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Robert Storrs.-Contagious Effects of Puerperal Fever on the Male Subject; or on Persons not Child-bearing. (From Provincial Med. and Surg. Journal.) Am. Jour. Med. Sc., January, 1846. Numerous cases. See also Dr. Reid's case in same journal for April, 1846.

Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med. Sc., April, 1849, also in B. and F. Med. Chir. Review, April, 1850.

Hill, of Leuchars.-A Series of Cases Illustrating the Contagious Nature of Erysipelas and Puerperal Fever, and their Intimate Pathological Connection. (From Monthly Journal of Med. Sc.) Am. Jour. Med. Sc., July, 1850.

Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, from inoculation with different morbid secretions.) Am. Jour. Med. Sc., October, 1850.

Arneth.-Paper read before the National Academy of Medicine. Annales d'Hygiène, Tome LXV. 2e Partie. (Means of Disinfection proposed by M. “Semmeliveis." Semmelweiss.) Lotions of chloride of lime and use of nail-brush before admission to lying-in wards. Alleged sudden and great decrease of mortality from puerperal fever. Cause of disease attributed to inoculation with cadaveric matters.) See also Routh's paper, mentioned above.

Moir.—Remarks at a meeting of the Edinburgh Medico-chirurgical Society. Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, all fatal. Also to several instances of individual pupils having had a succession of cases in various quarters of the town, while others, practising as extensively in the same localities, had none. Also to several special cases not mentioned elsewhere. Am. Jour. Med. Sc. for October, 1851. (From New Monthly Journal of Med. Science.)

Simpson.- Observations at a Meeting of the Edinburgh Obstetrical Society. (An “eminent gentleman,” according to Dr. Meigs, whose

name is as well known in America as in (his) native land," Obstetrics, Phil., 1852, pp. 368, 375.) The student is referred to this paper for a valuable résumé of many of the facts, and the necessary inferences, relating to this subject. Also for another series of cases, Mr. Sidey's, five or six in rapid succession. Dr. Sinipson attended the dissection of two of Dr. Sidey's cases, and freely handled the diseased parts. His next four child-bed patients were affected with puerperal fever, and it was the first time he had seen it in practice. As Dr. Simpson is a gentleman (Dr. Meigs, as above), and as a gentleman's hands are clean” (Dr. Meigs' sixth letter), it follows that a gentleman with clean hands may carry the disease. Am. Jour. Med. Sc., October, 1851.

Peddie.—The five or six cases of Dr. Sidey, followed by the four of Dr. Simpson, did not end the series. A practitioner in Leith having examined in Dr. Simpson's house, a portion of the uterus obtained from one of the patients, had immediately afterwards three fatal cases of puerperal fever. Dr. Peddie referred to two distinct series of consecutive cases in his own practice. He had since taken precautions, and not met with any such cases. Am. Jour. Med Scor October, 1851.

Copland.-Considers it proved that puerperal fever may be propagated by the hands and the clothes, or either, of a third person, the bed-clothes or body-clothes of a patient. Mentions a new series of cases, one of which he saw, with the practitioner who had attended them. She was the sixth he had had within a few days. All died. Dr. Copland insisted that contagion had caused these cases; advised precautionary measures, and the practitioner had no other cases for a considerable time. Considers it criminal, after the evidence adduced, which he cor id have quadrupled,-and the weight of authority brought forward, for a practitioner to be the medium of transmitting contagion and death to his patients. Dr. Copland lays down rules similar to those suggested by myself, and is therefore entitled to the same epithet for so doing. Medical Dictionary, New York, 1852. Article, Puerperal States and Diseases.

If there is any appetite for facts so craving as to be yet unappeased, lassata, necdum satiata,-more can be obtained. Dr. Hodge remarks that the frequency and importance of this singular circumstance (that the disease is occasionally more prevalent with one practitioner than another) has been exceedingly overrated.” More than thirty strings of cases, more than two hundred and fifty sufferers from puerperal fever, more than one hundred and thirty deaths, appear as the results of a sparing estimate of such among the facts I have gleaned as could be numerically valued. These facts constitute, we may take it for granted, but a small fraction of those that have actually occurred. The number of them might be greater, but “'t is enough, 't will serve," in Mercutio's modest phrase, so far as frequency is concerned. For a just estimate of the importance of the singular circumstance, it might be proper to consult the languid survivors, the widowed husbands, and the motherless children, as well as

the unfortunate accoucheur."

ON THE ANTISEPTIC PRINCIPLE OF

THE PRACTICE OF SURGERY

BY

JOSEPH LISTER

INTRODUCTORY NOTE

JOSEPH LISTER was born at Upton, Essex, England, in 1827, and received his general education at the University of London. After graduation he studied medicine in London and Edinburgh, and became lecturer in surgery at the University in the latter city. Later he was professor of surgery at Glasgow, at Edinburgh, and at King's College Hospital, London, and surgeon to Queen Victoria. He was made a baronet in 1883; retired from teaching in 1893; and was raised to the peerage in 1897, with the title of Baron Lister.

Even before the work of Pasteur on fermentation and putrefaction, Lister had been convinced of the importance of scrupulous cleanliness and the usefulness of deodorants in the operating room; and when, through Pasteur's researches, he realized that the formation of pus was due to bacteria, he proceeded to develop his antiseptic surgical methods. The immediate success of the new treatment led to its general adoption, with results of such beneficence as to make it rank as one of the great discoveries of the age.

ON THE ANTISEPTIC PRINCIPLE OF THE PRACTICE OF SURGERY

(1867)

I

N the course of an extended investigation into the na

ture of inflammation, and the healthy and morbid con

ditions of the blood in relation to it, I arrived several years ago at the conclusion that the essential cause of suppuration in wounds is decomposition brought about by the influence of the atmosphere upon blood or serum retained within them, and, in the case of contused wounds, upon portions of tissue destroyed by the violence of the injury.

To prevent the occurrence of suppuration with all its attendant risks was an object manifestly desirable, but till lately apparently unattainable, since it seemed hopeless to attempt to exclude the oxygen which was universally regarded as the agent by which putrefaction was effected. But when it had been shown by the researches of Pasteur that the septic properties of the atmosphere depended not on the oxygen, or any gaseous constituent, but on minute organisms suspended in it, which owed their energy to their vitality, it occurred to me that decomposition in the injured part might be avoided without excluding the air, by applying as a dressing some material capable of destroying the life of the floating particles. Upon this principle I have based a practice of which I will now attempt to give a short account.

The material which I have employed is carbolic or phenic acid, a volatile organic compound, which appears to exercise a peculiarly destructive influence upon low forms of life, and hence is the most powerful antiseptic with which we are at present acquainted. The first class of cases to which I applied it was that

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