XVI 



Obituary Notices of Fellows deceased. 



progressively, and at last, in the summer and autumn of 1871, the deaths 

 from pyaemia and septicaemia were so numerous that he made up his mind to 

 close the hospital altogether for a time. Before resorting to this desperate 

 remedy, however, he determined to try the Listerian method for a few 

 weeks, and the result of this trial was entirely to alter the aspect of affairs. 



" Similar facts were published by Nussbaum of Munich, who commenced 

 the treatment two years later than Volkmann. The hospital at Munich, a 

 building by no means satisfactory as regards sanitary arrangements, became 

 a hotbed of septic infection, to so great an extent that almost every case of 

 open wound was attacked by one or other of these diseases. Pyaemia was 

 rife, affecting nearly all cases of compound fracture, wounds of bones, and 

 amputations. Erysipelas was constantly present. During 1872 hospital 

 gangrene also appeared and steadily spread in spite of all the precautions 

 which experience dictated or ingenuity could devise ; in that year 26 per 

 cent, of all the wounds were attacked by this dreaded disease ; during 

 1873 the proportion increased to 50 per cent., and it ultimately reached 

 80 per cent. Erysipelas, too, which in 1872 was of a comparatively mild 

 type, became much more virulent as well as more frequent. All this 

 occurred in spite of the use of antiseptic lotions, of the open method, and 

 other devices. In 1878, after he had put Lister's method to the test of 

 practice, Nussbaum published an essay entitled ' Sonst und Jetzt,' in which 

 he drew the following striking contrast between the previous state of 

 affairs and that which followed the introduction of Listerism : — 



Formerly. Now. 

 Injuries of the head, compound fractures, amputations, and No pysemia. 



excisions, in fact almost all patients in whom bones were 



injured, were attacked by pyaemia. For example, of 17 cases 



of amputation, 11 died from this cause. Even patients with 



severe whitlow died from it. 

 Hospital gangrene had got the upper hand to such an extent No hospital gangrene. 



that, in spite of the open method, in spite of continuous 



water-baths, in spite of the use of chlorine water, or the 



actual cautery, finally 80 per cent, of all wounds and ulcers 



were attacked, large arteries being opened into. 

 Almost every wound was attacked with erysipelas No erysipelas. 



" It would be easy to produce a great cloud of witnesses to the appalling 

 state of matters in various hospitals before the introduction of the Listerian 

 method, but their testimony would merely be a repetition of the above 

 statements. It is true that these untoward results were witnessed most 

 often, and in their direst form, under hospital conditions of a particularly 

 insanitary kind, and that their frequency and severity varied considerably, 

 according to the methods of wound treatment adopted. Nevertheless, these 

 infective diseases were present everywhere, and it will readily be understood 

 that the dread of them, never absent from the surgeon's mind, was a serious 

 bar to progress." 



