History of the development of asepsis and antisepsis. History of the development of antisepsis and asepsis Antisepsis and asepsis history of medicine

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History of antisepsis and asepsis in Russia

§1. Development of ideas about wound treatment methods in the middle of the 19th century I 10th century in Russia

Since the middle of the 19th century, applied anatomy, experimental physiology and pathological anatomy began to develop successfully in Russia. Based on these sciences, operative surgery began to develop and operative technology achieved brilliant results.

Surgeons learned to operate skillfully, but they did not know how to treat wounds. Patients sometimes died after even minor operations. In 1845, N.I. Pirogov, 10 guardsmen died of sepsis after bloodletting. Introduced by the hands of a surgeon, dressing material, etc. the infection mercilessly struck the patients. Every sixth patient went from the operating room to the cemetery.

Gas infection, erysipelas, and diphtheria of wounds caused terrible epidemics in hospitals. Sometimes we had to close hospitals completely. Some surgeons stopped operating (Cooper), others themselves became victims of infection (Semmelweis). Gradually accumulated practical experience led to the doctrine of the “hospital miasma”; miasma is a hypothetical carrier of disease.

N.I. Pirogov came closest to antiseptics. His articles and statements collected together represent a coherent methodology for combating infection. He recommended separating patients infected with various hospital miasmas from uninfected patients. He also recommended various methods of purifying the air, burning mattresses stained with pus, keeping linen clean, and washing walls and floors in hospitals with bleach.

N.I. Pirogov noted in his articles that he is “... an ardent supporter of the antiseptic method of treating wounds...”. Even before 1852 N.I. Pirogov used bandages impregnated with antiseptic substances (silver nitrate, zinc sulfate, wine alcohol, etc.) in the treatment of wounds.

Almost simultaneously with N.I. Pirogov used antiseptic substances to treat wounds by Russian surgeon and anatomist I.V. Buyalsky, who widely used a solution of bleach to treat infected wounds. The Hungarian obstetrician Ignaz Semmelweis and the St. Petersburg obstetricians F.K. came very close to the idea of antiseptics. Guggenberger and A.A. Keeter.

In the 1850-1860s, in hospitals, a doctor and a paramedic walked from one patient to another and introduced infection into the wounds with their own hands, dressing material, and water with which they washed the wounds. It was necessary to create a rational method of treating wounds, which was started by N.I. Pirogov, Semmelweis, finally formulated this method by Joseph Lister, who introduced the antiseptic method in 1865 and published the first results of its use. Lister based his method on Pasteur's discovery of the essence of putrefaction. 1865-1870 Lister used oil solutions of carbolic acid, which he smeared with lint and covered with a lead sheet on top. I used the so-called Lister dough, consisting of carbolic acid, whitewash, and linseed oil. The surgeon's hands were washed with a 2.5% carbolic acid solution. The wound circumference was washed with the same solution before the operation and the wound itself was washed during and after the operation. The instruments were kept in a 2.5-5% phenol solution during the operation.

The works of Joseph Lister revolutionized surgery and their significance for the further development of surgery and other medical disciplines is extremely great.

In subsequent years, antisepsis was improved and developed by surgeons from all countries. Russian scientists (Pelekhin P.P., Sklifosofsky N.V., Anoshchenko M.I., Grubee V.F., Krasovsky A.Ya., Rozanov N.N., Burtsev I.I., etc.) also contributed great contribution to this most important problem of science.

§2. Spread of the antiseptic method

In 1870 begin to use cotton wool and gauze instead of lint.

A serious competitor to the antiseptic method was the method of open wound treatment, proposed by a number of surgeons Burov A., Billroth T., Krenlein R., Kostarev S.I.) and supported by the Surgical Society in Moscow, in which the wound was not covered with any bandages. The same Kostarev S.I. in 1873 he recognized the need to use antiseptic substances, but still the proposed open method was significantly less perfect than the antiseptic method accepted at that time. The benefits of the open method Kostareva S.I. has never been supported by either observations or experiments.

The thick volumes of the Chronicle of the Surgical Society in Moscow are almost half devoted to discussions about the treatment of wounds. The debate continued for more than three years. Thus, by paying attention to wound treatment as the main problem of surgery, the Moscow Society played a progressive role. At the same time, with the promotion of the open method, it interfered with the development of antiseptics.

The antiseptic method slowly but surely gained ground. A milestone in the development of antiseptics is 1870. Joseph Lister introduced, instead of simply wetting the dressing with carbolic acid, carbolized gauze treated in a special way, aqueous solutions, spraying, the well-known eight-layer dressing, washing hands and instruments.

Nevertheless, the antiseptic method required a radical restructuring of all surgical work - the creation of operating rooms, the acquisition of new expensive dressings, devices, and medications. It was the high cost that prevented the further spread of the antiseptic method, which led to the fact that about 10 years passed from the first cases of using the antiseptic method to its widespread use in Russia.

From 1868 to 1871 The antiseptic method is experiencing a period of fashion. Having not yet thoroughly mastered the method and technique of antiseptic treatment, surgeons begin to use it, and due to the fact that they do not use antiseptics pedantically enough, they do not always get good results.

In the mid-70s There are reports from a number of authors on the use of antiseptics. In 1875 S.I. Soborov reported on the use of an antiseptic salicylic dressing and disinfection of hands and instruments with salicylic acid in a Moscow military hospital, after which erysipelas and “Antonov fire” disappeared there. Subbotin M.S. reported to the St. Petersburg Society of Physicians about my use of antiseptics, etc. (Grube V.F., Bobrov A.A., Levshin L.L.) not only in big cities, but also in the provinces, the antiseptic method was used in those years (Tiflis, Oryol, Yaroslavl, Tambov city hospitals, etc.)

The development of the doctrine of antiseptics indirectly influenced the hygienic conditions of clinics and hospitals, the cleanliness of everything and everywhere. Surgeons began to pay even more attention to the cleanliness of rooms, linen, dressings, etc. Cleanliness was the main element of antiseptics. In 1872, L.L. Levshin wrote an article “A few words about the care of surgical patients” and made a report on the same topic at the St. Petersburg Society of Russian Doctors. He considered it necessary to polish instruments in order to make them easier to clean; use an irrigator instead of a kettle to wash wounds; change instruments at each dressing, which was news then and became the subject of discussion in the community of doctors. They were also asked to introduce white coats.

