Following an extensive thermal burn, a complex derangement of normal physiologic processes develops, which can be separated into at least two components, shock and toxemia. Most of the recent developments in the systemic treatment of burns have been directed toward decreasing the severity of shock, and as the treatment of shock has improved one has seen more patients survive the period of shock only to succumb to toxemia.
For many years shock and toxemia were regarded as one process. Observers debated whether the whole picture was due to toxins produced in the area of the burn and distributed throughout the body by the circulation or whether the local loss of plasma in the burned area, with the resultant disturbance of circulatory dynamics, was the primary cause of systemic damage.
In 1923 the toxin theory, supported by the work of Boyd and Robertson,1 was in the ascendency, but during the
WALKER J, SALTONSTALL H, RHOADS JE, LEE WE. TOXEMIA SYNDROME AFTER BURNSBIOCHEMICAL AND PATHOLOGIC OBSERVATIONS AND STUDIES. Arch Surg. 1946;52(2):177-186. doi:10.1001/archsurg.1946.01230050181006