[나의 좌충우돌 의학유산 탐방기] Joseph Lister who sterilized the surgery⑥

In 1867, Sir James Young Simpson (1st Baronet; 1811-1870), an Edinburgh surgeon-obstetrician, published the results of a survey of 2,000 patients admitted to hospitals in England who underwent ‘limb amputation’. In a large hospital with more than 300 beds, the mortality rate was 41% and the main cause was infection.

It was a shocking fact. But even more shocking was the fact that out-of-hospital amputations had a mortality rate of only 11% (200 people surveyed)! If you have surgery in a hospital night, the mortality rate will be reduced by a quarter? At least, it had to be interpreted as saying that hospitals are more dangerous for amputees.

okay? Then why not have the surgery done at home instead of in the hospital? It might have been possible if you were rich. But poor patients did not have the money to call doctors and assistants home to operate.

So, was the in-hospital surgical mortality rate so high in the UK alone? not. So did other European cities. Paris at 60%, Zurich at 46% and Glasgow at 34%. Others, such as Berlin, Munich, and Copenhagen, did not show significant differences in mortality rates. North America was similar, with MGH in Boston at 26% and Pennsylvania Hospital in Philadelphia at 24%.

Because of these disappointing results, Simpson boldly declared that “those who lie on the operating table of one of our country’s surgical hospitals are more likely to die than the British soldiers at the Battle of Waterloo.” Hey, do you really want to be like that? So I did some research.

John H Clark, ‘The Morning After the Battle of Waterloo’, 1826. Wikipedia source.

At the Battle of Waterloo in 1815, Britain, Prussia, and the Netherlands formed an allied force against Napoleon’s French forces. A total of 190,000 troops clashed on both sides.

To test whether Simpson’s claim is true, let’s look at the British military. The number of troops involved in the battle was 68,000. Of these, 3,500 were dead, 3,300 were missing, and 10,200 were injured. Combat mortality is estimated at about 5%, and 10% including missing persons. In addition, the death rate for wounded soldiers hospitalized in the field hospital was 9%, so if you add up these factors, the death rate for British soldiers who participated in the Battle of Waterloo is about 20%.

When calculated in this way, it is less than the 24 to 60% chance of dying after an amputation operation in a large hospital in a large city in peacetime. So Simpson’s statement is not without basis.
However, there is one pitfall here. Intuitively, the death rate for veterans at that time was only 20%? In many classic movies, dramas, and novels, being dragged to the battlefield is described as death, but the mortality rate is only about 20%? Unbelievable.

There were other variables. In fact, far more people died in the war than those who died in war. For example, in 1802, Napoleon sent 25,000 men to suppress Haiti’s independence movement by force, of which 22,000 died of yellow fever. A whopping 88% died from infectious diseases rather than combat.

Not just yellow fever. Thousands of soldiers mobilized on the battlefield contracted typhoid, dysentery, plague, typhus, malaria, measles, mumps, meningitis, smallpox, diphtheria, tetanus, and the flu. Therefore, an absolutely large number of military personnel lost their lives to the attack of microorganisms, not the enemy’s guns. What’s more, the microbes did not differentiate between friendly and foe.

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The number of dead more than the number of soldiers was from World War I, which began in 1925. From this war on, military commanders and military officers were able to save a little face. But what is the difference between a soldier and a warrior from the perspective of a family waiting for a father and son to go to war?

James Simpson.  Wikipedia source.
James Simpson. Wikipedia source.

If the Simpson’s revelations (!) were calculated by adding up the number of soldiers and casualties at the Battle of Waterloo, wouldn’t the surgeons be a little more respectful? But who is Simpson? Wasn’t he Edinburgh’s premier surgeon-obstetrician, and one who introduced chloroform anesthesia, and even received the title of baron from Queen Victoria in 1866 with the honor of ‘conqueror of pain’? So the weight of his remarks is never light. For surgeons, it would have been a bittersweet word.

In addition to Simpson’s revelations, let’s look at a novel that shows the reality of surgery at the time. Written by Sir Frederick Treves (1st Baronet; 1853-1923) is part of The author was also made into a movie, <The Elephant Man; Surgeon and writer who wrote The Elephant Man and Other Reminiscences (1923).

I was instructed by a woman to obtain permission for her daughter’s surgery. The surgery wasn’t great. I talked to the woman in the parlor. She discussed her and her surgical procedure in great detail, in my opinion, in a sympathetic and hopeful tone. After her conversation, she asked her if she consented to her surgery, and she replied. “Agreeing to the operation is fine, but who pays for the funeral?”

Contrary to the enthusiasm of the doctors, the citizens thought that surgery was death. Unfortunately, that was the reality. Anesthesia alone cannot be said to be a revolutionary breakthrough in surgery. Because of the drastic surgery, more patients died from infection. Special measures were required. Wasn’t this the darkest period in the history of surgery? But since it was the darkest period, a new light was coming little by little.

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