Burn care

Burn care: a historical perspective

By: Mölnlycke Health Care, August 23 2013Posted 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 20th 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 19th and early 20th 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 19th 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 19th 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 20th Century. The middle of the 20th 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 19th 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

Date/Source

Animal

Plant

Mineral/Chemical

Comments

1500 BC Papyrus

 

Lemon strips in an oily preparation

 

 

500 BC

 

Mixture of tea leaves (tannic acid)

 

 

430 BC

Hippocrates

Old swine’s seam (lard)

 

 

 

(Roman) Galen

 

Vinegar and wine

 

 

9th Century

Rhazes Arabian

 

 

Cold Water

 

1799

Earle

 

 

Ice Water

 

1769-1797

 

 

Heated strong spirits

Warm stimulating remedies

1821

 

 

Nitrate of silver

 

Thomasen

 

Emollient poultices, spirits of wine, turpentine

 

 

1847

 

Scraped potato, onion, apple, alcohol – brandy, flour, bread and milk poultice

 

 

1882

 

 

Savage

Carron Oil

 

Carbolic acid, bicarbonate of soda, oxide of zinc, white lead paint, silver nitrates, 3g/1 fl oz. water

 

1875

Lister

 

 

Furniture vanish, boric acid

Antiseptic treatment

1925

 

 

Tannic acid replaced carbolic acid as it was found to burn skin

 

1939

 

Maggots

 

 

1944

 

 

Petroleum jelly on fine mesh gauze

 

1945

 

 

10% silver nitrate solution

 

1953

 

 

 

 

Mafenide

Improved antibiotics available. New era of antibacterial agents

1968

 

 

Silver sulphadiazine

 

1973

 

 

Normal saline, Peroxide

 

1975

 

 

Betadyne

 

1976

 

 

Polyethylene glycol artificial skin

 

1978

 

Pigskin

 

 

1981

 

 

Gentamycin, Nystatin

 

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.

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