XX INTRODUCTION 
50 per cent., and it ultimately reached 80 per cent. Erysipelas, too, which 
in 1872 was of a comparatively mild type, became much more virulent as well 
as more frequent. All this occurred in spite of the use of antiseptic lotions, 
of the open method, and other devices. In 1878, after he had put Lister’s method 
to the test of practice, Nussbaum published an essay entitled Sonst und Jetzt, in 
which he drew the following striking contrast between the previous state of 
affairs and that which followed the introduction of Listerism : 
Formerly. Now. 
Injuries of the head, compound fractures,ampu- 
tations and excisions, in fact almost all patients in 
whom bones were injured, were attacked by pyaemia. 
For example, of 17 cases of amputation 11 died from 
this cause. Even patients with severe whitlow died 
from it. No pyaemia. 
Hospital gangrene had got the upper hand to 
such an extent, that in spite of the open method, in 
spite of continuous water-baths, in spite of the use of 
chlorine water, or the actual cautery, finally 80 per 
cent. of all wounds and ulcers were attacked, large 
arteries being opened into. No hospital gangrene. 
Almost every wound was attacked with ery- 
sipelas. No erysipelas. 
It would be easy to produce a great cloud of witnesses to the appalling state 
of matters in various hospitals before the introduction of the Listerian method, 
but their testimony would merely be a repetition of the above statements. Itis 
true that these untoward results were witnessed most often and in their direst 
form under hospital conditions of a particularly insanitary kind, and that their 
frequency and severity varied considerably, according to the methods of wound 
treatment adopted. Nevertheless these infective diseases were present every- 
where, and it will readily be understood that the dread of them, never absent 
from the surgeon’s mind, was a serious bar to progress. 
Further, the operations undertaken in those days were very different from 
those now commonly performed. Surgical intervention was then limited 
more or less entirely to operations absolutely necessary for the saving of life. 
Operations of expediency, designed to add to the patient’s comfort or to make 
his life more useful, were not deemed justifiable owing to the probability of the 
onset of some form of infection, and the consequent risk of the development of 
one of the severe general infections which so frequently ended in death. The 
major operations then performed were for the most part amputations for 
injury and disease, excision of joints, amputation of the breast, removal of 
tumours, operations on the jaw and tongue, trephining, operations for strangu- 
