am a medical graduate from Glasgow. I graduated in 1950, and we came to Australia, my wife and I and three of our children, in 1963. I began to develop an interest in burn care in the UK, but it wasn't really until I came to Australia that I really matured into becoming what you might call a burns surgeon. I was attached to the Alfred Hospital as a member of staff, but also as an academic with Monash University. When I came to the Alfred in `63, burn patients were looked after by whoever happened to be on duty at the time. This was typical throughout the whole of Australia.

There was beginning to be a specialty in burn care at the Royal Children's Hospital in Melbourne, but there were no specifically adult burns unit in Melbourne, and I think I might be right in saying, anywhere in the country. So we, the Department of Surgery of Monash University at the Alfred, offered to take on the care of all people admitted with burns to the hospital. And the surgical staff at the time accepted that suggestion.

I was not a plastic surgeon. Traditionally, people think that burns people are looked after by plastic surgeons, but burns are a very complex illness, if you like to call it an illness. Not only do you have the problem of skin cover - which means grafting, perhaps - but you've also got the problem of infection and the need for adequate nutrition and fluids. It's a very comprehensive and complex illness, and it requires skill beyond the immediate skills of, say, being able to do skin grafts.

The Bali bombing - you could learn lessons from that. It was in the summer time, in a dry tropical environment. That is better than the wet tropics because the wet encourages infection. Delay in getting someone to hospital increases the risk of infection, so when somebody is burned, the sooner you get them to hospital, the better. It doesn't require a panic - everyone doesn't need to be brought to hospital by helicopter. But it's a good thing if people can come to a good hospital within about an hour of the accident.

Now that may not have happened at all in 1939. Bear in mind that many of the people burned in 1939 would have been transported in the back of trucks. There were no ambulances out there, and none able to get through, because the roads were blocked. So they were maybe in the back of a truck that may have had cow poo in it - a real farming environment. They would be exposed to significant bacterial infection, which would be given the chance to take hold really quickly.

I have looked after a patient who was an epileptic, who had horrendous burns. He was in my care for a year. He had a very complicated burn. His scalp and the bottom of his skull was actually burned, and we ended up having to remove quite a significant amount of it. So even now, people with a complicated burn injury can spend a long period in hospital. The fact that they even survived in 1939 to get out of hospital after a year is quite remarkable. It says a lot for the care that they must have had.

It's perhaps hard to visualise, but burns all over the world were quite inadequately treated at that time. For example, in Denmark at that time, a very sophisticated country, burns were treated in a dermatology ward. Can you imagine that - people with skin rashes? I'm talking about a big burn, I'm not talking about a little scold that might happen in any domestic situation. Most people have had burns at some time in their lives, but these are people with burns to maybe 20 per cent or more of their body surface area.

One of the initial problems with these people is that they loose a tremendous amount of fluid. They swell up, they get thick, they get what is called Edema. The fluid leaves the body's circulation and weeps from the body surface. The understanding of fluid dynamics in 1939 was not good. It took the Second World War for people to learn more about burns.

And the Second World War was a real turning point in burns care, because people focused on the fluid management of burn patients much more. Some of the scarring I have heard about on burns survivors of 1939 means they must have had quite significant burns. It's even surprising to me that they survived.

It's interesting that burns victims from 1939 got severe burns under their arms from lying over their children, and protecting the children with their arms over the top of their heads. Generally when people are exposed to burning, they hold their arms together, so the arm pits and the side of the trunk are sometimes protected and it is the outer side of the trunk that is burned.

Some of the burns victims from the 1939 fires couldn't bring their arms to their sides because they must have had neck burns as well, and so their burns wouldn't heal well at all. They would heal by scarring. If they heal by scarring, you get contractions, terrible contractions. The contractions are so powerful that they can overcome any muscle power that the person might have, so their hands could easily be in this permanently fixed position, almost folded above their shoulders, because of scars mainly down the side of the neck.

They might have had scars on their arm pits as well, but the whole area would be very significantly scarred with what we call good quality skin. You must be familiar with maggots and rotting meat. If you stick something in the dustbin in the summer time and you go back to the dustbin a day later, the smell is terrible. That is because of, to use a lay person's term, putrefaction, which occurs basically because of infection.

Well, remember in 1939, the only means of combating infection were very primitive. There were things called sulphonamides around then. Now sulphonamides were developed by the Germans as the main means for combat of infection, immediately before the discovery of penicillin by Sir Alexander Fleming in the 1930s.

Before penicillin became available to the world, the treatment of any significant infection like pneumonia and infected wounds was very poor quality.

So the wounds almost invariably became infected, and that led to the smell. Once it becomes infected, healing takes place either very, very slowly or not at all. Even nowadays, people with varicose ulcers - leg ulcers as the result of having varicose veins - if they're not well treated, they go on for years and they smell.

Back then they had to spend long periods in hospital because of the infection. They just would not be well. They would become dreadfully undernourished, for example, because remember, in 1939, there was no such thing as feeding people intravenously.

Within a few weeks of being burned and surviving, these people would have become abjectly weak and it would be difficult to maintain their nutrition. It is the same pattern of illness as you would imagine in a concentration camp. They would just be weak through starvation and the doctors and nurses looking after them didn't have the facilities or the know-how to maintain their nutrition.

They had drips and they had blood transfusions, but one of the mainstays of feeding people intravenously is intravenous fat. Now, intravenous fat only came into existence in about 1960.

In 1939, the only thing they would have had would have been blood. They would have had sulphonamide cream, but it wasn't an easy cream to use because people had significant hypersensitivity to it. It was an antibacterial agent, a precursor of penicillin, and it killed the bacteria. If you could spread it on the skin surface, it would lessen the infection, but it wouldn't necessarily cure it.

