BURNS AND SCALDS. A burn is the effect of dry heat of 140° F and over, a scald being the result of moist heat of over Ito° F. Clinically there is no distinction between the two, and their classification and treatment are identical. In Dupuytren's classification, burns are divided into six classes according to the severest part of the lesion. Burns of the first degree are charac terized by severe pain, redness, transient swelling, and later ex foliation of the skin. Burns of the second degree show vesicles (small blisters) over the inflamed area. Beneath the vesicle the highly sensitive papillae of the skin are exposed. They leave no scar, but often produce a permanent discoloration. In burns of the third degree, there is a partial destruction of the true skin, leaving sloughs of a yellowish or black colour. The pain is at first intense, but passes off on about the second day to return again at the end of a week, when the sloughs separate, exposing the sensitive nerve filaments of the underlying skin. This results in a slightly depressed cicatrix which shows but slight tendency to contraction. Burns of the fourth degree, which follow the pro longed application of any form of intense heat, involve the total destruction of the true skin. The pain is much less severe than in the preceding class, since the nerve endings have been totally destroyed. The results, however, are far more serious, and healing is slow. Deep puckered scars are formed, which show great tendency to contract, and the resulting loss of function may be ex tremely serious. In burns of the fifth degree the underlying muscles are more or less destroyed, and in those of the sixth the bones are also charred.
The clinical history of a severe burn can be divided into three periods. The first lasts from 36 to 48 hours, during which the patient lies in a condition of profound shock and feels little or no pain. If death results coma first supervenes. The second period begins when the effects of shock pass, and continues until the slough separates, which takes one to two weeks. Much fever is present, and the tendency to complications is great. Bronchitis, pneumonia, pleurisy, meningitis, intestinal catarrh, and ulceration of the duodenum, have been recorded. These complications are the result of septic infection and absorption, and antiseptic treat ment reduces their frequency. The third period lasts until recov ery. The prognosis depends chiefly on the extent of skin involved, death almost invariably resulting when one-third of the total area of the body is affected, however superficially. Of secondary but still grave importance is the position of the burn, one over a serous cavity being more serious than one on a limb. Also it must be remembered that children very easily succumb to shock.
Treatment.—The treatment is both general and local. The general treatment in severe burns consists in dealing promptly with shock bef ore attempting to treat the burn itself. Stimulants should be avoided, and every effort made to soothe the patient, a useful aid being immersion in a hot bath. After the stage of shock has passed, the secondary effects, such as toxaemia and septicaemia, must be dealt with on general medical principles. The local treatment should aim at preventing sepsis, avoiding frequent dressings, favouring the removal of the eschar, and of obtaining a pliant scar and avoiding deformity.
Scars from burns may be reduced to some extent by radium and X-rays, provided the treatment is commenced within a few months of the injury.
BIBLIOGRAPHY.- J. M. H. MacLeod, Handbook of the Pathology of Bibliography.- J. M. H. MacLeod, Handbook of the Pathology of the Skin (1903) ; Burns and their Treatment (1918) ; The Diseases of the Skin (192o) .