No "Laudable Pus" in Western Medicine post 750 CE

Guy de Chauliac (1300–1368)

The most influential surgeon of the 14th and 15th centuries and a writer who demonstrated rare learning and a fine historical sense, Guy de Chauliac exerted an influence so great that he became physician to three popes at Avignon (Clement VI, Innocent VI, and Urban V) and a leading surgeon at the school of Montpellier. His work was copied and translated well into the 17th century and was considered to be the principal didactic surgical text (Collectorium cyrurgie, AD 1363) of this period (Fig. 15).[21,22] Guy posited four conditions that must be satisfied for a practitioner to be a good surgeon: 1) the surgeon should be learned; 2) he should be expert; 3) he must be ingenious; and 4) he should be able to adapt himself (from the introduction of Ars Chirurgica). Guy advocated repair by primary suture and claimed good results. He used egg albumin to stop bleeding and provide adequate hemostasis, which always posed a difficult problem for surgeons. A major error on his part was to reintroduce the concept of laudable pus to the healing of wounds, which set back surgery approximately 600 years, until the time of Lord Lister in the latter half of the 19th century.

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The urgency of operating during the "primary period" (the first 24 hours) was thought urgent in order to avoid the "irritative period" when infection showed itself. Believing the formation of "laudable pus" a sign of healing, surgeons were relieved by this "positive turn". The surgeon seldom had to wait more than three or four days for "laudable pus" to appear. This was believed to be the lining of the wound being expelled, thus clean tissue could replace it and the wound would heal. In fact, it was a sign that Staphylococcus aureus had invaded the wound, and was actively destroying tissue and over time would usually kill the soldier. In the rare cases when no pus appeared, medical practitioners described, "healing by first intention", and admitted that they knew not why.

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Came across 'laudable pus' when reading Ash by Mary Gentle. It's mentioned that hundreds of thousands of soldiers in Christian Europe died due to infection because physicians misunderstood what Galen meant.

So what if the idea of 'laudable pus' wasn't re-introduced to Western Medicine? Hundreds of thousands of soldiers wouldn't die is the first answer but this would have butterflies. Some famous people who would have died from this kind of infection would live as well.
 
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I don't think it would have much of an effect; Europeans weren't consciously trying to cause the infection.
 
It might make a difference in the long run not to have a theory about it. This Aristotelian millstone around Europe's neck has long been a hindrance to progress - that you needed not just evidence but explanations. Epirical observation taught many surgeons that wounds without pus healed better, and that cleanliness helped. But without a theory to explain the fact, it usually got chalked up to happenstance or extraneous interferences.

Which brings us back to the whole Europe-China thing...
 
Europe inheirited lots of things from India, the Arabs, and China. They could have adopted Byzantine/Arab medical methods couldn't they?
 

Oddball

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carlton_bach said:
This Aristotelian millstone around Europe's neck has long been a hindrance to progress - that you needed not just evidence but explanations.

Huh, I tought Aristoteles was kind of a founder for epirism :confused:

Was it not Plato that demanded explanations, "a priori?"
 
fortyseven said:
Europe inheirited lots of things from India, the Arabs, and China. They could have adopted Byzantine/Arab medical methods couldn't they?

They did, but these were the ones they read as based on theory. Western Europe's natzive medicine is empirical, folkloric and religious, but its professional medical writers were trained in the medicine of the Arab world and antiquity. They just developed their own readiong of it, sometimes well, sometimes not.
 
Red said:
Huh, I tought Aristoteles was kind of a founder for epirism :confused:

Was it not Plato that demanded explanations, "a priori?"

IIRC Aristotle developed his system based on em,piriocal observation. Unfoprtunately, he was quite frequently *read* as having developed the unified field theory everything now fit into. But you are right, the habit of putting theory before observation is older and unfairly ascribed to him.

Interestingly, most highly respected doctors didn't actually follow theory. They observed and learned, and then tried to find a way to say it politely, without offending Galen, Hippocrates or Avicenna.
 
OK, both the original links are inaccessible - the first I'd have to subscribe to a site, the second is a 404.

Apart from that, I would think that the more bizarre, nonsensical, and in some cases (like this one) actually detrimental medical practices can be got rid of early, the better. I am a little unclear, though, on what Galen originally said about this "laudable pus". Is it just that he said it was good to get rid of it if it appeared, and others interpreted it as "wait for the pus to appear, then your patient is getting better!"? Or something else?
 
The whole problem of the middle ages and science was that they held ancient doctors, philosophers, etc... in such high regard that they never attempted to improve on previous discoveries. Galen achieved many of his conclusions by observation, dissection, and study. Later europeans never expanded on his works due to the fact that they were basically afraid of going against standard belief. The same applies to aristotle, ptolemy, and others.
 
I could see how they would come up with the theory. Pus often forms in the later stages of wound healing. As a child I too thought it was a sign of healing. When pus appeared I knew it wont be long before healing was completed.
 
alt,

Laudable Pus

Hippocrates (circa 460–370 BC) may have been the first to hold an opinion on suppuration, asserting that the formation of pus was not a natural component in the healing process and suppuration should be avoided. His recommendations for managing wounds were similar to those of the Sumerians: cleansing with wine, applying a bandage, and then pouring wine on the bandage.[4]

Claudius Galen (circa A.D. 130–200), a surgeon to the gladiators in Pergamum, idealized Hippocrates and championed Hippocratic doctrines in the practice of medicine. Galen was a prolific writer on the science of medicine and became an outspoken proponent for experimentation, encouraging the questioning of established doctrines to expand scientific knowledge. (Ironically, his ideas became an established orthodoxy and prevailed unquestioned for 15 centuries.) His works were translated into many languages and became the lexicon for medical practice until the modern era. Many of his assertions proved true; however, one very important assumption was horrifically incorrect: that the formation of pus was essential for wound healing. This deviation from the Hippocratic dogma is one that would plague surgeons and hinder surgical progress until the time of Lister.[1]

One thousand years later, Theodoric Borgognoni of Cervia (1205–1298) challenged Galen's view of suppuration. Theodoric dedicated much of his career to finding the ideal conditions for wound healing and settled on four essentials: control of bleeding, removal of contaminated or necrotic material, avoidance of dead space, and careful application of the wound dressing. He also strongly emphasized the avoidance of "laudable" pus.[16] Nevertheless, because his views were in opposition to the established orthodoxy of Galen, he was denounced by his colleagues and the church.[4] Galen's doctrine of suppuration would remain the rule for wound management until the late 19th century.

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I have a better WI. What if Galen didn't deviate from Hippocratic dogma?
 
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