Report on the charitable institutions of Melbourne / by Dr. Gresswell.
- Gresswell, D. Astley (Dan Astley), 1853-1904.
- Date:
- 1893
Licence: Public Domain Mark
Credit: Report on the charitable institutions of Melbourne / by Dr. Gresswell. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
4/20 page 4
![r 4 (Results of ■wounds aud of operations before and after introduction of sterilization- treatment.) Mode of action of sterilization- treatment. Sources of disease- producins micro- orgauisms. Best results in hospitals where sterilization- treatment accompanied by improvement of Kcncral conditions. methods tlie rate lias become smaller even than 0*5 per cent. The statistics relating to a few of these maternities may here be cited. At the maternity of Copenhagen the mortality from puerperal fever in the years 1850 to 1864 was 4*1 per cent.; but after the introduction of antiseptic treatment in 1865 it fell at once, until in 1870 to 1874 it was only 1*1 per cent. At the maternity in Paris the mortality 30 years ago was 9 per cent, or more ; eight years ago it was only 2'5 per cent.; whereas during the years 1890-91, when there were 1,340 confinements, the maternal mortality was only 1*04 per cent., and there was not a single death attributable to puerperal fever. At the Imperial Maternity in Vienna the mortality from puerperal fever has fallen from 2*8 to 0'4 per cent, since sterilization-treatment was introduced. At the maternity in New York the mortality from puerperal fever has fallen from 6 per cent, in 1883 to O'l per cent,; and at the maternity in Boston City it has fallen from 4*5 per cent, to zero. During the last three years there has been only one death from puerperal fever in the maternity at St. Petersburg. So also at the general Lying-in Hospital, in York-road, London, where prior to 1887, when sterilization-treatment was adopted, the mortality from this affection, always high, occasionally became fearful. At the maternity of Helsingfors the maternal mortality, which for years had been only 1*26 per cent., fell, after the introduction of sterilization-treatment, so far that among the 3,841 confinements, which have since taken place there, it has been only 0*60 per cent.; while cases of illness after confinement, which were at the rate of 12*10 per cent., fell in the latter period to the rate of 4-11 per cent. The contrast, thus presented in connexion with the natural rents attendant upon childbirth, is to be found also in connexion with other forms of wounds and with many forms of surgical operations, and to so marked a degree that, as with fever in cases of childbirth, so also with erysipelas, with pyaemia, and septicaemia in surgical cases, the cause of the complicating, and but too often fatal, affection is nowadays rigorously inquired into; whereas previous to the introduction of sterilization-treatment these affections were so commonly repeated that their occurrence was regarded as commonplace, and scarcely if at all preventable. These affections are now explained by the occurrence of certain kinds of micro-organic life at the seat of injury, it being all but universally accepted that, in proportion as certain kinds of micro-organisms are allowed access to cut or broken surfaces, so, according to the circumstances of the case, will puerperal fever, erysipelas, pyaemia, septicaemia, malignant oedema, tetanus, and certain other diseases flourish; and that in some cases the absorption of the products merely of the vital activity of such micro-organisms from the seat of injury into the system may bring about similar results. The question now arises as to the nature of the conditions which favour retCixuion, cultivation, and distribution of these minute organisms. Semmelweiss, nearly half a century ago, showed that the poison of puerperal fever was transmitted to women in childbirth by persons engaged in the post-mortem or in the dissecting room ; while the conveyance of this poison by persons attending on women in the condition just mentioned had been recognised many years before. Then Sir James Simpson showed that surgical fever was much the same as puerperal fever, and that the two probably depended on one and the same poison ; while Lister proved the dependence of the former on micro-organic life. And of late years the micro- organisms concerned in pus- or matter-production (sup])uration), in septicaemia, in malignant oedema, and in tetanus have been demonstrated in the superficial layers of many soils, especially of inhabited and of cultivated localities ; and at least some of them, as also other infecting micro-organisms, no doubt flourish or at least retain their vitality on dirty surfaces, on dirty articles of bedding and of clothing, and in foul sinks and closets. It will, then, cause no surprise that the best results have been obtained in those hospitals where sterilization-methods of treatment have been accompanied by measures directed to the removal of conditions such as those just mentioned—to the maintenance of cleanliness, and to the prevention of likelihood of carriage of infecting agents by persons attendant on the sick. The necessity for the adoption of these measures is indicated in many ways. At the Vienna and the Paris maternities a great reduction of mortality followed removal of general unwholesome conditions even before sterilization-treatment was adopted, the reduction in the latter case having been from a rate of 9-3 per cent, to a rate of 2*3 per cent.; and then, after the adoption of sterilization-methods, the rate fell to 1-1 per cent. The lowness of the maternal mortality in the hospital at Helsingfors before sterilization-methods were adopted—](https://iiif.wellcomecollection.org/image/b24398305_0004.jp2/full/800%2C/0/default.jpg)
