Burns at Mare Island

A burn treatment, in which a wax film is sprayed from a flit gun on damaged tissues, was described last week by Lieut. Commander Ralph Cooper Pendleton of the Navy Medical Corps. The new treatment was used with success on 97 sailors who were badly burned at Pearl Harbor and removed to Mare Island Naval Hospital (on San Francisco Bay). Now it is fast being adopted by more & more surgeons aboard the Navy's ships.

Treatment of burns has long been a controversial medical problem. Few doctors are really satisfied with present methods (tannic acid, aniline dyes, etc.). Burns are always a major problem in naval warfare. Sailors work within enclosed areas where they are exposed to bomb flashes and hot oil. Of Naval casualties at Pearl Harbor, half were burn cases, whereas at nearby airfields burns accounted for only 2% or 3% of casualties. Dr. Pendleton does not claim the wax treatment is perfect, but he and his Mare Island colleagues think it is a big improvement.

His treatment is a refinement of a method used before World War I but largely neglected since. It consists simply in spraying the burned areas with a melted mixture of paraffin wax, vaseline, cod-liver oil and sulfanilamide (plus traces of camphor, menthol and eucalyptus oil). This wax film is gently washed off the burn with warm water and renewed daily. The burn is not cleaned before spraying, although it may be dusted with sulfa powders; nor is it bandaged afterward. The patient is also given the plasma transfusions and high protein diet common to other forms of burn therapy.

Advantages claimed for the wax treatment:

> Pain is stopped instantly, probably because the wax protects bared nerve tips from cold and air. It thus eliminates the need for morphine (which causes dopiness, constipation and loss of appetite) which must accompany other treatments until a scablike "eschar" forms over the burn.

> Debridement -- the time-consuming cleansing and removal of dead tissues and blisters--is eliminated as the necessary first step in burn therapy. Dr. Pendleton believes that sulfa drugs now make debridement unnecessary and the wax can be safely sprayed on top of oil, dirt, charred clothing, etc. He also thinks that debridement may remove live tissues vitally needed to bridge over the destroyed areas. When burns are treated with wax film (which is washed away each day), a slow, gentle debridement takes place without injury to the growing cells.

> Mass treatment of the wounded is greatly expedited. The first day the wax was used at Mare Island, an orderly treated Dr. Pendleton's group of patients in an hour and a half, while in the next ward five nurses--using other methods--took four hours to fix the dressings on a like number of patients.

> Because bandages are eliminated, wounds can be inspected at any time. In several Mare Island cases bullet and shrapnel wounds were discovered in burned areas which would have been overlooked had they been bandaged. ^ Wax treatment does not produce the leathery crust which forms on burns treated with tannic acid and dyes. These crusts often trap purulent materials and have to be removed painfully.

> It avoids the pressure bandages applied, for example, in the British tulle-fras (wax-impregnated gauze) method. Dr. Pendleton contends that any sort of pressure injures the delicate skin cells.

Disadvantage of the wax treatment is that the unbandaged patient is usually an unpretty sight, even to case-hardened hospital attendants. This esthetic factor, Dr. Pendleton suspects, in part explains former neglect of the wax treatment.

Ruddy-faced, greying, intense Ralph Pendleton, 47, had been practicing medicine in Salt Lake City and working on his wax treatment for 20 years when he was ordered to Mare Island last December. "I'm sort of a hoarder," he says. "I had laid in a supply of flit guns. When I started for Mare Island, I threw them in the back of the car figuring they might come in handy." They did--by chance he was assigned to a burn ward, told to do anything he thought would help the suffering sailors.

Many of the sailors, still in great pain, were fed up with any sort of treatment. "Man, I thought I was going to die," said one healthy sailor last week. "I couldn't figure out how I was going to live. Then, when the wax was sprayed on me, right away I could feel the pain drifting away."

At first the wax-coated sailors felt silly: they felt naked without bandages. Then they realized that 1) painful changing of dressings had stopped, 2) they could bathe themselves and get around. They began to like it. "We're all taking flit guns of that stuff back to duty," said a discharged sailor as he packed his bag last week. Dr. Pendleton now has invented a small heater, powered by a 25-watt light bulb, to melt the wax and make it available quickly in ships' turrets.

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