VOL. II. No. 10,

School Surgery.

BY ALFRED CARPENTER, M.D. (LOND.), C.S.S. (CAMB.), Vice-President of the British Medical Association.

X.

BURNS, SCALDS, AND CORROSIVE ACIDS.

THER

HERE is nothing so terrifying as a person on fire. The moment a child is in flames it loses all power of control, and but too often common sense is lost among those who witness the misfortune. The mind appears to be paralysed. If a child is seen to be in flames, wrap something round it as quick as thought, and throw the sufferer on to the ground; if nothing else is at hand take off your coat, or a mat, a tablecloth, anything which will not burn rapidly. If nothing is at hand roll the child over and over on the ground, but don't let it run about. If it is your coat which is used, or whatever else it may be, press it lightly down and smother the flames; they will then extinguish themselves. Recollect that the child must be made to lie down and kept on the ground, and not allowed to stand upright. If water is at hand so much the better, but don't let the child run some distance to a water supply; make it lie still, and let some one fetch the water to it, if they like. The accident happens more often to girls than to boys, from the more inflammable nature of their clothes. As soon as the fire is extinguished don't proceed to pull off the burnt articles. You may get some water and moisten the burnt part, because there may be smouldering fire ready to burst out again if air be admitted. If you are certain that there is nothing which can do so, don't use the water at all; be careful not to expose the burnt part to the action of the air, and if possible keep away all cold air. The burnt material is the best covering that can be used; it is charcoal and an antiseptic of itself. It is a serious error to clear off all the burnt substance. As soon as the fire is perfectly extinguished, cover up everything as quickly as possible that does not come away without tearing. If the clothes are soaked with water, this is not so easy. If, therefore, water has not been used, so much the better for the ultimate result. It is astonishing how the evil consequences of burns diminish when these rules have been observed. If water is at hand, of

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course it should be at once used to extinguish the fire, as being most rapidly and immediately effective; but it is worse than useless to apply water after the fire has been extinguished; and then to tear off the charred clothing, bringing the skin with them, is bad treatment. Cut the clothing away and leave the adhering parts in situ.

The succeeding treatment resolves itself into three sections. First, that to be adopted to remove the incidence of the shock to the system, which is usually great; second, that for the immediate treatment of the burnt part; and third, the subsequent course to be adopted to cure the burns. The shock is sometimes so great that life is lost, without any attempt at rally being made. Examine the hands and feet; if they are cold, and if there is scarcely any pulse to be felt, it may be advisable to administer a few teaspoonfuls of brandy-and-water every few minutes until the pulse returns. Use hot bottles to the extremities. If a cup of hot tea can be rapidly obtained it will be better than the alcoholic liquid, and not afterwards have any injurious consequences; indeed, it will be beneficial in all cases. If there is a continuous exhaustion, a little sal volatile in water (a teaspoonful in a wineglassful) will be useful. It is more rapid in its action than the brandy. If there is not much shock, a little cold water will be better than either brandy or sal volatile. The remedies should be used as soon as they can be obtained; in the meantime, preparation should be made for local treatment. The principle to be aimed at is to cover up the burnt part as quickly as possible from being acted upon by cold air. Sheets of wadding are the best covering, the woolly side being placed next to the burnt part. If there are blisters they should not be interfered with; they should be kept, if possible, from injury, as the serum and detached cuticle is the best covering that the raw surface can have. It protects the cutis until it is capable of protecting itself. If it is necessary to remove the soaked matter, or if suppuration should afterwards be established, then carbolised oil freely applied, and more cotton wadding being again used. If neither wadding nor carbolised oil are at hand, the burnt part may be covered up with flour, and loose bandages should be applied to keep it on the burn. Linseed oil and lime water is sometimes applied, but they are inferior to cotton wadding and carbolised oil.

2 I

It is astonishing how rapidly burns will heal if the air is kept away, and the blisters are not interfered with, provided the cutis has not been completely destroyed.

As soon as the dressing is completed, and the child is in bed, if the pain continues to be excessive, ten grains of chloral in sugar and water may be given to a child ten years old, provided reaction has taken place. If it is a younger child, a grain may be dropped for each year. The dose may be repeated in two hours if it does not produce refreshing sleep. It is better to give a full dose at once, though some practitioners recommend a smaller dose at shorter intervals. If chloral is not at hand, a few drops of laudanum may be given, a drop for each year, according to the age of the child.