They would have had good nursing care, TLC, which is very important - there would be no question about the dedication of the people that looked after them. But the actual weapons to combat the burn would have been limited. There were no antibiotics, and the surgeons had skills, but not the sophisticated skills we now have to actually skin graft the patients.

Nowadays there has been a complete change in attitude. If one gets someone with severe burning, most surgeons who specialise in burn care will immediately define the area that is what we call full thickness burning. That is the equivalent to third degree burning. They would take the person to the operating theatre maybe soon after they arrived in hospital, and definitely within the first two or three days. They would cut away all the dead burned skin, all the stuff that has no chance of survival, and replace that with skin grafts from another part of the patient's body.

And, of course, with burns the problem is that there may be a limited amount of unburned area to graft. But in 1939 they didn't do that, they waited until the burned skin dropped off by what is called sloughing. It might take weeks, and then it came away and you were left with a raw surface. Underneath that was still perhaps significantly infected, and then you grafted that. Graft failure rate was very high because of infection.

A burn is a burn, is a burn. They're all the same; there is no difference. Looking at somebody with a burn, you wouldn't be saying, "Oh, I can see that's a bushfire burn." Of course not, that would be a gross misconception. People get burns because of heat. It may be in the form of flame; it may be in the form of a chemical that releases heat when it touches your skin, like sulphuric acid; it may be in the form of radiation, like the Nagasaki and Hiroshima atomic bombs, where people were subjected and exposed to incredible heat.

Most of the ones we got came from the Berwick area of the Dandenongs. I didn't spend a lot of time talking to them about the circumstances of their burns - we were too busy getting on with treating them. You don't indulge in long social histories when you've got someone pretty sick and you're taking them to theatre. More of the details of Ash Wednesday came out in the weeks subsequent to the fires. I might say none of the patients that we got died, they all survived.

There was a certain amount of exaggeration at the time in some areas, but there were people with burns up to 60 per cent of their bodies. Now that is a big burn.

I'll just give you an account of my own experience. I had a very good registrar at the time. A registrar is a sort of doctor in training. He's now a professor of vascular surgery in Melbourne, a very distinguished man, but he was actually on duty at the time. I wasn't even actually in Melbourne, I think I was having a drive somewhere out of town.

Anyway, when the Ash Wednesday fires occurred we were listening to the radio in the car. We high-tailed it back to Melbourne as quickly as possible. By the time I got into Melbourne and then got in touch with the hospital, knowing that something like this was likely to happen, we had cleared a particular ward.

We sent patients home, so we were prepared to take up to 30 patients, but we didn't get that. I think we got about 15. How long did they take to get to the hospital? It would only have been several hours. There was all this great talk about ambulance delays, but I think the evacuation process was very well done. I think we have a community where Australians perform best in a crisis.

Many of the people in the 1939 fires would not have been burned to death, they would have been suffocated through lack of oxygen. People will die and then the fire continues, and having died, they are not able to move and then they are exposed to significant heat.

Our grasp on life is quite tenuous. If I put my hand across your nose and mouth and held it there for two or three minutes, you would be dead. We are very dependent on a normal environment, which contains 20 per cent oxygen. That is the way air is made up. A fire requires oxygen, and if there is no oxygen, the fire will go out. That is why we use carbon dioxide fire extinguishers. We smother the flames with carbon dioxide, and there is no oxygen, so the flames go out.

The principal thing, knowing that the fire was coming, would have been panic - people knowing that inevitably they are going to be engulfed, and not knowing what to do. And there is no difference there between then and now, of course. I don't think people are better adapted now than they might have been 20 years ago. They just panic when there is fire. Fire has been around since man and woman first appeared on this planet, and it always must have been a frightening thing really.

Pain is a funny paradox. If you get burned and you've got a partial thickness burn - first and second degree - the skin is damaged but not destroyed. You have pain, and that pain continues. It is memorable for any person who has ever been burned that they get a lot of pain.

But that is the pain generated by the partial thickness burns. No one ever has entirely one particular burn, it is always a mixture. So all burn patients have pain really, but the paradox that I was referring to is where people have extensive areas of full thickness, third degree burning. That is when the skin is completely burned in depth, the burn has extended down into the fat, and it's like crackling in roast pork.

The skin is a complicated and complex tissue and full of nerves. These nerves are destroyed in the process of full thickness burns, so whilst it is very painful getting the burn, after you've been burned, it's like you're anaesthetised. It's like a local anaesthetic - you've no longer any sensation. That's how we tell the difference. If you get a patient into hospital, you take a sterile needle and the patient tells you where the pain disappears. When you get onto full thickness burning, you stick the needle right in and they don't know it's there.

When the Sims metal disaster occurred about 20 years ago, a famous picture appeared on the front of the Herald or the Age. There were these two men who walked out of the building of the Sims metal explosion. Their clothes had been burned off them, but they had walked out, these men. They were dead within a few hours, but they didn't have any pain as they walked out.

This is one of the great difficulties that you have as a burn therapist. You get people come in who have been horribly, very, very severely burned, but they are not in so much pain as you might think. People commit suicide by burning. They pour petrol over themselves, a terrible way of destroying themselves as well as punishing their relatives.

They are going to die, and you take their relatives in and you hold their hand and you comfort them, and you say, "You know, your loved one is going to die". They say, "Doctor, how can you say that? I was speaking to them a few minutes ago. They must be alright".

They can't grasp that they are going to die because they've had 80 or 90 per cent of their body burned. That man you saw talking sitting in the emergency ward in Bali, he would be able to converse with his relatives. The person who is doomed to die of burns is not necessarily bombed out. They are quite coherent. Inside that dreadfully burned body there is a full person.