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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 264-267

Hot iron rods branding, its complications: Still continue in central India


1 Medicine, LN Medical College Hospital and Research Centre, Bhopal, Madhya Pradesh, India
2 Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
3 General Surgery, LN Medical College Hospital and Research Centre, Bhopal, Madhya Pradesh, India

Date of Web Publication11-Oct-2017

Correspondence Address:
Seema Mahant
LN Medical College Hospital and Research Centre, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.216463

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  Abstract 

Introduction: The middle of the 20th century has often been described as a golden age of scientific advancement and miraculous medical breakthroughs. In spite of a lot of awareness and many health education programs, still some traditional treatment exists in many places in our country including Central India. In some villages of Madhya Pradesh, many horrifying therapies such as iron rods branding are well known for a few common diseases such as ascites, headache, pneumonia, common cold, or hernia. Bruise marks can be seen on the bodies of a majority of villagers. Main reasons behind such therapy are lack of money for medical treatment, lack of medical facilities, and the unwillingness of medical officers to stay in small villages. Besides this, illiteracy compels them to follow old customs and practices. All these strengthen the faith of villagers in such treatments. It is all due to lack of education and proper awareness. Many female patients come to hospital with complications of iron rods branding suggest that despite being educated, strong cultural beliefs forces people to undergo branding as a treatment of many common diseases in India even in the 21st century. Aims and Objectives: To study the reasons and complications of hot iron branding. Materials and Methods: Sample size was 30. Thirty patients with old, healed (within 1 year), or recent scars of iron branding were included in the study. Patients were evaluated for the sociodemographic details and the information of underlying disease, pattern of lesions, and complications of branding. Results: Hot iron branding is still carrying on as traditional treatment in Central India. It is commonly seen in females of age 20–50 years. It is mostly found in illiterate patients of low socioeconomic status who have chronic disease and chronic pain. Conclusion: Skin branding which still has therapeutic uses in some cultural societies have severe medical complications in Central India.

Keywords: Branding and its complications, education programs, traditional treatment


How to cite this article:
Mahant S, Reddy C M, Mahant S, Singh M P. Hot iron rods branding, its complications: Still continue in central India. CHRISMED J Health Res 2017;4:264-7

How to cite this URL:
Mahant S, Reddy C M, Mahant S, Singh M P. Hot iron rods branding, its complications: Still continue in central India. CHRISMED J Health Res [serial online] 2017 [cited 2019 Oct 14];4:264-7. Available from: http://www.cjhr.org/text.asp?2017/4/4/264/216463


  Introduction Top


Hot iron rods branding is a very ancient, traditional, and alternative forms of treatment. This practice first time began by Portuguese in 1440, the branding of slave with a hot iron leaving a mark, so that it was evident that he or she was the property of the King of Portugal.[1],[2],[3] Iron rods branding is a process in which the third-degree burns are inflicted on the skin with a hot iron rod or metallic object; it causes “counter-irritation” and is widely used by faith healers in developing countries for therapeutic purposes. Some methods, which are very crude and inhuman, carry a large risk of complications. The purpose of this study is to present a series of complications and to familiarize clinicians with this dangerous method of treatment.

Aims and objectives

To study the reasons behind the hot iron branding; to study the sociodemographic profile of patients of hot iron branding; to study the method and complications of hot iron branding.


  Materials and Methods Top


Consecutive thirty patients diagnosed or associated with hot iron branding lesions fulfilling the inclusion and exclusion criteria were included in the study.

Inclusion criteria

All patients with hot iron branding lesions and patients with old lesions of less than 1 year were included in the study.

Exclusion criteria

Patients with old lesions of more than 1 year were excluded from the study.

Ethics Committee's approval was taken for the study. The sociodemographic details of patients were collected using a specially designed semi-structured pro forma.

Patients were evaluated for underlying disease or disorders.

Detailed examinations of hot iron branding lesions were done.

Routine blood investigations – complete blood count, liver function test (LFT), kidney function test, ultrasonography (USG) of the abdomen, chest X-ray, blood culture and sensitivity, urine routine microscopy – were done. We have collected all data, photographs, and consent form of patients.


