History of wound care

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The history of wound care spans from prehistory to modern medicine. Wounds naturally heal by themselves, but hunter-gatherers would have noticed several factors and certain herbal remedies would speed up or assist the process, especially if it was grievous. In ancient history, this was followed by the realisation of the necessity of hygiene and the halting of bleeding, where wound dressing techniques and surgery developed. Eventually the germ theory of disease also assisted in improving wound care.

Contents

Ancient medical practice

A glass container containing tubocurarine chloride. Tubocurarine was used in ancient times as a poison, but was used in the 20th century as a muscle relaxant. Ampoule of tubocurarine chloride. Front view. Grey background Wellcome L0058707.jpg
A glass container containing tubocurarine chloride. Tubocurarine was used in ancient times as a poison, but was used in the 20th century as a muscle relaxant.

Over time, different civilizations began to create their own herbal medicinal treatments for wounds depending on the trees, shrubs, or any other type of plants located in their environment. These herbal treatments became the oldest form of wound therapy. It is logically assumed that this may not have been a very safe way of treating humans with wounds due to overdosing or choosing the wrong plants to treat a person until the right one was found. Nevertheless, most of the ancient people who were given the duty of healers through the usage of herbs were well accustomed with which plants from their local flora could be used to help the injured. This knowledge was learned and passed down after healers repeatedly used an herbal remedy for a specific wound with the belief that it promoted healing. [1]

Numerous ancient herbal remedies and poisons now serve as models for modern medicine. For example, curare, which was an ancient South American arrow poison, was used in the 20th century as the muscle relaxant tubocurarine. [2] Tribesmen conducted various observations on the effects of different plant parts, meaning roots, leaves, etc., on specific wounds. They also observed what seasons, time of day, or moon phase would result in a most active plant. The former however resulted in a minimal influence in modern medicine as compared to plants parts or seasons of growth. [1]

Ancient Egypt

The clinical history of the treatment of acute and chronic wounds can also trace its origins to ancient Egypt, and many Egyptian medical papyri have survived which document herbal, surgical and magical remedies for wounds. The Edwin Smith Papyrus, c. 1600 BCE, describes closing wounds with sutures (for wounds of the lip, throat, and shoulder), [3] bandaging, splints, poultices, [4] preventing and curing infection with honey, and stopping bleeding with raw meat. [5] : 72  The Ebers Papyrus, c. 1500 BCE, details the use of lint, animal grease, and honey as topical treatments for wounds. The lint provided its natural absorbency, the animal grease provided a barrier to environmental pathogens, and the honey served as an antibiotic agent. [6] The Brugsch Papyrus, c. 1200 BCE, stated that the Egyptians believed that making sure a person's wound stayed closed would help their own spirit not be invaded by external evil spirits. [7] [8]

Ancient Greece and Rome

Achilles tending Patroclus wounded by an arrow (Attic red-figure kylix, c. 500 BC) Akhilleus Patroklos Antikensammlung Berlin F2278.jpg
Achilles tending Patroclus wounded by an arrow (Attic red-figure kylix, c. 500 BC)

As tribal healers developed into doctors, it spurred on a primitive pharmaceutical industry that included traders who would travel overseas bringing herbs that would be used for specific wounds. Soon, like most industries, patients began to skip the doctors altogether and purchased the herbs directly from the traders who were also aware of the effects and quantities that should be taken while also informing their "patients" of them. These merchants that supplied people with herbs were known as rhizotomiki, or gatherers of roots, in Ancient Greece. The earliest known list of herbs and remedies was probably written for these herbal merchants. The earliest known to men is the Rhizotomikaof Diocles of Carustius, a student of Greek philosopher Aristotle. This book includes the author's observation of the effects of the herbal medicine on specific parts of the human body. This then became the beginning of scientific research on herbal remedies on humans, which has been modified and significantly changed from modern wound remedies. [1]

The Greeks also acknowledged the importance of wound closure, and were the first to differentiate between acute and chronic wounds, calling them "fresh" and "non-healing", respectively. Galen of Pergamum, a Greek surgeon who served Roman gladiators circa 120–201 A.D., made many contributions to the field of wound care. [9] The most important was the acknowledgment of the importance of maintaining wound-site moisture to ensure successful closure of the wound. [10]

