Re: Ulcers and Burns

Hi GG,

Glad to be back when i can. I always think of you as the Borax lady (very fondly of course!)

Strangely Ulcers cause vicious BURNS in the stomach. So I always refer back to the Canadian Doctor, who stumbled upon one of the greatest miracles of our time, IODINE!!!

t2t


THE CANADIAN NURSE:

a Monthly Journal for the Nursing Profession in Canada

Editor and Business Manager MISS HELEN RANDAL, R.N.

VOL. XVII. VANCOUVER, B.C., MARCH, 1921 No. 3 NURSES, 1920-1921


Treatment of Burns by Tincture of Iodine

By O. F. MERCIER, M.D., Montreal



For a couple of years past, convinced (by an accidental experience)
of the value of the tincture of Iodine in the treatment and cure of burns,
I have adopted its use systematically in my hospital service, as well as
in my civil practice ; and to-day, after different experiences in a number
of varying- cases, from the slightest to the most severe, I thought it
would be advisable to appear here before your honorable meeting and
give you my sincere opinion upon this treatment.

I have said that my first experience was an accidental one. and T
should have added that this experience was obtained upon myself.

One day I had the misfortune to burn a small spot, of about three-
quarters of an inch diameter, upon the palmar surface of my left hand ;
this burn was of the second degree, and excessively painful. Having on
hand in my office a small bottle of the 10 per cent, tincture of iodine, T
covered the burn with it. Of course, the application was painful, but
I felt immediately a complete relief it stopped the pain at once ; and
the next morning I was so well that, having some operations to perform
at the Xotre Dame Hospital, I was able to attend to my duty and oper
ate that morning upon several cases which were on my list, and that

without the least pain. I could wash, brush my hands, keep them cov
ered with the rubber gloves for a few hours, without any inconvenience ;
and the blister never burst, but dried up in two or three days, leaving
under it a tissue of new formation of normal coloration and suppleness.

Judging from this result, and not knowing that this treatment had
already been tested by Baumgarten in France, I started using it sys
tematically in the Xotre Dame Hospital, having in my mind that, if it
could do for a small thing, most probably it would be satisfactory in
more severe cases. The result, fortunately, confirmed to the utmost my
expectations, and to-day I am here in a position to tell you that I con
sider it to be the best treatment I ever used against this accidental
disease.

As far as I can understand, the treatment was rejected in France
on account of the fear that it might be injurious to the kidneys; but in
all the different cases in which I have used it I have constantly watched
closely the function of that organ, and in no case could I detect any
trouble, clinical, functional or chemical. In fact, in one of my last cases,
the patient was a young lad of about twelve years, who was certainly
burnt over at least the half of the surface of his whole body, and even
in that case no trouble whatever could be detected with his kidneys.

Another objection that one can raise is the pain caused by the appli
cation. I have, of course, to admit that the treatment is painful during
its application and for the few minutes (say four or five) following it;
but as soon as the pain so caused is over, the pain that always accom
panies the burn is completely suppressed and the patient feels a complete
relief. In one case, to which I would like to draw your attention, a
woman, of about forty years old, having had her two arms, forearms
and hands badly burned to the second degree, and, in some spots, going
as far as the third degree, I tried treating her on one arm with anti
septic and anaesthetic ointment, and on the other one with the tincture of
iodine, and she herself asked to have both arms treated with the iodine,
feeling so much difference in the comfort caused by the above treatment
compared with the ordinary antiseptic applications.

At about the same time a man was brought into the hospital, ward
St. Joseph, with a bad burn covering the surface of his face and head,
neck and shoulders, hands and wrists. In this case I started the iodine
treatment immediately after his entry in the hospital. The temperature,
which went high from the start (104 degrees), was brought down to
the normal in four days. Eight days after the accident the crust formed
by the burn, epidermis hardened by the fluid, started to fall off, and
fourteen days after the accident he was able to leave the hospital, com
pletely cured, with a fine pink, supple, new skin, replacing all the one
that was destroyed by the burn.

I have had since then three other cases of the same seriousness,
location and surface, and the three responded faithfully to my treatment
and developed and recovered in the same way. In fact, in the Xotre

Dame Hospital, the treatment demonstrated so well its own value that
it has been adopted by all my confreres of the hospital, and it is now
systematically used there.

