Læknablaðið - 01.04.1943, Blaðsíða 11

LÆK X A B LAÐ1Ð
vented the escape of the body
fluids, and relieved pain, thereby
greatly reducing shock. These fac-
tors, plus its ease of handling,
caused it to becorne extremely
popular. Its advocates, however,
are becoming fewer and fewer at
the present tirne.
Tannic acid, has, however, many
disadvantages. First of all, and
most important, it is not anti-
septic. In those cases where the
tannic acid was applied soon after
the injury had occured, the burned
area was still sterile, due to tho
thermal injury itself, and healing
was prompt without infection. This
fact was Iargely responsible for the
success in the use of tannic acid.
However, if delay occurred bet-
ween the injury and t’he institu-
tion of treatment, this picture was
changed. The fact that shock had
to be treated first, often led to
sudh delay, and in war time, great
delay in collecting and getting
patients to the, treatment stations.
greatly increases the chances of
having to deal with an infected
burned area. Where these burned
areas were already infected, care-
ful cleansing and scrubbing of the
involved areas was necessary in
an effort to render them sterile.
And, this had to be done in .1
patient who was either potentially
shocked or who was recovering
from primary shock.
Unquestionably many cases of
severe infection, toxemia and death
were the result of infection oc-
curing beneath the tannic acid
eschar. The presence of early in-
fection was sometimes difficult to
determine. It could be told only
by signs of texomia, fever, leuko-
cytosis, and evidence of local tend-
erness over the eschar. It would not
be told by inspection of the eschar.
115
I have seen patients who had se-
vere burns, who were toxic, and
wlho complained bitterly of local
pain in the affected area. Upon
inspection, there was a fine, firm
tannic acid eschar which looked
normal in every wray. However,
local tenderness was easily elici
ted. Upon making a small incision
into the eschar, thin stre])tococcic
pus which was under pressurc
escaped. 'J'his finding, of ourse,
necessitated complete excision of
the eschar, and a period of anti-
se])tic dressings to combat the in-
fection, after which one had to
start all over again to treat the
burned area. I am certain, too,
that in these cases, excess scar
tissue resulted from the tissue in-
sult, w'itlh resulting poor cosmetic
and functional results. No one can
question that the primary and
uppermost idea in our treatment
of burns is to save life. However,
it is almost as important to try
and have these patients recover,
with as little deviation from nor-
mal, both cosmetically and funct-
ionally, as is possible. The English
have, with their vast experience
with burns in the present war,
stressed this fearure.
If you will please remember my
first postulates, I mentioned that
great care should be takeu not
to harm or damage the new grow-
ing islands of epithelium. In most
cases of burns, not all of the epit-
helium is destroyed, even in the
third degree cases. There remain
small islands of epithelium, whose
function is to form new skin. Great
care must be taken not to damage
these islands, so that they mav
produce at least nearly normal
epithelium, thus decreasing de-
formities, and the necessity for
])lastic jíroceedures. One of the