Burns – treat with heat not cold

Fight Fire with Fire
Fire cools fire, within the scorched veins of one new burn’d – Shakespeare (Quoted by Dr Kentish)
Tea is Best for You in Hot Weather

Update (Thursday 11th June 2015)
After I published the post below, I heard a discussion on Liveline, the talk show on RTE Radio 1, discussing burns. Deborah Donnelly ‘phoned in explaining her child burnt himself. She explains she had done a first aid course otherwise she wouldn’t have done what she did; run a cold tap over the burn. Herein she confirms Hahnemann’s advice, that cold does more harm than good for a burn, for she tells us, as the cold water hit the skin, it was “like pouring acid onto it and it began to melt, it just dissolved…” Her interview begins about 48 minutes in
(click here).

Introduction
Would you put a hot plate under a cold tap? No, you know what would happen. I have often suggested to clients that the best way to treat superficial burns is to apply heat. Frequently, chefs will agree. One such chef once explained how he was working in a kitchen when another chef fell into a boiling fat. “Another chef grabbed him and held him to the heat, he was screaming, but he didn’t even blister”, he told me. On another occasion, a client said she had been watching the cookery programme Hell’s Kitchen the night before. The chef on the programme burnt herself but put her finger under the hot tap, not the cold one. And the saying Fight Fire with Fire can be appreciated while watching Australian firemen fighting bush fires with fire – by back-burning.

burns treat with heat

Backburning: fighting fire with fire

We’ve all experienced the painful effects of sunburn. Why is it so painful for so many days? Probably because we follow instinct not science – knowledge gained by others over the millennia. with sunburn, most people jump into a cold shower and feel great for 2 minutes then burn up for 4 days after. Next time experiment; take a few hot showers and see what happens. I can guarantee you will feel a bit worse for 2 minutes then feel better thereafter – and without the peeling. Be a scientist and experiment.

Commentary on Hahnemann and Burns
This is the advice Dr Hahnemann gave in the articles he wrote to a famous German medical journal (see below). It’s a fair suggestion but one modern critics who feel they know better have failed to perform. Hahnemann’s suggested experiment is outlined in the article below.

As Hahnemann says, in treating burns, we are not seeking a temporary relief but to relieve the pain and heal the skin and the best method can only be determined by “comparative experiments”.

Hahnemann explains that this experiment has already been settled by observations; that heat heals burns and cold does harm. He then gives the experiences of chefs who have surely tried cold but prefer to use heat as it heals without blistering, even though the pain might intensify initially but is then followed by relief.

The second example he gives is that of lacquer workers who prefer to use alcohol and oil of turpentine – which have been shown to cause a burning fire-like pain yet in the burning of the skin, is incomparable as a treatment (as it is homeopathic, i.e. like cures like).

The lacquer workers know this, he says, from multiplied experience. So Hahnemann asks of Prof Dzondi,”Surely, these workmen had thought of using cold water?” And we can ask the same question of Hahnemann’s critics, those medical men and women of today who assume cold is better even though they haven’t done a comparative study. Any child would have thought of using cold water, but says the rational Hahnemann, such workmen have been rendered wise by experience. Let these critics try one experiment as he outlines in his paper. It is only by such experiment that truth will be brought to light. Hahnemann was a true scientist in theory and practise.

Hahnemann was not alone in his assertions, he was in the best of company. He refers to Prof Benjamin Bell, a great English surgeon, and gives an example from his experience – “as A.H.Richter had already done with heated brandy.” Kentish, who wrote the book On Burns in 1797, recommends likewise.

To prove his point further, Hahnemann shows the corollary to using heat for burns; using cold in the form of snow for frostbite. Would Hahnemann’s critics of today apply heat to a patient with hypothermia? No! Similarly, a client whose left hand becomes cold in winter now bathes it in cold water. The heat then returns – in accordance with a law of physics: with every action, there’s an equal and opposite reaction. Science! After all, doesn’t ice burn and don’t one’s ears burn on entering the house from a cold wind? So heat will cool and cold will heat as the body reacts to these stimuli accordingly.

In his follow-up article quoted below, Hahnemann backs up his claims by quoting two of the greats of medicine – and still held in high esteem – Thomas Sydenham and “the great observer John Hunter” in his book On the Blood and Inflammation, page 218, both of whom attested to heat being better for burns and cold being harmful.

