This Podcast Will Kill You - Ep 212 Burns Part 1: The first million or so years

Episode Date: June 9, 2026

Burns have been a part of the human experience since our hominin relatives began controlling fire 1.5 million years ago. Until very recently, we’ve been limited in our ability to manage burn wounds with any success, having instead to rely on our body’s innate healing responses. In this episode, we delve into those repair responses, explore what makes burns different from other types of injuries, and examine how we categorize burns based on severity. On the history side of things, we take a tour through humanity’s quest to alleviate the pain and suffering caused by the near-universal experience of getting burned. Ever wondered what Hippocrates would have recommended for a burn? Or what distinguishes a second- from third-degree burn? Tune in to find out. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAuSee omnystudio.com/listener for privacy information.

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Case 1. A lady, aged 20 years in feeble health, was extensively burned by her mosquito curtains and calico bed cover being set on fire after she had fallen asleep. The flames enveloped her head, neck, and arms and were not extinguished for 20 or 30 seconds. Ardent spirits were first applied, then flaxseed oil, and lastly, a calcareous soap of the same oil and lime water. Laudanum was administered freely, both externally and internally. Case two, the editor, while rescuing the patient described in case one, was severely burnt on both hands from compressing the burning clothes with his bare hands until the flames were extinguished. The cuticle exfoliated from nearly the whole right hand, and the cutus vera sloughed in seven places.

The left hand suffered much worse. The whole cuticle was separated and much of it was rolled up, especially that which covered the space between the wrist and hollow of the hand and extended up the inner side of the thumb as far as the middle of the second phalanx. Between these limits and the metacarpal bone of the little finger on one side and the corresponding bone of the thumb on the other, the true skin was killed and turned black. Immediately after the accident, he immersed both hands in whiskey,

then in a liniment of flaxseed oil and lime water. after which the affected parts were wrapped in rags dipped in a painter's mixture of the same kind of oil and white lead ground together. In three days, this was replaced by carrot poultices with yeast and Peruvian bark. The deeply burnt parts being stimulated at different times with tincture of myrrh, oil of turpentine, ammoniated alcohol, and other excitants. After a few days, separation was established and the dead skin sloughed off. Had the case presented nothing but what has been stated, a report of it would have been of interest. There resulted, however, from this local injury, a great constitutional disturbance. And to this, I beg leave to direct the attention of the reader. Several causes seem to have

conspired to depress the energy and disorder the sensibilities of his nervous system. Number one, the acute sensibility of the parts injured. The pain, for several hours after the accident, was excruciating, notwithstanding the liberal use of laudanum. number two, the scene of concentrated horror under which the injury was inflicted contributed not a little to overthrow the powers of the nervous system. Number three, the immersion of both hands, extensively denuded of cuticle, and a liniment of oil and white lead, seems to me to have contributed largely to the same effect. Number four, two, three, or four days after the accident when febrile symptoms were developed, the patient, by his own advice, lost about 10 ounces of

blood. This was done under the apprehension that the fever and inflammation might run too high for healthy separation, but it manifestly did harm. It would be difficult to set forth the variety of physical and moral suffering which were attendant on the protracted state of nervous or constitutional irritation which these causes generated. A great variety of applications were advised and employed for this formidable affection, but with little good. Time only has been efficacious, but even a period of nearly two years has not entirely overcome the effect. I can't believe that they survived. Yeah. Yes, I know.

So that, it is, it is, it's horrible. It's horrible. And it exhibits, I think there are some, there's an entire paper actually that I found this in that was like discussing what this represents in terms of the history of burn treatment and where things stood. So the author of that was a medical doctor named Daniel Drake, who was actually like a famous doctor at the time. And he wrote this about his own experience. and he was the editor of a journal and he was like, I need to tell everyone about this. Like all of these. And I think the realization that he came to was like all of these treatments.

We have so many different treatments and none seem to have a positive effect. Right. Like if anything, they might have made things worse. Yes. Yeah. The article, if you're interested, is titled History of Two Cases of Burn, producing serious constitutional irritations by Daniel Drake. It was published in 1830. And the paper that I found this in was called Daniel Drake's account of his own hand burns by Eric Mooney.

That was published in like 1998, I think. So, yeah, truly awful stuff. But hi, I'm Aaron Welsh. And I'm Aaron Oman Updike. And this is, this podcast will kill you. Welcome to Burns. Yeah, part one. Part one.

Yeah. Two parts, because this is. This is a big, this is a big one. I mean, each, there are, as I was working on the second episode, and like the way that I split up the history for this is that I did like most of history. Most of history and beyond. Most of everything. And then like the last 80 years, basically. And like the various developments in the last 80 years, each one of those could be its own episode.

Not to mention burn centers being its own episode. Multidisciplinary, like all these things anyway. I know. There's so much. And like even in the newer, like the techniques and the newer technologies and things that we have, like there's so much more detail that we... Listen, we've got a lot to cover, though. We did. And next week.

Yes. Today is Burns part one. Should we tell people like kind of what we're covering today, what we're covering next week? Sure. Let them know a little bit. Yeah, we can do that. I don't know if you want to know. Here's a preview.

