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Title: The treatment of burns and scalds
Author: Wilkinson, A. W.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1942
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1. A review has been made of 116 cases of burns and scalds treated by coagulation with 1 per cent. gentian violet and 10 per cent. silver nitrate. 2. The average number of burned and scalded children admitted to hospital per month was fairly constant until the winter months of 1939-40 when an increase occurred, the number being nearly doubled; reasons for this rise have been suggested. 3. Of 101 patients under the age of 12 years, 40 per cent. were aged 1-2 years, 67 per cent. 1-3 years and 74 per cent. under 6 years. 4. The circumstances under which the injury was sustained show that carelessness and lack of supervision on the part of parents or guardians were in the majority of cases the chief causal factors. Any attempt to reduce the number of injuries will meet with difficulties, and the only approach considered likely to yield results is by widespread propaganda and education of the public in the causes and dangers of such injuries. 5. The first aid treatment applied to the cases of this series was unsatisfactory; a scheme of instruction has been drawn up for inclusion in the propaganda suggested above. 6. Of 105 cases 39 per cent. were admitted within one hour of injury, 65 per cent. within 2 hours and 75 per cent. within 3 hours. There is still a proportion of cases which arrive at hospital only after attempts at treatment at home have been made and abandoned. 7. In 78 per cent. of the patients the extent of injury was less than 20 per cent. of the body surface; in 7 per cent. it was 50 per cent. or more. Extent of injury per se is not now as lethal a factor as formerly. 8. Initial shock was infrequent and showed no constant relation to the extent of the injury. Secondary shock was common and its severity was related to the extent of injury and the duration of local treatment. Gum saline and plasma saline had beneficial effects on the shock when given in adequate amounts. The administration of cortical hormone proved beneficial in a number of cases. In 5 cases death was due to secondary shock; in certain of these treatment was inadequate. The importance of the combination of general resuscitatory treatment with local treatment of the burn has been emphasised. 9. In 39 consecutive cases healing was complete in an average time of 19.2 days and the stay in hospital was 20 days. In some cases healing was complete in from 8 to 14 days; in others it took many weeks, the time depending on such factors as depth and site. 10. Investigation of the blood chemistry has confirmed previous observations; it has been suggested that there may be a change in the selective permeability of capillary walls in and near the burned area as a result of the injury, and that this change is at least in part responsible for the alteration in the relative amounts of certain constituents of the circulating blood. 11. The mortality rate in this series of 116 patients was 6.9 per cent. (8 deaths), which compares favourably with that in other series in which tannic acid was used as the coagulant. 12. The nursing of burns and scalds is of the greatest importance. Unremitting care and a deep interest in the problems peculiar to the injury are essential. Much of the credit for the successful treatment of these injuries by the coagulation method must be given to the nursing staff whose part is greater than in almost any other surgical condition.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available