Introduction

September is designated as Sepsis Awareness Month, and it offers us time to reflect on the critical medical developments that have brought us to the current era of infectious disease treatment. The first movement toward infection control was with the introduction of antiseptics in the 19^th century. To today’s clinicians, it may seem unfathomable that hand washing was once viewed as preposterous, but the progression of medicine can be convoluted. This convolution can be observed when discussing the beginning of the Antiseptic Era.

The Hazard of Hand Washing?

In 1847, Dr. Ignaz Semmelweis, a Hungarian physician, had a 2-year position as an obstetrics assistant at a hospital in Vienna.² Dr. Semmelweis noticed a high patient mortality rate due to childbed fever in his maternity ward. He noted that the patients of midwives had better survival rates than those of physicians. Dr. Semmelweis speculated that this increased patient mortality rate was caused by physicians handling corpses between deliveries.² As a result, he instituted a policy of hand washing with a solution of chloride of lime (calcium hypochlorite) between each delivery and noted a huge reduction in fever deaths. In 1861, Semmelweis published a book, The Etiology, Concept, and Prophylaxis of Childbed Fever, that was ridiculed and rejected by the established medical community.² Dr. Semmelweis never recovered from this backlash and died in an insane asylum. Today, he is regarded as the "Savior of Mothers.”²

The Antisepsis System: Louis Pasteur’s Innovations

After his series of experiments starting in 1857, Louis Pasteur’s groundbreaking discovery of Germ Theory, which centers around the world of microbes, was the catalyst to finally abandon Claudius Galen’s Humoral Theory of Disease, which had been dominant since the Roman period.¹ Pasteur's work began with the field of microbiology and laid the foundation for the future study of virology using the term "virus," derived from the Latin word meaning “poison.”¹ He later developed the earliest forms of rabies and anthrax vaccines.¹ However, Pasteur's innovations would not immediately crossover into the clinical realm.

Germ Theory: From the Laboratory to the Medical World

Dr. Joseph Lister, a British surgeon, took Louis Pasteur’s scientific theory and implemented it into clinical practice. He theorized that non-healing wounds post-debridement occurred because of the environment within the wound itself and not from miasmas "foul air," which was the standard explanation of that time.³ Inspired by Germ Theory in 1867, Dr. Lister began using carbolic acid (phenol) as a disinfectant on all surgical wounds. As a result, he found a considerable improvement in healing outcomes, thus officially beginning the era of antiseptic use.³ He is widely regarded as the "Father of Modern Surgery," and the antiseptic mouthwash, Listerine, is named in his honor.³ Pasteur and Lister’s contributions helped those in medicine understand how to handle the deadly specter of infection, but there was still much ground to cover. The next step would be taken by the Prussian physician, Dr. Robert Koch.

The Discovery of Staphylococcus and Other Microorganisms

Building upon the work of his predecessors, Dr. Koch identified the following pathogens, Staphylococcus (wound infections) and Vibrio cholera bacterium (cholera).⁴ In 1882, he achieved a medical milestone when he identified tubercle bacillus as the causative agent of tuberculosis.⁴ Tuberculosis was a lethal disease that tormented humanity for centuries, and for this discovery he won the Nobel Prize for Medicine and Physiology in 1905.⁴

Treating Battlefield Wounds

The battlefield wounds of World War I (1914-1918) were regularly treated with antiseptics, but the heavily manured soil in the trenches of Western Europe served as a breeding ground for deadly gas-forming bacteria which were not susceptible to carbolic acid (phenol).⁵ Alexis Carrel, a French surgeon, and Henry Dakin, an English chemist, combatted this new virulent threat by developing a new cleansing solution, sodium hypochlorite. Sodium hypochlorite irrigated wounds after surgical debridement and killed most bacteria.⁶ The Carrel-Dakin Method, due to its success, was widely adopted.⁶ Dakin’s Solution is still used in contemporary wound care.

Conclusion

As the 20^th century progressed, antibiotics took center stage in the therapeutic spectrum, but antiseptics still maintain an important position in infection management. Clinicians of the past overcame many challenges in the pursuit of healing. Hopefully, this history will inspire the next medical generation to overcome current obstacles, such as multidrug-resistant organisms (MDROs).

References

1. Smith KA. Louis Pasteur, the father of immunology? Front Immunol. 2012;3:1-10. https://doi.org/10.3389/fimmu.2012.00068
2. Best M, Neuhauser D. Ignaz Semmelweis and the birth of infection control. BMJ Qual Saf. 2004;13(3):233-234. https://doi.org/10.1136/qshc.2004.010918
3. Pitt D, Aubin JM. Joseph Lister: Father of modern surgery. Can. J. Surg. 2012;55(5):E8-E9. https://doi.org/10.1503/cjs.007112
4. Lakhtakia R. The legacy of Robert Koch: Surmise, search, substantiate. Sultan Qaboos Univ Med J. 2014;14(1):37–41, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916274/
5. Bourke J. War's carnage: wounds and weapons. Lancet. 2016;387(10028):1610-1611. https://doi.org/10.1016/S0140-6736(16)30209-4
6. Keyes M, Zohaib J, Thibodeau R. Dakin Solution. Treasure Island (FL): StatPearls Publishing. 2022. www.ncbi.nlm.nih.gov/books/NBK507916/

About the Author

Christine Miller, DPM, PhD is a certified wound specialist by the American Board of Wound Management and a Fellow of the American College of Clinical Wound Specialists. She currently serves as the Co-Director of the Limb Salvage Program at the University of Florida, College of Medicine-Jacksonville.