POISONS OF BURNS 571 



and Pi^ron).'^ This cannot well be choline or any similar substance, 

 for it does not filter, is insoluble in alcohol, and is destroyed by heating 

 at 65°. 



THE POISONS PRODUCED IN SUPERFICIAL BURNS" 



In a certain proportion of cases of extensive but superficial burns, 

 death follows after an interval of from six hours to a few days, 

 apparentl}^ because of a profound intoxication. As evidence of intoxi- 

 cation we have not only clinical manifestations, such as delirium, hemo- 

 globinuria, and albuminuria, vomiting, bloody diarrhea, etc., but, more 

 convincingly, the anatomical findings at autopsy, which are strikingly 

 similar to those resulting from acute intoxication with bacterial prod- 

 ucts. Bardeen found quite constantly cloudy swelling and focal and 

 parenchymatous degeneration in the liver and kidneys; softening and 

 enlargement of the spleen with focal degeneration in the Malpighian 

 bodies; and particularly degenerative changes in the Ij-mph-glands 

 and intestinal follicles resembling those observed in diphtheria, which 

 McCrae-' considers due to proliferation and phagocytosis by the en- 

 dothelial cells of the lymphatic structures. The severe degenerative 

 changes seen in the adrenals and myocardium especially recall diph- 

 theria intoxication (Weiskotten).-'* Marked changes are usually 

 present in the blood, consisting of fragmentation and distortion of the 

 red corpuscles, hemoglobinemia, loss of water with a relative increase 

 in the number of corpuscles by from one to four millions per cubic 

 millimeter, an increase in the blood platelets, and a rise in the number 

 of leucocytes as high as 30,000 to 50,000.-^ Hemoglobinuria is also 

 frequently present, and almost constantly gastrointestinal irritation 

 occurs, with anatomical evidences of acute enteritis, acute gastritis, 

 and occasionally gastric or duodenal ulcers. According to Korolenko,-^ 

 the sjnnpathetic nervous system is seriously involved. 



It therefore seems probable that poisons are formed as a result 

 of superficial burns, which have the effect of causing hemolysis, and 

 which are also cytotoxic for parenchymatous cells. These hypotheti- 

 cal poisons seem to be eliminated In' the intestines and kidneys, which 

 are injured by the poisons in their passage through these organs. The 

 attempts to explain all the observed effects of burns as due to throm- 

 bosis or to embolism by altered corpuscles seem to have failed, for 

 the peculiar location of the lesions (e. g., duodenal ulcers, necrosis in the 



21 Zeit. allg. Physiol., 1912 (14), 2.35. 



"Literature given by Bardeen, Johns Hopkins Hosp. Reports, 1898 (7), 1.37; 

 Eyff, Cent. Grenzgeb. Med. u. Cliir., 1901 (4), 428; Pfeiffer, Virchow's Arch., 

 190.5 (180), 367. Full discussion of theories by Vogt, Zeit. exp. Path. u. Pharm., 

 1912 (11), 191. 



" Amer. Med., 1901 (2), 735. 



"Jour. Amer. Med. Assoc, 1917 (69), 776; 1919 (72), 259; also Xakata, Corr 

 Bl. Schw. Aerzte. 1918 (48), 1283. 



" Locke. Boston Med. and Surg. Jour., 1902 (147), 480. 



-*Cent. f. Path., 1903 (10), 663. 



