Paper
Saturday, July 14, 2007
This presentation is part of : Nursing History Issues
Evidence-Based Practice in the Great War Era, 1914-1918: Trial and Adoption of the Carrel-Dakins Wound Irrigation Method in a World War I Hospital in France
Marjorie Louise DesRosier, PhD, RN, School of Nursing, University of Washington, Seattle, WA, USA
Learning Objective #1: describe the key historical events of a 1917 study illustrating evidence-based practice in the World War I era.
Learning Objective #2: The learner will be able to discuss the role of international nursing collaboration in development of therapeutic treatment advances in World War I.

Purpose: To describe evidence-based practice and transdisciplinary collaboration within an historical context using archival records of a 1917 clinical trial of the Carrel-Dakins Wound Irrigation Method (CDM) for treatment of war-related infected wounds in a French army evacuation hospital.

Significance: Within the historical context of World War I this study describes organizational events associated with the testing and institutional adoption of a clinically superior wound treatment method for infections characteristic of wounded soldiers from the Western Front of battle in France.

Methods: A multi-site international archival study of the 1915-1919 span of service of Hôpital Temporaire d’Arc-en-Barrois, Haute-Marne, France, provided historical evidence for ethnographic study. Primary source archives were compiled in a relevant time frame of January-December 1917. Hospital records were reviewed for historical content specific to CDM clinical trial protocols, clinical outcomes, transdisciplinary collaboration and organizational policy changes. Ethnographic analysis was used to create a descriptive historical narrative of events illustrating evidence-based treatment practices.

Findings: British and North American nurses and surgeons instituted an observational study determining the clinical efficacy of a CDM treatment protocol in a selected population of hospitalized French soldiers. Patients with chronically infected wounds were segregated for treatment in two hospital wards (n=not reported). Patients treated with CDM showed qualitative improvements in wound healing and faster rates of hospital discharge compared to patients receiving ordinary care. Based on favorable study outcomes, CDM was adopted as institutional policy in 1917 as an exclusive wound treatment protocol.

Conclusions: In the pre-antibiotic World War I hospital era international collaboration between British and North American nurses and surgeons figured significantly in the clinical testing and adoption of an efficacious wound treatment method. Results of this study allow contemporary scholars of evidence-based practice to acknowledge an historical precedence for scientific-based transdisciplinary collaboration in global health projects.