690 Journal of the Royal Society of Medicine Volume 83 November 1990
A study of scalds in Birmingham
C G Cason SrN DN The Burns Research Group, Birmingham Accident Hospital, Bath Row, Birmingham B15 1NA Keywords: scalds; children; first aid; prevention
Summary The causes of serious domestic scald injuries in Birmingham were studied for one year. Seventy-eight people sustained such scalds, 11 adults and 67 children. Only 51 ofthe patients received satisfactory first aid. Most accidents could have been avoided and the severity of the injury would have been less if appropriate first aid had been given. Introduction Patients in Birmingham (population about 1 000 000) with scald injuries serious enough to be admitted to the Burns Unit at Birmingham Accident Hospital in the acute stage were studied to ascertain how such accidents occur. To obtain a true sample the study was restricted to the City, as less serious scalds from the region would be treated at local hospitals. Homes were visited to collect information about the accident, social conditions, family health, who was present at the time and any first-aid given; also to consider how such accidents could be prevented. Methods Ideally the patient, or if a child the parent, was seen briefly in hospital to ask permission to visit them at home after discharge. Going to their house kept the interview informal and was preferable to talking in a busy ward when patients and relatives were distressed. Questions and note-taking were kept to a minimum, much of the information could be acquired by observation and conversation. Photographs were taken of the site and utensils involved if permission was given. It was important to explain the role ofthe researcher as parents feel guilty and exposed to criticism following such accidents. Data was stored on a small microcomputer (Amstrad CPC6128) where it could be sorted, counted and cross-tabulated. An account of the visit was also stored on the computer in text form. Results
Seventy-eight patients were admitted, 11 adults and 67 children under 16 years of age. Ten patients were not visited because they were transferred or were away from home but known details were included. One family refused a visit. Three of the adults had straightforward accidents, the remainder had contributory predisposing conditions. Two were assaults concerned with drunkenness and one was mentally retarded. The other five, who were over 45 years of age, had variously: epilepsy, schizophrenia with a fractured femur, stroke or 'fainting' attacks. Of the 67 children scalded, 53 were under 3 years old, the youngest was aged 5 months; 43 were male and 35 female.
Prior medical and social care of the children Fifty-four of the children (83%) had attended clinics and 80% had received inoculations, the remainder were omitted for medical reasons or parental opposition. Most of the children appeared healthy. Of the 59 under-fives, 40 were at home all day, only 18 went to any group play. Seven were school children. There were four very large families, the remainder had up to four children. Only two families were known to social workers prior to the accident.
Family and home conditions Seventy-five per cent of parental relationships were said to be stable when the accident occurred; 64% of partners were married, 21% ofthe children were from single parent families, four mothers were divorced. Fifty-nine per cent of fathers were in full time employment, 25% were unemployed. Five mothers worked full-time and 10 part-time. Forty-five mothers were full-time housewives. Fifty-four of the patients were white, seven were Afro-Caribbean and 14 Asian. Ten families lived in flats and 58 in houses, mainly terraced or semi-detached. Forty-one were pre-1939 houses and 32 post-1960. Forty-one families lived in rented accommodation and 31 in owner-occupied homes, but these included young mothers living with parents. Forty-three 'homes were in good repair, 22 homes were in a poor state but some ofthese were awaiting or undergoing improvements. Most homes were clean and pleasant, but 10 were very dirty. Six of the council houses had tiny, badly designed kitchens with five or six doors giving access to the living room, stairs, understairs, lavatory, bathroom and outside. Only 68% of the children had a suitable outside play area, 18 had nowhere to play. Most households were equipped with a refrigerator, washing machine, vacuum cleaner, and kettle. Ninety-four per cent of families had a television set, 75% had a music centre, 50% a video recorder and 50% a car. By contrast safety devices were poorly employed. Four homes were without the statutory minimum guards on gas and electric fires, and only 25 had a large extender guard. Nineteen parents used safety gates and fourteen had electric socket covers. Forty-nine had electric kettles, 26 were jug kettles and 23 were of conventional design; only three were fitted with coiled flexes.
Monthly and daily incidence March, July and November had the highest incidence 0141-0768/90/ 110690-03/$02.00/0 of scalds. Sundays and Wednesdays were the worst o 1990 days and predictably, more scalds occurred at The Royal mealtimes, particularly between 1800 and 2000 Society of hours.
