A method of managing serious burns which is in use at Groote Schuur Hospital has been descriptionbed. The prompt treatment of shock is emphasized and it is suggested that burns exceeding 10% of the body surface of adults and 6%of the surface of children should be regarded as serious. Intravenous therapy and ancillary methods of treating shock are descriptionbed. It is pointed out that the burns should be cleansed in an operating theatre and that general anaesthesia should be used. Two methods of local treatment, viz. exposure and absorbent dressings, are descriptionbed. The exposure method is preferred in children. The value of general treatment and repeated blood transfusions is noted, the subsequent care is outlined, the control of infection is discussed, precautionary measures against scarring and deformity are descriptionbed and the value of grafting deep and infected burns is stressed. Details of patients treated over a period of one year are briefly discussed and 40 cases in children are analysed. The mortality in this series was 2%and the average stay in hospital was 7 weeks. The survivors include a boy of 10 years who sustained deep burns covering 65%of his body surface. With the aid of blood transfusions, ACTH and repeated skin grafts he is now well, with minimal deformity. In conclusion the great value of early skin grafting is re-emphasized.
A case of nephrosis in a child aged 3 years is recorded. Clinical recovery following treatment with cortisone and ACTH was accompanied by a dramatic reversal of the marked metabolic changes which occur in this disease (Fig. I and Table I). With the onset of diuresis as shown by rapid loss of body weight the albuminuria ceased abrupt1y, there was an increase in the serum albumin concentration and a gradual return of the A /G ratio to normal. The serum cholinesterase activity which was initially raised above 'normal' levels decreased rapidly below normal as the serum albumin level rose with cortisone therapy. An attempt is made to correlate the fluctuations in cholinesterase activity with the liver function in nephrosis and the effects of cortisone. In contrast to cholinesterase, the level of the serum protein-bound iodine (PBI), which was initially markedly below normal, appeared to be associated with cholesterol rather than with protein metabolism or proteinuria. The significance of this finding is discussed and it is suggested that the persistently low PBI following cessation of the albuminuria indicates that the loss of thyroid hormone in the urine attached to protein may not be the explanation for the low serum PBI. Its association with a persistently high serum-cholesterol level is in favour of a hypothyroid state.
*A paper read at the First Paediatric Congress, held in Durban, 20 August 1953. A positive approach is the best policy. Radiate complete confidence. There must be less 'babying' and less emotionalism. The child must learn confidence and selfrespect. If these methods fail after a few months of serious endeavour there is every likelihood that uropathology exists and the child should be referred to a uro-surgeon for a thorough overhaul. Retrograde and intravenous pyelography, as well as cystoscopic examination will reveal any gross anatomic abnormalities. The importance of a careful chemical and microscopic urinary analysis is often overlooked. The constant appearance of red or white corpuscles in the urine would point to an organic lesion.
It is popularly supposed that syphilis is acquired only congenitally or venereally. But where suitable conditions favourable to its spread are found, namely a high syphilis rate and low standards of living, it is possible for the disease to spread by contact among the age-group most vulnerable, the children. The disease is probably endemic, but improved medical supervision may make it appear as a sudden outbreak or epidemic. The signs of the disease are indistinguishable from congenital syphilis or from secondary venereal syphilis, its true nature being suspected only from the age-group attacked and the suggestion of contact-spread.