ABSTRACT
As the number of constructive repairs and voluntary operations on patients who were not already on the verge of death grew, however, the rate of postoperative mortality from infection became increasingly apparent. "Pyaemia" (caused by staphyloccus bacteria) was endemic in hospitals and epidemics of (streptococcal) "hospital infection" would occasionally sweep the wards. Although surgeons had as yet no understanding of the bacterial causes, they perceived the need for cleanliness and fought postoperative infection by dressing wounds with such agents as zinc permanganate (Condy's fluid), chlorine, cold boiled water, and bread poultices. When epidemics of "hospital infection" were particularly severe, wise surgeons closed their theaters and refused to operate. Surgical mortality rates for this period are extremely difficult to calculate and subject to wide variation. Contrary to popular mythology, however, most infections were probably not caused by the surgeon's hands or by dirty instruments. Studies of deaths following amputation show that the rate was highest after traumatic injuries, when patients were brought into the hospital already contaminated by rough-andready bandaging and dung-strewn streets.
