Speaker 1: This episode features descriptions that some listeners might find upsetting.
Speaker 1: Please listen with discretion. Case one, a lady aged twenty
Speaker 1: years in feeble health was extensively burned by her mosquito
Speaker 1: curtains and calico bed cover being set on fire after
Speaker 1: she had fallen asleep. The flames enveloped her head, neck,
Speaker 1: and arms, and were not extinguished for twenty or thirty seconds.
Speaker 1: Ardent spirits were first applied, then flaxied oil, and lastly
Speaker 1: a calcareous soap of the same oil and lime water laudanum,
Speaker 1: was administered freely, both externally and internally.
Speaker 2: Case two.
Speaker 1: The editor, while rescuing the patient described in case one,
Speaker 1: was severely burnt on both hands from compressing the burning
Speaker 1: clothes with his bare hands until the flames were extinguished.
Speaker 1: The cuticle exfoliated from nearly the whole right hand, and
Speaker 1: the cutis vera sloughed in seven places. The left hand
Speaker 1: suffered much worse. The whole cuticle was separated and much
Speaker 1: of it was rolled up, especially that which covered the
Speaker 1: space between the wrist and hollow of the hand and
Speaker 1: extended up the inner side of the thumb as far
Speaker 1: as the middle of the second phalanx between these limits
Speaker 1: and the metacarpal bone of the little finger on one
Speaker 1: side and the corresponding bone of the thumb on the other.
Speaker 1: The true skin was killed and turned black. Immediately after
Speaker 1: the accident. He immersed both hands in whiskey, then in
Speaker 1: a liniment of flaxeied oil and lime water, after which
Speaker 1: the affected parts were wrapped in rags dipped in a
Speaker 1: painter's mixture of the same kind of oil and white lead,
Speaker 1: ground together.
Speaker 2: In three days.
Speaker 1: This was replaced by carrot poultices with yeast and peruvian bark,
Speaker 1: the deeply burnt parts being stimulated at different times with
Speaker 1: tincture of mir oil of turpentine, ammoniated alcohol, and other excitents.
Speaker 1: After a few days, separation was established and the dead
Speaker 1: skin sloughed off. Had the case presented nothing but what
Speaker 1: has been stated, a report of it would have been
Speaker 1: of little interest. There resulted, however, from this local injury,
Speaker 1: a great constitutional disturbs, And to this I beg leave
Speaker 1: to direct the attention of the reader. Several causes seem
Speaker 1: to have conspired to depress the energy and disorder the
Speaker 1: sensibilities of his nervous system. Number one, the acute sensibility
Speaker 1: of the parts injured. The pain for several hours after
Speaker 1: the accident was excruciating, notwithstanding the liberal use of laudanum.
Speaker 1: Number two, the scene of concentrated horror under which the
Speaker 1: injury was inflicted contributed not a little to overthrow the
Speaker 1: powers of the nervous system. Number three. The immersion of
Speaker 1: both hands extensively denuded of cuticle in a liniment of
Speaker 1: oil and white lead, seems to me to have contributed
Speaker 1: largely to the same effect. Number four.
Speaker 3: Two.
Speaker 1: Three or four days after the accident, when febrile symptoms
Speaker 1: were developed, the patient, by his own advice, lost about
Speaker 1: ten ounces of blood. This was done under the apprehension
Speaker 1: that the fever and inflammation might run too high for
Speaker 1: healthy separation, but it manifestly did harm. It would be
Speaker 1: difficult to set forth the variety of physical and moral
Speaker 1: suffering which were attendant on the protracted state of nervous
Speaker 1: or constitutional irritation which these causes generated. A great variety
Speaker 1: of applications were advised and employed for this formidable affection,
Speaker 1: but with little good time only has been efficacious. But
Speaker 1: even a period of nearly two years has not entirely
Speaker 1: overcome the effect.
Speaker 4: I can't believe that they survived.
Speaker 2: Yeah, yes, I know, uh so that it is.
Speaker 5: It is.
Speaker 2: It's horrible.
Speaker 1: It's horrible, and it exhibits I think there are some
Speaker 1: it's There's an entire paper actually that I found this
Speaker 1: in that was like discussing, uh what this represents in
Speaker 1: terms of the history of burned treatment and where things stood.
Speaker 1: So the author of that was a medical doctor named
Speaker 1: Daniel Drake, who was actually one of like a famous
Speaker 1: doctor at the time, and he wrote this about his
Speaker 1: own experience, and he was the editor of a journal,
Speaker 1: and he was like, I need to tell everyone about this,
Speaker 1: like all of these and I think the realization that
Speaker 1: he came to was, like all of these treatments. We
Speaker 1: have so many different treatments and none seem to have
Speaker 1: a positive effect.
Speaker 4: Like, if anything, they might have made things worse. Yes. Yeah.
Speaker 1: The article, if you're interested, is titled History of two
Speaker 1: Cases of burn producing Serious Constitutional Irritations by Daniel Drake.
Speaker 1: It was published in eighteen thirty. And the paper that
Speaker 1: I found this in was called Daniel Drake's Account of
Speaker 1: his Own hand Burns by Eric Mooney that was published
Speaker 1: in like nineteen ninety eight. I think so yeah, truly
Speaker 1: awful stuff. But Hi, I'm erin Welsh.
Speaker 3: And I'm erin aman Upnike and this is this podcast
Speaker 3: will kill you.
Speaker 4: Welcome to Burns. Yeah, part one, Part one, two parts,
Speaker 4: because this is a big this is a big one.
Speaker 1: I mean each there are as I was working on
Speaker 1: the second episode and like the way that I split
Speaker 1: up the history for this is that I did, like
Speaker 1: most of history, most of history, stand right, most of everything,
Speaker 1: and then like the last eighty years basically, and like
Speaker 1: the various developments in the last eighty years, each one
Speaker 1: of those could be its own episode, not to mention
Speaker 1: burn Centers being its own episode, multidisciplinary like all these things.
Speaker 4: Anyway, I know, there's so there's so much and like
Speaker 4: even in the newer like the techniques and the newer
Speaker 4: technologies and things that we have, Like there's so much
Speaker 4: more detail that we listen. We've got a lot to
Speaker 4: cover though today and next week. Yes, today is Burns
Speaker 4: Part one. Should we tell people like kind of what
Speaker 4: we're covering today, what we're covering next week? Sure? Sure,
Speaker 4: let them know a little biting to I don't know,
Speaker 4: if you want to know.
Speaker 2: Here's a preview.
Speaker 4: Here's a preview. Today, we're going to talk about the
Speaker 4: biology of burns, what is happening in our bodies to
Speaker 4: our bodies when we suffer a burn, and then Aaron,
Speaker 4: you're going to walk us through, like you said, the
Speaker 4: most of humans's history with burns, and then next week
Speaker 4: we're going to pick up with more modern history and
Speaker 4: how we actually treat and deal with burns. Today.
Speaker 2: Yeah, yeah, there's a lot. There's a lot. There's a lot.
Speaker 2: And before we can do any.
Speaker 4: Of this, it is quarantine time any time.
Speaker 2: What are we drinking this week?
