Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-04T19:19:59.674Z Has data issue: false hasContentIssue false
  • English
  • Français

Standardizing wounds: Alexis Carrel and the scientific management of life in the First World War

Published online by Cambridge University Press:  11 September 2007

PERRIN SELCER
PERRIN SELCER
Affiliation:
History and Sociology of Science, Medicine, and Technology, University of Pennsylvania, Suite 303, 249 South 36th St, Philadelphia, PA 19104, USA. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

This essay analyses the development of the Carrel-Dakin treatment for infected wounds during the First World War to explore the relationship between industrialized warfare and experimental medicine, the politics of standardization, and the relationship between the theories and practices of physiology and scientific management. It first describes the intellectual and institutional context from which Alexis Carrel's wound research emerged: experimental medicine and the Rockefeller Institute for Medical Research. Next the story moves to the experimental laboratory hospital on the Western Front and the quantification of wounds. Then it considers the propaganda and training campaign in support of the method at the War Demonstration Hospital located on the institute's New York City campus. The de-skilling inherent in the standardization of surgical practice was a response to the incompetence of inexperienced military surgeons, but also an attempt to restructure the medical profession into a hierarchical organization capable of being administered by elite scientist–physicians. Underlying the narrative is the paradox of simultaneous segregation of the biological and the social through laboratory practices and their conflation through the organic analogy.

Type
Research Article
Information
The British Journal for the History of Science , Volume 41 , Issue 1 , March 2008 , pp. 73 - 107
Copyright
Copyright © British Society for the History of Science 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 A. Carrel, Man, the Unknown, New York, 1939 (first published 1935), 60.

2 ‘Clinical Congress of Surgeons of North America: “War Session”’, Journal of the American Medical Association (1917), 69, 1538–9.

3 Carrel, A., ‘Science has perfected the art of killing – why not of saving?’, Surgery, Gynecology, & Obstetrics (1915), 20, 710–11Google Scholar, 710.

4 For a survey of the hospital's activities see Walker, L. G. Jr., ‘Carrel's War Research Hospital at Compiègne: prototype of a research facility at the Front’, Journal of the American College of Surgeons (2002), 195, 870–6CrossRefGoogle ScholarPubMed.

5 Gould, A. P. et al. ., ‘Report to the Director-General Medical Services on our recent visit to France to study the Carrel-Dakin treatment of wounds’, Journal of the Royal Army Medical Corps (1917), 29, 616–28Google Scholar.

6 New York Times, 29 December 1918, 36.

7 K. Alder, Engineering the Revolution: Arms and Enlightenment in France, 1763–1815, Princeton, 1997, 4.

8 Sturdy, S. and Cooter, R., ‘Science, scientific management, and the transformation of medicine in Britain c. 1870–1950’, History of Science (1998), 36, 421–66CrossRefGoogle Scholar, 437. On medicine and war see R. Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century, New York, 1989; R. Cooter, Surgery and Society in Peace and War, London, 1993; idem, ‘War and modern medicine’, in Companion Encyclopedia of the History of Medicine (ed. W. Bynum and R. Porter), London, 1993, 1536–73; R. Cooter, M. Harrison and S. Sturdy (eds.), War, Medicine and Modernity, Stroud, 1998; R. Cooter, M. Harrison and S. Sturdy (eds.), Medicine and Modern Warfare, Amsterdam, 1999.

9 The contemporary medical literature on the Carrel-Dakin method is vast, but many examples are referenced below. For useful histories of the treatment of infected wounds during the First World War based on reviews of the medical literature see Wangensteen, O. and Wangensteen, S., ‘Military surgeons and surgery, old and new: an instructive chapter in management of contaminated wounds’, Surgery (1967), 62, 1102–24Google ScholarPubMed; Haller, J. Jr., ‘Treatment of infected wounds during the Great War, 1914 to 1918’, Southern Medical Journal (1992), 85, 303–15CrossRefGoogle ScholarPubMed. Both of these articles acknowledge that control of a spreading infection was impossible prior to antibiotics. On the German treatment of gas gangrene during the war see Linton, D., ‘The obscure object of knowledge: German military medicine confronts gas gangrene during World War I’, Bulletin of the History of Medicine (2000), 74, 291–316CrossRefGoogle ScholarPubMed. Through statistical investigation, Linton finds that the Germans were unsuccessful in treating gangrene. (They had a ‘vast literature’ on the Carrel-Dakin method.)