Conclusion
I will leave the last word with Hahnemann, who is fair and rational: “Let him who can prove this to be false come forward.”

Further Information
The Hunterian Museum click here 
An Essay on Burns: First Part can be viewed here
A Second Essay on Burns by Dr Edward Kentish can be viewed here

A commentary by Nodes Dickinson on On Burns by Dr Edward Kentish can be viewed here
John Hunter’s book On the Blood and Inflammation (ed. 1794), page 218 can be viewed here
Image: Wikicommons

 

ON THE TREATMENT OF BURNS

By Dr. Samuel Hahnemann, 1816.
(From the Allg. Am. d. D., No. 156, 18] 6. In reply to Professor Dzondi’s recommendation of cold water in the same journal, No. 104.) (Available here and here)

It is to be regretted that Professor Dzondi, of Halle, should have recommended as the only sure, efficacious and best remedy for burns, a means of the injurious nature of which all who have much to do with fire are perfectly convinced. Has he then instituted comparative experiments with all remedies recommended for this purpose, that he can now with any degree of truth vaunt his cold water as being the only sure, the best remedy? In such injuries the question is, not what shall give relief for the first few moments, but what shall most speedily render the burnt skin entirely destitute of pain and heal it. This can only be determined by comparative experiments, not by speculation. But it has already been settled by observation, which may easily be repeated, that it is exactly the opposite of cold water that heals burns most rapidly. For with the true physician the object should be to heal, not to relieve for a few moments.

Slight burns – for example, when a hand has been scalded with hot water of from 180o to 190o Fahrenheit – heal without any application, in the course of from twenty-four to forty-eight hours; but they take a somewhat longer time to do so if we employ cold water in order to give relief at first. For such slight injuries hardly any remedy is requisite, least of all one like cold water, which delays the cure. But for large severe burns, the best remedies are not so generally known, and the public requires some instruction on that subject; it is in these that cold water is specially shows itself to be the most wretched palliative and in some cases the most dangerous remedy that can be conceived. Comparative experiments and observations will, I repeat, convince everyone most conclusively, that the exact opposite of cold water is the best remedy for severe burns. Thus the experienced cook, who from the nature of his occupation must so often happen to burn himself, and must consequently have learned by experience the remedy for burns, never puts his hand that he has burned with boiling soup or grease into a jug of cold water (he knows from experience the bad consequences of so doing), no, he holds the burned spot so near to the hot glow of the incandescent coals, that the burning pain is thereby at first increased, and he holds it for some time in this situation, until, namely, the burning pain becomes considerably diminished and almost entirely removed in this high temperature. He knows, if he does so, that the epidermis will not even raise and form a blister, not to speak of the skin suppurating, but that, on the contrary, after thus bringing his hand near the fire, the redness of the burned spot, together with the pain, will often disappear in a quarter of an hour; it is healed all at once, quickly and without any after-sufferings, though the remedy was at first disagreeable. To this method he gives decidedly the preference, because he knows form experience that the use of cold water, which at first procures for him a delusive alleviation, will be followed by blisters and suppuration of the part, lasting for days and weeks.

The maker of lacquered ware and other workmen who use in their business alcohol and ethereal oils, and who have to do with boiling linseed oil, know from experience that the most rapid and permanent way to cure the most severe burns and to get rid of the pain, is to apply to them the best alcohol and oil of turpentine, substances which on a sensitive skin (as that of the mouth, the nose , the eyes) cause a pain of burning like fire, but in cases of burning of the skin (the slightest, more severe, and even the most serious ones) act as a most incomparable[i.e. Homeopathic] remedy. True, they know not the rationale of this cure – they only say, “one bad thing must drive out another”; but this they know from multiplied experience, – that nothing will make the burned spot painless and cause it to heal without suppurating, except rectified alcohol and oil of turpentine.

Does Professor Dzondi imagine that it would never have occurred to these workmen to use cold water as a palliative remedy immediately after burning themselves? Any child who had burned itself would in its alarm would fly to cold water; it would not require any advise to do so; but the workman has repeatedly tried it to his own injury, and experience, which in such cases is always purchased at the expense of ones own suffering, has taught and convinced him that the very opposite of cold water is the surest, quickest and truest remedy for even the worst burns: he has been rendered wise by experience, and in all cases he greatly prefers the remedy which at first causes pain (alcohol, oil of turpentine) to that which deludes by instantaneous relief to the pain (cold water).

