AN ESSAY, &c.

THE object of the enſuing pages is to endeavour to prevent or leſſen the deſtructive effect of fire, when applied to the human body, by means which ſeem to be not gene⯑rally known, or not ſufficiently attended to.

There are few accidents or maladies to which mankind are ſubject, which have met with a greater variety of treatment than burns; and, as it appears to me, theſe various methods have in general been received and adopted as things of courſe, and handed down without any fixed principle or determined idea annexed to them: as we continually ſee [2]in ſimilar caſes of burns, ſcalds, &c. applica⯑tions made uſe of which entirely vary from each other in their nature and effect.

If we conſult the ancient writers on this ſubject, we find a great variety of remedies, conſiſting of decoctions of different herbs and ointments of various ingredients, many of which form compoſitions totally oppoſite to each other; but which were all in their turns recommended and brought into uſe.

There does not appear any great improve⯑ment in the applications introduced by the moderns on ſuch occaſions. As far as I have been able to collect from obſervation and en⯑quiry, the treatment of theſe caſes for years paſt has been confined to the following or ſi⯑milar remedies.

Linen dipped in ſpirit of wine, applied to the burn and often renewed, is now in fre⯑quent uſe. This was alſo adviſed by Syden⯑ham and other authors; but whatever advan⯑tage [3]is to be derived from it, it can only, with propriety, be applied to ſuperficial burns; ſhould any ulceration, or even excoriation have taken place, ſpirituous applications would be more likely to increaſe than abate the pain and inflammation.

Some practitioners think it right to bleed, to take away the wrinkled cuticle, and then to apply to the part, ointments compoſed of preparations of lead, and poultices impreg⯑nated with this mineral.

Some recommend the extract of lead and tincture of opium, mixed with water to be applied immediately, and ſimple dreſſings afterwards.

Or a mixture of vinegar and water, or of fine oatmeal and cold water.

Or ſpirits of wine and vinegar, in the pro⯑portion of two ounces of each, mixed with eight ounces of water, and applied warm.

Another remedy which has been much [4]commended, conſiſts of potato-juice and diſ⯑tilled water, to which is added as much com⯑mon ſalt as can be diſſolved in it, with a ſmall quantity of crude opium.

Greaſy applications alſo are commonly uſed, ſuch as olive oil by itſelf, or mixed with ſpermaceti ointment, or oil and lime water well ſhaken together.

There are other formulae which might be mentioned; but theſe will ſuffice to ſhew the common practice, and to prove the diſ⯑cordance and uncertainty prevailing in the treatment of burns. In general they appear to be intended to cool, relax, or give eaſe, and ſeveral of them anſwer theſe purpoſes in ſome meaſure, but they certainly do not fur⯑niſh effectual means to ſtop the progreſs, or leſſen the powerful action of the matter of fire, in whatever it conſiſts, but which pro⯑bably continues to exiſt in the burnt part, and to extend its influence for ſome time.

I muſt confeſs that I had been long diſ⯑ſatisfied with all theſe methods of treatment, as they ſeemed of very little efficacy, for not⯑withſtanding their application, I had too of⯑ten witneſſed that the pain was very little abated, that bliſters aroſe, and ſloughs took place in no very inferiour degree to what might have been expected if no means had been employed; theſe obſervations often led me to wiſh for a better method than the uſual practice ſeemed to offer; when, ſome years ſince, I was ſent for to a medical gentleman, who being near a bottle of ſpirits of wine, which had been imprudently heated to a great degree, by ſome accident it took fire, the bottle burſt and its contents flew over his hands, face, and upper part of his neck, all of which were miſerably burnt. At a conſultation on this unfortunate caſe, the uſual modes of treating burns were diſcuſſed, [6]and from a thorough conviction of the little good to be derived from the applications in common uſe, it was agreed that after the loſs of ſome blood, cold water alone ſhould be ap⯑plied to bathe the parts; and this, being found to give eaſe, was continually renewed, and the patient during ſeveral days drank nothing but cold water, and took very little nouriſhment. By theſe means he was kept in a cool and to⯑lerably eaſy ſtate, though the pain often re⯑turned at ſhort intervals; ſome bliſters aroſe, which however in little more than a week ſubſided and no ſcar was produced.

