BURNS According to the nature and duration of the burn we distinguish three degrees.
Burns of the first degree are caused in children by scalding with water at a temperatum of BA° to 18S° F. or by slightly touching hot objects, etc. The skin becomes red, swells, burns, pains, and exhibits the manifestations of simple heat dermatitis. After a few clays the inflam mation pales off and there is a gradual transition into the normal state.
Burns of the second degree occur in children by scalding with water between 1SS° F. and 242° F., steam, fire, etc., acting on the skin only a short time. On the hypertemic, mdematous skirl we observe vesicles which may attain the size of a hen's egg and are filled with a limpid or yellowish serous fluid and after a time become ulcerative. On removing the cystic cover, the inflamed, suppurative rete Malpighii is exposed, and it requires one to three weeks until the new formation of the skin is complete. This takes place in the following way. On the red secretory surface arise small whitish epithelial islands which gradually expand and run into each other. The healed places have first a red and then a brownish pigmentation. Burns of the second degree are exceedingly painful, especially' after the cystic cover has been removed and the wound exposed to the air.
Burns ol the third degree occur through the long continued effect of boiling fluid, burning clothes, contact with molten metals, etc. They lead to necrosis or eschars of the burnt skin, which looks white, black, incinerated or leatherlike and is insensitive. After a demarcation line has been formed (after about three to five (lays) the sloughs gradually scale off (one to two weeks), the I1CW formation of the skin again takes place from the epithelial islands as in burns of the second degree. If the defects are very deep, the burns heal with an irregular cieatrix, often with very unpleasant ectopia (trismus) and contractures of the extremi ties. The more extensive the bur»s, the more unfavorable the prognosis, the general acceptation being that if one-third of the body has been consumed, all attempts to save the patie»t's life are (loomed to failure. In severe burns on an extensive scale sufferers perish under the following manifestations: whereas during the first day or two the temperature is normal or subnormal, fever gradually develops, and under excrueiating pain, conditions of excitation, delirium, numbness, epilepsy, cardiac weakness, vomiting, singultus and anuria occur. After one or two more
days death ensues in deep corna.
In children, especially the newborn, the most frequent burns are those of the first degree, caused by hot water, the skin of the newborn infant being so sensitive that it responds with manifestations of burns even to a temperature of 37° C. (9".i.6° F.).
children the prognosis is good only in burns of the first degree; the more extensive burns of the second degree very frequently prove fatal. The prognosis of the third degree is directly unfavorable.
Diagnosis.—For purposes of differential diagnosis pemphigus neonatorum and epidermolysis bullosa eome in question. To recognize the former affection, the question of contagiousness is of importance, as to whether similar cases have occurred in the same family or in that of the midwife. In epidermolysis heredity is the point to elucidate, but above all in all eases of !RIMS there are always inflammatory manifestations.
treatment should be anodyne in the first place by shutting off the air and applying cooling bandages. In the second place antiseptic measures should be instituted in order to prevent the spreading of infectious inflammations. The burns of the first and second degrees are best carefully cleansed, washed and powdered dry with bismuth powder or dermatol. excellent result is attained in burns of the second degree by Bardeleben's bismuth bandages (open the wheals, cover burned places with bismuth bandage and change bandage every eight days). Limewater bandages with linseed oil (aqua calcis, oleum lini aa 50.0, thymol 0.1). To relieve the pain I have found 10 per cent. bismuth-ichthyol ointment to be of good effect. As disinfecting and cool ing lotions after the desquarnat ion, the best effect is produced by acetic aluinina, boric acid bandages, etc. In deep (`XiellSiVe destructions Hebra's permanent waterbath, 26° to 30° C. (Th.s° F. to SG° F.) will prove indispensable. The patient remains suspended in the unifortnly heated water by means of a frame or sheet. If the extrentities are extensively burnt, extension bandages have to be applied on account of eicatrization. To meet conditions of excitation, eollapse and pain, the corresponding general directions have to be applied.