Speaker 4: We're drinking by degrees? By degrees it is technically still
Speaker 4: how we measure burns is ish okay, okay, ish, we'll
Speaker 4: get there, but kind of okay okay. It's still all
Speaker 4: over the literature.
Speaker 1: It is when when I was like, oh, degrees and
Speaker 1: you were like, no, we don't talk about that anymore,
Speaker 1: it's like it's fine, We're going to okay, okay, okay. Well,
Speaker 1: by degrees is the name of the quarantini, and the
Speaker 1: quarantini is a non alcoholic bee's knees basically, so some
Speaker 1: non alcoholic gin. Lots of different varieties out there, take
Speaker 1: your pick. Lemon juice honey.
Speaker 4: Yeah, just a great anti septic for.
Speaker 2: It is it is historically used as well as today.
Speaker 4: As well as today. Yep. Yeah, you can find the
Speaker 4: full recipe for that on our website. This podcast we
Speaker 4: kill You dot com and all of our socials This
Speaker 4: podcast will kill you most places.
Speaker 1: Just search this podcast kill you and you'll find us.
Speaker 1: You'll find us and if you if that searching lands
Speaker 1: you on our website. Other things that you can find include.
Speaker 3: Bookshop dot org, affiliate page, Goodreads list, links to music
Speaker 3: by Bloodmobile, a Furtian account, form of contact us form,
Speaker 3: links to merch Patreon, transcripts, et cetera.
Speaker 4: There's a lot there, isn't there a lot there? Yeah?
Speaker 4: This podcast will kill You dot com. Thank you for
Speaker 4: rating and reviewing and subscribing to this podcast on your
Speaker 4: favorite podcasterer and or on YouTube hello or on YouTube
Speaker 4: on YouTube satchers Yep. The end? Shall we have got
Speaker 4: a lot to cover? Yeah, let's get into it.
Speaker 5: Yeah, Okay.
Speaker 4: For today's episode, I wanted to take us through how
Speaker 4: exactly we classify burns in medicine and what this classification
Speaker 4: means for how our body responds to a burn injury.
Speaker 4: Because although a burn is a type of trauma to
Speaker 4: our skin. And there's a lot of other traumas that
Speaker 4: we could get to our skin right scrapes, cuts, et cetera.
Speaker 4: Our body's response to burn injuries is actually fairly unique.
Speaker 4: Even though it is still the same inflammatory response, it
Speaker 4: is also unique. It's kind of interesting, huh. Okay, And
Speaker 4: what I really think and what I took away from
Speaker 4: digging really deep into this is that what burns really
Speaker 4: show us is just how incredible and how important of
Speaker 4: an organ our skin is, true, and how severe damage
Speaker 4: to that skin has life threatening consequences and long lasting consequences.
Speaker 4: So I'm gonna walk us through the types of burns
Speaker 4: that we can see, burn severity and how we actually
Speaker 4: determine severe versus minor or major versus minor burns, and
Speaker 4: what is happening to our whole entire body as a
Speaker 4: result of a burn injury, and then save the like,
Speaker 4: what do we do about these burns for next week's episode?
Speaker 2: Okay, sounds good.
Speaker 4: So a lot of different things can actually cause the
Speaker 4: type of damage that we would refer to as a burn,
Speaker 4: and the source of a burn really does matter a
Speaker 4: lot because the pattern of injury that you see can
Speaker 4: be really different depending on the source of that burn. So,
Speaker 4: as an example, electrical burns, which we've talked about in
Speaker 4: our Lightning episode, we talked a lot about electric burns.
Speaker 4: They can cause really severe deep damage to our internal
Speaker 4: structures with very minimal visible surface injury. But those are
Speaker 4: still going to be burn injuries, but deeper. A burn
Speaker 4: from a chemical, like say a strong acid, might cause
Speaker 4: coagulation necrosis, so your blood vessels are all clotting and
Speaker 4: all your blood is clotting, while a burn from an
Speaker 4: alkaline chemical might actually liquefy your tissues completely. WHOA, Yeah,
Speaker 4: So burns from chemicals are going to act a little
Speaker 4: bit differently, and they might differ in how we need
Speaker 4: to treat them. You can think of frostbite as a
Speaker 4: type of cold burn, and those need to be rewarmed
Speaker 4: and watched. See our two episodes on cold and cold injuries.
Speaker 4: Hypotheth that what we call them, I think, So, yeah,
Speaker 4: I was like, what did we call this? Whereas a
Speaker 4: heat burn is going to be different, and so most
Speaker 4: of what I'm going to talk about, though it pro
Speaker 4: probaly applies to most all burns. They're really I'm talking
Speaker 4: mostly about thermal burns. So burns as a result of
Speaker 4: heat injury.
Speaker 2: Did you mention radiation burns?
Speaker 4: I didn't, But those are yet another type of ok
Speaker 4: that might be more like more similar to maybe a
Speaker 4: chemical burn, or or somewhere in between a little bit different. Okay, Yeah,
Speaker 4: So yeah, there's a lot of different kinds of burns,
Speaker 4: but so I'm focusing mostly on thermal burns. These are
Speaker 4: the most common types of burns worldwide. And these can
Speaker 4: be flame burns so from a fire, as well as
Speaker 4: skaled type burns, so think hot liquid and those sorts
Speaker 4: of things, and those are the two most common types
Speaker 4: of burns worldwide. Once we know what caused the burn,
Speaker 4: then the next thing that we need to know is
Speaker 4: the severity of that burn. And the severity is a
Speaker 4: combination of the body surface area that's affected, so how
Speaker 4: much of your body got burned and the depth of
Speaker 4: that burn. And then of course we also need to
Speaker 4: look for whether there was any additional injury or traumas,
Speaker 4: especially in the case of something like a flame burn,
Speaker 4: you might have inhalational injuries or a chemical burn, you
Speaker 4: might have other toxin exposures. You could even have like
Speaker 4: blunt trauma injuries, right, depending on how the burn was sustained.
Speaker 4: And then there's patient factors that might make someone more
Speaker 4: susceptible to severe outcomes from a less severe burn, like
Speaker 4: say a very young child or a very old person,
Speaker 4: et cetera.
Speaker 2: Underlying health issues.
