Antiseptic practice in surgery

Greek medicine used wine and vinegar in wound dressing. Alcohol gained favor and around 1820 iodine became popular in France for treating wounds.

Charles White (1728-1813) of Manchester emphasized the importance of cleanliness in obstetrical practice while Oliver Wendell Holmes (1809-1894), in a paper On the Contagiousness of Puerperal Fever in 1843, argued that women in labor should not be treated by a doctor who had recently conducted an autopsy or how had treated a patient with puerperal fever.

Germ-theory first came to the attention of medical practitioners in the controversies over antiseptic surgery that began in Britain in the late 1860s. Joseph Lister accepted Louis Pasteur’s notion that microorganisms were involved in suppuration and began developing the elements of antiseptic wound management in 1865.

Joseph Lister

By the end of the decade, Lister has created an elaborate surgical protocol incorporating antiseptic sprays and dressings, particularly of carbolic acid.

As early as 1874, Pasteur had suggested placing the instruments in boiling water and passing them through a flame; heat sterilization of instruments was accepted by Robert Koch in 1881.

Primed with the science of bacteriology and knowledge of Pasteur and Koch’s laboratory autoclaves surgical heat sterilization emerged in France and Germany between 1883 and 1893.

Neuber of Kiel was probably the first to autoclave operating gowns in 1883 and then advocate sterile caps and rubber shows in 1886.

In 1867, Lister published Antiseptic Principle of the Practice of Medicine. Within five years, surgeons using Lister’s antiseptic techniques were able to reduce the surgical mortality rate from nearly 60 percent all the way down to 4 percent. By the time Lister retired in 1892, antiseptic surgery had established itself.
Antiseptic practice in surgery

Theodoric Borgognoni (1205-1298)

One of the most important medieval surgeons, also known as Teodorico dei Borgognoni, Teodorico of Lucca, and Teodorico of Cervia, Theodoric Borgognoni was born in Lucca (Tuscany) in 1205. He was the last of the five children of the Luccan surgeon Ugo Borgognoni (d. c. 1259).

Theodoric was a medieval Italian surgeon who anticipated Henri de Mondeville, Paracelsus and Lord Joseph Lister in suggesting that cleanliness was of major importance in wound healing.

Theodoric moved to Bologna in 1214 when his father was hired as town physician, possibly at the instigation of count Rodolfo Borgognoni.

Theodoric learned the art of surgery from his father, an art he exercised with notable success both inside and outside the monastery. Though he joined the Dominican Order and later became a bishop, Theodoric continued to practice surgery and composed a textbook on the subject.

He compiled a Surgery in 1267 in which he proposed that the common practice of promoting suppuration in a wound by probing, packing and dressing was worse than useless. Indeed, he recommends that ‘all wound except bruises ought to be dried out’.

Theodoric Borgognoni was also an advocate of anesthesia and there is evidence that attempts were made to induce a state of unconsciousness to allow surgery to be carried out. Opiates and other plant extracts, including hemlock were soaked into a sponge which was then held under a patient’s nose.
Theodoric Borgognoni (1205-1298)