A misfortune of a ſimilar nature is related to have happened to the illuſtrious Boerhaave by the burſting of Papin's machine or digeſt⯑er, in conſequence of which his face and arm were ſcalded by hot water. The whole face was in a little time bliſtered and the eyelids ſo much ſwelled as totally to obſtruct his [7]ſight. He immediately ordered himſelf to be bled ad deliquium, and the next day cauſed the venaeſection to be repeated; and afterwards took a pretty ſtrong purgative, although he had been reduced nearly to a ſtate of fainting by the ſlighter purgatives. He took care to have his face anointed only with unguentum nu⯑tritum, and covered with emplaſtrum ex la⯑pide calaminari. After theſe profuſe evacua⯑tions the tumour of the parts ſubſided and by the uſe of a thin diet, and the plentiful drink⯑ing of cooling liquors, the cure of this dan⯑gerous ſcald was ſo happily advanced in eight or nine days, that he was able to appear again in public, his eyes having eſcaped from ſo great a danger; an unſightly ſcar however re⯑maining in his arm after a tedious ſuppuration.

Now it appears to me that in this caſe had more cooling topical applications been uſed, ſuch plentiful evacuations and ſuch ſevere treatment of his conſtitution would not have [8]been neceſſary. If for inſtance ſome cool⯑ing fluid had been applied which would have been ſoon evaporated, inſtead of the burnt and inflamed parts being covered with greaſy ointments and plaſters, which ne⯑ceſſarily ſtop the pores, obſtruct perſpiration and confine the heat, perhaps the accident might have ended ſtill more favorably, and poſſibly without any tedious ſuppuration. We know from experiment that the effects of aqua-fortis when applied to the body are more violent than thoſe which ariſe from hot water, yet the gentleman before alluded to, by the plan which he purſued, avoided any ſuppuration, and even the ſeparation of the cuticle to any conſiderable extent. As I had every reaſon to be pleaſed and ſatisfied with the termination of his caſe, I frequently af⯑terwards on ſimilar occaſions uſed cold water, and all applications in as cold a ſtate as poſ⯑ſible, notwithſtanding the opinion of many re⯑ſpectable [9]authors and practitioners in favour of warmth to be applied to the parts. The good effect of this mode of treatment I expe⯑rienced on many occaſions, yet ſomething further ſeemed wanting; for though this plan well followed up and renewed as often as poſ⯑ſible, leſſened the pain, and abated the heat, it did not quickly ſubdue them; and in large and ſevere burns it ſeemed diſproportioned to the violent effect produced by the fire.

Some years after this, I was ſent for to a lady whoſe neck and face were very much burnt, from her neck-kerchief having taken fire: at a conſultation on her caſe, Sir Walter Farquhar, who was preſent, propoſed to apply ice to the whole of the burnt parts, although they were very extenſive. As my experience had hitherto been ſo much in favor of cold ap⯑plications, my aſſent to the propoſal was moſt readily given, ice was accordingly applied, and appearing to give immediate eaſe, was conti⯑nued [10]unceaſingly during ſeveral nights and days, after which I had the ſatisfaction of ſeeing the lady recover without any ſcar re⯑maining, and without any injury to her health from the cold ſtate in which ſhe had ſo long remained.

Not long after this accident, I had occa⯑ſion, in my own family to make trial of this plan. A little boy about three years old, playing with his brothers, was thrown down on the hearth, and to ſave himſelf caught hold, with one hand, of a hot bar of the grate. Before I ſaw him, which was in leſs than a quarter of an hour, the nurſe had wrapped his hand in oil. I found him in exquiſite pain, and inſtantly ſent for ice, with which I covered the hand. The child felt immediate eaſe; but as ſoon as the ice was melted, which was at firſt in a ſhort time, the pain returned, and he cried out for more. A bliſter aroſe, which, by degrees, in one large [11]bladder, occupied the whole of the palm of the hand, and the inſide of the thumb and fingers, and it increaſed ſo as to become glo⯑bular, and nearly of the ſize of a hen's egg. The opening or breaking of this was moſt carefully avoided; and ice was conſtantly ap⯑plied to the whole hand, it being immerged, during the day, in a baſon of ice and ice-wa⯑ter, and at night wrapped in cloths, or co⯑vered with ſcraped potatoes, ſoaked in it. Whenever this application was recent, the child was eaſy and ſlept; but at intervals, as the hand grew hot, from the melting of the ice, he became reſtleſs and cried until it was renewed, when his ſleep was again compoſed. This plan was continued during a week, at the end of which an abſorption of the extravaſed lymph took place, the cu⯑ticle which had been elevated, to ſo great an extent, began to ſhrink and ſhrivel; in a few days it became ragged and torn, and was [12]taken away, without any painful ſenſation, a perfectly well-healed ſurface appearing un⯑derneath.

