![]() ![]() Meanwhile, sepsis is now the commonest cause of death following burn injury and contributes to almost 75–85% of all burn victim deaths. With the advancement of resuscitation methods in burn patients, deaths due to hypovolemia and hyperosmolar shock are now uncommon. Damaged skin that provides a fertile ground to bacterial growth, together with immunosuppression that accompanies major burns, are the main contributors to wound infection, invasive sepsis and if not managed, death. The use of a myriad of other different substances is interesting, however few of the ancient methods have any modern applications as they are unable to prevent bacterial infection which is one of the major causes of death of burn victims (the exception being vinegar, first described by Hippocrates but which is now being rediscovered for its antibacterial properties especially in the treatment of Pseudomonal infections).īurn injury damages the skin which is the primary barrier to infection. With our current understanding of microbiology and infection, it would be difficult to comprehend why faeces and excrement, rich in disease causing pathogens, was used in the open wounds caused by burn. A more recent example can be found in the 19 th century, where a mixture of linseed oil and lime-water (termed Carron oil) was being used to treat burns in Ironworkers in Scotland. The first description of first aid for burns was around 854 CE-925 CE, by Muhammad ibn Zakariya al-Razi (or otherwise known as Rhases in the west), an Arabian physician who recommended cold water for the relief of pain from burns. Many famous philosophers and physicians have contributed to burn wound management such as Hippocrates, who in 400 BC, described the use of bulky dressings impregnated with rendered pig fat and resin with alternated warm vinegar soaks, augmented with tanning solutions made from oak bark and in the 1 st century AD, Celsus described the use of wine and myrrh as a burn lotion, which had bacteriostatic properties. In 600 BC, Chinese described the use of tea leave abstracts and tinctures for burns. One of the earliest records of burn treatment was described in an Egyptian Smith Papyrus written in 1600 BC which advocated the use of resin and honey salve for treating burns, and the Ebers Papyrus in 1500 BC described the use of a wide variety of substances to treat burn wounds. The majority of ancient burn care consisted of topical therapies and can be traced back to centuries. It was not until the past 50 years that the mortality of burns has been dramatically improved, thanks to the better understanding of the patho-physiology of burn injury. However, this was not reflected in improving survival and many patients still died of shock and infection. There was an exponential increase in biomedical research and knowledge from the 18 th to early 20 th century in burn care, such as the recognition of the importance of burn surface area and skin grafting by Reverdin. Physicians have searched for and formulated a myriad of treatments for burns over the centuries but these treatments mostly were of little benefit to the victims mainly because the fundamental understanding of the patho-physiological impact of burns was not known yet. Burns are still one of the top causes of death and disability in the world. We also briefly discuss some future directions in burn care such as the use of cell and pharmalogical therapies.īurn injuries are amongst one of the most devastating of all injuries, having a great impact on the patients physically, physiologically and psychologically. The introduction of metabolic care, nutritional support and care of inhalational injuries further improved the outcome of burn patients. Advancements in the methods of assessing the surface area of burns paved way for more accurate fluid resuscitation, minimising the effects of shock and avoiding fluid over-loading. This along with the advent of antiseptic surgical techniques, burn depth classification and skin grafting allowed the excision and coverage of full-thickness burns which resulted in greatly improved survival rates. The use of systemic antibiotics and topical silver therapy greatly reduced sepsis related mortality. ![]() Most major advances in burn care occurred in the last 50 years, spurred on by wars and great fires. In this article we look back at how the treatment of burns has evolved over the centuries from a primarily topical therapy consisting of weird and wonderful topical concoctions in ancient times to one that spans multiple scientific fields of topical therapy, antibiotics, fluid resuscitation, skin excision and grafting, respiratory and metabolic care and nutrition. Burn injuries are one of the most common and devastating afflictions on the human body.
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