Any complication, such as bleeding, of small or large vessels, must be checked by appropriate surgical measures. Sep sis must be prevented by the early moval of any obnoxious material. Parti cles of dead skin laying over the surface are to be removed, clothing if present, if that can be accomplished without any further destruction of the tissues, thereby exposing the healthy parts, or producing pain to the sufferer.
Emphasis upon the great importance of keeping the injured part aseptic; the patient may recover from the shock only to die of blood-poisoning. This is espe cially to he feared where the side of the face and the chest are extensively burnt. The wound should be at once thoroughly disinfected. It is then covered with sub nitrate of bismuth, and then with iodo form gauze, kept in place by light band ages. Tschmarke (Deutsche Zeit. f. Chin, vol. xliv, pp. 346-392. '97).
The fatal result in severe burns is due to the absorption of a toxic substance derived from chemical changes in the burnt tissues. The lethal tendency is best met by removing the necrosed tis sues and infusing saline solution. Three cases of very severe burns in which the patients were in a most critical condi tion, with stupor, suppression of urine. etc., in which recovery followed as a re sult of this method. The infusion was repeated daily for several days. Para scandolo (Centralb. f. Chin, Apr. 27, 1901).
Calcium hypochloride an excellent antiseptic. It is not largely used for burns, and therefore attention is called to the good results which have been obtained by the author. Having been dissatisfied with the usual methods of treating burns, putting up one foot of a smith, who had been burned on both feet, with calcium hypochloride, and the other one with oil was tried; the foot treated with the calcium healed in a fortnight, while the other took four weeks. A cool bandage with oil is now applied on the first day, which causes the vesicles to form quickly, and after twenty-four hours these are opened, under antiseptic precautions. Com
presses steeped in the solution are then applied, and this is renewed after twenty-four hours, but they are kept moist by pouring on fresh solution dur ing that time. It is of importance to leave the compresses on as long as pos sible, and to keep them constantly damp. Great care must be exercised in removing the old compresses not to disturb the scabs under which the wound is to heal. The solution which the author uses is:— H. Cale. hypochlor., 2.4 to 5 grammes (37 grains) (circa).
Aquie destil., 9.900 grammes (35 ounces).
Solve, ultra, et adde:— Spt. camphor., 5 grammes (S5 minims).
F. Tichy (Deutsche med. Woch., July 17, 1902).
Granulations may often be assisted by powders of acetanilid in full strength, dusted over the surface, or by the use of some of the iodine derivatives, such as iodol, europhen, or aristol (15 to GO grains to the ounce of powdered starch or ointment), applied to the exposed sur face.
Limitation of deformity is a very seri ous problem. Splints are to be placed so as to prevent the parts from losing their anatomical relation and should be kept applied for some time after the parts have healed because of the in herent tendency of the contraction for long periods, even years, after the ap parent cure. Bandages are to be kept continuously applied to prevent con tiguous surfaces from becoming agglu tinated. Massage must be advised at the very earliest moment so as to restore the pliability of the part and prevent anky losis, when a joint is involved. Even with all the measures that we can adopt the loss of skin-tissue may be so extensive that skin-grafting will be the only means with which we can hope to restore the integrity of the part. The relief of cica trices or contractions, ankylosis, or press ure upon the nerve-filaments sometimes requires the most energetic surgical in terference.