Here's a preview. Today we're going to talk about the biology of burns, what is happening in our bodies, to our bodies when we suffer a burn. And then, Erin, you're going to walk us through, like you said, the most of humanity's history with burns. And then next week we're going to pick up with more modern history and how we actually treat and deal with burns today. Yeah. Yeah. There's a lot. There's a lot. There's a lot. There's a lot. And before we can do any of this, it is quarantine time. What are we drinking this week? We're drinking by degrees. By degrees. It is technically still how we measure burns. Is it?

Okay. It is-ish. We'll get there, but kind of. Okay, okay. It's still all over the literature. It is. When I was like, oh, degrees and you were like, no, we don't talk about that anymore. Yeah, it's like, it's fine.

We're going to. Okay, okay, okay. Well, by degrees is the name of the quarantini, and the quarantini is a non-alcoholic bees knees, basically. So non-alcoholic gin, lots of different varieties out there. Take your pick. Lemon juice, honey. Which is a great antiseptic for wounds. It is.

It is historically used as well as today. As well as today. Yep. Yeah. You can find the full recipe for that on our website, this podcast, we'll kill you.com, and all of our socials. All of our socials. All of our socials. Podcast will kill you most places.

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failed these victims. Listen to Bleep with Anna Navarro on the IHeart Radio app, Apple Podcasts, or wherever you get your podcast. For today's episode, I wanted to take us through how exactly we classify burns in medicine and what this classification means for how our body responds to a burn injury. Because although a burn is a type of trauma to our skin, and there's a lot of other traumas that we could get to our skin, right? Scrapes, cuts, etc., our body's response to burn injuries is actually fairly unique. Even though it is still the same inflammatory response, it is also unique. It's kind of interesting. Huh. Okay.

And what I really think and what I took away from digging really deep into this is that what Burns really show us is just how incredible and how important of an organ our skin is. Truly. And how severe damage to that skin has life-threatening consequences and long-lasting consequences. So I'm going to walk us through the. types of burns that we can see, burn severity, and how we actually determine severe versus minor or major versus minor burns, and what is happening to our whole entire body as a result of a burn injury, and then save the like, what do we do about these burns for next week's episode?

Okay. Sounds good. So a lot of different things can actually cause the type of damage that we would refer to as a burn. And the source of a burn really does matter a lot because the pattern of injury that you see can be really different depending on the source of that burn. So as an example, electrical burns, which we've talked about in our lightning episode, we talked about electric burns, they can cause really severe deep damage to like our internal structures with very minimal visible surface injury.

But those are still going to be burn injuries, but deeper. A burn from a chemical, like say a strong acid, might cause coagulation necrosis. So your blood vessels are all clotting and all your blood is clotting, while a burn from an alkaline chemical might actually liquefy your tissues completely. Whoa. Yeah. So burns from chemicals are going to act a little bit differently. And they might differ in how we need to treat them. You can think of frostbite as a type of cold burn, and those need to be rewarmed and watched.

See our two episodes on cold and cold injuries. hypothermia? Is that what we called them? Yeah. I was like, what did we call this? Whereas a heat burn is going to be different. And so most of what I'm going to talk about, though it probably applies to most all burns, they're really, I'm talking mostly about thermal burns. So burns as a result of heat injury. Did you mention radiation burns? I didn't, but those are yet another type of that might be more like more similar to maybe a chemical burn or or somewhere in between a little bit different. Okay. Yeah. So yeah, there's a lot of different kinds of burns. But so I'm focusing mostly on thermal burns. These are the most common types of burns worldwide. And these can be

flame burns, so from a fire, as well as scald type burns. So think hot liquid and those sorts of things. And those are the two most common types of burns worldwide. Once we know what caused the burn, then the next thing that we need to know is the severity of that burn. And the Severity is a combination of the body surface area that's affected, so how much of your body got burned and the depth of that burn. And then, of course, we also need to look for whether there was any additional injuries or traumas, especially in the case of something like a flame burn. You might have inhalational injuries or a chemical burn. You might have other toxin exposures. You could even have like blunt trauma injuries, right, depending on how the burn was sustained. And then there's patient factors that might make someone more susceptible to severe outcomes from a less severe burn, like, say, a very young child or a very old person, etc.

Underlying health issues, so on. Exactly. Diabetes that might interfere with wound healing, things like that. So let's go through how we kind of get to this severity. We already mentioned, and a lot of us have heard of the idea of a first, second, and third degree burn. And that is like classically how we classify burns. And I say that we don't quite use it as much today because we now get a little bit more specific based on the thickness or the depth of the burn in our skin. But colloquially, we still use for second, third degree.

So we'll just go a little bit more detailed, okay? Okay. And first I want to take us through our skin. And we've talked about our skin on a number of episodes before, including like our retinoids episodes. Yes. But our skin is an incredibly important organ, and it's a layered organ, the largest organ in our whole entire body. And it's made up of several different layers. The top layer, the outside, what you're touching and what you see, is called the epidermis.

