The Struggle Against Sepsis **

The struggle against sepsis is as old as man. Primitive man believed that infections were inflicted upon him by the gods or by evil spirits. The Bible reflects this belief in that the boils of the plagues of Egypt were brought about under the Lord's direction, and Job's boils were due to Satan's ministrations.' The Hippocratic School made the first attempt to deal with the surgical treatment of infection. Cleanliness and little interference with natural processes resulted in prompt healing of incised wounds.' Infected wounds and empyema were well handled.' From the time of Hippocrates down to Pasteur's brilliant studies on fermentation, there were two schools of thought regarding the treatment of wounds. The Hippocratic doctrine of letting Nature take the lead in healing was forgotten and rediscovered many times. Galen, though he made many contributions to medicine, introduced the idea that suppuration was essential to the healing of wounds.'0 Followers of Galen introduced salves, and plasters into wounds.'"40 The Muslims extolled the virtues of fire over the cold knife in surgery and this doctrine held well into the 15th century.""' During the Middle Ages, Galen's philosophy of the necessity for pus formation for healing was forwarded by Roger of Palermo's introduction in 1170 of the seton=a bundle of linen threads stitched through a fold of skin and led to the exterior." Guy de Chauliac supported Galen's idea of suppuration as essential to healing.' Three other surgeons had the courage to deny that suppuration was necessary to healing though they made little impression on their colleagues."0 " War wounds were thought by both Brunschwig and Vigo to be poisoned.""' This led to disagreement among some surgeons.' "' Pare followed Vigo in practice although later he fully abandoned the boiling oil treatment of war wounds. His theory of wound treatment as well as