10 This mindset was not peculiar to Carrel. Carrel the mystic vitalist fascist is sometimes contrasted with Jacques Loeb the atheist mechanist leftist, but their conceptions of the physio-chemical basis of life and the goal of controlling life were remarkably similar. See P. Pauly, Controlling Life: Jacques Loeb and the Engineering Ideal in Biology, New York, 1987.

11 On the significance of the organic analogy in this period see especially Cross, S. and Albury, W., ‘Walter B. Cannon, L. J. Henderson, and the organic analogy’, Osiris (1987), 2nd series, 3, 165–92CrossRefGoogle Scholar. On the reciprocal relationship between physiology and sociology see Barberis, D., ‘In search of an object: organicist sociology and the reality of society in fin-de-siècle France’, History of the Human Sciences (2003), 16, 51–72CrossRefGoogle Scholar; J. Michel, ‘Emile Durkheim et la naissance de la science sociale dans le milieu bernardien’, in La Nécessité de Claude Bernard (ed. J. Michel), Paris, 1991, 229–54. On individuality and cell theory see G. Canguilhem, ‘Cell theory’, in idem, A Vital Rationalist: Selected Writings from Georges Canguilhelm, New York, 1994, 161–78.

12 This was the principal mistake against which Claude Bernard had warned. For a description of the meeting, see Witkowski, J., ‘Alexis Carrel and the mysticism of tissue culture’, Medical History (1979), 23, 279–96CrossRefGoogle ScholarPubMed, 290.

13 ‘Report of Dr. Carrel’, Scientific Reports to the Corporation and the Board of Scientific Directors of the Rockefeller Institute of Medical Research v. 1 (1902–1908), January 1907, Rockefeller University Archives (subsequently RUC), Rockefeller Archive Center, Sleepy Hollow, NY (subsequently RAC).

14 Carrel, A., ‘The treatment of wounds: a first article’, Journal of the American Medical Association (1910), 55, 2148–50CrossRefGoogle Scholar, 2148.

15 Carrel to Flexner, 3 September 1909, Lyon, France, Folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232 Faculty: Alexis Carrel, RUC, RAC; underlining in original.

16 A. Carrel, ‘Treatment of wounds’, Folder 9, 2 of 2, Box 3, Alexis Carrel Papers (hereafter ACP), Georgetown University Archives (hereafter GTU).

17 Carrel, op. cit. (14), 2149.

18 Carrel, A., ‘Rejuvenation of cultures of tissues’, Journal of the American Medical Association (1911), 57, 1611CrossRefGoogle Scholar.

19 Carrel, A., ‘On the permanent life of tissues outside of the organism’, Journal of Experimental Medicine (1912), 15, 516–28CrossRefGoogle ScholarPubMed, 528 (emphasis added).

20 On the implications of unicellular life to metazoan life at the end of the nineteenth century and the beginning of the twentieth see Schloegel, J. and Schmidgen, H., ‘General physiology, experimental psychology, and evolutionism: unicellular organisms as objects of psychophysiological research, 1877–1918’, Isis (2002), 93, 614–45CrossRefGoogle Scholar; Jacobs, N., ‘From unit to unity: protozoology, cell theory, and the new concept of life’, Journal of the History of Biology (1989), 22, 215–42CrossRefGoogle ScholarPubMed; Richmond, M., ‘Protozoa as precursors of metazoa: German cell theory and its critics at the turn of the century’, Journal of the History of Biology (1989), 22, 243–76CrossRefGoogle ScholarPubMed.

21 H. G. Wells, J. Huxley and C. P. Wells, The Science of Life, Vol. 1, New York, 1931, 40.

22 E. B. Wilson, The Cell in Development and Heredity, 3rd edn, New York, 1928 (1924, 1896), 5. A useful analysis of the evolution of this text is Droscher, A., ‘Edmund B. Wilson's The Cell and cell theory between 1896 and 1925’, History and Philosophy of Life Science (2002), 24, 357–89Google Scholar.

