Amish Home Burn Treatment: B&W Salve and Burdock Leaves

People in the Amish community have been using “The New Concept in Treating Burns” and their experience is recounted in a little booklet by that title. It is a compilation of articles, testimonials, and letters to the editor of a monthly newspaper Plain Interests, published in Millersburg PA.

The treatment, involving B&W ointment and dressings of scalded burdock leaves, was developed by John Keim, an Amish farmer and natural healer. The Amish have a tradition of taking care of their own, and they try to avoid hospitals whenever possible. In the booklet, they even recommend treating hip fractures at home without surgery. (Which, after all, is what we did before we had hospitals and surgery).

They claim that with the B&W burn treatment:

  • Painful burns are rendered non-painful.
  • Healing is faster.
  • Painful debridement is not necessary.
  • Skin grafting is not necessary.
  • Scarring seldom occurs.
  • Iatrogenic harm from hospitals is avoided.
  • Patients can be treated at home at much less expense.

According to Keim, with his method it seldom takes more than seven days to get a completely new skin cover on second and third degree burns, and in over two decades he never had an infection. He saw only 2 cases of scarring, and they were minimal. He does not charge for his services.

The ointment and a booklet by John Keim are available on this website. The ointment costs between $1.50 and $3.00 per ounce, depending on the amount purchased.

The ingredients of the B&W ointment are honey, lanolin, olive oil, wheat germ oil, aloe vera gel, wormwood, marshmallow root, comfrey root, white oak bark, lobelia, vegetable glycerin, and beeswax.

I have been unable to find how he decided which ingredients to include and how much of each to use, but I did find this example of his methods of discovery:

When he was in dire need for a remedy to treat the burns on his own son, he had gone to the woods to meditate and seek Divine guidance. In due time, his attention was drawn to some nice, big plantain leaves right before him which he believed would serve as an ideal non-stick barrier between the salve he had applied to his son’s body and the gauze body wrap. It worked, but later, it was discovered that burdock leaves are more effective, although plantain leaves are still used under certain circumstances.

Some of the ingredients (aloe vera, lobelia) – reduce inflammation. Several of them are inert emollients. I’m puzzled as to why comfrey is included, since the Natural Medicines Comprehensive Database warns that it should only be used on unbroken skin.

The main ingredient, and probably the active ingredient, is honey. This is nothing new. Honey was recommended for burn treatment in ancient Egyptian papyrus medical texts. There has been a recent resurgence of interest in honey, especially Manuka honey, for which special claims have been made.

There is some research to support honey for burns. One recent study compared honey to conventional treatment for partial thickness burns, and found that the honey-treated burns healed faster with less scarring.

According to this article from the Honey Research Institute (a possibly biased source?)

In the past decade there have been many reports of case studies, experiments using animal models, and randomized controlled clinical trials that provide a large body of very convincing evidence for its effectiveness, and biomedical research that explains how honey produces such good results. As a dressing on wounds, honey provides a moist healing environment, rapidly clears infection, deodorizes, and reduces inflammation, edema, and exudation. Also, it increases the rate of healing by stimulation of angiogenesis, granulation, and epithelialization, making skin grafting unnecessary and giving excellent cosmetic results.

One systematic review found that

For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments. The quality of studies was low. CONCLUSION: Confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low. There is biological plausibility.

A Cochrane review concluded

There is insufficient evidence to determine the effect of honey compared with other treatments for burns or in other acute or chronic wound types. Honey may improve healing times in mild to moderate superficial and partial thickness burns compared with some conventional dressings.

I didn’t find any data on honey for third degree burns, and I found evidence that it is ineffective for leg ulcers.

How does plain honey compare to the B&W mixture? We have absolutely no idea, because the B&W treatment has never been scientifically tested.

It is puzzling that in a booklet touting the B&W treatment, they also mention that many other alternative treatments have worked for them, notably lard-and-flour poultices, bag balm, and olive oil. It is their impression that the B&W ointment works best, but that seems to be based on nothing more than opinion. They also say if burdock leaves are not available, you can use any clean leaves, grass or sprouts, scalding them first to provide moisture.

