Read CHAPTER XXIV of A Journey Through France in War Time , free online book, by Joseph G. Butler‚ Jr., on ReadCentral.com.

THE CARREL METHOD OF TREATING WOUNDS

So much interest has been expressed in the new method of treating wounds discovered by Dr. Carrel and bearing his name, and the subject being of such great importance to the cause of humanity and the preservation of human life, I have thought it worth while to give here the following authoritative descriptions of this new and epochal discovery in the science of medicine. It is now generally known as the Carrel-Dakin treatment.

Reference has been made to meeting Dr. Sherman in London. On discovering that this physician had enjoyed considerable experience with the Carrel treatment and was thoroughly familiar with it, I invited him to deliver an address on this subject at my home town after his return from Europe. He readily agreed to do this, speaking to an interested audience under the auspices of the Mahoning County Medical Society on De, 1916. A newspaper account of this address is appended. This will, in a measure, serve to show the importance of the Carrel treatment.

Out of the horror and carnage that is raging across the seas some inconceivable good must come. This is the opinion of all who have been close to the din of battle, who have visited hospitals and seen with their own eyes the human wrecks wrought by grape shot, shrapnel and bursting shells. Dr. William O’Neill Sherman’s visit to this city Tuesday night, when he opened the eyes of the medical profession here to new and greater things, is the first inkling of one great good that is to come out of this war. To treat the millions of wounded and maimed, medical genius has been taxed to the limit. As in all great times, great minds have come to the rescue and found a way. The old saying that where there is a will there is a way, has been clearly proven.

Particularly is this true in the medical world. Dr. Sherman came here from Pittsburgh, the invited guest of the Mahoning County Medical Society, at the suggestion of J. G. Butler, Jr., who wanted him to tell the physicians of this city and county the many things he had learned by close application and association with conditions in European hospitals and trenches. Dr. Sherman was filled with an enthusiasm that he made every man who attended the annual banquet of the Mahoning Medical Society feel. Particularly was he anxious to bring the local medical fraternity to a realization of the methods and treatments developed by the horrible carnage raging now in the European countries. He drove home his point without gloves when he told physicians of Youngstown that medical men throughout this country were given too much to criticising new methods rather than investigating them.

The Carrel method, he explained at length. It is simply a newly discovered antiseptic solution, conceived by Dr. Alexis Carrel, which sterilizes wounds and arrests infection and inflammation before they have an opportunity to spread and result in blood poisoning and death.

TRANSLATION

REPUBLIC OF FRANCE CITY OF REIMS

TO THE INHABITANTS

At the moment when the German army is at our gates, and will probably enter the city, the municipal authorities request you to preserve all your presence of mind, and all calmness necessary to permit you to undergo this trial.

There must not be any manifestations, any riotous gatherings, any outcries to trouble the tranquility of the streets. Public Service, Charity, Health, and street maintenance should continue to be safe. You must co-operate with us. You must remain in the city to help the unfortunate. We shall remain with you at our post to defend your interests.

It does not devolve upon you, the population of an unfortified city, to alter events. It does devolve upon you not to aggravate the consequences. To this end it is necessary to keep silence, dignity and prudence.

We rely upon you, you may rely upon us.

Reims, September 3, 1914. Dr. LANGLET, Mayor.

Mr. Butler said to visit European capitals is to witness a revelation difficult to convey in mere words. Soldiers of every nationality are treated by the expert and world famed in medicine. Human wrecks, victims of shot and shell, are repaired and rebuilt. It matters little whether a man is friend or foe, as long as a spark of life is there, he is picked tenderly from the trench and everything known to medical science done to bring about his recovery.

The mind is filled with horror and wonder of it all. New thoughts bombard the mind as one looks on. A man is brought in. His face is practically shot away. It seems that even should he recover he will be so disfigured that life will not be worth the living. The Carrel solution is applied. By plastic surgery and other means the disfigured mass is shaped. In a few short weeks the man again begins to resemble a human being and eventually is well, with little more than a few indistinct scars. Not infrequently he returns to the trenches. Some of the things that shock the mind are metal jaws, screened behind false beards, artificial noses, ears, cheeks, eyes and limbs. Sometimes when a man is facially disfigured beyond repair, that is, when nature can never replace the countenance, a copper mask is fitted. These sculptors in flesh-and-blood do their work with such precision and accuracy that it is startling and cannot be believed unless it is seen.