23 For a different version of the significance of life outside the body see Landecker, H., ‘New times for biology: nerve cultures and the advent of cellular life in vitro’, Studies in History and Philosophy of Biological and Biomedical Sciences (2002), 33, 667–94CrossRefGoogle Scholar; on Carrel's contribution to tissue culture see H. Landecker, ‘“Building a new type of body in which to grow a cell”: tissue culture at the Rockefeller Institute, 1910–1914’, in Creating a Tradition of Biomedical Research: Contributions to the History of the Rockefeller University (ed. D. Stapleton), New York, 2004, 151–74.

24 Pearl, R., ‘The biology of death: I – the problem’, Scientific Monthly (1921), 12, 193–214Google Scholar, 211; and idem, ‘The biology of death: II – conditions of cellular immortality’, Scientific Monthly (1921), 12, 321–35, 334.

25 After the Second World War Leonard Hayflick proved that intracellular factors limited the life of cells, which eventually led to the discovery of telomeres, the so-called cellular clock. Hayflick writes that he first submitted his seminal paper to the Journal of Experimental Medicine (the Rockefeller Institute journal) because it had published most of the key works (i.e. Carrel's papers) on tissue culture and cellular ageing. Peyton Rous rejected the article because ‘the inference that death of the cells … is due to “senescence at the cellular level” seems notably rash. The largest fact to have come out from tissue culture in the last 50 years is that cells inherently capable of multiplying will do so indefinitely if supplied with the right milieu in vitro.’ Hayflick blames this ‘dogma’ on Carrel's chicken heart experiment, and Witowski, a scientist and historian who has written on Carrel's tissue cultures, accuses Carrel of fraud in this experiment. Hayflick, L., ‘Living forever and dying in the attempt’, Experimental Gerontology (2003), 38, 1231–41CrossRefGoogle ScholarPubMed; Witowski, J. A., ‘Dr. Carrel's immortal cells’, Medical History (1980), 24, 129–40CrossRefGoogle Scholar.

26 Scientific Reports to the Corporation and the Board of Scientific Directors of the Rockefeller Institute of Medical Research v. 2, 1909–1911, Carrel's Report of 1 October 1911, RUC, RAC.

27 Flexner to New York Times, 24 June 1909, Folder 39, Correspondence of Flexner, Miss Crutcher, du Nouy, 14-4, Box 43–, Rockefeller Institute 1906–39, 1920–45, ACP, GTU.

28 ‘Curb on vivisection urged in meeting: gathering of a thousand New Yorkers supports the bill now in legislature: appeal to Rockefeller: his Institute here is the centre of vivisection which the law cannot reach’, New York Times, 15 February 1908, 14. B. Unti, ‘“The doctors are so sure that they are right”: the Rockefeller Institute and the defeat of vivisection reform in New York, 1908–1914’, in Creating a Tradition of Biomedical Research (ed. D. Stapleton), New York, 2004, 175–90.

29 For example, ‘The wonders of plastic surgery: details of Dr. Alexis Carrel's remarkable experiments in The Rockefeller Institute – transplanting vital organs, bones, and tissues’, New York Times, 15 November 1908, SM4; ‘Heart surgery is science's latest marvel: Dr. Alexis Carrel of the Rockefeller Institute successfully performs operations that may revolutionize surgery’, New York Times, 27 March 1910, SM4.

30 J. Harrison, ‘Dr. Flexner's work should be guarded against the attacks of fanatics’, New York Times, letter to the editor, 3 January 1910, 8.

31 G. Corner, A History of the Rockefeller Institute: 1901–1953, Origins and Growth, New York, 1964. I rely on Corner's invaluable authorized biography of the institute for my historical narrative of it.

32 J. Sealander, Private Wealth and Public Life: Foundation Philanthropy and the Reshaping of American Social Policy from the Progressive Era to the New Deal, Baltimore, 1997, 23.

