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Claude Pouteau, Hôtel-Dieu de Lyon's surgeon (1725-1775), did not improve surgical teaching, as Mareschal or Lapeyronie did with their reforming law. But he is reminiscent of an extremely skilful surgeon, always having a remarkable high rate of recoveries. For instance when it came to operate on bladder with a perineal approach (vesical cut), only three patients died out of one hundred and twenty operations. One century before Semmelweiss and more earlier than Pasteur, Pouteau thought that hospital-gangrene was not only caused by air miasma but also by direct contact, which could be indebted dirty instruments or hands, or hospital-made bandages. So he advised impeccably cleanliness for surgical students. According to his mind, soap was inadequate for cleaning hospital linen. Those must be pull out of neat material fitted by clean hands out of hospitals. It shall be supplied every day and never gathered inside. In order to keep clear of gangrene, the patient will not wait too long inside hospital. In case of bleeding, cautery must preferable to ligature for Pouteau "We can do without the bitter sadness of seeing a lighter wound become a lethal or incurable one ..." (Posthumous works, vol. III, p. 237-238).