In addition to the practical application of antiseptics, discussion in societies and publication of its advantages and disadvantages, in Russia they were also engaged in the theoretical development of the antiseptic method, the manufacture and sale of various accessories of the antiseptic method (carbolized and salicylic cotton wool and gauze, solutions of antiseptic substances, protectants, macintosh, sprays, etc. .P.). With the advent of factories in Russia that produced antiseptic drugs, the possibilities for using antiseptics increased.

The war opened up great opportunities for surgeons, and on the battlefields they once again tested existing methods of treating wounds. K.K. most strictly and consistently used antiseptics in the war (1876-1878 - Russian-Turkish and Caucasian wars). Reyer, who divided antiseptic treatment into primary antiseptic, in which antiseptics were used starting from the dressing station, and secondary antiseptic, in which antiseptics were used only in the field hospital. Analyzing the data obtained during primary and secondary antiseptic treatment of K.K. Reyer proved that the best results are obtained with sequential (primary) use of antiseptics.

Nevertheless, at the same time, S.P. Kolomnin believed that due to lack of time, the use of a Lister bandage at a dressing station and in most hospitals is impossible, that a “neat and intelligently made antiseptic bandage” is simply necessary.

In 1881, A.I. Schmidt wrote the book “Newest Surgery in Its Application to Military Field Practice,” in which he gave an in-depth analysis of the work environment and tactics of a surgeon in military field conditions. A.I. Schmidt considered it necessary in war to use a dressing that complies with the principles of antiseptics, although the dressing may not be typically Lister.

Working in military field conditions, Russian surgeons, through extensive experience, were once again convinced of the benefits of the antiseptic method of treatment and, returning to peaceful conditions, began to use antiseptics even more.

In the second half of the seventies, carbolic acid ceased to be the only disinfectant used for antiseptic dressings. Salicylic acid was introduced, boric acid was proposed, and then various surgeons began to use other antiseptics. Russia is the birthplace of the first “aseptic” instruments (entirely metal, without wooden or bone handles).

In 1880, L.L. Levshin’s book “Fundamentals of Surgery” was published, which was the second domestic textbook on general surgery, where the author devoted a lot of space to describing various modifications of antiseptic dressings, listed more than 20 different disinfectants used in surgery, methods for preparing various antiseptic drugs.

Three main circumstances hampered the development of surgery and the introduction of new types of surgical intervention: lack of prevention of infection of surgical wounds, lack of a method to combat bleeding, and lack of pain relief. However, these issues were resolved.

In 1846, the American chemist Jackson and dentist W. Morton used inhalation of ether vapor during tooth extraction. The patient lost consciousness and pain sensitivity. Surgeon Warren in 1846 removed a neck tumor under ether anesthesia. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved loss of consciousness and loss of sensitivity. This was the beginning of general anesthesia - anesthesia. Although operations were now carried out painlessly, patients died either from blood loss and shock, or from the development of purulent complications.

L. Pasteur (1822-1895) as a result of his experiments proved that high temperature and chemicals destroy microbes and thus eliminate the process of decay. This discovery of Pasteur was a huge contribution to the development of the science of microbiology and surgery. The English surgeon J. Lister (1827-1912), based on Pasteur's discoveries, came to the conclusion that wound infection occurs through the air. Therefore, to combat microorganisms (microbes), they began to spray carbolic acid in the operating room. Before the operation, the surgeon's hands and the surgical field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. This is how a method of fighting infection appeared - antiseptics . Even before Pasteur discovered the processes of fermentation and decay.

In 1867, in the Lancet magazine, Lister published an article “On a new method of treating fractures and ulcers with comments on the causes of suppuration,” which outlined the basics of the antiseptic method he proposed. Later, Lister improved the technique, and in its full form it included a whole range of activities.
Antiseptic measures according to Lister:

spraying operating carbolic acid into the air;

treatment of instruments, suture and dressing material, as well as the surgeon’s hands with a 2-3% solution of carbolic acid;

treatment of the surgical field with the same solution;

use of a special dressing: after the operation, the wound was covered with a multilayer dressing, the layers of which were impregnated with carbolic acid in combination with other substances.

Thus, the merit of J. Lister was, first of all, that he did not simply use the antiseptic properties of carbolic acid, but created a complete method of fighting infection. Therefore, it was Lister who went down in the history of surgery as the founder of antiseptics.

Advances in microbiology and the works of L. Pasteur and R. Koch put forward a number of new principles as the basis for the prevention of surgical infection. The main one was to prevent bacteria from contaminating the surgeon’s hands and objects in contact with the wound. Thus, surgery included the cleaning of the surgeon’s hands, sterilization of instruments, dressings, linen, etc.
The development of the aseptic method is associated primarily with the names of two scientists: E. Bergman and his student K. Schimmelbusch. The name of the latter is immortalized by the name of the bix - a box still used for sterilization - the Schimmelbusch bix.
At the X International Congress of Surgeons in Berlin in 1890, the principles of asepsis in the treatment of wounds received universal recognition. At this congress, E. Bergman demonstrated patients operated on under aseptic conditions, without the use of Lister antiseptics. Here the basic postulate of asepsis was officially adopted: everything that comes into contact with the wound must be sterile.

First of all, high temperature was used to sterilize the dressing material. R. Koch (1881) and E. Esmarch proposed a method of sterilization with flowing steam. At the same time, in Russia, L.L. Heidenreich was the first in the world to prove that sterilization with steam under high pressure is the most perfect, and in 1884 he proposed using an autoclave for sterilization.
In the same 1884, A.P. Dobroslavin, a professor at the Military Medical Academy in St. Petersburg, proposed a salt oven for sterilization, the active agent in which was the steam of a saline solution boiling at 108°C. Sterile material required special storage conditions and a clean environment.
In 1885, a Russian surgeon M. S. Subbotin To perform surgical interventions, he sterilized the dressing material, which laid the foundation for the asepsis method. Subsequently, Ernst von Bergmann, N. devoted his works to this section of surgery. I. Pirogov, N. V. Sklifosovsky and many others.

