Surgery.

Date:
[1913]
Catalogue details

Licence: In copyright

Credit: Surgery. Source: Wellcome Collection.

    46/412 page 38
    Stage four is that of healing and it may be complicated by sepsis and is often prolonged. What are the Complications of Burns ? Scarring with consequent deformity and contractures. Duodenal ulcer. Describe the Treatment of Burns and Scalds. Minor burns or scalds are of little consequence and are treated by the application of tannic acid jelly or ointment. The treatment of more severe cases is better considered in stages. Stage 1.—Warmth in bed with shock cage. Morphine to allay pain and the administration of fluid. When the shock has been recovered from the local treatment is carried out. Stage 2.—Local Treatment.—Under gas and oxygen an- aesthesia the burnt area is carefully cleansed with normal saline, all the dead raised epidermis being removed. Vigorous scrubbing causes exudation and is not indicated. The part is “tanned ” by the application of an aqueous solution of tannic acid. Various strengths are used—from 2i% to 20%—by different surgeons. When weak solutions are employed the area must be sprayed with the tannic solution every two hours until a firm coagulum is obtained. The method commonly in use is the combination of tannic acid and silver nitrate. After cleansing 10% tannic acid is applied and after drying with hot air 10% silver nitrate is employed in the same way. Neither of these two solutions is antiseptic and as a rule some lotion such as gentian violet, acriflavine or mercuro- chrome is applied over the whole extent of the burn. No dressings are required, the patient is returned to bed and is nursed under a shock cage, no bedclothes being allowed in contact with the tan. Limbs are splinted to prevent the subsequent development of contractures. The tan must be carefully looked after and the edges are the important part. They should be kept dry by the application of ether and gentian violet. Care must be taken in burns of the hand that the forma- tion of a thick coagulum does not interfere with the eircula-
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