Surgery of the human cerebrum--a collective modernity.

Safe and beneficial surgery of the human cerebrum is arguably one of mankind's most notable achievements and one of the great testimonials to human creativity, intelligence, and character. In many ways, it is a testimony to the climates of civilization that have marked human history. In historical terms, in the year 2007, cranial surgery celebrated its 12,000th birthday, with cranial manipulation for various religious, mystical, and therapeutic reasons being evident in Africa more than 10 millennia before the birth of Christ. This article traces the major developments and attitudes that have laid the foundations of modernity in what is currently surgery and medicine's most exciting and complex technical exercise. It is in fact a 12,000 year prelude to the modernity that we currently enjoy. Before attempting to define our modernity and emerging futurism with reinvention, examination of the prolonged and tedious invention is appropriate for perspective. The following examines and recounts the accrual of data and changes in attitude over the stream of history that have allowed refined surgery of the human cerebrum to become a reality.

[From the history of wound care]. / Aus der Geschichte der Wundbehandlung.

Wound care in ancient times was based on many techniques: Bandages soaked with antibiotics, Sutures continuous or in separate stitches, apply of poultices around the wounds, honey and propolis as antibiotics in the treatment of wounds, surgical drainage of pus with a piece of tin pipe etc. The oldest wound clamp is shown with the jaws of ants holding together the edges of a wound. Finally are discussed the cauterization and the principles of Antisepsis and Asepsis.

[Hospital infections in changing times]. / Hospitalinfektionen im Wandel.

It has already been known in ancient medicine that diseases with similar clinical picture can occur all at once at a certain place and under certain climatic conditions, and the Hippocratics dedicated a special book of their Hippocratic Scriptures to epidemics. The symptom complex of what is nowadays called "hospitalism", however, could only develop when the first hospitals were founded in early Christian cultures, which means social foundations, which were not at all hospitals like today, but social institutions for the old people, for pilgrims and--only in the third place--an asylum for poor, homeless, ill people. As well as in other places where large numbers of people are crowded together under poor hygienic conditions, e.g. in prisons or on overcrowded ships, in those overcrowded hospitals, which were called "Nosokomeion" in the Byzantine world and thus might well have been institutions where nursing of sick people was done, specific epidemic diseases occurred which were rarely found in individuals living in freedom or at their domiciles. Like all other epidemics, they were thought to be attributed to a miasma transported by the air and resulting from bad vapours, and it was for two milleniums that this remained the explanation for infectiosity. As in the hospitals before introduction of anti- and asepsis wound-healing per secundam, i.e. purulence, was regarded as normal and pus was called "Pus bonum and laudabile", which was thought to be the supposition for wound-healing and was the reason for the infernal stench which one could smell. One attributed the occurrence of miasma to this component. It was therefore attempted to combat the hospital infections by all means with desodorizing procedures, thus trying primarily to suppress the stench by frequent whitewashing of the rooms, spraying of vinegar, by burning powder and even using precious incense. On the other hand, various infectious diseases could easily be brought into those overcrowded hospitals, where often three up to six patients had to share one bed, so that still in 1865 no less a person than the famous Theodor Billroth (1829-1894) felt himself obliged to warn of the dangers of a stay in hospital. The danger of "hospitalism" or of "nosocomial infection" let the rich refrain from going into a hospital, until the progress in surgery, which was initiated by the introduction of narcosis, allowed surgical treatment only to be effected in hospitals.(ABSTRACT TRUNCATED AT 400 WORDS)

The impact of early medical technology on maternal mortality in late 19th century Sweden.

The prevention of fatal complications of childbirth is a priority of health care in the developing countries. This historical study of maternal deaths in Sweden analyses the decline in mortality between 1751-1900 and during this years maternal mortality was reduced by 76% whereas the female mortality dropped only by 33% The decline was especially pronounced during the period 1861-1900, when maternal mortality declined from 567 to 227 per 100,000 live births. The potential impact of medical technology was analysed by epidemiological methods for the period 1861-1900. The introduction of antiseptic technique was estimated to reduce septic maternal mortality 25-fold in lying-in hospitals and 2.7-fold in rural home deliveries, implying that 49% of the septic maternal deaths were thus "prevented". In addition, licensed midwives assisting at home deliveries were estimated to reduce non-septic mortality 5-fold, thus "preventing" 46% of the non-septic maternal deaths. This could be one explanation why Sweden had a lower maternal mortality than the U.S. and the U.K. in the beginning of the 20th century.

[Our surgical heritage. History of modern surgery: a brief survey. I]. / Das chirurgische Erbe. Zur Geschichte der modernen Chirurgie; ein Abriss. Teil I.

A short review is given that deals with modern surgery beginning from 1880. This amazing development began with general anaesthesia, anti- and asepsis. Its further progress till to the present time resulted mainly from research in bacteriology X-ray technique, endoscopy, chemotherapy, anaesthesiology, biochemistry, immunology and last not least from better knowledge of protein-, water- and elektrolyte metabolism. Thanks to microsurgery organ transplantation and replantation of severed limbs became possible: a new dimension of surgery.

[Antiseptics and aseptics in changing times]. / Anti- und Aseptik im Wandel der Zeiten.

The history of wound healing is a series of errors not to be understood today. Historical aspects of anti- and aseptis are dealt with; the merits of Ignaz Semmelweis, Joseph Lister and Robert Koch are stressed; conclusions for the time being are drawn.