Medicine
Journal of the Royal Society of Medicine Volume 83 November 1990
Nature and circumstance of injuries Sixteen children and one adult required intravenous resuscitation and 14 patients had primary skin grafting. Twenty-four of the children had scalds involving the face. Forty-two accidents occurred in the kitchen, 11 in the living room and 15 in the bathroom. Spilt water accounted for 37 scalds, 19 from kettles and eight from saucepans. Beverages caused 27 scalds and 13 injuries were associated with bathing. Fiftyone patients had satisfactory first aid, ten had unsatisfactory first aid and 12 had none at all. Discussion As most of the adult casualties had predisposing conditions prevention seemed difficult. Close supervision would cause loss ofconfidence even though they had an infirmity and their actions were, at times, unpredictable. Their illnesses caused fits, loss of consciousness, loss of balance, or altered behaviour when they were near to a heat source. It is difficult to see how these accidents could have been avoided if they were to live in a normal home environment. In the two cases of assault associated with excessive alcohol it was the drinkers who were scalded. All the children's inuries were classed as accidental, there was no evidence of assault or deliberate negligence; nevertheless, most ofthe accidents could have been avoided. The accidents occurred because the carer had not appreciated the hazards; parents need to be aware ofthe child's ability to devise means to satisfy curiosity or reach an object. Mothers told of leaving the room briefly or being momentarily distracted, leaving the children alone in a situation that proved to be injurious. Children from working class backgrounds were more at risk than those from more affluent households, but there is no suggestion that they were deprived of care or love. The majority of homes were decent and reasonably well equipped. Fourteen Asian children were scalded which was proportionately more than other ethnic groups, findings similar to those of Vipulendran et al. 1. It is a deprivation when small children have no safe, outside play area at home. There are parents who do not make the garden safe, others live in accommodation with landscaping open to roads where unaccompanied small children are not safe. Those families residing in high rise flats would, understandably, not allow their children to play on the balcony and kept all windows and balcony door shut. The stability of family life was not always as secure as it appeared. The partnerships were not always stable in the long term neither were the partners necessarily both parents of the child. However, instability in the home was not obviously a contributory factor. Unemployment and lack -of financial security caused stress to parents, as did the mortgage payments for those buying their own homes. This can lead to distraction and lack of concentration thereby increasing the risk of accident. Either parents did not appreciate the advantages of both child and parent in going to play groups or there were insufficient places or funds. Forty under-fives (65%) were at home all day. Five homes were grossly overcrowded, one had fifteen occupants in a two bedroomed house and, in another, 13 in three bedrooms which, possibly, contributed to the risk. It is not surpising that most accidents red in kitchens but they could have been made safer by a more careful arrangement of equipment. This was often
done immediately after the accident. Some kitchens were so small that there was no room for a table or work surface and often there was no table in the one living room. Ironically, most of those were council houses. Families who had bought such properties had converted a bedroom into -bathroom and lavatory and had enlarged the kitchen. Ideally parents should use safety gates between the living room and kitchen whilst preparing or serving food but it is pointless in that type of house. Mugs of tea and coffee were frequently placed within a child's reach. As pointed out by Meyer2, baby-walkers feature in scalding accidents by giving small children mobility and access to trailing flexes and containers of hot liquids. A small child will be attracted by his feeding bottle, probably uncapped or standing in a container of very hot water, and he may devise ways to reach it. Most homes had a television set, generally regarded as essential for providing diversion for the children and some respite for the adults. Amenities contrasted with the lack of safety devices in use though 'luxuries' may have arrived before the children. Safety gates on stairs and in doorways were seldom used. Few people used coiled flexes on kettles or safety caps on electric sockets. Trailing leads were a common cause of accidents. Manufacturers are aware of such accidents but they still do not give the public a choice of flex at no extra cost. Scalds in the bathroom resulted from the water supply being maintained at a very high temperature, children being left unsupervised, people running the hot water into the bath first or supplementing the hot water with boiled saucepans and kettles. Plain cold water efficiently applied will reduce the damaging effects of heat on body tissues. It is disturbing that 22 scald victims did not get this simple and effective first aid, if they had, the severity of the injury and possibly the need for skin grafting would have been reduced. This may have shortened the patient's length of stay in hospital and avoided the necessity of re-admission. As the majority of scalds were of small children the psychological trauma to them and their families was considerable. Treatment necessarily involved frequent dressings both as inpatients and outpatients and numerous clinic attendances. In 1954 40 children with scald injuries were admitted from the West Midlands Region3. Throughout the 1980s the numbers from the City of Birmingham are consistently higher4 running at an unacceptable rate.
