Annals of Burns and Fire Disasters - vol. XI - n. 4 - December 1998

THE TREATMENT OF BURNS DISEASE IN THE HIPPOCRATIC ERA

John D. loannovich M.D.

Clinic for Plastic Surgery,and Microsurgery, Second Department of Paediatric Surgery P. and A. Kyriakou, Athens, Greece

"Some of the arts are hard to learn and beneficial for those who use them, a fountain of well-being for the common people but of bitterness and sorrow for the professionals ... of these arts there is one the Greeks call medicine (iatrike)."
By this definition Hippocrates tries to give medicine its place among the rest of the sciences, away from the religious view that existed till his time.
Hippocrates describes the character of a doctor as sincere, clever, hardworking, and in good physical condition. He considers a better physician one that predicts the outcome of the disease, rather than one that treats the disease at a later stage.
Although Hippocrates wrote an immense volume of work there are only few references to burns disease. This is probably due to the severity and high mortality of the disease at that time. This is also proved by the fact that he describes only minor burns and local therapy.
Even today, 26 centuries after the Hippocrates era, the mortality of burns is relevant to their extent. A burn of 50% of the body surface is still a very dangerous injury, since thirty patients out of a hundred will eventually die.
It is easy therefore to understand why Hippocrates teaches the necessity to know the nature of diseases, and whether they can overcome the natural defence mechanism of the body.
The physician therefore should take precautions for all patients in order to predict "those who will eventually die and those who will survive." In other words Hippocrates knew the importance of prognostic factors that have been used in modem medicine for the last 30 years.
Hippocrates knew and described well the burn wound. He urged his colleagues to work under as aseptic conditions as possible and to wear clean and properly tailored garments.
Twenty-five centuries later we are still trying to persuade our authorities to provide new burn units for the prevention of cross infections.
With his astonishing ability to notice and describe the events of the disease, Hippocrates realized the significance of loss of fluids from the burn surface and advised "lots of fluids and diluted honey by mouth" for the patient.
But he was also a desperate witness of septicaemia: "In this condition acute fever and increased pulse rate occurred" ... "In major burns, spasm or tetanus are poor prognostic signs" ... "Rigors with delirium lead to death."
Local treatment was clarified by Hippocrates. He advocated lavage with lukewarm water to prevent pain and promote healing. He used sodium chloride in the form of sea water to prevent infection of the wounds. He also used wine, preferably red, because it combined alcohol and styptic substances.
Hippocrates wrote a paragraph on burn wounds in his book on ulcers. He described various medicaments containing wine and roots of various plants, such as oak, etc. He also used ointments made of fat, wax and olive oil spread on clean sheets of cloth. These were the same Vaseline gauzes that we thought were used for the first time in the 1940s!
The management of the wound and change of dressing should be as quick as possible, painless, comfortable and presentable, he said. The school of Hippocrates managed to give a specific description of the symptoms of burn disease. We should note that although Hippocrates refers to the symptoms, he does not consider them a consequence of the disease and suggests therapeutic measures only for the wound.
Just 40 years ago medicine understood that a "superficial" thermal burn causes a systemic disease that affects all organs and causes a high percentage of deaths. It is now evident that if such a disease is not properly treated in a burn unit, its mortality and morbidity is high. A considerable number of young people die or become crippled every year. For this reason prevention is emphasized nowadays (see paragraph three).
Epidemiological studies in many countries, including Greece, have shown that most burn accidents occur either at home from scalding during childhood, or at work during adulthood, or in the solitary environment that today's society imposes on the elderly. These accidents can be prevented.