And this is very, very thin layer. And it differs in thickness depending on where on your body. So it's a lot thicker in places like the soles of our feet and our back. And it's a lot thinner in places like, say, your eyes or. you know, the backs of your hands or things like that. Underneath the epidermis is the dermis, and this is the layer that has a lot of structure to it. It's a little bit thicker, still only on the order of millimeters. But the dermis is underneath that. And then underneath the dermis is a layer of subcutaneous tissue. So this is like fat and things like that. And then below that is

when we get to muscles and bones. Okay. So the degree of a burn depends on how far through that, that skin layers, through those layers of skin, we actually get. A superficial burn or a first-degree burn is one that burns only the uppermost layer, the epidermis. This you can think of as a bad sunburn. Right. A blister type of a thing? Well, no, not a blister type of a thing. So a bad sunburn. Your skin is red, it's angry, and it's painful. But beyond that, it generally does not blister. And it does not need any kind of specialized treatment. And you're not going to get a scar or any residual defects or anything. These type of superficial or first degree burns generally heal within a week or so, but no blistering. That is when we get into second degree burns. And what used to be

just lumped as second degree burns is now split into two different types. So the first is a superficial partial thickness burn. This is the one, Erin, that will blister. Okay. And so this is a burn that burns completely through the epidermis and then into the first part of the dermis, but does not go, like, deeply into the dermis. Okay. And so this is something that you might get if you burn yourself on a pan or the oven or like really hot, you know, liquid that spills on you or something. These burns are very, very painful. They might be red. They might be red. They might be blistered, they might be very wet and kind of weep. And you have to take care of these wounds, but you're not going to need surgery to fix these wounds. Yeah. Because the layer of the dermis

has not been completely burned through. And so your skin is going to be able to, it's called re-epithelialize. It's going to be able to make new skin to cover up this wound without a lot of additional help. Most of the time you're not going to get a scar from these types of burns. If you do, it might just be pigmentation changes because of losses of like the melanocytes that are in more of the epidermal layer. Okay. Okay. Next is, again, within this considered second degree burn is called a deep partial thickness burn.

And the deep partial thickness burns actually tend to hurt a little bit less than the first two. And that's because they burn deeply enough that they're actually destroying our pain receptors in our skin. These burns tend to be a lot drier than a superficial partial thickness burn. So you don't necessarily have blisters or if you do, they're just not quite as wet as a superficial burn. They often look either very dark pink or sometimes almost white where they just look like it doesn't really look like there's anything there. it's just like completely white, regardless of your skin color. Right. And they're almost kind of pearly looking, or like waxy looking a little bit.

Yeah. These generally do need surgery. Very often, these are deep enough that the skin is not going to be able to completely heal over this without some kind of surgical intervention. And that means that they're at much higher risk of some kind of scar formation. There's not a huge leap then from a deep partial thickness to a, a full thickness burn or a third degree burn. And this is one that extends completely through the dermis.

So the epidermal layer and the dermis are completely burned through all the way down into that subcutaneous tissue. In some cases, a burn can extend all the way down into our deeper tissues, which is sometimes called a fourth degree burn or sometimes it's just lumped under this third degree. And that means that there's damage to the muscles or the bones depending on how deep it goes. these full thickness burns are not painful because all of our nerve endings have been destroyed. And I asterisk that, Erin. Yeah.

Because that just means that at the time of the injury, that specific area that sustained a full thickness burn, if you touch it, you will not feel that the way that if you touch a burn blister, it really hurts. But that doesn't mean that they're not painful in the long run. Or that you only have a third degree burn and that other parts of your body are not experiencing first and second degrees. Exactly, exactly. Very, very often, almost always, if someone has severe burns, not every part of the burn is the same degree, right? You have a mix of burns of varying degrees or varying thicknesses on different parts of that burn, which means, yes, things are likely going to be very painful, even if parts of those burns have. have completely destroyed the nerve endings and everything. Okay.

So I have a question about like surface area and degrees. Yeah. Because it's a big, like we just talked about, there's a mixture of different degrees or severities of the burn in different parts of your body. So how is that calculated or how does that get incorporated into total body surface area? That's a great question. So total body surface area is the next thing that we have to look at. So once we know, and I say it as if these are separate things, they're really not.

Like we're looking at all of this at the same time if someone comes into a hospital with a burn. But total body surface area is how much of your body surface is covered by this burn regardless of the degree. So you don't need to separate it by, oh, you know, this much surface area was the first degree versus second versus third. Here we're just looking at how much of your skin got burned. And this is actually the most important part in looking at mortality is surface area. surface area. So how we classify something as a so-called minor burn, this is actually a lot more, I won't even say contentious in the literature, because I don't think anyone's fighting over it, but it really depends on this situation, whether something is considered a severe or a minor burn.

