Burns and Infections: The Birmingham Accident Hospital

Dr Jonathan Reinarz

Nearly 60% of burns patients die of infections contracted after their initial injuries. Historically, burns-related infections have proved particularly challenging. Burn wounds contain devitalised tissue and remain moist and warm during the healing process, thus an excellent breeding ground for bacteria. In the early twentieth century, burns did not appear to respond to existing antiseptic methods. Many doctors believed that burns themselves released toxins and attempted to neutralise these by treating burns with dyes and acids, which often hindered recovery. As a result, many practitioners continued to regard the infection of burns as inevitable.

In the 1940s, important research in this field began to be undertaken in the English midlands at Birmingham Accident Hospital. When an existing general hospital on Bath Row in the city centre was moved to facilities behind the newly constructed Birmingham Medical School in 1938, the old site was renovated and reopened in 1941 as the Birmingham Accident Hospital. (Incidentally, the site was also the last voluntary (or charity) hospital established in England and Wales before the introduction of the National Health Service). The new hospital’s Surgeon-in-Chief and Clinical Director William Gissane (1898-1981) regarded this as an experiment in the care of trauma in order to improve local accident services, which were inadequate across the country. At the outbreak of the Second World War and the associated production of military hardware, this had become obvious; the incidence of local industrial injuries, including burns, increased by 40%. During 1943, a small unit to treat burns and scalds was opened, and Gissane invited Leonard Colebrook (1883-1967) to be its first Director. Like Gillies (see yesterday’s post), Colebrook was a veteran of the Great War and contributed to a Government-appointed war wounds sub-committee run by Archibald McIndoe during the Second World War. Colebrook had investigated the bacteriology of wounds at the burns unit at Glasgow Royal Infirmary, where he had previously investigated puerperal sepsis in maternity cases. He therefore had experience of both burns and streptococcal infections when called on by Gissane to run the Medical Research Council-funded unit.

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‘The Topical and the Local’

On arrival, Colebrook quickly turned to the investigation of streptococcus infections in burns. With new topical anti-microbial agents, such as penicillin and propamide, he and his team managed to reduce the prevalence of these infections to 5%. Controlling infection, whether through topical creams, or ventilated wards and bandaging stations, allowed for new burns treatments, such as early excision, which is still described as an important measure to prevent infection as well as disfiguring contractures. When he retired in 1948, Colebrook turned to organising local and national burns prevention campaigns, focusing, for example, on safer electrical heaters and the introduction of less flammable clothing for children.

Colebrook’s successor was Edward Lowbury (1913-2007), who became bacteriologist at what was later renamed the MRC Industrial Injuries and Burns Research Unit in 1952. Among other things, Lowbury initiated the first properly controlled clinical trials in burns, and infection rates continued their downward trend, until the emergence of antibiotic-resistant bacteria in the late-1950s. The introduction of silver nitrate in 1966 halted this rise, but rates would continue to fluctuate, as safer alternatives were introduced. By 1963, the burns unit had already become a large regional centre comprising 36 beds, a ‘clean air’ dressing station and expanding research facilities, with Lowbury compiling a unique record of resistance changes until his retirement in 1979. Treating over 18,000 burned patients between 1941 and 1993, the burns unit developed a planned, systematic approach to the treatment of these injuries, which greatly reduced the frequency of associated infections.

Problems of infection in hospitals in the wider Birmingham region led to the establishment of the Hospital Infection Research Laboratory in the grounds of Dudley Road Hospital (later City Hospital) in 1964. Administered by the MRC Burns Unit and under the direction of Lowbury, the laboratory assessed the number of infections in regional hospitals, determining causes when possible. Although the Accident Hospital closed its doors in 1993, the Infection Control Research Laboratory continues to exist in a new location. Many of its earlier recommendations for controlling infection are still in place today. With the laboratory celebrating its 50th anniversary this year, staff have organised a commemorative conference, and the History of Medicine Unit at the University of Birmingham has organised an exhibition on ‘the history of hospital infection’, which will be on display in the foyer of the Medical School until the summer.

Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.

 
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