Conclusions People of all ages are prone to scalding accidents, particularly those who are infirm or very young. Saucepans were heated on front burners, containers of hot fluid were left where a child could reach them. Electric kettles were left with hot water standing in them. Electric flexes were left dangling over the edges of work surfaces where a child could grasp them. Children were left alone in the bathroom with a supply of very hot water on tap. The consequences were severe scalds to those dependent on us for their well being. Accidents were due to a temporary lack of vigilance. Afterwards the parents felt guilty and incompetent, requiring help and sympathy rather than harsh criticism. Nevertheless action must be taken to reduce the numbers of such accidents. It is a situation which is not improving and will continue
691
692
Journal of the Royal Society of Medicine Volume 83 November 1990
unless the public is educated to be aware of the hazards that exist in their homes and take measures to alleviate them. By promoting awareness, reducing hazards, adopting safe habits and knowing the firstaid procedures many ofthese injuries could be avoided or their severity lessened. Parents should be given help to acquire safety devices if they are unable to afford them. Safety in domestic equipment should not be an added extra, it should be mandatory or at least the public should have the right of choice at no extra cost.
References 1 Vipulendran V, Lawrence JC, Sunderland R. Ethnic differences in incidence of severe burns and scalds to children in Birmingham. BMJ 1989;298:1493-4 2 Meyer M. Baby walker frames. A preventable factor in infant burns. Burns 1988;14:145 3 Colebrook L, Colebrook V, Bull JP, Jackson DM. The prevention of burning accidents. BMJ 1956;i:1379 4 Lawrence JC, Wilkins MD. The epidemiology of burns. In: Burns Symposium: Burncare. Hull: British Burn Association/Smith & Nephew 1986:13-26
Acknowledgments: I thank the Medical Commission on Accident Prevention for providing expenses for this study.
(Accepted 1 June 1990)
Forthcoming events
Recent Advances in Neurology 15-17 February 1991, San Francisco, California Further details from: (see entry for 2-3 November 1990)
Update on Thyroid Disease - 1990 2-3 November 1990, Hyatt Regency Embarcadero Further details from: Extended Programs in Medical Education, Room C-124, University of California School of Medicine, San Francisco, CA 94143-0742, USA (Tel: 415 4764251) 4th Annual Facial Pain Conference: How to Recognise and Treat Difficult Facial Pain 16-17 November 1990, Eastman Dental Hospital, London Further details from: Ms Pat Johnson, Student Administator, Eastman Dental Hospital, Gray's Inn Road, London WClX 8LD (Tel: 071-837 3646) Environmental Health Risks and Responses 26-27 November 1990, Robin Brook Centre, St Bartholomew's Hospital, London The aim is to review the ways in which man and other living things are exposed to toxicants, and consider the medical and biological consequences and the legal systems for regulating exposures Applications by 5 October 1990 Further details from: The Education Department, BPMF, 33 Millman Street, London WClN 3EJ (Tel: 071-831 6222: Fax: 071-831 7599) 6th International Symposium on Cardiopulmonary Urgencies and Emergencies 26-29 November 1990. Rotterdam. The Netherlands Further details from: Dr Omar Prakash, Thorax Centre, Erasmus University, 3000 DR Rotterdam, The Netherlands (Tel: 31 10 463 5230; Fax 31 10 463 5240) New Ideas on Common Retinal Disorders 13-14 December 1990, San Francisco, California Further details from: (see entry for 2-3 November 1990) 3rd International Congress on Trace Elements in Medicine and Biology: Chromium and Trace Elements in Endocrinology 15-18 January 1991, Les Deux Alpes, France Further details from: Arlette Alcaraz, Laboratoire de Biochimie C, CHRU de Grenoble, BP217 X, 38043 Grenoble Cedex, France (Tel: 76 42 81 21) MRCP Part II Courses Five-day Clinical 11-15 February 1991, Royal Free Hospital, London Further details from: Dr D Geraint James, Royal Free Hospital, Pond Street, London NW3 2QG (Tel: 071-794 0550) Colorectal Disease in 1991: An International Exchange of Medical and Surgical Concepts 14-16 February 1991, Ft Lauderdale Florida Further details from: The Cleveland Clinic Educational Foundation, Department of Continuing Education, 9500 Euclid Avenue, IT-31, Cleveland, OH 44195-5241, USA (Tel: 1 800 762 8173)