Speaker 4: So exactly diabetes that might interfere with wound healing things
Speaker 4: like that. So let's go through how we kind of
Speaker 4: get to the severity we already mentioned. And a lot
Speaker 4: of us have heard of the idea of a first, second,
Speaker 4: and third degree burn, and that is like classically how
Speaker 4: we classify burns. And I say that we don't quite
Speaker 4: use it as much today because we now get a
Speaker 4: little bit more specific based on the thickness or the
Speaker 4: depth of the burn in our skin, but colloquially we
Speaker 4: still use for second, third degree. So we'll just go
Speaker 4: a little bit more detailed, Okay, And first I want
Speaker 4: to take us through our skin. And we've talked about
Speaker 4: our skin on a number of episodes before, including like
Speaker 4: our retinoid's episodes. Yes, but our skin is an incredibly
Speaker 4: important organ, and it's a layered organ, the largest organ
Speaker 4: in our whole entire body, and it's made up of
Speaker 4: several different layers. The top layer, the outside what you're
Speaker 4: touching and what you see, is called the epidermis. And
Speaker 4: this is very very thin layer, and it differs in
Speaker 4: thickness depending on where on your body. So it's a
Speaker 4: lot thicker in places like the soles of our feet
Speaker 4: and our back, and it's a lot thinner in places
Speaker 4: like say, your eyes or you know, the backs of
Speaker 4: your hands or things like that. Underneath the epidermis is
Speaker 4: the dermis, and this is the layer that has a
Speaker 4: lot of structure to it. It's a little bit thicker still,
Speaker 4: only on the order of millimeters, but the dermis is
Speaker 4: underneath that. And then underneath the dermis is a layer
Speaker 4: of subcutaneous tissue, so this is like fa and things
Speaker 4: like that. And then below that is when we get
Speaker 4: to muscles and bones. Okay, So the degree of a
Speaker 4: burn depends on how far through that skin layers. Through
Speaker 4: those layers of skin, we actually get. A superficial burn,
Speaker 4: or a first degree burn, is one that burns only
Speaker 4: the uppermost layer, the epidermis. This you can think of
Speaker 4: as a bad sunburn, right, okay, blister, no, not a
Speaker 4: blister type of thing. Okay, So a bad sunburn. Your
Speaker 4: skin is red, angry, and it's painful, but beyond that,
Speaker 4: it's generally does not blister, okay, And it does not
Speaker 4: need any kind of specialized treatment, and you're not going
Speaker 4: to get a scar or any residual defects or anything.
Speaker 4: These type of superficial or first degree burns generally heal
Speaker 4: within a week or so, but no blistering. That is
Speaker 4: when we get into second degree burns, okay. And what
Speaker 4: used to be just lumped as second degree burns is
Speaker 4: now into two different types. So the first is a
Speaker 4: superficial partial thickness burn. This is the one erin that
Speaker 4: will blister, okay. And so this is a burn that
Speaker 4: burns completely through the epidermis and then into the first
Speaker 4: part of the dermis, but does not go like deeply
Speaker 4: into the dermis, okay. And so this is something that
Speaker 4: you might get if you burn yourself on a pan
Speaker 4: or the oven or like really hot you know, liquid
Speaker 4: that spills on you or something. These burns are very
Speaker 4: very painful. They might be red, they might be blistered,
Speaker 4: they might be very wet and kind of weep and
Speaker 4: you have to take care of these wounds. But you're
Speaker 4: not going to need surgery to fix these wounds. Ye,
Speaker 4: because the layer of the dermis has not been completely
Speaker 4: burned through, and so your skin is going to be
Speaker 4: able to it's called re epithelialize. It's going to be
Speaker 4: able to make new skin to cover up this wound
Speaker 4: without a lot of additional help. Most of the time,
Speaker 4: you're not going to get a scar from these types
Speaker 4: of burns. If you do, it might just be pigmentation
Speaker 4: changes because of losses of like the melanocytes that are
Speaker 4: in more of the epidermal layer. Okay, okay. Next is
Speaker 4: again within this considered second degree burn is called a
Speaker 4: deep partial thickness burn, and the deep partial thickness burns
Speaker 4: actually tend to hurt a little bit less than the
Speaker 4: first two, and that's because they burn deeply enough that
Speaker 4: they're actually destroying our pain receptors in our skin. These
Speaker 4: burns tend to be a lot drier than a superficial
Speaker 4: partial thickness burn, so you don't necessarily have blisters, or
Speaker 4: if you do, they're just not quite as wet as
Speaker 4: a superficial burn. They often look either very dark pink
Speaker 4: or sometimes almost white, where they just look like it
Speaker 4: doesn't really look like there's anything there. It's just like
Speaker 4: completely white, regardless of your skin color. And they're almost
Speaker 4: kind of pearly looking, rather like or like waxy looking
Speaker 4: a little bit. These generally do need surgery very often.
Speaker 4: These are deep enough that the skin is not going
Speaker 4: to be able to completely heal over this without some
Speaker 4: kind of surgical intervention, and that means that they're at
Speaker 4: much higher risk of some kind of scar formation. There's
Speaker 4: not a huge leap then, from a deep partial thickness
Speaker 4: to a full thickness burn or a third degree burn,
Speaker 4: and this is one that extends completely through the dermis,
Speaker 4: so the epidermal layer and the dermis are completely burned
Speaker 4: through all the way down into that subcutaneous tissue. In
Speaker 4: some cases it a burn can extend all the way
Speaker 4: down into our deeper tissues, which is sometimes called a
Speaker 4: fourth degree burn, or sometimes it's just lumped under this
Speaker 4: third degree, and that means that there's damage to the
Speaker 4: muscles or the bones, depending on how deep it goes.
Speaker 4: These full thickness burns are not painful because all of
Speaker 4: our nerve endings have been destroyed. And I asked risk
Speaker 4: that erin, Yeah, because that just means that at the
Speaker 4: time of the injury, that specific area that sustained a
Speaker 4: full thickness burn, if you touch it, you will not
Speaker 4: feel that the way that if you touch a burn blister,
Speaker 4: it really hurts. But that doesn't mean that they're not
Speaker 4: painful in the long run, or.
Speaker 1: That you only have a third degree burn and that
Speaker 1: other parts of your body are not experiencing first and
Speaker 1: second degrees.
Speaker 4: Yeah, exactly, exactly, very very often, almost always, if someone
Speaker 4: has severe burns, not every part of the burn is
Speaker 4: the same degree. Right, You have a mix of burns
Speaker 4: of varying degrees or varying thicknesses on different parts of
Speaker 4: that burn, which means, yes, things are likely going to
Speaker 4: be very painful, even if parts of those burns have
Speaker 4: completely destroyed the nerve endings and everything.
Speaker 1: Okay, So I have a question about like surface area
Speaker 1: and degrees. Yeah, because it's a big like we just
Speaker 1: talked about, there's a mixture of, yes, different degrees or
Speaker 1: severities of the burn in different parts of your body.
Speaker 1: So how is that calculated? How does that get incorporated
Speaker 1: into total body surface area?
Speaker 4: That's a great question. So total body surface area is
Speaker 4: the next thing that we have to look at. So
Speaker 4: once we know, and I say it as if these
Speaker 4: are separate things, they're really not. Like we're looking at
Speaker 4: all of this at the same time. If someone comes
Speaker 4: into a hospital with a burn, but total body surface
Speaker 4: area is how much of your body surface is covered
Speaker 4: by this burn, regardless of the degree, So you don't
Speaker 4: need to separate it by oh, you know this much
Speaker 4: surface area was a first degree versus second versus third.
Speaker 4: Here we're just looking at how much of your skin
Speaker 4: got burned. And this is actually the most important part
Speaker 4: in looking at mortality is surface area. So how we
Speaker 4: classify something as a so called minor burn, This is
Speaker 4: actually a lot more. I won't even say contentious in
Speaker 4: the literature because I don't think anyone's fighting over it.