Ancient China

A seminal work of traditional Chinese medicine was the Huangdi neijing (Yellow Emperor's Inner Canon) compiled between the 3rd and 2nd centuries BC (i.e. originating in the Warring States period), which viewed the human body, its organs and tissues through the lens of the metaphysical five phases and yin and yang, and stated a belief in two circulatory channels of qi vital energy. [11] In surgery, Han dynasty era Chinese texts offered practical advice for certain procedures such as clinical lancing of abscesses. [12] The first known physician in China to describe the use anesthesia for patients undergoing surgery was the Eastern Han physician Hua Tuo (d. 208 AD), who utilized his knowledge of Chinese herbology based in the Huangdi neijing to create an ointment that healed surgical wounds within a month. [13] One of his surgical procedures was the removal of a dead fetus from the womb of a woman whom he diagnosed and cured of her ailments. [13]

Remedies used in ancient treatments

Honey

Honey was utilized for its antibacterial properties that helped heal infected wounds. [14] Moreover, honey was used as a topical ointment. Other than sugar, honey also contains a variety of trace amounts of many different vitamins and proteins.

Alcohol

Detail from The Good Samaritan by Cornelis van Haarlem (1627) showing the Samaritan pouring oil and wine on the injured man's wounds Parable of the Good Samaritan (detail) by Cornelis van Haarlem.jpg
Detail from The Good Samaritan by Cornelis van Haarlem (1627) showing the Samaritan pouring oil and wine on the injured man's wounds

Various types of alcohol were also used in ancient medical practices.

One of the first uses was wine mixed with oil was a common remedy in the ancient world to cleanse wounds and assuage their pain as noted in the context of Alcohol in the Bible. [15]

The Sumerians used beer as an antiseptic along with the dressing of wounds, using up to 19 different types of beer. [16] Other ancient Mesopotamian cultures, including the Sumerians and Akkadians used wine with sesame infusions, which were "purified and pulverized" before application along with the many beers. [17] A medical prescription from Mesopotamia describes a method for healing wounds: [18] [19]

Pound together fur-turpentine, pine-turpentine, tamarisk, daisy, flour of inninnu strain; mix in milk and beer in a small copper pan; spread on skin; bind on him, and he shall recover.

Another peoples to take advantage of the cleansing properties of alcohol were the Greeks. They used wine along with boiled water and vinegar to cleanse wounds. The Greeks, specifically Hippocrates (430–377 BC), were also the first to establish the four cardinal signs of inflammation: redness, swelling, heat and pain. [16] Alcohol is still in use today as a wound cleanser largely as rubbing alcohol. However the side effects can be skin cell death resulting in inflammation and itchiness at the site of application. [20]

Middle Ages

There were limited advances that continued throughout the Middle Ages and the Renaissance, but the most profound advances—both technological and clinical—came with the development of microbiology and cellular pathology in the 19th century.[ citation needed ]

19th century

This is a portrait of Joseph Lister, who was the first doctor to begin to sterilize his surgical gauze. Joseph Lister c1855.jpg
This is a portrait of Joseph Lister, who was the first doctor to begin to sterilize his surgical gauze.

The first advances in wound care in this era began with the work of Ignaz Philipp Semmelweis, a Hungarian obstetrician who discovered how hand washing and cleanliness in general in medical procedures prevents maternal deaths. Semmelweis's work was furthered by an English surgeon, Joseph Lister, who in 1860s began treating his surgical gauze with carbolic acid, known today as phenol, and subsequently dropped his surgical team's mortality rate by 45%. Building on the success of Lister's pretreated surgical gauze, Robert Wood Johnson I, co-founder of Johnson & Johnson, began in the 1890s producing gauze and wound dressings sterilized with dry heat, steam, and pressure. [21] These innovations in wound-site dressings marked the first major steps forward in the field since the advances of the Egyptians and Greeks centuries earlier.

