UPON THE GENERAL SALUBRITY OF SURGICAL HOSPITALS 249 



I saw the convalescent wards — which previously had always been filled and 

 overflowing — standing one after another empty, because the patients, no longer 

 affected with hospital gangrene, recovered much more rapidly.^ 



I next proceeded to Leipzig, where Professor Thiersch is clinical teacher. 

 He has three hundred beds under his own charge, of course seconded by able 

 assistants. Professor Thiersch was the first to introduce antiseptic treatment 

 on scientific principles into Germany. His results, as regards the general 

 salubrity of the hospital, have been, on the whole, progressively more and more 

 satisfactory, and in the present year he was able to state that he had only had 

 one case of pyaemia in twelve months ; and that, you will observe, in a service 

 of three hundred beds. Hospital gangrene, also, had almost disappeared. 

 There had been in 1871 a curious attack of that disease in two barrack wards, 

 which seemed to be due to old hospital furniture piled up in an empty space 

 under those apartments ; but of late this also has vanished. Professor Thiersch 

 has of late used, instead of carbolic acid, salicylic acid as an external dressing ; 

 but he still employs carbolic acid for the spray and lotion. Salicylic acid, as 

 he uses it, certainly works very well ; but that his increasingly satisfactory 

 results are due to any special virtues of that agent cannot be maintained." 



From Leipzig I passed to Halle, where I found Professor Volkmann carrying 



' Since the delivery of this address, I have received from Professor Nussbaum a pamphlet entitled 

 Die Chirurgische Clinik zn Miinchen un Jahr 1875 : Ein Andenken fiir seine Schiiler. Published by 

 Ferdinand Enke, Stuttgart. The subject of this work is the complete revolution brought about in the 

 salubrity of the hospital by antiseptic treatment, and the means by which this result has been attained. 

 One passage from the first chapter seems to me to demand reproduction here. After describing the 

 previous frightful state of unhealthiness, he says : ' Everything that we had tried against the above- 

 mentioned horrors had proved unsuccessful. The open treatment, the occlusion dressing, the con- 

 tinuous water-bath, irrigation with chlorine water or with carbolic-acid solutions, saUcyhc acid in powder 

 and in solution, the putting on of Lister's antiseptic materials — carbolic paste, &c. — all, all were unable 

 to combat hospital gangrene and pyaemia. But when in the course of a single week, with great energ\- 

 and industry, we applied to all our patients the newest antiseptic method, now in many respects improved 

 by Lister, and did all operations according to his directions, we experienced one surprise after another. 

 Everything went well ; not a single other case of hospital gangrene occurred. Pyaemia and erysipelas 

 were observed a few times at the very beginning ; but only, as the result proved, because we did not yet 

 possess the necessary practice in the carrying out of Lister's directions. We took pains, as you know, 

 and learned from day to day more exactly how to comply with his instructions. Our results became better 

 and better, the time of healing shorter, and pyaemia and erysipelas completely disappeared ' (op. cit, p. 6). 

 ^ The true explanation of the improved results is given by Professor Thiersch himself in the following 

 passage in a work which he has recently published on this subject — a statement characterized by the 

 usual perfect candour of the distinguished writer : ' Our results have constantly improved in proportion 

 to the perfecting of the method and our own practice in carrying out its details. They arc, indeed. 

 not so good as those of Lister himself, or of Volkmann, &c.' (sec Klinischc Eigebiiissc dcr Lister schcn 

 Wundbehandliing, &c., one of the Klinischc Vortrdge edited by Volkmann ; Leipzig. 1875, p. 645). To 

 the same cause, I have httle doubt, is to be attributed the fact that erysipelas was considerably less 

 ('bedeutend geringer,' op. cit., p. 676) in the year 1874 than in the previous year. Professor Thiersch 

 himself believes that erysipelas is not influenced by antiseptic treatment; but this view is entirely 

 opposed to the experience of Saxtorph and Nussbaum already mentioned in the text, and to that of 

 others to be alluded to in the sequel. 



LISTER u S 