  Results Top


Hot iron branding is still continuing as a traditional treatment in Central India. A total of 30 patients having old, healed (within 1 year), or recent scars of iron branding were studied. Out of 30 patients, 26 patients were young adult between 20 and 60 years and were predominantly seen in females (In India, female are more illiterate, neglected, and less aware of health facilities). As shown in [Table 3], it was mostly found in illiterate patients of low socioeconomic status [Table 1] and [Table 2]. In [Table 4], we found that branding was frequently seen with disease of abdomen (20 patients) and chronic pain. As shown in [Table 5], nearly one-fourth cases (8 patients) were associated with complications such as hypertrophic scars, wound infections, and septicemia. On routine investigations, 6 patients had leukocytosis, altered LFT were seen in 12 patients, and raised urea and creatinine were found only in 1 patient. On USG, 6 patients had hepatomegaly, 2 patients had splenohepatomegaly, 4 patients diagnosed as ascites with portal hypertension, and 1 patient had abdominal Koch's. Most of the patients came with normally healed wound, 4 of them had infected wound, and only one patient developed spontaneous bacterial peritonitis. All patients received treatment with no mortality [Figure 1] and [Figure 2].
Figure 1: Branding done to treat jaundice and ascites

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Figure 2: Branding done to treat abdominal pain and ascites

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Table 1: Gender distribution

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Table 2: Age distribution of overall cases

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Table 3: Socioeconomic status of branding patients

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Table 4: Symptoms/reasons behind the branding

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Table 5: Condition of lesion at the time of presentation

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  Discussion Top


This article suggests that despite health awareness, strong cultural beliefs force people to undergo branding as a treatment in India even in the 21st century. Hot iron branding is still very common in some villages of Madhya Pradesh for a few common diseases such as ascites, headache, pneumonia, common cold, or hernia.[1]

Usually, poor, illiterate, and neglected females and those have chronic pain adopt this therapy to get relief of pain at minimum cost.

Role of branding as a body art is well known; however, its role in disease management or as a subjective control of pain is unclear. It is proposed that the secondary inflammatory response to the applied irritant comprising vasodilatation, enzyme release, swelling, edema, blebs, vesicles, and suppuration may aid leukocytes and opsonins released in the inflamed area, leading to bacterial destruction, and this response aids in the rapid elimination of toxins.[1],[2]

There are various forms of branding which include as follows [Figure 3] and [Figure 4].
Figure 3: Branding with a metal rod distributed in a circular and wedge pattern on the back of chest, healed ulcers for back pain

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Figure 4: Branding with a heated metal sheet strips, wedge pattern on the back of chest, healed ulcers for back pain

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Strike branding

The most common and traditional form of branding is “strike branding” which is performed with sheet metal strips heated by a propane torch (1900°F–2100°F). The “strike” is performed by applying the heated strip to the skin.

Hypothermal (freeze) or cold branding

Hypothermal (freeze) branding was initially introduced by cattle ranchers as an alternative method to heat branding. It involves immersing a metallic rod, similar to the metal used in strike branding, into a solution of liquid nitrogen or another cooling agent (commonly dry ice 5% in 95% pure alcohol solution).

Chemical branding

Ink rubbing tattoo ink (or another sterile coloring agent) is rubbed into a fresh cut. Most of the ink remains on the skin as the cut heals and will have the same basic effect as a tattoo.

Electrocautery branding

This is a less common form of branding. It uses a thermal cautery tool with a heated wire tip to cause the burns.