Speaker 4: But it really depends on the situation whether something is
Speaker 4: considered a severe or a minor burn. In general, most
Speaker 4: people don't require hospitalization for burns that cover less than
Speaker 4: ten percent of their body surface. But that's a huge
Speaker 4: generalization because a burn on the face, a burn on
Speaker 4: the groin, a burn on the hands, even if it's
Speaker 4: significantly less than ten percent, might still require hospitalization as
Speaker 4: well as depending on the thickness or the degree of
Speaker 4: that burn.
Speaker 1: Or other injuries sustained or types of exact type of
Speaker 1: burn that it is.
Speaker 4: Yeah, exactly, So that is really an over generalization. Most
Speaker 4: of the time, if we're thinking about what is going
Speaker 4: to cause more likely to cause systemic symptoms, then we're
Speaker 4: looking at burns that are maybe more than fifteen or
Speaker 4: twenty percent of your body surface area, depending on the
Speaker 4: person and their age and like how big they are, right,
Speaker 4: Like a kid might have a less body surface area
Speaker 4: to cause severe effects. But all of that is really
Speaker 4: like it so depends on the person, right, So there's
Speaker 4: not like a clear cut definition of like this is
Speaker 4: a major burn versus a minor burn, or a severe
Speaker 4: burn versus a non severe burn. But calculating that body
Speaker 4: surface area is a really important part of the care
Speaker 4: of a person and understanding how severe their outcomes are
Speaker 4: going to be. And the way that we do that
Speaker 4: is there's a couple different ways. There's a fast and
Speaker 4: ready way kind of that is called the rule of nines,
Speaker 4: and that is that we just split up an adult
Speaker 4: body area into areas that are about nine percent. So
Speaker 4: our head is about nine percent of our body surface.
Speaker 4: Our chest, the front side of our chest, and the
Speaker 4: front side of our abdomen are each nine percent, and
Speaker 4: same thing with the back, so that's like eighteen and eighteen,
Speaker 4: and then the front of our legs are nine percent,
Speaker 4: the back of our legs are nine percent, on our
Speaker 4: two arms put together are nine percent, and then an
Speaker 4: extra one percent for the genitals.
Speaker 2: Okay.
Speaker 4: The other way that you can do it though, because
Speaker 4: that calculation does not hold true for children because children
Speaker 4: their head is a magnificantly larger body surface than especially
Speaker 4: for babies, So there's different calculations that we use for
Speaker 4: children and babies. But you also could use a person's hand,
Speaker 4: so not my hand to calculate your burn area, but
Speaker 4: your hand to calculated mind to calculate mine our palm.
Speaker 4: So the entire surface of our hand, including our fingers
Speaker 4: on our palm is about one percent. Okay, that's considered
Speaker 4: about one percent total, so you can use that to
Speaker 4: kind of estimate if it's less than nine percent or something.
Speaker 4: You're trying to get a rough estimate. So that's how
Speaker 4: we sort of calculate and estimate how severe a burn is.
Speaker 4: And of course, like I said at the very top,
Speaker 4: our skin is the largest organ in our body, so
Speaker 4: damage even to a small portion of that organ has
Speaker 4: the potential to cause a whole body response, and the
Speaker 4: response that we see really depends on the depth of
Speaker 4: that burn, the surface area of that burn, and the
Speaker 4: person who sustained that burn and what their underlying conditions is.
Speaker 4: But we can kind of understand how this process is
Speaker 4: going to go if we understand our basic inflammatory response
Speaker 4: and how our body responds to wounds in our skin,
Speaker 4: which we've talked about on previous episodes. I think on
Speaker 4: our Maggot's episode, we talked about this inflammatory response because
Speaker 4: anytime that our skin is wounded from a burn or
Speaker 4: a scrape or a scratch, our body follows a very
Speaker 4: predictable series of responses to try and repair that wound.
Speaker 4: The very first thing is hemostasis right. We have to
Speaker 4: stop the bleeding because most of the time wounds bleed
Speaker 4: very often they don't in the case of burns, and
Speaker 4: we'll get to why that is. But the second thing
Speaker 4: that's going to happen is inflammation, and this is to
Speaker 4: bring helpers to the area in order to start the
Speaker 4: repair process. The third step is prolifer. We need to
Speaker 4: start making new cells to fill in the gaps that
Speaker 4: are left by this wound, and finally we have maturation
Speaker 4: or remodeling. That's the finishing up that is really scar formation,
Speaker 4: because our skin pretty much always heals by scarring, so
Speaker 4: in the event of a burn, our body is going
Speaker 4: to attempt to heal by this similar process. However, because
Speaker 4: of some specific things that happen, especially in the case
Speaker 4: of a thermal burn, so a heat related burn, as
Speaker 4: well as the potential for a very large portion of
Speaker 4: our skin to be affected, the end result is often
Speaker 4: a pretty disregulated body response that can be really severe.
Speaker 4: So unlike say a cut or a scrape that just
Speaker 4: has damage wherever that scrape actually happened, a burned wound
Speaker 4: actually has several different zones of injury. In the very
Speaker 4: center or like where the burn was actually sustained is
Speaker 4: what's called a zone of coagulation. You can think of
Speaker 4: this as not necessarily the deepest part of the burn,
Speaker 4: but like the part that actually had contact with the
Speaker 4: hot liquid or the flame or whatever it was that
Speaker 4: caused the injury, and in that area the tissue is dead,
Speaker 4: the blood cells are coagulated, so there's no bleeding in
Speaker 4: that area because of the strong heat that was applied
Speaker 4: and that tissue in that area cannot be completely salvaged. Okay, Okay.
Speaker 4: Immediately around this there is a zone of stasis, and
Speaker 4: in this area there is a lot of inflammation. So
Speaker 4: our body is trying to respond to that central area.
Speaker 4: It knows that there's something wrong here, but there's very
Speaker 4: low levels of blood flow. There's a lot less profusion
Speaker 4: in this zone because of damage that was sustained and
Speaker 4: our body's response of kind of clamping down to try
Speaker 4: and protect that area, which has the effect that if
Speaker 4: that area is not addressed, then the damage from the
Speaker 4: burn can actually extend out over the next twenty four
Speaker 4: to forty eight hours.
Speaker 2: How can it do that.
Speaker 4: Because that area, that zone of stasis, is not getting
Speaker 4: enough blood flow. If that blood flow is not restored
Speaker 4: to that area, then that area is also going to
Speaker 4: die because of a lack of blood flow. Okay, that
Speaker 4: kind of makes sense, I think, so.
Speaker 2: Yeah.
Speaker 4: And then outside of that zone is called the zone
Speaker 4: of hyperaemia. And this is non damage tissue where perfusion
Speaker 4: hasn't been affected, and this is all like viable tissue essentially.
Speaker 4: So in the first forty eight hours, it's important to
Speaker 4: be able to find those areas and see how much
Speaker 4: tissue can be salvaged, especially and I'm talking really in
Speaker 4: the case of deep partial thickness, so like those more
Speaker 4: severe second degree burns or third degree or full thickness burns, right, Okay,
Speaker 4: this isn't necessarily happening in a superficial burn where it's
Speaker 4: just the epidermis.
