The clothing must be cut away from the burned parts with the greatest care, and only a portion of the body should be uncovered at a time and in a warm room. Pain may be subdued by laudanum[10]; fifteen drops may be given to an adult, and the drug may be repeated at hour intervals in doses of ten drops until the suffering has been allayed. Lumps of ice held in the mouth will quench thirst, and the diet should be liquid, as milk, soups, gruels, white of egg, and water. The bowels should be moved daily by rectal injections of soap and warm water. As a matter of local treatment, the surface layer of the skin should be kept intact if possible. Blisters are not to be disturbed unless they are large and tense; if so, their bases may be pricked with a needle sufficiently to let out the fluid contents.
Carron oil (equal parts of olive oil and limewater) has been the common remedy for burns, and it is an efficient, though very dirty, dressing, useful if the skin is generally unbroken. It should be applied on clean, soft linen or cotton cloth, which is soaked in the oil, laid over the burned area, and covered with a thick layer of cotton batting and a bandage. When the skin is denuded, leaving a raw surface exposed, the burn must be treated on the same plan as wounds, and should be kept as clean and free from germs as possible. An ointment made of equal parts of boric acid and vaseline, spread thickly on clean cloth, is a good antiseptic preparation in cases where the skin is broken. It is best not to change the dressing oftener than once in two or three days, unless the discharge or odor are considerable. Fresh dressing is very painful and often harmful.
When the dressing is removed, warm saline solution (one teaspoonful of common salt in a quart of water) is allowed to flow over the burn until all discharge is washed off. Then the raw surface is dusted over with pure boric acid or aristol, and the boric-acid ointment applied as before. The cloth upon which the ointment is spread should be made free from germs by boiling in water, and then drying it in an oven and keeping it well wrapped in a clean towel except when wanted.
The same care is requisite as that described under wounds (p. [50]) in regard to cleanliness.
Very extensive burns are most satisfactorily treated by complete immersion of the burned limbs or entire body in salt solution (same strength as above), which is kept at a temperature of from 94° to 104° F., according to the feelings of the patient. The patient lies in a bath tub on horsehair, or better, rubber mattress and rubber pillows; completely covered with water except the head. The urine and bowel discharges must be passed in the water, which is then changed, and the temperature is kept at an even mark by allowing warm water to continually run into the tub to displace that which runs out. The latter can be arranged by siphonage with a rubber tube. While this method requires more care, and running hot and cold water, it is the most comfortable treatment for these cases, usually attended by awful suffering, and at the same time it is most favorable to healing.
It is beyond the scope of this work to describe the various complications and the details of the after treatment in severe burns, including skin grafting, which may tax all the ingenuity of the skilled surgeon. It is hoped that the foregoing may give a clear idea of the treatment to be pursued in emergencies and may prove of some use to those who may unfortunately be compelled to care for burns during a considerable time without the aid of a physician.
BURN BY STRONG ACID.
First Aid Rule 1.—Neutralize the acid. Scatter baking soda thickly over burn, or pour limewater over it.
Rule 2.—Control pain. Wash off soda with stream of water. Apply Carron oil (equal parts of limewater and linseed oil or olive oil). Bandage lightly.
BURN BY STRONG ALKALI.—As ammonia, quicklime, lye.