This method having been thus fortunately purſued, I have the happineſs to ſay that my boy enjoys the perfect uſe of his hand, and I take this opportunity to expreſs my obli⯑gation to Sir Walter Farquhar for the firſt ſuggeſtion of the plan, and for his obliging at⯑tention on this occaſion. In ſome ſubſequent converſations which have paſſed between us, it has been mutually regretted that this prac⯑tice was ſo little known, which has probably given riſe to the preſent attempt toward in⯑troducing it to more general notice.

If I am allowed to judge from the ſeverity and ſituation of the burn and from the ſoft and tender ſtructure of the parts concerned in the caſe juſt deſcribed, and to reaſon from what I have ſeen, in many others, I am decidedly of opinion that, had it been treated by any of [13]the means commonly employed, the inflam⯑mation would have riſen much higher, and continued much longer; conſequently the pain would have been more ſevere and of longer duration, accompanied with fever. From the greater degree of heat and irritation the bliſter would have continued to increaſe, and, if the intentional opening of it which by ſome was adviſed, had been avoided, it would have burſt. The admiſſion of air would have pro⯑duced a ſlough, in which the tendons would have been implicated, in conſequence the muſ⯑cles no longer ſerviceable would have become contracted, and the hand for ever been left maimed and uſeleſs.

Some years previous to this accident my own leg was ſcalded with hot oil, on the out⯑ſide, from the knee to the ankle. The beſt remedies then in practice were applied, but did not prevent my ſuffering exceſſive pain for many hours, which was followed by the ſepa⯑ration [14]of the cuticle and an ulceration which was not healed for a conſiderable time.

Since I have found the advantage ariſing from ice, I have had many opportunities of uſing it on large and extenſive burns, which have ſerved to confirm me in my good opinion of its beneficial effects, whenever it has been timely and properly applied. In ſeveral caſes it has happened, that either from motives of de⯑licacy on the part of the patient, or from the at⯑tention of every one concerned being occupied with the moſt apparent injuries, parts which were burnt have not been diſcovered in time to receive benefit from the cold application, in conſequence of which the cuticle in thoſe parts has ſeparated, ſloughs have formed, and have been caſt off, leaving ſores difficult to be healed; while the parts in their neigh⯑bourhood more ſeverely burnt, but covered with ice, have eſcaped without a blemiſh.

I could detail many inſtances of miſchief [15]prevented, and cures effected by theſe means; but as the progreſs of them was in general ſimilar to the two caſes already. mentioned, it does not appear to be neceſſary to add to their teſtimony.

I ſhall however take notice of one which occurred very lately.—A gentleman was much ſcalded by the overturning of a tea-urn. I ſaw him ſoon after the accident, and ſent to the neareſt confectioners for ice, with which the burnt parts were bathed; the heat and pain were ſoon leſſened, and afterwards he felt very little inconvenience.

And I cannot paſs over another unhappy caſe of a poor woman, who, in a fit, fell into the fire. The injury extended over the whole of the neck, back and breaſts, in ſhort nearly half of the body was ſcorched, and there was one continued burn, which made a ſurface, by meaſurement, of more than four hundred inches. A conſiderable time had elapſed after [16]the accident before ſhe was brought to the hoſpital, ſo that the heat of the fire had had ſcope enough to do great miſchief; added to this, the inflammatory attack had been ag⯑gravated by the injudicious application of ſpi⯑rits of turpentine, ſo that her ſufferings were extreme. The burnt parts were covered as ſoon as poſſible with pounded ice and ice⯑water, from which ſhe found immediate eaſe, and lived three weeks without complaining of much pain, and without that diſtreſſing fever, which uſually accompanies ſevere burns; after which ſhe ſunk under the profuſeneſs of the diſ⯑charge from ſo large a ſurface, and expired.

In this caſe probably the injury was too deeply inflicted at firſt, to allow of a poſſi⯑bility of the burnt parts being prevented from ſloughing off and leaving a ſore; for it can⯑not be ſuppoſed that any means can prevent the effects ariſing from the deſtruction which the firſt contact of the fire has cauſed. If [17]that has been ſufficiently violent to deſtroy the living principle of the parts in the firſt in⯑ſtance, ice being applied may take off the heat, abate inflammation and give eaſe, but if the patient lives, the dead parts muſt be thrown off by the living, as happens in all caſes of mortifications from other cauſes.

