The Treatment of Burns by the Closed-plaster Amethod, with Certain Physiological Considerations

The loss of plasma from dilated and injured capillaries may be disastrous in several ways. One of these, the systemic effect, is so widely appreciated as to have dominated physiological thinking in the treatment of burns almost to the exclusion of other principles very vital to efficient v therapy. There can be no doubt that reduction in plasma volume by leakage from abnormal capillaries in burned regions and possibly a slower but obstinately insidious leakage from capillaries all over the body may and often does cause surgical shock and death. If, as in our experiments, the feet of an anesthetized dog are burned quantitatively by immersion in very hot water for precise periods of time (Glenn, Peterson, and Drinker (1 ) ), the amount of plasma that may be lost into the subcutaneous tissue without leakage from the surface of the skin has not been sufficiently appreciated. Underhill et al. (2) and Harkins (3) called attention to how great this loss may be. Following an experimental burn such as we have utilized, edematous swelling may spread though the subcutaneous tissue for a considerable distance-especially so after the lymphatics draining this area become blocked. Indeed, in one animal with the 2 front feet severely burned and with the exudate spreading beyond the burned area, there was a loss of 1/3 the total blood volume into the subcutaneous tissue from the toenails to the humero-radio-ulnar joints. To combat this loss