History of Burns
http://www.100md.com
《新英格兰医药杂志》
To write a history of burn care is a colossal task. Klasen has undertaken a review of the massive first stage — the development of acute care — and written a fascinating and deeply researched book. Anyone who has been severely burned, as I was back in the early 1970s, will have knowingly been through many tests, treatments, and operations — and unknowingly, through many other procedures as well. Reading Klasen's explanation of how the science and clinical care of burns developed was, for me, reassuring and informative, but it was also a gripping detective story in its gradual unraveling of the mysteries of severe deep-burn wounds.
This is a book for the clinical reader as well as for the student of the history of medicine. It contains no personal stories whatsoever. How much richer the book would have been had it referenced or quoted from some of the personal or group accounts that have been written in the past 50 years. For example, E.R. Mayhew has just produced a beautifully written account of the patients — the Guinea Pigs, as they became known — of Archie McIndoe (The Reconstruction of Warriors: Archibald McIndoe, the Royal Air Force and the Guinea Pig Club. London: Greenhill Books, 2004).
Klasen explains, with extensive references that go back to 1500 b.c., when boiled goat excrement, herbs, and onions were the recommended treatments, how burn care emerged as a specialty. The first burn hospital was not created until August 21, 1843, when a cottage on the grounds of Edinburgh Royal Infirmary was dedicated to men and women with severe burns. Later it was discovered that this part of the hospital was established only because "the surgeons . . . wanted these damned stinking things out of their wards."
Some problems have yet to be resolved. For instance, how can deep dermal burns be measured precisely? Even so, many of the life-threatening difficulties have been tackled successfully. Klasen traces how the research fraternity around the world worked tirelessly, often going up blind alleys for years, before breakthroughs were made. The incredible search for the burn toxin is particularly well described, as are the technological developments of skin grafting, silver treatments, and early excision.
What is missing from this book — and Klasen admits it — is a historical perspective on the psychosocial effects of burns and adjustment to life afterward (in which there has been considerable progress in recent years), on physical rehabilitation, and on the bacteriologic and nutritional aspects. These are all vital, lifesaving strands of the burns story. Being on fire is unforgettable. If you survive, you are transferred to a totally foreign world, where the language and customs are unknown and impenetrable. The sensations are of pain, numbness, swelling, of being completely dependent on other people. And most patients will know virtually nothing of what they are going through or why it is that today's lifesaving burn care takes the form it does.
Although much has been done to prevent fires today, we live in a violent world in which fires in homes, in vehicles, in industrial settings, in wars, and in nature will put human beings at risk for the rest of our history. Klasen points up the challenges facing those who dedicate themselves to saving the lives of burn-injured patients. Without them, I myself could not have written this.
James Partridge, M.Sc.
Changing Faces
London WC1E 6JN, United Kingdom
jamesp@changingfaces.org.uk(By H. J. Klasen. 632 pp.,)
This is a book for the clinical reader as well as for the student of the history of medicine. It contains no personal stories whatsoever. How much richer the book would have been had it referenced or quoted from some of the personal or group accounts that have been written in the past 50 years. For example, E.R. Mayhew has just produced a beautifully written account of the patients — the Guinea Pigs, as they became known — of Archie McIndoe (The Reconstruction of Warriors: Archibald McIndoe, the Royal Air Force and the Guinea Pig Club. London: Greenhill Books, 2004).
Klasen explains, with extensive references that go back to 1500 b.c., when boiled goat excrement, herbs, and onions were the recommended treatments, how burn care emerged as a specialty. The first burn hospital was not created until August 21, 1843, when a cottage on the grounds of Edinburgh Royal Infirmary was dedicated to men and women with severe burns. Later it was discovered that this part of the hospital was established only because "the surgeons . . . wanted these damned stinking things out of their wards."
Some problems have yet to be resolved. For instance, how can deep dermal burns be measured precisely? Even so, many of the life-threatening difficulties have been tackled successfully. Klasen traces how the research fraternity around the world worked tirelessly, often going up blind alleys for years, before breakthroughs were made. The incredible search for the burn toxin is particularly well described, as are the technological developments of skin grafting, silver treatments, and early excision.
What is missing from this book — and Klasen admits it — is a historical perspective on the psychosocial effects of burns and adjustment to life afterward (in which there has been considerable progress in recent years), on physical rehabilitation, and on the bacteriologic and nutritional aspects. These are all vital, lifesaving strands of the burns story. Being on fire is unforgettable. If you survive, you are transferred to a totally foreign world, where the language and customs are unknown and impenetrable. The sensations are of pain, numbness, swelling, of being completely dependent on other people. And most patients will know virtually nothing of what they are going through or why it is that today's lifesaving burn care takes the form it does.
Although much has been done to prevent fires today, we live in a violent world in which fires in homes, in vehicles, in industrial settings, in wars, and in nature will put human beings at risk for the rest of our history. Klasen points up the challenges facing those who dedicate themselves to saving the lives of burn-injured patients. Without them, I myself could not have written this.
James Partridge, M.Sc.
Changing Faces
London WC1E 6JN, United Kingdom
jamesp@changingfaces.org.uk(By H. J. Klasen. 632 pp.,)