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The Treatment Of Infected Wounds | by A. Carrel And G. Dehelly



It is well known that nearly all the wounds resulting from explosions of shells, torpedoes, and bombs are septic; and that the methods employed up to the present in the treatment of these wounds are generally impotent to check the progress of the infection. To be convinced of this, one has only to be present at the arrival at a base hospital of a convoy of wounded, who have been operated on in the dressing-stations or the hospitals near the front. Then one grasps the danger of those paradoxes upheld by surgeons who still deny the universality of infection...

TitleThe Treatment Of Infected Wounds
AuthorA. Carrel And G. Dehelly
PublisherBailliere, Tindall And Cox
Year1918
Copyright1917, Bailliere, Tindall And Cox
AmazonThe Treatment Of Infected Wounds

Translation By Herbert Child Capt. R.A.M.C. (Ty.), Formerly Surgeon, French Red Cross

With Introduction By Sir Anthony A. Bowlby K.C M.G., K.C.V.O., F.R.C.S., Surgeon-General, Army Medical Service Advising Consulting Surgeon To The British Armies In France

Second Edition

The Treatment Of Infected Wounds 1
-Translation Introduction
I HAVE been asked to write an Introduction to the English edition of the work by Dr. A. Carrel and Dr. G. Dehelly, and I am glad to take the opportunity of expressing the appreciation of British surge...
-Preface
Preface To The Second Edition In this New Edition will be found a description of the technical improvements which have been effected during the last few months. We have also thought it desirable to d...
-Introduction
I. It is well known that nearly all the wounds resulting from explosions of shells, torpedoes, and bombs are septic; and that the methods employed up to the present in the treatment of these wounds ar...
-Introduction. Part 2
1 Burghard, Leishman, Moynihan and Wright, Office international d'hygiene publique, 1915, vol. vii. p. 946. Although Sir Almroth Wright's doctrine was founded, not on observations and experiments mad...
-Introduction. Part 3
1 Dakin, Presse Medicale, loco citato. 2 Carrel, Dakin, Daufresne, Dehelly, and Dumas, Presse Medicale, Oct. 11, 1915. 3 Carrel, Archives de Midecine et de Pharmacie Militaires, May, 1916. 4 Pozzi,...
-Chapter I. The Principles Of The Technique
Destruction by chemical means of the micro-organisms infecting a wound is rendered possible by the different resistances presented by the tissues equipped with a circulation, and the microbes which ar...
-I. The Choice Of An Antiseptic
In order to choose the fittest substance to sterilise an infected wound we must consider, apart from its bactericidal action, many other factors, such as its capacity for irritating the tissues, its t...
-I. The Choice Of An Antiseptic. Continued
Bichloride of mercury readily loses the greater part of its antiseptic power in presence of pus and the substances of which the tissues are made. Besides, it is very irritating, even in dilute solutio...
-A. Dakin's Hypochlorite Of Soda
The antiseptic properties of hypochlorite of soda have been known for a very long time.1 But it is not possible to use hypochlorite, either in the form of eau de Javel or of Labar-raque's solution, fo...
-A. Dakin's Hypochlorite Of Soda. Part 2
Fig. 1. - Four fragments of skin of identical dimensions were placed in chlor-amine (4), hypochlorite of magnesium (3), Dakin's hypochlorite (1), and electrolytic hypochlorite (2). Results at ...
-A. Dakin's Hypochlorite Of Soda. Part 3
Fig. 2. - Disappearance of the microbes of a highly infected wound, after treatment by Dakin's hypochlorite, May 31st to June 2nd, 1915. (Case 28.) The bactericidal action of Dakin's hypochlorite w...
-A. Dakin's Hypochlorite Of Soda. Part 4
In another series of experiments the wounds were irrigated either by distilled water or by Wright's hypertonic solution. The wounds had previously been sterilised. After some hours' instillation the b...
-A. Dakin's Hypochlorite Of Soda. Part 5
M. Lumiere's experiments prove, therefore, that hypochlorite of soda destroys toxins contained in pus. This destruction of toxins by oxidising antiseptics plays a favourable part in sterilisation, eit...
-A. Dakin's Hypochlorite Of Soda. Part 6
This is why we must employ a substance capable of destroying all the anatomical elements deprived of circulation. The concentration of Dakin's solution is such that it enables us to utilise the differ...
-A. Dakin's Hypochlorite Of Soda. Part 7
Graphic representation of the cicatrisation of a wound was obtained in the following manner. Time was represented in abscissae and surface in ordinates. Curves were thus obtained which enabled one, da...
-A. Dakin's Hypochlorite Of Soda. Part 8
