My clinical television study of Ronald Reagan brings us to a much broader issue. His case is certainly not unique. The paradox of human society is that the age of ascendancy to the summit of power in our political, cultural, and business institutions is also the age of onset of numerous forms of neurological decline. A large number of world political leaders are men and women in their sixties and seventies. And while we accept as a given the inevitability that by this age assorted physical infirmities accumulate, society is by and large oblivious to the fact that by this age dementia also develops in a significant number of people.The illusion that the demigod figures who make it to the summit of human society are spared the indignity of brain rot is precisely that: an illusion. Dementia operates on the basis of age and genetic vulnerability, just like any physical malady. Dementia is an age-related physical malady affecting the brain, just as coronary insufficiency is an age-related physical malady affecting the heart. The mind is not exempt from the fundamental laws of biological decay.One might expect that the individuals who make it to the very top are brighter than the population as a whole, and this is probably mostly true. But history is replete with instances of individuals endowed with great intellectual powers succumbing to dementia toward the end of their lives for reasons of genetics, or for some yet-to-be understood environmental reasons. Contrary to our wishful thinking, an exalted social status does not offer protection in these matters, nor, as it turns out, does a great intellectual power.It is intuitively plausible, and certainly teleologically “desirable,” that great minds should be protected from decay. Indeed, the last decade has witnessed a paradigm shift in neuroscience, as the evidence began to accumulate that vigorous mental life reshapes the brain itself and helps protect it from biological rot. But other factors, like heredity, are less malleable, at least today.The history of science and philosophy is similarly replete with poignant observations of decaying great minds. Isaac Newton, Immanuel Kant, and Michael Faraday all suffered dramatic memory loss with age. Among the more recent examples, Claude Shannon, the father of information theory, was diagnosed with Alzheimer’s disease toward the end of his life.But mental decline in a scientist is not likely to result in a societal disaster. It may have a retarding effect, delaying a great discovery or invention by years, decades, or even generations, but hardly a precipitously catastrophic one. Besides, most great scientists have their definitive insights relatively early in their careers. By the time dementia is likely to strike, they will have already made their seminal contribution to society long ago, and their decline, sad as it may be on a personal level, is no longer of broad historical relevance.Not so with a political leader, a powerful statesman at the helm of a major military or state machine, when the age of supreme power often overlaps with the age of early cognitive decline, under whose shadow fateful decisions are made. Mental infirmity may take many forms, from what I call mild “neuroerosion” to frank dementia, but the brain machinery of the sublime and the ridiculous is fundamentally the same. A world leader whose decisions affect the lives (and deaths) of thousands of people fundamentally employs the same brain machinery as the owner of a family-run neighborhood bodega making a decision about what brand of canned tuna to stock next week. This means that the consequences of an early “mild” dementia, which may be imperceptibly benign in a neighborhood grocer, will be perilously magnified in a world leader through the sheer impact of his mental faux pas.Reagan was in his seventies at the time of my observations. At this age, Alzheimer’s type dementia, multiinfarct dementia (a disease of blood vessels of the brain resulting in a multitude of small strokes), and other forms of dementias are all distinct statistical possibilities. An early-stage dementing disease process often eludes detection by an untrained eye even in a leader who is constantly in the public eye. But it is particularly likely to remain unnoticed or ignored under the conditions of an authoritarian regime, where the leader is relatively exempt from popular scrutiny. Impairment of judgment, self-control, and other higher mental functions, first subtle and then increasingly transparent, takes place well before an individual becomes frankly disoriented, totally disabled, and no longer capable of hiding his mental infirmities even from distant observers.The past century witnessed the stewardship of more than a few “neuroeroding,” dementing, or indeed demented individuals at the helm of major nations. Dementia strikes the villains and heroes of our world in a morally agnostic way.On the villains’ side, Adolf Hitler suffered from severe symptoms of Parkinson’s disease toward the end of World War II. According to some reports, memory decline was also apparent. Contrary to the popular belief, Parkinson’s disease is not just a movement disorder. It often causes some degree of cognitive impairment and even outright dementia. Other conditions also exist whose outward symptoms resemble those of Parkinson’s disease, but in which serious mental impairment is expected to be present. Most common among them is Lewy body dementia, a degenerative brain disease of aging. At the age of fifty-six, toward the end of the war, Hitler was more likely to suffer from Parkinson’s disease than from Lewy body dementia. Either way, based on simple epidemiological considerations, some mental deterioration was highly probable. Indeed, his close associate, Albert Speer writes about Hitler’s “apathy,” “mental torpor,” and difficulties with decision-making becoming increasingly evident during the second half of the war.The brain diseases of aging did not spare the political heroes of the twentieth century either. Woodrow Wilson suffered a severe stroke while in office in 1919. He recovered, but only partly. According to his biographers, Wilson was a different man after his stroke. His mind became rigid, devoid of nuance, casting everything in black and white. These newly acquired untoward traits haunted the last two years of his presidency and undermined his ability to deal with the isolationist Congress, contributing to the ruin of his League of Nations policy.Franklin Delano Roosevelt was felled by a lethal stroke, but a major stroke is often preceded by what is known today as multiinfarct disease, characterized by a gradual accumulation of ministrokes. In FDR’s days this condition was not known, nor were there any diagnostic tests available capable of revealing it (such as a CT scan or an MRI). Nonetheless, the decline of FDR’s mental powers and decision-making abilities, and his “new disinclination to apply himself to serious business” during the final phase of World War II, have been noted by credible historians. He was likely suffering from cognitive decline already well before his final stroke.And so was the man whom I admired more than virtually any other twentieth-century political leader, Winston Churchill. When he was elected to his first term as Britain’s prime minister, Churchill was already sixty-five, older than most of the last century’s other major political leaders at the time of their ascendancy to supreme power.Churchill’s occasional mental lapses during World War II have been noted by both his wartime associates, like Field Marshal Alanbrooke (leaving them occasionally worried about their leader’s mental state), and his biographers, like Roy Jenkins. These lapses nonetheless did not prevent him from dispatching his business with overall brilliance, if with only occasional flagging. Churchill suffered his first known minor stroke in 1949, between his two terms as prime minister. During his second, post-war term in 1951—1955, Churchill was, in the memorable words of Roy Jenkins (as sympathetic a biographer as any pub-he figure can hope for), “gloriously unfit for office.”*13\302\2*

