The Bolognese surgeon Giuseppe Ruggi: how and why the aseptic surgery was introduced in Bologna in the middle half of the XIX century.

BACKGROUND: The first reliable statistic data about perioperatory mortality were published in 1841 by the French Joseph-Francois Malgaigne (1806-1863): he referred to a mean mortality of 60% for amputations and this bad result was to be attributed mainly to hospital acquired diseases. The idea of "hospital acquired disease" although vague, included five infective nosologic entities, which at that time were diagnosed more frequently: erysipelas, tetan, pyemia, septicemia, and gangrene. Nonetheless, the suppuration with pus production was considered from most of the surgeons and doctors of that time as a necessary and unavoidable step in the process of wound healing. During the end of the eighteenth century, hospitals of the main European cities were transforming into aggregations of several wards, where the high concentration of patients created poor sanitary conditions and a consistent increase of perioperatory mortality. In 1865, Lister applied his first antiseptic dressing on the surface of an exposed fracture. These experimental attempts lead to an effective reduction of wound infections respect to the dressing with strings used previously. DISCUSSION: Lister's innovations in the field of wound treatment were based on two brand new concepts: germs causing rot were ubiquitarious and the wound infection was not a normal step in the process of wound healing. The concept of antisepsis was hardly accepted in the European surgical world: "Of all countries, Italy is the most indifferent and uninterested in experimenting this method, which has been so favorably judged from the greatest surgical societies in Germany". This quotation from the young surgeon Giuseppe Ruggi (1844-1925) from Bologna comes from his article where he presented his first experiences on aseptic medications started the previous year in the Surgical Department of Maggiore Hospital in Bologna. In his report, Ruggi described the adopted technique and suggested that the medication should be extended to all the surgical patients of the hospital:"… this is needed to totally remove from the hospital all those elements of infection which grow in the wounds dressed with the old method". The experimentation of this new dressing for the few treated cases was rigorous and concerned both the sterilization of surgical tools with the fenic acid (5%) and the shaving of the skin. Ruggi also observed that there was no correlation between the seriousness of the wound and its extension or way of healing: when "simple" cases that "should heal without complication" showed fever he often realized that "it was often due to a medication performed without following the rules for an accurate disinfection and dressing". Ruggi thought that the fever was connected to "reabsorption of pyrogenic substances, which can be removed cleaning and disinfecting the wound" in cases of wounds not accurately dressed and rarely medicated. Frequent postoperative medications of the wound were able to eliminate the fever within 2 h. Ruggi's attitude toward the fine reasoning lead him to introduce the concept of immunodeficiency related to physical deterioration: "… patients treated for surgical disease may sometimes suffer from complications of medical conditions, which initially escape the most accurate investigations… The surgical operation could, in some cases, hold the balance of power". CONCLUSIONS: The obtained results, published in 1879, appear extremely interesting. As he wrote in 1898, for the presentation of his case record of more than 1000 laparotomies, he had started "… operating as a young surgeon without any tutor, helped only by his mind and what he could deduce from publications existing at the moment …".

[Three centuries of surgery at Coltea Hospital]. / Trei secole de chirurgie la Spitalul Coltea.

The authors present the evolution of surgery at Coltea Hospital during the last three centuries. After a brief history of the Coltea hospital and its masters surgeons, the attention is drawn on the masters efforts to optimize the care, equipment and surgery techniques, things that became of national and world-wide importance.

The Glove Made from Love: A History of Surgical Attire.

The development of surgical attire is well documented in historical photographs and evolved in response to the changing understanding of aseptic and antiseptic techniques. Surgeons throughout time remained significantly opposed to changes in attire, and it was over a century that we evolved from wearing black frock coats to the current attire of today. Interestingly, surgical attire remains a source of controversy even today, with a recent argument regarding skull versus bouffant caps that was quite publicly debated.

[Semmelweis and his outstanding contribution to medicine: washing hands saves lives]. / Semmelweis y su aporte científico a la medicina: Un lavado de manos salva vidas.

Ignaz Semmelweis was a Hungarian obstetrician who in the nineteenth century, preceding the discoveries of Pasteur and Lister, proposed the infectious etiology of puerperal sepsis. With a simple antiseptic procedure, he achieved marked reduction of the prevalence of this disease. However, he needed to fight against the reluctance of his colleagues who didn't accept his observations although they were, for the first time in the history of science, supported by statistical significance analysis. This report describes biographical data of this revolutionary physician and the circumstances of his strange death based on information not often revealed.

[A network of control technologies. A new perspective on the origins of modern surgery]. / Ein Netzwerk von Kontrolltechnologien. Eine neue Perspektive auf die Entstehung der modernen Chirurgie.

This essay describes the emergence of modern surgery as the construction of a network of control technologies. The theoretica basis of this analysis makes use of Actor Network Theory and Joseph Rouse's Foucaultian approach for characterizing the laboratory as an artificial micro-world. On a concrete level, the paper first deals with the history of surgical instruments as tools for a controlled intervention into the human body. The introduction of antisepsis and asepsis make up a second example, since these technologies embody with particular clarity the increase of control that went along with the emergence of modern surgery. These examples demonstrate the use of the concept of control as an analytic category for a better understanding of the origins of modern surgery's technological success and its interpretation in the context of the emergence of modern societies.

