Who Will Follow?

The impact of the work that we do daily, what the value of these efforts will be to those who follow us, and what the challenges will be to providing high-quality burn care are issues that we must understand if we are to build to the future. As a society, we can look to our past to gain important insights about what the future may hold and the problems we will encounter. The past also allows us to reflect on the accomplishments of those who have been a part of our success, recall memories that have become distant, and view our concerns in new and important ways. From this reflection, we may better understand how we are doing and develop solutions to today's problems in a way that will pave the route to tomorrow's successes. The history of burn care can be rightfully traced to many important periods in our civilization's history. Advances in the treatment of the burn patients have tracked the evolution of civilization. New scientific knowledge based on empiric clinical observations and experimental studies as occurred during the Renaissance and period of enlightenment promoted changes in patient care. Warfare, although a human tragedy, often has stimulated progress in the treatment and management of the injured. The treatment of burns was recorded as early as 1550 BC in the Ebers papyrus.1 The writings of Galen (200 AD) document further advances in the treatment of wounds resulting from his work in anatomy and physiology. Ambrose Pare of France (1510–1590), the surgeon of the Renaissance, was not only the most influential surgeon of his time but also the originator of modern surgery. His treatment of injuries and in particular burns was based upon comparative studies of alternative forms of therapy with the patient serving as their own control.2 Burn depth classification, as developed by the French surgeon and surgical pathologist Guillaume Dupuytren (1778–1835), entailed six degrees of burn based on the depth of injury. Dupuytren's classification approach was used for more than a century and widely so outside of France. It embodies many of the same principles that we still use today in burn depth classification.3 The Viennese surgeon Theodore Billroth (1815–1877) performed animal studies to investigate the etiology of burn fever and clarify the role of inflamation.4 Walter Buchanan following up on observations made during the treatment of injured soldiers during World War I continued to perform studies on postinjury-induced shock.5 F. D. Underhill noted that fluid and electrolyte changes and the development of hemoconcentration and its deleterious consequences on tissue oxygen delivery in World War I victims of vesicant injuries paralleled that of burn patients.6 During the Second World War, H. N. Harkins established protocols for the resuscitation of burn patients incorporating infusions of plasma titrated to the patients' physiologic needs and their response to the injury.7,8