CHAPTER VIII.

Burns and scalds-Poisons-Healing of wounds-Resuscitation of people apparently drowned or otherwise suffocated.

Burns and Scalds.-Burns and scalds vary in degree. In the simpler forms the skin is simply congested or reddened, and if the part is dusted over with dry flour and wrapped up, this is all the treatment that will be required. When the scarf skin or cuticle is raised and there is an effusion of fluid underneath, which shows itself in the shape of blisters, carron oil is a good application; it is made by mixing equal parts of linseed oil and lime water. Squeeze out pieces of lint in this mixture and apply it to the part, covering the whole with cotton wool to exclude the air. The same kind of dressing may be used in severe burns when the skin and parts beneath are absolutely destroyed, and an ash-grey sore formed. Extreme gentleness is necessary in the redressing of burns, as this operation causes great pain to the patient if roughly performed.

A small scald may be dressed temporarily with a solution of warm milk and water, and if handy, add a little carbonate of soda or some alkali. It must be borne in mind that after severe burns involving great

destruction of tissue, cicatrices are very apt to form during the healing, which may contract a joint, and so interfere materially with the usefulness of a limb. If the neck should be burnt, some distortion may occur by the head being drawn to one side.

Limbs should be extended by splints and other mechanical contrivances during the healing of a burn. As skin is such an important factor in respiration and excretion, burns extending over a large surface are more dangerous than even a deep burn confined to one spot.

Poisons may be introduced into the system by the mouth, or absorbed after being injected under the skin. In the latter case, if the patient come directly under notice the wound may be sucked, and bleeding encouraged by bathing the part with warm water ; after-treatment consists in keeping the system up by stimulants, exciting the excretory organs, and if necessary artificial respiration must be resorted to.

Poisons taken by the mouth may be divided into narcotics, which produce insensibility by their action on the brain, and irritants which destroy all the tissues with which they come in contact.

In the treatment of poisons, try and get rid of the poison by encouraging vomiting; it is knowledge requisite for a physician to counteract the effect of poisons by means of antidotes. The most simple emetic is a large draught of tepid water, a tablespoonful of powdered mustard, or salt in warm water,

or to tickle the back of the throat with a feather or the introduction of a finger into the throat.

There are other means of causing vomiting, but they should not be resorted to without medical advice, such as one or two tablespoonfuls of ipecacuanha wine, or twenty grains of sulphate of zinc in water.

It might be well to remember that white of raw eggs, the administration of salad oil, protects the walls of the stomach and gullet in poisoning by irritants. Further, acids and alkalies form antidotes to each other. The alkalies suitable are, soda, potash, magnesia, or the salts of lime diluted with water. The acids usually ready at hand are orange and lime juice, or better, vinegar and water.

In narcotic poisoning, if the patient has swallowed the poison, after an emetic, walking exercise and coffee stimulation must be resorted to. In the more potent poisons little can be done after an emetic has been administered, but to try if possible to keep the patient alive by artificial respiration and warmth.

Wounds.-Wounds are usually divided into incised, lacerated, contused, punctured, and poisoned. The four latter classes of wounds do not heal kindly, and will benefit by medical skill being sought for their management, so we do not intend saying anything about them in this little work; they are merely mentioned to call the nurse's attention to the fact that she must carefully consider the class of wound she has to deal with in a case of accident or disease. She

must not think that because one wound she may have seen healed by a certain method, therefore all will yield in the same manner and be benefited by the same line of treatment.

Incised wounds may unite in four different ways; first, by the direct growing together of opposite surfaces, or by opposite surfaces uniting through the medium of coagulable effused lymph, adhesive inflammation; this is called union by "first intention." Secondly, by scabbing or incrustation; it consists in the wound healing under a crust which forms an airtight covering. Thirdly, by granulation or "second intention," where pus or matter is secreted and the wound fills up gradually from the bottom, as is seen in the healing of ulcers. Fourthly, by the growing together of two granulating surfaces. These two latter are the means by which lacerated and contused wounds usually heal. It must of course be understood that no wound can possibly heal without being cleaned from dirt, and all foreign bodies removed.

In a simple incised wound try if possible to get healing by first intention. The conditions necessary are, a healthy constitution, the perfect coaptation of cut surfaces, the absence of all inflammatory action, the exclusion of air, and a homogeneity of structure; by this latter is meant parts corresponding in structure, for instance, it cannot take place between a muscular flap and the cut end of bone. The first thing to be done then in the case of a simple incised

wound is accurately to bring together and keep together the separated lips and sides of the wound; this can usually be effected by strapping. Next exclude the air, lastly guard against inflammation by placing the part perfectly at rest.

The Resuscitation of those apparently Drowned or otherwise Suffocated. Numerous methods for restoring the apparently dead or drowned have been devised by different surgeons in this country, in America, and other places.

They each have their advantages and admirers. Dr. H. B. Silvester's method has been approved by the Fellows of the Royal Medical and Chirurgical Society, and Dr. Marshall Hall's are circulated by the Royal National Lifeboat Institution, and used by Her Majesty's Coastguard Service. They both commence with the following directions :

In cases of apparent death, either from drowning or other suffocation, send immediately for medical assistance, blankets, and dry clothing, but proceed to treat the patient instantly on the spot in the open air, with the face downward, whether on shore or afloat, exposing the face, neck and chest to the wind, except in severe weather, and removing all tight clothing from the neck and chest, especially the braces.

The points to be aimed at are first and immediately, the restoration of breathing; and secondly, after breathing is restored, the promotion of warmth and circulation.