Thus, the structure of operating rooms and dressing rooms was gradually formed. Here, much credit goes to Russian surgeons M. S. Subbotin and L. L. Levshin, who essentially created the prototype of modern operating rooms. N.V. Sklifosovsky was the first to propose distinguishing operating rooms for operations with different levels of infectious contamination.
After the above, and knowing the current state of affairs, the statement of the famous surgeon Volkmann (1887) seems very strange: “Armed with an antiseptic method, I am ready to perform an operation in a railway latrine,” but it once again emphasizes the enormous historical significance of Lister’s antiseptics.
The results of asepsis were so satisfactory that the use of antiseptics began to be considered unnecessary, not corresponding to the level of scientific knowledge. But this misconception was soon overcome.

At the same time, developments in methods to combat bleeding during wounds and operations appeared. F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. The works of N. I. Pirogov were devoted to the fight against bleeding, especially when studying the surgical anatomy of blood vessels, secondary bleeding, etc.

High temperature, which is the main method of asepsis, could not be used to process living tissue or treat infected wounds. Thanks to the successes of chemistry for the treatment of purulent wounds and infectious processes, a number of new antiseptic agents have been proposed that are much less toxic to the tissues and body of the patient than carbolic acid.
Similar substances began to be used to treat surgical instruments and objects surrounding the patient. Thus, gradually asepsis became closely intertwined with antiseptics, and now surgery is simply unthinkable without the unity of these two disciplines.
As a result of the spread of aseptic and antiseptic methods, the same Theodor Billroth, who had recently laughed at Lister’s antiseptics, in 1891. said: “Now, with clean hands and a clear conscience, an inexperienced surgeon can achieve better results than before the most famous professor of surgery.
And this is not far from the truth. Now the most ordinary surgeon can help a patient much more than Pirogov, Billroth and others, precisely because he knows the methods of asepsis and antisepsis.

N.I. Pirogov (1810-1881) believed that pus could contain “sticky infection” and used antiseptic substances. The doctrine of wound infection arose. The use of an antiseptic method in surgery has led to a reduction in purulent complications of wounds and improved surgical outcomes. The main significance of all Pirogov’s activities is that with his selfless and often selfless work, he turned surgery into a science, equipping doctors with a scientifically based method of surgical intervention.

The following figures are indicative: before the introduction of asepsis and antisepsis, postoperative mortality in Russia in 1857 was 25%, and in 1895 - 2.1%.
In modern asepsis and antiseptics, thermal sterilization methods, ultrasound, ultraviolet and X-rays are widely used; there is a whole arsenal of various chemical antiseptics, antibiotics of several generations, as well as a huge number of other methods of fighting infection.
Scientific period

The scientific period in the history of blood transfusion and blood-substituting drugs is associated with the further development of medical science, the emergence of the doctrine of immunity, the emergence of immunohematology, the subject of which was the antigenic structure of human blood, and its significance in physiology and clinical practice. In 1901, Karl Landsteiner discovered blood groups. In 1907 Ya. Yansky developed a blood transfusion technique.

Physiological period

Asepsis and antiseptics, anesthesiology and the doctrine of blood transfusion became the three pillars on which surgery developed in a new quality. Knowing the essence of pathological processes, surgeons began to correct the impaired functions of various organs. At the same time, the risk of developing fatal complications was significantly reduced. The physiological period of development of surgery has arrived.
At this time, the greatest German surgeons B. Langenbeck, F. Trendelenburg and A. Bier lived and worked fruitfully. The works of the Swiss T. Kocher and Ts. Ru will forever go down in the history of surgery. T. Kocher proposed a hemostatic clamp that is still in use today, and developed a technique for operations on the thyroid gland and many other organs.
A number of operations and intestinal anastomoses bear the name Ru. He proposed plasty of the esophagus with the small intestine, a method of surgery for inguinal hernia.
French surgeons are better known in the field of vascular surgery. R. Leriche made a great contribution to the study of diseases of the aorta and arteries (his name is immortalized in the name Leriche syndrome). A. Carrel received the Nobel Prize in 1912 for the development of types of vascular suture, one of which currently exists as the Carrel suture.
In the USA, successes were achieved by a whole galaxy of surgeons, the founder of which was W. Mayo (1819-1911). His sons created the world's largest surgery center. In the USA, surgery from the very beginning was closely connected with the latest achievements of science and technology, therefore it was American surgeons who stood at the origins of cardiac surgery, modern vascular surgery, and transplantology.
A feature of the physiological stage was that surgeons, no longer especially afraid of lethal complications of anesthesia, infectious complications, could afford, on the one hand, to operate calmly and for quite a long time in various areas and cavities of the human body, sometimes performing very complex manipulations, and on the other On the other hand, to use the surgical method not only as a last resort to save the patient, as a last chance, but also as an alternative method of treating diseases that do not directly threaten the patient’s life. Surgery of the 20th century developed rapidly. So, what is surgery today?

The first antiseptic methods are found in the descriptions of doctors from ancient times. “One skilled healer is worth many people: he will cut out an arrow and sprinkle medicine on the wound,” Homer, “Iliad.”

Hippocrates spoke about the cleanliness of the doctor’s hands and used only boiled rainwater and wine in treatment. In laws Moses It was forbidden to touch the wound with your hands. 500 years BC in India it was known that smooth healing of wounds is possible only after thorough cleaning of them from foreign bodies.

And in folk medicine for centuries, myrrh (an aromatic resin), frankincense, chamomile, wormwood, aloe, rose hips, alcohol, honey, sugar, sulfur, kerosene, salt and much more have been used as antiseptics.

But meaningful, targeted actions to introduce antiseptics began only in the middle of the 19th century.

Ignaz Semmelweis. Photo: www.globallookpress.com

Unhappy Semmelweis

Hungarian obstetrician Ignaz Semmelweis drew attention to the fact that for some reason, midwives have fewer deaths during childbirth than in his hospital. (This was explained by the fact that midwives dealt mainly with healthy women in labor, and doctors also worked with patients, in addition, together with students they practiced in the anatomical theater.)

Semmelweis suggested that doctors treat their hands with bleach... And a phenomenal result: postpartum mortality in the hospital due to the development of sepsis decreased to 1%. This was in 1847. Alas, not only was Ignatz not supported... The persecution began. The very suggestion that a doctor’s hands could be a source of danger was considered offensive. And in general, how can something that is not visible, and therefore something that is not there, kill?!

The short life of Ignaz Semmelweis, full of struggle and humiliation - for some time he was placed in a psychiatric hospital - ended early, at the age of forty. Ironically, he died of sepsis after cutting his finger during surgery.