Let professor Dzondi only makes upon himself as he offers to do one pure comparative experiment, and he will be convinced that he has made a grievous mistake in recommending cold water as the only sure an best remedy for burns.

Let him plunge both his healthy hands at the same instant full of boiling water and retain them there for from 2 to 3 seconds only, and withdraw them both at the same time: they will, as may easily be imagined, be both equally severely scalded, and as the hands belong to one and the same body, if one hand be treated with cold water and the with alcohol or oil of turpentine, the experiment will furnish a pure comparison and convincing result. This case will not admit of the excuse offered in that of the burns of two different individuals, where the bad consequences that always result when the hand is treated with cold water are sought to be ascribed to impure humours, bad constitution, or some other difference in the one so treated to the one that has been much more easily cured by alcohol. No, let one and the same individual (best of all the professor himself, in order to convince him), scald both his hands in the most equal manner before competent witnesses, and then plunge one hand (which we shall call A) into his cold water as often and as long as he pleases, but let him hold the other hand (which we shall call B) uninterruptedly in a vessel of warmed alcohol, keeping the (covered) vessel constantly warm. In this the burning pain of the hand B rises in a few seconds to double its intensity, but thereafter it will go on diminishing, and in three, six, twelve, or at the most twenty-four hours (according to the degree of the burn) it will be completely and for ever removed, but the hand, without the production of any blister, far less of suppuration, will become covered with a brown, hard, painless epidermis, which peels off after a few days, and appears fresh and healthy, clad in its new skin.

But the hand A, which the professor plunges into cold water, as often and as long as he pleases, does not experience the primary increase of pain felt by hand B; on the contrary, the first instant it is as if in heaven; all the pain of the burn is as if vanished, but – after a few minutes it recommences and increases, and soon becomes intolerably severe, if cold water be not again used for it, when the pains likewise in the first instants as if extinguished; this amelioration, however, also lasts but a few minutes; they then return, even in this colder water, and in a short time increased to greater and greater intensity. If he now puts his severely burned hand into the coldest snow water, he runs the risk of sphacelus, and yet after a few hours he can find no relief from the pains in the water that is less cold. If he now withdraws his ill-treated hand from the water, the pain, instead of being less than it was immediately after the scald, is four and six times greater than it was at first; the hand becomes excessively inflamed, and swells up to a great extent with blisters, and he may now apply cold water, or saturnine lotion, lead ointment, hemp-seed oil, or any other of the ordinary remedies he likes; the hand A, treated in this manner, inevitably turns into a suppurating ulcer, which, treated with these ordinary so-called cooling and smoothing remedies, at length heals up after many weeks or even months. (solely by the natural powers of his body), with hideously deformed cicatrices and tedious, agonizing pains. This is what experience teaches us with respect to burns of any severity.

If Professor Dzondi imagines he knows better than is here stated, if he believes he is certain of the sole curative power of cold water, – which lie lauds so much, in all degrees of burns, then he may confidently undertake to institute the above decisive, purely comparative experiment before competent witnesses. It is only by such an experiment that truth will be brought to light. What risk does he run if his cold water will procure as rapid relief for the hand A as the warm alcohol will for the hand B?

But no! I pity the poor hand ; I know very well how it would be ! Let the Professor, if he is not quite so sure of the efficacy of cold water in severe burns, perform but a small portion of this experiment, let him dip only two fingers of each hand into boiling water for two or three seconds, and let him treat the fingers of hand A and those of hand B in the way above described, and this little comparative experiment will teach him how wrong he was to recommend to the public as the only, best and efficacious remedy in all degrees of burns, cold water, an agent which, though it is uncommonly soothing in the commencement, is subsequently so treacherous, so extremely noxious. For severe burns he could not advise any thing more injurious than cold water (except perhaps the ointments and oils ordinarily used for burns), and in slighter cases where no blister would rise if left alone, blisters come on when they are treated with the palliative cold water.

