cleansing properties of alcohol were the Greeks. They used wine along with boiled water and vinegar to cleanse wounds. The Greeks, specifically Hippocrates (430–377 BC), were also the first to establish the four cardinal signs of inflammation: redness, swelling, heat and pain. Alcohol is still in use today as a wound cleanser largely as rubbing alcohol. However the side effects can be skin cell death resulting in inflammation and itchiness at the site of application. Middle Ages There were limited advances that continued throughout the Middle Ages and the Renaissance, but the most profound advances—both technological and clinical—came with the development of microbiology and cellular pathology in the 19th century. 19th century The first advances in wound care in this era began with the work of Ignaz Philipp Semmelweis, a Hungarian obstetrician who discovered how hand washing and cleanliness in general in medical procedures prevents maternal deaths. Semmelweis's work was furthered by an English surgeon, Joseph Lister, who in 1860s began treating his surgical gauze with carbolic acid, known today as phenol, and subsequently dropped his surgical team's mortality rate by 45%. Building on the success of Lister's pretreated surgical gauze, Robert Wood Johnson I, co-founder of Johnson & Johnson, began in the 1890s producing gauze and wound dressings sterilized with dry heat, steam, and pressure. These innovations in wound-site dressings marked the first major steps forward in the field since the advances of the Egyptians and Greeks centuries earlier. In 1886, Ernst von Bergmann introduced heat sterilization of surgical instruments, which marked the beginning of aseptic surgery and significantly reduced the frequency of infections. Conrad Brunner did extensive research into wound management and experimentation with wound disinfection methods, publishing his comprehensive Erfahrungen und Studien über Wundinfektion und Wundbehandlung in 1898. That same year, Paul Leopold Friedrich introduced wound excision and experimentally showed that excision of open wounds substantially reduced the risk of infection. The next advances would arise from the development of polymer synthetics for wound dressings and the "rediscovery" of moist wound-site care protocols in the mid 20th century. Wound-site dressing During World War I, chemist Henry Drysdale Dakin was consulted and invented Dakin's Solution, a mixture of sodium hypochlorite and boric acid, to wash out the traumatic wounds of British soldiers fighting in France. 1950s onward The advent in the 1950s of fibrous synthetics such as nylon, polyethylene, polypropylene, and polyvinyls provided new materials from which researchers