11th Instructional Course on Tinnitus and its Management 24-27 March 1991, Nottingham University Further details from: Mrs J P Willoughby, Course Secretary, MRC Institute of Hearing Research, University of Nottingham, University Park, Nottingham NG7 2RD (Tel: 0602 223431; Fax: 0602 423710) The Food Network: Achieving a healthy diet by the year 2000 19-20 March 1991, Royal College of Physicians, London Further details from: Conference Secretariat: Conference Associates & Services Ltd BDA/HEA, Congress House, 55 New Cavendish Street, London WlM 7RE (Tel: 071486 0531; Fax: 071-935 7559)
Spring Meeting of the British Association of Oral and Maxillofacial Surgeons 12 April 1991, Brighton A joint meeting with the British Society for the Study of Orthodontics and will take the form of a Festschrift to celebrate the contributions of the late Mr John Hovell to the specialties of oral and maxillofacial surgery and orthodontics. Further details from: John C Lowry, Honorary Secretary, British Association of Oral and Maxillofacial Surgeons, Royal College of Surgeons of England, 35/43 Lincoln's Inn Fields, London WC2A 3PN 24th Annual Advances and Controversies in Clinical Pediatrics 16-18 May 1991, San Francisco, California Further details from: (see entry for 2-3 November 1990)
Thyroid '91 4-5 July 1991, Newcastle upon Tyne Further details from: Dr Petros Perros, Department of Medicine, The Medical School, University of Newcastle, Newcastle NE2 4HH Autumn Meeting of the British Association of Oral and Maxillofacial Surgeons 27-29 September 1991, Harrogate Conference Centre Further details from: John C Lowry, Honorary Secretary, British Association of Oral and Maxillofacial Surgeons, Royal College of Surgeons of England, 35/43 Lincoln's Inn Fields, London WC2A 3PN 3rd International Conference on SLE 13-15 April 1992, Queen Elizabeth II Conference Centre, London Further details from: Dr Graham Hughes or Mrs Denzil Fletcher, Rheumatology Department, St Thomas' Hospital, London SEI 7EH (Tel and Fax: 071-633 9422)
A study of scalds in Birmingham
C G Cason SrN DN The Burns Research Group, Birmingham Accident Hospital, Bath Row, Birmingham B15 1NA Keywords: scalds; children; first aid; prevention
Summary The causes of serious domestic scald injuries in Birmingham were studied for one year. Seventy-eight people sustained such scalds, 11 adults and 67 children. Only 51 ofthe patients received satisfactory first aid. Most accidents could have been avoided and the severity of the injury would have been less if appropriate first aid had been given. Introduction Patients in Birmingham (population about 1 000 000) with scald injuries serious enough to be admitted to the Burns Unit at Birmingham Accident Hospital in the acute stage were studied to ascertain how such accidents occur. To obtain a true sample the study was restricted to the City, as less serious scalds from the region would be treated at local hospitals. Homes were visited to collect information about the accident, social conditions, family health, who was present at the time and any first-aid given; also to consider how such accidents could be prevented. Methods Ideally the patient, or if a child the parent, was seen briefly in hospital to ask permission to visit them at home after discharge. Going to their house kept the interview informal and was preferable to talking in a busy ward when patients and relatives were distressed. Questions and note-taking were kept to a minimum, much of the information could be acquired by observation and conversation. Photographs were taken of the site and utensils involved if permission was given. It was important to explain the role ofthe researcher as parents feel guilty and exposed to criticism following such accidents. Data was stored on a small microcomputer (Amstrad CPC6128) where it could be sorted, counted and cross-tabulated. An account of the visit was also stored on the computer in text form. Results
Seventy-eight patients were admitted, 11 adults and 67 children under 16 years of age. Ten patients were not visited because they were transferred or were away from home but known details were included. One family refused a visit. Three of the adults had straightforward accidents, the remainder had contributory predisposing conditions. Two were assaults concerned with drunkenness and one was mentally retarded. The other five, who were over 45 years of age, had variously: epilepsy, schizophrenia with a fractured femur, stroke or 'fainting' attacks. Of the 67 children scalded, 53 were under 3 years old, the youngest was aged 5 months; 43 were male and 35 female.
