Back to Home
CHAPTER 183

Making the Revolutionary New Carrel-Dakin Wound Treatment Available to Save Soldiers’ Lives During World War I

Profile picture for user mgurowi
By Margaret Gurowitz
Nov 08, 2013

As we celebrate Veterans Day in the U.S. and Remembrance Day elsewhere in the world, we salute the men and women who serve their countries.

A Johnson & Johnson employee, "Somewhere in France," during World War I.  From our archives.
A Johnson & Johnson employee, "Somewhere in France," during World War I. From our archives.

Johnson & Johnson has a long heritage of employees serving in the military, dating back to 1898, and the Company has supported the men and women who serve their countries for well over a century.  As the younger brothers of Union Army veterans, the three founders of Johnson & Johnson had tremendous respect for those who serve and a desire to do what they could to help them – whether it was supporting employees during their service, the hiring of veterans or the development of medical innovations to treat wounded soldiers.  During World War I, Johnson & Johnson mass produced one of those medical innovations -- a revolutionary new way of treating battlefield injuries and saving soldiers’ lives.

An underground trench hospital during World War I, from RED CROSS® Notes, in our archives.
Believe it or not, this was a hospital. An underground trench hospital during World War I, from RED CROSS® Notes, showing some of the conditions of the makeshift medical facilities. From our archives.

World War I, with its muddy trench warfare, gave rise to new and devastating injuries among soldiers.  The wounded were treated in battlefield hospitals behind the front lines of combat, but the types of injuries suffered during the Great War (as it was called back then) were frequently complicated by infection from the trenches, overwhelming the antiseptic methods available to treat them.  To make matters even worse, wounded soldiers often didn’t reach a hospital situation until 36 or 48 hours – or more – after they were wounded.

King George V of England visits a field hospital in France.  Cover photo from a 1918 edition of RED CROSS® Notes, from our archives.
King George V of England visits a field hospital in France. Cover photo from a 1918 edition of RED CROSS® Notes, from our archives.

The results were low survival rates, and surgeons were forced to make immediate decisions to amputate limbs in order to save lives -- a dilemma that showed how little some conditions had progressed since the 1860s.  According to Johnson & Johnson’s scientific director Fred Kilmer, 80% of amputations in French military hospitals during World War I were due to infection. [RED CROSS® Notes, Series VII, Number Eight, Special War Issue, published by Johnson & Johnson, 1917, “The Birth of a New Era in Surgery,” p. 195.]

Dr. Alexis Carrel, from our archives.
Dr. Alexis Carrel, from our archives.

A prominent French surgeon, Dr. Alexis Carrel, was working in a temporary field hospital and lab near the forest of Compiegne in France, just six and a half miles from the front.  Carrel realized that the greatest surgical need was a better method of sterilizing wounds, so he and English chemist Henry D. Dakin developed a system that would irrigate wounds with a sterilizing solution – saving soldiers’ lives and limbs.  Dakin developed the solution, while Carrel developed an apparatus to deliver it.  (Carrel would later be awarded the French Legion d’Honneure for this work.)

Madame Carrel demonstrating the Carrel-Dakin method at a French hospital.  From a 1917 edition of RED CROSS® Notes in our archives.
Madame Carrel demonstrating the Carrel-Dakin method at a French hospital. From a 1917 edition of RED CROSS® Notes in our archives.

Fred Kilmer, who had researched and put together Johnson & Johnson’s 1888 Modern Methods of Antiseptic Wound Treatment and partnered with Company founder Robert Wood Johnson in the drive to help make surgery sterile, understood the importance of the Carrel-Dakin method.  (Kilmer’s son, Joyce, an occasional freelance writer for Johnson & Johnson, was also fighting in the war – as were a number of Johnson & Johnson employees.)  Fred Kilmer wrote:

“Out of that need came the Carrel-Dakin method of antiseptic irrigation of deep wounds, the success of which in France and this country inspires confidence that it will prevent almost all amputations due to infection.  It gives the surgeon perfect control; it makes him master of infection.  [RED CROSS® Notes, Series VII, Number Eight, 1917, Johnson & Johnson, New Brunswick, NJ, “The Birth of a New Era in Surgery” Fred Kilmer, p. 195]

Drawing of the complete Carrel-Dakin equipment, from our archives.
Drawing of the complete Carrel-Dakin equipment, from our archives.