Laser branding

The technical term is “electrosurgical branding.” Although it is technically possible to use a medical laser for scarification, it uses electricity to cut and cauterize the skin. Electric sparks jump from the hand-held pen of the device to the skin, vaporizing it. This is a more precise form of scarification because it is possible to greatly regulate the depth and nature of the damage being done to the skin [Figure 5], [Figure 6], [Figure 7].[1],[4]
Figure 5: Branding done around the umbilicus to treat abdominal pain

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Figure 6: Branding done on forehead for chronic headache

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Figure 7: Large branding lesions over abdomen for chronic abdominal pain

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In our country, faith healers used hot metal rods and coals for branding that break-down skin and improper wound care can lead to severe infections. Most of the traditional branding methods are crude and inhumane, so associated with lots of complications. Thus, local wound infections resulted in exacerbation of the current illness and complications such as hepatic encephalopathy, severe intra-abdominal Staphylococcus aureus infection in the form of bacterial peritonitis, multiple splenic abscesses, cavernous sinus thrombosis, and systemic bacterial sepsis in our cases. It is likely that these procedures were done in an unsterile procedure resulting in these complications and therefore carry a larger risk outweigh the benefits of short-term pain relief.[4],[5] Other complications include hypertrophic scars and keloids, temporary or permanent hyperpigmentation or hypopigmentation, foreign body reaction, oral and tooth complications, aspiration and hypoxia, edema and swelling, and viral transmission including hepatitis and HIV.[1],[6],[7],[8] Because of all above-mentioned reasons, nearly one-fourth cases are associated with complications such as hypertrophic scars, wound infections, and septicemia in our study.

Wound management can be challenging in these patients. Patients' branded lesions typically look like multiple circular burns ranging in size from 2 to 5 cm across with central sparing of the skin and they are likely to present complaining of symptoms suggestive of infection. They have diminished resistance to infection and like any other third-degree burn; parenteral antibiotics fail to penetrate the dead tissue due to poor blood supply. Treatment includes local irrigation of the burns with saline solution and gentle debridement of the eschar if necessary. Infected limbs should be rested and elevated. Silver sulfadiazine or another appropriate antimicrobial agent should be applied to the wound as required. If cellulite is present, empiric intravenous broad-spectrum antibiotic coverage should be initiated (nafcillin, levofloxacin, or cephalosporin) in these patients. However, the extent of the infection and its location helps determine what type and route of coverage are required. In our study, only four patients came with infected wound immediately start empirical higher antibiotics and proper wound care that results in no mortality.[1],[5]


  Conclusion Top


This article describes the complications of skin branding which still has therapeutic uses in some cultural societies. Severe medical complications of skin branding are worrisome and these risks far outweigh the benefits of these procedures. In Central India, this horrifying therapy is well known for common diseases even in the 21st century.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Raza S, Mahmood K, Hakeem A, Polsky S, Haemel A, Rai S, et al. Adverse clinical sequelae after skin branding: A case series. J Med Case Rep 2009;3:25.  Back to cited text no. 1
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2.
Kumar S, Kumar PR. Skin branding. J Postgrad Med 2004;50:204.  Back to cited text no. 2
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3.
Howe SW. Slavery as punishment: Original public meaning, cruel and unusual punishments and the neglected clause in the thirteenth amendment. Ariz Law Rev 2009;51:983. Available from: http:\\www.arizonalawreview.org/pdf/51-4/51arizlrev983.pdf. [Last retrieved on 2013 Sep 20].  Back to cited text no. 3
    
4.
Karamanoukian R, Ukatu C, Lee E, Hyman J, Sundine M, Kobayashi M, et al. Aesthetic skin branding: A novel form of body art with adverse clinical sequela. J Burn Care Res 2006;27:108-10.  Back to cited text no. 4
[PUBMED]    
5.
Adhisivam B, Gowtham R. Branding treatment of children in rural India should be banned. BMJ 2005;330:481.  Back to cited text no. 5
[PUBMED]    
6.
Tweeten SS, Rickman LS. Infectious complications of body piercing. Clin Infect Dis 1998;26:735-40.  Back to cited text no. 6
[PUBMED]    
7.
Kaatz M, Elsner P, Bauer A. Body-modifying concepts and dermatologic problems: Tattooing and piercing. Clin Dermatol 2008;26:35-44.  Back to cited text no. 7
[PUBMED]    
8.
Martin A. On teenagers and tattoos. J Am Acad Child Adolesc Psychiatry 1997;36:860-1.  Back to cited text no. 8
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Materials and Me...
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