In general, most people don't require hospitalization for burns that cover less than 10% of their body surface, but that's a huge generalization because a burn on the face, a burn on the groin, a burn on the hands, even if it's significantly less than 10% might still require hospitalization, as well as depending on the thickness or the degree of that burn. Right. Or other injuries sustained or the type of burn that it is. Yeah. Exactly. So that is really an overgeneralization. Most of the time, if we're thinking about what is going to cause more likely to cause systemic symptoms, then we're looking at burns that are maybe more than 15 or 20% of your body's surface area, depending on. the person and their age and like how big they are, right? Like a kid might have a less body surface area to cause severe effects. But all of that is really like it's so depends on the person, right? So there's not like a clear cut definition of like this is a major burn versus a minor burn or a severe burn versus a non-severe burn. But calculating that body surface area is a really important

part of the care of a person and understanding like how severe their outcomes are going to be. And the way that we do that is there's a couple different ways. There's a fast and ready way kind of that is called the rule of nines. And that is that we just split up an adult body area into areas that are about 9%. So our head is about 9% of our body surface. Our chest, the front side of our chest and the front side of our abdomen are each 9%. And same thing with the back. So that's like 18 and 18.

And then the front of our legs are 9%. The back of our legs are 9%. And our two arms put together are 9%. are 9% and then an extra 1% for the genitals. Okay. The other way that you can do it, though, because that calculation does not hold true for children because children, their head is a significantly larger body surface than especially for babies.

So there's different calculations that we use for children and babies. But you also could use a person's hand. So not my hand to calculate your burn area, but your hand to calculate mine to calculate mine. Mine to calculate mine. Our palm, so the entire surface of our hand, including our fingers on our palm, is about 1%. Okay. That's considered about 1% total. So you can use that to kind of estimate if it's less than 9% or something you're trying to get a rough estimate. So that's how we sort of calculate and estimate how severe a burn is. And of course, like I said at the very top, our skin is the largest organ in our body. So damage, even to a small portion of that organ, has the potential to cause a whole body response. And the response that we see really depends on the depth of that burn, the surface area of that burn, and the person who sustained that burn and what their underlying conditions is. Right. But we can kind of understand how this process is going to go if we understand our basic inflammatory

response and how our body responds to wounds in our skin, which we've talked about on previous episodes. I think on our maggots episode, we talked about this inflammatory response. Because any time that our skin is wounded from a burn or a scrape or a scratch, our body follows a very predictable series of responses to try and repair that wound. The very first thing is hemistasis, right? We have to stop the bleeding because most of the time wounds bleed. Very often they don't in the case of burns, and we'll get to why that is. is. But the second thing that's going to happen is inflammation. And this is to bring helpers to the

area in order to start the repair process. The third step is proliferation. We need to start making new cells to fill in the gaps that are left by this wound. And finally, we have maturation or remodeling. That's the finishing up that is really scar formation because our skin pretty much always heals by scarring. So in the event of a burn, our body is going to attempt to heal by this similar process. However, because of some specific things that happen, especially in the case of a thermal burn, so a heat-related burn, as well as the potential for a very large portion of our skin to be affected, the end result is often a pretty dysregulated body response. that can be really severe.

So unlike, say, a cut or a scrape that just has damage wherever that scrape actually happened, a burned wound actually has several different zones of injury. In the very center or like where the burn was actually sustained is what's called a zone of coagulation. You can think of this as not necessarily the deepest part of the burn, but like the part that actually had contact with the hot liquid or the flame or whatever it was that caused the injury. Mm-hmm.

And in that area, the tissue is dead. The blood cells are coagulated. So there's no bleeding in that area because of the strong heat that was applied. And that tissue in that area cannot be completely salvaged. Okay. Okay. Immediately around this, there is a zone of stasis. And in this area, there is a lot of...

inflammation. So our body is trying to respond to that central area. It knows that there's something wrong here. But there's very low levels of blood flow. There's a lot less profusion in this zone because of damage that was sustained and our body's response of kind of clamping down to try and protect that area. Okay. Which has the effect that if that area is not addressed, then the damage from the burn can actually extend out over the next 24 to 48 hours. How can it do that? Because that area, that zone of stasis, is not getting enough blood flow, if that blood flow is not restored to that area, then that area is also going to die because of a lack of blood flow. Okay. Does that kind of make sense? I think so, yeah.

And then outside of that zone is called the zone of hyperemia. And this is non-damaged tissue where perfusion hasn't been affected, and this is all like viable tissue, essentially. So in the first 48 hours, it's important to be able to find those areas and see how much tissue can be salvaged, especially, and I'm talking really in the case of deep partial thickness, so like those more severe second degree burns or third degree or full thickness burns, right? Okay. This isn't necessarily happening in a superficial burn where it's just the epidermis. Okay. So just so I want to go over this, so I make sure I understand this. So you experience a second degree burn, let's say it's like on your leg, there's the area that is like the most severe part

that things are bad. The burn has happened directly there. And then surrounding that area, there's sort of the area that has also been kind of affected but not directly by the thermal injury. But it's that area that needs to be like looked after because it's at risk of dying. And so that's where a lot of the inflammation comes into there. Yes. Yes. But not necessarily the central point of the burn itself because there's nothing left. There's no more tissue left to go to that is alive and receptive. Right. Right. Right. Right. It has to do the remodeling first. Exactly. So yes, in that tissue that is completely dead, our inflammatory response can't kick in there. We don't have blood flow there. There's no blood flow. There's no opportunity for anything. So then, okay,

everything has to be restored. Everything has to be restored. So that's the first challenge. is identifying those areas that need restoration, that we need to do something, otherwise that repair process is not going to be able to start. That's the first challenge. Right. The second challenge is that all of the surrounding tissue will have a lot of inflammation, right? Because our body knows that something is going on, and they're trying really hard to send in all the troops. That means in the surrounding areas, we have a lot of vasodilation. That means our blood vessels are getting larger, and that's to accommodate more flow.

