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Since the dawn of humanity, wounds have afflicted humans, and healers have held responsibility for treating them. This article tracks the evolution of wound care from antiquity to the present, highlighting the roles of surgeons, scientists, culture, and society in the ever-changing management of traumatic and iatrogenic injuries., Competing Interests: Disclosure None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Dakin's solution and the Carrel-Dakin method were developed and integrated into clinical practice in the early 20th century, which were found to aid in effective wound healing and infection. This historical review briefly outlines highlights with regard to the history of infection management, wartime amputation, and wound treatment dating back to Galen through the early 20th century. This paper extensively reviews and discusses the historic use of Dakin's solution, which was developed almost a century ago, in both wartime settings and in the civilian sector as well. This review further elaborates on the use of Dakin's solution in the current treatment of wounds in the United States. Additionally, we discuss the history of wound care with the emphasis on the Carrel-Dakin method. Finally, this review discusses and presents contemporary application and utilization of Dakin's solution in two large tertiary care centers., (Copyright © 2018. Published by Elsevier Ltd.)

The First World War was a huge tragedy for mankind, but, paradoxically, it represented a source of significant progress in a broad series of human activities, including medicine, since it forced physicians to improve their knowledge in the treatment of a large number of wounded soldiers. The use of heavy artillery and machine guns, as well as chemical warfare, caused very serious and life-threatening lesions and wounds. The most frequent causes of death were not mainly related to gunshot wounds, but rather to fractures, tetanus and septic complications of infectious diseases. In the first part of this article, we describe the surgical procedures and medical therapies carried out by Italian physicians during the First World War, with the aim of treating wounded soldiers in this pre-antibiotic era. Antibacterial solutions, such as those of Dakin-Carrel and sodium hypochlorite and boric acid, the tincture of iodine as well as the surgical and dressing approaches and techniques used to remove pus from wounds, such as ignipuncture and thermocautery or lamellar drainage are reported in detail. In the second part of the paper, the organization of the Italian military hospitals network, the systems and tools useful to transport wounded soldiers both in the front lines and in the rear is amply discussed. In addition, the number of soldiers enrolling, and those dying, wounded or missing during the Great War on the Italian front is estimated.

During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.

This article takes its cue from the original work of sir Alexander Fleming on penicillin, published in the first issue of Recenti Progressi in Medicina in 1946 and reproduced here on the occasion of the approaching 70-year anniversary of the journal. The path that brought Fleming to the discovery of penicillin, one of the major milestones in the history of clinical pharmacology, provides insight for a range of considerations: the painstaking efforts of researchers, the contribution from accidental findings, and the dissemination of study results. Although the discovery of penicillin has changed the course of medicine, the benefits deriving from such an important advance are most likely to be offset by the overprescription of antibiotics, which is the leading cause of antimicrobial resistance and one of the most serious public health problems of our time.

Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base.

The essential role of wound antiseptics was discovered in the 18th century. Since then, many different procedures and substances have been developed and used for this indication. In the 1980s, polihexanide was introduced by Prof. Willenegger in Switzerland. Today, consensus recommendations confirm the potential of this substance for wound treatment. Various polihexanide-containing wound care products are available and these are now also gaining in importance throughout Europe and throughout the world., (Copyright © 2010 S. Karger AG, Basel.)

Existing scholarship on the experiments performed in concentration camps beginning in 1942 on the value of sulfonamides in treatment of wound infections, in which inmates were used as experimental subjects, maintains that not only were the experiments ethically and legally completely reprehensible and unacceptable, but that they were also bad science in the sense that they were investigating questions that had already been resolved by valid medical research. In contrast to this, the paper argues on the basis of contemporary publications that the value of sulfonamides in the treatment of wound infections, including gas gangrene infections, was not yet established, that is, that the questions pursued by the experiments had not been resolved. It also argues that regarding their "design" and methodical principles, the experiments directly followed the rationality of contemporary clinical trials and animal experiments. However, for the step from animal to the human experiment, the experimental "objects" were only in regard to their body, but not to their individuality and subjectivity regarded as "human". In a concluding section, the paper lines out some implications for an adequate historical reconstruction of medical research on humans, in particular the importance of a combined focus on the scientific rationality as well as explicit or implicit value hierarchies. Further, the article points to the potential impact of such a revised image of the sulfonamide experiments for present day debates on the ethics of medical research.

Despite the innumerable variations in war-making throughout the millennia, wounds have always been characterized by devitalized tissue, the presence of foreign bodies, clots, fluid collection, and contamination by microorganisms. Even in the postantibiotic era, infections of these wounds remain a significant contributor to both morbidity and mortality. Shifts in causal organisms and their resistance profiles continue to challenge each new generation of therapeutics. This article reviews the history of war wound infections, with an emphasis on wound microbiology and combat casualty management during US conflicts from World War I through the end of 20th century.

The year 2005 marks the 100th anniversary of Robert Koch's Nobel Prize. Here, we describe the scientific career of Robert Koch, the discoverer of the etiologic agent of tuberculosis but also of those of anthrax, cholera and wound infections. Equally important, Koch developed the methodologies and concepts that made medical microbiology a scientific discipline. Despite great efforts, however, Koch failed to conquer tuberculosis, which still causes enormous health problems worldwide 100 years after his Nobel award.

