BURNS AND SCALDS.
Preventive treatment in the ordinary sense of the word need not be considered, but the consequences of a burning accident may often he so minimised that a fatal issue may be prevented by presence of mind and prompt action at the time. The victim should be instantly rolled over on the floor, or enveloped rapidly in a heavy loose garment, rug, or carpet, so as to exclude the air and stop the combustion of his clothing, instead of permitting him to rush frantically through the air fanning the flames, and to plunge him into water is a grave error. In the case of limited burns, when the skin has been for a short time submitted to even an intense heat, if a saturated Solution of Bicarbonate of Soda be instantly applied, no vesication or destruction of cuticle occurs, and pain is almost instantly relieved. In this simple way, what would otherwise have been a troublesome and painful burn will be effectually prevented. But the application must be made without delay, and before the cuticle is raised, and the quickest way is to apply the dry salt made into a paste with a little water, and gently rubbed over the smarting spot for a few minutes, adding a few drops of water from time to time.
For severe and extensive burns the first treatment required is to relieve the shock and collapse, and bring about reaction, by enveloping the patient in flannel or wadding and administering liberal doses of hot stimulants, whiskey punch, or wine whey; warm saline solution by the rectum or subcutaneously may be necessary, and a hypodermic of Morphia when the pain becomes intense as the symptoms of shock begin to pass off; and whilst this is being done only very limited attention should be bestowed upon the burn itself.
As soon as shock is relieved the clothing must be carefully cut off, piecemeal, and only a limited portion of the surface of the body should be exposed at one time. Corrosive liquids, if they have been the cause of the burn or scald, should be washed off with an appropriate solvent or antidote. Thus, scalds by boiling acids should be lightly washed with
warm water or weak alkaline solutions, and boiling tar scalds may be gently cleaned with any warm bland oil or lard.
In the case of extensive burns and scalds, even when only of the first or second degree, which are often the most painful, and especially in all degrees of extensive burning occurring in children, a general anaesthetic is essential during the first dressing, and may be required also at subsequent dressings.
The selection of the application is important, and since the recognition of the grave part played by sepsis the use of the old-fashioned soothing and emolient Carron Oil is being abandoned for antiseptic solutions. But where the burn is of the first degree and the cutaneous surface is unbroken, no better dressing can be employed than lint, linen cloths, or a layer of cotton-wool soaked in the emulsion and kept in place by a light bandage. Slight superficial burns may be treated by the application of powdered Starch or wheaten Flour. In burns of the second degree where vesication is always present, and in the deeper degrees of burning and scalding, the surface should be carefully cleansed by a warm antiseptic, as solution of Boric Acid, Condy's fluid, or other unirritating germicidal liquid before applying dressings. Where a very large surface of the body is superficially burned and the patient is suffering great pain, relief may be obtained by immersing the patient in a bath at about 98° F., consisting of Boric Acid Solution or weak Permanganate of Potash Solution, and this plan with advantage may be continued throughout the treatment from time to time when the dressings require removal and sloughs are slow of separating. There is no doubt about the value of external warmth; in most cases the temperature of the body may be found de pressed, and recently good reports have been obtained from the use of the hot-air bath.