Now all roads lead to France and heavy is the tread
Of the living; but the dead returning lightly dance.
Edward Thomas, Roads

Sunday, June 8, 2014

The First World War, Dr. Dakin, and His Wound Care Solution



BY ALAN COULSON M.D.


About this time a hundred years ago the nations of Europe were on an unsuccessful suicide watch.  

Imperial rivalries, competition for markets and ultra nationalism made International conflict all but inevitable. Thus the subsequent assassination of Archduke Ferdinand in June, 1914, was all it took to trigger one of the deadliest wars in history, an Armageddon with a final tally of 16 million dead.

On the Western Front, German forces were bogged down fighting against those of France and Britain, and so by 1915, trench systems scarred the face of Northern France stretching 400 miles from Switzerland to the English Channel. Much of the fighting took place on agricultural land which had been fertilized with manure, and was thus loaded with gangrene-causing bacteria. Since it rained so much, the ground was usually muddy so a soldier wounded and falling to the ground would inevitably get infected.

The number of casualties was inconceivable. For example, in the first few hours of fighting during the ill-fated Battle of the Somme on July 1st 1916, Britain lost 57 thousand men, including 19 thousand dead, as wave after wave of men were ordered to walk towards the German machine guns.  The front line hospitals were overwhelmed and many soldiers died unnecessarily from infections that spread from their bullet and shrapnel wounds.

Henry Dakin, PhD, and Alexis Carrel, MD

Enter Henry Dakin (1880–1952), a PhD biochemist born in England and working in New York in 1905. Although he was not a physician, he was interested in finding an antiseptic that would kill bacteria in the presence of body fluids but not hurt the white cells trying to defend the patient. It is important to note all his work was done in test tubes, and Dakin never saw a patient or a wound. He observed that chemicals like iodine are so powerful that they kill bacteria and human tissues indiscriminately, and then they bind with human proteins and are rendered ineffective in a short time.

Dakin eventually found that dilute household bleach, sodium hypochlorite, was the best antiseptic chemical, thus confirming the work of the French researchers Labarraque and Berthollet, who first described this phenomenon in the early 1800s. Dakin was shy and retiring and was reluctant to speak in public. As a result, the world would probably never have heard of Dakin or his obscure solution except for two things: the start of World War I and Alexis Carrel.

Alexis Carrel (1873–1944) was in many ways the opposite of Dakin. He was a short Napoleonic figure and in his photographs looks like an arrogant prelate of medical science, and for a good reason; among other things he invented vascular surgery, performed the first heart bypass surgery and the first heart transplant, won a Nobel Prize, and invented tissue culture. But even though he was working in New York at the Rockefeller Institute, and had been there since 1905, as a French citizen he was drafted when the war started and deployed to a hospital just behind the front lines at Compiègne. 

An Underground French Field Hospital During the War

There he did a number of important things, including combining thorough cleansing of wounds with antiseptic irrigation and recruiting his former New York neighbor Dr. Dakin to be his hospital chemist. Intuitively, Carrel also chose Dakin’s solution to be the medicine to use for the irrigation.

This concept was termed the Carrel-Dakin technique, and as far as I can tell, it was the first time Dakin’s solution was actually used on patients and also the first time irrigation had been used. The gamble soon paid off; Dakin’s solution successfully killed the bacteria and, more important, also did not hurt growing skin. Wounded soldiers began to get better. So Carrel then renamed the all-important solution — it was christened the “Carrel-Dakin solution”.

Headlines in the New York Times soon followed: “Drs. Carrel and Dakin find new antiseptic; Remedy said to make infection impossible.” Certainly the technique and the solution were used all over the world and saved thousands of lives, with Carrel largely taking credit for Dakin’s discovery. After the war Carrel came home to a hero’s welcome.

A tube is inserted in the leg of an American soldier wounded in World War I,
providing irrigation of the knee with Dakin’s solution.

Once the war was over, Dakin and Carrel drifted apart. The mild-mannered Dr. Dakin essentially retired, whereas Carrel became increasingly famous, or so it seemed until his decision to return to his native France in 1941, during the Second World War, where he became linked to the Vichy government and eugenics research. This move made him very unpopular to say the least, so much so, that after his death in Paris in 1944, Carrel’s name was rarely mentioned in polite society.

With Carrel out of the picture, the lifesaving medication reverted back to its original name, “Dakin’s Solution”, and as such it is used by the gallon in wound care centers worldwide, including the one here at Hamlet, the Sandhills Center for Wound Healing and Hyperbaric Medicine. Remarkably, a hundred years after its rediscovery it remains one of our most valuable treatment modalities.

My friend Dr. Alan Coulson was on the battlefield tour I helped lead in 1991. We subsequently co-authored two articles: War and the First Century of Heart Surgery and The Case of the Elusive Angel of Mons. Today Alan is a panel physician at the Sandhills Center for Wound Healing and Hyperbaric Medicine. He is a certified wound care specialist, and he is also board certified in surgery, and in hyperbaric medicine.

The Wound Care Center is located at 108 Endo Lane, Suite 2, in Hamlet, NC. It offers advanced treatment for hard-to-heal wounds and bone infections and operates two hyperbaric chambers. 

3 comments:

  1. Thanks, fabulous article on the medical advance and profiles of both men. Did not know that medical procedures like vascular surgery, heart bypass and heart transplant were available back in the 1940s!

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  2. I began my training as a physician and surgeon 32 years ago and have been using Dakin's solution ever since without ever knowing that history. Thanks.

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  3. Alexis Carrel did indeed perform the first heart transplant but lest readers interpret this incorrectly, his work was on dogs, not humans. His Nobel Prize in 1912 was for some of the groundwork which lead to transplant surgery and he was one of the first to identify the problem of rejection. But the first successful heart transplant was performed by a South African,Dr Christiaan Barnard, in 1967 and his patient, Louis Washkansky, lived for 18 days thereafter (if this can be called a success). His second heart-transplant patient, Philip Blaiberg lived for 19 months thereafter.

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