The best topical application to hasten cicatrization in burns is picric acid. Its application is recommended from super ficial burns to those of the third de gree. It is contra-indicated in deep, old, or suppurating burns, and in very young children. Technique consists of antiseptic cleansing of the burn in a picric-acid bath of 1 per cent., with a careful preservation of the epidermis.
This washing is to be repeated, taking all possible care to prevent raising the epidermis. When burns are very super ficial, remarkable cures have been ef fected by painting with ether or alcohol saturated with picric acid. Dakhyle (Le Progres Med., Jan. 7, '99).
The combination of picric and citric acids, which Esbach devised for the de tection of albumin, is more effective than the picric acid alone, in burns of the second degree.
Esbach's solution consists of 10 parts of picric acid, 20 of citric acid, and 1000 of water. Without any elaborate at tempts at antisepsis the bullae and vesi cles should be opened with a clean blade and the fluid applied freely, care being taken that the solution reaches the in terior of each one. The combination after the first smart has passed removes the pain very quickly. After the excess of fluid has drained off the part may be covered with tissue or soft gauze and left undisturbed for several days. After two or three days the fluid should be reapplied to such areas as are moist and the part carefully recovered. E. M. Alger (Ther. Gaz., June 15, '99).
For burns in infancy and children the best application is a 1-per-cent. aqueous solution of picric acid. This gives al most immediate relief from pain, and healing takes place rapidly. After the burned area has been coated once or twice with the solution a thin layer of absorbent cotton may be applied dry, and over this a. layer of impervious tis sue, and, finally, as much cotton as may be required for warmth, protection, ex clusion of air and germs, and over this a loose bandage. Charles Warren Allen (Pediatrics, Mar. 15, 1901).
Some French observers also claim that it is not poisonous, and that, excepting its effect upon the urine, which it turns very yellow, it has no other bad effects; but negative evidence has been adduced, however, and several cases of poisoning (smarting at the part of application, with the production of vomiting in the course of twenty-four hours) have been recorded by Walther, Berger, Labouche, Tuffier, and others. Colic, diarrhma, yellowish discoloration of the skin, sleep iness, and scanty, dark-colored urine were the main symptoms.
Calcined magnesia is a valuable agent for the treatment of burns of the first and second degrees.
The affected parts are covered with a thick layer of a paste, which is prepared by mixing the calcined magnesia with a certain quantity of water. This paste is allowed to dry on the skin, and when it becomes detached and falls off it is re placed by a fresh application. Very soon after the paste is applied the pain ceases, and under the protective covering formed by the magnesia the wounds recover without leaving the cutaneous pigmenta tion which is so often observed to fol low burns that have been allowed to remain exposed to the air. Vergely (Revue Med., Feb. 10, '96).
Iodoform is anmsthetic and antiseptic. It may be left in situ for a considerable period—a week—without necessitating a change of dressing. It should not be strewn upon the raw corium nor upon granulating tissues.
After accidents by burning, and par ticularly where the surface of the skin destroyed has been very extensive, atrophy of the optic nerves has resulted. It is also known that iodoform is capa ble of giving rise to a form of toxic amblyopia, resembling somewhat closely that produced by alcohol or tobacco. Whether these eye-symptoms are due to the burn in all eases, or to absorption of iodoform (and similar substances) ap plied to the wound, the possibility of the occurrence of a condition so very serious ought to be borne in mind. Terson (Arch. d'Opht.. Oct., '97).
Nitrate of potassium, or nitre, has been found to be useful in all kinds of burns, and may be employed to great advantage when the other agents described cannot be had. It acts mainly as a refrigerant by causing notable lowering of the tem perature of the liquid used as solvent.
If a burned hand or foot is plunged into a basin of water to which a few spoonfuls of the nitrate have been added, the pain ceases rapidly; if the water be comes slightly heated, the pain returns, but it is allayed as soon as a fresh quan tity of the salt is added. This bath, which is prolonged from two to three hours, may bring about the definitive disappearance of the pain and even pre vent the production of blisters. The ap plication of the compresses also exercises the same influence. By this means the pain is allayed and cicatrization takes place without delay. l'oggi (Revue Med., Feb. 16, '96).