Burn care

Burn care: a historical perspective

By: Mölnlycke Health Care, December 28 2011Posted in: Burn care

Introduction

The successful treatment of burns is a very recent development. As late as 1939 it was thought that someone with burns over one third of their body would probably die, whilst today we expect to successfully treat someone with 65% burns of total body surface area. This is due to expanding knowledge of the pathophysiology of thermal injury and its systemic consequences, medical technology advances and improved surgical techniques.

Until recently the majority of topical treatments were obtained from nature: plant or animal byproducts or mineral/chemical agents. Amongst physicians there were two schools of topical treatment: those who sought to dry the wound and promote the formation of scabs and those who saw greater benefit in keeping the wound moist with ointments and poultices.

Treatments Derived From Animal Sources

Curatives such as lard, honey, milk, butter and eggs have been widely used since ancient times and are still used as home remedies today whilst pure lard was the most commonly used. Following World War II the use of any oil was increasingly discouraged because it is not water soluble and therefore difficult to remove. The use of live animal sources were also used in the 20^th Century through the use of maggots to debride burn wounds as they are able to distinguish from dead tissue, which they eat and the live tissue, which they leave.

Treatments Derived From Plant Based Ingredients

Agents such as plant oils, potatoes, flour, apples, onions, leaves, vinegar and turpentine have also been recommended as curatives. Carron oil, a mixture of equal parts of linseed or olive oil and ‘lime water’ (an aqueous suspension of calcium carbonate and calcium oxide or quick lime) was recommended in most burn care studies in the 19^th and early 20^th Centuries. Its alkaline pH, healing and soothing properties made it ubiquitous until the advent of antiseptics following Lister’s studies in the 1870’s.

During the 19^th Century emollient poultices made largely from ingredients such as potatoes, apples, onions and leaves were used alongside bread and milk poultices to slough wounds and were the treatment of choice during the American Civil War. Also during this time vinegar or turpentine use was still prevalent having first been used in ancient Greek and Roman times with its proposed beneficial effect due to the cooling process incidental to its evaporation.

Mineral and Chemical Agents or Burn Treatment

Surprisingly, lead treatments were used extensively during the 19^th Century as an escarotic agent until toxic effects were noted. Of less toxic effect ice and iced water is mentioned occasionally throughout history for its cooling and anti-swelling properties until it was realized it led to burn shock at the end of the 20^th Century. The middle of the 20^th Century saw the development of petroleum based products and especially petrolatum or petroleum jelly, which were used to relieve pain and hyperemia. During World War II the branded Vaseline impregnated gauze was the standard topical treatment for burn injuries.

The introduction of carbolic acid or phenol marked an important advance in burns treatment towards bacterial control. It had many beneficial qualities to recommend it to 19^th century physicians experimenting in this field, unfortunately there were many toxic effects including burning tissue. It was not until 1965 that the first effective bactericide was produced, 0.5% silver nitrate, followed by mafenide and then silver sulphadiazine (1968). The latter proving less toxic and less painful to apply whilst reducing burn wound contamination and blocking sepsis.

Conclusion

For centuries people with severe burns were bandaged and left to heal on their own or often they died or were hideously disfigured. Because of radical changes in topical treatment, which have been rivalled by advances in all other aspects of patient care healing and survival rates have fundamentally improved.

The history of topical treatment in burn care

Adapted from: Pinnegar and Pinnegar (1986)

Reference

Pinnegar MD and Pinnegar FC III. History of Burn Care – A Survey of Important Changes in the Topical Treatment of Thermal Injuries. Burns. 1986; 12(7): 508-517.