The treatment of wounds during World War I

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.

[Healing Dental and Oral Problems by Remedies of Animal and of Human Origin]

Use of matierials of animal or human origin in dentistry (and generally in medicine) these days is regarded as an unusal way of intervention. However in earlier times, different tissues, parts, products and organs of animals were frequently used in healing. Some of these methods were rooted in magical thinking. As analogical treatments--based on similarity or analogy--e.g. powder of horn or teeth of pike was used for the treatment of decayed teeth and different worms, maggots, veenies were applied against "toothworm". By difficult eruption of primary teeth bone marrow or brain mixed with cockridge-blood and goatmilk was a widely used medicine. Butter and honey were able to help the growing of teeth, as well. Parts of frog (fe: flippers) were also components of curing materials. Egg as the symbol of life was often an ingredient of medicaments. For the treatment of inflamed gum different animal materials were used, like chin and teeth of wolf, pike, crayfish, milk, honey, human saliva etc. Animal or human stools, mucks (containing enzymes) did one's bit in healing of oral and dental illnesses and were applied as fomentation or swathing. Placing a leech on the inflamed face was a common procedure in the past even as the use of earwax in lipnook. In our days tissues, parts or products of animals (or human beings) usually never allowed to get into contact with the body of patients. It's a much safer routine, at the same time however a precious traditional knowledge vanishes forever.

Management of proximal humeral fractures in the nineteenth century: an historical review of preradiographic sources

BACKGROUND

The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed.

QUESTIONS/PURPOSES

I reviewed nineteenth-century principles of (1) diagnosis, (2) classification, (3) reduction, (4) bandaging, and (5) concepts of displacement in fractures of the proximal humerus.

METHODS

A narrative review of nineteenth-century surgical texts is presented. Sources were identified by searching bibliographic databases, orthopaedic sourcebooks, textbooks in medical history, and a subsequent hand search.

RESULTS

Substantial progress in understanding fractures of the proximal humerus is found in nineteenth-century textbooks. A rational approach to understanding fractures of the proximal humerus was made possible by an appreciation of the underlying functional anatomy and subsequent pathoanatomy. Thus, new principles of diagnosis, pathoanatomic classifications, modified methods of reduction, functional bandaging, and advanced concepts of displacement were proposed, challenging the classic management adhered to for more than 2000 years.

CONCLUSIONS

The principles for modern pathoanatomic and pathophysiologic understanding of proximal humeral fractures and the principles for classification, nonsurgical treatment, and bandaging were established in the preradiographic era.

Five millennia of wound care products--what is new? A literature review

The first wound an wound treatments were described five millennia ago. Since then, various principles of wound care have been passed on from generation to generation. In contrast to large numbers of general technological inventions over the last 100 years, progress beyond ancient wound care practices is a recent phenomenon. It is essential to know the historical aspects of wound treatment (both successes and failures) in order to continue this progress and provide future direction. A survey of the literature shows that concepts such as "laudable pus" persisted for hundreds of years and that lasting discoveries and meaningful progress did not occur until grand-scale manufacturing and marketing started. Landmarks such as understanding the principles of asepsis/antisepsis, fundamental cellular research findings, knowledge about antibiotics/antimicrobials, moist wound healing, and the chemical and physical processes of wound healing have provided the foundation to guide major developments in wound management, including available evidence-based guidelines. Although research regarding interaction of basic wound management principles remains limited, the combined efforts of global research and clinical groups predict a bright future for improved wound management.

[Esmarch's tourniquet: 135 years in use]

Based on thoroughly reviewing the 135-year historical experience gained worldwide, thi author analyses advantages and disadvantages of using the Esmarch 's haemostatic tourniquet t( arrest external haemorrhage. With due references made to its practical application during globa wars, local military conflicts, as well as in a variety of peace-time situations and circumstance; that urgently require rendering first medical aid, substantiated herein is currently rather a restrained attitude to and certain concern about appropriate applications of this antihaemorrhagic tourniquet, accordingly accompanied and followed by a now appreciable tendency towards a relative reduction in the number of indications for its use.

A medical bandage in an Italian Renaissance mummy (Naples, XVI century)

A dressing was observed on the left arm of the mummy of Mary of Aragon (1503-1568), under her precious Renaissance clothes. It consisted of a true medical bandage, covering a large syphilitic cutaneous ulcer, with a sulphur-embedded wad still in situ. The bandage has a very peculiar shape, rather different from the usual dressings described in the contemporary medical texts: a central rectangular pad, used as compressing appliance, is provided with a sort of pocket containing ivy leaves. The function of the dressing was not only to cover and protect the ulcer, but also to apply a plant drug. This is the first case of ancient medical bandage studied directly on a mummified body.

