The results observed at Compiegne showed us that suppuration of wounds can be suppressed, and that the majority of wounds are capable of being sterilised and sutured. The practical value of the method depends upon the possibility of its being employed at other hospitals. As a matter of fact, the objection has been raised that the chemical sterilisation of wounds is, technically speaking, too delicate a method for general employment. It will be as well, therefore, to demonstrate how, without increase of staff, by the aid of apparatus whose cost does not exceed a dozen francs per bed, using substances which cost much less than ether, hydrogen peroxide, or alcohol, usually employed in treatment of wounds, it has been possible to apply the abortive treatment of infection and the curative treatment of suppuration in some of the hospitals at the front {ambulances de I'avant), and in some of the territorial hospitals.

A. Abortive Treatment Of Infection

The abortive treatment of infection, instituted at Compiegne in the spring of 1915, was tried experimentally in the hospitals from the month of July in the same year by le Medecin Principal Uffoltz, Directeur du Service de Sante d'un Corps d'Armee. From that date M. Uffoltz and his colleagues demonstrated that under the ordinary conditions of a field-hospital, the method could be employed almost in its entirety, and that a considerable improvement in results was the consequence. In one of the hospitals under the charge of M. Uffoltz, le Medecin-Major Perret succeeded in banishing wound infection almost completely. The ordinary staff was able to apply the method in accurate detail. The demonstration of the practical value of the method in the field-hospitals was brilliantly achieved by MM. Hornus and Perrin, who succeeded in protecting their cases from septic accidents, in preserving limbs with enormous injuries, and in cutting short to a large extent the duration of treatment, by the secondary union of wounds.

Nor is the number of cases any obstacle to the employment of the method. At the hospital at La Panne, which contains from 600 to 700 wounded, M. Depage and his colleagues proved that the sterilisation of wounds could be carried out on a large scale. It had, however, been said that the small size of our hospital at Compiegne allowed us to lavish an amount of attention on our cases which would have been impossible if these cases had amounted to several hundreds. Therefore it is important to realise that the staff of a great hospital succeeded in practising the sterilisation of wounds in every case, in following the progress of chemical cleansing upon the bacteriological charts, and in closing wounds as soon as they ceased to harbour microbes. In this hospital, which contains nearly 700 wounded, suppuration was almost completely abolished, without the necessity of increasing the personnel or altering the general organisation.

The results observed in M. Uffoltz' field-hospitals and M. Depage's hospital show that the abortive treatment of infection can be realised in the "formations sanitaires" at the front, when these are well organised and controlled.

Where wounded men are arriving in large numbers, and it is necessary to evacuate them rapidly on the hospitals in the rear, the abortive treatment of infection may still be attempted. As the surgical intervention which precedes chemical sterilisation is identical with that which should always be practised, it matters little that the treatment may be interrupted a few hours or days after its institution. In this case, indeed, the wounded man is in the same position as would be his after the ordinary treatment; but he has benefited by the commencement of the sterilising process. Moreover, the treatment can be resumed the moment he reaches the hospital in which he is finally to remain.

B. The Disinfection Of Suppurating Wounds

The application of the method, which is difficult and occasionally impossible in field-hospitals crowded with wounded men, can always be carried out in the territorial hospitals, in which men with suppurating wounds are received after the lapse of a few days or weeks. The observations made at the Compiegne hospital since September, 1916, have shown that wounds already deeply infected, whether accompanied by fractures or otherwise, can be sterilised as well as fresh wounds, although somewhat more slowly. When the patient had gone through the commencement of chemical sterilisation by Dakin's solution in the advanced field-hospital (first-line ambulance), the wound was comparatively lightly infected, and the rate of disinfection was more rapid.

Identical results have been obtained in all those hospitals in which the method has been applied in all its details. Thus in M. Tuffier's hospital at Saint-Germain, and in M. Chutro's wards at the Buffon hospital, suppurating wounds became a thing of the past. Suppuration in wounds, in short, ought not to exist, except in exceptional cases and for a limited time. The presence of pus in a hospital denotes that the technical methods employed there are defective. Every wounded man whose injury suppurates has a right to call his surgeon to account.

V. Conclusions

Since our methods have been employed with success under the ordinary conditions of field and base hospitals, the sterilisation of both fresh and suppurating wounds ought to be practised almost everywhere. But surgeons should not forget that all the details of the method have been studied experimentally and established in a certain way to produce a certain result. Neither the preparation of Dakin's solution may be modified, nor the processes for the mechanical and chemical cleansing of wounds. It is indispensable to learn the method before attempting to apply it, and this apprenticeship demands several weeks, even from an experienced surgeon. But we can be quite sure that, applied in their entirety, the methods just described will produce the desired results. Admitted, their use exacts more precision and more care than the old methods, for any approach towards technical perfection requires more elaborate apparatus and a more specialised staff. But efforts of no great magnitude on the part of doctors and nurses will most certainly yield an immense improvement in results.

The nation has the right to ask from the medical corps that progress in the treatment of the wounded which is so acutely needed