In 1886, Ernst von Bergmann introduced heat sterilization of surgical instruments, which marked the beginning of aseptic surgery and significantly reduced the frequency of infections. Conrad Brunner did extensive research into wound management and experimentation with wound disinfection methods, publishing his comprehensive Erfahrungen und Studien über Wundinfektion und Wundbehandlung [22] in 1898. That same year, Paul Leopold Friedrich introduced wound excision and experimentally showed that excision of open wounds substantially reduced the risk of infection. The next advances would arise from the development of polymer synthetics for wound dressings and the "rediscovery" of moist wound-site care protocols in the mid 20th century.

Wound-site dressing

During World War I, chemist Henry Drysdale Dakin was consulted and invented Dakin's Solution, a mixture of sodium hypochlorite and boric acid, to wash out the traumatic wounds of British soldiers fighting in France. [23]

1950s onward

The advent in the 1950s of fibrous synthetics such as nylon, polyethylene, polypropylene, and polyvinyls provided new materials from which researchers and doctors in the field of wound care could explore better protecting of healing wounds and even accelerating the natural wound healing process.

In the 1960s, research and articles by George Winter and Howard Maibach reported on the superior efficacy of moist wound dressings. The adoption of moist wound dressing technique as recommended best wound dressing practice reflected a large advance in approach producing markedly superior clinical outcomes. This dawn of modern wound care treatment initiated a process of improvement in the clinician's ability to bolster wound-site re-epithelialization and healing. The focus on evidence-based best practices and research continues.

In the 1990s, improvements in composite and hybrid polymers expanded the range of materials available for wound dressing. Grafting and biotechnology have produced usable and useful protective covering of actual human skin generated through cloning procedures. These improvements, coupled with the developments in tissue engineering, have given rise to a number of new classes of wound dressings. One of these, "living skin equivalents, " is often cited as a misnomer because they lack key components of whole living skin. "Living skin equivalents" may have the potential to serve as cellular platforms for the release of growth factors essential for proper wound healing. Many biologics, skin substitutes, biomembranes and scaffolds have been developed to facilitate wound healing through various mechanisms. [24]

Other recent developments has been the renewed focus on the prominent patient concern of pain. Burn patients and others affected by severe wounds often report pain as the dominant negative impact of the wounds on their lives. [25] Clinical management of the pain associated with chronic wounds has been an emergency wound treatment priority and is now viewed as an integral part of treatment.

Modern wound care

In modern-day 21st century, medicine has evolved to involve past treatments such as leech therapy, as well as advancing wound prevention and the treatment. A large part of wound care is wound treatment. This involves promoting healing, preventing infections, and getting rid of an already existent infection. Deciding on a treatment depends on the type of wound that a person has sustained. Varying from infections to burns, wound care is a priority in saving the limb, extremity, or life of a person. In a hospital or medical care setting, more severe wounds like diabetic ulcers, decubitus ulcers, and burns require sterile or clean (depending on the severity of the wound) dressings and wound care. The types of wound dressing include: dry dressings, wet-to-dry dressings, chemical-impregnated dressings, foam dressings, alginate dressings, hydrofiber dressings, transparent film dressings, hydrogel dressings, and hydrocolloid dressings. All of the listed dressing types require different materials to complete the dressing.

Alternative treatments for wounds: leeches and maggots

Medical leeches were cleared as a medical device in 2004 after being an indispensable tool in the 19th century and even in use in the Middle Ages. This unique use of creatures is utilized in many surgeries today. Leeches have the ability to assist with compromised tissue with the components of their saliva. Their saliva contains a local anesthetic, thrombin inhibitor, antibiotic properties and a histamine-like vasodilator. These capabilities help in surgeries such as transplants, skin grafts, and even reconstructive surgeries. The leeches help localize the wound and help produce blood flow. This is helpful in operations where blood clots occur and they help dilate the blood vessels.

