14
REPORT ON THE
1875. These results are indicative of three different modes of treatment. The
earliest period represents the treatment adopted prior to the introduction of
Esmarch's bloodless apparatus. Between 1875 and 1879 this apparatus was
used, and in the course of 1880 Lister's antiseptic treatment was added in
its entirety. This system was adopted in the First Surgeon's ward, the
Second Surgeon treating his cases in the style that was successful between 1876
and 1878.
21. The First Surgeon had 26 operations, nine of which were treated on the
old method and 17 by the antiseptic system. Of the former group (all treated
to their end) one died, and of the latter (of which 11 only were treated to a
termination) two died, " giving a mortality in the antiseptic cases of 18 per
cent.," and in the former it would appear of 11 per cent. only. The Second
Surgeon had 16 operations with three deaths among 14 cases treated to the
end, giving a death-rate of 21 per cent. The strict antiseptic system com
-
pared with the results of the five years, viz. 1875 to 1879, when modified
antiseptics were used, represents a mortality in excess of the latter by 3.72 per
cent. Dr. Coates adds: "It has been urged in support of Lister's system in the
treatment of these cases, that it reduces the death-rate, obviates putrefactive
changes in the wound, and septic contamination of the system; that it sup
-
presses all constitutional disturbance, and materially accelerates healing, thereby
contracting the period of treatment. It thus counterbalances by saving
in the patient's diet the expense which the system entails." The following
facts bear upon the last point. The average weight of the tumours removed
in former years was 142 ounces, and the patients were under treatment on an
average 90 days. The average weight in 1880 was 60 ounces, and the
average period was 72 days There is no evidence of shortened duration here,
and on the whole I think but little advantage can at present be claimed for
Lister's system in this class of cases. In the special report appended, Dr. McLeod
points out that the wounds after scrotal operation are with great difficulty kept
in an aseptic state, being particularly prone to become the nidus of septic
infection. This is quite intelligible, and it may be wrong to estimate the
general value of the system by so severe a test; but if it should appear
that, in these same difficult cases results as good or better are obtainable
by the former system, the difficulty will not save the credit of strict
Listerism; but the generally better results of late years will point rather to
those collateral improvements which Dr. Raye shows to have accompanied
antiseptic practice—viz. greater general care and cleanliness in dealing with
surgical cases. Dr. Coates bears testimony to the merits of Listerism in its
effect on the hospital atmosphere; but here also it must have had a potent
ally in increased cleanliness, for that a great change has been effected in the
hospital in this respect is a matter of no doubt. 'The comparative merits of
the systems will be subjected to further test, for the several methods will
continue to be practised in the wards of the hospital, and their results will be
carefully recorded. All that need be said at present is that Listerism has
not yet established its claim to infallibility, or the precise degree of its
superiority over other treatment; that the amount of its debt to other con
-
current improvements is unsettled; but that, even in the minds of men who
are not moved by enthusiasm, it has proved itself to have a very high value,
though in a class of cases which might, by some people, be taken as crucial,
Listerism has not as yet appeared to advantage. So far as scrotal operations are
concerned, it does not seem that either bloodless or antiseptic surgery has
effected them beneficially.
22. Concerning the presence of septic disease in the hospital in 1880,
Dr. Coates writes that erysipelas made its appearance in a few surgical cases,
but prompt segregation effectually checked its spread. Fifty-six cases of blood
poisoning in its various forms were treated in the surgical wards, whereof no
less than 39 were suffering on admission from some form of putrefactive con
-
tamination. Of the number of deaths after operation, six, or 12.5 per cent. to
compare with 20.9 per cent. in 1879, were due to blood poison, and in one of
these the condition was present on admission. It is elsewhere stated that one
death arose from pyæmia in addition to the above number, but no account is
given of it.