(c) Action of Hypochlorite upon the Cicatrisation of an Infected Wound. - Many experiments were made upon surface-wounds whose curves of cicatrisation were known, and of which the bacteriological cond...
-A. Dakin's Hypochlorite Of Soda. Part 9
Fig. 14. - Influence of hypochlorite on an infected wound. Wound on the external aspect of the arm presenting an infection of cutaneous origin. A, control filter-paper. B, filter-paper soaked in Dak...
-A. Dakin's Hypochlorite Of Soda. Part 10
FiG. 17. - Influence of hypochlorite on an infected wound. The preceding wound, under the influence of vaselin, became slightly reinfected. The dressings, however, were continued, the part A with vase...
-A. Dakin's Hypochlorite Of Soda. Part 11
Other substances - for example, Browning's flavine-exert a direct action on the process of cicatrisation, as is shown by the curves of cicatrisation and sterilisation. In the case of a patient whose w...
-A. Dakin's Hypochlorite Of Soda. Part 12
Fig. 30. - Curve showing the rate at which hypochlorite of sodium is destroyed in contact with living tissues. A 0.4 per cent. solution placed in an almost aseptic wound was reduced to 0.24 per cen...
-B. Chloramines
After having studied the mode of action of hypochlorites, Dakin was led to investigate the substances which act in a manner almost identical, but which are of greater practical value. He believed that...
-II. Contact Of Antiseptic And Microorganisms
The antiseptic solution, only sterilising what it touches, must enter into intimate contact with the microbes infecting the wound. This contact has been considered impossible by the majority of modern...
-II. Contact Of Antiseptic And Microorganisms. Part 2
Everything goes on as though during the first twenty-four hours, and sometimes during the early days following the receipt of the wound, the microbes dwelt on the surface of the wound; consequently, w...
-II. Contact Of Antiseptic And Microorganisms. Part 3
Incisions are made in such a manner that the diverticula of the wound are laid open as freely as possible. The liquid should penetrate everywhere, and remain in contact with the infected area as long ...
-III. Maintaining The Concentration Of The Antiseptic
The second essential principle is the keeping the fluid on the surface of the tissues at a constant degree of concentration. Up to the present, this principle has been completely ignored. As a rule, a...
-IV. Duration Of The Application Of The Antiseptic
An essential point of the method is the prolonged application of the antiseptic. This principle seems to have been neglected as much as the preceding. Although experiments in vitro have shown that mic...
-V. Knowledge Of The Bacteriological Conditions Of The Wound
The bactericidal potency of the chloramines and of hypochlorite is such that every wound should respond to the treatment by a diminution in the number of microbes and by their final disappearance. The...
-Chapter II. The Technique Of The Manufacture Of Dakin's Solution
Hypochlorite of soda was discovered by Berthollet in 1788, and its antiseptic properties have been known for a long time. Labarraque gained great renown by-embalming, by the aid of his liquor, the cor...
-II. Dakin's Solution Prepared By Daufresne's Method
Having repeatedly examined similar solutions, Daufresne sought a remedy for these inconveniences by a more accurate mode of preparation which would give constant results. After numerous trials he deci...
-II. Dakin's Solution Prepared By Daufresne's Method. Continued
Ca(OH)2 + CO3Na2 = CO3Ca + 2NaOH setting free a small quantity of alkali, to which the classic Labarraque's liquor owes its causticity. In Dakin's process, this alkali is neutralised by an excess of b...
-III. Keeping Qualities Of The Solution
Solutions of hypochlorite do not keep indefinitely, they change very slowly in the dark, much more quickly in the light. Daufresne studied the influence of light in the following manner. Portions of ...
-IV. Comparison Of Dakin's Solution With Labarraque's Liquor And Commercial Eau De Javel
The mistake is often made of identifying Labarraque's liquor and even commercial eau de Javel with Dakin's solution. But Daufresne has shown by simple methods, that, from the biological as well as the...
-V. Causes Of Error
When the rules laid down by Dakin and by Daufresne for the manufacture of hypochlorite of soda are followed, the solution fulfils all the desired conditions. Experience has shown us, however, that in ...
-Chapter III. The Technique Of The Sterilisation Of Wounds - Mechanical, Chemical, And Surgical Cleansing
THE first stage of treatment consists in preparing for the penetration of the liquid by surgical interference and by mechanical cleaning of the wound. This intervention is indispensable, in order that...
-II. Technique Of The Mechanical Cleansing Of The Wound