Yet, ſevere as this caſe certainly was, it is impoſſible to ſay what a more early application of ice might not have effected; but in my opinion, much greater advantage would have been obtained; ſince in other inſtances, where it has been applied early, and where, though the burn has been both extenſive and deeply inflicted, a ſtop has been put to the heat and inflammation, and ſloughs have been pre⯑vented from forming. But conſidering this caſe abſtractedly, if ice could act with ſuch effect as to keep this patient ſo long alive and eaſy, what may not be expected from it in ſlighter burns?

From repeated obſervation of ſimilar caſes, I am confident that this wretched woman by the common modes of treatment would have continued to ſuffer great pain, and would have exiſted but a few hours longer.—Perhaps the prolongation of life in ſuch a ſituation, and under ſuch circumſtances is not greatly to be deſired; but to preſerve it in all caſes, as far as lies in our power, is our duty.—The reſt we leave to Heaven.

It was not my intention, as I have ob⯑ſerved, to adduce any more inſtances, but ſince the preceding pages were printed, I have been favoured with an account of an accident which happened to a young lady, in Cur⯑ [...]on Street. May Fair, written by herſelf, and which having permiſſion to inſert, I conceive it would not be doing juſtice to the ſubject of this eſſay if it were omitted; it will therefore be related in her own impreſſive words.

Early in the month of March, 1792, one morning juſt after breakfaſt, I went into the parlour, to ſpeak to my mother who was ſitting by the fire-ſide, ſo that I ſtood on the hearth with my back to the fire; and as ſoon as I had communicated what I had to ſay to her and my ſiſter, who was with her, I was going to quit the room, when the latter looking up, perceived that the back of my dreſs was on fire. Fright deprived her of all power to act, but my mother immediately endeavoured to ex⯑tinguiſh the flames by wrapping her clothes round me, but in vain; the fire was become too ſtrong; and as ſhe concluded the carpet was nailed to the floor, ſhe went out of the room to get ſomething to throw over me; my firſt impulſe was that of following her, when, providentially, I had the preſence of mind to ſee that ſuch a ſtep muſt prove fa⯑tal; [20]and throwing myſelf down on the car⯑pet, I rolled over and over, begging my ſiſter would try and cover me with it, which ſhe could not do, being deprived of ſtrength by her fear; my mother ſoon returned with a large mat, and the ſervants, who had been alarmed by my ſcreams, came in at the ſame inſtant to my aſſiſtance; they threw the mat over me, and themſelves upon it, in order to ſmother the fire; and after ſome little time ſucceeded; but not before I was ſeverely burnt in two places in the ſmall of my back; the back of my neck, and the under parts of both arms, juſt above the elbows. I had burnt the fingers of my right hand in at⯑tempting to untie my muſlin ſaſh. My mo⯑ther's hands alſo ſuffered; as, on raiſing me from the floor, ſome fire ſtill blazed from the back of my handkerchief and cape of my gown, which ſhe ſtroked down from my head and preſſed out with her hands.

When I had a little recovered from the ſhock, I ſent off directly to requeſt the favour of Mr. Farquhar, if at home, to come to me immediately; if not, that he might be in⯑formed of the accident as ſoon as he return⯑ed, and that I was impatient to ſee him; three or four hours having elapſed, I ſent again to Mr. F. and as he was not come home, one of the gentlemen from his houſe very obligingly came to me; yet I declined availing myſelf of his advice, being deter⯑mined to wait till Mr. Farquhar could come to me, owing to the anxious wiſh I had of having his opinion and advice in preference to all others. In the mean time I had applied ſcraped potatoes to my hand, and ſome oil to the reſt of the burns. About ten o'clock in the evening Mr. Farquhar arrived; and after he had ſeen the places which were burnt, he ordered ſome ice to be ſent for inſtantly, and that I ſhould have ſomebody ſit up with me [22]all night, who was to keep conſtantly apply⯑ing to the burns cloths dipped in the ice, and to be changed as ſoon as the chill went off; that if I became weary, and could ſleep, they ſhould get ſome freſh hogs-lard, and firſt waſh it extremely well with water; after which it was to be beat up with ice ſpread on linen, and laid on the burns: but as ſoon as I waked, to uſe the ice ſimply as before. When Mr. F. left me, I had my bed immediately laid on the floor, as being more eaſy and con⯑venient to thoſe who attended me, and ſtrictly followed Mr. Farquhar's directions the whole night. On firſt applying the ice, it made me ſhudder for a minute or two; but the pain I felt was ſoon abated, and in the courſe of the night I got a little ſleep. At noon, next day, when Mr. Farquhar came, he found me in a fair way of doing well, and only re⯑queſted I would perſevere in applying the ice frequently, and in the intervals keep the [23]hogs-lard and ice to the burns. I ſoon expe⯑rienced the benefit of this method of treat⯑ment, for in a few days the fire was entirely drawn out, and though all the bliſters had broke, not one of them had the leaſt tendency to become a ſore. Conſidering how much I was burnt, the pain I ſuffered was comparative⯑ly trifling; which I am perſuaded, was entire⯑ly owing to the application of the ice: and my mother, who alſo uſed the ice to her hands, was cured in a few days. In the courſe of a month or five weeks, I perfectly recovered; and have never ſince ſuffered the ſmalleſt in⯑convenience from that accident; nor did I at the time catch any cold, though I ſat up for the moſt part of the firſt night, with ſcarce any cloathing, and as the ice diſſolved, of courſe I was very wet, and although I had before this accident, been for more than two years greatly indiſpoſed by nervous com⯑plaints, I had not any fit, or thoſe nervous [24]ſymptons which my friends were apprehen⯑ſive would have been the caſe after the ter⯑ror and fright I ſuffered by the accident.

