Læknablaðið - 01.04.1943, Side 12

LÆKNABLAÐIÐ
116
great disadvantages of tannic acid
is that its use does not avoid such
damage. The tannic acid tans and
harms these islands of new deli-
cate epithelium. Tliey then become
abnormal islands, and can not in
any sense produce anything- like
normal epithelium. The scar tissue
that they do produce is tough,
dense and fibrous, with a great
tendency to contract. This is the
cause of so many of the truly
horrible deformities that. we have
seen. This is especially true of
burns involving the hands, face
and genitals. You will notice that
I again mention these areas se-
parately. This should be stressed.
Burns of these areas should and
must be considered from an enti-
rely different angle than, let us
say, burns of the torso. Even a
fairly small burn of the face, if
severe, may produce a terrible
contracture. The patient in whom
such deformities occur faces long
periods of plastic operations, many
times unsuccesful, in an effort to
make him • look something likc
normal, and to enable him to re-
sume his normal occupation. I can
not stress too strongly, the psycho-
logical effect of a marked defor-
mity of the face.This is not only
upon the patient hinself, but also
upon his associates. It is difficult
for such associates to look upon
the patient without loathing or
horror, and this is promptly felt
by him, with evident result.
Furthermore, in 1942, there was
some experimental work done,
which at least indicates that the
extensive use of tannic acid may
lead to liver damage.
However, tannic still has its
strong advocates. In an article in
the Journal of Surgery, in 1942.
I am again impressed by what
statistics can be made to show.
Casual reading of this article leads
one to wonder why we have ever
considered anything but tannic
acid in the treatment of burn;:.
However, upon closer inspection
of the íigures we begin to wonder.
The writers offer a set of figures'
in which nine different groups of
workers have tried tannic as well
as ,,other methods". Note the
words „other methods“. In the
report, 1369 cases were treated
with „other methods“, with a
mortality rate of 24.5%. 1913 cases
were tracted with tannic acid with
an 11.3% mortality. These differ-
ences are indeed striking. But, the
authors then naively drew the con-
clusi’on that if all of the cases had
been treated with tannic, 252 fatal
cases could have been saved. 1 can
only cast doubts on the conclusion.
Not one word wás said about a
comparison of the severity of the
cases in the groups, nor about
what other methods were used.
Unquestionaljly the tannic acid is
superior to all „other methods“,
but it is only fair to demand that
its" use be compared to a single
other method, such as triple dye,
and only in cases of comparable
severity. I am perfectly convinced
that if the cases treated with triple
dye, or cod liver oil ointment were
picked out of the “other methods”,
and similarly compared, the same
striking difference in results would
be obtained. I can only disagree
with the authors conclusions as
l^eing unwarranted.
About eight years after David-
son brought out the use of tannic
acid, Robert Aldrich began using
and recommending the triple dye
treatment. The eschar producing
substance was an aqueous solution
of 1% gentian violet, 1% brilliant