HISTORY OF SURGICAL INFECTION Background

HISTORY OF SURGICAL INFECTION Background

Surgical infections have always been a major complication related to surgery and trauma and have been documented for 4000–5000 years. Egyptians popularised some concepts about infection, as they were able to prevent putrefaction using their skills in mummification. Their medical papyruses also describe the use of salves and antiseptics to prevent surgical site infec tions (SSIs). This ‘prophylaxis’ had also been known earlier by the Assyrians, although it is less well documented. It was described again independently by the Greeks. The Hippocratic teachings described the use of antimicrobials, such as wine and vinegar, w hich were widely used to irrigate open, infected wounds before delayed primary or secondary wound closure. A belief common to all these civilisations, and indeed even later to the Romans, was that Hippocrates of Kos , Greek physician and surgeon, and by common consent ‘the father of medicine’, was born on the island of Kos, o ff Turkey , about 460 /uni00A0/b.sc/c.sc/e.sc and probably died in 375 /uni00A0 /b.sc/c.sc/e.sc . Galen , 130–200, Roman physician, commenced practice as Surgeon to the Gladiators at Pergamum (now Bergama in Turkey) and later became personal physician to the Emperor Marcus Aurelius. As a prolific writer in anatomy , medicine, pathology and philosophy , his work a ff ected medical thinking for 15 centuries after his death. (Gladiator is Latin for ‘swordsman’.) Theodoric of Cervia , 1210–1298, Bishop of Cervia, published a book on surgery ca. 1267. Ambroise Paré , 1510–1590, French military surgeon, also worked at the Hotel Dieu, Paris, France. Guy de Chauliac , 1298–1368, physician and chaplain to Pope Clement VI at Avignon, France, and the author of Robert Koch , 1843–1910, Professor of Hygiene and Bacteriology , Berlin, Germany , stated his ‘Postulates’ in 1882. Ignaz Semmelweis , 1818–1865, Professor of Obstetrics, Budapest, Hungary . whenever pus was localised in an infected wound it needed to be drained. Galen recognised that this localisation of infection (sup - puration) in wounds inflicted in the gladiatorial arena often heralded recovery , particularly after drainage ( pus bonum et laudabile ) . Theodoric of Cervia, Ambroise Paré and Guy de Chauliac observed that clean wounds, closed primarily , could heal without infection or suppuration. -

To learn: Koch’s postulates • The management of abscesses • The Surviving Sepsis Campaign, sepsis bundle and • Sepsis Six Surgical implications of the COVID-19 pandemic • To appreciate: The importance of aseptic and antiseptic techniques and • delayed primary or secondary closure in contaminated wounds To be aware of: The causes of reduced resistance to infection (host • response) To know: The de /f_i nitions of infection, particularly at surgical sites • What basic precautions to take to avoid surgically relevant • hospital-acquired infections

HISTORY OF SURGICAL INFECTION Background

Surgical infections have always been a major complication related to surgery and trauma and have been documented for 4000–5000 years. Egyptians popularised some concepts about infection, as they were able to prevent putrefaction using their skills in mummification. Their medical papyruses also describe the use of salves and antiseptics to prevent surgical site infec tions (SSIs). This ‘prophylaxis’ had also been known earlier by the Assyrians, although it is less well documented. It was described again independently by the Greeks. The Hippocratic teachings described the use of antimicrobials, such as wine and vinegar, w hich were widely used to irrigate open, infected wounds before delayed primary or secondary wound closure. A belief common to all these civilisations, and indeed even later to the Romans, was that Hippocrates of Kos , Greek physician and surgeon, and by common consent ‘the father of medicine’, was born on the island of Kos, o ff Turkey , about 460 /uni00A0/b.sc/c.sc/e.sc and probably died in 375 /uni00A0 /b.sc/c.sc/e.sc . Galen , 130–200, Roman physician, commenced practice as Surgeon to the Gladiators at Pergamum (now Bergama in Turkey) and later became personal physician to the Emperor Marcus Aurelius. As a prolific writer in anatomy , medicine, pathology and philosophy , his work a ff ected medical thinking for 15 centuries after his death. (Gladiator is Latin for ‘swordsman’.) Theodoric of Cervia , 1210–1298, Bishop of Cervia, published a book on surgery ca. 1267. Ambroise Paré , 1510–1590, French military surgeon, also worked at the Hotel Dieu, Paris, France. Guy de Chauliac , 1298–1368, physician and chaplain to Pope Clement VI at Avignon, France, and the author of Robert Koch , 1843–1910, Professor of Hygiene and Bacteriology , Berlin, Germany , stated his ‘Postulates’ in 1882. Ignaz Semmelweis , 1818–1865, Professor of Obstetrics, Budapest, Hungary . whenever pus was localised in an infected wound it needed to be drained. Galen recognised that this localisation of infection (sup - puration) in wounds inflicted in the gladiatorial arena often heralded recovery , particularly after drainage ( pus bonum et laudabile ) . Theodoric of Cervia, Ambroise Paré and Guy de Chauliac observed that clean wounds, closed primarily , could heal without infection or suppuration. -