The Carrel-Dakin solution had to be extremely precise.  If the percentages of combined ingredients were even slightly off one way, the solution would be too irritating; if they were off the other way, they would fail to sterilize the wound.  And with the sterile solution having to be mixed from scratch – and then tested -- each time it was used, there was a very high margin for error.  There was a tremendous need for the Carrel-Dakin solution to be mass-produced, ready to use, consistent and reliable…so that surgeons had the precise percentages of  pre-measured ingredients at their fingertips, ready to combine and use at a moment’s notice.

Johnson & Johnson employees in our Cotton Mill pose in front of bandages produced to treat wounded soldiers, 1915.  From our archives.
Johnson & Johnson employees in our Cotton Mill pose in front of bandages produced to treat wounded soldiers, 1915. From our archives.

So Johnson & Johnson, already running its production lines around the clock to meet the demand for dressings and bandages, began making mass produced supplies for Carrel-Dakin sterilization.  “Realizing that the exceptional conditions required for making this solution were not available to many hospitals and practitioners, Johnson & Johnson have met the situation by preparing the Carrel-Dakin Solution in a way that is practical and useful under all conditions.”  [RED CROSS Notes, Series VII, Number Nine, War Surgery Issue, published by Johnson & Johnson, 1918, p. 225.]

The Company produced the ingredients for the solution in two ampoules (sealed glass tubes and vials) labeled Package A and Package B, as well as ampoule holders, protective bags for the glass bottle, the rubber tubing, diffusers and charts needed to administer and track the progress of the treatment.  Johnson & Johnson also issued an eight-page illustrated how-to pamphlet called “The Carrel-Dakin Method of Wound Sterilization,” which we made available for free to doctors and surgeons.

Some Johnson & Johnson employee veterans in uniform during World War I, from our archives.
Some Johnson & Johnson employee veterans in uniform during World War I, from our archives.

Not only did the mass produced Carrel-Dakin system save lives, it helped wounded soldiers keep their limbs, making it easier for them to recover and make the transition back to civilian life and work.  “It is believed that the Carrel method opens a new and hitherto unknown field to surgery.  By means of this technique many amputations can be avoided and much suffering prevented.”  [RED CROSS Notes, War Surgery Issue, Series VII, Number Nine, 1918, Johnson & Johnson, “Carrel’s Technique to Benefit All Mankind,” p. 224.]

Shadowbox in the Johnson & Johnson Museum showing wound dressing packet developed by Johnson & Johnson during the war.
Shadowbox in the Johnson & Johnson Museum showing wound dressing packet developed by Johnson & Johnson during the war.

Back in New Brunswick, Johnson & Johnson employees worked in around-the-clock shifts to produce sterile dressings, sutures and bandages – and components of the Carrel-Dakin solution.  Employees were very aware that the products they were making were saving lives – potentially even the lives of their family members, friends, and colleagues, and they doubled their efforts.  In their spare time, they sent care packages to their colleagues that included news, copies of the local newspaper, clothing and personal care items.

The only surviving example of the Carrel-Dakin method of wound treatment at Johnson & Johnson – from our Museum and archives.
The only surviving example of the Carrel-Dakin method of wound treatment at Johnson & Johnson – from our Museum and archives.

Today, Johnson & Johnson operating companies continue the legacy of advancing medical innovation to treat wounded soldiers.  And although -- almost 100 years after it was developed -- the Carrel-Dakin method of saving lives during World War I has become lost in the pages of history, it remains a key example of the many ways in which Johnson & Johnson has stepped forward to meet unmet needs over the course of its 127-year history.  

Share this article

Read 28 comments
Full name will be displayed as entered.

Plain text

  • No HTML tags allowed.
  • Lines and paragraphs break automatically.
  • Web page addresses and email addresses turn into links automatically.
By submitting your comments, you agree that your comments may be made available to the public. All comments will be reviewed before posting, and if approved, will be shared publicly on the site. Please do not include any information and/or comments that you would like to remain private. Since this blog is about history, topics that don’t directly relate to the history of Johnson & Johnson and its operating companies won’t be posted.. Issues not related to the history of J&J, including any product complaints, will be forwarded to the appropriate Johnson & Johnson team for follow-up as appropriate. This site will not publish any comments that have inappropriate language... so be nice! We will use the information you submit in accordance with our  Privacy Policy.
Sandy
JULY 06, 2015 12:10 AM

Just thought you might like to know that I read your info about the Carrel-Dakin
method after viewing the PBS show "Crimson Field". I enjoy the series and your history adds a lot of interest.

