyaemia was rife, affecting 
nearly all cases of compound fracture, wounds of bones, and amputations. 
Erysipelas was constantly present. During 1872 hospital gangrene also appeared, 
and steadily spread in spite of all the precautions which experience dictated 
or ingenuity could devise; in that year 26 per cent. of all the wounds were 
attacked by this dreaded disease; during 1873 the proportion increased to 
* See vol. li, p. 129. 2 See vol. ii, p. 440 * Beitydge sur Chirurgie. 
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