For Burns

What is the best treatment for a burn? The Chinese swear by tea. U.S. doctors, who have argued loudly about the subject for more than 20 years, have tried a vast variety of applications, including tannic acid (a component of tea), silver nitrate, hormone ointment, triple aniline dyes, sulphur water, cold water, ice, and a concoction of paraffin wax, sulfanilamide, menthol, camphor, vaseline and cod liver oil, the whole topped off by oil of eucalyptus to kill the smell.

Last week one of the leading authorities on burns poured all these down the drain and reported that burns specialists now agree on much simpler methods. His recommendation: just wrap up the patient, feed him well and let him heal.

The new treatment brings together what has been learned from such disasters as Boston's 1942 Cocoanut Grove fire and from wartime experience with men burned aboard ships and planes. It was described in Surgery, Gynecology and Obstetrics by Dr. Robert Elman, husky, 49-year-old surgery professor in Washington University's Medical School, St. Louis.

Basis of the treatment is the discovery that the chief dangers to a burn victim are: 1) loss of protein from burned tissues, i.e., starvation; 2) infection, usually picked up when the burns are being dressed; 3) shock. The treatment casts aside not only elaborate ointments but the standard prewar practice of debriding (scraping away) the charred skin and flesh. Specialists now recognize that most preparations doctors used to smear on burns were either a hindrance or dangerous.

The Proof. At Homer G. Phillips Hospital in St. Louis (a city institution for Negroes), Dr. Elman's group, supported by a Government grant, experimented on the basis of the later findings. Most of their patients got no morphine; by the time they reached the hospital they usually felt no pain. On arrival, they were promptly put between sterile sheets, given anti-tetanus injections and, if necessary, plasma transfusions for shock.

Even though some had wounds covered with molasses, lard, talcum powder, bluing, the surgeons did not debride, merely washed the burns with soap & water. Wearing surgical masks and using operating-room sterility procedure (to avoid infection), they wrapped the burned areas in gauze bandages, with or without a mild ointment (Dr. Elman: "None is really required"). They left on the original dressing as long as possible, usually ten to 14 days. After bandaging, patients able to stand were urged to get up and walk around. The only drug: anti-infection sulfathiazole pills.

The big item in the treatment was heavy feeding. Patients had to take a minimum of 100 grams of liquid or solid protein a day, were threatened with tube feeding if they balked.

Results of the treatment: of 55 badly burned patients, 26 (with burns covering up to 45% of their body) were healed without skin grafts, 17 needed skin grafts, twelve (nearly half of whom were 75% to 100% covered with burns) died. Among patients who recovered, healing was more rapid and required less skin grafting than under previous treatments. Previously, few patients with more than a third of the body surface burned ever survived.

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