# The Carrel-Dakin method

Discovered in an advanced post, this skeleton of a German soldier still wearing his uniform  - Private collection, Mrs. Anne-Marie Falmagne ©

Discovered in an advanced post, this skeleton of a German soldier still wearing his uniform - Private collection, Mrs. Anne-Marie Falmagne ©

In parallel with field experience that will change the organisation of the Health services, medicine will experience an unprecedented scientific advance during the First World War. Numerous medical methods from the Great War are still in use today. Amongst these legacies are the use of the "Carrel-Dakin" method.

Often neglected at the start of the war, injuries considered to be less significant are not the subject of specific treatments. The living conditions during the First World War do not allow the soldiers to maintain correct hygiene. Easily infected wounds result in amputations in the best cases, and many deaths in the worst. It is in this context that two physicians, Henry Dakin and Alexis Carrel, will develop an antiseptic treatment to combat the infection of wounds.

While at the start of the conflict, the only way to stop gangrene was to amputate the infected limb, during this war, improved methods and scientific research confirm that this mutilating surgical operation should in fact be the physician's last recourse.

The return of gangrene!

Medical experience in wartime was very limited before 1914. As such, for the treatments given to soldiers hit by gunfire, it's common to rely on a totally incorrect and widely disseminated idea: injuries caused by bullets are always neat (the only destroy a specific part of the body) and clean, since munitions cannot carry illnesses. Another idea based on hazardous hypotheses will be to think that soldiers will most often be injured by gunfire rather than by exploding shells.

These preconceived ideas will result in faulty diagnoses and inadequate urgency when dealing with the wounded. Amongst other things, it is the artillery, and therefore bursting shells, that will decimate the armies rather than gunfire. Also, bullets will result in many complications that will exceed the estimates of surgeons.

In France, general inspector physician Edmond Delorme (1847-1929), chief of French military surgery, is part of the old guard that believes in these ideas and that calls for surgical methods that are totally inadequate for this special type of war in the trenches, during which extensive use is made of artillery. Recognising his mistake, Edmond Delorme appears before the Science Academy on 28 September 1914, in order to correct his statements:

"To be efficient, the defence against infection must begin very quickly. It cannot be provided to the wounded who are transported over long distances. As such, surgery in the front lines must no longer be content with the preparatory actions that it previously undertook. It must itself do whatever is necessary. The rule of systematic abstention (operating only when the injuries were very serious, otherwise the wounded soldier receives basic care before being transported to the Rear), while excellent in the case of wounds from gunfire, cannot be applied when having to deal with shrapnel (shrapnel shells) and shell fragments. Up to now, there were reasons to defer active surgery to the rear lines; circumstances now force us to concentrate resolutely on the front."

However, despite this speech, preconceived ideas have a long shelf life, and will influence the treatment of the wounded for a long time.

From the very start of the war, there is an incalculable stream of the wounded. Surgeons concentrate on "repairing" the wound, and totally neglect the bacteriological aspect. The consequences are dramatic. Though certain soldiers receive the necessary treatments, physicians cannot prevent them from dying. For a single illness, physicians observe a multitude of symptoms, the source of which is beyond their understanding. Considerable research will be performed in order to identify the origin of this illness.

In 1915, the Pasteur Institute (French foundation devoted to biological studies) will identify the germs with which gas gangrene (necrosis of the tissues) originates. The absence of sanitary standards in the trenches and the extreme living conditions (mud, rats, fecal matter, cadavers) are responsible for the proliferation of infections, and gas gangrene – often followed by amputation – will be one of the most widespread ailments suffered by soldiers wounded by shell bursts. These fragments have the particularity that they can penetrate all muscular tissues and carry in all kinds of filth, including the mud in which the gas gangrene germs are present.

While at the start of the conflict, the only way to stop gangrene was to amputate the infected limb, during this war, improved methods and scientific research confirm that this mutilating surgical operation should in fact be the physician's last recourse.

How to stop infection?

As previously explained, treating infection of the wounds is essential. To combat infection, two types of chemical treatments could be used: asepsis and antisepsis. Asepsis represents all of the preventive standards implemented against infectious illnesses. Sterilisation, intended to avoid transmitting illness, is a component of these aseptic standards.