Prior medical and social care of the children Fifty-four of the children (83%) had attended clinics and 80% had received inoculations, the remainder were omitted for medical reasons or parental opposition. Most of the children appeared healthy. Of the 59 under-fives, 40 were at home all day, only 18 went to any group play. Seven were school children. There were four very large families, the remainder had up to four children. Only two families were known to social workers prior to the accident.
Family and home conditions Seventy-five per cent of parental relationships were said to be stable when the accident occurred; 64% of partners were married, 21% ofthe children were from single parent families, four mothers were divorced. Fifty-nine per cent of fathers were in full time employment, 25% were unemployed. Five mothers worked full-time and 10 part-time. Forty-five mothers were full-time housewives. Fifty-four of the patients were white, seven were Afro-Caribbean and 14 Asian. Ten families lived in flats and 58 in houses, mainly terraced or semi-detached. Forty-one were pre-1939 houses and 32 post-1960. Forty-one families lived in rented accommodation and 31 in owner-occupied homes, but these included young mothers living with parents. Forty-three 'homes were in good repair, 22 homes were in a poor state but some ofthese were awaiting or undergoing improvements. Most homes were clean and pleasant, but 10 were very dirty. Six of the council houses had tiny, badly designed kitchens with five or six doors giving access to the living room, stairs, understairs, lavatory, bathroom and outside. Only 68% of the children had a suitable outside play area, 18 had nowhere to play. Most households were equipped with a refrigerator, washing machine, vacuum cleaner, and kettle. Ninety-four per cent of families had a television set, 75% had a music centre, 50% a video recorder and 50% a car. By contrast safety devices were poorly employed. Four homes were without the statutory minimum guards on gas and electric fires, and only 25 had a large extender guard. Nineteen parents used safety gates and fourteen had electric socket covers. Forty-nine had electric kettles, 26 were jug kettles and 23 were of conventional design; only three were fitted with coiled flexes.
Monthly and daily incidence March, July and November had the highest incidence 0141-0768/90/ 110690-03/$02.00/0 of scalds. Sundays and Wednesdays were the worst o 1990 days and predictably, more scalds occurred at The Royal mealtimes, particularly between 1800 and 2000 Society of hours.
Medicine
Journal of the Royal Society of Medicine Volume 83 November 1990
Nature and circumstance of injuries Sixteen children and one adult required intravenous resuscitation and 14 patients had primary skin grafting. Twenty-four of the children had scalds involving the face. Forty-two accidents occurred in the kitchen, 11 in the living room and 15 in the bathroom. Spilt water accounted for 37 scalds, 19 from kettles and eight from saucepans. Beverages caused 27 scalds and 13 injuries were associated with bathing. Fiftyone patients had satisfactory first aid, ten had unsatisfactory first aid and 12 had none at all. Discussion As most of the adult casualties had predisposing conditions prevention seemed difficult. Close supervision would cause loss ofconfidence even though they had an infirmity and their actions were, at times, unpredictable. Their illnesses caused fits, loss of consciousness, loss of balance, or altered behaviour when they were near to a heat source. It is difficult to see how these accidents could have been avoided if they were to live in a normal home environment. In the two cases of assault associated with excessive alcohol it was the drinkers who were scalded. All the children's inuries were classed as accidental, there was no evidence of assault or deliberate negligence; nevertheless, most ofthe accidents could have been avoided. The accidents occurred because the carer had not appreciated the hazards; parents need to be aware ofthe child's ability to devise means to satisfy curiosity or reach an object. Mothers told of leaving the room briefly or being momentarily distracted, leaving the children alone in a situation that proved to be injurious. Children from working class backgrounds were more at risk than those from more affluent households, but there is no suggestion that they were deprived of care or love. The majority of homes were decent and reasonably well equipped. Fourteen Asian children were scalded which was proportionately more than other ethnic groups, findings similar to those of Vipulendran et al. 1. It is a deprivation when small children have no safe, outside play area at home. There are parents who do not make the garden safe, others live in accommodation with landscaping open to roads where unaccompanied small children are not safe. Those families residing in high rise flats would, understandably, not allow their children to play on the balcony and kept all windows and balcony door shut. The stability of family life was not always as secure as it appeared. The partnerships were not always stable in the long term neither were the partners necessarily both parents of the child. However, instability in the home was not obviously a contributory factor. Unemployment and lack -of financial security caused stress to parents, as did the mortgage payments for those buying their own homes. This can lead to distraction and lack of concentration thereby increasing the risk of accident. Either parents did not appreciate the advantages of both child and parent in going to play groups or there were insufficient places or funds. Forty under-fives (65%) were at home all day. Five homes were grossly overcrowded, one had fifteen occupants in a two bedroomed house and, in another, 13 in three bedrooms which, possibly, contributed to the risk. It is not surpising that most accidents red in kitchens but they could have been made safer by a more careful arrangement of equipment. This was often
