Looking at burn wounds: The A. B. Wallace Memorial Lecture 1991

Abstract

Perhaps I am the first of the Wallace Lecturers not to have been able to meet Mr Alastair B. Wallace. I entered the field of clinical investigation into the effects of bum injury after his death. However it is evident to me that it is in large measure due to his advocacy of the concept of the specialist bum treatment unit (Wallace, 1958) that I am fortunate to be able to work today in this fascinating field. Wallace’s views on the appropriateness of bums units included the desirability of bringing patients together for the purposes of conducting research into the special problems associated with bum injuries. The name of our laboratory commemorates Wallace’s colleague, the late Mr Jim Ellsworth Laing, who by virtue of his opportunistic political skills was able to translate the visionary aspects of Wallace’s work into a working laboratory closely linked to the clinical operations of the Wessex Regional Bums Unit at Odstock Hospital in Salisbury. It is obviously a great compliment from the British Bums Association (BBA) to the Laing Laboratory that the memory of A. B. Wallace should be more closely linked with our work through the medium of this, the 1991 A. B. Wallace Memorial Lecture. I am grateful for the opportunity that the BBA has afforded me to present to you in this lecture some of my own views on perhaps the oldest, and possibly still most intransigent, problem in bum treatment, that of assessing the severity of the wound. Many members of the BBA will recall that Wallace himself, towards the end of his life, wrote a thesis on the Diagnosis of Depth of Bum Injury (Wallace, 1973), a topic that is exemplified in the rather throwaway title that I have given to this lecture. I have deliberately chosen the word ‘looking’ rather than the more stringent alternatives such as ‘examining’ or ‘assessing’ because of its implied wide connotations and linkages with the natural curiosity which is an integral part of clinical investigation. In the lecture I will be concerned to outline and assess the methods that are available to us today to examine bum wounds with a view to providing information about the severity of the injury. It should also be remembered that the assessment of the bum wound does not stop at this point and that a continuous process of assessment of the healing of the wound goes on until the patient is discharged from treatment. Thus it is not simply appropriate to consider methods of diagnosing