Challenges for the future in burn research and burn care. The 1990 A. B. wallace memorial lecture

Abstract

Although I met Mr Wallace occasionally in the late 1950s and at the Second International Congress on Research in Burns held in Edinburgh in 1965, the 300 miles which separated our respective bum units meant that my knowledge of his work with burned patients has relied on his published papers and his PhD thesis. I was not as lucky as Anne B. Sutherland who worked with Mr Wallace for many years and gave her personal assessment of Mr Wallace’s work in her 1986 A. B. Wallace Memorial Lecture (Sutherland, 1987). A retrospective survey of his writings (Wallace, 1951, 1958, 1966, 1967, 1973) provided me with convincing evidence of his, at least, two-fold concern for patients with bums. These were for the welfare of his own patients, how could he give them the best possible treatment?, and secondly the welfare of burned patients in the less developed parts of the world. How could he help the people with medical or paramedical training in Asia, Africa and South America to try to reduce their very high incidence of bums and scalds, and to treat in the best possible way those patients who had been injured, bearing in mind the often primitive conditions in which the patients were treated and in which the doctors had to work. This memorial lecture highlights both these aspirations and explores their sequelae and their ramifications for the future care of burned patients. Mr Wallace showed considerable interest in burn research to the extent that he rescued from near oblivion the exposure form of treatment for bums (Wallace, 1951). He thoroughly explored both the advantages and disadvantages of the method and came to the conclusion that it had a secure place alongside the judicious use of topical antibacterial agents applied to the wound surface, either alone or beneath dressings. He also delved deeply into the need for a classification of the depth of bums, the fruits of his labours appearing as a PhD thesis in 1973 (Wallace, 1973). Since the ability to predict bum depth soon after admission to hospital would have important consequences for mode of care, should it be conservative treatment or aggressive surgery? Research thoughts on these two topics were published in the Kazanjian lecture (Wallace, 1966) with the provocative title of ‘Bums past, present and future’. Almost 25 years later this memorial lecture follows in his footsteps. To a very considerable extent these research thoughts are inextricably linked with burn care. While Mr Wallace’s research studies were mainly concerned with, and imple-