ADVANCES IN SURGERY DURING THE WAR 315 



now as a result of war experience than it ever has been before. 

 When infection of a wound is evidently unavoidable or is 

 already frankly present when the patient reaches surgical aid, 

 either through inability thoroughly to excise the wound, if 

 seen early, or due to the general condition of the patient which 

 prevents a radical primary operation, or through the impossi- 

 bility of early evacuation to a surgical hospital, the problem 

 of early control of the infection, cutting short its course, so 

 that the wound may be sterilized and rendered capable of 

 secondary closure without the long wait for healing from the 

 bottom out by granulation, is the effort to which the surgeon 

 bends his knowledge and energy. In the years of peace, sur- 

 geons had striven steadily with success to render surgical 

 operations aseptic or free from infection, and the use and 

 elaboration of antiseptic agents, employed to destroy bacteria 

 and control infection, had claimed but little of their thought 

 and attention. Faced with the treatment of many and viru- 

 lently infected wounds, interest in antiseptics was revived and 

 out of experiments with many substances and many methods of 

 application were evolved successful means of combating infec- 

 tion. Holding first place, probably, in efficiency of controlling 

 infection is the Carrel method of wound sterilization by use of 

 Dakin's solution. Dakin's fluid is a solution of sodium hypo- 

 chlorite of a given strength, 0.45-0.5 per cent, of the hypo- 

 chlorite. If stronger than this it is too irritating; if weaker, it 

 has but small antiseptic power. If employed haphazard, in 

 any sort of fashion, it has no more value than any fluid em- 

 ployed for irrigation or mechanical cleansing. Carrel worked 

 out a method which utilizes its full antiseptic value. He found 

 that by the use of many small, soft rubber tubes (4mm. inside 

 diameter) with small perforations in the tubes towards their 

 ends, so that the fluid might be evenly distributed in the wound, 

 this antiseptic fluid could be brought into contact with all the 

 wound surface. By trial the frequency of the use of the fluid 

 in the wound was determined to be at two-hour intervals for 

 the best results. To get results the technic as elaborated after 