Background: This review covers the pathogenesis and treatment of the disease along with the reexamination of the current recommendations for prophylaxis against tetanus in the United States. Although tetanus is still a major problem worldwide, the incidence in North America has become almost negligible because of the highly effective primary immunization program. Recently, there have been no deaths reported attributable to tetanus in the United States in trauma patients who had received the primary childhood immunization. However, tetanus immunization and prophylaxis in the acute injury setting is frequently misused and misunderstood., Methods: A review of the literature regarding tetanus., Results: After review, the authors recommend tetanus toxoid in adults only if it has been more than 10 years since their last immunization. There is no urgency for the administration of tetanus toxoid in the acute setting, as it provides protection against the next injury and not the current injury. Tetanus-diphtheria toxoid is not required unless there are plans for the injured patient to travel to diphtheria-prone countries in the future, as the incidence of diphtheria is negligible in the United States., Conclusion: The review of reported cases of tetanus demonstrates that it is not possible to clinically determine which wounds are tetanus prone, as tetanus can occur after minor, seemingly innocuous injuries, yet is rare after severely contaminated wounds. Tetanus immunoglobulin should be reserved for patients with wounds who had never received primary immunization against tetanus.

On 22 April 1676, Admiral De Ruyter suffered a fatal open fracture of the right lower leg during the naval battle near the Etna. The fleet doctor, Jan Mannart, and the two ship's surgeons treated the wound with brandy and prescribed rest, but fatal gangrene developed a few days later. Before Lister first reported his technique of antiseptic treatment in 1876, the possibilities for the treatment of open wounds were limited to cauterisation and application of hot oil. Until the middle of the 19th century, amputation of the wounded limb was the most obvious solution. Why amputation was not performed in the case of De Ruyter is unknown. Actually, however, amputation would probably have increased his chances of survival only to a limited extent.

The Egyptian civilisation is one of the oldest in history and was renowned for its scientific and artistic achievements, and medicine was no exception. The ancient Egyptians were masters in applying and arranging bandages, and they recognized the cardinal signs of infection and inflammation. Egyptian drug therapy can be regarded as having evolved from a system rooted in magic and empirical observation. To illustrate how the Egyptian wound healing methods provided a major stimulus for the development of surgery, we conducted a literature search.

Wound care through the ages has ranged from good to bad, and at times has been disgusting, with little scientific approach. von Eiselsberg's dictum of no touch for military wounds proved disastrous to patients with gunshot and shrapnel wounds in the First World War. Alexis Carrel, a brilliant experimental surgeon, spearheaded the research that led to the development and application of débridement and irrigation for combat wounds. Early in his career, Carrel reported on a miraculous cure that he had observed in Lourdes, France. However, this report resulted in a strained professional environment in his homeland of France, which persisted in spite of his subsequent moves to Canada and then to the United States. There he was awarded the Nobel Prize for Physiology and Medicine.

Changes in patient management, increased survival rates, and widespread use of antimicrobials have altered the flora that are found to colonize the wounds of patients with burns and trauma-related injuries. Enterococci have emerged as a prominent cause of wound infection and are capable of producing significant morbidity. Staphylococcus aureus, although it remains a common colonizer, has developed resistance to several antimicrobial agents. Recent reports suggest that the incidence of Pseudomonas infections is decreasing, whereas multiple antimicrobial resistance has emerged in a number of other gram-negative organisms that were not heretofore considered major pathogens. Candida organisms appear to be the prominent pathogens among opportunistic yeasts and fungi, and Bacteroides and Clostridium species appear to be the most common causes of infection by anaerobes. Patterns of viral infection in patients with burns and trauma-related injuries have not been investigated in detail. Overall, it appears that rates of infection and associated mortality have decreased in some patient populations; progress in this regard can be attributed to improvements in antimicrobial therapy, would management, and nutrition.

Bacterial colonization of burned and devitalized tissue is inevitable. The types of organisms that are isolated from burn wounds depend on such factors as preexisting illness, types of topical antiseptics and antimicrobials used, microbial sampling techniques, and indigenous flora that inhibit the burn unit. Among organisms that are capable of producing disease, Staphylococcus aureus remains the most common isolate in the patient with burns. The decrease in the prevalence of Pseudomonas aeruginosa, which was initiated by the advent of effective topical antiseptics, appears to have continued to the present. Acinetobacter is now a common organism in the burn unit; although the organism has developed resistance to multiple antimicrobial agents, it infrequently causes serious problems. Comparisons between burn units with intensive-care capability that practice an aggressive approach to surgical management and burn units that continue to use a more traditional approach have revealed little difference with regard to incidence of or time to acquisition of potentially pathogenic bacteria. In a recent comparison that involved a unit of each type, marked reductions in the incidence of isolation of P. aeruginosa and Streptococcus group A organisms were observed over the course of 2 years in both of the units. Significant problems with viruses, yeasts, and fungi have not yet been encountered (or identified) in burn units; further study of the potential role of such organisms in infection in the patient with burns is required.

The academic surgeon must teach by example and action the importance of aseptic technique and proper wound care, practices that were supremely important in the prevention and treatment of surgical infections before the introduction of antibiotics but that remain so even in the modern medical age. The advent of antibiotics has greatly lowered the incidence of hand and other infections, opened the way for prophylactic treatment, and reduced the need for surgical drainage. However, over the years one theme has recurred: Initial care is preeminent in the prevention and treatment of all surgical infections.