Know how to prevent and treat them
The skin is the body’s largest organ, protecting us against infection and helping to regulate the balance of water and temperature. Burns — whether caused by fire, hot objects or fluids, electricity, chemicals, radiation or other sources — threaten these vital functions. For the very young or old, or those with other medical conditions, burns can be even more serious.
Burns are classified based on their depth of penetration of the skin.
First-degree burns involve only the tough, outer layer of skin. The skin turns bright red and becomes sensitive and painful. It may be dry, but it does not blister.
Second-degree burns are deeper than first-degree burns and are very painful, red and mottled. The burned area may blister and/or be swollen and puffy.
Third-degree burns are still deeper and can involve muscle, internal organs and bone. The skin will look charred and dry and may break open. Underlying muscle or tendons may be visible. Pain may be severe. If nerves have been damaged, however, there may be no pain except around edges of the burn.
First- and second-degree burns are also called “partial thickness” burns, and third-degree burns are called “full thickness” burns.

What you can do if someone is on fire
• Try not to panic.
• Help the person drop down and roll in a blanket, rug, coat or some
type of covering to smother the flames. Do not let the person run — this will cause the fire to burn more.
Completely extinguish the fire and stop skin and clothes from smoldering by soaking with water. Do not remove burned clothing.
Cover the burn with a cool, damp, sterile bandage or a clean, non-fibrous cloth such as a sheet.
Seek emergency care.

