Blood & Water

Into an Indianapolis hospital, three years ago, interns carried a screaming two-year-old girl who had just fallen over backwards into a scalding tub of water. Her burns were not deep, but they stretched from her plump shoulders to her knees. She had a 1-to-3 chance to live.

The doctors washed her, gave her the standard textbook treatment: a coating of tannic acid solution to ease her pain, keep out harmful bacteria, seal in her body fluids. After a severe burn, blood escapes from the capillaries into tissue spaces, and circulation "dries up," stagnates. So the doctors followed their textbook schedule by feeding and injecting the baby with enormous quantities of water and fruit juices. For two days she was quiet and fairly comfortable; on the third day she swelled up, lost consciousness, went into convulsions, died.

Dr. Harold Milton Trusler and colleagues performed an autopsy to find out why the child had died under such "ideal" medical conditions. They saw that the baby's tissues were "tremendously waterlogged," her blood so dilute that it could not clot. The classic treatment for burns, they decided was clumsy and "fallacious." Last week, in the Journal of the American Medical Association, they told of their new method for treating "burn shock."

They performed a series of experiments on dogs, who had "burns of critical degree but not utterly hopeless." They found: 1) dogs which were given no fluids died in twelve hours; 2) dogs which received large quantities of water lived a little longer, but died, like the baby, in convulsions; 3) dogs which were given moderate amounts of salt and sugar solutions to maintain their "blood chemistry," and which received "repeated large transfusions of blood in addition . . . were able to survive the otherwise fatal shock." The doctors came to the conclusion that a stagnant circulation must be stimulated with extreme delicacy, that blood transfusions were absolutely necessary.

"While these experimental studies were in progress," the doctors were called on to treat severe back and chest burns of a 15-year-old girl. They gently bathed her in soap and water, but gave her no tannic acid, permitted only occasional mouthfuls of water to moisten her throat, and placed her in an oxygen tent.

Over the first four days she was given six large blood transfusions (the last three of blood serum alone), as well as moderate injections of salt and sugar water. In nine days she was out of danger; in two months, neatly patched with skin grafts, she was "completely healed." The "complex regimen" of "properly balanced fluids" and blood transfusions, said Dr. Trusler last week, saved her life. "No local application [of tannic acid]," he warned, ". . . or forcing of water . . . can be expected to save life after a large burn."

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