the epithelial
cells of the tubules of the kidneys; (3) minute thrombi and
extravasations throughout the tissues of the body; (4) degeneration of
the ganglion cells of the solar plexus; (5) oedema and degeneration of
the lymphoid tissue throughout the body; (6) cloudy swelling of the
liver and kidneys, and softening and enlargement of the spleen. Bardeen
suggests that these morbid phenomena correspond so closely to those met
with where the presence of a toxin is known to produce them, that in all
probability death is similarly due to the action of some poison produced
by the action of heat on the skin and on the proteins of the blood.

#Clinical Features--Local Phenomena.#--The most generally accepted
classification of burns is that of Dupuytren, which is based upon the
depth of the lesion. Six degrees are thus, recognised: (1) hyperaemia or
erythema; (2) vesication; (3) partial destruction of the true skin; (4)
total destruction of the true skin; (5) charring of muscles; (6)
charring of bones.

It must be observed, however, that burns met with at the bedside always
illustrate more than one of these degrees, the deeper forms always being
associated with those less deep, and the clinical picture is made up of
the combined characters of all. A burn is classified in terms of its
most severe portion. It is also to be remarked that the extent and
severity of a burn usually prove to be greater than at first sight
appears.

_Burns of the first degree_ are associated with erythema of the skin,
due to hyperaemia of its blood vessels, and result from scorching by
flame, from contact with solids or fluids below 212 F., or from
exposure to the sun's rays. They are characterised clinically by acute
pain, redness, transitory swelling from oedema, and subsequent
desquamation of the surface layers of the epidermis. A special form of
pigmentation of the skin is seen on the front of the legs of women from
exposure to the heat of the fire.

_Burns of Second Degree--Vesication of the Skin._--These are
characterised by the occurrence of vesicles or blisters which are
scattered over the hyperaemic area, and contain a clear yellowish or
brownish fluid. On removing the raised epidermis, the congested and
highly sensitive papillae of the skin are exposed. Unna has found that
pyogenic bacteria are invariably present in these blisters. Burns of the
second degree leave no scar but frequently a persistent discoloration.
In rare instances the b