To learn: Koch’s postulates • The management of abscesses • The Surviving Sepsis Campaign, sepsis bundle and • Sepsis Six Surgical implications of the COVID-19 pandemic • To appreciate: The importance of aseptic and antiseptic techniques and • delayed primary or secondary closure in contaminated wounds To be aware of: The causes of reduced resistance to infection (host • response) To know: The de /f_i nitions of infection, particularly at surgical sites • What basic precautions to take to avoid surgically relevant • hospital-acquired infections

HISTORY OF SURGICAL INFECTION Background

Surgical infections have always been a major complication related to surgery and trauma and have been documented for 4000–5000 years. Egyptians popularised some concepts about infection, as they were able to prevent putrefaction using their skills in mummification. Their medical papyruses also describe the use of salves and antiseptics to prevent surgical site infec tions (SSIs). This ‘prophylaxis’ had also been known earlier by the Assyrians, although it is less well documented. It was described again independently by the Greeks. The Hippocratic teachings described the use of antimicrobials, such as wine and vinegar, w hich were widely used to irrigate open, infected wounds before delayed primary or secondary wound closure. A belief common to all these civilisations, and indeed even later to the Romans, was that Hippocrates of Kos , Greek physician and surgeon, and by common consent ‘the father of medicine’, was born on the island of Kos, o ff Turkey , about 460 /uni00A0/b.sc/c.sc/e.sc and probably died in 375 /uni00A0 /b.sc/c.sc/e.sc . Galen , 130–200, Roman physician, commenced practice as Surgeon to the Gladiators at Pergamum (now Bergama in Turkey) and later became personal physician to the Emperor Marcus Aurelius. As a prolific writer in anatomy , medicine, pathology and philosophy , his work a ff ected medical thinking for 15 centuries after his death. (Gladiator is Latin for ‘swordsman’.) Theodoric of Cervia , 1210–1298, Bishop of Cervia, published a book on surgery ca. 1267. Ambroise Paré , 1510–1590, French military surgeon, also worked at the Hotel Dieu, Paris, France. Guy de Chauliac , 1298–1368, physician and chaplain to Pope Clement VI at Avignon, France, and the author of Robert Koch , 1843–1910, Professor of Hygiene and Bacteriology , Berlin, Germany , stated his ‘Postulates’ in 1882. Ignaz Semmelweis , 1818–1865, Professor of Obstetrics, Budapest, Hungary . whenever pus was localised in an infected wound it needed to be drained. Galen recognised that this localisation of infection (sup - puration) in wounds inflicted in the gladiatorial arena often heralded recovery , particularly after drainage ( pus bonum et laudabile ) . Theodoric of Cervia, Ambroise Paré and Guy de Chauliac observed that clean wounds, closed primarily , could heal without infection or suppuration. -

To learn: Koch’s postulates • The management of abscesses • The Surviving Sepsis Campaign, sepsis bundle and • Sepsis Six Surgical implications of the COVID-19 pandemic • To appreciate: The importance of aseptic and antiseptic techniques and • delayed primary or secondary closure in contaminated wounds To be aware of: The causes of reduced resistance to infection (host • response) To know: The de /f_i nitions of infection, particularly at surgical sites • What basic precautions to take to avoid surgically relevant • hospital-acquired infections