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Antiseptics
BIBLIOGRAPHY
Close, Frank. Antimatter. Oxford: Oxford University Press, 2009.
Fraser, Gordon. Antimatter: The Ultimate Mirror. Cambridge,
UK: Cambridge University Press, 2002.
Kane, Gordon. The Particle Garden: Our Universe as Understood
by Particle Physicists. New York: Perseus Press, 1995.
Lincoln, Don. The Quantum Frontier: From Quarks to the
Cosmos. Baltimore: Johns Hopkins University Press, 2009.
Lincoln, Don. Understanding the Universe: From Quarks to
the Cosmos. Revised ed. Singapore: World Scientific, 2012.
Don Lincoln
Senior Scientist
Fermi National Accelerator Laboratory
ANTISEPTICS
The discovery of antiseptics and their effect on public
health can be considered one of the great milestones in
medical history. In 1907 the American physician and
historian Franklin C. Clark (1847–1915) characterized
three events that revolutionized the practice of surgery in
an article appearing in the Medical Library and Historical
Journal (145–146): (1) arresting blood flow with ligatures, (2) anesthesia, and (3) antiseptic surgery. The third
event is the subject of this review. Antiseptics and antisepsis have had a profound influence on the practice of
medicine as well as contributing to the betterment of
public health. Although the scope and spectrum of antiseptic medicine and surgery has evolved to its current
excellent state, there remain issues today in parts of the
world where conditions are not completely unlike the
dawn of the era of antisepsis. The topic is current, timely,
and ongoing. The history of the discovery of antiseptics
and their subsequent development and application is
populated by a group of intelligent, energetic, and determined individuals who were purpose driven. Some
became well known and others are not as well known.
Yet collectively, they constitute a remarkable body of
work that led to a solution for one of medicine’s greatest
challenges.
By definition, antiseptics are substances applied to
living tissue to either kill bacteria (bactericidal) or inhibit
their growth (bacteriostatic). Similar substances are able
to destroy viruses (viricidal). Disinfectants are substances
that destroy bacteria and viruses on nonliving objects and
surfaces. Antisepsis refers to the practice of destroying or
inhibiting growth of microorganisms with the goal of
infection prevention. This is often accomplished by the
application of antiseptics.
THE HISTORICAL MOTIVATION FOR
DEVELOPING ANTISEPTICS
With this background, the story of the development of
antiseptics is quite interesting. In 1843 Boston physician
Oliver Wendell Holmes Sr. (1809–1894) theorized in an
essay appearing in the New England Quarterly Journal of
Medicine and Surgery that puerperal fever (or childbed
fever) was ‘‘communicated from one person to another,
both directly and indirectly’’ (p. 503). Although he did
not identify an etiological agent, his reasoning regarding
contagion was sound. Unfortunately, his ideas were
largely unnoticed and even attacked by distinguished
colleagues. Later, in 1855, he had the essay re published
in pamphlet form titled, Puerperal Fever as a Private
Pestilence.
Hungarian
obstetrician
Ignaz
Semmelweis
(1818–1865) is largely credited with the origin of the
antiseptic technique of hand washing as a means of infection control in 1847. This discovery was in relation to
puerperal fever. Semmelweis observed and studied the fact
that the obstetrical clinic in Vienna, Austria, where he
worked and trained had an increased number of deaths
from puerperal fever as compared to a similar clinic in the
same hospital where only midwives were trained. After the
death of a close friend and colleague from an illness similar
to puerperal fever that followed an accidental sharps injury
(i.e., a wound due to skin penetration from a scalpel or
other medical instrument) while performing an autopsy,
Semmelweis concluded that a connection existed between
autopsies and puerperal fever. That link was the hands of
the medical students and trainees. This led to the initiation
of a policy of hand washing with chlorinated lime (calcium
hypochlorite) between autopsies and obstetrical patient
examinations. The incidence of deaths from puerperal fever
decreased 90 percent. Although this contribution was probably not original with Semmelweis, this was very likely the
first time a single necessary cause of a disease was identified.
Although Semmelweis’s major work on the subject did not
appear in publication until 1861, his conclusions were
announced by others through editorials, letters, and
lectures. His ideas were considered out of the mainstream
of established medical practice and were attacked on several
fronts, including by Scottish physician James Young Simpson (1811–1870), who pioneered chloroform anesthesia in
1847. Simpson believed that the British had previously
reached the same conclusions as Semmelweis regarding
transmission of puerperal fever.
GRADUAL ACCEPTANCE OF THE GERM THEORY
The germ theory of disease was unknown at the time of
Semmelweis’s discovery. The French scientist Louis Pasteur (1822–1895), who made important discoveries in
chemistry and microbiology, and taught physics for a
DISCOVERIES IN MODERN SCIENCE: EXPLORATION, INVENTION, TECHNOLOGY
(c) 2014 Cengage Learning. All Rights Reserved.
