Volume 1

Sajous's analytical cyclopædia of practical medicine / by Charles E. de M. Sajous and one hundred associate editors.

  • Charles E. de M. Sajous
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Sajous's analytical cyclopædia of practical medicine / by Charles E. de M. Sajous and one hundred associate editors. Source: Wellcome Collection.

    700/748 (page 662)
    Prognosis.—The termination of this class of injuries is often of serious import especially when medico-legal questions arise. This should be determined by the several factors which arise in each case. Consideration must be given to indi¬ viduality of the sufferer, both his age and constitutional acquirements; the ex¬ tent of the burn, both as to surface and depth involved; the location of the in¬ jury, and the nature of the exciting medium. The effects upon strong, ro¬ bust subjects are not so marked as upon those of weaker constitutions, and, while the same degree or extent of burn will soon be recovered from by the former, the most dire results may follow in the latter persons. Thus it may be noticed that burns among machinists, glass- blowers, plumbers, and foundrymen will not be so serious as would the same de¬ gree or extent among clerks or those engaged in gentlemanly pursuits. Col¬ ored persons suffer less severely than do the white. Females, on account of more delicate systems, are less able to resist shock than are the males. Middle life is not so severely affected as are children or aged people. Some persons may be able to resist the shock only to be car¬ ried off by the complications that arise. Surface involvement seems to exert a greater depression or fatality than does depth of tissue. A burn, even of the first degree, which occupies an extended area and those of the second may terminate fatally if one-fourth or one-third of the superficial parts are involved; a fatal issue may also occur in burns occupying one-half of the body-surface. A burn of the second degree which occupies only a limited extent of surface, but which de¬ stroys the epidermis entire, may end in recovery, while those of the third may, through their deep involvement, produce complications with which we are unable to combat. Burns occupying the abdo¬ men give the highest mortality, while those of the thorax are only second to a slightly minor extent; but those of the head, neck, and limbs prove fatal in many instances. [Of 2G cases seen by Sajous after a boiler explosion, on the Lake of Geneva, in 1892, 22 died within a few hours after the accident, although, with few excep¬ tions, the scalds, though involving the greater part of the body, did not reach beyond the epidermic layer, excepting over the face and hands. Ed.] Of the 298 men killed or injured on the Japanese side of the Battle of the Yalu, a large number had received burns cover¬ ing an area of more than one-third of the body. Only 2 out of the 57 cases of this class recovered. Susuki (Boston Med. and Surg. Jour., Dec. 9, ’97). The nature of the exciting medium often governs the termination of burns, and those produced by cohesive bodies cause the greater destruction of part or life. The length of time required for the partial or complete reparation of the sur¬ face may be an important question in medico-legal cases. This can only be governed by the type of injury, the length of contact of the exciting agent, the nature of the affected person, and the general aspects of the case in ques¬ tion. Treatment.—Constitutional. — The constitutional treatment is to be directed toward the relief of pain, the restoration of the depressed vitality at the time of accident, — i.e., sustaining the system throughout the entire restorative proc¬ ess. Pain is best relieved by opium, or its alkaloid, morphine (preferably by hypodermic injection), because these agents have little, if any, depressing ac¬ tion upon the cardiac functions. The dose required will be much greater than ordinarily used, because of the sudden character and great amount of depres¬ sion in these injuries.