It is quite generally accepted that clinical manifestations, anatomic findings and experimental evidence all indicate that extensive superficial burns are followed by severe toxemia which not infrequently results fatally within a few days. Of the lesions found at necropsy, emphasis has been placed on cloudy swelling of the liver and kidneys, focal degeneration in the splenic lymph nodules, and degenerative changes in the lymph nodes and intestinal lymph nodules.My necropsy experience in uncomplicated cases of superficial burns fatal within a few days has shown that, in addition to the lesions mentioned, in all of these cases there occur changes in the suprarenals which are more or less characteristic. In fact, these changes in the suprarenals are the most prominent and characteristic of the necropsy findings.The suprarenals are markedly swollen and deep red. The perisuprarenal fat tissue shows marked edema. On section, certain areas suggest extensive hemorrhage obliterating the normal markings. On section through other parts, the cortex and medulla appear markedly swollen and show reddish streaks suggesting congestion of the blood vessels.On microscopic examination, there is evident marked congestion of the blood vessels with scattered areas of hemorrhage penetrating among the parenchymal cells. The gland cells are pale staining and much swollen. Many are apparently undergoing hydropic degeneration. Necrotic cells being invaded by polymorphonuclear and endothelial leukocytes are not infrequent. The picture in general is more or less comparable to the central necrosis occurring in the liver of the guinea-pig in chloroform poisoning, except that in the suprarenals the process is diffuse.These changes in the suprarenals have been noted at necropsy in cases in which death has apparently resulted primarily from extensive superficial burns of two, three, four and six days' duration. In one case the left suprarenal measured 9 by 3 by 1.5 cm. and weighed 20.5 gm. ; the right measured 7 by 4.5 by 2.5 cm. and weighed 25 gm. (average normal weight, from 4 to 7 gm.). This was the case of a railroad fireman, aged 21, who received extensive superficial burns of the face, forearms, thighs and legs as a result of a boiler explosion, and died three days later.Kolosko,1 in 1914, described what were apparently similar findings in the suprarenals in a number of fatal cases of extensive superficial burns. He interpreted the findings as representing hemorrhagic infarction of the glands.It is perhaps noteworthy that these changes in the suprarenals are comparable to the changes occurring in the suprarenals of guinea-pigs dying several days after the administration of diphtheria toxin. This suggests that the changes are the result of the action of a more or less specific toxin possibly somewhat similar to diphtheria toxin.
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