THE POISONS PRODUCED IN SUPERFICIAL BURNS 461 



transverse myelitis, and especially in general paresis. 1 That it 

 or neurin actually is the cause of any of the symptoms of 

 fatigue, however, has not been established ; but Donath 2 con- 

 siders cholin an important factor in the production of epileptic 

 convulsions. (Concerning the theories and literature of the 

 subject of epilepsy in relation to its pathological chemistry and 

 to autointoxication, see the review by Masoin. 3 ) 



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, apparently because of a profound intoxication. As 

 evidence of intoxication we have not only clinical manifesta- 

 tions, such as delirium, hemoglobinuria, 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 products. 

 Bardeen found quite constantly cloudy swelling and focal 

 and parenchymatous degeneration in the liver and kidneys ; 

 softening and enlargement of the spleen with focal degenera- 

 tion in the Malpighian bodies ; and particularly degenerative 

 changes in the lymph-glands and intestinal follicles resembling 

 those observed in diphtheria, which McCrae 5 considers due to 

 proliferation and phagocytosis by the endothelial cells of the 

 lymphatic structures. 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 mil- 

 lions 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. 6 Hemoglobinuria is also frequently present, and 

 almost constantly gastro-intestinal irritation occurs, with ana- 

 tomical evidences of acute enteritis, acute gastritis, and occasion- 

 ally gastric or duodenal ulcers. According to Korolenko, 7 the 

 sympathetic nervous system is seriously involved. 



1 Halliburton, " Biochemistry of Muscle and Nerve," 1904, p. 116 ; Donath, 

 Jour, of Physiol., 1905 (33), 211. 



2 Zeit. physiol. Chem., 1903 (39), 526. 



3 Arch, internat. de Pharmacodynamie, 1904 (13), 387. 



4 Literature given by Bardeen, Johns Hopkins Hosp. Eeports, 1898 (7), 

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

 Arch., 1905 (180), 367. 



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



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



7 Cent. f. Path., 1903 (10), 663. 