In the meantime, before Professor Dzondi can make known the result of this decisive experiment upon himself, it may be useful for the public to know, that one of the greatest surgeons of our times, Benjamin Bell¹ of England, instituted a similar experiment for the instruction of the world, which was almost as pure as the one I have proposed. He made a lady who had scalded both arms, apply to the one oil of turpentine, and plunge the other into cold water. The first arm was well in an hour—but the other continued painful for six hours; if she withdrew it an instant from the water she experienced in it more intense pain, and it required a much longer time for its cure than the first.² He therefore recommends, as A. H. Eichter³ had already done, the application of brandy,4 he also advises that the part be kept constantly moistened with it (Benjamin Bell’s System of Surgery, vol. v) . Kentish (On Burns, London 1797) also greatly prefers, and that very properly, the spirituous remedies to all others. I shall not adduce the experience confirmatory to this I have myself had.

(Footnotes to the aforementioned: 1. Heister already knew and had recommended the treatment of burns by oil of turpentine, which has recently created so much sensation in England : “expeditum quoque hic esse solet terebinthinae oleum ; siquidem opportune ac saepius corpori illinatur.”
2. See Physisch-Medic. Journal, herausgegeben von Kiihn, Leipzig, 1801, Jun., s. 428.
3. Ansfangsgr. d. Wundarz., Bd. i.
4. The strongest alcohol heated is much more excellent in burns of various parts,even where the epidermis has come off; but in scalds of the whole body (from which no one ever recovered under the usual mode of treatment with cold water, saturnine lotions, burn-salves, or oils, all died generally within four days), we must content ourselves with ordinary spirits made very warm, or at least commence the treatment for the first hours with this, and constantly renew this warm application, keeping the patient warmly wrapped up in bed. Of all conceivable modes of treatment tins is the best.)

From all this it appears that Professor Dzondi has made a mistake, and that cold water, far from being a curative agent, is, on the contrary, an obstacle to the cure of slight burns, and occasions a great aggravation of more serious ones, that in the highest degree of such lesions, it even exposes the part to the risk of sphacelus, if the temperature of the water applied be very low (just as warm applications are apt to cause mortification of frost-bitten limbs), and that on the other hand, warm alcohol and oil of turpentine are inestimable, wonderfully rapid, perfectly efficacious, and genuine remedies for burns, just as snow is for frost-bitten limbs.

The adherents of the old system of medicine ought not longer to strive against the irresistible efforts towards improvement and perfection that characterizes the spirit of the age. They must see that it is of no use doing so. The accumulated lumber of their eternal palliatives, with their bad results, stands revealed in its nothingness before the light of truth and pure experience.

I know very well that the doctor insinuates himself uncommonly into the affections of his patient, if he procures him a momentary heavenly relief by plunging the seriously burnt part into cold water, unmindful of the evil consequences resulting therefrom, but his conscience would give him a much higher reward than such a deluded patient ever can, if he would give the preference to the treatment with heated alcohol (or oil of turpentine), which is only painful in the first moments, over all traditional pernicious palliatives (cold water, saturnine lotions, burn salves, oils, &c.) ; if he could be taught by experience and pure comparative experiments, that by the former means alone is all danger of mortification guarded against, and that the patient is thereby cured and relieved of all his sufferings, often in less than a hundredth part of the time required for the cure by cold water, saturnine lotions, salves and oils.

So also the girl heated by dancing to the highest degree of fever, and tormented by uncontrollable thirst, finds the greater, refreshment for the first few moments from exposure to a draught of air, and from drinking a glass of ice cold water, until she is taught by the speedy occurrence of a dangerous or even fatal illness, that it is not what affords us the greatest gratification for the first few moments that is for our real welfare, but that, like the pleasant cup of sin, it is fraught with evil, often with ruin and death.

ADDITION TO THE FOREGOING ARTICLE.
(From the Allgem. Anzciger der Deutschen. No. 204. 1816.)

When ancient errors that should justly sink into oblivion are attempted to be palmed off upon the world anew, he who knows better ought not to neglect to publish his convictions, and thereby to consign the pernicious error to its proper ignominious place, and to exalt the true and the salutary to its right position for the welfare of mankind. It was this idea that guided me in No. 156 of this Journal (see above) where I displayed the inestimable advantages of warm spirituous fluids for the rapid and permanent healing of extensive burns, over cold water, which only alleviates for an instant, but whose results are extremely pernicious.