The dressings are not to be interfered with for several days, and in the meantime milk is the best diet, with eggs and beef-tea. Solid food is to be avoided until there is complete recovery, and the wounded parts have cleared from all sloughs. If the mischief has penetrated deeply there will be considerable sloughing, but carbolised oil diminishes the smell which used to come from such injuries before antiseptic dressings were in vogue; these decrease the resulting mischief very materially by excluding the septic germs which abound everywhere. If there is a large granulating wound, it may be treated with slips of lint spread with Turner's cerate (compound calamine ointment), alternating now and then with water-dressing, and sometimes using a solution of sulphate of zinc, soaking a piece of lint the same size as the sore, and placing the wetted lint directly on it. When the granulations are very florid and luxuriant, the parts affected must be kept perfectly quiet and not exercised in any way, by which the tendency to contraction, which so often disfigures the victim, will be diminished.

The longer the first dressings are kept in their place the better. If there is no swelling and no offensive discharge, they should be continued as long as possible and not interfered with; length of time being no argument for removal, if other things do not call for it. The treatment must be regulated according to the part affected. The joints and the parts about the neck are those most liable to be disfigured by contraction. The greatest care is to be taken to avoid unnecessary movement, but whenever a flexure has its opposing surfaces burnt, the opposite sides must be kept apart and the greater care used to prevent adhesions and contractions.

Scalds. The results are very similar to those produced by fire, and the treatment is of a similar character. We must take care not to drag away the skin with the clothes; cut them away very carefully. In taking off a shirt, or a stocking, or a coat, the skin is very easily brought with it. Blisters must not be broken, and the best protection the cutis can have is the skin which is raised over it by the serum. Instantly envelope the scalded part in wadding, and treat it afterwards with carbolised oil, just as directed for burns, whilst the shock of the pain and the after treatment is precisely similar. The most painful results sometimes follow from accidently taking a draught of boiling water. All that can be done is to get the patient to swallow salad oil, or perhaps the surgeon may find it advisable to perform tracheotomy, that is, to open the throat below the larynx, insert a

silver tube and allow the breathing to be continued in that manner until the swelling in the mouth and gullet has subsided. Usually, however, no kind of treatment is satisfactory in its ultimate results, and the patient dies from asphyxia or suffocation.

CORROSIVE ACIDS produce very similar results to those which boiling water sets up in the throat, when they have been accidently or designedly swallowed. Sulphuric acid (or oil of vitriol), hydrochloric acid (or spirit of salt), oxalic acid, carbolic acid, nitric acid, corrosive sublimate, chloride of zinc, etc., etc., are the more common poisons which act by destroying those parts of the body with which they come into contact. Chalk, magnesia, lime, mortar scraped from the wall or ceiling of an ordinary room, and mixed with water, and syringed into the mouth or on to the burnt part, are the more easily available antidotes. Corrosive sublimate poisoning is treated best with white of egg and milk; but for the corrosive acids chalk is the best antidote. It must be used as quickly as possible. After all trace of acid has been removed, the part should be kept covered with salad oil, which should be carbolised it the mischief is outside the mouth. Caustic alkalies and their carbonates act somewhat differently to the acids. They do not effervesce when they touch the ground and come in contact with stones and lime compounds, as is the case with the corrosive acids; this result may be used to diagnose the nature of the poison which has been used. The best antidotes for the caustic alkalies are lemon juice or vinegar, afterwards olive oil and milk. The stomach pump is not on any account to be used in such cases, for the passage of the tube would be sure to inflict further injury upon the corroded parts. The nature of the acid is not of much importance, and whether it is potass or soda which has been taken is of no moment; in the one case—that is, acids--chalk, lime, or magnesia, must be given, and in the other-in poisoning by alkalies-vinegar or lemon juice, or any vegetable acid in solution.

DROWNING.

This is a very frequent accident among schoolboys. It may happen to the very best swimmer from various circumstances, although a boy who knows how to swim will be much less liable to the danger. It may be worldly wisdom to adopt the determination of the man who declared he would never go into the water until he knew how to swim, but it is not a pleasant thing to see a fellow-creature in imminent danger of death, and feel oneself utterly unable to assist him because of one's ignorance of the art of swimming. Every boy and girl ought to be able to swim, so that he or she may not feel in after life that they might have saved a fellow-creature's life if their education had been conducted properly. The mode of death varies. It may be caused by drunkenness or by concussion, the head striking against a rock or post in the water; it may be caused by fright, producing syncope or fainting, or an epileptic fit may have preceded the fall into or come on after immersion in the water. There may be paralysis of the muscles of respiration, or some disease of the heart may have given rise to the fatal result; all these conditions may prevent recovery, although the body is taken out of the water very rapidly. The human body has a specific gravity slightly greater than water, so that under ordi