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The American civil War

My Paper is about a Baltic- German surgeon named, Ernst Von Bergmann. Dr. Bergmann was Born on December 1836 Riga, Russian Baltic Provinces. He is known as the first surgeon to use heat to sterilize surgical instruments. Dr. Bergmann came from a religious family. His father was a Lutheran Pastor in Rujen, Livonia. His mother was a refugee from an epidemic in Riga, thus Ernst Von Bergmann being born in the city where his mother was a refugee.

Ernst Von Bergmann tried to enter the Theological faculty,trying to follow his father’s steps but The Czar did not give him permission, so he signed up with the medical faculty of the Germano-Russian University of Dorpat in 1854. Six years later he graduated. He visited Hospitals for the following three years, learning and finally he settled down in Dorpat as a Clinical Assistant. Three years later he volunteered to the Prussian and Austrian war where he continued to learn all things surgery.

The war gave him invaluable knowledge in the surgery field. After the war, Dr. Bergmann went back to Dorpat. Later, he went on becoming what the Germans call: Chef-Artz in different base hospitals during the Franco-German War of 1870-1871. Later on the same year, he became a proffessor of surgery in Dorpat. In the spring of 1877 Russia declared war on Turkey and guess where Dr. Bergmann went? He offered his expertice and became a surgent consultant to the Army.

This war gave him the opportunity to treat the wounded under better conditions all due to the Baltic Hospital of the Red Cross where he adopted Lister’s antiseptic methods for the first time. Thus amputation became impractical due to the wider maneuvers of war. Ernst Von Bergmann had written about the impracticalities of amputation and with Lister’s antiseptic methods, the casualties of battle wounds had drasticaly been reduced.

As stated by “ Statistics from the American Civil War that of 1000 gunshot wounds of the knee-joint area, 837 died, of 1000 gunshot wounds of the elbow area, 194 died. Bergmann dressed 15 cases of gunshot fractures involving the knee-joint area, and for the first time, thirty to sixty hours after the injury, by thoroughly exploring and cleaning the wound and joint, using 5% carbolic acid as fluid, 8 healed without pus, in 7 cases there was pus, in 2 only a little pus and in 5 it was still severe and prolonged. 2 dressed forty-eight and sixty hours after wounding underwent secondary amputation through the thigh and recovered.

One dressed forty-eight hours after the injury, suffered from pyaemia, ( a diseased state in which pyogenic bacteria are circulating in the blood, characterized by the development of abscesses in various organs) underwent secondary amputation, and died. There was much limitation of movement in all the healed cases. Among a more inclusive number of 59, 30 healed, 2 after secondary amputations; 24 died, 9 of whom had been amputated. and 5 cases they lost sight of the patients.

Not very good odds by today’s standards but for that time, this was an advancement both in respect to the saving of life, and not having to amputate limbs. After a severe dysentery complicated by Pyaemia, he accepted the possition of Proffessor of Surgery at Wurzburg in Octuber of 1878 where he gave a speech on “The Treatment of Gunshot Wounds of the Knee-joint in War”. He stayed in Wurzburg untill 1882. After Wurzburg, he became a professor of surgery at theUniversity of Klinik in Berlin, this placed him in the highest rank of German surgeons.

Later Ernst Von Bergmann together with his assistant experimented with different ways of sterilizing surgical instruments. Idea he got from Koch’s report on the effects of sublimate in destroying anthrax bacteria, Bergmann substituted for carbolic acid the use of perchloride of mercury. On the 10th Internation Medical Congress, Bergmann had his assistant introduce the benefits of heat sterilization and dressings and how these affect micro-organisms and healing of wounds. The biggest trial and misfortune for Ernst Von Bergmann came with the death of Crown Prince and Kaiser, Frederick.