done immediately after the accident. Some kitchens were so small that there was no room for a table or work surface and often there was no table in the one living room. Ironically, most of those were council houses. Families who had bought such properties had converted a bedroom into -bathroom and lavatory and had enlarged the kitchen. Ideally parents should use safety gates between the living room and kitchen whilst preparing or serving food but it is pointless in that type of house. Mugs of tea and coffee were frequently placed within a child's reach. As pointed out by Meyer2, baby-walkers feature in scalding accidents by giving small children mobility and access to trailing flexes and containers of hot liquids. A small child will be attracted by his feeding bottle, probably uncapped or standing in a container of very hot water, and he may devise ways to reach it. Most homes had a television set, generally regarded as essential for providing diversion for the children and some respite for the adults. Amenities contrasted with the lack of safety devices in use though 'luxuries' may have arrived before the children. Safety gates on stairs and in doorways were seldom used. Few people used coiled flexes on kettles or safety caps on electric sockets. Trailing leads were a common cause of accidents. Manufacturers are aware of such accidents but they still do not give the public a choice of flex at no extra cost. Scalds in the bathroom resulted from the water supply being maintained at a very high temperature, children being left unsupervised, people running the hot water into the bath first or supplementing the hot water with boiled saucepans and kettles. Plain cold water efficiently applied will reduce the damaging effects of heat on body tissues. It is disturbing that 22 scald victims did not get this simple and effective first aid, if they had, the severity of the injury and possibly the need for skin grafting would have been reduced. This may have shortened the patient's length of stay in hospital and avoided the necessity of re-admission. As the majority of scalds were of small children the psychological trauma to them and their families was considerable. Treatment necessarily involved frequent dressings both as inpatients and outpatients and numerous clinic attendances. In 1954 40 children with scald injuries were admitted from the West Midlands Region3. Throughout the 1980s the numbers from the City of Birmingham are consistently higher4 running at an unacceptable rate.
Conclusions People of all ages are prone to scalding accidents, particularly those who are infirm or very young. Saucepans were heated on front burners, containers of hot fluid were left where a child could reach them. Electric kettles were left with hot water standing in them. Electric flexes were left dangling over the edges of work surfaces where a child could grasp them. Children were left alone in the bathroom with a supply of very hot water on tap. The consequences were severe scalds to those dependent on us for their well being. Accidents were due to a temporary lack of vigilance. Afterwards the parents felt guilty and incompetent, requiring help and sympathy rather than harsh criticism. Nevertheless action must be taken to reduce the numbers of such accidents. It is a situation which is not improving and will continue
691
692
Journal of the Royal Society of Medicine Volume 83 November 1990
unless the public is educated to be aware of the hazards that exist in their homes and take measures to alleviate them. By promoting awareness, reducing hazards, adopting safe habits and knowing the firstaid procedures many ofthese injuries could be avoided or their severity lessened. Parents should be given help to acquire safety devices if they are unable to afford them. Safety in domestic equipment should not be an added extra, it should be mandatory or at least the public should have the right of choice at no extra cost.
References 1 Vipulendran V, Lawrence JC, Sunderland R. Ethnic differences in incidence of severe burns and scalds to children in Birmingham. BMJ 1989;298:1493-4 2 Meyer M. Baby walker frames. A preventable factor in infant burns. Burns 1988;14:145 3 Colebrook L, Colebrook V, Bull JP, Jackson DM. The prevention of burning accidents. BMJ 1956;i:1379 4 Lawrence JC, Wilkins MD. The epidemiology of burns. In: Burns Symposium: Burncare. Hull: British Burn Association/Smith & Nephew 1986:13-26
Acknowledgments: I thank the Medical Commission on Accident Prevention for providing expenses for this study.
