or serous cavities may be implicated.

#General Phenomena.#--It is customary to divide the clinical history of
a severe burn into three periods; but it is to be observed that the
features characteristic of the periods have been greatly modified since
burns have been treated on the same lines as other wounds.

_The first period_ lasts for from thirty-six to forty-eight hours,
during which time the patient remains in a more or less profound state
of _shock_, and there is a remarkable absence of pain. When shock is
absent or little marked, however, the amount of suffering may be great.
When the injury proves fatal during this period, death is due to shock,
probably aggravated by the absorption of poisonous substances produced
in the burned tissues. In fatal cases there is often evidence of
cerebral congestion and oedema.

The _second period_ begins when the shock passes off, and lasts till the
sloughs separate. The outstanding feature of this period is _toxaemia_,
manifested by fever, the temperature rising to 102, 103, or 104 F.,
and congestive or inflammatory conditions of internal organs, giving
rise to such clinical complications as bronchitis, broncho-pneumonia, or
pleurisy--especially in burns of the thorax; or meningitis and
cerebritis, when the neck or head is the seat of the burn. Intestinal
catarrh associated with diarrhoea is not uncommon; and ulceration of the
duodenum leading to perforation has been met with in a few cases. These
phenomena are much more prominent when bacterial infection has taken
place, and it seems probable that they are to be attributed chiefly to
the infection, as they have become less frequent and less severe since
burns have been treated like other breaches of the surface. Albuminuria
is a fairly constant symptom in severe burns, and is associated with
congestion of the kidneys. In burns implicating the face, neck, mouth,
or pharynx, oedema of the glottis is a dangerous complication, entailing
as it does the risk of suffocation.

The _third period_ begins when the sloughs separate, usually between
the seventh and fourteenth days, and lasts till the wound heals, its
duration depending upon the size, depth, and asepticity of the raw area.
The chief causes of death during this period are toxin absorption in any
of its forms; waxy disease of the liver, kidneys, or intestine; less
commonly erysipelas, tetanus, or other diseases due to infection by
specific organisms. We have seen nothing t