Baron Dominique Jean Larrey, surgeon-in-chief of Napoleon's Grande Armée pioneered the use of maggots to prevent infection in wounds. [28] They were also used by military medical aids during World War II. They worked as biomedical debriding agents by ingesting bacteria and breaking them down within their intestines. Maggots give off an enzyme that disinfects wounds and promotes healing and this is why they became the first organism in the United States that were used as a medical device in January 2004. [29]

See also

Related Research Articles

<span class="mw-page-title-main">Wound</span> Acute injury from laceration, puncture, blunt force, or compression

A wound is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. Wounds can either be the sudden result of direct trauma, or can develop slowly over time due to underlying disease processes such as diabetes mellitus, venous/arterial insufficiency, or immunologic disease. Wounds can vary greatly in their appearance depending on wound location, injury mechanism, depth of injury, timing of onset, and wound sterility, among other factors. Treatment strategies for wounds will vary based on the classification of the wound, therefore it is essential that wounds be thoroughly evaluated by a healthcare professional for proper management. In normal physiology, all wounds will undergo a series of steps collectively known as the wound healing process, which include hemostasis, inflammation, proliferation, and tissue remodeling. Age, tissue oxygenation, stress, underlying medical conditions, and certain medications are just a few of the many factors known to affect the rate of wound healing.

<span class="mw-page-title-main">Pilonidal disease</span> Skin infection between the buttocks

Pilonidal disease is a type of skin infection which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end. Symptoms may include pain, swelling, and redness. There may also be drainage of fluid, but rarely a fever.

<span class="mw-page-title-main">Medieval medicine of Western Europe</span>

In the Middle Ages, the medicine of Western Europe was composed of a mixture of existing ideas from antiquity. In the Early Middle Ages, following the fall of the Western Roman Empire, standard medical knowledge was based chiefly upon surviving Greek and Roman texts, preserved in monasteries and elsewhere. Medieval medicine is widely misunderstood, thought of as a uniform attitude composed of placing hopes in the church and God to heal all sicknesses, while sickness itself exists as a product of destiny, sin, and astral influences as physical causes. On the other hand, medieval medicine, especially in the second half of the medieval period, became a formal body of theoretical knowledge and was institutionalized in the universities. Medieval medicine attributed illnesses, and disease, not to sinful behavior, but to natural causes, and sin was connected to illness only in a more general sense of the view that disease manifested in humanity as a result of its fallen state from God. Medieval medicine also recognized that illnesses spread from person to person, that certain lifestyles may cause ill health, and some people have a greater predisposition towards bad health than others.

<span class="mw-page-title-main">Wound healing</span> Series of events that restore integrity to damaged tissue after an injury

Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue.

<span class="mw-page-title-main">Debridement</span> Medical removal of dead, damaged, or infected tissue

Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy.

<span class="mw-page-title-main">Skin grafting</span> Surgical transplantation of skin

Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft.

<span class="mw-page-title-main">Pressure ulcer</span> Skin damage resulting from long-term pressure

Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

<span class="mw-page-title-main">Dressing (medicine)</span> Sterile pad or compress applied to wounds

A dressing or compress is a piece of material such as a pad applied to a wound to promote healing and protect the wound from further harm. A dressing is designed to be in direct contact with the wound, as distinguished from a bandage, which is most often used to hold a dressing in place. Modern dressings are sterile.

<span class="mw-page-title-main">Maggot therapy</span> Wound care by maggot therapy

Maggot therapy is a type of biotherapy involving the introduction of live, disinfected maggots into non-healing skin and soft-tissue wounds of a human or other animal for the purpose of cleaning out the necrotic (dead) tissue within a wound (debridement), and disinfection.

<span class="mw-page-title-main">Venous ulcer</span> Skin sore sustained by a vasculatory disease

Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are an important cause of chronic wounds, affecting 1% of the population. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.

A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long. To overcome that stage and jump-start the healing process, a number of factors need to be addressed such as bacterial burden, necrotic tissue, and moisture balance of the whole wound. In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds this balance is lost and degradation plays too large a role.

<span class="mw-page-title-main">Negative-pressure wound therapy</span> Therapeutic technique

Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), is a therapeutic technique using a suction pump, tubing, and a dressing to remove excess exudate and promote healing in acute or chronic wounds and second- and third-degree burns. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment using a sealed wound dressing connected to a vacuum pump. The use of this technique in wound management started in the 1990s and this technique is often recommended for treatment of a range of wounds including dehisced surgical wounds, closed surgical wounds, open abdominal wounds, open fractures, pressure injuries or pressure ulcers, diabetic foot ulcers, venous insufficiency ulcers, some types of skin grafts, burns, sternal wounds. It may also be considered after a clean surgery in a person who is obese.

