A history of burn care
If one uses the incontrovertible index of postburn mortality, it is evident that our ability to care for burn patients has improved markedly since World War II. This can be quantified by the lethal area 50 % (that burn size which is lethal for 50 % of a p
- PDF / 288,808 Bytes
- 15 Pages / 595.22 x 842 pts (A4) Page_size
- 81 Downloads / 167 Views
2
MD, FACS, Colonel, Medical Corps, U. S. Army, Clinical Professor of Surgery, U. S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA MD, FACS, Professor and Vice Chairman for Research, Betty and Bob Kelso Distinguished Chair in Burn and Trauma Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
“Black sheep in surgical wards” If one uses the incontrovertible index of postburn mortality, it is evident that our ability to care for burn patients has improved markedly since World War II. This can be quantified by the lethal area 50 % (that burn size which is lethal for 50 % of a population), which in the immediate postwar era was approximately 40 % of the total body surface area (TBSA) for young adults in the U. S., whereas it increased to approximately 80 % TBSA by the 1990 s [1]. Furthermore, the mortality rate at the Galveston Shrine for children with 80 % TBSA or greater (mean 70 % full-thickness burn size) during 1982 – 96 was only 33 % [2]. What has been responsible for these improved outcomes in burn care? What practices were essential to this growth, and what are the major problems that remain unsolved? In this chapter, we will take as our focal point the fire disaster at the Cocoanut Grove Night Club which took place in Boston in 1942, less than a year after Pearl Harbor. The response to that disaster, and the monograph written in its aftermath, serves as a useful benchmark for the burn care advances which followed. To fully appreciate those advances, however, we must go back in time to an earlier era. A wide variety of therapies for burns have been described since ancient times [3], but the idea of collecting burn patients in a special place is relatively new, and emerged in Scotland during the 19th century. James Syme established the first burn unit in
Edinburgh in 1843. He argued that mixing burn patients with postoperative patients would make him “chargeable with the highest degree of culpable recklessness.” This logic motivated the Edinburgh Royal Infirmary leadership to set aside the former High School Janitor’s House for burn patients. This experiment was relatively short-lived, however, since burn patients were transferred to one of the “Sheds” in 1848 to make way for an increased number of mechanical trauma casualties from railway accidents [4]. Another Scottish hospital, the Glasgow Royal Infirmary, had by 1933 accumulated 100 years of experience with over 10,000 burn patients, having established a separate burn ward midway through that period in 1883. In Dunbar’s report on these patients, he commented: Burn cases have until recently been looked upon as black sheep in surgical wards, and have been almost entirely treated by junior members of the staff, who have not had any great clinical experience from which to judge their results (. . .) In
Data Loading...
