11
CALCUTTA MEDICAL INSTITUTIONS.
23. "That the success of surgical treatment during the year has been
largely due to the diligent and careful use of antiseptics, I have no doubt
whatever. The more strictly I carry out the antiseptic system of wound treat
-
ment, the better results I obtain and failure of antiseptics from accident or
carelessness has invariably been followed by untoward consequences, local or
constitutional, or both."
24. With regard to the cost of strict Listerism Dr. McLeod claims—and,
so far as I can yet learn, justly claims—on behalf of the system that, although
the appliances are doubtless costly, there is much compensation in the lessened
use of expensive dietary articles. The First Surgeon fully recognises the diffi
-
culties arising from unskilful and untrustworthy assistants, and the events over
which Listerism has no power, though practised in its entirety. He is careful
also, in speaking of results, to remember other improvements in surgery, which
have been contemporaneous with Lister's work.
25. The Second Surgeon writes:—"Ten deaths from septic poisoning took
place in my wards during the past year, viz., three from pyæmia, three from
cellulitis and erysipelas, and four from septicism. Judging from the total figures,
there would seem to be an improvement on the previous year, when thirteen
deaths occurred from septic desease. It has, however, to be observed that of
these thirteen deaths no less than six occurred in patients who were suffering at
the time of their admission, whereas in the year under report one death only
took place in a patient admitted with septic disease. Perhaps the deaths for
which the hospital may be held accountable might strictly be reduced from
nine to six, by eliminating three deaths after operation for infiltration of
wounds. I am inclined to think that pyæmia, in such cases, is likely to occur
in almost any atmosphere."
26. Dr. Raye varied the treatment of his cases during the year, as he
found the antiseptic system failed to effect its object. He continues:—"As all
severe operations, &c., ending fatally (with the exception of scrotal tumour
cases) were, at one part of their course, under antiseptic treatment, all such
might perhaps be said to be fatal cases occurring under Listerism, but it has to
be remembered that in almost all these cases Listerism was not persevered
with, as I failed, by means of it, to keep the wounds aseptic." This of course
is simple failure, stated in other words, but from the following remarks it
seems probable that strict Listerism had not failed, because it had not been.
followed, and it is probable also that there are not many places in which it ever
will be followed. "I have since learned," writes Dr. Raye, "that the proper
use of antiseptics is not a thing to be acquired in a moment. There are a
multitude of precautions, the non-observance of some of which may cause the
dressing to fail, and I believe that most of my failures were due to the anti
-
septic treatment having been imperfectly carried out by me, as I did not attach
sufficient importance to details." * * * "I hope in future to obtain better
success in keeping wounds aseptic." Dr. Raye recognizes the collateral advan
-
tages of the system, and thinks it probable that further experience may lead
him to employ Listerism universally, though at present he considers that the
risk of infection in the College Hospital is not so great in simple cases as to
necessitate the invariable use of antiseptic dressings.
27. These statements show the impossibility which I have represented
o f d r a w i n g s p e c i a l c o n c l u s i o n s f r o m s u r g i c a l f i g u r e s . T h e m o r e m i n u t e t h e
analysis is, the more numerous do the sources of possible error become. As the
comparative merits of Listerism are not shown by the results of the one
hospital, I have endeavoured to draw comparisons with the other hospitals of
Calcutta, where practice is different, but the complexity of the question forbids
my pursuing it here. At the Campbell Hospital ordinary antiseptic dressings
are used, but Listerism is not attempted. Dr. Mackenzie holds that as his
pupils will never be able to practice the system in after life, it is unwise to teach
it in the place of that which will be useful to them.
28. At the Mayo Hospital the mortality after amputations in 1881 was
exceptionally small, as it had been at the College in 1880. Dr. Cayley thus
describes his practice:—"I employ a modified form of Listerism, that is, I endea
-
vour, as much as possible, by cleanliness and a free use of antiseptics both in
cleansing and dressing to keep wounds aseptic, without always following the
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