886 



SCIENCE 



[N. S. Vol. XLI. No. 1068 



the antiseptic system to man is well stated 

 in his very first paper on the antiseptic 

 method in 1867.^^ He wrote 



The frequency of disastrous consequences in 

 compound fracture, contrasted with the complete 

 immunity from danger to life or limb in simple 

 fracture, is one of the most striking as well as 

 melancholy facts in surgical practise. 



Well might he say this, for while simple 

 fractures had practically no mortality, the 

 mortality of compound fractures was all 

 the way from 28 to 68 per cent. ! In this, 

 his first paper, he reported in detail eleven 

 cases, with one death, an unheard of mor- 

 tality of only 9 per cent. ! 



Thus encouraged, he attacked with an 

 equally happy outcome abscesses, especially 

 that bane of surgery in those septic days, 

 abscesses of the spine. Be it observed too 

 that fifteen long years were to elapse be- 

 fore the tubercle bacillus, the cause of such 

 abscesses, was discovered by Koch (1882). 



From accidental wounds it was but a step 

 to deliberately inflicted wounds, i. e., sur- 

 gical operations. Here too preventive anti- 

 sepsis gave equally valuable results. 



Lister, however, was much more given to 

 establishing principles and methods than 

 to statistics, but some of his early disciples 

 published striking proofs of the value of 

 his method by contrasting their former re- 

 sults with those which folloAved the accept- 

 ance of the germ theory and the adoption 

 of Lister's antiseptic treatment. 



Thus Dennis^* (1890) says that 



The time is within my own recollection when, 

 in Bellevue Hospital, amputation was immediately 

 performed as a routine treatment to prevent blood 

 poisoning, upon the admittance of a compound 

 fracture; and this operation was considered by 

 surgeons as offering to the patient the only chance 

 of recovery. 



This but corroborates what Syme had 



13 Lancet, 1867, I., p. 326 et seq. and II., p. 95, 

 and Lister's "Collected Papers," II., p. 1. 

 " Medical Neios, April 19, 1890, p. 423. 



already said in Edinburgh, that on the 

 whole he was inclined to think 



it would be better if in every case of compound 

 fracture of the leg amputation were done without 

 any attempt to save the limb.is 



Dennis in his paper reported 681 cases 

 of compound fracture, with only 19 deaths, 

 a mortality of only 2.8 per cent., and only 

 one of these 19 deaths was from sepsis, or 

 1/7 of 1 per cent. ! 



In Nussbaum's insanitary hospital in 

 Munich, which Lister visited in the sum- 

 mer or autumn of 1875, he states^" that 

 pyemia had been 



very frequent and hospital gangrene which made 

 its appearance in 1872, had become annually a 

 more and more frightful scourge until in 1874 it 

 had reached the astounding proportion of 80 per 

 cent, of all wounds that occurred in the hospital, 

 whether accidental or inflicted by the surgeon! 



After trying every possible different 

 method of treatment and still being unable 

 to combat hospital gangrene and pyemia, 

 Nussbaum finally adopted Lister's full anti- 

 septic treatment and from the beginning of 

 1875 they had "not had one single case of 

 hospital gangrene . . . and were doubtful 

 whether they had had one case of pyemia ' ' ; 

 and 



the convalescent wards — which previously had 

 been filled and overflowing constantly — Lister saw 

 standing one after another empty, because pa- 

 tients, no longer affected with hospital gangrene, 

 recovered much more rapidly. 



In Halle Volkmann" was operating in 

 an extremely unhealthy hospital in small, 

 overcrowded wards, with the toilet rooms 

 opening directly into them and a large drain 

 running directly underneath. It was so 



15 Cameron, Brit. Med. Jour., December 13, 1902, 

 pp. 1844-45. 



16 Brit. Med. Jour., 1875, II., p. 769, and "Lis- 

 ter 's "Works, ' ' Vol. II., p. 248. 



17 "Lister's Works," IL, pp. 249-51, Brit. 

 Med. Jour., 1875, IL, p. 769, and Lindpainter 

 (Volkmann's assistant), Beutsch Zeit. f. Chir., 

 October, 1876, p. 187. 