The second type of treatment will involve antiseptic chemical substances. These substances will combat illnesses and control infection. The major disadvantage of antiseptic methods is that they destroy not only the infections, but they also have a toxic effect on the patient's's organism. As such, efforts will be required in order to find the best compromise between maximum antiseptic efficiency and minimum toxicity.

The solution for stopping gas gangrene contamination will come from two scientists: the French physician Auguste (Alexis) Carrel (1873-1944) and the English chemist Henry Drysdale Dakin (1880-1952). These two physicians will have fairly similar career paths. A. Carrel did his medical studies in Lyon. He then went to New York, to join the "Rockefeller Institute for Medical Research". In 1912, he receives the Nobel Prize for physiology and medicine. When the conflict begins, he's assigned to the hospitals of Lyon. After a promotion, he then moves to Compiègne (a city 80 km north of Paris), to a former hotel transformed into a hospital, close to the front.

Henry Drysdale Dakin completes his chemistry studies in England and works at the University of Leeds before also eventually making his way to New York. There, he joins the Herter laboratory. He returns to Europe during the First World War and works with A. Carrel in Compiègne.

They jointly develop a very efficient antiseptic method for combating wound infections, while remaining low in toxicity for the patient: the Carrel-Dakin treatment.

Henry Dakin develops his eponymous solution (the Dakin liquid), an antiseptic based on sodium hypochlorite, with the formula then being improved by his colleague, the pharmacist Maurice Daufresne. For his part, Alexis Carrel develops a method for using the Dakin solution that involves intermittent irrigation of the wound until its complete sterilisation. This method is applied in two hospital establishments at the forefront of scientific research, one in France and the other in Belgium.

A. Carrel wants to provide France with a hospital where research will be at the heart of the concerns of the physicians. In March 1915, "temporary hospital n°21" sees the light of day in Compiègne. The Carrel-Dakin treatment is used in this scientific hospital, but without the expected success in France. It is in Belgium that this method will be used most widely, in one of the most modern hospitals of the First World War: the Ambulance of the Ocean, directed by surgeon Antoine Depage.

Depage had already promoted the importance of aseptic standards when training nurses in the treatment of patients, and he applies the methods recommended by Alexis Carrel and Henry Dakin to complete the rigorous treatments that he demands for his patients.

With the means available to the Ocean Hospital, Antoine Depage is able to extend sterilisation to all of the equipment needed for operations. By adding a reliable antiseptic method to the aseptic precautions, he transforms his establishment into one of the best war hospitals. Nurse Jeanne de Launoy, who worked at the Ocean Ambulance, describes the efficiency of this method in her work ("Infirmières de guerre. En service commandé (front de 14 à 18)"):

" Sunday the 20th, 7 AM. First Catholic mass at the Ambulance. Service thereafter. – The initially widespread cases of gas gangrene are seemingly becoming more rare since we've been applying the method developed by Carrel, this little man who, like Poincarré, has intelligence flowing from every pore. "

As such, the Carrel-Dakin is an enormous medical success. While at the start of the conflict, the only way to stop gangrene is to amputate the infected limb, during this war, improved methods and scientific research confirm that this mutilating surgical operation should in fact be the physician's last recourse. The innovation produced by these two scientists will therefore have an essential impact on maintaining the physical integrity of the soldiers.

Despite the positive results of the Carrel-Dakin method, the two scientists will have to display patience and make great efforts for their solution to be taken into account in their respective countries. The method will be widely discussed, and even claimed to be dangerous. Only physicians such as Antoine Depage will agree to experiment with these new techniques.

At the end of the war, Henry Dakin and Alexis Carrel return to their respective laboratories in New York. To this day, there still exists an antiseptic that bears the name of the British chemist.

Sources Click to view the sources

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  • DEBUE-BARAZER, C., "La gangrène gazeuse pendant la Première Guerre mondiale (Front occidental)", Annales de démographie historique, n°103, 2002/1, pp. 51-70.
  • DEBUE-BARAZER, C., PERROLAT, S., "1914-18 : guerre, chirurgie, image. Le Service de Santé et ses représentations dans la société militaire ", Sociétés & Représentations, n° 25, 2008/1, pp. 233-253.
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  • DROUARD, A., Alexis Carrel (1873-1944). De la mémoire à l’histoire, Paris, 1995.
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  • TOURNES, L., "La fondation Rockefeller et la naissance de l'universalisme philanthropique américain", Critique internationale, n° 35, 2007/2, pp. 173-197.