Semmelweis's activities were appreciated only decades later. His compatriots even erected a monument to him in his homeland in one of the parks in Budapest. Recognition came to Ignatz after Pasteur's discovery.

Louis Pasteur's grape juice

Investigating, to the delight of French winemakers, the diseases of wines, a chemist Pasteur studied fermentation agents... “Discoveries come only to those who are prepared to understand them,” he would write later. The French scientist Louis Pasteur, the founder of microbiology (by the way, also an honorary member of the St. Petersburg Academy of Sciences), in 1863 was the first to scientifically prove that the cause of rotting is microorganisms that entered the grape juice from the outside - from the air and from surrounding objects. And fermentation is not a chemical process, as previously thought, but a biological phenomenon - the result of the life activity of these microscopic organisms. And if they are not visible, this does not mean that they are not there (poor Semmelweis!).

Louis Pasteur in his laboratory in Paris. Photo: www.globallookpress.com

Louis Pasteur was not a doctor, but he accurately assessed the significance of his discovery for medicine. Addressing members of the Paris Academy of Surgery in 1878, he said: “If I had the honor of being a surgeon, then, aware of the dangers posed by microbial germs present on the surface of all objects, especially in hospitals, before each operation I would first thoroughly wash hands and then held them over the burner flame for a second. I would pre-heat lint, bandages and sponges in dry air at a temperature of 130-150 degrees, I would never use water without boiling it.” (So we returned to Hippocrates.)

By the way, pasteurized products are a daily greeting to us from the founder of microbiology, Pasteur, who once proposed this disinfection technology - pasteurization.

Photo: www.globallookpress.com

Never say forever

Reading many books on medicine, an English surgeon Joseph Lister, who worked in the 60s of the 19th century, came across a brochure by the chemist Pasteur, who believed that microorganisms are afraid of chemicals. Getting acquainted with the works of this French scientist, Lister also came to the conclusion that microorganisms enter the patient’s body from the hands of the surgeon.

In 1865, having become convinced of the antiseptic properties of carbolic acid (they were first discovered by a Parisian pharmacist Leboeuf), the Englishman used a bandage with its solution in the treatment of an open fracture and sprayed carbolic acid in the air of the operating room: he attached particular importance to airborne infection. His measures also included the treatment of hands, suture and dressing material, and instruments.

Lister (1827-1912) became the founder of antiseptics - a system of measures aimed at destroying microorganisms in a wound, organs and tissues, as well as in the patient’s body as a whole. Surgery was unpopular before Lister. “The man who lies on the operating table in our surgical hospitals is in greater danger than an English soldier on the fields of Waterloo.” In 1850, in Paris, out of 550 patients, 300 died after operations. Surgeons did not take the risks associated with opening the cavities of the human body - such an intervention was accompanied by one hundred percent mortality from infections. Erikoen, Lister's teacher, stated that the abdominal, thoracic, and cranial cavities would forever remain inaccessible to surgeons.

Joseph Lister. Photo: www.globallookpress.com

Recognition of Lister's merits began only after 1884, he became a baronet, then president of the Royal Society of London for the Advancement of Knowledge of Nature. And the introduction of antiseptics into surgical practice is one of the fundamental achievements of medicine of the 19th century.

In Russia Nikolai Ivanovich Pirogov back in 1844 he wrote: “The time is not far off when a careful study of traumatic and hospital miasms will give surgeons a different direction” (miasma - “pollution.” - Ed.). Pirogov was close to creating a doctrine of antiseptics. In some cases, he used antiseptics: silver nitrate, bleach, wine alcohol and camphor alcohol. He tried to organizationally solve the problem of surgical infections: he demanded the allocation of a “special department” for infectious patients. And he formulated one of the main postulates of modern antiseptics - the principle of flow separation: “clean” patients - separately.

"Antiseptics. Types and methods"

Work completed

St. Petersburg Polina

3rd year, 13th group, Tim Taekwondo

History of antisepsis

Empirical period

Dolister antiseptic

Lister antiseptic

The emergence of asepsis

Modern antiseptics

Types of antiseptics

Mechanical antiseptics

Physical antisepsis

Chemical antiseptic

Biological antiseptics

Literature

Antiseptics (Latin anti - against, septicus - rotting) - a system of measures aimed at destroying microorganisms in a wound, pathological focus, organs and tissues, as well as in the patient’s body as a whole, using mechanical and physical methods of influence, active chemicals and biological factors.

The term was introduced in 1750 by the English surgeon J. Pringle, who described the antiseptic effect of quinine.

The introduction of asepsis and antisepsis into surgical practice (along with anesthesia and the discovery of blood groups) is one of the fundamental achievements of medicine of the 19th century.

Before the advent of antiseptics, surgeons almost never took the risk of operations associated with opening the cavities of the human body, since interventions in them were accompanied by almost one hundred percent mortality from surgical infections. Professor Erikoen, Lister's teacher, stated in 1874 that the abdominal and thoracic cavities, as well as the cranial cavity, would forever remain inaccessible to surgeons.

History of antisepsis

In the emergence and development of asepsis and antisepsis, five stages can be distinguished:

empirical period (the period of application of individual, not scientifically substantiated methods);

Dolister antiseptic;

Lister antiseptic;

the emergence of asepsis;

modern antiseptics.

Empirical period

The first "antiseptic" methods can be found in many descriptions of the work of doctors in ancient times, 500 BC. In India, it was known that smooth healing of wounds is possible only after they are thoroughly cleaned of foreign bodies. In Ancient Greece, Hippocrates always covered the surgical field with a clean cloth and used only boiled water during the operation. In folk medicine, for several centuries, myrrh, frankincense, chamomile, wormwood, aloe, rose hips, alcohol, honey, sugar, sulfur, kerosene, salt, etc. were used for antiseptic purposes. However, targeted, meaningful actions of surgeons to prevent purulent complications began much later - only in the middle of the 19th century.

Dolister antiseptic

A special role in the development of antiseptics during this period was played by I. Semmelweis and N. I. Pirogov.

The Hungarian obstetrician Ignaz Semmelweis in 1847 suggested the possibility of the development of puerperal fever (endometritis with septic complications) due to the introduction of cadaveric poison by students and doctors during vaginal examination (students and doctors also studied in the anatomical theater).