Crwon Prince and Kaiser suffered from hoarseness which means having a “vocal tone characterized by weakness of intensity and excessive breathiness, the hoarse voice of the auctioneer”. It began when The Crown Prince was diagnosed by another Doctor, named Gerhardt. Gerhardt saw that the Prince had an irregular projection of the left vocal cord and diagnosed him with Polypoid (nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder, or intestine, often causing obstruction) which continued to grow.

A few months later, on May of 1887, The Prince was diagnosed with Epithelioma (benign or malignant tumor derived from epithelial cells. Bergmann came to see the Prince and recommend laryngofissure and also removal of the affected cord, and possibly part of the thyroid cartilage if it was affected. Since a well known Doctor name Hahn in Berlin had successfully operated for the same disease. A couple of days later, another Doctor confirmed the diagnosys of Bergmann, a Doctor name Tobold.

They brought it to the Crown Prince and the Prince also agreed with to have the surgery performed. The complete laryngectomy had been specifically excluded but on request of Queen Victoria Doctor Morrell Mackenzie was called and Doctor Mackenszie arrive a couple of days after the laryngectomy was performed. Mackenzie brought no instruments with him which seems that it was a mistake on his part, gave his opinion that the growth was of a non-malignant polypous or fibromatous nature. Gerhardt did not agreed based on his previous diagnosys of the fixation of the vocal cord.

Mackenzie proposed to nip off a bit for examination, to which Bergmann still did not agreed due to adding complications to the surgery just performe and was afraid that additional complications would make it harder on the Crown Prince. The next day, Mackenzie removed bit of normal mucous membrane, leaving a visible wound of the right vocal cord which had previously been seen to be quite sound. A few more days later when Gerhardt was not present, Mackenzie removed two superficial bits of tissue which Virchow reported to be specimens of pachydermia.

Virchow used of the indefinite term pachydermia (an abnormal thickness of tissue of skin or of the laryngeal mucous membrane) instead of leukoplakia, (a disorder of a mucous membrane characterized by one or more white patches, occurring most commonly on the cheek, tongue, vulva, or penis: often medically insignificant but sometimes becoming malignant). already defined as a precursor of Epithelioma, there is to be noted that the galvano-cautery had already been applied, and there was the uncertainty as to what Mackenzie had actually removed. Virchow’s report showed that it favored the diagnosis of a non-cancerous growth.

Mackenzie persisted in making optimistic assertions as regards prognosis, while attributing the fixation of the cord and the steady progress of the disease to Perichondritis. Even when Bramnn, Bergmann’s assistant was compelled to perform tracheotomy, Doctor Mackenzie continued to speak and also publish his diagnosis as correct. Bergmann and Mackenzie argued on the use of the tracheotomy tubes. After Bergmann’s returned to Berlin, a piece of necrosed cartilage was coughed up, which Mackenzie said to be as part of his diagnosis of perichondritis, but about a month later, Mackenzie asked Bergmann for help.

When Bergmann and his assistant Bramann arrived, they found the Crown Prince asphyxiating. Bergmann and Bremann successfully inserted a tube and the Crown Prince’s life was prolonged for six more weeks. A port-mortem exam was performed and it was concluded that the original diagnosis of Bergmann was correct. Bergmann continued to make great contributions to the science of surgery and continued to be an active surgeon at the ripe age of 70.

Ernst Von Bergmann went on writing different books, one being “ System of Practical Surgery” This book covered malformations, injuries, and diseases of the pelvis which includes “congenital malformation of the pelvis, the different injuries, disease of the and operations of the pelvis”, malformation, injuries of the anus and rectum which includes, “anatomy, methods of examining the rectum”.

Congenital abnormalities, injuries, and diseases of the kidneys and ureter, congenital abnormalities, injuries, and diseases of the prostate and bladder, malformation, injuries and diseases of the Urethra, malformation, injuries and diseases of the penis, anomalies, injuries and diseases of the scrotum, testicles, vas deferens, and seminal vesicles, disease of the covering of the testicles and the spermatic cord.

Ernst Von Bergmann died on March 25, 1907 from what post-mortem examination showed to be inflammatory stricture of the colon.

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