APPENDIX II.
Report by the Second Surgeon, Medical College Hospital, on Antiseptic Surgery.
I USE the word septicæmia in its fullest sense, including pyæmia proper, and even the
mildest forms of erysipelas.
By antiseptics . I mean the method of dressing wounds introduced by Professor Lister,
and mainly consisting of a free use of carbolic acid in various ways.
Using the word antiseptics in this full sense, I should mention that I have not
employed them indiscriminately in all cases, but only for the more severe operations, such as
amputations, hernias, and large chronic abscesses, &c. For minor cases I used the ordinary
and less elaborate dressings commonly employed in surgery, partly because I did not consider
antiseptics needed in such cases, partly also because the cases in the wards being utilised
for teaching purposes, I thought it desirable that the students should learn the more simple
methods, and not imagine that no wound would heal without antiseptics, and with the
object of impressing upon their attention that manipulative skill and cleanliness were in
reality all that was necessary in most cases to secure perfect results. The practical inculcat
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ing of such a doctrine is, I consider, of great importance amongst students whose practice
will hereafter be amongst people unable to give such large fees as would secure the, to them,
somewhat expensive appliances necessary for carrying out Listerism in every-day work.
The number of cases of septic poisoning, mild and severe, treated has been considerable ;
and, were I to attend merely to figures, I could not say that in my hands antiseptics have
been very successful, but figures notwithstanding, I think I may safely state the following
opinions :—
1. In severe recent open wounds, whether following operations or accidents, antiseptics
thoroughly applied do afford the patient a considerable degree of safety and materially
reduce the chance of his contracting the severer forms of septic disease. I shall adduce but
one fact bearing on this point. There were 16 amputations of all sorts performed by me
during the year, all dressed antiseptically ; amongst these 16 cases so treated, osteomyelitis
occurred but once, and in that case it was doubtful whether the bone was not affected before
the operation.
2. I doubt if antiseptics have much effect in controlling the spread of simple erysipelas,
for I noticed that, when once introduced into the wards, this disease attacked patients dressed
antiseptically or non-antiseptically with about equal impartiality.
3. When severe septicæmia has once been established in the system, I believe that
antiseptic dressings to a wound have absolutely no effect in controlling the progress of the
disease. Whether by disinfecting the discharges in such cases they may protect other
patients is a different question, and I am inclined to think that they might do so.
4. In treating large chronic abscesses, such as iliac and psoas abscess, Lister's dress
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ing seems to me invaluable. In the few such cases which came under my care, putrefaction
of the abscess contents was controlled in a way that surpasses any other dressing with which
I am acquainted.
It is a matter of difficulty to fairly estimate the value of any solitary measure or mode
of treatment in controlling septic diseases ; for not only are the causes of such diseases pro
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bably various, but now- a-days no single precautionary measure is, I fancy, ever trusted to ;
general cleanliness of the wards and beds, as well as of the dressings, antiseptic or otherwise,
needing much care.
As an instance of the effects of cleanliness, I would point to the first five cases in the
table appended. Finding the disease (erysipelas) spreading, I had all the dressings in use
changed, and Dr. Smith had the sacking of the beds destroyed, as they were old and greatly
soiled. After this the disease ceased. Here no antiseptics were used. Cleanliness alone,
combined with careful dressing in the ordinary way, and isolation of the dressers to indivi
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dual cases, seemed sufficient.
Some of the cases of erysipelas which occurred during the year were clearly imported
from outside ; some seemed to originate in the tents and wards, but by isolation of patients
and dressers, and cleanliness in the dressings, the disease never assumed any formidable
proportions.
Having had no personal experience of the hospital in former years, I cannot compare
the results attained by the present more close attention to antiseptic surgery with what was
attained in former years, except by statistics, and for such a purpose crude figures would not
be of any value.
It should not be overlooked that our predecessors at this hospital also used antiseptics
of various kinds before the present elaborate use of carbolic acid became the general fashion,
and many of the leading London surgeons stoutly maintain that some of the older
antiseptic media are quite as good as the new, and publicly challenge Professor Lister and
his disciples to a practical comparison of the results. The difficulty therefore of judging
of the effects of Listerism, as opposed to the other methods of dressing wounds, is obviously
very great.
I append a tabular statement of all cases in which any form of septic disease appeared
in my wards during the year. It should be noticed that this table includes mild cases of
transitory erysipelas and other mild septic diseases. A large number of these patients
were admitted for diseases other than septicæmic, and hence would not appear