Autopsies on the bodies of five small children who had died of severe burns: The most noticeable 'gross lesions were cloudy swelling of the liver and kidney, acute swelling of the spleen, and swell ing and congestion of the lymphatic glands and other lymphatic tissue. Mi croscopically the most interesting lesions noted were parenchymatous degeneration of the kidneys and liver, focal areas of necrosis in the liver, and pronounced focal necrosis in the lymphatic tissue. The lymphatic tissue was affected throughout the body. The Malpighian corpuscles of the spleen, the tonsils, the gastric lymphatic follicles, the enteric, solitary, and agminated follicles, and the lymphatic glands, all showed essentially the same changes. The lymphatic glands were much swelled and at times con gested. The earliest changes were in the follicles, and consisted of an oedematous swelling. This was more marked toward the centre of the follicle. In areas of less advanced alteration the lymphocytes NN ere merely less closely packed together than is usual, but in the areas of more marked change the lymphocytes were swelled and their nuclei fragmented. The focal degeneration in the lymphatic follicles of the tonsil and of the stomach and in the Malpighian bodies of the spleen is essentially similar to that of the follicles of the lymphatic glands. In these areas of degeneration in the lym phatic tissue we find appearances essen tially similar to those seen after the in jection into the body of various bacterial and other toxalbuminous substances. The lymphatic glands from the cases cf skin-burn might readily be mistaken for the lymphatic glands of children dead of diphtheria. The lesions in the other organs are also essentially similar to those found in the bodies of persons dead from acute infectious diseases. One of the main causes of death after burns, therefore, is in a toxmmia caused by alterations in the blood and tissues, the direct effect of the elevations of tempera ture. Bardeen (Johns Hopkins Hosp. Bull., Apr., '97).
The theories of the causes of death from burns may be divided into four classes: (1) death from shock or extreme pain; (2) embolism. thrombosis, and destruction of the blood-elements: (3) pylemic infection through the burned surface; (4) poisons formed by the ac tion of heat on the tissues, or autoin toxication from deficient excretion by the skin. By experimenting upon dogs and rabbits it is personally claimed that the intoxication theory is the correct one. Injection of large quantities of artificial blood-serum subcutaneously appeared to save life in several cases. Azzarello (Glom. Ital. delle Mal. Ven. e delle I'elle. face. 11, '99).
Two sets of experiments conducted to determine the influence of the skin in producing the poisons which lead to a fatal issue in burns, from which it is con cluded that the blood itself, rather than the tissues, is the scat of the chemical ehange. E. Scholz (MtInchener med. Woch., Jan. 30, 1900).
1. The entire pathological picture presents great similarity to the condi tions found in the diseases characterized by the presence of toxins of bacterial origin in the blood.
2. Damage to the lymphatic tissue is a constant feature, but is not neces sarily focal, some cases presenting only diffuse degeneration. The cases which live but a few hours after infliction seem more likely to present a focal con dition than those which live a longer time, as the condition which the writer interprets as proliferation and phagocy tosis is one which may very rapidly dis appear.
3. The focal lesions are not a true necrosis, but rather a proliferation of the endothelial cells of the reticulum and the capillaries, and a phagocytosis by the leucocytes and endothelial cells, to which latter is due the fragmented, disintegrated appearance which suggests a true necrosis. John MeCrae (Amer. Medicine, Nov. 9, 1901).
The attempt of nature to restore a covering for these denuded tissues often results unwisely. Vicious scars, ad hesions of contiguous parts (causing webbed fingers, the arm being attached to the side by granulations), and deform ities may be encountered. Cicatrices may be small and fiat or large and rugous. The skin may be as soft and pliable as in the normal state, or tightly stretched and drawing the parts from their anatomical position. Calcareous degeneration or even epithelioma may attack the scars. Pressure upon the terminals of the nerves may either cause neuralgia or spasm of the glottis, which may demand surgical interference for its removal. Finally, keloidal tumors may be observed as a consequence of vicious scarring. They will not differ from those produced by other abnormalities and will accept all the gyrations en countered in other conditions. All of the scar may not be affected with keloid, as, for instance, one end may show the prolongations, while the other resembles ordinary cicatrices. The contractions of the skin after scarring may produce great deformity and the hand may be drawn backward upon the arm or talipes cal caneous may result or other disfigura tions too numerous to mention may be shown. Exposure of joints has taken place followed by ankylosis. Bones have been fractured from loss of substance (cooking of the muscles).
Diagnosis.—Ordinarily the recognition of burns is not a difficult task, although the differentiation of the varieties, espe cially of the second and third degrees, may demand careful examination. Burn ing flesh with destruction of its particles, exposure of the underlying tissues (mus cles, bones, etc.), will be a train of symp toms not to be controverted. The dif ference between burns and scalds often may occasion difficulty, but the fact of the greater and deeper destruction of the former with the more superficial char acter of the latter will generally be suf ficient. The loss of hair follows the former because of this deep destruction of the hair-follicle and papilla.
Legal aspects of burns. In eases where the persons have been alive when they were exposed to the fire, soot is found in the ramifications of the trachea and bronchi. If the red blood-corpuscles are found disintegrated and disfigured throughout, then this is a further sign of a person having been burnt while alive; the blood of animals which have been burnt or scalded after death shows only occasionally a few broken-up, cre nated, or polymorphous red corpuscles; as a rule, the red blood-corpuscles retain their shape and integrity, and appear only swelled and paler. Robert Neupert (Friedreich's Bl. f. ger. med. u. Sani tEetspol, vol. xlviii, pt. 3, '97).