CHAPTER IX DEATH FROM BURNS, SCALDS, LIGHTNING, AND ELECTRICITY BURNS AND SCALDS Definition.—Burns are injuries produced by the application of flame, radiant heat or some heated solid substance to the surface of the body. Injuries caused by friction, lightning, electricity, X-rays and corrosive chemical substances are all classified as burns for medico-legal purposes. Scalds are injuries produced by the application to the body of a liquid at or near its boiling point, or in its gaseous form, such as steam. Scalds are usually not so severe as burns, as the liquids producing them run off the surface of the body, and rapidly cool on account of their evapor- ation, but they resemble burns very much in severity, when produced by oils or other sticky substances, which boil at a much higher temperature than water. Scalds produced by molten metals cause great destruction of the tissues, as they adhere to the parts struck. Burns resulting from X-rays are generally due to faulty exposure, and vary from mere redness of the skin to dermatitis with shedding of the hair and epidermis and pigmentation of the surrounding skin. Severe exposure may produce vesicles or pustules, which often form sloughing ulcers after they have burst, and take a long time to heal. The cicatrix formed is radiate in shape with the surrounding skin marked with the pigmentation or per- meated with numerous capillary vessels. Persons employed in the X-ray department and constantly exposed to the influence of the rays have sometimes suffered from chronic, intractable dermatitis and cancer of the parts exposed. Burns caused by radium are very similar to X-ray burns. The chemical rays of light, e.g. ultra-violet rays, may produce erythema of the exposed part, or acute eczematous dermatitis. These burns are rarely seen now, as the operator uses special protective measures for himself and for his patient. Burns produced by chemical corrosive substances, such as strong acids 1 and caustic alkalies, are usually uniform in character, and the resulting eschars are soft and moist, and readily slough away. In these burns the red line of demarcation is absent, the hairs are not scorched, nor are the vesicles formed. But Greek fire, which is formed by dissolving phosphorus in carbon bisulphide, produces vesication by the rapid oxidation and burning of the phosphorus. The characteristic stains found on the skin and clothing usually assist in determining the nature of the corrosive used. Chemical analysis of the clothing is also of importance in establishing the identity of the substance used. i These burns do not, as a rule, result in death, but may constitute I grievous injuries involving loss of sight or permanent disfigurement from f unsightly scars on the head or face. Classification of Burns.—Dupuytren has classified burns into the follow- ing six degrees according to the nature of their severity : — First Degree.—This consists of erytl^ma or simple redness of the skin ^ caused by the momentary application of flame or hot solids, or liquids much below the boiling point. It can also be produced by mild irritants. The redness and swelling of the skin, marked with superficial inflammation usually disappear in a few hours, but may last for several days, when the upper layer of the skin peels off. At any rate, they disappear after death.