We see an increase in vascular permeability. So that means that our blood vessels are more leaky. And that is to allow all of the plasma that has our white blood cells and the inflammatory markers and the cytokines and all these things into the area to try and help. But unfortunately, what that ends up resulting in is a lot of edema. So a lot of fluid in the area because the degree of inflammatory signals is so high. And this can be in and of itself very dangerous. especially in the event of like a circumferential burn. So think like a burn that goes around your entire arm, for example.

Basically, the fluid has nowhere to go. And so that's going to increase pressure in that area. Does that make sense? Yes. How does blood pressure overall play? Like what happens to your blood pressure? Yeah. So the pathophysiology of burns, severe burns especially, is divided into two phases.

The first phase is in these first 24 to 72 hours. hours. And that's called the hypodynamic phase. And that is when all this inflammation is happening. Our bodies kick into high gear. Inflammatory markers are going everywhere. Vascular permeability is up. So we are at very high risk of going into shock. And shock, as we learned in our sepsis episode, means a drop in your blood pressure, enough so that all of your other organs are not getting enough blood. So this is incredibly dangerous. It can result in multi-organ failure, kidney failure, liver failure, your heart is not pumping out enough blood. And really, it's because you're not losing blood, so you're not bleeding out, but you're

losing so much fluid from this process that your blood pressure just can't keep up. We can also see really bad fluid imbalances and electrolyte imbalances as well. So in this period, what's really important is fluid resuscitation, as well as management of these wounds to try and prevent all of this stuff from getting worse. And in the case of those, like if we have circumferential burns and things, there has to be like pressure relief. So you have to do some kind of surgical intervention, even if it's something small, to literally release that pressure so that you don't cause further damage to the tissue or the tissue

downstream from that. Okay. After that initial 24 to 72 hours after a burn, your body enters a new phase that's called the hyper dynamic and hyper metabolic flow phase. And you can kind of think of this as your body like releasing all the stress hormones that it has. So you're still alive. Your body has kept you alive for this first few days. And now it's recognizing that without a portion of your largest organ, being able to thermoregulate, being able to regulate the water in your body, being able to protect you from infection, your body is going to have to compensate in a huge, huge way.

So what we see are blood vessels actually clamping down, so a real decrease in vascular permeability. We see your heart rate going up. We see the like small blood vessels or the microvascular of the area around that wound starting to heal and redistribute blood to these areas to actually promote healing rather than just like kind of freaking out like they were at first. Right. And then we also see huge increases in our basal metabolic rate. So our body literally starts burning way more energy than it has in the past. Right. And what is so wild about burns are that these changes in metabolism and total body functioning, like changes in cardiac output, changes in insulin and glucose regulation, changes in heat production, last for years following. a severe burn. Really? Yes. So if we see body surface area burns of 20% or greater, then these changes in metabolism can last for two or more years. Yeah. And this is, okay, I have so many questions

about everything. Yeah. And that's like, at that point, what does the burn, like, what does the burned skin or tissue look like? Has it been healed? Is it scar? Yeah. It really, so. So, it's really, really going to depend on what kind of treatment you have access to. Okay. Yeah. Right. If you don't have access to any treatment, especially if this was a deep burn, then the tissue that has died is going to form what's called an eschkar. I think that's how you say it.

And that's basically like you can think of it as a really, really bad scab. So something that's completely black, completely necrotic, can be very thick. And it will take a very long time. if ever for that wound to heal completely. Because again, if the burn extends all the way through the dermis, so a deep partial thickness burn or a complete thickness burn, so a late second degree to be or a third degree burn or greater, there aren't any like dermal cells left to re-epathelialize.

And so that wound has to heal like from the bottom, up and it's really a slow process. And in some cases, it just never completely makes new skin again without some kind of wound management. So that wound might never heal and it might become a chronic wound. Okay. If you don't have any access to essentially surgical debreedment and then treatment for it. So that's mostly burns and kind of how severe they can be, what damage they can cause. There's obviously a lot of complications that can arise during the treatment of these burns. You're at very high risk of infection because your skin is the main barrier from infection. And depending on what caused the burn, you might have additional like inhalational injuries.

And smoke inhalation deserves its whole own episode because that can cause a really severe injury. It deserves its whole entire own episode. But that's kind of like the main how we deal with burns in terms of how our body is responding. to that burn. And the management is going to really vary depending on what you have access to and depending on how severe that burn is. But Aaron, I have to assume that we've been subject to, vulnerable to burns ever since, I don't know, forever since we lost our fur. Like, furry animals can still burn. What, tell me. I'll, I will get there. I do have one other question for you, though. And that's just sort of like, in general, you know, so much of what I encountered in the history of burns is that burns were, it could be very, very fatal. And they're not as much now

today if you have access to all these top of the line treatments and burn centers. But what is behind or driving that mortality? It really depends. It depends on the total body surface area. There's actually like a calculator that you can use based on someone's age and their body surface area to like predict essentially whether someone is likely to die from it. In the case of severe burns, then it's that first like 24, 48 hours that you really need access to resuscitation or somebody could die from shock and organ failure. And then after that, it's more likely to be infection or potentially other complications, like if there was an inhalation injury or something like that at the same time. Gotcha. Okay. Yeah. Okay. Yeah. It is grim. Aaron. It is grim.

