X Wounds and Mechanical Injuries
A wound may be defined as a ‘breach of continuity in the structures of the body, whether external or internal, suddenly occasioned by mechanical violence.’ The law does not define ‘a wound,’ but the true skin must be broken. Wounds are dangerous from shock, hæmorrhage, from the supervention of crysipelas or pyæmia, and from malum regimen on the part of the patient or surgeon. Is the wound dangerous to life? This question can only be answered by a full consideration of all the circumstances of the case; a guarded prognosis is wise in all cases.
Burns are caused by flames, highly heated solids, or very cold solids, as solid carbonic acid; scalds, by steam or hot fluids. Burns may cause death from shock, suffocation, œdema glottidis, inflammation of serous surfaces, bronchitis, pneumonia, duodenal ulcer, coma, or exhaustion. A burn of the skin inflicted during life is followed by a bleb containing serum; the edges of this blister are bright red, and the base, seen after removing the cuticle, is red and inflamed; if sustained after death, a bleb, if present, contains but little fluid, and there are no signs of vital reaction. There are six degrees of burns: (1) Superficial inflammation; (2) formation of vesicles; (3) destruction of superficial layer of skin; (4) destruction of cellular tissue; (5) deep parts charred; (6) carbonization of bones.
The larger the area of skin burnt, the more grave is the prognosis. Burns of the abdomen and genital organs are especially dangerous. Young children are specially liable to die after burns.