外科感染
1.Where this is pus, we cut.
—— Mark M.Ravitch, 1910——1989
【译文】哪儿有脓就在哪儿切开。
2.Drain pus through the shortest route.
—— Mark M.Ravitch, 1910——1989
【译文】以最短的路径引流脓液。
3.Pus is like the truth——you have to let it out.
—— Gareth Morris-Stiff
【译文】脓液像事情的真相，你一定要让它流出来。
4.The mechanical control of the source of infection, while itself nonbiologic,determines the extent of the host biologic response to the disease.
—— Ronald V.Maier
【译文】用机械手段控制感染源，虽然本身是非生物的，但却改变了宿主对疾病的生物反应强度。
5.In peritonitis——source control is above all.
【译文】处理腹膜炎——控制感染源最重要。
6.The most novel antibiotics and the best supportive care are meaningless, if principles of source control are not adhered to with obsessiveness.
—— Moshe Schein
【译文】如果不能坚持感染源控制的原则，最新的抗生素和最好的支持疗法都毫无意义。
【点评】 “敏感的抗生素”“有效的支持疗法”和“及时控制感染源”是处理严重全身感染患者的三大法宝，缺一不可。
7.In peritonitis, operating on a poorly resuscitated patient is like throwing both ends of the rope at a drowning man.
【译文】给未成功复苏的腹膜炎患者做手术就如同把绳子的两端都扔给一个溺水的人。
8.Attempting trans-laparoscopic management of complicated post-operative peritonitis is like making love to a fully dressed harem woman.
—— Moshe Schein
【译文】试图通过腹腔镜处理复杂的手术后腹膜炎，就像和一个穿戴整齐的后宫妃子做爱（意指——碍手碍脚，很难施展得淋漓尽致）。
【点评】腹腔镜发展到今天，每个医生掌握腹腔镜技术的程度不一样，或许有同道对上述观点有不一样的看法。
9.Pus somewhere, pus nowhere, pus under the diaphragm (and masked by antibiotics.)
—— Mark M.Ravitch, 1910——1989
【译文】似乎哪里都有脓、却哪里都没有脓的时候，其实，脓就在膈下（真相常为抗生素所掩盖）。
10. "Signs of pus somewhere, signs of pus nowhere else, signs of pus there-under the diaphragm".This was 100% true when I was a student, 50% true when I was a resident.Today it is irrelevant.And Mark M Ravitch added: " ... and masked by antibiotics".
—— Moshe Schein
【译文】“哪里都有脓，哪里都没脓，是膈下积脓的征象”这句话在我当学生的时候是100%正确的，当我做住院医师时就只剩50%可靠了，时至今日，好像彼此已经没什么关联了。这一切正如Mark M.Ravitch所说：“……都被抗生素掩盖了。”
【点评】在如今无论有无指征动辄抗生素先上去的环境下，患者很多经典的感染症状和体征都变得不那么典型了，这将给临床医生带来更大的挑战。
11.Every operation in surgery is an experiment in bacteriology.
—— Berkeley Moynihan, 1865——1936
【译文】外科的每一次手术都是一次细菌学实验。
12.As long as surgical infections exist, surgeons must make never-ending efforts to control them.It may be described as a time when science and art can absolutely prevent bacteria from gaining a foothold in the human body and can abruptly terminate their activity, if they have already become established.
—— Frank L.Meleney, 1889——1963
【译文】只要外科感染存在，外科医生就必须不断努力控制它。可以说，这是一个科学和技术可以绝对阻止细菌在人体立足的时代，即使它们已经入侵也可即刻令其失去活力。
【点评】现在看来，将人体内的细菌赶尽杀绝既不是我们的目标，也没有可能。
13.The only solution for endemic infection was complete demolition, repeated in regular intervals of every hospital afflicted with hospitalism.
—— John Erichsen, 1818——1896
【译文】解决（院内）流行感染的唯一办法是完全彻底的清除，受院内感染之困的每家医院都应每隔一段时间就这样重复清除一次。
【点评】200年过去了，该建议依然是控制院内感染流行的绝招。
14.Sepsis is not an antibiotic-deficiency syndrome.
—— John Marshal
【译文】脓毒血症不是“抗生素不足综合征”。
15.Patients can get well without antibiotics.
—— Mark M.Ravitch, 1910——1989
【译文】没有抗生素患者照样能好起来。
【点评】当然前提是患者免疫力正常，感染不十分严重。
16.The greatest boom to surgery's advance in this century has been control of cellulitic infections through chemotherapeutic agencies, the sulfonamides and antibiotics.When will surgery experience another great catalytic forward thrust like that achieved through anesthesia，prophylactic antisepsis, and the antibiotics?
—— Owen H.Wangensteen, 1898——1981
【译文】通过化疗制剂、磺胺类药物和抗生素来控制蜂窝组织炎是本世纪最大的外科进展。外科何时能再经历一场像麻醉、预防性消毒和抗生素发现这样伟大的具有催化作用的突破呢？
【点评】的确，纵览抗生素发现以来几十年中的各种外科进步，还没有哪一项对外科全局的影响可与“麻醉、预防性消毒和抗生素”的发现相提并论。句中的“cellulitic infections”应该是只由细菌感染所引发的广义的“各种组织的非特异性化脓性感染”。
17.The advent of antibiotics has greatly lowered the incidence of hand and other infections opened the way for prophylactic treatment, and reduced the need for surgical drainage.However, over the years one theme has recurred: initial care is pre-eminent in the prevention and treatment of all surgical infections.
