JiTNE 18, 1915] 



SCIENCE 



887 



bad that it had been condemned to demoli- 

 tion. In the two years after his introduc- 

 tion of the antiseptic method in 1872, no 

 single patient suffering from compound 

 fracture had died either from the fracture 

 or from a necessary amputation, nor was 

 there a single death from secondary hemor- 

 rhage or gangrene. No case of blood poison- 

 ing had occurred for a year and a half, 

 though sixty amputations had been done. 

 Just before Lister's method had been in- 

 troduced, of 17 amputations 11 had died 

 from pyemia alone, a mortality of 65 per 

 cent. Just after adopting Listerism the 

 death rate of his amputations fell to 4 or 

 5 per eent.^^ 



Hospital gangrene had been as it were 

 "blown away" by a puff ("weggeblasen") ; 

 not a single ease occurred. In Lind- 

 painter's extensive tables of Nussbaum's 

 cases one is struck, on glancing over them, 

 to see how before the antiseptic method was 

 adopted case after case is marked "died," 

 "died," "died," and in the later tables, 

 after its adoption, almost a uniform "re- 

 covered," "recovered," "recovered." 



But the most striking testimony to the 

 value of Lister's services to suffering hu- 

 manity is not the statistics of the mortality 

 in amputations, compound fractures, puer- 

 peral fever^^ or in any single disease or 

 operation, but in the enormous and success- 

 ful enlargement of the beneficent field of 

 surgery. In my own early days "before 

 Lister" the common operations were 



1. Amputations. 



2. Ligation of arteries. 



3. Eemoval of external tumors. 



4. Lithotomy. 



5. Tracheotomy, chiefly for croup and 



foreign bodies. 

 A few resections, colostomies, trephining 



IS Lancet, 1881, II., p. 281. 



13 See the extraordinarily interesting paper by 

 J. Whitridge Williams, Jour. Am. Med. Ass., April 

 22, 1911. 



(Avhen unavoidable) and herniotomies (for 

 strangulation) were done. Ovariotomy was 

 never done until the tumor had become so 

 large as to threaten life, and even then op- 

 eration was denounced by many as wholly 

 unjustifiable, for it had a mortality as high 

 as two out of every three cases. The head, 

 the chest, the abdomen were ticketed "Noli 

 me tangere" except in the rare cases when 

 operation was absolutely unavoidable. 



I used to wonder why the students in 

 "Rab and His Friends" rushed to the am- 

 phitheater to get the best seats to see Syme 

 amputate a breast — a so very common op- 

 eration nowadays. But then I recalled the 

 fact that even in my student days, when 

 anesthesia was the rule, capital operations 

 were rare. But in the preanesthetic days 

 operations were far rarer. In the five years 

 preceding the introduction of ether at the 

 Massachusetts General Hospital the entire 

 staff only performed in all 184 operations 

 or tJiree operations a month. When opera- 

 tions had become not only painless, but safe, 

 then the number performed increased al- 

 most at a geometrical ratio, so that at pres- 

 ent the numbers even of single operations 

 by single surgeons — e. g., of ovariotomies, 

 appendectomies, goiters — mount into the 

 thousands. What is still more gratifying, 

 the usual death rates of most capital opera- 

 tions in the pre-Listerian days of one pa- 

 tient in four, in three, or in two, or even 

 two out of three ( ! ) have been changed to 

 one in twenty, thirty, fifty, or to even less 

 than one life lost in one hundred or even 

 one in two hundred operations! 



It is impressive — most impressive — to 

 call the list of only the most frequent and 

 the most important of our present opera- 

 tions. Were Mott, Bigelow or Pancoast — 

 all of whom I remember well — to come to 

 life again they would wonder whether we 

 were not stark crazy. 