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Antiseptics
were related. He noted that these patients seemed to
recover better in wards in which bromine deodorants were
used. Believing that bromine could be safely used on
patients with hospital gangrene, he developed a protocol
of surgical debridement (i.e., the removal of dead or
damaged tissues) followed by subcutaneous injection of
bromine solution and topical application. He carefully
compiled data and analyzed his results and found an overall 2.6 percent mortality with bromine-based therapy compared to 45.6 percent mortality without it. His results
were challenged by the contemporary medical establishment, but his contribution to surgical antisepsis remains
significant.
Joseph Lister. Lister theorized that a shield of antiseptic between
the surgical wound and air would protect the wound from
microorganisms in the air. He used carbolic acid, a well-known
disinfectant, to soak his surgical gauzes and instruments. As a
result, surgeons gained the ability to carry out complex surgery
without patients developing fatal infections. COURTESY OF THE
NATIONAL LIBRARY OF MEDICINE
time, demonstrated the germ theory between 1860 and
1864. This remarkable discovery gave credibility to the
findings of Semmelweis.
During this time in the United States, the Civil War
was raging. It was during this conflict that two significant
events in the field of antiseptics occurred. George H.
Tichenor (1837–1923), a Confederate cavalryman with a
background in chemistry and business, gained considerable medical knowledge during his time of service that
would eventually lead to his medical license. In 1863 in
Mississippi he sustained a gunshot wound to his left arm
that he treated with a formulation containing 70 percent
alcohol and avoided amputation. After the war he bottled
and sold his product while practicing medicine. The company bearing his name remains in existence today in New
Orleans, Louisiana. Middleton Goldsmith (1818–1888), a
Union surgeon working in Louisville, Kentucky, in 1863,
faced the horrible problem of hospital gangrene. He theorized that ‘‘hospital gangrene, erysipelas, and pyaemia’’
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Building on the work of Pasteur, the British surgeon
Joseph Lister (1827–1912) is credited with beginning
modern surgery between 1865 and 1867. He theorized
that a shield of antiseptic between the surgical wound and
air would protect the wound from microorganisms in the
air. He chose carbolic acid after noting it was used to
neutralize odors from fields fertilized with sewage and
that livestock grazing on those fields did not become sick.
Carbolic acid was used to spray instruments and was
applied to surgical wounds and dressings. With significant improvement in wound outcomes related to infection, Lister taught hand washing with antiseptic solution
as well as spraying the operative field. Within a few years,
the medical profession realized that infection was best
prevented by keeping microorganisms from gaining
entrance into wounds. Thus, modern surgery and modern antisepsis had come to fruition. Lister’s results were
published in the Lancet medical journal in 1867.
As others before him had experienced, his ideas
and doctrine of antisepsis were not immediately nor
universally accepted. The German physician Robert
Koch (1827–1912) had isolated, identified, and cultured
various disease causing bacteria in the 1880s, and by
1890 the world of surgery had been converted to the
antiseptic method. Lister always acknowledged his debt
to Pasteur’s work.
Other noteworthy advancements augment the story
of antiseptics. In 1886 the German surgeon Ernst von
Bergmann (1836–1907) became the first to utilize heat
sterilization of surgical instruments. This began aseptic
surgery (i.e., surgery performed under sterile conditions),
which aimed to prevent microorganisms from contacting
the wound. Antiseptic surgery came to the United States
in 1876 when New York surgeon Lewis A. Stimson
(1844–1917) successfully performed a mid-thigh amputation using Lister’s antiseptic methodology. Finally, in
1889, Baltimore surgeon William S. Halsted (1852–
1922) of Johns Hopkins University requested the Goodyear Rubber Company to make thin rubber gloves for his
scrub nurse and fiancée, Caroline Hampton. She had
DISCOVERIES IN MODERN SCIENCE: EXPLORATION, INVENTION, TECHNOLOGY
(c) 2014 Cengage Learning. All Rights Reserved.
Apollo 11
developed severe contact dermatitis from the antiseptic
and disinfectant solutions. Soon others began using them
and by 1899 there was nearly a 100 percent decrease in
the infection rate for hernia operations at Johns Hopkins.
The major transformation in surgery due to antiseptics and the subsequent benefit to public health was the
result of the accumulation of several distinct pathways to
discovery after deviating from the established standards
of the day. The universal ability of microorganisms to
adapt to the environment has led to the concept of
resistance, or tolerance, to some antiseptic formulations.
Nevertheless, nothing would have a greater impact on the
problem of infection until the discovery of penicillin.
Anesthesia; Human Microbiome Project;
Microbes Cause Disease; Penicillin and Other
Antibiotics; Public Health and Sanitation.
