the highlighting of numerous chemically active toxic substances in the fire smokes enables the assertion of the reality of the entity and helps to understand its mechanism.

use of such solutions could have a positive effect even in case of late application. It is then necessary to develop a more and more universal solution that could neutralize a lot of chemical agents, as well as it is necessary to develop more specific solutions.

1.1.3  History of the Treatment

of Chemical Skin Burns

For a long time, the only applied and applicable treatment of chemical burns was water washing. The importance of the time passed between burn and the washing was an evidence. In front of the importance of pain and lesions, the idea of neutralization came out using the following reaction

Acid + Base → Salt +Water

but it was soon noticed that the treatment was not perfect because it required a balance of one to one molecule of the reagents and the exothermic character of the reaction was ignored.

So, the treatment of an acid burn by a base resulted in the following reaction

Acid + excess of base ® salt + base + heat with following results

•Possibly an acid burn due to the first instants of contact

•An alkali burn

•A thermal burn!

What an ambivalent result!

Before the little convincing result of this treatment, it became recommended to wash only with current water.

From the 1970s, the introduction of tampon solutions or amphoteric solutions, particularly in France and Germany, was quite difficult because of the legislation, which would not include specific cases. Particularly in France, it was difficult to convince the doctors of the interest of amphoteric solutions, which did not let heat out, but brought the skin or eye to a neutral pH and left no acid or alkali residue. This situation was partly due to a weak knowledge of chemistry in the medical world, whereas it was easier to convince chemists. Anyway, the use of amphoteric solutions has little by little spread into the industrial world and lead to some exciting results. In opposition to previous reasoning, it was noticed that the

1.1.4  Conclusion

The history of the treatment of burns was first made of a long period from Antiquity to the first half of the twentieth century, during which men tried to do their best and understand the mechanisms of local burn and general symptoms from the nineteenth century. Intensive care has revolutionized the treatment and survival of burnt patients. There is a lot to expect from the future not only because of the possible development of solutions that can neutralize chemical agents and because of the improvement of the intensive care techniques, but also because of the improvement of the skin transplantation techniques or eye surgical methods and of the treatment of lesions due to gas breathing, the mortality of which is still very high and for which it will be necessary to imagine neutralization and decontamination using a spray as soon as possible.

1.2  Modern History

of the Chemical Burns

Eye burns are an old phenomenon and have been described as soon as high temperature and small amounts of concentrated liquids were available. In Antiquity, it was a common procedure to damage eyes for punishment or for assault as described in the Old Testimony.

In the Middle Ages, there were only a few historical descriptions of eye burns from hot fluids and chemicals.

1.2.1  Burns, a Disease

of Different Origins

The differentiation between chemical burns and thermal burns has first been made by ophthalmologists in the early 1920s of the last century. Poor prognosis

and early primary enucleation were due to the lack of therapeutic alternatives and resulted in devastating outcomes at this time.

cosmetics to be approved by the regulatory bodies in America and Europe.

1.2.2  Start of Medical Treatment

First systematic work rose in the highly industrialized areas of Europe when ophthalmologists were facing a lot of patients exposed to splashes of highly corrosive substances. One of the first books specialized in this topic that addressed the special problems of those patients was “Augenschäedigungen in Industrie und Gewerbe,” written by Jaensch in 1958. Jaensch was a German ophthalmologist recognizing the interaction of occupational medicine, ophthalmology, and toxicology. He lived in the area of Düsseldorf, where there were a lot of chemical and metal industry plants. Starting with lid corrections, conjunctival surgery and intraocular glaucoma and cataract surgery, the emerging possibilities of anterior segment surgery has provided the first opportunities of improvement of the prognosis of these devastating diseases. Except this experiment, within the following decades, eye burns did not interest the researchers as eye burns but only served as a model of non-healing inflammatory disease.

1.2.4  Rinsing Therapy

Beside the medical interest, the first pharmaceutical companies have offered specific solutions and installations to rinse the burnt eye. To the early recommendations of rinsing with water were added the recommendations to use phosphate buffer from Laux [19–21] whose ideas have been set up by the Winzer Company in Germany. Other recommendations were to use borate or diluted acetate solutions sold in France by a pharmaceutical enterprise directed by Jacques Blomet. In the USA, the systematic treatment and prevention program in health and occupational work started in 1959 with firms such as FendAll distributing phosphate buffer solutions. The rinsing solutions gave first efficient treatment options and a lot of severe eye burns could be prevented by the use of water and buffers.

Training and education of workers in exposed areas became a standard procedure, but the number of chemicals, their concentrations, and their use spread faster than safety developments improved, so that within the 1970s the number of victims of eye burns reached a peak in the industrialized world.

First systematic therapeutic strategies were introduced by Passow [15, 16] who recommended rinsing with water and releasing the toxic secret from the conjunctiva via the “Passow incisions.” Later on Thiel [17, 18] in Frankfurt published his work on decontamination of the burnt eye with buffers and first approached the healing of the chronic inflammation. After World War II, some young researchers tried to identify the chronic inflammation after eye burns as a crucial problem and as a fruitful field of research to address a lot of specific diseases of the eye. The test model being introduced in this field was the Draize test, which since the late 50s of the last century has served as a toxicological evaluation of chemicals, drugs, and

A new systematic approach started with the classification of eye burns introduced by Roper Hall in 1978, giving hints from the initial clinical presentation to the later outcome. The modified classification from Reim reflected the observation that limbus affection and circulation in the limbus area in the early posttraumatic phase gives major information on the later outcome of eye burns.

Thus, Reim et al. introduced early treatment options for eye burns starting with a concept of corneal opacity, limbal ischemia, and conjunctival damage. Thus a prognostic and therapeutic concept existed that made the prognosis more certain. Modifications of this concept are all based on this fundamental work.