Dermatitis ambustionis, when produced by heat in dry form, such as fire, hot solids, sun rays, etc., is termed a burn, and when caused by contact with hot fluids, such as water of fats, it is known as a scald.
Symptoms. Burns and scalds are ordinarily described by the effects produced on the tissues and three degrees are arbitrarily considered. The first degree presents local sensations of burning, smarting, tension, swelling and redness. In the second degree, three is added vesicular or bullous exudation, more or less shock, fever, and some mild consecutive visceral congestion. In the third degree, there is extensive destruction of the skin, even of the subcutaneous tissues, and consequent scarring, pronounced shock, and complications which may take the form of gastrointestinal disturbances, even ending in perforation, peritonitis and collapse. In the extreme variety, delirium, mania, convulsions or coma may appear as symptoms of cerebral congestion. Even if the shock is not great, or is overcome, suppuration will lead to sloughing of the injured parts and hence produce exhaustion or nephritis. Septicemia or erysipelas may cause a fatal ending.
Diagnosis. The condition is usually distinguishable and whether from a burn or a scald is not practically important.
Prognosis depends somewhat upon the extent and degree of the burn. The wider the surface involved, the deeper the burn, its location upon the chest, neck, or abdomen, old age, debility, or any constitutional dyscrasia, all contribute to a poor prognosis. Small and superficial burns usually proceed to an uneventful recovery.
Treatment. Mechanical protection is the first essential and, in the case of vesiculation or destruction of the skin, perfect asepsis. For simple burns, a dusting powder of bicarbonate of soda or 2 to 2 per cent. solution of the same will usually suffice. The following prescription will be found useful for extensive burns of the first degree:
R Acidi picrici, 3ij; 8
Spts. vin. rect., 3iv; 120
M. et adde
Aq. distil., 3xl; 1200
Layers of gauze saturated with the above may be applied to the affected surface and a supporting bandage added. When the inflammatory action is greater, 1 to 2 per cent. carbolic acid in olive oil or vaseline, dilute lead water, 5 per cent. of boroglycerid (50 Percent) in white was and vaseline, carron oil (equal parts of linseed oil and lime water), or thiol or ichthyol in ointment or solution, may be used. Often 1 or 2 per cent. of creolin in glycerin will relieve the intense inflammation and pain. If blebs form and become full or tense, they may be punctured at their most dependent border, so as to save the roof wall of the blister which, falling on the surface beneath, will protect it from the air and possibly serve as a natural skin graft. A comfortable dressing when serous exudation has ceased may be an ointment like the following:
R Thymol iodid., 3j; 4
Ol. olivae, 3j; 30
Cerat. simplex, 3j; 30 M.
This prescription should be applied directly to the surface and covered with a sufficient amount of gauze and bandage to thoroughly protect the parts. When burning is excessive, tincture of cantharides (one to twelve parts of sterilized water) is useful. Very small areas of unbroken skin may be protected with flexible collodion. After the acute stage is passed, succus Calendula (1 part to 10 of carron oil) is most effective in promoting repair. If burns become suppurative or gangrenous, strict local antisepsis is indicated. Carbolic acid (2 to 5 per cent.) may be used to disinfect the surface, after which, if the area affected is not large, an antiseptic dusting powder like aristol or boric acid may be applied, and the whole surface dressed as directed for burns of the second degree. If the area is extensive, a 5 per cent. solution of sodium biborate may follow the carbolic acid solution. Many layers of borated gauze, covered with rubber tissue,should be place above the first dressing. When inflammation subsides or healing has begun, oily antiseptic dressings may be used. In extreme cases, amputation of the affected parts may be required and plastic surgical methods may be needed to promote healing or to prevent cicatricial formations.
In burns and scalds of any degree, constitutional treatment is is of the first importance. Shock must be prevented or combated. The supporting and steadying effects of opium are of much value here. Morphin hypodermically, sufficiently frequently to meet the needs of the patient is the best method of administration; always giving the minimum physiological dose until the susceptibility of the patient is known. It is more to be relied on to modify local pain and for general effects, except for burns of small size, than the local pain and for general effects, except for burns of small size, than the local application of cocain. Stimulation, alcoholic or otherwise, is often essential. Internal medication plays an important role especially in stimulating healing and modifying tendencies to excessive scar formation. See indications for Arnica, Cantharis, Kali mur., K. phos., Silicea, Sul. acid, Urt. urens and Graphites, while cicatrization is under way.