Elsevier

Burns

Volume 26, Issue 2, March 2000, Pages 117-130
Burns

Historical review of the use of silver in the treatment of burns. I. Early uses

https://doi.org/10.1016/S0305-4179(99)00108-4Get rights and content

Introduction

Many agents have been used for the treatment of burns over the centuries. The well known ‘Cruydt-boek’ [Herb Book] by Rembertus Dodonaeus1 (1644) already contained 73 herb preparations [1]. James Earle (1755–1817) [2], known for his early use of ice-water for burns, complained in 1799, “there are few accidents or maladies to which mankind are subject, which have met with a greater variety of treatments than burns.”

There are still countless possible treatments at the present time, and it seems unlikely that the situation will change appreciably in the foreseeable future.

One of the agents which has gained an established place in the topical treatment of severe burns is silver, presently in the form of silver sulphadiazine cream with or without added cerium nitrate.

Reviews of the application of silver to burns usually refer to Moyer, who popularized treatment with silver nitrate and who was responsible for a break-through in the treatment of burns [3]. He stressed in his publications that his proposal to use silver was not original [3], [4]. Intrigued by this remark, we surveyed the literature to trace past references to the therapeutic use of silver compounds.

Section snippets

Early times

The first topical applications of silver nitrate were probably for the treatment of chronic wounds or ulcers. Silver nitrate seems to have been used in the solid, hardened form, which is known under many different names. Practically every language has its own term for this substance: apart from the usual English term ‘lunar caustic’ we have e.g. lapis infernalis in Latin, Höllenstein in German and pierre infernale in French. It will be seen that in all the languages mentioned apart from

The use of silver nitrate in the treatment of ulcers in the 17th and 18th centuries

The external application of hardened silver nitrate must be of great antiquity. Most authors refer to the Middle Ages as the period in which its use began [12]. Some suggest tentatively that the monk Basil Valentine (Basilius Valentinus) may have discovered silver nitrate in the 15th century [13]. Others suspect that Basilius Valentinus never existed, and was a pseudonym of Paracelsus2

Silver nitrate for slow healing and ulcers due to burns in the 19th century

Until the discovery of skin grafting as a reproducible method of speeding up the healing of wounds, the possibilities of achieving healing of deep, extensive burns were limited [37]. In deep burns, where no vital epithelial components were present in the surface of the wound, healing depended on epithelization from the wound edges and on contraction. It was thus to be expected that large wounds, and those in unfavourable places, would heal slowly. Colonization by micro-organisms also retarded

Bacteriological aspects

The development of bacteriology has strongly stimulated investigation of the effect of all kinds of substances on micro-organisms, although the use of medicaments on an empirical basis still continued for a considerable time after this. In a historical survey of the effects of silver, Issekutz mentioned that Billroth was the first to demonstrate the bacterial properties of silver, in 1874 [12]. Behring commented in 1887 that little was known about the effect of silver on micro-organisms [65].

Silver foil in the treatment of wounds

In contrast with the use of silver salts, silver foil continued to interest surgeons. Applications are still found regularly during the first few decades of the 20th century. Two main fields of applications may be distinguished: (1) for the treatment of (burn) wounds [74], [75], [76] and (2) for the treatment of graft wounds [74], [77], [78], [79], [80], [81], [82], [83]. As late as 1919, Lotichius advised application of silver foil to second-degree burns after removal of blisters, until

Silver nitrate and tanning

The search for treatment of toxaemia, the clinical syndrome elicited by toxic substances and leading to a life-threatening situation, was intensified in the early decades of the 20th century [89]. All kinds of attempts were made to bind these (hypothetical) toxins. The proposal by Davidson to treat burns with tannic acid should be seen in this light [90]. His published results were based on the treatment of 25 patients. The fresh wounds were dressed with sterile gauze and bandages, which were

Summary

Silver, e.g. in the form of hardened silver nitrate (lunar caustic), has long played a role in the treatment of burns.

In the 18th century, lunar caustic as lapis infernalis was commonly called then was already used to remove granulation tissue from wounds which were healing slowly or not at all. In the 19th century, lapis infernalis had won a permanent place for itself for this indication. “Argentis nitras is the best of the mildest caustics. Its utility for stimulating indolent ulcars, and

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