And I will say that the history is, for a large part, is quite grim as well. But this is why I'm so glad that we're doing these two episodes is because it really does exemplify how far we have come in our ability to treat and manage burns. It's pretty remarkable. It really is. It's medical revolutions. It's incredible. But let's see where things came from, right? Okay.

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Stream us on your phone or listen now at iHartRadio.ca. How much you wait, wonder? Right now, about 1.30. 83. We should race. No, I want to leave here with my original hips. On the podcast, The Matchup with Alia, I pair prominent female athletes with unexpected guests. On a recent episode, I sat down with undisputed boxing champ, Cloressa Shields, and comedian Wanda Sykes, to talk about Wanda's new movie, Undercard, The Art of Trash Talk and what it really means to be ladylike. Open your free IHeartRadio app. Search the Matchup with Alia and listen now. Brought to you by Novartis, founding partner of IHeart Women's Sports Network.

How could this have happened in City Hall? Somebody tell me that. A shocking public murder. This is one of the most dramatic events that really ever happened in New York City politics. I scream, get down, get down. Those are shots. A tragedy that's now forgotten.

And a mystery. That may or may not have been political. That may have been about sex. Listen to Roershack, murder at City Hall on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Do you remember your first bad burn? I remember some really, really bad sunburns when I was a kid.

Yeah. Probably that came close to a second degree they were so bad. But that's it. That's what I can remember. Really bad sunburns. Yeah, yeah. A sunburns probably like hot stove when you were a child, I'm sure, that kind of thing. Probably, yeah.

I'm sure that I burned myself earlier than this. Seared into my memory is the summer of 1997. I was running around my friend's yard, Kathleen. She lived down the street from us in Kentucky. And we had a bonfire going. It was classic. It got a bunch of neighbors there. Hot dog smores the whole nine yards. And I see a marshmallow on the ground near the fire. Never wanting a marshmallow to go to waste, I pick it up. And it takes a few seconds to register that what I was holding was not, in fact, a delicious marshmallow, but it was a white hot ember that had shot out of the fire and into the grass. It was looked just like a marshmallow. And I had a rough time for a few days, but ultimately it was a very minor burn,

like very minor, right? I iced my fingers. I covered them in aloe. I soaked them in water, cold water overnight. And I was fine. This story is not unique. And I'm sure everyone has a story just like this, or one much, much more severe because I was extremely lucky. Hundreds of millions of people are burned every year, which is, I would guess, a conservative estimate, and nearly 200,000 lose their lives around the globe every year due to burn injuries. Burns are a routine feature of our lives as human beings, and that's been the case for a very long time. My story of picking up a white hot ember, not only is that a common story today, it's been a common story for hundreds of thousands of years.

Wow. At least. Okay. Okay. Many a paper that describes the history of burn treatments starts off with some variation of ever since man discovered fire, he's had to deal with burns. Yeah. So many of them start just like that. And it's the truth.

Like, it is absolutely the truth. I mean, sure, there may have been some hot springs accidents or severe sunburns, lightning strikes, wildfires maybe that caught up with early humans. And in this, we're no different than the other animals that have suffered the same fate for the 400 million years that fire has been possible on this planet. Whoa. It wasn't possible before that. It was only once. Because no oxygen or why? Oxygen and land plants.

Okay. Okay. Fascinating. fascinating, yeah. But it's the domestication of fire that sets us apart. Controlling and creating fire, making fire, gave us warmth. It protected us from predators. It provided a means of cooking, giving us access to higher quality in more easily digestible foods, which provided the energy needed to fuel bigger brains. It helped us to make tools, weapons, and ceramics. fire is a fundamental essential step in hominine evolution second in importance only to language which may have been encouraged by fire

without fire we would not have developed into the humans that we are today wow at all burns are a consequence of fire domestication for the large part thanks a lot prometheus just kidding sorry deep cut I like it But as our homin and ancestors learned to use fire, first by controlling wildfires, then making fires from scratch, they were sure to suffer burns. Just last year, a paper came out that pushed back the estimate of fire making to actually originating fire to 400,000 years. Wow. So researchers found compelling evidence of fire making in eastern England in Neanderthal sites. And before this, the earliest evidence was like 50,000 years, which didn't mean that people thought it wasn't older, but like this was like pretty. That was the only evidence they had.

Okay. Wow. But it's likely that our hominin relatives had been controlling fire for much longer than that. Perhaps as far back as like one and a half million years, they would have had to in order to migrate to regions with colder climates in the first place. Okay. All this is to say. This is my long, my long winded way of saying, ever since. man discovered fire, he's had to deal with burns, right?

