Asepsia, clínicas "particulares" y beneficencia pública / Asepsis, "private" clinics and public charity

Este trabajo se centra en el análisis de las primeras clínicas privadas de la ciudad de Valencia, una serie de pequeños hospitales quirúrgicos fundados a lo largo de las últimas décadas del siglo XIX y del primer tercio del XX en paralelo a un modelo de beneficencia insuficiente. Durante el período de estudio, coincidiendo con la introducción en Valencia de la antisepsia y la asepsia quirúrgicas, empezó a gestarse un modelo asistencial dual. Por una parte, el sistema sanitario heredado del Antiguo Régimen basado en un gran hospital general de beneficencia; por otra, una incipiente sanidad “particular” o privada basada en la progresiva habilitación de una serie de clínicas quirúrgicas, una estrategia asistencial que se inscribe en el complejo proceso de medicalización del conjunto de la población, no solo de la burguesía urbana, sino también de las clases populares, la menestralía y el obrerismo. El desarrollo de estas clínicas se vio truncado de raíz con el estallido de la Guerra Civil Española, dado que la mayoría fueron incautadas por los comités revolucionarios y transformados en hospitales de sangre, con el objetivo de satisfacer las necesidades asistenciales del estado de guerra (AU)

Una aportación al origen de las mascarillas / A contribution to the origin of masks

Las mascarillas, de demostrada eficacia a partir del siglo XIX (antisepsia-asepsia), se han visto reactualizadas debido a la pandemia COVID-19. En 1897, el cirujano Jan Mikulicz (1850-1905) fue el creador de las mascarillas quirúrgicas, al demostrar la teoría de la infección por las gotas de saliva (Flügge). No obstante, existen precedentes «pre-científicos» que conocemos fundamentalmente a través de grabados (s. XVII) y pinturas (s. XVIII). Presentamos una obra del pintor barroco Michel Serre (1658-1773), donde se observan personas utilizando mascarillas durante la gran peste de Marsella de 1720. (AU)

The masks, of proven efficacy from the 19th century (antisepsis-asepsis), have been updated due to the COVID-19 pandemic. In 1897, the surgeon Jan Mikulicz (1850-1905) was the creator of surgical masks, by demonstrating the theory of infection by drops of saliva (Flügge). However, there are «pre-scientific» precedents that we know mainly through engravings (17th century) and paintings (18th century). We present a work by the Baroque painter Michel Serre (1658-1773), where people are seen wearing masks during the great plague of Marseille in 1720. (AU)

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.

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.

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.

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 …".

De la antisepsia a la asepsia / No disponible

Revisamos la antisepsia obstétrica, desarrollada a mediados del siglo XIX por O.W. Holmes y especialmente por I. Semmelweis, con una aportación fundamental en el control de infecciones, el lavado de manos previo a la atención al parto, lo que supuso un avance definitivo en la lucha contra la infección puerperal. Aproximadamente dos décadas más tarde, J. Lister introduce la antisepsia quirúrgica, que supuso asimismo un gran avance en el desarrollo de la cirugía, al reducir sustancialmente las infecciones y permitir intervenciones que hasta entonces no era posible realizar. En las postrimerías del siglo XIX, el método de Lister se fue modificando y la introducción de la esterilización dio paso a la asepsia que, junto con otros avances, como la introducción de guantes, primero de algodón y posteriormente de goma, así como gorro y mascarilla, permitieron modificar sustancialmente la práctica quirúrgica

In this paper we do a revision of obstetric antisepsis developed in the XIX century by O.W. Holmes and especially by I. Semmelweis. He did a fundamental contribution in controlling infections by introducing the washing of hands before the act of child bearing. This meant a definite advance in the fight against puerperal infection. J. Lister introduced the surgical antisepsis about two decades later. This also meant a significant advance in the development of surgery by reducing infections substantially and allowing surgical interventions hard to perform until then. By the end of the 19th century, Lister's method was modified and sterilization introduced. This gave way to antisepsis. The introduction of gloves- which were made out of cotton at first and of rubber later on - as well as surgical caps and masks, allowed substantial modifications to the surgical practice

Asepsis and bacteriology: a realignment of surgery and laboratory science.

This paper examines the origins of aseptic surgery in the German-speaking countries. It interprets asepsis as the outcome of a mutual realignment of surgery and laboratory science. In that process, phenomena of surgical reality were being modelled and simplified in the bacteriological laboratory so that they could be subjected to control by the researcher's hands and eyes. Once control was achieved, it was being extended to surgical practice by recreating the relevant features of the controlled laboratory environment in the surgical work place. This strategy can be seen in the adoption of Robert Koch's bacteriology by German-speaking surgeons, and the resulting technical changes of surgery, leading to a set of beliefs and practices, which eventually came to be called 'asepsis'.

[Johannes Anton von Mikulicz-Radecki (1850-1905). His contributions to the development of urology]. / Johannes Anton Freiherr von Mikulicz-Radecki (1850-1905). Sein Beitrag zur Urologieentwicklung.

On June 14, 1905, Johann Anton von Mikulicz-Radecki, one of the most famous surgeons of the time, died. He was a disciple of famous Theodor Billroth of Vienna and the teacher of Ferdinand Sauerbruch in Breslau. Mikulicz-Radecki's merits in the field of the history of medicine are based on his achievements in developing the system of antisepsis and asepsis. He also devoted himself to urological surgery, and his name is linked with diseases, operations, and construction of new medical instruments. Mikulicz-Radecki created two surgical schools, one in Cracow and a second one in Breslau, where he worked for over 15 years until his death.

[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.