33 D. Rodgers, Atlantic Crossings: Social Politics in a Progressive Age, Cambridge, MA, 1998, 26.

34 Wheeler, E., ‘The unofficial government of cities’, Atlantic Monthly (1900), 86, 370–6Google Scholar, 371.

35 E. Fitzpatrick, ‘A most scientific institution’, Chapter 5 of idem, Endless Crusade: Women Social Scientists and Progressive Reform, New York, 1990, 92–129.

36 On the Bureau of Municipal Research see M. Schiesl, The Politics of Efficiency: Municipal Administration and Reform in America, 1880–1920, Berkeley, CA, 1977. On political power relations in New York City see D. Hammack, Power and Society: Greater New York at the Turn of the Century, New York, 1982.

37 The thousand billion figure (English billions, not American ones) comes from Wells, Huxley and Wells, op. cit. (21), 46.

38 O. Amsterdamska, ‘Research at the Hospital of the Rockefeller Institute for Medical Research’, in Creating a Tradition of Biomedical Research (ed. D. Stapleton), New York, 2004, 111–26.

39 ‘Report of the Director of the Hospital’, Scientific Reports to the Corporation and the Board of Scientific Directors of the Rockefeller Institute of Medical Research v. 2, 1909–1911, RUC, RAC.

40 ‘Report of the Director of the Hospital, 16 October 1914’, Scientific Reports to the Corporation and the Board of Scientific Directors of the Rockefeller Institute of Medical Research v. 3, 1912–1914, RUC, RAC.

41 The seventy–eighty per cent figure is not based on reliable statistics. It seems to come from Dr Tuffier, a French surgeon and avid proponent of the Carrel method. Cf. O'Neill Sherman, W., ‘The abortive treatment of wound infection’, Journal of the American Medical Association (1917), 69, 185–92CrossRefGoogle Scholar.

42 On the effects of maimed soldiers on civilian perceptions of the war see J. Bourke, Dismembering the Male: Men's Bodies, Britain and the Great War, Chicago, 1996.

43 Eiselsberg, A. von, ‘Ten commandments for the military surgeon’, Surgery, Gynecology, and Obstetrics (1915), 20, 717–18Google Scholar. The first commandment was that ‘the fresh wound must not be touched with the finger and no antiseptics applied’; the conclusion was, ‘the most important of these commandments is: Dressings must be aseptic and military surgery as conservative as possible’.

44 Foulerton, A. G. R., ‘A consideration of some elementary principles involved in the treatment of soil-contaminated wounds’, The Lancet, 6 March 1915, 484–90CrossRefGoogle Scholar; E. Nelson, ‘Open-air treatment for wounds: a simple and inexpensive form of open-air ward, as used at the V. A. D. Hospital, Henley-In-Arden’, British Medical Journal (1915), 324; Sumner, F. W., ‘Prevention and treatment of septic wounds in warfare’, Indian Medical Gazette (1914), 49, 433–6Google ScholarPubMed; Cyriax, E. F., ‘The mechano-therapeutics of septic warfare wounds’, Medical Press Circular (1915), 99, 291–4Google Scholar, quoted in Haller, op. cit. (9).

45 Two exemplary, and entertaining, articles in this debate from which the following quotations come are Sir Cheyne, W. Watson, ‘On the treatment of wounds in war’, British Journal of Surgery (1915), 3, 427–48CrossRefGoogle Scholar; Sir A. Wright, ‘The question as to how septic war wounds should be treated (being a reply to polemical criticism published by Sir W. Watson Cheyne in the British Journal of Surgery)’, The Lancet, 16 September 1916, 503–13.

46 Wright explicitly stated this: ‘All controversy is a warfare from which the one or the other of the parties has got to emerge discredited. And it is the task of every disputant to minish [sic] the prestige of the protagonist on the other side; and also, if possible, to bring home to the reader that he is, when reading the author he favours, as liable to be led away into fallacy as is a man listening to an advocate setting out his cause.’ Wright, op. cit. (45), 504.

47 Cheyne, op. cit. (45), 436.

48 Wright, op. cit. (45), 507.

49 Colonel H. M. Gray, ‘Remarks on the general treatment of infected “gunshot wounds” from a clinical point of view’, British Medical Journal (1916), 1–7.

