APPENDIX I.
Report by the First Surgeon, Medical College Hospital, on Antiseptic Surgery.
THE number and varieties of septic diseases treated during the year were as follow :—
Pyæmia
3 cases.
3 deaths.
Septicæmia
3 "
3
"
Erysipelas
7
"
2
"
Gangrenous cellulitis
2 "
1
"
Total
15
"
9
"
-
The number of cases treated in the wards during the year was 577, and the number of
deaths which occurred amongst these, 63.
2. Out of these 15 cases, six, namely two cases of pyæmia, one of septicæmia,
two of erysipelas, and one of gangrenous cellulitis, were admitted into hospital with the
disease fully developed. That disease of septic type occurs in Calcutta, beyond the
precincts of hospitals, I have had. abundant evidence in practice. I have lately met with
a case of erysipelas of the face following removal of a wen from the scalp by operation,
a severe case of "idiopathic" cutaneous erysipelas affecting the general surface, and
a fatal case of facial erysipelas of very severe type and rapid course.
3. Of the remaining nine cases, seven followed operation and were unquestionably caused
thereby. Of these, four were cases of erysipelas, three of which occurred in cases of scrotal
tumour. A. case of pyæmia followed removal of an osseous tumour of the lower
jaw; septicæmia followed tracheotomy and necrosis of the larynx, and sloughing cellulitis
supervened on a scrotal operation. Four out of the seven were cases of removal of
scrotal elephantiasis. These have always been found very specially prone to hospitalism.
The wound is a very large one, the period of its repair very protracted, the constitutional
rigour of the subjects of the disease generally below par, and sources of contamination
exist adjacent to the sore. Of the remaining two cases, one was a wound which had
been inoculated with filth and went rapidly " wrong," and the other was a case of ulcer
in process of healing, which seemed in some mysterious way to be the starting point of
erysipelas.
4. Having been in charge of the Second Surgeon's wards from 1st April 1874 to
15th June 1875, I am. in a position to compare, on the grounds of personal experience,
two periods separated by an interval of five years. I have no hesitation in stating that
the prevalence of "hospitalism" has been very decidedly less in the year 1880 than in
1874-75. Erysipelas then prevailed epidemically in the hospital, and almost every
entry of the knife into tissue was succeeded by cellulitis or erysipelas, and occasionally
by the graver form of septic infection. I practised what I thought was antiseptic
surgery, and was grievously disappointed with the result. It was not until I went to
Edinburgh in 1876, and followed Professor Lister in his wards, that I became aware
that what I had been doing was not in full accord with his tenets and teaching, and that a
"modified antiseptic" system is a delusion.
5. This leads me to offer some remarks on antiseptic surgery with special regard
to its preventive control over "hospitalism." The fact that "hospitalism" has decreased
with the increased use of antiseptics is undeniable. Other influences may have been in
operation, but I am inclined to attach to these a secondary value. Not one of the cases
in which I have succeeded in carrying out strict "Listerism" since I rejoined the hos-
pital in April 1879 has manifested any sign or form of septic infection. In the seven
post-operation cases referred to in paragraph 5, either Listerism could not be .employed
(cases 3, 4, 7,), was not employed (case 15), or having been tried failed (cases 11, 12, 13).
In the treatment of the other cases, "Listerism," for various reasons, could not be estab-
lished. Short of rigid "Listerism," however, that is, the maintenance of a perfectly aseptic
state of wound or sore, and complete prevention of putrefaction from beginning to end
of the case, the "modified antiseptic" or disinfectant plan of treatment must exercise
an advantageous influence on the patient by way of diminishing the risk of septic infection,
and a still greater on the ward and hospital by way of preventing contamination of the
atmosphere, &c., with septic impurities.
6. But I believe that the practice of strict antiseptic surgery confers other very
substantial advantages in addition to the prevention of septic infection, by aborting the
development of septic products in a wound or sore. It reduces mortality, diminishes suffer-
ing, and accelerates repair and recovery. When it succeeds, local inflammation and
general febrile disturbance are absent, and the natural reparative processes are fulfilled
without hinderance. The practice is rather preventive of mischief than corrective of
it. When mischief, local or constitutional, does set in, the disinfectant plan may limit
its harmful influence, but the aim of antiseptic surgery is mainly preventive, and the scope
of its operation embraces a large portion, but not the whole of the field of practical
surgery.