Speaker 1: Okay, So just so I want to go over this,
Speaker 1: so I think make sure I understand this. So you
Speaker 1: experience a second degree burn, Let's say it's like on
Speaker 1: your leg, there's the area that is like the most
Speaker 1: severe part that things are bad. The burn has happened
Speaker 1: directly there, and then surrounding that area there's sort of
Speaker 1: the area that has also been kind of affected but
Speaker 1: not directly by the thermal injury. But it's that area
Speaker 1: that needs to be like looked after because it's at
Speaker 1: risk of dying. And so that's where a lot of
Speaker 1: the inflammation comes into there. Yes, Yes, not necessarily the
Speaker 1: central point of the burn itself, because there's nothing left.
Speaker 1: There's no more tissue left to go to that is
Speaker 1: alive and receptive, right, right to do the remodeling first, exactly,
Speaker 1: So yes, in that tissue that is completely dead, our
Speaker 1: inflammatory response can't kick in there.
Speaker 4: We don't have blood flow there, there's.
Speaker 1: No blood flow, there's no opportunity for anything. So then okay,
Speaker 1: everything has to be restored.
Speaker 4: Everything has to be restored. So that's the first challenge
Speaker 4: is identifying those areas that need restoration that we need
Speaker 4: to do something otherwise that repair process is not going
Speaker 4: to be able to start. That's the first challenge. The
Speaker 4: second challenge is that all of the surrounding tissue will
Speaker 4: have a lot of inflammation right because our body knows
Speaker 4: that something is going on and they're trying really hard
Speaker 4: to send in all the troops. That means in the
Speaker 4: surrounding areas we have a lot of vasodilation. That means
Speaker 4: our blood vessels are getting larger, and that's to accommodate
Speaker 4: more flow. We see an increase in vascular permeability, so
Speaker 4: that means that our blood vessels are more leaky, and
Speaker 4: that is to allow all of the plasma that has
Speaker 4: our white blood cells and the inflammatory markers and the
Speaker 4: cytokines and all these things into the area to try
Speaker 4: and help. But unfortunate only what that ends up resulting
Speaker 4: in is a lot of edema. So a lot of
Speaker 4: fluid in the area because the degree of inflammatory signals
Speaker 4: is so high, and this can be in and of
Speaker 4: itself very dangerous, especially in the event of like a
Speaker 4: circumferential burn. So think like a burn that goes around
Speaker 4: your entire arm, for example. Basically the fluid has nowhere
Speaker 4: to go and so that's going to increase pressure in
Speaker 4: that area. Does that make sense, yes?
Speaker 1: How how does blood pressure overall play, Like what happens
Speaker 1: to your blood pressure?
Speaker 4: Yeah? So the path of physiology of burns, severe burns
Speaker 4: especially is divided into two phases. The first phase is
Speaker 4: in these first twenty four to seventy two hours, okay,
Speaker 4: and that's called the hypodynamic phase, and that is when
Speaker 4: all this inflammation is happening. Our bodies kicking into high gear.
Speaker 4: Inflammatory markers are going everywhere, Vascular permeability is up, so
Speaker 4: we are at very high risk of going into shock.
Speaker 4: And shock, as we learned in our sepsis episode, means
Speaker 4: a drop in your blood pressure enough so that all
Speaker 4: of your other organs are not getting enough blood. So
Speaker 4: this is incredibly dangerous. It can result in multi organ failure,
Speaker 4: kidney failure, liver failure. Your heart is not pumping out
Speaker 4: enough blood, and really it's because you're not losing blood,
Speaker 4: so you're not bleeding out, but you are losing so
Speaker 4: much fluid from this process that your blood pressure just
Speaker 4: can't keep up. We can also see really bad fluid
Speaker 4: imbalances and electrolyte imbalances as well. So in this period
Speaker 4: what's really important is fluid resuscitation as well as management
Speaker 4: of these wounds to try and prevent all of this
Speaker 4: stuff from getting worse. And in the case of those,
Speaker 4: if we have circumferential burns and things, there has to
Speaker 4: be like pressure relief, so you have to do some
Speaker 4: kind of surgical intervention, even if it's something small, to
Speaker 4: literally release that pressure so that you don't cause further
Speaker 4: damage to the tissue or the tissue downstream. That Okay,
Speaker 4: after that initial twenty four to seventy two hours after
Speaker 4: a burn, your body enters a new phase that's called
Speaker 4: the hyper dynamic and hyper metabolic flow phase. And you
Speaker 4: can kind of think of this as your body like
Speaker 4: releasing all the stress hormones that it has so you're
Speaker 4: still alive. Your body has kept you alive for this
Speaker 4: first few days, and now it's recognizing that without a
Speaker 4: portion of your largest organ being able to thermoregulate, being
Speaker 4: able to regulate the water in your body, being able
Speaker 4: to protect you from infection. Your body is going to
Speaker 4: have to compensate in a huge, huge way. So what
Speaker 4: we see our blood vessels actually clamping down, so a
Speaker 4: real decrease in vascular permeability. We see your heart rate
Speaker 4: going up. We see the small blood vessels or the
Speaker 4: microvascular of the area around that wound starting to heal
Speaker 4: and redistribute blood to these areas to actually promote healing
Speaker 4: rather than just like kind of freaking out like they
Speaker 4: were at first. Right. And then we also see huge
Speaker 4: increases in our basal metabolic rate, so our body literally
Speaker 4: starts burning way more energy than it has in the past.
Speaker 4: And what is so wild about burns are that these
Speaker 4: changes in metabolism and total body functioning, like changes in
Speaker 4: cardiac output, changes in insulin and glucose regulation, changes in
Speaker 4: heat production, last for years following a severe burn. Really, yes,
Speaker 4: So if we see body surface area burns of twenty
Speaker 4: percent or greater than these changes in metabolism can last
Speaker 4: for two or more years.
Speaker 1: Yeah, and this is okay, I have so many questions
Speaker 1: about everything.
Speaker 2: Yeah, And that's like at that.
Speaker 1: Point, what does the burn like, what does the burned
Speaker 1: skin or tissue look like, has it been healed?
Speaker 2: Is it scar?
Speaker 4: Yeah? It really So it's really really going to depend
Speaker 4: on what kind of treatment you have access to. Okay, yeah, right.
Speaker 4: If you don't have access to any treatment, especially if
Speaker 4: this was a deep burn, then the tissue that has
Speaker 4: died is going to form what's called an esh scar.
Speaker 4: I think that's how you say it, and that's basically
Speaker 4: like you can think of it as a really really
Speaker 4: bad scab. So something that's completely black, completely necrotic, can
Speaker 4: be very thick, and it will take a very long time,
Speaker 4: if ever, for that wound to heal completely because again,
Speaker 4: if the burn extends all the way through the dermis,
Speaker 4: so a deep partial thickness burn, or a complete thickness
Speaker 4: burn so a late second degree to be or a
Speaker 4: third degree burn or greater, there aren't any like dermal
Speaker 4: cells left to re epithelialize, and so that wound has
Speaker 4: to heal like from the bottom up, and it's really
Speaker 4: a slow process and in some cases it just never
Speaker 4: completely makes new skin again without some kind of wound management,
Speaker 4: So that wound might never heal and it might become
Speaker 4: a chronic wound, okay if you don't have any access
Speaker 4: to essentially surgical debreatment and then treatment for it. So
Speaker 4: that's mostly burns and kind of how severe they can be,
Speaker 4: what damage they can cause. There's obviously a lot of
Speaker 4: complications that can arise during the treatment of these burns.