I think that, in our day, it would be very hard to find a surgeon, a
medical doctor, or any scientific man. who would not admit that iodine
is one of our best antiseptics, if not the very best of all. Its power of
penetration into the skin, its power of destruction of the germs, are the
two qualities which place it at the head of the list. Another advantage
of it is that, if you want to have all its effectiveness and if you use it on
the skin, you can apply it just as well and better on a skin that has not
been previously washed, because the alcohol in which the drug is dis
solved is quite sufficient for the cleaning, and would have a better effect
on a dry or greasy skin than on a skin covered with soap and water.

The same problem presents itself in the treatment of burns. Every
body knows how painful, difficult and long was the first dressing in all
the other treatments made upon the burnt surface.

The cleaning of the wound, the removing of dirt, burnt epidermis,
and so on. was practically impossible, not only from the fact of its own
difficulty, but also from the fact of the pain occasioned by that long and
tedious manipulation. With this new treatment there is nothing of that
sort; the dressing is so simple, so quick, that in a few minutes it can
be made with -all its effectiveness. Of course. I observed that, to use
this treatment, one must follow a very precise and systematic technique,
because one has to remember that the application is painful, and that
the pain caused by that application will only last a few seconds, and
that, besides, the application must be liberally made, so I remarked that
the tincture of Iodine must be largely spread over all the wound, I
would say, in one jet. The way to do it is very simple. Take a piece
of absorbent cotton, soak it heavily in the tincture, holding it with a
forceps, and put on a coat of it, liberally, all over the wound. If the
patient is too nervous and too sensitive, give him first a hypodermic in
jection of morphine, or even it may be worth while giving him gas-
anasthesia. The worst would be if. being afraid of hurting him, you
should make the application lightly, gently, with a tampon not sufficiently
soaked with the preparation, and apply it spot by spot, small surface by
small surface, increasing so, the time required for dressing, and instead
of taking just a few seconds, or, at the most, two or three minutes, to
complete the whole thing, you would take, say, fifteen or twenty min
utes, and then have a wound that would not be properly covered and
soaked with the fluid. I insist upon this point because, every time I
entrusted the treatment to the hands of one of our nurses or sisters,
they all made the same error, and I had to insist, in order to convince
them, and even, at times, do it myself before them.

Another very important point is the quality and strength of the
preparation. I observed that the best is the one of the French lodex. or
the 10 per cent, solution in pure alcohol, 90 degrees." The alcohol must

be very pure, and everybody will easily understand that it would be very
dangerous to use tincture of Iodine prepared with methylated spirit , or
the one that we have on the market under the name of "Columbian."
This latter would not only irritate and injure the tissue, but would be
dangerous by its absorption, and that to the utmost.

You will most probably enquire what sort of dressing is to be
applied after the coat of tincture of iodine has been spread over the
wound. A simple sterile dressing with gauze compresses, and a bandage
to keep it on, is quite sufficient. In fact, I have remarked that the solu
tion is a dressing in itself, and in a few cases I ventured to use no
dressing at all, besides the liquid application, and kept the part open.
The explanation is very simple : the wound, after the application, covers
itself with a thick, brown crust, which protects the raw tissues com
pletely.

A very interesting experience, which contributes to the illustration
of the effectiveness of the treatment, is the fact that, in cases of burns
of the face, I could not, of course, apply it on the eye-lids, fearing to
injure the globe of the eye, and I confined myself to using around there
a preparation of argyrol or sylvol, but in every case the whole face was
already healed many days, while the eyelids were still unhealed ; and the
worst of it was that the eyelids healed slowly, giving rise to ectropion.
The treatment must be done once every day.

As I said above, when the above-mentioned crusts fall, they give
way to a fine new tissue, pink, neat, having all its suppleness, and in no
case had I any of those retractile scars which, ordinarily, as everybody
knows, are one of the worst complications following burns. I have no
doubt that the worst enemy is the infection, not only because it delays
the cure, but also because it causes the pain, causes the general infec
tion, which generally shows itself by the regular and steady increase of
temperature, loss of appetite, weakness, and so on ; and then gives way
to the formation of that scar tissue, which in mostly all cases is bound
to retract sooner or later. With this new treatment, nothing of the sort.
After a few days, four or five, the temperature comes down to normal,
and this gradually and steadily, and stays at normal until the complete
cure is over. The patient keeps his normal general condition of health ;
he sleeps very well at night, because the pain, which exists in every case
treated by the other methods, is absent ; in fact, the only pain is the one
during the application, and it is easy to manage it ; but as for the pain
of the burn itself, there is none whatever.

The treatment, to have all its effectiveness, must be made as soon
as possible following the accident. It is easy to understand that it i
more difficult to disinfect an infected wound than to prevent the infec
tion. This is a fact that I have always experienced, and 1 consider it to
be of the highest importance.

