History of Medicine

DAKIN’S SOLUTION and THE GREAT WAR

     There must be surgeons who still remember Dakin’s Solution, a tried and true antiseptic solution, named after its inventor Henry Dakin. 

     Like many surgical advances this one started in wartime – the First World War.  Soldiers attacked by shells and bullets ever more destructive to human flesh, fighting in fields and trenches in well-manured farmland, suffered gaping wounds prone to anaerobic infections and gas gangrene. Delays transporting the wounded to proper hospitals added to the burden. 

     To combat the problem Alexis Carrel, a French surgeon at the Rockefeller Institute in New York who already had a Nobel Prize 

Alexis Carrel (Wellcome Library)

for pioneering work in vascular surgery, stepped in. He and his wife were vacationing in France when the Great War broke out and being a French citizen was  called up.

     Through an influential American friend he was put in touch with the French War Minister who granted him a hospital for research if he could get his own funds for a laboratory. Carrel reached to the Rockefeller Foundation and received ample funds, and the name of a good chemist – Henry Dakin.

     Henry Dakin was born in London in 1880. As a schoolboy he was apprenticed to a City Analyst and did analyses of water, sewage, etc. He enjoyed chemistry and went on to obtain a degree and work in the field. In 1905 he accepted a job in the private

Henry Dakin (from Wellcome Library)

biochemical laboratory of Dr. Christian Herter in New York (on the top floor of his large house). Herter, a wealthy, respected, physician with ties to the Rockefeller Institute, had given up his practice to found the laboratory, do chemical investigations, and consult. He died in 1910, and Dakin stayed on as director of the lab at Mrs. Herter’s request. Dakin’s main work was in amino acid and lipid metabolism.

      When the war broke out Dakin, a British citizen, was eager to help and responded to the call from Carrel. They collaborated at “Temporary Hospital #21”, set up in the Round Royal Hotel outside Compiège, a village just 14 kilometers from the front. The Round Royal was a huge luxury hotel, once owned by Napoleon III, now housing 50 beds on the main floor and more (for officers) upstairs. The thunder of cannons not far away provided background noise to the constant flow of mangled, infected bodies arriving at the hospital. 

     Life at the Round Royal was hard. There were occasional shellings and bombings of nearby Campiègne itself, but no one deserted. Madame Carrel helped supervise nursing. On site were a radiologist, bacteriologist, pharmacist, biologist, and surgeons. 

     Antibiotics were unknown. Surgeons realized that debridement of damaged tissue was essential to survival but antiseptics for cleaning wounds proved either toxic or poorly effective (due to inactivation by proteins in tissue fluids). Almoth Wright, the British bacteriologist, had introduced concentrated saline as a way to draw out more lymph to clean wounds, but this too was inadequate.

     Dakin set to work. He tested over 200 compounds, finally settling on a dilute solution (0.05%) of sodium hypochlorite 

Carrel-Dakin tubing
(from Treatment of
Infected Wounds)

buffered with boric acid (to reduce tissue irritation). Dakin’s new solution was washed through tubing with holes in the wall that was introduced into deep areas of wounds. At first the fluid was pushed in by syringe but later IV drips were used. Nurses had to frequently adjust IV drips and change dressings and the solution, being unstable, was mixed on site. Using bacteriologic culture counts, wounds were closed when sterile on 2 or 3 cultures. The results were amazing. Suppuration was almost eliminated and healing accelerated, and the method quickly became the preferred one throughout the allied front. Dakin also invented an electrolysis process for making hypochlorite from sea water, allowing a hospital ship an unlimited supply. And he synthesized chloramine-T, a surface disinfectant.     

Method of wound irrigation (from
Treatment of Infected Wounds)

     When the U.S. entered the war Carrel returned to New York to head a school on the grounds of the Rockefeller Institute to train doctors in military medicine, where the Carrel-Dakins method was taught. 

Alexis Carrel teaching at Rockefeller Institute
(from National Library of Medicine)

     Dakin, on his return to the U.S., married Mrs. Herter, who was 16 years his senior, and moved into a large house in Scarborough overlooking the Hudson River. There Dakin built his own laboratory, pursued work on amino and fatty acids and published a Handbook of Chemical Antiseptics. His chemical work was of high caliber and earned him honorary degrees, a fellowship in the Royal Society, several medals, and later a directorship in Merck & Co. He was an editor of the Journal of Biological Chemistry. As a person he was reserved and shy, seldom collaborated, did not take on “post-docs”, did not have a university affiliation, and entertained infrequently. Thus he is less well-known than he might have been. 

     Henry Dakin considered his antiseptic work as less important “chemically” than his other work, but it was clearly important to grateful war surgeons and their patients.

Sources

Edwards, W.S.  Alexis Carrel: Visionary Surgeon. 1974

Malinin, T.I.  Surgery and Life: The Extraordinary Career of Alexis Carrel. 1979

Mottier, G.  L’Ambulance du Docteur Alexis Carrel.  1977.

Dis Colon Rectum 1983; 26: 354-358 (contains Dakin’s original   

          paper).

Hawthorne, R.M.  Henry Drysdale Dakin, Biochemist: The Option of Obscurity.  Persp Biol Med 1983; 26 (4): 553-67.

Carrel, A. and Dehelly, G.  The Treatment of Infected Wounds. 1917 

         (English Translation).

“Dr. H.D. Dakin” (obituary). Nature 1952; 169: 481-2.

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