You can imagine, as a medical historian, much of my research centres on ‘Saving Humans’. When I was asked to contribute to this blog, though, one particularly timely subject immediately leapt out: burns. I began researching burns last year in the British context for the years 1800 to 2000, and, in that time, the public has been reminded of the subject with regular reports of acid attacks, house fires, wars, suicides and revolutions. More than many other subjects I have researched, burns are both timeless and very timely. In June 2013, the Burns Collective was launched in Birmingham, creating a national centre for burns research linking hospitals in London, Bristol and the ‘Second City’. I attended the inaugural conference and instantly found myself fascinated by papers outlining current practices, research and priorities. Though the history of burns remains to be explored, they should also be familiar to all of us. Unlike many diseases and accidents which will thankfully remain a mystery to most of this blog’s readers, we have all experienced burns. However prevalent or timely, burns are also particularly suited to a blog managed by the University’s Institute of Advanced Studies. Like the IAS, which aims to bring together scholars from across the University of Birmingham’s various academic disciplines, burns are unique in the way they bring together people from across medicine’s many specialties.
In a previous project, I had the opportunity broadly to explore the medical, social and cultural history of the skin. At its most basic, a burn is an injury of the skin, the body’s largest organ (though some now call it a ‘multi-organ’). Addressing burns and scalds only in passing, the project reminded us that burns are prominent in the cultural imagination, and have been so for hundreds of years. Neither are they confined to the realm of the dermatologist. Besides contributing significantly to the way in which we conceive of ourselves and others, the skin has many essential functions: it regulates the passage of fluids in and out of the body; it helps synthesis vitamin D, while shielding the body’s interior from ultraviolet radiation; it is a barrier that prevents disease-causing organisms from entering the body, while simultaneously receiving sensations which it passes on to the brain via the nervous system. As a result, when the skin is burned, whether by hot tea, a sunburn, or following more serious flame, electrical or chemical accidents, we experience pain, and much else that is more than just skin deep. The skin’s many features and functions are invariably compromised by burns, and people’s identities may be changed forever. The more serious the burn – anything larger than 10% total body surface area is considered a major burn – the more violent the body’s response. It is for this reason that burns have been described as ‘a riot in the body’. All bodily systems potentially respond to serious burns, especially if the victim also experiences smoke inhalation.
What is a burn?
The immediate aftermath of a severe burn is shock and suffocation, both related to a lack of oxygen. Plasma normally circulating in the blood surges to the tissues, leaving the blood thicker and prone to clotting. During the 24-hours following a burn, the affected area grows progressively more swollen; this is the period when blisters form. Fluid must be replaced to restore circulation and dilute the toxins being expelled in greater amounts by the kidneys (one formula used to help calculate fluid replacement was developed by Basil Pruitt, who attended the Birmingham congress). In the nineteenth century, the oozing appearance of burns might have led doctors to introduce treatments which only encouraged dehydration. As a result of these physiological changes, the body is less able to regulate temperature and shock ensues. One by one, the major organs are compromised by the loss of liquids. When the respiratory system is effected, breathing becomes difficult and the body deals with lower cardiac output by pumping more blood. The additional effort required to do so sends the body into a hypermetabolic, or catabolic, state, and it begins to break down tissues, burning protein as well as fat. As body mass decreases, the patient becomes more susceptible to infection and wounds also heal more slowly. The destructive increase in metabolism, on the other hand, is countered by feeding the patient amounts of food that might ordinarily be regarded as excessive. And, importantly, the whole process is not over in a day or two. Burns are an acute illness that lasts weeks or even months. Treatment of burns patients therefore becomes an intensive life-saving process, which these days extends beyond the immediate survival of the burned individual, and aims for full psychological recovery, involving psychiatrists, physiotherapists and social workers, among many other specialists and professionals. It is for this reason that victims of severe burns are treated in burns units. According to the British Burns Association, there are currently 27 specialised burn units in Britain. In the 1930s, more than half of major burns cases in this country might have died from their injuries. Today, 97% of approximately 16,000 people hospitalised for burns each year survive this ordeal.
Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.