The treatment is not without side effects. In many of the case histories, patients developed rashes, redness, red pimples, prickliness, and hives, interpreted as reactions to burdock leaves or to the ointment itself, requiring substitution or alternation with lettuce leaves, grape leaves, flaxseed paste, bag balm or other natural products. When reactions and pain occur, they use a remedy called Calm Crème. There seems to be a lot of improvisation: B&W is supposed to work so well, but when it doesn’t they resort to trial and error with pretty much anything that occurs to them.

One of the biggest dangers in burns is infection. Keim tells patients not to worry about fever. He says fever is perfectly normal and part of the healing process but you should watch for a bad smell to detect infection. Fever can be treated with vitamin C powder.

In one testimonial a child was hospitalized and got 8 days of conventional burn treatment, then B&W was used when the child was back at home. Guess which got the credit.

One case I found particularly troubling was that of a 14 year old boy with a leg injury. After 5 days of treatment, “the tissue of the leg broke apart, draining so much that a bed pan was kept under the leg to catch the fluids while redressing.” The dressing had a putrefying odor. The calf muscle was no longer attached to the bone on one side and they kept pushing it back into position. Burdock leaves were “drawing too much fluids” so they were replaced with gauze. On day 12 a mixture of milk of magnesia and brown sugar replaced the B&W to help dry up the wound, also colloidal silver was used. Then B&W was used again and he developed an allergic reaction to it. When the healing “came to a halt,” they put him on a diet of lemonade with maple syrup and cayenne pepper, no food. The healing resumed after 5 days of this.

I think he was a very lucky boy to survive both the wound and the treatment. A healthy body has great healing powers and we tend to forget that even without effective treatment people sometimes get well.

Some of the medical advice in the booklet is irresponsible. One parent claims his doctor told them to treat dehydration by sitting the child in lukewarm water for 30 minutes at a time so the body could absorb water through the skin. Another article claims that “Our bodies breathe through the skin” –a man who fell into vat of paint died because his pores were clogged so he couldn’t absorb enough oxygen through his skin. Don’t add sugar to boiling water, as it decomposes the sugar. “Dehydrated children should never be given plain water as this may make their condition worse.” Give juices instead. You can determine if a patient is responding and has “good vitals” by doing one simple test: verifying that his pupils constrict briskly when you shine a light in his eyes.

The testimonials are impressive and they may be onto something, but there are so many unanswered questions! Is the B&W mixture better than just honey? Does it matter what kind of honey you use and whether it is raw or pasteurized? Are all 12 ingredients necessary and are the amounts optimal? Is there something special about burdock leaves? Is it possible that the ointment or the leaves could introduce bacteria or contaminants into the wounds? (The blanching process would not sterilize the leaves). Can we trust a parent’s assessment that the child really had third degree burns over 20% of the body surface and second degree burns over another 10%? Would the patients who healed without skin grafts really have needed skin grafts with conventional treatment? Was the absence of pain due to the treatment or to the fact that third degree burns destroy the nerve endings and are painless?

The testimonials themselves reveal a real danger: treating burns at home can kill people. The booklet describes a 2 ½ year old girl who was treated at home, became unresponsive and died en route to the hospital. They say she died of shock and explain that shock can be from loss of body fluids but in this case they attributed it to the trauma she had gone through. Another 3 year old died of dehydration during treatment. They explain that if they had known then what they know now about using a water/salt/sugar oral rehydration solution, her death might have been prevented. Maybe. It seems certain that both deaths would have been prevented by prompt conventional burn treatment in a hospital.

The Amish have enlisted the cooperation of doctors who are now allowing them to use the B&W treatment in the hospital under supervision. That’s a step in the right direction, because it will allow for detection of dehydration and infection, will permit professional assessment of burn depth and extent, and hopefully will produce accurate case histories that can be published in peer reviewed journals, a step up from the testimonials of uneducated and scientifically naïve parents. But what is really needed is a simple controlled study comparing conventional burn treatment to the B&W/burdock treatment. Until that is done, all we have is speculation, opinion, and guesswork.

This article was originally published in the Science-Based Medicine Blog

Dr. Hall is a contributing editor to both Skeptic magazine and the Skeptical Inquirer. She is a weekly contributor to the Science-Based Medicine Blog and is one of its editors. She has also contributed to Quackwatch and to a number of other respected journals and publications. She is the author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon and co-author of the textbook, Consumer Health: A Guide to Intelligent Decisions.

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