A. Pre-Inflammatory Period As soon as the patient arrives at the hospital (ambulance, Fr.), he is warmed and cleaned up. If needed, treatment for shock is carried out. Then surgical treatment of the ...
-II. Technique Of The Mechanical Cleansing Of The Wound. Part 2
The mechanical cleansing of a wound, therefore, commences by removal of the skin which adjoins the orifices, of the sub-cutaneous cellular tissue fouled by fragments of clothing and often infiltrated ...
-II. Technique Of The Mechanical Cleansing Of The Wound. Part 3
4. Cleansing of Compound Fractures or Wounds of Joints. - (a) Cleaning-tip a Compound Fracture. - The incisions for exploration and cleaning-up of compound fractures should always be very free. A long...
-I. Gas-Producing Infection
Gas-gangrene presents itself under three different forms: the septicaemic type, the grave local type, and gas-cellulitis. (a) The septicaemic form is particularly frequent in fractures of the femur w...
-I. Gas-Producing Infection. Part 2
Some modifications have to be made in this technique, due to the nature of the injury. (a) Infected Fractures. - The course to pursue in compound fractures, the seat of acute diffuse inflammation, is...
-I. Gas-Producing Infection. Part 3
2nd. Surgical Cleaning. - After a little time, in wounds accompanied by injuries to bone, the amelioration resulting from the application of the antiseptic is arrested. The number of microbes found on...
-Chapter IV. The Technique Of The Sterilisation Of Wounds - Chemical Sterilisation
Chemical sterilisation of a wound is brought about by instillation, continuous or intermittent, of an antiseptic liquid, by means of small rubber tubes, into all the recesses of a wound. As the quanti...
-C. The Irrigating Apparatus
The irrigating apparatus is composed essentially of a reservoir (ampoule or flask) fixed at a certain height above the patient's bed, with a tube (equipped or not with a drop-counting contrivance) and...
-D. Method Of Using The Different Tubes And Apparatus
1st. The appliance for continuous instillation should never be connected up with several tubes, nor with a tube perforated with several holes. As the output of a drop-counter is very small, all the li...
-II. Arrangement Of The Tubes In A Wound
A. General Principles The disposition of the tubes in a wound is such that the liquid may readily spread over the whole surface. As it is essential that the antiseptic liquid should be in contact wit...
-II. Arrangement Of The Tubes In A Wound. Continued
2nd. The Seton Type of Wounds. -If a tube closed at one end and pierced with small holes is placed in a seton wound whose axis is almost horizontal, liquid readily remains in the wound (Fig. 52). ...
-III. Dressing
1st. Method of carrying out the Dressing. - As soon as the tubes are in position, gauze compresses soaked in Dakin's solution are applied. These compresses help to fix the tubes on the surface of the ...
-IV. Instillation Of The Antiseptic Liquid
The flask holding a litre, or other convenient reservoir, is filled with Dakin's solution, coloured to a rose-tint with permanganate of potassium. This coloration distinguishes Dakin's solution from p...
-V. Duration Of The Instillation
Instillation of liquid continues day and night until all microbes have disappeared from the smears. Therefore it is inspection of the microbial curves which indicates when the irrigation can be stop...
-VI. Errors Of Technique
A. Insufficient Penetration Of The Liquid Whenever examination of the curve of sterilisation shows that, before attaining surgical asepsis, the line has become horizontal, we may be sure that a fault...
-Chapter V. The Clinical And Bacteriological Examination Of Wounds
Every infected wound should respond to chemiotherapy, when this is applied in correct manner. It is necessary, therefore, that the progress of treatment should be controlled each day by examination of...
-The Clinical And Bacteriological Examination Of Wounds. Continued
It is important to notice the rapid disappearance of pain in these cases of infected wounds. As soon as Dakin's solution has got rid of the infiltration of the tissues, the dressings cease to be painf...
-II. Bacteriological Examination
The object of the bacteriological examination is to demonstrate the progress of sterilisation and to mark the moment at which this sterilisation is advanced sufficiently to allow of effectual closing ...
-II. Bacteriological Examination. Part 2
The bacteriological condition of the wound is expressed by a fraction in which the numerator gives the number of microbes observed, while the denominator shows the number of fields examined. Graphica...
-II. Bacteriological Examination. Part 3
Fig. 75. - Curve representing the sterilisation of the wound in case 522. It shows that the microbes which were in great number on May 31, diminished and practically disappeared by June 17. FlG. ...