A conſiderable time appears to have elap⯑ſed in this lady's caſe before the ice was re⯑ſorted to, notwithſtanding which it ſeems to have acted with great power and efficacy. On the whole I cannot too ſtrongly recommend the uſe of this remedy in burns of every de⯑ſcription, as I preſume we may fairly conclude from what has been premiſed that it poſſeſſes great capability of giving eaſe, and preventing the deplorable ravages and miſchief which ſuffering the heat to remain in the part pro⯑duces, for from every obſervation I have made, the fire does not produce all its effects on the firſt attack, or immediate contact with the part; but afterwards lies rankling in [25]it, and continues to ſpread its deſtructive in⯑fluence until its fury is ſpent, or its power counteracted: as is evident from the continu⯑ance and even encreaſe of the exceſſive pain and inflammation.

Whether modern philoſophers will allow that fire applied to any part of the human body does remain united to it for a time, I am not certain; but ſuch appears to me to be the fact, and this opinion has, I find, been main⯑tained by ſeveral very reſpectable authors.

Hildanus mentions it as his opinion, and ſeems to lay great ſtreſs, as indeed moſt of the old writers did, on the frequent change of the dreſſings in burns. In a caſe which he deſcribes, he ſays, that he renewed the plaſters four times every hour, for the firſt day, and by thoſe means drew out the greateſt part of the fire.

Fernelius aſſerts that fire itſelf applied near, is its own antidote to drive out the fire of the burnt part, and by which pain is aba⯑ted. [26]He adds that ſome remedies applied to the parts entice out the fire.

Ambroſe Parey alſo ſays, if we carry the burnt part near to a candle, or live coal, and hold it there long enough, the fire will at⯑tract the igneous particles which have been imbibed, and which are the cauſe of the pain. This, though a painful proceſs, will, I believe, be generally allowed to be efficacious, as it certainly does after a time cool the part and give eaſe. May not this effect be cauſed by the attraction which takes place between ſimilar particles, and from the abſorption of a ſmaller body of fire into the larger maſs? Or may it not happen from the air ſurround⯑ing the burn being rarified and deprived of its oxygen by the preſence, of the larger body of fire, ſo as to become leſs capable of afford⯑ing pabulum to the heat in the burnt part, and which is thus gradually extinguiſhed? Or does it ariſe from the ſame principle, what⯑ever [27]that may be, by which the rays of the ſun thrown on a fire extinguiſh it?

However, in whatever way it is account⯑ed for, if it be admitted that, by any means, we can immediately abate pain by leſſening heat in a burnt part, it ſurely proves that it did there ſuperfluouſly exiſt; and as there is perhaps but one ſpecies of heat throughout all nature, which, whether evident to the ſight or only ſen⯑ſible to the touch, whether it gives life to the blood and vegetation to plants, or fuſes me⯑tals, and decompoſes combuſtible ſubſtances, is ſtill only a different modification of the ſame element, it may be eaſily conceived that a much greater quantity of its particles may be added to a living part, to which fire it⯑ſelf has been applied, than can poſſibly be produced by the powers of animal life; and with regard to the retention of it, the tem⯑porary continuance of ſuperabundant heat in every ſpecies of matter is ſelf-evident. If then [28]dead animal parts are capable of retaining it for a time, is it not likely to be longer pre⯑ſerved in living parts, whoſe powers of per⯑petually keeping up a conſiderable degree of heat under every variety of climate are ſo univerſal? In ſome meaſure to prove that this is the fact, it may be obſerved, that if any ſuch ſubſtance as ſcraped potatoes be ap⯑plied to a burnt part of the body, it will very ſoon become heated, and to ſuch a degree, as to emit ſmoke; and if the ſame be made to co⯑ver an inflammation on the ſurface of the body, from an internal cauſe, it will certainly grow hot, but in a very inferior degree: which ſurely ſhews, that heat in a part ariſing from a burn, is ſomething more than mere inflammation.

