Burns and Scalds are injuries to the body caused by excessive heat or by chemical agents. These accidents are extremely common; moreover they are in their severer forms far the most painful of injuries, and the most commonly fatal in civil life. Dupuytren's classification in six degrees, according to the depth of the injury, is now generally accepted: (1) Skin reddened; (2) skin blistered—i.e. cuticle destroyed; (3) true skin partly destroyed; (4) skin wholly destroyed; (5) soft parts below skin (muscles, tendons, &c.) more or less destroyed; (6) all parts, including bone, destroyed. In almost every burn beyond the first degree, two or more of the degrees are combined in different parts of the affected surface. The last two are rarely met with. But the danger to life from these injuries depends even more on their extent than on their depth; if a very large surface of skin be involved, even in the first or second degree, the case is a serious one; and the more so the younger the sufferer. Persons 'burned to death' in a conflagration, however, perish much oftener by suffocation, resulting from the noxious gases evolved, than from the effects of a burn properly so called.
In a severe burn or scald the pain is intense, and the Shock (q.v.) and prostration extreme and often fatal. At this stage opiates, warmth, and stimulating remedies are necessary. In two days or less, if the patient survive the shock of the injury, reaction sets in, and serious internal inflammations frequently occur. The organs situated beneath the injured surface are often affected, if this be on the trunk; but whatever part of the skin has suffered there is a tendency to inflammation and ulceration of the mucous membrane of the digestive tract, particularly the duodenum. These inflammations are not readily amenable to treatment, which must in the great majority of cases be directed chiefly to the support of the patient's strength and the alleviation of his sufferings. They occur for the most part within two weeks of the injury; after this period, however, there is the further risk that he may sink from exhaustion in consequence of the prolonged suppuration which follows the separation of the dead portions of tissue in burns deeper than the first degree.
For the local treatment of burns, innumerable measures have been recommended. Here only a few of the simpler applications, suitable to the slight degrees and early stages, can be described. The clothes must be removed with the greatest care, cut and not dragged off the injured part, lest the cuticle be adherent and be torn off with them, exposing the tender skin beneath. If the burn be of the first degree and not extensive, cold applications are generally most useful and pleasant to the patient; lint or rags dipped in plain water, or better, Goulard water (dilute solution of subacetate of lead), or a solution of carbonate of soda, and frequently moistened, do well. If the injured surface be extensive, cold applications are apt to increase the shock and the tendency to internal inflammations; and fine flour should be thickly dusted over the surface and covered with cotton-wool. If the burn be of the second degree, the blisters should be snipped with scissors and the contained fluid let out; but the raised skin must be carefully preserved as a protection to the tender surface below. In the second and higher degrees flour may be used as described above; or carron oil may be applied on lint or rags. (Carron oil consists of linseed oil and lime-water mixed in equal parts. Any unirritating vegetable oil, such as olive oil, may be substituted if linseed oil be not procurable. It takes its name from the Carron ironworks, where it has long been used, and is an excellent application). Carbolic lotion, carbolic oil, iodoform in powder or ointment, and many other antiseptics, are useful from their power of preventing putrefaction of the discharges and consequent irritation. A solution of cocaine is often valuable at the early stage from its effect in deadening pain; but such remedies should not be used except to a small surface without medical advice, lest they become absorbed and cause symptoms of poisoning. It is most important that the dressings be not changed oftener than absolutely necessary, whatever application is adopted; they should be left till the discharge loosens them, or till they become uncomfortable, or offensive on account of putrefaction of the dead tissues and discharges.
The local effects of burns, particularly those of the fourth degree, are of great importance; for during and after the healing of the resulting sores there is an excessive tendency to contraction of the cicatrix, and very serious deformity often results, especially when the injury is on the neck or near the joints of the limbs. Severe injuries of this kind should therefore be under skilled observation not only during the healing process, but for some time after its completion, in order that, if any such tendency appears, measures may at once be taken to counteract it.
When the clothes catch fire, the person should lie down on the floor, and roll herself, or be rolled, in the rug, table-cover, or anything sufficiently voluminous to stifle the flames; and afterwards the clothes, especially stockings, should be removed with great care, lest the cuticle should separate with them, which would materially increase the sufferings of the patient.
Extensive scalds or burns are very fatal to young children; and it must be remembered that their skin is more susceptible to external impressions, and will suffer from a degree of heat innocuous to an adult. Infants have frequently been scalded to death in too hot baths, or by too hot fomentations. The principles of treatment for burns produced by the contact of chemical agents to the skin, are the same as those for burns by fire.