50 Morison, R., ‘Treatment of infected suppurating war wounds’, British Journal of Surgery (1916), 4, 658–78CrossRefGoogle Scholar, 663.

51 I. Feldman and A. J. Walton, ‘Observations on the antiseptic treatment of wounds’, The Lancet, 23 December 1916, 1043–8.

52 Carrel to Flexner, 17 December 1914, Paris, folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232 Faculty, ACP, RUC, RAC.

53 Carrel, A., du Nouy, P. Lecomte and Carrel, A., ‘Cicatrization of wounds IX: influence on the healing of wounds of variation in the osmotic tension of the dressing’, Journal of Experimental Medicine (1917), 26, 279–95CrossRefGoogle Scholar, 292.

54 Carrel to Flexner, 5 July 1916, folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232 Faculty: Alexis Carrel, ACP, RUC, RAC.

55 Carrel to James, 1 November 1915, folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232 Faculty: Alexis Carrel, ACP, RUC, RAC.

56 Carrel to James, 25 November 1915, folder entitled ‘27: AC Writings: “The future progress of medicine”’, Box 1, 450C232, ACP, RUC, RAC.

57 Carrel to Flexner, 18 March 1916, folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232 Faculty: Alexis Carrel, ACP, RUC, RAC.

58 Letter to nephew, 1918, quoted in T. Malinin, Surgery and Life: The Extraordinary Career of Alexis Carrel, New York, 1979, 93.

59 James to Coudert, 20 November 1915, folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232 Faculty: Alexis Carrel, ACP, RUC, RAC.

60 The French – and, for that matter, the British – intellectual, institutional and political milieux were clearly critical factors in shaping the history of the Carrel-Dakin method. Within the confines of this already long paper, however, I can only address them as background – as they appeared from the American perspective and set the terms of the debate.

61 James to Carrel, 22 May 1915, folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232 Faculty: Alexis Carrel, ACP, RUC, RAC.

62 H. D. Dakin, ‘On the use of certain antiseptic substances in the treatment of infected wounds’, British Medical Journal (1915), 318–20.

63 A. Carrel and G. Dehelly, The Treatment of Infected Wounds, New York, 1917, 11–12.

64 Lyle, H. M., ‘Disinfection of war wounds by the Carrel method: as carried out in an ambulance at the front’, Journal of the American Medical Association (1917), 68, 108Google Scholar.

65 Lt. Col. E. Pool, ‘Wounds of soft parts’, in The Medical Department of the United States Army in the World War, Volume 11: Surgery Part 1: General Surgery, Orthopedic Surgery, Neurosurgery, Washington, DC, 1927, 294–316, 294.

66 ‘Clinical Congress’, op. cit. (2), 1539.

67 Carrel to Flexner, 9 August 1918, Paris, folder entitled ‘Faculty/Alexis Carrel, Admin corresp. 1917–1922’, Box 2, ACP, RUC, RAC.

68 Stevens, op. cit. (8), 90.

69 Carrel and Dehelly, op. cit. (63), 153.

70 Carrel to James, 1 July 1915, folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232, ACP, RUC, RAC.

71 Roosevelt to Carrel, 29 November 1916, Folder 7, Box 15, 600-2 War Demonstration Hospital, RUC, RAC.

72 Carrel, A. and Hartmann, A., ‘Cicatrization of wounds I: the relation between the size of a wound and the rate of its cicatrization’, Journal of Experimental Medicine (1916), 24, 429–50CrossRefGoogle ScholarPubMed, 430.

73 P. Lecomte du Nouy, Biological Time, New York, 1937, 55.

74 In fact, particularly deep wounds were supposed to be measured by filling them with a known volume of liquid, though these wounds were not very useful for experiments.

75 O. Pedersen, ‘The Prytz planimeter’, in From Ancient Omens to Statistical Mechanics: Essays on the Exact Sciences Presented to Asger Aaobe (ed. J. L. Berggen and B. R. Goldstein), Copenhagen, 1987, 259–71.

76 See any of the series of articles ‘Cicatrization of wounds’ in the Journal of Experimental Medicine. This example is the first case in the first article of the series.