We've been dealing with burns for hundreds of thousands of years in the quest to harness fire. Okay. And throughout all that time, humans have attempted to treat the burns that they experienced. And of course, we can only guess that the variety of remedies used before the invention of writing, but it's likely they were plant-based. Like there is some evidence for that, including a ghost citation I couldn't track down, so I'm not going to even reference it. But our earliest confirmed insight into the treatment of burns comes from the medical text from ancient civilizations that were used to encountering.

You know, the Ebers Papyrus, the Hippocratic text, medical treatises from China, writings by Shusruda, and so on. The majority of these treatments for burns were centered on the application of like a goo or an ointment or a cream to the burn itself, to the actual location of the burn, with a little bit on pain relief and maybe early like debreedment. type of approaches. Interesting. Okay. Yeah. Ancient Egyptian physicians seemed to favor recipes that included resin and honey or oil-soaked linen wraps, but milk also made an appearance, specifically goat milk or milk from women who had given birth to a son. Interesting. I don't know if that means like, highly specific. Right. Only sons. Only sons. Only sons. Only sons. Only sons. Only sons. Do you have sons and you know? I don't know. Fascinating. Other remedies. Like you had a son before, but now you just had a daughter. Like, does that, is that okay? I don't, yeah, you'll have to ask.

We need more detail. The author of the text. Yeah. Okay. Who might not be reachable. But the other other remedies called for a sequence of different ointments to be applied. So like day one, black mud, day two, boiled cow dung, so on and so forth. Animal products feature prominently in many of the recipes from ancient Egypt, Greece, Rome, and India, not just milk. Like, for instance, Bulls fat boiled with papyrus is one treatment. The Hippocratic text recommend that for a burn you should, quote, take melted fat of old pigs, mix it with resin and bitumen, spread it out over a cloth, warm it at the fire, and apply it as a plaster, end quote. Dung was also a popular choice, specifically hares dung and she goat dung. She goat.

She goat. She goat. She goat. She goat. Okay. She goat. She goat. Okay. Eggs here and there were mentioned, you know, hard-boiled yolks mixed with rose oil as an example. There were also many plant-based remedies as well. So in ancient China, tea leaf

extract was applied to burns. In ancient India, you might get an ointment made from butter mixed with the bark of a fig tree. To quote from a 1977 paper by Thompson on the history of burn treatment, quote, it would be tedious and not a little revolting to detail all the hundreds of variations on this theme, end quote. Fair enough. Fair enough. But hopefully I've given you a small taste of the variations on this theme. And I think that there are two main takeaways with this foray into ancient burn treatment.

First, there are a lot of treatments, which suggests, of course, that this was a problem encountered frequently enough to keep trying new things. Right. And everywhere. So everyone's got their own version of a treatment. Everyone's got their own version. And because there was no. clearly single reliable remedy, people were constantly inventing new recipes. Right. And second, by and large, treatments were topical aimed at promoting healing and providing relief. And when you think

of these in comparison to the full-scale multi-specialty approach that we use today, it's barely a drop in the bucket. I mean, they were doing the best that they could with the knowledge that they had. And as that knowledge grew, so did their approaches, but not necessarily with. with success. Just sort of there were limitations for thousands of years. By the middle ages, the list of options for treating a burn had grown tremendously. So I'm sure, still plenty of people were opting for raw onion slices, which remained popular for long, like a really long time, actually, with Ambrose Paray employing onions and salt allegedly effectively in the 16th century. But there was one sizable shift in focus over that time, and that was sort of.

sort of towards temperature. So physicians found that topical treatments that invoked a cooling sensation or were themselves cooling, like melted snow, provided relief to those with burns, especially with superficial burns. Others suggested that treating like with like, so applying heat to the burn, would yield more positive results, especially for those with deep wounds. Okay. Yeah.

The first book dedicated to burns, a day combustion. Ginebus was written by Fabricius Hildonus in 1607, and it warned that if cooling were applied to burn skin, it would, quote, harden like fat when it is cooled and thus shut in the moisture. How fascinating. Okay. So keep things warm. Keep things warm. Keep things flowing is kind of like their idea.

Okay. But this book also was among the first to propose treatments for contractures. Okay. But which did you, did we talk about contractures? No, but I'll talk more about it next week. Okay, okay, so we'll get there. Stay tuned for explanation on contractures. But this idea of treating burns with heat, it was, yeah, kind of like to keep things flowing,

prevent fluid accumulation, and encouraging this like, yeah, just free flow. Free flow. Okay. Shakespeare even makes a reference to heat treatments in King John and falsehood, falsehood cures as fire cools fire within the scorched veins of one new burned. I'm really great at reading Shakespeare. Nailed it, Aaron. I remember for a really long time, we had to do iambic pentameter or speak in Iambic pentameter in like 10th grade English. And I was just like, I don't get it. And it's been a block for me ever since. So there you go. But this debate, cold versus heat, it went on for hundreds of

years. And it wasn't the only debate. There was an argument over whether open air exposure or covering a burn in dressing soaked with various substances was the better approach. Then there was a discussion over which substances and which dressings, you know, whiskey, linseed oil, olive oil, alkaline, water, lead, silver, linen, wool, cotton. Then you could argue over whether you should feed your patient and provide plenty of fluids or do some bloodletting and purging. Everyone had their favorite approach, backed up by an anecdote, a gut feeling. professional pride, take your pick. This lack of consensus on how to best manage burns,

it plagued doctors throughout the Renaissance and into the 1700s and 1800s. Wars, industrial accidents, and train crashes served as a painful reminder that, in fact, medicine had not substantially advanced since the time of Galen and Hippocrates when it came to Burns. What was needed to make any type of progress

was consensus. First and foremost, on how to measure the severity of burns and the rate of healing. Because only then could you compare treatments or approaches. Only then could you pick lead ointment versus whiskey, ice water versus warming cloths. Only then could you have a hope of saving someone's life. How do you get consensus? You gather data. In the early 19th century, Guillaume Duputrin reviewed 50 cases of burn patients and followed their treatments and outcomes.

