By JOHN B. ROBERTS, A.M., M.D., Professor of Surgery in the Woman's Medical College and in the Philadelphia Polyclinic.

The revolution which has occurred in practical surgery since the discovery of the relation of micro-organisms to the complications occurring in wounds has caused me to select this subject for discussion. Although many of my hearers are familiar with the germ theory of disease, it is possible that it may interest some of them to have put before them in a short address a few points in bacteriology which are of value to the practical surgeon.

It must be remembered that the groups of symptoms which were formerly classed under the heads "inflammatory fever," "symptomatic fever," "traumatic fever," "hectic fever," and similar terms, varying in name with the surgeon speaking of them, or with the location of the disease, are now known to be due to the invasion of the wound by microscopic plants. These bacteria, after entering the blood current at the wound, multiply with such prodigious rapidity that the whole system gives evidence of their existence. Suppuration of wounds is undoubtedly due to these organisms, as is tubercular disease, whether of surgical or medical character. Tetanus, erysipelas, and many other surgical conditions have been almost proved to be the result of infection by similar microscopic plants, which, though acting in the same way, have various forms and life histories.

A distinction must be made between the "yeast plants," one of which produces thrush, and the "mould plants," the existence of which, as parasites in the skin, gives rise to certain cutaneous diseases. These two classes of germs are foreign to the present topic, which is surgery; and I shall, therefore, confine my remarks to that group of vegetable parasites to which the term bacteria has been given. These are the micro-organisms whose actions and methods of growth particularly concern the surgeon. The individual plants are so minute that it takes in the neighborhood of ten or fifteen hundred of them grouped together to cover a spot as large as a full stop or period used in punctuating an ordinary newspaper. This rough estimate applies to the globular and the egg-shaped bacteria, to which is given the name "coccus" (plural, cocci). The cane or rod shaped bacteria are rather larger plants. Fifteen hundred of these placed end to end would reach across the head of a pin. Because of the resemblance of these latter to a walking stick they have been termed bacillus (plural, bacilli).

The bacteria most interesting to the surgeon belong to the cocci and the bacilli. There are other forms which bacteriologists have dubbed with similar descriptive names, but they are more interesting to the physician than to the surgeon. Many micro-organisms, whether cocci, bacilli, or of other shapes, are harmless, hence they are called non-pathogenic, to distinguish them from the disease-producing or pathogenic germs.

As many trees have the same shape and a similar method of growing, but bear different fruits - in the one case edible and in the other poisonous - so, too, bacteria may look alike to the microscopist's eye, and grow much in the same way, but one will cause no disease, while the other will produce perhaps tuberculosis of the lungs or brain.

Many scores of bacteria have been, by patient study, differentiated from their fellows and given distinctive names. Their nomenclature corresponds in classification and arrangement with the nomenclature adopted in different departments of botany. Thus we have the pus-causing chain coccus (streptococcus pyogenes), so-called because it is globular in shape, because it grows with the individual plants attached to each other, or arranged in a row like a chain of beads on a string, and because it produces pus. In a similar way we have the pus-causing grape coccus of a golden color (staphylococcus pyogenes aureus). It grows with the individual plants arranged somewhat after the manner of a bunch of grapes, and when millions of them are collected together, the mass has a golden yellow hue. Again, we have the bacillus tuberculosis, the rod-shaped plant which is known to cause tuberculosis of the lungs, joints, brain, etc.

It is hardly astonishing that these fruitful sources of disease have so long remained undetected, when their microscopic size is borne in mind. That some of them do cause disease is indisputable, since bacteriologists have, by their watchful and careful methods, separated almost a single plant from its surroundings and congeners, planted it free from all contamination, and observed it produce an infinitesimal brood of its own kind. Animals and patients inoculated with the plants thus cultivated have rapidly become subjects of the special disease which the particular plant was supposed to produce.

The difficulty of such investigation becomes apparent when it is remembered that under the microscope many of these forms of vegetable life are identical in appearance, and it is only by observing their growth when in a proper soil that they can be distinguished from each other. In certain cases it is quite difficult to distinguish them by the physical appearances produced during their growth. Then it is only after an animal has been inoculated with them that the individual parasite can be accurately recognized and called by name. It is known then by the results which it is capable of producing.

The various forms of bacteria are recognized, as I have said, by their method of growth and by their shape. Another means of recognition is their individual peculiarity of taking certain dyes, so that special plants can be recognized, under the microscope, by the color which a dye gives to them, and which they refuse to give up when treated with chemical substances which remove the stain from, or bleach, all the other tissues which at first have been similarly stained.

The similarity between bacteria and the ordinary plants with which florists are familiar is, indeed, remarkable. Bacteria grow in animal and other albuminous fluids; but it is just as essential for them to have a suitable soil as it is for the corn or wheat that the farmer plants in his field. By altering the character of the albuminous fluid in which the micro-organism finds its subsistence, these small plants can be given a vigorous growth, or may be actually starved to death. The farmer knows that it is impossible for him to grow the same crop year after year in the same field, and he is, therefore, compelled to rotate his crops. So it is with the microscopic plants which we are considering.