77 du Nouy, P. Lecomte, ‘Cicatrization of wounds II: mathematical expression of the curve representing cicatrization’, Journal of Experimental Medicine (1916), 24, 451–60CrossRefGoogle ScholarPubMed, 451, 460; Nouy, P. du, ‘Mathematical study of the extrapolation formula and the curve of cicatrization’, Journal of Experimental Medicine (1917), 25, 721–8CrossRefGoogle ScholarPubMed. Du Nouy continued to refine the formula, but the changes are immaterial to this paper.

78 I. Hacking, The Taming of Chance, Cambridge, 1990, 63.

79 T. Tuffier and R. Desmarres, ‘A note on the progress of cicatrization of war wounds’, Journal of Experimental Medicine (1918), 165–78, 165.

80 Ebeling to Carrel, 12 August 1921, folder 37, folder entitled ‘Ebeling correspondence 1912–27’, 14-4, Box 43, ‘Correspondence of Flexner, Miss Crutcher, du Nouy, Rockefeller Institute 1920–45’, ACP, GTU.

81 See, for example, Gould et al. (the official delegation of surgeons from the Royal Medical Service), ‘Report to the Director-General’, op. cit. (5), 621, which calls the sign the ‘most striking evidence of the value of the treatment that we saw’.

82 Du Nouy, op. cit. (73), 161.

83 Carrel, A., ‘Physiological time’, Science (1931), 74, 618–21CrossRefGoogle ScholarPubMed, 619.

84 On age norms see H. Chudacoff, ‘Intensification of age norms: 1900–1920’, in idem, How Old Are You? Age Consciousness in American Culture, Princeton, NJ, 1989, 65–91.

85 T. Cole, The Journey of Life: A Cultural History of Aging in America, Cambridge, 1992.

86 Carrel and Hartmann, op. cit. (72), 444.

87 New York Times, 5 August 1915, 9.

88 ‘Dr. Carrel uses algebra to heal: reduces wounds to mathematical equations in France’, New York City Tribune, 12 July 1916.

89 H. L. Mencken, ‘The Carrel-Dakin treatment’, Evening Mail, 24 October 1917.

90 R. Skerrett, ‘The revival of antisepsis’, Harper's (1918), 862–8, 862.

91 For a concise description of the military (primary) and medical (secondary) objectives of the British Medical Corps, see Captain Sylvester Bradley, C. R., ‘Reflection on the Army Medical Service in campaign’, Royal Army Medical Corps (1914), 23, 177–86Google Scholar. Americans may have been less cold-hearted, but military and medical objectives could conflict, and the logic of war dictated that military objectives came first.

92 James to Carrel, 29 March 1916, folder entitled ‘Faculty/Alexis Carrel: Admin. Corresp. 1906–1916’, Box 2, 450C232 Faculty: Alexis Carrel, ACP, RUC, RAC.

93 Description of Chutro from R. Cooter, Surgery and Society in Peace and War, op. cit. (8), 122.

94 Sherman, W. O'Neill, ‘The abortive treatment of wound infection: Carrel's method – Dakin's solution’, Journal of the American Medical Association (1917), 69, 185–92CrossRefGoogle Scholar, 186, 190.

95 Copy of letter from Dr W. O'Neill Sherman to the Surgeon General forwarded to Mr Rockefeller, 16 April 1917, folder 433: ‘Dr. A. Carrel, 1915–1918’ Box 44, RG III 20: Rockefeller Boards, RAC.

96 New York Times, 29 March 1917, 3.

97 ‘Dr. A. Carrel, 1915–1918’, minutes from March 1917 meeting, folder 433, Box 44, RG III 20: Rockefeller Boards, RUC, RAC.

98 Major G. Stewart, ‘The Rockefeller Institute for Medical Research: War Demonstration Hospital’, Report of 15 April 1919, Folder 71, 15-2, Box 47, ACP, GTU.