APOLLO 11
The primary objective of the Apollo 11 mission was to
meet the national commitment made by President John F.
Kennedy in an address to a joint session of Congress on
May 25, 1961: ‘‘Achieving the goal, before this decade is
out, of landing a man on the Moon and returning him
safely to Earth.’’ As an engineering test flight, the scientific
objectives of the mission were modest; the main technical
purpose of the mission was to demonstrate that the Apollo
systems could successfully operate through all stages of the
mission. But as the first voyage to carry humans to the
surface of another celestial body, Apollo 11 has had lasting
historical significance.
SEE ALSO
BIBLIOGRAPHY
Carter, F. C. ‘‘Semmelweis and His Predecessors.’’ Medical
History 25 (1981): 57–72.
Clark, F. C. ‘‘A Brief History of Antiseptic Surgery.’’ Medical
Library and Historical Journal 5 (1907): 145–172.
Cope, Z. ‘‘Joseph Lister, 1827–1912.’’ British Medical Journal 2
(1967): 7–8.
Holmes, Oliver Wendell. ‘‘The Contagiousness of Puerperal
Fever.’’ New England Quarterly Journal of Medicine and
Surgery 1 (1842–1843): 503–530.
Holmes, Oliver Wendell. Puerperal Fever as a Private Pestilence.
Boston: Ticknor and Fields, 1855.
Kessin, Richard H., and K. A. Forde. ‘‘How Antiseptic Surgery
Arrived in America.’’ Physicians & Surgeons Journal 28,
nos. 1–2 (2008).
Lathan, S. R. ‘‘Caroline Hampton Halsted: The First to Use
Rubber Gloves in the Operating Room.’’ Proceedings of Baylor
University Medical Center 23 (2010): 389–392.
Pennington, T. H. ‘‘Listerism, Its Decline and Its Persistence:
The Introduction of Aseptic Surgical Techniques in Three
British Teaching Hospitals, 1890–99.’’ Medical History 39
(1995): 35–60.
Trombold, J. M. ‘‘Gangrene Therapy and Antisepsis before
Lister: The Civil War Contributions of Middleton Goldsmith
of Louisville.’’ American Surgeon 77, no. 9 (2011):
1138–1143.
Trotter, Michael. C. ‘‘G. H. Tichenor and His Antiseptic
Solution: The Mississippi Years—Part 1 of 2.’’ Journal of the
Mississippi State Medical Association 53 (2012): 88–92.
Trotter, Michael. C. ‘‘G. H. Tichenor and His Antiseptic
Solution: The ‘Dr.’ in Dr. Tichenor—Part 2 of 2.’’ Journal of
the Mississippi State Medical Association 53 (2012): 127–130.
Michael C. Trotter
Doctor of Medicine; Fellow of the American College of Surgeons
Delta Regional Medical Center, Greenville, Mississippi
PROJECT APOLLO
Project Apollo had its origins in the National Aeronautics
and Space Administration (NASA) plan for a human
spaceflight effort to follow on its initial program, Project
Mercury. Apollo’s original objective was to develop a
three-person spacecraft capable of both operations in
orbit around Earth and of a flight to circle the Moon,
without landing. However, in reaction to the April 12,
1961, flight of Soviet cosmonaut Yuri Gagarin
(1934–1968), President Kennedy decided that the
United States should compete with the Soviet Union
for dramatic space achievements, and Apollo was transformed into a program to send Americans to the Moon.
Kennedy was willing to back up his decision with a
warlike but peaceful commitment of immense financial
and human resources, and after Kennedy’s assassination,
President Lyndon B. Johnson continued to support
Apollo as a memorial to the fallen leader. Between
1961 and 1968 NASA and its industrial and university
partners developed the capabilities needed to carry out a
lunar landing mission. They included a command module spacecraft in which the three-person crew would
make the journey to lunar orbit and from lunar orbit
back to Earth; an attached service module that carried the
rocket engine that would be fired to take the spacecraft
into and out of lunar orbit and other support equipment;
and a fragile lunar module designed to go only from
lunar orbit to the Moon’s surface and then back to a
rendezvous with the command and service modules. The
three elements of the Apollo spacecraft were to be
launched by the Saturn V, an extremely powerful and
massive launch vehicle. Large ground facilities were
developed on Merritt Island, Florida, for launch operations; after Kennedy’s assassination, these facilities were
named the Kennedy Space Center.
In 1967 Apollo planners set out a sequence of missions, each more ambitious than its predecessor, that had to
be successfully completed before the first landing mission
could be undertaken. The first crewed mission in that
DISCOVERIES IN MODERN SCIENCE: EXPLORATION, INVENTION, TECHNOLOGY
(c) 2014 Cengage Learning. All Rights Reserved.
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