Antisepsis

The search for antiseptic agents is as old as humanity. In a hieroglyphic prescription dating from c. 1500 B.C., an Egyptian is depicted ordering a mixture of grease and honey for treatment of a wound. While infections and their causes were not known at that time, the relief provided by antiseptic compounds was recognized.

Other historical "cures" for infections include plant extracts, broths of animal or plant materials, and poultices of moss, mud, or dung, Not until the eighteenth century did progress begin to be made toward conquering everyday infections.

As late as the beginning of the nineteenth century, physicians had no knowledge of the septic (infectious) process or its prevention. Although surgery had developed steadily, the mortality rate among patients was high. Whether the patient would die from an infected organ or from the surgery to remove it often was a moot point. Surgeons went from one patient to the next without washing their hands or changing aprons. Thus, the bacteria from one patient were readily passed to the next and sepsis was an accepted fact.

In the middle of the nineteenth century, the Hungarian obstetrician Ignaz Semmelweiss (1818–1865) proposed that the infectious agent of puerperal fever, which was fatal to many women during childbirth (hence its other name, childbed fever), could be spread by the attending physician. Semmelweiss further suggested that washing hands between patients could prevent the infection. At first he was ridiculed, but when his rate of fatal puerperal fever infections declined rapidly with his practice of washing his hands, other obstetricians soon adopted the practice. This was the first introduction of antisepsis into medical practice.

In the latter half of the nineteenth century, British physician Joseph Lister (1827–1912) introduced the practice of spraying carbolic acid over patients during operations. This reduced the contamination of the open wound from airborne microorganisms and microbes on the doctor's clothing or gloves. Lister's innovation brought aseptic technique into the operating theatre.

The early antiseptics were based on mercury (mercurochrome, merthiolate), but have fallen into disuse. Although mercury poses a serious health hazard if absorbed into the body, the small amounts of mercury in the mercury-based antiseptics posed little threat. They were discontinued because they were relatively ineffective. Although mercury-based antiseptics readily stopped bacteria from reproducing and spreading, they did not kill the microorganism. Once the merthiolate was washed away, the bacteria revived and resumed their invasion of the tissues.