The Use of Tannic Acid in the Local Treatment of Burn Wounds: Intriguing Old and New Perspectives

Wounds. 2001;13(4) 

In This Article

Experience with the Tannic Acid Method in the Anglo-Saxon World from the 1920s up to the Early 1940s

The tannic acid treatment of burns was adopted by many other clinicians, but in actual practice, only a few strictly adhered to Davidson's original method.[19] In the hands of others, it was soon modified to yield simpler or more efficacious treatment procedures. Beck and Powers[20] sprayed the burn frequently with a 2.5-percent aqueous solution until the wound surface was tanned. This became the standard method of treatment and was widely employed, although the concentrations of tannic acid used were liable to vary and ranged from 2 to 20 percent.[21,22,23,24,25,26,27,28] Other ways to apply tannic acid were also advocated, e.g., solved in physiological salt or Ringer's solution instead of water,[29] in the form of gels and/or ointments,[21,24,30,31,32] or as a bath.[33,34] Moreover, the use of a diverse array of additives was proposed. Hunt and Scott[35] used mixtures of tannic acid and collodion to strengthen the crust formed over the burn wound. To speed up the tanning process, Bettman[36,37] applied a 10-percent silver nitrate solution to the burn immediately after treatment with tannic acid. For protection against infection, antiseptics, such as perchloride of mercury,[25,26] dettol,[38] gentian violet,[28,30] acriflavine,[27,28] salicylic acid,[29] amyl-tricresol,[39] or hexyl-dichloro-resorcinol[31,32] were sometimes added.

These changes did not appear to influence the efficacy of tannic acid treatment, as the results in general remained satisfactory and confirmed those of Davidson. In agreement with Davidson, many authors stated that the use of tannic acid was a distinct advance in the treatment of cutaneous burns and found the care of patients relatively simple, since there was no longer distress from dressing changes. Similarly, based on clinical experience, they almost unanimously agreed upon such beneficial effects as rapid alleviation of pain, lessened infection, reduced local loss of body fluids, prosperous epithelization, relative absence of contractures, and diminished scar-tissue formation. But perhaps most important of all, good survival statistics were reported in several studies (Figure). Thus, in 1926, one year after the introduction of the tanning method, Bancroft and Rogers[40] observed a reduction in the number of deaths in patients treated with tannic acid in comparison to patients who had undergone debridement or were treated with an electric cradle; mortality rates were 22, 57, and 50 percent, respectively. Only patients treated by means of boric acid, picric acid, sodium carbonate, or magnesium sulfate, alone or in combination, had a lower mortality rate of 10 percent, but these were cases with burns of small total body surface areas requiring little therapy. In a follow-up study with 114 patients by the same authors, these preliminary findings could be confirmed.[41] In a series of 50 patients, Wilson[42] found the total number of death to be seven, of which only four (8%) were directly attributable to the injury. According to the author, this figure compared favorably with any that had been quoted from other methods. In a group of 114 patients treated with tannic acid, Beekman[43] observed a mortality rate of 14.9 percent, which was considerably lower than the death rate of 27.8 percent in the 320 patients treated otherwise. He also showed that the number of patients dying from the second to the tenth day, the period of toxemia, was strongly decreased in the tannic acid-treated group. Likewise, Davidson and Penberthy44 mentioned a drop in mortality in the period after thermal insult that was generally associated with the toxemic phase. Moreover, the results of nearly all studies carried out in subsequent years, up to the early forties, paralleled these initial observations.[24,25,26,45,46,47,48,49,50,51] In one publication only, an increase in the incidence of death after tannic acid treatment was noted, although this was no reason for the authors to reject this method since, as it was stated, it had numerous distinct advantages.[52]

Comparative mortality rates of tannic acid and other methods of burn treatment as mentioned in the literature. Note that in many instances only a limited number of patients were available to establish the mortality rates, and those patients did not always represent uniformly distributed populations with respect to the severity of the burn injury or age. This is best exemplified by quoting Ollinger[105] who stated that "for the proper evaluation of the high mortality rate in the tannic acid-treated burn patients it is essential to keep in mind that merely the most severe cases were treated with tannic acid, a group which would anyhow have shown the highest number of death." Some authors used several alternatives for tannic acid. In those cases where no overall mortality rates could be calculated,[25,26,40,41] bars depict only one other treatment method: * debridement; † picric acid and dry air; ‡ picric acid (1924-1928). For the study by Fuchs and Lutzeyer,[101] a mean mortality rate of four different treatment regimens is depicted. The mortality rate of single alternative methods was, in some cases, much higher. Thus, the number of deaths in sulfonamide-treated children was identical to that of tannic acid-treated children.

The application of tannic acid to burn wounds has not been restricted to North America and the United Kingdom. Its effectiveness was also recognized in several other countries, such as France,[53] Spain,[54] Romania,[55] The Netherlands,[56] and Denmark.[57] However, in German-speaking countries in particular, many studies were performed to rate this new treatment regimen at its true value and to compare it with the current local therapy at that time of cod-liver oil.[58] With just one exception, which was a trial with severely burned patients of whom it was doubtful whether they would have survived or not under normal treatment,[59] the outcome of those studies were in line with the Anglo-Saxon literature data. Patients did clinically well,[60,61,62,63,64,65,66] and a reduction in mortality was observed.[67,68] It is striking to note that in most cases, these positive effects were obtained with Davidson's original method that was quite strictly adhered to. The only major modification that was propagated was the use of tannic acid ointments on a basis of glycerine,[66,69] lanolin, and petrolatum-based ointment[68,70,71] or other fatty oils.[72]

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