Abstract Following an extensive thermal burn, a complex derangement of normal physiologic processes develops, which can be separated into at least two components, shock and toxemia. Most of the recent developments in the systemic treatment of burns have been directed toward decreasing the severity of shock, and as the treatment of shock has improved one has seen more patients survive the period of shock only to succumb to toxemia. For many years shock and toxemia were regarded as one process. Observers debated whether the whole picture was due to toxins produced in the area of the burn and distributed throughout the body by the circulation or whether the local loss of plasma in the burned area, with the resultant disturbance of circulatory dynamics, was the primary cause of systemic damage. In 1923 the toxin theory, supported by the work of Boyd and Robertson,1 was in the ascendency, but during the References 1. Boyd, G. L., and Robertson, B.: Toxemia of Severe Superficial Burns in Children , Am. J. Dis. Child. 25:163 ( (Feb.) ) 1923. 2. Underhill, F. P.; Kapsinow, R., and Fisk, M. E.: Am. J. Physiol. 95:302, 1930. 3. Underhill, F. P.; Fisk, M. E., and Kapsinow, R.: Am. J. Physiol. 95:325, 1930. 4. Underhill, F. P., and Fisk, M. E.: Am. J. Physiol. 95:330, 1930. 5. Underhill, F. P.; Fisk, M. E., and Kapsinow, R.: Am. J. Physiol. 95: 339, 1930. 6. Blalock, A.: Experimental Shock , Arch. Surg. 20:959 ( (June) ) 1930Crossref 7. Trauma to Intestines , Blalock Arch. Surg. 22: 314 ( (Feb.) ) 1931.Crossref 8. Wilson, W. C.; Macgregor, A. R., and Stewart, C. P.: Brit. J. Surg. 25:826, 1938.Crossref 9. Wolff, W. A.; Elkinton, J. R., and Rhoads, J. E.: Ann. Surg. 112:158, 1940.Crossref 10. Wells, D. B.; Humphrey, H. D., and Coll, J. J.: New England J. Med. 226:629, 1942.Crossref 11. Hartman, F. W., and Romence, H. L.: Ann. Surg. 118:402, 1943.Crossref 12. Saltonstall, H.; Walker, J.; Rhoads, J. E., and Lee, W. E.: To be published. 13. Walker, J., Jr.: To be published. 14. Hirshfeld, J. W.; Williams, H. H.; Abbott, W. E.; Heller, C. G., and Pilling, M. A.: Surgery 15: 766, 1944. 15. 11 and 12. Deleted by author. 16. Walker, J., Jr., and Shenkin, H.: Studies on Toxemia Syndrome after Burns: Central Nervous System Changes as Cause of Death , Ann. Surg. 121: 301-303 ( (March) ) 1945.Crossref 17. Netzky, M.: Personal communication to the authors. 18. Netzky, M. G., and Leiter, S. S.: Am. J. Physiol. 140:1, 1943. 19. Erb, I. H.; Morgan, E. M., and Farmer, A. W.: Ann. Surg. 117:234, 1943.Crossref 20. Weed, L. H., and McKibben, P. S.: Am. J. Physiol. 48:531, 1919.
Archives of Surgery – American Medical Association
Published: Feb 1, 1946