THE 2005 ABA PRESIDENTIAL ADDRESS Who Will Follow?

The impact of the work that we do daily, what the value of these efforts will be to those who follow us, and what the challenges will be to providing high-quality burn care are issues that we must understand if we are to build to the future. As a society, we can look to our past to gain important insights about what the future may hold and the problems we will encounter. The past also allows us to reflect on the accomplishments of those who have been a part of our success, recall memories that have become distant, and view our concerns in new and important ways. From this reflection, we may better understand how we are doing and develop solutions to today’s problems in a way that will pave the route to tomorrow’s successes. The history of burn care can be rightfully traced to many important periods in our civilization’s history. Advances in the treatment of the burn patients have tracked the evolution of civilization. New scientific knowledge based on empiric clinical observations and experimental studies as occurred during the Renaissance and period of enlightenment promoted changes in patient care. Warfare, although a human tragedy, often has stimulated progress in the treatment and management of the injured. The treatment of burns was recorded as early as 1550 BC in the Ebers papyrus. The writings of Galen (200 AD) document further advances in the treatment of wounds resulting from his work in anatomy and physiology. Ambrose Pare of France (1510–1590), the surgeon of the Renaissance, was not only the most influential surgeon of his time but also the originator of modern surgery. His treatment of injuries and in particular burns was based upon comparative studies of alternative forms of therapy with the patient serving as their own control. Burn depth classification, as developed by the French surgeon and surgical pathologist Guillaume Dupuytren (1778–1835), entailed six degrees of burn based on the depth of injury. Dupuytren’s classification approach was used for more than a century and widely so outside of France. It embodies many of the same principles that we still use today in burn depth classification. The Viennese surgeon Theodore Billroth (1815–1877) performed animal studies to investigate the etiology of burn fever and clarify the role of inflamation. Walter Buchanan following up on observations made during the treatment of injured soldiers during World War I continued to perform studies on postinjury-induced shock. F. D. Underhill noted that fluid and electrolyte changes and the development of hemoconcentration and its deleterious consequences on tissue oxygen delivery in World War I victims of vesicant injuries paralleled that of burn patients. During the Second World War, H. N. Harkins established protocols for the resuscitation of burn patients incorporating infusions of plasma titrated to the patients’ physiologic needs and their response to the injury. The care of burn victims has an intriguing history and has been shaped by major societal geopolitical events. The Knights Hospitalers of St. John began as a group of monks who aided travelers visiting the holy lands. Their mission was “to care for our Lords’ sick and our Lords’ poor.” At the time of the first crusades in 1095, they joined in the battles against the Saracens. The Knights of St. John as they have become known were medieval knights, crusaders, master mariners, builders, and navigators and represented the first organized fire fighters and paramedics. In their battles with the Saracens, the crusaders encountered a new weapon—fire. As the crusaders advanced on the walls of the Saracens’ fortresses, the Saracens saturated the battlefield with naphtha from flying glass bombs. When the knights came in contact with this highly flammable material, the Saracens ignited the field of battle. Many of the knights died of their wounds, and others were rescued by their compatriots. Their fellow crusaders recognized the heroic effort of the rescuers by the awarding them a badge of honor. The Cross of Calvary that we now know as the Maltese cross represents the ideals of charity, loyalty, chivalry, generosity to friends and foe; protection of the weak; and dexterity in service. These are common values for all that provide care to burn patients. The Maltese cross is today embodied in the shield of the fire service. The delivery and organization of burn care has likewise been shaped by similar events as have influenced burn treatment. The notation that a special care environment was required for burn patients can seemingly be traced back to Edinburgh, Scotland, in 1843. It is not clear whether the motivation behind this plan to develop “burns hospital” was for the benefit of the burn patients who smelled or to From Loyola University Medical Center, Maywood, Illinois. Presented at the 37th Annual Meeting of the American Burn Association, May 10–13, 2005, Chicago, Illinois. Address correspondence to Richard L. Gamelli, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois. 60153. Copyright © 2006 by the American Burn Association. 1559-047X/2006