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 to substantiate the belief that duodenal ulcers are liable to perforate during the third period.

The prognosis in burns depends on (1) the superficial extent, and, to a much less degree, the depth of the injury.  When more than one-third of the entire surface of the body is involved, even in a mild degree, the prognosis is grave. (2) The situation of the burn is important.  Burns over the serous cavities—­abdomen, thorax, or skull—­are, other things being equal, much more dangerous than burns of the limbs.  The risk of oedema of the glottis in burns about the neck and mouth has already been referred to. (3) Children are more liable to succumb to shock during the early period, but withstand prolonged suppuration better than adults. (4) When the patient survives the shock, the presence or absence of infection is the all-important factor in prognosis.

#Treatment.#—­The general treatment consists in combating the shock.  When pain is severe, morphin must be injected.

Local Treatment.—­The local treatment must be carried out on antiseptic lines, a general anaesthetic being administered, if necessary, to enable the purification to be carried out thoroughly.  After carefully removing the clothing, the whole of the burned area is gently, but thoroughly, cleansed with peroxide of hydrogen or warm boracic lotion, followed by sterilised saline solution.  As pyogenic bacteria are invariably found in the blisters of burns, these must be opened and the raised epithelium removed.

The dressings subsequently applied should meet the following indications:  the relief of pain; the prevention of sepsis; and the promotion of cicatrisation.