Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
Among the causes of burns are: steam; hot water; melted glass, wax,
rubber, sugar; molten metal; red-hot metal; gas and flame; burning
wood, paper, clothing; electricity; X-ray; ultra-violet ray;
chemicals; acid sulphuric, trichloracetic acid, common lye; alkalis;
carbolic acid; iodin; croton oil, mustard, cantharides.
From these various causes there is very little difference in symptoms,
course, pathology, and treatment. The molten lead burns are usually
small in area, but of the third degree. The underlying tissues are
often devitalized, especially around the feet, making a deep, pale,
slow-healing ulcer. The same is true of many burns from electricity.
The effects of X-ray burns are only seen after several days or weeks
and stubbornly resist treatment. Ultra-violet ray burns may not show
any effects at first, but develop symptoms in about six hours,
sometimes accompanied by great pain. Such burns may be due to sunburn
or powerful electric light.
The epidermis contains no blood vessels, but the mucous layer has
lymph spaces between the cells, draining into the lymph spaces and
channels of the dermis. Nowhere in the body are nerves more abundant
than in the skin. Here we have nerves of motion to the muscles of the
skin; nerves of pain, temperature, and touch; forming an intricate
plexus of nonmedulated fibres sending their branches upward into each
papilla, and even to the mucous layer of the epidermis. Vasomotor
nerves supply the coats of most blood vessels of the skin, and trophic
nerves are everywhere controlling the nutrition of each part. When it
is considered what a complex organ the skin really is; how delicately
its parts are adjusted to the body; how extremely sensitive its nerve
supply, slight stimuli bringing responses and causing reflex action in
far distant organs; how many the uses of the skin (protection,
excretion, expression, and sensation in various forms), it can readily
be understood how great is its importance, and the far-reaching
results of its serious injury.
Burns are classified into three degrees: first, second and third. In
every burn there are two layers of tissue to be considered: _first_,
the layer destroyed—the dead flesh; _second_, the layer injured—the
sick flesh.
+BURNS OF FIRST DEGREE+
+Pathology.+
(1) Destruction of the cells of the horny layer.
(2) Injury of the cells of the mucous layer with an excess of
lymph. No blistering.
(3) Congestion of the subpapillary plexus with some
destruction of the hemoglobin.
(4) Closing of the ducts of the sweat and oil glands.
(5) Slight edema of the underlying dermis.
+Clinical Stages.+
1st stage—hyperemia and pain.
2nd stage—edema.
3rd stage—peeling and staining the skin.
4th stage—cells of the horny layer replaced by pushing upward
of cells from stratum lucidum.
BURNS OF THE SECOND DEGREE
+Pathology.+
(1) Destruction of cells of horny layer and sometimes of the
germinal layer.
Public-domain text, read in full here on John Shaqi.
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