Blaker Family of Sussex - Reminiscences

Reminiscences

House Surgeon, County Hospital.



I LEFT the Dispensary in 1862, and about mid-summer, 1864, was elected House Surgeon to the Sussex County Hospital, a post which had been my aim since the time I was pupil there. During that interval, surgery had advanced a little, but not very much. Diseases of joints which had, during my pupilage, been treated with blisters and cupping, were now put on splints and kept at rest. The first traces of the present aseptic and antiseptic treatment of wounds might be seen in the greater cleanliness, and in the use of such lotions as lead, zinc, and specially carbolic acid instead of plain water, though it must not be forgotten that Friar's balsam, balsam of Peru, and turpentine in various forms had been used from time immemorial. The three or four sponges, which it had been the custom to use for a whole ward and which were very imperfectly washed between each dressing, were superseded by swabs of cotton-wool or fine tow, but prac-tically nothing was done to prevent the spread of septic poison. Surgeons still operated in old coats kept for the purpose, the cleansing of which consisted in allowing the pus and blood to dry and then simply brushing them off. The same morbid fear of fresh air still continued, as well as the difficulty in keeping up any ventilation. Cases of erysipelas and hospital gangrene were constantly recurring, and in the autumn of that year these diseases raged to such an extent that fourteen or fifteen patients, and also the head nurse, died in the male accident-ward in one week. The disease usually came on suddenly. A patient with a wound, however caused, apparently going on well was reported to have a rigor. This was followed by fever (there were no clinical thermo-meters in those days), restlessness, loss of appetite and perhaps vomiting. In a short time the parts round the wound became red, hot and swelled, and in a few hours gangrene commenced in a small spot and spread rapidly, sometimes over a very large extent (many inches) of surface. In some, but not a large proportion of cases, the swelling was infiltrated with gas and on pressure with the finger, a crepitating sensation was felt, like pressing an emphysematous lung. If the case did not end fatally, as frequently happened, the slough separated, leaving the muscles exposed as if they had been cleanly dissected. Repair usually took place fairly quickly. The treatment consisted in free incisions, which were immediately plugged with strips of lint soaked in turpentine; poultices, frequently of charcoal; stimulants and nourishment, with quinine and opium.

I have described these cases rather minutely, because they are now seldom or never seen. Primary union in wounds was almost unknown, and the suppuration in the larger wounds, such as amputations (which were much more common in those days than now) was enormous, often many ounces daily. Ventilators and blocks placed in the window-frames so that the sashes could not be quite closed produced a great improve-ment, but septic cases still occurred. On one occasion there was an epidemic of diphtheria, and in one ward the characteristic membrane appeared on the surface of many of the wounds. The nursing of that day was very imperfect compared with the present system of highly-trained nurses. There were no sisters, and the head nurse was generally a woman of ordinary intelligence, who had worked her way through the grades of scrubber and under nurse. They did ordinary nursing fairly well, were very attentive to patients and took much pride in their wards, but they could not do dress-ings or work of that sort, which was usually done by pupils. No charts or records were then kept in the wards.

About this time two inventions came into general use : the clinical thermometer and the hypodermic syringe, which have had so great an influence on medicine and surgery that it is diffi-cult to realise how we could have got on without them. These were followed by the ophthalmos-cope and the laryngoscope, and I well recollect a passage in one of the journals, which expressed a doubt as to whether such a strong light thrown on the retina might not seriously injure that mem-brane. These new instruments, together with the Röntgen Rays, are of course of the greatest value as aids to diagnosis, and it is to be hoped will not lessen the cultivation of the power of observation, and the senses of touch, sight and hearing, which were so evident in the older men. I well recollect Mr. S. K. Scott, years ago, coming into what is now Overton Ward, and looking at a girl evidently very ill, but in whom no definite lesion could be found, and saying "that girl has pneumonia." Nothing could be found in the lungs that day, but the next, one was nearly solid. He had a large practice, and recognised the "physiog-nomy" of disease.

About this time, 1867, the first ovariotomy at this Hospital was done by Mr. H. M. Blaker. It was a perfectly straightforward case, but things were not well understood. The clamp slipped, there was considerable hæmorrhage and the patient died from septic inflammation. Mr. E. J. Furner about this time tied the subclavian artery on both sides at different times, on the same patient. On both occasions the operation was done without anæsthetic, in order to avoid any distention of the veins. The man scarcely moved during the operation, and slept afterwards for six-teen or seventeen hours each day till he got well. Of course, in those days one end of the ligature was cut off, and the other left hanging out of the wound.

A medical man is sometimes obliged to tell patients that their disease is of a very serious or indeed fatal nature, and it is curious to observe the different manner in which such news is received. A particularly nice old man, a farm labourer, was sent into the Hospital from East Sussex with malignant disease of the lower jaw. I advised him in the gentlest manner I could to return home to his friends, as nothing in the way of operation was considered advisable.

"Be I going to die den sir?" he asked. I could only say, "Well, I am afraid we shall not be able to cure you."

"Den I don't know what dey'll do in my parish. If dey buries me dey must go widout being buried durselves, for I be de sexton."

The majority of the labouring classes in East Sussex at that time always pronounced "th" as "d." Another proof of their Saxon ancestry.

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