Then and now: treatment volume, wound coverage, lung injury, and antibiotics: a capsule history of burn treatment at mid-century

Abstract

While there are many ways in which the treatment of burns was improved at mid-century, four seem to lead the list: uid therapy; prompt wound coverage; the nature of lung injury; and infection. Marked improvement in these four realms of burn therapy occurred simultaneously, beginning just before and during World War II, and for a decade afterwards. It was my privilege to be a part of this scene and I relate these stories with a sense of nostalgia and the triumphs of Oliver Cope and his group, while at the same time bowing to the immense advances that have been made by other groups since that time [1±21]. The ®rst of these foci was that of improved understanding of the pathophysiology of burns, the volume and nature of uid dislocations caused by burns, and their treatment, as well as the nature of toxic substances that, superimposed on volume-reduction, caused renal failure. The second advance was a clear de®nition of the importance and methods for expeditious wound closure by burn excision and prompt grafting. Thirdly, was the elucidation of the nature of lung injury in burns, and fourthly, the availability of antibiotics to control infection. All four of these advances became available at or about the time ofWorldWar II.