a. Causes of Burns
A report has been received which is an interesting analysis of the causes
and treatment of burns in British Middle East forces. Significant is the
observation that the greater number of burns are of accidental cause and
could be prevented. The ratio of accidental burns to battle-casualty burns
in Middle East forces is 2.3 to 1. During a period of 2 months when there
was little fighting on the desert, 250 cases of burns were treated at a
general hospital at Tobruk among troops of the British Eighth Army. In a
series of 83 fatal cases, 15 were burned during land fighting, 15 during
the bombing of ships, and 13 as a result of airplane crashes, and 40 of
the fatal cases were accidentally burned - 48 percent of the total.
The cause of accidental burns is almost always ignited gasoline, and most
frequently accidents occur from using the "desert stove, ' an improvised
gasoline fire in which the fuel is mixed with sand in a can. When the fire
burns low, more gasoline is poured on the stove with disastrous results. In
bright sunlight it may be difficult to see whether the fire is still
burning. In other cases, clothes become soaked with gasoline (it is
common to use gasoline in washing clothes), a match is struck, and the
clothing is ignited.
Accidental burns are often extensive and dangerous to life. A burn which
is extensive, and also in parts deep, is a very serious injury and its
treatment is one of the most difficult surgical problems in the Middle East.
Battle-casualty burns are a common form of battle injury. During recent
fighting, burns constituted 27 percent of wounds in personnel admitted
to hospitals. In tanks, the majority of such injuries are flash burns, caused
by exploding ammunition. Ordinary clothing, even light khaki, gives a
high degree of protection against flash burns. Study is at present
being made to determine the suitability of special protective clothing
for tank crews.
The treatment of burns is a controversial subject, and many of the opinions
expressed in this report as regards treatment will not meet with universal
approval. The treatment administered depends greatly on the circumstances. Where
facilities are available and time permits, "full" treatment is given: the
wound is cleansed and prepared for the local application thought most suitable. This
is carried out as a rule under general anaesthesia and may be
preceded, accompanied, or followed by resuscitation treatment for
shock. There are three main methods of local treatment: coagulation,
dyes, and non-coagulation.
The experience in the use of coagulants (tannic acid, and tannic acid--silver nitrate) in
Middle East forces has not been too satisfactory because: (a) in superficial
burns the surface is said to be dry and less pliable than when greasy
substances are used; (b) in deep burns the coagulant remains adherent for
long periods and delays the opportunity for skin grafting; and (c) in extensive
burns, sepsis is a common sequel. Also, the relationship of the absorption of
tannates to toxemia and liver damage when tannic acid is used in the coagulation
treatment of burns is still a disputed question.
Observations in the use of dyes (gentian violet, brillant green, and euflavine) in
the local treatment of burns in Middle East forces have shown that this
method of local treatment has most of the disadvantages without some of
the advantages of coagulation treatment.
(3) Sulfanilamide-Vaseline Treatment
Use of a sulfanilamide-vaseline mixture in the Middle East has shown
this form of local treatment to be: (a) comfortable, especially when the injured
part is immobilized with a plaster-of-Paris cast, (b) in superficial burns, healing
may be complete when the plaster is removed 2 weeks later, (c) in deep
burns, sloughs become separated more quickly than with the coagulation treatment, and
skin grafting can be done at an earlier stage. This method of local
treatment is considered at present the most suitable which is available.
c. Treatment of Shock
In the treatment of the shock associated with severe or extensive burns,
morphine, body warming, and transfusion of adequate amounts of plasma or
serum are advocated--with the employment of rapid transfusion when the
blood pressure is very low or unrecordable. If plasma is not immediately
available, blood is preferable to saline or glucosesaline solution. In
the treatment of the anemia which appears in the latter half of the
first week and in the second and third weeks, transfusion of blood is
often disappointing. The use of liver extracts and iron have been
strangely neglected in the treatment of the anemia associated with burns.
d. Transportation of Burned Men
Men with extensive burns travel badly; in fact, they are more upset by
travel than men with other types of wounds. Men with large septic burns
are most affected, and their condition deteriorates rapidly during long
journeys by road, rail, or sea. For the purpose of transport, the burned
limbs are often encased in plaster-of-Paris. This practice seems to
be of recent development and has been employed mainly with
the sulfanilamide-vaseline form of treatment.
e. Causes of Death in Burns
In an analysis of the cause of death in 83 fatal cases of burns, shock was
found to be responsible for 23 deaths, toxemia for 22, and sepsis
for 38 (46 percent).
From these figures, it is seen that the most frequent single cause of
death from burns in Middle East forces is bacterial infection. The organisms
found are of the usual variety: staphylococci, streptococci, B. pyocyaneus,
B. proteus, and coliform bacilli, etc.
Even when burns are only superficial and of moderate extent, bacterial
infection occurs in many cases, especially in those burns that involve
deep or extensive areas of tissue.