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, septicæmia, pyæmia, and surgical erysipelas would be
practically unknown. Death, then, would seldom occur after surgical
operations, except from hemorrhage, shock, or exhaustion.

I have taken the liberty of bringing here a number of culture tubes
containing beautiful specimens of some of the more common and