Speaker 4: You're at very high risk of infection because your skin
Speaker 4: is the main barrier from infection, and depending on what
Speaker 4: caused the burn, you might have additional like inhalational injuries,
Speaker 4: and smoke inhalation deserves its whole own episode because that
Speaker 4: can cause really severe injury. It deserves its whole, entire
Speaker 4: own episode. But that's kind of like the main how
Speaker 4: we deal with burns in terms of how our body
Speaker 4: is responding to that burn, and the management is going
Speaker 4: to really vary depending on what you have access to
Speaker 4: and depending on how severe that burn is. But Erin,
Speaker 4: I have to assume that we've been subject to vulnerable
Speaker 4: to burns ever since I don't know forever, since we
Speaker 4: lost our fur, like furry animals can still burn, tell me.
Speaker 2: I will get there.
Speaker 1: I do have one other question for you, though, and
Speaker 1: that's just sort of like in general, you know, so
Speaker 1: much of what I encountered in the history of burns
Speaker 1: is that burns were it could be very, very fatal,
Speaker 1: and they're not as much now today if you have
Speaker 1: access to all these top of the line treatments and
Speaker 1: burn centers. But what is behind or driving that mortality.
Speaker 4: It really depends. It depends on the total body surface area.
Speaker 4: There's actually like a calculator that you can use based
Speaker 4: on someone's age and their body surface area to predict
Speaker 4: essentially whether someone is likely to die from it. In
Speaker 4: the case of severe burns, then it's that first like
Speaker 4: twenty four to forty eight hours that you really need
Speaker 4: access to resuscitation or somebody could die from shock and
Speaker 4: organ failure. And then after that it's more likely to
Speaker 4: be infection or potentially other complications like if there was
Speaker 4: an inhalation injury or something like that. At the same time,
Speaker 4: gotcha o kyeah, Okay.
Speaker 1: Yeah, it is hm Aron, it is grim, and I
Speaker 1: will say that the history is for a large part
Speaker 1: is quite grim as well. But this is why I'm
Speaker 1: so glad that we're doing these two episodes, is because
Speaker 1: it really does exemplify how far we have come in
Speaker 1: our ability to treat and manage burns. It's pretty remarkable,
Speaker 1: Like it really is. Medical revolutions.
Speaker 4: It's incredible.
Speaker 1: But let's see where things came from. Okay, do you
Speaker 1: remember your first bad burn?
Speaker 4: I remember some really really bad sunburns when I was
Speaker 4: a kid, probably that came close to a second degree.
Speaker 4: They were so bad. But that's it. That's what I
Speaker 4: can remember, really bad sunburns.
Speaker 1: Yeah, yeah, a sunburn's probably like hot stove when you
Speaker 1: were a child.
Speaker 2: I'm sure that kind of thing.
Speaker 1: Yeah, I am sure that I burned myself earlier than this,
Speaker 1: But seared into my memory is the summer of nineteen
Speaker 1: ninety seven. I was running around my friend's yard, Kathleen.
Speaker 1: She lived down the street from us in Kentucky, and
Speaker 1: we had a bonfire going.
Speaker 2: You know, it was classic.
Speaker 1: Got a bunch of neighbors there, hot dogs, some'mores, the
Speaker 1: whole the whole nine yards, and I see a marshmallow
Speaker 1: on the ground near the fire. Never wanting a marshmallow
Speaker 1: to go to waste, I'd pick it up. And it
Speaker 1: takes a few seconds to register that what I was
Speaker 1: holding was not, in fact a delicious marshmallow, but it
Speaker 1: was a white, hot ember that had shot out of
Speaker 1: the fire and into the grass.
Speaker 2: It was looked just like a marshmallow.
Speaker 1: And I had a rough time for a few days,
Speaker 1: but ultimately it was a very minor burn, Like very minor, right.
Speaker 1: I iced my fingers, I covered them an aloe, I
Speaker 1: soaked them in water, cold water overnight, and I was fine.
Speaker 1: This story is not unique, and I'm sure everyone has
Speaker 1: a story just like this, or one much much more severe,
Speaker 1: because I was extremely lucky. Hundreds of millions of people
Speaker 1: are burned every year, which is I would guess a
Speaker 1: conservative estimate, and nearly two hundred thousand lose their lives
Speaker 1: around the globe every year due to burn injuries. Burns
Speaker 1: are a routine feature of our lives as human beings,
Speaker 1: and that's been the case for a very long time.
Speaker 1: My story of picking up a white hot ember, not
Speaker 1: only is that a common story today, it's been a
Speaker 1: common story for hundreds of thousands of years.
Speaker 2: At least at least Okay.
Speaker 1: Many a paper that describes the history of burn treatments
Speaker 1: starts off with some variation of ever since man discovered fire,
Speaker 1: he's had to deal with burns. Yeah, So many of
Speaker 1: them start just like that.
Speaker 2: And it's the truth. It is absolutely the truth.
Speaker 1: I mean, sure, there may have been some hot springs,
Speaker 1: accidents or severe sunburns, lightning strikes, wildfires, maybe that caught
Speaker 1: up with early humans. And in this we're no different
Speaker 1: than the other animals that have suffered the same fate
Speaker 1: for the four hundred million years that fire has been
Speaker 1: possible on this planet. Whoa, it wasn't possible before then,
Speaker 1: it was only one no oxygen or why oxygen and
Speaker 1: land plants?
Speaker 4: Okay, okay, yeah, fascinating and really fascinating.
Speaker 1: Yeah, but it's the domestication of fire that sets us apart.
Speaker 1: Controlling and creating fire making fire gave us warmth, It
Speaker 1: protected us from predators. It provided a means of cooking,
Speaker 1: giving us access to higher quality and more easily digestible foods,
Speaker 1: which provided the energy needed to fuel bigger brains. It
Speaker 1: helped us to make tools, weapons, and ceramics. Fire is
Speaker 1: a fundamental essential step in hominine evolution, second in importance
Speaker 1: only to language, which may have been encouraged by fire.
Speaker 1: Without fire, we would not have developed into the humans
Speaker 1: that we are today.
Speaker 4: Wow.
Speaker 2: At all.
Speaker 1: Burns are a consequence of fire domestication.
Speaker 4: For the large lot Prometheus. Just kidding, sorry, deep cut,
Speaker 4: I like it.
Speaker 1: But as as our homin and ancestors learned to use
Speaker 1: fire first by controlling wildfires, then making fires from scratch,
Speaker 1: they were sure to suffer burns. Just last year, a
Speaker 1: paper came out that pushed back the estimate of fire
Speaker 1: making to like actually originating fire to four hundred thousand years.
