The effect of these will vary with the extent of surface, or the depth of skin injured or destroyed. Recovery, moreover, must depend greatly upon the state of health at the time of the accident. Under ordinary states of health a superficial scald or burn, not destroying the skin below the surface and not involving more than half the superfices, may be recovered from. Less than half of this extent of burn may, however, be fatal, if it extend to the true skin and the muscles below.
Burns as a rule destroy more than scalds. Scalds usually form blisters and go no deeper, but burns may char the deeper skin and the muscles beneath; they are, therefore, the more dangerous of the two.
Treatment - Should the burn have resulted from the clothes catching fire, they should carefully be removed, so as not to break the blisters which may be forming or formed, lest violence be done to the raw skin beneath, and, for the same reason, pieces of the clothing that stick to the surface should not be removed at the time. If the burn or scald be extensive, some stimulant wine and water should be given at once to diminish the effect of "shock".
The principle to be observed in the treatment of burns and scalds, is to cause a gradual diminution of heat in the part, not to allow it to cool too quickly. This is effected by protecting the burnt or scalded part from the air, by immediately dredging with flour, or covering with cotton-wool or oil. If the case is a slight one, these dressings may be left on for a day or two; but if it be more severe the damaged parts should be dressed with lint, spread with basilicon or resin ointment, or a mixture of equal parts of that ointment and spirits of turpentine.
Another useful lotion for application to burns and scalds of slight extent consists of "carron oil," or - Lime-water, 1 part, Linseed-oil, 2 parts, well shaken together, and applied by means of strips of lint, or soft linen rag soaked in it, and changed twice a day.
It is generally advisable not to cut the blisters which may be formed, as they protect the true skin under them; but if the base of the blister shows symptoms of inflammation, it is as well to evacuate the contents, but even then to do it by means of a small prick, and to leave the skin on, so that it may protect the raw surface from the air.
The black char of skin that is sometimes left should be poulticed with bread, or linseed meal and bread, till the slough separates. When this has taken place, there is left a surface of what appear to be little mounds of flesh, and these give out a discharge of matter. They are called granulations, and are the commencements of the process of healing, At times these granulations grow very rapidly and abundantly, rising above the level of the adjacent skin. This is what is commonly meant by "proud flesh." Their growth may be checked by gently touching them with a stick of nitrate of silver, and dressing the surface with oxide of zinc ointment.
Burns between the fingers, or in any place where two contiguous surfaces are likely to come in contact, should be separately dressed, and great care should be taken to keep the granulating surfaces apart, or they may grow together and produce deformity.
Scars are often left after extensive burns. These scars contract, and have been known to produce great deformities, such as the head being pulled down on the shoulder, the arm bent at the elbow, the leg contracted at the knee. This may generally be remedied by keeping up gentle movement, or by keeping the limbs extended until the process is complete.
If there be much pain, it will be advisable to give opium, in the form of the tincture, as it will also allay nervous excitement.
Tincture of opium, 10 minims.
Water, 1 teaspoonful. Every four hours.
This dose, it should be borne in mind, is for an adult person.
The destructive chemicals most likely to produce these accidents are - sulphuric acid, or oil of vitriol; nitric acid, or aqua fortis; ammonia, and hydrofluoric acid; strong carbolic acid, and chloride of zinc. In cases of burns from any of these the parts should be well washed with water, in which a little bicarbonate of soda is dissolved, or soap and water in the case of the acids. Afterwards treat as in a case of inflammatory ulcer or ordinary burn.
Explosions of gunpowder cause destruction of skin, and resemble burns or scalds in their effects. They should be treated in the same manner as burns, first removing particles of carbon by means of a soft sponge and warm water.
The diet in severe burns should be supporting. Some stimulant is usually advisable.
After washing the hands, and before drying them, pour over the backs of them some glycerine and water (equal proportions), smear it over them, and then quickly dip into water and dry the hands gently, so as not entirely to wipe off the glycerine.
The best remedy for these, when not broken, is to paint them twice a day with strong tincture of iodine.
A liniment of equal parts of extract of lead and spirits of turpentine is also very useful.
If inflamed and broken, they should be poulticed and dressed with some simple ointment.