June 11, 1915] 



SCIENCE 



849 



recognize at a distance a surgical hospital 

 owing to the stench of the human putrid- 

 ity it contained." In the surgical wards, 

 "no matter how well ventilated, there was a 

 fetid sickening odor" up to the days of 

 Lister himself, wrote Sir Hector Cameron, 

 Lister's house surgeon in Glasgow. Death 

 always stalked grimly behind the surgeon. 



Secondary hemorrhage, tetanus, erysipelas, sep- 

 ticemia, pyemia and hospital gangrene were never 

 all absent . . . and at times pyemia and hospital 

 gangrene 'beeame alarmingly epidemic.^-^ 



After vividly describing the ravages of 

 hospital gangrene Bell then vehemently 

 asks : 



What, then, is the surgeon to do ? Is he to try 

 experiments with ointments and plasters while the 

 men are dying around him? Is he to seek for 

 washes and dressings to cure such a disease as this? 

 Is he to expend butts of wine contending, as it 

 were, against the elements? No! Let him bear 

 this always in mind, that no dressings have ever 

 been found to stop this ulcer, that no quantities of 

 wine or bark which a man can bear have ever re- 

 tarded this gangrene; let him bear in mind that 

 this is a hospital disease, that without the circle of 

 the infected walls the men are safe; let him, there- 

 fore, hurry them out of this house of death; let 

 him change the wards, let him take possession of 

 some empty house and so carry his patients into 

 good air; let him lay them in a schoolroom, a 

 church, on a dunghill, or in a stable; let him carry 

 them anywhere but to their graves.is 



To-day we do not even know the bacte- 

 riology of this foul disease. I saw many 

 cases of it during the Civil War, but since 

 1865 I have never seen a single case. There 

 has been no opportunity to discover its 

 germ if, as is probable, it is a germ disease. 

 Lister made its return impossible. 



But let us come down next to the period 

 immediately before Lister's work. 



You can not do better than read that re- 

 markable and revolutionary paper entitled 



12 Cameron, British Medical Jl., Dee. 13, 1902, 

 p. 1844. 



13 Bell, "Principles of Surgery," 1826, I., p. 

 149. 



"Hospitalism" by Sir James T. Simpson, 

 of Edinburgh, published in 1867.^* It was a 

 bombshell whose explosion aroused the pro- 

 fession as hardly any other paper in my 

 lifetime. The controversy was bitter and 

 widespread. Fortunately, antisepsis came 

 close upon its heels and has forever done 

 away with such a disgrace. 



Simpson collected the statistics of the ob- 

 stetrical mortality in hospitals and in homes 

 with the following startling result. 



Of 888,302 women delivered in hospitals, 30,394 



died or 1 in 29 — 3.4 per cent. 

 Of 934,781 delivered at home, 4,045 died, or 1 in 



212—0.47 per cent. 



The reason for the greatly increased 

 mortality in maternity hospitals — over seven 

 times greater than in individual homes — 

 was chiefly puerperal fever. After Oliver 

 Wendell Holmes (1843) and Semmelweiss 

 (1861) had attacked the evil, Pasteur 

 finally in 1879 showed its bacteriological 

 cause and gave it the coup de grace. 



The 0.47 per cent, of Simpson's home 

 cases has been reduced to 0.15 per cent, and 

 even 0.08 per cent, in the maternity hos- 

 pitals of to-day. 



But his chief assault was upon the sur- 

 geons. He analyzed the four main amputa- 

 tions — arm, forearm, thigh and leg — and 

 excluded amputations at joints and all the 

 minor amputations (fingers, toes, etc.). 



Of 2,089 such amputations in hospitals, 855 died, 



or 41 per cent. 

 Of 2,098 in country practise, 222 died, or 10.8 per 



cent. 



The latter were collected from 374 country 

 practitioners, thus eliminating the personal 

 equation. The difference was clearly due 

 to the crowding and lack of sanitation in 

 the hospitals of that day. 



He gives two very interesting tables. 

 The first is most instructive in showing the 



1* Simpson's Works, Vol. II., p. 345. 