Hot pack, nursing costs and suicide: the BJN over 100 years ago

The following are some of the interesting pieces which appeared in the BJN over 100 years ago. They include: the use of a hot pack for patient care and treatment, the costs of employing a qualified nurse and the efforts of workers to afford such a person, suicides in patients and nursing staff.

Whitehead's varnish nasal pack

Whitehead's varnish is a little known but excellent nasal packing agent. We review available literature on the historical aspects and clinical use of Whitehead's varnish. Our personal experience with Whitehead's varnish is described, and we strongly recommend its use.

Eponymous doctors associated with Edinburgh, Part 2--David Bruce, John Cheyne, William Stokes, Alexander Monro Secundus, Joseph Gamgee

This, the second in a three-paper series with this title, looks at famous doctors who trained in Edinburgh and their eponyms. With one possible exception, none seems to have sought the eponym, nor awarded it to themselves, nor used it for self-promotion. Unlike those in the first paper, all eponyms in this paper are still in use and their brevity is in contrast to the lengthy description needed if the eponym is not used. Examples are Cheyne-Stokes respiration, Stokes-Adam attacks, Brucellosis and Gamgee dressing. Monro Secundus is included because of his vehement defence of his professional reputation and research findings when he suspected others of trying to detract credit from him, a characteristic seldom reported for the others.

Special wound healing methods used in ancient egypt and the mythological background

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.

From the roots of rhinology: the reconstruction of nasal injuries by Hippocrates

The goal of this report is to describe the therapeutic methods and surgical techniques used by Hippocrates (5th century BC) in the treatment of nasal injuries. We studied the original Greek texts of the (generally considered genuine) Hippocratic book Mochlicon and, especially, the analytical On Joints. We identified the treatments and techniques applied to the restoration of injured noses. We found that Hippocrates classified nasal injuries, from simple contusions of soft tissues to complicated fractures. Hippocrates provided detailed instructions for each case, from poultice application and bandaging to reconstruction and reshaping of the nasal bones in cases of fractures and deviation. Hippocrates' texts reflect the interest of the classical period in nasal injuries, a common enough accident in athletics. Hippocratic conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine.

The evolution of wound management: ancient origins and advances of the past 20 years

Harkening back to the beginning of wound management, this article presents a fascinating look into how wounds have been viewed and cared for over the last 2,000 years. To celebrate 's 20th anniversary, changes in wound management over the past 2 decades are also described.

The Jones compression bandage. Review and clinical applications

Lower-extremity edema is a common condition that can be caused by many pathophysiologic processes. Control of edema associated with surgery or trauma is important and will help minimize pain and discomfort and prevent wound complications and blisters. Many techniques are used to control edema. The Jones compression dressing is an excellent tool that has been used successfully by the senior author for 18 years. It continues to be a primary treatment technique for the control of edema.

[From the collection of instruments at the Museum of medical history. Tourniquets and compressors]

This article calls attention to the extensiveness of our collection of instruments we have chosen to publish a description of the tourniquets and compressors. The era of these instruments is limited, that is to say from the discovery by Morel in 1674 to Esmarch about 1870. The many different types mentioned in the literature are richly represented. They are named after the originators, who were the great surgeons and instrumentmakers at that time. In the oldest existing list of the instruments dated from 1760 more of the tourniquets are recorded, others are included in a protocol dated 1875. A hand-written book with lecture-notes from 1860 shows evidence of the level of education in surgery.

A glimpse at the specialty of wound care

Many lessons have been learned over the course of the history of wound care. The answers to many questions still lie in the future. With this glimpse of where wound care has been and where it is headed in the future, certain trends were found. These trends are, in and of themselves, lessons that will be incorporated into this article as an act of reflection.

Ulcer care in the Middle Ages

A historical review of a document from 1392 detailing wound and ulcer care.

Wound healing--from poultices to maggots. (a short synopsis of wound healing throughout the ages)

Images

Ulcer management in medieval England

A review of a recently discovered 15th century manuscript

An appraisal of barrier agents in the reduction of adhesion formation following surgery

Reduction of pelvic adhesion formation and reformation represents a major challenge for the reproductive pelvic surgeon. Recently developed barrier methods appear promising, offering the advantage of nonsystemic therapy. Presented is a review of the literature and appraisal of the evolution of barrier agents. The current state-of-the-art barrier agent Interceed (TC-7) is discussed.