The war has seen the springing up of many hospitals of special character. There are groups of institutions where only faces are treated, eyes, ears and nose, maimed limbs, etc. Medical attention in most cases begins in the trenches and the patient is carefully watched while being transported to the hospital. By sterilizing wounds shortly after they occur, infection and pus are robbed of their chance to hinder nature and the patient recovers in a few weeks from a frightful wound that if infected would take that many months. There are many things of today that help in the preservation of human life. The highly developed X-ray has played an important part in this great war. Electricity, new antiseptics and anaesthetics have been at the finger’s end of the skilled medical profession, to work what can honestly be called miracles and wonders.

One of the strange things of this great war is the fact that new, unheard of diseases are developed. It has tended to make common rare diseases and greatly increased those that are usual. Thousands die, having no mark upon their body. Post-mortems held have disclosed in nearly every case that such deaths were caused by shell shock. Bombs from the huge guns dropping near a company of men will often so disarrange organs that death follows quickly. Many who survive lose mind, sight, hearing, speech, and so on. This has become one of the common things of this great war. As a result the warring countries will find themselves confronted with a new and difficult problem when peace comes and normal times are again established. There will be hundreds of thousands to pension and no doubt insane institutions will have to be enlarged. Rest is often a saviour. Men taken away from the fronts, minds blank, in the quiet of home often regain their reason. There is the large percentage that God in his goodness does not see fit to restore that will form an elephantine problem. There will have to be vast pension lists, for these men often have large families.

The way men may be pieced and patched together is one of the finds of the new medical era. It has been discovered that bones in legs and arms practically shot in two can be brought together by means of silver and vanadium steel plates fitted with screws and that the bones will knit and after a period the afflicted can walk almost as satisfactorily as if nothing had happened. Dr. Sherman while in this city this week displayed a steel plate that he worked out and used with marked success in the hospitals of France. These plates are applied in what would seem to be a very simple manner. A man may have a leg or an arm practically shot off. By placing the broken bones together, after a treatment with the Carrel solution to keep down infection, a plate is fitted on either side of the fracture and screws are applied. This holds the two members solidly together and in a few short weeks the bones knit. In time this place is practically the strongest part of the limb. What this means can best be told by explaining that before the discovery, an arm or a leg so badly shattered was simply amputated because this was the only safe and logical way to save the life of the individual. In the olden days gangrene would invariably set in and the patient die within a short time unless amputation was performed promptly following the accident.

Dr. Carrel has gone a long way to eliminate this danger.

Having seen with my own eyes the wonderful results of this treatment during my visits to the American Ambulance and other hospitals in France, I requested Mr. Laurence V. Benet, superintendent of the American Ambulance, to furnish me with an authoritative description of the treatment. The chief purpose of this is to enable medical authorities in this country, particularly those connected with hospitals maintained by iron and steel plants, to gain a reliable outline of the treatment. Dr. Benet, in spite of the fact that he is one of the busiest men in France, kindly agreed to furnish this information. In doing so he accompanied the description with the following letter:

1 Avenue De Camoens Paris, October 26, 1916.

Mr. Joseph G. Butler, Jr.,
Youngstown, O.

My dear Mr. Butler:

In compliance with my request, Dr. Joseph Lawrence, of the American Ambulance, has kindly prepared a short note on the Carrel treatment of wounds, and this I am now enclosing. I trust that you will find it sufficiently explicit for your purposes, and that it will be of use and interest to you.

Now that you are again home I hope that your wonderful trip in France will be less than a mere memory and that the labors of the Industrial Commission will prove, as they should, most valuable to the manufacturers and exporters of the United States. Believe me that it was to me a great privilege as well as a great pleasure to have met you and your distinguished colleagues, and that my only regret is that I was unable to be of greater use to the Commission.

I am, with very kind regards,

Sincerely yours,
Laurence V. Benet
1 encl.

