Surface involvement seems to exert a greater depression or fatality than does depth of tissue. A burn, even of the first degree, which occupies an extended area and those of the second may terminate fatally if one-fourth or one-third of the superficial parts are involved; a fatal issue may also occur in burns occupying one-half of the body-surface. A burn of the second degree which occupies only a limited extent of surface, but which de stroys the epidermis entire, may end in recovery, while those of the third may, through their deep involvement, produce complications with which we are unable to combat. Burns occupying the abdo men give the highest mortality, while those of the thorax are only second to a slightly minor extent; but those of the head, neck, and limbs prove fatal in many instances.
[Of 26 eases seen by Sajous after a boiler explosion, on the Lake of Geneva, in 1392, 22 died within a few hours after the accident, although, with few excep tions, the scalds, though involving the greater part of the body, did not reach beyond the epidermic layer, excepting over the face and hands. ED.] Of the 293 men killed or injured on the Japanese side of the Battle of the Yalu, a large number had received burns cover ing an area of more than one-third of the body. Only 2 out of the 57 cases of this class recovered. Susuki (Boston Med. and Surg. Jour., Dec. 9, '97).
The nature of the exciting medium often governs the termination of burns, and those produced by cohesive bodies cause the greater destruction of part or life. The length of time required for the partial or complete reparation of the face may be an important question in medico-legal cases. This can only be governed by the type of injury, the length of contact of the exciting agent, the nature of the affected person, and the general aspects of the case in ques tion.
Treatment.—CONSTITUTIONAL. —The constitutional treatment is to be directed toward the relief of pain, the restoration of the depressed vitality at the time of accident, — i.e., sustaining the system throughout the entire restorative proc ess. Pain is best relieved by opium, or its alkaloid, morphine (preferably by hypodermic injection), because these agents have little, if any, depressing ac tion upon the cardiac functions. The dose required will be much greater than ordinarily used, because of the sudden character and great amount of depres sion in these injuries.
Vitality must be restored as quickly as possible, and the use of ammonia (preferably carbonate), strychnine, and caffeine (because of their stimulating effect upon the cardiac muscle); hot drinks, such as milk and tea; alcoholic drugs in the form of whisky or brandy, and the production of local or gener alized sweating. A most desirable plan
of restoring heat is by using hot-water bottles placed at regular points so as to diffuse its effects. Other means, as, for instance, covering the body with a sheet and conveying heat through a pipe or by placing heated bricks beneath this covering. To keep the sufferer fairly comfortable during the local treatment stimulation must be kept up, care being taken not to produce overactivity and thus allow reaction to prove as deleteri ous as the effect of the burn.
The functions of the body must be regulated, the bowels being kept free or confined, according to the conditions present; the action of the kidneys should be watched. In some cases it may be wise to anaesthetize the patient during the first few hours immediately follow ing the burn, and especially during the first dressings of aggravated cases.
LOCAL—The local treatment is to be directed toward the limitation of the re sulting inflammation, the prevention of septic infection, assisting the normal elimination of the eschar, the develop ment of granulations, and limitation of the deformity.
In burns of the first degree little or no treatment may be demanded. In the more aggravated cases of this type the application of home measures, such as bicarbonate of sodium, the white of egg and sweet oil (equal parts), lead water and laudanum, and the various hot or cold means generally at the dis posal of housewives.
Burns of the second and third degrees must be more strenuously treated. It is often a difficult problem to know which is the more soothing application to be advised and from which we may get the better result. In one case hot applications, in another cold; in some wet, and in others dry, measures are to be given. The vesicles, if numerous, should be untouched; but if only a few, they are best evacuated.
Prof. S. D. Gross was wont, in many mild and severe cases, to use ordinary white-lead paint; the results achieved were often marvelous.
[This is a remarkably efficacious meas ure. Mere painting of the burn, as if it were an article of furniture, etc., causes. immediate cessation of the pain. En.] The use of carbolized vaselin (15 to 30 grains to the ounce), watery solutions of carbolic acid (about 20 grains to the ounce), subnitrate of bismuth ('/, to drachm to ounce of ointment of zinc oxide or petrolatum), boric acid (either in watery saturated solutions or oint ments of either zinc oxide or petrolatum in strengths varying from to 2 drachms to the ounce), bicarbonate of soda in almost full strength (in ointment or watery solutions). and starch in vary ing proportions will usually be found very efficacious.