Fran
JULY 06, 2015 10:28 PM

Same for me! I'm always looking up information to learn more about the real history behind what we see in movies and TV series. Very informative blog post.

Ellen
JULY 07, 2015 07:32 AM

I also just looked up Carrel Dakin after seeing the Crimson Fields. Amazing work. Thanks for filling in the background information.

David L.
JULY 08, 2015 12:35 PM

I also am watching The Crimson Field which prompted me to look this procedure up. Fascinating. Thanks.

Ccmartin
JULY 09, 2015 02:36 PM

How very timely! Am in the midst of writing a novel which takes place partly at the WWI hospital at Etaples, France, which I suspect may also be the setting for The Crimson Fields. The information re Carrel-Dakin may prove useful re one character's surviving a "blighty" wound. Thank you,

Melissa
JULY 10, 2015 02:52 PM

I too found out about the Carrel-Dakin wound treatment from Crimson Fields. I'm so grateful to PBS for exposing audiences to important progresses in history. Thanks for the information!

E Laine Calderone
JULY 10, 2015 05:33 PM

Thank you for the information! I love the show Crimson Field and I am sorry to hear that it won't continue into a second season. I enjoy learning about medical procedures and nursing in the past. I'm assuming Dakin is the same person that Dakin's solution is named after-I remember it from my nursing school days in the 1970'S!

Thomas D Schmitz Md
JULY 11, 2015 10:17 AM

great info about dakins soln as you can see change is often scoffed at . now we also use external fixators to treat open infected wounds thanks j@j .thanks tom schmitz md ortho surgeon in oakland cal

Maria Mize
JULY 12, 2015 06:59 PM

I love the show Crimson Field, and I'm so sorry it will not be continued....
I have learned so much history.....the show is very realistic and very well delivered.
It is obvious why I found this website....wanted to have more info about the procedure: Carrel-Dakin. I'm impressed how important the role Johnson & Johnson play in advancing medical technology for the treatment of soldiers
during WWI and continue till today.

Elizabeth
JULY 14, 2015 01:13 AM

Incredible information. Also heard of this WWI device watching PBS Crimson Fields. Thank goodness for all the incredible advances in medical technology.

Joan
JULY 20, 2015 06:19 PM

I also heard about the Carrel-Dakin treatment from Crimson Fields and appreciate the info you have on this site.

Lucille (lynn) Trout Fetterolf
AUGUST 15, 2015 06:16 PM

I can't tell you how much The Crimson Fields meant to me as my father was one of the soldiers whose leg was saved by that French Doctor. Here's his story:

Charles Owen Trout’s wounding in France in WWI

I’m here in a strange land far from our farm and America.
I’ve been sent to help these Europeans settle this War.
I’m a good shot as we lived on the small and large game
my brother and I harvested in Cross Roads.
Now it’s Germans I’m to hunt. Strange as most of us
from Pennsylvania are of German descent.
Here in the Argonne Forest it looks like the woods back home.
But I can’t even pronounce Montfaucon properly. However I know
I’m in France and that‘s where they tell us we are.

Incoming! Oh, hell, I’ve been hit! Where is the nearest field hospital?
Guess I’ll have to hoof it till I find one. It’s been eight days
and my wound is looking awful, black and filled with pus.
If I don’t get some help soon, I’m afraid I’ll lose my leg.

Thank God! I see a tent ahead. The nurses help me to a cot and call
the surgeon to assess the damage to my leg. “It’s bad, son,” says the Doctor,
There’s a lot of shrapnel in that wound and gangrene has set in.
I’m carried into surgery and they prepare for amputation. The young surgeon
has seen so many of these hideous wounds he has been researching
a way to heal them Unheard of in 1918 but he asks if I’ll agree
to trying his new technique which may save the leg.
I agree wholeheartedly and then I smell the ether.