The most convincing tests of the relative value of these two opposite methods, viz., the curative (the really healing) method, (the employment of warm spirituous fluids, such as alcohol or oil of turpentine), and the palliative (alleviating) method, (the use of cold water, &c), are furnished firstly, by pure comparative experiments, where burns of two limbs of the same body are simultaneously treated, the one by the one method, the other by the other ; secondly, by the expressed convictions of the most unprejudiced and honourable physicians. One single such authority, who, knowing the worthlessness as facts of the favourite pre-conceived notions of the age, dispossesses his mind of them, and, rejecting the old pernicious errors from genuine conviction, is not afraid to claim for truth its merited station, is worth thousands of prejudiced upholders and combatants for the opposite.

Thousands of over hasty advocates of the pernicious employment of cold water in serious burns, must hold their peace before the expressed convictions of that most upright of practical physicians, Thomas Sydenham, who despising the prejudiced opinion that has prevailed universally from Galen’s time till now, morbi contrariis curentur (therefore cold water for burns), and influenced by his convictions and by truth alone, thus expresses himself¹: As an application in burns, alcohol bears the bell from all other remedies that have ever been discovered, for it effects a most rapid cure. Lint dipped in alcohol and applied, immediately after the injury, to any part of the body that shall have been scalded with hot water or singed by gunpowder, will do this, provided that as long as the pain lasts the spirit be renewed; after that, only twice a-day will suffice.” Let him who can prove this to be false come forward!

Or, who can contradict one of the best and most enlightened practical surgeons of our time, Benjamin Bell, when from his extensive experience he alleges (System of Surgery, 3rd Edit. Vol. v.): “One of the best applications to every burn of this kind is strong brandy, or any other ardent spirit; it seems to induce a momentary additional pain, but this soon subsides and is succeeded by an agreeable soothing sensation. It proves most effectual when the parts can be kept immersed in it ; but where this cannot be done, they should be kept constantly moist with pieces of old linen soaked in spirits.”

Kentish, who, as a practitioner in Newcastle, had to treat the workmen who were often fearfully burnt in the coal pits, considers very carefully in his book (On Burns, London and Newcastle, 1797, two Essays) all the claims preferred in favour of cold water and all other cooling remedies for burns, and he finds as the result of all his experience, contrary to the great prejudice he felt in favour of these long used things, that under their use no single person who had got a severe burn on a great part of his body ever recovered, but that all were cured who were treated by the speediest possible application and frequent renewal of hot turpentine.

But no proof for the truth of this can be so strong as that which is afforded by comparative experiments performed simultaneously on one and the same body. In my former paper I cited the case of a lady who got both her arms burnt, one of which was treated by Bell with cold water, but the other was kept covered with oil of turpentine; in the first the pains persisted for a much longer time and a much greater period was required for the cure than in the last, which was treated with the volatile oil.

Another experiment of not less convincing character is related by John Anderson (Kentish’s second essay on burns, p.43.) A lady scalded her face and right arm with boiling grease ; the face was very red, very much scalded, and the seat of violent pains; the arm she had plunged into a jug full of cold water. In the course of a few minutes oil of turpentine was applied to the face. For her arm she desired to continue the use of the cold water for some hours, because it had formerly been of service to her in burns (she could not say whether those had been more severe or less so than the present one). In the course of seven hours her face looked much better and was relieved. In the meantime she had often renewed the cold water for the arm, but whenever she withdrew it she complained of much pain, and in truth the inflammation in it had increased. The following morning I found that she had suffered great pain in the arm during the night; the inflammation had extended above the elbow, several large blisters had risen, and thick eschars had formed on the arm and hand. The face on the contrary was completely free from pain, had no blisters, and only a little of the epidermis had become detached. The arm had to be dressed for a fortnight with emollient remedies before it was cured.”

Who can read these honest observations of illustrious men without being satisfied of the much superior healing power of the application of spirituous fluids to that of cold water, which affords a delusive alleviation, but delays the cure ?

I shall not, therefore, adduce my own very extensive experience to the same effect. Were I even to add a hundred such
comparative observations, could they prove more plainly, strongly, and convincingly than is done by these two cases, that (warm) spirituous fluids possess an inestimable advantage over the transiently alleviating cold water in the case of severe burns?

How instructing and consoling, then, for mankind is the truth that is to be deduced from these facts: that for serious and for the most severe injuries from burning, though cold water is very hurtful for them, spirituous applications (warm alcohol or oil of turpentine) are highly beneficial and capable if saving many lives.

These proofs will serve to guide the great numbers of mankind who require help, to the only effectual method, to the only health bringing (sanative) remedy, without which, in the case of extensive burns (that is where the greater part of the surface of the body has been scalded or burnt), delivery from death and recovery is perfectly impossible, and has never been witnessed.