But whether the theory be doubted or not it muſt be univerſally allowed, that the moſt rational and beſt practice will be to oppoſe the action of fire as ſoon as poſſible, by every means in our power. And to ef⯑fect [29]this purpoſe, I muſt again obſerve that I think myſelf well warranted in main⯑taining ice to be ſuper-eminently uſeful The mode of its action on a burn may poſſi⯑bly be accounted for on the ſame grounds at the paſſage of the electric fluid, by the doc⯑trine of plus and minus, ice being a ſubſtance which has acquired ſolidity by the depriva⯑tion of heat, readily abſorbs it from warmer bodies till they become of the ſame degree of temperature. Ice applied to a hand in a na⯑tural healthy ſtate, gives pain, and why? be⯑cauſe it deprives it of its due, inherent, vital heat; on the ſame principle if a part ſuffers pain by being overcharged with heat from having been expoſed to the application of fire, ice will give eaſe, by abſorbing the ſu⯑per-abundant heat which had taken poſſeſ⯑ſion of it.

It follows then that the ſooner it is applied after the accident has happened the better, as [30]the fire will have leſs time to do miſchief, if the application be deferred till bliſters are formed, and ſloughs produced, a great degree of eaſe may be obtained, but the deſtruction of parts which has already taken place, can⯑not entirely be prevented from going through its uſual courſe of ſloughs and ſuppuration.

In London this remedy may be readily procured, indeed it is now ſo common an ar⯑ticle of luxury, that in moſt large towns, and often at gentlemens country ſeats, it is to be had at all ſeaſons. If however it ſhould at any time be wanting, the coldeſt water, or any other good conductor of heat may be ſubſtituted. The method of freezing water by the ſolution of neutral ſalts may in caſes of urgency be well adapted to our purpoſe; and as this can be performed with materials to be procured in almoſt every neighbourhood, we have happily this valuable application ſel⯑dom out of our reach.

Equal parts of ſal ammoniac and ſalt-pe⯑tre finely powdered and mixed together, in the proportion of three ounces of each put into four ounces of water, produce a ſolution which ſinks the thermometer thirty ſix degrees, and as it is eaſy even in ſummer to procure water as cool as fifty degrees, a ſufficient degree of cold may be obtained at once to freeze water in a glaſs veſſel immerſed it it.

Even a ſaturated ſolution of common ſalt in water, will conſiderably increaſe the cold of water immerſed in it.

Cold fluids may be uſed either by plung⯑ing the burnt parts into them, if the limbs have received the injury, or by ſcraped potatoes, or linen moiſtened with them, or by other means, and the plan ſhould not be diſconti⯑nued ſo long as heat and pain remain, the idea being conſtantly kept in view, that the effect of heat in theſe caſes is beſt counteracted by cold.

There is certainly ſomething alarming [32]and very repugnant to our feelings, in the ap⯑plication of ſo cold a ſubſtance as ice to a large ſurface of the body, particularly of perſons of a weak and delicate conſtitution; and it can⯑not be wondered at if the friends of the party, and alſo medical men ſhould at firſt object to it, as likely to give cold, cauſe rheumatiſm, or do perhaps as much harm, as the burn it⯑ſelf might have occaſioned; but from repeat⯑ed experience, I can affirm that it may be uſed with ſafety; indeed it appears that the ſame effect does not follow the application of cold to the body in this ſituation, as would infallibly happen at any other time; which may, I think, be accounted for from the body being in a ſtate of heat and irritation, and therefore capable of reſiſting the effect of cold more than at another time, or in other words, from the additional heat counteracting the cold, and preventing its uſual effect on the conſti⯑tution.

Ever ſince I have been convinced of the powerful effect of ice in theſe caſes, I have endeavoured by practice and converſation to inculcate the uſe of it. If by thus making it more publicly known I ſhall at all contri⯑bute to reſtrain the ravages cauſed by fire ap⯑plied to the human body, or prevent the de⯑formity which is the uſual conſequence of ſe⯑vere burns, my feelings will be abundantly gratified.