(Accepted 1 June 1990)
Forthcoming events
Recent Advances in Neurology 15-17 February 1991, San Francisco, California Further details from: (see entry for 2-3 November 1990)
Update on Thyroid Disease - 1990 2-3 November 1990, Hyatt Regency Embarcadero Further details from: Extended Programs in Medical Education, Room C-124, University of California School of Medicine, San Francisco, CA 94143-0742, USA (Tel: 415 4764251) 4th Annual Facial Pain Conference: How to Recognise and Treat Difficult Facial Pain 16-17 November 1990, Eastman Dental Hospital, London Further details from: Ms Pat Johnson, Student Administator, Eastman Dental Hospital, Gray's Inn Road, London WClX 8LD (Tel: 071-837 3646) Environmental Health Risks and Responses 26-27 November 1990, Robin Brook Centre, St Bartholomew's Hospital, London The aim is to review the ways in which man and other living things are exposed to toxicants, and consider the medical and biological consequences and the legal systems for regulating exposures Applications by 5 October 1990 Further details from: The Education Department, BPMF, 33 Millman Street, London WClN 3EJ (Tel: 071-831 6222: Fax: 071-831 7599) 6th International Symposium on Cardiopulmonary Urgencies and Emergencies 26-29 November 1990. Rotterdam. The Netherlands Further details from: Dr Omar Prakash, Thorax Centre, Erasmus University, 3000 DR Rotterdam, The Netherlands (Tel: 31 10 463 5230; Fax 31 10 463 5240) New Ideas on Common Retinal Disorders 13-14 December 1990, San Francisco, California Further details from: (see entry for 2-3 November 1990) 3rd International Congress on Trace Elements in Medicine and Biology: Chromium and Trace Elements in Endocrinology 15-18 January 1991, Les Deux Alpes, France Further details from: Arlette Alcaraz, Laboratoire de Biochimie C, CHRU de Grenoble, BP217 X, 38043 Grenoble Cedex, France (Tel: 76 42 81 21) MRCP Part II Courses Five-day Clinical 11-15 February 1991, Royal Free Hospital, London Further details from: Dr D Geraint James, Royal Free Hospital, Pond Street, London NW3 2QG (Tel: 071-794 0550) Colorectal Disease in 1991: An International Exchange of Medical and Surgical Concepts 14-16 February 1991, Ft Lauderdale Florida Further details from: The Cleveland Clinic Educational Foundation, Department of Continuing Education, 9500 Euclid Avenue, IT-31, Cleveland, OH 44195-5241, USA (Tel: 1 800 762 8173)
11th Instructional Course on Tinnitus and its Management 24-27 March 1991, Nottingham University Further details from: Mrs J P Willoughby, Course Secretary, MRC Institute of Hearing Research, University of Nottingham, University Park, Nottingham NG7 2RD (Tel: 0602 223431; Fax: 0602 423710) The Food Network: Achieving a healthy diet by the year 2000 19-20 March 1991, Royal College of Physicians, London Further details from: Conference Secretariat: Conference Associates & Services Ltd BDA/HEA, Congress House, 55 New Cavendish Street, London WlM 7RE (Tel: 071486 0531; Fax: 071-935 7559)
Spring Meeting of the British Association of Oral and Maxillofacial Surgeons 12 April 1991, Brighton A joint meeting with the British Society for the Study of Orthodontics and will take the form of a Festschrift to celebrate the contributions of the late Mr John Hovell to the specialties of oral and maxillofacial surgery and orthodontics. Further details from: John C Lowry, Honorary Secretary, British Association of Oral and Maxillofacial Surgeons, Royal College of Surgeons of England, 35/43 Lincoln's Inn Fields, London WC2A 3PN 24th Annual Advances and Controversies in Clinical Pediatrics 16-18 May 1991, San Francisco, California Further details from: (see entry for 2-3 November 1990)
Thyroid '91 4-5 July 1991, Newcastle upon Tyne Further details from: Dr Petros Perros, Department of Medicine, The Medical School, University of Newcastle, Newcastle NE2 4HH Autumn Meeting of the British Association of Oral and Maxillofacial Surgeons 27-29 September 1991, Harrogate Conference Centre Further details from: John C Lowry, Honorary Secretary, British Association of Oral and Maxillofacial Surgeons, Royal College of Surgeons of England, 35/43 Lincoln's Inn Fields, London WC2A 3PN 3rd International Conference on SLE 13-15 April 1992, Queen Elizabeth II Conference Centre, London Further details from: Dr Graham Hughes or Mrs Denzil Fletcher, Rheumatology Department, St Thomas' Hospital, London SEI 7EH (Tel and Fax: 071-633 9422)