99 In fact the hospital became embroiled in a dispute over Rockefeller's property taxes in 1919 when the tycoon clashed with a new Democratic municipal administration. This episode suggests the relative ease with which Rockefeller philanthropies could shift their patronage and strategic alliances between different levels of American government. On the strategic moves of Rockefeller's philanthropy between city, state and federal governments see Sealander, op. cit. (32).

100 Stewart, op. cit. (98).

101 Lt. Markham to Major Stewart, 22 April 1918, Camp MacArthur, Waco, Texas, Folder 2: ‘Subject Files – Students' Reports (1917–1918)’ Box 17: ‘Stewart, George A. (Subject Files, S to Z) Superintendents' Files (Corresp., A–R)’, War Demonstration Hospital (Record Group I 600–2), RUC, RAC.

102 Major T. Wright to Stewart, Base Hospital Camp Sevier, S.C., 14 August 1918, folder 2: ‘Subject Files – Students' Reports (1917–1918)’, ACP, RUC, RAC.

103 Major Stewart to Lt. Lear, 1 April 1918, Folder 2: ‘Subject Files – Students' Reports (1917–1918)’, Box 17: ‘Stewart, George A. (Subject Files, S to Z) Superintendents' Files (Corresp., A–R)’, War Demonstration Hospital (Record Group I 600-2), RUC, RAC.

104 Bevan, A., ‘The Carrel-Dakin treatment’, Journal of the American Medical Association (1917), 69, 1727–8CrossRefGoogle Scholar, 1728.

105 Major Stewart to S. Murphy, 9 January 1918, Folder 433: ‘Dr. A. Carrel, 1915–1918,’ Box 44, RG III 20: Rockefeller Boards, RUC, RAC. For replies see Bloodgood, J. and McCormack, A. T., ‘Correspondence: the Carrel-Dakin treatment’, Journal of the American Medical Association (1917), 69, 2061–2CrossRefGoogle Scholar.

106 J. Coupal, ‘Pathology of gas gangrene following war wounds’, in The Medical Department of the United States Army in the World War, Volume 12: Pathology of the Acute Respiratory Disease, Gas Gangrene Following War Wounds, Washington, DC, 1929, 407–567, 411–13.

107 Coupal, op. cit. (106), 411–13.

108 Maj. E. Elliot, ‘Gas gangrene’, in The Medical Department of the United States Army in the World War, Volume 11: Surgery, Washington, 1927, 265–83, 278.

109 ‘Clinical Congress’, op. cit. (2), 1539.

110 P. Starr, ‘Escape from the Corporation, 1900–1930’, Chapter 6 of idem, The Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry, New York, 1982.

111 Timmermans, S. and Berg, M., ‘Standardization in action: achieving local universality through medical protocols’, Social Studies of Science (1997), 27, 273–305CrossRefGoogle Scholar.

112 After the war Carrel was rewarded with an extensive renovation of his laboratories at a cost of ‘about $184,000 – an immense sum, and about double what the cost would have been in 1914. However, everyone wants you to have just the facilities you need for your work these next years’. Flexner to Alexis Carrel, 16 July 1919, Folder 8, Box 96, ACP, GTU.

113 In the official history of the Medical Department of the US Army, L. Pool describes the circumstances in which the Carrel-Dakin method should be used. The principle considerations concern the number of wounded and the capacity of the hospital. Primary suture – that is, closing the wound immediately after debridement – is recommended if time permits, though for some wounds Carrel-Dakin may be a better choice.

114 Col. G. De Tarnowsky, ‘Surgery at the Front’, in The Medical Department of the United States Army in the World War, Volume 11: Surgery Part 1: General Surgery, Orthopedic Surgery, Neurosurgery, Washington, 1927, 87–129, 128 (emphasis added).

115 S. Timmermans and M. Berg, The Gold Standard: The Challenge of Evidence-Based Medicine and Standardization in Health Care, Philadelphia, 2003, 53.

116 H. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900–1990, Cambridge, 1997.

117 Carrel, A., ‘The future progress of medicine’, Scientific Monthly (1925), 21, 54–8Google Scholar.

118 Among other things, Carrel's call for large base hospitals within a few kilometres of the trenches would have required an acceptance of the permanence of the stalemate.

119 Carrel, op. cit. (1), 204, 319.