COMPARISON OF METHODS OF TREATING WOUNDS
Journal of the American Medical Association
ner in which products are kept influences deteriora¬ tion. The serum or vaccine displayed on the phar¬ macist's shelves, or stored in a drawer, loses its efficacy much faster than one kept in an adequate refrigerating device. If the purchaser knows the age of a preparation, he may be in some position to judge of its probable value, when kept under given condi¬ tions. SUMMARY From the foregoing it is evident that these ques¬ tions have already claimed much attention, and that the subject of
... the subject of standardization may be thus sum¬ marized : The chief difficulty in standardizing biologic prod¬ ucts is due to the unstable nature of the factors. Legal standards have been established for diphthe¬ ria antitoxin and tetanus antitoxin. A provisional standard has been established for antityphoid vaccine. Vaccine virus and antirabic virus are, in effect, tested for potency in the process of manufacture. It is not wise to attempt to standardize products in the purely experimental stage, or those for which there is no sound scientific basis. Those who are engaged in manufacturing and con¬ trolling these products are alive to the necessity for standardization. The difficulty of judging and comparing the clinical results of different methods of the treatment of wounds is so great that it seems desirable to consider how more exact information as to the value of a treatment can be attained. It is obvious from a study of the literature since the beginning of the war that the superiority of no one form of treatment has become firmly established. The treatment of infection in wounds is thus still largely in the experimental stage. The haphazard way of trying first one and then another method on each case, hoping to stumble on a suitable one, is as nearly barren of progress as is treating all wounds in the same way. This proceeding is not likely to lead to the recognition of the best methods of treatment for infected wounds. It is important, therefore, to organize in hospitals a system which may give a clear idea of what is being accomplished by each method of treatment. As in most other therapeutic problems, the great difficulty in associating cause and effect lies in the number of variable factors which must be controlled. In the case of infected wounds, the first and one of the most important of these factors is the personal element in the manner of applying the treatment and handling the wound. It is of little use to compare two methods of treatment conducted by different men. No two surgeons will carry out the details of the same treatment in exactly the same way. One may secure satisfactory results by a certain method entirely from delicate and careful handling of the regenerating tis¬ sues of the wound, while another, using the same method of dressing, may counteract the benefits of the system by careless treatment of the young epithelium and granulations with which he is dealing. Yet both results may be ascribed to the particular method or dressing solution which is being used. It is also unsatisfactory to compare the results of one method of treatment conducted in a series of cases with a different method used by the same surgeon in a previous series. It will often be stated that better results were obtained with the second method than with the first, when the difference is really due, not to a better method, but to the increased experience of wounds that has been gained by the surgeon. There are other important factors which vary with the patient. First there is that of the general vitality and ability to react to the infection. Although this is not so great as might be supposed, owing to the fact that much of the military surgery deals with men more or less carefully selected for their sound health and freedom from debilitating disease, it cannot be entirely discounted. The age of the wound and the previous treatment to which it has been subjected are also factors which must be standardized to be compared. This can partly be accomplished by establishing a system of periodic examinations and descriptions of each case at short intervals, and grouping the cases according to the number of days since the injury was received.