Burn injury

“ There is more assistance to ease the psychological impact on those who suffer burn injury.
Much more can be done to make ourselves safe from burn injury. We can all cooperate with the dedicated professionals who are working to prevent burns and care for the injured. ”

“ The best approach to burn injury, of course, is prevention. Because a great number of burns could be prevented, there is a great need for national attention to all aspects of burn prevention.
We can all be truly grateful to the many Americans who devote themselves to treating, caring for, and rehabilitating burn victims; to all those involved in the vital work of burn research; to the dedicated fire fighters who risk their own lives daily to protect others; and to everyone who promotes burn awareness and prevention. ”

“ A burn involving two-thirds of the body may be regarded as necessarily fatal; but the injury of a much less proportion, even one-fourth of the surface, has resulted in death. The qualifications to be made in burns of less extent are pronounced. The part affected is of much importance. Burns of the trunk are more fatal than those of the extremities ”

“ A scald is an injury produced by the application of a liquid at or near its boiling-point.
Appearances as Indicating Origin.
A hot body may produce a burn of any intensity, ranging between reddening of the skin and complete charring of the tissues, according as its temperature is elevated and the period of contact prolonged: the shape of the object and its size being indicated by the form of the burn. Metallic substances heated to a temperature of 100° C. (212° F.) are capable of producing redness and vesication and other injurious effects. ”

“ This treatment was continued for four or five days, during which time the wound presented the usual aspect of a burn from ordinary causes, except in its greater depth and more tardy progress towards cicatrization, which did not take place till after thirty-two days from the date of the infliction of the injury. The part of the ulcer which healed last was the point of inception and intensity of the pain at the time of attack, and which point was evidently the seat of deeper injury than any other portion of the wounded surface. ”

“ The great essential in all such applications is that they should completely exclude the air; for the very slightest irritation to{384} the surface of a burn will give rise to the most excruciating pain. To prevent irritation and to keep the parts at rest is indeed one of the surest ways of relieving pain, not only in the case of burns, but in the treatment of other forms of injury, and also in many kinds of disease. An instance of this is found in the method adopted to relieve the pain in certain joint diseases. ”

“ The moment a person is called to a case of scald or burn, he should cover the part with a sheet, or a portion of a sheet, of wadding, taking care not to break any blister that may have formed, or stay to remove any burnt clothes that may adhere to the surface, but as quickly as possible envelope every part of the injury from all access of the air, laying one or two more pieces of wadding on the first, so as to effectually guard the burn or scald from the irritation of the atmosphere ”

“ Different degrees of injury are inflicted on the surface from the application of heated solids or fluids. The term scald is generally confined to the effects of heated fluids, whilst burn denotes the consequences of the application of a heated solid, or of ignited combustible matter; the latter class of accidents is, in general, the more serious, yet the former, though not injuring the skin deeply, gives rise to the most alarming symptoms when a large extent of surface is affected. ”

“ The extraordinary effects produced on the internal organs by an extensive burn on the surface of the body, consisting in violent inflammation of the tissues of the abdomen, chest, or head, which, when death ensues from this kind of injury, is one of the most frequent causes of it ”

“ Burns are caused by flames, highly heated solids, or very cold solids, as solid carbonic acid; scalds, by steam or hot fluids. Burns may cause death from shock, suffocation, œdema glottidis, inflammation of serous surfaces, bronchitis, pneumonia, duodenal ulcer, coma, or exhaustion. A burn of the skin inflicted during life is followed by a bleb containing serum; the edges of this blister are bright red, and the base, seen after removing the cuticle, is red and inflamed; if sustained after death, a bleb, if present, contains but little fluid, and there are no signs of vital reaction. ”

“ It must be observed, however, that burns met with at the bedside always illustrate more than one of these degrees, the deeper forms always being associated with those less deep, and the clinical picture is made up of the combined characters of all. A burn is classified in terms of its most severe portion. It is also to be remarked that the extent and severity of a burn usually prove to be greater than at first sight appears. ”

“ In case of a large burn, lose no delay in bringing a physician. If a burn be near a joint or on the face, even if small, let a doctor see it, and do not be in any hurry about having it healed. Remember that with all the care and skill which can be used, contractions will sometimes take place. The danger to life from a burn or scald is not in proportion to its severity, but to its extent—that is, a small part, such as a hand or a foot, may be burned so deeply as to cripple it for life, and yet not much endanger the general health ”

“ BURNS AND SCALDS. A burn is the effect of dry heat applied to some part of the human body, a scald being the result of moist heat. Clinically there is no distinction between the two, and their classification and treatment are identical. In Dupuytren’s classification, now most generally accepted, burns are divided into six classes according to the severest part of the lesion. Burns of the first degree are characterized by severe pain, redness of the skin, a certain amount of swelling that soon passes, and later exfoliation of the skin. ”

“ Sometimes large patches of skin are scorched or stained, the discoloured area showing an arborescent appearance. In other cases the injured skin becomes dry and glazed, resembling parchment. Appearances are occasionally met with corresponding to those of a superficial burn produced by heat. The chief difference from ordinary burns is the extreme slowness with which healing takes place. Localised paralysis of groups of muscles, or even of a whole limb, may follow any degree of lightning-stroke. ”

“ Is a burn more dangerous than a scald?
A burn is generally more serious than a scald. Burns and scalds are more dangerous on the body, especially on the chest, than either on the face or on the extremities. The younger the child, the greater the danger.
Scalds both of the mouth and the throat, from a child drinking boiling water from the spout of a tea-kettle, are most dangerous. ”

