Treatment of Burns by Tincture of Iodine

Kai Tiaki : the journal of the nurses of New Zealand, Volume XIV, Issue 3, 1 July 1921, Page 131

Treatment of Burns by Tincture of Iodine

O. F. MERCIER

(By

M.D.,

Montreal.)

For a couple of years past, convinced (by an accidental experience) of the value of the tincture of iodine m the treatment and cure of burns, I have adopted its use systematically m my hospital service, as well as m my civil practice; and to-day, after different experiences m a number of varying cases, from the slightest to the most severe, I thought it would be advisable to appear here before your honourable meeting and give you my sincere opinion upon this treatment. I have said that my first experience was an accidental one, and I should have added that this experience was obtained upon myself. One day T 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 Avas of the second degree, and excessively painful. Having on hand m my office a small bottle of the 10 per cent, tincture of iodine, I covered the burn with it. Of course, the application was painful, but I felt immediately a complete relicf — it stopped the pain at once ; and the next morning I was so w T ell that, having some operations to perform at the Notre Dame Hospital, I was able to attend to my duty and operate that morning upon several cases which were on my list, and that without the least pain. I could wash, brush my hands, keep them covered with the rubber gloves for a few hours, without any inconvenience ; and the blister never burst, but dried up m 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 m France, I started using it systematically m the Notre Dame Hospital, having m my mind that, if it could do for a small thing, most probably it would be satisfactory m more severe cases. The result, fortunately, confirmed to the utmost my expectations, and to-day I am here m a position to tell you that I

consider it to be the best treatment I ever used against this accidental disease. As far as T can understand, the treatment was rejected m France on account of the fear that it might- be injurious to the kidneys; but m all the different cases m which I have used it I have constantly watched closely the function of that organ, and m no case could I detect any trouble, clinical, functional or chemical. In fact, m one of my last cases, the patient was a young* lad of about 12 years, who was certainly burnt over at least the half of the surface of his whole body, and even m that case no trouble whatever could be detected with his kidneys. Another objection that one can raise is the pain caused by the application. 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 accompanies 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 40 years old, having had her two arms, forearms and hands badly burned to the second decree, and, m some spots, igoing as far as the third degree, I tried treating her on one arm with antiseptic 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, feelinig so much difference m 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 m the hospital. The temperature, which went high from the start (104 degrees), was brought down to the normal m four days. Eight days after the accident the crust formed by the burn,

epidermis hardened by the fluid, started to fall off, and 14 days after the accident he was able to leave the hospital, completely 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 m the same way. In fact, m the Notre Dame Hospital, the treatment demonstrated so well its own value that it has been adopted by all my confreres of tho hospital, and it is now systematically used there. I think that, m 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 tho 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 bettor on a skin that has not boon previously washed, because tho alcohol m which the drug is dissolved is quite sufficiont for the cleaning, and would have a better offeet on a dry or greasy skin than on a skin covered, with soap and water. The same problem presents itself m tho treatment of burns. Everybody knows how painful, difficult and lonsr was tho first dressing m all the other treatments made upon the burnt surface. The cleaning of tho wound, tho 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 tho 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 m a few minutes it can be made with all its effectiveness. Of course, T observed that, to use this treatment, onp 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, m one jet. The way to do it is very simple. Take a piece of absorbent cotton, soak it heavily m 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 injection of morphine, or even it may be worth while giving him gas-anresthesia. 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 uninutes, to complete the whole thing, you would take, say, 15 or 20 minutes, 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, m order to convince them, and even, at times, do it myself before them. Another very important point is the quality and strength of tho preparation. I observed that the best is tho one of the French Todox. or the 10 per cent, solution m pure alcohol, 90 degrees. The alcohol must be very pure, and everybody will easily understand that it Avould be very dangerous to use tincture of iodine prepared with methylated spirit, or the one that wo have on tho 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 tho utmost. You will most probably enquire what sort of dressing is to bo aopliod after the coat of tincture of iodino has been spread over tho wound. A simple sterile dressing with gauze compresses, and a bandage to keep it on, is quite sufficient, In fact, T have remarked that tho solution is a dressing m itself, and m a few cases 1 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 completely. A very interesting experience, which contributes to the illustration of the effectiveness of the treatment, is the fact that, m cases of burns of the face, I could not, of course, apply it on the eyelids, fearing to injure the globe of the eye, and I confined myself to using- around there a preparation of argyrol or sylvol, but m 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 over once e.Ycry day. As I said above, when the above-men-tioned crusts fall, they give way to a fine new tissue, pink, neat, having all its suppleness, and m 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 infection, which generally shows itself by the Tegular and steady increase of temperature, loss of appetite, weakness, and so on ; and then gives way to the formation of that scar tissue, which iii 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 m every case treated by other methods, is absent ; m 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. Tt is easy to understand that it is more difficult to disinfect an infected wound than to prevent the infection. This is a fact that I have always experienced, and T 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 everybody 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 m 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 ordinary antiseptic dressings. To complete the cure and prevent the retractile 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 m a few days, and do not bring any complication 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 vapours of nascent iodine; but, of course, m every one of the cases the first treatment was always made by usimg the tincture of iodine, m the way above described, and I used the nascent iodine only for the subsequent treatments, which must be applied then once a day, as m the case of the tincture. I feel so highly convinced of the great and practical value of this treatment, that, m coming before your meeting, I come with only one object m view, which is that of trying to popularise the method, knowing 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 wero 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 decrease, m any degree, the said calamity. There is another question, which has m itself its

own importance, and this interests mostly companies and employers. We all know the amount of responsibility that falls upon them under the law providing for indemnity to be given to employees m these cases. If, by this method, it were possible to. diminish the amount of incapacity resulting from the accident, I thick 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 manufacturers, and even the fire brigades, knoAving 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 bo used as the first, the best of all emergency treatments, that could be applied to the case. Only a few weeks ago a case was brought to the hospital — a man, a labourer, burnt m the face, neck and head by an explosion of gasoline. Ido not know 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 m 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 12 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 m hospital only the next day after the burn, and some ointment (I do not know Avhat 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 any treatment, and I was obliged to submit to their desire. After two or three days the parents realised 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 eveiy 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 importance: urine analysis, and taking the quantity of urine, was done every day during the applications, and I could not notice any clinical symptoms of kidney alterations, neither by the clinical symptoms nor by the laboratory reports. Since the antiseptic value of iodine has been discovered and admitted by the profession m general, this chemical product has rendered us all sorts of service. 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 utmost importance This is another application m 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. — "Canadian Medical Association Journal." [Note. — We should like some notes re this treatment from nurses who may have seen it used.]