Semmelweis proposed treating hands with bleach before an internal study and achieved phenomenal results: at the beginning of 1847, postpartum mortality due to sepsis was 18.3%, in the second half of the year it dropped to 3%, and the next year to 1.3%. However, Semmelweis was not supported, and the persecution and humiliation that he experienced led to the fact that the obstetrician was placed in a mental hospital, and then, ironically, in 1865 he died of sepsis due to felon, which developed after wounding his finger while performing one from operations.

Semmelweis's merits were appreciated only several decades later, after the discoveries of Pasteur and Lister, when his compatriots erected a monument to him in his homeland.

Nikolai Ivanovich Pirogov did not create a complete doctrine of antiseptics, but he was close to it. N.I. Pirogov used in some cases antiseptic agents for the treatment of wounds - silver nitrate, bleach, zinc sulfate, wine alcohol and camphor alcohol.

Nikolai Ivanovich Pirogov tried to organizationally solve the problem of preventing surgical infections, demanding the establishment of a “special department” for infectious patients. He formulated one of the main postulates of modern antisepsis: the principle of dividing flows into “clean” and “purulent” patients.

All this, of course, could not make a revolution in science. “The ice really started to move” only after the great discovery of Louis Pasteur (1863), who for the first time strictly scientifically proved that the cause of fermentation and rotting are microorganisms that entered the grape juice from the outside during the production of wine from the air or from surrounding objects. It is interesting that Pasteur, who was not only a surgeon, but also a doctor in general, completely correctly assessed the significance of his discovery for medicine. Addressing members of the Paris Academy of Surgery in 1878, he said: “If I had the honor of being a surgeon, then, aware of the danger posed by the germs of microbes present on the surface of all objects, especially in hospitals, I would not limit myself to caring for absolutely clean instruments ; Before each operation I would first wash my hands thoroughly and then hold them over the flame of the burner for a second; I would pre-heat lint, bandages and sponges in dry air at a temperature of 130-150ºC; I would never use water without boiling it.”

Lister antiseptic

In the 60s of the 19th century in Glasgow, the English surgeon Joseph Lister (1829-1912), having familiarized himself with the works of Pasteur, came to the conclusion that microorganisms enter the wound from the air and from the surgeon’s hands. In 1865, having become convinced of the antiseptic properties of carbolic acid, which the Parisian pharmacist Lemaire began to use in 1860, he used a bandage with its solution in the treatment of an open fracture. In 1867, Lister published an article “On a new method of treating fractures and ulcers with comments on the causes of suppuration.” It outlined the basics of the antiseptic method he proposed. Lister went down in the history of surgery as the founder of antiseptics, creating the first integral, multicomponent method of fighting infection.

Lister's method included a multi-layer bandage (a layer of silk soaked in a 5% solution of carbolic acid was attached to the wound, 8 layers of gauze soaked in the same solution with the addition of rosin were placed on top of it, all this was covered with rubberized fabric and fixed with bandages soaked in carbolic acid), hand treatment , instruments, dressing and suture material, surgical field - 2-3% solution, sterilization of the air in the operating room (using a special “spray” before and during the intervention).

In Russia, the task of introducing antiseptics was carried out by a number of outstanding surgeons, among them N.V. Sklifosovsky, K.K. Reyer, S.P. Kolomin, P.P. Pelekhin (author of the first article on antiseptics in Russia), I. I. Burtsev (the first surgeon in Russia who published the results of his own use of the antiseptic method in 1870), L. L. Levshin, N. I. Studensky, N. A. Velyaminov, N. I. Pirogov.

Lister's antiseptics, in addition to its supporters, had many ardent opponents. This was due to the fact that carbolic acid had a pronounced toxic and irritating effect on the patient’s tissue and the surgeon’s hand (plus the spraying of a solution of carbolic acid in the air of the operating room), which made some surgeons doubt the value of this method.

The emergence of asepsis

25 years later, Lister’s antiseptic method was replaced by a new method - aseptic. The results of its use were so impressive that there were calls for the abandonment of antiseptics and the exclusion of antiseptics from surgical practice. However, it turned out to be impossible to do without them in surgery.

Modern antiseptics

Thanks to the successes of chemistry for the treatment of purulent wounds and infectious processes, a number of new antiseptic agents have been proposed that are much less toxic to the tissues and body of the patient than carbolic acid. Similar substances began to be used to treat surgical instruments and objects surrounding the patient. Thus, gradually, asepsis was closely intertwined with antiseptics; now surgery is simply unthinkable without the unity of these two disciplines.

The arsenal of surgeons also included a variety of biological agents (biological antiseptics).

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Federal State Budgetary Educational Institution of Higher Professional Education "Novosibirsk State Agrarian University"

Faculty of Veterinary Medicine

Department of Epizootology and Microbiology

History of the development of asepsis and antisepsis

Completed by: 1st year student,

FVM, gr. 6102a

Rudakova Z.A.

Checked by: Gryazin V.N.

Novosibirsk, 2015

antiseptic infection disinfection surgery

Introduction

1. Definition

2. History of asepsis and antisepsis

Conclusion

Introduction

Asepsis and antisepsis are one of the most important components of the success of any operation.

“Everything that comes into contact with the wound must be sterile,” these words were said by E. Bergman in 1980 at the Tenth International Congress of Surgeons. And this principle now helps all medicine to successfully treat and operate on patients. But to whom do we owe such a successful progress in most operations? In my work I will try to answer this question, briefly tell the history of the development of asepsis and antisepsis, and also present basic information about them.

1. Definition

Asepsis is a set of measures aimed at preventing the entry of microorganisms into the wound.

Antiseptics is a set of measures aimed at destroying microorganisms in a wound, source of infection, organs, tissues, and body.

2. History of the development of asepsis and antisepsis

The term “antiseptics” (Greek anti - against, sepsis - rotting) was first proposed by the English scientist J. Pringle in 1750 to denote the anti-putrefactive effect of mineral acids. In the 19th century, this term extended to activities carried out to prevent postpartum complications and wound suppuration.

The history of antiseptics in this new understanding goes far back to the period of gathering, when a person, choosing edible plants through trial and error, discovered the medicinal or toxic effect of some of them. The selection of such plants may have been facilitated by observations of herbivores. Once sick, they begin to eat certain types of herbs that they would not normally consume.

