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CommunicationsAuthor(s): Henry WilkinsonSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 12, No. 7 (Apr. 5, 1848), pp.185-186Published by: BMJStable URL: http://www.jstor.org/stable/25500275 .

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REPORT ON BURNS AND SCALDS. 185

In this class of cases, where there are exuberant granu. nations, I prefer the potassafusa to any other caustic. In some instances which I have witnessed after the medical

practitioner had been dismissed, the cicatrized parts were attended with much pain and irritation, in consequence of the surface being above the natural skin, and the only

remedy from which relief could be found, was the free application of the potassa fusa.

CASE II.-February 25th, 1845, my attendance was

requested upon Ann Croxen, aged 8 years, of Aldreth, a hamlet of this parish, who had been severely burnt, com

prising the entire of the exterior of the front and lateral

pafts of the neck, together with the under part of the lower jaw; the right and left axillae; the posterior and lateral parts of the right and left upper arm, along their

whole extent; the right and left scapula, with the intermediate integument of the back, and the undivided lateral parts of the chest. She was submitted to the same plan of treatment as in the other case. After three months of unremitting assiduity on my part, I

resigned it to the care of the parents, at which time the wounds of the right and left chest, left scapula, axilla, and arm, were well; cicatrization was somewhat advanced over the right scapula, axilla, and upper arm, but the remain.

ing part of the case did not go on so prosperously as

heretofore, which I consider to have arisen from motion of this extremity not having been enforced, and the dressings not being in co-aptation. In consequence of the latter, the wound lost its healthy action. Unguents

were employed, and ultimately this part of the cure was

effected, but much less perfectly than in those parts wholly treated by the cotton wool. I may here be per mitted to remark, that in the like cases, where cotton has been misused, and the abrasion has been some time in existence, I have never been enabled to employ it with the same advantage as in the early stages.

The present condition of the child is the following: She has the free and unrestrained motion of the left

shoulder; the new-formed skin, and that of the axilla, is smooth and pliable; the chin is not at all depressed, and she has the free motion of the mouth, but the skin over each sterno-cleido-mastoideus muscle is puckered; the exterior of the left side is smooth. Mobility of the right arm is less perfect than that of its fellow, though she can raise the arm as high as the head; it is restricted by a band of integument, from the side to the

upper arm. I do not remember ever having before seen a burn of such extent, and involving such important parts, recover; yet, contrary to expectation, there was

scarcely a militating circumstance which impeded the successful result of the case. In the diarrhea following burns which might be supposed to arise from suppression of a discharge to which the constitution has become naturalized, I have found the sulphate of copper and opium most invaluable;

I travelled 168 miles to this case, and my time was

occupied a greater number of hours in attending to it, for which I received nothing more than my annual salary for general illness. I pray that in the new

Mledical-relief regulations, burns may be one of the

extra-charges.

Haddenham, March 4, 1848.

CO5MMI UNICATIONS.

[The following communications have been forwarded

by Mr. Crompton.]

From HENRY WILKINSON, Esq., Surgeon, Rotherham, There is no subject connected with medicine or surgery

on which there is more diversity of opinion than the treat. ment of burns. During my apprenticeship, and for some time after commencing practice on my own account, we used to treat all cases by the Kentish or stimulant method. But often observing that the patient suffered severe pain, as the consequence of this treatment, besides meeting with

many intractable sores, I began to think that the prin ciple or theory of such practice was not sound; and on

reflecting that the skin was a highly sensitive and vascular organ, and that when inflamed by fire or other

stimuli, its sensibility was increased, I came to the con clusion that a more rational method of treating these accidents might be arrived at, during the first or inflam

matory stage in particular, by which method we might lessen considerably the morbid sensibility of the parts, and consequently the suffering of the patient, whilst at the same time we diminish the liability to a tedious, debilitating, and intractable sore. With these impressions I decided on the trial of cotton wool, along with such other remedies as were most likely to allay pain and

irritation, which plan proving so successful in my hands, I have continued to follow it up to the present time, so that whenever I am called to a burn or scald, whether

superficial or deep, slight or extensive, I first smear the

parts over freely with a liniment, composed of equal parts of Oleum Lini and Aqua Calcis, with about two drachms of Liquor Plumbi Acetatis to the pint; after. wards I cover them effectually with cotton wool, which is

very easy of application, and may be retained without

difficulty. The patient will generally experience relief from pain immediately, and this first dressing I allow to remain until it can be easily removed by the exhalation from the skin, or the desquamation of the cuticle

itself, (for we frequently find in extensive burns, that we have every degree of injury, from a simple scorch to the complete destruction of the substance of the skin ;) I therefore remove the wool piece.meal, according as it

may be set at liberty by the discharge, or become

offensive, and I only re-apply it after the same manner to such parts as may have to slough, and merely require a covering whilst nature is performing that process, so that the wool is only made use of as a means of protec tion to the highly sensitive surface, preventing access of

atmospheric air, and, being a bad conductor,* assisting. the animal heat in promoting suppuration.

The next step to be considered is that of checking the

tendency to inordinate discharge, a striking feature in such cases. For this purpose I generally use some absorbent powder, such as chalk or calamine; or if these should be found to irritate, (which they seldom do,) I

* Mr. Wilkinson has written to me to say that his paper was written before he received the last number of the Journal, in which there is a foot note, at page 155, respect. ing most remedies in burns being either non-conductors

of heat, or what the old writers called calorifacients. He

observes, * You must not imagine that the idea was borrowed from perusing that Journal. It was.singular enough that

my assistant, Mr. Dixon, who had read my original copy whilst I transcribed it, happened to take up the Journal when I had the letters sealed up for you in my pocket, and he being struck with the similitude of some of the remarks, called my attention to them.''--S. C.)

