—A rapid restoration of warmth to the part is most undesirable. The thawing-out process in a case of severe freezing should be begun in cold or ice-cold water. Crude petroleum at a temperature of 60° F. has been recommended as a substitute for cold water, and immersion may be continuous for several hours. A rubbing with alcohol and water may be substituted for the cold water, and then a gradual restoration to the ordinary temperature of the air. Unless this treatment be skilfully managed there may be such a rapid reaction as to be painful and even injurious. By the time there is any active exudation, or putrefaction has begun, an absorbent dry dressing and suitable antiseptics may be used.
DERMATITIS OF RADIO-ACTIVE ORIGIN.
The common expression of this form of skin affection is called a burn. This is something more than its name implies, for it is understood that the active factors are the ultraviolet rays, or the rays beyond the color region of the spectrum; that it is not due to the heat rays is shown by the intense burning that is frequently seen in the Arctic regions. In the skin of the young and tender, sunburn is sometimes followed by vesication and desquamation; ordinarily it simply produces the latter. Any soothing ointment or solution is usually sufficient for the treatment of sunburn, which should, however, include avoidance of the exciting cause.
Fig. 99
“X-ray burn,” result of nine exposures in nine days. Extensive necrosis and sloughing, with an intractable ulcer. (From collection of Dr. G. W. Wende.)
Much more intense actinic effects are produced by the x-rays, leading sometimes to complete destruction of the skin. These phenomena are usually called x-ray dermatitis. They vary from local discomfort, with itching, loss of hair on hairy surfaces, and partial anesthesia, with later a glossy appearance, to edema of the cellular tissue, by which anatomical outlines are effaced. The natural color of the skin, owing to pigmentation, appears dark. If the exciting cause be stopped before or as soon as this stage is reached complete recovery is possible, save that hair does not always grow from the surface which has lost it. The x-ray treatment should be pushed up to this stage. Careful management is now necessary, especially should any surface irritation like chafing occur. That x-ray burn, so called, may result from x-ray exposure made some time previously seems to be established by a case reported to me by Dr. L. L. McArthur, of Chicago, where he had to do skin grafting upon a lesion of this kind which did not appear until fifteen months after the last exposure.
The stage of danger is characterized by extreme itching with multiform eruptions in successive crops, desquamation, formation of minute vesicles, and ulcers; or the process may be more acute and the skin begin to slough. Small lesions will become confluent, and large excavations may be formed. The sloughing process is usually slow, and by it are produced ulcers characterized by extreme pain and discomfort and a lack of tendency to heal.
These ulcers are exquisitely sensitive and applications intended for relief are of themselves most distressing. Everything about such an ulcer seems sluggish, while small areas which have apparently healed break down again; healthy scabs are not formed and granulations are extremely indolent.