Any physician who is called on to treat a child who has just been severely burned finds that he has a number of difficult therapeutic problems before him. Initially, he must care for the burned area or areas. Following this, during the first few hours and sometimes up to several days, the problem of shock arises and, along with it, the rapid changes of intravascular physiology, as indicated by the changing hematocrit and plasma volume. An excellent monograph on the therapy of these and other problems in burned persons has been published by Harkins.1 If the child survives these crucial days, the physician is then frequently confronted with the following problems: (1) marked pyrexia, (2) marked anorexia leading to weight loss and malnutrition, (3) marked irritability and emotional instability and (4) loss of body proteins from the burned areas.
The first three problems are related to each other and