Treatment of Burns and Tropical

Ulcers With Penicillin

By Daika

SINCE reading in a 1946 copy of PIM where “JDW” reported his ex periences with the use of penicillin in the treatment of tropical ulcers by skin grafting, others have found that by using similar methods to those he de scribed, the results have been equally successful.

It was found also that, if a large, acute tropical ulcer was treated with a solution of penicillin in sterile normal saline (0.9 per cent.) it would, in most cases, heal without extensive scarring in a shorter time than if the accepted method of treatment were used, and this does away with the necessity of skin grafting at all (which was often the only way such tropical ulcers could be healed without fear of their breaking down and recur ring periodically).

I would like to state that I am not a medical officer, but that my experience has been gained by close contact with large numbers of natives over a number of years, in both Territories of Papua- New Guinea as a member of ANGAU, the Administration and the missions.

The treatments used were as follows: For a large and chronic tropical ulcer it was found that after cleaning, a solu tion of penicillin in normal saline well soaked into a dressing and applied daily for one week would stop active infection, and often, in that time the lesion would be completely healed.

If a skin graft were necessary, the best method was found to be a thorough

irrigation of the ulcer with the penicillin solution, then the skin graft applied, and a wet dressing of penicillin firmly bound into position. This was left in place for five days, and it was invariably found, on removal, that an excellent percentage of the grafts had taken.

This was always followed with a fur ther application of the penicillin solution under a firm strapping of adhesive bandage (elastoplast) which was left in position for a further five days. Usually in that time, healing would be complete, or at least so far advanced that one more application of the solution would com plete the treatment.

IN treating native patients suffering (from extensive burns—usually caused by children falling into the fire, or a house burning down around a family— it was found that most patients suffered from infection of the burnt areas either before coming into hospital, or shortly after admission.

One such case (photo next page), a casualty from a house fire, suffering from second and third degree burns of the back, face, and arms was admitted to hospital a week after the accident in an unconscious state. During that pre vious week, two days were spent lying in his village while others who had died in the fire were buried; and five days were taken up while the patient was carried to the hospital. No treatment, other than wrapping him in banana leaves, was given him, so the state of his burns on admission to hospital, can be imagined.

As the patient was in such a bad state, the burnt areas were treated conserva

tively. The original treatment consisted of removing obvious debris only—no attempt being made to clean away de stroyed skin or small debris. The clean ing was carried out with the penicillin and normal saline solution mentioned earlier; after which large dressings of the same solution were applied, and every two hours these dressings—without being removed —were soaked well with the penicillin solution. In the meantime, routine treatment for keeping the patient alive was carried out, plus large doses of penicillin given intramuscularly.

After three days, as the patient had regained consciousness and was slightly improved, the dressings were removed

and the burnt areas cleaned, again using penicillin. The improvement in that short time must have been seen to be believed. The badly infected areas were reduced considerably in. size and were surrounded by healthy, healing tissue, and some of the deep third degree areas had already started to heal. Another application of penicillin was made and the soaking of the dressings was cut down to every four hours, as the patient com plained that the continual applications kept him awake. This was kept up for four more days at which stage the dress ings were again removed. It was found then that healing around the edges of the burnt areas of the back was well

advanced. The bums on the face were completely healed, as were most of the burns on the arms.

Owing to the fact that healing was so rapid, a dressing of Tulle Gras was ap plied over the penicillin, and was left in position until the patient complained that the itching was so bad that he couldn’t sleep. When the dressings were removed this time, there was no sign of infection. Healing, with the exception of a spot on the neck and a small area

Showing burns on back of patient.

low on the back, was complete. In a couple of days, they too, were completely healed.

IN this case skin grafting would prob ably have been necessary if any other treatment had been carried out.

Patients treated by the method described have a better chance of obtaining a com plete healing in quick time than if treated by the conventional methods. And, in the past three years, when I have had the penicillin to use, there has not oeen one patient return to hospital with a broken-down ulcer.