Speaker 4: Wow.
Speaker 1: Wow, So researchers found compelling evidence of fire making in
Speaker 1: eastern England in Neanderthal sites. Before this, the earliest evidence
Speaker 1: was like fifty thousand years, which didn't mean that people
Speaker 1: thought it wasn't older, but like this was like.
Speaker 4: That was the evidence they had. Yeakay wow.
Speaker 2: But it's likely that our Haminin relatives had been controlling.
Speaker 1: Fire for much longer than that, perhaps as far back
Speaker 1: as like one and a half million years. They would
Speaker 1: have had to in order to migrate to regions with
Speaker 1: colder climates in the first place.
Speaker 2: Okay, all this is to say.
Speaker 1: This is my long, my long winded way of saying,
Speaker 1: ever since man discovered fire, that he's had to deal
Speaker 1: with burns. Right, We've been dealing with burns for hundreds
Speaker 1: of thousands of years. In the quest to harness fire.
Speaker 4: Okay, And throughout all.
Speaker 1: That time, humans have attempted to treat the burns that
Speaker 1: they experienced, and of course we can only guess that
Speaker 1: the variety of remedies used before the invention of writing,
Speaker 1: but it's likely they were plant based. Like there is
Speaker 1: some evidence for that, including a ghost citation I couldn't
Speaker 1: track down, so I'm not going to even reference it.
Speaker 1: But our earliest confirmed insight into the treatment of burns
Speaker 1: comes from the medical texts from ancient civilizations that were
Speaker 1: used to encountering, you know, the Ebers Papyrus, the Hippocratic texts,
Speaker 1: medical treatises from China, writings by Shushruda, and so on.
Speaker 1: The majority of these treatments for burns were centered on
Speaker 1: the application of like a goo or an ointment or
Speaker 1: a cream to the burn itself, to the actual location
Speaker 1: of the burn, with a little bit on pain relief
Speaker 1: and maybe early like debreedment type of approaches.
Speaker 4: Okay.
Speaker 1: Ancient Egyptian physicians seem to favor recipes that included resin
Speaker 1: and honey or oil soaked linen wraps, but milk also.
Speaker 2: Made an appearance, specifically.
Speaker 1: Goat milk or milk from women who had given birth
Speaker 1: to a son. I don't know if that means like
Speaker 1: specific right, only sons?
Speaker 2: Only just one son? Is okay? Do you have sons?
Speaker 2: And you know, I don't know other.
Speaker 4: Remedies like you had a son before, but now you
Speaker 4: just had a daughter, Like does that is that okay?
Speaker 2: I don't Yeah, you'll have to ask.
Speaker 4: We need detail.
Speaker 1: The author of the texts, yeah, whose might not be reachable.
Speaker 1: But the other other remedies called for a sequence of
Speaker 1: different ointments to be applied, so like day one black mud,
Speaker 1: day two, boiled cow dung, so on, and so forth.
Speaker 1: Animal products feature prominently in many of the recipes from
Speaker 1: ancient Egypt, Greece, Rome, and India, not just milk, like,
Speaker 1: for instance, bowls fat boiled with papyrus is one treatment.
Speaker 1: The Hippocratic texts recommend that for a burn, you should
Speaker 1: quote take melted fat of old pigs, mix it with
Speaker 1: resin and bitumen, spread it out over a cloth, warm
Speaker 1: it at the fire, and apply it as a plaster
Speaker 1: end quote.
Speaker 4: Okay.
Speaker 1: Dung was also a popular choice, specifically hare's dung, and
Speaker 1: she goat dung.
Speaker 4: She goat, she goat, she goat, she goat, she okay,
Speaker 4: she goat, she goat. Okay.
Speaker 1: Eggs here and there we're mentioned, you know, hard boiled
Speaker 1: yolks mixed with rose oil as an example. There were
Speaker 1: also many plant based remedies as well, So an ancient
Speaker 1: China tea leaf extract was applied to burns. In ancient India,
Speaker 1: you might get an ointment made from butter mixed with
Speaker 1: the bark of a fig tree. To quote from a
Speaker 1: nineteen seventy seven paper by Thompson on the history of
Speaker 1: burn treatment, quote it would be tedious and not a
Speaker 1: little revolting to detail all the hundreds of variations on
Speaker 1: this theme and quote fair enough enough, But hopefully I've
Speaker 1: given you a small taste of the variations on the theme.
Speaker 1: And I think that there are two main takeaways with
Speaker 1: this foray into ancient burned treatment. First, there are a
Speaker 1: lot of treatments, which suggests, of course, that this was
Speaker 1: a problem encountered frequently enough to keep trying new things.
Speaker 4: Right and everywhere, So everyone's got their own version of etrans.
Speaker 2: Got their own version.
Speaker 1: And because there was no clearly single reliable remedy, people
Speaker 1: were constantly inventing new recipes. And second, by and large
Speaker 1: treatments were topical aimed at promoting healing and providing relief,
Speaker 1: and when you think of these in comparison to the
Speaker 1: full scale, multi specialty approach that we use today, it's
Speaker 1: barely a drop in the bucket. I mean, they were
Speaker 1: doing the best that they could with the knowledge that
Speaker 1: they had, and as that knowledge grew, so did their approaches,
Speaker 1: but not necessarily with success, just sort of there were
Speaker 1: limitations for thousands of years. By the Middle Ages, the
Speaker 1: list of options for treating a burn had grown tremendously,
Speaker 1: so sure, still plenty of people were opting for raw
Speaker 1: onion slices, which remained popular for long, like a really
Speaker 1: long time actually, with Ambrose Paree employing onions and salt
Speaker 1: allegedly effectively in the sixteenth century. But there was one
Speaker 1: sizeable shift in focus over that time, and that was
Speaker 1: sort of towards temperature. Physicians found that topical treatments that
Speaker 1: invoked a cooling sensation or were themselves cooling like melted snow,
Speaker 1: provided relief to those with burns, especially with superficial burns.
Speaker 1: Others suggested that treating like with like, so applying heat
Speaker 1: to the burn would yield more positive results, especially for
Speaker 1: those with deep wounds.
Speaker 4: Okay.
Speaker 2: Yeah.
Speaker 1: The first book dedicated to burns des Combustion of Us
Speaker 1: was written by Fabricious hild in Us in sixteen o seven,
Speaker 1: and it warned that if cooling were applied to burn skin,
Speaker 1: it would quote harden like fat when it is cooled,
Speaker 1: and thus shut in the moisture.
Speaker 4: How fascinating.
Speaker 1: Okay, keep things warm, keep things more flowing is kind
Speaker 1: of like their idea. But this book also was among
Speaker 1: the first to propose treatments for contractors. Okay, but which
Speaker 1: did you?
Speaker 2: Did we talk about contractors?
Speaker 4: No, but I'll talk more about it next week.
Speaker 1: Okay, Okay, so we'll get there. Stay tuned for explanation
Speaker 1: on contractors. But this idea of treating burns with heat,
Speaker 1: it was kind of like to keep things flowing, prevent
Speaker 1: fluid accumulation and encouraging this like, yeah, just free flow, freelow.