In folk medicine of the beginning of our era, myrrh, chamomile, wormwood, thyme, rose, aloe and other plants, as well as alcohol, honey, coal, sugar, kerosene, sulfur, incense, sea salt, alum, and copper sulfate were used for antiseptic purposes.

The rapid development of inorganic and organic chemistry in the 13th - 19th centuries enriched the list of local antimicrobial drugs with inorganic and organic compounds. Thus, in the middle of the 18th century the antimicrobial effect of mineral acids was established; In 1786, the production of potassium hypochlorite was established, in 1798 - bleach, and in 1822 - sodium hypochlorite. In 1811, iodine was discovered, which was first used to treat wounds in 1888. In 1818, hydrogen peroxide was synthesized. Since 1867, formaldehyde began to be used as an antiseptic, and since 1885 its derivative, formalin. In 1881, potassium permanganate was introduced into medical practice. In the 80s of the XIX century, the antimicrobial effect of malachite green, methylene blue, safranin and other dyes was established. At the end of the 19th century, acetic and citric acids began to be used for antimicrobial purposes. In 1863, carbolic acid began to be used in medical practice, which soon, thanks to the work of J. Lister (1867), became widespread as a means of preventing postoperative complications. In 1874-1875, the antimicrobial effect of salicylic acid was established.

The modern (scientific) history of antiseptics is associated with the names of the Viennese obstetrician I. Semmelweis and the English surgeon J. Lister. They scientifically substantiated, developed and introduced antiseptics into practice as a method of treating and preventing the development of suppurative processes and sepsis. In 1847, Semmelweis, based on many years of observations, came to the conclusion that maternity fever, which was widespread in those days and had a high mortality rate, was caused by cadaveric poison transmitted in maternity hospitals through the hands of medical personnel. In Viennese hospitals, he introduced mandatory and thorough cleaning of the hands of medical personnel with a bleach solution. Morbidity and mortality from puerperal fever in the hospital fell sharply as a result of this measure, while in other hospitals they continued to remain at high levels. Unfortunately, the death of Semmelweis slowed down the introduction of this method into widespread practice.

In 1867, Lister's article "The Antiseptic Principle in Surgical Practice" was published in the Lancet. Based on Louis Pasteur's research on the content of tiny organisms in the air - causative agents of septic processes, Lister reported that he had developed a method for destroying microorganisms in a wound and in all things that the wound comes into contact with. As such an antimicrobial substance, he used a solution of carbolic acid, which he introduced into the wound. Subsequently, he treated healthy skin surrounding the wound, instruments, the surgeon’s hands with carbolic acid, and sprayed the air in the operating room. To test the effectiveness of the antiseptic treatment method, a group of patients with open fractures, which usually ended in amputation or death of the patient, was initially selected. The success exceeded all expectations.

Postoperative complications and a high percentage of deaths hampered the development of surgery. Lister's "antiseptic principle" fell into fertile ground. Within a few years, it was adopted by most surgical clinics in Europe.

Paying tribute to I. Semmelweis and J. Lister as the founders of antiseptics, it should be mentioned that simultaneously with them or even earlier, other doctors used chemicals for the prevention and treatment of wounds. The Russian surgeon N.I. should rightfully be included among them. Pirogov, who during the Caucasian expedition of 1847 and the Crimean War of 1853-1856 widely used a solution of bleach, ethyl alcohol, and silver nitrate to prevent suppuration and treat wounds.

Lister's antiseptic method quickly gained recognition. However, as it spread, its disadvantages were also revealed, first of all, the local and general toxic effect of carbolic acid on the body of the patient and medical workers (“carbolism”) was expressed. This circumstance, as well as the development of scientific ideas about the causative agents of suppuration, the ways of their spread in hospitals, the sensitivity of microbes to various damaging factors, the development of I.I. Mechnikov's teachings on phagocytosis led to widespread criticism of antisepsis and the formation of a new medical doctrine of asepsis.

For the development of Asepsis in the 80s. In the 19th century, the German surgeons E. Bergman and K. Schimmelbusch did a lot, who can rightfully be considered the founders of Asepsis. In Russia, asepsis became widespread in the 90s. 19th century

Initially, asepsis arose as an alternative to antiseptics, but the subsequent development of both teachings showed that asepsis and antiseptics do not contradict, but complement each other.

3. Modern asepsis and antiseptics

Antiseptic. XIX - XX century

At this time, 2 main antiseptic methods were used:

1. Lister’s antiseptic dressing mainly consisted of gauze soaked in a solution of carbolic acid; it was applied with hands washed in carbolic acid, and the instruments used for dressing were also pre-treated with carbolic acid, and even the air of the dressing room and operating room was purified by rain from the carbolic solution. With the implementation of this method, the results of wound treatment improved incomparably, suppuration usually proceeded more favorably, epidemics of contagious surgical diseases decreased, and most importantly, the use of surgical treatment became possible, since its result was no longer the inevitable and dangerous wound disease, and sometimes a postoperative wound healed without any signs of suppuration.

But Lister’s method also had its drawbacks: eczema sometimes appeared around the wound, green urine appeared in the patient, and sometimes necrosis of the limb was observed - these were phenomena of the patient’s poisoning with carbolic acid. Similar poisonings were observed among medical personnel. Also among the disadvantages of this method is the unreliability of its action, especially on bacteria that form spores.

All this can be explained by the fact that, given the level of knowledge that doctors had, they simply did not have the right to refuse to use any antiseptic measures, even knowing that the substance they were using was poisonous.

It should also be noted that in the past, sublimate and iodoform were used very widely.

2. Sublimate - mercury dichloride. It was produced in the form of crystalline pieces, tablets, powders and solutions. This is a strong disinfectant. Used as a 0.1% solution.

In the presence of protein liquids (blood, pus), the antiseptic effect of sublimate ceases. Sublimate is very poisonous. poisoning is characterized by severe vomiting, blue discoloration, weak pulse, ulcerated gums, inflammation of the kidneys, etc.

Iodoform is yellow crystals or powder with a characteristic strong odor. It has a disinfectant effect only in a purulent wound, where, as it decomposes, it releases iodine. In case of poisoning, the patient's condition is serious. A very small amount of sublimate is enough for poisoning. Poisoning is expressed by paleness of the patient, severe vomiting, the smell of iodoform when breathing, serious condition and agitation of the patient.

