Note 17 — Chapter XXVII · THE SKIN.

The Poisons Produced in Superficial Burns.—The intoxication which often proves fatal in from a few hours to a few days after an extensive burn of the surface, with its attendant delirium, albuminuria, hematuria, vomiting of blood, diarrhea, etc., is very similar to the acute intoxications produced by bacterial products. The sympathetic nervous system is seriously involved in both. These toxins are evidently the result of hemolysis, and it has been shown that they are slow poisons, especially for nerve tissue, apparently eliminated by the intestines and kidneys, which thus suffer during the process of elimination. This is a more rational explanation than the theories of thrombosis or of alterations in the red corpuscles, which would not account for duodenal ulcers, necroses in the Malpighian bodies of the spleen, etc. These poisons are formed in the burnt area and not externally; hence, if this burnt area be removed immediate death may be prevented, whereas if it be permitted to remain for a few hours it may be too late. The poisons seem to be produced in the skin, as the burning of the muscle is not followed by any such degree of intoxication. They seem to be neither ptomain nor pyridin derivatives, but rather resemble the poison of snake venom. Pfeiffer believes them to be derived from the splitting up of proteids altered in composition by the heat of the burn.

[18] Cargile membrane makes an excellent covering for burns whose surfaces have been cleaned of sloughs and which are granulating. It adapts itself perfectly to all irregularity of contour, may be snugly applied and not changed until necessity requires it.