What you can do for severe burns of any kind
Make sure:
Person is breathing. If not, call for emergency help and start CPR immediately.
Bleeding is controlled.
There are no signs of shock: altered consciousness, faintness, paleness, rapid and shallow breathing, rapid and weak pulse, cool and clammy skin.
There are no signs of charring in the mouth or of nasal hairs. Check for sooty residue on the face, shortness of breath, a cough or hoarseness. If present, these signs indicate an emergency; the respiratory tract may be damaged. Seek emergency care.

for other burns
Electrical burns
Turn off power before touching someone who is in contact with an electrical wire or appliance. Assume a downed power line is live.
Try not to move the person.
If a power line has fallen across a car, passengers remain safest if they stay inside. If they have to leave because of fire or some other reason, they should jump clear of the car.
An electrical burn can appear minor even when it has caused major injuries. There will be wounds at the places of entry and exit of the electrical current which should be evaluated by a doctor.
Chemical burns
Flush the skin with large amounts of cool, running water for 20 minutes or until the burning pain has stopped. If the chemical is a dry solid, brush it off first.
If an eye has been burned, flush it immediately with lukewarm water. Angle the head so the contaminant does not flow into the other eye. After flushing, close the eye and cover with a loose, moist dressing and seek emergency care.
What you can do
Remove any contaminated clothing, jewelry and other items. Cover the area with a cool, damp, sterile dressing or clean cloth and other items.

Cover the area with a cool, damp, sterile dressing or clean cloth and call you doctor.

First-degree burns
Run cool water over the area or soak it in a cool-water bath for two to five minutes. If this is not possible, apply cold compresses. (If the burn has occurred in a cold environment, do not apply water.)
Cover the area with a cool, moist, clean bandage or clean cloth.
Pain relievers — such as aspirin, ibuprofen and acetaminophen (Tylenol) — may help reduce pain and swelling. NEVER give aspirin to children/teenagers. It can cause Reye’s syndrome, a rare but often fatal condition.
Sunburn pain may be relieved with oatmeal baths or by adding baking soda to the bath water (one-half cup into cool or lukewarm water).
A broken aloe vera leaf applied to the burned area may soothe the pain.
While caring for your burn at home, be aware of signs of infection which can develop in 24 to 48 hours.
Second-degree burns
Treat like first-degree burns if no bigger than two to three inches in diameter and not on face, hands, feet, groin, buttocks, completely encircling a digit or extremity, or a major joint — in which case you should seek emergency care.
Third-degree burns
Cover the burned area with a cool, damp, sterile dressing or clean cloth and seek emergency care immediately.

Prevention
For adults and children
Conduct fire drills at home and work. Know the location of fire escapes when sleeping away from home.
Install smoke detectors in every bedroom and on every floor and test them periodically.
Keep emergency numbers by the telephone.
Place a fire extinguisher in the kitchen and check the expiration date on a routine basis.
Keep a large box of baking soda within easy reach of the stove.
Keep a potted aloe vera plant in the kitchen (where most burns occur) to use the fresh jelly for treating minor burns.
Never put lighter fluid on lit charcoal briquettes.
Only use kerosene or other space heaters that have the UL (Underwriter’s Laboratory) seal of approval.
Always follow safety instructions when using chemicals, and note any warnings or precautions on container.
Learn how to deal with an overheated engine, car fire, or live wire on a car.
Never touch a downed electrical wire.
Know where all electrical wiring is located before starting construction or renovation. This also applies to any kind of outdoor digging.
Check with your utility company if you are unsure about the location of power lines in your area.

For children
Never leave a young child at home alone.
Keep matches and chemicals out of reach.
Turn pot handles toward the back of the stove while cooking.
Never drink hot beverages with a child on your lap.
Never place hot beverages or liquids near a table edge.
Don’t use mats or tablecloths that can be pulled easily off a table.
Make sure pajamas are flame-retardant.
Cover electrical outlets when not in use.
Set water heater thermostats no higher than 120° F to 125° F.

Final notes
for all types and degrees of burns
NEVER apply ointments, such as Vaseline, sprays, butter, oils or creams. They may slow healing and increase risk of infection. Use cool water instead.
NEVER cover a burn with materials such as blankets, towels or tissue since fibers may become stuck to the wound. Use a clean sheet or sterile dressing.
NEVER break blisters. Blisters protect the burn from infection and should only be ruptured if swelling constricts circulation.
*4\303\2*