A hydrocolloid dressing is an opaque or transparent dressing for wounds. A hydrocolloid dressing is biodegradable, breathable, and depending on the dressing selected, may adhere to the skin, so no separate taping is needed.

<span class="mw-page-title-main">Medicine in ancient Rome</span>

Medicine in ancient Rome was highly influenced by ancient Greek medicine, but also developed new practices through knowledge of the Hippocratic Corpus combined with use of the treatment of diet, regimen, along with surgical procedures. This was most notably seen through the works of two of the prominent Greek physicians, Dioscorides and Galen, who practiced medicine and recorded their discoveries. This is contrary to two other physicians like Soranus of Ephesus and Asclepiades of Bithynia, who practiced medicine both in outside territories and in ancient Roman territory, subsequently. Dioscorides was a Roman army physician, Soranus was a representative for the Methodic school of medicine, Galen performed public demonstrations, and Asclepiades was a leading Roman physician. These four physicians all had knowledge of medicine, ailments, and treatments that were healing, long lasting and influential to human history.

Incision and drainage (I&D), also known as clinical lancing, are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus. It is performed by treating the area with an antiseptic, such as iodine-based solution, and then making a small incision to puncture the skin using a sterile instrument such as a sharp needle or a pointed scalpel. This allows the pus to escape by draining out through the incision.

Aesthetic medicine is a branch of modern medicine that focuses on altering natural or acquired unwanted appearance through the treatment of conditions including scars, skin laxity, wrinkles, moles, liver spots, excess fat, cellulite, unwanted hair, skin discoloration, spider veins and or any unwanted externally visible appearance. Traditionally, it includes dermatology, oral and maxillofacial surgery, reconstructive surgery and plastic surgery, surgical procedures, non-surgical procedures, and a combination of both. Aesthetic medicine procedures are usually elective. There is a long history of aesthetic medicine procedures, dating back to many notable cases in the 19th century, though techniques have developed much since then.

<span class="mw-page-title-main">Inadine</span> Surgical dressing

Inadine is an iodine-containing non-sticky surgical dressing consisting of a knitted viscose fabric with a polyethylene glycol base that contains and slowly releases the antiseptic povidone-iodine (PVP-1). It is applied to superficial wounds.

Postoperative wounds are those wounds acquired during surgical procedures. Postoperative wound healing occurs after surgery and normally follows distinct bodily reactions: the inflammatory response, the proliferation of cells and tissues that initiate healing, and the final remodeling. Postoperative wounds are different from other wounds in that they are anticipated and treatment is usually standardized depending on the type of surgery performed. Since the wounds are 'predicted' actions can be taken beforehand and after surgery that can reduce complications and promote healing.

<span class="mw-page-title-main">Mellivory</span> Consumption of honey

Mellivory is a term for the eating of honey. Honey is a sweet and viscous substance created by some eusocial insects, notably bees, for consumption by members of their hives, especially their young. Honey is also consumed by many other animals including human beings, who have developed beekeeping to make supplies of honey both reliable and plentiful. Despite honey's limited antimicrobial properties, it remains a food source for a variety of microorganisms.

<span class="mw-page-title-main">Dermatologic surgical procedure</span> Skin surgery

Dermatologic surgical procedures are treatments aimed at managing a wide range of medically necessary and cosmetic conditions, with a long history dating back to ancient times.

References

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  6. ↑ Fonder, Margaret A.; Lazarus, Gerald S.; Cowan, David A.; Aronson-Cook, Barbara; Kohli, Angela R.; Mamelak, Adam J. (2008). "Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings". Journal of the American Academy of Dermatology. 58 (2): 192. doi:10.1016/j.jaad.2007.08.048. PMID   18222318.
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  15. ↑ John Gill's Exposition of the Bible Classic Bible Commentaries
  16. 1 2 Shah, Jayesh B. (19 April 2012). "The History of Wound Care". The Journal of the American College of Certified Wound Specialists. 3 (3): 65–66. doi:10.1016/j.jcws.2012.04.002. ISSN   1876-4983. PMC   3601883 . PMID   24525756.
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  29. ↑ "Alternative Treatments for Wounds: Leeches, Maggots, and Bees".

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