History of Burns (review)

Monographs of this sort and of this quality are always welcome. It was with some trepidation that I approached History of Burns, expecting a long narrative extending from the Ebers Papyrus and incorporating plenty of jokes (if that is the word) about goat's dung. But although the Ebers Papyrus opens the book, and indeed a little goat's dung does appear, this study has virtually nothing in common with stories from the triumphalist genre. Although, in a way, it is triumphalist by default (who would dispute that the modern treatment of burns is a relative triumph?), H. J. Klasen is well aware of the pitfalls of modern interpretations of past practices. As he points out, it is easy to see fluid therapy, for example, as a response to dehydration, but it was in fact introduced as a treatment for toxemia (p. 167).

Klasen's work is rigorously devoted to ideas and practices; institutions have only an incidental place. He is not, however, bound by a linear perspective: First, unlike other success stories, his history is structured by subject: classification, pathogenesis, shock, treatment, and mortality. Second, it is overwhelmingly devoted to the late nineteenth and twentieth centuries (although the earlier material is treated meticulously—notably the studies of Dupuytren). Third, it is referenced to a degree that puts many professional historical studies to shame. Finally, it is the work of a polyglot.

Although not deliberately keying into explicit concerns to be found in the current historiography of modern medicine, Klasen's work does include much material pertinent to them. It is particularly to be valued for the way in which he deals with the therapeutic use of investigations usually studied by historians to understand theoretical change. In the classification section the obvious criteria such as size and depth of burns are dealt with, but Klasen also shows how histology—so often explored in contexts relating to the conceptual understanding of biology and disease—was adopted as a practical guide to treatment. Similarly, the section on pathogenesis shows how extensively animal experiments were used by surgeons for attaining theoretical understanding, with practical goals very much in mind. War is another subject that has of late vexed historians looking for bigger explanatory pictures; Klasen provides many concrete examples of exactly how belligerent encounters determined therapeutic change.

This book is a tremendous achievement and should not be overlooked by medical historians, however far it might initially appear from their immediate interests.