This one single, and, as I have imagined, not unworthy object of my essay, was evidently not perceived by Professor Dzondi, as is proved by his violent letters to me; he only perceives in my remarks an attack upon his opinion. It is a matter of very little interest to me to find that cold water which has already been recommended ninety-nine times by others for burns, from a predilection in favour of this palliative whose effects are so injurious, is now served up to us again for the hundredth time, and I should feel ashamed to make use of a Journal so useful in promoting the happiness of the people as this is, for the purposes of merely personal recrimination and discussion. Moreover, as in the article I allude to I advised him to convince himself of the truth of my assertions by an experiment upon himself, my object was thereby to inform everyone of the conditions necessary to be observed in order to constitute a really convincing pure experiment of this kind.

I avail myself of this opportunity to expose the disadvantage of cold water (and other ordinary palliatives) in the treatment of serious burns, and call the attention of the public to the only effectual remedies, warm spirituous fluids, in order that they may avail themselves of them in the hour of need. This is not any mere idea of my own, but it has been clearly proved and irrefragably demonstrated by the observations of the most honourable and illustrious men of our profession (Sydenham, Heister, B. Bell, J. Hunter, Kentish), and especially by the convincing comparative experiments of Bell and Anderson.

I shall only observe further, that the burnt parts must be kept moistened uninterruptedly with the warm spirituous fluid, e.g. warm alcohol, for which end the linen rags soaked in it should first be simply laid upon the injured parts, and then, in order to prevent evaporation, and to keep all warm, covered with pieces of woollen cloth or sheepskin. If a very large portion of the surface of the body is burnt, then some one will be obliged to devote himself entirely and constantly to the external care of the patient, removing the pieces of cloth or skin one by one and pouring with a spoon warm alcohol (or oil of turpentine) over the linen rags upon the skin (without removing them), then as soon as they are dry, covering up the part and going on to the others, so that when the last part has been moistened and covered up, it is time to commence again with the first part, which, in the case of such a volatile fluid as warm alcohol, has in the meantime generally become dry. This process must be continued day and night unremittingly, for which purpose the person engaged in the performing it must be changed every two hours for a fresh one. The chief benefit, especially in severe and very serious injuries from burns, depends on what is done within the first twenty-four hours, or in the worst cases, the first forty-eight hours, that is, until all trace of the pain of the burn is permanently removed. A basin should be at hand containing very hot water, which should be frequently renewed, in which some vessels full of alcohol should stand, of which the attendant takes out the warmest for the purpose of wetting the rags, whilst the rest stand in the basin in order to remain sufficiently warm so that there never shall be a want of warm alcohol for the purpose of pouring on the rags. If the parts of the body on which the patient is obliged to lie are also burnt, the rags, dipped in warm alcohol, should be applied to them on the commencement, and a layer of water-proof cloth spread underneath; these parts can subsequently be wetted from above without being removed. If the greater part of the body is burnt, the first application must only consist of warm brandy, in order to spare the first shock to the patient which is the worst, the second wetting should be preformed with stronger alcohol, and afterwards the very strongest alcohol may be used. And as this operation must be continued uninterruptedly during the night, the precaution must be used of keeping the candle (or lantern) at a good distance, otherwise the warm spirituous vapour rising from the skin might readily catch fire, and prove destructive to the patient.

If the burn has been effected with gun powder, the small black particles should not be picked out of the skin before all traces of the pain of the burn are permanently removed.

1. Opera. Lipsiae, 1695, p. 343, (Edit. Syd. Soc.p. 255). “Ambustis extus (admovendus), quo casu omnibus remediis, quotquot adhuc inventa fuere, hie liquor (spiritus vini) facile palmam praeripit, cum curationem quam cito absolvat—nempe si lintea spiritu vini imbuta partibus ab aqua fervente, pulvere pyris, vel simili laesis, quam primum hoc infligitur malum, applicentur, eademque dicto epiritu madefacta subinde repetantur, donee dolor ab igne penitus evanuerit, et postea solum bis in die.” That cold external applications to burnt parts render them liable to increase of pains, that such parts soon become altogether painless from the application of external heat as he had often witnessed, is testified by the great observer, John Hunter, in his work On the blood and inflammation, p. 218.

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