11)17] on The Treatment of War Wounds <:i 



CarreVs Method of Irri;ia(iii(j Hie Wound. 



I now come to Currers proccdiire of interailating between the 

 complete dressings a fi'cqnenfc tlnsliing and refrcsliing of the wound 

 surface and for carrying out this flushing unlaboriously. Allow me 

 to say that we have here, 1 think, far the mosb iuiporbant contril)U- 

 tion made to surgical technique since the beginning of the war. IJut 

 to that let me add, that while Carrel's procedure gives us a new and 

 improved technique for the application of antiseptics, much more 

 does it give us a wavf and improved technique for physiological 

 treatment. In all physiological treatment the assiduous removal of 

 corrupted and corruptil)le discharges is the primary desideratum. 



We now return to the results of the treatment of infected wound 

 surfaces by Carrel's method, and we may take them from Carrel's 

 book. But it will he well, in order to keep to the kind of wound 

 infection here under discussion, to exclude from consideration 

 wounds complicated with fractures — ^for in those effective washing is 

 difficult. And we may further, looking to the classification of 

 wounds of soft parts in Carrel's book, exclude from consideration his 

 class of phlegmonous and gangrenous wounds, and his class of 

 suppurating wounds. These would correspond to wounds which 

 have, through postponement of treatment or its interruption by 

 transport, suffered a set-back, converting an originally light surface 

 infection into a heavy infection with invasion of the deeper tissues. 

 There would then fall within our purview only his class of fresh 

 wounds of soft parts taken in hand when 5 to 24 hours old. And 

 we learn from the data he gives with respect to these that, where 

 there are sloughs, 15 to 20 days, and, where there are none, 5 to 12 

 days are required to prepare the wound for secondary suture. That 

 gives us a measure of what can be done by what I have, I hope not 

 without good warranty, called Carrel's " combined antiseptic and 

 physiological treatment." . 



Let us consider what Carrel's results tell us. They tell us in 

 the first place that, whatever else it is. Carrel's treatment is not in 

 any sense a therapia magna sterilisans. Regarded as an antiseptic 

 method, it is a method of "'fractional sterilisation " requiring for the 

 case we are considering — the simplest case of all — at the rate of 

 12 douches a day a series of 00 to 144 antiseptic douches. And if I 

 am right in regarding Carrel's treatment as a combined antiseptic and 

 physiological treatment, we have, superadded to the antiseptic, 

 a series of 60 to 144 physiological attacks upon the microbes — each 

 such attack starting from an atryptic condition. 



The consideration of these figures leads directly to what I have 

 to say in conclusion. While Carrel's work constitutes a very notable 

 practical achievement, regarded as science it comes short in the 

 respect that adequate control experiments are lacking. I do not 



