Ciencia y moral en la prevención de las enfermedades venéreas. La Sociedad Mexicana de Profilaxis Sanitaria y Moral, 1908-1923 / Science and morality in the prevention of venereal diseases. The Mexican Society for Sanitary and Moral Prophylaxis, 1908-1923

La Sociedad Mexicana de Profilaxis Sanitaria y Moral fue fundada en 1908 con el propósito de luchar contra las enfermedades venéreas. A diferencia de iniciativas anteriores de prevención que se centraban en el control sanitario de la prostitución, la Sociedad promovió la creación de dispensarios para la atención médica de los enfermos, así como la difusión de conocimientos por medio de conferencias y de propaganda impresa. Este artículo analiza las ideas que dieron lugar a la fundación de la Sociedad, los principales mensajes que buscaba difundir, los obstáculos y las críticas que enfrentó, y las causas que la llevaron a su disolución en 1923. El artículo muestra que la ciencia y la moral fueron dos elementos centrales que la Sociedad buscó promover, pues sus integrantes asumieron que las enfermedades venéreas eran un problema sanitario y moral, que debía prevenirse con el control de la voluntad y las pasiones, y llegado el caso, tratarse con la ayuda de médicos calificados (AU)

The Mexican Society for Sanitary and Moral Prophylaxis was founded in 1908 for the purpose of fighting against venereal diseases. Unlike previous prevention initiatives that focused on sanitary control of prostitution, the Society promoted the creation of dispensaries for medical care for the sick, and the dissemination of knowledge through lectures and printed propaganda. This article analyzes the ideas that led to the founding of the Society, the main messages which it sought to spread, obstacles and criticism it faced, and the causes that led to its dissolution in 1923. The article shows that science and morality were two core elements that the Society sought to promote, since its members assumed that venereal diseases concerned to public health and morals, and that they could be prevented by the control of the will and passions, and if necessary, treated with the help of qualified physicians (AU)

The fire at Cocoanut Grove.

On November 28, 1942, a fire broke out at The Cocoanut Grove Nightclub, in Boston, Massachusetts. The fire claimed the lives of hundreds, and injured 170 patients who were treated at either Boston City Hospital or the Massachusetts General Hospital. With extraordinary leadership and scientific focus, this tragedy led to many important advances in burn management, including improvements in burn wound care, the first descriptions of inhalation injury, formulas to guide fluid resuscitation, and the initial studies of antimicrobial therapy with burns. This overview describes the treatment of the Cocoanut Gove victims, and how it transformed the management of burns forever.

The anticipated severity of a "1918-like" influenza pandemic in contemporary populations: the contribution of antibacterial interventions.

Recent studies have shown that most of deaths in the 1918 influenza pandemic were caused by secondary bacterial infections, primarily pneumococcal pneumonia. Given the availability of antibiotics and pneumococcal vaccination, how will contemporary populations fare when they are next confronted with pandemic influenza due to a virus with the transmissibility and virulence of that of 1918? To address this question we use a mathematical model and computer simulations. Our model considers the epidemiology of both the influenza virus and pneumonia-causing bacteria and allows for co-infection by these two agents as well as antibiotic treatment, prophylaxis and pneumococcal vaccination. For our simulations we use influenza transmission and virulence parameters estimated from 1918 pandemic data. We explore the anticipated rates of secondary pneumococcal pneumonia and death in populations with different prevalence of pneumococcal carriage and contributions of antibiotic prophylaxis, treatment, and vaccination to these rates. Our analysis predicts that in countries with lower prevalence of pneumococcal carriage and access to antibiotics and pneumococcal conjugate vaccines, there would substantially fewer deaths due to pneumonia in contemporary populations confronted with a 1918-like virus than that observed in the 1918. Our results also predict that if the pneumococcal carriage prevalence is less than 40%, the positive effects of antibiotic prophylaxis and treatment would be manifest primarily at of level of individuals. These antibiotic interventions would have little effect on the incidence of pneumonia in the population at large. We conclude with the recommendation that pandemic preparedness plans should consider co-infection with and the prevalence of carriage of pneumococci and other bacteria responsible for pneumonia. While antibiotics and vaccines will certainly reduce the rate of individual mortality, the factor contributing most to the relatively lower anticipated lethality of a pandemic with a 1918-like influenza virus in contemporary population is the lower prevalence of pneumococcal carriage.

Inicio de la docencia urológica en la universidad española. Dr. Alberto Suárez de Mendoza / The start of urological teaching in the Spanish University. Dr. Alberto Suárez de Mendoza

OBJETIVO: Presentamos la semblanza del Dr. Suárez de Mendoza, uno de los primeros urólogos formado en Urología en el Hospital Necker, de París, junto al Dr. Guyon, que abrió el campo a la creación de la especialidad en España y el primer profesor oficial de la asignatura en la Facultad de Medicina de Madrid. MÉTODO: Hemos revisado su expediente académico en el Archivo Histórico Nacional y buscado datos en la Facultad de Medicina y en el Colegio de Médicos madrileño sobre su presencia en España. Extraído de los Reales Decretos información sobre la escuela libre de Medicina y la creación de las especialidades médicas en los planes de estudios universitarios y, por último, analizamos su obra escrita. RESULTADO/CONCLUSIÓN: Consideramos al Dr. Suárez de Mendoza una de las personalidades que dieron entidad a la Urología en nuestro país, por su formación, por su amplitud de saberes y por su vasta experiencia, como profesor de la asignatura en la Universidad española, como autor de un gran número de trabajos publicados y como inventor por sus aportaciones al desarrollo de la anestesia y de la Urología. Su tratado, el primero en español que recoge con detalle las primeras innovaciones en los medios de exploración urológicos, nos permite conocer y valorar el progresivo avance y evolución del conocimiento que presenta la Urología