“ The situation of the burn is important. Burns over the serous cavities--abdomen, thorax, or skull--are, other things being equal, much more dangerous than burns of the limbs. The risk of oedema of the glottis in burns about the neck and mouth has already been referred to. (3) Children are more liable to succumb to shock during the early period, but withstand prolonged suppuration better than adults. (4) When the patient survives the shock, the presence or absence of infection is the all-important factor in prognosis. ”

“ This is the cause of the frequent burns in the heel or sole of the foot in the case of those struck by lightning while standing, as the electricity passes away from the body into the ground and finds a strong resistance at the point of leaving the body. This is also the cause of the burns where the current leaves the body from any other cause, as from the contact or proximity of a metallic object. The greater the resistance so long as the current passes, other things being equal, the more severe is the burn. ”

“ His neck should not be allowed to bend when he is being moved.
Burns
Non-serious or superficial (first degree) burns should not be covered--in fact, nothing need be done for them. However, if a first degree burn covers a large area of the body, the patient should be given fluids to drink as mentioned in item 2 following.
The most important things to do about serious (second or third degree) burns are: (a) Treat the patient for shock, (b) Prevent infection, and (c) Relieve pain. These specific actions should be taken:
1. ”

“ In the large majority of cases the upper portion of the body is the part first touched by the lightning, and thence it descends along the body to the ground. We are apt, therefore, to find a severe burn about the upper portion of the body, the head, neck, or shoulders; then a scorching, singeing, or burning, more or less severe, in the form of a stripe or stripes more or less broad down the body: the burns being deeper where the clothes are tighter or where metallic objects come into contact with or are near the body ”

“ In case of severe burns of the body immerse the patient in a warm bath, keeping it at even temperature. Separating a layer of common white cotton wadding, and wrapping it about the injured part will allay the pain, and the cotton has the advantage of not adhering to the raw surface. Splints and bandages should be employed to prevent contractions.
BURNS OF THE EYE.
For burns resulting from molten lead, strong alkalies, lime, or acids, flush freely with warm water or boric-acid solution, and anoint with pure vaselin or a few drops of castor oil. Do not rub the injured tissues. ”

“ If two similar exposures are made on the arm of a sensitive man, and one of these burns is treated, so to speak, by contact for five minutes, with the skin of a resistant man, the treated burn will be markedly less severe than the control, in some cases being entirely prevented. ”

“ When a large surface of the skin is burned or scalded, the animal (if it does not die at once from shock) will soon show signs of fever—shivering, coldness of the extremities, weakness, restlessness, quick and feeble pulse, and labored breathing. No matter which agent is a factor in the production of burns, the lesions are practically of the same nature. The extent and site of the burn should lead one in the determination and course of treatment. ”

“ It must not be forgotten that patients who are burned extensively very frequently die shortly after the accident. A burn that involves more than one-half of the body, no matter how superficial the burning may be, will always have a fatal termination. ”

“ Was the burn inflicted before or after death?—The answer to this question depends upon careful consideration of all the evidences afforded by the external and internal appearances, and upon the presence or absence of vital reaction in the lesions found.
Two characteristic appearances—redness and vesication—are present in burns inflicted during life when the surface of the body is not charred and the tissues destroyed. The redness affects the surface and entire substance of the true skin, which is dotted by the deep red openings of the sudoriferous and sebaceous ducts. ”

“ The burns, however, vary greatly. The eyes may be burnt and severely injured or destroyed. The lightning has been known to enter the mouth and burn the mucous membrane within. The deeper burns not infrequently assume the form of holes. ”

“ Slight burns, such as one often gets in the kitchen or laundry, can be relieved, and blistering be prevented, by coating the burned part with oil, lard, or butter, then covering with baking soda, and finally with a piece of linen. In a short time the pain will cease, and, unless the burn be very deep or the remedies be applied too late, there will be no blister. Lime water also is good for burns.
Children are often scalded by falling into hot water left within their reach, or by overturning some hot liquid upon themselves. ”

“ If it be requisite to bring this Tumour to Suppuration, white Lillies roasted under Embers may be added to the preceeding Cataplasm; or else a new Cataplasm may be made with Sorrel boil'd, fresh Butter, and a little Leaven.
What is a Burn?
A burn is an Impression of Fire made upon a Part, wherein remains a great deal of Heat, with Blisters full of serous Particles, or Scabs, accordingly as the Fire hath taken more or less effect.
What are the Remedies proper for a Burn? ”

“ One striking difference between the medical picture presented by World War I and the one we are fighting today lies in the enormously increased number of burn cases. As a result of modern warfare, burns have become a major casualty. Of the patients sent to the Pearl Harbor Hospital, 254 were burn cases. ”

“ It effectually protects and sheathes the burn or the scald from the air; (4.) It is readily and easily applied: all that has to be done is to spread the lard either on pieces of old linen rag, or on lint, and then to apply them smoothly to the parts affected, keeping them in their places by means of bandages—which bandages may be readily made from either old linen or calico shirts. Dr John Packard, of Philadelphia, was the first to bring this remedy for burns and scalds before the public—he having tried it in numerous instances, and with the happiest results. ”

“ The severity of the accident depends mainly, 1, on the intensity of the heat of the burning body, together with, 2, the extent of surface, and, 3, the vitality of the parts involved in the injury, thus: a person may have a finger burned off with less danger to life than an extensive scald of his back.
The immediate effect of scalds is generally less violent than that of burns; fluids not being capable of acquiring so high a temperature as some solids, but flowing about with great facility, their effects become most serious by extending to a large surface of the body. ”