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186 BIRMINGHAM PATHOLOGICAL SOCIETY.

substitute flour, dusting the sore over with one of them previous to an application of wax, lead plaster, olive oil, and calamine, in such proportions as to form 'a very firm cerate. This cerate I invariably use as a covering to promote the cicatrization of all

granulating sores resulting from burns or scalds, hav

ing found it the best sedative application for keeping down irritation in the sore or surrounding parts.; But as the granulations in these ulcers have a great ternency to become fungoid, I find it necessary to apply an

escharotic; and for this purpose I know of nothing better than brushing them over with a solution of nitrate of silver, (about a scruple to an ounce of water,) with

dry lint to the most prominent points, supporting the

dressings with bandages on all such parts as will admit

of them, as moderate pressure will always have the effect of assisting the healing process.

The next thing to be considered is the constitutional

treatment, which is of so much importance in all serious

burns, and this, of course, will be regulated by the dis cretion of the practitioner. As far as my experience

goes, I find opium a most valuable auxiliary, during the

inflammatory stage in particular, giving it in proportion to the amount of pain or constitutional irritation the

patient may suffer. Aperients are also useful during the early stage, inasmuch as they reduce morbid or

excessive heat, and act as revulsives to the skin; but when the suppuration stage has once set in, they cannot be too carefully administered, as the patient's strength

might be injured thereby, a circumstance, of all things, to be guarded against, as nothing is more prejudicial to a speedy recovery than a diarrhoea, which not unfreqently comes on spontaneously when we least desire it. There are other remedies which might be mentioned,-diuretics, for instance, which counterbalance, in some measure, the loss of the functions of the skin. But these having

been pointed out by Sir Astley Cooper, Mr. Earle, and

others, in their lectures and treatises, it is not necessary for me to do more than allude to them. It is likewise almost needless for me to say, that when the reparative

process is going on, it is proper that the patient be

allowed a generous diet, with plenty of animal food; but I entertain strong doubts as to the propriety of stimulating

drinks, particularly during the summer months, having frequenty found them produce uneasiness in the wounds, and prevent the patient resting. The constitutional

symptoms will vary according to age, sex, and tempera. ment, as well as situation and extent of injury. I had a case of burn some time ago, which so strikingly illustrates the two last-named modifications, that I cannot avoid alluding to it here. A boy, about ten years of age, sustained a burn of the abdomen and thighs.

Within twenty-four hours tympanites, with vomiting and constipation, supervened; in short, every symptom of peritoneal inflammation. I bled him from the arm, to complete muscular relaxation. The bowels acted

freely immediately, and the little patient did well,

although most of the skin of the abdomen sloughed. This is the only case wherein I have opened a vein on account of a burn, but it serves to show that we must not be deterred from treating a case upon established

principles, because it was the result of an uncommon

cause; and it likewise appears to reverse the theory of the homoeopathists, (similia similibm curantur,) as the external inflammation, instead of curing or preventing, actually occasioned the internal.

.The preceding remarks are the result of a pretty fair

field of observation and practice, holding as I do appoint ments to collieries where these accidents are very common, besides what may happen in union and private practice; so that if there be a branch of surgery on which I can

speak with confidence, it is in the treatment of burns and

scalds, as the plan I have adopted has been invariably attended with success in all cases which offered a pros. pect of cure: In conclusion, I must not omit to allude to the state of the cicatrices, as the result of this treat

ment, and the best mode of describing them, will be to

say, that out of the whole number of burns which I

have had to treat, I do not know of one patient with a contracted joint as a consequence of the burn. I had. one case of a little girl, who had a contracted elbow 4n

consequence of the friends undertaking to dress the wound themselves. She was brought back to me after cicatrization was complete; I divided the cicatrix with a

scalpel, extended the limb on a splint until the wound

healed, and the deformity did not return.

[A communication from Mr. Barrow, of Bath, is

unavoidably delayed till the next nnmber.]

iros ebing0 of as i etis 0.

BIRMINGHAM. PATHOLOGICAL SOCIETY.

January 6th, 1848.

JAMES RUSSELL, Esq., in the Chair.

FIBROUS TUMOUR OF THE UTERUS.

Dr. Russell presented a uterus, containing a small

fibrous tumour, round, about one inch in diameter, situated in the fundus of the organ, embedded in its

muscular coat, but projecting towards the peritoneal

surface, where it was only covered by a very thin

layer of the fibres of the uterus. It had been taken

from a woman of middle age, mother of two children; she died from perforation of the stomach. Dr. Russell

was not aware that she had ever had any symptom from which to infer the existence of the disease.

LARYNGITIS.

Dr. Russell presented a larynx, lined with soft

lymph. It had been given him by Mr. Percival, with

the following history, and notes of the post-mortem examination:

A girl, aged 19, previously healthy, stout and

muscular, was at work at pearl buttons all day on

Thursday, December 23rd. On Friday she was poorly,. and complained of sore-throat. She was seen by a

medical man, who thought she was labouring under

influenza, and treated her mildly for that complaint. On Saturday morning she was lying in bed, when she

sprang up suddenly, put her hand to her throat, called

out " Oh ! my throat," and fell down dead.

Sectio cadaveris, thirty-six hours after death. Brain

enormously congested, and unusually dense and firm,

with an immense quantity of grey matter. The sinuses

were full of blood; choroid plexus also congested; not an unusual quantity of serum in the ventricles.

Convex surface of the right lung adhered unevenly

by quite recent lymph; lungs healthy, containing only a few tubercles. Heart healthy. There was a patch of

recent lymph on the peritoneal surface of the liver.

Intestines healthy. Larynx :_The mucous membrane

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