First Aid Rule 1.—Stop pain quickly. Cut away clothing very gently. Break no blisters. Cover with Carron oil (equal parts of limewater and linseed or olive oil) and light bandage. Give fifteen drops of laudanum[9] every half hour in tablespoonful of water, till relieved in part or three doses are taken.
Rule 2.—Combat shock. If patient is cold, pulse weak, head confused, give tablespoonful of whisky in a quarter of a glass of hot water. Put hot-water bottles at feet.
Rule 3.—Quench thirst with pieces of ice held in mouth or a swallow of cold milk.
See page [174] for subsequent treatment.
A burn is produced by dry heat, a scald by moist heat; the effect and treatment of both are practically identical. Burns are commonly divided into three classes, according to the amount of damage inflicted upon the body.
First Class.—There is redness, pain, and some swelling of the skin, followed, in a few days, by peeling of the surface layer (epidermis) and recovery. Sunburn and burns caused by slight exposures to gases and vapors fall into this category.
Treatment.—The immediate immersion of the part in cold water is followed by relief, or the application of cloths wet with a saturated solution of saleratus or baking powder is useful. Anything which protects the burned skin from the irritating effect of the air is efficacious, and in emergencies any one of the following may be applied: starch, flour, molasses, white paint, or a mixture of white of egg and sweet oil, equal parts. Usually after the first pain has been relieved by bathing with soda and water, or its application on cloths, the employment of a simple ointment suffices, as cold cream or vaseline.
Second Class.—In this class of cases the inflammation is more severe and the deeper layers of the skin are involved. In addition to the redness and swelling of the skin there are present blisters which appear at once or within a few hours. The general condition is affected according to the size of the burn. If half of the body is only reddened, death usually results, and a burn of a third of the body is often fatal. The shock is so great at times that pain may not be at once intense. Shock is evidenced by general depression, with weakness, apathy, cold feet and hands, and failure of the pulse. If the patient rallies from this condition, then fever and pain become prominent. If steam has been inhaled, there may be sudden death from swelling of the interior of the throat, or inflammation of the lungs may follow inhalation of smoke and hot air.
Third Class.—In this class are included burns of so severe a nature that destruction and death of the tissues follows; not only of the skin but of the flesh and bones in the worst cases. It is impossible to tell by the appearance of the skin what the extent of the destruction may be until the dead parts slough away after a week or ten days. The skin is of a uniform white color in some cases, or may be of a yellow, brown, gray, or black hue, and is comparatively insensitive at first. Pus ("matter") begins to form around the dead part in a few days, and the dead tissue comes away later, to be followed by a long course of suppuration, pain, excessive granulations ("proud flesh"), and, unless skillfully treated, by contraction of the surrounding area, leaving ugly scars and interfering with the appearance and usefulness of the parts. The treatment of such cases after the first care becomes that to be pursued in wounds generally (p. [50]), and belongs within the domain of the surgeon.
Treatment of the More Severe Burns.—If the patient is suffering from shock he should receive some hot alcoholic drink, as hot water and whisky, and be put to bed under warm coverings with hot-water bags or bottles at his feet.