OBJECTIVES: We present a biographical sketch of Dr. Suarez de Mendoza, one of the first urologists trained as so in the Necker Hospital in Paris with Dr. Guyon, who opened the field to the creation of this speciality in Spain, and first official professor of the subject of in the Faculty of Medicine of Madrid. METHODS: We reviewed his academic expedient in the National Historical Archive and search for data about his presence in Spain in the Faculty of Medicine and Medical College of Madrid. From the Royal Decrees we obtained information about the Free School of Medicine, and the creation of medical specialities in the University study plans; finally, we analyzed his written works. RESULTS /CONCLUSIONS: We consider Dr. Suarez de Mendoza one of the personalities giving entity to Urology in our country, for his education, for the amplitudeof his knowledge, and for his wide experience, as professor of the subject in the Spanish University, as author of a great number of published works, and as inventor of his contributions to the development of anesthesia and urology. His treaty, the first in Spanish coveringin detail the innovations in urological examination methods, enables us to know and value the progressive advance and evolution of knowledge in urology

Preventing surgical site infections.

Over the past 50 years, increased interest in the discipline of surgical infection has resulted in advances in post-surgical infection control. Early investigations focused on the importance of anaerobic microflora to postoperative infection and paved the way for significant improvements in prophylactic and therapeutic antibiotic treatment of surgical patients. Later research centered on the identification of risk factors to better predict postoperative infection rates. This article reviews the evolution of postoperative infection control and highlights antibiotic prophylaxis in specific clinical situations.

Current dental concepts in antibiotic prophylaxis for total joint replacement patients.

The subject of antibiotic prophylaxis has evoked controversy and much debate over the validity of such practice. In July 1997, the American Dental Association and American Academy of Orthopedic Surgeons issued an advisory statement concerning the use of antibiotic prophylaxis for patients with total joint replacements. A historical perspective of the subject is presented, with a review of the recommendation for total joint replacement antibiotic prophylaxis, a discussion of the new decision-making responsibility for the dentist, and medicolegal ramifications of this change.

Ethical issues in the history of prophylactic antibiotic use in neurosurgery.

There has always been controversy about the indications for prescribing antibiotics to prevent postoperative sepsis in patients undergoing cranial and spinal surgery. The earlier specialists in infectious diseases warned that the effectiveness of antimicrobial drugs was leading to indiscriminate administration for the prevention of wound infection. Three clinical researchers present a review of the history of prophylactic antibiotic use in neurosurgery, including their own work, and raise a number of ethical issues not previously discussed in the literature about: (1) scientific methodology; (2) random selection; (3) prospective study; (4) blinded control; (5) placebo medication; (6) professional equipoise; (7) statistical analysis; (8) informed consent; (9) utilitarian philosophy; and (10) managed care. Also discussed are the dual role of physician and investigator and the ethical dilemma of depending upon meticulous technique versus adopting regimens of prophylactic antibiotics.

Leonard I. Malis and prophylactic antibiotics.

Leonard I. Malis introduced important changes in the antimicrobial regimen for neurosurgical procedures at The Mount Sinai Hospital. Among Dr. Malis' innovations, intraoperative administration of a single dose each of vancomycin and gentamicin or tobramicin and constant irrigation of the surgical site with a bactericidal antibiotic (streptomycin) led to the elimination of primary wound infections during a 20-year period. In a study to locate potential sources of microbial contamination in his operating room, this combination of parenteral antibiotics was justified, because 36% of patients were at risk for exposure to methicillin-resistant Staphylococcus aureus and Gram-negative bacteria. Streptomycin as a topical agent was found to be highly efficacious in preventing intraoperative growth of potential pathogens cultured from the surgical wound and the operating room environment.

Prophylaxis in bowel surgery.

The busy colon and rectal surgeon deals daily with a sea of bacteria. Using good surgical judgment as well as time-honored techniques and innovative equipment the postoperative results are generally good. The role that appropriately administered efficacious antibiotics play in this scenario should not be underestimated and can only be realized when historical controls are evaluated. The results of these studies of antibiotic bowel preparation suggest that many different approaches may be equally effective in reducing infection after elective colonic resection. Certain features, however, appear to be common to most of the studies. 1 Oral antibiotic regimens with both aerobic and anaerobic activity (e.g., neomycin/erythromycin base) were used. 2 The oral agents were given in limited doses the day before operation. 3 Addition of systemic antibiotic agents without broad-spectrum coverage to the oral regimen generally did not improve the results. 4 Use of broad-spectrum parenteral antibiotic agents alone was associated with a lower infection rate than the use of systemic agents having only limited coverage. 5 Addition of a broad-spectrum parenteral antibiotic to the oral antibiotics may further reduce the postoperative infection rate. 6 Parenteral or oral antibiotics should be administered only for short periods of time during the perioperative period. Since the general acceptance of the approach outlined above, infection rates have decreased and the number of clinical studies reported has drastically decreased. The authors do feel, however, that there is a need for further study to outline possible benefits of other appropriate regimens (34).