Symptoms.—Burns may vary from a slight redness, as, for example,
that produced by exposure to the sun's rays—erythema solare, eczema
solare—to that in which rapid destruction or necrosis ensues. They
are, according to their severity, usually divided into three degrees: In
that of the first degree (dermatitis ambustionis erythematosa) there is
simply redness, accompanied with more or less heat of the affected part,
and at times with slight swelling; in that of the second degree (dermatitis
ambustionis bullosa), to the above symptoms are added vesiculation and
the formation of bullæ, due to considerable serous exudation, and along
with these there may be greater swelling, and the part may even have an
erysipelatous aspect. In both of these grades the subjective symptoms
of heat and burning are present; in those of the second degree, more or
less tenderness and actual pain. In the third grade (dermatitis ambus-
tionis escharotica) of burns, to the characters already named, are added
those of escharotic action, involving superficially or deeply according to
the intensity and duration of the exposure. In the more severe instances,
and even in the milder cases of any extent, there are usually constitu­
tional symptoms of considerable violence. In fact, if the burn is severe
or very extensive, the patient may suffer profoundly from shock, from
which, in the most extreme cases, he does not rally. In serious burns,
especially those of escharotic character, various and grave complica­
tions of the internal organs may occur; or the patient may suffer from
the drain of the suppurative action which ensues. In favorable instances
of the severe type the slough is gradually cast off and repair takes place;
or, after tissue repair, there may remain considerable surface which fails
to skin over.

Prognosis and Treatment.—Burns of the first and second de­
grees almost invariably make rapid recovery, unless extensive; the latter
are always serious, and may be rapidly fatal from shock. The cause of
death has been variously suggested as due to induced changes in the red
blood-corpuscles (Wertheim, Lesser, and others) or to the development
of toxins or ptomains (Lustgarten, Spiegel, and others). The prognosis
in those of the third degree depends upon the extent of the destruction.
In all grades the extremes of life are the most dangerous periods.

In severe cases constitutional measures of supporting character are
made necessary by the general condition of the patient. Stimulants,
and sometimes narcotics also, are required. The local treatment de­
pends, in part at least, upon the degree of inflammation or destruction,

436                                  INFLAMMATIONS

and whether it be limited or extensive. If of a mild degree, the applica­
tion of sodium bicarbonate as a powder, covering the parts thoroughly,
is often sufficient; or it may be applied in solution, from 3 to 5 grains
(0.2-0.33) or more to the ounce (32.), enveloping the part with linen
cloths kept constantly wet with it. The application of cold-water
compresses, or compresses wet with boric acid solution, will also be of
value. Dilute lead-water is often very grateful and satisfactory, and
can be used when the surface is not large. In those cases with vesicles
and bullæ, these should be carefully punctured, the contents gently
pressed out, and the dressings, such as above, applied. In those involv­
ing extensive surface relief is often obtained by the well-known lini-
mentum calcis (Carron oil); if the area is not too large, this can be made
more effective in painful cases by the addition of a small amount of
carbolic acid, ½ to 5 grains (0.033-0.33) to the ounce (32.). Many of
the soothing applications advised in the acute types of eczema will also
give relief in the majority of the milder burns. If very extensive, espe­
cially when there is profound shock, the continuous immersion of the
patient in a warm bath affords great comfort and relief. In recent years
a 1 per cent, solution of picric acid has been extolled (Thiery, Debacq,
Power, Dakhyle, and others), especially in the first and second grades;
it is applied in the form of compresses, but should not be applied over a
large surface for fear of absorption. In suppurative surfaces attention
should be given to cleanliness and frequent change of applications.
The graver, escharotic cases belong properly to the surgeon. In some
of these skin-grafting will be eventually necessary.

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