taken with the patient the more likely he was to suffer from some of these troubles.  The soldier who was treated on the battlefield and nursed in an improvised field hospital would frequently recover, while the soldier who had the fortune to be taken into the regular hospital, where greater care was possible, succumbed to hospital gangrene.  All these facts were clearly recognised, but the surgeon, through ignorance of their cause, was helpless in the presence of these inflammatory troubles, and felt it always necessary to take them into consideration.

The demonstration that putrefaction and decay were caused by bacteria, and the early proof that the silkworm disease was produced by a micro-organism, led to the suggestion that the inflammatory diseases accompanying wounds were similarly caused.  There are many striking similarities between these troubles and putrefaction, and the suggestion was an obvious one.  At first, however, and for quite a number of years, it was impossible to demonstrate the theory by finding the distinct species of micro-organisms which produced the troubles.  We have already seen that there are several different species of bacteria which are associated with this general class of diseases, but that no specific one has any particular relation to a definite type of inflammation.  This fact made discoveries in this connection a slow matter from the microscopical standpoint.  But long before this demonstration was finally reached the theory had received practical application in the form of what has developed into antiseptic or aseptic surgery.

Antiseptic surgery is based simply upon the attempt to prevent the entrance of bacteria into the surgical wound.  It is assumed that if these organisms are kept from the wound the healing will take place without the secondary fevers and inflammations which occur if they do get a chance to grow in the wound.  The theory met with decided opposition at first, but accumulating facts demonstrated its value, and to-day its methods have been adopted everywhere in the civilized world.  As the evidence has been accumulating, surgeons have learned many important facts, foremost among which is a knowledge of the common sources from which the infection of wounds occurs.  At first it was thought that the air was the great source of infection, but the air bacteria have been found to be usually harmless.  It has appeared that the more common sources are the surgeon’s instruments, or his hands, or the clothing or sponges which are allowed to come in contact with the wounds.  It has also appeared that the bacteria which produce this class of troubles are common species, existing everywhere and universally present around the body, clinging to the clothing or skin, and always on hand to enter the wound if occasion offers.  They are always present, but commonly harmless.  They are not foreign invaders like the more violent pathogenic species, such as those of Asiatic cholera, but may be compared to domestic enemies at hand.  It is these ever-present bacteria which the surgeon must guard against.  The methods by which he does this need not detain us here.  They consist essentially in bacteriological cleanliness.  The operation is performed with sterilized instruments under most exacting conditions of cleanliness.