Treatment of Major Burns in 1940 and 1946. Comparison of Tannic Acid Treatment with Compression Bandage Method

Resident Surgeon, Campbell Hospital, Calcutta An attempt is made in this article to compare the results of general and local treatment of major (Wallace, 1941) burns in the abovementioned years. By major burn is meant any burn that covers more than 1 per cent of the body surface or that covers any joint surface or that is too near any source of natural contamination, e.g. mouth, anus, etc. In 1940, shock was treated by ordinary normal saline or gum saline and the burnt areas were tanned by tannic acid in 1 in 1,000 acriflavine. In 1946, one had /the good fortune of treating shock with serum and the burnt areas by compression dressing using sulfathiazole and vaseline gauze. The infections could be prevented or combated by penicillin in 1946 over and above the sulfa group -of drugs of 1940 and of later years. If one traces the history of local treatment of burnt areas, one comes across a great many ointments and tanning reagents. Starting from picric acid, cod-liver oil, one passes through 1925 when Davidson (Lee and Rhoads, 1944) introduced tannic acid to precipitate the denatured protein and thus to prevent absorption of burn-toxin as that was the accepted theory at the time. He claimed that tannic acid stopped fluid loss too. Tannic acid held the field in treatment of burns for nearly 20 years. Tannic acid brought the mortality rate down from 26.7 to 10.5 per cent in Harkins (Riehl, 1942) series of cases. The tannic acid treatment has been losing its reputation rather quickly. It has been suggested by Erb, Morgan and Farmer (1943) that tannic acid causes liver damage after absorption from the burnt area especially when a big surface is involved. Tannic acid is also toxic to epithelial cells. Pus spreads under the crust spreading infection from 3rd degree areas to 2nd degree areas. Mild infections under the crust destroy a number of epithelial islets especially in deeper 2nd degree burns. The crust is uncomfortable to the patient and takes a long time to separate. In 3rd degree burns which are almost always infected, the crust with the pus underneath it will only delav healing processes (Mclndoe, 1940). The method of surgical cleanliness, compression bandage using some antiseptic ointment and rest, is advocated by many in America (Koch, 1944). A simple method of the above principle was followed in tlie series of cases treated in 1946 in the Campbell Hospital and. is described below in detail. Procedure.?As soon as a burn case came to the out-patient department, the officer on duty quickly examined the case. To a case of major burn, he gave a proper dose of morphia, covered him up with a clean sheet and blanket and sent,