Having mentioned the deformity which is often cauſed by burns, I ſhall take the op⯑portunity of adding a few words on that ſub⯑ject.

The cicatrix which takes place on the healing of a wound, after the deſtruction of the ſkin and cellular membrane by fire, ge⯑nerally makes a very unſeemly appearance, [34]even where it is ſuperficial, owing princi⯑pally to the contraction of the circumference toward the center, and the loſs of the true ſkin which is never perfectly reſtored. But when unnatural adheſions take place between parts which ſhould be ſeparate, it becomes an object of infinitely greater importance, as beſides the ſhocking fight which ſuch in⯑ſtances exhibit, the uſe of the parts concerned, if not wholly deſtroyed, will be, more or leſs according to circumſtances, reſtricted and di⯑miniſhed. Every one muſt have obſerved melancholy inſtances of this nature, and pro⯑feſſionally I have been obliged to ſee many; in ſome the head drawn down ſideways has been fixed to the ſhoulder, in others the fore arm bent has adhered to the upper arm: the leg I have ſeen contracted and firmly in con⯑tact with the thigh. Such and ſimilar caſes are not infrequently brought to St. Bartholo⯑mew's Hoſpital, in hopes that the parts may [35]be reſtored to their natural functions; but in general, the aſſiſtance which ſurgery can af⯑ford in theſe caſes is by no means adequace to the expectation or wiſhes of the unfortunate ſufferers, for although the moſt prominent part of the contraction, and that which ap⯑pears to be the main cauſe or hindrance to the replacement of the parts in their natural ſi⯑tuation be divided, ſuch is the rigidity pro⯑duced in all the neighbouring parts, from the loſs of the cellular membrane, and from that degree of criſpation which is cauſed by the fire in all the ſurrounding muſcles, membranes, and ligaments, that after the diviſion of the principal cord, as it may be called, is perform⯑ed, the parts contiguous will not recede or give way; and when joints are included in the burn they too often remain completely locked, or retain a very confined motion. But although a complete cure cannot be promiſed, theſe miſerable caſes are not to be abandoned with⯑out [36]attempting ſome means for their relief, as they may ſometimes receive advantages be⯑yond what could be expected.

I have lately ſeen a boy about ſix years old, who nine months before had been moſt dread⯑fully burnt in the neck and face, the cicatrix had drawn the under lip down toward the lower part of the neck, over which the ſaliva was conſtantly flowing, the under jaw was connected by a tight rigid cord to the breaſt; on the whole, as may be eaſily conceived, the child was a moſt pitiable and frightful object.

Although conſiderable benefit was not ex⯑pected to be derived from any operation in this caſe, it was in itſelf ſo deplorable, that it was determined to give it the chance of what might ariſe from the diviſion of that part of the cord, which appeared to be the prominent or principal cauſe of detaining the chin in ſo diſtreſſing a ſituation, more eſpe⯑cially as it appeared to be formed in a great []

[37]degree of hardened ſkin which with perfect ſafety might be divided. On the diviſion I found as I had ſuſpected, that it was compo⯑ſed of a rigid maſs which gave but little way, while all the parts contiguous retained an un⯑alterably fixed contraction, and no great ad⯑vantage appeared likely to be gained from the operation; however, the edges of the wound being kept apart as much as poſſible during the healing of it, I had the pleaſure to find, that by the aſſiſtance of ſticking plaſter and bandage we were enabled to raiſe the chin, and bring the lip much nearer to the mouth; and thus, with conſtant attention, the appearance which ſuch a diſtortion of ſo principal a feature had occaſioned is conſiderably leſſened, the ſa⯑liva and food no longer eſcape from the mouth and the ſpeech is rendered articulate.^*

But though the chirurgical art is much re⯑ſtricted in its powers of remedying theſe dread⯑ful conſequences of fire, it can do a great deal by way of preventing them from taking place. This however will depend not only on the ſkill and management of the ſurgeon, but of⯑ten on the attention of nurſes, and in many caſes the reſolution and aſſiſtance of the pa⯑tients themſelves muſt be called in aid.

