The value of cleanliness in the conduct of examination and surgical procedures had been recognized since ancient times and was also strongly promoted by the writings of Guy de Chauliac and others. However, the re-introduction of cadaveric dissection and the role of the autopsy (often carried out in the operating theatre) to identify the cause of death introduced a carelessness (or unwillingness to recognize the risks) as to how a lack of cleanliness might promote infection. Even in the 1870s surgeons were want to wear a jacket stained with blood from their other operations and the same jacket would be worn with pride, the more stains the greater the prowess of the surgeon. Lenses to facilitate microscopy were first developed in the 1600's which enabled microbes to be visualised though their role was not then understood. The miasma theory of disease transmission predominated well into the 19th century until the work of Louis Pasteur (fowl cholera) and Robert Koch (anthrax and malaria) demonstrated the link between microbes and disease. Progress in infection prevention, particularly in relation to post-partum infection took place during the first half of the 19th century with the work of Alexander Gordon (Aberdeen), Oliver Wendall Holmes (Boston) and Ignác Semmelweis (Vienna and Budapest). Their approach was cleanliness (hands and clothes), avoiding contamination from autopsy and, in Semmelweis' units hand washing with chlorina liquida with the result that post partum infections were dramatically reduced. Between the 1830's and 1860's chemists and doctors in France, Italy and England recognised the ability of carbolic acid to eradicate infection from wounds, amputation stumps and ulcers. In 1867, James Lister, Professor of Surgery in Glasgow reported a small case series on open fractures in the Lancet with impressive results. Under Lister's influence and reputation, the use of carbolic for antisepsis slowly increased and became best practice through the rest of the century, with strong advocates in Italy, France and Germany, despite carbolic's deleterious effects and toxicity for the granulation tissue and epitheliasation so essential for wound healing. Robert Koch's work on wound infection led to the concept of asepsis rather than antisepsis. In the twentieth century carbolic (phenol) was replaced by other antiseptic agents that are less toxic, such as hypochlorite, hydrogen peroxide, mercuric chloride, eusol, iodine and alcohol. Today, povidone iodine and chlorhexidine (acqueous or alcohol based) are the commonly used antiseptics. During the late nineteenth century laboratories also investigated how to kill bacteria using heat, steam and pressure as well as developing chemical disinfectants. This enabled surgeons to sterilize their instruments and dressings as well as safer disinfection of wound and excision sites. The second half of this chapter deals with the introduction of anaesthesia (general, local and spinal) in the nineteenth century and further progress in anaesthesia, intensive care, and pain medicine through the twentieth century.

The Nineteenth Century: Anti-sepsis, Asepsis, Antibiotics and Anaesthesia

章节
发表日期：

2025年

查看全文

Saleh Abbas,
David Watters

摘要

The value of cleanliness in the conduct of examination and surgical procedures had been recognized since ancient times and was also strongly promoted by the writings of Guy de Chauliac and others. However, the re-introduction of cadaveric dissection and the role of the autopsy (often carried out in the operating theatre) to identify the cause of death introduced a carelessness (or unwillingness to recognize the risks) as to how a lack of cleanliness might promote infection. Even in the 1870s surgeons were want to wear a jacket stained with blood from their other operations and the same jacket would be worn with pride, the more stains the greater the prowess of the surgeon. Lenses to facilitate microscopy were first developed in the 1600's which enabled microbes to be visualised though their role was not then understood. The miasma theory of disease transmission predominated well into the 19th century until the work of Louis Pasteur (fowl cholera) and Robert Koch (anthrax and malaria) demonstrated the link between microbes and disease. Progress in infection prevention, particularly in relation to post-partum infection took place during the first half of the 19th century with the work of Alexander Gordon (Aberdeen), Oliver Wendall Holmes (Boston) and Ignác Semmelweis (Vienna and Budapest). Their approach was cleanliness (hands and clothes), avoiding contamination from autopsy and, in Semmelweis' units hand washing with chlorina liquida with the result that post partum infections were dramatically reduced. Between the 1830's and 1860's chemists and doctors in France, Italy and England recognised the ability of carbolic acid to eradicate infection from wounds, amputation stumps and ulcers. In 1867, James Lister, Professor of Surgery in Glasgow reported a small case series on open fractures in the Lancet with impressive results. Under Lister's influence and reputation, the use of carbolic for antisepsis slowly increased and became best practice through the rest of the century, with strong advocates in Italy, France and Germany, despite carbolic's deleterious effects and toxicity for the granulation tissue and epitheliasation so essential for wound healing. Robert Koch's work on wound infection led to the concept of asepsis rather than antisepsis. In the twentieth century carbolic (phenol) was replaced by other antiseptic agents that are less toxic, such as hypochlorite, hydrogen peroxide, mercuric chloride, eusol, iodine and alcohol. Today, povidone iodine and chlorhexidine (acqueous or alcohol based) are the commonly used antiseptics. During the late nineteenth century laboratories also investigated how to kill bacteria using heat, steam and pressure as well as developing chemical disinfectants. This enabled surgeons to sterilize their instruments and dressings as well as safer disinfection of wound and excision sites. The second half of this chapter deals with the introduction of anaesthesia (general, local and spinal) in the nineteenth century and further progress in anaesthesia, intensive care, and pain medicine through the twentieth century.