Antiseptics continued to develop with the emergence of more effective, but less toxic antiseptics (antiseptics), which have bactericidal and bacteriostatic qualities, activate the body's defenses and enhance phagocytosis, are devoid of harmful effects on the body and do not lose activity when in contact with pus. Antibiotics meet these requirements to the greatest extent. Sulfonamide drugs (streptocide, sulfazol, sulfadimezin, etazol, etc.), which are used when streptococcal, pneumococcal, meningococcal infections predominate, also have antiseptic properties. Phytoncides contained in a number of plants (garlic, onions, bird cherry, black currant, citrus fruits, conifers, etc.) have high antibacterial qualities - these methods were used both a couple of centuries ago and now.

Currently in medicine, antiseptic agents are used: for disinfection of premises for preoperative treatment of surgeons' hands. When treating infectious and invasive diseases, the method of using a particular antiseptic depends on the form of the disease, the nature of the operation, the localization of the pathological process, the possibility of draining the wound, and the type of microbes. Antiseptics are used to lubricate the skin and mucous membranes, their solutions wash wounds, soak tampons and wet-dry dressings, irrigate wounds and cavities; powdered antiseptics are sprinkled on wounds, etc.; some are used orally, administered intramuscularly, intravenously.

The list of substances used in the 20s - 30s of the 20th century is still used today, and it has not become smaller, but is only replenished every year with more effective and less toxic drugs.

Asepsis. XIX - XX century

Before the advent of asepsis, the main route of transmission of infection was medical personnel. During operations and dressings, basic hygienic requirements were violated; the doctor put on a greasy, dirty suit, rolled up his sleeves so as not to stain them, and stuck needles with waxed threads into the lapel of his coat. When changing dressings, the paramedic used the same sponge to wash the wounds of all patients in a row, etc.

At the beginning of the 20th century, 4 main aseptic methods were used:

· boiling, burning;

· dry heat;

· flowing steam;

· Autoclaving is the most preferred method.

1. Calcination. Although the method is quite reliable, only a few instruments could be sterilized (i.e., sterilized) in this way, for example, smallpox vaccination needles, needles for drawing blood, etc. The rest of the instruments deteriorated greatly and became unusable. Currently, basins, trays, etc. are subjected to this disinfection method.

1.1. Boiling. Boiling in solutions of various salts, mainly alkalis, was used to sterilize instruments, except cutting ones, dishes and many other items. The most common method of sterilizing instruments was the Schimmelbusch method. The instruments were boiled in a 1% solution of ordinary soda for 15 minutes.

Before starting to boil, be sure to check the serviceability and whether the instruments were assembled correctly, then they were washed in soapy water and only after that they were put into the boiler. To prevent nickel-plated instruments from deteriorating during boiling, they were lowered into the boiler (along with the tray) when the soda solution was already boiling, and taken out immediately after boiling. Glass objects were boiled separately from the tools. Before boiling, the syringes were taken apart and wrapped in gauze. Glass objects were placed in warm water or saline, which was then heated to a boil.

To boil water, the Tyndall and Koch method was used, the water was boiled for 30 minutes, then a break was taken for 6 hours and boiled again.

Several types of boilers were used for boiling. Now metal tools and gloves are being boiled.

2. Dry heat. The apparatus for sterilization by chemical heat was a metal box with double walls and a door. The internal space was intended to accommodate sterilized items and was equipped with a thermometer. A burner was placed under the bottom of the apparatus, with the help of which the air inside the device was heated. Apparatuses operating with dry heat had significant inconveniences: 1) it is very difficult to achieve uniform heating of the entire space - the temperature at the walls is higher than in the middle; 2) dry heated air kills bacteria only at a temperature of 140, provided that it remains in it for at least one hour. Dressing material - cotton wool and gauze - at this temperature become charred or dry out so much that they become unfit for use.

It is for these reasons that in 1930-1940. This method was used to sterilize instruments and glass.

3. Flowing steam. As a method of asepsis, flowing steam at the end of the 19th and beginning of the 20th centuries was considered unreliable and complex, and therefore was used extremely rarely and not by all specialists. But already in the 30-40s it was used to sterilize dressings and linen at a temperature of 100C and lasting 1-2 hours.

4. Autoclaving. Autoclaving is considered the most reliable, fastest and most effective method of sterilization, both in the past and in our century.

Steam under pressure can sterilize almost everything, with the exception of leather and fur items. Sterilization was carried out as follows. 1 - 2 liters of hot water were poured into the bottom of the boiler, a metal grate was inserted, and objects were placed on it, the lid was closed and screwed, and heated until steam began to come out of the tap. By closing the tap, the pressure was brought to 1 or 2 atm. and released the remaining air. After making sure that all the air had escaped, we began the sterilization itself, using a pressure of 2 atm. and t 134 C for half an hour or longer, depending on the size of the apparatus and the number of things placed in it.

The samples of that time were sealed tubes containing sulfur or crushed sulfur placed in the middle of a drum (as bixes were called in the past). If, at the end of sterilization, sulfur fused everywhere, then it was considered that the sterilization was quite successful, because everything was heated in the presence of steam to a temperature of 120C (and sulfur melts at 111, and fuses at about 120). Upon completion of sterilization, it was necessary to extinguish the fire and open the tap on the lid. Dispossessed, i.e. Sterilized items can be removed immediately after sterilization is completed.

A more advanced device was the Kny-Scheerer sterilizer. The advantages of this autoclave are that sterilization is done at a pressure of one atmosphere, so that cotton wool and gauze do not deteriorate; steam penetrates evenly everywhere and the temperature quickly reaches its limit everywhere (sulfur melts evenly, even if the cotton wool is packed very tightly); everything that was sterilized in it was taken out completely dry; metal objects (knives) did not rust; Little fuel was required.

A wide variety of devices were used for sterilization and storage of various fertilized substances and objects.

The dressing material was placed in special nickel-plated drums, or in willow baskets lined with thick canvas on the inside. Baskets for small autoclaves were made round, and for large ones - quadrangular. Baskets provided the convenience that you could have a lot of them and take a whole basket for each individual bandage. At the same time, the dressing material did not need to be repositioned when removed, which was difficult to do without when using bixes.

Instruments - knives, needles with raised threads for intestinal sutures or for emergency needs, catheters, tips, etc. were sterilized in glass tubes covered with cotton wool. But since glass test tubes easily burst, metal tubes (like test tubes), which were plugged at both ends with cotton wool, were more convenient.