Antisepsis and Asepsis and How They Shaped Modern Surgery.

Surgical antisepsis and asepsis established the standard of using scientific evidence to determine surgical practice. The microbiological discoveries of Louis Pasteur (1822-1895) were the inspiration for Joseph Lister's (1827-1912) use of carbolic acid as an antiseptic on surgical wounds. German and Swiss surgeons invented aseptic surgical practice based on the studies of Robert Koch (1843-1910), a life-saving revolution in medicine as profound as anesthesia. Together they changed human history, sparing millions the horrors of hospital gangrene and making the entire body accessible to surgical intervention. In the United States, surgeons followed the lead of their brethren across the Atlantic. Americans, characteristically pragmatic, naturally resisted what they saw as unnecessary complexity in Listerism. Once they accepted germ theory, the undeniable scientific evidence led to the rapid acceptance of asepsis. Among the wide-ranging effects of this transition in practice were the creation of the current model of the academic department of surgery and the modern concept of surgical professionalism.

[On the centennial of Ernst von Bergmann's death]. / Zum 100. Todestag Ernst von Bergmanns.

"dear aunt lina. i do not know any big letters yet, but i want to thank you in small letters for the beautiful pens. say hello to grandpa and to everybody. yours truly, ernst." These are the first surviving written words of Ernst von Bergmann. Between them and his last words about his suspected colon cancer on 25 March 1907 ("I diagnosed this 5 years ago, and now it has come to pass.") lie many years in a vigorous life characterised by untiring activity and creativity, self-discipline, and care for patients and his family. They were years of enormous success in surgery and private happiness but also of professional setbacks and tragic family loss. Ernst von Bergmann became a leading German surgeon not only because of his surgical and scientific achievements, particularly in the fields of asepsis and war surgery, but also due to his exemplary character, reliability, engaging personality, and commitment to medical training in various medical societies. Of these, the German Society of Surgery is most indebted to him. After assuming a chair in surgery in 1882, he continued to play a leading role in this society, not least as its five-time president from 1888 to 1890 and in 1896 and 1900. A worthy successor to Bernhard von Langenbeck, he was a full professor at the Berlin University Hospital for 25 years. He also taught at the Medical and Surgical Academy for the Military after being appointed there by Emperor Wilhelm I on 16 November 1882. This position was important to him and corresponded to his patriotic views.

Joseph Landsberger (1848-1933): medical man in a time of change.

Joseph Landsberger was a Jewish doctor in Germany in the second half of the 19th and much of the first half of the 20th century. He was involved in the scientific advances of his time, especially in the fields of antisepsis and asepsis, bacteriology, surgical technique, public health and therapeutics.

Nosocomial infection control: scope and implications for health care--a historical view.

Knowing where we have come from helps to decide where we should be going. Many principles and practices of modern infection control were developed in the nineteenth and early twentieth century. The story is one of halting, yet relentless, progress. The history of these discoveries and their application to infection control, then and now, is described, such as principles of hygiene, antiseptic surgery, antimicrobial therapy, and improved hospital design. Many of the issues today are not new, nor are some of the fundamental solutions. An acceptance of this historical continuum may temper expectations and make us more accepting of change.

Endodontics 1776-1976: a bicentennial history against the background of general dentistry.

During 200 years of progress in endodontics, various sciences have contributed to our understanding of the physiology and pathology of the dental pulp. Early treatment included cauterization of the pulp, the use of poultices or leeches, and tooth transplantation or replantation. Various methods of pulp devitalization are reviewed. Near the turn of the century, the discovery of X rays made diagnosis more accurate and the discovery of local anesthetics eliminated pain during endodontic treatment. Although the focal infection theory slowed the acceptance of endodontic treatment in this century, the biomechanical concept of treatment and research have recently opened new avenues for treatment and have initiated improvements in medicaments and filling materials.

Historical perspectives on health. Semmelweis: a lesson to relearn?

PIP: This paper focuses on the historical perspective on health based on Ignaz Phillipp Semmelweis's beliefs, which indicated that most hospital infections are spread manually by staff. A considerable body of circumstantial evidence supported this notion when Semmelweis, known as the "Father of Infection Control," studied the incidence of "puerperal fever", an acute febrile illness that attacked lying-in women. His study showed that the cause of puerperal fever was transmitted not only by way of cadaveric material but also by way of living organisms. The findings of the study led to his insistence that the procedure of handwashing with chlorinated lime should be routinely performed between examining different patients, thus preventing transfer of transient microorganisms to other patients. However, Semmmelweis's beliefs were largely ignored by many clinicians until recent work evidenced that the simple exercise of handwashing is not "practices de rigor" and demonstrated that hands could become contaminated from objects which have themselves been contaminated. This paper also presents the life, times, and family history of Semmelweis.^ieng

Localisation and William Macewen's early brain surgery Part I: the controversy.

