A letter from Alexis Carrel concerning the preantibiotic treatment of war wounds: The Carrel-Dakin solution.

The morbidity and mortality of soldiers injured during the First World War stemmed in large part from infections of battle wounds. Preventing and treating such infections was a major challenge for the medical corps. Alexis Carrel, a French-American surgeon, advocated irrigating open wounds with a hypochlorite solution (the Carrel-Dakin solution) to prevent the growth of bacteria contaminating them. His method of treatment was complicated and time consuming and was not well followed by surgeons who doubted the necessity of such an exacting protocol. In 1917, Carrel wrote a letter to an American colonel overseeing U.S. medical personnel soliciting his support in training American medical personnel in the proper use of the Carrel-Dakin solution. This letter was the stimulus for recalling here the opposition encountered by both Carrel and Joseph Lister, his predecessor in the aseptic-antiseptic treatment of open wounds, and for noting the conflicting views of contemporary surgeons over surgical sepsis.

Dakin's Solution: "One of the most important and far-reaching contributions to the armamentarium of the surgeons".

Henry Drysdale Dakin is a notable person in the history of surgery, wound care, military medicine and infectious disease control. Dakin is an exemplar scientist who in the midst of war forged an international collaboration with scientists in multiple fields to create and universalize an antiseptic utopia, which saved thousands lives during World War I, remarkably diminished functional disabilities from wounds and continues to be a "far-reaching armamentarium" of the surgeons and wound care specialists around the globe. Dakin investigated over 200 different antiseptic substances to finally conclude that a 0.5% buffered sodium hypochlorite solution satisfies his criteria for an ideal antiseptic. The only potential limitation was that the germicidal property of the solution was short lived, which meant the solution had to be used continuously or repeatedly delivered into wounds. Dakin's solution, still in use by modern wound care specialists around the globe, has laid the foundation for wound care management as we know it today. Nevertheless, Dakin contributed more to science than just his solution. In this article, Dakin's life story, his unique scientific career and his contributions to surgical literature are explored. The article also illustrates how a wartime necessity resulted in a medical discovery that is still in use to date.

Historical review of Dakin's solution applications.

Dakin's solution and the Carrel-Dakin method were developed and integrated into clinical practice in the early 20th century, which were found to aid in effective wound healing and infection. This historical review briefly outlines highlights with regard to the history of infection management, wartime amputation, and wound treatment dating back to Galen through the early 20th century. This paper extensively reviews and discusses the historic use of Dakin's solution, which was developed almost a century ago, in both wartime settings and in the civilian sector as well. This review further elaborates on the use of Dakin's solution in the current treatment of wounds in the United States. Additionally, we discuss the history of wound care with the emphasis on the Carrel-Dakin method. Finally, this review discusses and presents contemporary application and utilization of Dakin's solution in two large tertiary care centers.

Dakin's solution: historical perspective and current practice.

Dakin's solution was first introduced by military physicians responding to the challenges of treating artillery injuries in World War I. Administration was personnel intensive, and at times unpredictable in the conditions of the frontlines, but nonetheless the practice saved countless lives and limbs. Dakin's solution remained the prevailing method for treating contaminated wounds until the introduction of antibiotics during World War II. With the emergence of antibiotic-resistant organisms in the 1980s, interest in antiseptic treatment of wounds resurfaced; especially in chronic wounds, antiseptics once again saw liberal use. However, as the understanding of wound healing advanced, focus shifted from "prevention of infection" to "creation of an optimal environment for the repair process." Concern that antiseptics could be toxic to the cells of the repair process has led many to discontinue their use. Although such all-or-none approaches might simplify the decision-making process, they fail to address the complexity of optimal wound management. As recent research suggests, there may be a renewed role for Dakin's solution.

Dakin's solution: past, present, and future.

Dakin's solution has been used for almost a century. It is a dilute solution of sodium hypochlorite, which is commonly known as household bleach. When properly applied, it can kill pathogenic microorganisms with minimum cytotoxicity. This article reviews its history and discusses how evolving technology might pave the way for a new role for this antiseptic.

Sodium hypochlorite: history, properties, electrochemical production.

This paper analyses the evolution of hypochlorite as strong disinfectant. The electrochemical production of hypochloric acid or sodium hypochlorite represents the best method to obtain a pure product. To have a good production (as quality and quantity), it is necessary to optimize the electrochemical process with the optimal of electrocatalytic electrodes (cathode and anode) the gap between electrodes, the temperature of electrochemical cell. It is very important for the product stability during a long period, avoid the presence of heavy metal ions and particulate as impurity-like carbon micro-powders in suspension. It is necessary a rigorous control of the pH of final product to have the optimal disinfection power of hypochlorite solution. The most stable sodium hypochlorite solutions are those that show the following characteristics: (1) low concentration of hypochlorite; (2) pH -> 11.5 and <13; (3) absence of graphite particulate and metallic ions; (4) storage at controlled temperature <30 degrees C. Packing in containers impermeable to light.

Root canal irrigation--a historical perspective.

The concept of the germ theory of disease combined with the development of dentistry during the latter half of the 19th century had a direct effect on the practice of endodontics. The significance of root canal irrigation to endodontics strengthened in the period between 1859 when Taft recommended frequent syringing of the root canal to remove "irritants" until the mid-1940s when endodontics became a special field within dentistry and the American Endodontic Society was established. This paper reviews the role of irrigants and irrigation in root canal treatment during this period. A variety of recommendations on the use of solutions to clean root canals appeared in the dental literature, often innovative and at times entrepreneurial, but invariably empirically based. While it was widely assumed that by wiping the root canal with disinfectants sterilization would be achieved, many of the principles associated with cleaning the root canal published during this period, in particular by Willoughby Dayton Miller in the 1890s and Louis Grossman in the 1940s, remain equally relevant in the 21st century.