-II. Bacteriological Examination. Part 4
Fig. 78. - Burn. Curve showing a reinfection of cutaneous origin upon a surface wound previously aseptic. Fig. 79. - Curve showing a prolonged reinfection of cutaneous origin. Fig. 80. - Cicat...
-II. Bacteriological Examination. Part 5
In the second case, the bacteriological curve drops under the influence of the antiseptic liquid, then, when it has reached a certain level, becomes horizontal. However generous may be the instillatio...
-II. Bacteriological Examination. Part 6
The method we have just described permits a large number of wounds to be examined in a short time. But it is far from being exact. So we must inquire if the simple counting of microbes on a smear give...
-Chapter VI. The Closure Of Wounds
The corollary to the sterilisation of a wound is its closure. But a wound should never be closed without knowing what it contains. Suture of a wound enclosing microbes may be followed by downright dis...
-II. Technique Of Wound-Closing
Wounds are closed by strapping, by elastic bands, or sutures. A. Wound-Closing By Means Of Strapping Co-aptation of the margins of the wound by means of bands of adhesive plaster may be carried out ...
-III. The Use Of Different Methods According To Wound Conditions
The preceding methods are chosen according to the particular conditions presented by the wounds it is desired to close. These wounds may be divided into different categories according to age and the p...
-Chapter VII. The Results Of The Sterilisation Of Wounds
The method should only be credited with the results obtained by application in its entirety. If the details of the technique or the composition of the antiseptic be modified at hazard, sterilisation o...
-The Results Of The Sterilisation Of Wounds. Part 2
Similar results were observed in cases of gangrenous infection. Case 454 presented fourteen wounds of the lower limbs, due to the explosion of a grenade. He was operated on six hours after the injury....
-The Results Of The Sterilisation Of Wounds. Part 3
Case 321 came to hospital four hours after having received a shell-wound in the right arm. He presented an extremely comminuted fracture of the superior extremity of the humerus directly below the hea...
-The Results Of The Sterilisation Of Wounds. Part 4
Fig.107. - Fracture of the tibia. Case 627. Fig. 108. - Fracture of the femur. Case 560. Another case, No. 495, aged 29 years, had received a wound from the explosion of a mine which fractured t...
-The Results Of The Sterilisation Of Wounds. Part 5
Case 289 was operated upon twenty-four hours after having received a shell-wound which broke the patella into fragments and displaced the condyles of the femur in an anterior direction without their f...
-The Results Of The Sterilisation Of Wounds. Part 6
(b) In the second category of cases, the number of microbes contained in the secretions diminished rapidly at first, then at the end of a few days the bacteriological curve became a horizontal line. T...
-The Results Of The Sterilisation Of Wounds. Part 7
The treatment of suppurating wounds, accompanied or not by fracture, taken from the convoys going to Paris, has shown us that suppuration can be easily dried up in a few days. Between the 5th Septembe...
-II. Consequences Of The Sterilisation Of Wounds
The suppression of suppuration and infection in the majority of wounds has important consequences for the patient, since it diminishes to a very large extent the local and general complications of wou...
-II. Consequences Of The Sterilisation Of Wounds. Continued
1st. Influence of Secondary Closure on the Duration of Treatment. - Wounds of the soft parts, both fresh and suppurating, were closed in the proportion of 90 per cent. from the fifth to the twentieth ...
-III. Failures And Their Causes
Failures teach more than successes. Therefore it is important to examine in what cases the method fails to sterilise wounds, and what are the causes of these failures. A. Wounds Of The Soft Parts Not...
-IV. Practical Value Of The Method
The results observed at Compiegne showed us that suppuration of wounds can be suppressed, and that the majority of wounds are capable of being sterilised and sutured. The practical value of the method...
-Chloramine Paste
The formula for chloramine paste is not given in the French edition. M. Carrel informs me it is made as follows:- Chloramine T 10 Stearate of Soda 70 Water..... ...









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previous page: The Sushruta Samhita - An English Translation Based on Original Texts
  
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next page: Applied Anatomy: The Construction Of The Human Body | by Gwilym G. Davis