History of the Burns Unit Melbourne

  • The Murray Clarke Oration By Mr E.J. Keogh

    Alfred Murray Clarke was born in China in 1909 and died on the 14th August 1987. His great interest in surgery was the care of children with burn injury. Early on, he recognised that the overall care of children with burn injuries would greatly improve with the "team approach" - the coordination of the collective expertise of all involved in their care: These included nurses, doctors, physiotherapists, social workers, occupational therapists.

    The Board of Management of the Royal Children's Hospital established a Burn Unit in 1955. Along with the initiative and efforts of Murray Clarke, inspiration for this new Unit was provided by the visit to Melbourne of Dr Leonard Colebrook from a pioneer Burn Unit in Birmingham, England. The author of the History of the Royal Children's Hospital, Peter Yule, writes:

    "The Committee and Senior Medical Staff of the Children's Hospital had been concerned by the large number of burn patients at the hospital, with 10% of surgical beds occupied by children with burns, half of whom were aged between one and three".

    Soon after Dr Colebrook's visit, the Committee agreed that a Burn Unit should be developed in part of Ward 10." This was the first paediatric burn unit in Australia, and one of the first in the world. Dr Clarke was the first supervisor of the Burn Unit and he recalled that its establishment "was a very big step, because at that time, burns were treated by general surgeons in various wards"..
    Peter Yule goes on to say, "the concentration of patients in the Burn Unit and the consequent development of expertise in their care led to rapid improvement in the treatment of children with burns and scalds. It was one of the first in the hospital to develop the modern system of a team approach to patient care." He quotes the Burns Charge sister of the day, the great Val Duke: "It was the first ward where I saw teamwork with patients. We had the physiotherapists, the occupational therapists, coming to the ward areas instead of the patients going to them. We had dietitians involved. It was the first time I experienced total patient care where we have all the other professionals involved in the care of patients." It is interesting that the team approach, introduced so successfully to burn care in this hospital back in 1955, is now again being actively promoted for general application by management at this hospital.

    Murray Clarke was a man of vision. As a specialist burns surgeon, he recognised the recurring nature of serious accidents, exemplified by those children who sustained burn injuries. He believed most accidents could be reduced in frequency - if not prevented - by education in safety, by the better design of homes and domestic equipment and - if necessary - by the introduction of appropriate legislation.

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    With the goal of establishing safety standards for children's nightwear, he established a close, friendly and extremely productive collaboration with Dr Tom Prestley of the CSIRO Division of Protein Chemistry in Parkville. A recent issue of the CSIRO publication, Helix, (August-Sept 2001, No. 71), recalled for me some of the work done by the late Tom Prestley on the flammability of textiles.

    Only weeks before the first Qantas jumbo jet was to leave on its inaugural flight in 1971, a problem arose which threatened to dent Australia's prestige overseas. Qantas intended to furnish their Boeing 747s with wool seat-covers (a discrete promotion of Australia's finest product), but the Boeing Corporation in America was worried about its perceived fire hazard. CSIRO research scientist, Dr Tom Prestley, began researching fire retardant agents and, with the help of the Wool Corporation, was able to send enough non-burning wool to Boeing to furnish the 747. Soon after, an article published in Choice Magazine claimed that fire safety labels on clothing were inaccurate, and often contradictory. This convinced Tom to continue his work on the flammability of fabrics. He debunked the popular notion that girls in nightwear were most likely to be accidentally burned. In fact, he found that it was boys dressed in day-clothes who were most at risk. Subsequently, fire safety standards were immediately re-written.

    With scientific evidence gained through research, Murray Clarke began work on achieving legislation to enforce safety standards, becoming a consultant to the Standards Association of Australia Subcommittee, which drafted flammability safety standards for children's nightwear. With the wool research for Qantas came the collection of data Australia-wide on burn injury sustained by children wearing nightwear. Tom with co-workers, Peter Gordon and Caird Ramsay at CSIRO - tested all burned garments collated at the Royal Children's Hospital (and other burn units throughout Australia?). This research was a cooperative effort of all burn unit staff in this country. It led to an Australian standard for children's textile flammability - a standard that was then adopted world-wide and which manufacturers of children's nightwear are obliged by legislation to adopt. .Subsequently, standards were published setting out the textile flammability of night clothes. That standards report, which is now a joint Australia and New Zealand standard, was updated three years ago, and I have attended meetings reviewing these standards every five years.

    I feel very strongly, as did Murray Clarke in his lifetime, that while on the one hand we are called on to treat patients with burn injuries, we also have a major obligation, from our privileged knowledge of the nature and causes of burn injury, to take steps to educate the community, its leaders and representatives, on ways to reduce the incidence of burn trauma. A significant by-product of the collaborative research on textile flammability in Australia was the foundation of the A N Z B A.

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    In September 1974, when the International Society for Burn Injuries (ISBI) held its quadrennial congress at Buenos Aires in Argentina, Murray Clarke was the Director of the Burn Unit at the Royal Children's Hospital, Melbourne, and one of the Foundation Members of the International Burn Society. It was apparent to Murray that most countries had a national association of Burn Carers, and that there was no such group in Australasia. He was also of the opinion that, in our country, we were geographically isolated from other burn centres. So he established a Travel Fund for the purpose of sending Australian burns professionals to international meetings. In 1974, it was able to send six members of the Burn Team of the Hospital to Buenos Aires, to give papers. Furthermore, the CSIRO sent Dr Prestley, who presented his work on the textile flammability of the garments of children who sustained burns when their nightclothes ignited.

    The Buenos Aires meeting was held at the Sheraton Hotel during times of significant political upheaval in Argentina. I can recall feeling very ill at ease, with an armoured car in the forecourt of the hotel, and security personnel moving through all floors of the building. Despite the uneasy political climate in the city, on one occasion we had lunch at a small, cheap local bistro where our concerns at the absence of a Burn Centre in Australia were shared with John Heslop from Dunedin, New Zealand, and John Masterton of the Alfred Hospital, Melbourne. We resolved when we returned home to establish an association of burn carers, and the Australia and New Zealand Burn Association came into being.

    Murray Clarke conveyed our ideas to colleagues in Australian, with John Heslop doing likewise in New Zealand. Subsequently, an interim committee of the Association was formed by a number of surgeons attending the Royal Australasian College of Surgeons' Annual Meeting in Queenstown, New Zealand in 1975.

    The Inaugural Meeting of the A N Z B A was hosted by John Marsterton at the Alfred Hospital in Melbourne in July 1976. On that occasion, the complete journey of burn care was discussed; there was there was a full exchange of information from four concurrent workshops which were subsequently reported to the general body of those attending.

    At the Business Meeting, the Australia and New Zealand Burn Association was formally constituted, with John Solomon as President and myself as Secretary/Treasurer, and Committee representing each state in Australia and New Zealand.

    I believe our association, when established, was unique in that our membership was made up of disciplines of nursing, medicine, allied health and ambulance personnel as well as research scientists. In fact, anyone interested in the care, research or prevention of burn injury. The concept of "the burn care team" - the idea of the dissemination of knowledge and the sharing of ideas amongst ALL workers in the field, was raised to a new plane in Australia and New Zealand.

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