—— J.J.Byrne
【译文】抗生素的出现大大降低了手部和其他感染的发生率，开辟了一条预防性治疗之路，减少了手术引流的需要。然而，许多年过去了，这样一个话题再次出现，即：基本无菌原则在所有外科感染的预防和治疗中依然举足轻重。
【点评】不遵守基本无菌原则再强大的抗生素也枉然。
18.Inflammation is not itself considered a disease but a salutary operation...but when it cannot accomplish that salutary purpose ...it does mischief.
—— John Hunter, 1728——1793
【译文】炎症本身并不是一种疾病，而是有益于机体的一种防御反应……但若无法实现这一目标时……反倒酿成了灾祸。
19.The real danger in fever is not the pyrexia but the poison causing it.
—— Augustus Charles Bernays, 1854——1907
【译文】发热的真正危险不是发热，而是引起发热的毒素。
20.View with anxiety any case of sepsis, which has a low temperature.
—— Augustus Charles Bernays, 1854——1907
【译文】任何体温不升的脓毒血症都令我们感到焦虑。
21.Infectious disease specialists: don't they know that an abscess reflects the victory of the peritoneal defences?
—— Moshe Schein(https://www.daowen.com)
【译文】感染病专家：难道他们不知道脓肿形成是腹膜防御获胜的标志吗？
22.The phagocyte is the best antiseptic.
—— Alexander Fleming, 1881——1955
【译文】吞噬细胞是最好的抗菌药。
23.People claim that lavage is the solution to pollution by dilution of the contaminants, but remember that macrophages do not swim well.
—— Moshe Schein
【译文】人们声称灌洗是通过稀释污染物来解决污染。但是，别忘了巨噬细胞并不擅长游泳。
24.A surgeon should never be satisfied with himself nor with the others as far as a sepsis is concerned.
—— Robert Danis, 1880——1962
【译文】外科医生自己永远不要止步于，也不应该满足于他人对脓毒血症的关注。
【点评】作为外科医生，面对脓毒血症首先应问感染源在哪里？其次应该想到是否可通过外科手段清除或控制感染源。
25.Sepsis is an insult to a surgeon.
【译文】（手术后）发生脓毒血症是外科医生的羞辱。
【点评】 不可一概而论，关键要看脓毒血症的发生是否与外科医生的判断或操作失误有关。
以下收集的这些有关“外科感染”的名言较好再现了“现代外科”之前外科先辈们从“认识伤口化脓”到“阻止伤口化脓”这段历经千余年的苦难而辉煌的历史，尽管每一句都不再有任何现实意义，但却闪耀着“化石”般的光芒，给吾辈以无限感慨和启迪。
26.The wound should be treated in such a way as to produce suppuration as quickly as possible.
—— Hippocrates, 460——377 BC
【译文】伤口的治疗应尽快让其化脓。
27.It is not necessary...as all modern surgeons profess, that pus should be generated in wounds.No error can be greater than this.
—— Hugh of Lucca, 1160——1257
【译文】没有必要……像所有“现代外科医生”所宣称的那样，伤口一定要化脓，没有比这种观念更大的错误了。
【考注】根据哥伦比亚大学的C.G.Heyd教授[Am.J.Surgery，1941；51（1）：54-65]在其文章“The evolution of modern surgery”中对西方外科发展阶段的划分意见，公元前410年至1846年乙醚麻醉出现之前这段时间统称为“中世纪至早期现代外科时期（Timeline of Medieval to Early Modern Surgery）”。因此，此处所指“现代外科医生”是相对于“古代外科（Timeline of Surgery in Antiquity）”而言的。
28.Suppuration may be considered a resolution but it is a mode of resolution which we mainly wish to avoid.
—— John Hunter, 1728——1793
【译文】化脓可被视作一种解决办法，但我们还是希望避免通过这种方法来解决问题。
29.Many more surgeons know how to cause suppuration than to heal a wound.
—— Henri de Mondeville, 1260——1320
【译文】知道如何促使伤口化脓的外科医生远多于如何促使伤口愈合的外科医生。
【考注】在李斯特发现“消毒灭菌技术”之前，人们一直认为伤口化脓是不可避免的自然发展过程，为了伤口早日愈合应促使其早日成脓。直到13世纪意大利多米尼加修士Theodoric（1205——1296）在他出版的Chirurgia一书中才首次对“化脓和脓液的形成是伤口愈合所必需的过程”提出了质疑。尽管如此，“值得称赞的脓液”这一概念一直延续到将近七百年后的19世纪李斯特才得以纠正。在漫漫外科历史中，“伤口必经化脓方能愈合”这一观念竟然误导了我们先辈数千年之久。
30.He should bind with white cloths, for if they are not clean, harm results.He should also wash his hands before he treats anyone.