If the method is used on burns of the first and second degree, it Is
a complete treatment, and you do not need anything else ; but. as every-

body knows, there may always be spots or surfaces where the burn
would have gone more deeply and attained the third degree, injuring
the whole thickness of the skin, and sometimes the adipose tissue, and
even the muscles. For those deep burns I apply, just the same, the
tincture of iodine in the same way as I do for the surrounding surfaces ;
but, of course, after a certain time, the destroyed parts, which have been
killed by the fire, must detach themselves, and this surface of sphacelus
leaves a wound more or less large, which has to be treated by the ordi
nary antiseptic dressings. To complete the cure and prevent the re
tractile scars, now is the time to appeal to grafting of new skin. This
is what I do, using the Thiersch method.

In cases where the surface of the burn is covered by blisters, it is
important not to open them, and to let them dry up under the effect of
the iodine. They dry up in a few days, and do not bring any complica
tion whatever.

In a few cases, when the patient was too sensitive, or when, for any
other reason, the pain was too great, I replaced the tincture of iodine by
the vapors of nascent iodine ; but, of course, in every one of the cases
the first treatment was always made by using the tincture of iodine, in
the way above described, and I used the nascent iodine only for the sub
sequent treatments, which must be applied then once a day, as in the
case of the tincture.

I feel so highly convinced of the great and practical value of this
treatment, that, in coming before your meeting, I come with only one
object in view, which is that of trying to popularize the method, know
ing that it will be such a great help to this class of poor patients. When
one imagines or represents to himself the pain, the dangers of all sorts,
that followed these terrible accidents when we were using most of the
other treatments, it is easy to understand the amount of the services
that would be rendered to our poor humanity if it were possible to de
crease, in any degree, the said calamity. There is another question,
which has in itself its own importance, and this interests mostly com
panies and employers. We all know the amount of responsibility that
falls upon them under the law providing for indemnity to be given to
employees in these cases. If, by this method, it were possible to dimin
ish the amount of incapacity resulting from the accident, I think it
would save them certainly large amounts of money, and it would, at
the same time, prevent the employee from remaining a lame man for the
rest of his life.

I would like to see all the manufacturers, and even the fire bri
gades, knowing this fact, and knowing also that the best thing they can
do for any one of their employees, who should have the misfortune of
having one of these terrible accidents, would be to have on hand a bottle
of tincture of iodine, ready to be used as the first, the best of all emer
gency treatments, that could be applied to the case.

Only a few weeks ago a case was brought to the hospital a man,
a laborer, burnt in the face, neck and head by an explosion of gasoline.
I do not know 7 whether it was from the fact that they had heard of the
treatment that they did it ; but they did it, at any rate. The patient sent
to the hospital had only to be continuously treated along the same lines,
and following the rules. In two weeks he was in a condition to resume
his work.

Whether it be for a small or a large burn, I insist that I consider
this treatment to be the best. About two months ago a child of twelve
years old was brought to me, as a private patient, after a burn covering
certainly over half the surface of his body. I saw him in hospital only
the next day after the burn, and some ointment (I do not know what
kind) had already been used on it. Nevertheless, I ordered the iodine
treatment. The poor little thing went on as well as possible for seven
or eight days ; the only pain endured was the one at the moment of
the applications. Unfortunately, I had the parents against my treat
ment, and I was obliged to submit to their desire. After two or three
days the parents realized what I had told them : that the dressings were
nearly as painful as the iodine dressing, but that these dressings were
not quieting the pain of the burn. The temperature started going
higher ; the general condition of patient got worse and worse every
day; and on the eleventh day the final result that I was expecting came,
and the poor boy died.

Although at least half of the surface of the body was burnt, I feel
convinced that if I could have kept on with the iodine treatment I
would have saved his life. But one fact remains, with all its import
ance : urine analysis, and taking the quantity of urine, was done every
day during the applications, and I could not notice any clinical symp
toms of kidney alterations, neither by the clinical symptoms nor by the
laboratory reports.

Since the antiseptic value of iodine has been discovered and ad
mitted by the profession in general, this chemical product has rendered
us all sorts of services. We use it for disinfecting the skin before
operations ; we use it for disinfecting some surgical wounds ; we treat
the wounds with it, and everybody admits that its value is of the ut
most importance. This is another application in which I sincerely
believe it is going to prove again that it is the most important, the most
powerful, and the most harmless of all antiseptics.



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