History of asepsis and antisepsis

Pre-antiseptic period: theories and misconceptions

In the 18th and 19th centuries, surgery faced colossal mortality rates. For example, according to T. Billroth's statistics, mortality after mastectomy and strumectomy was 50%. To combat "miasmas", alcohol, iodine, and silver nitrate were used, but there was no systematic approach.

Surgeons tried to explain the causes of suppuration using two main theories:

• Airborne theory (18th century). It was believed that air dried the wound and caused putrefaction. Benjamin Bell recommended performing dressings as quickly as possible, Pringle suggested ventilating rooms, and the standard treatment became the application of airtight (occlusive) dressings.
• Contact theory. In the 18th century in France, the surgeon Pouteau established the fact of cross-infection: pus from one patient caused inflammation in another via contaminated hands or dressing materials.

A huge contribution was made by N.I. Pirogov during the Crimean War (1853–1856). He argued that most wounded soldiers died from "hospital gangrene" and predicted the importance of studying microorganisms. Pirogov identified the key pathways of infection transmission: medical staff hands, linen, mattresses, and dressing materials.

Ignaz Semmelweis: the first breakthrough

Priority in the development of systemic antisepsis belongs to the Hungarian obstetrician Ignaz Semmelweis. In 1847, he applied disinfection with calcium hypochlorite solution to birth canals, staff hands, and instruments to prevent puerperal fever (sepsis).

Semmelweis experimentally proved his point: when blood from patients with sepsis was injected into rabbits, the animals died. He established the pathogenesis of the disease—the transfer of the infectious agent through the uterine wound surface. The method reduced clinic mortality by a third. However, most surgeons rejected his approach because they continued to believe in airborne rather than contact infection.

Joseph Lister and the triumph of antisepsis

The turning point came after Louis Pasteur's discovery (1863) of the microbial nature of fermentation and putrefaction. The English surgeon Joseph Lister applied this discovery to medicine, suggesting that suppuration was caused by the penetration of pathogenic bacteria from the outside.

In 1867, Lister published a paper describing the principles of his method. The main antiseptic was carbolic acid (phenol), the disinfecting properties of which had previously been noticed by Lemaire when treating cesspools.

Lister created a comprehensive prevention system. Its core was the famous multilayer dressing:

1. Silk soaked in a 5% phenol solution (applied to the wound).
2. Eight layers of gauze with phenol and rosin.
3. Rubberized fabric (mackintosh) for airtightness.
4. Gauze bandages soaked in phenol.

Toxicity of phenol and proof of the role of microbes

Lister's method drastically reduced the frequency of purulent complications, but had severe side effects. Phenol caused tissue burns, general intoxication, and kidney damage in patients, while surgeons suffered from occupational dermatitis and eczema. Attempts to replace phenol (boric and salicylic acids, potassium permanganate, mercuric chloride) revealed a pattern: the stronger the antimicrobial effect, the higher the toxicity of the drug to the body.

At the same time, it was necessary to definitively prove the etiology of suppuration. E. Bergman doubted Pasteur's theory of a single pathogen. The dispute was settled by the Swiss surgeon C. Garré. He rubbed a culture of staphylococcus obtained from an osteomyelitis patient into the skin of his forearm. The resulting severe carbuncle proved that staphylococci specifically cause various purulent lesions (from a furuncle to osteomyelitis).

Emergence of asepsis and the modern approach

Due to the shortcomings of chemical antisepsis, the search for new paths began. The founder of the aseptic method was the German surgeon Ernst Bergman. The essence of the method consisted in sterilizing everything that comes into contact with the wound using high temperature (boiling, hot steam).

At the 10th International Surgical Congress in Berlin (1890), Bergman reported on the success of the method. Lister recognized it as a "brilliant conquest of surgery," and starting in 1892, asepsis began its triumphant march through the clinics of the world.

Despite calls to completely abandon chemicals, antisepsis retained its role for:

• Surgeon's hand disinfection.
• Preparation of the operative field.
• Sanation of purulent cavities.

Today, antisepsis has evolved: low-toxicity drugs are used and physical methods of action, such as laser and ultrasound, are introduced.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Structure and layers of the classical Lister dressing
• Symptoms of carbolic acid intoxication in patients and surgeons
• Alternative 19th-century antiseptics: mercuric chloride, salicylic acid
• Miasma and pneuma theories in pre-antiseptic surgery
• Evolution of physical methods of antisepsis (laser, ultrasound)

Other topics in the section "CHAPTER 2. ASEPSIS AND ANTISEPSIS"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.