—— Heinrich von Pfolspeundt, ?——1460
【译文】他应该用白布包扎，因为如果不干净，则会带来危害。他在处理任何患者前也应该先洗手。
【点评】此时外科开始有了“一般清洁”的概念。
31.The fear of "hospitalism" is past and the surgical patient no longer is exposed to more chances of death than the English soldier on the field of Waterloo.
—— James Y.Simpson, 1811——1870
【译文】对“院内感染”的恐惧已经过去，外科患者不再面临比滑铁卢战场上的英国士兵有更多的死亡机会。
【点评】一定是李斯特“消毒灭菌技术”的功劳。
32.Nearly ten years after Lister's publication, Gross commented: "Little, if any faith, is placed by any enlightened or experienced surgeon on this side of the Atlantic in the so-called carbolic acid treatment of Professor Lister".
—— Samuel Gross, 1805——1884
【译文】李斯特的论文发表近十年后，格罗斯评论道：“大西洋这边几乎没有任何开明或有经验的外科医生对李斯特教授的所谓石炭酸处理法有信心，即或有，也是微乎其微。”
【点评】可见传统、权威势力对新生事物有多么大的阻力！
33.Had I had the honour of being a surgeon, impressed as I am with the dangers of exposure to germs and microbes scattered on the surface of all objects,particularly in hospitals, not only would I use perfectly clean instruments, but after washing my hands with the greatest care and submitting them to a rapid flaming,which would cause no more discomfort than a smoker feels in passing a burning coal from one hand to another, I would use charpie, bandages, sponges previously exposed to air at 130℃ to 150℃ temperature.
—— Louis Pasteur, 1822——1895
【译文】我对所接触的所有物体表面散布的细菌和微生物的危险性印象太深刻，尤其在医院。因此，如果我有幸成为一名外科医生，我不仅要使用完全干净的器械，而且要非常小心地洗手，并将器械迅速在火焰中过一下（这个动作一点不比吸烟者相互传递一个燃烧着的点烟木炭更难受），我还会将敷料、绷带、吸水敷料这些东西放进130～150℃的气体中蒸一蒸再用。
【点评】现代消毒供应室的鼻祖非巴斯德莫属。
34.My house surgeon ...acting under my instructions ...laid a piece of lint dipped in liquid carbolic acid upon the wound, and applied ...splints …the remarkable retardation of suppuration, and the immediate conversion of the compound fracture into a simple fracture with a superficial sore, were more encouraging facts.
—— Joseph Lister, 1827——1912
【译文】我的外科住院医生……按照我的指示……在伤口上放一块浸有石炭酸的敷料，然后用夹板固定，从而化脓显著减少，复合性（开放性）骨折立即转为仅有些许表浅溃烂面的单纯性（闭合性）骨折，这是一个相当令人鼓舞的事实。
35.When it had been shown by the researchers of Pasteur that the specific property of the atmosphere depends on minute organisms, it occurred to me that decomposition in an injured part might be avoided by applying as a dressing some material capable of destroying the life of the floating particles.
—— Joseph Lister, 1827——1912
【译文】当巴斯德的研究人员证实了空气中的某些特殊属性取决于其中所含的微小生物体时，我突然想到，用一些能够破坏漂浮在空气中的颗粒生物体的材料作为敷料，从而避免了受伤部位的腐烂化脓。
36.In using the expression "dressed antiseptically "I do not mean merely"dressed with an antiseptic "but" dressed so as to ensure absence of putrefaction".
—— Joseph Lister, 1827——1912
【译文】在使用“无菌覆盖”这一表述时，我的意思不仅仅是指“用消毒的布料覆盖”，而是“通过这种覆盖来确保感染腐败不会发生”。
37.I do not expect my contemporaries to accept all my doctrines, but I look to the coming generation to adopt and perfect them.
—— Joseph Lister, 1827——1912
【译文】我不指望我的同辈人接受我所有的信条，但我期待下一代能够采纳它们并加以完善。
【点评】看来李斯特也知道“消毒灭菌技术”这一新技术推广与普及的巨大阻力。
38.The time will assuredly arrive when peritonitis will not kill, because we will lean that the effusions in the peritoneal cavity may be as safely evacuated as those in the pleural cavity.
—— James Marion Sims, 1813——1883
【译文】腹膜炎不会致命的时刻一定会到来，因为我们相信腹腔感染性渗液可以像胸腔积液一样安全地排出。
【点评】看来历史上胸腔引流还早于腹腔引流。
39.Many cocci, particularly pneumococci and the cocci found in pyaemia, are stained intensely, whilst some few other bacteria, such as typhoid, are decolorized.
—— Christian Gram, 1853——1938
【译文】许多球菌，特别是肺炎球菌和脓毒血症中发现的球菌，染色浓郁；而一些其他细菌，如伤寒，则像褪过色一样浅淡。
40.These bacteria are called Escherichia coli in honour of Theodor Escherich,a scientist of the nineteenth century.
—— Francis D.Moore, 1913——2001
【译文】为了纪念19世纪的科学家西奥多·埃斯克里希，这些细菌被称为埃希杆菌。