D. MacG. Jackson

The psychological effects of burns

Abstract THE incidence of psychiatric disorders in burned patients before they receive their injury is high; this is one reason why these persons get burned. Until this background is appreciated, no realistic measure of the psychiatric effects of burns can be made. Burns are among the largest wounds people receive and treatment is frightening and uncomfortable, so it is not surprising that this stress, sometimes imposed on people who are already disturbed, can produce further mental and emotional disorders. Some of the psychological effects relate to basic fears about survival, but they merge with secondary attitudes and adaptive reactions to the accident, the burn injury and the people around. Disorders of the mind in burned patients frequently have a medical cause, such as water intoxication, renal failure or septicaemia. Treatment for these conditions is not psychiatric; it is medical, and often urgent. These cases should not be labelled ‘toxic psychosis’ and referred with some delay for the opinion of a psychiatric specialist. Emotional disorders in children following burns are common and as much a complication of faulty management, such as lack of visiting by the mother, as of the burn itself. They should therefore be regarded as preventable suffering. The psychological effects of burns have had little attention in the past, but those interested may study it in the work of Cobb and Lindemann (1943) and Adler (1943) on the victims of the Coconut Grove Disaster; Hamburg et al. (1953) from the Brooke Army Hospital; and Woodward (1959, 1962), Woodward and Jackson (1961), Long and Cope (1961), Vigliano et al. (1964) and Martin (1970a,b) on psychiatric effects of burns in children and their parents.

Destructive burns: Some orthopaedic complications

Abstract Deeply destructive burns are uncommon and no surgeon has a very extensive experience of them. In such cases, where no set rules of treatment have yet been established, we still have to feel our way towards the recovery of form and function, sensitive to the patients physical and emotional responses and guided by general surgical principles. The orthopaedic complications of these severe lesions are discussed under the following headings: the destruction of the central extensor mechanism of the knee joint, disordered growth, septic arthritis, dislocations, the wasted calf, new bone formation and amputations.

Burns into joints

Summary This study is a sequel to a previous investigation into burns of bone ( Jackson, 1975 ). The purpose of this paper is to report 24 cases of burns which penetrated into joints, treated at the Birmingham Accident Hospital over 27 years (1948–74). The cases were treated to save the limb and secure healing, usually with the further aim of preserving movement or getting stable, bony fusion. Burns into interphalangeal joints of fingers and toes are excluded, and so are burns into major joints if early treatment for the limb as a whole necessitated amputation. The aetiology and diagnosis of this type of burn are described, and the various treatments and their indications are discussed. Early excision and closure with skin flaps is encouraged to preserve movement, and early arthrodesis is recommended in the lower limb to get a stable, pain-free limb if joint destruction is inevitable.

Child-bearing in relation to the scarred abdominal wall from burns

Abstract A retrospective study has been carried out to see the effect of a scarred anterior abdominal wall from burns on the course of pregnancy. Attention has been drawn to the feeling of tightness and itching in the scar which can sometimes be expected, but no evidence has been found to suggest that tight scars on the abdomen cause complications in pregnancy or in labour.

Local dibrompropamidine in the treatment of burns

CLAIMS for the value of local dibrompropamidine in burns and wounds have been put forward by several writers (Kohn and Cross, 1948 ; Arden, 1949 and 1954; Champion and McDowall, 1949). Our experience with the compound (see Bull et al., 1948 ; Lowbury et al., 1952) and the report of its toxic action on leucocytes by Wien et al. (1948) led us to abandon its use in favour of other agents which were found to be safer and also more effective (Jackson et al., 1951 a, b). We report below four groups of observations in support of our opinion that dibrompropamidine is unsuitable as a routine application for burns.