BEFORE AND AFTER LISTER 163 



hospital for the recent graduate before allowing him full 

 liberty of action ! 



In France matters were as bad if not even worse. T. 

 Holmes and Bristowe in 1861 had found that in Paris, 

 of 102 of the four amputations in question, 67 died, a 

 mortality of 65.7 per cent., or two out of every three. 

 Out of 1,656 amputations in the Paris hospitals collected 

 by Malgaigne and Trelat 803 died, 48.5 per cent., almost 

 one in every two (Simpson, p. 291). 



To-day, how entirely changed is all this. Listerism has 

 transformed what Bell well called "Houses of Death" 

 into "Havens of Safety." No home, however wealthy its 

 inmate, can be as sanitary, as surgically clean or give as 

 good results as a modern hospital. 



The best evidence of the truth of this statement I can 

 give you is the statistics of Dr. W. L. Estes, 14 of South 

 Bethlehem, Pennsylvania. They are of especial value in 

 that they are the statistics of the same surgeon in the same 

 hospital and on the same class of patients. He reports 

 the result in 724 major amputations. In 616 single am- 

 putations there were 28 deaths, a mortality rate of 4.54 

 per cent. Of 469 of the four selected amputations, 25 

 died, a mortality of 5.3 per cent. Of synchronous double, 

 triple and one quadruple amputation, many of them com- 

 plicated with other wounds and operations, there were 

 108, with 19 deaths, a mortality of only 18 per cent. It 

 is very noticeable that in an earlier paper in 1894 in which 

 he had reported the first 46 cases of synchronous double, 

 triple and quadruple and complicated amputations, there 

 were 13 deaths, 28.3 per cent., whereas from 1894 to 1913 

 in the last 62 such cases there were only six deaths, a 

 mortality of 9.6 per cent., showing again the value of still 

 larger experience even to an already experienced surgeon. 

 In the second series there was no quadruple amputation. 



But as officers of the Medical Corps of the Army you 

 will be especially interested in the facts as to military 



14 Annals of Surgery, July, 1913. 



