Sunday, August 12, 2007

History of Wound Management


A review of the history of veterinary wound management

  • In 1378, Gaston Phoebus, in his Le Livre de Chasse, devoted two chapters to the care of hounds. Wounds were not sutured and only bite wounds were treated. These were covered with raw wool drenched in olive oil, the dressings changed every day for three days. The wound was then left open to the fresh air and the healing effect of the dog's tongue. This would have been a reasonably effective treatment as lanolin (present in raw wool) and oil have an emollient as well as a light anaesthetic and antiseptic effect.

  • In 1605, Leonard Mascall in his First Booke of Cattell, under the heading of 'Impostumes in beastes to helpe', advised to 'open the place with an yron, and when it is cut, then shall yet crush forth all the ill humour and matter therein'. This is one of the very first mentions of cauterization. Mascall next suggested washing the wound with warm wine to cleanse it and using a mixture of 'Cherpi, tarre and oyle Olive' to 'close the sore therwith'.

  • In 1763, John Reeves advised suturing deep wounds, and suggested that waxed thread was better than silk because it rotted more easily and was not as prone to cutting. He believed that one stitch was sufficient for wounds of two or three inches, but where more were required they should be an inch apart.

  • In 1766, Osmer wrote of the the need to drain infected wounds : "In all wounds, where matter lies lower than the orifice of the wound, and cannot flow out, it produces fistulous cavities in the parts ... Now it is always necessary to go to the bottom of such (where the parts will admit of incision) otherwise no cure can be expected."

  • In 1769 J. de Saunier, riding-master and director of the Academy at Leyden, recommended dosing wounds with wine, a primitve kind of disinfectant, which he promoted as "Water proper for all Sorts of Wounds."

  • In 1803, Delabere Blaine was an advocate of suturing, but he believed that "when a wound is much torn, or bruised, stitches are better avoided".

  • In 1817, Francis Clater recommended cleaning wounds with "Tincture of Benzoin" -- the first modern antiseptic.

  • In 1830, William Youatt favoured the application of "lunar caustic" (silver nitrate) to wounds. Silver nitrate is still used on wounds, and is the standard solution to reduce infections after burns.

  • In 1865s, Joseph Lister suggested the germ concept of infection and suggested the use of carbolic acid (phenol, a type of coal-tar derivative), as an antiseptic agent. This worked so well that infection largely disappeared in Lister's operating theatre.

  • In 1904, Mayhew's Illustrated Horse Doctor recommends treating lacerated wounds with a mixture of cantharides, chloride of zinc and water. It is about this time that the use of saline washes first appears in literature as pehaps beneficial to wound management.

  • In 1911, the US Department of Agriculture's Special Report on Diseases of the Horse (1911) lists new wound antiseptics such as bichloride of mercury, carbolic acid, aluminium acetate, borasic acid, creolin, Lysol, iodoform and tannic acid.

  • With the introduction of sulphonamides and then penicillin in the 1930s and 1940s, great advances in wound treatment became possible. In recent years new classes of antibiotics have become available and can be had without prescription from most "vet and pet" supply catalogues -- "Fish-Flex" is cephelaxin, Fish-Mox is Amoxycillin, etc.

Did the old cures work? As The Journal of Veterinary History notes: "Despite the array of unpleasant compounds used in treatment, wound healing generally appears to have been successful. This was probably because the body's natural response to a wound is to heal it in spite of any 'veterinary' intervention." In short, the animal got better despite veterinary attention, not because of it.

We have better veterinary care today, but the determinant elements with most simple flesh wounds are still time and antibiotics. For more on antibiotics see the web site.


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