If the effect of the fire has been ſo violent as to cauſe the ſkin and cellular membrane and perhaps the faſcia, or even the parts ſtill deeper to ſeparate from the living, at the time when the ſloughs are caſting off and during the healing of the wounds, great care ſhould be taken to keep the parts aſunder by every means in our power; if for inſtance the fin⯑gers are burnt, they ſhould be carefully kept apart by dreſſings and bandages, otherwiſe they will adhere together and become one maſs as I have often ſeen. When the parts [39]ſurrounding joints are burnt, the patient, if let alone and truſted to his own judgment and diſcretion, in order to obtain a little eaſe will generally place the ſuffering limb in a ſtate of flexion; but this ſhould be oppoſed as much as can prudently and properly be done, and the patient alſo ſhould be warned of the ill conſequences ariſing from ſuch poſition, and be perſuaded to lend his aſſiſtance toward placing and maintaining the limb in a proper ſituation; for if the joint muſt neceſſarily be locked, as frequently in ſpite of all our endea⯑vours will be the caſe, the parts connected with the joint will be more uſeful in an ex⯑tended than in a contracted ſtate. But though this will apply to joints in general, as the neck, knee, or ancle, the lower-arm is an ex⯑ception; for if the parts ſurrounding the joint of the elbow be ſo burnt that all hopes of pre⯑ſerving its motion are given over, and conſe⯑quently there is no expectation when the [40]wounds are healed, but that it muſt remain locked, it will be a more uſeful member in a bent poſition than in a ſtrait one. The fin⯑gers alſo will be moſt properly left in in a ſtate of ſemiflexion.

What has been obſerved with regard to the burns of the arm will apply to fractures in the elbow joint, in which it ſometimes hap⯑pens that a portion of one of the condyles of the humerus, or the head of the radius is broken off and forced into the joint, or placed in ſuch a poſition as to cauſe an anchyloſis. In all theſe caſes when it can be brought a⯑bout, the arm ſhould be placed in a bent po⯑ſition: if then a ſtiff joint be the conſequence, the hand can aſſiſt in adminiſtering food, and be uſeful for moſt of the ordinary purpoſes of life. Theſe circumſtances may appear too [41]obvious to require to be noticed; but the plain⯑eſt facts do not always occur moſt readily to the recollection. And this is a caſe which re⯑quires immediate deciſion; for if the limb be not laid properly very early, before tenſion and inflammation take place, it ſoon becomes out of our power to alter it. I have more than once ſeen an arm laid and kept ſtrait with a fracture in the joint of the elbow, in conſe⯑quence of which an anchyloſis was formed, and the limb became irrecoverably uſeleſs: I have therefore thought the caution not un⯑neceſſary.

However ſevere and irremediable the effect of fire on the joints may be, in many inſtances, after the firſt and moſt violent inflammation is a little ſubſided, ſome degree of motion may be given, at leaſt an attempt from time [42]to time ſhould be made, and continued if poſ⯑ſible during the progreſs of ſuppuration and cicatrization.

Parey and Hildanus adviſe opening the bliſters ariſing from burns, and ſome modern ſurgeons recommend this practice, but I am clearly of opinion that the cuticle ſhould not be removed ſo long as it will remain to cover the part and defend it from the air. Every one knows how extremely painful it is to have any part of the body touched from whence the cuticle is abraded; if the bliſters are let alone, the extravaſed lymph will often be abſorbed and diſſipated, and when the ſubjacent ſkin is covered with a new cuticle, that which was elevated into bliſters ſpontaneouſly ſeparates of itſelf without any pain. Soft ointments, fomentations and poultices may be occaſion⯑ally applied, but great attention ſhould be paid to repreſs and keep down the granulations, which in the healing of wounds after burns, [43]are particularly apt to be luxuriant, and to cauſe an uneven, unſightly cicatrix.

That miſerably maimed and deformed ob⯑jects ariſing from burns, often happen through neglect, I am ready to admit; but am far from concluding that the ſurgeon is always to blame: I know the peculiar difficulties which attend theſe caſes, where, beſides the diſpoſi⯑tion which after loſs of ſubſtance by burns, the parts ſurrounding have to contract, the natural inclination which patients feel to obtain eaſe, by putting the parts in a wrong ſituation, will often counteract the beſt inten⯑tions; and in infants, added to the cries and reſiſtance of the child, the miſplaced tender⯑neſs of parents and nurſes is ſometimes to be encountered. But in ſpite of every obſtacle, it ſhould never be ſuffered to eſcape the memory, that if ulcerations ariſing from burns, are not watched with the moſt ſcrupulous and daily attention, contractions and unnatural adheſions [44]will often take place, which will remain to the end of life; but which, by artificial and ſkilful management, may be very frequently prevented. However, I ſhall conclude with repeating what I firmly believe to be true, that theſe dreadful caſes would happen much leſs frequently, or might often be totally and ab⯑ſolutely prevented by the timely application of ice.