Friday, Mar. 05, 1965

Black Magic

Because burns are among the most common disfiguring, crippling and fatal accidents, physicians and surgeons have tried almost every imaginable therapy. In the 100 years since Lister discovered asepsis, practitioners have hopefully tried phenol, boric acid, picric acid, iodoform, tannic acid, sulfa drugs and ACTH, only to wind up, after a few years, disappointed in all of them. Now another new and seemingly miraculous treatment has been discovered, and once again doctors are hopeful--this time with better reason.

With impressive statistics to back up his claims, Dr. Carl A. Moyer, head surgery professor at St. Louis' Washington University and surgeon-in-chief of the city's famed Barnes Hospital, reported to the New York Academy of Medicine on the near-magical healing qualities of silver nitrate. Ironically, the inexpensive, familiar chemical was many years ago discredited as a proper treatment for burns.

Freedom from Pain. Recent burn therapy has been so unsatisfactory that Dr. Moyer and Dr. William Monafo were seeking some agent to act as a barrier against the invasion of burned skin by bacteria. Silver nitrate, they knew, would do the job, but in the 5% to 10% concentrations formerly used, it would also burn healthy skin. They wondered whether a weaker solution would work. At 1%, it worked but it still burned skin. Without much hope of success they switched to the greater dilution of .5%.

The first 15 patients to get the new treatment all had deep (third-degree) burns over more than 25% of their bodies. Doctors covered the burns with gauze dressings soaked in the dilute silver nitrate. Three of these patients were too ill to be saved. But in the other twelve, both surface infection and systemic infection (blood poisoning)--major causes of death in burns--were for all practical purposes eliminated. Equally important from the doctors' viewpoint, the patients lost only a negligible amount of body fluids or weight and did not need special diet supplements or plasma.

What the patients appreciated first of all was relative freedom from pain and fever. Then they were relieved to find that they did not need to make that dreaded trip to the operating room for skin grafting. What little grafting they needed was done at the bedside and was virtually painless, even without anesthesia. Finally, doctors and patients alike could watch the wounds heal with a minimum of scarring (except where the burn had penetrated deep into the flesh) or deformities.

Wash Off the Black. The treatment, Dr. Moyer admitted, is "an exceedingly primitive scientific solution" to the burn problem, but it is "unbelievably successful." It also produces some bizarre effects. All the dressings, which have to be kept soaked in the solution and changed daily, turn the blackish color of tarnished silver. So do doctors' and nurses' gowns and the equipment in the patients' rooms. New skin also appears black at first, but when it is strong enough to be washed, it appears a normal, healthy pink.

Dr. Moyer issued one warning. Because the solution leaches out some of the patient's body chemicals, the treatment must be accompanied by checks on the microchemistry of his blood salts so that any imbalance can be quickly corrected. How well the treatment works under these conditions is shown by the fact that Barnes has lost only one of the last 30 burn patients admitted since last April whose therapy began with the silver nitrate. In the month since Dr. Moyer made his report, other hospitals have begun using his treatment and with similar promising results.

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