Neurosurgery for the removal of brain tumours based on localising signs is usually dated from the 1884 operation by Bennett and Godlee. However, within weeks of that operation claims were made on behalf of William Macewen, the Glasgow surgeon, to have been the real pioneer of such surgery. According to Macewen's protagonists, he had conducted seven similar operations earlier than Bennett and Godlee and, in a notable 1888 address, Macewen described these seven pre-1884 cases and a number of others operated on after 1884. This paper, which is in two parts, contains an evaluation of the claims made for the priority of Macewen's pre-1884 operations. Part I deals mainly with Macewen's work in fields other than brain surgery that are relevant to it and sets out the facts of the controversy. It begins with a brief biography of Macewen, describes his pioneering work in antiseptic and aseptic surgery, his work on osteotomy and bone regeneration, and his use in brain surgery of the knowledge so gained. Part I concludes with an examination of the battle waged in the newspapers between Macewen's and Bennett's and Godlee's supporters, and of previously unpublished correspondence between Macewen himself, David Ferrier and Hughes Bennett. The primary records of the patients on whom Macewen operated, together with other materials relevant to the controversy, are examined in Part II.

[Clause Pouteau (1725-1775), surgeon at the l'Hôtel-Dieu de Lyon: his "asepsis" using water, fire and ligne propre]. / Claude Pouteau (1725-1775), chirurgien de l'Hôtel-Dieu de Lyon: son "asepsie" au moyen de l'eau, du feu et du linge propre.

Claude Pouteau, Hôtel-Dieu de Lyon's surgeon (1725-1775), did not improve surgical teaching, as Mareschal or Lapeyronie did with their reforming law. But he is reminiscent of an extremely skilful surgeon, always having a remarkable high rate of recoveries. For instance when it came to operate on bladder with a perineal approach (vesical cut), only three patients died out of one hundred and twenty operations. One century before Semmelweiss and more earlier than Pasteur, Pouteau thought that hospital-gangrene was not only caused by air miasma but also by direct contact, which could be indebted dirty instruments or hands, or hospital-made bandages. So he advised impeccably cleanliness for surgical students. According to his mind, soap was inadequate for cleaning hospital linen. Those must be pull out of neat material fitted by clean hands out of hospitals. It shall be supplied every day and never gathered inside. In order to keep clear of gangrene, the patient will not wait too long inside hospital. In case of bleeding, cautery must preferable to ligature for Pouteau "We can do without the bitter sadness of seeing a lighter wound become a lethal or incurable one ..." (Posthumous works, vol. III, p. 237-238).

O higienismo no campo da Educação Física: estudos históricos / Hygiene in the field of Physical Education: Historical Studies / El higienismo en el campo de la Educación Física: estudios históricos

Com intuito de contribuir para o conhecimento e a produção científica sobre o higienismo e as teorias de assepsia nas áreas da saúde e das ciências humanas, o presente artigo tem como objetivo verificar como estão configurados os estudos históricos sobre o movimento higiênico no campo da Educação Física. Os textos foram localizados e coletados nos sites eletrônicos da CAPES e SciELO, os quais têm contribuído para a divulgação do conhecimento científico em diversas áreas de pesquisa. Foi revelado um total de 141 artigos, dos quais 104 (74%) eram pesquisas históricas e os demais 37 (26%) são gerais. Do total, apenas 30 (21,27%) possuíam ligação como campo da Educação Física, 21 (70%) pertencem à temática histórica e os restante 9 (30%) generalizam temáticas com o campo em questão. Conclui-se que, apesar dos discursos higiênicos estarem historicamente presentes na legitimação da Educação Física, este é ainda pouco explorado na área.

In order to contribute to the knowledge and scientific production on Hygiene and asepsis theories in the areas of Health and Human Sciences, this article aims to verify how the historical studies about the hygiene movement in the field of Physical Education are configured. The texts were located and collected on the electronic websites of CAPES and SciELO, which have contributed to the dissemination of scientific knowledge in several research areas. It was reveled a total of 141 articles, of which 104 (74%) were historical research and the other 37 (26%) are general. From the total, just 30 (21.27%) were connect the Physical Education field, 21 (70%) belong to the historical theme and the rest 9 (30%) generalize thematic with the field in question. It is concluded that, although the Hygienic discourses are historically present in the legitimation of Physical Education, this is still a few explored in the area.

Para contribuir al conocimiento y la producción científica en el Higienismo y las teorías de la asepsia en las áreas de Ciencias de la Salud y Humanas, este artículo tiene como objetivo determinar cómo los estudios históricos sobre el movimiento hihienista están configurados en el campo de la educación física. Los textos fueran localizados y recogidos en los sitios electrónicos que han contribuido a la difusión de los conocimientos científicos en diversas áreas. Se reveló un total de 141 artículos, de los cuales 104 (74%) fueron la investigación histórica. Del total, sólo el 30 (21,27%) tenían conexión con el campo de la Educación Física, 21 (70%) pertenecen al tema histórico y el restante 9 (30%) generalizar los problemas con el campo en cuestión. Por lo tanto, a pesar de los discursos higienistas son históricamente presente en la legitimación de la educación física, esto sigue siendo un área relativamente inexplorada.