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