The Carrel Treatment of Wounds.

The Carrel treatment consists in thorough irrigation guided by the bacteriological observation of the wound.

For the irrigation of the wound, Carrel has chosen a certain size of rubber tube about 4 mm. in diameter into which he punches small holes at intervals. The one end of this tube is shut, the other end is allowed to protrude from the dressing.

On the surface wound, the tube is laid over the wound in the direction of the greatest diameter of the wound with the open end towards the most elevated part.

In perforating wounds, the tube or several tubes, when the wound is large, are passed through from both sides, or pushed into cavities or pockets that may exist.

If the wound is not a perforating wound, but a deep wound, the tubes are planted deep into the cavity that may be formed. These tubes are always of sufficient number to thoroughly irrigate the broken surface.

Over the uninjured skin, about the wound, is placed thin strips of gauze which have been steeped in vaseline, the skin having been thoroughly washed before with soap and water.

To keep these tubes in place, a bandage wet with Dakin’s solution is placed over them. The wound is flushed every two hours with Dakin’s solution. The amount of solution used per wound, varies in proportion to the size of the wound from 500 c.c. per day up. Wounds are dressed daily.

The bacteriological observation is made by taking a smear from the most vicious part of the wound at intervals of two or three days. The number of bacteria on these smears is noted and counted per oil immersion field. A count of more than 75 bacteria per field is considered infinity. When there are less than 10 bacilli to the field, and not less than 5 to the field, three fields are counted. When less than 5, and not less than 7, five fields are counted. When less than one, from five to twenty fields will be counted.

A wound that retains a count of one bacillus to two fields or less for three observations, is considered bacteriologically clean, and suitable for operation. If the wound is a compound fracture, it is advisable to close the wound, converting it into a simple fracture.

If this can be done without exerting too great tension on the sutures.

If the wound is a flesh wound, and can be drawn together without too great tension, its closure is indicated.

The important parts of the treatment consist in thorough irrigation, and careful bacteriological observation. The bacteriological observations are charted on charts similar to temperature charts.

Dakin’s Solution.
(Sodium Hypochlorite at 0.50%)

1 To prepare 10 litres of solution, weight exactly:
Chloride of Lime (Bleaching Powder) 200 grms.
Carbonate of Soda (dried) 100 grms. or if used in crystals
grms.

Bi-carbonate of Soda 200 grms.

2 Put the Chloride of Lime into a large mouthed bottle of about
litres capacity. Add 5 litres of water (half the quantity) and
shake well two or three times. Let this stand all night.

3 Dissolve in another 5 litres of water of two Soda salts

4 Pour this latter solution directly into the bottle containing
the maceration of lime. Stir well and let the solution stand in
order to allow the precipitate of Carbonate of Lime to settle.

5 At the end of half an hour, siphon the clear liquid and filter
by means of a paper, in order to have a perfectly clear solution.
This should be kept away from the light.

6 No heat should be employed in the manufacture of Dakin’s and
ordinary Tapwater should be used.

Preparation of Dakin Solution.

Technique of Dr. Daufresne.

The solution of sodium hypochlorite for surgical use must be free of caustic alkali; it must only contain 0.45% to 0.50 of hypochlorite. Under 0.45% it is not active enough and above 0.50 it is irritant. With chloride of lime (bleaching powder) having 25% of active chlorine, the quantities of necessary substances to prepare ten litres of solution are the following:

Chloride of Lime (bleaching powder) 25% CI act....200 gr.
Sodium Carbonate, dry (Soda of Solway) 100 gr.
Sodium Bi-carbonate....80 gr.

Pour into 12 litre flask the two hundred grammes of chloride of lime and five litres of ordinary water, shake vigorously for a few minutes and leave in contact for six to twelve hours, one night for example. (Shake until dissolved) at least the big pieces are dissolved, large pieces float notice only floating pieces. At the same time, dissolve in five litres of cold ordinary water the carbonate and bi-carbonate of soda.

After leaving from six to twelve hours, pour the salt solution in the flask containing the macerated chloride of lime, shake vigorously for a few minutes and leave to allow the calcium carbonate to be precipitated. In about half an hour, siphon the liquid and filter with a double paper to obtain a good, clear liquid, which should always be kept in a dark place.