And with this information, he put together a class of. specification system for burns organized by depth, similar to the degree system that many people are familiar with today that we just went through. His was not the first burn grading system overall, but it was the first to relate burn severity, depth and total area, with mortality. With this system, doctors were not just treating burns. They were measuring them. Establishing this baseline was super important to compare different approaches. You know, again, Turpentine versus Linstein, look the same in a severely burned individual, but if you tried them out on a more moderate or minor burn, you might see a difference in healing. Right, right, right, right. And it also opened

the door to other kinds of treatments entirely, not just those based on topical ointments, such as surgical approaches, skin debreedment and skin grafts, supportive therapies in the form of fluid replenishment, pain relief. By the end of the 19th century, many, though not all of the pieces, were there to revolutionize burn care. They were just sort of like scattered all over the place, waiting for someone to put them together. Okay. Up to this point, so around, I'm going to say the early 1900s,

for pretty much all of human history, Burns had remained out of reach for physicians who could at most hope for the body's innate wound healing methods to kick in as they, the doctors, provided some modicum of pain relief. Frankly speaking, medicine, had made no progress in increasing survival or healing in burns. That's so wild, even into the 1900s. Into the 1900s. And if this story so far feels unsatisfying or incomplete, then I've succeeded. That's what I, that was my aim here. Like I wanted to spend this episode, this, my part of this

episode, taking us through the desperate centuries and millennia in which medicine remained completely in the dark. So that next week, when we, we get to share the story of how that changed, when we get to really take stock of how far we've come and stand a little bit in awe of scientific progress, what funding for research has helped us to achieve and how working across disciplines can make a huge difference so that when we get there, we get to go, oh my God. Oh, my gosh. We've actually come so far.

We actually have. But that's where I'm going to stop it here. So I love it, Aaron. For now, we can fill you in on where you can read more. There's a lot. There is a lot. There is a lot. So I'm going to shout out just three sources in particular. There's 1986, History of Burn Care by Pinnigar and Pinnigar. Then 1977, Thompson, historical landmarks and the treatment of burns. And then by Van He from 2007, from fat of old pigs to fenestrated skin grafts. I have lots more. Lots more on the site. I can't wait. My absolute favorite paper that I read for this. next week's episode is by Jeski. I'm so sorry if I said that wrong at all from nature reviews,

disease primers. Love it when there's one of these from 2020 called burn injury. And it was, I mean, it's so good. It's so comprehensive. It has everything. But you know that there's also more. So if you want way more in-depth information about the response and the path of physiology and

all of this biology, don't you worry, because we have the list of all of our sources. On our website, this podcast will kill you. under the episodes tab. We do. Thank you to Bloodmobile for providing the music for this episode and all of our episodes. Thank you to Leanna and Tom and Mark and Pete and everyone at exactly right. Yes, thank you. Thank you to everyone. Thank you to everyone. And thank you to you, listeners. We and watchers, anyone who participates in this podcast in some way, we really do appreciate you tuning in

and telling us what you think and just sharing this? I don't know, everything. Yeah. Thank you for being new. And a special shout-out, as always, to our patrons. Thank you so much for your support over on Patreon. It really does mean so much to us.

Truly, truly. Until next time, wash your hands. You filthy animals? How much you wait, Wanda? Right now, I'm about 130. I'm at 183. We should race. No, I want to leave here with my original hips.

On the podcast and matchup with Alia, I pair prominent female athletes with unexpected guests. On a recent episode, I sat down with undisputed boxing champ, Coresa Shields, and comedian Wanda Sykes, to talk about Wanda's new movie Undercard, the art of trash talk, and what it really means to be ladylike. Open your free I-HeartRadio app. Search the matchup with Alia and listen now.

Brought to you by Novartis, founding partner of IHeart Women's Sports Network. Before Nexium, Nancy Solzman wanted to help people. Being able to help somebody, it's probably the biggest motivator of my entire life. She trained in something called neurolinguistic programming. People loved our training. Then everything changed.

Yeah, and they called it a cult. How does a method designed to improve lives end up in a cult? A knife in the hands of a surgeon is an amazing tool. A knife in the hands of a murderer is a weapon. Listen to Mind Games on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Anna Navarro, and on my new podcast, Bleep with Anna Navarro. I'm talking to the people closest to the biggest issues happening in your community and around the world. Because I know deep down inside right now, we are all cursing and asking what the bleep is going on.

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