Lord Lister. 



xv 



however, do not always show the profound insight and thoroughness of the 

 Master, but, nevertheless, aim at still more perfectly attaining his ideal. 



The principles on which Lister worked were on the one hand to keep 

 living bacteria out of wounds, and on the other to remove as far as possible 

 anything which would hinder nature to carry out its work, viz., the repair of 

 the wounds, as quickly and satisfactorily as possible ; in fact, as has already 

 been said, he aimed at converting an open wound into a subcutaneous one. 

 We have sketched the methods by which these aims were gradually attained 

 in the course of a long and most laborious research. What then were the 

 results ? They were the complete abolition of suppuration and the septic 

 diseases associated with wounds. 



Previous to the introduction of his methods a surgical ward was a most 

 depressing and painful sight. The odour in the wards, in spite of ventilation, 

 was nauseating and often foul, the patients were suffering, in pain, flushed, 

 feverish, and very ill ; some were dying of one or other of the septic diseases 

 of wounds. Union by first intention was a very rare occurrence ; suppuration 

 occurred in practically every case ; indeed it could hardly be otherwise, as in 

 most cases bunches of ligatures were hanging out of the wounds; associated 

 with these ligatures was the danger of secondary haemorrhage when they 

 began to separate. 



Still more serious than these local troubles was the frequent occurrence of 

 general septic diseases, such as septicaemia, pyaemia, erysipelas, tetanus, or 

 hospital gangrene. In a large proportion of the cases in which a wound of 

 any considerable size was produced, whether by accident or by the surgeon's 

 knife, the patient suffered more or less severely from one or other of these 

 surgical diseases. After major amputations, for example, the mortality was 

 very high ; the average in the practice of various surgeons at that time 

 varied from 30 to 50 per cent. We may here quote from the introduction 

 to Lister's ' Collected Papers ' : — 



" Lister collected his statistics of amputation for two years (186-i and 

 1866), just before he introduced the antiseptic method of treatment, and 

 found, the mortality to be 45 per cent. The causes of death are not 

 definitely stated, but almost all the deaths were due to infective diseases ; 

 for example, of six deaths following amputation of the upper extremity four 

 were due to pyaemia and one to hospital gangrene. In his paper on excision 

 of the wrist-joint, published in 1865, he refers to fifteen cases in which he 

 had performed this operation, and incidentally remarks that six were 

 attacked by hospital gangrene, while one died of pyaemia. 



" Volkmann, in one of his earliest papers on antiseptic treatment, stated 

 that for the four years preceding the adoption of Lister's method, that is 

 down to 1872, he had left his wounds entirely open. During the first year 

 in which this method was carried out, the results were very favourable, and 

 he was thoroughly convinced of its superiority over the plans which he had 

 formerly adopted. As time went on, however, and as overcrowding of 

 the wards became unavoidable, infective diseases of wounds increased 



VOL. LXXXVI. — B. C 



