UPON SALUBRITY OF A SURGICAL HOSPITAL 133 



Considering, then, the circumstances of the onl}- two cases of pyaemia 

 which have occurred in my department during the three years of the antiseptic 

 period, I am justified in saying that the wards have been completely freed from 

 their former liability to this frightful scourge. 



Next of erysipelas, a disease which, though not so fatal as pyaemia, used 

 not infrequently to occasion death amongst my patients. During the anti- 

 septic period several cases have been admitted into my wards from without, 

 but one only has originated in them. This occurred in a young man with disease 

 of the foot, accompanied by sinuses extending into the leg. I performed 

 amputation at the ankle, but putrefaction continued in the sinuses ; and after 

 the lapse of a considerable period erysipelas occurred in connexion with them. 

 He recovered from the complaint, and after a while went to his lodgings for 

 change of air, with the sinuses still unhealed, and subsequently had another 

 attack of erysipelas there, implying that the tendency to it was in his own system 

 rather than in the locality. That such was realty the case was afterwards 

 fully demonstrated. The sinuses refusing to heal, and disease recurring in the 

 bone, he was readmitted under my care, and I performed amputation in the 

 leg above the sinuses. The stump healed without any deep-seated suppuration, 

 presenting a very good example of the result of a modification of Mr. Teale's 

 method of amputation ; and I requested him to ascertain, by ^Ir. Teale's plan 

 of introducing circular pieces of flannel into the socket of the artificial limb, 

 how much of his weight he could conveniently rest upon the end of the stump. 

 As he did not call to report the result on the day arranged, I inquired into the 

 cause, and learned that the stump had been seized with a third attack of 

 erysipelas, although perfectly cicatrized without sinus or sore of any kind.^ 

 Thus, as regards erysipelas, our only exception to perfect immunity from the 

 disease during the three years was one that strikingly proves the rule. 



It remains to speak of hospital gangrene. This w^as formerly both frequent 

 and severe amongst my patients. It often grievously marred the most pro- 

 mising results of surgery, and sometimes committed fearful ravages. Thus, 

 I have known a boy admitted with a small superficial wound near the elbow, 

 in which hospital gangrene occurring caused such destruction of tissue, deeply 

 as well as superficially, in spite of the most energetic treatment, that it became 

 necessary to amputate the limb. Now and then it led to a fatal result, as in 

 one of the amputations before referred to. In that case I removed the arm 

 at the shoulder-joint for injurv in a boy, and for some time all went on well, 

 till I regarded him as perfectly safe ; but hospital gangrene came on in the 



' This case seems to me to possess considerable interest, as something inlermediate — as it were 

 a connecting Hnk — between traumatic and idiopathic erysipelas. 



