Content area
Full Text
ABSTRACT
The presence of pus is one of the most easily recognizable signs of an infection. However, for several centuries suppuration, known as 'laudable pus,' was believed to be a sign of a healthy, healing wound. This historical misconception can be explained by the difference in the presentation of a necrotizing soft tissue infection versus other more common skin and soft tissue infections. Chronic wound infections, due to pyogenic bacteria, typically produce large amounts of thick, whitish-yellow pus. On the other hand, necrotizing soft tissue infections, despite their severe mortality and morbidity, are devoid of pus in the traditional sense. What the ancient medical observers recognized was the fact that pus is not characteristic of this subset of incredibly severe infections. This is an important distinction to remember when evaluating an infection, even today.
ARTICLE HISTORY
Received 28 April 2017
Accepted 8 June 2017
KEYWORDS
Laudable pus; Staphylococcus; Streptococcus; Clostridium; SSTIs; NSTIs
Our modern-day attention to sterility in the operating room makes antiseptic technique seem second nature. However, for many centuries the idea that pus was necessary and beneficial for wound healing was considered dogma among surgeons [1]. Although the phrase 'pus bonum et laudabile' (good and laudable pus) was crafted by later physicians [2], it arose from observations that date back to ancient Greece. Hippocrates, commenting on wound healing, remarked that 'if the pus is white, and not offensive, health will follow,' but if it is 'sanious1 and muddy, death is to be looked for' [3]. However, the Greek physician, surgeon, and philosopher Galen of Pergamon (129-199 AD) is typically the one who is blamed for the pervasiveness of the concept of 'laudable pus' in early Western medicine. This is an unfortunate misunderstanding, as Galen did not believe that pus was required for wound healing [4]. He actually advocated crude medical therapies designed to dry wounds and reduce the amount of suppuration [5]. The confusion probably arose from Galen's advice on abscesses, a condition where he did think it was important to see pus since the lack of drainage could prove fatal [5].
It was not until the 13th century that the doctrine of laudable pus was substantially challenged. Theodoric Borgognoni, an Italian surgeon writing in 1267 AD, called for the use of...