Tritration of Chloride of Lime (Bleaching Powder).

Because of the variation of the products now obtained in the market, it is necessary to determine the quantity of active chlorine contained in the chloride of lime which is to be used. This, in order to employ an exact calculated quantity according to its concentration. The test is made in the following manner:

Take from different parts of the bar a small quantity of beaching powder to have a medium sample, weigh 20 grammes of it, mix as well as possible in a litre of tap water and leave in contact for a few hours. Measure 10 c.c. of the clear liquid and add 20 c.c. of a 10% solution of potassium iodide, 2 c.c. of acetic acid or hydrochloric acid, then put drop by drop into the mixture a decinormal solution of sodium hyposulfite (2.48%) until décoloration. The number “N” of cubic centimeters of hyposulfite employed multiplied by 1,775 will give the weight “N” of active chloride contained in 100 grammes of chloride of lime.

The test must be made every time a new product is received. When the result obtained will differ more or less than 25%, it will be necessary to reduce or enlarge the proportion of the three products contained in the preparation. This can be easily obtained by multiplying each of the three numbers 200, 100, 60 by the factor N/25 in which N represents the weight of the active chlorine per cent of chloride of lime.

Measure 10 c.c. of the solution, add 20 c.c. of potassium iodide 1/10, 2 c.c. of acetic acid and drop by drop a decinormal solution of sodium hyposulfite until décoloration. The number of cubic centimeters used multiplied by 0.03725 will give the weight of the hypochlorite of soda contained in 100 c.c. of the solution.

Never heat the solution and if in case of urgency one is obliged to resort to trituration of chloride of lime in a mortar, only employ water, never salt solution.

Test of Thetalkalinity of Dakin Solution:

To easily differentiate the solution obtained by this process from the commercial hypochlorites, pour into a glass about 20 c.c. of the solution and drop on the surface of the liquid a few centigrammes of phenol-phthaleine in powder. The correct solution does not give any coloration while Lebarraque’s solution and Rau de Javel will give an intense red color which shows in the last two solutions existence of free caustic alkali.

Technique Dakin Solution.

The procedure is very simple. The solution, however, must be between 45 to 50% hypochlorite. Anything above this strength will burn and anything below is too weak. The edges of the wound should be covered with gauze which has been well soaked in vaseline, the solution should then be introduced into the wounds from an irrigator every two hours. A stopcock should be put on the tube and only sufficient solution should be allowed to enter the wound to completely saturate all parts of the wound. In other words, the wounds should be bathed with the solution every two hours do not mistake this and irrigate continuously. You can easily tell how much solution it takes to keep the wound wet.

Rubber tubes are used. The end of the tube is tied off and six to eight small perforations are made so that the solution can run into all parts of the wound. If the wounds are superficial, the same kind of a tube can be used to which a cuff of turkish towel is wrapped around the end of the tube.

If you feel that the wounds are sure to be infected, it would be well to lay them open freely and immediately start this treatment, be sure to have the skin well protected with the vaseline and gauze and see that the solution does not run out of the wound on the bed. Just keep the wound bathed every two hours.

I have been informed that a movement is on foot to inaugurate the use of this remarkable discovery in the United States military hospitals, and that the Rockefeller Foundation has in view the erection at New York of a large hospital where the treatment may be studied and still further perfected for the benefit of this country.

TRANSLATION

Appeal
to the population of Reims.

Dear Citizens:

To-day and in the days following, many from among you, both prominent citizens and workmen, will be kept as hostages to guarantee to the German authorities the quiet and good order which your representatives have promised in your name.

It is to your security and to the safety of the City and to your proper interests that you do nothing which may break this agreement and compromise the future.

Have realization of your responsibility and facilitate our task.

Men, women, children, remain as far as possible in your homes, avoid all discussion.

We depend upon you to be equal to this occasion.

All riotous gathering is absolutely forbidden and will be immediately dispersed.

J. B. LANGLET, Mayor.
L. Rousseau, Dr. Jacquin,
E. Charbonneaux, J. De BRUIGNAC.
Assistants.