I’m back in Pennsylvania. The sea trip was long and rough but nothing
ever looked so good to me as that Hospital in Carlisle. Filled with
war wounded like me, I made good friends there and a family named
Keller kind of adopted a couple of us and made my eighteen month stay
a bit more bearable.

My leg was saved and my only regret was that I never knew
the name of that young French surgeon so I could thank him.

lynn fetterolf December 27, 2013

Karen Barbaro
SEPTEMBER 08, 2015 06:16 PM

I found the article on the Carrel-Dakin method fascinating. What a wonderful advantage discovered originally for service members . . . a medical miracle.

I'm really enjoying Crimson Fields also. Wish it would continue.

Sally Bloom
DECEMBER 03, 2015 11:59 AM

Thanks for sharing this terrific history. I'm wondering if you could share HOW bandages/dressings were affixed during World War I? Were they all tied into place? Or was there a type of tape around? Thanks!

Margaret
DECEMBER 03, 2015 12:11 PM

In reply to by Sally Bloom

Hi Sally,

That's a great question! During World War I, dressings could be affixed a number of ways: they could be tied in place, pinned using safety pins, or held in place with adhesive tape. Johnson & Johnson developed and made a wound dressing packet during WWI that contained dressings designed to be fastened with safety pins. Johnson & Johnson also made adhesive tape (referred to as "adhesive plaster") in that era. Before the invention of duct tape, the company's ZONAS® Adhesive Plaster was the tape people used to fix everything. Here's a post with more information, if you're interested: http://www.kilmerhouse.com/2009/09/zonas-the-duct-tape-of-its-day/

Margaret

Bidisha Majumdar
DECEMBER 08, 2015 01:57 AM

Lovely Margaret! I am currently working on creating an Ethicon Legacy compendium to stress on the J&J quality vs. competition and bumped upon this article...I feel so proud to be a Johnsonian and the narration gives me goosebumps...thanks for recounting this!! I am now looking through the whole site now to help me gather more information that many of our colleagues might not know...I would like to share with them and with our customers...for surely quality is deeply rooted in the legacy we have...thanks Margaret!

G Zeigler
DECEMBER 27, 2015 10:29 PM

I enjoyed reading the history of Dakin and Carrel's contribution and also that of J&J to wounded soldiers in WWI. My grandfathr credited prompt battlefield administration Dakin solution with saving his life after being wounded by a machinegun bullet. He was in US Army's 3rd Infantry and was hospitalized in medical ward at converted Limoges China factory in Blois France where he recovered from his injuries.

Charles Kiefer
APRIL 09, 2016 04:11 PM

I first heard of the Carrel-Dakin method in episode 6 of the Anzac Girls, the Australian 2014 mini-series based on the diary of Alice Ross-King. Showing the method in practice (with a one tube glass distributor), Nurse Elsie, from the French Military Hospital at Amiens, writes to Alice in the late summer of 1917, "We're using a new method for treating septic wounds -- the Carrel-Dakin."

Dr Gerald Stulc
APRIL 18, 2016 11:26 PM

As a retired surgeon and naval captain, I am currently writing a book on the history of military medicine. The First World War was unlike any war before or after regarding the incorporation of momentous technological and scientific advances from the previous several decades toward the care of the wounded. The new fields of bacteriology and antisepsis went far to save countless lives from the unprecedented injuries encountered in that tragic conflict. Antisepsis allowed for the successful development of neurosurgery, thoracic, abdominal and orthopedic surgery. Dakin's solution is still used today for those infections caused by bacteria resistant to most of our antibiotics. Incidentally, Alexis Carrel won the Nobel Prize in Medicine, in 1912, for his pioneering techniques in blood vessel (vascular) surgery.

