CALCUTTA MEDICAL INSTITUTIONS.
7
in the several hospitals with a view to ascertaining how far reduced mortality
may be ascribed to increased strictness in pursuing the costly system of Lister
in treating cases of operation.
14. In the first surgeon's ward at the college hospital, Dr. McLeod
reports a total number of 127 operations with 9 deaths, showing marked im-
provement on past years. He ascribes this to the absence of hospitalism, the
more thorough use of antiseptics, and in some measure to the absence of
desperate cases requiring operation in the last resort. All the deaths are satis-
factorily explained as beyond prevention. Dr. McLeod says that the favour-
able results were not due to any exceptional paucity of severe operations,
though a large majority presented fair promise of recovery. Taking, as tests,
those cases which may be fairly regarded as illustrating the effects of anti-
septic practice, it does not appear that there was improvement on the results
of the previous year. Thus in 1882 there were 16 operations for excision of
bones and joints with 3 deaths. In 1881 there were 11 operations with one
death. These figures apply to both surgical wards; but in both antiseptic
practice was more strictly pursued in 1882. There were 24 major amputations
in 1882 with 8 deaths, and 17 in 1881 with 6 deaths. In the first surgeon's
ward there was a single imported case of erysipelas during the year, and the
cases of septic fever which occurred had arisen mostly before admission.
15. The second surgeon reports 152 major operations in his ward in
1882 with 20 deaths, against 102 with 20 deaths in 1881. Three deaths only
were due in 1882 to septicaemia contracted in hospital. Of the 17 remaining
cases 4 were desperate, operation being the last resort. There were 9 deaths
from septicaemia in 1881. Dr. Raye, in the absence of any other known
difference between the years, attributes "some part at least of the success to the
use of antiseptics." There were three cases of erysipelas in his ward in 1882,
but no death from it. He believes antiseptics to give better results than other
modes of treatment, if for no other reason, simply from their essential cleanli-
ness. He continues to employ less elaborate dressings in his less important
cases.
16. The large number of scrotal tumours removed in 1882 at the college
hospital and the small number of deaths will, no doubt, attract attention.
The record of these cases cannot be used for my present purpose without
details. The cases differ so widely among themselves, in severity and other
points, and the application of strict Listerism to them is so difficult, that
it can scarcely be said to succeed or fail.
17. In the Medical college hospital, then, there was in 1882 a great
reduction in the quantity of those affections known as hospitalism. There was
very little mortality after surgical operation in general, but no improvement
in the results of certain severe cases employed as tests. All this accompanied
increased strictness in the application of antiseptic dressings, and the question
is, was this the cause, and that the effect ? Test cases may be said to have
t aken t hei r own cour se; but t hey ar e pr obabl y cases i n whi ch Li st er i sm was
most fully used in the two years, and therefore results have fluctuated from
other causes. Surgical mortality, generally low in the wards, indicates some
general and favourable influence. This may still be the influence of Listerism,
for its use is general and the system includes much that is good besides its pecu-
liar dressings. All else, however, can be employed without the great cost and
skill which the system demands. It is easy to conceive that greater strictness
of method, applied to all surgical cases, may so far have affected septic
influence in the wards as to have favoured the progress of operation cases, but
this cannot be derived as an inference from the events of 1882, inasmuch as
the most illustrative class of cases shared no advantage. There was, therefore,
probably some other cause for the great total difference of the year, and this
must be sought for in the events of other hospitals where practice differs, but
where general, that is outside, influences are much the same. The comparison
is not now between absolute results in the several hospitals, but between
events of the separate years in each. If it should appear that elsewhere the
year 1882 has differed, in its surgical incidents, as widely from 1881 as it has
at the medical college, we shall be debarred from carrying the change to the
credit of Listerism.