The metastatic abscesses of pyaemia are clearly explained when the surgeon remembers that they are simply due to a softened blood clot containing pus-causing germs being carried through the circulation and lodged in some of the small capillaries.

A patient suffering with numerous boils upon his skin has often been a puzzle to his physician, who has in vain attempted to find some cause for the trouble in the general health alone.  Had he known that every boil owed its origin to pus bacteria, which had infected a sweat gland or hair follicle, the treatment would probably have been more efficacious.  The suppuration is due to pus germs either lodged upon the surface of the skin from the exterior or deposited from the current of blood in which they have been carried to the spot.

I have not taken time to go into a discussion of the methods by which the relationship of micro-organisms to surgical affections has been established; but the absolute necessity for every surgeon to be fully alive to the inestimable value of aseptic and antiseptic surgery has led me to make the foregoing statements as a sort of resume of the relation of the germ theory of disease to surgical practice.  It is clearly the duty of every man who attempts to practice surgery to prevent, by every means in his power, the access of germs, whether of suppuration, putrefaction, erysipelas, tubercle, tetanus, or any other disease, to the wounds of a patient.  This, as we all know, can be done by absolute bacteriological cleanliness.  It is best, however, not to rely solely upon absolute cleanliness, which is almost unattainable, but to secure further protection by the use of heat and antiseptic solutions.  I am fully of the opinion that chemical antiseptics would be needless if absolute freedom from germs was easily obtained.  When I know that even such an enthusiast as I myself is continually liable to forget or neglect some step in this direction, I feel that the additional security of chemical antisepsis is of great value.  It is difficult to convince the majority of physicians, and even ourselves, that to touch a finger to a door knob, to an assistant’s clothing, or to one’s own body, may vitiate the entire operation by introducing one or two microbic germs into the wound.

An illustration of how carefully the various steps of an operation should be guarded is afforded by the appended rules, which I have adopted at the Woman’s Hospital of Philadelphia for the guidance of the assistants and nurses.  If such rules were taught every medical student and every physician entering practice as earnestly as the paragraphs of the catechism are taught the Sunday school pupil (and they certainly ought to be so taught) the occurrence of suppuration, hectic fever, septicaemia, pyaemia, and surgical erysipelas would be practically unknown.  Death, then, would seldom occur after surgical operations, except from hemorrhage, shock, or exhaustion.