Speaker 4: Okay.
Speaker 1: Shakespeare even makes a reference to heat treatments in King
Speaker 1: John and Falsehood Falsehood cures as fire cools fire within
Speaker 1: the scorched veins of one new burned. I'm really great
Speaker 1: at reading.
Speaker 4: Shakespeare nailed it erin.
Speaker 2: I remember for.
Speaker 1: A really long time we had to do iambic pentameter
Speaker 1: or speak an iamic pentameter in like tenth grade English.
Speaker 1: And I was just like, I don't get it, and
Speaker 1: it's been a block for me ever since.
Speaker 2: So there you go.
Speaker 1: But this debate cold versus heat, it went on for
Speaker 1: hundreds of years, and it wasn't the only debate. There
Speaker 1: was an argument over whether open air exposure or covering
Speaker 1: a burn and dressing soaked with various substances was the
Speaker 1: better approach.
Speaker 2: Then there was a discussion over.
Speaker 1: Which substances and which dressings, you know, whiskey, linseed oil,
Speaker 1: olive oil, alkaline, water, leads, silver, linen, wool, cotton. Then
Speaker 1: you could argue over whether you should feed your patient
Speaker 1: and provide plenty of fluids or do some blood letting
Speaker 1: and purging.
Speaker 4: Oo.
Speaker 1: Everyone had their favorite approach, backed up by an anecdote,
Speaker 1: a gut feeling, professional pride.
Speaker 4: Take your pick.
Speaker 1: This lack of consensus on how to best manage burns
Speaker 1: it plagued doctors throughout the Renaissance and into the seventeen
Speaker 1: hundreds and eighteen hundreds. Wars, industrial as accidents and train
Speaker 1: crashes served as a painful reminder that in fact, medicine
Speaker 1: had not substantially advanced since the time of Galen and Hippocrates.
Speaker 1: When it came to burns, what was needed to make
Speaker 1: any type of progress was consensus, first and foremost on
Speaker 1: how to measure the severity of burns and the rate
Speaker 1: of healing, because only then could you compare treatments or approaches.
Speaker 1: Only then could you pick lead ointment versus whiskey, ice
Speaker 1: water versus warming cloths. Only then could you have a
Speaker 1: hope of saving someone's life. How do you get consensus,
Speaker 1: You gather data. In the early nineteenth century, Guillam Duputrin
Speaker 1: reviewed fifty cases of burn patients and followed their treatments
Speaker 1: and outcomes, and with this information he put together a
Speaker 1: classification system for burns organized by depth, similar to the
Speaker 1: degree system that many people are familiar with today that
Speaker 1: we just went through. His was not the first burn
Speaker 1: grading system overall, but it was the first to relate
Speaker 1: burned severity, depth, and total area with mortality. With this system,
Speaker 1: doctors were not just treating burns, they were measuring them.
Speaker 1: Establishing this baseline was super important to compare different approaches.
Speaker 1: You know, again, turpentine versus lindseed oil might look the
Speaker 1: same in a severely burned individual, but if you tried
Speaker 1: them out on a more moderate or minor burn, you
Speaker 1: might see a difference in healing, right. And it also
Speaker 1: opened the door to other kinds of treatments entirely, not
Speaker 1: just those based on topical ointments, such as surgical approaches
Speaker 1: you know, skin debreaedment and skin grafts, supportive therapies in
Speaker 1: the form of fluid replenishment pain relief. By the end
Speaker 1: of the nineteenth century, many, though not all, of the
Speaker 1: pieces were there to revolutionize burn care. They were just
Speaker 1: sort of scattered all over the place waiting for someone
Speaker 1: to put them together. Up to this point, so around
Speaker 1: I'm going to say early nineteen hundreds, much all of
Speaker 1: human history, burns had remained out of reach for physicians,
Speaker 1: who could at most hope for the body's innate wound
Speaker 1: healing methods to kick in as they the doctors provided
Speaker 1: some modicum of pain relief. Frankly speaking, medicine had made
Speaker 1: no progress in increasing survival or healing in brace.
Speaker 4: That's so wild, even into the nineteen hundreds.
Speaker 1: Into the nineteen hundreds, And if this story so far
Speaker 1: feels unsatisfying or incomplete, then I've succeeded. That's what that
Speaker 1: was my aim here, Like I wanted to spend this
Speaker 1: episode with this, my part of this episode taking us
Speaker 1: through the desperate centuries and millennia in which medicine remained
Speaker 1: completely in the dark, so that next week when we
Speaker 1: get to share the story of how that changed, when
Speaker 1: we get to really take stock of how far we've
Speaker 1: come and stand a little bit in awe of scientific progress,
Speaker 1: what funding for research has helped us to achieve, and
Speaker 1: how working across disciplines can make a huge difference, so
Speaker 1: that when we get there we get to go, oh
Speaker 1: my god, Oh my gosh.
Speaker 4: We've actually come so far.
Speaker 2: We actually have.
Speaker 1: But that's where I'm gonna stop it here, so I
Speaker 1: learn it there. For now we can fill you in
Speaker 1: on where you can read more.
Speaker 4: There's a lot.
Speaker 2: There is a lot. There is a lot.
Speaker 1: So I'm going to shout out just three sources in particular,
Speaker 1: there's nineteen eighty six History of burn Care by Pinnagar
Speaker 1: and Pinnagar, then nineteen seventy seven Thompson Historical Landmarks and
Speaker 1: the Treatment of Burns, and then by van He from
Speaker 1: two thousand and seven from Fat of Old pigs to
Speaker 1: fenestrated skin grafts. Oh, I have lots more, lots more.
Speaker 4: I can't wait. My absolute favorite paper that I read
Speaker 4: for this and next week's episode is by Jeshki. I'm
Speaker 4: so sorry if I said that wrong at all, from
Speaker 4: Nature Reviews. Disease primers love it when there's one of
Speaker 4: these from twenty twenty called burn injury and it was.
Speaker 4: I mean, it's so good, it's so comprehensive. It has everything,
Speaker 4: but you know that there's also more. So if you
Speaker 4: want way more in depth information about the response and
Speaker 4: the path of physiology and all of this biology, don't
Speaker 4: you worry because we have the list of all of
Speaker 4: our sources on our website this podcast will kill You
Speaker 4: dot com under the episode STAB.
Speaker 2: We do.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our episodes.
Speaker 4: Thank you to Leanna and Tom and Mark and Pete
Speaker 4: and everyone at exactly right.
Speaker 2: Yes, thank you, probly everyone.
Speaker 1: Thank you to everyone, and thank you to you listeners
Speaker 1: and watchers, anyone who participates in this podcast in some way.
Speaker 1: We really do appreciate you tuning in and telling us
Speaker 1: what you think and just sharing this. I don't know everything,
Speaker 1: Thank you for being you you, and.
Speaker 4: A special shout out as always to our patrons. Thank
Speaker 4: you so much for your support over on Patreon. It
Speaker 4: really does mean so much to us, truly, truly.
Speaker 2: Until next time, wash your hands you feel the animals.
Speaker 1: Um um