Historical recount and epistemological analysis of the sepsis derived from wounds and its surgical control: From the papyrus of Edwin Smith to the “pus bonum et laudabile”

Abstract

Sepsis, as a fearsome complication of trauma, has accompanied mankind throughout history, particularly in the Antiquity. In this article the historical evolution of surgical sepsis control and of the importance of suppuration is reviewed, from the Ancient Egypt through the Middle Ages. The evolution of different therapeutic approaches for wounds is described, from the non-suppurative healing of the Egyptians and Alexandrians to the irrepressible desire of seeing wound suppuration that was common in the Middle Ages. The causes of the ambiguity of Greeks concerning the promotion or limitation of suppuration are presented. They were based on the classical theory of Humoralism. This conception became the framework of the Galenic dogma expressed as the “good and laudable pus”, which served as the basis for wound care during more than one thousand years. It was responsible, together with the loss of valuable surgical knowledge during the Middle Ages, of the establishement of cauterization as the treatment of choice for different types of lesions. The epistemological reasons for the failure to overthrow the Galenic dogma during the XIII Century are also discussed.