Water and liquids for subcutaneous and intravenous infusions were sterilized either in a simple glass bottle, plugged with cotton wool, or in special metal cylinders.

Proper hand disinfection plays an important role in all surgical work, especially during operations, since insufficiently well-treated hands of medical personnel are one of the main sources of wound infection.

4. Methods for disinfecting hands and surgical materials

Methods for hand disinfection

A large number of different methods have been used to disinfect hands.

· washing hands with soap and boiled brushes (change at least two brushes) for 10-15 minutes. They washed either with running warm water under the tap or in clean basins with water, in this case the water was changed 2-3 times. The water was taken as hot as could be tolerated. Then they were disinfected with sublimate, carbolic acid, etc.

· tanning the leather after washing it. To do this, hands were wiped for 5 minutes with alcohol (sterile gauze), a solution of iodine in gasoline, alcohol-tannin 5% or iodine tincture (the ends of the fingers and nail beds). Some hospitals used tanning without first washing hands in hot water.

· also, old methods of hand treatment include: the Furbringer method (hand brushing, washing them with warm water and soap for 1 minute, cleaning nails, wiping hands with 80% alcohol for 1 minute and mercuric chloride solution 1:1000 for 1--2 minutes to prepare the hands of the surgeon for the operation; in a later modification, alcohol was used after the sublimate solution), Spasokukotsky, Kochergin, Alfeld.

Glove processing

· having carefully sprinkled talcum powder inside and out, each individually is wrapped in a gauze napkin and sterilized for 15 minutes.

· gloves are boiled in water with a soda solution for 5-10 minutes.

· gloves are immersed in a solution of sublimate 1:1000 for at least 40-60 minutes.

Seam material and processing

Absorbable and non-absorbable threads are used to stitch tissues.

1. Catgut is a string made from lamb intestines. Catgut loses its tensile strength within 60 days. In industrial conditions, catgut is sterilized with chemical antiseptics, and it is sold in ampoules. There was a method for preparing catgut in a hospital setting.

· it was kept for 8 days rolled into small hanks in a solution of 1 part iodine and 1 part potassium iodide in 100 parts water (that is, in Lugol's solution). After 8 days, the solution was changed, and the catgut was stored in a new solution until used. It was also possible to disinfect it under the influence of iodine vapor, in special devices - dry iodine catgut.

· catgut was immersed in a 1% solution of malachite green and placed in a thermostat at a temperature of 20-30C for 3 days; the catgut swells somewhat and turns dark green. After this, it was removed with sterile tweezers and placed in a sterile jar with 90% alcohol for decolorization. The catgut in alcohol was kept in a thermostat at the same temperature for 24 hours. Catgut is stored in alcohol.

2. Silk has the form of a twisted polyfiber thread of varying thickness. For best results, properly prepared antiseptic silk was used.

· The main method was the Kocher method: silk was treated for 12 hours in ether and 12 hours in alcohol, then boiled in a solution of sublimate 1:1000, after which it was wound loosely on glass spools with disinfected gloved hands and boiled a second time before the operation.

· The second method is a modification of the first. The silk was boiled in water or 5% carbolic acid for 5 minutes, then with clean hands it was wound onto sterile spools in a thin layer and placed in a sterile jar with a ground stopper for 12 hours with ether. Then, using tweezers, the coils with shell were transferred to another identical sterile jar with alcohol, changing it 3 times: after 12 hours, after 24 hours, after two hours. Finally, having changed the alcohol, they stored the silk in it until use. But before the operation itself, they boiled it in an aqueous solution of mercuric chloride for 2 minutes.

· The third method is using malachite greens. The silk was wound onto glass or spools in no more than 3 rows and dipped into a boiling 1% solution of malachite green for 5 minutes. Then it was transferred to a sterile jar with 90-95% alcohol to extract excess paint. Here it was kept until the operation.

Dressing

The following requirements are imposed on the dressing material used during operations and applied directly to the wound during dressings: it must be soft, not friable, that is, it must not produce individual fibers that clog the wound, and it must absorb water well.

To establish suction capacity, you need to throw a piece of material onto the water and see how quickly it gets wet and sinks; the faster, the better the material.

In order to save money, washing of used dressing material was widely used in surgical departments. First of all, all gauze wipes used during a clean operation (non-purulent) had to be washed. The napkins were collected, the blood, before it had time to dry, was soaked in cold water, then washed, and the gauze was dried. After this, the gauze was sterilized and used for dressings. Bandages could be washed even after purulent cases. They were soaked in a soap-carbol solution and only then washed, then sterilized and used for bandaging in the dressing room.

Untreated cotton (plain cotton wool) did not have the ability to absorb and was used only to protect the wound from bruises or pressure. Absorbent cotton, defatted by boiling for a long time in lye, was used for dressing, but was applied over gauze.

Lignin - wood wool and moss - were also used for these purposes. But both had a number of inconveniences. Lignin quickly got wet, and it was covered with cotton wool on top, and moss was sewn into the pads because of the debris; moreover, when heated, it quickly lost its ability to absorb.

In addition to aseptic material, antiseptic material was also used - sterile material impregnated with a solution of sublimate, carbolic acid, etc. did not have any special advantages and was used where rare dressings were done, for example, at the front.

Liquids that do not have disinfectant properties were often used. Such as saline solution, its use is no different from the present; its 1% solution was used for wet dressings and washing off blood around the operation site; ether was used not only for anesthesia, but also for disinfecting instruments, skin and when processing silk; gasoline was used to wash the skin around the wound.

Conclusion

Having studied the history of the development of asepsis and antisepsis, we can distinguish several stages of their development:

Empirical period (the period of application of individual, not scientifically substantiated methods);

Dolister antiseptic;

Lister antiseptic;

The emergence of asepsis;

Modern antiseptics.

Also, after the materials I have studied on the history of the development and definition of asepsis and antisepsis, one main conclusion can be drawn: without these phenomena in medicine, it is impossible to talk about the correct treatment and complete recovery of the patient.

Asepsis and antisepsis are one of the most important components of our life, allowing us to cure and save many people and prevent a huge number of diseases, as well as requiring further development for more successful operations and treatments and being very interesting for study by medical and veterinary sciences.

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