Hazel Johnston
MAY 05, 2016 08:15 AM

I am the grand-daughter of Captain William H Johnston who was a surgeon originally from New Zealand, who qualified as a doctor from The University of Edinburgh in Scotland. He then served in the RAMC (Royal Army Medical Corps) during WW1 and worked as a 'surgical specialist' based at Nos 1 and 2 General Hospital in Etretat, near le Havre, in France from 1915-17. Afterwards he was based at the Reading war hospital in the UK during 1918. He was undoubtedly a fine and innovative surgeon. I have scanned into my pc his original typed up paper (which he submitted as a research paper) to "The Lancet" (a UK Medical journal) in January 1918 on his use of the Carrel-Dakin method to save the life of a soldier suffering from peritonitis after a gunshot wound to the stomach. (Unfortunately he does not give the name or the battalion of the soldier, and I would dearly like to find this out, if I could.) I am happy to email a copy of my grandfather's original typed report of the operation and subsequent treatment to this soldier that he carried out, to anyone who wishes to see this. The soldier, who was clearly on the point of death, survived - so this was a happy outcome. Sincerely Hazel Johnston.

Hazel Johnston
MAY 05, 2016 08:37 AM

My apologies - my last comment contains an inaccuracy: my grandfather's published report in "The Lancet" journal does indeed give the battalion of the soldier. He is described as 26 and from the "2/Rifle Brigade" and that he was wounded on 4th April 1917 and taken by field ambulance on 4th April to a casualty clearing station. My grandfather's report simply (as might be expected) does not give the soldier's name. Does anyone have any ideas how I can go about trying to trace the family of this soldier as I would love to pass this story on to them too (as well as leaving this report on your website.) I have checked online and it appears that on the 4th April 1917 the 2nd Rifle Brigade were engaged in battle at Gouzeaucourt Wood.
Sincerely, Hazel Johnston.

Debi King
NOVEMBER 02, 2016 03:25 PM

Thankyou so very much on this look back in time. I am a RN and have watched The Crimson Field and Anzac Girls many times on Prime, and was fascinated with the Carrel-Dakin method enough to look it up. I love shows that make me learn and this site is a treasure, again thank you!

Ginger Monette
NOVEMBER 11, 2016 06:31 PM

So bizarre that I am visiting this page on Nov 11, 2016, exactly 98 years after the end of WW1, and it is also Veterans Day in American / Remembrance Day for Commonwealth countries.

Like another commenter, I am also an author who writes WW1 fiction and studied the WW1 patient evacuation system. The quote below shows how Carrel-Dakin solution was used in conjunction with debridement:

"The primary step in the process consists in what the French term, 'debridement'. .... They open everything up wide, clean out all foreign bodies and torn tissue and clots of blood and leave no hidden corners for the malicious germs to linger in. It is rather startling at first sight, but if one has any Jesuitical tendencies he cannot but believe after seeing the results, that 'the end justifies the means.' Once opened up and cleaned out, the wound is kept open by gauze packing and subjected to a constant bath of the Carrel Solution. This is fed into the wound by rubber tubes which search out and go into all the ultimate nooks and crannies in order that there may be no area which is not constantly bathed by the hypochlorite. Dressings are at first made every day an as the wound becomes progressively more free from infection, at longer intervals. Cultures from the wounds are taken every day at the dressing time and these as well as the temperature and the clinical symptom are the index of progress. When the culture is negative, that is to say, when no bacteria are found on microscopic examination of the slide, the drainage is removed and the gaping wound brought together by strips of adhesive tape, and it promptly heals, leaving only a thin red line to mark the injury."

From https://archive.org/details/doctorspartwhat00chur [This man was an American doctor who was sent to France as a 'neutral party.' He went around France and observed their medical practices in 1916.]
~GingerMonette.com

Ellegarden
NOVEMBER 13, 2016 07:26 PM

Thanks you for this article. What was the combination of liquids for the Dakins Solution? Bleach? Vinegar? How was it applied? How often did they change the bandages? Why was it so painful? How did the irrigation process work? Where can I find more details like this? Also I read that during the Civil War they used a similar solution, do you have any information resources on that? It was Dakins and Carrel that thankfully upgraded the basic 1860s Civil War Treatment.
In Crimson Fields it shows that the patient was on it for an extended period of time. Thanks so much!!
Thanks

Terra Ciurro
JULY 18, 2017 01:16 PM

I, too, came looking for information on the Carrel-Dakin apparatus after watching Episode 3 of Crimson Fields. I'm a Registered Nurse and I actually thought the idea of a wound irrigation device during that time to be anachronistic. It has been most satisfying to learn that that I was wrong and that this brilliant (for it's time) device was being used to prevent or treat infection and to save limbs.